Addiction could be an unintended consequence for employees who have turned to alcohol to help them de-stress during the COVID-19 pandemic—which can lead to reduced productivity and increased costs for health benefits, including disability. Fortunately, new resources are available to help employers raise awareness and offer support.
Numerous polls align on changes in alcohol consumption:
- LEGER’S survey in June 2021 found that 16% of Canadians are drinking more alcohol since the start of the pandemic. On average, they are drinking 6.3 more servings a week.
- BENEFITS CANADA’S 2021 CAP Member Survey, conducted in March 2021, indicates that 17% of respondents increased alcohol consumption in the past year.
- In a survey by STATISTICS CANADA in March 2021, 24% of those who consumed alcohol in the past month believe their consumption has increased compared to before the pandemic. Among them, 18% consume five or more drinks at a time, the threshold for binge drinking, compared to 11% in 2017.
- The July 2021 installment of the COVID-19 National Survey Dashboard by CAMH (Centre for Addiction and Mental Health) reported that 27% of Canadians engage in binge drinking, increasing to 36% among those who were very worried about finances.
Experts interviewed by Take 5 for Health Benefits emphasize two takeaways from these findings: more employees are struggling with their mental health; and more are at risk of addiction, also known as substance use disorder (SUD), which adds a complex layer of mental and physical health challenges. They also noted that self-reported substance use is almost always under-reported.
Even before taking under-reporting into account, “the level of binge drinking is high,” says Dr. Donna Ferguson, clinical psychologist, CAMH Work Stress and Health Program. “We focus on that because it’s a major factor when people become stressed and anxious. Some turn to drinking to self-medicate.”
At first, people feel that alcohol does help with symptoms of depression and anxiety, including trouble with sleeping. “People feel they can move on with their day a bit more. But alcohol is a depressant on the central nervous system. Over time sleep becomes more disturbed and anxiety and depression increase,” says Ferguson.
By then, the pathophysiology of addiction, a mental disorder, may have set in. “People may think they have it under control but find they can’t just turn it on and off,” says Ferguson.
More employees are at risk
“Over a third of mental health issues involve substance use. That’s a big part of the mental health landscape,” says Elliot Stone, CEO of ALAViDA, a Canadian, completely digital healthcare provider focused on substance use and partner of The Benefits Alliance Group. He adds that the additional 6.3 servings a week reported by Leger definitely suggest “more people are at risk of developing a substance use disorder.”
Canada’s Low-Risk Alcohol DRINKING GUIDELINES currently recommend no more than 10 drinks a week for women, with no more than two a day on most days, and 15 drinks a week and three a day for men. Those numbers are expected to go down with the release of new guidelines by the Canadian Centre on Substance Use and Addiction, scheduled for March 2022.
Research conducted in 2020 by the CANADIAN INSTITUTE FOR SUBSTANCE ABUSE found that people who drank within the low-risk guidelines experienced significantly higher rates of hospitalization and death. It concluded that a low-risk guideline of one drink a day may be more appropriate.
The May 2021 edition of the Mental Health Index by LIFEWORKS provides perhaps the most complete picture of overall alcohol consumption among employed Canadians during the pandemic. Almost half (47%) of those surveyed reported consuming alcohol at least once a week, of whom 34% said they are drinking more than before the pandemic. Among them, 50% consume one to three drinks per week and 30% have four to eight drinks—levels that can be described as low-risk. The remaining 19%—or 9% of the total Canadian workforce—consume at least nine drinks a week. Eight per cent consume 15 or more drinks, compared to just 2% before the pandemic.
One in four (24%) of the surveyed alcohol users would like to drink less, increasing to 62% among those drinking 15 or more drinks a week.
“At 15 drinks a week, physical changes in the brain occur, which make it much more difficult to change behaviours,” says Paula Allen, global leader and senior vice-president, research and total wellbeing at LifeWorks, a wellbeing provider and partner of The Benefits Alliance Group.
The CANADIAN MENTAL HEALTH ASSOCIATION estimates that 21% of the population (about 6 million people) will meet the criteria for addiction in their lifetime. Alcohol was the most common substance for addiction.
At high-risk levels of consumption, alcohol weakens the immune system and leads to the onset or worsening of chronic conditions, including cancer, diabetes, heart disease, depression and anxiety. It can affect learning, memory, decision-making and mood (e.g, increased feelings of anger or frustration).
“It absolutely impacts your employees’ ability to do their job, even if an employee appears to function well,” says Ferguson.
Among patients privately paying to use ALAViDA’s services, more than 90% work full-time and 80% have severe substance use disorder. “They are going to work every day but not functioning at their best capacity. They’ve come to us because they know they need help,” says Stone.
Role of the workplace
Some of these employees did reach out to their employer but found that support was unavailable unless they were on disability. “Right now benefits plans are over indexing for reactive, late-stage cases, which are expensive, punitive and prevent people from getting help before it becomes a crisis,” says Stone.
Instead, employers can achieve more by shifting their focus to early intervention. “Businesses have made significant gains supporting employees as they face mental health challenges. Yet substance use remains steeped in stigma and only one in 10 seek help. We need a workplace attitude shift towards alcohol consumption and drug use as this is a medical issue, not a moral failing,” explains Stone. He adds that several medications are available that can curb cravings for alcohol.
Allen agrees. “We’ve normalized the conversation more around mental health, which is great. Now we need to expand that to include substance use,” she says.
LifeWorks’ Mental Health Index notes that 40% of employees do not know or are unsure of what their employers offered to help with problem drinking or drug use; just 27% indicated they were aware of resources available through their employer.
Ferguson emphasizes that many people cannot reduce or stop substance use on their own. “It’s really important to provide resources. That includes training managers so they are able to notice when something is wrong, and from there identify what can be done.”
If you have an employee assistance program (EAP), don’t assume it’s sufficiently equipped to support plan members with substance use disorders. “You may need to put things in place beyond the EAP,” notes Ferguson.
Harm reduction strategies—that is, reduced consumption of alcohol rather than total abstinence—are more appropriate for some people, she continues, and digital supports—including virtual appointments and asynchronous communications with a counsellor—are improving access and removing barriers tied to stigma.
To help develop a workplace strategy for substance use support, employers can take advantage of the following resources:
- “CAMH’s Mental Health Playbook for Business Leaders,” produced by CAMH in February 2020, and “Navigating the New Normal: A COVID-19 Supplement to CAMH’s Mental Health Playbook for Business Leaders,” a supplementary guide released in August 2020.
- Free materials to raise awareness from WELLNESS TOGETHER CANADA, launched in 2021 in response to COVID-19 and funded by the federal government.
- “Substance Use and the Workplace: Supporting Employers and Employees in the Trades,” a free toolkit created in 2021 by the CANADIAN CENTRE ON SUBSTANCE USE AND ADDICTION in partnership with Health Canada.
- “Management of impairment in the workplace,” a standard released by the CSA GROUP, formerly the Canadian Standards Association, early in 2021 with funding from Health Canada. Purchase price of $15.
This article is part of The Benefits Alliance Take 5 for Health Benefits. Take 5 is a quarterly initiative that provides a deeper look a the employee benefits space by providing examples, research and case studies on what’s working for employers in Canada.