Addiction's Hidden Costs

Mental health and addiction cost Canada's economy more than $11 billion in productivity

Brian Wilson, spokesperson for the Toronto chapters of Alcoholics Anonymous and a project manager at a national construction company, recalls the day he first stumbled into AA. “When I got here, I was a mess,” acknowledges Wilson, whose name has been changed to preserve his anonymity. “I shook violently if I didn't have a drink.” Twenty years later, he's cleaned up his act–and watched many others do the same. “One executive, who was earning in the high six figures, was going to lose it all because of alcoholism. He had to get sober to bring his business back from bankruptcy,” Wilson says. “I even know of a doctor who practised while drunk.”

If you think alcoholism and drug addiction are rare in executive suites, think again. While corporate top dogs don't often get liquored up before an AGM or snort cocaine in the office washroom, substance abuse definitely exists at the highest levels of the business world. As Kevin Roxby, managing director of workplace programs at Toronto-based rehab centre Renascent, says: “Addiction is an equal-opportunity disease. No one is immune.”

Roxby estimates that 7% to 10% of all executives are alcohol dependent or addicted to illegal or prescription drugs–the same percentage as in the general population. Nancy Waite-O'Brien, vice-president of clinical services at the Betty Ford Center in Rancho Mirage, Calif., echoes those figures, while adding that late-onset alcoholism–the result of years of social drinking that has evolved into addiction–is quite common among senior managers. What's more, while the three-martini lunch may be passé, some suggest easily hidden pill-popping is replacing daytime drinking. Toby Levinson, manager of continuing health and therapy at Bellwood Health Services Inc., an addiction treatment centre in Toronto, says that among high-powered business people addicted to drugs, prescription painkillers (such as OxyContin, Vicodin, or Percocet) are especially popular.

Alcohol and drug addiction is an extremely difficult issue to deal with, especially in the workplace. And despite some progress, the topic remains largely taboo. But the costs of addiction–both to the person suffering and to business–are too high to ignore. An addict is more likely than others to be inattentive to detail, exhibit inappropriate behaviour and exercise errors of judgment. “If they are at a high level in a corporation,” says Waite-O'Brien, “they can make mistakes that are costly to companies.”

A 2002 study by the Scientific Advisory Committee to the Global Business and Economic Roundtable on Addiction and Mental Health estimated the burden of mental health and addiction on the Canadian economy exceeds $11 billion each year in productivity costs alone. What's more, according to the principles of Canadian law, a contract can be nullified by the courts if it can be demonstrated that the signatory wasn't of sound mind and body at the time of the deal.

Some contend addiction problems are not especially acute in the higher echelons of the business world, however. Albert de Goias, a medical doctor and director of the Prometheum Institute, a Toronto-based treatment centre, emphasizes that in his experience addiction is not especially common among senior executives. He differentiates between very senior executives–who, he claims, “usually have the ability to manage themselves” and their time–and younger workers in middle to senior management roles. De Goias suggests the latter “are very vulnerable to drifting into the abuse of drugs,” because they're putting in long hours at the office and may turn to something that will relax them quickly and easily.

Either way, no one quibbles with the fact that identifying a high-performer's alcoholism or drug addiction–and dealing with it before it becomes a massive corporate headache–isn't easy. It's not always clear when casual substance use crosses the line and becomes dangerous. What's more, denial is a key part of addiction. Someone struggling with the problem may not even realize he or she is in trouble. And even if individuals do come to terms with their addiction, they are usually loath to admit it to their employer. “We find that the work area is one of the last places to be affected,” says David Nesbitt, director of the Northern Addiction Centre in Grand Prairie, Alta. “People work hardest to protect that.”

Addiction can be especially detrimental to a firm when it's the head honcho swallowing pills by the handful. Nonetheless, the further one climbs up the management ladder–and the more important an individual's decision-making becomes to a company–the less likely it is others will confront the person about an addiction. Not only do power and prestige make accessing a drug of choice easier–executives generally have the financial wherewithal to support a habit, even a wildly expensive one like cocaine; sitting atop the corporate pyramid can isolate an addict from the truth. “A subordinate is not going to say to a boss, 'You're not behaving the way you should,'” explains Levinson. “People cover up for a boss who might be responsible for promotions.” Senior executives also have more flexibility than your average worker, Levinson adds. “If the boss doesn't come in one morning because he is too sick and hungover, who is going to question him?”

A common misperception is that alcoholics or drug addicts won't be appointed to top jobs. Not true. Levinson says there are plenty of high-functioning people who have alcohol and drug problems. So long as they're getting the job done, and especially if they're getting the job done well, promotions tend to pile up, while bad behaviour is excused.

What senior managers struggling with addiction might not realize, however, is that they're more likely than most to have a successful recovery. Waite-O'Brien suggests the success rate for executives “is probably higher than average” because of their tendency to be hard-working and highly motivated. Execs also have a job to return to–a significant predictor of somebody's ability to stay sober.

When a high-rolling addict decides to get treatment, either of his own volition or because his behaviour has become so out of control that his company demands it, the usual first step is a professional assessment. An assessment determines the severity of the problem, and helps an individual determine what type of treatment–an in-patient program, out-patient program or something else–will serve him best.

At Renascent, where addiction is treated as a disease, an assessment usually takes one to two hours, and includes filling out a number of questionnaires, such as the Substance Abuse Subtle Screening Inventory, and then discussing the results. Roxby says addicts “may challenge the veracity of the tools we use,” so the facility goes “to great lengths” to ensure questionnaires “are well-recognized and will stand up under scrutiny in a court of law.” Renascent, a non-profit charity, charges about $500 for an initial assessment, which is often paid for by an employer. At the Prometheum Institute, where the underlying approach is that addiction is not a disease but a reactive behaviour, an assessment takes about three hours, and costs $200.

Following an assessment, and depending on the severity of an individual's addiction, one might spend a few days detoxifying. Many treatment centres have detox facilities. Stand-alone clinics, such as Canada Detox Centre in Richmond Hill, Ont., exist, too. But, according to Levinson, “an executive would probably go through detox at home, with the help of a family member or a private nurse.” Abstinence-based treatment centres like Bellwood or Renascent won't allow someone to begin an in-patient program without being clean for 72 hours.

One of the biggest issues for execs is deciding where to get treatment. Disgrace and embarrassment still hover over addiction; substance abusers desperately seek secrecy. “We have people here who tell their friends and co-workers they're going to Palm Springs on vacation,” says the Betty Ford's Waite-O'Brien. If an employee's firm knows what's up, management may want to keep the incident quiet, too, especially if it is a public company answering to shareholders.

The other key factor for execs is finding a program that they feel comfortable with. Roxby argues that a chief financial officer may drink more expensive alcohol than a truck driver, but dismisses addiction treatment boutiques that offer horseback riding and spas along with rehab. He advocates identical therapies for all. Renascent has separate facilities for men and women, but otherwise the treatment offered by the $4,000 to $8,000 three-week residential program is the same.

On the other hand, de Goias observes that most clinics use directive- or abstinence-based methods to help addicts deal with alcohol and drug abuse, and speculates that the “intelligent and sophisticated” executive “will have difficulty being told how to handle themselves.” Rather than focus on people's substance-abuse patterns, the Prometheum Institute helps analyse their relationship with the world as a whole. Its $6,000 to $7,500 outpatient program does not demand abstinence, and usually lasts about two months.

It's often easier to ignore or work around a colleague's alcoholism or drug addiction than it is to deal with it in an upfront way. As Wilson puts it, “It's pretty hard being a fully blown drunk and a successful executive.” But in most provinces, alcoholism and substance abuse are legally considered disabilities, which employers are obligated to accommodate. The overall health of a company, as well that of any addicted employees it may have, could very well be on the line.

Action Plan: How To Help

Confronting a colleague about alcoholism or substance abuse is no easy task. Nonetheless, if you suspect an employee is struggling with addiction, and simultaneously endangering the health of your business, an intervention is critical.

Two current trends make speaking up a little easier. First, a growing number of companies are implementing alcohol and drug policies. According to Barb Butler, a private consultant and author of Alcohol and Drugs in the Workplace, these are most popular in higher-risk industries, such as transportation and oil and gas, where safety is a major concern. But they're increasingly championed by other types of businesses too.

What's more, such policies tend to apply equally to all employees, regardless of seniority. With a firm policy in place, it's much simpler to convince a worker to go for a professional addiction assessment. That's because, as a manager, you can point to a specific broken corporate rule, not just rely on a gut feeling.

Secondly, there's the booming employee assistance programs (EAP) movement. Large corporations are increasingly hiring firms such as Warren Shepell or FGIworld to supply emotional and psychological health and well-being services to their employees. Those include providing confidential addiction counselling. Allon Bross, CEO of FGIworld, says of those employees who take advantage of EAPs, about 5% have addiction issues. But he adds this percentage is steadily increasing.

Discussing drug and alcohol abuse in the office may seem indelicate. But watching someone bankrupt your firm while derailing their own career will make you wish you'd gone ahead with that difficult conversation much earlier.