Supporting Employees with Substance Use Disorder (SUD): A Guide for Employers

Introduction

Supporting Employees with SUD

Questions and Answers

Introduction

An estimated 46 million Americans aged 18 or older experience substance use disorder (SUD). Nearly two-thirds of this population, 30.1 million, are employed. Employees with SUD, both treated and untreated, work across various sectors, industries, and sizes of employers. Employers who effectively respond to substance use in the workplace and work to hire, onboard, retain, and advance people in recovery from SUD benefit from an expanded labor pool, increased worker well-being, decreased turnover, improved productivity, and reduced health care costs. 

Employers are uniquely positioned to address SUD in a way that benefits them and the nation’s economy. This document supports employers in developing recovery-ready workplace (RRW) policies and provides information to help them address substance use in their workforce.

What is SUD?

SUD is a health condition that involves the recurrent use of alcohol and/or drugs in a way that causes impairment. SUD is described by the Substance Abuse and Mental Health Services Administration (SAMSHA) (PDF) as “impairment caused by the recurrent use of alcohol or other drugs (or both), including health problems, disability, and failure to meet major responsibilities at work, school, or home.” SUD is a “treatable [condition] that affects a person’s brain and behavior, leading to their inability to control their use of substances like legal or illegal drugs, alcohol, or medications.” SAMSHA classifies people who used alcohol or drugs in the past 12 months as having SUD if they met criteria specified in the APA's Diagnostic and Statistical Manual of Mental Disorders, 5th edition.

Commonly known SUD subsets focus on specific types of substance use:

• Opioid use disorder (OUD): OUD refers to the “problematic use of opioids causing significant impairment or distress” and is classified as a public health emergency in the United States.
• Alcohol use disorder (AUD): AUD is “a medical condition characterized by an impaired ability to stop or control alcohol use despite adverse social, occupational or health consequences.” 

Who is impacted by SUD?

SUD exists across all sectors of society. Many people with SUD also have underlying mental health conditions such as anxiety and depression. According to SAMHSA's 2023 National Survey on Drug Use and Health (PDF), 20.4 million adults aged 18 and older had both SUD and a mental health condition, and 6.8 million adults with SUD had a “serious” mental health condition. Data show that SUD significantly impacts all populations. 

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Supporting Employees with SUD

Are people with SUD protected from employment discrimination? 

According to the Equal Employment Opportunity Commission (EEOC), SUD may be a disability under the Americans with Disabilities Act (ADA). Under Title I of the ADA, employers with 15 or more employees who are private, state government, or local government may have a legal obligation to provide accommodations to people with SUD. Subtitle A of Title II of the ADA prohibits public entities such as state and local governments, regardless of workforce size, from discriminating against people with disabilities in their employment practices. 

The ADA’s nondiscrimination standards also apply to federal sector employees under Section 501 of the Rehabilitation Act (Rehab Act). Section 501 prohibits federal agencies from discriminating on the basis of disability and requires them to provide reasonable accommodations. As a part of doing business with the Federal Government, federal contractors and subcontractors must meet certain obligations under Section 503 of the Rehab Act, including not discriminating against qualified job applicants or employees on the basis of disability.

How can employers support and retain employees with SUD?

Fostering a culture in which SUD is recognized as a treatable health condition from which people can and do recover is the first step in creating a recovery-ready workplace. A key to developing this is to provide a seamless accommodation process that results in effective accommodations when needed.

When exploring accommodations for employees with SUD, start by asking the employee for suggestions—employees are often the best resource for practical accommodation ideas. If the employee does not have ideas that work, the Job Accommodation Network (JAN) can help. JAN provides confidential technical assistance on workplace accommodations and related disability employment issues at no cost, which includes offering accommodation ideas for people with SUD.

Another way to support employees with SUD is to provide workplace flexibility, such as telework and flexible scheduling, as a benefit of employment. When flexibility is built-in, employees with disabilities have less need to disclose personal medical information and request accommodations. In addition to providing accommodations through a formal process, workplace flexibility is another way to help promote RRW policies.

Mental health and workplace well-being should also be at the forefront of every employer’s planning. Through collaboration, employers can create mental health-friendly workplaces for all workers. The Employer Assistance and Resource Network on Disability (EARN) Mental Health Toolkit contains information and tools that can help. 

Finally, another way to support employees with SUD is to refer them to available organizational resources, especially when they are undergoing treatment. If you have internal resources such as an Employee Assistance Program (EAP), an employer can remind employees that these options are available.

Do employees with SUD work successfully with accommodations?

Meet Aisha. Aisha is a production worker for a manufacturing company. Aisha asked for a transfer from the night shift to the day shift to attend counseling with her sponsor, who is only available in the evening. The Human Resources Business Partner worked with Aisha’s manager to change the shift and remove the mandatory overtime requirement on days when attending counseling. 

Meet Bryer. Bryer is a package handler for a distribution company. Bryer is in recovery from SUD and experiences anxiety in face-to-face discussions. This prompted Bryer to request a change in management style from his operations manager when providing performance-related feedback. Bryer now receives a written performance review with the option to have a discussion later.

Meet Kiran. Kiran is a substance use counselor with a history of OUD and a mental health condition who approached her supervisor to request an accommodation. Kiran expressed that her disability is exacerbated during specific time periods, e.g., holidays, anniversaries of traumatic events, etc. After working with Kiran to develop her work schedule, the supervisor modified Kiran’s attendance agreement to give her leave during the times requested. Kiran also has the flexibility to request unscheduled leave if needed. 

Meet Riddhi. Riddhi is a sales representative with AUD who faced termination for violating a workplace policy against being under the influence of alcohol when working. As part of a “fair chance offer” of continued employment, Riddhi agreed to seek treatment and undergo periodic alcohol testing for several months after returning to work.

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Questions and Answers

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