Heavy Drinking by the Numbers
This is an infographic that we put together to illustrate the Heavy Drinking patterns in Canada. The data is based on the 2012 Canadian Community Health Survey. Overall in 2012, the rate of heavy drinking decreased to 17.4% in 2012 from 19% in 2011, which is great. But sadly heavy drinking remains high in our society and the numbers have been relatively constant at around 17% between 2005 and 2010, before an increase in 2011.
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Addiction in the workplace and Safety-Sensitive Assessments
From big rigs to balance sheets – Addiction and safety sensitive assessments know no bounds
Safety. Not many workplace issues have caught the attention of employers in the past few years, as has the issue of safety. This is not surprising given that workplace safety impacts employees, customers, and the general public. Corporate responsibility to employees and other stakeholders, as well as government regulations, have led to the creation of new policies, procedures, committees, and specialized fields within the human resources and occupational health professions. Workplace safety is now viewed as an indicator of a positive work environment. In fact, companies promote their track records of “accident-free work-days” and reward employees for their roles in maintaining a safe workplace.
For many people, obvious thoughts of workplace safety include hard hats, safety boots, safety glasses and hearing protection. Construction is often the first type of job to come to mind where safety is a priority, because our understanding of safety is frequently related to the dangers of heavy or falling objects, and hazards such as heights. In contrast, people working in other environments and industries such as healthcare, retail and business are less likely to think about potential safety hazards when they arrive for work each day. However, many of the causes of workplace injuries are just as likely to be found in a law firm, as in a manufacturing plant. These causes include fatigue, stress, slips, lifting, trips and falling objects. While the resulting incident may not lead to an injury, an accountant’s miscalculation or a teacher’s classroom behaviour can have far-reaching implications and therefore may be deemed just as serious. As a result, workplace safety needs to be a priority regardless of how risk-free a job appears to be.
Addiction in the Canadian Workplace
While workplace safety mishaps can occur at any time, the likelihood of the above-mentioned scenarios is compounded when an employee suffers from a substance abuse problem. While many employers believe that they are immune from issues relating to substance abuse, studies show otherwise. Current research estimates that over one in ten adults in Canada have a substance abuse problem, and 76 per cent of these people are employed. The total cost of substance abuse to the Canadian economy in 2002 included $24.3 billion in productivity losses due to incidences such as accidents and injuries, on the job errors, absenteeism, tardiness, and employee morale. Whether an employee’s job involves high-risk, safety-sensitive activities or office-related processes, an employee’s addiction can put an organization at risk.
Identifying and dealing with employee substance abuse is not an easy task. It can challenge the most experienced managers, human resources and occupational health professionals. However, organizations and managers who are willing to help a struggling employee will realize many benefits, including: decreased absenteeism; a reduction in the number of times the employee arrived late or left early, increased productivity; decreased presenteeism. Studies also demonstrate the importance of an employer’s role in an individual’s recovery. Bellwood Health Services’ outcome studies show that 82 per cent of clients who were referred and supported by their employer were in high recovery when followed-up six months after completing residential addiction treatment.
One of the most effective ways to identify an employee addiction issue is to arrange for a specialized assessment to be completed by an addiction professional. While this is a valuable exercise for employees working in a safety-sensitive position, it is just as helpful in identifying issues relating to addiction in less “high-risk” roles and industries. Often referred to as safety-sensitive assessments or independent medical examinations, they can also be called workplace, corporate or executive assessments, and can be a useful tool for any position where there is a risk of accident or serious error. More and more organizations are using these types of assessments as a tool to pro-actively manage employee addiction issues in order to retain valuable employees.
By Susan McGrail, MSW, RSW, PhD (Can) and Julie Bowles
Women and Alcohol: Why you’re not “one of the boys…”
In January 2013, The Centre for Disease Control (CDC) released a report that revealed that more women are engaging in a dangerous practice, that was probably at one time, characterized as a “male” behaviour – binge drinking. In particular, the CDC found that approximately 1 in 8 women and 1 in 5 high school girls binge drink about three times a month. Binge drinking for women is described as consuming four or more drinks on one occasion. What makes this finding especially alarming is the impact this behaviour can have on women’s health.
While excessive drinking isn’t healthy for anyone, this practice puts women at an increased risk of experiencing adverse health consequences. Compared to men, the physical health of women is affected more severely and in a shorter period of time by intensive alcohol use. Specifically, binge drinking puts women at risk for heart disease, breast and other cancers as well as causing reproductive health problems.
There are obvious biological differences between men and women and these translate into different experiences when it comes to alcohol. For example, women are more susceptible to the toxic effects of alcohol because they metabolize it differently than men do. Because of this difference and because of her body size, a woman experiences a higher blood alcohol level than a man, even after consuming comparable amounts of alcohol. Scientists speculate that these differences translate into a number of consequences for women drinkers including potential health problems associated with the liver, heart, and skeletal muscles. These problems are heightened when alcohol is consumed in large quantities, as is the case with binge drinking.
In order to prevent the damaging effects of binge drinking and drinking in general, it is important for women to understand how alcohol affects their bodies and maybe even examine their own drinking patterns and behaviours. Alcohol consumption not only leads to physical health problems, but can also impact relationships, work and psychological health. Misusing and abusing alcohol (as is the case with binge drinking) can, and often leads to addiction.
Although the consequences of substance misuse and abuse are of concern in general, they are of particular concern for women because a woman’s experience with addiction can be unlike that of a man’s. Compared to men, women who misuse substances may be more likely to experience low self-esteem, shame, guilt and self-blame. There may also be many barriers preventing women from seeking help. For example, women tend to hold a greater share of responsibility for caring for their children than men and this can impede their ability to attend treatment (for fear of losing their children or inability to find alternative arrangements for childcare). Another barrier preventing women from attending treatment is the stigmatization they may experience as a result of their addiction. Unlike men with alcohol addiction, women may be judged and treated more harshly, especially if a woman is pregnant and seeking addiction treatment.
Although women have unique needs when it comes to their issues with alcohol and their health, it is important that they do seek help if they find that their pattern of alcohol use is of concern. Because although it may be difficult for women to seek out the help they need, once they do, they experience the same benefits of treatment compared to men. Bellwood’s own outcome research has demonstrated that both men and women respond equally well to the holistic addiction treatment approach, addressing their physical, mental, social and spiritual health.
What is more, the scientific community and society in general are slowly beginning to understand that addiction is a disease, not unlike Type I diabetes or cancer. Individuals do not set out to become addicted to anything. Individuals seeking treatment need compassion and help for their health issues too. However, it is important that it is understood that just like the lifestyle or behavioural risk factors that may put individuals at risk for developing other diseases, there are factors that put individuals at risk for developing an addiction. For women, one such factor may be the increasingly common practice of binge drinking. If binge drinking is becoming more and more commonplace for women, it is imperative that they understand it does not impact them in the same way as it does men. Therefore, attempting to “keep up” with their male counterparts when it comes to drinking is extremely hazardous. Women need to understand that when it comes to alcohol and it’s effects on our bodies…we’re not “one of the boys.”
Trauma, Addiction and Mood
Trauma, Addiction and Mood: Self-Regulation For Recovery
A favourite saying in 12-Step fellowships is: “It’s a simple program for complicated people.” To be human is to be complex, but that complexity can make addiction seem like a labyrinthine problem, both for the addicted person and for others seeking to help. Trauma, too, is a complex condition. Researchers and clinicians have identified a large number of facets that can be related to trauma: “stuck” (that is, undischarged) flight/fight responses, tonic immobility (“freeze” response) and dissociation, disrupted and damaged belief systems and self-image, chronic anger and rage, debilitating anxiety, major depression, suicidality and homicidal ideation, massive breakdown of lifestyle and relationships, deep shame, guilt, and distrust of people. When addictions and trauma occur together, the complexity can become quite daunting. However, understanding how trauma and addiction interact can open the door to understanding how to recover.
Addiction Can Be a Coping Method for Trauma
Traumatic events are shockingly common. The General Social Survey in 1998 reported that two-thirds of Canadians over the age of 15 had experienced at least one traumatic event in the previous 12 months; and more than one-third of Canadians had experienced multiple traumatic events in the previous year.1
Not knowing how to manage the emotional and physiological stress that may be experienced after a traumatic event, many people turn to addictive substances and behaviours as a means to cope with their discomfort and pain. Studies done in the United States have found that more than two-thirds of people seeking treatment for substance abuse report having experienced one or more traumatic events in their lives.2 Substance users are two to three times more likely than the general population to witness serious injury or death and to experience physical assault.
Trauma Symptoms Fuel Addiction
Overwhelming emotions, along with frequent physical arousal and tension, are primary symptoms of trauma that sufferers have great difficulty regulating. The biological threat response (flight/fight/freeze) appears to become lodged in the nervous system of the survivor, with the result that their body feels as though – and gives their brain the message that – they are constantly in mortal danger. In addition, multisensory images of traumatic experiences may intrude frequently on the mind – images that are charged with intense feelings such as fear, rage, guilt or grief. A leading clinician and research psychiatrist in the field of trauma, Dr. Bessel A. van der Kolk, has said that, “The inability to modulate emotions gives rise to a range of behaviors that are best understood as attempts at self-regulation. These include aggression against others, self-destructive behavior, eating disorders, and substance abuse.”
People who suffer from concurrent trauma and addictions are often able to identify the specific symptoms that they have been seeking to regulate with their addictive behaviour. For example, both alcohol and cannabis can temporarily reduce chronic hypervigilance and thus help people sleep, function at work, and maintain relationships. These substances, as well as opiates or disordered eating, can also be used to “numb out” chronic anxiety by facilitating a dissociative state. On the other hand, self-harming behaviour (including some types of disordered eating) can counteract numbing and help the person feel more alive. Similarly, cocaine and stimulants can increase hypervigilance and associated feelings of power and control.
Activities that re-enact traumatic arousal can counteract a prevailing sense of emotional numbness, and may also be driven by the “stuck” flight/fight energy that is seeking to discharge itself. For example, addictive sexual behaviour can be a (not necessarily literal) re-enactment of sexual trauma, and high-risk behaviour as a result of alcohol or cocaine use can also be a way of re-enacting the anxious arousal of past traumatic experiences. Gambling, along with the sometimes consequent levels of debt, borrowing, and sketchy companions, can in itself be a high-risk re-enactment. Different types of physical exertion may replicate aspects of the flight (such as bicycling or running) or fight (such as weight training or martial arts) response, and as such can become a form of compulsive re-enactment. Sometimes people combine the functions of different addictive behaviours to move sequentially between, for instance, the arousal of re-enactment and sleep.
Another favourite 12-Step fellowship saying is: “The good news about recovery is that you get your feelings back; and the bad news is that you get your feelings back.” For survivors of trauma, this can be bad news indeed. The very symptoms they have been using substances and addictive behaviours to manage may now emerge in full force. For people in recovery, learning and practicing healthy means to self-regulate mood and physiological state is an urgent need.
Stabilizing Emotions for Recovery
Stabilization is a central principle of addiction relapse prevention. It involves establishing a balanced and health-promoting routine that includes appropriate nutrition, physical exercise, and rest, along with recovery-focused activities, work, family life and leisure. The first stage of recovery from trauma is often termed “safety and stabilization,” and is a vital foundation for the eventual work of processing and releasing traumatic memories. For the person recovering from both trauma and addiction, stabilization has an internal as well as an external component. Along with the balanced lifestyle, a trauma survivor must learn how to pay on-going attention to their internal state.
It can be extremely helpful for a traumatized person to become aware of the specific symptoms they were seeking to regulate through their addiction. Someone who had been drinking to get to sleep can focus on sleep hygiene to begin creating a sense of safety and stability. A person who has been on a roller coaster of anxious hyperarousal followed by depressed lethargy can prioritize the learning of methods to bring down the highs and bring up the lows. And if intrusive memories and images have been haunting or flooding the person’s mind, then she or he can focus on techniques for mindfully containing the images, without numbing or fearfully seeking to suppress them. Thankfully, there are methods available that can, with determined practice, effectively address the full range of trauma symptoms.
A fundamental practice for anyone seeking to recover from the suffering of concurrent trauma and addiction is to use tension reducing methods to regulate the nervous system. These techniques also help people to gradually become re-acquainted with, and accepting of their internal states, both positive and negative. A few of the most beneficial are gentle, mindful breathing, progressive muscle relaxation, specific types of soothing imagery, listening deeply to calming music, walking outdoors at a relaxed pace, and engaging in mutually nurturing social interaction and connectedness.
Recovery from the combination of trauma and addiction is absolutely possible. For as long as there have been mood altering substances, mood-altering behaviours, and human beings experiencing the trials of living, it is probable that the two conditions have been afflicting people; but recovery has also been occurring. Certainly, since Alcoholics Anonymous began in the mid-1930s, many addicted people with trauma have succeeded in regaining health and a satisfying way of life.
However, this does not mean that such recovery is easily achieved, nor has there has been a 100% success rate. As more effort has been devoted to understanding the interaction between trauma and addiction, we’ve come to understand how challenging the work of recovery can be. At the same time, a much wider array of approaches has emerged for responding to the challenges. The simple good news for complicated people is that anyone entering into recovery can learn techniques to manage traumatic emotions and memories – and physical arousal and tension – in a way that the addiction never could. While it takes a lot of work to recover from trauma and addiction, there is a very thorough set of tools at our disposal.
Originally published in the Fall 2012 issue of Moods Magazine, www.moodsmag.com.
- Statistics Canada, General Social Survey 1998
- O’Brien JM, Addiction and Trauma, Presented at the 3rd Annual Co-Occurring Disorders Institute, University of Maine at Augusta, 2011, citing Back et al, 2000
- O’Brien JM. Addiction and Trauma. Presented at the 3rd Annual Co-Occurring Disorders Institute, University of Maine at Augusta, 2011, citing Cottler et al, 2001, & Kessler et al, 1995. [Kessler RC, Sonnega A, Bromet E, Hughes M, Nelson CB. Posttraumatic stress disorder in the National Comorbidity Survey. Archives of General Psychiatry. 1995 Dec;52(12):1048-60.]
- Van der Kolk, BA, Fisler, RE. Childhood abuse and neglect and loss of self-regulation. Bulletin of the Menninger Clinic. 1994 Spring;58(2):145-68
- Janina Fisher, Addictions and Trauma Recovery, Paper presented at the International Society for the Study of Dissociation. San Antonio, Texas, November 13, 2000
5 steps to create a safe and productive workplace
How do you help an employee with an addiction?
Addiction costs Canadian employers over $24 billion a year in lost productivity! (Canadian Centre on Substance Abuse, 2006).
75% of people with an addiction are employed!
So it would come as no surprise that at one time or another, as a manager or an employer, you would struggle with the question of ‘how do you help a worker with an addiction?’
Dealing with an employee who is struggling with an addiction issue to alcohol, drugs, gambling or sexual addiction is not easy. But on the flip side, ignoring the problem is even more costly. In almost every case, it is more cost effective to help an employee get well than to find, train and replace a worker. Discover more: Calculating the Cost of an Addicted Employee.
Helping an employee with an addiction begin with a strategic framework that educates, communicates and facilitates a clean, positive and productive workplace.
Educate! Communicate! Facilitate!
(1) Communicate! Build a workplace culture that ensures your employees feel safe about approaching you to discuss their own – or a co-worker’s – problem.
(2) Educate! Learn how to identify signs of potential substance abuse and how to approach your employee to discuss your concerns. Discover more: Signs of Addiction
(3) Facilitate! Encourage your employees to seek help and offer them guidance, support and financial assistance to make it easier for them to get the best quality treatment.
(4) Be Involved! Learn how you can support them during treatment and when they return to work.
(5) Outline! Plan and layout your expectations and conditions of your ongoing support, including post-treatment support programs, reporting, monitoring and testing.
Building an effective framework will help you effectively manage an employee with addiction. In turn, this will save you and your company time, money and resources.
The One in Ten
Look around your office. Your family gathering. Look around the room at your next cocktail party or bingo night. We’re told that one out of every ten people you see has fallen into a destructive pattern of addiction.
Let’s try a little experiment. Go ahead and think of the people in your social circle. Write down their names. How many do you think may have a problem?
Just one in ten?
Addiction takes many forms; the most common picture that comes to mind, is the friend, or loved one, who has dropped out of school, lost their job, or their family, due to excessive drinking or drug use. But addictions may be entrenched in lives and families in ways that are not immediately obvious. Many people with alcohol and drug addictions are still gainfully employed, may have high profiles in their communities, and may generally appear to have their life in order. But what could be going on under the surface… increasing absenteeism and decreasing productivity at work, neglect of family and responsibilities, cover-ups about the consequences of their addiction. And what about that friend who is up all night gambling or surfing porn on-line? What about the kid down the street who spends every waking hour computer gaming and throws a tantrum when his parents try and reign in his Internet use? Are they addicted? It’s very possible.
So what is “addiction”? It’s a tough word with a lot of negative stereotypes. Any behaviour characterized by an uncontrolled dependence, that continues in spite of causing physical, social or spiritual harm can be defined as an addiction.
Believe me, nobody wants to think of themselves as an addict, it carries a lot of shame.
But why should it? Firstly, addiction is a disease, not a choice. No one plans to become addicted, just as no one plans to get cancer, heart disease or any other illness. For some people there is a genetic component, for others, these behaviours have become a coping mechanism for abuse or trauma.
And although addiction is an equal opportunity disease (men and women, rich and poor from any culture can become addicts) we don’t talk about addiction as openly and honestly as we discuss other diseases.
Which makes getting healthy so much more difficult.
We always treat people with diabetes or heart disease or lung cancer with compassion. Yet just like addiction, all of those diseases have a genetic precursor that is exacerbated by unhealthy lifestyle choices. People with these conditions can organize fundraisers to help them get well, yet when was the last time you were asked to help Suzie go to rehab?
It’s true. We are still very smug and judgmental of people who struggle with addictions.
Now… back to that list!
In my social circle I can count eight people as being in need of treatment. Some are routine binge drinkers, some are daily heavy drinkers, some routinely drink and drive, some use drugs to the point where there is a negative impact on their lives, and at least one person I can think of will probably die from alcoholism.
What does your list look like? Still believe it’s just 10%?
In spite of the general knowledge that I am a recovering addict myself and an addiction counsellor, only one person has come to me and asked for help. I guess that person is the one in ten everybody talks about.
Whether your list includes one, two or three people in ten, the important truth is that an addiction is a disease caused by a complex set of circumstances. Becoming an addict isn’t a choice. But seeking recovery is. And their responsibility. They’ll need all your support and compassion in the journey.
Brian E. Johnson