Episode 058 - Addiction at Work: What It Really Looks Like (And How to Help)

Dr Austin Tay (00:01)
Welcome to PsychChat. I'm your host, Dr. Austin Tay. Today I'm joined by Karen Mills, a business psychologist, a senior manager for adult care, director of business and strategy for psychology business incubator, PBI for short, an author, and also a PhD student researching addiction. Hi, Karen, how are you?

Karen Mills (00:27)
Hi, thank you so much for having me. I'm great, thank you.

Dr Austin Tay (00:31)
What the pleasure is mine. Today we're going to be talking about something that is ⁓ an important topic, I think, that people don't really talk about. So perhaps I could just ask you the first question. When most of us hear the word addiction, we immediately think of illegal drugs or rock bottom moments. Why is that picture so incomplete? And what does addiction actually look like in everyday life?

Karen Mills (01:01)
Thank you. I agree, it's a very important topic. ⁓ When we talk about addiction, we rarely talk about the patterns of behaviour ⁓ and the go-to generalisation about illegal substances. ⁓ Addiction is best understood as a compulsion rather than a choice, a continued engagement despite potential harm, ⁓ whether that harms physical, financial or emotional. ⁓

It's not a failure of intelligence, of moral weakness or a lack of insight.

Dr Austin Tay (01:37)
Now you say addiction is a compulsion, not a choice. There's a big shift from how most people think about it. Can you help us understand what that actually means for someone who is living with addiction?

Karen Mills (01:55)
Yeah, so there's an assumption that addiction is about wanting something more. ⁓ When an actual fact is about being able to choose it less, ⁓ there is a stigma attached to addiction, ⁓ which makes it even more difficult for people to come forward. So that's definitely something that I'm keen to break down and have conversations like this is really important. There are...

Dr Austin Tay (02:21)
Mm.

Karen Mills (02:24)
broad terms of addiction. There is substance addiction and there is behavioural addiction as well.

Dr Austin Tay (02:31)
Tell us a little bit more about these two broad terms of addiction please.

Karen Mills (02:37)
Yeah, sure. So with ⁓ substance addiction, generally involves a psychoactive substance that alters the brain chemistry. And over time, the body adapts and the tolerance adapts and makes the choosing part a lot more difficult and the need more difficult to ignore. This is generally where withdrawal symptoms start to occur. ⁓

and risks develop both physically and medically as well. Examples of psychoactive substances include alcohol, opioids and prescription medication. When we talk about behavioral addiction, there's no external chemical substance involved, but it involves rewarding behaviors and reinforcing them behaviors. And that's through dopamine release in the brain.

This is more of a psychological dependence than a physical one or a medical one as compared to substance addiction. ⁓ Examples of behavioural addiction include gambling, pornography, shopping.

Dr Austin Tay (03:48)
So with behavioral addiction, because there's no chemical substance involved, right? So why is it just as hard to stop?

Karen Mills (03:49)
There are.

Yeah, there's shared features between both of them, including compulsion, a loss of control, shame, and also a continued engagement in the addiction despite harm. ⁓ Yeah, so for the purposes of this podcast, I would like to be focusing a bit more on substance addiction, but I thought it'd be important to introduce both types.

Dr Austin Tay (04:27)
I think it would be quite interesting for the listeners and also for the viewers on YouTube to understand a little bit more about the substance addiction. So please do tell us a bit more about that.

Karen Mills (04:40)
Yeah, so substance addiction can be really complex. ⁓ There are several components that need to be considered when looking at substance addiction. If we consider the biological component, ⁓ this is the neurochemical adaptation in the brain. There's a personalisation in escalation and intolerance levels, physical withdrawals and the increase in medical risk, the secondary health conditions as well that come alongside.

the substance addiction. We also need to consider the societal normalization of substances and that makes the addiction more difficult to determine or separate. And when I say that, I mean the example of alcohol being embedded into a culture. For example, you know, a big law firm might have a big win and the societal normalization is to go out for a meal. You know, you have one drink, you have two drinks.

And that's what makes it more difficult to determine the actual addiction if it's built in to the culture of an organization or, you know, into what you do normally to celebrate things. ⁓ Also, prescription medication is legal, which makes it even more difficult to identify. But it's the misuse of these drugs and alcohol that mostly begin in acceptable contexts.

Dr Austin Tay (05:53)
Yep.

Mm.

Karen Mills (06:09)
which makes it even more difficult to determine.

Dr Austin Tay (06:13)
Right. I mean you were talking about social normalisation. How is it making it very difficult to spot when someone has actually crossed that line towards addiction itself?

Karen Mills (06:28)
Yeah, addiction is identified in the DSM-5 and it's rooted on the effect that the behaviour has on the individual in a 12 month period. in the DSM-5 you have substance abuse, substance dependence and substance use disorder and they are separately determined and they're determined on the effect that the usage is having on other areas of that individual's life such as where

home, life, relationships and they're tiered on levels of mild, moderate and severe.

Dr Austin Tay (07:06)
So what is the impact then on the individual with a substance addiction?

Karen Mills (07:14)
I think above all else, it is the individual experiencing it at the centre of this addiction and the impact it has must always be considered. There is a psychological impact, the growing shame, the anxiety of being discovered, the constant internal conflict and many people live with a widening gap between who they believe they are and what they're doing. Over time, this can affect people's mood, their sleep,

their emotional regulation and there's a constant mental negotiation of it's okay, I'll just stop next week. We also have to consider the physical impact, the health deterioration, the effects of withdrawal on the body and the buildup of tolerance. This all creates the increased risk of potential overdose. The body adapts and that adaptation is what can trap people.

Thirdly, we consider the relational impact, becoming emotionally withdrawn, ⁓ avoiding socialisation for the fear of being found out, secrecy and conflict with loved ones because they might not know what's going on.

Dr Austin Tay (08:29)
So as most of us are not clinicians, if a colleague of mine or someone we care about is struggling, what are the early signs we should be paying attention to before it becomes a crisis?

Karen Mills (08:46)
Yeah, this is really, really important. And what I'd like to get across is there isn't one checklist. The important thing is to look out for patterns. It's important to note you cannot diagnose, but simply identify and support that individual to approach the appropriate health professional that can support them. indicators that I'll discuss, ⁓

do not necessarily mean they have a substance use disorder. But these things over time and prolonged are things that you can look out for that may suggest somebody is leaning more towards a substance use disorder.

If we talk about behavioural indicators first. ⁓

The things that often come up are increased secrecy in everyday life. Quite often they begin secrecy because of the addictive habits that often goes on to other areas of an individual's life. ⁓ Usually because these things are being developed and moved around because of the habit in that individual's life. So they generally become more, more secretive. It's important to look out for subtle reliability shifts. So somebody not quite

turning up when they usually would or not being as reliable as they often once was. And that's usually because the addictive habit is working around and affecting their daily habits. Defensiveness in their abilities in the relationship is another behavioral indicator. ⁓ And that's usually because an individual feels that they can cope with everything in life and also at the same time, maintain the relationship, maintain work.

and they don't like the idea that one area of their life is struggling, so they often become quite defensive. And risk taking often goes into other areas of their life. So taking risks in areas they wouldn't normally do is another behavioural indicator.

When we think about emotional indicators, generally a good indicator to look out for is irritability. That's not usual for them. Now I'm not talking about the 9 p.m. ready to go to bed, had a long day, stress. It's prolonged general irritability. Similarly, mood swings, and that's over a prolonged period of time. It's not just once or twice or during a particularly stressful time in their life. It is...

daily, often mood swings. And one thing that I often look out for with the emotional indicator is minimization. when an individual thinks something that is a big deal is not a big deal, that often for me is an indicator that they haven't got the capacity at that moment to understand the realization of something. So that's a key emotional indicator that I would look out for.

When we talk about cognitive indicators, rationalization is more challenging with everyday things and that coincides with the emotional indicators. So mood swings, irritability. It's difficult to have a rational conversation and come to a mutual understanding or a mutual standing with the situation. That's one thing that I would look out for.

Another one for me would be preoccupation. if somebody is struggling to focus on some things or enjoy the things that they would usually enjoy, that is preoccupation that generally comes alongside some substance addiction because it's starting to develop their, envelop their world. They're starting to solely focus on that habit. So they're preoccupied from things they usually enjoy.

Another one is narrowed decision-making. And when I refer to this, it's, you know, if you have a conversation and you say, yeah, we're going to go out for a meal tonight. I finished work at five o'clock. Anytime after half five, I can get there. When the decision-making starts to come any time between six and eight and we have to be finished by eight o'clock, it's that narrowing of decisions that...

is another cognitive indicator that might suggest there's an alternative thing that they need to get to after that meal or they have to get in before that meal.

I think the final indicators for me are physical indicators and these are usually the things that people notice first, but are often set to one side. And I think that's really important to discuss them today. the first one I would discuss is withdrawal symptoms. These are things as sweating, cold shivers, dry mouth, upset stomachs, dizziness.

These are often signs and symptoms where we will go, ⁓ they're just really tired today. they must have stayed up late doing work last night. They're things that are easily dismissed because of day-to-day feelings and habits that we all have. They are easily dismissed. Another physical indicator for me would be health changes. So poor dental hygiene and secondary health conditions such as unstable sugar levels, again, coincides with the dizziness.

having tremors, breathing problems and extreme fatigue. And yet again, these things can be easily dismissed from having a particularly busy week or a stressful situation or outside of work. If we talk about having children and PhD or anything else that you're doing, these are the symptoms that can be easily dismissed.

Another physical sign for me is sleep disruption. And when I say that it could be on either end of the continuum, could be insomnia or it could be extreme drowsiness. And I think it depends on where that individual is in their, I say addictive journey. ⁓ You know, you could be, and also dependent on the type of substance that you are taking.

So these are, it's kind of a continuum based on what that person is engaging in. A big indicator for me is somebody's physical appearance. So looking unkept, not dressing the way that they would, not taking the physical effort that they usually would in how they dress, how they put their makeup on, how they do their hair, know, having their nails done, them little things that you notice about an individual.

And that's something like, again, that can be easily dismissed. Another one for me is change in appetite. Now, usually during ⁓ active addiction, weight loss is quite a big indicator because your appetite is suppressed. However, when you're not actively taking that substance, you can find that people either excessively eat to make up for that period of suppressed appetite.

or they become very...

what I can't think of the words, they become very obsessed with one or two types of food and they eat them continually. And that's because of the changes to the body and the effects that the substance addiction can have on your appetite. You taste change. So these are a couple of things that I would look out for. But what I would like to be very clear on that one sign alone means very little.

It's the pattern of these things over time and prolonged. You know, we can all have a bad day. We can all have a really stressful week where, you know, for me not getting my nails done, you know, that's happened. You know, we all have stressful weeks and months. And what it is, is about identifying these and seeing these patterns over a period of time.

Dr Austin Tay (17:00)
Yep.

Yes.

Yeah, I kind of agree with what you just said. Well, we can't have a list to identify addiction, but those indicators that you share, my kind of ⁓ question would be, should we then be using those indicators in tandem or together, or should we just look at it separately? And as you also alluded just now, some of those behaviors might not necessarily mean addiction. It's just people having a bad day, right? Or just

⁓ overindulging on TikTok or social media or whatever you. So it could be just one time off and not a clear sign of addiction. So would you recommend if someone who is looking out for their friends or colleagues are seeing things, should they use these indicators in tandem or should we just look at using it ⁓ separately, individually rather?

Karen Mills (18:07)
I think it's important to note them and I think it's really difficult the relationship you have for that person I think outside of work and in a professional capacity you would deal with them very very differently if that was my friends and you know I notice something I would have a conversation with them and say look you know you're not quite yourself I've noticed this this and this do you want to talk about it is there anything we need to know and that's something that's really difficult in a professional capacity

And I think the relationship you have is very different. In a professional capacity, if it was me looking at my staff member or somebody that we look after in adult social care, it would be noting these things over time, taking a note, letting other people know, you know, I'm just a little bit concerned about this person, you know, within confidentiality. I've noticed these things, but I'll keep an eye on them and I'll just make sure that they know that I'm here to support them if they need to.

Dr Austin Tay (19:08)
Well, with those indicators that you share, my mind I was just thinking, I know you work in healthcare. Are there any specific high risk sectors that we need to know whether we see more people getting addicted to all forms of addiction?

Karen Mills (19:28)
I think, yeah, addiction doesn't discriminate, but there's definitely environments that can increase the risk. ⁓ Risk factors can include, you know, ⁓ isolation, physical injury, pressure in your role, having access to substances, chronic stress. So there's all these elements that are risk factors. And if we look at certain, you know, career sectors, ⁓

I would like to say it's not a determinant, but they can definitely increase your risk. So as you said there, I work in healthcare. With healthcare, we've got chronic stress and we've got access to substances. So that gives us a bit more of an increased risk of the potential for a substance addiction. You know, if we think about law and finance sector, they've got constant performance pressure and they've got

and alcohol culture. it's different risks in different sectors. For example, as well, construction, you've got a high risk of physical injury and therefore a high rate of people that are on long-term opioids for physical injury. Again, that's an increased risk factor. For me, the biggest risk factor is any type of senior leadership role. You are in isolation, you are making difficult decisions daily.

You've got a lot of pressure, you know, you've got identity pressure within that organization as well. But it's definitely less about the job title, but it's more about the stress, the access, culture and identity. And these sectors are just high risk. It doesn't mean that by being in these roles, you were determined to have an addiction, addictive habit, but it's definitely elements of these sectors that make it more high risk.

Dr Austin Tay (21:27)
Well thank you for sharing that because I think that leads very kind of nicely to my next question. Well this high-risk sectors itself, why is then there's still this myth about well substance addiction is definitely not in a workplace. It is very personal, you know it's outside of a workplace. Why is there a myth there?

Karen Mills (21:50)
Yeah, there is a common assumption that ⁓ substance addiction sits outside of professional life, you know, that it belongs somewhere else and it's sort of left at the proverbial door. Often many people continue working and they ⁓ may perform well and they often hold senior positions in organizations. Substance addiction doesn't always look chaotic and I think it often goes undetected for a long period of time in the workplace.

many people continue to perform well in all areas of their life and often show more competence in the early stages of their addiction. yeah, I think it's a difficult thing to notice, but it's that common assumption that it sits outside of the workplace.

Dr Austin Tay (22:39)
But then why is it so invisible at work though, if it's kind of a common thing that people are using addiction as a form of, I know, maybe a strategy to deal with the stress that if you're at work.

Karen Mills (22:57)
Yeah. Competence often acts as camouflage in the workplace. You you can't see the identifiers or, you you dismiss them or perceive the identifiers as, you know, stress of the job or the societal norm in that sector. High performance often reassures managers that everything is okay. And in an organization, high performance and doing well, you know, you won't have them further discussions.

as to why they're doing well, you're assuming they're just doing well because they're good at what they do. And I think most importantly, the fear of damage to reputation often delays help seeking behaviors from employees. The more that someone's identity is built around being capable in their role, the harder it can feel to admit when they are struggling. Isolation.

often increases due to the pressure and decisions being made in the role. And the perceived notion that there's no room to fall apart, know, disclosing difficulties with substance often feels very threatening professionally.

Dr Austin Tay (24:11)
But work itself can be both, I mean, in this sense, a stabilizer and also a stressor, right? Then how do organizations tip this balance to make sure that it's going towards the right direction for the employees?

Karen Mills (24:31)
Yeah, I agree. can be both. Work can provide structure and purpose to an individual and it can create a sense of accountability, it can create routine and almost a reason to get up in the morning. It also acts as a way to restrict the availability for the addictive habit to develop quicker because, you know, usually in the early stages of addiction,

It is avoided during working hours and I say nine till five very rounded and healthcare we don't work nine till five. ⁓ But yeah, it kind of creates that routine or restriction in the early stages of substance use. ⁓ But work can also increase stress. It can reinforce coping and coping with this through substances. can...

normalize a culture where alcohol and substances are already available as we discussed earlier and almost acceptable. ⁓

But just to confirm, work doesn't cause addiction, but it can shape how it develops and how long it can go unnoticed for. Work can be a positive or a negative, but I think what is important is having people in the workplace who can identify these concerns, these identifiers, and are capable of having them discussions if they do have concerns.

Dr Austin Tay (25:55)
And then you were talking about the identifiers and also ⁓ perhaps was thinking about substance abuse here. Obviously, there will be kind of co-factors that implicate that. the kind of work that you do and what you have from experience yourself. Do you think there are factors that actually increase the use of substance in the workplace?

Karen Mills (26:21)
Yeah, substance misuse rarely exists alone. There's usually, we say co-occurrences, ⁓ things such as ⁓ anxiety, depression, previous trauma, burnout, neurodiversity, chronic pain. Often the addiction is the agenda that everyone thinks needs to be resolved first, but we often treat the individual while the system around them still remains unchanged.

So we're not fully supporting the individual in all areas that they require the support, but there are definitely areas that can increase the risk.

Dr Austin Tay (27:04)
So in a context of an organization then, what can they do to actually support employees who are suffering or dealing with substance issues?

Karen Mills (27:18)
Yeah, there are a number of things that organisations can do. ⁓ They can look at the culture within the organisation. They can look at their manager capability and also their structure as well. I'm happy to go a little bit more in depth into each of them if you think that's a good idea.

Dr Austin Tay (27:40)
Yeah please do.

Karen Mills (27:42)
Okay, so when I speak about the culture of an organization, I'm talking about creating a psychologically safe place in the workplace. ⁓ People often delay help because they have a fear of damaging their career, the fear of disciplinary action against them, the stigma attached to substance addiction is ⁓ a major roadblock. It's important that any disclosure is dealt with privately.

and in line with the company policies and GDPR is maintained throughout any wellbeing conversations. You think what's important as organisations encouraging early curious, I say curious conversations when identifiers are seen ⁓ and providing the opportunity for employees to come forward and discuss the concerns that they have. I think

What's also important is ensuring organizations separate wellbeing discussions and performance related discussions. So the employee feels safe and secure to have them discussions about wellbeing. As we mentioned earlier, there's this massive fear of, know, disciplinary of stigma of, you know, the fear of disclosures being made to staff teams. think it's important that we create that psychologically safe space.

And I often believe that if the first conversation that someone has about substance use being in a formal HR meeting, then we've intervened too late.

Dr Austin Tay (29:24)
I was just wondering, you were talking about people who are using substance in the workplace. It's good that if organization can have those first conversations, what if it has gone beyond that? I'm just wondering, is there any legal framework that we can use or an organization could look at in the context of the UK itself?

Karen Mills (29:58)
Yep, I think...

I've just realised I've only gone through one of the... ⁓

one of the things that the organisations can do in regards to substance addiction.

Dr Austin Tay (30:14)
Sure, no problem. mean, we can talk about the legal framework later, but if you want to add on to what you were saying earlier on, please do.

Karen Mills (30:23)
Sorry, yeah, I think I was a bit in the flow then and then I stopped. So I do apologize. I think one thing for me that's important is I say there about having early discussions, but the second thing that's important is making sure that your managers have the confidence to have them conversations. And they're not there to diagnose the addiction. What would they need to do is be able to notice changes in the employees.

Dr Austin Tay (30:27)
No worries, no worries.

Karen Mills (30:50)
at whatever level they are within the organization and they need to ask questions with avoiding accusations. They need to maintain their professional boundaries, but they also have a duty of care to all of their employees. All they need to do is simply notice the changing behaviors. The biggest thing we can do is empower our managers to feel prepared for these types of conversations and they are really tricky to navigate.

Dr Austin Tay (31:02)
Yep, definitely.

Karen Mills (31:18)
and these conversations are usually very emotionally charged. These conversations need to be done so in a psychologically safe space, as we mentioned earlier. When I referred to structure earlier, think, and leading on to what you said as well, it's referring to companies' policies and the pathways that they have in place. And organisations' policies are usually based on UK, within the UK, the UK laws, legislations and best practice.

There is a couple of organizational policies that I would also always suggest people to read as a part of their induction into the organization anyway. But if you believe that you have a staff member who is struggling with substance addiction, please refer to your sickness or your absence policy. Have a look at your health and safety policy. A lot of organizations do have their own addiction policies. It may require you just to dig a little bit deeper, but always feel comfortable to

Ask your HR or your line manager for the support and guidance that you need if you are concerned about one of your employees.

Dr Austin Tay (32:28)
So with regards to what we were talking about, the legal framework, is there some legal framework that we could actually look at?

Karen Mills (32:38)
Legally, addiction sits in a very complicated space. Although organizations have a legal duty to ensure the safety of their employees, they also have a duty to report any illegal conduct during working hours. If we look at laws and legislations that I would consider, if we look under the Equality Act 2010, addiction is not automatically classed as a disability.

However, the associated mental health conditions that are often associated with addiction, you would be protected under the Equality Act if you have that dual diagnosis. So they may have legal standing under this act for support during any ongoing discussion, HR implications or disciplineries. If we look at the Health and Safety at Work Act 1974, employees have a duty

to ensure the safety of their employees. They have to risk assess appropriately, ensure that there's adjustments put in place and any decisions are made in line with legal obligation. So this act would come into effect if the addiction was directly affecting the role that the individual was employed for.

The Employment Rights Act of 1996, employers must follow a fair and legal process with any investigation. This also includes extenuating circumstances, which addiction would sit under extenuating circumstance. It needs to be considered during any disciplinary, any investigation. But the problem is the stigma attached to addiction and often this outweighs the employees.

Dr Austin Tay (33:59)
Mm.

Karen Mills (34:26)
comfortableness to disclose their addictive habit.

We mentioned earlier about GDPR as well, ⁓ general data protection regulation. Any health information that is collated is protected and must be handled in the reason for which it was intended. The law sets the minimum standard and expectation, but the organizational culture is what determines whether someone's seeking help early and whether this is a roadblock for help seeking behavior during work.

Dr Austin Tay (34:37)
Yes.

Karen Mills (35:03)
And I think the most influential one is the Misuse of Drugs Act 2001. So that states that employer has a legal obligation to have an appropriate policy on substance misuse and must take reasonable steps to ensure that the employee doesn't pose a threat to themselves or to others due to the influence of drugs or alcohol. But this is limited to only during work hours.

which is another roadblock because as we mentioned earlier, addiction often starts in outside of work and falls into work practice later on. There is definitely a fine balancing act for organizations. They have to balance safety, fairness, accountability, compassion, but organizations are not treatment centers.

they can accelerate the harm or they can support to reduce it. And I think it's knowing what the legal obligation is of an organization that will help us to support. The goal isn't to eliminate all risk. We can't eliminate all risk. It's to make sure that when someone begins to struggle, the system doesn't make it worse. And people have the employees have the legal standing behind them to support them.

Organizations have a duty of care and so do the employees. If you are deemed to have put someone else at risk due to your substance misuse, this can be seen as gross misconduct. So it's really important that an individual feels safe and secure to come forward about any addiction that they have because they have a legal obligation as well.

Dr Austin Tay (36:35)
Yep.

Yeah, it is very important to understand what addiction is. And thank you very much, Karen, for sharing so much about how we can actually help to identify people are going through addiction and how organization can ⁓ help them. And at the same time, be mindful of the legal framework in the UK, especially ⁓ for the organization themselves. I was just wondering any closing thoughts for our listeners ⁓ in this podcast with regards to addiction?

Karen Mills (37:28)
Yeah, I think the main thing for me is addiction rarely announces itself loudly. It starts with a whisper. And that's something that we need to be mindful of. think with addiction, tend to often see it as a continuum. We have substance use, substance abuse, then substance use disorder. Along that continuum, people can move across that continuum as quietly

as they can and they often sit in a part of that continuum for a very long period of time. So this often means, you know, certain habits or identifiers aren't noticed because they're quite comfortable in that part of the continuum. I think if we understood addiction less as a moral failure and more as a narrowed coping under pressure, I think our responses would be very, very different. And I'd like to visit again that.

Substance addiction is not a lack of willpower. It's not a lack of moral standing. It is a chronic disorder. And when we change our perspective on that stigma, it will change our views on it.

Dr Austin Tay (38:40)
Thank you very much for that last few points there. I think it has been very illuminating for myself too, to be able to understand what addiction is, especially in the workplace with different sectors that are more prone to it and how organization can help those people who are going through that. With that, I really like to say thank you for taking the time to share with us on your expertise in the area of addiction. Thank you very much, Karen.

Karen Mills (39:08)
Thank you for having me.