Winter Think Tank Meeting
March 1st and 2nd
Austin, Texas

How are we doing as a profession, and as family members and citizens, speaking up about addiction? As I was preparing our Think Tank Agenda focused on the opioid epidemic, I was weighing how much time to allow for personal reflections during our sessions. After all, if stigma–and related silence–is a barrier to action, what better place to model what open discussions could look like than at a convening of health professionals? For an incisive essay on how easy it is for “in-groups to mark outgroups as different” and how facile we are in avoiding outgroups, read Goldberg’s “On Stigma and Health.”[1] So, I wondered, would it be indiscreet to ask how addiction has touched the lives of our participants? I decided to put my trepidation to the test at a luncheon attended by twelve health promotion professionals, most of whom were meeting each other for the first time. I initiated a round-robin discussion by saying: “I’m hosting a Think Tank attended by employers to discuss addiction and opioids in the workplace. Do you think I should ask about how addiction affected their lives? And, only if you are comfortable with it, perhaps you can share what you would say at such a session?”

If it’s mentionable it’s manageable.” Fred Rogers

To a person they each shared personal stories, both poignant and hopeful, that made it clear that they put openness above privacy when it came to dealing with the stigma surrounding addiction. Why was I so surprised? I am the author of a book entitled, “Breaking Stone Silence: Giving Voice to HIV Prevention in Africa,” and have discussed AIDS with hundreds of Africans both living with and affected by the AIDS epidemic.[2] By now one would think that I would have become inured to the caprices of individual and cultural differences relating to stigma, private lives and public education. Nevertheless, I doubt I’m alone in my bewilderment at the deep irony that stigma commands: where peer pressure is what likely keeps us quiet, peer support is what enables us to speak up.

The goal of this reading list is to equip our HERO members and Think Tank participants with opioid education resources that enable you as leaders and silence-breakers to role model what it looks like to speak out about addiction.

Surgeon General Jerome Adams’ # 1 Priority

With today’s opioid epidemic claiming four lives an hour in the U.S.A., I was heartened that Surgeon General Jerome Adams, America’s Newest Doctor, is naming the epidemic his number one priority. For a brief primer on his approach to assessing and confronting this disease, I recommend a webcast interview with Dr. Adams hosted by Dr. Robert L. Blendon as part of the “Voices of Leadership” series at the Harvard T.H. Chan School of Public Health.[3]

As an employer, and as one who advocates for employer leadership in health promotion, I feel employers, particularly middle managers, have a front row seat for watching the epidemic. Clearly, because EEOC rules protect employee privacy related to health issues, our role is not steeped in the complexity of clinical assessment or diagnosis. Instead, our role relates to what I consider the most straightforward definition of addiction: It is when “it” (i.e., alcohol, opioids, gambling) begins to cause problems. Though the National Safety Council recommends supervisors be trained in recognizing addiction, only 30 percent of companies offer such instruction.[4]

 “The Working Well Toolkit”

A collaborative effort between the National Alliance on Mental Illness – NYC Metro, Northeast Business Group on Health, Partnership for Workplace Mental Health/American Psychiatric Association Foundation, PricewaterhouseCoopers, and The Kennedy Forum, a “Working Well toolkit” was developed that discusses how stigma and the related silence about mental health issues is a key underlying impediment to business success.[5]

Principles for Driving Change

  1. Know the Impact.
  2. Break the Silence.
  3. Deliver Affordable Access.
  4. Build a Culture of Well-Being.

“Dreamland: The True Tale of America’s Opiate Epidemic”

Our HERO Think Tank participants who join us in Austin will receive Sam Quinones’ 2015 book, “Dreamland: The True Tale of America’s Opiate Epidemic.” It is the most comprehensive reportage to date for explaining how painkillers have led to heroin addiction in America.[6] Watch for a “Dreamland Book Club Meeting” that will be hosted by HERO and Quinones who regularly posts on his “Reporter’s Blog” which remains focused on stories from around the nation that illuminate and trace the pathway to addiction.

 “Pain in the Nation: The Drug, Alcohol, and Suicide Crises and the Need for a National Resilience Strategy.” A report by Trust for America’s Health, Robert Wood Johnson Foundation and Well Being Trust

One of our Think Tank presenters will be Benjamin Miller who is one of the contributors of this comprehensive pain report[7], about how overdosing has run amok and he is quick to point out the problem resides with all of us. “Anytime I hear someone cast aspersions at doctors who are overprescribing or drug companies who are to blame I get concerned; there is plenty of blame to go around, but what good is that if we do not get to the root cause?” Every one of us experiences pain at some time in our life, Miller reminded me, and we all have the capacity to empathize, listen and overcome stigma by breaking the silence. “These are deaths of despair” according to Miller, who is Chief Strategy Officer at Well Being Trust, and the “Pain in the Nation” report details state by state statistics foretelling the inexorable links between issues like alcohol, drugs, and suicide.

“Understanding the Opioid Epidemic” by PBS

What is the number one reason for a doctor visit? Pain. It’s a point that writers at PBS use as a simple starting point to build a case around the complex cascade of trends that have fueled the opioid epidemic. Simply called, “Understanding the Opioid Epidemic,” PBS aired a powerfully rendered blend of journalistic investigation into the march of the epidemic alongside poignant stories about lives affected by addiction.[8] Where Quinones’ book is a tour de force chronicling the collision of societal, research, medical practice, and criminal justice missteps, this PBS program is a crash course in the current state of affairs of opioid use, a crisis that now knows no boundaries relating to class, race or religion.

 

Other Readings the HERO Team reviewed in preparation for “Overdosed: Are We taking in too Much?”

Prescription Pain Medications: A Fatal Cure for Injured Workers

Prescription Nation 2016: Addressing America’s Drug Epidemic

How Prescription Opioids May be Affecting Your Workers Compensation Program

Opioid Crisis Looms Over Job Market, Worrying Employers and Economists

Substance Use Calculator

Alcohol Consumption and Workplace Health

Payers to identify, promote, and rewards SUD treatment that aligns with Principles of Care

Real Costs of Substance Use in your Workforce

Why Your Mind is Better than Pain at Conquering Pain

Understanding the Opioid Epidemic

Opioid Disorders

Improving Access to Psychosocial Care for Individuals with Persistent Pain: Supporting the National Pain Strategy Call for Interdisciplinary Pain Care

Improving Access to Psychosocial Care

How opioids started killing Americans

ASA Report on Stress in America State of the Nation

Article from ASAE on the report on Stress in America State of the Nation

What Impact will Generation Z Have on the Workplace?

Smartphone Detox: How To Power Down In A Wired World

References

[1] Goldberg, D. “Stigma and Health.” The Journal of Law, Medicine and Ethics, Winter 2017, 45: 475-483. http://journals.sagepub.com/doi/abs/10.1177/1073110517750581?journalCode=lmec (accessed 2/5/18)

[2] Terry, P. “Breaking Stone Silence, Giving Voice to AIDS Prevention in Africa.” Africa World Press. http://africaworldpressbooks.com/breaking-stone-silence-giving-voice-to-aids-prevention-in-africa-by-paul-terry/ (accessed 2/5/18)

[3]  “Voices in Leadership” Live stream. “A Conversation on the Opioid Epidemic with Vice Admiral Jerome M. Adams, 20th Surgeon General of the United States.” https://www.hsph.harvard.edu/voices/events/jerome-adams-20th-surgeon-general-of-the-united-states/  Harvard T.H. Chan School of Public Health. Jan. 24, 2018. (accessed 1/24/18)

[4] Pirtle, R. “Detecting and Dealing with Workplace Opioid Abuse.” Safety Management Group. Posted 3/28/16. https://safetymanagementgroup.com/detecting-and-dealing-with-workplace-opioid-abuse/ (accessed 1/30/18)

[5] “Working Well: Leading a Mentally Healthy Business.” Working Well Toolkit. June 2016. https://www.google.com/urlsa=t&rct=j&q=&esrc=s&source=web&cd=1&cad=rja&uact=8&ved=0ahUKEwjyzOKL9vPYAhWE6YMKHY9IBu4QFggpMAA&url=http%3A%2F%2Fworkplacementalhealth.org%2Fgetattachment%2FMaking-The-Business-Case%2FLink-2-Title%2Fworking-well-toolkit.pdf%3Flang%3Den-US&usg=AOvVaw2JwMpsR_joTGObP6p5DZNe (PDF; accessed 1/25/18)

[6] Quinones, Sam. “Dreamland: The True Tale of America’s Opiate Epidemic,” 2015, Bloomsbury Press, 1385 Broadway, New York, NY, 10018, USA.

[7]Pain in the Nation: The Drug, Alcohol, and Suicide Crises and the Need for a National Resilience Strategy.” A collaboration between Trust for America’s Health, Robert Wood Johnson Foundation, and Well Being Trust. http://wellbeingtrust.org/for-media/pain-in-the-nation-report (accessed 1/19/18)

[8] Grant, John. “Understanding the Opioid Epidemic,” PBS, January 17, 2018. Copyright 2015, Public Broadcasting Service. http://www.pbs.org/show/understanding-opioid-epidemic/ (accessed 1/19/18)

 

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