Dependency and Mental Health

Information taken from BITC – Alcohol, Drugs and Tobacco toolkit

People may be affected in different ways, and sometimes it may not be obvious that someone has a problem with drugs and/or alcohol. Some signs to be aware of include:

Patterns of depression or fatigue (often after the weekend)

  • Absenteeism – short term/frequent patterns • Poor timekeeping • Erratic performance
  • Lack of discipline • Unusual irritability or aggression • Over-confidence • Sudden mood swings
  • Inappropriate behaviour • Reduced response times • Becoming easily confused
  • Reduced productivity • Deterioration in relationships with colleagues, customers or management
  • Financial irregularities • Dishonesty and theft

Evidence suggests that about half of people with signs of dependence on drugs other than cannabis are also in receipt of mental health treatment. The relationship between coexisting substance misuse and mental ill-health can be complex, with one condition influencing the other (although they sometimes coexist independently). For example, people experiencing mental health issues may also use alcohol or drugs to self-medicate, attempting to use them as a coping mechanism. When people stop using alcohol or substances, underlying symptoms such as depression and anxiety that the substances may have been masking can come to the fore.

There is also a strong link between smoking and poor mental health. It is a common misconception among smokers that smoking relieves stress and anxiety. The evidence shows that stopping smoking improves mental health, with a similar effect size to antidepressants.

Alcohol

The National Institute for Health and Care Excellence (NICE) defines harmful drinking as a pattern of alcohol consumption that is causing health problems, including psychological problems such as depression, alcohol related accidents or physical illness. These higher-risk drinkers can become alcohol dependent, which NICE defines as characterised by craving, tolerance, a preoccupation with alcohol and continued drinking despite harmful consequences.

Estimates of the costs of alcohol misuse to the workplace have been consistently high, with a 2012 Cabinet Office estimate reporting that alcohol misuse costs the English economy £7.3 billion each year.

How to support employees who have a problem with alcohol:

  • Employees with an alcohol problem should have the same rights to confidentiality and support as they would if they had any other health condition
  • It may be very difficult for people to admit to themselves or others that they have a problem. They may feel there is a stigma attached to their condition and they may well fear reprisals if they admit to taking illegal drugs or being dependent on alcohol
  • Disciplinary action should be taken as a last resort. In some circumstances, you could be found by an employment tribunal to have unfairly dismissed employees whose work problems are related to alcohol misuse if you have made no attempt to help them. However, you may need to temporarily move them to another job if their normal work is safety-critical
  • The cost of recruiting and training a replacement may be greater than the cost of allowing someone time off to get expert help
  • If one of your employees is misusing alcohol or drugs, you should encourage them to seek help from your organisation’s occupational physician or nurse (if you have one), their GP or a specialist agency; you can find specialist alcohol addiction services online at NHS Choices: Local authorities will usually have details of locally commissioned treatment services
  • In taking action, you need to ensure that you have the support of other managers and gain the support of your employees. When you have gathered together your information and consulted relevant people you will be ready to take action

Drugs

Drug misuse is the use of illicit drugs and the misuse of prescribed drugs and substances such as solvents. An estimated 1.5 million people in the UK are addicted to prescription and over-the-counter medicines, and some of these drugs can have a significant effect on performance, concentration, or alertness. It is important that managers and supervisors are trained to recognise the signs of problems with drug misuse, and the approach should aim to support affected employees rather than punish them.

  • Employees with a drug problem should have the same rights to confidentiality and support as they would if they had any other health condition
  • It may be very difficult for people to admit they have a problem. They may feel there is a stigma attached to their condition and fear reprisals if they admit to taking illegal drugs or being dependent on alcohol
  • Let staff know that you will, as far as possible, treat drug misuse as a health issue rather than an immediate cause for dismissal or disciplinary action (This will of course differ depending on the company’s policy: safety-critical industries, such as transport, will face different considerations to other sectors)
  • Disciplinary action should be taken as a last resort. In some circumstances, you could be found to have unfairly dismissed employees whose work problems are related to substance misuse if you have made no attempt to help them. However, you may need to temporarily move them to another job if their normal work is safety-critical
  • The cost of recruiting and training a replacement may be greater than the cost of allowing someone time off to get expert help
  • If one of your employees is misusing alcohol or drugs, you should encourage them to seek help from your organisation’s occupational health service (if you have one), their GP or a specialist agency. Some of these can be found online at Talk to Frank, and local authorities will have details of local treatment services
  • Employee assistance programmes can also be a source of specialist support
  • In taking action, you need to ensure that you have the support of other managers and gain the support of your employees. When you have gathered together your information and consulted relevant people you will be ready to take action

Tobacco

Although the number of smokers has fallen in recent years, nearly seven million people in England still smoke. Smoking remains entrenched in some sections of society, with the harm concentrated among the most disadvantaged. Two thirds of smokers say they want to stop smoking and many smokers make repeated attempts to quit; however, success rates are low.

Support in the workplace can make a big difference by giving smokers access to the advice and help they need to maximise their chances of success. Employers also benefit if employees stop smoking, because they will be healthier and are likely to take fewer days off work through ill-health.

Your approach to health and wellbeing in the workplace should pay close attention to smoking and tobacco-related harm, creating an environment in which employees will feel supported to make healthier choices, including stopping smoking.

  • Implement a smokefree policy in accordance with UK smokefree laws and ensure all staff are aware of its provisions.
  • Your smokefree policy should apply to contractors and visitors, as well as staff. It should cover not only premises but work vehicles, including leased vehicles.
  • Reception and grounds staff should receive training on the smokefree policy, including how to report breaches.
  • The smokefree policy should include a section on illegal tobacco (the workplace being a common venue for the trading of illegal tobacco). Employers are subject to legal sanctions if they permit such activity on their premises.
  • Your smokefree policy should be embedded within corporate advertising, recruitment, induction and training, occupational health provision and disciplinary procedures Display no-smoking signs clearly in premises and company vehicles Make a clear distinction between smoking and vaping (e-cigarette use).
  • E-cigarettes do not burn tobacco or produce smoke, and UK smokefree laws do not cover vaping.
  • Employers can choose to prohibit vaping or to permit it in all or part of the premises.
  • Signage should be displayed indicating no smoking and where vaping is prohibited or permitted.
  • If the permitted area is outdoors, vapers should be provided with an area away from smokers.

How to support employees to stop smoking

Having put the building blocks in place, take steps to actively encourage employees who smoke to improve their health by quitting.

  • Offer advice, guidance and support to employees who smoke to help them stop.
  • Information provided to staff should include details of help available, when, where, and how to access the services.
  • Employees who want to quit smoking should also be made aware that success rates are higher when smoking support services are used.
  • Allow staff to attend local stop smoking services during working hours without loss of pay.
  • The most effective way to stop smoking is with help and support from specialist stop smoking services.
  • The commitment to providing facilitated access to local services should be included in your smokefree policy, in management guidance and in staff communications on stopping smoking.
  • Promote national quitting campaigns including Stoptober and regional/local campaigns, and encourage staff who smoke to take part Implement a vaping policy that supports smokers to quit and stay smokefree while managing any identified risks.