Substance Abuse in the Workplace: What to Do?

If a friend or colleague were suffering from an illness, such as cancer, you wouldn’t hesitate to reach out to them with concern about their wellbeing. It is much harder to do this when the illness is an addiction. Would you step in and offer help?

In September 2015, Dr. Jon Geller and Dr. Lori Kogan of Colorado State University shared the results of an online survey of veterinarians in a story on JAVMA’s website.¹ The results showed that 72% of respondents said they had worked with a veterinary colleague whom they suspected of having a drug problem. More than 40% said they knew of 2 or more people that fit the description. Sixty-eight percent said drug abuse was at least as big a problem in veterinary medicine as it was in the general population.¹ Let’s face it; veterinary professionals have access to an extensive list of potentially addictive drugs within the practice.²

My personal experience with this prevalent problem happened several years ago while I was a practice manager at a small general practice. There had been a few minor issues with the controlled substance logs. Then I received a phone call from a pharmacist concerned about a recurring prescription written by one of our veterinarians for his dog; however, I never thought about drug abuse. The last thing I expected was to receive a phone call while speaking at a conference, telling me that one of my doctors had put himself in rehab for drug addiction. Were there signs? In hindsight, yes—there were a few but nothing that clicked at the time.

Warning Signs of Substance Abuse

Warning signs of substance abuse can be difficult to recognize due to the individual’s secrecy. Signs may include increased covertness, moodiness, abrupt changes in behavior, withdrawal from relationships, changes in appearance, financial stress, unexplained absences, borrowing money, working long hours or after closing, and disappearance of medications.³ These symptoms are often subtle and may occur over time, therefore making it difficult to be recognized.

Legal and Ethical Dilemma

The possibility that an individual is experiencing substance abuse may be difficult to address with that individual, but remaining silent is just as dangerous. A team member’s substance abuse can result in numerous problems for the practice and the individual.

Potential concerns include:

• legal action, especially if the substance abuse results in wrongdoing or inadequate patient care
• suspension/loss of license to practice medicine (hospital or individual)
• media coverage
• loss of clients
• Additionally, there are ethical ramifications that the addiction could lead to an accidental overdose and potential death of a team member.²

It is important to remember to protect patient safety and professional standards as required by your state’s licensing board. The standards can usually be found on your state veterinary board’s website. Then, when the legal and ethical requirements are clear, you can focus on intervening.

Ask the Question

The dynamics of the veterinary team play a role in the conversation, as does the hierarchy in the practice. A subordinate suspected of substance abuse may be easier to address through focusing on technical job performance. When addressing a peer, it may be beneficial to bring your concerns to a supervisor to ensure your concerns are addressed. Remember, addressing the concern is in the best interest of the hospital, the patient, and the individual. What happens when the person suspected is the supervisor? You want to help the person and protect the practice but at the same time may be concerned about losing your job when addressing the issue. Opening the dialogue and asking the difficult questions may make the person fearful, defensive, and vulnerable, and they may react with anger, denial, and avoidance.⁴

Both personal and professional relationships complicate the concern. How do you open those delicate conversations with a co-worker? This can be a challenging conversation that must be opened with empathy and compassion.⁴

Before you have the conversation, check to see if your practice has a policy for addressing the concern. Also, does the practice have an employee assistance program? What are other resources in your area? Be prepared, follow the policies in place, and have the information ready to give to the individual. Avoid confrontational interventions; they rarely work, and an individual who feels uncomfortable opening up to you is more likely to seek outside help if you have the information readily available.⁶

Begin the discussion with an inquiry about the individual’s wellbeing. You could start with, “I’ve noticed you’re not yourself lately and you seem troubled. I’m worried about you. Is there anything I can do to help?”

If the initial conversation does not resolve the issue, subsequent conversations may need to be more confrontational but still delivered with compassion. For example: “I’ve noticed a change in your behavior and job performance. I’m worried that this change may put a patient at risk. While I’m concerned about you, I also have a duty to the patient, so I need to ask if you are struggling with addiction. I can imagine that it is difficult, but I need to consider our patients, so I’m asking you to seek professional help.” At this time, lay out the steps that you and the individual need to take, such as mandating time off for the employee, reporting to the state board, and possibly terminating the individual.

Be Prepared to Help

By raising the issue, you have planted the seed to recovery. Continue to show concern and support to this person.

Substance abuse is a significant concern in our profession. It is essential to know the regulations for controlled substances,⁵ take an active part in creating and activating proper controlled substance protocols within your practice, be vigilant in the enforcement of those protocols, and be aware of your team members in order to identify the signs and intervene quickly.