Work and Well-Being: A Guide for Addiction 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 Medicine 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 Introduction Introduction Why is a Work & Well-Being Guide for Addiction Professionals Needed? Section 1 The work of an addiction professional can be the agency as a whole due to higher caseloads hard. It can also be very rewarding. We have an and frequently onboarding new employees. opportunity to change the lives of our clients for the better. We often even help save lives. To break this cycle, we all have a responsibility to Our work can be physically, mentally, and take care of our personal well-being. We know emotionally demanding. As we assist others in that healthcare professionals who strive to meet Section 2 their recovery, we are dealing with complex their own wellness needs not only report being problems. We work with our clients around their happier and healthier, but also provide higher addiction as well as their medical, legal, family, quality care to clients (Shanafelt et al., 2003; housing, and employment issues. It is easy to Shanafelt et al., 2010). If we are to lead balanced get overwhelmed by clients’ needs or by the lives and maximize our effectiveness at work, sheer number of people we are trying to treat. it is essential that agency leadership promotes wellness, and that staff advocates for and takes Section 3 Over time, high relapse rates among clients can advantage of wellness opportunities. also be a drain on our empathy (Rothschild & Rand, 2006). Given the intensity of our work, To create a healthy workplace, agencies when we fail to pay attention to our own and employees need to work together. It is well-being, we are at risk for “burnout” or a towards this end that the Central East Addiction secondary stress disorder commonly referred Technology Transfer Center (Central East) has Appendix to as “empathy exhaustion” or “compassion developed this self-care guide for addiction fatigue” (Figley, 1985). And burnout, among professionals. This guide offers evidenced- other factors, can lead to extremely high staff based, practical strategies and resources to turnover rates (McLellan et al., 2003). This can promote healthy lifestyles and productive generate more stress for the remaining staff and professional lives. It is intended to assist agencies to create supportive work environments as well as provide guidance to employees on enhancing their own well-being. This icon designates activities and worksheets in this guide that designed to support your well-being. Take time to complete these activities. The information you gain can provide insight and awareness, direct your focus, and guide your actions. Work and Well-Being: A Guide for Addiction Professionals 4 Introduction Section 1: Common Workplace Stressors Addiction professionals face many challenges, way they did. Addiction professionals who are in and burnout can be caused by a variety of recovery must be mindful of the risks this work Section 1 factors (Maslach et al., 2001): has for their own recovery and must ensure their own self-care plan is in place. Importantly, Job-related factors such as having too much working as an addiction professional may to do and not enough time to do it, working be rewarding on many levels but it does not with too many clients or many clients with constitute a personal plan of recovery. highly complex issues, paperwork and client Section 2 records, facing competing demands at work, Comorbidity being treated disrespectfully, interactions with co-workers, lack of freedom to practice or make Because of the nature of addiction, there is a career decisions autonomously. high rate of co-morbidity with other chronic illnesses (e.g., Dickey et al., 2002; Wadland Organizational factors including chaotic work & Ferenchick, 2004). Professionals who are environments, high staff turnover, insufficient also in recovery may be dealing with other Section 3 agency funding and resources, fragmented chronic diseases or infections as a result of treatment settings, lack of adequate and their past drug use. Most of these conditions appropriate supervision, high productivity are manageable but may impact an individual’s expectations, inappropriate or insufficient ability to perform their professional duties. Such feedback about performance. conditions require regular, ongoing medical management, potentially necessitating time off Appendix Personal factors like emotional exhaustion, the job for medical appointments. which can occur when addiction professionals frequently work with low functioning clients, Tensions can also arise as employees who are not experience incongruence between their confronted by such health issues are repeatedly individual values and those of their employer, asked to cover shifts and responsibilities of possess low levels of resiliency, employ a passive colleagues who must frequently address their communication style, or are new to their jobs. medical conditions. Personal History of Recovery Addiction professionals also continue to smoke at much higher rates than other healthcare Many addiction professionals come to the field professionals, which may lead to increased rates as a result of their own experience with addiction, of chronic disease (U.S. Department of Health with at least half of addiction counselors in and Human Services [USDHHS], 2014). The their own recovery (Center for Substance Spotlight Section later in this document provides Abuse Treatment [CSAT], 2006). This personal further details regarding addiction professionals’ perspective can result in unique and valuable high prevalence of tobacco use. insight and empathy. However, it can also put those in recovery at risk of relapse. Every day, addiction counselors work with people who are struggling with addiction in much the same Work and Well-Being: A Guide for Addiction Professionals 5 Introduction Treatment Boundaries Addiction professionals confront boundary Symptoms of Burnout Section 1 issues on a daily basis. Persons with addictions often have poor boundaries and addiction When one or more stressful factors are professionals are continuously asked to present, addiction professionals may assess the ethics of therapeutic relationships. quickly become frustrated or dissatisfied Employees need to know how much of with their work. Healthcare professionals who report less satisfaction with their work themselves they can give to clients and the Section 2 extent to which they can help them. Burnout also report (Maslach et al., 2001; Shanafelt can directly result from a lack of appropriate et al., 2012): boundaries (Rothschild & Rand, 2006). • Missing work frequently • Impaired concentration and Symptoms of Burnout attention • Lower levels of productivity Section 3 • Leaving the profession or retiring early • Anxiety • Depression • Irritability Appendix • Lower self-esteem • Chronic fatigue • Illegal drug use, problematic alcohol or prescription drug use • Sleeping pattern changes • Detachment from patients, colleagues, family, and friends • Feelings of isolation • Experiencing dread before going to work • Suicidal ideation Work and Well-Being: A Guide for Addiction Professionals 6 Introduction Section 2: How Agencies Support Well-Being Goal of Section 2 — Identify ways agencies can reduce stress Section 1 in the workplace and support well-being of employees There are numerous benefits to promoting well-being in the workplace. Employees who are physically, emotionally, and mentally healthy are more productive, perform better, and are absent less often than other employees (Aldana, 2001). Agencies can play an important role in encouraging a culture and climate that facilitates self-care. The efforts of agencies to promote well-being in the workplace must Section 2 focus on all employees, including (but not limited to) support staff, provider extenders, maintenance staff, and security. Every agency is unique; each has different strengths, resources, and needs. No single approach to worksite well-being will work in all workplaces. However, there are generally effective approaches that agencies should consider. Section 3 SPOTLIGHT SECTION A Model for Whole Health There exists a variety of wellness models. • Environmental Wellness involves living Wellness is not just the absence of illness, and working in environments that are Appendix but a personal journey toward living the most clean, safe, healthy, and facilitate a meaningful life possible.