Abstract
BACKGROUND:
Employee assistance programs (EAPs) are responsible for helping employees cope with problems such as: mental distress, alcoholism and other drug dependencies, marital and financial difficulties – in short, the whole host of personal and family troubles endemic to the human condition.
OBJECTIVE:
The study explored the challenges that employees who abuse substances experience when returning to work after the completion of an employee assistance program.
METHODS:
The study used a qualitative exploratory descriptive research design. Three male participants and two key informants participated in the study. One semi structured interview was conducted with each one of the participants and one semi structured interview with the key informants.
RESULTS:
Four themes emerged: 1) Loss of one’s worker role identity, 2) Negative influences of the community continues to effect the success of EAP, 3) EAP as a vehicle for change and, 4) Healthy occupations strengthen EAP.
CONCLUSIONS:
This study portrayed the following: how substance abuse effect the worker role of individuals employed in the open labor market, the challenges and facilitators experienced by employees who abuse substances when returning to their previous work roles and how occupation based interventions can be incorporated in EAP programs. Occupational therapists could use the health promotion approach, work simplification, energy conservation techniques and ergonomic analysis techniques.
Keywords
Introduction
Occupational therapy is defined as the art and science of helping people do the day-to-day activities that are meaningful to their health and well-being through engagement in purposeful occupation such as work related activities, leisure and self-care [1]. The occupational performance of individuals with disabilities could be influenced by many factors including physical, psychological and social factors. Occupational therapists use occupation based interventions to address issues of performance in work, leisure and self-care activities.
According to Louw [2], one of the developmental tasks that signify normal development of the individual in the adult stage is the ability to become established in a career, that is, the adult’s ability to assume a worker role and be able to maintain it, and also get satisfaction from it. This can be a challenge to individuals who fall ill or become injured during the performance of the daily occupations that contribute to this role. According to Soderberg, Jumisko & Gard [3], falling ill or being injured is always an unpleasant experience that presents a threat to one’s self and identity, and it effects whole areas of living, including family and working environment.
Many studies have been done on interventions and programs that help individuals to optimally perform their worker roles when faced with factors that affect their work performance. Programs that are often used by employers of different companies and organizations are employee assistance programs. Rajin [4] defines this program as an employee benefit consisting of diagnostic and referral services for employees and their families. The services of the program are to identify and resolve the problems of the employee that affect or may affect their work performance. Employee assistance programmes have been established within the South African public service. The program focuses on a variety of employee problems within the workplace including substance abuse and dependency, adaptation problems, mental and personal relationship problems, dealing with diseases, and providing counseling. Employee assistance programs are new in South Africa; it was initially developed in the USA and few organizations have been using it in South Africa [4]. There are few studies in South Africa that focus on the employee assistance program and there have been no recent studies to review the effectiveness of EAPs and their services.
Although Employee Assistance Programmes (EAPs) have been operating in another form in the South African Public Service as a function within Human Resource Management for decades, few comprehensive studies have been conducted into their functioning and efficacy in addressing the problems of workers in the Public Service workplace. Although the programme has been incorporated into the South African Public Service, but there have been few studies conducted that explores the effectiveness and the ability to address the problems of employees.
There are few studies of EAP with occupational therapists as part of the practice because the current studies are mostly administered by other professions. Maynard [5] did studies focusing on EAP in the USA and South Africa and identifies that the occupational therapist can contribute to EAP’s by identifying and providing services for workers who are at risk of occupational dysfunction or have early signs of maladaptive occupational behaviors.
Literature review
Introduction
This literature review will discuss the following: alcohol and substance abuse; the impact of alcohol and drug abuse on health, wellbeing and productivity; and occupational therapy in relation to the EAP.
Alcohol and substance abuse in South Africa
Alcohol and substance abuse are defined as patterns of drinking or using drugs (prescription and illicit) that result in harm to a person’s health, well-being, relationships, and productivity. Substance abuse is a destructive pattern of use of any substance for mood shifting purposes which ultimately lead to frequent and severe problems. Substances include inhalant, solvents, alcohol, cigarettes, and caffeine. In the Western Cape, alcohol remains the most abused substance. According to Freeman and Parry [6] a large number of people consume alcohol to deal with social and psychological issues. However, he further suggests that alcohol can be used as a social lubricant, and for rituals. It is a problem of degree, the severity of the problems determines the extent to which the individuals consume alcohol. Excessive and regular consuming of alcohol usually leads to the abuse of alcohol. This is the state at which an individual drinks alcohol for a combination of different reasons. Characteristics of abuse are having a strong need to drink and inability to limit drinking, withdrawal symptoms such as nausea, sweating and anxiety after heavy drinking and the need to increase amounts of alcohol to feel its effects [6]. People who abuse alcohol feel a need to drink regardless of the harmful effect it has on their work skills and health.
The South African Community Epidemiology Network on Drug Use (SACENDU) has found that an increasing number of patients are being admitted to rehabilitation centers for alcohol and other drug related problems. Statistics show that drug consumption in South Africa is twice the world norm of consumption. There is high prevalence of alcohol and drug abuse in the South African context posing a threat to South Africa’s social, economic (production) and or cultural environment. More than 15% of South Africa’s population have a drug problem and considering the total population (50.6 million) of South Africa, this stands as a significant form of concern. Drug abuse is costing South Africa R20-billion a year and could pose a bigger threat to the country’s future than the AIDS pandemic. According to South African Police Service figures, ∼60% of crimes nationally were related to substance abuse (in the Western Cape, the figure was closer to 80%). The perpetrators of crimes are either under the influence of substances, or trying to secure money to consume drugs [7]. Most of the literature conveys that substance abuse affects performance in work and home environments.
Impact of alcohol and substance abuse in the workplace and on work performance
Alcohol and other drugs can manifest harm in terms of physical harms (e.g. fatalities and injuries) and productivity related harms (e.g. poor performance, workforce reduction and absenteeism). According to the National Occupational Health & Safety Commission [8] alcohol has been found to be a contributing factor in physical harm in an estimated 4% of work-related fatalities and between 3–11% of workplace injuries. Other drugs are estimated to contribute to 2% of work-related fatalities. In total, it is estimated that alcohol and other drugs are contributing factors in at least 6% of work-related fatalities [8]. Furthermore, safety and other risks for employers can increase workers’ compensation and disability claims. Collins and Lapsley [9] stated that alcohol and other drug use resulted in productivity loss in the work place due to illness or premature death, and absenteeism. Greenberg and Grunberg [10] further state that the cost-effectiveness and preventive implications of EAP, found negative associations between employee drinking behaviour and job autonomy and the individual’s job satisfaction. These negative associations included an increase in arriving late to work, absenteeism, workplace injuries and lack of motivation to work.
Employee assistance programs (EAP)
The concept of employee assistance extends back at least a half century to the early efforts of some companies to encourage employees who abuse alcohol into Alcoholics Anonymous Programs (AA). While many of the newer programs such as Employee Wellness Program (EWP) and EAP have from the outset defined their missions in broader terms, others evolve first through an alcohol-oriented beginning stage [11]. An understanding of these origins is indispensable to an appreciation of the dynamics of the modern programs-whether limited to alcohol or broader in scope-and the issues they face. EAP can be defined as a set of company policies and procedures for identifying, or responding to, personal or emotional problems of employees which interfere, directly or indirectly, with job performance. These programs help employees to overcome the distresses they encounter in their lives when in the workplace; they contribute towards their working performance which gets affected by whatever problems they experience. EAPs can be of service in two kinds, internal or external service. An internal EAP service is provided by the employer with the aim to benefit their own employees. The employer ensures that the service is beneficial for the employees who need it. An external EAP service is provided by a specialist service provider hired by the employer. According to Maiden [12] South African EAPs are staffed predominantly by social workers, psychologists, nurses, medical officers and labor related personnel. Walsh, [13] described that EAPs are responsible for providing information and/or referrals to appropriate counseling, treatment, and support services, for which the company takes the responsibility of paying in whole or in part. Merrick, Volpe-Vartanian, Horgan and McCann [14] commented that EAPs are now designed to address all problems that negatively affect the employees’ well-being or job performance. However, Rajin, [4] describes EAPs in South Africa as a relatively new workplace management system designed similarly to EAP model’s in the USA.
The support service offered by the EAPs help to improve occupational performance among the workers as well as saves the company money by reducing the company’s losses in the form of work production. In general, companies have found it more cost-effective to rehabilitate good workers with problems than to dismiss them and train new workers [15]. Therefore the role of EAPs in a work setting is to ensure that individuals perform optimally in work related activities and occupations with a healthy life style and sense of well-being.
Occupational therapy and employee assistance programs
Maynard [5] suggested that occupational therapists can contribute to EAPs by identifying and providing services for workers who are at risk for occupational dysfunction or who have early signs of maladaptive occupational behavior. Maynard [5] stated that in the beginning, most EAPs were staffed by counselors and human services professionals, including mental health and rehabilitation counselors, social workers, and industrial health nurses and related health personnel. The staffing pattern within the EAP team varies in companies, depending on the location in the organizational structure and on the services provided. She further noted that EAPs expanded into health promotion and disease and disability prevention activities. This created a substantial role for occupational therapists to perform as members of the EAP team. Johnson, Kielhofner, Burke and Heard [16] supported Maynard [5] by suggesting that occupational therapy’s major contribution to prevention or health maintenance is to enable people to modify their health-threatening lifestyles and restore healthy patterns of work and leisure. The Model of Human Occupation (MoHO) as described by Kielhofner [16] could serve as a guiding framework for a therapist working on an EAP team. It helps to identify the worker’s problems, setting goals, facilitating role performance, and enhancing behavioral functioning. The occupational therapy interventions could take the form of workplace adaptations, providing advice on ergonomics in the workplace, suggesting the reasonable accommodation for an individual returning to work after an illness or disability, and developing injury prevention programs such as back protection and stress management programs.
Aim
The aim of the study was to explore the challenges that employees who abuse substances experience when returning to work after the completion of an employee assistance program.
Objectives
To explore how substance abuse affect the worker role of individuals employed in the open labor market. To explore the barriers and facilitators that workers experience when returning to work after the completion of a EAP program in the workplace. To explore how occupation based interventions can be incorporated in EAP programs.
Research design
The researchers used an exploratory descriptive qualitative research design in order to explore workers’ perceptions and experiences of the challenges they face when resuming their worker roles after participating in an EAP. The researchers chose a qualitative design for the study because it facilitates the precise actions the researcher aims to achieve such as identifying any issues with current practice or justifying current practice in a corporate environment [17]. Descriptive design aims to describe the essential findings in a rigorous way that is free from distortion and bias [18]. Descriptive studies help discover new meaning, describe what currently exists, verify the rate of which something occurs, and categorise the information [18].
Study setting and the sampling strategy
The researchers acquired a purposive sample by recruiting employees from a corporate environment through the South African National Council on Alcoholism and drug dependence (SANCA), established in 1956. The study was conducted in the Western Cape, SANCA offices. SANCA is an organisation of different health professionals and specialists who offer services to referred employees who have difficulties in performing their worker roles as a result of alcohol and substance abuse related issues. SANCA renders its services to different companies in the corporate environment and also to individuals who want to change their substance abuse behaviour. SANCA provides employees abusing substance with an 8 weeks therapeutic intervention. Treatment during this period can be both individual and group treatment. Intervention is based on the number of clients and the nature of problems being addressed. Assessment and intervention are provided as well as appropriate referrals for on-going support in available support groups.
Participant and recruitment methods
Prior to gaining consent from participants, letters requesting permission to carry out the study were sent to SANCA and the companies to which it renders its services. The participants were selected according to specific characteristics considered to be related to the research question. Participants in this study were selected by the therapist who is the social worker of the organisation SANCA. The therapist is responsible for facilitating therapeutic interventions. The researchers first gathered background information on SANCA from pamphlets, resource books and internet and then organised a meeting with the SANCA management to present the research proposal. The researchers provided the inclusion and exclusion criteria for participation in the study and asked to find people who suit the inclusion criteria from the organisation. SANCA is a non-governmental organisation whose major objectives are the prevention and treatment of Alcohol and Drug Dependence. Cormack [19] suggests that qualitative researchers use a small selective sample, because of the in-depth nature of the study and the analysis of data required. Six participants were recruited based on the inclusion and exclusion criteria; only three participants participated in the study.
The following inclusion and exclusion criteria were used:
Inclusion criteria
Minimum of three years’ work experience with current employer. Employees who abused substances and have participated in an EAP provided by SANCA. The participants must be at least 18 years of age or older. Both genders can participate in the study.
Exclusion criteria
Employees with severe psychiatric impairments, which could limit functioning, for example schizophrenia. Individuals with multiple disabilities, for examples severe, head injuries or stroke.
Data collection
Face to face interviews
The researchers used face to face interviews which allowed the researchers to observe any non-verbal communication and also allowed both the interviewer and participant to seek any clarification necessary. According to Kahn and Cannel [20] a face to face interview is a purposeful discussion between two or more people that can help gather valid and reliable data that is relevant to a study’s research objectives. Semi-structured interviews are non-standardized ways to collect data as well as to gain knowledge from individuals [21]. In this study, three face to face interviews were conducted with the research study participants and one face to face interview was conducted with two key informants.
Data management
The participants were invited to the interview with the help of the therapist working at SANCA. The interviews were audio-taped to make sure an accurate account of the interview can be replayed for analytic purposes. To ensure confidentiality was maintained, the audio tapes were coded and dated to keep track of different information from different participants and key informants without retrieving their identity. All the audio taped information was transcribed verbatim in order to analyze the dataand the original audio tapes were stored in case there was a need for clarity or if reference to raw data was made. The researchers read through the transcripts and re-listened to the audio tapes over and over so as to gain a good understanding of the information for analysis. All the data related to the research were stored in a research file.
4.4 Data analysis
The purpose of data analysis is to organize, provide structure to, and elicit meaning from research data [22]. The data was recorded by means of audio tapes. Data analysis, organisation, and interpretation, was done using Tesch’s [23] five step method of data analysis for qualitative research: Get a sense of the whole: The researchers listened to the tapes, reading through the transcriptions carefully and wrote down some ideas as they came to mind. The researchers listened to the audiotapes several times so as to internalize the content and then the content was transcribed verbatim. The researchers then carefully read through the transcriptions and wrote down ideas as they came to mind. Pick one interview tape and go through it: The researchers asked themselves what the interview was about thinking of the underlying meaning, then wrote thoughts in the margins. The underlying meaning was achieved by logically selecting the tapes and listening to them thoroughly and repeatedly and also writing down the emerging thoughts in the margin. During this process the various codes were developed that related to the barriers and facilitators relating to the participant’s experiences of returning to work after participating in a EAP. Clustering of similar topics: The researchers made a list of topics and similar topics were clustered. The researchers had 5 individual face-to-face interviews which were from the participants and key informants. From these interviews similar topics were clustered together and formed the categories and themes. Relook at the data: The researchers took the list and went back to the data, abbreviated the topics as codes and wrote the codes next to the appropriate segments of the texts (e.g. barriers and facilitators were viewed as codes). The researchers tried the preliminary organizing scheme to see whether new categories and codes emerged. Reduction of categories: The researchers reduced the total list of categories by grouping together topics that relate to each other and linked together categories to show interrelationships.
The last two steps were combined and followed the preliminary organizing scheme to identify new categories and emerging codes. The most descriptive wording for the categories were found and turned into themes.
Strategies such as credibility, transferability, dependability and confirmability were used in order to ensure the trustworthiness of the data [24]. Credibility was ensured by the dense description of the lived experience of the research participants. The descriptions of the lived experience of the participants were audio-recorded as they were talking and the audiotapes were transcribed verbatim to ensure that each participant’s story was captured in their own narrative. Credibility was ensured by means of member checking whereby a summary of the findings were reviewed by the participants in order to ensure its accuracy. Credibility was enhanced by triangulation. Triangulation is described as a means of establishing different patterns of agreement based on more than one method of observation, information gathering or the use of more than one data source in order to establish credibility [25]. Within this study triangulation was ensured by collecting information from different types of research participants namely: individuals who used substance abuse programmes and the two key informants. Each piece of data, when added to the previous data, strengthened or confirmed previous findings thus reinforcing the triangulation of the data. Transferability was ensured by the detailed description of the research methods, contexts, detailed description of the participants and the experience of the participants. Dependability was ensured by means of dense descriptions, peer examination and triangulation. The study was documented in such a manner that the readers could follow a decision trail. Confirmability was ensured by the process of reflexivity whereby the researcher’s own biases or assumptions were made apparent by means of a reflexive journal. In the current study, the research findings were purely from the perspective of the participants.
Ethics
Informants were contacted by telephone to explain the aim, purpose and process of the study. The details with regard to the study together with the consent forms were fully disclosed to the participants on arrival at the interview session. All the participants gave written consent to participate in the study as well as to have the findings of the study published in journals. Ethics approval was provided by the University of the Western Cape.
Findings
Theme 1: Loss of one’s worker role Identity
All the participants in the study had expressed their experiences relating to loss of one’s worker role identity in the workplace because of substance abuse. This theme outlines the different experiences of the participants regarding the use of substances before joining the EAP. It outlines how the participants lose their worker roles because all that mattered to them at that time was substance use, and they did not perform as expected by the companies in relation to their job titles.
Work routine disturbance
All three participants expressed how their work routines were disturbed during the time they were using substances. Their experiences showing the disturbances in work routine came through during the interview with the participants and were also supported by the two key informants. One of the participants expressed his views related to how his work routine was affected by the use of substances.
“You would like to drink on a Sunday and Monday you can’t stand up for work and it became a habit…it’s either am late, and I still smell like liquor or am not at all in work.” (Participant X)
Participant X expressed the disturbances which became visible through his late coming and constant absenteeism from work especially after the weekend. This is supported by the feelings from Participant Y.
“When it comes to Monday uh-I’m not actually focused., Yah uhm! The time when I was using. I, most of the times on a Monday I was, I used to tell the guys uhm Monday, it’s actually my sick day and a Tuesday is actually my Monday. You Understand. Coz a Monday— a Tuesday I’m actually feeling better. You understand.” (Participant Y)
Participant Z elaborated this theme further to show these disturbances become unbreakable habits which shows throughout the week as daily routines become paralysed.
“The next morning I still do the thing (drinking alcohol), whatsoever, I come late to work, I keep on staying out. I keep saying. I have sick leave I can go to the doctor… Doctor put me off for three days.” (Participant Z)
“Now on the Tuesday, you can’t stand up for work then you decide hey I’m gonna sleep now. Then you sleep.” (Participant Y)
Confirmation came from the key informant about the participants paralysed routines:
“Attendance of the worker, poor attendance, aahhh loitering, aaah not being present in work station, long lunches, tiredness, long tea time, long visits to the bathroom, with other words like appresentism, where the worker is not present where he is supposed to be.” (Key informant 1)
Neglecting work responsibilities
The roles and responsibilities that contribute to the worker role were affected by substance abuse. This category was derived when all three participants mentioned they did not care about their work and did not perform according to the expected standard. The participants expressed that they failed to meet the expected work responsibilities.
One participant expressed that he did not worry about his job during the time he was using substance and this had an impact on his responsibilities as a worker.
“ … uhm I didn’t still worry much about my work because I had just thought— Okay it’s just another day. I’m just going to do my job and then I’m gonna leave.” (Participant X)
This quote shows that the substance abuse took precedence over the participant’s expected responsibilities. The same sentiment was shared by the second participant. It is evident that the worker wanted to get over the work and continue with what matters most to him, the substance use.
“My mind is always just drifting… Can’t this time goes quicker or whatever. You See!! Just to get out of that place…” (Participant Y)
Loss of concentration on work related tasks
Focus and concentration on work related tasks deteriorates becoming evident in sloppy, unfinished work and overall poor quality of the product. The participants and the key informant expressed that loss of concentration becomes evident when using substances and that it can affected the worker role. The loss of concentration then leads to the loss of the individual’s work identity in the workplace.
“I wasn’t actually concentrating a lot in my work.” Participant Y “ … I’m not actually focused.” (Participant Z)
“I don’t think straight…” (Participant Z)
“The way he performs his job, sloppiness, poor workmanship, poor finishing, aaahm not meeting his deadlines, etc…” (Key informant 2)
Theme 2: Negative influences of the community continues to affect the success of EAP
The theme is constructed from the experiences of the participants returning to work after participation in the program and also during the time of participation in the program. This theme outlines the negative influences of the community on the participants after attending the EAP, the participants relapsed because they were surrounded by people who continued to abuse substances.
Triggers to abusing substances continues to exist after EAP
Triggers continue to influence participants after attending an EAP. These triggers affect them because they are in the participant’s environment (both at work and home), where people still abuse substance in their presence. The quote by Participant Y expresses how much it was challenging for him at work after attending the EAP. His colleagues were not supportive and instead they continued to influence him to abuse substance. He said:
“And uhm even the challenges like working with these guys, they gonna continue saying eh they gonna buy now this wine, they gonna do this today. It’s almost like they trying to fisher you or trying to get you back to the circle … it’s like a lot of triggers. Do you understand? Cos now you getting angry. Understand. So you must keep yourself calm.” (Participant Y)
The key informant and Participant Y express the triggers at home become a negative influence on the participants. These triggers are in their home environment which then becomes a huge problem because they are exposed to them.
“At home you see you’ve got family that’s that is still on the substances” (Participant X)
“Challenges … ja especially over weekend’s holidays, your big big festive holidays like Christmas and Easter those are particularly difficult times.” (Key informant 1)
Bad company corrupts good habits
Maintenance of relationships both at home and work, family members, friends and colleagues affected the balance the EAP has started bringing in the participant’s life. The participants indicatedthey have been abusing substance with the family members or friends before starting the program and that becomes a very big temptation for them after the program.
“Well , challenges it’s like uhm … you get some of your colleagues that will pressure you or they will make a re uhm-uh remarks to you, understand.” (Participant Y)
“So the challenges was tough because even like I told you me and my brother did it together and sometimes when I went in the room I saw him use it and he would ask me also … Now it’s difficult to say no because you know that for you that time it was nice.” (Participant Z)
Workplace culture negatively influences the success of EAP
The participants expressed how difficult it was for them to be around colleagues who still drink at work and continue with the arrangements of collecting money to buy substances and alcohol. The participants expressed that their colleagues expect them to take part in their traditions of drinking together on Fridays.
“And uhm even the challenges like working with these guys, they gonna continue saying they gonna buy this wine, they gonna do this today.” (Participant Y)
The two key informants shared the same point of view about how work cultures contribute negatively on the participants after attending EAP.
“They drink too much they drink irresponsible they binge drink they explosively they drink nothing in the week but they drink excessively in weekends.” (Key informant 1)
“What they find challenging is maybe Thursday evening, and the weekend you know.” (Key informant 2)
Theme 3: EAP as a vehicle for change
This theme emerged from experiences of all participants after attending the EAP. The participants shared a sense of accomplishment and they also valued the tools they acquired in the program and how it positively changed their lives. EAP changed the participants’ lives. EAP improved their work performance as well as behavior at the workplace. Participants felt empowered after attending the EAP. The different categories expressed how EAP brought about a positive change in the participants’ lives.
Life changing experience
Changes occurred in the participants’ lives after attending the EAP. The positive experiences of the participants at the workplace changed their lives after attending the EAP. The quote below by one of the participants indicates how EAP changed his behavior to an extent that he was able to abide to the rules and respected his superiors.
“I came to work I looked so happy and I was eager to work.” (Participant X)
“Well , they, they taught me to respect. Number one, to respect and that is very important because I never had respect for anybody.” (Participant Y)
“ … because now I respected him at work should he tell me. Look here, you must pick up the paper or take the broom and sweep-I’ll do it.” (Participant Y)
“You learn new skills u learn how to resolve conflicts, he learns to control his anger he learns to put aside his resentment and judgement, he learns to put aside his focus on himself and focus more on other people’s feelings.” (Key informant 1)
Positive changes in interpersonal relationship
The vast improvement of the participant’s interpersonal relationships (IPR) in the workplace increased the effectiveness of their relationships with their colleagues. The two participants expressed their experiences about how much their colleagues could not believe the positive changes in them after attending the EAP. The quote below is extracted from one of the participants who identified positive changes in his boss and himself. He said:
“…It felt good because I see uhm there was a lot of changes in my foreman.” (Participant X)
The two key informants gave their perspectives on the positive changes in IPR after attending the EAP.
“A positive change is the personal relationships back home… another area that shows vast improvement with the girlfriend or boyfriend or the wife or the parent will tell you you know his really I can see his trying, his more friendly, he comes home more regularly, he has dinner with us more regularly.” (Key informant 2)
Reorganization of life and work goals
Participants’ lives have changed at home, at the workplace and with their families. The participants expressed how they used the tools they acquired in the EAP to reorganize their lives. The quote below indicates how one of the participants expressed how much his life has changed and he is a better person now. He said:
“Am 4 years now oooh 4 and 3months without ahhhm drugs now. For that 4years that am now permanent here by the company am married I have now two children; I have my own house am busy studying/starting now through the company.” (Participant Z)
“If I was still on drugs I wouldn’t have had my own house, I wouldn’t have a family because I would have left my girlfriend a long time ago.” (Participant Z)
The quote from the key informant supports the information the participants expressed about re-organization of life and work goals. He said:
“…Another area that that shows vast improvement with the girlfriend or boyfriend or the wife or the parent will tell you you know his really I can see his trying, his more friendly, he comes home more regularly, he has dinner with us more regularly.” (Key informant 1)
Theme 4: Healthy occupations strengthens EAP
The theme explains how engaging in healthy occupations would make a difference in the participant’s lives. Healthy occupations incorporated in the EAP as preventative measures would alleviate poor work performance and unhealthy lifestyles. The participation in healthy occupations such as leisure would improve EAP. Improving money management skills is a skill needed to adapt to life after the completion of an EAP.
Leisure: Meaningful replacement for drugs
Leisure could be used as a tool to eradicate extensive abuse of substance in the workplace by employees. It could improve lifestyles of the employees, as well as alleviate leisure boredom which results in employees abusing substance. Substances replaced leisure exploration. Leisure participation can be a good replacement for substances. When the participants were asked how they would spend their free times, it appeared that the free time they had would be spent on drinking. The quote below illustrates how substance use was used in free time.
“You would like to drink on a Sunday and Monday you can’t stand up for work…” (Participant X)
The key informant expressed how the participants would not make positive decisions because they spent most of their time abusing substances.
“…they don’t make a,a,a, decision to change their whole way of living…, how they spend their leisure time, how they spend their money…” (Key informant 1)
In the following quote the key informant describes how she thinks leisure time fits into the lifestyle of the substance user. She explained that the participants would share there are meaningful hobbies and leisure activities they would like to engage in after attending EAP, but they could not because their time was consumed by the use of substances.
“…there is a specific interest, the person wants to do something and they struggling to get into it again…They always want to do drumming or they were drumming before, uhm or they want to learn again…” (Key informant 2)
The participant recalls how substance use would occupy time. Substance use replaced healthy activities or occupations.
“I did not think of anything else, my free time was alcohol man…(laughs). Uhm. Now I just, I just sit at home, I don’t know what to do.” (Participant Y)
Financial management and its influence on wellbeing
Participants had poor money management skills while abusing substances before participating in the EAP. Inability to manage the finances affected the participants before EAP. One participant indicated that there was no time to manage money because he would take it straight from the ATM and spend it on substances. He said:
“If I have money now but you don’t think if you don’t have a work then you don’t have money to buy drugs… when it comes to the 25th then I wait for the alarm to go off then uhm;… when the phone go off … my money is in the bank. Then I go straight to the ATM from there;… I go to the merchants.” (Participant Z)
The key informant supported this by expressing the events for the workers to use their money even after they had attended EAP. She said:
“October , November but now he may be doing well so here comes 14 December, the factory closes on the 14 ok it’s a lot of money, he has time off, he has money he is in the festive mood, relapse…” (Key informant 1)
“I meant, I’m, I usually say, money is not a problem, it is to use it. but you see it down the drain, if you don’t have something to do with it.” (Participant Y)
OT involvement in work retraining
The participant’s work performance is negatively affected during the time of substance abuse. The key informant expressed that the employers send workers to the EAP to regain their work performance and quality in production, as expected in job descriptions. Therefore, when the employer refers the worker to the EAP there would have been a negative effect on work performance due to substance abuse or illness.
“The first expectation of the employer is that aaam regain your work performance that is because we pay you for a certain output that for you to be here and to finish the product the way you should.” (Key informant 1)
The participants disclosed they would not abide by their work duties and expectations. Those who abused alcohol would not focus and concentrate. They failed to be on time for work. They were in danger in the work area around machines.
“I get at work late, and leave early, and get home very late..a-ah and that’s warning after warning, you see…coz, coz, my work is not done so no profit for company.” (Participant X)
“I’m not actually focused. You See. Which already is dangerous for the machines that is around and I was, that was actually a hazard to the fellow worker next to me because anything can happen or I can just slip and knock against him and he gets hurt. You understand.” (Participant Y)
“oh ja, that machine choked my hand nhe. I was off work for a week, I was danger to myself and other workers.” (Participant Y)
The participants indicated those who abused drugs could concentrate but they would not abide by the work expectations. They would do more jobs than required but with bad quality. He said:
“I will do two; three people’s work but I have overworked myself… But I can’t say that I do it perfectly because orders has been coming in … I’m not sure but there was maybe coming returns in sold stocks and stuff like that.” (Participant Z)
Discussion
Barriers
The workers described how much substances affected their work routines, responsibilities and attention span in the workplace. Work routine disturbance illustrates the shift of description in one’s work environment according to the habits performed during the substance abuse. The participants would not be available at their work stations due to the influence of the substances and or not being present at work resulting in absenteeism. Their work habits were affected negatively. The participants would perform their expected work task in a way that does not meet the standards required in the workplace.
Neglecting work responsibilities described how participants would not pay attention to the responsibilities scheduled in the workplace. They did not care about the expectations in the workplace because their minds were influenced by the substances. Addictive drugs have the ability to strongly activate brain reward mechanisms and chemically altering the normal functioning of these systems can produce an addiction. Drugs reduce a person’s level of consciousness, impairing ability to think or be fully aware of present surroundings within the environment [26].
The category loss of concentration on work related tasks describe the performance of the participants when they are engaging in work tasks, the level of attention and their ability to prolong their focus on the tasks they perform. Loss of concentration on work related tasks was evident as a consequence of substance abuse resulting in loss of the worker role identity. Attention would not be directed to the tasks. The key informant described the quality of the work as that of a person who was not interested in their work tasks.
The category negative influence of the community continues to affect the success of the EAP describes the barriers that employees experienced when resuming their work roles after the program. According to Galizio and Maisto [27] environmental factors that act as triggers to relapse include cultural factors, geographic location, population of the place of residence and general availability of alcohol and drugs. These triggers to abusing substances continue to exist after EAP which indicates there are factors that influence relapsing into the use of substances and those are not always taken into consideration in EAP intervention. The participants expressed they are still surrounded by the same factors that were there before they attended EAP. It could be argued the participants’ choices and behaviour would change as a result of EAP intervention but their environment remains the same, and these environments are characterised by many triggers to relapse. They expressed those triggers and negative environmental factors as the families (or other family members), colleagues, events and memories associated with the time of substance use in their environments. The community barriers were pointed out to be in both home and work environments. The participants described these factors as the challenges they face in their environment after attending EAP. Alcohol and drug addiction have an important effect not only on the individual who is addicted but on the family as well. It has been stated in literature that successfully overcoming addiction to substances requires the collaborative effort of the whole family and all those who are directly affected by the substance, which can be the workplace [28]. One of the biggest setbacks to long term relapse prevention is the temptation to return to old habits once the recovered addict leaves the structured environment of the rehab program and re-enters his old surroundings (the community), in the absence of a solid support system, the former addict will most likely slip back into addiction [29].
The category bad company corrupts good habits describes the participant’s immediate environment and rehabilitation. The environment provides opportunities for performance and presses for certain behavior [30]. According to the participants in the study their colleagues and family members still continued to be a bad influence to the individuals attending the EAP. They become bad company when they try to influence the recovering addict when they either drink or smoke regardless of their awareness that their colleague or family member is a recovering addict. In an article that focused on the return to work process of traumatic brain injured individuals, Soeker, van Rensburg and Travill [31] reinforce the importance of family support during the rehabilitation and work reintegration period. They state a family and work colleagues that are not supportive will negatively influence the return to work potential of the sick or injured individual. The key informants explained that the events like Christmas and weekends are challenging because they would socialise with the negative company they used to have before attending the EAP. Activities such as drinking and smoking would negatively influence the good habits gained from the EAP.
The category workplace culture negatively influences the success of EAP describes the behaviour adopted by the participants and their colleagues in the work environment. The lifestyles and behaviours of others in the workplace would not change. This meant they were expected to participate in all social activities in the workplace which included the use of substances such as smoking and drinking alcohol. The key informants described that within the workplace, employees would bring substances and they would alternate the days on which they would bring specific substance to work in order to ensure they would always have substances available. Colleagues would see this as team-building or social gathering. It promoted a culture of substance abuse within the workplace. The culture of using substances including alcohol would serve as a barrier that prevented the individual from abstaining fromsubstance use [29].
Facilitators
The category life changing experience describes the program as the experience that positively changes the individuals’ life. Participants expressed their new way of understanding stressors and challenges. They explained the changes as different experiences as compared to before they attended the EAP. The key informants explain the participant’s behaviour changes as positive lifestyles. The participants mentioned before attending the program they would not worry about work but after the program they would be eager to work, respect colleagues and those around them in the workplace and be able to resolve conflicts. These are new experiences for them. They changed from the ways they used to live and adopted new positive ways. According to Kielhofner [30] occupation is a result of motivation, patterns, performance capacity factors and environmental influences. Participants were motivated after completion of the program to focus on positive occupations. Even though there were limited positive environmental influences, there were positive experiences that helped to improve their occupational roles.
The category positive changes in interpersonal relationship describe improvement of social relationships within the workplace and the home environment. The participants expressed how the rapport between colleagues, wives, girlfriends and family started to improve after the EAP. The key informants shared that communication would be positive and the workers would have a better way of conducting and organizing themselves in the workplace and home environment. According to the EAP Workgroup (2007) EAP assists in preventing and addressing inappropriate or dangerous behaviours. According to Kielhofner [32] behaviour is dynamic and context dependent. Behaviour changes continuously to meet the demands and opportunities afforded by the context. According to Kielhofner [32] roles influence our interactions with others, the style, manner and content as well as the role related tasks that form daily routines. The participants’ expected roles were workers, husbands, boyfriends, brothers, fathers and colleagues. Their daily lives entailed the use of substances which caused them not to fulfil their roles; therefore, they were unable to commit to the expected tasks in the work and home environments. The changes in their role performance after attending EAP had a positive effect.
The category reorganization of life and work goals describes how one’s goals are organised at work and life in general. The participants clarified this as the way they would adhere to the work requirements and start to plan their behaviours to suit their work goals. According to Kielhofner [32] occupation is the essence of self-organisation. Through everyday doing, people shape who they are. Individual’s daily lives started to be reorganised as new positive goals were developed to shape meaningful occupations of everyday. According to Kirk [33] and McLeod & McLeod [34] an EAP provides improvements in employee absenteeism, productivity, and a positive impact on workers compensation costs. Habits regulate routine actions and behaviour within a role [32]. The interwoven nature of habits and roles is evident in daily life and in turn, routine behaviour is organized. Winson, Martin-Saez, Brentnal & Malley [35] utilised MOHO as a conceptual framework in the work context. They indicated that individuals with brain injury have shown difficulties with motivation. They indicated that these individuals struggle to abide by rules and take responsibilities due to their mental incapacity due to brain injuries and substance use. People with impaired process skills fail to organise their time, and fail to solve problems. It is evident that people who abuse substances have difficulties in paying attention to work roles. They struggle to give output in terms of productivity due to their impaired processingskill.
Occupation based intervention and EAP programs
Forsyth and Keilhofner and Forsyth [36] describe volition as the composition of self-knowledge or common sense, gained through experience from doing which gives motivation for occupations. According to Forsyth and Keilhofner and Forsyth [36] volition covers the components of values, interests and personal causation. Interests describe the perceptions, feelings and emotions associated with pleasure and satisfaction [36]. A person could choose to engage in an occupation that they find satisfying and pleasurable. Substance abuse is a threat to leisure participation as it disrupts the essence and content of leisure exploration, leisure is one of the activities that an individual can choose to engage in. Participation in leisure related activities was seen as a facilitator because it was a meaningful replacement to drugs. The category leisure: meaningful replacement for substances describes how leisure time would be substituted by the use of substances in the participants’ lives during the time of substance abuse. The key informants explained how the workers would not engage in the leisure activities, because they are mainly abusing substances. Their interests most of the time were directed on the particular substance they were taking, it could therefore be argued, that their volition was disturbed. Only after participation in an EAP are they able to recognise and identify the leisure activities they are interested in to enhance their health and wellbeing. Klieber, Nimrod and Hutchinson [37] describes leisure as an activity that is personally meaningful and brings fun during the individual’s free time. It usually initiates a sense of freedom and intrinsic motivation as one would be doing something because they want to rather than have to. According to Klieber, Nimrod and Hutchinson [37] leisure times are divided into social, (where people spend time with friends and family in a socially acceptable manner), creative or expressive (in artistic pursuits), cognitive (would include reading), spiritual (where people meditate and attend religious events) or physical (where people walk, run, garden, and perform sports activities). The participants in the current study expressed that they spent their social times with friends.
The category financial management and its influence on wellbeing describe how the workers handled money and how it affected their wellbeing and use of substances. According to Rosen, Carroll, Stefanovice and Rosenheck [38], money itself can be a relapse trigger to individuals who had used substances. The participants felt their money was spent only on substances. Within the context of the current study, it could be argued that the inclusion of money management skills in rehabilitation programmes could enhance the effectiveness of rehabilitation programmes. They expressed this by stating that they would wait for the money to come in the ATMs and spend on substances without budgeting for other things. The key informant explained this as not having proper financial management but to rather satisfy their craving for alcohol andsubstances.
The category work performance retraining describes the need for individuals in the work place to be retrained. Rosen et al. [38] argues that even though an employee may abuse substances long hours before they get to the workplace, psychomotor skills and judgement are affected by fatigue and hangover that may increase the risk of injuries within the workplace. Therefore, the improvement of the individuals work skills is integral to EAP. When individuals attend EAP, as explained by the key informant, the workers must be able to meet the requirements of the work environment. The key informant explains this as the expectations of the employer, as employees are referred to EAP by the employers when they identify poor work performance. The participants describe their performance in different ways as there are those participants who used alcohol and those who used drugs. The participant that used drugs recalls his work production as being of a poor quality. Even though he would perform with lots of energy and focus, he would not be able to produce the quality of work that was required of him. Whereas the participant who abused alcohol would not focus and concentrate on work, the quality of work would not be good and he could be a danger to the colleague who was working next to him. The workers’ mental capacity would be affected as they would be distracted and not oblige by the expectations of their roles in their work stations. According to Substance Abuse and Mental Services Administration [39], the EAP approach is to take care of the clients’ addiction problems and in doing so the chance of finding employment would increase due to the increased self-esteem and desire to succeed. The Substance Abuse and Mental Services Administration [39], stressed to not only focus on clients’ addiction problem but include vocational services to support substance abusing employees who want to improve self-sufficiency. The Substance Abuse and Mental Services Administration [39] supported vocational services incorporated in treatment programs to serve individuals with substance related problems who must find or maintain employment within a very short time. According to Markos & Sridevi [40], performance of employees need to be improved by addressing human resources because if they are not addressed employees fail to engage in their job requirements.
Implications for occupational therapy and Employee Assistance Programmes
EAP services should include family support services throughout the intervention process in order to help in the creation of a strong support system for the employee which will inevitably minimise the challenges faced when returning to work after an EAP. Occupational therapists could enhance EAP services by providing activity based interventions Engaging clients in leisure activities such as, after work sports programs, or weekend programs helps with the meaningful replacement of substance use after the program. The incorporation of work related tasks will help clients easily adjust to the requirements of their various workplaces. Occupational therapists could enhance EAP services by providing money management as part of a life skills programme and training. Individuals who abuse substances will be able to budget money which will directly improve the role as a worker through an appropriate use of money for the payment of work expenses such as transport, appropriate work related clothing and sustenance. Occupational therapists could enhance EAP services to improve the work performance of clients by using the health promotion approach, work simplification, energy conservation techniques and ergonomic analysis techniques. EAP should involve a multidisciplinary approach to allow for a thorough diagnosis and intervention of the employee’s problems. An EAP would benefit greatly from disciplines including OT, Psychologist, Spiritual leaders (priest). These professionals would provide intervention in meaningful and holistic ways.
Limitations of the study
The limitations of this study was as follows: The researchers had planned to interview at least 6 participants and 1 key informant during the study, however only managed to recruit 3 participants and 2 key informants due to restrictions of different companies and due to company confidentiality laws. This has resulted in the researchers using a small sample size which could have affected depth and range of information obtained. Furthermore the researchers could have used focus group discussions as well as additional face to face interviews in order to enhance the depth of the study.
Conclusion
The aim of the study was to explore the challenges that employees who abuse substances experience when returning to work after the completion of an employee assistance program. This study indicated the following: substance abuse effects the worker role of individuals employed in the open labor market, there are challenges and facilitators experienced by employees who abuse substances when returning to their previous work roles, and occupation based interventions can be incorporated in EAP programs. Employees faced barriers such as poor support systems in the home and work environment after the completion of the EAP, but they also experienced some positive facilitators when returning to work such as the positive behavioral changes that enhanced their work skills. The participants face challenges after the completion of the program. Communities, family and friends continue using substances which acts as a barrier in the workplace. However the positive changes were that the participants were able to reshape their lives. Based on the finding of this study, the researchers recommend using occupational therapy. The occupational therapist using occupation based interventions and looking at the person holistically will strengthen the EAP.
Footnotes
Acknowledgments
This project was supported by the staff and final year Occupational Therapy students namely: Tandokazi Matimba, Last Machingura, Henry Msimango, Bobo Moswaane and Sinazo Tom at the University of the Western Cape, South Africa.