Canadian Centre on Substance Abuse 75 Albert Street, Suite 300

Ottawa, ON Canada K1P 5E7

Interventions To Assist Small Businesses: A literature review for the International Labour

Organization

May, 1997

Summary

There is need to give further attention to small business substance abuse issues by virtue of (i) the sheer numbers of enterprises and workers that they represent, and (ii) the likelihood that both owners and employees in these businesses are at higher risk for health and substance abuse problems.

Sustaining a small enterprise in today's global economy is a daunting exercise. A preoccupation with business survival often means that substance abuse gives way to more "bottom line" issues for the owner/manager’s attention. No business is immune to problems associated with substance abuse, however, smaller enterprises may be at particular risk due to these very conditions of work, a lack of awareness of the issues, relatively fewer resources to deal with these problems, and a generally low priority on human resource development.

There are few examples of sustained, effective action in this area to refer to, however, the extant literature suggests that small business action requires creative, and possibly, unconventional measures. For example, rather than seeking to provide comprehensive supervisor training, the intervenor may be more effective in consulting or coaching over the phone (or over a cup of coffee!). Important for any action involving small business on substance abuse is the need for less formal, inexpensive and easily accessed options that are problem-focused.

Some type of incentive helps to capture the interest of owners. Positive incentives in support of business development, such as workers compensation or insurance rebates are preferable to imposed regulatory or corporate requirements. Getting the small business owner’s attention on this issue also requires an overarching environment that promotes health and safety. The value of a "champion" from the sector to mobilize businesses in a way that helping agencies cannot, shouldn’t be overlooked.

Given that members of any small business community will be at various stages of readiness to act on this issue, some mix of community awareness, information and access to resources is important.

Methodology

The literature on small business and substance abuse interventions is scant. Beyond the specific literature on small business substance abuse, selected health promotion, health and safety and general workplace substance abuse literature was referred to for possible application to small business substance abuse interventions. The search included scientific and non-scientific English literature (predominantly Canadian and US) and was supplemented by key informant discussion. Because much of the literature is in the form of industry commentary with only a few scientific studies reported, and because sustained, evaluated projects in this sector are rare, caution must be exercised in identifying the best approaches to supporting small business activity. There is much to yet learn.

Databases Searched:

• CCSADOCS • CANBASE • Canadian business and current affairs (CBCA) abstracts 1993-96 • NCADI (US National Clearinghouse on Alcohol and Drug Information) • ILO docs • ETOH (NIAAA) • Drug Info/University of Minnesota • Cork/Dartmouth

Understanding the small business environment

Small business is pervasive in all economies. In Canada, for example, small enterprises constitute 97% of the businesses and are most likely to be found in the construction, retail, business services and manufacturing sectors (Industry Canada, 1995). The sector is also very diverse in terms of: (a) size, culture and dynamics of the enterprises, and (b) the level of substance abuse-related risk or sensitivity associated with their work. And, with their size and composition, will vary the extent to which family dynamics merge with organizational dynamics.

Regardless, many communities and countries see small enterprises that are quick to take up innovation and respond to market opportunities as being increasingly important "engines" to their economies. Small companies that fulfill this promise and thrive in the current competitve environment will be

companies that place a premium on human resources and product/service quality. The prevention and intervention of substance abuse problems is an important aspect of human resource management that will need to be taken up by small business to a much greater extent than is presently the case. However, there are a number of traits shared by many small businesses, the owners and their employees that present challenges to those interested in mobilizing them.

General characteristics of the sector:

• higher accident rate (COH&S, 33/1, 1995) • generally lack money/resources (Williams et al., 1996) • social distance tends to be less between owner and workers (Pyke, F

Henriques, M, 1997) • often provide less training (COH&S, 33/1, 1995) • often in higher risk industries in terms of health and safety (Jack, 1991) • often involve remote work sites that are difficult to supervise (Eakin,

1995) • less likely to be networked, more difficult to reach and communicate with

(Williams et al., 1996, Eakin, 1995) • turn over and dismissal rates tend to be higher (Stanworth and Curran,

1989) • less able to access information and resources on h&s issues (Williams et

al., 1996) • unlikely to be unionized, so lack this source of advocacy on h&s (Eakin,

1995) • generally slip through h&s regulations because of lack of enforcement

capacity • less likely to comply with h&s legislation (COH&S, 33/1, 1995) • utilize informal control systems based on relationships rather than on

rules (Williams et al., 1996)

General characteristics of the employees

• often are younger people who are at higher risk in terms of alcohol/drug problems (Eakin, 1992)

• tend to be part time and short term workers with less experience, less knowledge of their rights and responsibilities in this area (Eakin, 1992, Jack, 1991)

• there may be illiteracy or language barriers (Eakin, 1992) • employees may be too intimidated to speak out on health and safety

concerns (Eakin, 1992) • generally have a higher accident rate (Eakin, 1992) • often have skills that are easily transferable (Bennett, 1996)

General characteristics of the owner/manager

• value independence and autonomy (Williams et al., 1996) • reluctant to seek outside advice (Williams et al., 1996)

• dislike government bureaucracy and paperwork (Williams et al., 1996) • lack of time to give to anything but emergencies, crises; preference for

short cuts Williams et al., 1996) • health and safety not a priority (Eakin, 1992) • less likely to see a role for themselves in rehabilitating workers

(Hunneycutt, 1989)

Drawing away from a single profile of the owner/manager, Shain et al (1997), hypothesized that owners respond to employee problems in different ways that could be predicted. They found that owners approached employee problems from one of three major perspectives:

1. from a highly individualistic perspective that generally places profits over people;

1. from a philanthropic perspective placing importance on employee/employer relations;

2. from a balanced, pragmatic perspective focused on what works.

The authors suggest that both ends of the continuum could pose difficulties for the owner when problems with employees arise. Owners who terminate workers without due cause and process risk legal violations, while those who become immersed in an employee's problems risk personal burn out and productivity concerns.

The size of small businesses means that they are more likely to assume many of the personal characteristics of the owner (Bennett, 1993). For this reason, and the fact that unions are not prominent in this sector, the owner/manager is seen as a key determinant of worker health (Eakin, 1992). In this context, the perspective of the owner/manager and their readiness to take action or receive support in this area is extremely important. Most initiatives recognize this "gatekeeping" function and target the owner/manager with their initiatives (see for example, Quartarone, 1996). The risk of doing so is obvious - an inherent management bias in the initiative - and needs to be guarded against (Eakin, 1995).

Orientation and Awareness

There is evidence that small business owners do not understand the extent to which their business can be affected by substance abuse and other health, safety and performance problems and are not motivated to become greatly involved. As a sector, small business tends to be poorly informed of health and safety issues (List, 1991). Eakin (1992) reported that businesses that have been inspected, took health & safety much more seriously. However, there is little motivation to become informed arising from regulations because inspection within this sector is, by virtue of their sheer numbers, relatively rare. For example, the New Brunswick Occupational Health & Safety

Commission estimated that more than 80% of the province’s small business population is unawareof health and safety requirements (Jack, 1991). Regarding substance abuse, this group does not generally see itself responsible for dealing with society’s ills or rehabilitating workers (Hunneycutt, 1989).

So, a picture emerges of a "leave it to the workers" approach to health and safety (Eakin,1992). In a study on owner perspectives on health and safety, Eakin arrived at several possible explanations for this response:

Not a priority: because they hadn`t experienced any problems, and were rarely if ever inspected, and because they had many other preoccupations (i.e. getting orders, financing, etc.), it didn’t surface as a priority;

Personal responsibility: the small business culture, characterized by an appreciation for independence, resulted in health and safety issues being regarded as a personal issue that the owner didn't feel was appropriate to intrude on;

Relationship between owner and employees: these workplaces were also characterized by a close relationship between owner and staff (pitching in right along side), and sometimes an actual dependence on a highly skilled worker who might be very difficult to replace; this resulted in owners not feeling that they had legitimate authority for this type of intervention.

This inclination to avoid health and safety issues is worrisome in light of the suggestion that as many as 75% of business failures may be attributable in whole or in part to the impact of workplace (both empoyer and employee) health and safety problems, prominent among which is substance abuse (Shain, 1996).

Regarding substance abuse specifically, managers appear somewhat more aware of problems in their workforce. An Australian study reported 40% of owner/managers were able to cite an example of a situation or concern relating to alcohol or other drugs in the past year (Williams et al., 1996). Hunneycutt et al (1989) found that a third of a sample of small business managers in Louisiana had experienced problems. Lasher, et al, 1993 in a study of businesses of fewer than 500 in the US southeast found that owners generally felt that the problem was significant, but not in their firm. In a study of small businesses in the city of North York, the Addiction Research Foundation found that close to 30% of owners had experienced at least one negative effect from substance abuse in the form of absenteeism, lower productivity, lower morale and safety concerns. Twenty percent indicated that dealing with substance abuse had taken a toll on their own well-being and affected their ability to manage their business.

While there appears to be some appreciation for the impact of substance abuse, there is, for various reasons, less inclination to take action. There is then, significant need to raise the awareness of small business owners concerning substance abuse issues. Williams (1996), in summarizing results of

a small business pilot in south Australia, concluded that strong awareness raising efforts were required to "prepare the ground" for other interventions, such as training.

Given the small business preoccupation with the health of the business, it is important for small business owners to understand that no company is immune from substance abuse and that, given the make up and conditions of their work, some small businesses may be at greater risk for problems. In the ARF small busines project located in North York, Ontario, awareness was raised on the following issues:

• health of employers and employees can affect the success of a small business

• personal problems can affect the well-being of all staff • unresolved problems and stress in the workplace can result in the abuse

of alcohol and other drugs, which in turn could jeopardize safety and impact on productivity

• some small business owners are more skilled than others in recognizing and dealing with employee problems

• there are positive ways to help troubled employees while still maintaining a focus on job performance and the business as a whole

The demonstration project in South Australia (Williams, 1996), developed awareness raising information on the following topics:

• effects of various drugs • legal responsibilities • how to approach problem situations • further contacts for help or advice

Based on the small business focus on business survival, awareness raising information should present a strong business case for taking action in this area (Carr, 1997, HC, 1996). The point of this business case is that action - often simple and inexpensive - to address substance abuse will promote business success by increasing productivity while reducing costs and legal liabilities. A parallel message from the Addiction Research Foundation’s PASE project is that employee development contributes to business development (Quartarone, 1996).

Possible issues to be addressed in a business case:

1. Costs: associated with fatality, injury, absenteeism, lateness, poor performance, employee morale, increased benefits costs, theft, material waste due to negligence, recruiting replacement workers, damage to property/equipment (CCSA, 1996). Shahendeh (1985), points out the cost of replacing workers: (a) obvious costs: search, interviewing, recruitment and training and lower productivity during learning curve of newer employee; and (b) hidden costs: loss of skills, business acumen, corporate history, etc. invested by company.

2. Legal Issues: in relation to health and safety responsibilities, driver liability, alcohol serving liability at company functions, labour arbitration, human rights issues, criminal actions related to possession and trafficking of illicit drugs on company property (CCSA, 1996).

3. Headaches: increased grievances and deteriorating work relationships, lost time and stress on the part of the owner while dealing with these issues may jeopardize the business (Shain, 1997).

4. Government Requirements: for example, to comply with goverment regulations - small transport companies in the US, Canada, and Mexico are required by the US government to drug test drivers who drive in the United States. The Canadian industry has responded by providing one stop shopping for drug testing, supervisor training and EAP services.

5. Corporate Contracting Requirements: increasingly, larger companies are recognizing that they cannot contract away their legal obligations. For example, Imperial Oil Canada is in the process of requiring all sub-contractors to test their risk and safety-sensitive employees. So, those sub-contractors who in turn sub contract, will be obliged to require this of their contractors. This is an international initiative of Esso`s - other oil industry companies are undertaking similar actions (Butler, 1997).

Other points that might be brought out:

1. While the impact of a substance abuse problem is potentially more devastating for a small business, the owner has greater opportunity to take action because: (a) the worker will be harder to hide and easier to identify; and (b) it's easier to shift the corporate culture of a smaller business (CCSA, 1996).

2. A focus on short term (ad hoc) solutions may not be conducive to long term business health. By investing in H&S, substance abuse and personal problems up front, the business will benefit in terms of product quality, employee productivity, and customer satisfaction.

3. As larger firms continue to take strong positions against substance abuse, smaller firms may become "dumping grounds" for substance abusers. Similarly, with several states denying workers compensation benefits to those impaired, firms without policies would attract those workers hoping to avoid detection of impairment (Lasher, 1993).

It is important that this information be clearly and simply stated and be free of technical terms not easily understood by small business owners (Williams, 1996). A Canadian survey of small businesses indicated that much of the H&S information received by small businesses isn’t clear and that respondents would actually be willing to pay for superior information (List, 1991).

The business case message can be disseminated by such means as: making fact sheets available through recognized outlets on an "as needed" basis (Williams, 1996) or; one-stop shopping services utilizing telephone hotlines (Carr, 1993, Quartarone, 1996). Health Canada prepared a kit consisting of photocopiable pull-out sheets to communicate a business case for taking action on HIV/AIDS (Health Canada, 1996).

Lessons learned on orientation and awareness

• many small business owners are not prepared to take action because they are not aware of the issues;

• work in partnership with business groups as credible sources of information;

• awareness messages should be packaged as a business case; • information needs to be simple, focused and free of jargon; • prepare information to address the owner, bearing in mind the interests

of employees; • orient messages/strategies to augment, rather than interfere with, the

flexibility and independence of the owner.

Needs Assessment

Because particular circumstances vary, and because any intervention with small business must cater to specific identified problems or needs, it is important to assess these interests and needs before undertaking activity. Properly conceived needs assessment will also build a rapport between parties that will be important to later success. Needs assessment normally involves a written or live interview survey of a sample of the businesses for whom the intervention is intended. Given the time pressures and unpredictable work patterns experienced by most small business owners, live interviews can be dificult to schedule and need to be as brief as possible. On the other hand, a notorious disdain for paperwork makes response rates for mail-out surveys typically quite low. This rate might be increased by preceding the survey with a flyer introducing the project, as was done by Williams et al (1996). Alternatively, Health Canada (1992) suggest an orientation meeting to determine interest, resources and readiness to take action. The likelihood of strong representation at this type of session would be increased by "piggy-backing" it on an existing business development meeting. Being very clear and simple with aims will require relatively few questions and minimal disruption of the small business owners workday. Also, once a group of small business owners have become engaged, further elaboration on program design may be possible through another survey (Williams et al., 1996).

Lessons learned on needs assessment:

• "prepare the ground" for a survey through introduction from credible source;

• balance the need to know with the time constraints of the small business owner;

• link the assessment to another event or initiative to increase credibility and feedback;

• once businesses have been engaged, more information can be sought from them.

Policies

It is generally recommended that businesses develop substance abuse policies to clarify the company's position on alcohol and other drug use. Corporate policy should address the particular concerns and circumstances of the enterprise and it is recommended that the policy and program be "comprehensive" - that is, embrace employee education, supervisor training, access to assistance and possibly, employee drug testing. It is further recommended that the policy be written, receive input from employees, be well communicated and broadly and consistently enforced. Substance abuse policies, often imbedded in a health and safety policy, are common among large companies (AMA, 1996). For a variery of reasons, company policies aren't nearly so prevalent among smaller enterprises. For example, in a political and corporate environment that values a "drug free workplace" (US southeast), Hunneycutt (1989) nevertheless, found that 75% of smaller (>500) companies surveyed did not have a substance abuse policy.

Smaller companies generally have neither the internal expertise nor the resources to obtain policy development expertise externally. Though a number of surveys of small business owners show approximately 30-40% having experienced an employee substance abuse problem (Williams, 1996, Hunneycutt, 1989, Quartarone, 1996, O-C Small Business Health Committee, 1992), small business owners often feel they can deal with substance abuse problems through their own means (Lasher, 1993). This is consistent with the general level of attention paid to health and safety policy. A survey in the Canadian province of New Brunswick found that 80% of small business owners were not even aware of their legal responsibilities in relation to health and safety.

It is always useful to have "ground rules" or policy worked out and understood by all involved. For small business owners, who as a group, prefer flexibility of action, and dislike "paperwork", a written policy may not be a feasible outcome of a mobilizing strategy, at least initially. A brief written policy could nevertheless be useful in reflecting the importance placed on the issue by the small business owner and guiding action in relation to it. While it is important that the small business owner give some thought and serious committment to any policy development exercise, this effort might be facilitated by a mobilizing partnership who prepare a policy template that would prompt the owner on issues to consider. A case in point is the guide for small carriers that the

Canadian Motor Carriers Consortium has published to assist this sector in complying with US transport regulations (Butler, 1996).

Lessons learned on policy development

• a policy helps to underscore the importance placed on the issue by the owner;

• formal written policy may be beyond the resources or committment to the issue, initially;

• a partnership could help by creating a guide or policy template.

Pre-Employment Screening

In a survey of Louisiana small business owners, Bennett (1993) found that managers expressed confidence in being able to avoid people problems in general by screening these people out in the hiring process. This study, examining practices among small firms of at least 15 employees reported that 37% engaged in pre-employment drug screening. Pre-employment drug testing represents an expense that small business operators may not be prepared, or need, to incur. Small businesses can effectively and inexpensively screen prospective employees by asking references about absenteeism, lateness, patterns of illness and if social lifestyle interfered with their work. When interviewing a candidate, the owner/manager can ask questions to gain insight into the person's attitudes towards alcohol and other drugs and also highlight the importance the company places on this issue (an occasion where a policy would be helpful). While giving the owner important information, this attention to substance abuse within a general concern for health and safety will, no doubt, result in some candidates simply taking themselves out of the job competition. In countries where substance dependence is considered a disability for human rights purposes, care must be taken not to infer alcoholism or drug dependence as a reason for not hiring (CCSA/RCMP, 1996).

Lessons learned on pre-employment screening

• pre-employment screening doesn’t need to involve testing for drugs; • pre-employment screening is inexpensive and can be a very important

element in a plan to prevent substance abuse.

Training and awareness for supervisors

Supervisor training is considered an extremely important element in a comprehensive substance abuse program. Supervisor training typically includes information on corporate policy, alcohol and other drugs, and how to deal with a substance abusing worker. The point of the drug information is not to help supervisors diagnose problems, but to understand the impact of alcohol

and other drug use on job performance (Butler, 1993). Training is often within the context of an employee assistance program that urges the supervisor to utilize management skills to monitor employee performance, allowing for troubled employees to be identified and offered access to assistance on this basis.

As has been noted, small business owners are less likely to consider employees as human resources "investments" (Eakin, 1992). For this reason, and a number of others, small business owners are also less likely to provide training for employees. Hunneycutt (1989) reported that the majority of small business supervisors would not attend a training program if offered in their locale. Lasher and Grashof (1993) found that 59% of owners/managers thought that managerial personnel in their firm would attend a workshop dealing with substance abuse if one were available; however, when local workshops were offered through various chambers of commerce, attendance was extremely low.

Williams et al (1996) when studying the prospects of substance abuse training within a demonstration project set in South Australia, cited the following reasons for small business owner disinterest in training:

• lack of time • more likely to seek assistance through informal means, like a business

acquaintance • preferred dealing with problems as they arose • unaware that courses were available • course work too theoretical • reluctance to expose business deficiencies to third parties

However, in some sectors, such as the transport sector in the US, two hours of supervisor training on identifying impairment by substance use is a legislated requirement (Butler, 1996). Similarly, as interest increases in areas like quality standard and ethical provider accreditation status, small business interest in substance abuse and health and safety training may increase.

Without this type of external motivation, opportunities to provide supervisor training may be limited and alternatives will need to be found. Clearly focused substance abuse training might, for instance, be inserted into enterprise and management development schemes (Pyke and Henriques, 1997) and business school curricula. Williams (1996) found owner/managers preferred low cost, flexible, informal avenues to substance abuse information that were specific and problem-based. So, peer or large- small business mentoring approaches might hold promise (Pyke and Henriques, 1997). Alternatively, a self-guided training package as suggested by Williams or guide as produced by the Ottawa-Carleton Regional Workplace Substance Abuse Work Group (1991) might be useful. Given the increase in Internet access world-wide, this type of training might be rendered on the Internet. Substance abuse and employee assistance courses are currently available on the Internet (CCSA, 1997); the

flexibility of this means of training might be of interest to some small business owners.

Lesson learned on supervisor training

• without incentive or legal requirement, the best prospect for supervisor training on substance abuse is through existing business development training;

• alternative methods for getting information to the small business owner and for raising awareness need to explored.

Health Promotion

The prevention of substance abuse is often undertaken within a corporate health promotion program that typically also includes attention to stress management, smoking cessation, fitness, and nutrition education. Substance abuse education within a health promotion program can involve personal assessment of substance use, and strategies and resources for cutting back (CCSA/RCMP, 1996). The workplace can also be seen as an important setting for addressing family and parenting issues with respect to substance use (CCSA/RCMP, 1996). Health Canada (1992) promotes corporate health promotion through the Workplace Health System, which includes resources specifically for small businesses. According to Erfurt et al (1991), cost is a significant issue in participation in these programs. In a study of health promotion in three small enterprises, it was found that, where workers were required to share in the costs, participation was low. Eakin (1995) found that most health promotion programs focused on lifestyle change issues rather than investigating the workplace as a determinant of health. She recommended an integration of the two orientations.

Lessons learned on health promotion

• programs that cost may cut down on participation in health promotion; • health promotors and owners need to give attention to work conditions

as a determinant of worker and owner health.

Improvement of working conditions

Although it is a sensitive issue because small business owners identify so closely with their business (Eakin, 1992), it is important that small business owners understand that the worksite itself is a significant determinant of health for both the employer and employees. Heightened competiveness arising from the globalizing of economies has placed significant pressures on workers in all sectors. For example, Statistics Canada reports that 33% of Canadians are constantly under stress from trying to do more than they can

handle (Cdn OS v 32/4, 1994 pg 14-17). There is reason to suspect that the broad characteristics of small business owners, which may include many of the factors that lead to success: independence; enthusiasm; ability and willingness to work long hours; and staying power may also place them at particular risk for job stress and possibly substance abuse (Williams, 1996). And they may be inadvertently subjecting their workers to similar conditions, which the employees may not feel comfortable in raising with the owner for fear of losing their job (Eakin, 1992).

In relation to safety, a recent survey in Ontario found that workplaces of 20-40 employees have the highest accident rates in the province. Karasek and Theorell (1990) have theorized that work situations that combine higher demand and less control over one's work result in job strain that can have significant impact on health. In fact, more than 80 studies in 8 countries that have shown that workers exposed to high production and very low possibilities for control over their work experience significantly greater than average depression, heart disease, high blood pressure and anxiety (Cdn OH&S, #4, 1994). Other psychosocial contributors to job stress are unsatisfactory communication, job insecurity, poor relations, and ambiguity on roles.

An investigation into the conditions of work at a particular site requires analysis into the pertinant issues and circumstances of that site. Following are generic suggestions for addressing conditions of work that could give straightforward guidance to a small business owner (Canadian OH&S, #4, 1994):

• ask workers by private survey what could be done to reduce stress, take worker advice and implement ideas if feasible, if not, explain why;

• give regular feedback on performance; • encourage and accept real involvement of workers in decisions affecting

their jobs; • find ways to turn anger into creative energy; • allow job rotation or transfers to relieve boredom; • tell workers all you can about changing circumstances or new technology

before changes; • let work schedules be reasonable, flexible- consider family needs; • provide clear definition to roles, tasks, rights, responsibilites and

reporting relationships; • provide tasks that challenge workers.

ARF’s PASE project approaches the topic by positioning work-related owner health as a business issue; providing an opening to discuss worker health in the enterprise more generally.

Lesson learned on improving working conditions

• this issue may be sensitive to raise, but is ultimately very important to address;

• worker conditions may be best introduced through review of owner/manager work-related health.

Assistance including counselling, referral to treatment, return to work arrangements and follow-up aftercare

The substance abuse issue that is often of greatest urgency to small employers is, "What do I do with an employee whose substance abuse has affected workplace performance"? Consistent with a generally low priority on human resources investment, many small business owners simply terminate a substance abusing worker (Lasher, 1993). On the other hand, Shain et al (1997) note that a portion of small business owners actually become so involved in trying to resolve problems with a worker that it takes a significant toll on the owner and possibly, the business. A number of projects, including the Project to Assist Small Enterprises (PASE) of the Addiction Research Foundation of Ontario (1996) have encouraged both of these types of employers to consider a third option — of offering assistance to the employee.

The most structured arrangement for providing access to assistance for substance abusing employees is the employee assistance program. Now offered in a number of forms, EAPs have the basic aim of identifying troubled employees, motivating them to address the problems and providing assistance to do so. EAPs are quite prevalent in larger companies with Hartwell et al (1996) in a survey of US worksites finding that 76% of companies of over 1,000 employees possessed an EAP. Confirming what is well established, Hartwell reported that only 21% of firms with 50-99 employees (the smallest business size sampled) had EAPs. A variety of reasons can be suggested:

• relatively less value placed on employees as human resources (Eakin, 1992);

• many small business workers are part time and short term employees (Eakin, 1992);

• financing of EAP is more difficult for small firms because the cost is greater per employee;

• many small business owners are confident they can deal with problems through their own means (Lasher, 1993);

• many small business owner do not believe rehabilitation to be a responsiblity of the business (Hunneycutt, 1991);

• most small business owners felt that it was more expensive to rehabilitate a worker than to replace them (Hunneycutt, 1991).

As noted by one source, "the potential savings to the employer of a service to troubled employees is far from evident to small businesses. For instance, a firm with half a dozen or fewer employees can easily feel sheltered from such problems and therefore not see the need for an additional business expense to obtain a service it feels its employees do not need" (OC Small Business Health Committee, 1993).

It needs to be pointed out to these and other employers that formalized access to assistance can ultimately save the business money. A 40 month study of an EAP service for small employers found that for every dollar spent on EAP, $4.23 was realized in saved expense claims (Intindola, 1991).

Recognizing that owners vary in their needs, resource levels and readiness to support access to assistance, several options for facilitating this access can be delineated (O-C Small Business Health Committee, 1993):

Option 1: Enhanced Use of Existing Services: by raising awareness of the options available through "brown bag" presentations, print, and broadcast media, community service providers. Having a coordinating body helps to create a regular and sustained campaign;

Option 2: Referral and Assessment Service: takes the form of a "one stop" number which employees and employers can call to either get information on the types of services available or for a direct referral (also see Quartarone, 1996);

Option 3: Group Purchase of an EAP: through a coordinating body, such as a board of trade, chamber of commerce or industry association, small businesses purchase an EAP as a group to take advantage of economies of scale (O-C Small Business Health Committee, 1993).

There are a number of examples of EAP consortia in the US and several in Canada. A threat to consortia is the prospect of a low subscription rate on the part of small businesses in a community, combined with a high utilization rate on the part of those in the consortium (Carr,1997). What looms as an unviable scenario for the provider can be offset by bringing in larger businesses to give stability to the consortium (Brennan, C, 1997).

Ozga (1989) suggests an approach wherein a staff person is designated to be responsible for employee identification and outreach activities and referral to appropriate community resources. The official would need training in early identification, referral, case managing procedures, a knowledge of the resources in the community and in the case of identifying, would need to have knowledge of intervention on the basis of performance or impaired behaviour.

This approach has the advantage of facilitating the return to work and aftercare arrangements. The ability of the small employer to adjust schedule and other work conditions for an employee returning from treatment will likely be quite limited, however, in Canada, at least, the employer has a legal obligation under human rights legislation to accomodate to a reasonable degree, to the needs of the returning employee following treatment. This could extend to flexible scheduling to allow attendance at continuing care meetings or counselling.

Lessons learned on access to assistance

• assisting employees to resolve their problems makes good business sense;

• a number of options exist to allow small businesses to facilitate employee access to help;

• identifying a person responsible allows for earlier intervention and case managing.

Community-based programmes which can be influenced or utilized for prevention of substance abuse among workers engaged in small business

There are a number of community-based programmes and organizations that have the potential to support small business activity around substance abuse (labour organizations, the United Way, service groups, local task forces, councils on substance abuse, etc.). Many small businesses are firmly based in their communities and are in a position to forge links and draw support from these organizations. However, as with all small business services, community-based initiatives must be problem-focused and address the perceived needs of the owners. When Spiegel and Yassi (1989) studied the potential of a communiity health centre-based approach to providing health services for small workplaces they found the large majority of small businesses had few health & safety concerns, with close to half of the respondents actually not aware of their legislated health & safety responsibilities. However, respondents did express interest in education and information- preventive functions that a community health centre could provide.

Perhaps recognizing this, the Ontario Ministry of Health has recently directed community health services to become more involved in addressing small business health issues. In a Canadian survey of agencies offering prevention and health promotion services to small businesses, Eakin (1995) found that 25% of the agencies focusing on lifestyle behaviours addressed substance abuse, while only 3% of those with an occupational health orientation did so.

Organizations in this survey noted personal, face to face contact and low cost as the most important factors contributing to their effectiveness as helping agencies, while identifying lack of money and time (on the part of both parties) and low priority for health issues on the part of the businesses as the most important factors impeding effectiveness.

The study also noted that while most of the agencies engaged in collaborative projects, those projects were more likely to be with other agencies, universities or voluntary associations and less likely to be with their business clients.

Eakin also noted that contact with small businesses was largely with management. This is necessarily so because the owner/manager is often the only entry point into the enterprise. In doing so, however, it is important to be aware that the health issues raised will be defined or framed by the

owner/manager. It then becomes a matter of judgment for support agencies to determine when and how crucial health issues (like the effects of employee lack of control over work) that are less likely to be raised by owners, will become addressed.

Again, it will be important for those interested in supporting action on health/substance abuse with small business to think in terms of a business case. The following steps to the development of a business case were intended for larger companies - they may, however, have some application:

• define the problem; • determine the cost pressures on substance abuse; • collect data to quantify the cost pressures; • review the data and determine why the cost pressures exist; • consider the solutions; • don’t make assumptions and; develop responses that address the

identified factor(s) (Benefits Canada, v 19 /8 1995 pg 49, 51)

It should be noted that meaningful change takes time. Organizations wishing to support business initiative need to be prepared to provide long term support. This may be one of the lessons arising from the ARF PASE project which was not able to continue due to a changing mandate on the part of the sponsor.

Lessons learned on community-based involvement

• agencies can provide effective support by utilizing personal, low-cost methods;

• agencies need to be aware of a management bias in any ensuing strategies;

• long-term committment from supporting agencies is quite important.

Strategies which have been adopted in promoting acceptance and support for integrating prevention and assistance into ongoing small business development initiatives

Clearly, initiatives directed to small business, must, in order to be effective, meaningfully involve the targetted businesses. Perhaps, the most obvious means is through "gatekeeper" groups such as chambers of commerce, boards of trade or industry associations (Lasher et al, 1993). The PASE project of the Addiction Research Foundation, for example, sought to engage the Canadian Federation of Independent Business and the Small Business Centre of North York. If actual ownership of the program by gatekeeper groups is not possible, strong committment is nevertheless crucial.

An example of a recent public/private sector partnership is the Safe Communities Foundation recently begun in Canada. Funded by large business

and the Ontario and Alberta governments, the Foundation aims to link safety organizations, service clubs, district health councils, local businesses and chambers of commerce to improve the health & safety of employees. These groups will form a steering committee that will research injury patterns and identify health and safety training needs in the small business community, while aiming to instill a general culture of safety in the broader community. Sponsors claim that in investing in employee health and safety, businesses will increase profitability and productivity, and raise their profile in their own community (Cdn OS, v 34 /4, 1996 pg 2).

Other examples of strategies integrating business development and substance abuse prevention

1. In its Project to Assist Small Enterprise, ARF, (1996) initiated a liaison with the Canadian Federal Business Development Bank, who sponsor Counselling Assistance for Small Enterprise (CASE). The CASE program utilizes retired business persons to provide advice to start-up businesses, providing an interesting "one stop" model for the PACE program, but also offering an intervention opportunity for substance abuse discussion in its own right.

2. Several states, including Florida, will give businesses a 5% discount on their worker compensation premiums if they have substance abuse policies in place with certain elements (Working Partners, DOL, 1994).

3. In both Alberta and Ontario, the Construction Safety Associations have responded to indications that employees are at high-risk for substance abuse by sponsoring the development and delivery of substance abuse training in an industry comprised of many small businesses.

4. A large firm- small firm mentoring program for business development, such as found in Belgium might be utilized to stimulate substance abuse activity (Pyke and Hendriques, 1997). This may be a particularly appropriate role for those larger companies that require compliance on substance abuse policy from their sub-contractors.

5. Substance abuse-related elements could be included in a standards or accreditation program concerned with quality, personnel, safety, or ethical issues (in some cases this is a requirement of larger companies on smaller ones) (Williams et al., 1996).

6. Urging creativity in addressing health in small businesses, Moser (1989) suggests such measures as:

• offering continuing education credits or professional designation points to a (substance abuse ) professional for working with a small business (ex. assessment, education, counselling, advice as required);

• industrial park consortium: small business initiated or developer initiated;

• small businesses who hire a consultant to help establish policy become eligible to deduct fees from workers compenation payments.

7. When a business is registered, information on health and safety issues, including substance abuse could be presented.

8. In the construction business where the workforce is typically short term and shared with competitors, management is unlikely to invest in human resources. An option may be for a labourers union to sponsor EAP benefits by pooling contributions from participating companies into an existing health and welfare fund. The Laborers' Health and Safety Fund of North America offers assistance to any such labor health fund interested in adding EAP as a benefit.

There are service providers in most communities with an interest in mobilizing small businesses to address substance abuse. These agencies are most effective when they position themselves as partners in support of business-led initiative. Partnerships may vary, however, it is key that efforts begin from an understanding of the particular circumstances and needs of the businesses concerned. There are few examples of sustained, effective action in this area to refer to, however, the extant literature suggests that small business action requires creative thought, possibly in the form of incentive to capture the interest of owners.

Positive incentives in support of business development, such as workers compensation or insurance rebates are preferable to imposed regulatory or corporate requirements, although these may be necessary in some cases. Each community and each business in that community present their own strengths and opportunities. An overriding principle for any action involving small business on substance abuse is the need for simple, inexpensive and easily accessed options that are problem-focused. A mix of community awareness, information and access to resources will address the needs of businesses in various stages of readiness to act on this issue.

Lessons learned on strategies integrating business development and substance abuse prevention

• commitment and, ideally, ownership of small business in any initiative is crucial;

• creating incentives may be an important element in mobilizing business in this area;

• positive incentives will be better received than regulations or requirements imposed.

Bringing it all together: seeing action on substance abuse as a process

It is apparent from the research and from experience with small business mobilization that there is much work in store for any group wishing to support

meaningful action on substance abuse with this sector. While arguments in favour of action are quite persuasive, there are, as well, very real obstacles to small business action on substance abuse. Those wishing to instigate and support this kind of action may benefit from seeing change as a process, with owners being at different stages in the process. In fact, readiness to change or take action will vary from company to company, owner to owner. The transtheoretical model of change (Prochaska and DiClemente, 1983) suggests that individuals tend to move through a series of stages when changing behaviours. While first proposed to bring insight into tobacco cessation and other addiction treatment, its application to owner action on health and safety issues has been proposed (Leviton & Sheehy, 1996). The model suggests that individuals can be located in one of several stages with respect to a behavioural change, in this case, action on substance abuse, and also gives guidance on how to support movement towards action:

Stage of Change Appropriate Measure Precontemplation: don’t see this as a problem and will be difficult to mobilize awareness raising + incentives, possibly regulation Contemplation: see this as a problem but aren`t prepared to take action awareness raising + incentives Preparation: see this as a problem and are prepared to take action clear information on options Action: taking steps to address issue access to resources: training, policy development, access to assistance Maintenance: have fully adopted the behaviour more elaborate measures; mentoring other businesses Relapse: have discontinued initiative in this area support from other businesses

While the use of this model to support small business initiative is speculative, it may nevertheless be useful to point out to supporting organizations that change tends to be a long-term process and that a mix of measures may need to be prepared to support owners though different levels of a change process.

Lessons learned from seeing action on substance abuse as a process

• a mobilizing initiative may need to develop a mix of measures; • it may be possible to match measures with the level of readiness of the

target.

Case Study

Project to assist small business (PASE), Addiction Research Foundation, 1996

This project was preceded by research conducted between 1992-94 in the City of North York. Viewing small businesses as those with fewer than 50

employees, researchers found that close to 30% of owners had experienced at least one negative effect from substance abuse in the form of absenteeism, lower productivity, lower morale and safety concerns. Twenty percent indicated that dealing with substance abuse issues in the workplace had ‘taken a heavy toll’ on their own well-being and affected their ability to manage their business. Three quarters expressed interest in a one stop shopping approach to the provision of substance abuse-related services.

A program, The Health Connection for Small Business, was developed with attention to community development and the determinants of health as guiding principles. The intent was to create awareness of the apparent link between business health and employee health and to add to the owners' understanding of how to promote a healthy workplace.

Other considerations:

• target owners and managers rather than employees; • provide a range of information to help troubled employees and support

access to treatment; • position health-related information within the context of business

development information, such as human resource management and marketing strategies.

Project activities:

• develop model • assess community for interest and potential for committment • convene community meetings to discuss research results and issues • develop a marketing strategy and resources • identify barriers to implementation • identify resource needs • identify and deliver training/consultation to program consultants • develop evaluation tools • promote and launch "The Health Connection for Small Business in North

York"

Materials developed:

• marketing plan and evaluation template • visual identity items (posters, buttons, brochures, direct mail flyers) • volunteer manual • workshop presentation kit

Lessons learned:

(a) diffusing project messages was a challenge — sponsors found they were "selling" a number of concepts that were quite foreign to small business owners, eliciting questions such as:

• · What can your service provide that I can’t do for myself?

· I don’t have time for this?

· Why is this free?

· Who is behind this service?

(b) developing partnerships proved to be a challenge with both the public and private sector interests (the public sector said, "we need financial resources to participate", while the business sector asked, "how is this going to benefit us?").

Issues for future projects:

• the range of success indicators for a project need to be expanded (ex. time spent on the process of community development needs to be counted as an important deliverable and subject of evaluation);

• representation from the key target groups need occur at project design phase;

• local needs assessment should be a high priority following moe general research;

• need to deliver a "product" from what is essentially a "process", needs to be reconciled, particularly in terms of flexibility of time frame & management of funds).

For various reasons, (partnership development challenges, changing mandates of sponsors, financing issues) at the point of producing this report, this pilot was not sustained. Nevertheless, important lessons were learned around project design, management and evaluation.

Annotated Bibliography

Bennett, N. (1993) Report of program activities: small business responses to drug problems at work. US NIDA grant 07712. Technical report #11, Louisiana State University, Baton Rouge, LA

This report describes a study of 400 hundred employees with at least 15 workers in Louisiana. Noting that these businesses may be harder hit by these problems (harder to work around), don't have the slack resources to commit to the problem and lack the knowledge of the resources available to them. The study found that pre-employment drug screening (37%) and EAPs (11%) were more prevalent than previously thought. This study reported 49% of owners indicating they had been negatively affected by a drug problem. EAPs were more common in companies with workforces of higher average education levels. Generally, however, employers reported a confidence in being able to weed out potential abusers at the point of recruitment, and moreover, if an abuser surfaced, they would more likely fire the person than facilitate assistance, because workers were generally not seen as investments.

Bickerton, Dick How EA practitioners can help small businesses get out of the court room and back to business, EAPA Exchange, Oct. 1994

With the 1990’s Americans with Disabilities Act expanding on the Rehabilitation Act of 1973 to obligate the US employer to accommodate those with mental and physical disabilities in the workplace, the small business owner can become bewildered with regulations and court decisions. The author suggests several roles (training, counselling, awareness, demonstration of concern to employee, case management)to support the owner and play a mediating role with employees. The theme behind these functions is to help the owner understand and act appropriately on these issues before they end up in court.

Butler, Barbara, Drug and alcohol testing in the workplace: a guide for small carriers, Canadian Motor Carrier Consortium, 1996

A self-help guide for small transport companies required to comply with US government regulations concerning drug testing of drivers entering the US. The guide offers background information on substance abuse in the workplace and highlights procedures for workplace drug and alcohol testing. The guide advocates an approach that supplements testing with employee education, supervisor training and access to assistance.

Barbara Butler (Interview): the effect of US regulations on small foreign carriers (50 or fewer, only one needs to cross the border). Interest among this sector is growing, according to attendance at Motor Carrier Consortium workshops. By joining the consortium, member companies will have access to information, policy assistance, drug testing and EAP services at the rate of $7CDN per employee per month ($2.45 for EAP).

Imperial Oil is in the process of requiring all sub-contractors to test their risk and safety sensitive (no supervision) employees. So, those sub-contractors who in turn, sub contract, will be obliged to required this of their contractors. This is an international initiative of Esso's - other oil industry companies are undertaking similar actions

Collison, Jim Why small businesses aren’t rushing to employee assistance programs. EAPA Exchange, Oct. 1994

Noting that Inc. while survey estimates of small companies with EAPs are higher (10%), the author suggests the actual number is probably more like around 3%, noting that smaller business owners are often too busy, too distrustful and too disinterested to respond to a survey (so only those firms where the owner takes the time to participate are represented, skewing the results). The author suggests three reasons why small firms aren’t sponsoring EAPs: (a) lack of knowledge of EAPs and what they can do; (b) low interest in spending money on any expense not directly related to keeping the business going and; (c) more interested in employee benefits that employees immediately perceive as valuable (ex. pay raises, bonuses, flex time, more vacation pay).

Eakin, JM, Leaving it up to the workers: sociological perspective on the management of health and safety in small workplaces, International journal of health services, Vol 22, (4), 1992

This article reports on a study of 53 small business owners perceptions of their responsibilities surrounding health and safety matters. The general response of these owners was to leave H&S concerns up to the workers. Through personal interviewing, observing and in many cases touring the site, the author arrived at several possible explanations for this response.

The author placed owners on a continuum of approaches — between the extremes — the leave it to the workers and the come down hard appoaches — there were a number who saw some responsibility while leaving the remainder to the worker (ex. we provide them with the mask and then its their option).

She recommended that the promotion of health among small businesses account for:

· awareness raising of H&S issues

· H&S is a problem

· increasing motivation

· making available resources to take action

Eakin, JM , Weir, N. Canadian approaches to the promotion of health in small workplaces. Canadian journal of public health, Vol. 86 (2), 1995

Notes that small workplaces are known to have higher rates of injury and ill-health than larger workplaces, due to higher risk types of work, employment of younger, less experienced workers, and immigrants who may not be aware of their rights. The article reports on a survey of 58 agencies across Canada who provide business with health promotion services. The study notes the top down origination of many of these agencies and the inherent management bias found in many of the approaches. The stduy distinguishes between lifestyle change through the workplace and the workplace as a determinant of health approaches and recommends an integration of the two.

Erfurt, JC, Holtyn, K, Health Promotion in Small Business: what works and what doesn’t work. Journal of occupational medicine, Vol 33, 1, 1991

The article discusses a study of the implementation of wellness programs at three worksites, ranging in size from 5 to 300 workers, (the authors regarded 5 to 500 as small to medium). The program at each site consisted of the following:

· screening for BP, cholesterol, overweight, etc.

· referral of those at risk to community physician

· a menu of wellness programs (guided self help, mini group, full group

· long term follow-up — of one to one counselling

Participation was fully voluntary in each site, with one employer offering 50 % copayment, while the others fully covered the program costs.

Examples of measures that are successful are: one to one wellness screening rather than self administered screens, signing up employees on the spot rather than depending on media to publicize programs, offering a menu of deliveries rather than the standard classroom approach. The authors strongly recommend that the company or union fully pay for the program.

Fearst, Dan, Small business: keeping EA’s promise alive, Employee Assistance, July 1993

The author contends that EAP providers are risking the credibility of EAPs by marketting various cost containing "access to assistance arrangements" (ex. counselling hot lines as EAPs) to small business and forgetting the EAP’s core principles. The author suggests that owner buy-in to an EAP is increased if it is marketed as a management tool that doubles as a resource to employees. He advises EAPs to know the dynamics of the small business and understand that the owner probably knows that she shouldn’t counsel employees, but does it anyway -- and probably knows that one significant problem could ruin the business, but is slow to try prevention. Marketing, he argues, should focus on reducing risks of wrongful discharge, sexual harrassment and developing better trained supervisors.

Hagen, Karen, Why small businesses should be searching for EAPs, EAPA Exchange, Oct. 1994

Noting that troubled employees can cause major ripples through a company, the author points out that per usage fee arrangements are more attractive and that much of the service concerns effective management consulting.

Health and Welfare Canada, 1992, The small business health model, Ottawa: Minister of Supply and Services Canada.

This resource is part of a series of resources for promoting Health Canada's Workplace Health System in different sectors. The booklet is intended to support those wishing to determine interest in the Small Business Health Model in a community. Suggesting that the key ingredients are interest, resources and organizers, the booklet provides a checklist for determining readiness of a company to become involved.

Health and Welfare Canada, 1996, The business case for HIV-AIDS, Ottawa: Minister of Supply and Services Canada.

This is a kit aimed at HR in medium or larger businesses to argue for attention to managing AIDS in the workplace. Using a modularized, photocopiable format, the kit raises a number of issues, including the likelihood of having someone with HIV-AIDS in the workplace, the human rights and employee morale implications and the need for awareness and policy in this area.

Hunneycutt, A, Wibker, E, Managerial responses to drug abuse in the workplace, Journal of small business management. V27(2), 1989.

The article reports on a survey of 700 small firms (under 100) in Louisiana, wherein managers were asked of their perception of the extent of substance abuse problem and whether they had policies to address problems. Approximately a third had experienced problems and about the same number had policies. Employers were twice as likely to favour immediate discharge for a drug abusing employee than for an alcohol abusing employee. Over three quarters did not believe rehabilitation to be a responsibility of the business and most felt that it was more expensive to rehabilitate a worker than to replace them.

Intindola, Brendan, EAPs still foreign to many small businesses, National underwriter, May 6, 1991.

A note on the EAP provided by the Paul Revere Life Insurance Co in the US. A 40 month study of the EAP found that for every $ of premium diverted to the EAP, $4.23 is realized in the expense claims saved. While 75 to 80% of Fortune 500 companies have EAPs, less than 10% of smaller companies offer them. Yet a troubled employee can be crippling to a small business. A proponent of EAPs claims to not understand the sheriff mentality of firms that spend $300 a year on drug tests, but wont spend $30 dollars on an EAP.

Jack, L, The ones that got away, Occupational Health and Safety Canada, V 7(5), 1991. Discusses a report on H&S in Ontario. The report notes that small firms are often concentrated in high risk industries such as construction and forest industries. Individuals who work in small business often lack knowledge of hazards and their prevention, and of their legal rights and the companies often are unaware of their obligations and lack the resources to manage these concerns. The need for more public education, probably on a sector by sector basis rather than aimed at small business would be useful.

Lasher, JL, Grashof, JF, Substance abuse in small business: business owner perceptions and reactions, Journal of small business management, Jan 1993

The article describes a study of businesses of fewer than 500 in the US southeast that collects base line information on the owners views on the following:

• # of firms with policies - the larger the firm, the more likely to have policy

• reasons for not having policies - would create more problems than it solves, dont have a problem, don’t know how to design policy, not the business of business to be rehabilitating workers

• the extent of the problem - they generally felt that the problem was significant but not in their firm

• approaches to dealing with an employee problem - temporarily or permanently remove from job, most would require the worker to obtain treatment but a much smaller number would pay for it

When asked about ways they could be supported: clarification of laws and more information on testing, supervisor training to detect problems. It is suggested that business associations (chambers of commerce ) could be effective in marshalling resources and providing information when issues arise. The authors note that if action is taken, it is out of self interest rather than societal interest. They also note that with larger firms taking strong positions against substance abuse, smaller firms may become dumping grounds for substance abusers. Similarly, with several states denying workers comp benefits to those impaired, firms without policies would attract those workers hoping to avoid detection of impairment.

Leviton, L., Sheehy, J, Encouraging small businesses to adopt effective technologies to prevent exposure to health hazards. American journal of industrial medicine V29, 1996

A case study on the adoption of health and safety technology among small business, the paper notes the ineffectiveness of legislation with this sector and suggests that voluntary methods utilizing Prochaska and DiClemente's readiness to change theory and Rogers' diffusion of innovation theory may be more effective.

List, Wifred, Bringing the gospel of health and safety to small business, Canadian occupational safety, Vol 29 (3) May-June, 1991

Reporting on a recent H&S conference, the article discusses the merits of greater efforts on enforcement of H&S legislation vs greater awareness and education concerning the issues. A survey of small businesses indicated that much of the H&S information received by small businesses isn't clear and that respondents would actually be willing to pay for superior information.

Martinez, Bob, A big fight for small business, Occupational health and safety, V 61, Sept, 1992.

Mr. Martinez was at the time the director of the President's office of National drug control policy. In a brief column he cites statistics on productivity losses, replacement of worker costs and accident rates among cocaine users and highlights efforts of the small business administration, the department of labor and the office of national drug control policy.

Moser, Cindy, ed. Giving help to small business, Occupational health and safety Canada, Vol 5(3), 19??

In noting the difficulty of enlisting small companies to address H&S issues, the author urges creativity, briefly mentioning the following ideas:

• continuing education credits or professional designation points to a (substance abuse) professional for working with a small business (assessment, education, counselling, advice as required)

• industrial park consortium: small business initiated or developer initiated • small businesses who hire a consultant to help establish policy eligible to

deduct fees from workers compensation payments

Mckee, Bradford A, Small firms enlist to fight drugs, Nations business, V78#2, Feb, 1990.

The article cites several examples of initiatives taken on by small business groups, typically coordinated by chambers of commerce and supported by community groups. One proponent, claiming that the key to addressing the problem is education, provides employers with a kit consisting of: information describing drug terms, the common signs of drug abuse, sample drug policy, legal issues around drug testing. An advocate of EAPs says to business, "it doesn’t matter whether you like these employees, it doesn’t matter whether you want to help them or not. The question is how much of this loss do you want to take" The concluding comment is that small businesses may actually have a particular opportunity to address substance abuse due to their connection to their community.

Ottawa Carleton Small Business Health Plan, O-C Small Business Health Committee, October, 1993.

Focusing on businesses with fewer than 100 employees, this committee, with support from a number of partners including the Federal Government, surveyed the owners and employees of a sample of 58 businesses on a broad range of health issues. The survey was the basis of priority-setting focus group sessions - resulting in action on two fronts: the establishement of an EAP consortium, and the promotion of lifestyle improvement.

Ozga, Jan Peter, Drug abuse and small business, Workplace drug abuse policy: considerations and experience in the business community, in Walsh, MJ, Steven, WG, eds, DHHS, 1989.

The author suggests that small businesses can be disproportionately affected by employee substance abuse, (one problem worker in 20 versus one in 100 ) citing the following scenarios:

• a drug abusing employee who is responsible for the quality of a product while operating under diminished capacity could cause a firm to lose a contract, which could affect the very survival of the company.

• a malingering employee could have severe negative effect on the morale and productivity of a staff

• the insidious impact of an employee supplying drugs to fellow employees

While impact can be greater, opportunity for addressing it may be also greater (ex. more likely to be identified - harder to hide - may not require large resources)

The general approach suggested was to designate someone to be responsible for employee identification and outreach activities and referral to appropriate community resources - the official would then need some training in referral, case managing procedures, a knowledge of the resources in the community and in the case of identifying, would need to have knowledge of intervention on the basis of performance or impaired behaviour.

Discusses options for firms in remote or rural locations where community resources are sparce, suggesting that firms could encourage local public health officials to support service in this area or to avail of a HOTLINE service.

Pyke, F and Henriques, M. Small firms and substance abuse: an economic development perspective, International Labour Office, April, 1997

This paper highlights the emerging role that smaller businesses will have in fast changing globalized economies. The authors contend that in order to remain competitive in this environment, small firms will need to be supported in striving for excellence in a number of areas, including health and safety matters. An appropriate role for governments is to facilitate public/private partnerships that involve local agencies in achieving economic and social development. New roles for labour, the community, and larger corporations in supporting small enterprise development are also noted. The paper concludes

with concrete examples of initiatives and services for action on substance abuse.

Quartarone, M. Report on the Project to assist small business (PASE), Addiction research foundation, 1996.

This report describes activity stemming from research conducted between 1992-94 in the City of North York. Viewing small business as those with fewer than 50 employees, researchers found that close to 30% of owners had experienced at least one negative effect from substance abuse in the form of absenteeism, lower productivity, lower morale and safety concerns. Twenty percent indicated that dealing with substance abuse issues in the workplace had ‘taken a heavy toll’ on their own well-being and affected their ability to manage their business. Three quarters expressed interest in a one stop shopping approach to the provision of substance abuse-related services.

A program, The Health Connecton for Small Business, was developed with attention to community development and the determinants of health as guiding principles. The intent was to create awareness of the apparent link between business health and employee health and to add to the owners understanding of how to promote a healthy workplace. For various reasons, (partnership development challenges, changing mandates of sponsors, financing issues) at the point of producing this report, just one of four pilot sites were sustained. Nevertheless, important lessons were learned around project design, management and evaluation.

Regional Workplace Substance Abuse Work Group Taking care of business (1991)

This is a bilingual booklet for small firms concerning substance abuse. The booklet provides brief information on why a firm should be concerned, how you can identify someon abusing a substance, what to do if you identify someone, and a listing of community resources.

Shain M, Eakin, J, Suurvali, H, Currie, A Small business owners and the management of employees with problems: a descriptive study, March, 1997

This paper suggests that one of the reasons that EAPs have not been particularly successful in working with the small business sector is that providers may have a limited idea of the owner/manager's needs. The authors submit that employers may need counselling or coaching support to manage their many demands. The paper reports on a study in Ontario, involving nearly 100 interviews, intended to develop an understanding of the owners' world view and their approach to dealing with employee problems. The research suggested that it may be possible to group owners into one of three categories: "philanthropists", "calculators" and "pragmatists" that describe among other things, their inclination to help an employee.

Spiegel, J. Yassi, A., Community health centre-based occupational health services for the small workplace: an Ontario study of employer acceptability, Canadian journal of public health, V80, Sept/Oct 1989

This paper reports on a study on the acceptability of using community health centres as a resource for small businesses to satisfy OH&S needs. The large majority of small businesses had few H&S concerns and had used available services in a very limited way. Close to half of the respondents were not aware of their legislated H&S responsibilities. Strongest support was for education and information - preventive functions that a community health centre could provide.

Vinton, Peg and Kristine, Brennan, How to tailor EAPs to reach small business, The Almacan, Oct. 1988

Being squeezed at both ends -- too little money for a human resource function to prevent an impaired worker that can disproportionately affect the small business -- calls for unconventional means to support this sector. The authors suggest that smaller companies require more management consultation and coaching rather than comprehensive supervisor training. More time is spent on separating issues stemming from the family-like nature of the business (ex. reluctance to apply corrective measures due to family loyalty). The small employer is more likely to use the human resources and organizational development functions of an EAP, such as consultation on team building, conflict resolution and policy development.

Williams, M, Bush, R, Harmoni, R, Alcohol and other drugs and small business workplaces, National centre for education and training on addiction, Australia, Feb, 1996

An extensive report on a demonstration project that was preceded by a literature review and a survey of 55 small business owners on their perception of substance abuse problems and their interest in becoming more involved in this area. Through the course of this action research project the goal was adjusted from one centered on evaluating harm reduction interventions to one evaluating the effectiveness of raising awareness of substance abuse problems. Each stage of the project, from establishing the management team, to dissemination of information was considered an intervention and was evaluated.

Other sources:

1996 AMA Survey: workplace drug testing and drug abuse policies, American Management Association, New York, New York

Brennan, Christine, member, EAPA Small business & EAP committee, Lincoln, Nebraska (Interview, March, 1997)

Carr, Janet, Health Dept, Regional Municipality of Ottawa-Carleton (Interview, March, 1997)

Canadian Centre on Substance Abuse, The Winning Solution, workplace drug awareness presentation guide, Ottawa 1996

Karasek, R and Theorell, T Healthy Work: stress, productivity and the reconstruction of working life. Basic books, New York 1990

Pearson, S, et al. Assessing Costs: substance abuse in the workplace -- a literature review for AADAC, August, 1995

Prochaska JD, DiClemente C, Stages and processes of self-change of smoking: toward an integrative model of change Journal of consulting and clinical psychology V51, 1983.

Quartarone, Mary, ARF (Interview/correspondence)

Shain, Martin, ARF (Interview)

Shehendeh, B. (1985) Drug and alcohol abuse in the workplace: Consequences and countermeasures. International Labour Review, 124 (2).

Stanworth, J and Curran, J (1989) Employment relations in the small firms, in P burns & J Dewhurst (Eds) Small business and entrepreneurship, Macmillan Education Ltd

Acknowledgement

Thanks are expressed to Martin Shain and Margo Hawley for invaluable assistance with the search for the literature.

Gary Roberts Senior Associate Canadian Centre on Substance Abuse 75 Albert St., Room 300, Ottawa K1P 5E7 email: groberts@ccsa.ca; Tel: 613-235-4048-225; Fax: 613-235-8101