Helping an Alcoholic Employee in Recovery
If you are an employee assistance professional, counselor, or other provider, the following model is one approach to supporting an employee after treatment or at some point during outpatient treatment for addictive disease. It's an approach that I have seen work very well because it is simple, places responsibility for managing the disease on the employee, yet offers many opportunities for early detection of behaviors that often lead to relapse.
You may be able to suggest additional elements of a follow-up system. I would love to have them. I will consider posting them on the EAP blog if you send them along.
This approach is designed to both intervene with known contributors to relapse and identify decreasing involvement with a recovery program, which is the leading contributing factor to relapse.
The prevention of relapse has significant implications for reducing many types of risk to the organization.
Obviously, only a "high touch" EAP or similar program operating under confidentiality provisions is capable of delivering this level of behavioral risk management and customer service to the host employer, so knowing how to do it and being able to argue its value can be helpful to your program's sustainability.
I suggest using a chart, graph, or checklist to visually assist your client/patient tracking the recovery program. A useful tool for this purpose is a tip sheet you will find at WorkExcel.com: Follow-up Sheet for Monitoring Recovering Clients
I believe it is essential to meet once per week post-treatment for a determined length of time to assist the recovering employee and tapering off these meetings over time depending on what other supportive elements are in play with the recovery program. For awhile however, in each meeting, consider discussing the following issues.
Ask about Abstinence
Is the employee completely and continuously abstinent from alcohol and cross-tolerant, cross-addictive drugs? Abstinence must include no consumption of beverage alcohol products (including things like "alcohol-free beer", etc.) medicinal products with ethanol or other mood altering substances.
Mention Last EAP/Follow-up Contact Date
(If recurring, discuss missed or broken follow up appointments and implication for relapse)
12-Step Meetings Per Week
Note the number of meetings the employee is attending per week. Note, as time goes by, any diminishing involvement in the number and quality of meetings. This is perhaps the key factor to measure in the follow-up process. Nearly all relapses are associated with this issue, and the idea is spot the trend and intervene.
Motivating the employee to maintain meeting involvement is easier before a drink is taken and easier when the number of meetings has dropped from five meetings to four, or from four to three. If the number of meetings is lower than that recommended by the treatment program or in a discharge summary, this is a critical situation.
Home Group
Does the employee have a home group? A home group provides the employee with an anchor to AA and an opportunity to establish closer relationships with those in recovery. Without a home group employees usually fail to "attach" themselves to a recovering community that can mentor them.
Does the Employee have a Sponsor Now?
Does employee have a sponsor? Switching sponsors typically indicates problems with following sponsor recommendations, particularly if the number of meetings drops below three. Many will drop a sponsored new member in AA who does not follow recommendations because the sobriety of the AA sponsor is threatened by "chasing" or hounding a new member and, of course, doing so is enabling. This is referred to as "firing the pigeon.”
Number of Sponsors?
Some employees have more than one sponsor initially. These different sponsors may play different roles in supporting the employee or new member of AA because of their ability to more closely identify with personal issues affecting the employee.
Days Since Last Spoke with Sponsor
Frequency of contact with sponsor is an indicator of the quality of the relationship and the likelihood of the relationship helping the employee be successful in a 12-step program.
Sponsor Add/Drops
Number of add and drops and the time between relationships should be examined. Frequent switching is problematic. Sometimes employees will postpone asking for a sponsor or say they cannot find one. Temporary sponsors can usually be readily be obtained at AA meetings, and often the leader of a meeting will ask if anyone attending needs a temporary sponsor. A protracted period without a sponsor is a red flag to address.
What AA Step Working Now?
What step in AA is the employee working on? More importantly, what information can the employee provide about progress on Steps. This can provide an indication of the quality of the step work and investment in a 12-step program.
12-Step Volunteer Activities
Is the employee helping with 12-step volunteer activities? Setting up coffee pots, etc. These activities also increase engagement are generally positive indicators. Sponsors may request those who they sponsor to get involved in these sorts of activity that increase engagement with the 12-step program.
Family Member in a 12-Step Program (Alanon?)
Family involvement is a possible measure of a more secure recovery program. Is the family member -- the spouse in particular -- participating in his or her own recovery? Has the spouse dropped out? Participation or non-participation does not detract from the employee’s responsibility for his/her recovery program, but it can be provocative or lead to renewed conflict unhelpful to the stability of the recovery program.
Antabuse/Naltrexone Use?
Was employee using Antabuse upon discharge? How long did this last before it stopped? How many meetings are now being attended? Are there fewer meetings coinciding with the stopped Antabuse. The use of Antabuse is philosophical issue for some treatment programs. Some strongly encourage its use. Others do not. Its discontinuance may or may not indicate an anticipated plan to drink alcohol again soon. Always discuss the role of Antabuse in the recovery program if it being used.
Resource: Follow-up Sheet for Monitoring Recovering Clients
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