Work and Well-Being: A Guide for Professionals This document was prepared by The Central East Addiction Technology Transfer Center (Central East) and managed by the Danya Institute. The contents of this publication are solely the responsibility of the authors and do not necessarily reflect the official views of the U.S. Department of Health and Human Services, the Substance Abuse and Mental Health Services Administration, or the Center for Substance Abuse Treatment.

Program Director: Renata Henry, MEd

Editor: Stephen Reese, MS, MPA

Author: Chad Morris, PhD Behavioral Health & Wellness Program University of Colorado School of

Published May 2017

Acknowledgments: The Central East ATTC would like to thank the authors and advisory committee who created the first version of this guide, particularly Aaron Williams, Paula Jones, Thomas Durham, and Glenda Clare.

Introduction Section 1 Table of Contents

Introduction: Why is a Work and Well-Being

Guide for Addiction Professionals Needed? 4 Section 2

Section 1: Common Workplace Stressors 5

Section 2: How Agencies Support Well-Being 7 Section 3 Section 3: Self-Care Strategies 20

Appendix 44 Appendix

Work and Well-Being: A Guide for Addiction Professionals 3 generate more stress for the remaining staff and turnover rates (McLellan etal.,2003).Thiscan staff high extremely to lead can factors, other fatigue” (Figley,among 1985).Andburnout, to as“empathy exhaustion” or“compassion secondary stress disorder commonly referred well-being, weare at risk for “burnout” or a when wefailtopayattention to ourown Rand, 2006). Given theintensity of ourwork, also beadrainonourempathy (Rothschild & time, highrelapseOver ratesclients can among sheer numberof peopleweare tryingtotreat. or bythe by clients’needs overwhelmed get housing, andemploymentissues.Itiseasyto addiction as welltheir medical, legal,family, problems. We workwith our clients around their their recovery, we are dealingwith complex emotionally demanding.Asweassistothersin Our workcanbephysically, mentally, and for thebetter. We often evenhelpsavelives. the livesofopportunity tochange ourclients hard. It can also beveryrewarding. We havean The workof anaddictionprofessional canbe Why isa Work & Well-Being for Guide AddictionProfessionals Needed? Introduction it isessentialthat agencyleadershippromotes work, at effectiveness our maximize and lives Shanafelt etal.,2010).If weare to leadbalanced quality care toclients(Shanafelt etal.,2003; happier andhealthier, butalsoprovide higher not onlyreporttheir ownwellnessneeds being that healthcare professionals whostrivetomeet take care of ourpersonalwell-being.We know To break this cycle, weallhavearesponsibility to and frequently onboarding newemployees. the agencyasawholeduetohighercaseloads their ownwell-being. as provide guidance toemployeesonenhancing to create supportivework environments aswell professional lives. It is intended to assist agencies promotehealthy lifestyles andproductive evidenced- offers based, practical strategies andresources to guide This professionals. this developed self-care guidefor addiction Technology Transfer Center(Central East) has towards thisendthat theCentralEastAddiction and employeesneedtoworktogether. Itis To create ahealthyworkplace, agencies advantage ofwellnessopportunities. takes and for advocates staff that and wellness, insight andawareness, direct your focus, worksheets inthis guidethat designed time to complete these activities. The This icondesignates activities and information you gaincanprovide to supportyour well-being. Take Work andWell-Being: AGuide for AddictionProfessionals and guideyour actions.

4 Appendix Section 3 Section 2 Section 1 Introduction are strugglingwith addiction in much the same addiction counselors workwith people who those inrecovery at riskof relapse.Every day, insight andempathy. However, itcanalsoput perspective canresult in unique andvaluable Abuse Treatment [CSAT], 2006).Thispersonal their own recovery (Center for Substance with atofhalf least addictioncounselorsin as aresult of their own experience with addiction, field the to come professionals addiction Many ofRecovery Personal History communication style,orare newtotheirjobs. ofpossess lowlevels resiliency, employapassive individual valuesandthoseof theiremployer, experience incongruence betweentheir frequently workwith low functioning clients, which can occur whenaddictionprofessionals factors Personal insufficient or feedback aboutperformance. inappropriate expectations, appropriate supervision,highproductivity treatment settings,lackof adequate and agency funding and resources, fragmented insufficient turnover, staff high environments, Organizational factors career decisionsautonomously. co-workers, lackof freedom topractice ormake being treated disrespectfully, interactions with records, facing competing demandsat work, highly complex issues,paperworkandclient with too many clients or many clients with to doandnotenoughtimeit,working Job-related factors factors (Maslachetal.,2001): and burnoutcan be causedby a varietyof Addiction professionals face many challenges, Section 1:Common Section Workplace Stressors like emotional exhaustion, suchashavingtoomuch including chaotic work

& Ferenchick, 2004). Professionals who are illnesses (e.g., Dickey et al.,2002;Wadland high rate of co-morbidity with other chronic Because of thenature of addiction,there isa Comorbidity constitute apersonalplanof recovery. be rewardingnot but itdoes onmanylevels working asanaddictionprofessional may their own self-care planis in place. Importantly, has for their own recovery andmustensure recovery mustbemindfulof therisksthis work way theydid.Addictionprofessionals whoare in high prevalence of tobacco use. further detailsregarding addiction professionals’ Spotlight Section later in this document provides and HumanServices2014).[USDHHS], The of chronic(U.S. disease of Department Health professionals, which may leadtoincreased rates at much higher rates than other healthcare Addiction professionals alsocontinue to smoke medical conditions. colleagueswho mustfrequently address their asked tocover shiftsandresponsibilities of confronted bysuchhealthissuesare repeatedly Tensions can also arise as employees who are not the jobfor medicalappointments. offtime necessitating potentially management, conditions require regular, ongoingmedical ability to perform theirprofessional duties.Such are butmayimpactanindividual’s manageable their pastdruguse.Mostof theseconditions chronic diseasesorinfections asaresult of in recoveryalso with other dealing maybe Work andWell-Being: AGuide for AddictionProfessionals

5 Appendix Section 3 Section 2 Section 1 Introduction Symptoms ofBurnout boundaries (Rothschild &Rand,2006). can directly result from a lack of appropriate extent towhich they canhelpthem.Burnout themselves theycangivetoclients and the to knowhowmuchofEmployees need assess theethics of therapeuticrelationships. professionalsare continuously asked to and addiction oftenpoor boundaries have issues onadailybasis.Persons with Addiction professionals confront boundary Treatment Boundaries et al.,2012): also report (Maslachetal.,2001;Shanafelt who reportsatisfaction less withtheirwork with their work. Healthcare professionals dissatisfied or frustrated become quickly present,addiction professionals may When oneormore stressful factorsare Symptoms ofBurnout • • • • • • • • • • • • • • • attention Impaired concentration and Missing workfrequently Suicidal ideation to work Experiencing dread before going Feelings of isolation colleagues, family, andfriends Detachment from patients, Sleeping pattern changes alcohol orprescription druguse Illegal druguse,problematic Chronic fatigue Lower self-esteem Irritability Depression early Leaving theprofession orretiring Lower levelsof productivity Work andWell-Being: AGuide for AddictionProfessionals

6 Appendix Section 3 Section 2 Section 1 Introduction approach to worksite well-being will work in all workplaces. However, there are generally effective approaches that agenciesshouldconsider. generally are there However, workplaces. all in work will well-being worksite to approach staff, and security. Every agency is unique; each has different strengths, resources, maintenance extenders, and provider needs.staff, Nosupport to) single limited not (but including employees, all on focus must workplace the in well-being promote to agencies of efforts The self-care. facilitates that climate 2001). Agenciescanplayanimportantroleother employees(Aldana, inencouraginga culture and emotionally, andmentallyhealthyare more productive, perform better, andare absentlessoften than There are numerous benefits to promoting well-being in the workplace. Employees who are physically, Section 2:HowSection AgenciesSupport Well-Being philosophy ( whole healthencompasses eightdimensions & Wellness Program’s (BHWP)modelof The Universityof ColoradoBehavioralHealth there are multipledoorstowellness. approach, wellnessismulti-dimensional,and meaningful life possible.From awhole-health but apersonaljourneytoward livingthemost Wellness isnotjusttheabsence of illness, There existsavarietyof wellnessmodels. A Modelfor Whole Health https://www.bhwellness.org/about-us/ • Goal of Section 2—Identifyways ofSection Goal agenciescanreduce stress approaching life with optimism,creating your emotionstoguideactions, way, usingtheinsightprovided by emotions inaproductive andpositive occur, expressing andprocessing your awareness of youremotionsasthey Emotional Wellness coping mechanisms. trust andrespect, andutilizinghealthy interdependent relationships that involve in the workplace andsupportwell-being ofemployees SPOTLIGHT SECTION ): involves

• • values anddesires. this isinalignmentwithyourpersonal investments are distributedandwhether your billsontime,orknowinghow mean livingwithinyourmeans,paying Depending onyourfinancialstate itmay to direct financialdecisionsandplanning. your financial resources andknowledge Financial Wellness environment. and inbalance withthebroader natural from clutterandexposure totoxins, environment tobepleasingyou,free how wefeel, itisimportant for your environments haveabigimpacton positive senseof well-being.Since our clean, safe, healthy, andfacilitate a and workinginenvironments that are Environmental Wellness Work andWell-Being: AGuide for AddictionProfessionals involvesaccessing involvesliving

7 Appendix Section 3 Section 2 Section 1 Introduction • • • personal satisfaction andfulfillment Occupational Wellness information. the exploration of newideasand Intellectual wellnessalsoencompasses and professional knowledgeandskills. creativity, andexpandingyourpersonal in mentallystimulating activities, Intellectual Wellness tobacco-free. check-ups, sleepingwell,andliving also involvesobtainingregular medical healthy andnutritious.Physicalwellness physical activityandeating food that is including engaginginpleasurable aware of andtakingcare of yourbody, Physical Wellness time. a balance between work andpersonal understanding theneedfor andcreating throughout yourcareer aswell talents andskillstotheirfullestextent through work.Itincludesusingyour involvesbeing involvesengaging involvesfinding Depending onanindividual’suniqueneeds, change potentiallyspanningalldimensions. that translates intosustainedhealthbehavior towards wellness,theycreate momentum will bedifferent. Whenapersontakes steps each person’sentrypointtoward well-being • • day interactionsyouexperience. attribute meaningto life andtheday-to- rather, itcanfocus onyourabilityto necessarily meanhavingareligion; others. Spiritualwellnessdoesnot a life purposeandcompassion towards matches yourvalues,andthat establishes belief systemthat ismeaningfuland Spiritual Wellness community. positively toone’sfamilyand/or wellness alsoinvolvescontributing that feel supportiveandsatisfying. Social meaningful interpersonalrelationships Social Wellness Work andWell-Being: AGuide for AddictionProfessionals involvescreating involveshavinga

8 Appendix Section 3 Section 2 Section 1 Introduction Wellness Committeetasksare to: and strategicmission, values, actions.The to integrate self-care intoanorganizations’ andclient wellness andcanassisttheexecutive leadership employee address efficiently can Program [BHWP],2015).Suchacommittee already haveone(BehavioralHealth&Wellness a Wellnessassembling Committee ifyoudon’t To beginyourprocess, it is critical to startby Convene aWellness Committee that promote mentalwellness. a chance torelax,rejuvenate, skills anddevelop to highlight staff wellness and provide employees Agency retreats present excellent opportunities organizational andemployeewellnessactivities. This includes taking anactiverole in promoting create aculture of wellnessfrom thetopdown. supervisors shouldmodelhealthybehaviorsand and they needto“walkthetalk.”Management to attendemployees totheirownwellness, leadership is lacking. If leadership is asking initiatives failisthat buy-inandsupportof senior One of themostfrequent reasons that wellness Provide Role Models • • • programming andpolicy. Design, implement,andmaintainrelated organizational needs; Adapt bestpractices basedonunique Receive inputfrom staff; waiting tobecalled. your organization already hassuchchampions across diverse perspectives.Theoddsare skills that allow them to create a dialogue leaders. Theyhaveexcellent communication are respectedwho areemployees opinion personally investedin whole health.Champions resourcesisn’t if HRleadership department champion should not be relegated to the human a callingandpassion.Therole of wellness champions. Being anagencychampion is wellness recruit and identify to is step first The enduring component of theagencyculture. an but month” the of flavor “the not is wellness senior leadership convey that employee agency demands.Wellness champions and ofbarriers suchasever-emerging expected ensure that agencyplansdonotstallintheface champions Wellness starts. and fits their have Wellness initiatives, like mostbehaviorchange, Work andWell-Being: AGuide for AddictionProfessionals

9 Appendix Section 3 Section 2 Section 1 Introduction to respond. to respond. agency how leadership and the Wellness Committee intends and findings aggregate the with to participate in a survey that they are presented encouraged are staff if that imperative also is It be presented and acted upon in the aggregate. responses aren’t anonymous.Findingsshould leadership maybeimpactediftheir with may feel that healthcare benefits or relationships Staffcritical. is participants survey of anonymity implementing awellnessassessment.First, the There are severalfactorstoconsider when interest-survey/ www.welcoa.org/resources/employee-needs- employee_interest_survey.pdf hap.org/employers/worksite/pdfs/sample_ survey examplescanbefound at supports wellnessfor each dimension. Other personal wellnessandhowtheworkplace eight dimensionsofboth exploring wellness, services/evaluation/organizational Wellness Survey Health &Wellness Program’s Workplace your agency.the Behavioral Asanexample, wellness surveys that may be appropriate for for change. There are anumberof workplace instrumental in setting a quantitative baseline and/or community resources. Surveys are also through employeeinsurance, wellnesspolicy, have staff benefits wellness the of review a as fromobtained insurance employee aswell focus groups andforums andquantitative data qualitative data yougather through employee accurately gauge progress. This may include they are in their pursuit of wellness,theycan agency has a baselinemeasurement of where Wellness initiatives shouldbe data driven. If an Agency Wellness Assessment ( https://www.bhwellness.org/ and ) https://www. measures https:// information and training on nutrition. Agencies information andtrainingonnutrition.Agencies affordable to and nutritiousfood that tastesgood,aswell access convenient provide can to encourage employeestoeat well,agencies facilities shouldbemadeavailable.Asexamples, as aquietroom, kitchen,andshower/changing emergency response). Ifpossible,amenitiessuch needs to be safe (e.g., parking lot lighting, adequate meetingspace. Theworkplace also with comfortable furniture, goodlighting,and Organizations canworktocreate workspaces Agencies shouldfullyassesstheworkenvironment. Environmental Scan Appendix for anexample). environmental scanusingexistingtemplates (see baseline, agenciesmightengageinamore formal As acomponent of settingaworkplace wellness safe outdooractivitiessuchaswalkingpaths. work alternatives, and/or promoting access to sponsorships, standingdesksorotherkinesthetic providing exercise equipment and space, gym stay hydrated. Employers canencourage physicalactivityby employees sure to make office can provide drinkingwater throughout the Work andWell-Being: AGuide for AddictionProfessionals data driven. should be initiatives Wellness 10 Appendix Section 3 Section 2 Section 1 Introduction physical healthconditions. treatment optionsandvaryingadvice regarding may beeasilyoverwhelmedbythenumberof support. Addiction professionals, just like clients, primary care physician require planningand diet, regular healthscreenings andvisits to a changes suchasregularexercise andabalanced Morris, 2014). Much like otherhealthylifestyle physical illnesses like(Morris & heartdisease preventionof andself-management chronic in positivehealthoutcomes, especiallyinthe referral activities are associated with increases (e.g., Goetzel & Ronald, 2008). Screening and such as unhealthy diet or sedentary behavior factors risk on effect positive a have to shown in comparison togenericfeedback, hasbeen feedback from individual health risk assessments, health screenings forPersonalized employees. is tofacilitateto encouragewellness personal One of theprimary methods agenciescanuse Promote Health Screening Agencies canbestassistemployeesby: • • • • have received; comfortablethey with theknowledge those visits, ask questions until they are care physician regularly and,during Incentivizing themtovisit their primary Holding anagencyhealthfair; access todetailedinformation; health screening benefits and giving them their of basis regular a on them Notifying confidential. bekept will records medical that affirm Agencies andwellnesschampions can part of their permanent medical record. conditions for fear that itmaybecome may bereluctant tomention certain appear weakordependent.Also,people support becausetheyfeel it makes them professionals maybereluctant toaskfor chronic illness outcomes. Healthcare support from othersleadstoimproved communities. Studies haveshownthat friends, family, andother membersof their Encouraging themtoaskfor supportfrom Work andWell-Being: AGuide for AddictionProfessionals 11 Appendix Section 3 Section 2 Section 1 Introduction Addiction Professionals andSmoking healthcare professionals. than thegeneralpopulation andother own recovery, smoke at muchhigherrates professionals, manyof whomare intheir Services Administration, 2014). Addiction Substance AbuseandMentalHealth tobacco dependent(Kalmanetal.,2005; population; 40-80%of thispopulation is remained muchhigherthanthegeneral use disorder, therate of tobacco usehas who strugglewithanalcohol orsubstance in thegeneralpopulation, amongthose tobacco usershasbeenslowlydecreasing (USDHHS, 2015).Whilethenumberof of adultsintheU.S. are dailytobacco users 2015; Carteretal.,2015).Currently, 17.8% smoke exposure (USDHHS, 2014; Grady, per yearare attributed tosecond-hand with tobacco use.Another42,000 deaths year are attributable toillnessesassociated 2014). IntheU.S., 540,000 deaths each mortality intheUnitedStates (USDHHS, preventable causeofmorbidityand Tobacco useremains thesinglemost SPOTLIGHT SECTION Many smokers attempt toquitontheir most difficultaddictionstoovercome.” the samething-“Smokingisoneof the struggled withotheraddictionswillreport When asked, smokers whohavealso (Guydish etal.,2007). of smokingcessation services toclients Staff smokingisalsoabarriertoprovision during cessation attempts. level of dependence, andpriorexperience are thebestfitgiventheirsmokinghistory, determine whichcessation medications a visitwiththeirprimarycare provider to insurance willcover andalsoschedule should determinewhat treatments their therapy, Zyban, orChantix).Smokers medications (nicotine replacement cessation counseling andFDA-approved evidence-based treatments including if smokers receive acombination of chances of quittingdramatically increase attempts doworkfor some people,the own or“cold turkey.” Whileunaidedquit Work andWell-Being: AGuide for AddictionProfessionals 12 Appendix Section 3 Section 2 Section 1 Introduction women helpingeachotherlivenicotine- profit 12-step fellowship of menand Nicotine Anonymous(“NicA”) Several helpfultobacco cessationresources include: http://www.lung.org/stop-smoking/ and beginanew, smoke free phaseof life. support tohelpendtobacco addiction smoking facts,proven tools,tipsand American LungAssociation https://www.smokefree.gov support, tips,tools,andexpertadvice. an onlineguidetoquittingincluding the federal government.Thesiteprovides Smokefree.gov anonymous.org abstinence from nicotine. from Alcoholics Anonymous)toachieve recovery usingthe12Steps(asadapted The fellowship offers group supportand programs andnicotine withdrawalaids. addiction, includingthoseusingcessation all thoseseekingfreedom from nicotine free lives.Nicotine Anonymouswelcomes isawebsiteprovided by https://nicotine- provides isanon- The DIMENSIONSTobacco Free Toolkit their quitlines. medications at noorlowcost through states alsooffer sometypes of cessation of operation varyfrom state tostate. Many with quitting.Specificservices andhours coaches whoprovide information and help states havequitlinesinplace withtrained smokers directly totheirstate’s quitline.All is thetoll-free numberthat willconnect 1-800-QUIT-NOW (1-800-784-8669) bhwellness.org/resources/toolkits/tobacco need of theseindividuals. treatment isbesttailored tomeetthe addictions), includinghowcessation (i.e. thosewithmentalillnessesand related tobehavioralhealthpopulations The supplementdescribesspecialissues evidence-based guidance for clinicians. Behavioral HealthPopulations and companionSupplementfor Work andWell-Being: AGuide for AddictionProfessionals https://www. provide

13 Appendix Section 3 Section 2 Section 1 Introduction following (CSAT, 2006): it is important that supervisors also address the addiction professionals,research that suggests is strongly associated with job satisfaction. For performing well.Recognition of ajobwelldone of recognizing employeeswhen they are Supervisors alsohavetheessentialrole gain orloss,tardiness, and/orabsenteeism. concerning signssuch as moodswings,weight noticing including wellness, staff assessing line of first the often are Supervisors check-ins. This process shouldinclude formal, scheduled on bothclinical andotherwork-related issues. Employees needregular, consistent feedback professional boundaries. provide emotionalsupportwhile maintaining to how as well as skills reflective and listening educationregarding and supervisionthemselves This should includesupervisorsreceiving continuing adequately. staff supervise to necessary in supervisorytechniquesandhavethetime 2004). Supervisorsshouldbebothwell-trained stress and increase motivation (Powell &Brodsky, staffreduce can supervision clinical appropriate to providing anongoingevaluation of skills, performance. Research suggests that in addition involves consideringimpacts wellness howpersonal also supervision Effective jobs. their determining whetheremployeesare performing Supervision isnotsimply a mechanismfor Quality Supervision • • • • • • Impaired counselors. Liability concerns; Staff performance evaluations; Cultural biasandunfair treatment; Professional credibility; and clients; Relationships between recovering staff that they are available to discuss concerns staffconcerns discuss to available are they that should directly communicate tosupervisees should notbeusedin isolation. Supervisors Supervisors arethat advised self-assessments worksheets in Section 3: Self-Care Strategies. themselves through instruments such as the assess to staff encourage can Supervisors state. their lifestyle choices andcurrent emotional arerisk assessments review helpfulasemployees sustaining desired behaviors.Individualhealth toward step first behavior changeandanongoingskillin necessary a is Awareness in Motivational Interviewing. so, supervisorsshouldreceive adequate training in responsemay have Toself-assessments. do Fatigue Self-Test forHelpers currently functioninginyourrole as Take the Appendix toassesshowyouare an addictionprofessional Work andWell-Being: AGuide for AddictionProfessionals Compassion Satisfaction/

in the 14 Appendix Section 3 Section 2 Section 1 Introduction ethically addressing theneedsof theirclients. personal time and space while still fully and strategies will allow employeestomaintain their Effective boundaries. clear setting for strategies relationships. Supervisors might further suggest for theseencountersdual andhowtoavoid staffprepare to need Agencies work. of outside in smaller communities, may encounter clients counselors,example, especiallythoseworking certain commonly occurring situations. For Employees requirewith trainingonhow todeal an idealtimetoreinforce healthyboundaries. trauma, abuse,and/oraddiction. Supervision is boundaries, which may be tiedtohistories of The clients we work with often lack healthy to gohomeorchangeshifts. end of thedaywhenemployeesare preparing the at staff all with in checking of point a make take many forms. For supervisorsmay example, may complement individualsupportandcan Informal teamor group supervisioncheck-ins recovery priortobeinghired. Peoplewho have the lengthof time counselors mustbein a policy Agencies shouldhaveinplace about for staff to attend AAorNAmeetings. support groups onsiteorprovideopportunities employees in recovery. Other agenciesmay hold of having separate activities and programs for wellness-relatedtheir general activitiesinstead agencies choosetoincorporate recovery into their employeesin recovery will vary. Some to The degree which supervisors andagenciescansupport morale. and motivation staff can improve recovery in staff supporting Also, Wellness Committee. be includedunderthescope of the agency of standard operating procedures. This could and decompress shouldbe core components loss. Opportunitiestodiscusswhat happened providedwith such a deal to helpemployees or client should beacknowledgedandsupport For example, thedeath of a fellow employee such as employeeassistance programs (EAPs). responseand referral services tosupportive as agency-specific occurrences demand a rapid Adverse community or national events aswell to provide additional support toemployees. increase stress in the workplace andbeprepared Agencies should be mindful of eventsthat Rapid Response toStressfulEvents ladder toward otheragencyjobopportunities. recovery (CSAT, 2006),andprovidea career positions maybeappropriate forin early people peer specialist, non-counseling, orvolunteer not hired for counseling positions. However, been inrecovery lessthanayearare generally Work andWell-Being: AGuide for AddictionProfessionals 15 Appendix Section 3 Section 2 Section 1 Introduction are universallyobservedandenforced. rules these that ensure and staff, to supervision conduct, provide appropriate training and their ownrulesofAgencies shoulddevelop inappropriate or unprofessional behavior. not havereceived trainingonwhat constitutes may staff often, but intentional, be may lapses declines inworkplace wellness.Someof these violation of ethical standards andsubsequent Various workplace challengesmay lead to a rotating basisthroughout theyear. code of ethics and review sections of these on are encouragedto downloadtherecent 2016 www.naadac.org/code-of-ethics) code of ethicsaddressesnine principles Association of Addiction Professionals (NAADAC) colleagues, and society in general. The National professionals in their interactions with clients, obligations. Codesguidetheconduct of principles related tomoralandprofessional which provides standards of behaviorand Addiction professionals haveacode of ethics, Professional/Ethical Standards . Supervisors (http:// Addiction Professionals Characteristics ofEthical • • • • • • • • • • • • assessments togaininsights supervision andpeer Willingness touseclinical sponsor toaclient versus beingapeercounselor or between aclinicalrelationship Knowledge of the difference standards andscope of practice Adherence toprofessional reporting requirements Familiarity withmandatory backgrounds Respect for clientsfrom diverse Use of self-care strategies growth opportunities continuing education andself- Participation inregular evaluation Capacity toconduct self- provision of treatment recovery anditseffect onthe Understanding of personal on treatment cultures andlifestyles canhave personal biastoward other Recognition of theeffects organizations Involvement inprofessional related fields and trends inaddictionand Awareness of current research for professional growth especially areas of opportunity into clinicalperformance, Work andWell-Being: AGuide for AddictionProfessionals 16 Appendix Section 3 Section 2 Section 1 Introduction in-service topics: input. The following areof examples common staff of forms other and described previously curriculum based ontheagency wellness survey of themes. Agencies might build a staff wellness Wellness in-services cancovera broad spectrum flexible community classes. allowing or in-services attend can staff that so schedules and/or reimbursement, by paying conference fees, providing tuition pursue additionaleducationhelp employees the resourcesSome agenciesmayhave to expectations concerning professional conduct. standards sothat theyhaveanunderstandingof receivetraining onprofessional and ethical growth and self-awareness. Employeesshould environment that encouragesprofessional an obligationAgencies have tofoster an Professional andPersonalDevelopment • • • • • • • • • • • Conflict resolution Dual relationships Financial wellness Motivational enhancement strategies Resiliency Positive relationships Healthy physicalexercise andeating Healthy sleep Stress reduction personal wellnessneedslike goingtothegym lunch, mightprovide opportunitiestoaddress during the workday, suchas whenemployeestake flexibility some Similarly, satisfaction. calendar, aperkdirectly tiedtolong-termjob increasedemployees give control of over their in variation from thetraditional9-5workday, can flexibility Allowing scheduling, such as multiple-shift options or family. and growth, to balance their health, recovery, professional try they as lives employees’ in stress significant Conforming toarigidschedulecancreate Flexible Schedules communicated, ensuring that staff are made aware of what isandnotacceptable. are staff that ensuring communicated, policy, itshouldbeclearlystated andregularly from home or telework practices. Whatever the feasible alternative. This might alsoinclude work does not but reduce thehoursworked maybethemost adjusts that policy “flex-time” a time into the standard work week. Adopting agencies havechosentobuildpersonalwellness or schedulingatherapyappointment.Some Work andWell-Being: AGuide for AddictionProfessionals agencies to foster growth andself- that encourages an environment It isthe role of professional awareness. 17 Appendix Section 3 Section 2 Section 1 Introduction 2014). greater community services (Morris &Morris, set internalpolicy, andbeapointof linkageto provide environmental cuesandresources, Organizations cansupportpeerinteractions, a normative choice (Aldanaetal.,2012). that make choosing a healthybehavior wellness bycreatingemployee environments Addictions agencies haveopportunities to foster 2014). satisfaction2001; Morris&Morris, (e.g.,Aldana, and healthplancosts, andimproveemployee lead to decreased absenteeism,sick leave, (ROI) for agencies.Worksite wellnessprograms evidence that showsareturn oninvestment forThere anagencyanditsemployees. isample Providing wellness services is mutually beneficial Employee Wellness Incentives recovery advocacybyincreasing access support local,state, regional andnational and organizations brought togetherto national organization of individuals Faces &Voices ofRecovery National Recovery Resources facesandvoicesofrecovery.org point for recovery advocates. media; andproviding anational rallying improving access topolicymakers andthe among localandregional groups; technical support;facilitating relationships to research, policy, organizing, and is a http:// substanceuse_misusetoolkit.pdf http://www.naadac.org/assets/1959/ in theaddictiontreatment workforce. address substance use,misuse,andrelapse Toolkit The USDHHS’sPartnersforRecovery treatment-recovery-resources/ and recovery. that maintainastrong focus ontreatment provides information aboutorganizations and DrugAbuseDirectors(NASADAD) National AssociationofState Alcohol behavior change is notrelatedchange behavior tothegreatest of wellnessprogramming. Even iftheinitial increaseshealth goals personal the impact Providing access tomultiple paths toward surroundings). (e.g., no-smokingpolicies,aestheticallypleasing goals) andsupportiveenvironmental change reduced assistance insurance rates for reaching weight management (e.g., employee incentives financial (e.g., programs), benefits health access toresources (e.g.,gymmembership), steps perday, walkinggroups, nutritioneducation), to increaserisks (e.g.,pedometers number of cholesterol) to interventions addressing health health risk screening (e.g.,bodymassindex, The interventionsthemselvesare diverse,from smoking, fitness, weight, substanceand stresssleep, abuse, management. nutrition, as such Employers might provide interventionsin areas provides guidance onhowto Work andWell-Being: AGuide for AddictionProfessionals http://nasadad.org/ 18 Appendix Section 3 Section 2 Section 1 Introduction of organizational belonging that increases 2006). MIinterventionscancreate asense and diseasemanagement(Butterworthetal., that addresses multiple behaviors, health risks programs withMI-basedhealthcoaching suited for worksitehealthpromotion Motivational Interviewing (MI) is particularly toward changingtheirhealthbehaviors. consultation toshiftemployees’perspective Agencies might provide motivational and learningstyles. by matching individuals’motivations, skill sets a offer that menu of optionsfare thebestin building skills Organizations health. personal motivated towork on at leastonearea of & Ozminkowski,are 2008).Mostemployees confidence (Goetzel changes lifestyle difficult more greater toward with move eventually to participants tobuilduponinitialsuccesses risk factors,awholehealthapproach will enable be challengingyetattainable. Asanexample, to need Short-term steps healthy livinggoals. term milestonesthat buildtoward ultimate are aseriesof individually determined, short- programming Thebestgoals isgoal-setting. Another integralcomponent of wellness that complement biometrictesting. an excellent opportunity to offer brief MI interviews programs. Forexample,corporate healthfairsare in conjunction with other health promotion et al.,2012).MIinterventionscaneasilybeused encourages aculture of worksitewellness(Seifert personal satisfaction, improved mood and such aslosingfivepounds. might be rewarded for reaching realistic goals on anultimate weightlosstarget,employees instead of makingagencyincentives contingent Work andWell-Being: AGuide for AddictionProfessionals 19 Appendix Section 3 Section 2 Section 1 Introduction (Nedrow etal.,2013;Weight etal.,2013). professionals can achieve thebalance they seek compassionate totheir own needs,healthcare home lives. By being aware of their actions and achieving a balance betweentheir work and duties, maintainingworkday,a manageable and care patient or client fulfilling between tension Many healthcare professionals report feeling to wellness. approach sustainable balanced, a find you that important is It suggestions. these to efforts care right direction, butyoushould notlimityourself- in the to getyoustarted This guideisdesigned other, or a rewarding volunteer commitment. significant a or family with time hobby,quality a can be derived from various sources, whether well-being. Personal happinessandwell-being However, they are nottheonly ways to increase start. to places good are below identified areas stress, which increases mentalwellness.The below.regular Forexample, exercise canreduce identified topics the across overlap of lot a also overall healthandpersonaloutlook.There is on impact significant a have all can well-being regularly, andtakingstepstoenhance mental that their well-being.Eating better, exercising areas specific employees can focus on in order to improve identifies section This Section 3:Self-CareSection Strategies To facilitate theprocess of developingnewhabitsandbehaviors: 1. 3. 2. Goal of Section 3—Identifysomeofthe ofSection self-careGoal approaches

Shape theenvironment tosupport thenewbehavior Change thereward pathway bysettingup newroutines andrewards Identify cuesfor habitsyouwant tochange employees canuseto increase their well-being resulting routines, andrewards. Triggered by are theresult of aprocess that includescues, atin manyotherways.Allbehaviors, theirroot, positively impactourownhealthandwell-being environment. However, wedohavetheability to we have little or no control, such as genetics and There are someaspectsof our health over which Healthy Behavior Change steps that can add up to significant change. significant to up add can that steps of practice involvestakingsmall,manageable needs of anindividual or system. The bestkind in order todiscover waystomeettheunique behaviors refine and adjust to opportunity developing skills. Practice provides the Practicing is thekeynew behaviors to Practice of homeostasis(Hilario &Costa,2008). behaviors may be soughtouttoachieveastate to attaining pleasurable experiences. Still other experiences negative from relief finding simply reward. Thereward itselfmay varygreatly, from react inwaysthatthem towards lead obtaininga any numberof environmental cues,individuals emotions, physical events, people,arousal, or Work andWell-Being: AGuide for AddictionProfessionals 20 Appendix Section 3 Section 2 Section 1 Introduction health (Bandura,1997). and buildingmomentumforlong-term overall feelings of satisfaction andaccomplishment self-efficacy and enthusiasm grow, engendering sustainable. Asshort-termgoalsare achieved, month ismuchmore realistic, motivating, and motivation, whereas losingonepounda may actuallyleadtoavoidance anddecreased effort. sustains setting agoaltolose50pounds For example, turn in which wins, small the motivation byproviding regular feedback on or “microchanges,”steps which strengthens goal shouldbemadeupof manyshort-term ultimate health goals can be difficult. A long-term reaching from results that gratification Delayed with repetition (Hilario & Costa,2008). well-being, newbehaviorsare reinforced toward increasingthatbehaviors support steps initial take to difficult be may it while So, are repeated, theassociation isstrengthened. not smoking.Asnewcue-routine-reward cycles air breakor shortwalkwithcolleagueswhile same reward. In this case, it could beafresh to identify healthy behaviorsthat provide the While thecuesremain, there isanopportunity or theopportunity to socialize with others. breakbe takinganeeded from dailytasksand/ a smoke break. Often,thereward mayactually day which prompt cravingandthedrivetotake smoking maybetiedtocuesthroughout the As oneexample,thebehavioralhabitof Who mightsupportmywellnessgoals? health goals? What are potentialbarrierstomeetingmy What are mygoalsregarding myhealth? What ismyfirststep? with greater clarityandconfidence. level of well-being are ableto make choices takeand goals, their values, thetimetoassess overall wellness.Addiction professionals who engage in self-assessment is imperative to healthy realistic, making life choices isself-awareness. Taking timeto toward step first A Cultivate Self-Awareness What are potential barriers to meeting health? What are my goalsregarding my What ismy firststep? following questions: Consider your responses to the StartedGetting Creating Personal Goals: Who might supportmy wellness goals? my health goals? Work andWell-Being: AGuide for AddictionProfessionals 21 Appendix Section 3 Section 2 Section 1 Introduction Excerpted from: BehavioralHealth&Wellness Program, PhysicianWork andWell-Being Toolkit, 2014 your wellnessinanyonedimension. Isthere aparticular dimensionof wellnessonwhich you High (8-10),Moderate (4-7)andLow(1-3)?Consider theactivitiesthat facilitate ordetractfrom Review yourresponses toeachof the8Dimensionsof Wellness. Where doyourate yourself would like tofocus yourattention? Intellectual Wellness Financial Wellness Environmental Wellness Emotional Wellness 1-Low to10-Highintermsof yourwellnessinthat area. following questionsasrelated toeachdimensionof wellness.Thenrate yourselfonascaleof information aboutyourspecificlevel of wellnessacross these8dimensions.Considerthe Let’s examinethese8Dimensionsof Wellness through asimpleexercise. Thisexercise provides • • • • • • • • • • • • • Are youintentionalandaware inyour natural environments? Do youregularly spendtimeinnature or work environment? How are youaffected byyourhomeand environment? Do youliveandworkinasafe andhealthy perceive ashealthy? Do youpractice coping skillsthat you Are you generally optimistic? that isrespectful toyourself and others? Do youexpress youremotionsinaway throughout theday? Are you aware of youremotions issues andideas? Do youkeep uptodate withcurrent creatively? Do youfindwaystoexpress yourself professional life? for learninginyourpersonaland Do youtake advantageofopportunities financial future? Do youplanfor andfeel secure inyour keep yourselffinanciallyhealthy? Do youhaveresources andknowledgeto spending? Assess YourWellness Physical Wellness Occupational Wellness Spiritual WellnessSpiritual WellnessSocial • • • • • • • • • • • • per week? Are youphysicallyactiveat least3days Do youchoosetoeat healthyfoods? career seems tobeheading? Are you satisfied withthedirection your Do youlookforward togoingwork? energized byyourwork? Do youfeel personallyfulfilledand values? Is theworkyoudocompatible withyour different valueswith respect? Is iteasyfor youtotreat otherswhohave events? Do youfindexistentialmeaninginlife when youneedsupport? Are there peopleyoucanreach outto community? in Do youactively activities engage in your and meaningful? Are yourinterpersonalrelationships close with stress? Do youusedrugsandalcohol tocope Work andWell-Being: AGuide for AddictionProfessionals 22 Appendix Section 3 Section 2 Section 1 Introduction 56 pointsorhigher 25–55 points 0–25 points Coping IndexScale Total 4. 3. 2. 1. 15. 14. 13. 12. 11. 10. 9. 8. 7. 6. 5.

Foreachdayperweekthat youtake workhome,subtract5points(upto35points). For eachdayperweekthat youusealcohol tohelpyourelax, subtract10points. For eachdayperweekthat youdrinkalcohol, subtract5points. For eachdayperweekyouuseaform of medication torelax, subtract5points. For eachpackof cigarettes that yousmoke perday, subtract 10points. If youuseatimemanagementprogram or process regularly, giveyourself10points. yourself 10points. If youhaveaplace in yourhomewhere youcanrelax withoutinterruptions,give If youdoat leastoneactivityperweek“justfor you,”giveyourself10points. day, uptoatotalof 15points) For eachbalanced mealyoueat perday, giveyourself5points(figure youraverage yourself 5points. For eachdayperweekyouperform at least30minutesof aerobic exercise, give yourself 10points. Ifyoudoat least90minutesof deeprelaxation or meditation perweek,give If youare within15poundsof youridealweight,giveyourself15points. Ifyouattend asocialactivityat leastonce perweek,giveyourself10points. If youpursueahobbyat least1–2hoursaweek,giveyourself10points. If youhaveasupportivefamily, giveyourself10points. A healthystress index.Goodreserves for managingstress. Index isstillproblematic. Someillnessesare likely. already happeningorare imminent. Heading for serioustrouble. Stress illnessesand/orburnoutmaybe Coping Index Work andWell-Being: AGuide for AddictionProfessionals 23 Appendix Section 3 Section 2 Section 1 Introduction et al.,2014). associated2013; Shanafelt withburnout(Gabel, can result indemoralization, which is directly feelings of hopelessnessand helplessness. This of valuesandpractice canin turn lead to adequate care orcompassion, themismatch offer cannot they where situation a in are they at all times. When addiction professionals feel ethic of doingwhat is in the client’s best interest This valuesystemlinesupwiththeprofessional and compassion for othersisanimportantvalue. Many addictionprofessionals report that care dissatisfaction andfrustration. of source significant a be can values one’s to Conversely, notbeingabletoworkaccording in theworld. difference positive a making are they though as work that they do is a significant factor in feeling ability to seetheir own valuesrepresented in the to one’svalues.Anaddictionprofessional’s every day. There isincentive toremaining true apparent, valuesguidechoices andactions making decisions. Whether ornotitisalways and action,includingsettinglife priorities and career, satisfying are guidingprinciples that candirect behavior and fulfilling arevalues of theutmostimportance. Values a build To Defining Values in three key ways,by: and prioritizing values in lifeeveryday canhelp whatabout ismostimportanttothem.Knowing the values, gained canprovideknowledge information their defines individual an When values. one’s define to time take to useful is It 3. 2. 1.

Work andWell-Being: AGuide for AddictionProfessionals Resolving tensioninconflictual process; Bringing claritytothedecision-making resources; Prioritizing howtospendtimeand situations. 24 Appendix Section 3 Section 2 Section 1 Introduction Excerpted from: BehavioralHealth&Wellness Program, PhysicianWork andWell-Being Toolkit, 2014 Commitment Change Challenge Caring Benevolence Beauty Authenticity Autonomy Authority Attractiveness Adventure Achievement Accuracy Acceptance Step 3. Step 2. Step 1. Identify 10 values that are important to you. 10valuesthat are importanttoyou. Identify • • • • • • • • • fulfillment? What factorscontribute toyourfeelings of Are youwithanyone?Whoare youwith? Why doyoufeel fulfilled? pride? What factorscontribute toyourfeelings of Are youwith anyone?Whoare youwith? Why are you proud? What factorscontribute toyourhappiness? Are youwith anyone?Whoare youwith? What are youdoing?

Identifytimeswhenyoufeel mostproud. Identify timeswhenyoufeel thehappiest. Identify times when you feel most fulfilled. Flexibility Fitness Family Fame Faithfulness Excitement Ecology Duty Dependability Creativity Courtesy Cooperation Compassion Contribution Define Define Your Values Health Growth Generosity Fun Friends Freedom Inner Peace Industry Independence Humor Humility Hope Honesty Helpfulness Nurturance Non-conformist Monogamy Moderation Mindfulness Mastery Loving Love Leisure Knowledge Justice Joy Intimacy Integrity 2 values.You willlikely findthat thesevalues Step 6. correct. through your list,shiftingtheorder untilitis you could onlychooseone.Work yourway asking yourselfwhichyouwouldchooseif in anyorder. Compare onevaluetoanother, list of 10importantvalues.Write themdown Step 5. fulfillment. your experiences of happiness, prideand important toyou.Baseyourselectionon & Rollnick, 2013).Identify10valuesthat are values. Review thelistof valuesbelow(Miller Step 4. you envisionthesevaluesbeingexemplified? into yourprofessional practices. Where do not, explore waystointegrate thesevalues values reflected inyourday-to-daywork?If treatment asacareer? Doyouseethese life. Didthesevaluesleadyoutoaddictions have guidedyourdecisionsthroughout your Prioritize yourtopvalues.Take your Determine your most important Determineyourmostimportant Reaffirm your values. Review your top Reaffirm yourvalues. Reviewyourtop Work andWell-Being: AGuide for AddictionProfessionals Self-Acceptance Safety Romance Risk Responsibility Realism Rationality Purpose Power Popularity Pleasure Passion Order Openness World Peace Wealth Virtue Tradition Tolerance Stability Spirituality Solitude Simplicity Sexuality Service Self-Knowledge Self-Esteem Self-Control 25 Appendix Section 3 Section 2 Section 1 Introduction 2013): The goalsof mindfulnessare to(Fortneyetal., commitment, awareness andintention. that isconsistent withrequiresyour values on yourownwell-being.Livinginamanner mindfulness isanexcellentofmeans focusing wakefulness or being in the present.” Practicing being in a “heightenedstate of involvement and the subjectiveexperience of mindfulnessas 1994). (2000)describe Langer andMoldoveanu moment, andnonjudgmentally”(Kabat-Zinn, a particular way: on purpose, in the present supporting well-beingby“payingattention in one toattendenables totheirexperience, that ofbeing away as defined is Mindfulness Mindfulness 2. 1.

of being. ways different and new for allows which that donotsupportwell-being, behaviors Recognize habitualthoughtsand and well-being; experience to emotional balance support of one’s awareness open Maintain engages in behaviors with afocusedin behaviors engages attention. In order toactwithawareness,an individual a personlabelstheir experience with words. environmental stimuli. Description occurs when thoughts, feelings, bodily sensations and other to internal and external experiences such as Observation includes noticing andattending experience inthemoment (Baer, 2009). but simply observing anddescribingyour critiquing, or reacting to your inner experience, It is important to bemindful without judging, creativity (Langer&Moldoveanu,2000). can leadtodecreased stress andincreased a senseof empowermentandcontrol, which from different perspectives. All of these facilitate openness tonewinformation, andobservation an increasedawareness of one’senvironment, change ismore likely tooccur, andthere is and behaviorsfrom aplace of mindfulness, When apersoncanapproach theirdailyroutines while on“autopilot.” This practice canbecontrasted withacting Work andWell-Being: AGuide for AddictionProfessionals 26 Appendix Section 3 Section 2 Section 1 Introduction Excerpted from: Brown & Ryan,2003 other item. what youthinkyourexperience shouldbe.Pleasetreat eachitemseparately from every experience. Pleaseansweraccording towhat really reflects yourexperience rather than scale below, pleaseindicate howfrequently orinfrequently youcurrently haveeach Below isacollection of statements aboutyoureverydayexperience. Usingthe1-6 I snackwithoutbeingaware that I’m eating. I findmyselfdoingthingswithoutpaying attention. I findmyselfpreoccupied withthefuture orthepast. I wentthere. I driveplaces on‘automatic pilot’andthenwonderwhy something elseat thesametime. I findmyselflisteningtosomeonewithoneear, doing what I’m doing. I dojobsortasksautomatically, withoutbeingaware of lose touchwithwhat I’m doingrightnowtogetthere. I getsofocused onthegoalIwanttoachievethat I them. I rushthrough activitieswithoutbeingreally attentive to awareness of what I’m doing. It seemsIam“runningonautomatic,” withoutmuch told itfor thefirsttime. I forget aperson’snamealmostassoonI’ve been discomfort untiltheyreally grabmyattention. I tendnottonotice feelings of physicaltension or paying attention towhat Iexperience alongtheway. I tendtowalkquicklygetwhere I’m goingwithout the present. I finditdifficulttostay focusedon what’s happeningin paying attention, orthinkingof somethingelse. I break orspillthingsbecauseof carelessness, not conscious of ituntilsometimelater. I could beexperiencingsomeemotionandnot Mindful Awareness Attention (MAAS) Scale Almost Always 1 Frequently Very 2 Somewhat Frequently 3 Infrequently Somewhat 4 Work andWell-Being: AGuide for AddictionProfessionals 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 Infrequently Very 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 5 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 Almost Never 6 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 27 Appendix Section 3 Section 2 Section 1 Introduction moment tocheckinwithyourself. patients andcolleagues.Or youmayjusttake a deep breathing in between your meetings with also beassimpletakingtimetopractice workshop orseminaronmindfulness.It can time to meditate. Oryou can participate in a behaviors. You maychoosetoreservesome you willneedspace torehearsemindfulness emotional, or mental space for mindfulness, Create space. focus andcommitment tomake itareality. As with any otherskill,mindfulnesswill require mindfully. Setthishighonyourlistof priorities. your intention. Set are afew toconsider (BHWP, 2014): momentum toward greater mindfulness. Here life, there are manyusefulstrategies tobuild a mindfulness practice into your professional Although there is not one “right” way to integrate Whether it is by creating aphysical, Set ithigh on yourSet listof priorities. ae h coc t lv mindfully. live to choice the Make Make thechoice tolive you make. Draw onyourwisdomtoinform thechoices unique needs.There isno“right” or “wrong.” out mindfulnesspractices that match your the information yougaintoassistin seeking an openandnon-judgmentalperspective.Use experience. Focusonthepresent momentfrom that promote curiosity about yourinternal Practice. Company. integration. NewYork: W. W. Norton& A clinician’s guide tomindsight and neural Siegel, D. J. (2010).Themindful therapist: DC: AmericanPsychologicalAssociation. and thehelpingprofessions. Washington, Integrating mindfulnessintopsychology The artandscience of mindfulness: Shapiro, S. L.&Carlson,E.(2009). Routledge. health professionals (2nded).NewYork: counselors, therapists,teachers,and prevention andself-care strategies for (2010). Theresilient practitioner:Burnout Skovholt, T. &Trotter-Mathison, M. J. Mindfulness Resources Work andWell-Being: AGuide for AddictionProfessionals Ask yourself reflective questions reflective yourself Ask 28 Appendix Section 3 Section 2 Section 1 Introduction sustainable. original stressor itself. The stressed body is not responsecan become morethan the damaging The problem isthat inthelong-term, thestress processes)essential the threat. tohelpescape is to activate its energy reserves (and stop non- response body’s The response. stress flight” or physical “fight the with responds body the words, other specific developed responsesto cope with it in the shortterm.In have bodies Whatever thesource of thestressor is,our including improved sleepandbetter physicalhealth. benefits, multiple have will relax to enhance mentalwellness.Increased ability grounding, andmusclerelaxation, can greatly Various exercises centered around meditation, and socialresources.drawing onpersonal to problems, elevating their performance, and solutions find to people challenging activating, experiencepeople asstressful. Stress canbe from daily life; there will always besituations that It isimpossibletocompletely eradicate stress Stress Management 2000): (Dallman etal.,2000;Buckingham, consequences onthebody, suchas Chronic stressmany negative canhave • • • • • • • • • Immunosuppression and cardiovascular disease Hypertension and Insulin-resistant diabetes Depression andmoodchanges Increased susceptibility toulcers Infertility, bothmaleandfemale cholesterol Raised serumlipidsand Central adiposity(bellyfat) healing Poor tissuerepair andwound vulnerability toinfection Work andWell-Being: AGuide for AddictionProfessionals 29 Appendix Section 3 Section 2 Section 1 Introduction Created byDanielGoleman or themind. Based onyourscore, youcandeterminewhether yourstress reduction shouldfocus onthebody pointifyoucheckedGive yourselfa“body” thefollowingquestions:1,4, 5, 8, 9, 11,and13. Give yourselfa“mind”pointifyouchecked thefollowingquestions:2,3, 6, 7, 10, 12,and14. Body Total: Mind Total: 14. 13. 12. 11. 10. 9. 8. 7. 6. 5. 4. 3. 2. 1.

I can’tstopthinkingworrisomethoughts. I perspire. I feel Iamlosingoutonthingsbecausecan’tmake decisionsfastenough. I become immobilized. I ambothered byunimportantthoughtsrunningthrough mymind. I pace upanddownnervously. My stomachgetstense. I can’tkeep anxiety-provoking pictures andimagesoutof mymind. I imagineterrifyingscenes. I getdiarrhea. I feel jittery. I worrytoomuchaboutthingsthat don’treally matter. I finditdifficultto concentrate because ofdistractingthoughts. My heartbeats faster.

StressStyle Test Work andWell-Being: AGuide for AddictionProfessionals 30 Appendix Section 3 Section 2 Section 1 Introduction (Glanz etal.,2008;Lazarus&Folkman,1984): There are three main types of coping strategies tendency to“open up”toothers). their personality(e.g.,optimism,neuroticism, moderate aperson’sresponse alsoinclude environmental resources. Theprocessesthat characteristics as well as their social and based on a person’s unique individual differently interpreted are experiences Stressful • your values.Are there waystodelegate oreliminate someof thelessimportantresponsibilities? Review yourresponsibilities andprioritizethem. stress. Consider yourpriorities. walk, inorder toavoidemotionaloutbursts, whichcangreatly increase stress. Manage anger. magazine, orengageinsomeotherform of mental“escape.” aside longerperiodsseveraltimesaweek.Usethistime torelax, meditate, exercise, lookat a rejuvenate. Considertakingat leastafew minutesseveraltimesaday. Wheneverpossible,set Take abreak. help youidentifystressful situations soyoucantake stepstoaddress oravoidthem. Monitor moods. minimizing it. the source of thisstress. Even ifyoucannotalleviate thestress, youcandevelopaplanfor thecause. Identify The following strategies canassistwithstress reduction: Stress Reduction Tips standards for yourself andothers. Cut yourselfsomeslack. directed at changingthestressful situation. Problem-focused. Personal timecanallowyoutotake astepbackfrom stressful situations and Employ anger management techniques such as counting to ten or taking a Employangermanagementtechniquessuchascounting totenortakinga Try todeterminewhen,where, andwhyyouhavenegative moods.Thiscan Take timetocheckinwithyourself. Explore whyyoufeel stressed and These strategies These are Anoverlyfullscheduleandtoomanyresponsibilities cancreate Perfectionists are often very stressed-out people.Setreasonable Assess whether your responsibilities match Assesswhetheryourresponsibilities match will helpyoucope effectively. the aspectsof theproblem that you can control your control orabilitytochange.Focusingon It is important to askwhat is within or outside of • • create meaningorunderstandingof self. directed at using thestressful situation to Meaning-focused. thinks orfeelsthe stressfulabout situation. are directed at changingthewayaperson changing the situation, these strategies Emotion-focused. Work andWell-Being: AGuide for AddictionProfessionals Insteadof focusing on These strategies These are 31 Appendix Section 3 Section 2 Section 1 Introduction demands mentalrigor, suchas: Mind/Body clears themindwonderfullyandisveryeffective therapy. Here are somesuggestions: meditation. Onthe other hand,somepeoplefindthat thesheerexertion of physicalexercise intervention isanythingthat willengageyourmindcompletely andredirect it,suchas Mind lazy -relaxation exercise maybeequallyeffective. Here are somesuggestions: pattern of physicaltension.Thismaybeavigorous bodyworkout, butaslow-paced -even Body . .

If stress registers mainlyinyourbody, youwillneedaremedy that willbreak upthe If youexperience stress asaninvasionof worrisomethoughts,themostdirect • • • • • • • • • • • • • • .

If youare amixed type,youmaywanttotryaphysicalactivitythat also Other activitiesthat combine mindandbody Competitive sports(tennis,racquetball,squash,volleyball) Games Movies Crosswords Reading Physical exercise Meditation Biking Hiking Tennis Swimming Progressive relaxation Aerobic exercise Choosing aRelaxer • • • • • • • • • • • Creative imagery Any absorbinghobby Handicrafts Carpentry Knitting orsewing Yoga Walking Running Rowing Deep breathing Massage Work andWell-Being: AGuide for AddictionProfessionals 32 Appendix Section 3 Section 2 Section 1 Introduction repercussions. Therefore, it is imperative that and in this line of work, that can have serious be unabletorespond totheirclients’ needs, arewith stress struggling or depression may 2012). Counselorsoroutreach workers who also growing stronger (Southwick & Charney, individuals bounce back after challenges while minimal psychologicalandphysical cost; resilient in ahealthywaysuchthat goalsare achievedat Resilience is the capacity to respond tostress deaths ornegative treatment outcomes. when dealingwithstressfulsuch asclient events healthier emotionalexperienceshave needed supervisors, andmentalhealthprofessionals as lives. Providers who receive help from peers, ofwhich can thenimpactmultipleaspects their providersto experience emotionalupheaval, occur during client care. events These eventscan cause adverse field, addictions the In addiction professionals often have stressful jobs. healthy. We liveinaverystressful society, and addiction professionals mustbementally In order toprovide optimalservices toclients, Mental Wellness seeking treatment. Treatment Locator Services Administration’s BehavioralHealth Services The SubstanceAbuseand MentalHealth emotional well-being. articles andinformation related topsychological issuesaffecting yourdailyandphysical American PsychologicalAssociation’sPsychology Help Center Services that provides resources andlinkstomental healthservices MentalHealth.gov In emergency situations: Mental Wellness Resources • • National SuicideHotline(800)273-8255 Call 911,GotoEmergency Department isanonlineresource provided bytheU.S. Departmentof HealthandHuman https://findtreatment.samhsa.gov https://www.apa.org/helpcenter/

is aconfidential andanonymoussource of information for persons symptoms that: health professional. Other key signs include should immediately seekcare from amental you about hurtingyourselforsomeoneelse, professional. Inparticular,thoughts ifyouhave you mayneedhelpfrom amentalhealth It iscrucialtoknowthesignsthat indicate self-care that promotes mentalwellness. addiction professionals aregimen develop of cannot benefitfrom help. helping others,itdoesn’tmeanthat youtoo with sessions a therapist. Just becauseyouspendallday individual from benefit Others professionals. “helping” for specifically designed find it beneficial to participate in support groups Many mentalhealthandaddictionprofessionals • • • • Become aregular pattern insteadof an Become markedly more severe Disrupt performance of regular activities Increase innumber intermittent occurrence Work andWell-Being: AGuide for AddictionProfessionals isanonlineresource featuring 33 Appendix Section 3 Section 2 Section 1 Introduction performed at the startof theday, betweenclient refocus. Personal wellness rituals can be between clientstodecompress, relax, and ritual or just taking a break, try to take a few minutes specific a performing are you Whether clear theirmindsandrefocus theirthoughts. Some counselors rely on personalrituals to help Create PositivePersonalRituals through theirownissues. boundaries maintaining when theyhaveresolved orare actively working effective more are to theirownaddiction. Addiction professionals if professionals haveunresolved issuesrelated with clients; however, it can also beproblematic can helpaddictionprofessionalsempathize are in recovery themselves.Beingin recovery Many individuals working in the field of addiction clients. stress, compromise thequalityof care provided to job-related significant severely impact professional performance, and create can workplace. Failure theseboundaries toobserve ethics, andinteractionswithclientsoutsidethe professionalapply toemotionalengagement, must interactions withclients.Theseboundaries in It isessentialtomaintainboundaries Maintain Healthy Boundaries support positive need inthe moment to What doI thinking? ensure that work is left at the office and not and brought home. office the at left is work that ensure making a “To Do”list for the next day, to help as such day, the of end the for ritual specific a the client is stopped by the bubble. Othershave the client. However, any negative energy from the counselor cantravelthroughto thebubble enclosed inabubble.Thepositiveenergy from use betweenclients is to imagine they are one visualization techniquesomecounselors visits, or at the endof the day. For example, become serious. and hopefullyaddressproblems before they problems early, interventioncanbeginearlier prostate exams).Bydetectinghealth-related (e.g., cholesterol screenings,mammograms, recommended screenings for your age group This includes regular physical examsandthe the necessary stepstomonitor your health. An importantaspectof wellnessistotake Preventive Care Work andWell-Being: AGuide for AddictionProfessionals 34 Appendix Section 3 Section 2 Section 1 Introduction objectives. make adjustmentstoyourpersonalgrowth Use theseexchanges to continually assess and growth. professional your refine to ways and their observations of your professional practices and to elicit direct feedback from others about may incorporate mindfulnessintoyourpractice, opportunities to exchange ideasabouthow you successes and failures - with others. These are they when share experiences -including bothperceived benefit professionals Addiction personal integrity. check-ins onissuesrelatedand toyourvalues and whocanbesoundingboards for regular co-workers who provide support and feedback, find it helpful to maintain close relationships with healthy (BHWP,themselves 2017). Some people relationships reduce workstress andare in and of the practice ofbut positive healthybehaviors, change. Not only can social support encourage smartphone appsthat support health behavior virtual learning communities, social media, or one oringroup settingsaswellthrough essential. Thissupportcanoccur one-on- collaboration and supportfrom othersis order tocreate wellnessinanyenvironment, Wellness doesnothappenin a vacuum.In Healthy SocialContact For thepurposesof thisguide,we may notbeeasilydefined. different thingstodifferent peopleand 1998). However, spiritualitycanmean of humanmaterial existence (Miller, typically emphasizes theboundaries as a“search for thesacred,” and Spirituality hasbeengenerallydefined Importance ofSpirituality others. while othersseekoutthefellowship of individualized approach tospirituality Some peoplechoosetotake an elements of spiritualitymayinclude: many, itiscrucialto well-being.Key because itisintenselypersonal.For will notattempt todefinespirituality, • • • • A feeling of hope power A relationship withahigher Seeking outinterconnectedness awareness Development ofgreater self- Work andWell-Being: AGuide for AddictionProfessionals

35 Appendix Section 3 Section 2 Section 1 Introduction eating habits(BHWP, 2017). but there arein healthy waystoactivelyengage because effective changesarethese behavior notsustainable, not usually are restriction goal of improving health.Dietingandcalorie make aboutwhat andhowtheyeat, withthe and metabolism,there are choicescan people However, givenwhatnutrition we knowabout person may not be the same for another person. what mayconstitute healthyeating for one health (biology, genetics,environment, etc.), different for different influence that variables many the Given people. looks eating Healthy how muchsugar, fat, andsaltweconsume. on effect dramatic a had have changes These manufactured andhowAmericanseat them. has drastically changed thewayfoods are like oilandhighfructosecorn vegetable syrup home. Finally, theintroduction of ingredients increasingly consuming foods outsideof the and take-out restaurants hasledtoAmericans and cooking. Also, theadventof fast-food eat, asopposedtofoods that require preparation has shiftedtoproducing foods that are ready-to- convenient, long-lasting,andcheap.Thefocus processing havecreated products that are of howAmericans eat. Innovations in food A lothaschangedinthelastcentury interms Mindful Eating eating looks for different Healthy different people. • • • • • • Reduceguilt. to healthierchoices. to whenandhow much you eat can lead of theirdailyeating habits.Payingattention Track habits. differently. the opportunitytochoosedothings healthy. With increasedawareness comes go alongwaytosupportdecisionseat feelings,aroundand behaviors eating can mindful. Be meals from diverse,rawingredients. ingredients. unprocessed Use additives. or hydrogenatedvegetable oils, and food often contain highamountsof sugar, salt, usually not healthy options because they are ready-to-eat orready-to-heat, are foods, including convenience foods that Avoid processedfoods. diseases. refined resistance, and obesity, and other chronic sugars carbohydrates, which can lead to insulin of consumption Decrease certainfoods. your eating. in flexibility yourself allow and yourself to your eating.kind talk toyourselfabout Be Work andWell-Being: AGuide for AddictionProfessionals Awarenessof thoughts, Manypeopleare notaware Pay attention to how you Avoid over- Processed Prepare 36 Appendix Section 3 Section 2 Section 1 Introduction • • • • size, for exampleat work. accessonly have totheproper serving single servingsof snackfoods sothat you kitchen rather thanat thetable.Measure portion control. Use added with sugar. drinks coffee and drinks,” consumption of sodas/soft drinks, “energy your healthy eating is to reduce or stop most straightforward meansof increasing beverages. Cut outsugary weight gain. carbohydratesthat andsugarsto willlead addictive, many alcoholic drinks are fullof use. stop alcohol or Limit are satisfying andsustaining. that fiber dietary high with foods whole to over-eating. Make thechoice to eat apt tocurbyourhunger, which can lead For example,foods highinsugarsare less regular meals that support feeling full. Schedule healthy meals. Serve mealsinthe Besides being Besides One of One the Consume • • • the choice for healthyeating. ingredients at hand,it is easiertomake commitments. Withhealthymealsor around youandyour family’s other daily you canplanmealsandprepare food Plan ahead. of supportiveenvironments. other through accountability andcreation to eat healthy. Peoplecan supporteach friends, community members-canmake iteasier others, family, co-workers, neighbors,andother significant including Get support your food costs. starch, andcanalsopotentiallylower foods that are highinsimplesugarsand decrease thelikelihood of impulsebuysof shopping listandfollow that list.Thiswill the meals you want to make. Create a Shop withalist. Work andWell-Being: AGuide for AddictionProfessionals Consideryourscheduleso . Supportivepeople- Set your intention for 37 Appendix Section 3 Section 2 Section 1 Introduction performance. risk for motor vehicle accidents to poor work increased from far-reaching, are effects these memory, of impacts The function. executive fluency, and affects deprivation attention, motor skills, reaction time, verbal Sleep stress. are verysimilartothosethat result from chronic long-term physical consequences of shiftwork never fullyadapttoanalternate schedule.The workers typically get much less sleepandmay (Puttonen etal.,2010;Wang etal.,2011).Shift stress, andnegative healthconsequences particularly problematic in terms of sleeploss, Work schedules(e.g.,shiftwork)canbe foods. hunger -particularly for high-carbohydrate metabolic consequences, including increased deprivational., 2010).Sleep hasanumberof illness (Cappuccio etal.,2010;Luckhaupt common and is more clearly linked to increased health risks,butgettingtoolittlesleepisfarmore defined as less than 6 hours) are correlated with more(usually than9hours)ortoolittlesleep Both getting too much sleep (usually defined as having thefollowing characteristics: describedas adults, healthysleepisgenerally illness can affect an individual’s sleep needs. For Factorsgender, suchasage, or activity levels, Sleeping Well • • • • productive throughout theday. Waking refreshed, andfeeling alertand long periodsof wakefulness); thatsleep Having iscontinuous (i.e.,no Sleeping 7-9hoursina24-hour period; down; Falling asleepwithin 15 minutesof lying increase healthysleep(BHWP, 2017): impact sleep.There are severalwaysyoucan modifiable in thatwe engage cansubstantially behaviors are there conditions, medical our whereor someof welive,ourworkschedule, While we may not have much control over • • • • • • • • • • • • • • Decrease caffeine, nicotine, or alcohol nicotine, caffeine, Decrease Do notworkorread inbed; Minimize screen timeinthebedroom; Keep aregular sleepschedule; such Cognitive Behavioral Therapy (CBT) . Therapy (CBT) such CognitiveBehavioral treatment psychological effective Seek fail toaddress thecausesof poorsleep; Avoidmedications overusingsleep which needed; medical assessmentandtreatment as Address apartner’s snoring through range) for sleeping; Set anidealtemperature (inthe60-66F Make sure yourbediscomfortable; circadian rhythm; (e.g., walksoutside)tomaintain your Get adequate exposure tonatural light close tobedtime; Avoid large meals,particularlyspicy foods, afternoon; ideally limitedtothemorningorlate Exercise regularly, with vigorous exercise sleep; meditation, orguided imagery prior to relaxingUse exercises like yoga, avoid longdaytimenaps; Take short naps of around 15 minutes, but use, particularlyclosetobedtime; Work andWell-Being: AGuide for AddictionProfessionals 38 Appendix Section 3 Section 2 Section 1 Introduction (hypertension, coronary heart disease, heart (hypertension, coronary heartdisease, conditions including cardiovascular diseases exercise is effective in treating numerous chronic risk for chronic disease,evidence also showsthat reduce or prevent help exercise does only Not through aprocess of stress andrebuilding. exercises buildstronger musclesandbones vessels. Strength trainingandweightbearing waste products andnewgrowth of blood throughout thebody, supportingremovalof exchange in the lungsdelivers oxygen tocells During exercise, increased heartrate andgas neural pathways and improves overall function. stimulates theformation of newneurons and throughout our bodies. In our brains, exercise result of exercise, carrying life-giving oxygen as a increases flow Blood ways. important of number a in bodies our affects activity Physical Get Active exercise program. * Consultwithyourphysicianbefore startingany WHO, 2010) (CDC, 2010;NIH, 1996;USDHHS, 2008; words before takingabreath. in whichapersoncanonlysayfew Vigorous intensity which apersoncantalkbutnotsing. Moderate intensity week.* include strengthening activitiestwice per per weekof vigorous intensityactivity; moderate intensityactivity or75minutes Get at least150minutes perweekof I Get? How MuchExercise Should activities are activities activities are activities activitiesare onesin Exercise enhances efficient and effective fewer symptoms associated with chronic stress and have fit physically are who efficient People functioning. enhances Exercise Saltin, 2015). cholesterol andtriglycerides) (e.g.,Pedersen & diseases (type1and2diabetes,obesity, high sclerosis, dementia,Parkinson’s),andmetabolic (multiple diseases neurological cancer, fibrosis), pulmonary diseases(COPD, asthma,cystic osteoporosis, backpain,rheumatoid arthritis), failure), musculoskeletal disorders (osteoarthritis, 2008), major findings about the benefits of benefits the physical activityare described,including: about findings major 2008), Activity Guidelines for Americans(USDHHS, and higheroverallwell-being.In the Physical • • • • • • being active. of havingan adverse outcome causedby in physical engaging activity are muchgreater thanthechance of benefits The have healthbenefits; strengthening (resistance) physical activity Both aerobic (endurance) andmuscle- physical activity; 150 minutesaweekof moderate intensity atleast with occur benefits health Most duration; intensity, greater frequency, and/or longer increasing physical activity through higher from result can benefits health Additional Some physical activity is better than none; outcomes; lowers theriskforhealth manyadverse Regularlyin physicalactivity engaging Work andWell-Being: AGuide for AddictionProfessionals 39 Appendix Section 3 Section 2 Section 1 Introduction • • • • preferences. based onyourinterests and and momentum,chooseactivities Set realisticgoals. walking shoes,gymbag). be physicallyactivecloseat hand(e.g. Make iteasy. the easieritwillbecome overtime. more likely youwillengageinit.And habitual physicalactivitybecomes, the Create adailyroutine. physical activitygoals. and make decisionsbasedonyour Make itapriority. goal that is a priority. And support the wellnessgoalsof your peers. create realistic and sustainable goals. Start where you at. Pick one provides ideasfor agenciesand addiction professionals on how to Creating well-being,inworkandlife, canfeeldaunting. This guide Tips for Healthy Physical Activity Keep what youneedto Planyourschedule To buildenergy Themore Get Active.Get Gt Aware. Get Pass itOn! • • • new activitiescannotonlymake repeatedly cangetboring.Exploring for many, doingthesame thing thrive onthesameroutine but Keep itinteresting. activity, itmakes itmore fun. with others.Notonlywillthisincrease Make itsocial. support yourexercise routines. technologies maybeagreat wayto monitors orothersupportive Utilize technology. reduce thechance of injuries. things more interesting, butcanalso Work andWell-Being: AGuide for AddictionProfessionals Be physicallyactive Somepeople Wearable 40 Appendix Section 3 Section 2 Section 1 Introduction Journal of Medicine, 372 and mortality—Beyondestablishedcauses. Hartge, P., Lewis, C. E.,…Jacobs, E.J. (2015).Smoking Carter, B. D., Abnet,C. C., Feskanich,D., Freedman, N. D., 33 review andmeta-analysisof prospective studies. (2010). Sleepduration andall-causemortality:Asystematic Cappuccio, F. P., D’Elia,L.,Strazzullo,P., &Miller, M. A. of Occupational Health Psychology, 11 on employees’physicalandmentalhealthstatus. Effect of motivational interviewing-basedhealth Butterworth, S., Linden,A.,McClay, W., &Leo, M. C. (2006). New York: Academic Press. . In G. Fink(Ed.), Buckingham, J. C. (2000).Glucocorticoids, role instress. 822-848. being. present: Mindfulness anditsrole inpsychologicalwell- Brown, K.W. &Ryan,R.M. (2003).Thebenefits of being Manual. Universityof ColoradoSchoolof Medicine. BHWP (2017).Well BodyProgram, Advanced Techniques org/toolkits/Tobacco-Free-Facilities-Toolkit.pdf Colorado Schoolof Medicine. BHWP (2015).Tobacco Free Policy Toolkit. Universityof pdf org/toolkits/Work-and-Well-Being-Toolkit-for-Physicians. Colorado Schoolof Medicine. Work &Well-Being Toolkit for Physicians.Universityof Behavioral HealthandWellness Program [BHWP](2014). New York, NY: W. H. Freeman. Bandura, A.(1997). Behaviour Therapy, of changeinmindfulness-basedtreatment. Baer, R.A.(2009).Self-focused attention andmechanisms 419. of Occupational andEnvironmental Medicine, the knowledgebaseonhealthyworksiteculture,” R. M. Merrill, V. George, andJ. Noyce (2012),“A review of Aldana, S. G., D. R.Anderson,T. B. Adams,R.W. Whitmer, American Journalof Health Promotion, 15 programs: Acomprehensive review of theliterature. Aldana, S. G. (2001).Financialimpactof healthpromotion References (5), 585-592. Journal of PersonalityandSocialPsychology, 84 Encyclopedia of stress Self-efficacy: The exercise of control. 38 (S1), 15-20. (7), 631-640. https://www.bhwellness. https://www.bhwellness. (Vol. 2,pp.261-269) (4), 358-365. (5), 296-320. Cognitive New England

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41 Appendix Section 3 Section 2 Section 1 Introduction Health, 36 morbidity. cardiovascular disease—pathways from circadian stress to Puttonen, S., Härmä,M., &Hublin,C. (2010).Shiftworkand Fransisco, CA:JohnWiley& Sons drug abusecounseling: Powell, D. J. (2004). Science inSports,25 chronic diseases. evidence for prescribing exercise astherapyin26different Pedersen, B. K.,&Saltin,B. (2015).Exercise asmedicine– cardiovascular health. and Cardiovascular Health(1996).Physical activityand NIH ConsensusDevelopmentPanelonPhysicalActivity Practice Management, 20 resilience andburnout:canyoumake theswitch?. Nedrow, A.,Steckler, N. A.,&Hardman, J. (2013).Physician Kingdom: Edward ElgarPublishingLtd. organizational health (Eds.), wellness programs. InR.J. Burke andA.M. Richardsen healthy habitsandhealthbehaviorchangeincorporate Morris CW, MorrisCD(2014). Chapter10:Increasing Guilford Press. helping peoplechange,Thirdedition. Miller, W. R.,&Rollnick, S. (2012). 979-990. of alcohol andotherdrugproblems. Miller, W. R.(1998).Researching thespiritualdimensions Abuse Treatment, 25 public’s demandfor qualitycare? national addictiontreatment infrastructure supportthe McLellan, A.T., Carise,D., &Kleber, H. D. (2003).Canthe burnout. Maslach, C., Schaufeli, W. B., &Leiter, M. P. (2001).Job 33 occupation intheNational HealthInterviewSurvey. prevalence of shortsleepduration byindustryand Luckhaupt, S. E.,Tak, S., &Calvert,G. M. (2010).The coping. Lazarus, R.S., &Folkman,S. (1984). mindfulness. Langer, E.J., &Moldoveanu,M. (2000).Theconstruct of 14 substance usedisorders. Co-morbidity of smokinginpatients withpsychiatric and Kalman, D., Morissette,S. B., &George, T. P. (2005). (2), 106-123. (2), 149-159. Corporate wellnessprograms: Linking individualand New York: SpringerPublishingCompany. Annual Reviewof Psychology, (2), 96-108. Scandinavian Journalof Work, Environment & Journal of SocialIssues,56 Scandinavian Journalof Medicine& Clinical supervisioninalcoholand (2) 117-121. (S3), 1-72. (pp.215-240). Gloucestershire, United JAMA, 276

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26 (3), 1-12. (3), 1-12. 42 Appendix Section 3 Section 2 Section 1 Introduction en/?platform=hootsuite who.int/dietphysicalactivity/factsheet_recommendations/ World HealthOrganization. Retrieved from recommendations onphysicalactivityfor health.Geneva: World HealthOrganization [WHO](2010).Global 1442. exercise program. physician trainees:Theeffect of ateam-based,incentivized Physical activity, qualityof life, andburnoutamong Shanafelt, T. D., Olsen,K.D., &Laskowski, E.R.(2013). Weight, C. J., Sellon,J. L.,Lessard-Anderson, C. R., 78-89. epidemiological evidence. & Travis, R.C. (2011).Shiftworkandchronic disease:The Wang, X.S., Armstrong, M. E.G., Cairns,B. J., Key, T. J., North America, comorbidity inaddictivedisorders. Wadland, W. C., &Ferenchick, G. S. (2004).Medical

27 (4), 675-687. Mayo ClinicalProceedings, 88 Occupational Medicine,61 Psychiatric Clinicsof http://www. (12), 1435- (2), Work andWell-Being: AGuide for AddictionProfessionals 43 Appendix Section 3 Section 2 Section 1 Introduction Date: Building/Address: Worksite: Created bytheBehavioral Health&Wellness Program, University of Colorado,2015 Workplace Environmental Scan Appendix Building Structure Name/Contact for SiteVisitGuide: Number of peopleemployedattheworksite: Comments Comments Secure Access for majorityof building Receptionist orCheck-Infor Visitors Singleentrance Security Comments Attractive Reminder signtotake stairs Convenient Unlocked Stairwells: Is worksiteallorpartof building? Number of floors conducted in allbuildings? one building,istheinterventionbeing If theworksiteislocated inmore than (verify aheadof sitevisit,ifpossible) Number of buildingsat theworksite Automatic doors&elevators Ramps isnotaformal determination) (This Compliance ADA ______Time: ______No. = o o o o o o o o No. = o o o Yes Yes Yes Yes Yes Yes Yes All Yes Good Good ______Observer: o o o Fair Fair o o o o o o o o Part No No No No No No No No o o Poor Poor

Work andWell-Being: AGuide for AddictionProfessionals ______

44 Appendix Section 3 Section 2 Section 1 Introduction Rest Rooms Comments Comments Hand washingSign Stalls Comments Scales Showers Changingrooms Options Comments Toiletries Available Pleasant/Inviting Comments Cleanliness Comments Water Fountain Seat covers available handrails,etc. Hooksonstalldoors Adequate size andnumber ADA accessible stall,wideraccess,

o o o o o o o o o o o o Good Good Good Good Yes Yes None None None Good Good Good o o o o o o o o o o Fair Fair Fair Fair One One One Fair Fair Fair o o No No o o o o o o o o o o Poor Poor Poor Poor Poor Poor Poor AFew AFew AFew Work andWell-Being: AGuide for AddictionProfessionals o o o Many Many Many 45 Appendix Section 3 Section 2 Section 1 Introduction Room Comments Generalscent/smell of place Healthyplants Interior Natural Light Lamps/Alternative Lighting OverheadLighting Lighting Comments products displayed,magazines,etc. Messaging (suchasTVprogramming, Comments Financial Services (401k, credit union,etc.) Training Opportunities/Career Advancement Tobacco Cessation Nutrition PhysicalActivities Signs/BulletinBoards Comments Artwork Condition Walls &Flooring Comments Accommodates different bodytypes Condition Furniture Comments Staff Secure Area for Personal Belongingsof Comments Cleanliness o o o o o o o o o o o o o o o o o Good Good Good Good Good Good Good None None None None None None Good Good Good Good o o o o o o o o o o o o o o o o o Fair Fair Fair One One One One One One Fair Fair Fair Fair Fair Fair Fair Fair o o o o o o o o o o o o o o o o o Poor Poor Poor Poor Poor Poor Poor Poor Poor Poor Poor AFew AFew AFew AFew AFew AFew Work andWell-Being: AGuide for AddictionProfessionals o o o o o o Many Many Many Many Many Many 46 Appendix Section 3 Section 2 Section 1 Introduction Not applicable(there isnofitnesscenter) Fitness Center Comments Comments Condition Treadmills Comments Volume Programming Music Volume Programming Number Televisions (for running/walking) exercising, etc. OpenSpaces availablefor stretching, Crowded Environment Comments Diverseclasstypes Available onsite Classes Comments Condition Strength trainingequipment/Free weights Comments Condition Elliptical Machines Condition Bikes

Accessible totheoutdoors o Hoursof operation: o o o o o o o o o o o o o o o o o o o o o o o Good None Good None Good None Good Good Good Good Good None Good Good Good Good Good Good Good Good None Good None o o o o o o o o o o o o o o o o o o o o o o o One One Fair Fair One One One One Fair Fair Fair Fair Fair Fair Fair Fair Fair Fair Fair Fair Fair Fair Fair o o o o o o o o o o o o o o o o o o o o o o o Poor Poor Poor Poor Poor Poor Poor Poor Poor Poor Poor Poor Poor Poor Poor Poor Poor AFew AFew AFew AFew AFew AFew ______Work andWell-Being: AGuide for AddictionProfessionals o o o o o o Many Many Many Many Many Many 47 Appendix Section 3 Section 2 Section 1 Introduction Not applicable(there isnocafeteria orsimilarother) (e.g., canteen,on-sitesandwichshop,food vendor, lunchcart) Cafeteria (orOtherResource that SubstitutesforaCafeteria) Healthy Optionsavailable Appropriate portionsize Comments Fresh Vegetables Fresh Fruits Diversity of food o o o o o Good Good Good Good Good o o o o o o Fair Fair Fair Fair Fair o o o o o Poor Poor Poor Poor Poor Work andWell-Being: AGuide for AddictionProfessionals 48 Appendix Section 3 Section 2 Section 1 Introduction Not applicable(there isnolunch/break room) Lunch Room /BreakRoom Comments Comments Cleanliness Condition Other ovensortoasters Cleanliness Condition Microwaves Comments Low-Fat/Low Sugar/Low CalorieSnacks Nuts ChipsCrackers Candy Fruit Juice DietSoda/Juice Regular Soda Bottledwater Vending Machine Comments Financial Services (401k, credit union,etc.) Training Opportunities/Career Advancement Tobacco Cessation Nutrition PhysicalActivities Signs/Bulletin Boards Comments Cleanliness Condition Seating inornearthefood preparation area Comments Cleanliness Condition Sink Comments Cleanliness Condition Refrigerator/Freezer o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o Good Good None Good None Good Good None Good Good None None None None None None None None None None None None None None None None Good Good None Good o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o One Fair Fair One One One One One One One One One One One One One One One One One One One Fair Fair Fair Fair Fair Fair Fair Fair o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o Poor Poor Poor Poor Poor Poor Poor Poor Poor Poor AFew AFew AFew AFew AFew AFew AFew AFew AFew AFew AFew AFew AFew AFew AFew AFew AFew AFew AFew AFew Work andWell-Being: AGuide for AddictionProfessionals o o o o o o o o o o o o o o o o o o o o Many Many Many Many Many Many Many Many Many Many Many Many Many Many Many Many Many Many Many Many 49 Appendix Section 3 Section 2 Section 1 Introduction Grounds andParking Comments Racksinsidethebuilding Racksoutsidethebuilding Bicycle Parking Comments Adherence tofacilitytobacco policies areas, etc. Signage Designated SmokingArea Tobacco Free Facility? Tobacco Policy Comments Appealing? Shaded? activities Picnic Tables for lunch/breaks/employee Comments Landscaped Walking path onoradjacent togrounds physicalactivity Openspace/Large grassyarea for Basketball Hoops Volleyball Court Grounds Comments securitymeasure) Parkingiswell-lit Parkingisconvenient toworklocation Vehicle Parking Emergency call-boxes (orequivalent Proximity tobuildingentrances, other o o o o o o o o o o o o o o o o o o o o None None None Good Good Good Good Good Good Yes Yes Yes Yes Yes None Yes Yes Yes Yes Yes o o o o o o o o o o One One One One Fair Fair Fair Fair Fair Fair o o o o o o o o o o No No No No No No No No No No o o o o o o o o o o Poor Poor Poor Poor Poor Poor AFew AFew AFew AFew Work andWell-Being: AGuide for AddictionProfessionals o o o o Many Many Many Many 50 Appendix Section 3 Section 2 Section 1 Introduction What istheapproximate distancefrom theworksite (inmiles)tothenearest: Site description:Rural Community Restaurants orfastfood outlets: Town, downtownorcity: Comments Fitness Facility/Recreation Center Comments Athletic Field Open-space/ Large grassy area/ Comments Grocery stores Comments Ethnic/Family Restaurants Comments Café, deli’s,cafeteria Comments high fat foods: Fast food chainoutlets--featuring Comments Sidewalks Comments Bike Lanes/Traffic/ Masstransit Comments Park orothernatural area: ______Suburban ______Urban ______o ______o o o o o o o None None None None None None None None ______Miles Miles Miles o o o o o o o o One One One One One One One One o o o o o o o o AFew AFew AFew AFew AFew AFew AFew AFew Work andWell-Being: AGuide for AddictionProfessionals o o o o o o o o Many Many Many Many Many Many Many Many 51 Appendix Section 3 Section 2 Section 1 Introduction ______Note anyrelevant comments that theemployeemadewhilefacilitating thetour: Observations/Interactions ______Conclusion/Comments: ______Observe anyinteractionsamongststaff, staff &customers/clients,vendors,etc.: ______Work andWell-Being: AGuide for AddictionProfessionals 52 Appendix Section 3 Section 2 Section 1 Introduction Items AboutYou week. Thenfollow thescoring directions at theendof theself-test. situation. Write inthenumber that honestlyreflects howfrequently youexperienced thesecharacteristicsinthelast satisfaction withhelpingothers.Considereachof thefollowing characteristicsaboutyouandyourcurrent compassion status: howmuchat riskyouare of burnoutandcompassion fatigue andalsothedegree of compassion for thoseyouhelphasbothpositiveandnegative aspects.Thisself-testhelpsyouestimate your Helping othersputsyouindirect contact withotherpeople’slives.Asyouprobably haveexperienced, your Compassion Satisfaction/Fatigue Self-Test for Helpers 0=Never 1=Rarely 2=AFewTimes3=Somewhat Often4=Often5=Very Often 24. 23. 22. 21. 20. 19. 18. 17. 16. 15. 14. 13. 12. 11. 10. 9. 8. 7. 6. 5. 4. 3. 2. 1.

I thinkthat there isno onetotalkwithabouthighlystressful experiences. I thinkthat I need more closefriends. I thinkthat I need to“workthrough” atraumatic experience in mylife. I havehadfirst-handexperience withtraumatic eventsin mychildhood. I havehadfirst-handexperience withtraumatic eventsin myadultlife. have hadfirst-handexperience withtraumatic eventsinmy adultlife. I havegoodpeersupportwhenneedtoworkthrough ahighly stressful experience. I I haveflashbacks connected tothoseIhelp. I amasensitiveperson. While workingwithavictim,Ithoughtaboutviolence against theperpetrator. I startleeasily. Iamthepersonalwayswantedtobe. I haveoutburstsof angerorirritabilitywithlittleprovocation. I havedifficultyfallingorstayingasleep. I believethat Ihaveagoodbalance betweenmyworkandfree time. I feel calm. I feel connected toothers. I havegapsinmymemoryaboutfrighteningevents. experience. I findmyselfavoiding certain activities orsituations becausethey remind me of afrightening I force myself to avoidcertain thoughtsorfeelings that remind meof afrighteningexperience. I findthat Ilearnnewthingsfrom thoseIcare for. I feel estrangedfrom others. I havebeliefsthat sustainme. I findmylife satisfying. I amhappy. Work andWell-Being: AGuide for AddictionProfessionals 53 Appendix Section 3 Section 2 Section 1 Introduction 0=Never 1=Rarely 2=AFewTimes3=Somewhat Often4=Often5=Very Often 50. 49. 48. 47. 46. 45. 44. 43. 42. 41. 40. 39. 38. 37. 36. 35. 34. 33. 32. 31. 30. 29. 28. 27. 26. 25. I like my workasahelper. I feel that somepeople Ihelpdislike mepersonally. I havebeenindangerworkingwithpeoplehelp. Some peopleIhelpare particularlyenjoyabletoworkwith. I wishthat Icould avoidworkingwithsomepeopleIhelp. certain peopleIhelp. I havefelt “on edge”aboutvariousthingsandIattribute thistoworkingwith I haveasenseof hopelessnessassociated withworking withthoseIhelp. I havefelt trappedbymyworkasahelper. I remind myselftobelessconcerned aboutthewell-beingof thoseIhelp. I thinkthat Imightbepositively“inoculated” bythetraumatic stress of thoseIhelp. I thinkthat Imighthavebeen“infected” bythetraumatic stress of thoseIhelp. I havejoyfulfeelings about howIcanhelpthevictimsworkwith. I amlosingsleepoverapersonhelp’straumatic experiences. I ampreoccupied withmore thanonepersonIhelp. with apersonIhelped. I havesuddenlyandinvoluntarilyrecalled afrighteningexperience whileworking helped. I haveexperienced intrusivethoughtsof timeswithespeciallydifficultpeopleI I havehappythoughtsaboutthosehelpandhowcould helpthem. I experience troubling dreams similartothoseIhelp. I amfrightenedof thingsapersonIhelpedhassaidordonetome. I feel invigorated after workingwiththoseIhelp. Working withthoseIhelpbringsmeagreat dealof satisfaction. I haveconcluded that Iworktoohard for myowngood. I havethoughtsthat Iama“success” asahelper. I havefelt depressed asaresult of myworkasahelper. I havefelt weak,tired, rundownasaresult of myworkashelper. I feel like Ihavethetoolsandresources that Ineedtodomyworkasahelper. Work andWell-Being: AGuide for AddictionProfessionals 54 Appendix Section 3 Section 2 Section 1 Introduction Items AboutBeingaHelperandYour HelpingEnvironment 0=Never 1=Rarely 2=AFewTimes3=Somewhat Often4=Often5=Very Often 66. 65. 64. 63. 62. 61. 60. 59. 58. 57. 56. 55. 54. 53. 52. 51. I plantobeahelperfor alongtime. I havetodealwithbureaucratic, unimportanttasksinmyworkasahelper. I havethoughtsthat Iamnotsucceeding at achievingmylife goals. Ihavethoughtsthat Iama“failure” asahelper. role asahelper. I haveasenseof worthlessness/disillusionment/resentment associated withmy protocols. I ampleasedwithhowabletokeep upwithhelpingtechniquesand I finditdifficultseparating mypersonal life frommyhelper life. those Ihelp. Although Ihavetodopaperworkthat Idon’tlike, Istillhavetimetoworkwith I feel Iamworkingmore for themoney/prestige thanfor personalfulfillment. I ampleasedwithhowabletokeep upwithhelpingtechnology. I feel littlecompassion toward mostof myco-workers. I trustmyco-workers. My co-workers candependonmefor helpwhentheyneedit. I dependonmyco-workers tohelpmewhenIneedit. I enjoymyco-workers. I amunsuccessful at separating helpingfrom personallife. Work andWell-Being: AGuide for AddictionProfessionals 55 Appendix Section 3 Section 2 Section 1 Introduction Brunner/Mazel] [Adopted byB. Stammandincluded inachapterC. R.Figley(Ed.) (inpress), Treating CompassionFatigue. Philadelphia: Satisfaction/Fatigue Self-Test for Helpers Scoring Instructions:Compassion for eachsetof itemsandnote: Add thenumbersyouwrote nexttotheitems 16, 18, 20-22,28, 29, 31-34, 36, 38-40and44. Circle thefollowing 23items:4, 6-8, 12,13, 15, 25, 41, 42,45, 48, 49, 51,56, 58,60, 62-65. Put acheckbythefollowing 16items:17, 23- 57, 59, 61,66. 14, 19, 26-27, 30, 35, 37, 43, 46-47, 50, 52-55, Put anxbythefollowing 26items:1-3, 5, 9-11, Mark theitemsfor scoring: Be certain yourespond toallitems. as aguide,notconfirmatory information. scale andthefollowing scores shouldbeused Please notethat research isongoingonthis Extremely Low/Low Moderate High/Extremely Level of Risk Chart bycircling theappropriate score categories belowfor yourassessedlevelof risk.

32 orless 34 –50 51 ormore Level Burnout

30 orless 31 –35 36 ormore (CF)Level Compassion Fatigue 34-50 =moderate risk51-75 =highrisk 33-37= low risk 32 orless=extremely low risk Your riskfor Burnout (check): 63 =low potential 64-81 =modestpotential below 82-99 =goodpotential 100-117 =highpotential 118 andabove =extremely highpotential Your potential for Compassion Satisfaction (x): 41 ormore =extremely highrisk 31-35 =moderate risk36-40 =highrisk 27-30 =low risk 26 orless=extremely low risk Your riskfor Compassion Fatigue (circle): 76-85 =extremely highrisk

Work andWell-Being: AGuide for AddictionProfessionals 63 orless 64 –81 82 ormore Level Satisfaction

56 Appendix Section 3 Section 2 Section 1 Introduction