Cost for Addiction Treatment

Nick Ringma ICADC
April 2011

Some years ago, okay let’s say 40 to be kind to some of the Grey hair in the room, there was this whole conversation about teaching mathematics in schools using set theory. The educators stumbled on nirvana. They found the ultimate narrative reframe for the drudgery of basic math. One of the outcomes was a new status for mathematics. Parents hated new math because they did not understand it and kids loved it because it had circles and drawings and talked about sets and being part of this group and not that group.

Addictions treatment has been that kind of misunderstood, that maligned by both detractors and employers. Only 3% of all persons with alcohol problems show up on skid row. The others walk among us.i The focus of what I want to share with you is not simply the numbers. I am not an accountant, but I do like set theory and if I can help you see how your employee can be in the set of trusted and valuable employees and in the set of living life in recovery then I have attained my goal. In the course of this presentation I will also share some observations about symptom identification and the pathway to treatment.

Addictions is often seen as a problem to be tabled, something to be put away, a behaviour to change or even a rebellious disobedience with a level of social disregard thrown in for good measure. My son is an avid cyclist, my friends ride bikes. Both will tell you that when the wheels of the bike get into a rut on a mud road and you keep struggling for control trying to balance the bike it is almost impossible and falling becomes the norm. However if the rutted road is seen as a path leading to the right destination and the rider looks ahead sets his mind on the way then the rut becomes a groove in which a steady sense of direction and a pathway to destination can be found. It’s time to get out of the rut of our thinking about addictions and begin seeing the groove of recovery. The results are life changing and treatment isn’t reduced to a housing issue.

What are we looking for? How do you know you’ve got exhibit A on your hands? The earliest signs are mood swings; those subtle changes in behaviour that seem irrational, from short and snappy to pout and sputter. They are gradual and often missed by the closer observers. They are also easily discounted as, “he was having a bad day.”

Tardiness and absenteeism are probably the easiest to track symptoms; however the person struggling with addictions has acquired a master list of excuses and rationalizations that rationalize his or her behaviour. The list looks like the classic check list in the accountants office, (that’s two shots, I hope there are no accountants here and if there are your not stereotypical and you won’t feel meant) the list of excuses has entrees like, waiting for new cheques from the bank, the second signature broke her arm, the invoice had coffee spilled on it, excuses that are fabrication. Addicts are masters at excuse making. The ones you have heard are similar to those we hear every day. Excuses from I lost my keys and the dog was inside and barking so loud I had to keep him quiet outside the door to I slept in because my sister never called from Ontario to I needed the day off to visit with my mothers’ ashes. The addict has this uncanny ability to weave enough truth in the excuse to stop questioning or to make you feel silly doubting his or her veracity.

Financial unmanageability often looks like requests for advances, cheques cashed at yellow banks, requests for overtime, repossessed vehicles, uninsured vehicles, and skipping lunch or never buying. Now I have you set up so you’ll all be offering to buy lunch or dinner! The range of financial unmanageability is from socially inappropriate to irresponsible and the consequent issues surrounding finances can include personal bankruptcies, repossessions, unanswered suits to the simple, “the rent is unpaid and the kids do not have food to eat.”

Errors and omissions are the first symptoms that have more than productivity consequences for the employer. Initially the errors are minor misplacements, miscalculations, miscounts, misappropriations but over time they become missed orders, missed deliveries, missed appointments and missed deadlines.

Addiction by prescription looks like the proverbial medicine cabinet come to the office. The employee is taking an upper to get started a downer to manage a mood an all-a-rounder at the bar and seeing three different doctors for the same medication with different symptoms presented in each case. Prescription addiction is difficult in that normal conditions have been amplified by an employee’s drug seeking behaviour to the point that Oxytocin, T3’s, Percocet’s, and any of the other narcotic pain medications coupled with the entire arsenal of designer and psychotropic drugs becomes a debilitating judgment-impaired functioning. Would you want your pilot on these “Do not operate machinery” drugs? Your fork-lift driver? Your neuro-surgeon? Your taxi driver? Impaired is impaired.

Dishonesty is the hallmark of the addicts greeting. Oh, they are honest individuals, however to maintain, continue or progress their addiction the disease requires a string of lies to the point of finally creating an altered reality. Some clients have told their sad tales for so long that when their dead parents show up to visit an entire house of cards comes crashing in and healing can begin. Dishonesty shows up in stories of adventures and misadventures, in excuses for tardiness and absence, it shows up in the denial that keeps saying I do not have a problem, or it’s not that bad, or everyone is doing it.

Theft as indicator. Late stage addiction demands money beyond what the average wage earner can earn. Even with all the overtime shifts and unattended punched in shifts. On the road producing nothing trips. Expense account addendums. Over purchasing of supplies or materials for jobs or job sites. Cash handling theft. I interviewed a cashier once and we had caught her with a shopper pocketing $20. When asked to write all the amounts she took in the past month on a piece of paper the list became $300 and over the past year $5,000. We had systems and everything was fool proof. Addicted persons are clever and desperate. We need to underscore that there is a desperation, a willingness to live recklessly to the point of death, for the drink or drug.

Accidents are the addicts’ badge of honour. The close calls. The near misses. The other idiots on the road. Spilling the coffee. Sometimes the slings, casts and crutches are a clue, sometimes they are a ruse. And if the accident requires paperwork, well, that somehow seems to never get done. The statisticians refer to such extreme accidents as death by misadventure. We prefer to say he was drunk, she was wasted or simply the accident was a result of impaired judgement. We know dead is dead, however preventable is preventable and that’s why we are here today.
I’m sure that most of you have encountered variations on the symptoms and could write your own book on the matter. The clincher story for me was a young man who had the same first and last name as his father and deviously managed to sell the family home while mom and dad were in Palm Springs for the winter. By the time Mom and Dad came home the house and the money were gone.

Somewhere we need to open the doors to helping our employees who suffer. Sometimes it begins with the management 101 mantra, “the results you measure are the ones you get” so if we start keeping track of absenteeism with stories, late with stories, accidents with causes, financial issues with excuses, moodiness and the situation, the peer complaints and the issues, the errors and mistakes and the theft and dishonesty then on a notepad we’ll have some data. One employer put it to us that not one of entire team of professionals would shift partner with the alcoholic employee. Notes would have brought that to light. Keeping records like a clinician does, not to condemn the person but to facilitate help and the journey of recovery.

Most journeys to recovery begin with a coffee and a conversation. To this day it is the most preferred one-on-one counselling style I know. When you chat with someone over a coffee and talk about what’s really going on, talk about others who have found the soloution, lay out a plan that has hope at the end of help and when the employee becomes ready to consider that he might have a problem that will not condemn him or get him fired but that he too can be treated.

The opinion and support of peers in a job unit or team are most valuable. Their expressed concern and support are in a community sense capable of assessing how severe the problem really is because the HR worker or Management person usually sees the tip of an ice-berg.

Now the triologue can begin. Between the interests of HR personnel and the EAP provider a conversation needs to evolve with the union and employee which truly needs to be a tri-partite conversation. Without seeking blame or pointing fingers the parties need an effective
New Math and Addictions Recovery April 2011 Nick Ringma ICADC 5
conversation that delivers hope to the employee in the context of the workplace. Whether this is a “last chance agreement” or a first encounter the process that moves someone from the workplace to a safe setting needs to be efficient, all inclusive, secure and compassionate. The employee needs to know the consequences of his continued use and the hope should he choose a life in recovery. Last Door has expertise and experience understanding collective agreements and how they impact leaves of absence, duty to accommodate and the return to work processes. In the course of admission and treatment we can provide the appropriate protection of a clients privacy concerns in an environment that respects the employee’s rights and responsibilities in the context of current legislation and the spirit of such legislation. In practice this requires a clear connection between the employee, the union, HR and the EAP provider. Employee plans need to include coverage for long-term residential treatment.

For treatment to be effective the client must be motivated by willingness to make a change. Once the trilogue has been established and the employee becomes contemplative in that he will at least acknowledge he has a problem then the assessments, screenings, site visits and interviews can take place in the context of steps to recovery. In the early steps the treatment planning will need to consider detoxification and any other medical conditions. Access to treatment can be fairly quick (1-5 days) in cases of pre arranged protocols.

The price of admission before the dollar and cents show up is much higher than most people estimate. The real numbers show the cost of untreated addiction in the workplace in Canada according to the Canadian Centre on Substance Abuse for lost productivity is 24.3 billion dollars.ii That works out to an average productivity loss of $25,500 per effected employee. These estimates rarely include the more significant costs of retraining, rehiring, insurance premiums, mysterious disappearance, and accident claims. I would suggest that those costs go well beyond that to include the additional costs to families, the visible emotional and psychological harms that far outstrip the family financial harm. The cost of addiction to society is even greater at the level of medical facilities, legal system involvement, motor vehicle accidents and social program costs. There is a meter on all these events and it is running. Our society is struggling to carry the costs. All these costs pale when compared to the costs to the affected person. Deteriorating general health, exposure to disease, criminal activity whether it be blue collar or white collar, the loss of relationships with self and others, the parentless children and the loss of potential income, opportunity and advancement all culminate in the schedule of harms to self. The figures could go on. The important thing for us to realize is that untreated addictions have costs that mount with every passing day.

Yes there is a price tag on recovery. An employee in treatment costs money. I would like to note that those dollars are a sound investment considering the monies invested in the employee prior to treatment, the loss of productivity and the productive capacity of the employee post treatment. An addict living in recovery is both extremely loyal and grateful.
The choices in the treatment world have been reduced to a discussion between long and short term treatment. With economic pressures over-riding good science much of treatment initially presents as 28-45 days. Underwriters and governments are pushing for 21 days and even 7 day “tune-ups” or introductions. The studies completed in Connecticut last year clearly indicate that 3-6 month treatment reduces recidivism by more than 50% iii when compared to 28 day treatment.

Short term treatment costs range per admission from $16,000 to $27,000 for the 28-45 day package and relapse rates are twice those of long-term treatment. Considering long term treatment at the Last Door for five months at a cost of $37,500 is both economic and effective. With total dollar costs nearly identical and the relative efficiency clearly in favour of long-term treatment employers and employees would be well served to insist on long term treatment. Aside from economic costs the emotional and social costs of relapse and repeated perceived “failure” the costs to the employer of repeated absences, one more treatment round and loss of peer support all point toward a long-term treatment approach for late stage chronic alcohol and drug misuse.

Simplified the two short term treatments would cost 150 work loss days and $43,000 in treatment costs compared to 150 days of work loss and a single treatment cost of $37,500. Further benefits include the HSR research (1999 dollars) on cost benefit analysis of addiction treatment that identifies that the savings per person once treated are $19,000 per annum. iv

One of the most practical things about Social Model Programming is that clients recover in community, with peers, in an urban setting because, very simply, that is their reality when they return home, return to work and maintain long term recovery. Clients are afforded every communal opportunity to develop skills in recovery that promote participation, that encourage an active social and recreational life and that interact with their family, colleagues and friends in a normalized way as their recovery progresses.

Treatment for clients can be funded by employers directly, by insurance underwriters, by the union, by a benevolent fund or even by family and friends. Typically treatment lasts 4-6 months and a client and their sponsoring agency should be prepared to commit to $37,500 in treatment costs plus such additional support that an employee’s family may need for food, shelter and essentials.

Treatment planning will initially be done with the client, however in the final stages a revised treatment plan may include a return to work agreement, a gradual return to work schedule and a monitoring agreement if indicated. A client’s treatment plan will include both short term and long term goals and will encourage in depth review of both the clients history, patterns of behaviour and alternative responses. The final stages of a client treatment plan include the return to work agreement.

Aftercare at Last Door is a threefold process. Clients never cease to be members of the Last Door community of recovery and they are welcome to re-attend anytime they require support in times of crisis, medical issues and relapse thinking, the second facet is participation in a continuing Alumni group and finally participation and service in a 12-step fellowship. Our daily group sessions can be attended on any day by three or four alumni celebrating clean-time, connecting with a sponsee or simply returning home to hook up to the energy of recovery.

As we stated earlier, clients participate in treatment for average periods from 3-6 months with specialized care available for up to 18 months. Clients complete a set of written exercises that incorporates the changes necessary to integrate the principles of recovery embedded in the 12 steps into their lives. Our goal is always to assist the client to prepare for a return to work and a re-integration with his peers. The home-stretch for a client in recovery is complete integration into a 12 step program. The most current research based on 16 year longitudinal study indicates that those who participate in a 12 step program as follow up to treatment maintained abstinence rates of 67% at 16 years post treatment.v Participation in the continuing recovery of peers is encouraged. Clients return to work on various schedules ranging from graduated return to work to complete return with a monitoring agreement.

One of the core benefits of Social Model Programming is that the client recovers in community with the best possible preparation for a return to full participation in their career and family. All the elements of recovery from Spousal Programs to Family Programs, activities, specific addiction focus, service participation and peer support facilitate the client recovery. Initiating recovery in community involves the development of a custom protocol agreement for your clients and a tailored care program to integrate a return to your workplace with appropriate benchmarks and scheduling requirements. Social Model Programming equips clients with the portable recovery skills that can be applied in any community where the client lives. From Terrace to Georgian Bay from Nanaimo to Edmonton alumni groups gather for recovery.

The mechanics of getting started are quite simple. Your organization may want to identify a key contact and have all communications channelled directly or you may elect to have a particular person identified for a particular client. If one of your team members needs treatment the process is as simple as a telephone call with any member of our client-care team, a telephone screening and a confirmation of financial agreement and we will facilitate the movement from crisis to action. The confluence of the employers interests, the employees interest and the EAP provider interest in a single focused action plan will create an opportunity for long-term recovery. The triologue creates a foundation that supports all parties at all stages of the process.

Thank-you for taking the time to hear about some of our program benefits. Our assurance to you is that your team members like thousands before them can recover. They can return to their careers, whether as trades persons, health-care workers, pilots, engineers, and even accountants.

Math is math, but if we can have your team in the set of recovering persons your organization will grow in compassion, empathy and understanding and on the journey become a more productive and holistic workplace. We are ready to help as we have been for the past 29 years.

Thank you,
Nick Ringma ICADC