A description of clients using employee assistance programs

Alcohol Health & Research World,  Spring, 1992  by Terry C. Blum,  Paul M. Roman

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We examined a large sample of users of employee assistance programs and found alcohol problems to be related to various characteristics of the users, including gender, race, route of referral, and incidence of other personal problems.

Upon its formation in 1970, the National Institute on Alcohol Abuse and Alcoholism (NIAAA) began to pursue the goal of mainstreaming alcoholism treatment into the U.S. health care delivery system (Roman and Blum 1987). As part of this effort, policymakers began to focus on the majority of American alcoholics who had intact families and jobs, and who were difficult to identify and jobs, and who were difficult to identify and motivate toward treatment. Within this strategy, workplaces offered referral sources for heretofore "hidden" alcoholics whose behaviors were costly to their employers. Many of these workers were covered by health insurance plans and were candidates for the newly emerging system of private alcoholism treatment.

The employee assistance program (EAP) emerged as NIAAA's transformation of the Alcoholics Anonymous-based industrial alcoholism programs (Blum and Roman 1989). The EAP model emphasized that monitoring of employee behaviors by supervisors should be limited to issues of job performance. Supervisors should not, for example, attempt to diagnose alcohol problems or other employee problems. The EAP also encouraged self-referral of employees for personal problems.

Thus EAPs are work site-based programs designed to assist in identifying and resolving problems adversely affecting the employee's well-being or job performance--problems involving alcohol or other drug abuse, health, family, stress, and emotional, marital, financial, legal, and other personal concerns. The Employee Assistance Professionals Association (EAPA) recognizes that a variety of services labeled as EAPs are in existence, some of which offer only barebones assistance to employees. EAPA standards include a core definition and core functions for EAPs that are addressed only by providing comprehensive services. EAPA guidelines state that alcohol and other drug problems will be addressed effectively if an EAP includes expert consultation and training in identifying and facilitating the resolution of behavioral health and job-performance problems; confidential, appropriate, and timely assessment services; referrals for appropriate diagnosis, treatment, and other assistance; links between the workplace and community resources that provide those services; followup services; and education on preventing alcohol and other drug

problems.

EAPs provide the workplace with a systematic means for dealing with a variety of employee problems. This is valuable because, as Roman (1989) pointed out, employee problems often are multiple and interrelated. An example is drug abuse--dealing with drug abuse in the workplace entails having a broad perspective on other issues, such as associated psychiatric, family, and financial problems. To be effective, EAPs should be integrated into the performance- and benefits-management functions of human resource management.

EAPs are usually based on a written policy statement, and provide a means for supervisors, managers, and union shop stewards to obtain guidance in dealing with subordinates or co-workers who need assistance. The guidance is supplied either by an internal EAP coordinator, who is employed by the same organization as the employee, or by a staff member of an external agency. Some external agency representatives spend time at the work sites for which they provide services, and some internal program coordinators are located offsite. The structures and sizes of work organizations tend to influence the structures of EAPs as they relate to personnel, corporate medical programs (when they exist), and employee benefit plans.

The EAP model has been well received by employers. In 1991, in the United States, 45 percent of full-time employees who were not self-employed had access to an EAP provided by their employers (Blum et al. unpublished data 1991). Virtually all large workplaces (>500 workers) provided some form of an EAP, and the majority of medium-sized workplaces (250-500 workers) also provided EAPs. EAP coverage was least likely in small work sites (<250 workers).

On average, approximately 5 percent of employees working in an organization offering an EAP used the EAP in a 12-month period. And approximately 1.5 percent of employees used an EAP because of alcohol or other drug-related problems in a single year (Blum 1989). [TABULAR DATA OMITTED]

It should be made clear that EAPs do not replace existing benefits packages. EAPs and third-party coverage for alcohol-related problems are synergistic, rather than competitive, services (Fennell 1984). In many instances, management consults with the EAP to structure the availability of health insurance benefits. New managed-care plans may be supplements to EAPs, and the EAP is sometimes formally integrated into alternative efforts to contain the costs of treating behavioral health problems. Alcohol and other drug treatment through EAP referral has been shown to be more efficient and effective than efforts of employees to use insurance benefits on their own (Smith and Mahoney 1989).