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The stigma of substance use is hurting employees — and the businesses they work for



American workers are silently screaming.

Nearly half of the U.S. workforce—roughly 72 million people—have experienced personal or family problems stemming from substance or alcohol use based on new research from Pelago Health.

Exhibit A: According to the Pelago 2023 Annual Substance Use Management Survey, 24% of workers have experienced personal concerns with substances or alcohol. Some 37% reported having such problems with family members. 

This is a problem that crosses all workforce demographic lines such as job titles and levels. And yet: Less than half of workers (38%) who report a personal problem with substances or alcohol have asked their employer for assistance, showing how feelings of shame and fear can deeply impact people grappling with substance use.

The result? Concerned that candid conversations around substance use might negatively affect their careers or relationships, many employees avoid seeking help from their employers. This despite a consensus that organizations are in the best position to provide meaningful aid to their workers.

But employers themselves often don’t recognize the power they hold to mitigate the impact of those negative feelings, despite clear evidence that substance and alcohol use contribute to missed days of work and other drains on productivity. To wit: In our survey, roughly half (49%) of those experiencing personal problems with substances or alcohol report missing work because of these issues.

In fact, U.S. employers incur an average of $15,640 in annual costs per employee struggling with a substance use disorder (SUD), not only through increased healthcare spending, but in missed time and lost productivity, too, according to new CDC data. Employees in recovery miss 13.7 fewer work days annually than those who do not receive treatment.

With this stark reality in mind, here’s what employers should know—and do—in regard to substance use stigma:

1. Negative feelings have real-world effects on recovery. When people feel shame around a substance use disorder (SUD), they’re less likely to seek help. Some worry that they’ll be blamed for their addictions, others that they’ll be told to quit using substances cold turkey. These feelings lower the likelihood of accessing effective treatment and achieving recovery. And that effect reverberates beyond the individual struggling to impact their employer. 

2. Such reticence also impacts family members—and their job performance. For the 37% of workers whose family members struggle with substance or alcohol use, the fallout is real: Caring for their loved ones often means lower productivity and higher absenteeism at work. 

These caregivers might be disinclined to explain that their lateness or poor performance stems from their family members’ SUD. That fear of being judged prevents frank and fruitful communication between employers and employees.

3. Stigma results in less awareness of solutions. Hesitation to discuss substance use issues perpetuates lack of awareness of possible solutions: 25% of respondents to Pelago’s survey believed there were no effective medications for addiction, while 39% believed rehab is the only way for people to recover from addiction. 

That so many Americans are unaware of treatment options is unconscionable. To address pressing substance use issues, we need more information and conversation and less ignorance, shame and secrecy.

4. Patterns of stigma can be curtailed in the workplace. There are ways to limit the SUD-related shame that employees experience, which will help them on the road to recovery. 

Organizational leaders can begin by understanding their population: How does substance use impact employees? Listen with an open mind. Foster a culture in which historically acceptable terms such as “drug addict” or “drunk” are now recognized as hurtful and are avoided. 

Try to facilitate a mindset shift within the organization: Normalize SUD by talking about them the way any other medical condition is discussed. Have leaders model that openness by sharing their personal or familial addiction stories at lectures or lunch n’ learns.

5. Addressing substance use issues is good business. Among the most compelling data points from Pelago’s recent survey was this: Two in three workers believe employer support for substance and alcohol problems is important, but only one in six employers offer support or treatment for those issues.

In other words: There’s a huge gap between the need and desire for substance use treatment and the assistance actually being provided by employers. In the current economic climate, benefits that produce significant ROI should not be overlooked. Substance use programs can be highly cost-effective and offer strong returns in terms of reduced direct costs, increased productivity (e.g., fewer sick days and accidents) and improved retention (e.g., stronger employee engagement).

Simply put, addressing substance use is not just the right thing to do, but also the smart thing to do.

Source: Pelago 2023 Annual Substance Use Management Survey

Pelago is the world’s leading virtual clinic for substance use management. We are transforming substance use support—from prevention to treatment—delivering education, management skills and opportunities for positive change to members struggling with substance use, most commonly tobacco, alcohol, or opioids. Visit for more information. 

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