Return to Work - Readiness Guidelines

Date Issued: November 3, 2014

RECIPIENT

  • All Providers of Treatment Services
  • Local Designated Agencies (LDAs)
  • Local Governmental Units (LGUs)


PURPOSE

The New York State Office of Alcoholism and Substance Abuse Services (OASAS) is committed to the care, recovery and sustained well being of individuals with chemical dependence problems. OASAS also is cognizant of the strong link between recovery from chemical dependence and economic self-sufficiency (i.e., employment). For the employee who has become involved in chemical dependence treatment, whether through the efforts of an Employee Assistance Program (EAP), referral by an employer or supervisor or self-referral, it is the responsibility of the treatment provider to make every effort to assist the individual to become fully functional. An important aspect of this recovery comprises the individual's capacity to achieve successful reintegration into the workplace, which is ultimately to the benefit of the individual, his/her family and the employer.

These Guidelines are intended to assist employers, supervisors, EAP professionals, chemical dependence professionals and employees who have found it necessary to engage in treatment to make the determination on what constitutes an impaired individual's readiness to return to the job, and what are the appropriate conditions under which this should occur.


BACKGROUND

The presentation of background material relative to Return to Work -- Readiness Guidelines for individuals with productive work records prior to the onset of impairment requires that the term "impairment" be defined. Generally, impairment resulting from chemical abuse or dependence is viewed in terms of the effects of chemical use on the individual's functioning in various life areas. For purposes of this document, "impairment" is defined as the loss of capacity of the individual to properly perform the required tasks required by the job for which he or she is responsible.

In the United States, efforts to address impaired employee issues led to the development of EAPs, whose distinguished history dates back to the 1930s. OASAS has been involved in supporting this type of program for approximately two decades. The benefits to employers, as well as employees, of the availability of this service have been well documented. In addition, employers without EAP services on site have often recognized the value of providing the opportunity for employees impaired by chemical abuse or dependence to seek and obtain treatment for their problems. The goals of such efforts have been to: (1) ensure the maximum likelihood of restoring the individual's productivity, self-worth and economic independence; and (2) restore for the employer the services of an experienced employee.

Even when the matter of an employee's impairment has been addressed in a positive manner, leading to appropriate treatment for the problem, the issue of the individual's return to work can be a thorny one. An employer, not having a full understanding of chemical dependence, or the treatment and recovery process, can confuse the issue through a desire to bring the employee back to the job prematurely. Unrealistic expectations surrounding the employee's return may jeopardize the potential for ultimate success. On the other hand, an individual who has engaged in the treatment/ recovery process may incorrectly assess his/her readiness to return to the job with all of its attendant stresses and demands.

The Return to Work - Readiness Guidelines are intended for use in the broad employment spectrum and, therefore, are general in nature. They should be considered by everyone involved in making return-to-work determinations in the context of the particular work environment and duties to which the previously impaired employee will be returning.


GUIDELINES

Indicators of an Individual's Readiness to Return to Work

The determination of an individual's readiness to return to work requires the involvement of the affected parties in the decision-making process. At the very least, communication is needed between the employer, supervisor, EAP and/or union representative (if applicable), the treatment program and the individual in recovery. Where an EAP exists, this often provides the best means for communication with the treatment program to address the employee's workplace needs for a successful return to the job. It must be understood that for individuals engaged in treatment for chemical dependence, Federal regulations require strict attention to the circumstances under which information regarding an individual's condition or treatment status may be shared. Treatment programs are well versed in these requirements and will ensure that they are adhered to in the process of communicating any information regarding a client to an outside source.

Generally, communication with employers or their representatives or other intermediaries will be confined to items of information that are directly relevant to an individual's readiness to resume proper functioning in the job to which he or she is returning. While various aspects of the individual's life, values, personal conflicts and anxieties may be addressed in the course of treatment, many are not of direct concern to others involved in the return-to-work decision.

Certain factors have a direct bearing on the employee's readiness to return to the job, and questions posed by an employer to the treatment program are appropriate in this regard. Among the areas that are of direct relevance to the employer are those listed below:

  • The definition of an employee's readiness to return to work may be determined in more formal terms through the utilization of clinically tested instruments1 found in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), published by the American Psychiatric Association. In the section of the DSM-IV regarding Remission from Substance-Related Disorders, the specifier "Early Full Remission" should be used as indicated: "This specifier is used if, for at least 1 month, but for less than 12 months, no criteria for Dependence or Abuse have been met." This should be viewed as a step toward an ultimate goal of "Sustained Full Remission," described as: "This specifier is used if none of the criteria for Dependence or Abuse have been met at any time during a period of 12 months or longer."

    The "Global Assessment of Functioning (GAF) Scale"¹ of the DSM-IV is another useful instrument used to: "Consider psychological, social, and occupational functioning on a hypothetical continuum of mental health-illness." If this scale is used, a score of no less than 61-80 is recommended as acceptable for favorable return-to-work consideration. The minimal level of functioning in this range is described as: "Some mild symptoms or some difficulty in social, occupational, or school functioning, but generally functioning pretty well, has some meaningful interpersonal relationships." Also included in the recommended range is the following description: "If symptoms are present, they are transient and expectable reactions to psychosocial stressors; no more than slight impairment in social, occupational, or school functioning."

    Finally, the "Social and Occupational Functioning Assessment Scale (SOFAS)"¹ of the DSM-IV is: A new scale that differs from the "Global Assessment of Functioning (GAF) Scale" in that it focuses exclusively on the individual's level of social and occupational functioning... Again, a score of no less than 61-80 is recommended for return-to-work consideration. Minimally, this requires that the individual has: "Some difficulty in social, occupational, or school functioning, but generally functioning well, has some meaningful interpersonal relationships." Included in the recommended range is the following: "No more than a slight impairment in social, occupational, or school functioning (e.g., infrequent interpersonal conflict, temporarily falling behind in schoolwork)."

    1 Please Note: It is recommended that use and interpretation of the results of these instruments be restricted to professional clinicians trained in their use.


    All of the above may be used appropriately in the dialogue between employer, other intermediaries, treatment personnel and the employee to consider the latter's readiness to resume the responsibilities of a previously held job. Of course, this presumes expressed written permission on the part of the employee.

    • The employee has an understanding of the specific behavioral and job performance issues that originally led to the referral to treatment, or the conditions which led to the approval of absence from the job for an agreed upon period of time for self-referred treatment participants. This includes recognition of why the problem behaviors cannot be tolerated in the workplace.
    • There is an understanding that the employee cannot arrive for work under the influence of alcohol or illicit substances, cannot use such substances while at the workplace and cannot bring such substances into the workplace.
    • That the employee must have demonstrated a commitment to sobriety/abstinence as determined by the program treating him/her. This might include:
       
      • A determination that the areas of impairment that led the employee to participate in treatment have been addressed, and that the employee has modified his/her behavior in acceptable ways. This may involve areas other than specific work behaviors (e.g., stability of residence, medical/psychiatric issues, legal problems, social maladaptations) that have manifested themselves in work-related difficulties. This is not meant to imply that all details of an individual's life that have been discussed in treatment should be revealed to the employer. Assurances that problem issues have been addressed should be sufficient.
         
      • Evidence that any recent laboratory tests conducted to detect chemical use have been negative. Such tests should occur no less than one month prior to the employee's proposed return to work. Demonstration of a willingness and commitment to participate in self-help or other constructive supportive activities as a component of sobriety/abstinence maintenance.

Workplace Conditions/Environment - Return to Work

While the readiness of the employee to resume productive and appropriate behavior on the job is of paramount importance, considerable attention must be given to the conditions that govern his/her return, and to the environment in which this will occur. The items delineated below represent areas to be considered by employers to ensure the maximum possible opportunity for the successful return of a recovering employee.

  • The behavioral expectations for the employee should be clearly defined by the employer, and these should be shared with the employee prior to his or her actual return to the job. This is an area in which collaboration between the employer and the treatment program should produce positive results. As stated earlier, an EAP may serve as a productive liaison for this exercise when available.
  • A plan for reintroduction to the workplace should be developed. The treatment program and the employee may be engaged as partners in this exercise, which may address areas such as:
     
    • the potential benefits of a gradual phase-in to the responsibilities of the job, thereby easing the transition back to the stresses that are inherent in it;
    • the requirements, if any, for drug testing on a random basis to assist in assuring ongoing sobriety/abstinence;
    • review of any changes that may have occurred in the job since the employee's absence to forestall unnecessary frustration for that individual; and
    • consideration of any adjustments in hours that may be needed by the employee to engage in self-help or other supportive activities as part of the relapse prevention plan, consistent with the provisions of the Americans with Disabilities Act.
       
  • If a collective bargaining agreement is in effect which spells out conditions pertinent to this subject, ensure that the provisions of the agreement are understood by all concerned and that they are honored.
  • In considering the matter of a previously impaired employee's return to work, the employer would be well advised to verify that the individual's level of participation and progress in treatment are taken into account -- not just attendance.
  • A significant element in the decision-making and planning processes regarding the employee's return is the content and recommendations included in a reassessment by a substance abuse professional, either employed by the treatment program or under separate contract with the employer.
  • For the sake of the returning employee and any other employees aware of the individual's absence for a period of time, the employer must consider what is known by the other employees; how the absence has been, or will be, explained to them; and how the potential embarrassment for all concerned will be handled.
  • It is incumbent upon the employer to provide feedback to the returning employee as he or she reengages in the job, both to let the individual know when improvement is needed and to provide encouragement or praise, when appropriate.
  • The employer should be cognizant of any inclination to grant special favors to the returning employee, or to treat that individual differently in any way from other employees. This type of action has the potential to make the employee's transition more difficult, rather than less difficult.
  • Many of the points made above, or others that may be relevant, should be summarized in a "contract" between the employer and employee. This provides a written record of current performance expectations that may help to avoid confusion or disagreements subsequent to the return to the job.


CONCLUSION

As part of its commitment to ensuring the highest quality care and services possible for chemically abusing and dependent persons, family members and others, OASAS is committed to facilitating the transition from treatment to other major life activities. Employment, as one of these activities, is an integral part in restoring to full function for individuals who seek treatment for impairments rooted in chemical dependence. It is the intent of OASAS to continue its work with the employment community to ensure that this element of recovery receives the attention it deserves.


SOURCE(S) OF FURTHER INFORMATION

If you require further clarification of the issues detailed in this Bulletin, please contact the OASAS Division of Practice Innovation and Care Management by email or by telephone at (518) 457-2149.