Occupational Relapse Prevention (ORP): An Enhancement For Employee Assistance (EAP) Programs

By Terence T. Gorski, Author

imagesAn Overview of Occupational Relapse Prevention (ORP)

Occupational Relapse Prevention Planning (ORPP)* integrates Relapse Prevention Therapy (RPT), an evidenced-based intervention, with employee assistance programming  to prevent relapse in the workplace.  ORPP requires the cooperation of labor and management to identify and intervene  upon the on-the-job warning signs that lead to relapse in the  workplace.  ORPP consists of::

1.    The Personal Relapse Prevention Plan which is completed by the treatment center prior to discharge and includes an assessment of past relapse episodes, a list of warning signs likely to cause relapse in the future, warning signs management methods, and recovery activities that include ongoing relapse prevention planning.

2.    The On-the-job Relapse Prevention Plan which is developed in a session with the EAP and therapist before discharge and includes a list of on-the-job relapse warning signs likely to cause relapse in the future and methods for intervening before addictive use begins.

3.    The Return To Work Plan which is developed by the EAP and the supervisor. It includes the ongoing treatment required for being reinstated to the job, a clear written description of job performance expectations, a list of critical warning signs, and the intervention and disciplinary methods that will be used if substandard performance or observable warning signs develop.

4.    The Employment Agreement is the final documentation of the return to work plan that is formally approved by representatives of both union and management.

5.   The Follow-up Plan is developed by the EAP and established a schedule of routine contacts with the patient, supervisor, and EAP counselor.

On-The-Job Relapse Warning Signs (ORWS) – Summary
Developed ByTerence T. Gorski – March, 1987 (Revised: March, 1992)

PHASE I  – RETURN OF DENIAL:  During this phase the relapsing worker has a compulsion to overwork, working harder and longer than co-workers; feels a great deal of loyalty and has a strong need to have his/her work efforts recognized and rewarded.  The relapsing worker is very productive and tries to make profound contributions to the work unit or to the company in general.

This phase includes: (1) a strong assertion that everything is ok; (2) patronizing responses when asked about performance; (3) talking about being indispensable and being better than other employees; and (4) criticizing management decisions.

PHASE 2:  AVOIDANCE AND DEFENSIVE BEHAVIOR:  This phase is marked by a change in work behavior and attitude.  Relapse signs are more visible to the trained supervisor.

This phase includes: (1) compulsive attempts to prove they’re a good worker; (2) disappointment with and blaming of co-workers; (3)  strained relationship with supervisor; (4) avoids boss or associates; (5) rigidity in following job instructions; (6) lectures and labels supervisors/co-workers; (7) dwells on positive aspects of treatment; (8) becomes restless; (9) tears down AA and counseling programs.

PHASE 3:  CRISIS BUILDING:  This phase is includes a progressive degeneration in all areas of work. Job performance problems are developing or returning.

This phase includes: (1) problems with concentration and memory; (2) work requires greater effort; (3) difficulty recalling own mistakes; (4) isolation from co-workers; (5) procrastination; (6) lower quantity and quality of work; (7) mistakes or error in judgment; (8) feels used and unappreciated; (9) morale problems result from behavior of relapsing worker; (10) occasional tardiness; (11) risk taking/safety problems; (12) self-generated stress.

PHASE 4:  IMMOBILIZATION:  Supervisors as well as co-workers are aware of the relapsing worker’s job performance impairments as well as his/her attempts to withdraw from the work unit.

This phase includes: (1) “if only…” thinking develops; (2) daydreaming and “spacing out” becomes noticeable; (3) frequent tardiness.

PHASE 5:  CONFUSION AND OVERREACTION:  Problems generated by the relapsing worker are beginning to affect other departments or customers who begin complaining about the attitude or behavior of the relapsing worker.

This phase includes: (1) overreaction to real or imagined criticism; (2) complaints from customers and co-workers; (3) violation of unwritten rules of the organizational culture.

PHASE 6:  DEPRESSION:  The relapsing worker is impaired in all life areas; physical, emotional and mental impairment is obvious to co-workers who are concerned and frustrated.

This phase includes: (1) apathy and cynicism; (2) leaving work early; (3) absenteeism; (4) laziness and lack of cooperation; (5) physical appearance declining.

PHASE 7:  BEHAVIORAL LOSS OF CONTROL:  Higher levels of management are becoming aware of the impact the relapsing worker is having on the department.  In this situation, the supervisor involved is usually forced to take action.  The supervisor is angry with the relapsing worker as well as the EAP department because this employee is still “not fixed”.

This phase includes: (1) changes in job efficiency; (2) hostile arguments with management; and(3) verbalizes total dissatisfaction with company.

PHASE 8:  RECOGNITION OF LOSS OF CONTROL:  PHASE 8 may be the first time in which the relapsing worker accepts responsibility for personal behavior and signs of remorse are visible for the first time.  Unfortunately, the search for sympathetic ears disrupts and continues to cause resentments.

This phase includes: (1) Explosive Behavior Followed By Shame/Guilt/Remorse; and (2) Self Pity.

PHASE 9:  OPTION REDUCTION:  The relapsing worker usually receives phone calls from the EAP department and refuses to return any of them; stops all contact with helping systems (AA, AA sponsor, counselors or EAP).  Worker may be terminated from EAP program.

This phase includes: (1) major attitude reversal; (2) withdraws from all treatment; (3) behavior with subordinates alternates between apathetic and explosive.

PHASE 10:  ACUTE RELAPSE EPISODES:  A return of all performance problems as well as newly developed problems. Absenteeism and safety problems increase and persist and a hospital admission is common.

This phase includes: (1) Physical Changes; (2) Drug Use (usually prescription); (3) Return to Drinking.

Following PHASE 10 relapsing workers will seek medical or psychiatric attention for relief.  A common complaint is stress, anxiety, or depression. In spite of treatment the problems persist as evidenced by: (1) progressive physical health changes; (2) treatment for physical illness; (3) treatment for psychiatric or nervous conditions; (4) drug use (usually prescription); (5) return to alcohol and/or illegal drug use; (6) absenteeism; (7) hospital admissions; (8) major job performance problems; (9)  serious accidents; (10) increased medical claims; (11) total inability to function on the job.

The Return To Work Plan

The return to work plan helps the employee rapidly return to full productivity after inpatient chemical dependency treatment.  It is a vital part of Occupational Relapse Prevention Planning (ORPP). The return to work plan is developed as a cooperative effort between the patient, inpatient therapist, EAP counselor, and supervisor.

The basic components of the Return To Work Plan are:

1.  The Evaluation of Past Performance is a report developed by the supervisor and EAP counselor that includes a summary past job performance (including attendance records, performance evaluations, corrective actions, safety violations, etc.), a list past job-related problems that need to be corrected in the future, and evidence (if any) that those problems were related to chemical use.  This report is communicated verbally or in writing to the inpatient therapist and the employee by the EAP.  The goal is for the employee to learn how their addiction has affected performance and safety.

2.  The Employee’s Corrective Plan is a description of the actions that the employee is willing take to correct each job-related problem.  It is developed by the employee and inpatient therapist in consultation with the EAP and presented to the EAP in writing shortly before discharge.

3.  The Ongoing Care Plan is developed by the employee, inpatient therapist, and EAP shortly before the employee’s discharge.  It describes the ongoing treatment that will be required for reinstatement to the job and any conditions that would require alteration of existing job duties.

3.  The Fitness For Duty Physical is conducted by the industrial physician in accordance with guidelines established by the EAP.  It assures that the employee is currently abstinent from alcohol and other drugs and is physically and psychologically able to resume job duties.

4.  Performance Goals are clearly identified and communicated to the employee in a meeting with the EAP, supervisor and union representative.

5.  The List of On-The-Job Warning Sign identifies critical on-the-job behaviors (such as changes in mood, communication problems, carelessness, etc) that the employee has identified as relapse indicators but are not severe enough to warrant corrective discipline.  The presence of these warning signs will result in referral for a fitness for duty physical.

6.  The Early Intervention Plan is developed by the supervisor and EAP and describes the procedures for referral and corrective discipline should warning signs or performance problems recur.

Goals Of The Return To Work Plan

The Return To Work Plan has four major goals that encompass the employee, the employee assistance counselor, the supervisor, and the union.

1.   Goals for the Employee:  The goal is to facilitate a rapid return to full productivity.

2.   Goal for the Employee Assistance Counselor (EAP):  The goal is to provide clear case management guidelines that will eliminate confusion and minimize complications in problem employee management.

3.  Goals for the Supervisor:  The goal is to provide clear performance expectations and corrective plans that will make future supervision effective, minimize the need for corrective discipline, and to make corrective discipline efficient and effective should it become necessary.

4.  The Goal for the Union:  The goal is to assure the fair and responsible management of grievances and assure that employee suffering from substance use disorders and mental disorders have an opportunity to recover by participating in effective treatment prior to undergoing corrective discipline.

Return to work planning is a vital part of Occupational Relapse Prevention Planning (ORPP).  The plan is developed as a cooperative effort of team consisting of the EAP counselor, the therapist, the employee/patient, the supervisor, and the union representative.

Components of The Return To Work Plan

There are seven components of the Return To Work Plan: (1) Evaluation of Past Performance; (2)  Employee’s Corrective Plan; (3) Continuing Plan; (4) Fitness For Duty Physical; (5) Performance Goals; (6) On-The-Job Warning Signs; (7) Relapse Early Intervention Plan.

1.  The Evaluation of Past Performance is a report developed by the supervisor and EAP counselor that includes a summary past job performance (including attendance records, performance evaluations, corrective actions, safety violations, etc.), a list past job-related problems that need to be corrected in the future, and evidence (if any) that those problems were related to chemical use.  This report is communicated verbally or in writing to the inpatient therapist and the employee by the EAP.  The goal is for the employee to learn how their addiction has affected performance and safety.

2.  The Recommended Corrective Plan is a description of the actions that the employee is willing take to correct each job-related problem.  It is developed by the employee and inpatient therapist in consultation with the EAP and presented to the EAP in writing shortly before discharge.

3.  The Continuing Plan is developed by the employee, inpatient therapist, and EAP shortly before the employee’s discharge.  It describes the ongoing treatment that will be required for reinstatement to the job and any conditions that would require alteration of existing job duties.

4.  The Fitness For Duty Physical is conducted by the industrial physician in accordance with guidelines established by the EAP.  It assures that the employee is currently abstinent from alcohol and other drugs and is physically and psychologically able to resume job duties.

5.  Performance Goals are clearly identified and communicated to the employee in a meeting with the EAP, supervisor and union representative.

6.  The List of On-the-job Warning Signs identifies critical on-the-job behaviors (such as changes in mood, communication problems, carelessness, etc) that the employee has identified as relapse indicators but are not severe enough to warrant corrective discipline.  The presence of these warning signs will result in referral for a fitness for duty physical.

7.  The Early Intervention Plan is developed by the supervisor and EAP and describes the procedures for referral and corrective discipline should warning signs or performance problems recur.

Occupational Relapse Warning Signs (ORWS) – Check-list
Developed ByTerence T. Gorski, March, 1987 (Revised: March, 1992)

Phase 1:  RETURN OF DENIAL:
[] 1.  Concern About Well Being.
[] 2.  Denial of the Concern.

Phase 2:  AVOIDANCE AND DEFENSIVE BEHAVIOR:
[] 3.  Believing “I’ll Never Drink Again”.
[] 4.  Worrying About Others Instead of Self.
[] 5.  Defensiveness.
[] 6.  Compulsive Behavior.
[] 7.  Impulsive Behavior.
[] 8.  Tendency Toward Loneliness.

Phase 3:  CRISIS BUILDING:
[] 9.  Tunnel Vision.
[] 10. Minor Depression.
[] 11. Loss of Constructive Planning.
[] 12. Plans Begin To Fail.

Phase 4:  IMMOBILIZATION:
[] 13. Daydreaming and Wishful Thinking.
[] 14. Feelings That Nothing Can Be Solved.
[] 15. Immature Wish To Be Happy.

Phase 5:  CONFUSION AND OVERREACTION:
[] 16. Periods of Confusion.
[] 17. Irritation With Friends.
[] 18. Easily Angered.

Phase 6:  DEPRESSION:
[] 19. Irregular Eating Habits.
[] 20. Lack of Desire To Take Action.
[] 21. Irregular Sleeping Habits.
[] 22. Loss of Daily Structure.
[] 23. Periods of Deep Depression.

Phase 7:  BEHAVIORAL LOSS OF CONTROL:
[] 24. Irregular Attendance At AA and Treatment Meetings.
[] 25. Development of an “I Don’t Care” Attitude.
[] 26. Open Rejection Of Help.
[] 27. Dissatisfaction With Life.
[] 28. Feelings of Powerlessness and Helplessness.

Phase 8:  RECOGNITION OF LOSS OF CONTROL:
[] 29. Self Pity.
[] 30. Thoughts of Social Drinking.
[] 31. Conscious Lying.
[] 32. Complete Loss of Self Confidence.

Phase 9:  OPTION REDUCTION:
[] 33. Unreasonable Resentments.
[] 34. Discontinues All Treatment.
[] 35. Overwhelming Loneliness, Frustration, Anger and Tension.

Phase 10:  ACUTE RELAPSE EPISODE:
[] 36. Loss of Behavioral Control.
[] 37. Acute Relapse Episode.  Marked by:
[] 38. Degeneration in all life areas.
[] 39. Alcohol or drug use.
[] 40. Emotional Collapse.
[] 41. Physical Collapse.
[] 42. Stress Related Illness.
[] 42. Acute Episode Psychiatric Illness.
[] 43. Suicide Attempt.
[] 44. Accident Proneness.
[] 45. Disruption of relationships and social structures.

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One Response to Occupational Relapse Prevention (ORP): An Enhancement For Employee Assistance (EAP) Programs

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    新課綱

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