Jan 29, 2015

Ok, Let’s Talk.


Yesterday was Bell Let’s Talk Day 2015.  You might have heard about it.  According to Bell, a record 122,150,772 Bell Let’s Talk tweets, texts, calls, and shares on January 28, 2015 translated into a new donation of $6,107,538 to mental health initiatives.

Let’s Talk is a multi-year campaign focused on four “action pillars” related to mental health — stigma, care and access, research, and workplace best practices.  Campaign funds support various projects and organizations, including community-based providers of critical services to people with mental health problems and addictions.

Let’s Talk is heavy on awareness, dialogue and conversation towards reducing stigma.  Which is good.

But despite all the “talking” yesterday, there was something missing, particularly in relation to the discussion around workplace health.

There was no talk and there were no texts regarding the social experiment currently being conducted in many BC workplaces in relation to employees with addictions.  There were no calls, no tweets, no shares with respect to the proliferation of formal social control tactics to facilitate addiction treatment, despite a lack of compelling evidence on the utility of these tactics.

Formal social control tactics are standard features of many workplace substance use policies.  They encompass a wide range of mandates and pressures used to ensure or encourage treatment entry and retention, without accounting for client perceptions of coercion.  These tactics are part and parcel of an approach to employees with substance use disorders that seems to have achieved the status of conventional wisdom in BC workplaces.

Under this conventional wisdom, all substance use disorders are chronic and progressive; complete abstinence is always a prerequisite to meaningful recovery; and every employee with a substance use disorder represents a risk to workplace safety.  Moreover, this conventional wisdom tells us that there is only one solution to the “problem” of employees with addictions – and it’s absolutely mandatory.  This single, uniquely superior solution includes prolonged, intensive treatment (usually in a pricey residential setting); ongoing participation in a mutual support group program; and adherence to a multi-year monitored “relapse prevention program” (usually administered by a pricey monitoring company), involving random biological testing, with disciplinary consequences (up to and including termination) for non-adherence.

We should have been talking about this conventional wisdom yesterday.  We should have been challenging it.  And here’s why.  Because it is rooted in generalizations and misconceptions.  Because it perpetuates harmful stereotypes and arbitrary assumptions commonly associated with substance use disorders.  And because it is not supported by a strong scientific evidence base.

Despite the heterogeneity of experiences, harms and recovery among people with substance use problems, despite the critical importance of individualized assessment and treatment (where necessary and appropriate), and despite the variety of addiction treatment approaches with demonstrated effectiveness, many employers, as a rule, are preventing employees with addictions from working unless they accept and submit to a deeply flawed and potentially harmful cookie-cutter.  And employers are doing this based on the unfounded assumption that each and every one of these employees poses a unique and unacceptable risk to workplace safety.

So, um, yeah; Let’s Talk about this.

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