Mounting pressures from COVID-19 call for employers’ renewed focus on alcohol use disorder

Sharon Phares, PhD, MPH
April 16, 2020

For a few years now, news feeds have been ablaze with headlines about the alarming impact of the opioid epidemic, and rightly so. At the same time, another epidemic has been lurking just beyond the shadows of the opioid crisis: alcohol use disorder (AUD), which affects one in 13 working adults. In light of the current COVID-19 environment, mental health and addiction experts are warning that substance abuse rates may rise as a consequence of the anxiety caused by the economic and social impact of this pandemic. An Axios-Ipsos poll for the week ending March 30 showed that about a third of Americans were already reporting worsening mental health and emotional well-being.

Working remotely is a challenge for many employees in the best of times, and the stress and isolation of working from home – perhaps for the first time ever – may be exacerbated by COVID-19 anxiety. Nielsen reported that online alcohol sales increased 243 percent and total alcohol sales rose 55 percent for the week ending March 21. And  according to the website,, people struggling with AUD face additional challenges due to loneliness, isolation from their support system, and anxiety as they face the unknown.

AUD is an expensive problem for both employers and employees. An estimated $74 billion is lost annually in reduced work productivity due to alcohol consumption that results in absenteeism, reduced output, higher turnover and illness. Estimated healthcare costs for employees with AUD are double that of other employees. And these employees visit the emergency room more often and spend more days in the hospital. In light of the current COVID-19 pandemic, it’s important to note the potential impact of alcohol on the body’s immune system, as well.


Why it’s hard to treat AUD

Sadly, only about 10 percent of people with AUD receive treatment. Several factors likely contribute to this low rate. For one, AUD in the workplace is difficult to identify and help resolve, and the current, temporary, work-from-home environment adds more complexity in identifying employees suffering from AUD. What’s more, alcohol is socially acceptable, unlike prescription misuse or street drugs. Further, the societal stigma associated with substance abuse prevents many from asking for help. Today’s economic situation creates even greater barriers for employees with AUD as they may fear losing their job if they admit to having a problem.

“Alcohol use disorder is a well-defined mental illness, not to mention a public health crisis,” says psychiatrist Dr. Helen Farrell. “But it is treated vastly differently from other deadly illnesses, such as cancer. Rather than running in celebrated annual races or participating in fundraisers, alcohol’s victims are hiding in shame. There is a chasm between our understanding of mental illness and our acceptance of it.”


Still, there’s hope

For those struggling with AUD or other mental health concerns, healing starts when the stigma stops. Employers can assist their employees through education, prevention, rehabilitation and return to work, such as:

  • Training managers how to recognize alcohol abuse issues and deal with them consistently.
  • Encouraging employees to seek help and providing information on treatment options available, such as employee assistance programs (EAPs) and medical plan benefits such as detoxification, medication-assisted treatment (MAT), and continuing care.
  • Tailoring communications to high-risk populations—including young people between 18 and 35—informing them of the risks of alcohol use disorder. Information can be found at the National Institute on Alcohol Abuse and Alcoholism, American Addiction Centers, and the Mayo Clinic, for example.
  • Establishing a return-to-work policy focused on helping employees reintegrate into the workplace.

In addition, employers should review and understand how their current medical and pharmacy plan coverage addresses:

  • Costs for AUD screening
  • Enhanced health plan or PBM services, including stronger interventions; plan monitoring of physicians, pharmacies, and patients; and addiction resources and support for patients and families
  • Utilization management strategies, such as step therapies and prior authorization requirements, that may delay substance abuse treatment or after care


Investing in the safety and health of your employees

Alcohol use disorder is costly to employers and a painful condition for employees who may suffer in silence. Thankfully, employers have many options available to help employees. A renewed focus on AUD education, prevention, and treatment now can not only lead to positive outcomes for employees – but can impact the financial health of the organization through increased productivity and reduced future care costs.

Sharon Phares, PhD, MPH, is the Senior Vice President of Research for PSG and an Assistant Adjunct Professor of Clinical Pediatrics and Assistant Adjunct Professor of Internal Medicine with Washington University in St. Louis. Prior to joining the PSG, Sharon was Vice President of Research and Analytics at Express Scripts where she led research strategy and execution for one of the largest PBMs in the nation. She has also held leadership roles in health and economic outcomes research, survey design, pilot and program design and evaluation, analytics and research consulting, advanced analytics, and the development of predictive models at Walgreens, LabCorp, and Landacorp. She was an instructor at North Carolina State University and provided evaluation research for various state and local government agencies before joining the private sector.