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Post-Traumatic Growth and the Fight to Stay Sober in Difficult Times


As if the new modern work environment isn’t challenging enough, the number of people consuming mind-altering substances while engaged in some form of remote work is alarming, according to a recent survey commissioned by Arizona-based mental health treatment center Sierra Tucson.

A staggering one in five (21%) United States employees admit they’ve used alcohol, marijuana or other recreational drugs while employed remotely in 2021 — a similar percentage admitted using alcohol during the workday, and of those who used, three out of four (73%) state that if their employer insists that they return to the office, they’ll miss the opportunity to use alcohol, marijuana or other recreational drugs during their workday.

In addition, 22% of employees surveyed said they had participated in a virtual work call while under the influence of alcohol, marijuana or other recreational drugs. Those are among the stunning findings of the new “Self-Medication Nation: The Numbing of America” survey.

“That (20% of people) is just a huge number in and of itself,” said Dr. Jasleen Chhatwal, chief medical officer at Sierra Tucson. “It is also interesting because about a fifth of people also said that they noticed a colleague on a Zoom call using [alcohol, marijuana, or other recreational drugs or illegal substances]. Even with a margin of error, that number is so high. That’s not a behavior we would engage in when we are physically present at the office.”

With such startling statistics illustrating the blurred line between work and life, WorldatWork Publications Director and Editor-in-Chief Dan Cafaro sat down with Dr. Chhatwal over the winter holidays to discuss what HR leaders need to consider doing to reorient people to what is OK in the workplace.

Dan Cafaro: Are employers in a Catch-22 because they want to support socializing, but at the same time, they don’t want to encourage drinking during company time? ‘Let's do a Zoom happy hour’ seems innocuous enough, but, of course, if that four o'clock one-time-a-week call turns into something more, then isn’t that a fine line for HR to navigate?

Dr. Jasleen Chhatwal: If we think people are getting into behavior that would be troublesome at work, not only do we have to say, “Hey, these are the rules, which is a way of setting boundaries, even for working at home. To really say, these are the rules and regulations, and on the other hand, also be able to support from the other side, that is, if you struggle with these, we’re here to support you.

In some ways, I think most successful HR professionals will tell you that their role is to hold that accountability line, but then also [to] bring in support. This is not very different than normal things HR would do. But I think, when you are talking about the four o’clock happy hour, maybe one of the things is, even if we want to do those events to really keep the structure of the workday in mind. To do it post-5 p.m. or whatever time your work ends, like we would do in the real world. In real life, we would go to happy hour at 6 p.m. So, if we want to do the happy hour, we're going to do it at 6 p.m.

Dan Cafaro: As a remote workforce we're dealing with a lot of time zone differences, so that becomes a challenge. We've talked about that as well for general work meetings: What is acceptable when somebody sends me a 7 a.m. work meeting notice? If this is somebody in India, I have to respect that.

Dr. Jasleen Chhatwal: And maybe it's 10 p.m. when you're talking to them in India, and they went out for a few beers with their friend that evening. I think that’s really what is challenging about this new work environment. We have to decide as workplaces how much responsibility we take of creating the structure, and then secondly, how we provide or add accountability structure to empower people to add their own structure.

Maybe this is not because alcohol is frowned upon in your work culture and maybe they live in a country or a state where marijuana is legal, so they’re just smoking a marijuana joint like they would be smoking a cigarette. Our survey can say they're under the influence, but they may say, “It’s just a joint I bought at the corner store.”

I think that’s where I feel like starting to educate people about the impacts of things and really drawing a line in the sand, which you have to [do] at some point for your own work environment. What are the resources that we can provide? Whether that’s offering employees access to apps that they can use for their own health monitoring, such as new wearables that everybody has — from your piano smartwatch to a wristband or ring that you can wear and monitor your heart rate variability to discounted rates to gyms across the country.

I think providing those pieces is a way to give people tools to deal with the stress. What we noticed in the survey was that there was a fairly large proportion who said they were using these substances to deal with anxiety, to deal with stress, depression and loneliness. However, there was a larger chunk that said they were also doing this for enjoyment.

When they have those underlying mental health issues or mental distress, then they’re more likely to fall into a pattern of unhealthy use, whereas for those maybe using just for enjoyment, they may be better able to modulate the amount they use.

Dan Cafaro: So, how can HR help and support other measures within their workforce when it comes to burnout?

Dr. Jasleen Chhatwal: I think that's a really great question, because I do a lot of guest speaking and engaging around physician burnout and physician wellness.

It’s usually a combination of feeling like you need to commit a lot more energy to the work than you’re able. There's a level of cynicism that starts to come in around the work. You don’t feel connected to what you’re doing or the purpose of your work that you may have had at some point to no longer feel like it resonates with you.

But now, with this chronic work stress — and chronic stress in so many other arenas — is where our health is really being impaired and with the kind of mind/body connection that we believe in, so it's both your mental and physical health.

Addressing job burnout starts even before we hire people to make sure we have the right people in the right roles.

Dan Cafaro: I’ve noticed a couple of things which are interesting to me about programs at Sierra Tucson. For example, there was one designed specifically for essential workers — which you called healthcare heroes — early on during COVID-19.

Dr. Jasleen Chhatwal: We have always had professionals come through our program, so we'll have a physician here and a nurse there. We were starting to see more and more veterans come in. One of our physician assistants, who leads our red, white and blue program, is ex-military so we were generally developing more of those relationships. We also know that a lot of the veterans who came in would go into law enforcement or other types of more essential duties. So, as we were looking into that and the pandemic kit, I remember talking to my-then CEO and our clinical director about how we can’t even imagine what they're going through. That really resonated off trauma, so we thought we would just start looking for programmatic elements that we could put together specifically to support them.

We reached out to our colleagues within our company in the New York area, which is the area that was hit most hard (by COVID-19). At the beginning of the pandemic, we still had staff, but not as many patients coming to us because everybody was afraid to fly. The more we thought about it, we started to think maybe they won’t be able to come for a month, which is essentially our traditional model because they're still working.

What we started noticing was that people did start to come three or four months later because in the beginning, everybody was just hunkering down and doing the work that they needed, but over the ongoing months, we had a cohort of health-care workers for treatment regularly, spanning from physicians to nurses to respiratory technicians.

Dan Cafaro: It clearly sounds like you were filling a need, so are you talking dozens or hundreds of people. What kind of response did you get?

Dr. Jasleen Chhatwal: We have one group that is the health-care professionals group — or we call it the licensed professionals group — but also we have another group for red, white and blue, which is our first responder groups. And then other professionals, sometimes even an attorney or an airline pilot, can get into the licensed professionals [group]. People will do some programmatic [treatment] and overlap with those two. If you have both groups full, we sometimes have had to do a third group, so that usually means about 16 or so people. And then they usually stay for about a month, so they cycle in and out of the group. So, definitely well over a dozen, probably over 100 [individuals under treatment at any given time] for sure.

Dan Cafaro: I like some of your phrasing in your report where you speak about post-traumatic growth. Would you like to elaborate on that unique term?

Dr. Jasleen Chhatwal: Post-traumatic stress is the term that is most used; however, we also know that human beings are inherently resilient. When going through adversity, many people may have negative impacts. There are a lot of people who like to say you get stronger when you go through something, that what doesn't kill you makes you stronger.

With that, post-traumatic growth is really where people become more connected to others around them. They have greater value for life, feel more connected to their values, and often also start to have a focus of interest around some of that adversity that they may have gone through.

Post-traumatic growth can be in many arenas and, for the same person, there can be growth in one area and struggle in another. So really thinking of trauma and response to trauma as a very nuanced thing. I could become resilient and feel like ‘OK, I can get through anything;’ however, on the other hand, I may also shut down emotionally and not let people in.

The concept of post-traumatic growth is important for our own recovery because the first step to really change our own path is self-awareness. Instead of saying, “Yes, it was hard. I don't want to think about it,” say, “Yes, it was hard and let's see how I’m responding differently because of that experience.” Looking at that, we may be able to actually be really present through that growth rather than rolling the dice and seeing if we’re going to get growth or post-traumatic stress.

About the Authors


Dan Cafaro is the director of publications at WorldatWork


Nu Yang is a writer and editor at WorldatWork.

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