Better understanding needed to address stigma of substance use

The Canadian Centre for Occupational Health and Safety (CCOHS) has recently released a free online course to help workplaces better understand the impact of stigma toward employees who use substances.

“Stigma is generally defined as a negative attitude, belief or behaviour that is about or towards an individual or group of people because of a characteristic they share. It could include discrimination, prejudice, judgment or stereotypes,” says Jan Chappel, Senior Technical Specialist, CCOHS.

Stigma is not just for substance use, but it is very prevalent – and can be present in the workplace:

“It evolves when we start negatively judging a person, or we believe that they’re somehow different or bad. And when we have a stigma that affects our attitudes towards them, and how we treat them, [it affects] the policies we make and the quality of care that we give,” says Chappel.

She explains that there are different kinds of stigma as well, one of which is structural stigma which can affect workplace policies or services, and can affect the how we treat people.

So how can employers assist workers who are suffering from this kind of stigma?

Chappel says that there is a difference between substance use, problematic substance use and substance use disorder.  We need to understand that when substance use becomes problematic, there may be a condition called substance use disorder – a medically diagnosed condition.

Workers suffering from this condition don’t have the same control over the need to use substances, with regard to the possibility of harm.

“We need to understand that it is not a choice that a person who is affected by substance use disorder makes, they crave the drug. They’re not concerned about its harmful effects, they think differently – their feelings and thoughts may be different,” says Chappel.

And workplace impairment testing may not be a good way for workplaces to handle substance abuse.

“Substance testing is a snapshot of time,” says Chappel. “The testing might be appropriate in certain situations where [employers] need to know your ability to do that task right now, or it can be included as a post incident procedure. But it's not an indication of overall substance use or if there's a substance use disorder.”

She also says that it is not the supervisor or the employer’s role to diagnose possible substance use or dependency problems:

“[Their] role is to identify if an employee can do that job safely at that time, and to keep the workplace safe. And then to take appropriate steps according to the organization's policies.”

Substance use disorder is actually very complex, and people develop the disorder for many reasons, including:

• Events in life, especially trauma or chronic stress.
• Environmental factors.
• Mental well-being (emotions, thoughts, feelings, mental illness, etc.).
• Genetics and biology.

“Workplaces should focus on solutions, and understanding and promoting a psychologically healthy and safe workplace,” says Chappel.

Employers can also focus on having a policy in place that encourages people to seek help so they don’t feel discriminated against, as well as having policies that describe what can happen when there is a suspected impairment situation and what steps will be taken.

“That way, everyone knows that every person is going to be treated the same,” she says.

Physical safety is also important, because preventing injuries could mean that pain medication is not necessary – and workers are not at risk of developing addictions to, for example, opioids.

In the case where an employer believes that opioids are a problem in their workplace, “they can train first aid responders on how to properly use the reversal drug Naloxone,” says Chappel.

“Substance use disorder is a treatable medical condition, no one chooses to become addicted,” she says. Managers and supervisors need to have the right training to be able to respond in a way that maintains worker privacy, dignity, confidentiality and human rights.

Says Chappel:

“When people seek help, this journey may take many routes and healing might take time. We need to be compassionate and to be without judgment to help the person.”