Substance Abuse and Dependence
Using substances to modify mood or behavior is generally regarded as normal and acceptable in our society. Many people drink coffee or tea for the stimulant effects of caffeine, or engage in the social drinking of alcohol. Certain drugs may be used medically to relieve tension or pain or to suppress appetite. When usage becomes excessive—or when the symptoms and behavioral changes associated with regular use of these substances becomes maladaptive—substance use becomes substance abuse or dependence.
Substance abuse—the misuse of alcohol and legal drugs or the use of illegal drugs—is by far the predominant cause of premature and preventable illness, disability and death in our society. Five to ten percent of American adults have a serious alcohol problem, and one to two percent have a serious problem with illegal drugs; many other abuse prescription drugs. Two to five times more males than females are heavy drinkers or drug abusers, and alcohol and drug abuse affect an estimated 15.5 million Americans. When the effects on the families of abusers and the victims of intoxicated drivers are considered, such abuse affects millions more.
substance abuse | substance dependence |
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Substance Dependence includes all the symptoms of abuse, but with additional features that develop after a period of consistent use of the substance:
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Causes of Substance Abuse
Society has, in the past, viewed alcoholism and drug abuse as a sign that a person lacked discipline or morality. Current research has shown however, that the causes of substance abuse are multifaceted, involving psychological, environmental, biological and cultural factors. Treatment of substance abuse and dependence includes a variety of therapies geared toward abstinence and designed to approach the illness from all vantage points.
How Do I Know if I Have a Problem?
If you are unsure whether you have a problem with alcohol or drugs, the following survey is a useful guideline. One positive response suggests a problem with your usage; two or more positive responses indicates probable substance abuse or dependence.
- Have you ever felt the need to cut back on your drinking or drug use?
- Have you ever felt annoyed by someone criticizing your drinking or drug use?
- Have you ever felt bad or guilty about your drinking or drug use?
- Have you ever had a drink or used drugs first thing in the morning to steady your nerves or get rid of a hangover?
Effects in the Workplace
In addition to the damaging effects on health, family, and personal functioning, drug and alcohol problems may influence work performance and professional relationships. The impact on productivity, morale, and career development can be significant, both for people with a problem and for those who work with them. The following list includes signs and symptoms that employees with substance problems may exhibit on the job.
Excessive Absenteeism and/or Tardiness |
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Declining or Impaired Productivity |
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Poor Concentration and Confusion |
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Avoidance of Responsibility for One's Actions |
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Poor Working Relationships |
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Persistent Mood Swings |
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High Accident Rate |
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Poor Personal Appearance |
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What Supervisors Can Do
A supervisor can help by directly addressing work performance problems with an employee. Supervisors should leave the diagnosis of alcoholism and drug addiction to the professionals; many signs and symptoms of alcoholism can be caused by other problems, and a misdiagnosis can be harmful. It is important, however, to be alert to patterns of impaired work performance that might indicate that an employee is experiencing personal difficulties that require professional assistance.
It is essential to let the employee know what is expected, and to suggest that the employee see professional help if the problems are serious. Supervisors are responsible for implementing the controlled substance and alcohol policy of the institution they work for; they are urged to consult with their employee relations representative or with the Stanford Faculty Staff Help Center for advice on issues regarding substance abuse in the workplace.
What Friends, Family and Co-Workers Can Do
Friends, family and co-workers can unwittingly become "enablers" to the substance abuse—that is, they can shield and protect the abuser from experiencing the full impact of the consequences of abuse. For example, a family member might call in to work to report that someone is sick when the real problem is a hangover. A co-worker might cover up for an abuser's mistakes, or might do part of the abuser's work for him. A friend might laugh at a person's account of his or her weekend binge, rather than expressing concern and pointing out the problem. Substance abusers often need to "hit bottom" or experience the painful consequences of their behavior before they decide to seek help. Those close to substance abusers can help most by refusing to make excuses for, cover up for, or protect the abuser, and by expressing concern and suggesting professional help. They may themselves benefit from counseling or support groups such as Al-Anon.
Finding Help
There are many resources available for individuals who are concerned about their alcohol and drug use, as well as for those whose lives are being affected by someone with a substance abuse problem. All employees enrolled in the health benefit plans of Stanford University, Stanford Health Services, Lucile Packard Children's Hospital, and SLAC have insurance coverage for the treatment of substance abuse. Contact your benefits department for specific information about your coverage.
The Stanford Faculty Staff Help Center (FSHC) is an employee assistance program that provides free confidential counseling, assessment and referral to all faculty, staff and their immediate family members. The Stanford Alcohol and Drug Treatment Center offers program for both inpatient and outpatient treatment.
There are also numerous self-help and twelve-step groups, such as Alcoholics Anonymous, which meet regularly in the local area and are open to anyone seeking assistance with drug or alcohol problems. For assistance with locating the right resource, you may contact FSHC, your physician or the resources listed below.
counseling and referral | Twelve Step programs |
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Stanford Faculty Staff Help Center(650)723-4577 |
Alcoholics AnonymousSanta Clara County: (408) 374-8511 San Mateo County: (650) 342-2615 View Alcoholics Anonymous website Al-AnonSanta Clara County: (408) 379-1051 San Mateo County: (650) 873-2356 |
Stanford University Policy on Controlled Substances and Alcohol