Substance use disorder: More employees are seeking treatment

May 31, 2024

For business owners, plan sponsors and administrators

Substance use disorders are complex health conditions that involve the habitual use of substances such as alcohol, opioids (like oxycodone or fentanyl), cocaine, crystal methamphetamine, or cannabis among others. These disorders can cause significant harm including physical dependence on the substance, difficulties in relationships at home and at work, and serious health issues.³

A contributor to workplace absence and disability

According to our disability claims data, when substance use becomes a problem, it can result in both short- and long-term disability, contributing to claims costs and lost productivity for employers. However, when looking at our drug claims data from 2023, it’s also clear that more people are reaching out for help.⁴ These claims trends might be due to an overall increased prevalence of opioid use disorder, better access to appropriate and timely treatment, or a combination of both.

The problem may be affecting more people than the claims reveal.

“At any given time, there are going to be people struggling with substance use disorder who haven’t yet reached out for help,” says Cori Lawson-Roberts, Assistant Vice-president of Disability Innovation and Integrity at Manulife. “Substance use disorders can affect people’s ability to work well and safely, which can have negative implications for their health, and their careers and livelihoods.”

Employers may have unique opportunities to help their employees before they need to go on short-term or long-term disability. This can include:

• Frequent and on-going education and awareness related to substance use disorders,
• Efforts to destigmatize these health conditions, and
• Support with access to the health supports employees need.

Safety is a top concern

Beyond the effects of substance use disorders on individuals, their quality of life, and those around them, there can be significant concerns about safety on the job.⁵ For example, the risk to workplace safety is heightened when a worker with a substance use disorder is in a job that demands a high degree of skill and focus – such as operating vehicles, equipment, or dangerous machinery.

Substance use disorder by industry: medications used to treat alcohol use disorder and opioid use disorder

We analyzed drug claims received in 2023, by unique claimant, to provide a glimpse into the industries where substance use disorders may be having the greatest effect on workers and organizations. Although there is some variation between industries, the data indicates that the problem isn’t unique to one industry or another. Rather, people from all walks of life and professions can be affected by alcohol use disorder and opioid use disorder.

“Training is key,” says Eric Pfeiffer, Workplace Well-being Consultant at Manulife. “Employees need easy access to resources, early and often, so they have the information before they might need it. It’s also important to foster a safe and non-judgmental culture in which team members at all levels can reach out for confidential help if they need it. Equally important, team leaders must have the tools and training to recognize when someone might be struggling, and the skills to intervene in a supportive, confidential, and non-threatening fashion when they recognize an employee who might be dealing with a difficult situation.”

Significant claims trend: More people reaching out for help

Since 2020, the number of individuals submitting claims for medications used as part of their treatment for alcohol and opioid use disorder grew by 52.0%. Over the course of 2023, the growth was 17.2%.  While the overall number of claimants is a small proportion of the roughly 5 million Canadians insured by Manulife Group Benefits, the growth during these periods is a significant trend.²

A concurrent diagnosis

It’s common for people with mental health issues to struggle with substance use disorder and vice versa. Often, the co-occurring disorders can exacerbate each other.⁶

For example, some individuals with mental health challenges may use alcohol or substances as a temporary coping mechanism for diagnosed or undiagnosed anxiety, depression, post-traumatic stress disorder, bipolar disorder, or other mental health conditions. However, this does not treat the underlying mental health disorder and may exacerbate symptoms in the short- and long-term.

Substance use can also worsen existing mental health issues or create new ones (such as depression, anxiety, and psychosis) by altering the chemistry of the brain. These changes to the brain can interfere with medications prescribed for mental health treatment and hinder the progress of other mental health therapies.⁷

Furthermore, the substances themselves may introduce a range of serious health problems – whether liver damage from alcohol, or risk of overdose with opioids – and can lead to substance use disorders.⁸

Sometimes, people don't seek support for their mental health conditions because they don’t recognize the signs and symptoms. Social stigma, and even self-stigma, create additional barriers to care.

The intertwined issues of substance use disorder and mental health can have serious implications for workers, their families, and the workplace.

“When we see a concurrent disorder of a mental health concern and substance use disorder, it’s crucial for both conditions to be addressed in tandem,” says Dr. Andrew Morgan, Psychiatrist, of Cleveland Clinic Canada. “A coordinated approach to treatment can provide comprehensive support and improve the outcomes for people facing these closely interconnected challenges.”

Life’s challenges

While the connection between mental health concerns and substance use disorder is well established, there are many other underlying factors that can contribute to substance use.

Stress, trauma, financial difficulties, and challenging life events increase the risk of a person turning to substances to cope.⁸

Individual physiology also plays a role. Some people are genetically more vulnerable to developing an addiction when exposed to alcohol and substances.⁸

The non-medical use of prescription drugs, coupled with the highly addictive properties of some medications, have contributed to rising rates of substance use disorder, particularly opioid use disorder. In this case, initiatives such as Manulife’s opioid management program have helped to create awareness and introduce added safeguards when people are prescribed these powerful pain medications – to reduce the risk of opioid misuse.

The employer’s role on the road to recovery

Here are some strategies that our experts recommend in response to the increasing percentage of people reaching out for help through their group benefits plans.

Provide coverage for comprehensive treatment

To effectively support employees with substance use disorders and mental health challenges, check to ensure that your plan offers coverage for comprehensive treatment.

It’s important that your plan offers an adequate amount of financial coverage for mental health practitioners with the experience, credentials, and qualifications to help address most mental health issues. Different types of practitioners can specialize in substance use and substance use disorder so comprehensive coverage helps facilitate access. This Guide to mental health professionals in Canada can help you understand the different types of experts who provide different kinds of treatment. Each type of provider also has different levels of education and qualifications.

For the treatment of substance use disorders, the range of services covered by your plan can include detoxification programs, inpatient rehabilitation, outpatient counselling, medication-assisted treatment, and post-treatment programs to help avoid relapses and support employees in maintaining a substance-free lifestyle. “By including a range of treatment options for employees, organizations increase the likelihood of a favorable recovery outcome and mitigate the chances for relapse,” says Dr. Morgan.

Coordination of care and access to specialists

Coverage for comprehensive treatment should include access to a range of experts (substance use specialists and counsellors, therapists, and psychiatrists), and the ability for those experts to coordinate efforts and treatments. Despite everyone’s best efforts, this coordinated care can be a challenge, but it’s a role that disability case managers can play by facilitating connections and aiding in the coordination of care across healthcare providers.

Workplace culture influences behaviours and attitudes

Your corporate culture can have a great influence on your team, and Manulife’s Wellness Report 2023 supports that view. The annual survey confirms that the organizations deemed to have the most effective wellness programs and cultures experience fewer days of lost productivity over the course of the year. Employees who work for these organizations are also at lower risk for a range of lifestyle-related health concerns.

Read highlights from The Wellness Report 2023

“Supportive workplace policies should include open communication between management, leaders, and staff that can help to reduce stigma around the conditions,” says Pfeiffer. “Prevention and education efforts can take the form of training, workshops, and other efforts that raise awareness about substance use disorders and promote healthy behaviours.”

Programs, including an Employee and Family Assistance Program (EFAP), are intended to support workers who are seeking confidential counselling, but employees must feel safe when engaging with the program.

While it’s important to have workplace programs in place to provide education and support to employees who are struggling with mental health and/or substance use disorders, it’s also useful to examine if there are elements in the work environment that are causing or exacerbating these issues. Leaders can review the demands being placed on staff to ensure that the organization is building a psychologically and physically safe environment. The Wellness Report found that 48% of employees participating in the survey are experiencing at least one work-related mental health risk factor. Challenges with Work-life balance and Involvement and influence on how to do their jobs were the leading mental health risk factors reported by these survey participants.⁹

By prioritizing prevention, intervention, and support programs, employers can have a powerful role to play in creating safe and non-judgmental environments where employees can seek confidential help without stigmatization or reprisal while on their road to recovery and wellness.

Sources:

^{1 Mental Health and Substance Use Health - Mental Health Commission of Canada, 2024}

^{2Manulife aggregate claims data, 2023}

^{3 Substance Use and Co-occurring Mental Disorders, 2023}

^{4 Manulife aggregate disability claims data, 2023}

^{5 About substance use - Canada.ca, 2023}

^{6 Mental Illness and Addiction: Facts and Statistics | CAMH, undated, accessed February 2024}

^{7 Substance Use and Co-Occurring Mental Disorders - National Institute of Mental Health (NIMH) (nih.gov), 2023}

^{8 Concurrent Discorders - CMHA, 2024}

^{9 The Wellness Report 2023. The report encompasses findings from three surveys conducted across 99 organizations, involving a total of 8,728 employees.}

^{10 Opioid- and Stimulant-related Harms — Canada.ca, 2023}

^{11 BC Centre for Disease Control, Unregulated Drug Poisoning Emergency Dashboard, Naloxone Program, 2024}

^{12 Publicly-funded take-home naloxone pharmacies across Canada, 2021}