It can be daunting to try to hold down a job while struggling with mental illness or drug addiction, as I know from experience.
A few years back, when my abuser re-entered my life for a few months, I started a part-time telesales job for a ballet company, similar to work I had done in the past. I had a supportive boss, but found the behaviors and comments of some co-workers—and one in particular—triggering. Eventually, even the thought of going to work saw my PTSD symptoms return. After a month or so, I decided to leave the position (with an invitation from that supportive boss to return later if I felt able).
Even people who are in remission may experience obstacles that interfere with their work performance. But that’s not because people with behavioral health conditions can’t be brilliant, competent or productive employees. Rather, conventional work environments are not conducive to health and healing.
We all know stories about the cruel boss who overburdens her employees with no regard to their mental or physical well-being. While the average employer is not intentionally vicious, corporate demands and unrealistic expectations can be harmful to anyone. This is particularly true for people dealing with behavioral health issues. But there are some simple steps employers can and should take—for their employees’ benefit and their own.
“The Americans with Disabilities Act requires employers to treat everybody with a disability individually and not based on assumptions.”
From a legal standpoint, employers are obligated to make certain accommodations for employees who disclose having a disability. Not all behavioral health conditions meet disability status, but many do. Substance use disorders in particular are recognized to impair one or more life functions—the American Psychiatric Association’s Diagnostic and Statistical Manual defines them in this way—thus meeting legal criteria to be recognized as a disability.
“The Americans with Disabilities Act [ADA] requires employers to treat everybody with a disability individually and not based on assumptions and conclusions about people who have that disability,” Sally Friedman, vice president of legal advocacy at Legal Action Center, told Filter.
One common issue voiced by people engaged in medication-based recovery from opioid use disorder (OUD) is fear that they will be denied or lose employment should their medication be detected in a drug test.
But the ADA “means an employer can’t auto-disqualify someone from a job because they have opioid use disorder that they treat with methadone or buprenorphine or any other medication,” said Friedman. Employers have specific legal obligations for employees in addiction recovery, or with mental illnesses that meet disability criteria.
One caveat is that employees must disclose their medication before it is discovered through a drug test or other means—employers can terminate for “dishonesty.” Friedman also noted that most calls she receives related to employment discrimination are based on being terminated or denied employment because of prescribed medication—indicating that some employers are ignoring the law.
It’s a good idea for hiring managers to learn some basic facts about methadone and buprenorphine.
Methadone and buprenorphine programs are becoming increasingly available to people with OUD. This is a good thing. But many people still hold the belief that these medications have intoxicating qualities that impair patients from performing labor-intensive or complex job functions. So it’s a good idea for hiring managers to learn some basic facts.
For example, methadone and buprenorphine are proven to be the most effective treatments for OUD, helping to cut down chaotic drug use, overdose fatalities, and the transmission of diseases like hepatitis C and HIV. And patients who are stabilized on a therapeutic dose won’t experience excessive drowsiness or impairment.
People engaged in medication-based therapy for OUD often have particular scheduling needs. In the United States, methadone programs require patients to come into the facility each morning to dose on the premises. Patients can slowly earn “take-home” doses if they adhere to the facility rules, which are often abstinence-based. Some clinics require patients with take-home doses to occasionally return to the clinic at random times for bottle-checks, which is one way clinics ensure patients are taking their doses as prescribed. Some buprenorphine programs have similar protocols.
The rigidity of these programs can be problematic for patients who wish to hold down conventional jobs, and the distrust expressed by these policies can lead to feelings of shame and low self-esteem. As an employer, you can’t cure the treatment system and its side effects, but you can help employees feel appreciated by allowing them to adjust their schedule to accommodate dosing, and granting them the ability to attend bottle-checks without penalty.
Blanket policies denying employment to people who use these medications are a violation of federal law—and beyond any legal consequences, will end up costing you skilled employees. If you’re an employer, it is your duty to evaluate current or prospective employees individually, based on their actual work performance—not on your opinion of their medication.
Beyond not excluding someone for taking methadone or buprenorphine, what else are employers required to do?
“Anybody with a disability is entitled to reasonable accommodations in the workplace… unless it’s what they call an ‘undue burden,’” said Friedman. Employers are not obligated to integrate such policies into their regular protocols, but if an employee discloses a disability and requests a reasonable accommodation, employers are obligated to provide it.
For example, employers don’t have to automatically offer employees the option to work from home. But, as Friedman observed with one of her clients, if someone has a disability that makes working in the office every day difficult, and their duties can be accomplished from home, they can request a reasonable accommodation that allows them to complete some shifts remotely.
“We have a client this year who had a mental health-related disability,” she said. “He found that the stress of the workplace like the noise and hubbub aggravated his mental illness. His accommodation was to work at home more so he didn’t have to be in the office environment.”
Similarly, if an employee needs to start a shift half an hour later than scheduled in order to pick up a methadone dose or attend a mental health appointment, and that half hour does not significantly disrupt general workplace functionality, the employer is required to make such an allowance.
If the nature of the job requires on-site work, however—for example, face-to-face sales at a ticketing counter—such an accommodation would not be considered reasonable and would not be required.
Conscientious employers should note that just because something isn’t legally mandated, that doesn’t mean it isn’t advisable.
Essentially, if a requested accommodation significantly disrupts an organization’s functionality or costs more than a company can reasonably afford, the company can seek an alternative accommodation. If one doesn’t exist, the employee may ultimately have to leave the position.
Conscientious employers should note that just because something isn’t legally mandated, that doesn’t mean it isn’t advisable. Although it’s impossible to predict every issue that might arise due to an employee’s behavioral health condition or other disability, there are some measures employers can take to be as open and accommodating as possible from the start.
One of the issues with ADA accommodations is that in order to access them, employees have to disclose their disability. This can be difficult for some people, especially those who have been stigmatized and shamed for their conditions in the past. So employers might wish to integrate flexible timing, for example, into their general policies, allowing all employees to access reasonable accommodations without having to explain themselves or disclose their diagnoses.
One of the smartest ways employers can help employees feel welcome is by forgoing workplace drug testing. Other than in a few specialized situations, such as for airline pilots, it is an unnecessary invasion of privacy that erodes trust.
Although years of misleading public messaging have culturally embedded the idea that drug use indicates poor work performance or general bad character, this is simply not true. The majority of people who use drugs do so responsibly, and for recreational purposes. Many people who use illegal drugs perform better in the workplace than many people who don’t. The practice of drug testing employees focuses on personal substance use when work performance should be the only criterion.
Even people with a substance use disorder—characterized by compulsive drug use despite serious negative consequences—can attain remission while still using some substances. Recovery often does not mean abstinence. For some, substances may even enhance their work performance compared to abstinence, for example by helping them mitigate symptoms of trauma or another mental illness.
Deciding not to drug test employees will signal that you care about the people you hire.
Although self-medicating is certainly not the recommended course of treatment for a behavioral health condition, barriers to general and mental healthcare mean it is sometimes the only way a person has to cope. Losing a job based solely on that substance use will only cause further harm, trauma and vulnerability.
If you’re an employer, deciding not to drug test employees will signal that you care about the people you hire. It makes clear that a person’s home life and personal choices will not be used against them in a workplace setting. Their only obligation to you is to work effectively.
This may not be possible for some government jobs, which are mandated to perform workplace drug testing. In these instances, it is still helpful to directly inform current and prospective employees that they will not be judged or discriminated against for the use of prescribed opioid-based medications (or any others). It’s also important to recognize that urine or mouth swab tests, which provide instant results, are prone to false positives. Partnering with a lab is a good idea, so that confirmation tests can be performed when an employee disputes the results.
If you suspect that an employee is struggling with an active addiction or mental illness, the compassionate and efficient course of action is to offer them a private conference and let them know you will support their recovery. This could mean offering leave so that they can attend an inpatient program, or making adjustments to their schedule to accommodate an outpatient program.
People living with mental illness and addiction are sometimes more sensitive than average to workplace stress. With this in mind, it can be helpful to provide structured work shifts, and to consistently offer two or more consecutive days off. While this is typically built into office-based jobs, restaurant and other service positions often have varying schedules with split days off. In these cases, offering employees in recovery stable schedules with consecutive days off can reduce stress and allow them to thrive in the workplace, in turn benefiting the employer.
Everyone wants to feel respected and valued, and it’s important for employees to know that they are safe to be themselves without shame.
“She made my life better for the years I was working for her.”
Sheila, a working mom from New Jersey who asked that only her first name be used, described a particularly encouraging boss she once worked with. She lives with bipolar disorder, and sometimes struggles with poor impulse-control. She recalls sometimes sending emails that bordered on paranoia.
Instead of judging her, this boss would help her work through the workplace issues, and did not penalize or shame her. She says this boss also helped her find positions within the company that were a better fit, helping to maximize her strengths. She was a valued employee for six years, until she moved to another state—which she says is the longest she has held a job.
“She really helped it be the best job I had and some of the best years of my life because she helped me keep a job for that long of a time, so much longer than any other company,” she said. “She made my life better for the years I was working for her.”
Employers can have a huge impact on the quality of life for people living with behavioral health conditions. By recognizing the general and individual needs of people living with addiction or mental illness, employers can reduce the stigma associated with these conditions, help their employees thrive, and in return gain some truly brilliant employees who are able to bring their best selves to work.