A Culture of Health

I spent the day today at the Northern Illinois Employee Assistance Professionals Association annual conference. There were some excellent presentations and the opportunity to network with a great many EAP and treatment professionals.

The keynote speakers, Rich Paul from Empathia Inc. (Formerly NEAS) and John Burke from Value Options, spoke about “creating a culture of health in the workplace.” As companies (and our nation) struggle with the uncertainty of our ability to contain healthcare costs, employee assistance programs can be leaders in helping employees and their families to develop healthy attitudes and healthy behaviors. The close connections between physical health, emotional well-being, and healthy behaviors provide us with an opportunity to help American workers practice self-care and focus on health instead of disease. One example they gave was asking members of an employer health plan to meet with the EAP before deciding to have bariatric surgery (such as gastric bypass). The actual number of procedures performed declined significantly when patients were given the opportunity to discuss and explore options and self-care strategies before deciding on a surgical procedure that can have many risks and complications (and can, in itself, often require dramatic lifestyle modifications). Other health-related issues and behaviors for which EAP’s can assist employees and family members include exercise, stress management, smoking, alcohol use, and improving relationships. Most EAP’s now include financial counseling, elder care assistance, and legal consultation. All of those needs can impact worker’s job performance and attendance if families are left to handle them without help.

Two of the afternoon speakers, Eric Gopelrud, PhD, and Tracy McPherson, Phd, of George Washington University’s Center for Integrated Behavioral Health Policy, described their efforts to foster wide use of a screening, brief intervention, and referral process to enhance the ability of EAP’s to identify and assist individuals with high-risk drinking behaviors. Only about one percent of employees and family members are typically identified as having alcohol problems by EAP’s and provided with services, despite many years of effort by EAP’s to carefully assess clients for the presence of substance abuse. Part of the problem has been that about 25% of clients may have patterns of drinking that are not clearly indicative of addiction or dependence, but may nonetheless lead to risks. These risks may include the worsening of other medical problems (such as sleep difficulties, diabetes, and high blood pressure) and the aggravation of depression and other emotional difficulties. Risks of accidents and missed work are also common even in workers who cannot clearly be considered as “alcoholics.”

The National Institutes on Alcohol Abuse and Alcoholism have supported efforts to increase awareness of “risky” drinking, which is defined (for men) as regularly having more than two drinks in a day, 14 drinks in a week, or five drinks in one sitting. (For women, the numbers are lower: one drink a day, seven drinks a week, or four drinks in a sitting). NIAAA has a highly informative website, www.rethinkingdrinking.niaaa.nih.gov, which contains many helpful guides to keeping one’s drinking safe and sensible. Obviously, for anyone who has quit drinking due to problems with alcohol, or who is physically dependent on alcohol, cutting back to “safe” levels is not possible. Abstinence is the only safe plan for those individuals. But the NIAAA’s recommendations on moderate drinking, along with the initiative to have EAP’s screen individuals and give non-judgmental advice on minimizing health risks from drinking, is a welcome development that differs somewhat from the older approach in which EAP’s (and treatment providers) operated on an “either-or” basis, trying to identify who was alcoholic and to get (only) those clients into treatment.

All this talk of developing a “culture of health” was brought into focus when I noticed how network TV seems to be filled with commercials urging people to ask their doctors about various prescription medications as part of “taking care of themselves.” These expensive medications, with their disturbing lists of side effects and risks, hardly seem to me to represent a culture of health. The idea that there’s a pill that will help you to lead a longer and healthier life is a relatively new development in our culture, and my concern is that it reflects the needs of the pharmaceutical industry more than the needs of people who want to live healthier lives. Of course, there are conditions for which medication is clearly indicated and needed. I am on medication for high blood pressure and expect to remain on it indefinitely. But the ads, for some of the cholesterol and arthritis medications especially, seem to raise questions about their benefits and risks, especially when the warnings say, for example, that raising “good cholesterol” may not be associated with any longer life span or reduction in heart attacks or strokes.

The costs of prescription medications, moreover, seem to be one of the factors that have been creating alarm as we contemplate the future of health care in America. Would so many prescriptions for sleep medications be written if doctors asked each patient about their alcohol use and provided non-judgmental counseling about the possible effects to alcohol on sleep patterns? It makes me wonder. But I think that employee assistance professionals may have an important role to play if they can lead the effort to help people adopt a true culture of health and wellness.

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