Employee Assistance Program

Employee assistance programs (EAPs) are among several policy-based activities that address alcohol and drug abuse in the workplace. At present, EAPs are singular in that they are designed to provide constructive assistance to personnel with such problems and also to encourage job retention rather than detection and punishment as is the case with other policies.

The basic form of EAPs emerged from industrial alcoholism programs, the latter dating back to the early [Page 359]1940s. Industrial alcoholism programs endeavored to introduce employees with alcohol dependence to Alcoholics Anonymous (AA). Company employees who had become affiliated with AA outside their employment were often instrumental in initiating or staffing these programs. Nearly all of these early programs were based in company medical departments and supervised by company physicians.

Upon the founding of the National Institute on Alcohol Abuse and Alcoholism in 1970, the workplace became a key target for its sponsored intervention projects and for some of its funded research. During the 1970s, the industrial alcoholism model was transformed to a broader-based EAP model, a change that eventually led to EAPs' diffusing widely in the United States and being adopted internationally. While the focus of EAPs on many workplace problems has increased their attractiveness, it has at the same time deflected many of them from devoting adequate resources to address workplace substance abuse problems. Nonetheless, their identity with substance abuse intervention remains significant.

Within a workplace, an EAP should have two main components: (1) access to qualified personnel who can implement the specific techniques of EAP intervention (i.e., identification, intervention, motivation, referral, and follow-up) and (2) written policies and procedures whereby the core techniques of EAP work are integrated with the workplace such that employees and supervisors will utilize program services when appropriate.

Such service provision varies considerably. In most worksites, access to assistance is provided by an external contracted organization. Such contracts vary greatly in their scope of services and in the managerial control that the contracting worksite exercises over the provider. In other, but increasingly rare instances, fully staffed EAP units are incorporated into the worksite's human resource management or medical function.

EAPs are found in nearly 60% of American workplaces, with their presence directly correlated with workplace size. Thus, on a nationwide basis, EAPs offer a clear potential for addressing employee substance abuse problems. This is, however, a potential that may not be achieved without a concerted effort to overcome the natural barriers to managing substance abuse when there are abundant opportunities to focus attention elsewhere.

Identification and referral to an EAP can occur through supervisory documentation of deteriorated job performance or through self-referral. Evidence from many sources indicates that self-referrals dominate caseloads, accounting for up to 90% of those who use EAP services. After entry into the program, it is the task of the designated EAP coordinator to identify the nature of the presenting problem or to send the individual to a qualified diagnostic facility. The coordinator needs to perform basic screening, for it is critical to determine whether (a) the employee's per-formance difficulties reflect an underlying behavior problem (such as substance abuse) that fits or approximates a diagnostic category, (b) the performance difficulties are an outcome of a poor fit between abilities and job demands, or (c) the referral is a consequence of underlying interpersonal conflicts or work-group politics. Thus, along with clinical expertise, workplace familiarity and knowledge of organizational behavior are critical for the effective performance of EAP coordinator roles.

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