When employees receive any kind of treatment for an alcohol problem, careful monitoring of their progress both during and after treatment – known as follow-up – can help them maintain sobriety. Providing thorough follow-up can pay substantial dividends for employers, too: research indicates that it can consolidate treatment gains in health and productivity as well as help reduce alcohol-related disability claims.¹ Follow-up services are but one component of effective Employee Assistance Programs (EAPs),² a structured strategy many companies provide to help employees with problems that negatively affect their job performance.

What Is EAP Follow-Up?

EAP follow-up, which requires an employee's consent, has two primary goals:

1. to help employees maintain “work continuity” during treatment (some employees remain on the job while they receive counseling on an outpatient basis) and afterward; and
   

2. to ensure that the employee adheres to the continuing care component of his or her treatment plan and, in cases of failure to comply with company policy (i.e. a positive drug test), continued monitoring.

Employers who offer health insurance coverage for alcohol treatment that includes continuing care, such as ongoing outpatient access to psychological or group counseling services, stand to reap the biggest gains from EAP follow-up. However, many employer-based health plans don't cover continuing care, so EAP follow-up may constitute the only systematic monitoring of an employee's recovery.

Elements of Effective Follow-Up

EAP follow-up typically continues for a minimum of six months, but research indicates that it is most effective at preventing relapse if it lasts for at least a year.³

EA professionals follow up by supporting client recovery efforts and checking in periodically to ask if they are adhering to their treatment plan and if their job performance has improved. Professionals trained in relapse prevention also explore with clients any other life changes they may be experiencing as a result of treatment. Many people with alcohol problems believe that drinking helped them cope with stress or emotional difficulties. Effective EAP follow-up can prevent clients from falling into old, destructive patterns of behavior by identifying “trigger mechanisms” – experiences that prompt cravings for alcohol – and referring clients to additional counseling services as needed.

Employee Incentives to Allow EAP Follow-Up

At least one study has shown that 80 percent of EAP clients agree to follow-up when certain things happen, including:

• an EA professional explains the reasons for follow-up and develops a timetable prior to employee's entering treatment; and
  

• the same EA professional who does the initial planning also conducts the follow-up service.⁴

If a supervisor formally refers an employee with an alcohol problem to the EAP (which usually happens only when termination looms because of poor job performance), the employee often has a strong incentive – fear of job loss – to participate in follow-up.

Fewer Relapses Among Health Care Workers in Cincinnati

EAPs offered by employers where alcohol problems can have significant consequences – including harm to human beings – recognize the value of follow-up. Dianne Carroll heads the internal EAP at the Health Alliance of Greater Cincinnati, a nonprofit health care group with more than 13,000 employees, including executives, doctors, nurses and custodial staff.

“Our philosophy is to treat individuals with alcohol and other drug problems and return them to work without jeopardizing the safety of the patients who rely on us for their medical care,” says Carroll. Asking EAP clients to sign a return-to-work agreement outlining what will be expected of them during follow-up is a key.

Initially, this return-to-work agreement remained in effect for a year, during which time employees were subject to random testing for use of alcohol and other drugs. “It became clear that in some severe cases of addiction, a year wasn't long enough,” Carroll explains. “We're seeing fewer relapses now that our return-to-work agreement has been extended for the duration of their employment with the Health Alliance.” Although self-referred employees with less serious problems also are asked to sign the agreement, the decision to continue random testing is made on a case-by-case basis by the EAP and is based on the client's job performance.

Footnotes

1. Foote, A. and Erfurt, J.C. 1991. Effects of EAP Follow-Up on Prevention of Relapse among Substance Abuse Clients. Journal of Studies on Alcohol. 52 (3): 241-248.

2. Employee Assistance Professionals Association. 2003. Core Technology. Available from the World Wide Web: http://www.eapassn.org/public/pages/index.cfm?pageid=507

3. Foote, A. and Erfurt, J.C.

4. Foote, A. and Erfurt, J.C.

Jeffrey Hon and Lynora Williams, January 2004

Working with policymakers, employers and concerned citizens, Ensuring Solutions to Alcohol Problems at The George Washington University Medical Center in Washington, DC, provides research-based information and tools to help curb the avoidable health care and other costs associated with alcohol use. The project works to improve access to treatment for Americans who need it. It is supported by a grant from The Pew Charitable Trusts. For more information, please visit the Ensuring Solutions Website at www.ensuringsolutions.org.