Factors that influence the use and perceptions of employee assistance programs at six worksites

Employee assistance programs (EAPs) have gained significant importance in contemporary worksites. This article uses data from 6 case studies to examine several research questions regarding the relationship between worker demographic (e.g., gender, job tenure, and marital status), substance use, and workplace policies and the actual and potential use of the company EAP. Unlike in most of the existing literature, the authors did not find that gender, marital status, or job dissatisfaction are statistically related to actual or potential EAP use at most worksites. However, job tenure and some substance use behaviors were related to actual EAP use in a positive and statistically significant way. Another important finding, underlying the credible integration of EAPs into worksite culture, is the positive and robust relationship between employee trust and confidence in the EAP and actual use. The results of our study both reinforce some long-established principles in the EAP field and encourage further consideration of other beliefs.

Factors that influence the use and perceptions of employee assistance programs at six worksites

Employee assistance programs (EAPs) have gained significant importance in contemporary worksites. This article uses data from 6 case studies to examine several research questions regarding the relationship between worker demographic (e.g., gender, job tenure, and marital status), substance use, and workplace policies and the actual and potential use of the company EAP. Unlike in most of the existing literature, the authors did not find that gender, marital status, or job dissatisfaction are statistically related to actual or potential EAP use at most worksites. However, job tenure and some substance use behaviors were related to actual EAP use in a positive and statistically significant way. Another important finding, underlying the credible integration of EAPs into worksite culture, is the positive and robust relationship between employee trust and confidence in the EAP and actual use. The results of our study both reinforce some long-established principles in the EAP field and encourage further consideration of other beliefs.

Alcohol: a review of the impact of worksite interventions on health and behavioral outcomes

PURPOSE

To review, evaluate, and summarize research published in scientific journals linking alcohol-related interventions in the worksite to either individual or organizational outcomes.

METHODS

A review of the literature published in peer-review journals between 1970 and 1995 identified 24 articles that reported the results of studies on the impact of worksite programs on alcohol control on health and behavioral outcomes.

IMPORTANT FINDINGS

There is strong suggestive evidence and some conclusive evidence that worksite interventions including core components of employee assistance programs are effective in rehabilitating employees with alcohol problems. There is suggestive and conclusive evidence that worksite training oriented toward alcohol problems affects the attitudes of supervisors and employees for reasonable periods after the completion of training.

CONCLUSIONS

Investment in worksite interventions directed at reducing alcohol-related problems appears to be a sound strategy, although considerably more research is needed. This research should include broad representation of appropriate worksite populations. Similar measurements should be used across studies. To the extent possible, randomized control group designs should be employed. Without significant external sponsorship, it is not likely that such an improved body of research data will emerge.

Subclinical depression and performance at work

The relationship between subclinical depression and the fulfillment of important work roles is the focus of this study. The analysis controls for social processes (i.e., interpersonal stress) that may precede the development of depressive symptomatology and potential depressive distortion associated with self-report of symptoms and performance. Using interview data collected from 265 community-dwelling adults, multiple regression analyses indicated that depressive symptomatology was significantly related to externally rated performance at work. This relationship was independent of other important social influences of interpersonal stress attributed to coworkers, spouses and others, and job stress related to dissatisfying work. Subclinical depression thus appeared related to decrements in job performance. Further, this effect was not entirely due to other social influences not measured in previous studies or to the problem of depressive mood affecting the direction of self-report measures.

Employed women with alcohol problems who seek help from employee assistance programs. Description and comparisons

After a brief description of employee assistance programs (EAP), we present data collected from 6,400 employees from 84 worksites who used the services of EAPs, a portion of whom were assessed by the EAP as having alcohol-related problems and/or received scores on the Alcohol Dependence Scale (ADS) indicative of a potential alcohol-related problem. In addition, data were collected at intake from the EAP administrators, and employment status of the employee clients was assessed 18 to 24 months later. These data indicate that EAPs are effective in sustaining the employment of most women with alcohol-related problems who seek services from EAPs and that EAPs' goal of early intervention is especially realized among women with alcohol problems. Other conclusions include: women with alcohol problems do not enter EAPs through routes that are strikingly different from those of men; many of the gender differences that are revealed are associated with job status differences; employed women with alcohol problems are detached from nuclear families, with markedly low rates of current marriage; even when married, spouses are less likely to play a role in the referral of women with alcohol problems than the spouses of the men; and, there is no clear indication that women are the target of any form of discrimination in the process of EAP utilization. However, women are considerably more likely to have less adequate insurance coverage, according to the EAP administrators' assessment reported at client intake, than their male counterparts, leading to treatment choices that may be less than appropriate.

Alcohol consumption and work performance

This study examines the work performance of 136 males, including both self-reports and reports of workplace collaterals. Comparisons are made on several dimensions of work performance and different levels of alcohol consumption. Different levels of drinking are not associated with scales of self-reported work performance, but relatively heavy drinkers are less frequently absent and late to work than their lighter drinking counterparts. Collateral reports of work performance, however, indicate that heavier drinkers are more likely to score lower on self-direction at work, conflict avoidance at work and interpersonal relations at work. The relationship of alcohol consumption to the technical aspects of work performance is less clear. There is, however, an overall negative relationship between alcohol consumption and technical aspects of work performance as indicated by workplace collateral reports. The implications for the design of workplace intervention programs are considered.

Dealing with alcohol problems in the workplace

The employee assistance program (EAP) is the principal vehicle for intervention in the workplace directed at employees with alcohol problems. As broad-gauged programs, EAPs represent "mainstreaming" of alcohol-problem concerns into health care management. However, alcohol problems are defined broadly within EAPs, going beyond other definitions of alcohol dependence. The historical context is important for understanding EAPs and their dynamics. External environmental changes have impacted EAPs considerably over the past decade. Particularly important have been the increased prominence of employee drug abuse, managed care, and increasing prevalence of dual diagnoses. Results of research about EAPs conducted over the past decade are reviewed. The persistent issue of EAP efficacy is considered, highlighting the variable structure of EAPs and the multiplicity of motives for their voluntary adoption. Prospects for continuing research are considered in light of problems in research funding, the ambiguous identity of EAPs, and the practical orientations of those who might facilitate such research.

Drinking patterns and the gender mix of occupations: evidence from a national survey of American workers

The linkage of the gender mix of occupations to drinking patterns has been suggested by Wilsnack and Wilsnack (1991). Using a national sample of American workers, associations among gender, the gender mix of occupations, occupation, and drinking variables were explored. The results suggest that the relationship between the gender mix of occupations and drinking variables operates through opportunities to drink with coworkers. Gender mix is associated with opportunities to drink with coworkers. Opportunities to drink with coworkers are, in turn, associated with whether respondents drink, who they are with when they drink, average number of drinks per month, and CAGE scores. Gender is associated with opportunities to drink with coworkers, drinks per month, and CAGE scores. Occupation is associated with opportunities to drink with coworkers, drinking patterns, and problem drinking. Further elaboration of the mechanisms linking the gender mix of occupations and drinking patterns is warranted.

Life transitions, work, and alcohol: an overview and preliminary data

The interrelations between age, life transitions, drinking, and work roles are considered. Increased focus of age-related research on employed adults is suggested. The relevance of concepts of age stratification and life transitions is discussed. Data from an ongoing study of the clients of employee assistance programs are presented to demonstrate relationships between age, job characteristics, and drinking problems.

'Enabling' of male problem drinkers in work groups

Theoretical understanding of the effects of groups on the development and the maintenance of adult problem drinking is sparse. Sociological theories predict that adult problem drinkers find support for their behavior among those with similar drinking patterns. By contrast, a widely diffused clinical conceptualization posits that 'significant others' who are not problem drinkers facilitate the maintenance of problem drinking. Several previous lines of research lead to the hypothesis that observed delays in identification and referral of problem drinkers in the workplace may be due to supportive relationships between problem drinkers and their coworkers and supervisors. Data from the 1973-77 Quality of Employment Panel Survey are utilized to provide a longitudinal test of this hypothesis among employed men. Results support the existence of enabling in the workplace. Data comparing 'enabled' and 'non-enabled' problem drinking workers fail to support four possible explanations of enabling.

Synergism in work site adoption of employee assistance programs and health promotion activities

As workplaces increasingly adopt proactive programs directed toward employee health issues, the interrelation between different programs becomes an important issue. Of interest here is the "synergy" in patterns of program adoption between employee assistance programs (EAPs) and health promotion activities (HPAs). We utilize the 1985 National Survey of Worksite Health Promotion Activities (N = 1358) for analyses of the dual presence of EAPs and HPAs, and in multivariate analyses we consider factors affecting such dual presence. The data suggest that synergy occurs, with EAP adoption appearing to influence HPA adoption to a greater extent than the reverse. In multivariate analyses, synergy is confirmed by the finding that, among a variety of relevant organizational characteristics, EAP presence and HPA presence are the best predictors of each other's presence. The analyses also indicate that there is minimal commonality in program ingredients across organizations reporting the presence of HPAs. Implications of the data for the future development of these two programming strategies are discussed.

Public images of alcoholism: data from a Georgia survey

Attitudes toward alcoholism among a representative sample of 524 adults in Georgia indicate acceptance of the disease concept remains incomplete. Despite expected regional differences, results from bivariate analyses are consistent with previous research conducted in other areas of the U.S. The Georgia data indicate similar levels of acceptance of the disease concept of alcoholism, similar demographic correlates with that acceptance and similar treatment recommendations for alcoholism. Attitudes toward alcoholism are found to be significantly correlated with views concerning cocaine dependence, but the acceptance of the disease concept of alcoholism is significantly greater. The multivariate discriminant analysis reveals that education and income are the most significant discriminators between the medical and moral/medical images of alcoholism, followed by religion, age and race.

Growth and transformation in workplace alcoholism programming

The origins of contemporary workplace programs to provide constructive assistance to employees with alcohol problems are described. The transformation from industrial alcoholism programming to employee assistance programming is delineated in terms of a seven-component "core technology." The high degree of reported success of these programs is described with general findings from a survey of 480 private-company sites. Increasing rates of self-referral for assistance with alcohol problems are described in terms of factors facilitating such referrals. Basic research knowledge is summarized, together with a projection of new studies considered to be critical for maximizing the effectiveness of alcoholism intervention as it relates to workplace programs. Throughout the chapter the large-scale impact of workplace programming is emphasized, with an urgency for greater attention to be paid to these activities by the alcohol problem research community.

Biological features of women's alcohol use: a review

Sensitivity to gender issues in the research community has generated a modest but growing amount of data on the biological effects of alcohol consumption on women. Data generally indicate that the same amounts of alcohol have greater effects on women and that women develop more severe alcohol problems than men over shorter drinking histories. Despite a number of studies, however, there are no clear differences between women and men in the impact of alcohol consumption on cognitive processes. Although the findings are mixed, the data point toward greater physiological deterioration among women as compared with men who have similar drinking histories. These differences may be related to the differences in patterns of social recognition and reaction that occur in instances of alcoholism among women. Such differences are confirmed by other data that indicate greater social isolation and general disorganization among female alcoholics than among male alcoholics. The risks of fetal alcohol syndrome that are associated with heavy alcohol consumption among women during pregnancy have been established, and a complex of other relationships between alcohol consumption and reproductive-related systems and behaviors exists. Linkages between sexual dysfunction, sexual satisfaction, and alcohol consumption appear to exist, but have not yet become clearly understood. It appears that alcohol may be used as a self-medication to cope with perceived problems of sexuality. It also appears that heavy alcohol consumption can contribute to sexual dysfunction and dissatisfaction. A growing body of sophisticated experimental research has established relationships between patterns of alcohol metabolism and phases of the menstrual cycle, with this literature offering some of the clearest indications of distinctive differences between the sexes in the biological consequences and correlates of alcohol consumption.

Formal intervention in employee health: comparisons of the nature and structure of employee assistance programs and health promotion programs

Health promotion programs (HPP) and employee assistance programs (EAP) are compared in terms of their structure and process. Two common themes are extracted: a belief that both are beneficial to both employers and employees, and a sense of 'mission'. The technology of HPP and EAP are examined and compared. EAPs' stimulation from Federal funding is contrasted with the more indigenous roots of HPPs. Examination of empirical data comparing organizations with EAPs which have and have not adopted HPPs indicate the former tend to be somewhat more 'caring' toward employees. An examination of program ingredients indicates much greater commonality of structural and processual ingredients within EAPs as compared to HPPs. The extent to which each program type has become more 'populist' in orientation and the implications of these changes for program technology are considered. Finally the paper describes differences in program evaluation stemming from target group definitions in the two types of programs.

Ethics in worksite health programming: who is served?

As relatively new innovations in the workplace, employee assistance and wellness/health promotion programs have not yet established clear identities. Thus ethical practices have not been fully considered or discussed. Based on extensive research experience with employee assistance programs, ethical issues are considered at three levels. Of primary concern are ethical issues affecting the individual employee, of which the scope of perceived or expected service relationships between employees and EAP coordinators is critical. There are tendencies to transfer models of community or private practice to the worksite, but the relationships both prescribed and implied at the worksite require that a different pattern of clinical relationships obtain. At the organizational level, it is critical for the worksite practitioners to be conscious of their authority in translating scientific data into recommended practices at the worksite and in transforming equivocal data and health practices into organizational norms. Finally, at the level of interorganizational relationships the worksite health program practitioner needs to be aware of the risks of becoming drawn into overly intimate relationships with external organizations who may come to benefit by special treatment that such relationships generate.

Effects of supervisory style and experientially based frames of reference on organizational alcoholism programs

Theoretical works concerning the influence of personal characteristics of work supervisors on their referral of subordinates to organizational alcoholism programs are reviewed. These works hypothesize two barriers to such referrals: supervisory style and experientially based frames of reference. The effects of these behavioral and attitudinal characteristics on supervisors' perceptions of subordinates' work readjustment are analyzed with a sample of 84 supervisors who had utilized the Federal Employee Alcoholism Policy (FEAP). Zero-order hypothesis tests illustrated that supervisory style, operationalized by the Least Preferred Co-worker Measure, was inversely related to perceived readjustment. Hence interpersonally oriented and more cognitively complex supervisors were less likely to perceive improvement. Experientially based frames of reference were operationalized by the Attitude toward the Recovering Alcoholic Scale and the Attitudes toward FEAP Scale. Only the latter was a significant influence, with high policy evaluation being positively associated with perceived readjustment. Multivariate analysis illustrated a significant main effect only for attitudes toward the alcoholism policy. These findings are discussed in terms of a need to reappraise the influence of supervisory style on referral to organizational alcoholism programs and the potential positive effects of organizational engineering on the success of such programs.