Strategies for Employee Assistance Programs: The Crucial Balance [Second Edition, Revised] 9781501717895

Table of contents :
Contents
Preface
I. Employee Assistance: An Overview
II. EAP Program Components And Implementation
III. Issues In Program Development
IV. Workers' Compensation, Arbitration, And EAPs
V. Program Evaluation And The Future Of EAPs
Appendix A: Constructive Confrontation And Its Effectiveness
Appendix B: Counseling And Its Effectiveness
References

Citation preview

Key Issues Number 30

STRATEGIES FOR EMPLOYEE ASSISTANCE PROGRAMS: THE CRUCIAL BALANCE

Second Edition, Revised

William J. Sonnenstuhl Harrison M. Trice

ILR Press School of Industrial and Labor Relations Cornell University

Copyright © 1986,1990 by Cornell University ISSN: 0070-0185 ISBN: 0-87546-167-0 Second printing, 1995

Library of Congress Cataloging-in-Publication Data Sonnenstuhl, William J., 1946Strategies for employee assistance programs: the crucial balance / William J. Sonnenstuhl, Harrison M. Trice. -2nd ed., rev.

p. cm. — (Key issues ; no. 30) Includes bibliographical references. 1. Employee assistance programs. 2. Alcoholism and employment. I. Trice, Harrison Miller, 1920- . H. Tide. m. Series: Key issues (Ithaca, N.Y.) ; no. 30. HF5549.5.E42S6 1990 658.3'82 -dc20 90-4469 CIP

CONTENTS PREFACE v I.

EMPLOYEE ASSISTANCE: AN OVERVIEW 1 Employee Assistance Terms Defined 1 Historical Antecedents of EAPs 3 Social Betterment 3 Personnel Counseling 3 Occupational Mental Health 4 Industrial Alcoholism 5 Employee Assistance Programs 6 Why EAPs Are Adopted 7 Union Reactions to Employee Assistance 8 Member Assistance 9 Summary 10

II.

EAP PROGRAM COMPONENTS AND IMPLEMENTATION 11 Program Policy 11 EAP Sensitivity to Alcoholism 13 The Core Technology of EAPs 14 Top-Management Support 15 Program Management and Coordination 16 Supervisory Training 18 Peer Training 19 Employee Education 20 The Counseling Component 21 In-House Services 22 External Services 23 Community Resource Network 23 Union Support and Involvement 24 Summary 26

III.

ISSUES IN PROGRAM DEVELOPMENT 27 Program Strategies and Their Effectiveness 27 Constructive Confrontation 28 Counseling 31 The Case for Balance 33 Corporate and Union Responsibilities 36 Provision of Services 36

Confidentiality 37 Third-Party Payment 38 Summary 40

IV. WORKERS' COMPENSATION, ARBITRATION, AND EAPs 41 Workers' Compensation Insurance 41 Physical-Mental Injuries 42 Mental-Physical Injuries 42 Mental-Mental Injuries 43 The Tort of Mental Distress 44 Alcohol and Workers' Compensation 45 Arbitration 46 Psychiatric Problems 47 Alcohol Problems 48 Drug Problems 51 EAPs and Employer Responsibility 53 V.

PROGRAM EVALUATION AND THE FUTURE OF EAPS 55 Program Evaluation 55 Some Neglected Aspects of Program Evaluation 60 Future Studies 62 Integrating Research into Practice 63 The Crucial Balance: A Summary 63 EAP Strategies: Constructive Confrontation and Counseling 64 Program Adoption 64 Labor-Management Cooperation 64

Appendix A: Constructive Confrontation and Its Effectiveness 65 Appendix B: Counseling and Its Effectiveness 66 References 69

PREFACE In the first edition, we attempted to make sense of the conflicting notions of "employee assistance11 by reviewing the historical origins of employee assistance programs (EAPs) and by building on the empirical research about program effectiveness. We concluded that effective programs maintain a crucial balance between constructive confrontations—the workplace strategy for identifying and motivating alcoholic and other troubled employees to change their behavior—and the dynamics of counseling because these strategies act synergetically. Today, there is an emerging consensus that maintaining this crucial balance is at the core of EAP work (Blum, Roman, and Tootle, 1988; Roman, 1988). According to Roman and Blum (1985, 1988b) the core tasks involved in maintaining this balance are: 1. consulting with and training supervisors, managers, stewards, and coworkers on the use of: job performance to identify employees' behavioral problems and constructive confrontation to motivate them to resolve their behavioral problems; 2. linking alcoholic and other troubled employees to community resources for counseling and treatment; 3. creating and maintaining links between the work organization and community resources; and 4. maintaining a program emphasis on alcohol and other substance abuse problems. Consensus is slowly emerging among employee assistance workers as they attempt to become more professional and cut out a protected labor market for themselves (Blum, 1988). Currently, they are organized into two occupational associations: the Employee Assistance Professional Association (EAPA) and the Employee Assistance Society of North America (EASNA). Originally founded in 1971, EAPA was known as the Association of Labor-Management Administrators and Consultants on Alcoholism (ALMACA). The association changed its name in 1989 to highlight members' identity as employee assistance rather than alcoholism workers and to reflect their belief that they are entitled to professional status. EASNA was formed by discontented ALMACA members who felt that it was moving too slowly toward development of professional standards. Generally, EAPA and EASNA agree that the core tasks listed above are the basis of employee assistance work; however, they disagree about what qualifications someone should possess to do such work and what qualities a program should possess to be accredited as an employee assistance program. EAPA has developed its certification process for workers around a single standard that assesses knowledge of the core tasks (ALMACAN, 1989). EASNA sees this standard as too narrow and argues for developing separate standards for each of the roles played by workers: marketing, administration, and counseling. Currently, EASNA is proposing standards for program accreditation that do not mention EAPA certification but do describe different standards for workers who perform different EAP roles and require all staff to have "EASNA-approved training" (EASNA, 1989a, 1989b). EAPA, on the other hand, rejects program accreditation by an outside agency and is developing a set of guidelines with which it expects EAPs to comply voluntarily.

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Workers cannot simply appropriate professional status for themselves by enacting the ritual symbols of professionalism; rather, society must also recognize their exclusive right to perform the tasks they claim as their own. By this standard, employee assistance workers have fared poorly. As yet, no college offers an EAP curriculum based exclusively on the core tasks which leads to a professional degree; rather, a small number of schools offer either a limited undergraduate curriculum (e.g., Trice, 1990; Quick, Sonnenstuhl, and Trice, 1987) or incorporate an EAP-specific course or two into such human service-oriented graduate programs as social work, alcohol counseling, and psychology (NIDA, 1988). Without a graduate curriculum to call its own, society will not recognize EAP work as a profession. Likewise, no state is considering licensing employee assistance workers—the ultimate symbol of professionalism. Some states have written voluntary guidelines reflective of the core tasks but they have not generally restricted the use of the term employee assistance to either personnel or programs that comply with those standards (e.g., NYSDAAA, 1990). For instance, California's Knox-Keene legislation, which was inspired by insurance industry complaints that EAPs are a form of prepaid health insurance and ought to be regulated like psychological health maintenance organizations, does not restrict the use of the term employee assistance to those programs that simply perform the core tasks: identification and referral (Cagney, 1989). Rather, it merely exempts the small EAP that does not provide psychological treatment from being licensed by the Department of Corporations like psychological health maintenance organizations, while allowing any organization to call itself an EAP. As one small independent employee assistance worker aptly explains, "My motivation was to protect my. . . business rather than protect any 'proprietary* claim on the 'concept of EAP'" (Collins, 1988:20). Conflict between professsionals and organizational managers occurs because professionals, claiming autonomy, reject administrative demands that they perform tasks outside of their claimed area of expertise. In contrast, employee assistance workers appear unable to confine their work to the core tasks and appear particularly willing to take on new assignments. For instance, managers have been able to make employee assistance workers comply with their requests to bypass constructive confrontation in favor of rushing employees into treatment (Trice and Beyer, 1984a). Likewise, in recent years, as pressures have increased for companies to cut health care costs and implement drug testing, EAPs seemingly have taken on these new chores with little resistance. Indeed, many EAP workers have seen these challenges as opportunities for increasing their domains. Finally, if employee assistance work is ever to achieve professional status, EAPA must do more than adopt the ceremonial trappings of a code of ethics (ALMACAN, 1988a, 1988b); it must also enforce them. Paul M. Roman (1990:10) puts the matter succinctly: Rumors abound regarding ethical issues. . . .Despite the juiciness of these stories, no one seems to want to take the next steps of determining facts which can be weighed by a respected tribunal, followed by disciplinary sanctions if appropriate If the field allows unethical behavior to fester and grow, these

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diffuse to those whose respect is essential. . . .Active recognition that ethics are taken seriously is the means by which constituencies have "faith" in the behavior of those in the established professions.

Despite any emerging consensus about the core tasks, then, it is impossible to assert that employee assistance work is a profession or will ever become one. Indeed, employee assistance may remain what it has been all along—a loosely connected group of people who believe in helping their fellow workers and have discovered in the crucial balance a simple, inexpensive, and effective means of doing so. Consequently, throughout this edition, we once again focus on the crucial balance between the workplace and treatment place, emphasizing the important roles that managers, supervisors, stewards, and coworkers play in identifying and motivating alcoholic and other troubled employees to change their behavior. Today, this seems particularly important because, despite verbal agreement with the core tasks, too many employee assistance workers appear to have lost sight of the critical and beneficial functions their actions play in rehabilitation, emphasizing instead the role of counselors in treatment. This discussion is designed not only for executives and labor leaders but also for EAP coordinators and directors as well as for managers, supervisors, counselors, and others involved with EAPs. Chapter 1 discusses the historical development of employee assistance programs within the larger context of management and labor efforts to assist alcoholic and other troubled employees. Chapter 2 describes the key components of EAPs—the most important of which are (a) a written policy and (b) a program coordinator whose primary function is to see that procedures and policies are implemented throughout the workplace and that employees in need of counseling services receive them. Chapter 3 focuses on the primary issues in program development: program strategies and their effectiveness and corporate and union responsibilities in relation to the provision of services and confidentiality. Chapter 4 examines what happens when alcoholic and other troubled employees involve their employers in workers' compensation and arbitration cases, and the role of EAPs in such cases. Chapter 5 emphasizes the need for program evaluation, basic research, and education and training to integrate research into practice. In this Key Issues report we hope to clarify some of the confusion surrounding EAPs by addressing the basic issues often raised by executives and union leaders setting out to implement new programs or involved in maintaining and improving existing programs. The report is based on the applied and evaluation research that has been accumulating very slowly since the publication in 1972 of Spirits and Demons at Work: Alcohol and Drugs on the Job (Trice and Roman, revised in 1978). As in these earlier publications, we highlight the workplace dynamics and the importance of impaired job performance as the basis for constructive intervention, usually by the employee's immediate supervisor. The importance of this approach has been underscored in recent cases of drug screening and Fourth Amendment rights. As evidenced by the courts and by arbitrators, the importance of the impairment standard is that it shifts the issue from the privacy rights of the employee to the legitimate right of the employer to intervene "because impaired performance violates the fundamental contract between

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employer and employees" (Trice and Roman, 1978:xiv). The following response to the question of when drug screening might be justified suggests that EAPs provide a viable alternative to drug screening-an alternative that is more consistent with American traditions of fairness and justice than is drug testing. The first [instance in which drug screening might be justified] concerns occupations in which there are elements of grave danger to public, co-worker and individual safety; the second concerns instances where employees have demonstrated deteriorating job performance and there is reason to believe it is caused by substance abuse. . . . However, while companies may have some legal support for drug screening in cases where job performance is deteriorating, screening may not be really necessary. A well-run EAP is sufficient for the identification of drug users in companies where there are few or no dangerous jobs. . .. This is possible because supervisors properly trained in constructive confrontation are equipped to break through the denial systems of users, abusers, and addicts-regardless of the drugs in question. It is important to emphasize, however, that the EAPs must be well run and supervisors well trained (Sonnenstuhl and Trice, 1986a:28-29).

Acknowledgments We wish to thank a number of people who have helped us in preparing this Key Issues report. The "EAP Lunch Bunch,11 who read and commented on our early draft, were particularly helpful. We would also like to thank our anonymous reviewers for their feedback and Shirley Foster and Pat Noteboom for their patience and diligence in typing the many drafts of this manuscript. Most of all we want to thank Jozetta Srb, a research associate here at the school and our editor, for the sincere interest she has taken in this manuscript. An original member of the Lunch Bunch, she has patiently waded through an enormous amount of research to learn about EAPs, knowledge she put to good work in prodding us to articulate clearly the crucial balance. She was particularly helpful in revising chapter 4, for which she sought out recent workers' compensation and arbitration cases. Finally, we should like to thank R. Brinkley Smithers and the Christopher D. Smithers Foundation for their financial support and encouragement.

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STRATEGIES FOR EMPLOYEE ASSISTANCE PROGRAMS: THE CRUCIAL BALANCE

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I

EMPLOYEE ASSISTANCE: AN OVERVIEW No one knows how many employee assistance programs (EAPs) currently exist in the United States, but everyone agrees that since 1970 their number has increased rapidly. William Dunkin, the former director of the National Council on Alcoholism's Labor-Management Services, estimates that in 1970 there were between three hundred and fifty and four hundred programs. The Executive Caravan Surveys conducted in 1972, 1974, 1976, and 1979 found that the percentage of Fortune 500 companies and leading utilities, transportation, and financial corporations claiming to have programs increased from 25 percent in 1972 to 56 percent in 1979 (Roman, 1982). Some current estimates put the number of U.S. companies with EAPs at more than five thousand and perhaps as many as ten thousand (Bureau of National Affairs, 1986:40; Blum and Roman, 1985). The Washington Business Group on Health predicts that EAPs will become the major form for the delivery of mental health services to employees in the future (Goldbeck, 1979). Despite management and labor interest in EAPs, there is no consensus on what constitutes a program. Companies call their programs by a bewildering number of names: counseling, special health services, troubled employee, mental wellness, occupational alcoholism, and, of course, employee assistance. Programs also possess a wide variety of organizational structures. Some are located within company medical departments and others within personnel departments; some are administered by alcoholism specialists and others by mental health specialists-for example, psychiatrists, psychologists, social workers; some offer employees extensive in-house treatment services, and others refer employees to community service agencies. Regardless of their tides and organizational structures, however, all are concerned with preventing, identifying, and treating personal problems that adversely affect job performance. Employee Assistance Terms Defined For the purpose of this report, we define EAPs as job-based programs operating within a work organization for the purposes of identifying "troubled employees," motivating them to resolve their troubles, and providing access to counseling or treatment for those employees who need these services. The term troubled employee refers to those individuals whose personal problems (such as alcoholism, drug addiction, marital difficulties, and emotional distress) preoccupy them to the extent that in either their own or their supervisors1 judgment, their work is disrupted. We use the term troubled for several reasons. First, despite the expansive nature of psychiatric diagnosis, the majority of employees who use EAPs do not appear to be seriously disturbed in a psychotic sense (Sonnenstuhl, 1986; Trice and Beyer, 1984b). These employees are more appropriately described as being chronically troubled by their problems. Second, the term troubled employee is historically consistent with the origin and use of the term employee assistance. When the National Institute of Alcohol Abuse and Alcoholism (NIAAA)

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introduced the term employee assistance to distinguish their programs from those being marketed by the National Council on Alcoholism, they described the program as helping troubled employees to cope with personal problems. This usage was picked up and popularized by James T. Wrich in his book The Employee Assistance Program (1980). Finally, troubled employee reflects Robert M. Emerson and Sheldon L. Messinger's usage in "The Micro-Politics of Trouble" (1977). Employees' personal troubles are not static entities; rather they have a natural history (Sonnenstuhl, 1986). Employees, either through self-reflection or conversations with their coworkers and managers, are first vaguely aware that something is wrong. In subsequent interaction, they either resolve their uneasiness or discover that their problems are more troublesome than they had imagined. In the process of searching for solutions, they come to see themselves as troubled. Eventually, some of them seek help from the services provided by the EAP. Within this context, supervisors identify troubled employees on the basis of deteriorating job performance and use a strategy known as constructive confrontation to motivate employees to resolve their troubles and improve their performance. Constructive confrontation means that supervisors confront employees with evidence of their unsatisfactory job performance, coach them on ways to improve their work, urge them to use the services of the EAP if they have personal problems, and, at the same time, emphasize to them the consequences of continued poor performance. Constructive confrontation proceeds in progressive stages. Initially, supervisors informally discuss performance problems with employees, encouraging them to seek help from the EAP if personal problems are adversely affecting their work. At this stage, some employees will correct their performance and resolve their problems without the help of the services provided by the EAP. For them, feedback from their supervisors is sufficient motivation to change their behavior. If employees do not improve their performance after several informal discussions, supervisors then implement standard formal disciplinary procedures-verbal warnings, written notices, suspension, and discharge. At each disciplinary step, employees are urged to seek help from the EAP if personal problems are affecting their performance. Research from the industrial alcoholism studies shows that when this strategy is properly implemented, most employees either will change their behavior or will seek help from the EAP services before disciplinary action is initiated. In unionized facilities, stewards also informally urge employees to improve performance and resolve their troubles. In many instances, employees are encouraged by their coworkers to seek help. Throughout this monograph, we use the term counseling in a generic sense-that is, to cover the assessment of employees' troubles, diagnosis, referral, and treatment. Counseling services are provided either within the corporation, within the community, or within some combination of the two. In-house EAP counseling services generally are staffed by mental health or alcoholism specialists. Currently, a wide variety of community organizations-such as alcoholism councils, family service agencies, and mental health centers-and private consulting agencies contract with companies to provide counseling services to employees. Since the mid-

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seventies, these EAP service providers have proliferated, and they may now be the predominant form in which counseling services are offered to employees. Indeed, many companies and unions simply equate the use of such services with having an EAP. As we point out in the pages that follow, however, a fully functioning program recognizes and actively supports the roles played by supervisors, stewards, and coworkers in preventing troubles, identifying troubled employees, and motivating them to change their behavior. Historical Antecedents of EAPs Since the end of the nineteenth century, work organizations in the United States have offered assistance to employees in many guises: social betterment, personnel counseling, occupational mental health, and industrial alcoholism. Each of these approaches blends management concerns for productivity with humanitarian values-that is, employers believe that helping employees with their troubles increases productivity. (A more extensive historical discussion than presented here can be found in Sonnenstuhl, 1986; Trice and Beyer, 1984a; Steele, 1988; Roman, 1988; Ames, 1989; Staudenmeier, 1985. A detailed discussion of the social betterment movement can be found in Brandes, 1970.) Social Betterment During the 1880s many companies began providing workers with social welfare services. These services included inexpensive housing, company-sponsored unions, sanitary working conditions, insurance, and pension plans, as well as facilities for banking, recreation, medical care, and education. The National Civic Foundation encouraged such employer philanthropy to ensure a stable labor force, promote worker loyalty, combat unionism, and prevent strikes (Nelson and Campbell, 1972). By 1913, there were approximately two thousand welfare workers in industry (Carter, 1977). During the mid-twenties the social betterment movement began to run out of steam and by the mid-thirties it had run its course. According to Stuart D. Brandes (1970), it died for several reasons. Employees became disenchanted with corporate paternalism, the Depression forced companies to cut back on many operations, and the Wagner Act of 1936 outlawed company-sponsored unions and encouraged employees to organize independently. Since companies had lost the struggle against unionism, they saw little reason to continue many of the betterment programs. Such services as health examinations, pensions, and other benefits still exist, but the comprehensive welfare programs of the social betterment era are gone. Personnel Counseling Personnel counseling grew out of the works of Elton Mayo (1923) and the experiments conducted at Western Electric's Hawthorne plant during the twenties and thirties-reported by Fritz Roethlisberger and William J. Dickson (1939). Mayo believed that employees' irrational sentiments prevented them from cooperating with management and caused unionization, slowdowns in production, and strikes. Consequently, he recommended that companies develop psychiatric clinics "to eliminate eccentricities from 'normal' persons engaged in industry" (Mayo,

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1923:483). The researchers discovered that workers at the Hawthorne plant systematically restricted output; established a "fair day's rate"; falsified records; and subjected "rate busters" to ostracism, sabotage, and physical threats. Following Mayo's thinking, the researchers interpreted the workers' lack of cooperation with management as irrational and believed that the irrational sentiments had been overcome by paying attention to workers' feelings and concerns. They reasoned that demonstrating concern for workers increases their morale and thereby improves productivity. Western Electric's personnel counseling program, also called "control through listening" (Dickson and Roethlisberger, 1966), trained some of the shop workers to be counselors. These "counselors" wandered the shop floors, talked informally with employees about personal and work issues, and invited those in need of further counseling to their offices. The counselors listened empathetically to the employees but did not give advice. They encouraged the workers to release their pent-up feelings and to work through their problems rationally. Throughout the forties and fifties, Western Electric's program was widely emulated by other companies (Bellows, 1961). There is little empirical research to support the conclusions reached in the Hawthorne studies. For example, Alex Carey (1967) and A. J. M. Sykes (1965) reexamined the Hawthorne studies and concluded that Roethlisberger and Dickson were incorrect and that the data, rather than supporting human relations theory, supported an old-world view about the value of monetary incentives, driving leadership, and discipline. Reviewing the empirical research produced by the human relations school, Charles Perrow (1972) reached a similar conclusion. Nevertheless, the human relations theory remains a dominant management philosophy, which is reflected in the number of companies calling their personnel departments by the title "human resources management." Occupational Mental Health Occupational mental health programs have taken two approaches to emotional problems in the workplace. The first approach emphasizes treatment for emotionally impaired employees. Employees seek treatment either on their own initiative or at management's encouragement. The second approach focuses on the prevention of emotional problems in employees. Preventive activities consist of teaching healthy beliefs and behaviors and designing healthy work environments. Both approaches have been part of mental health programs since psychiatrists began working in industry (see, for example, Burlingame, 1946; Southard, 1920). Prior to World War II, only a handful of psychiatrists, psychologists, and psychiatric social workers were employed in industry. When the war drained the available labor pool and industries had to employ inexperienced workers, however, the government funded hundreds of mental health and social service programs in industry in an effort to help integrate these employees into the workplace (Carter, 1977). For example, Bertha C. Reynolds (1975) pioneered psychiatric social work with the National Maritime Union's United Seamen's Service and Dr. F. W. Dershimer established a psychiatric practice at DuPont (Ferguson and Fersing, 1965). Employees, however, were primarily treated in "emotional first-aid

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stations" (Lott, 1946), where, it was argued, a minimum of on-the-job treatment resulted in conspicuous on-the-job improvement (McLean, 1973). After the war, the majority of companies shut down their mental health programs, and throughout the fifties and sixties, the number of businesses with programs remained small. For example, the Bureau of Business Research at the University of Texas (Mumm and Spiegel, 1962) surveyed 1,100 companies with "advanced personnel programs" and found that only 37 of the 567 companies that replied to the survey had formal mental health programs. A Harvard Business School report characterized management's disregard for employees' emotional problems as a Legacy of Neglect (Ferguson and Fersing, 1965) and urged companies to adopt mental health programs. During the seventies and eighties, many companies developed prevention programs focused on employees' emotional health. These efforts were primarily intended to cut escalating health care costs and to increase declining worker productivity. Wellness/health promotion programs, for example, teach workers healthy beliefs and behaviors (e.g., Conrad, 1987a, 1987b, 1988; Fielding, 1984; Sloan, Gruman, and Allegrante, 1987), and quality of work life demonstrations redesign work in order to construct healthy environments (e.g., O'Toole,1973; Faucheux, Amado, and Laurent, 1982; Pugh, Hickson, and Hinnings, 1985). The impact of these programs on employees' emotional health, productivity, and health costs has not been rigorously evaluated (e.g., Sonnenstuhl, 1988; Parker, 1985; Becker, 1986). An emerging preventive thrust centers on awareness of the workplace as a source of risks for alcoholism and other behavioral disorders (Trice and Sonnenstuhl, 1988; Trice and Sonnenstuhl, 1990). In short, this approach recognizes that not only can the workplace be a locale for constructive confrontation but also that it contains clear-cut hazards and risks. Examples are the presence of occupational drinking cultures, mobile jobs, work-related stress, plant closings and hostile takeovers, deskilling, and mandatory retirement. Efforts to reduce these risks constitute a preventive effort, making the workplace less an "enabler" of drug abuses and other psychiatric disorders. For instance, the definition of the appropriate use of alcohol at the workplace may be changed relatively easily by addressing drinking norms directly (e.g., using alcohol at lunch is inappropriate), problem drinkers on mobile jobs can be transferred to ones providing closer supervision, and mandatory retirements can be made more flexible so that an older person's structure and purpose are not suddenly shattered by retirement. Industrial Alcoholism Industrial alcoholism programs were started during World War II (Trice and Schonbrunn, 1981). Because problem drinking adversely affects work performance, these programs use the power of the job to motivate problem drinkers to change their behavior. When problem drinkers are confronted with the prospect of losing their jobs because of unsatisfactory work performance and, at the same time, are offered rehabilitation, they are likely to opt for treatment, become sober, and improve their performance. During the sixties, this concept evolved into the constructive confrontation strategy.

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Early industrial alcoholism programs were informal arrangements between "occupational physicians" and dedicated members of Alcoholics Anonymous (AA). The physicians often became aware of employees' drinking problems because supervisors reported them. Supervisors' suspicions were based on observations of drinking on the job or of disruptive behavior; often they were based on personal experiences and gossip. The doctors then encouraged AA members to approach the suspects and impress on them that they were in danger of losing their jobs and that if they sought help through AA, they could gain sobriety and retain their positions. Individual companies gradually transformed this informal procedure into a formal policy and program. The policy stated that alcoholism is a disease and stressed the company's willingness to help alcoholics. Each program had an administrator, often a member of AA, who either referred the alcoholic to AA or to an alcoholism treatment program. After the war, the Yale Center for Alcohol Studies promoted programs among business and labor leaders. By the mid-fifties, there were approximately fifty to sixty industrial alcoholism programs in the United States (Trice and Schonbrunn, 1981). In 1959, the National Council on Alcoholism (NCA), which had been allied with Yale, began marketing programs. Lewis F. Presnall (1966), NCA's industrial consultant, advocated the development of broad-based programs to assist alcoholic and other troubled employees and the training of supervisors to implement the constructive confrontation strategy. Based on his earlier experience as director of Kennecott Copper's Chino Mines Counseling Program and research developed by Harrison M. Trice (1962a, 1962b), Presnall believed that this was the most effective means of reaching alcoholic employees. By 1970, industrial programs were considered an integral ingredient in the identification and treatment of alcoholics. Consequently, when the federal government established the NIAAA in 1971, an "occupational" branch was organized to market programs to business and labor. Employee Assistance Programs NIAAA coined the term employee assistance program to establish an identity separate from the National Council on Alcoholism. The institute believed that alcoholism was the most prevalent personal problem of employees and that the workplace was the most effective place to identify, motivate, and provide for treatment of alcoholics. To promote EAPs, NIAAA funded two occupational program consultants (OPCs) in each state. Many of the OPCs recruited were not alcoholism treatment advocates; rather they were psychologists and social workers trained in the mental health traditions. Thus, the OPCs split into two groups-the alcoholism constituency and the mental health constituency. Both groups promoted EAPs with similar claims that employees' personal problems are caused by factors outside the workplace and treating those problems will improve employees' job performance. Both recommended that supervisors be trained in constructive confrontation and that employees be encouraged to refer themselves for counseling to the program. But the two groups differed in their emphasis. The alcoholism constituency emphasized the importance of treating alcoholism and the centrality of the constructive confrontation strategy for

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motivating alcoholics. The mental health constituency emphasized the importance of treating all personal problems equally, deemphasized the constructive confrontation strategy, and stressed that troubled employees must seek help from the EAP on their own initiative. Paul M. Roman (1981) and Harrison M. Trice and Janice M. Beyer (1984a) have found that in adopting EAPs, some employers have shown considerable interest in the mental health group's emphasis because they believe that providing counseling services that the employees can use is sufficient and will relieve supervisors from having to manage difficult workers. Why EAPs Are Adopted Between 1974 and 1976, the OPC network in New York State helped to develop or revitalize over three hundred and twenty job-based programs (Trice, Beyer, and Coppess, 1981). Between 1971 and 1980, OPC efforts helped to increase the number of national programs from approximately three hundred and fifty to an estimated five thousand. And by 1981, their success had spawned some two hundred private EAP consulting services selling employee counseling to companies (Roman, 1981). Why do companies adopt EAPs? Several rationales are evident. Companies adopt EAPs primarily on ideological grounds. Data from national surveys reported by Roman (1982) and from a field study by Trice and Beyer (1984a) using both quantitative and qualitative methods indicate that employers concerned about their employees1 welfare and those concerned about their social responsibility to the community are more likely to adopt EAPs than employers who do not express these sentiments. Simply stated, programs are adopted because employers believe that helping employees to solve their personal problems is good business and demonstrates social responsibility. It is often suggested that companies adopt programs because they are costeffective. Although it is extremely difficult to obtain accurate cost-benefit predictions for many management programs (Strauss and Sayles, 1967), cost-benefit analyses reporting significant benefits from industrial alcoholism programs have been published. These reports use a number of different methods for analyzing program costs and benefits (Schramm, 1980; Trice, 1980). The most common method is to compare employee performance prior to treatment with performance after treatment and to assign a dollar value to it. A wide range of indicators have been used to evaluate performance, including number of days absent, number of on-the-job and off-the-job accidents, number of discipline and grievance procedures, amount of insurance premiums, and amount of work completed. These studies generally report significant benefits, which they attribute to program treatment. At least one early study of an Ohio firm, however, did conclude that treatment of problem drinkers and employees with other personal problems was not economically efficient (Winslow et al., 1966). According to Roman (1982), employers who adopt EAPs report their programs are cost-effective, and some are able to produce cost-benefit analyses to prove it. Alternatively, companies that have not adopted EAPs reject the notion that programs are cost-effective. This difference probably reflects the underlying ideologies of the employers. Those who believe that helping employees is good business uncritically accept the analyses as supporting their decisions to adopt EAPs and those who reject this belief characterize the analyses as methodologically flawed.

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Martin Shain and Peggie Walden (1980) suggest the possibility that managers also adopt EAPs as "conflict-avoiding devices." Based on fair employment laws and labor contracts, the amount of discretion that employers can use in hiring, supervising, and firing employees is often restricted. For example, some labor arbitrators have ruled that dismissal and punitive discipline are inappropriate for employees with alcohol, drug, and emotional problems; and they have recommended that employers provide help for troubled employees (Denenberg and Denenberg, 1983; Greenbaum, 1982). In this context, rehabilitation is seen as a first step in helping employees to cope, and dismissal is considered a last resort (Emerson, 1981), to be used when all else fails. Union Reactions to Employee Assistance Historically, union leaders have had mixed reactions to management programs to assist employees. On the one hand, they want the services for their members; on the other, they perceive such services as attempts to undermine the union's authority and its traditional role as helper to union members (see, for example, Baritz, 1961; Brandes, 1970; Carter, 1977). Such concerns are not unfounded. For example, the National Civic Federation promoted social betterment as a way to deter union organizing (Brandes, 1970; Nelson and Campbell, 1972), and the Hawthorne experiments and their attendant counseling programs were undertaken in part to keep Western Electric union-free (Baritz, 1961). Unions prefer to operate their own mental health programs and have provided members with a wide range of services. Since World War II, the AFL-CIO's Community Services Department has operated a peer counseling program for its members. Its former director, Leo Perlis (1980), calls it the oldest continuous EAP in the United States. Its structure parallels Western Electee's Personnel Counseling Program, and since its inception, several hundred thousand union members have been trained to counsel millions of coworkers about a wide range of troubles. In addition, many of the AFL-CIO's central labor councils also provide professional mental health and social services to members. During the forties, fifties, and sixties a number of unions established their own comprehensive psychiatric clinics as well (Ferguson and Fersing, 1965; McLean, 1973). More recently, some unions have developed pretreatment referral programs. These programs contract with an employer to provide diagnostic and referral services for troubled employees (Johnson, 1981). In New York State, the International Longshoremen's Association and the National Maritime Union of America operate such programs. In promoting EAPs, the NCA and the NIAAA have encouraged labor and management to develop joint programs, but such development has been slow (Trice and Beyer, 1982a; Johnson, 1981). Unions distrust the idea of constructive confrontation because they condemn formal rating and supervisory evaluation methods as inconsistent with the seniority principle (Trice, Hunt, and Beyer, 1977). They believe that programs should be used to create well-adjusted human beings rather than to increase production (Perlis, 1980). Unions are also wary of any management program focused on mental health problems (Roman, 1981). They fear that the inclusive nature of mental health diagnosis is an open-ended device whereby union members who challenge management authority can be diagnosed as troubled employees, then treated and eventually fired. These concerns

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are difficult to overcome, but Beyer, Trice, and Richard Hunt (1980) have found that where management and labor are able to cooperate, they have helped alcoholic and other troubled employees. Member Assistance Although the majority of research on EAPs has focused on supervisors' interventions with alcoholic and other troubled employees, there is a growing body of literature on peer interventions. Peer confrontation represents the power of occupations to intercede and assist their members. For instance, many unions (e.g., Molloy, 1989; Weed, 1980; Miller and Oliver, 1988; Feuer, 1987; Eichler, Goldberg, Kier, and Allen, 1988) as well as some occupational and professional associations (e.g., Bissell and Haberman, 1984; McCrady, 1989; Kilburg, Nathan, and Thoreson, 1986), operate their own member assistance programs (MAPs). Unlike EAPs, which primarily emphasize the role of supervisors, MAPs emphasize the role of peers in identifying and motivating alcoholic and other troubled employees to change their behavior (Trice and Sonnenstuhl, 1990a; Sonnenstuhl, 1990). Often MAPs are built around a group of occupational members who belong to Alcoholics Anonymous and carry the fellowship's message of sobriety to their coworkers (Sonnenstuhl and Trice, 1987). Within this context, peers use their own version of constructive confrontation. The AAs confront suspected coworkers on and off the job, emphasizing that the coworkers' drinking is adversely affecting their work, family, and social relations and that help is available through the member assistance program and Alcoholics Anonymous. The constructive confrontation strategy employed by peers, however, is more flexible than that employed by supervisors in joint management-union programs because peers need not confine their interventions to observations of unsatisfactory performance. Peers are free to confront coworkers on the basis of gossip and offthe-job behavior. The gossip generally includes talk about how the coworkers' drinking is affecting their performance, but it also includes talk about family and physical problems. In the ensuing confrontations, the AAs use such evidence to demonstrate to coworkers how drinking is destroying their lives. Although the content and process of confrontation differ in joint management union EAPs and MAPs, the strategy they employ to break through alcoholic denial is quite similar. In EAPs, the process follows the outlines of progressive discipline and the content revolves around job performance; in MAPs, the process and content are more fluid. Both, however, employ a combination of constructive and confrontative elements to break through denial and to define what is appropriate and inappropriate behavior. The constructive elements underscore that the drinkers are valued and that change is possible; the confrontative elements highlight the stakes in not changing. In addition to helping alcoholics, MAPs assist members with other drug, family, and emotional problems (e.g., Perlis, 1980; Perlow, 1979). Unfortunately, empirical research on these helping processes does not yet exist.

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Summary Against a historical backdrop, EAPs can easily be seen to be descendants of a long line of programs combining concerns for productivity and compassion. At times employers adopted these programs to avoid unionization and retain control of the workplace. Many, however, adopted programs because they believed that helping employees solve their troubles is good for workers as well as the company. This ideology is, and will continue to be, a potent factor in the adoption of EAPs. Unionized companies may have special problems in establishing and implementing EAPs. Like their management counterparts, union officials believe deeply in helping workers. But whereas employers perceive doing so is a way to increase productivity, union officials see it as a way to maintain labor solidarity and are wary of management control of the EAP at the company level. As a consequence, conflict frequently ensues. Discovering ways to ensure a balance between management and labor concerns is essential to the operation of EAPs in unionized companies.

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II

EAP PROGRAM COMPONENTS AND IMPLEMENTATION While there is still no general agreement on what constitutes an EAP or where it fits in the organizational structure, certain basic components are generally considered essential to the implementation of a program. In this chapter we will discuss these essentials: program policy, top management support, program coordination, supervisory training, employee education, counseling resources, and union involvement. Program Policy One way to begin to understand how an EAP works is to examine a typical program policy. Policy is the cornerstone of an effective EAP because it articulates the balance between the role of supervisors and others in the workplace (constructive confrontation) and the role of practitioners in the counseling component of the program. The importance of a written EAP policy cannot be emphasized too strongly. Research shows repeatedly that supervisors' willingness to confront employees whose performance is impaired and, if necessary, refer them to counseling is related to the presence of a written policy and familiarity with it (Beyer and Trice, 1984a, 1978; Googins, 1978; Googins and Kurtz, 1981). Without a clearly written and widely publicized policy, supervisors and managers often do not know how to deal with employees' personal problems constructively. According to Presnall (1967), companies without written policies have unwritten procedures for handling troubled employees-that is, simply to muddle through until the employees' behavior becomes so disruptive that the employees must be fired. The inevitable consequences of muddling-through are exhausted supervisors and managers, angry workers, hostile unions, and depleted resources. An EAP policy provides a guide for a path through the confusion. While there are some general guidelines for developing an EAP policy, the final document should be shaped by a company's existing policies on performance, discipline, and medical practices. The EAP policy is a bridge to these other practices. The sample EAP policy (exhibit 1) is a skeleton that points out some of the more general EAP principles. A company's final EAP policy, however, should be fleshed out in accordance with its existing personnel policies and practices. Above all, the policy should reflect the principle that, on one hand, an EAP is a job-based technique for identifying troubled employees and motivating them to change their behavior, and, on the other, it is a mechanism for providing access to counseling services for employees. Principle 1: The EAP is a job-based strategy for helping employees solve their problems. Everyone has problems, and to believe otherwise is absurd. How people define those problems, with whom they choose to discuss them, and how they resolve them are the individual's affair. In most cases, the problems do not disrupt employees' work. When they affect performance, however, the company has an obligation and a legitimate right to help employees resolve those problems.

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Exhibit 1: A Sample Employee Assistance Program Policy

PURPOSE XYZ Corporation cares about the well-being of its employees and recognizes that a variety of personal problems can disrupt their personal and work lives. For instance, alcoholism is a treatable disease with devastating effects on one's personal health, family, and work. Drugs, family problems, and emotional distress can have similar effects. Most people solve their problems either on their own or with the advice of family and friends; however, sometimes people need professional advice. XYZ Corporation, through its EAP, provides access to professional counseling services for its employees, and those in need of professional assistance are encouraged to use it. In those facilities where XYZ Corporation has union contracts, the company will conduct the EAP as a cooperative and joint venture with labor's elected representatives. XYZ Corporation recognizes that it has no right to interfere unless employees' personal problems adversely affect their job performance. When unsatisfactory performance does occur, supervisors will encourage employees to solve their problems on their own or with the assistance of the EAP services. POLICY The EAP operates within the following framework: 1. A wide range of problems may affect employees' job performance adversely. These include alcohol and drug addiction, marital and family difficulties, and emotional distress. The EAP will assist employees to resolve these problems and others for which employees may seek help. 2. Employees' current jobs and future advancement will not be jeopardized by using EAP services. 3. As with all health and personnel documents, EAP records will be maintained in a confidential manner. 4. When necessary, sick leave may be granted for treatment and rehabilitation on the same basis as it is granted for other health problems. 5. Employees will be responsible for complying with the EAP service's recommendations and treatment plans. 6. The EAP service will also be available to employees' families. PROCEDURE 1. Employees who need professional advice are encouraged to use the EAP's counseling services, and those whose personal problems adversely affect their work are encouraged to seek help voluntarily from the EAP services. 2. Supervisors are responsible for confronting employees about their unsatisfactory performance and helping them to improve their work. a. Supervisors bring employees' unsatisfactory work to their attention and encourage them to solve the problem on their own or with the help of the EAP counseling services. Supervisors also point out to the employees that continued unsatisfactory performance will lead to formal discipline. b. If performance improves, no further action will be taken. c. If job performance continues to be unsatisfactory, regardless of whether or not employees have accepted help, regular disciplinary procedure will be followed, up to and including discharge. At each step of the procedure, supervisors will encourage employees to seek help from the EAP counseling service.

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Principle 2: Constructive confrontation is used to motivate employees to resolve their problems and to overcome denial. In some instances, workers may be unaware that they have a problem, either because no one has pointed it out to them or because when someone has pointed it out, they have denied its existence. Supervisors may become aware of employees' personal problems in the give and take of everyday activities and offer them1 friendly advice or encourage them to seek help from the EAP. When employees work deteriorates, supervisors confront employees and help them correct their performance. Such confrontation occurs within the company's established guidelines for due process, and at each step employees are encouraged to solve the problems on their own or with the EAP's assistance in order to prevent formal disciplinary action. Constructive confrontation provides a powerful motivation for employees to solve their problems one way or the other because it demonstrates both the possible consequences of inaction and a way to help resolve the problems. Principle 3: Counseling is used to help solve problems when it is clear that they are beyond employees' control. As employees look for solutions, they may eventually conclude that their own resources are exhausted and that the problems are beyond their control. At this point, troubled employees are most susceptible to seeking professional help (Sonnenstuhl, 1986). Rushing them into treatment at an earlier stage puts them at risk of being labeled "mentally ill" unnecessarily. According to Joseph Veroff et al. (1981), Americans continue to fear that they will be stigmatized by going into mental health treatment, and they often reject the "normal" person who seeks psychotherapy more than the "severely disturbed" person who does not seek it (Phillips, 1963). In the process of looking for help, however, employees may learn, in conversations with their supervisors and with coworkers who have used the services of the EAP, to overcome the fear of stigmatization (Sonnenstuhl, 1986, 1990; Harris and Fennell, 1988). When employees do go to the EAP they want to be assured that the EAP will treat their case confidentially and that their current and future positions with the company will not be jeopardized by using the EAP services. The sample EAP policy (exhibit 1) reflects these general principles and ensures balance between constructive confrontation and counseling in the program. The purpose clause establishes that the EAP is job-based and that employees normally solve their problems without professional assistance. The policy section reflects the company's commitment to helping employees work through their troubles. Within this section, companies may wish to restate their current policies on the confidentiality of personnel and medical records and its applicability to EAP records. In this section, the company may also wish to integrate its policies on sick leave. The procedures section of the EAP policy emphasizes the program's availability to employees and describes how supervisors are to use the policy. Within this section, the company should integrate its current policies on due process. EAP Sensitivity to Alcoholism Historically, broadly focused EAPs developed out of job-based alcoholism programs. Reflecting this development, there has been a great deal of discussion among employee assistance workers whether EAPs ought to be alcoholism-

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focused, often interpreted as alcohol-only, or broadly focused on all employee troubles. In practical terms, this is a moot question because all contemporary EAPs are broad-brush. Effective programs remain very sensitive toward alcohol abuse and dependence, however, because they are the most prevalent psychiatric disorders among Americans and because job-based strategies are highly effective in reaching these workers. A study of the lifetime prevalence of specific psychiatric disorders among approximately seventeen thousand community residents over the age of eighteen years showed alcohol abuse or dependence as the most common disorder (Robins et al., 1984). A companion piece of research-a six-month prevalence studyshowed much the same thing (Myers et al., 1984). In addition, since alcoholism carries an increased risk of death, alcohol dependency rates in older populations may be reduced by mortality (Gallant, 1983). Similarly, research from the National Institute of Drug Abuse reveals that alcohol is the most widely used and abused drug in the United States (e.g., Johnston, O'Malley, and Bachman, 1987; NIDA, 1987a, 1987b, 1987c ). These epidemiologic findings confirm the need for EAPs to continue to focus primarily on alcoholism and alcohol abuse, although most programs have expanded their efforts to help employees with other troubles. Research also shows that "significant others" in the work environmentmanagers, supervisors, and shop stewards-express considerable willingness to identify and refer employees with disruptive drinking problems to treatment. Ronald L. Crawford and Hugh Adamson (1980) demonstrated in a study of a large multinational firm that managers more readily recognized and showed greater readiness to use professional services for alcoholism cases than for six other types of psychiatric disorders. This finding is consistent with what is shown in Cornell University's Program on Alcoholism and Occupational Health data sets derived from studies of managers in a large utility company (Trice, 1965); a large university (Belasco and Trice, 1969); federal installations from all departments of the executive branch of government (Beyer and Trice, 1978); and nationwide locations of a private, for-profit manufacturing firm (Trice and Beyer, 1984b). Each of these data sets shows a willingness among managerial personnel to identify employees with alcohol-related problems and to refer them to professional services. Over the past quarter of a century a "core technology" to deal with alcoholic employees has developed (Roman and Blum, 1985, 1988a; Roman, 1988). In sharp contrast, however, there has been little, if any, accumulated knowledge regarding job-based strategies for other forms of emotional disturbances. Roman and Terry C. Blum (1985:18) insist that "EAPs are singular in their provision of constructive attention to alcohol problems in the workplace... .It is only in dealing with alcohol problems that EAPs have established a clearcut record across different workplaces and different degrees of program elaboration." The Core Technology of EAPs In addition to the centrality of employees' alcohol problems in EAPs, Roman and Blum spelled out five other elements that are unique to EAP practice and distinguish it from other workplace interventions.

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First, the identification of employees' personal problems is based on job performance, which is contrary to the usual approach of identifying personal problems by more general symptoms. EAPs use the job performance standard for two reasons: (1) according to standards of industrial justice, management cannot intervene in employees1 personal lives unless performance is affected, and (2) there is disagreement over the meaning of early versus late symptoms, even among well-trained diagnosticians. By training supervisors and union stewards to pay attention to performance issues, EAPs adhere to standards of industrial justice and introduce an objective criterion for deciding when something becomes a problem. Second, EAP specialists are expected to provide expert consultation and advice to supervisors, managers, and union stewards on how to follow the program's policies and procedures. Here the EAP specialist assists in deciding whether a given case is appropriate for referral to the program's counseling component or might be better managed by other means, such as retraining employees or reassigning them to different jobs. Third, EAP specialists are expected to advise and discuss with supervisors, managers, and union stewards the strategy and appropriate use of constructive confrontation throughout the entire process of referral and return to work. Instruction in the use of constructive confrontation is important because the strategy runs contrary to the overly sympathetic and helpful way most of us respond to troubled people. Constructive confrontation allows supervisors to be supportive while encouraging troubled employees to take responsibility for their behavior and giving them options for doing so. The fourth and fifth components consist of linking the program with community resources when necessary. Here the EAP specialist (coordinator) uses knowledge of confidentiality regulations and the specific types of community or entrepreneurial service providers available-and exercises ethical judgment to avoid unnecessary referrals as well as to avoid serving the vested treatment interests of either nonprofit or for-profit organizations. Taken as a whole, these elements of the core technology set EAP work apart from that of other occupations. Other occupations may include one or two components of the core technology, but none encompasses all of them. For instance, social workers are well versed in referring employees to community agencies but may have little training in how the workplace operates; personnel managers understand the workplace but may have little knowledge of community treatment resources. Top-Management Support According to folk wisdom, the most important factor in implementing policy is the support of top management. Indeed, administration courses in schools of management, industrial relations, social work, and public health tend to give students the impression that once a decision is made at the top, its implementation magically follows. Empirical research on EAPs does not support this impression. While top management support for the EAP may be essential to policy adoption,

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it is by no means sufficient for program implementation. For example, according to Beyer and Trice (1978), many directors of federal installations were ambivalent about implementing the government's alcoholism policy and their ambivalence was communicated to supervisors and facilitators. Many directors, however, supported the policy because they perceived a need for it in their installations. These managers reflected that perception in their own implementing behavior, which in turn affected the actions of program facilitators and supervisors, regardless of whether the manager exercised a great deal or very little power in the installations. The finding that directors who perceive a need for the policy are most likely to implement it suggests that excess reliance on the influence of top management to implement a policy may be misplaced. Excess reliance on the power of top management may lead to the neglect of other implementing strategies, such as creating familiarity with the policy-a force that Bradley Googins (1978) and Googins and Norman Kurtz (1981) found to be very potent among lower-status managers and facilitators. Program Management and Coordination Every company and union needs someone inside the work organization to manage and coordinate the EAP. Management entails seeing that the EAP policies and procedures are implemented throughout the organization, and coordination essentially entails seeing that supervisors and stewards are aware of their role in the program and that employees in need of services receive them. While it is tempting to contract out these managing and coordinating responsibilities to EAP service providers, it should be recognized that such agents may lack the necessary influence and organizational knowledge of insiders. When working with agencies that provide EAP counseling services, the program coordinator is responsible for ensuring that supervisors and stewards receive appropriate training and alcoholic and other troubled employees receive treatment when it is necessary. (See exhibits 2 and 3 for sample job descriptions of EAP staff.) Exhibit 2: Job Description for Director of XYZ's Employee Assistance Program RESPONSIBILITIES

The director of the EAP reports to XYZ's Vice President of Human Resources and is responsible for implementing and managing the corporate EAP policy and procedures in the company's business units. Specific responsibilities include: 1. Recommendation and implementation of approved changes in XYZ's Employee Assistance Policy and Procedures throughout the corporation. 2. Coordination of program activities with the employee relations and medical offices in the business units to ensure consistency in achieving company goals. 3. Procuring or conducting training on EAP policy and procedures for all levels of management, EAP staff, labor representatives, human resources managers, and medical personnel. 4. Evaluation of qualifications and capabilities of individuals and organizations used to provide counseling services to EAP employees. 5. Maintaining contact with outside organizations as appropriate. 6. Monitoring the EAP and utilizing evaluation findings to enhance its effectiveness.

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QUALIFICATIONS 1. A strong understanding of organizational structures and processes, including a knowledge of XYZ's business units and its human resources management and medical divisions. 2. A general understanding of the health and social service resources available to XYZ's employees. Counseling experience may be helpful but is not required. 3. A high level of skills in program management and administration, written and oral communications, education and training, and negotiating with outside organizations.

Exhibit 3: Job Description for Coordinator of XYZ's Employee Assistance Program RESPONSIBILITIES Every XYZ facility will designate an employee assistance coordinator. Who actually performs this role may vary from location to location depending on the availability of personnel. In facilities large enough to have a human resources management department and/or a medical office, the coordinator will be recruited from one of those departments. In smaller facilities, the part-time EAP role may be assumed by someone in either a line-management or staff position. Specific responsibilities of the EAP coordinator include: 1. Publicizing the EAP policy and procedure to all employees and their families. 2. Training managers, supervisors, and union representatives in the use of the EAP policy. 3. Consulting with managers, supervisors, and stewards about how to manage alcoholic and other troubled employees. 4. Evaluating and maintaining a directory of health and social service resources available to facility employees. 5. Negotiating contracts with, and closely monitoring, EAP service providers. 6. Making informal assessments of employees1 personal problems and directing them to appropriate community resources for diagnosis and counseling. 7. Ensuring that employees receive appropriate assistance. QUALIFICATIONS Specific qualifications include: 1. A knowledge of the local facility's policies, practices, and procedures and of local community resources. 2. A high level of compassion for employees' personal difficulties. 3. Skills in administration, verbal communication, education and training, and community relations. Counseling experience is helpful but not necessary.

Specialists in the EAP field disagree about who should coordinate the program. Wrich (1980) says that he knows people with a wide range of backgrounds who perform this job successfully, including Ph.D. clinical psychologists, psychiatric social workers, high school graduates, AA members, industrial nurses, and career

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personnel administrators. He finds that, regardless of their backgrounds, all of these people are sympathetic toward employees with problems and show a willingness to help them. James Manuso (1983:122), however, states, "Educational background should be at the doctoral level in psychology, psychiatry, or clinical social work. Staff members should certainly be skilled diagnosticians and practitioners of short-term group and individual psychotherapy." Disagreement stems partially from different perceptions of the coordinator's function. Wrich sees the coordinator doing preliminary assessments of employees1 problems and referring the employees (when necessary) to outside resources for treatment. Manuso sees the coordinator doing short-term counseling as well as referring employees in need of longer-term treatment. Both, however, may overemphasize the coordinator's role in counseling and deemphasize the role of internal change agent. Program coordinators are primarily internal change agents who ensure that the EAP policy is implemented and that a balance between workplace dynamics and counseling is maintained. Beyer and Trice (1978) studied the role of the program coordinator when they examined the federal government's implementation of its alcoholism and equal employment opportunity policies in a sample of seventy-one installations. The coordinator role in those installations was part-time, and the people assigned to it held other positions within the agencies as well. Sometimes the positions were line management, and other times they were staff positions. Implementation of the program consisted of publicizing the policies to all managers and developing appropriate organizational structures to process individuals with affirmative action complaints or drinking problems. In the alcoholism program, coordinators trained managers and supervisors to use constructive confrontation and referred problem drinkers to community rehabilitation programs for treatment. In this study, Beyer and Trice found that effective alcoholism program coordinators (1) held line-management rather than staff positions, (2) did not have overly formalized job descriptions that restricted their actions, (3) were not overloaded by the coordinator role, (4) had adequate staff and time to do the coordinator's job, and (5) supported change generally and the alcoholism policy specifically. These findings suggest that companies can implement effective programs without greatly increasing personnel and by relying on community agencies to provide treatment. Under these conditions coordinators are responsible for training managers and supervisors and for directing employees needing help to outside resouces. Supervisory Training Since the early 1970s, the job-performance model used in training supervisors for their role in implementing industrial alcoholism programs has grown in popularity (Etchen and Roman, 1977). Generally, the model consists of (1) defining program policy, (2) emphasizing the degree of management support for it, (3) explaining the supervisors' role in implementing it, and (4) demonstrating how it can be integrated into supervisors' existing responsibilities for employee job performance. James A. Belasco and Trice (1969) demonstrated the model's effectiveness in a controlled experiment. They divided 222 first-line supervisors into several groups:

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Group A completed questionnaires (tests)-concerning their attitudes toward alcoholism and other general emotional disturbances-before and after training; Group B received training and completed only the posttraining questionnaire; Group C completed pre- and posttraining questionnaires but received no training; Group D completed only the posttraining questionnaire. In addition, two series of training programs were run. During the first series supervisors received instruction in how to manage problem employees generally; during the second series supervisors received instruction in how to manage alcoholic employees. Training in both groups consisted of case studies, reading assignments, lectures, films, and discussions. The discussions focused on what supervisors would do in each case, why they would do it, and the consequences of those actions. Belasco and Trice concluded that (1) training alone produced relatively small changes in the supervisors' willingness to confront alcoholic and troubled employees, (2) completing the questionnaires (tests) alone produced rather pronounced changes in supervisors' willingness to confront such employees, and (3) the combination of testing and training produced more changes in their willingness than did training alone. They also found that using an approach for problem employees in general resulted in more favorable changes in supervisors' willingness to confront them than did the traditional emphasis on alcoholic employees-a finding that provided the major justification for the "broad-brush" development of EAPs. Belasco and Trice further recommended that EAP training be conducted within the context of a company's standard program for teaching supervisors to conduct performance appraisals and manage marginal performers. A number of research instruments could be used to assess the impact of supervisory training: attitude and behavior change of supervisors (Belasco and Trice, 1969), the best-worst technique (Beyer and Trice, 1984), receptivity to use of the EAP/aJcoholism policy (Beyer and Trice, 1978), and the behavioral index of troubled employees (Bayer and Gerstein, 1988). Such instruments could be used to assess supervisors' attitudes toward and receptivity to the constructive confrontation strategy before and after training. Peer Training Peers play important roles in both employee and member assistance programs. They constructively confront troubled coworkers, share their own troubled experiences with them, and tell them about the program's effectiveness and trustworthiness. Although data suggest that these roles are critical in helping coworkers to see themselves as troubled and decide to take advantage of the program (e.g., Sonnenstuhl, 1982, 1990; Harris and Fennell, 1989), few organizations, with the exception of the AFL-CIO's community services (Perlis, 1980) and some member assistance programs such as the National Maritime Union (Molloy, 1989) and the Airline Flight Attendants Association (Feuer, 1987), have developed peer training. Consequently, almost nothing is known about what constitutes effective training for these roles. In the future, both employee and member assistance programs will need to develop peer training. Building on the experience of the AFL-CIO community services and member assistance programs, such training would teach peers to

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identify troubled coworkers, confront them constructively, and refer them for help. In addition to providing peers with information on the work organization's own assistance program, training needs to acquaint them with the wide range of personal problems coworkers face and the variety of personal and community resources available for resolving them.

Employee Education Employee education has always been a part of occupational programs, and the newer, broad-based EAPs continue to conduct education for all employees. Today's curricula include posters, brochures, and workshops about a bewildering number of personal troubles and their solutions (Presnall, 1981). Educational materials generally stress prevention of problems, their early warning signs, and the availability of referral to professional help when problems occur. Martin Shain and Judith Groeneveld (1980) urge EAPs to develop workshops on life skills and health, decision making, values clarification, and information giving-and to coordinate their activities with such health promotion efforts as stress reduction, weight control, exercise, and diet (see also Shain, Suurvali, and Boutilier, 1986). Underlying all of these educational efforts is the basic assumption that mental health treatment is the "modern" and "scientific" way to solve personal problems and most individuals reject it out of ignorance and adherence to "primitive beliefs." Education, then, is often meant to instruct employees in the "proper" attitudes so that they will use mental health services "appropriately." This assumption, however, remains unsubstantiated (Becker, 1979); it is just as likely that employees adopt proper beliefs about mental health in response to using the services. EAP specialists, for example, do not assume that simply providing health information will prompt troubled employees to adopt new attitudes, take better care of themselves, or seek help through the EAP. Indeed, this is a complex social process in which people alternately seek and receive advice about their health conditions and the options available to them, and such social processes have been found to be remarkably resistant to change by health educators (Sonnenstuhl, 1982, 1986). Consequently, troubled employees often must be confronted by family, friends, coworkers, and supervisors before they will change their beliefs and behavior. What kind of employee education is needed or appropriate for the EAP? At a minimum, employees need to be aware of the company's policy and program, and such information should be widely disseminated. Unfamiliarity with the policy and its scope is likely to prevent employees from using it or lead to inappropriate use (Harris and Fennell, 1988; Reichman and Beidel, 1989). Education programs, however, might include information about a wide range of personal problems and solutions-for example, information about alcohol and drug abuse, family problems and stress management, what employees can do for themselves, self-help groups, and professional counseling. This selection of subject matter would make employees aware of the scope of the company's commitment to help them and also encourage employees to help themselves. A form of employee education called "wellness" has recently become popular. According to Rebecca S. Parkinson and Associates (1982), the effectiveness of these programs is untested, however, and probably will remain so since it is

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difficult to know if the program alone has prevented emotional and psychiatric disturbances. Many observers believe that the conspicuously well are attracted to and participate in the programs (Conrad, 1987b, 1988). Nevertheless, there is an inherent appeal in employee training in diet control, exercise, relaxation, smoking cessation, coping techniques, and health screening. These strategies have been imported into many workplaces by EAP practitioners because of pressures to contain health costs, but they are not part of the EAP core technology. The best evidence is that such tactics may reduce the risk of such physical conditions as cancer and heart disease if employees can be induced to eat well, stop smoking, and exercise. But there appears to be little, if any, evidence that they prevent alcohol abuse or the many other psychiatric troubles that beset a work force. Shain and his colleagues (1986) present evidence suggesting that a well-organized education program can reduce the amount of alcohol employees consume and promote appropriate beliefs about drinking. While it appears that such a program can encourage moderate drinkers to reduce their consumption, it is unlikely that heavy drinkers would react similarly. Given the voluntary nature of the program studied, it is likely that alcoholic employees opted out of it entirely. For instance, Harris and Fennell (1988) found that heavy drinkers were unlikely to use an EAP, and this finding may also apply to wellness programs. Strictly speaking, wellness programs are adjunct services that employees can be referred to by the EAP. For detailed comparisons of employee assistance and wellness programs see Roman and Blum, 1987, 1988, and Sonnenstuhl, 1988. The Counseling Component Every job-based program requires some method of providing help to those employees who wish it. We use the term counseling genetically to cover a wide range of tasks-preliminary assessments of employees' problems, diagnoses and referrals, and treatment. Some EAPs provide only preliminary assessment and referral, and others provide treatment as well. The early alcoholism programs relied heavily on AA members and outside rehabilitation programs to counsel problem drinkers. Today's more broadly based EAPs have developed a number of ways to provide counseling services to employees. Effective EAPs utilize two sets of beliefs that enable them to distinguish between alcoholic and other troubled employees (Sonnenstuhl, 1990). According to the mental health ideology, each individual is unique and must learn to adapt to the multiple, often competing, roles of modern life. Consequently, counseling consists of learning to identify the unique self and to nurture and use it in confronting the world. Treatment then becomes a cooperative venture in which the client is sufficiently motivated to help the counselors identify the problem and work toward its resolution. In contrast, according to the alcoholism ideology, alcoholism is a disease characterized by denial, which must be overcome so that the client will be motivated to quit drinking and pursue sobriety. This means that counselors must be more confrontative with alcoholics than with other troubled employees who are perceived as counselors' allies. In confronting the alcoholic employee, counselors downplay the unique self and underscore that a "healthy" life is possible only if the individual joins Alcoholics Anonymous and follows its twelve steps to sobriety. Keeping these ideologies in balance appears to make for effective employee/member assistance programs.

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Practitioners distinguish between services that are provided internally and those provided externally. Large work organizations may hire their own alcoholism counselors, social workers, or clinical psychologists to counsel employees. Smaller companies may contract with community therapists and agencies to provide treatment services. Whether internal or external services are chosen, it is important that the constructive confrontation strategy that takes place in the workplace and the counseling component remain in balance; that is, companies and unions must recognize that supervisors, stewards, and counselors have equally important, albeit different, functions to play in the EAP. In-House Services In-house services consist of a wide variety of activities, ranging from simple diagnosis and referral to extensive psychotherapeutic treatment of employees. Programs with in-house services are generally staffed by mental health professionals with strong clinical backgrounds. Many examples of this type of program structure exist, and the literature contains descriptions of several large organizations providing in-house services: Equitable Life Assurance Society (Manuso, 1983) and Metropolitan Life Insurance Company (Feinstein and Brown, 1982) were reported to employ social workers, psychologists, and certified alcoholism counselors who saw troubled employees during working hours. In such instances, most counseling is by EAP staff and employees requiring more specialized treatment are referred to outside agencies, particularly if the employees need to be treated within long-term intensive rehabilitation programs. But even long-term treatment is not beyond the scope of some EAP programs. For example, Ann Bensinger and Charles F. Pilkington (1983) reported that United Technologies Corporation operated its own alcoholism rehabilitation program. Companies develop in-house services for a number of reasons. Many do so because top executives are unfamiliar with mental health treatment generally and, to ensure expertise in this area, hire clinicians to develop the programs. Some companies provide in-house services because the employers believe this is the most tangible way to express their humanitarian concerns to employees. Others do so because they believe it is cost-effective. For example, United Technologies implemented its alcoholism treatment program after evaluating the costs of treating its alcoholic employees and concluding that many employees could be treated more quickly and less expensively in a company-run program than in the standard twenty-eight-day rehabilitation format. Companies are most apt to provide in-house services in facilities with large concentrations of employees because providing such services in smaller facilities is not considered cost-effective. For example, reports indicate that Equitable Life and Metropolitan Life did not duplicate their staff structures outside of corporate headquarters and United Technologies did not duplicate its rehabilitation program outside of Connecticut because the number of employees in other locations did not justify such arrangements (Manuso, 1983; Feinstein and Brown, 1982). In-house services are criticized for possibly jeopardizing employees' rights. Some therapists argue that many employees who need professional help will not

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use in-house services because they are afraid that management will learn of their problems and hold it against them. This logic may be persuasive in some ways, but empirical research has not resolved the argument. It is more certain, however, that in-house services present therapists with conflicts of interests (Sonnenstuhl, 1986). On the one hand, professional ethics stress that therapists must always act in the best interest of their patients. On the other hand, as employees of the company, they may feel compelled to resolve conflicts in the interest of their employer. When therapists try to work out these conflicting demands, employees' best interests might be compromised. External Services Many companies now contract with profit and nonprofit organizations to provide mental health services for troubled employees (Feinstein and Brown, 1982; Presnall, 1981). Some of these outside agencies provide a variety of services other than treatment, for example, supervisor training, diagnoses of employees' problems, and referrals to other treatment agencies. Service providers often operate a form of hotline that employees in great distress can use to call for immediate help. Companies are attracted to contract services for various reasons. Management may see contracting out as a quick and efficient way to implement a program in which no one in the company needs to take on the job of counseling employees and referring them to outside resources for help. This arrangement is particularly attractive to busy managers who are simply delegated the responsibility of coordinating the program. Some executives like the idea of contract services because they fear that if company clinicians treat employees, the company might be liable for medical malpractice (Sonnenstuhl, 1986). They believe that contract services are a way of shifting medical liabilities away from the company. Whether this is so remains a question, but it is likely that contracting out to EAP service providers merely increases the number of people who will be sued in malpractice cases. Contract services do have one major drawback: many of the groups that offer services do not have a great deal of experience with the workplace and may emphasize counseling and deemphasize the role of supervisors in identifying and motivating troubled employees. This posture can be particularly troublesome if service providers train supervisors because there would be a tendency to overemphasize the need to rush employees to professional treatment. Research indicates that companies contemplating contracts with outside agencies should consider integrating EAP training into their standard supervisory training program, where it can be done by company personnel. If outside service persons are allowed to do the training, the program coordinator should work closely with them to ensure that the focus on job performance is maintained. In any event, whenever a company or union uses an outside EAP service provider, or other community resources, the program coordinator retains responsibility for ensuring that supervisors and stewards receive appropriate training and that alcoholic and troubled employees get adequate help. Community Resource Network A third strategy for delivering counseling services to employees is the use of

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what we call the community resource network. This strategy recognizes that agencies outside the company already provide a wide range of counseling services that are available to employees and that the program coordinator's function is to direct employees to those resources. This strategy was used by the federal government in the implementation of its alcoholism policy and by William J. Sonnenstuhl in the implementation of International Paper Company's EAP. In International Paper's program, for example, the employee relations manager at each of the company's local facilities was designated as the EAP coordinator. He or she trained supervisors and union officials for their role in the program, conducted a survey and compiled a list of all the community services, and provided employees with such educational materials and programs as posters, films, and brochures. There are several advantages to using the community resource network: (1) treatment can be provided in the community under a company's existing medical coverage, and (2) most local facilities come to feel that they have a vested interest in the program and, therefore, may be more committed to making it work than would those that do not have this sense of ownership. Nevertheless, there is at least one disadvantage. When the local facility does not feel attached to the EAP itself but to the coordinator and the coordinator leaves, the program may fall into disrepair unless a new coordinator is designated quickly and establishes rapport with the local agencies. Maintaining this form of counseling model also requires continual reassessment of the community network and its functioning. Union Support and Involvement Beyer, Trice, and Hunt (1980) have found that in unionized facilities, union support and involvement greatly improve the effectiveness of EAPs. For example, they found for several reasons that supervisors in unionized federal installations were more likely than supervisors in nonunion installations to use the government's alcoholism policy. First, the unions generally supported the policy because they viewed it as an additional benefit for their members and a method of extending their traditional helping role to alcoholic employees. Second, union support was conveyed to supervisors in training sessions emphasizing general supervisory skills. Finally, unions emphasized their intentions to go to arbitration in cases in which supervisors failed to confront alcoholic employees and to offer them assistance. Thus, supervisors in unionized facilities were well informed about the unions' support of the policy and were therefore more willing to use it. Most labor-management experts would agree that to ensure support for the EAP, the union should be involved in the formulation of policy. When left out, the union will find it politically difficult to support the EAP, although it might see cooperation as highly desirable. Involvement can be either informal or formal. The policy and program may be worked out informally in a labor-management committee (Dyer, Lipsky, and Kochan, 1977) or formally as part of the collective bargaining agreement (Denenberg and Denenberg, 1983). The EAP's effectiveness, however, may be greatest when labor and management work together informally. Under the best of circumstances, labor-management cooperation on EAPs is difficult because of the traditional adversarial approach of industrial and labor relations. Leroy Johnson (1981), in a study of labor and management support for

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EAPs, concludes that even when program aims are rather modest, cooperation is difficult to accomplish. Trice and Beyer (1982a) found that cooperation on an alcoholism policy is more likely to occur in union locals in which the officers perceive problem drinking as a minor occurrence than in locals in which there is the perception of a great deal of problem drinking. Cooperation is also more likely to occur between managers and younger, lower-level union officers than between managers and higher-level officers-who may see such cooperation as a political liability. Union support and involvement can be increased by including union officials in sessions that train managers and supervisors to use the constructive confrontation strategy fairly and compassionately. Cooperation has been shown to be particularly effective when supervisors and stewards work together before the initiation of formal discipline. Research indicates that when this approach is used, the majority of employees will resolve their problems before punitive measures are called for. Once formal discipline goes into effect, grievances may be filed and cooperation between management and labor is more difficult because the process calls for unions to defend their members. According to Tia S. Denenberg and R. V. Denenberg (1983), arbitration signals the failure of management and labor to cooperate in assisting troubled employees. In many instances, unions develop EAPs on their own without any management involvement. Effective union-based member assistance programs usually include (1) a policy statement that is widely disseminated to union members, (2) unequivocal support from union officers and business agents, (3) an enthusiastic program coordinator who is a union member and is given the time and resources to make things work, (4) a steward training program, (5) a peer training program, (6) a member education program, and (7) a mechanism for providing members and their families with appropriate counseling services. Some labor leaders and researchers question whether the EAP core technology also applies to member assistance programs. In particular, they ask whether the job performance standard and the use of constructive confrontation fit with the union's responsibility to protect members' jobs. Research with the Tunnel and Construction Workers MAP strongly suggests that they do but that they take on slightly different meanings in union programs than in joint management-labor programs (Sonnenstuhl and Trice, 1987). In joint programs, job performance acts as the cue for supervisors to confront employees because, according to standards of industrial justice, they cannot interfere in employees' private lives unless personal problems adversely affect job performance. Union members are not bound by any such standard and are free to intervene in employees' private lives on the basis of other knowledge about coworkers' personal problems. Similarly, constructive confrontation takes on slightly different meanings in each type of program. In joint management-labor programs, constructive confrontation is integrated with the agreed-upon disciplinary process. Again, because unions are not bound by the same rules as management, the process is more fluid in union programs (see Sonnenstuhl and Trice, 1987). In both types of programs, however, it is employees' awareness that their deteriorating job performance may lead to job loss that motivates them to change their behavior.

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Summary Written EAP policies are essential in maintaining a job-based focus, with job performance as a criterion, and in emphasizing the balance between the role of managers, supervisors, and stewards in constructive confrontation and the role of clinicians and other professionals in counseling. Research shows that while top management support is necessary for program adoption, it is not always sufficient for program implementation; program coordinators do not need clinical training to implement policy, and the most effective EAP training for supervisors emphasizes general supervisory skills for managing marginal performers. The practical experience of many existing programs indicates that companies need not provide in-house counseling services to their employees since there are other ways to provide such services outside of the company, some of which may offer better options for maintaining a balance between constructive confrontation and counseling. Finally, experience and research indicate that in unionized companies, labor and management need to cooperate from the beginning of policy formulation to ensure that the program is effective.

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m ISSUES IN PROGRAM DEVELOPMENT As indicated in chapters 1 and 2 and underscored in the sample policy (exhibit 1), EAPs reflect the notion that personal problems can affect an employee's job performance and that helping the employee to solve those problems is both realistic, in terms of increasing productivity, and compassionate, in terms of expressing concern for the employee's well-being. The findings from basic and applied research suggest that maintaining the critical balance in this equation calls for careful consideration of (1) program strategies and their effectiveness and (2) corporate and union responsibilities related to the provision of services, confidentiality, and thirdparty payments. Program Strategies and Their Effectiveness To some extent all EAPs contain elements of both constructive confrontation and counseling strategies. In exhibit 4, however, we have broken them into their respective components to hypothesize two extreme models-those programs that emphasize constructive confrontation and those that emphasize counseling. These two types would occupy ends of a continuum along which actual programs with varying degrees of constructive confrontation and counseling could be aligned. Exhibit 4: Characteristics of Program Strategies COUNSELING

DIMENSIONS

CONSTRUCTIVE CONFRONTATION

Model's Origin

Based on sociological theory, AA experiences, and personnel practices

Based on theories of psychotherapy (e.g., psychodynamic, behavioral, and humanistic)

Focus

Focuses on job performance, emphasizing the natural setting and actors (i.e., supervisors and fellow employees)

Focuses on cause of problem, emphasizing professional-client relationships in the therapeutic setting

Cause of Trouble

No causal theory of trouble; however, the cause or causes of a particular trouble can be worked out in the give-and-take process between the employee and his or her supervisor and/or coworkers

Cause of trouble is "something" within the individual or in his or her social relationships, which the psychotherapist helps the individual to identify and learn to manage

ProblemSolving Techniques

Individual relies on everyday problemsolving techniques (e.g., advice from others)

Individual relies on psychotherapeutic techniques (e.g., behavior modification, cognitive psychotherapy, prescription drugs, family therapy)

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When examining program strategies, several questions are inevitably raised. What is the strategy? What are the assumptions underlying it? And what outcome is expected when the strategy is implemented? In evaluating effectiveness, one simply asks, Did the strategy produce the expected outcome? To answer this question requires demonstrating that the strategy and nothing else actually caused the result. Researchers use a number of techniques for ruling out alternative causes, including before and after tests, before and after tests with some form of control group, and multiple regression analysis. These tests follow from scientific logic and simply tell researchers how probable it is that the strategy actually worked. But because these tests of effectiveness deal in probabilities rather than in definitive answers, evaluation results are often hotly debated among researchers. In this section, we discuss the constructive confrontation strategy and some of the more generally used counseling strategies as well as the relevant research on their effectiveness. Appendixes A and B provide more detail on these subjects. Constructive Confrontation The constructive confrontation strategy evolved as a technique for identifying employed alcoholics and for counteracting the psychodynamics of alcoholismguilt, denial, rationalization, and manipulation (Donovan et al.,1977; Kellerman, 1970; Paredes, 1974; Pennoch and Poudrier, 1978; Trice, 1962a; Trice and Roman, 1978). Most observers agree that unless these psychodynamics of denial are overcome the likelihood of recovery from alcoholism is low and that the jobperformance standard of the constructive confrontation strategy offers one of the best vehicles for attacking denial (Trice and Sonnenstuhl, 1990c). Because alcoholism is a progressive disorder, it is difficult to distinguish in its early stages from social and problem drinking. This difficulty is compounded by the conflicting norms that surround drinking behavior in the United States. For example, some groups believe that any use of alcohol is sinful; some believe that three or four drinks a day is "normal11; still others believe that three or four drinks is a sign of incipient alcoholism. In addition, alcoholism is characterized by denial. When faced with evidence of their disruptive behavior, alcoholics deny that there is anything wrong with their drinking behavior and always have a good excuse for it. They have family problems; they were celebrating some occasion; they were carried away, but it won't happen again; they became involved with the wrong crowd. Alcoholics also manipulate the ambiguity surrounding drinking norms and exploit stereotypes of alcoholics as skid-row bums. After all, they quickly point out, "I really do not drink any more than everyone else. Besides, how could I have a problem? I work like everyone else!" Other emotional and physical disorders also are characterized by these psychodynamics (Schur, 1979), but they are particularly pronounced in highly stigmatized health problems such as alcoholism, drug addiction, and the psychoses. As a consequence, alcoholics and severely disturbed people are exceptionally difficult to help. Constructive confrontation solves the problem of identifying alcoholic employees by adopting a pragmatic definition of alcoholism that is based on job performance. Normal drinking does not unduly alter behavior and does not interfere with effective and efficient work performance. Problem drinking both exceeds the bounds of community definitions of appropriate behavior and impairs job

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performance. Alcoholism is the physiological loss of control over drinking, generally accompanied by the employee's inability to maintain acceptable levels of job performance. These definitions assume that the employees who are merely abusing alcohol can be motivated to change their behavior and those who have lost control of their drinking will be motivated to seek treatment. The constructive confrontation strategy is based on both academic and applied research and basic industrial relations practices that suggest that most people can be motivated to change if they receive appropriate feedback about their behavior. Studies of Alcoholics Anonymous, for example, demonstrate that problem drinkers who join AA have experienced intense reactions to their behavior from families, friends, and employers, which made it difficult for the drinkers to continue their denial. Other studies of AA (for example, Maxwell, 1960) and supervisors' reactions to alcoholics suggest that problem drinking begins to affect job performance adversely during the middle stages of the disease. Still other research illustrates that many problem drinkers mature out of their disruptive behavior and do not become alcoholics (Cahalan and Room, 1974; Clark and Cahalan, 1976; Plant, 1979). These findings from alcoholism studies parallel those from other studies. For example, many people seek psychiatric treatment only after experiencing prolonged and intense reactions to their bizarre behavior (Horwitz, 1977; Yarrow et al., 1955). And many people who might otherwise become delinquents, embezzlers, or marihuana smokers do not do so because the people around them do not support-and often actively discourage-such behaviors (Cohen, 1966; Cressey, 1953; Becker, 1973). In turn, these alcoholism and sociological findings complement the industrial relations practice of corrective discipline in which supervisors react to employees' unacceptable performance with progressively harsher sanctions (see Bacharach and Lawler, 1981; Black, 1970). Progressive discipline is designed to induce problem employees to conform to accepted performance standards and to discourage other employees from deviating from those standards, but such discipline usually is not imposed until job performance is seriously impaired. Research by Trice (1965) and others, however, has found that supervisors are aware of the unsatisfactory performance of neurotic and psychotic employees long before that stage. For constructive confrontation to be effective, a supervisor may need to hold a number of discussions with an employee whose performance is unacceptable. In the confrontational part of the initial discussion, the employee is given the specifics of unacceptable work performance and warned that continued unacceptable performance is likely to lead to formal discipline. In the constructive part, supervisors remind employees that practical assistance is available through the EAP. Subsequent steps in the process depend on the response of the employee. If performance improves, nothing happens; if unacceptable performance continues, several more informal discussions may follow. The constructive part of the informal discussions (1) expresses emotional support and group concern about the employee's welfare, (2) emphasizes that employment can be maintained if the employee performs better in the future, and (3) suggests an alternative course of behaviors that the employee can take to regain

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satisfactory work performance. The confrontational part of such discussions (1) reiterates expectations of work performance, (2) reminds the employee that he or she is not fulfilling these expectations and that formal sanctions will follow if expectations continue to be violated, and (3) establishes some distance between the employee and other employees who are meeting expectations, thus setting the stage for further sanctions if needed. Eventually, if the employee's performance still does not improve, a supplementary tactic called crisis precipitation is added. At this stage the employee is formally disciplined for continued poor performance-initially with a written warning, then with a series of increasingly long temporary suspensions, and finally with discharge. At all times up until discharge the employee is free to choose to go to the EAP for help. Controversy exists about whether supervisors will use the constructive confrontation strategy. Donald A. Phillips et al. (1980) claim that troubled employees beget troubled supervisors who must be counseled before they will use the strategy. This concept has been incorporated into the writings of other EAP practitioners (see, for example, Feinstein and Brown, 1982; Masi, 1982; Presnall, 1981). Empirical research, however, suggests that whether or not supervisors will use constructive confrontation is associated primarily with age and experience. Beyer and Trice (1978) as well as Googins and Kurtz (1981) have found that young, inexperienced supervisors are less likely than older, experienced ones to use it. Other research indicates that training programs that teach supervisors how to use constructive confrontation as a general technique for managing marginal performers increases familiarity with the policy and integrates supervisors into the formal and informal networks of the organization, thus increasing the likelihood that they will use the strategy (Belasco and Trice, 1969; Googins and Kurtz, 1979). Likewise, a recent study by Sonnenstuhl and Trice (1989; see also Sonnenstuhl, Trice, and Hathaway, 1990) found that relatively few supervisors are worried about using the strategy with alcoholic or other troubled employees. Troubled supervisors are young and inexperienced, occupy the lower rungs of the managerial ladder, and believe that their own career advancement does not depend upon their coaching employees to improve performance. In addition, being unfamiliar with the strategy generally and lacking any specific training in its use, they implement it too late, after employees' problems have become well developed and particularly difficult to manage. Despite the severity of employees' problems, troubled supervisors consulted few other people, further reinforcing their unfamiliarity with the strategy. A number of studies on the use of the constructive confrontation model have been completed since 1960. Each study has some methodological flaws, but when considered as a whole, the consistency of the findings suggests that the model is effective. Research by Trice and Beyer (1981) also indicates that the results obtained in these studies are not due to selection biases. These studies, however, have evaluated the effectiveness of constructive confrontation in industrial alcoholism programs rather than in broadly based employee assistance programs. Appendix A summarizes the studies and their reported findings.

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Counseling

While constructive confrontation focuses on the work relationship between supervisors and employees, counseling focuses on the therapeutic relationship between counselors and employees. The latter focus emerged as a program theme during the 1970s when trained counselors were becoming employed in EAPs and naturally bringing with them their own ideas about managing programs and helping troubled employees. They criticized earlier programs for lacking professional personnel capable of doing clinical diagnosis, treatment, and referral (Wrich, 1980). In addition, some of them worried that constructive confrontation, by coercing employees into treatment, would bring counselors into conflict with professional codes of ethics that require them to be clients1 allies at all times (Shain and Groeneveld, 1980). Some also argued that unacceptable job performance is a late sign of employees' troubles and that improved performance does not mean the underlying causes of problems have been resolved. To manage the ethical dilemma and promote early identification of personal troubles, counselors encouraged program emphasis on general educational efforts that would lead employees to refer themselves to the EAP, where their problems could be professionally diagnosed and appropriate treatment or referral recommendations made. The counseling strategy rests on a framework of psychological therapy-or more precisely a framework of many different psychotherapies. Psychotherapists generally speak of three basic types of therapy: psychoanalytic or psychodynamic, behavioral, and humanistic or phenomenological (see, for example, Bellack and Hersen, 1980; Garfield, 1983; Goldenberg, 1983). These therapies have several features in common. All are educational processes in which counselors try to teach a client-who may be either an individual, a family group, or an organization-a special way of viewing the problem behavior and lessons for changing it. Each therapy, however, has its own conception of human nature, explanation for abnormal development, strategy for changing behavior, and expected outcomes. Each type has its adherents and critics. Many therapists, however, would simply describe themselves as eclectic-picking and choosing between therapies according to the needs of particular clients. No one knows at present to what extent each type of psychotherapy is represented in EAP counseling. But the influx of professionally trained counselors into programs and their contributions to the EAP literature suggest that all types are represented. For example, Manuso (1983) under the tide of Occupational Clinical Psychology lists a wide range of approaches for treating troubled employees. Similarly, Masi (1982) describes a variety of cases and treatment alternatives used by industrial social workers. Whether employees are counseled in-house by the EAP staff or are referred to out-of-house treatment agencies and practitioners, they will be brought into contact with psychodynamic, behavioral, and humanistic psychotherapists. The following brief summary of the differences in these approaches may be helpful, although it is obviously an oversimplification of what goes on in the clinical setting. According to psychodynamic therapists, people progress from childhood to adulthood through successive stages of psychological development. At each stage, individuals unconsciously resolve questions about who they are and their

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relationship to the larger world. Abnormal behaviors reflect unresolved conflicts in earlier stages of development, and therapy consists of helping patients to resolve them so that the patients can become psychologically mature. Psychodynamic therapies are essentially "talking" cures in which therapists open up patients1 pasts and their unconscious thoughts and feelings to conscious scrutiny to promote self-understanding and growth. Attaining psychological maturity, however, may require many years of treatment. Psychodynamic therapies have been developed by Alfred Adler, Carl Jung, Karen Horney, Eric Fromm, and Erik Erikson, but the best known is Sigmund Freud's psychoanalysis. Each of these therapies has its own theory of psychological development and definition of maturity. Evaluation research of psychodynamic therapies is relatively rare because many of the concepts are impossible to measure. Behaviorists reject psychodynamic therapies as being unscientific. According to them, human nature is not predetermined but a product of social learning; that is, people learn how to behave from others, and they behave in ways that are rewarded. As a consequence, behavioral disorders stem from faulty learning and therapy consists of teaching clients to extinguish old behavioral patterns and learn new ones. Behaviorists, unlike psychodynamic therapists, believe that unconscious conflicts and insights are irrelevant to treatment. They focus on changing specific behaviors in targeted life situations (such as anxiety when speaking before an audience), changing faulty thought patterns (such as "no one likes me"), and teaching people to manage their lives better (such as being more assertive). Behaviorists have developed a wide range of techniques for teaching people to adopt new behaviors, but the best known of these is biofeedback. Cognitive-behavioral techniques such as Ellis's rational-emotive therapy and Meichenbaum's self-instructional training are currently popular with therapists. Behavioral therapies are relatively short term, usually lasting from several sessions to a year, and many of them have been rigorously evaluated. Humanistic therapists reject psychodynamic therapies as too deterministic and behavioral ones as too simplistic. Humanistic therapy is based on the proposition that everyone is unique and is able to direct his or her own psychological growth. People can become whatever they choose, and disordered behavior results from a lack of self-esteem. Treatment focuses on making people more aware of who they are, their values, how to accept themselves, and how to fulfill their potential. Unlike psychodynamic therapies that focus on the past, humanistic therapies focus on current experiences and feelings to foster psychological growth and self-esteem. Examples of humanistic approaches are Carl Rogers's person-centered therapy, Fritz Perls's gestalt therapy, William Glasser's reality therapy, and Janov's primal therapy. Except for research on person-centered therapy, there are few evaluations of humanistic psychotherapies. According to Sol L. Garfield (1983) and William M. Pinsof (1981), therapists are increasingly pursuing group and family therapies as alternatives to individual psychotherapies. These approaches may prove to be more effective than individual therapies because humans, as group members, are highly susceptible to group forces, especially when brought to bear on a shared problem by a strong leader operating within a belief system shared by the group. According to Horwitz

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(1982), throughout most of the world, treatment for mental illness is conducted within some form of group. EAP counselors are beginning to explore the use of such techniques in their programs (see, for example, deLara, 1988). While the logic is compelling, the methodological problems in evaluating group and family therapies are difficult to overcome (Gurman and Kniskern, 1981). Thus, we are left with much to learn about these promising approaches. So far we have found no evaluation studies of the effectiveness of the counseling strategy used generally in EAPs, which is understandable for a variety of reasons. Evaluation research is both time consuming and expensive, EAP therapists generally are oriented to treatment more than to research, and the issue of confidentiality has made it difficult for outside researchers to evaluate programs. EAP counseling, however, is the same as the psychotherapy received by employees in a mental health center or a private practice; therefore, its effectiveness may be understood by examining some of the many studies of psychotherapy outcomes. Appendix B summarizes some of the evaluations of outcome research that have led to conflicting conclusions in some instances and, thus, to debate within the psychotherapy community itself. What can one make of the conflicting conclusions about the effectiveness of various psychotherapies, and what do they mean for EAPs? Several observations seem warranted. First, spontaneous remissions do occur, and two-thirds of most neuroses can be expected to remit within two years of onset. Indeed, the findings of a well-regarded psychotherapy study by R.B. Sloane et al. (1975) at the Harvard Medical School suggest that 77 percent of employees with moderately severe neuroses can be expected to recover or improve within four months with or without treatment. Second, psychotherapy outcome research, especially for psychodynamic and humanistic approaches, is still in its infancy. Until better outcome data are available, individual EAP counselors undoubtedly will continue to deliver their own brand of counseling to employees. By remaining flexible and observing what works and what does not, they will develop a body of EAP counseling experiences and literature. Finally, it is possible that the form of psychotherapy is less important than the motivation of the employee, since psychotherapy outcome studies consistently demonstrate that highly motivated clients do better in treatment than less motivated ones. The Case for Balance As the discussion thus far indicates, many questions about constructive confrontation and counseling remain unanswered. Research by Trice and Beyer (1984b), however, suggests that programs maintaining a balance between constructive confrontation and counseling can expect to have better outcomes than those that do not. Constructive confrontation motivates employees to change their behavior, and counseling provides one means of doing so. The Trice and Beyer study, however, presents even stronger evidence concerning those factors in the constructive confrontation strategy that predicted acceptance or rejection of help and improvement or decrement in job performance. Their research to evaluate the contributions of constructive confrontation and counseling to improving job performance was conducted in a major corporation

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employing more than 120,000 people in more than 50 facilities throughout the United States. The company had had an alcoholism program since 1962, and in 1980 data were collected from a sustained random sample of 474 supervisors in 19 sample locations. In each facility, data were collected from two samples of supervisors. Sample A (n=153) consisted of one-half of all supervisors who had had a subordinate with a drinking problem and had referred that employee to the company alcoholism program within three years prior to the study. Sample B (n=321) consisted of one-tenth of all supervisors at each location, and they were interviewed about how they had managed an employee who presented some difficult behavior problem other than alcoholism during the same three-year period. In face-to-face interviews, the researchers collected information on the employee's job performance at the time the manager first realized that the employee had a serious problem (Time 1); a measure of the employee's performance at the time of the interview (Time 2); and information about what each manager said in discussions with the employee, who was present at those discussions, what formal discipline was taken with the employee, and the outcomes of the constructive confrontation discussion. These data were analyzed by multiple regression. The following questions and their answers highlight some of the findings in the study. What factors predicted that problem drinkers would accept or reject help? What supervisors said and how often they said it to problem drinkers predicted whether problem drinkers would accept or reject help from the program. Although supervisors used both constructive topics (for example, availability of services) and confrontative topics (for example, possible disciplinary actions), the constructive topics accounted for the problem drinkers accepting help, and the more often supervisors constructively confronted them, the more likely problem drinkers were to accept help. When supervisors used primarily confrontative topics, problem drinkers were likely to refuse treatment or leave the company. Who was present during the first discussion also appeared to affect whether problem drinkers accepted or refused help. When employees' immediate supervisors were absent and the supervisors' bosses were present, employees were apt to refuse help. When medical department representatives were present, employees were less likely to refuse help and more likely to accept treatment, but they were also more likely to take early retirement or medical disability. When EAP coordinators were present, employees were also likely to leave the company. What factors predicted whether problem drinkers would improve their job performance? At the time of the interview, supervisors indicated that based on "traditional" performance criteria, 69.8 percent of the problem drinkers improved their performance, another 9.3 percent improved with relapses, another 16.7 percent did not appear to change, and 4.2 percent seemed to deteriorate. A second measure of job performance was calculated using the "best-worst" technique, which asks supervisors to compare the performance of the alcoholic or troubled employee with the performance of their best and worst employees (see Beyer and Trice, 1984b, for a more detailed discussion). Using such comparisons for the time the supervisor first realized the employee had a problem and at the time of the interview, 75 percent were considered to have improved their performance, 11 percent remained the same, and 14 percent had gotten worse. Four factors were related to improved performance, and four factors were related

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to unimproved performance. Problem drinkers who had a somewhat higher performance rating than other problem drinkers, who were older, who experienced more confrontative topics in discussions, and who accepted treatment were more likely to improve their job performance than those who did not have these characteristics and experiences. Problem drinkers were unlikely to improve their performance if the EAP coordinator was present at the first discussion, if they had already opted to leave the company, if they had received a written warning, or if they had been suspended from work without pay. What factors predicted whether other troubled employees would accept or reject help from the EAP? Supervisors described managing employees with family problems (60 percent), general emotional disturbances (45 percent), legal problems (11 percent), drug-related problems (9 percent), and other problems (16 percent). As indicated by the percentages, some of these employees had more than one problem. Factors similar to those for problem drinkers predicted whether these employees would accept or reject help. Again, the kind and number of discussions were good predictors of accepting help. In these discussions, it was the supervisors' use of many constructive topics that prompted the employees to accept help. Troubled employees who refused help generally had very low performance ratings at Time 1 and had experienced more confrontative discussions with their supervisors in the presence of the supervisors' bosses. What factors predicted improvement in the job performance of troubled employees? At the time of the interview, supervisors indicated that 46 percent of the troubled employees improved their performance and 15 percent improved with relapses. The best-worst technique indicated that 55 percent had improved. Two factors were related to improved job performance, and four were related to unimproved performance. Employees whose job performance was high when their supervisors confronted them and whose supervisors had used more constructive topics in these discussions were likely to improve their job performance. Those problem employees who were young, refused assistance, or were formally disciplined were unlikely to improve. The findings from this study have important implications for EAPs. First, they indicate that balanced programs are effective in helping alcoholic and other troubled employees to improve job performance. Seventy-five percent of problem drinkers and 55 percent of other troubled employees showed a marked improvement in their performance. Second, a balance of constructive and confrontative topics in discussions is the best predictor of problem drinkers accepting assistance and improving performance. Confrontative topics alone have an impact on problem drinkers improving their job performance, but the greatest improvement occurs when problem drinkers accept treatment as well. This suggests that confrontative topics are important in breaking down alcoholics' denial systems and that constructive topics have an indirect effect on their performance by encouraging them to accept treatment. In dealing with alcoholic employees, it is important to be confrontative and yet remain constructive. On the other hand, constructive topics alone have an impact on improving the job performance of other problem employees. Although this study does not show that

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accepting treatment has a direct impact on the job performance of troubled employees, it suggests that outright rejection of assistance may have a negative effect on their work. In dealing with these employees, it is critically important that supervisors be empathetic and yet remain confrontative. Third, employees are likely to show marked improvement in their performance if supervisors constructively confront them before their job performance seriously deteriorates. Supervisors should be prepared to constructively confront employees at the earliest sign of a performance problem. Since performance appraisal is an ongoing process in which supervisors and employees interact, the opportunity for intervention at the earliest signs of a performance problem exists within a standard workplace setting. Fourth, formal disciplinary procedures have negative effects on whether employees will accept help and improve their performance, but they cannot be delayed indefinitely and employees must realize that formal discipline will be implemented when necessary. This is the confrontative element in the strategy. Positive outcomes are more likely when supervisors constructively confront employees prior to the initiation of formal discipline. Fifth, the initial constructive confrontation discussions should be between the supervisor and the employee. The presence of the EAP coordinator, medical department personnel, or the supervisor's boss generally leads to negative outcomes; for example, employees may refuse help, leave the company, and so on. Corporate and Union Responsibilities As companies and unions adopt EAPs, they frequently find themselves besieged by a variety of occupational specialists and service providers, each with his or her own occupational agenda for program development. Among the issues to be resolved in addition to questions concerning a balance in program strategies are those concerning the provision of counseling services to employees, confidentiality, and third-party payments for services. Provision of Services The key to understanding what kind of practitioner a company or union should employ to provide counseling is in defining the kind of services to be provided (Carahan, 1984; Gorman and Staples, 1982). As we indicated in chapters 1 and 2, there are a variety of EAP models, and unions and companies need to be quite clear about which one they are using and what services are being offered. Mental health specialists make a variety of claims about who should provide services in EAPs. For example, social workers claim that services should be provided by someone with at least a master's degree in social work (see Masi, 1982); psychologists claim that providers should have a doctoral degree (see Manuso, 1983). Such claims reflect the particular occupation's beliefs about who is qualified to treat patients, and frequently these beliefs are supported by state regulations.

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States generally regulate who is qualified to treat, and companies and unions must comply with those requirements. States, however, usually do not regulate who can make a referral. As a consequence, if the organization provides treatment, the counselors on the staff probably will be required to have advanced degrees, but if the organization acts only as a referral service, staff members will not necessarily need advanced degrees. Referral agents, however, should be careful to refer employees to agencies and therapists who meet the stated qualifications; it is the organization's responsibility to make sure that the referred employees receive appropriate services. Clarity about what services an organization provides and who provides them is important when considering negligence suits (Gorman and Staples, 1982). All counseling occupations are subject to negligence suits (Wilkinson, 1982), and internal and external EAP counselors and their employees have been sued for a variety of reasons (Carahan, 1984). These include alleged misdiagnosis, release of information without the employee's written consent, sexual abuse of a client, and false statements that a treatment facility was dirty and substandard. Negligence suits entail showing that the practitioners owed the employee a duty of care, that this duty was violated, and that the employee was injured by the practitioner's violation. Duty of care is a technical, legal concept and essentially means that the practitioner owes the client the skills and knowledge normally possessed by members of his or her occupation. In other words, counselors are judged by the standards set by other counselors. Courts have only begun to define the parameters of the duty of care for occupations other than physicians and attorneys. Until such standards are established, companies and unions are well advised to be particularly clear about the EAP services they provide and the qualifications of those who provide them to be sure that their services and personnel are adequately covered by liability insurance. Confidentiality Confidentiality is an important issue precisely because so many groups have a stake in it. It can be particularly vexing for employers who need to know about an employee's ability to work and who wish to evaluate their EAPs. Employees, however, will not use a service that does not ensure some measure of privacy. By the same token, confidentiality guidelines are important to ensure counselors a measure of autonomy in treating clients. Within an EAP, disclosure of any client information should be subject to a written agreement between the employer and the service provider; that is, they should negotiate between themselves to decide what is reasonable. But if either the employer or the service provider receives federal assistance, directly or indirectly, the federal confidentiality statute and regulations apply (Confidentiality of Alcohol and Drug Abuse Patient Records, 42 C.F.R. Part 2 [1983]; 40 U.S.C.A. S290dd-3 [West Supp. 1984]). According to the federal regulations, generally no information about a client may be released without his or her written authorization. The written consent must state the name of the treatment program, the employee's name, the party to whom the

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disclosure can be made, and for what purpose it is to be used. Even with the written authorization of the client, treatment agencies may release only that information absolutely necessary for the person requesting it to know. Under these circumstances, a service provider generally can tell an employer only about an employee's status in the program; however, if the employer has a bona fide need for more information to evaluate the employee's work situation, it may be furnished. Only under limited circumstances can programs release information without the employee's consent. Unauthorized disclosures may be made to the appropriate person in a medical emergency or in compliance with a court order. Under federal regulations patients do not have open access to their treatment records, but a patient may see them if the disclosure will not cause substantial harm to the relationship between the patient and the program or harm the patient and if such disclosure is limited to what the patient already knows through his or her participation in the program. Because confidentiality is an important issue for EAPs, the federal regulations offer reasonable guidelines for balancing the needs of employers, employees, and counseling staff. As a consequence, companies and unions not already subject to the regulations may wish to consider them in designing their own guidelines. Confidentiality, however, can be a two-edged sword. Employees need to know that the EAP will keep their troubles in confidence; yet managers need information by which to evaluate the EAP's effectiveness. In the past, counseling programs, such as those at Prudential Insurance and Western Electric, were reported to have been shut down by management when their program administrators, standing on confidentiality, became too secretive about their activities (Dickson and Roethlisberger, 1966; Levinson, 1983). Research by Paul Steele concerning the relationship between EAPs and work organizations concluded that "the EAP could be seen by the organizational leadership as secretive, antagonistic, and disorganized in its orientation to the rest of the organization" (1984:42). Therefore, one might speculate that the long-term survival of programs could depend on balancing employees' rights to privacy and management's need to know. Third-Party Payment Most companies provide benefit plans to cover health and medical costs for employees and their families, usually through Blue Cross/Blue Shield or other insurance schemes. A growing number of states now make third-party coverage of psychological, alcoholism, and drug treatment mandatory in health and medical insurance packages. Companies or unions with such benefits may use them to develop the community resource network strategy discussed in chapter 2. Companies and unions with in-house programs use the benefits to complement those counseling services. Companies and unions who contract with external EAP service providers handle benefits differently. Typically, outside EAP service providers operate on a per capita basis, charging "X" dollars per employee. The services covered vary greatly. Some packages provide simply for assessment and referral sessions that are free to individual employees; some may cover as many as ten or twelve free counseling sessions by

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the provider as well. When employees are referred out of the EAP service provider to other community resources, treatment is generally covered under the company's or the union's medical insurance. Concerned about the escalating costs of health care (Wallace, 1987), many companies and unions have turned to their EAPs for help (e.g., Danto, 1989; deLong, 1990; Thompson, 1989; Bridwell, Collins, and Levine, 1988; Tison, 1989); consequently, "managed health care" has become a new and much ballyhooed term in employee assistance. In truth, it is simply the old concept of controlling personnel benefits updated for the eighties and nineties, as corporate benefits managers have pressured EAPs to find innovative ways to curb the spiraling costs of alcohol, other drug, and psychiatric treatment. From a corporate perspective, this makes sense because these types of treatment have recently accounted for 8 to 25 percent of company expenditures for insured health costs and because the costs of treating alcohol, drug, and psychiatric problems are disproportionately high compared to other health care needs (Lee, 1988). Some EAPs have responded by promoting wellness programs, by helping benefit managers negotiate new insurance plans, by restricting whom employees can go to for treatment, by regulating the amount of time allotted for treatment, and by keeping a generally watchful eye on employees' treatment progress. Other employee assistance workers (e.g., Lake, 1988), particularly old-timers, blame themselves for letting things get out of hand by pursuing more expensive "professional" therapies and ignoring less expensive "time-worn" alternatives that may be equally effective. Self-help groups, for example, may be viable alternatives or additions to expensive counseling programs requiring third-party coverage. Usually self-help groups ask only that members make a small contribution toward the meeting expenses. Before third-party coverage for alcoholism treatment was available, many employed alcoholics successfully recovered through Alcoholics Anonymous. Today, even with third-party coverage, some continue to use AA as their only avenue to recovery. Other alcoholics, however, sober up in rehabilitation programs guided by the AA philosophy and then maintain their sobriety through the fellowship. The success of AA has spawned hundreds of other self-help groups and programs. These groups, however, do not provide the medical treatment that might be required for serious illnesses with debilitating psychological effects. There are groups for every human condition imaginable-aging, anxiety, bereavement, colitis, debt, depression, divorce and other family troubles, epilepsy, gambling, herpes, heart disease, learning disabilities, lupus, manic depression, mastectomy, menopause-the list goes on and on (see, for example, New York City Self-Help Clearinghouse, 1983). Some groups have their own versions of AA Twelve Steps and Traditions; others simply work on the principle that it takes one to know one. All such groups aim to provide members with support and understanding and to help them learn to manage their troubles. Although self-help groups have not been rigorously evaluated, qualitative research illustrates that they are effective in some cases. Most self-help groups are probably started by individuals looking for a solution

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to a shared problem, but counselors have started some as well. Since the late seventies, a growing network of self-help clearinghouses has been responsible for developing groups. There are now approximately two dozen clearinghouses providing a variety of services to their communities. For example, the New York City Self-Help Clearinghouse operates an information and referral service, provides technical assistance to people interested in starting groups, trains professionals to work with self-help groups, and publishes a directory of groups in New York City. Clearinghouses are valuable community resources for EAPs. Self-help groups are only one alternative to expensive treatment regimens. If EAP staff are alert to other options and incorporate them into their referral networks, lack of third-party coverage need not be a barrier to helping alcoholic or other troubled employees. For instance, many community-supported agencies such as mental health centers and family services generally charge clients according to their ability to pay. Summary Constructive confrontation uses the dynamics of the workplace to motivate employees to change their behavior, and counseling helps those employees who have difficulty doing so. While practitioners and researchers have much to learn about how and for whom and in what combination these strategies work, a great deal is already known. Research indicates that constructive confrontation and counseling when used separately may produce good results, but balanced programs produce the best results. And although research on the effectiveness of the different counseling techniques used in EAPs is still spotty, research on the effectiveness of particular combinations of constructive and confrontational techniques provides some solid guidelines for the EAP practitioner. Companies and unions that have assumed an obligation to help their employees need not be overwhelmed by the agenda of occupational professionals in meeting their responsibilities. These responsibilities include being clear about what services the EAP actually offers and making sure that employees understand what they are. If the EAP is merely acting as a referral agency, someone without a counseling degree may be able to coordinate the program on a part- or full-time basis. But if the EAP does provide in-house counseling, staff members should have advanced degrees in the appropriate fields. Likewise, if companies and unions act reasonably, confidentiality need not be a problem. Federal regulations offer a reasonable compromise for ensuring that the needs of employees, EAP staff, and companies and unions are met. Lack of comprehensive third-party coverage, although presenting some difficulties, need not deter companies and unions from helping alcoholic and other troubled employees. Self-help groups and other community health care programs can provide effective, but less expensive, service to employees and their families.

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IV

WORKERS1 COMPENSATION, ARBITRATION, AND EAPs Ideally, EAPs can be viewed as "conflict-avoidance devices" (see Shain and Walden, 1980). They prevent problems first by providing problem drinkers and troubled employees timely feedback on their behavior and second by offering them counseling. EAPs, however, are not a panacea for every personal problem in the workplace, and despite the best efforts of management and labor, some alcohol, drug, and emotional problems will become the focus of workers' compensation claims and arbitration hearings. This chapter examines (1) how workers' compensation and arbitration have dealt with alcohol, drug, and mental health problems and (2) how EAPs relate to those programs. Workers1 Compensation Insurance Prior to the passage of workers' compensation laws, some employers provided care and support for disabled workers, but the vast majority did not. Most disabled workers simply lost their jobs; some received private charity or state welfare, and many sued. Judges and juries ruled that injured workers could recover damages if they could prove that the injury was caused by the negligence of the employer, and they frequently found in favor of the disabled employees and made employers liable for large sums of money. To control liability costs, employers petitioned state legislators to intervene. In 1911, New York and New Jersey were among the first states to pass workers' compensation laws. Compensation insurance laws, then, developed as a compromise, insuring that employees would not automatically lose their jobs and would be justly compensated for their disabilities. In exchange for such assurances, workers' rights to sue were limited. According to Roberts' Dictionary of Industrial Relations (Roberts, 1971:31), the purpose of workers' compensation is "to provide financial aid through a system of insurance to compensate employees for damages or injuries incurred in the course of employment. Most employers insure [the] risks through private insurance companies and have set aside funds to make such insurance a pan of the general cost of doing business. Present laws . . . make compensation available without regard to carelessness of the individual or liability on the part of the employer. They cover both injuries and occupational diseases." Since its inception, workers' compensation insurance has undergone significant changes in the scope of coverage. Early statutory language limited compensation to physical injuries arising out of specific injury on the job, and it excluded mental illness because of the difficulties in defining psychiatric disorders and in translating them into measurable compensation. This approach is changing, and workers' compensation now recognizes several mental injury categories: (1) injuries that are primarily physical but have a resultant mental component, (2) injuries that are mental in nature but have a physical manifestation as well, and (3) injuries that are strictly mental with no prior or subsequent physical effect (Blum, 1980). To collect compensation, employees must show that something in the workplace caused the mental injury-a difficult, if not impossible, task because mental health and illness

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are not easily defined and causal explanations for emotional disturbances remain largely unsubstantiated (for example, see chapter 3 and appendix B for the conflicting ways psychotherapists conceptualize psychological disorders). Consequently, decisions to award compensation for mental injury often are not based on scientific evidence but on the value judgments of panel members and appellate court judges who are persuaded that the emotional suffering in question was caused by job-related factors. The following cases provide examples of state court decisions that are expanding the scope of workers' compensation for emotional disability. Physical-Mental Injuries Workers1 compensation laws in all of the states recognize that psychological trauma caused by a physical accident is compensable. In such cases, the physical injury may be only slight; however, the employee must show a causal connection between the physical injury and emotional or mental impairment. Many such cases have been litigated, and the following are illustrative. In HemphillDrug Company v. Mann [274 So.2d 117 (1973)], Mr. Mann broke his leg in an accident that occurred when he was driving his employer's truck. While awaiting surgery, he was sedated and tranquilized; as a result, he developed a severe psychosis. After returning home, he continued taking the medication and subsequently fell down a flight of stairs and broke his hip. He asked the Mississippi compensation panel to award him compensation for the broken leg, the psychosis, and the fractured hip. They did, and Hemphill Drug Company appealed the decision to the Mississippi Supreme Court, arguing that Mann should be compensated only for the broken leg and resultant mental illness. The court found in favor of Mann, ruling not only that emotional disorders caused by physical trauma can be compensated but that secondary injuries arising from the mental illness are also compensable, as long as the cause of the compensable event can be related to the initial episode for which compensation was awarded. Another case involves an employee's suicide. In Jakco Painting Contractors v. Industrial Commission of the State of Colorado [84 Colo. App. 597 (1985)], the employee, while at work, suffered severe facial burns that required plastic surgery. He subsequently underwent a striking personality change-he became selfconscious, depressed, prone to fits of rage, and abused his wife and children. In 1982, he committed suicide. The Colorado Court of Appeals [84 CA 0597, (1985)] found that the suicide was directly related to, and proximately caused by, the depression and anxiety he suffered from his industrial accident. In spite of a statute ruling that dependents are not eligible for benefits if death was intentionally selfinflicted, the court chooses to allow compensation in cases in which a compensable injury caused a deranged mental condition that in turn caused the suicide. Mental-Physical Injuries Workers' compensation panels generally recognize that physical injuries caused by mental trauma are compensable. As in physical-mental injury cases, these cases must demonstrate a causal relationship between mental trauma and physical injury. Each state, however, may define what constitutes psychic trauma differently.

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For example, in a New York State case, Klimas v. Trans Caribbean Airways, Inc. [10 N.Y.S.2d 209 (1961)], Klimas, in the course of his job, suffered severe anxiety and emotional disturbances that allegedly triggered his death by heart attack. The president of the company had held Klimas personally responsible for repairs on a grounded airplane. When the repair schedule fell behind, the airline went so far as to bill Klimas for the completed work. Faced with his work difficulties, Klimas suffered severe anxiety and emotional distress, which his estate claimed led to a myocardial infarction; he had no history of heart disease. The workers' compensation panel ruled against Klimas arguing that there was not enough factual evidence to make an award. The panel's decision was overturned by the New York Court of Appeals. In the court's opinion undue anxiety, strain, and mental stress from work are frequently more devastating than mere physical injury. In Liebmann Arctic Ice Company v. Henderson [486 P.2d 739 (1971)], which concerned an employee's heart attack under fairly different circumstances, the Oklahoma Supreme Court ruled differently. When a driver refused to move his truck, Liebmann became very angry and suffered a heart attack. The state industrial court awarded Liebmann compensation, but the supreme court overturned that decision, ruling that according to Oklahoma law Liebmann's anger was not the product of an emotional trauma but the result of a common work annoyance and consequently not compensable. Mental-Mental Injuries Workers' compensation panels do not all agree that psychological disorders caused by mental trauma are compensable because, without a physical injury present, they and the courts are unsure about awarding disability for mental injuries, which are often viewed as nebulous or subjective. In a growing number of states, however, such cases are viewed as being compensable, and some observers worry that the increase in these cases will force drastic changes in workers' compensation (Lublin, 1980). California law, for example, recognizes mental-mental injuries and processes three to four thousand cases each year. Mental-mental injuries fall into two categories-those caused by a single event and those caused by a gradual buildup of pressure over a considerable period of time. Cases stemming from a single event are often those in which a worker experiences trauma and in which the potential for shock is both obvious and medically established. The landmark case of this type is Bailey v. American General Insurance [279 S.W.2d 315 (1953)]. Bailey and a coworker were on a scaffold when it collapsed. Bailey watched his coworker plunge to his death, and he narrowly escaped physical injury himself. Afterward he developed an emotional neurosis and was unable to work as a structural steel worker. Although injury under Texas law was defined as "damage or harm to the physical structure of the body," in this case the Texas Supreme Court interpreted the statute liberally, stating that the inability to use one's body because of a nervous injury should be compensable. Since this ruling, other states have made similar interpretations although some have ruled quite differently. For example, the Kansas Supreme Court ruled that a claimant's posttraumatic stress disorder was not compensable under the Kansas Workers' Compensation Act because there was no physical injury. In this case, Tracy Followill v. Emerson Electric Company [674 P.2d 1050

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(1984)], an employee was traumatized by the death of his coworker and unable to return to work afterward. Cases involving disabilities caused by a gradual buildup of stress present particularly difficult problems and for many years workers1 compensation panels were reluctant to recognize them as compensable. Since the landmark case of Carter v. General Motors [106 N.W.2d 105 (I960)], however, more cases of gradual job stress have been filed. In this case, Carter found it difficult to keep up with the assembly line so he carried two hub assemblies at a time into his work area. His supervisor repeatedly reminded him that he was supposed to carry only one at a time. Carter's inability to keep up with the line and the pressure from his foreman increased his anxiety and resulted in an emotional collapse and a diagnosis of paranoid schizophrenia. The Michigan Supreme Court found a causal connection between employment and injury, although the injury was one that developed gradually. In this case, there was a strong dissent pointing out that Carter had a history of emotional problems resulting from a personality disorder. In Dexiel v. Difco Laboratories [232 N.W.2d 146 (1975)], the Michigan Supreme Court upheld a decision that the perceived effect of the work environment on a particular individual employee is significant rather than whether or not the work environment itself could cause or aggravate a psychological disorder. For example, in California a probation officer won a retirement allowance because of stress resulting from the county's unsuccessful attempt to dismiss him for alleged illegal drug dealing [Traub v. Board of Retirement of the Los Angeles County Retirement Association, 34 Cal. 3d 793 (1983)]. In Oregon, the court found that an employee's on-the-job pressures when compared with her off-the-job conditions were the major causes of her mental disorders and were therefore compensable under the state's compensation act [State Accident Insurance Fund Corporation v. Virginia S. Shilling, 675 P.2d 1081 (1984)]. Other mental-mental cases have dealt with whether the emotional trauma produced by layoffs, demotions, or terminations is compensable. For example, Helen J. Kelly developed severe depression and chest pains upon hearing that she was being laid off and transferred to another department. She was initially denied compensation, but on appeal the Massachusetts Supreme Court [477 N.E.2d 582 (1985)] ruled that an employee who suffers an emotional disability as a result of a layoff or transfer is entitled to workers' compensation. Three dissenting justices opined that never before had the court allowed compensation without proof that the injuries resulted from a particular stressful, work-related incident. In similar cases heard in other states, compensation has been denied [Paul Dean Kern v. Ideal Basic Industries, 689 P.2d 1272 (1984); Smith and Saunders, Inc., v. R. B. Perry, Jr., 473 So.2d 423 (1985)]. The Tort of Mental Distress Most mental distress cases in the workplace are handled within a state's workers' compensation program. In case of wrongful conduct by the employer, however, an employee may opt out of the system and sue his or her employer in a court of common law. According to John Blum (1980), torts of mental distress involve the following: (1) the employer's conduct must be reckless or intentional,

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(2) the conduct must be extreme or outrageous, (3) there must be a causal connection between the wrongful conduct and the emotional distress, and (4) the emotional distress must be severe. Agis v. Howard Johnson Corporation [355 N.E.2d 315 (1976)] illustrates the tort of mental distress. Howard Johnson notified its waitresses that someone was stealing and until the guilty party confessed, the waitresses would be fired, one by one, in alphabetical order. Agis was the first fired and suffered severe emotional distress, mental anguish, and loss of wages. She sued, and the Massachusetts court ruled in her favor, finding that her employer's conduct was sufficiently extreme to be classified as outrageous behavior leading to severe emotional distress. Alcohol and Workers1 Compensation Despite state laws providing that accidents caused by employee drinking are not compensable, the courts have made exceptions under certain circumstances. For example, intoxicated employees who have had accidents with company cars have been covered because compensation panels ruled that drinking to entertain customers was part of the job. For instance, in West Florida Distributors v. Sharon A. Laramie [438 So.2d 133 (1983)], an employee's widow sought death benefits after her husband, a liquor salesman, was killed in an automobile accident while on business. Evidence suggested that he was intoxicated at the time of the accident, and the employer raised the intoxication defense to avoid paying benefits. The district court ruled that an employer cannot encourage employees to drink to entertain customers and then refuse to face the consequences. According to the court, the employer implied that the employee would not be deprived of his job or of compensation if he became drunk. Therefore, the liquor company could not raise the intoxication defense, and benefits were awarded. In other cases, panels have ruled that intoxication, although a contributing factor to injuries, was not the sole cause of them and therefore the accidents were compensable. For example, in the case of Napa/General Automotive Parts v. Helen Witcomb [481 N.E.2d 1335(1985)], an employee was fatally injured in a car accident. At the board inquiry, it was determined that at the time of the collision the employee was intoxicated, that he was expected to entertain customers, and that the employer had failed to prove that intoxication and not something else was the proximate cause of death. Consequently, the panel awarded the employee's widow compensation, a decision later upheld by the Indiana Court of Appeals. In another alcohol case, the Georgia Court of Appeals denied compensation because drinking was not part of the job and the employee's intoxication was regarded as a willful violation of a state statute. A construction superintendent was killed in a head-on collision after attending a company banquet. The State Board of Workers Compensation denied compensation because the proximate cause of death was the superintendent's conscious violation of a penal statute against driving while intoxicated. The decision was appealed to, and upheld by, the Georgia Court of Appeals [Communications, Inc., et al., v. Cannon, et al., 331 S.E.2d 112 (1985)]. Cases in the mental-mental injury category suggest the possibility that employees could argue that their alcoholism was caused by pressures from the job. Although

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we do not know of any such case and have not located one, it may be only a matter of time before one occurs. The trend toward liberally interpreting workers' compensation suggests that a worker making such a claim might win. Arbitration According to Roberts (1971:31), arbitration is "a procedure whereby parties unable to agree on a solution to a problem indicate their willingness to be bound by the decision of a third party [the arbitrator]... .Collective bargaining agreements generally provide for arbitration as the final step in the machinery set up to handle grievances." Arbitration procedures also exist in many nonunion facilities. A basic issue in arbitration cases is just cause, a term commonly used in collective bargaining agreements to protect workers from disciplinary action that is unjust, arbitrary, or capricious. Collective bargaining agreements spell out what constitutes just cause for disciplining workers, but they cannot cover all possible contingencies. Consequently, arbitrators are often called on to decide whether an employee has been discharged, demoted, and so on for just cause. In deciding, arbitrators can ask themselves the seven questions suggested by Carroll R. Daugherty, who maintains that a no to any one of them would indicate that there has not been just cause for the action (see Roberts, 1971:241). 1. Was the employee given advance warning of the possible or probable disciplinary consequences of his conduct? 2. Was the rule or order reasonably related to the efficient and safe operation of the business? 3. Before administering discipline, did the employer make an effort to discover whether the employee did, in fact, violate a rule or order of management? 4. Was the employer's investigation conducted fairly and objectively? 5. Did the investigation produce substantial evidence or proof that the employee was guilty as charged? 6. Had the company applied its rules, orders and penalties without discrimination? 7. Was the degree of discipline administered in the particular case reasonably related to (a) the seriousness of the employee's proven offense, and (b) the employee's record of company service?

What happens when alcoholic and other troubled employees are formally disciplined for unsatisfactory job performance and file a grievance that is then taken to arbitration by the union? Among arbitrators there is a wide spectrum of thought about how to deal with an employee's personal problems that affect the workplace (Greenbaum, 1982). Some arbitrators maintain that the employer has no responsibility for the personal lives or problems of employees and that arbitration should not impose this duty on the employer. Other arbitrators are willing to reconcile the employer's right to retain only satisfactory, reliable, and productive workers with the employee's right to job protection, particularly where they have physical or mental health problems. Personal problems are introduced into arbitration hearings in two principal ways. First, they may be cited as the direct cause of the disciplinary action, demotion, discharge, or layoff. For example, an employee's alcoholism may cause him or her

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to have excessive absences, report to work under the influence, or be a danger to fellow workers. Second, they may be presented as mitigating circumstances. For example, the employer fires the employee, who is not overtly alcoholic, for excessive absenteeism. When the case goes to arbitration, the union presents evidence that the grievant is alcoholic and is going to AA and therefore should be given a second chance. Psychiatric Problems Among arbitrators there is a growing tendency to consider psychiatric problems as they would physical illnesses and to give the mentally ill employee the opportunity to seek treatment and to be reemployed upon recovery (Cramer, 1980; Greenbaum, 1982). Comparatively few psychiatric cases are reported in the literature. For example, between 1947 and 1978, Benjamin W. Wolkinson and David Barton (1980) found only thirty-eight reported decisions involving mental disabilities. Given the stigma still attached to mental illness and the fact that many arbitration opinions are not published for a number of reasons, this is not surprising. Some writers suggest that many grievances involving psychiatric problems are not published because they are resolved prior to arbitration or because employees may be reluctant to have their mental conditions raised as a defense in arbitration hearings. [Most of the cases referred to in our discussion here are from the Bureau of National Affairs, Labor Arbitration Reports (cited LA) or from the Commerce Clearing House, Labor Arbitration Awards (cited CCH).] Arbitrators have ruled that employers can require employees to have psychiatric examinations if there are compelling reasons to believe that because of mental health problems the employees are incapable of performing their work or are a danger to their own or their coworkers1 safety (see Jamestown Telephone Corporation, 73-1 ARB H8229, 1972; W. R. Grace and Company, 85-2ARB, H8348, 1985). Employees who refuse to submit to such examinations may be subject to suspension or discharge until they agree to do so. In the absence of compelling reasons to believe that an employee cannot perform safely, however, an arbitrator will reinstate the employee and not require the examination (see Midwest Telephone Company, 66 LA 311, 1976). General agreement exists among arbitrators that employees should not be discharged on the basis of mental disability for which it is believed they cannot be held accountable (Cramer, 1980). Where employers have discharged employees on the basis of their illness, arbitrators have customarily reinstated them. Employees, however, are usually expected to help themselves by complying with treatment recommendations. Discharge has been upheld only when there was overwhelming evidence that "a mental disability exposes the employee or others to serious risks of injury or harm, or alternatively, prevents the employee from performing his duties!t(Wolkinson and Barton, 1980:41). Paralleling the Vocational Rehabilitation Act of 1973, industrial justice requires employers to make "reasonable accommodation" to mentally ill employees (Wolkinson and Barton, 1980). Accommodation includes transferring employees to jobs they can perform and giving them leaves of absence for rehabilitation if necessary (see B. F. Goodrich, 69 LA 922, 1977). In particular, employers are

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inclined to accommodate long-term employees with good work records and who are trying to rehabilitate themselves. During arbitration the union may raise the mental illness of the grievant as a mitigating circumstance. In such cases arbitrators consider the medical evidence and in light of an employee's past work behavior will generally reduce the penalty and give the employee an opportunity for treatment. This is particularly true if, between the time of the disciplinary action and the hearing, employees seek and comply with medical help (Commonwealth Gas Co., 76-2 ARE p494, 1976). In a few instances, arbitrators have ruled against grievants when they have refused to reveal the reasons for their behavior, leaving the employer no choice but to exercise regular disciplinary policy (Husky Oil Co., 65 LA 47, 1975). According to Dorothy J. Cramer (1980:20-21): The one philosophy that appears to summarize the arbitrator's approach to the problem of mental illness is that employees whose conduct is the result of their mental condition should be given one last chance to prove their ability to perform safely and efficiently; provided, however, they seek professional help for their psychological problems and a medical expert is willing to certify that they are able to return to work.

While employers have an obligation to accommodate the emotionally disturbed employee, it does not prevent them from discharging employees. For example, Wolkinson and Barton (1980) said that, in the thirty-eight reported cases that they found, management's decision to discharge mentally ill employees was upheld in ten cases. Discharge, they pointed out, is upheld only when a mental disability exposes the employee or coworkers to serious harm or prevents the employee from performing his or her work or doing another job. Alcohol Problems Alcohol problems raise many of the same questions psychiatric problems do, and arbitrators usually view alcoholism in the same light as they do physical and mental illnesses (Greenbaum, 1982). Alcohol abuse and alcoholism show up on the job in a variety of ways-absenteeism, insubordination, reporting to work under the influence, drinking on the job, and poor performance. In many arbitration cases drinking is the direct cause of the disciplinary action and alcoholism is not raised as a mitigating circumstance. Typically, such cases are concerned with violations of company rules or collective bargaining agreements against drinking on the job or reporting to work under the influence. According to Denenberg and Denenberg (1983), arbitrators are inclined to support employers' decisions to discipline or discharge employees when rules and penalties for infractions have been well publicized and the rules are consistently enforced without discrimination. For instance, an employee who was observed with a bottle of wine on company property was suspended pending an investigation. He was subsequently discharged, and the union argued that he had been discriminated against and unfairly terminated. The arbitrator found no discrimination and upheld

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the discharge because the collective bargaining agreement stated that possession of alcohol was a major offense (American Transportation Corporation, 81 LA 318, 1983). In a similar case, the arbitrator upheld the discharge of two truckers for drinking and fighting at a motel during their layover. Their behavior violated the collective bargaining agreement as well as federal highway regulations requiring drivers not to consume alcohol within four hours of driving (83 LA 761, 1984). In another case involving drinking and fighting on the job, however, the arbitrator ordered the employee reinstated, arguing that discharge was too severe a punishment because the employee had no prior disciplinary problems and other employees caught drinking and fighting on the job were treated less harshly than she was (Imperial Clevite, Inc., 81 LA 1084, 1983). Michael Marmo (1982) points out that when alcoholism is raised as a mitigating circumstance, arbitrators have increasingly tended to look upon these arguments favorably, particularly when the grievant is a long-term employee and has undertaken treatment. In discharge cases they will often give employees a second or last chance, an opportunity to return to work and straighten out their lives. In the past, when employees received a second chance, they were seldom required to accept treatment as well. Research, however, indicated that when employees were reinstated without receiving treatment, they were likely to end up in a similar arbitration case and be discharged within two and one-half years (Adams, 1978; Trice and Belasco, 1966:27). When arbitrators give employees a second chance today, it is often accompanied by a requirement to accept treatment. Sometimes an arbitrator will make the employee's reinstatement conditional, stating that if the employee accepts treatment, he or she may return to work. In other cases, the arbitrator may convert the discharge into a medical leave of absence, stating that the employee may be reinstated if he or she demonstrates recovery from alcoholism. In some instances, employees will seek treatment after being discharged but prior to an arbitration hearing. Postdischarge behavior usually is not considered in arbitration hearings, but in alcoholism cases many arbitrators often seriously consider it. If in the arbitrator's judgment, the employee has made progress toward recovery, he or she will recommend that the employee be reinstated. Arbitrators are not always comfortable with making clinical decisions. They view their proper domain as the workplace and their proper role as deciding whether employers and employees have met their respective responsibilities. Nevertheless, in cases in which alcoholism is a mitigating circumstance, they appear increasingly willing to cross those boundaries and give alcoholic employees who are motivated to change a last chance. For instance, a drunken deckhand was discharged after he fell overboard. Between the time of the accident and the hearing, the employee stopped drinking and attended Alcoholics Anonymous. In considering the case, the arbitrator took this behavior into consideration and reduced the discharge to a sixty-day suspension because the employee had no prior disciplinary record and the employer had not consistently enforced its rules against drinking. The arbitrator saw his decision to change a discharge to a suspension as a "last chance opportunity" for the grievant (Ohio River Company, 83 LA 211, 1984).

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In another case, a long-time employee, known to be an alcoholic, had his discharge converted to a last chance but shortly thereafter was again absent with "alcoholic gastritis.11 The employer fired him. Here, the arbitrator upheld the discharge because the employer had demonstrated a good-faith effort to help the employee, who had violated the conditions of his reinstatement (Tecumseh Products Company, 82 LA 420,1984). Last chance opportunities for alcoholics are not automatic. For example, one arbitrator sustained an employee's discharge even though the union counseled treatment. The arbitrator stated that the severity of the infraction-the willful operation of heavy equipment while intoxicated-was just cause for discharge and that such a penalty was necessary to demonstrate that such reckless endangerment is not appropriate in the workplace (Freeman United Coal, 82 LA 861, 1984). According to Denenberg and Denenberg (1983), arbitration cases in companies with EAPs entail a different set of questions because the program policies convey the employers' intentions to provide help for employees. Such cases typically focus on whether companies have followed the guidelines set out in their EAP policies. Where companies have done so, arbitrators are likely to let a discharge stand. Where companies have failed to do so, employees are likely to be reinstated. For example, Denenberg and Denenberg (1983:38-39)) describe a case involving a company EAP policy. A telephone company employee was suspended and ten days later discharged for insubordination and absenteeism. Between the suspension and discharge, he voluntarily entered an alcoholism treatment program. The union maintained that the employee's behavior that led to the discharge was due to alcoholism and that the employer could not discharge the employee without offering him the chance to recover. The employer argued that the decision to fire the employee was made when the employee was suspended and prior to his admission of being an alcoholic. The arbitrator reviewed the company's EAP policy and the employee's prior job performance. He concluded that the employee's performance had demonstrated the classic signs of alcoholism stated in the EAP policy, that the employee's denial was symptomatic of alcoholism, and that it was normal for the employee to admit his alcoholism after the threat of discharge. In his summation, the arbitrator wrote as follows: "When such admission occurs prior to final termination and especially when accompanied by solid rehabilitative efforts, it imposes a duty on management to. . .investigate the genuineness of the grievant's condition and his attempts to become rehabilitated. This, seemingly, was not done in this case." In a similar case, a woman was discharged for absenteeism and prior to arbitration entered a rehabilitation program. The arbitrator reinstated her with a last chance because her employer had failed to publicize the company's alcohol and drug policy adequately and because she had been offered help in a public hearing rather than in a confidential area (Allegheny Ludlum Steel Corporation, 84 LA 476, 1985). In neither of the cases cited had the employers met their obligations. In another telephone company case, however, the discharge was upheld because the employer met its obligation but the employee was unable to improve his performance and unwilling to accept help. The employee was discharged for absenteeism and coming to work intoxicated. The union said the company had not

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met its obligation to be of help, but the company argued that supervisors repeatedly encouraged the employee to seek treatment. On several occasions he did but failed to act on the recommendations of the treatment staff. The arbitrator concluded that the employee did not demonstrate a willingness to do what was necessary to overcome his problem (Northwestern Bell Telephone Company and Communication Workers, described in Labor-Management Alcoholism Journal, May-June 1973, pp. 27-28). Drug Problems Arbitrators have generally held that there is no basis for treating alcohol and drug cases differently (Gerdt, 1985; Seeber and Lehman, 1989). In fact, the American Psychiatric Association classifies both alcohol and drug abuse in the general diagnostic category "substance use disorders." Many alcoholic employees, especially younger ones, are also addicted to other drugs, either prescription ones (such as tranquillizers and barbiturates) or illicit ones (such as marihuana, cocaine, and heroin). In practical terms, then, alcohol and drug cases should be handled in a similar manner. Drug cases are more complicated than alcohol cases simply because alcohol is legal and many abused drugs are not. Consequently many cases entail issues about the possession, sale, and use of drugs. Based on his review of forty drug cases, Pat Wynns concluded, "In the majority of discharge cases involving drugs on company premises in violation of a published plant rule, the penalty was sustained." Mitigating circumstances considered in reducing the penalty include the age of the employee, absence of adverse effects on the job, mere possession but not use or sale of drugs, and length of satisfactory service. If the employee demonstrates a sincere interest in kicking the drug habit, the arbitrator might reduce the discharge to a suspension if the employee accepts and complies with treatment; however, in some cases arbitrators have felt powerless to do so either because they did not perceive drug abuse and addiction as an illness or because collective bargaining agreements did not provide for rehabilitation from drugs (Levin and Denenberg, 1976; Greenbaum, 1982). Although arbitrators have taken a variety of positions on these issues, they are generally reluctant to sustain discipline based on drug incidents that occur outside the workplace, to uphold summary discharge for drug involvement in the workplace without such a contract provision, or to sustain a discharge because the employee is undergoing drug treatment (Denenberg and Denenberg, 1983, 1990). Denenberg and Denenberg (1983, 1990) argue that if company and union rules against substance abuse are drawn in terms of impairment and if progressive discipline is used to enforce the impairment standard, some of the conflict surrounding drug cases can be avoided. To establish impairment, the arbitrator must determine that the employee is unable to perform his or her duties safely and effectively. In arbitration cases, the impairment standard shifts the issues from the nature and amount of drug used to whether the employee can perform satisfactorily. Establishing impairment does not necessarily require interpreting laboratory tests-eyewitness accounts from the employee's supervisor and coworkers are generally sufficient. Adopting a graduated scale of discipline has several advantages. First, the incentive for cover-up by coworkers is diminished when

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they know that the employee will not be summarily discharged for a first offense. Second, arbitrators are more willing to sustain a discharge when they know that the employer has made repeated efforts to solve the problem. Third, the graduated scale of discipline provides a means of screening out employees whose jobs may be saved. Recreational drug users may be motivated to stop; addicts may be motivated to seek treatment; and offenders who do not respond to progressive discipline or treatment will be discharged. In recent years, drug cases have been complicated by the federal government's "war on drugs." Although drug use had been declining for the last decade, the Reagan administration made drugs a major campaign issue in 1986, calling for drug-free workplaces and drug testing of all employees (Staudenmeier, 1989). Essentially, the government continues to argue that drug use is sapping American productivity, all drug use is unacceptable and must be deterred, and testing is a potent deterrent. Critics argue that programs do not test for all drugs or even the most dangerous (e.g., alcohol), positive urine tests are not correlated with job impairment, no standards exist for laboratories to ensure test validity and reliability, random testing infringes on employee rights, and no data exist demonstrating testing actually deters drug use (Sonnenstuhl, Trice, Staudenmeier, Steele, 1987; Denenberg and Denenberg, 1983, 1990; see also Nova Law Review's special issue on drug testing, 1987). The war on drugs, however, struck and continues to strike a responsive chord within the mass media, which daily depict the violence wrought by drug gangs, and within the general public, which feels that something must be done (Shoemaker, 1989). Consequently, many employers and unions believe that testing is "a necessary evil" (Seeber and Lehman, 1989). Despite the hysteria about drugs, arbitrators remain committed to the performance standard when considering cases of drug testing. For instance, Ronald L. Seeber and Mary Lehman (1989) reviewed 150 arbitration cases concerning drug testing and concluded: 1. Arbitrators agree with unions and the General Council of the National Labor Relations Board that drug testing constitutes a working condition and is therefore a mandatory subject of bargaining under the National Labor Relations Act. 2. Employers have the right to require drug tests from specific employees when there is "reasonable suspicion" of drug use (e.g., deliberately violated safety procedures, was unable to provide reasonable explanations, addressed foreman in abusive language, was absent without notifying employer, and had past history of drug abuse). 3. Generally, a positive test must be combined with unusual performance before arbitrators will consider employees to have been impaired. "The fact that an employee has been performing his job, presumably unimpaired for some length of time, will generally go some distance toward proving he is not 'under the influence,1 even in the face of a positive urine test" (Seeber and Lehman, 1989:45). 4. In industries in which safety is a preeminent issue, the mere presence of drugs in one's system may be sufficient for discipline or discharge, regardless of when drugs were actually taken.

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5. When an employee has a past history of drug use, a positive test may be judged as just cause for disciplinary action or discharge, even if there is no impairment. 6. Most arbitrators have held that because of the stigma attached to drug use and the potential difficulty of finding other employment, strong proof or "clear and convincing evidence" is required to uphold a discharge decision. A mere "preponderance of evidence" is not strict enough, but "proof beyond a reasonable doubt" is considered too strict a standard. 7. Employees may refuse to submit to a drug test if the test order is unprovoked or the procedure is unreasonable. However, if the employer follows proper procedure (i.e., gives a direct order and informs the employee of the consequences of refusing to follow the order) and if the employer has reasonable cause to suspect the employee is under the influence of drugs (e.g., he or she is unsteady, staggering, swaying, disoriented, has glassy eyes and/or slurred speech), discharge for insubordination will be upheld if the employee refuses to take a drug test. Finally, companies and unions have constructive alternatives to drug testing. For instance, several observers (Denenberg and Denenberg, 1990; Sonnenstuhl, Trice, Staudenmeier, and Steele, 1987) have suggested that performance testing and EAPs are viable alternatives because they build upon the impairment standard and utilize progressive discipline. Performance testing requires only that supervisors periodically test employees' ability to perform their jobs and then take appropriate actions to correct the performance deficiency. This might entail coaching and/or progressive discipline. In addition, these actions could be combined with referral to an EAP, thus ensuring employees are treated fairly. The American Management Association appears to have reached a similar conclusion, arguing that companies have overemphasized drug testing and suggesting that it would be more productive to train supervisors to recognize impairment and confront employees (Bureau of National Affairs, 1987). Properly trained supervisors and stewards can break through the denial systems of users, abusers, and addicts, regardless of the drug in question. EAPs and Employer Responsibility Our review of workers1 compensation insurance and arbitration cases suggests that employers are increasingly being held liable for employees1 alcohol, drug, and emotional problems. Workers1 compensation1panels and state courts are finding that the workplace is hazardous to employees mental health. And arbitrators are willing to consider emotional distress, alcoholism, and drug addiction as mitigating circumstances. Typically, arbitrators will also reduce disciplinary penalties and reinstate alcoholic and troubled employees if they accept assistance and improve performance. Looking at these trends, labor and management relations specialists frequently counsel managers to take an active role in preventing problems. According to Donald T. deCarlo, vice president and general counsel of the National Council on

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Compensation Insurance in New York, "ways in which employers can control the costs of stress in the workplace include implementing wellness programs and employer assistance programs; identifying employees with the most stressful jobs and educating them; and providing rehabilitation programs for emotional problems" (Diblase, 1986: 53). EAPs have a good track record for handling employees' alcohol, drug, and emotional problems-many of which may result in workers' compensation claims or arbitration hearings. As pointed out in chapter 3, research indicates that when supervisors and stewards constructively confront alcoholic and troubled employees prior to initiating formal discipline, employees are likely to improve their job performance. When constructive confrontation is combined with counseling, either professional therapy or self-help groups, EAPs also have a good track record in treating alcoholism, drug addiction, and severe emotional disturbances. Compensation panels and courts will continue to hear cases involving these problems; however, the evidence suggests that EAPs, by helping employees to solve their problems, can reduce the number of incidents that lead to workers' compensation claims and arbitration hearings.

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V PROGRAM EVALUATION AND THE FUTURE OF EAPs EAPs will survive as long as managers and labor leaders believe that helping employees is good business. As EAPs travel into the future, however, practitioners must come to grips with (1) the need for reliable program evaluations and (2) the need to integrate evaluation findings into their practices. Program Evaluation In the EAP movement, program evaluation is often called for and attempted but rarely accomplished. And, according to some specialists in the field, what is attempted is frequently critiqued, summarized, and reviewed-and sometimes misinterpreted in the process (Terrell and Rightmeyer, 1982; Kurtz, Googins, and Howard, 1984). The upshot is that so far there have been few sound program evaluations, primarily because most practitioners in the alcoholism-EAP movement are action people; few, if any, are trained researchers. As a consequence, the many attempts at evaluation that appear in the popular literature seem to them to be sufficient (Burgrabbe and Swift, 1984). In addition, program coordinators often attempt to evaluate their own programs, a practice fraught with irresistible temptations to make one's program look good. Further, the primary criterion for judging success-job performance-although widely agreed on in theory is rarely put into operation as a yardstick for measuring program effectiveness. Over and over the purpose of EAPs has been declared to be to help employees whose performance is impaired by emotional problems. And reference to performance occurs repeatedly in the popular EAP press and in the marketing of programs as "performance resources." Yet evaluation studies have rarely used reliable measures of job performance. They have used sick days, job retention, number of grievances, number of visits to the medical department, use of sickness and accident benefits, and other indexes that may, or may not, correspond to actual performance. Even absenteeism is not necessarily an index of performance (Staw and Oldham, 1978), although it is obviously a matter of deep concern for employers and unions. The simple truth is that job performance is difficult to assess; consequently, it is rarely used by practitioners in a fashion suitable for research purposes. Put differently, typical performance assessments in most work organizations are misleading for research purposes; therefore, most evaluation researchers must generate their own estimates of job performance, and this is difficult to do. Although the calls for evaluation are many, the unprecedented growth and popularity of EAPs have obscured-probably temporarily-the value of program evaluation. For example, many companies and their unions seem to assume the effectiveness of their EAPs automatically and EAP personnel are apt to put a rather low priority on program evaluation. As a result, the keeping of accurate records is pushed aside in the excitement and enthusiasm of program action. Unfortunately, researchers who are trained and experienced in program evaluation have shown

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little interest in EAPs. For all practical purposes, the number of professional research persons who have undertaken program evaluation can be counted on one hand. A major cause for this apparent lack of interest is the difficult and complex set of tasks an outside researcher must accomplish to gain access to work organizations in which an EAP is operating and then establish and maintain rapport with management and the program personnel. Coupled with the problem of access is the practical impossibility of sustaining randomized research designs within work settings. Pressures to evaluate, however, seem to be inevitable. Among other reasons for the pressures is the mounting concern in all sectors about the inflation of employee benefits and cost containment vis-a-vis third-party payments. The unprecedented growth of professionals in the movement-social workers, psychologists, and counselors, to name the more prominent-has combined with the availability of third-party payments to escalate the costs of EAPs. At the same time, there are no sound data to show that all of this has enhanced the effectiveness of programs. In short, a good case can be made that sound, objective program evaluation done by outside, trained evaluators will be increasingly in demand. While there is much to criticize about the number and soundness of extant evaluation studies of EAPs, there are positive aspects to the overall picture. For example, in attempting to respond to the mounting demands for program evaluation, the EAP movement does not have to start from ground zero. The diversity and variety of past studies of alcoholism programs can be viewed as a form of triangulation, providing confidence in their common finding that these programs were quite successful. A variety of studies from 1957 to the present focused on different populations of problem drinkers, at different times and in different geographical locations. Although their outcome measures often did not directly measure job performance, there were indirect indexes. Overall, these studies generated the same finding: namely, constructive confrontation as used in job-based alcoholism programs was remarkably effective as an intervention strategy. The reliability of this conclusion was strengthened by findings that in one large alcoholism program selectivity factors were not as potent as at first believed (Trice and Beyer, 1981). For example, sampling problems that might have "stacked the cards" for the program-such as the retirement of difficult cases; involvement of only low-status employees; and acceptance into the programs of only long-term employees, few women, and only those approved by the unionwere minor in their influence. Optimism about job-based alcoholism programs was also reinforced by the Trice and Beyer study (1984b), described in chapter 3. Trice and Beyer used a simple, easily administered method for evaluating job performance that permits researchers "to translate job performance increases (or decreases) into estimates of the economic value of the program" because the "size and variability of the resulting increase in job performance" can be estimated (Hunter and Schmidt, 1983:473). This procedure requires estimates based on analysis of the economic values placed on specific jobs held by troubled employees in a given program. With such estimates in hand, specific increments or decrements in levels of performance can be assigned dollar and cents values. Further, Trice and Beyer (1984b) found that although they had to abandon the notion of any form of experimental design, they were able to

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introduce, via multiple regression analysis, control over prominent intervening variables. This approach offers reasonable hope for controlled studies even when the classical notion of randomized design is impossible. Another reason for some optimism is that EAP practitioners are developing awareness of, and giving attention to, the question of program implementation apart from program outcomes. After all, common sense dictates that a program must be actually in place and used before its outcomes can be assessed. A realization of this basic fact was expressed in the notion of "penetration rates," an idea that became prominent in the mid- and late 1970s (Schlenger and Hayward, 1976). The idea was to determine the extent to which a program reached a designated populationfor example, problem drinkers and alcoholics. An alcoholism program was considered successful, in terms of implementation, to the extent it penetrated this segment of a company's employee population. The rate was simple to determine: divide the number of problem drinkers who enter a program by the total number of cases in the company. Unfortunately, the method assumed that usually a fixed proportion of 6 percent of a given work force was in the problem drinker category -an assumption most observers would reject. Nevertheless, the approach gained some acceptance. For example, in 1975 the federal Civil Service Commission adopted this method for evaluating its drug abuse program. Despite these flawed assumptions, efforts to evaluate program implementation apart from outcomes gained recognition and were consistent with an overall trend among action programs toward "recognition of the importance of implementation research in overall evaluations" (Rossi and Wright, 1984). In 1978 Beyer and Trice published their assessment of the major dimensions of program implementation, using data generated from the federal government's alcoholism and EAP programs. They estimated the extent to which federal managers were receptive to the program's policy, how familiar they were with it, and how often they actually used it. "Familiarity with" turned out to be the major predictor of actual use. Googins (1978) found much the same thing. Andrea Foote and John Erfurt (1981a:231) contrasted the effectiveness of comprehensive EAP programs with that of alcohol-focused ones and found that comprehensive EAPs were "no less effective than alcohol-focused programs at reaching alcoholics." In all of these studies the emphasis was on outreach, the familiarity of potential users with the program, and their actual use of it. In other words, a sensitivity about outcome evaluation has been accompanied by the need to evaluate program implementation as a first step. The findings in this body of research, as we mentioned earlier, apply almost entirely to job-based programs concentrating on alcoholism and, to some degree, on the complications that accompany problem drinking-financial and marital troubles, for example. They do not necessarily apply to the EAP programs that have expanded to deal with a large variety of employee troubles. Evaluating the "broad-brush" programs is another ball game, although such EAPs are often sold on the documented record of job-based alcoholism programs. The one carry-over from alcoholism studies, however, is the evidence for the effectiveness of constructive confrontation as an intervention strategy that may characterize EAPs in the future. As discussed in chapter 3, the effectiveness of constructive confrontation combined with counseling of some sort seems to be evident in

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comprehensive EAPs. To the degree this is the case, past evaluation studies may apply. But the notion of alternatives to that strategy has broadened with expanded EAPs, although there has not yet been a clear description of any alternative strategy. Different strategies for helping impaired performers may well call for different modes and approaches to program evaluation. For example, as the EAP movement expands and diversifies, rather diffuse outlines of different strategies may emerge. Were these to become well defined, program development and evaluation would take on different forms. Some aspects of one alternative seem to be as follows. The program would emphasize self-initiated referral in an effort to increase early identification. This approach, its proponents assume, would generate referral to outside treatment facilities before job performance declines and would thereby avoid open knowledge of the problem. Such an effort probably would be designed for the younger generation and would rely largely on the ability of counselors to motivate troubled employees to change before emotional disturbances damage them. It would also depend to some degree on an educational program that would increase self-awareness sufficiently to overcome the denial syndrome characteristic of many troubles. This approach would deemphasize the power of the work setting, and persons in it, to motivate, and it would emphasize the role of the "motivational counselors,11 largely outside that setting. The rationale would be that such an approach would free line supervisors from dealing with troubled employees and also relieve them of the time spent in trying to manage such employees (Goldberg, 1982; Gualtieri et al., 1978). The approach would also individualize any intervention, reducing the uniformity of effort. In turn, because traditional evaluation methods assume relative uniformity from case to case, they would be inappropriate. More appropriate to evaluation of such programs would be the use of qualitative methods (Patton, 1980; Broadhead, 1980). Because these methods rely on longitudinal field work, participant observation, and ethnographic interviews (Spradley, 1979), they could be adapted to the diversity and individualization of the strategy just described. Justification for using this early identification, self-referral approach, however, would require overcoming negative research findings about major parts of its strategy; thus, it has already been partly evaluated. Other research has shown that self-referrals are seldom voluntary, self-generated actions (Sonnenstuhl, 1982, 1986); early identification appears to be significantly associated with poor response to treatment (Moberg, Krause, and Klein, 1982; Trice and Wahl, 1958); and declines in job performance are associated with relatively early stages of the emotional disturbance, not later stages (Cahalan, Cissin, and Crossley, 1969; Trice, 1962b). Finally, the ability of motivational counselors to intervene effectively, purely on their own, has not been demonstrated, and insofar as we now know, they may be no more effective than friends, relatives, coworkers, or the passage of time. Different researchers, using data from different methods of investigation and different populations of employees, consistently raise serious doubts that self-referral is an accurate description of an employee's motivation to seek counseling. For instance, Sonnenstuhl, Staudenmeier, and Trice (1988) argue that "self-referrraT and "supervisory referral" are cultural categories and including them

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in quantitative evaluation makes the interpretation of findings difficult because it is not possible to say what really motivated clients to change their behavior. The research findings also appear to support an almost universal perception that a strong denial syndrome, reinforced by manipulative skills and clever rationalizations, characterizes both the early and later periods of substance abuse of all types as well as these stages of such emotional disturbances as phobias, gambling addiction, and food abuse (Wrich, 1980). Most researchers who have studied alcoholism programs in actual workplaces agree that most self-referrals are actually under pressure from significant others, including supervisors and fellow workers (Smart, 1974; Schramm and DeFillippi, 1975; Heyman, 1978; Foote and Erfurt, 198 Ib). If the psychodynamics of alcoholism are similar to those of other substance abuse and emotional disturbances-as there are good reasons to believe-the assumption that sufferers will self-refer is questionable. Assumptions that early identification will lead to more effective rehabilitation have also been sharply questioned in research data. Moberg (1976) reported in a study of a large group of employed alcoholics that, based on an abstinence criterion, early-phase cases responded significantly less often than did chronic cases. Carl J. Schramm et al., (1978) reported that those alcoholics who remained longer in treatment, and responded better, were those who had had a longer period of heavy drinking. Joyce lutcovich and John Calderone (1984) also concluded, from a study that used stages of alcoholism as a variable, that individuals who are in the early stages, for the most part, do less well in treatment. These findings are consistent with earlier findings about affiliation with Alcoholics Anonymous (Trice and Wahl, 1958). Other research (Trice, 1962b; Cahalan, Cissin, and Crossley, 1969; Manello and Seaman, 1979) also indicates that regardless of occupation, status, or amount of supervision, job performance deteriorates as problem drinking increases. Nevertheless, rather than job impairment coinciding with later phases, there is respectable evidence to suggest that it occurs first in the earlier periods of the disorder. Such findings cast considerable doubt on the assumption that job-based interventions can be mounted prior to the development of impaired performance. Should EAP programs move toward emphasizing quality-of-work-life (QWL) strategies, they would encounter similar arguments based on research findings. Within the broad rubric of QWL, practicing managers have been offered a wide array of techniques for improving individual and organizational performance: organizational development (OD), management by objectives (MBO), transactional analysis (TA), behavior modification in work organizations (OB Mod.) and theories X, Y, and Z. Well-executed research projects to evaluate the effectiveness of these strategies, however, have concluded that only a few of them, under limited conditions, have been effective in improving individual job performance (Cummings, Malloy, and Glen, 1975; Locke et al., 1980). For example, one of the most popular techniques in OD is team building (French, Bell, and Zawacki, 1978), which supposedly produces improvements in interpersonal relations and thereby an improvement in productivity. The assumption is that work teams that remain intact become more effective than poorly formed ones. But the research that has assessed the results of team building is inconclusive. Many of these studies concluded that no firm statements could be

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made regarding the positive effects of the teamwork approach on individual and work group performance (Nicholas, 1982; Woodman and Sherwood, 1980). At bottom, QWL advocates propose to change the basic structure of the workplace by incorporating into it more participative management, democratic leadership, and worker autonomy-all most worthy ideals. In effect, QWL advocates hope to alter the bureaucratic makeup of most workplaces. Yet the evidence tends to suggest that the efficiency and quality of service in public sector organizations in which bureaucracy is rampant (hospitals, utilities, garbage collection) is sometimes superior to that in the private sector, where bureaucracy may be less operative (Goodsell, 1983). William F. Whyte (1978:132) put the matter forthrightly: "Many hoped to discover that 'democratic leadership,' 'participation management,' when skillfully practiced, was not only superior from a humanistic standpoint, but also led to greater productivity... . Research brought out such discrepant findings as to discredit the comforting view that democratic leadership or participation management necessarily resulted in greater productivity than more traditional styles of leadership." Some Neglected Aspects of Program Evaluation Often overlooked in program evaluation is the distinct possibility that there may be expressive outcomes as well as technical improvements (or declines) in job performance. By expressive outcomes we mean that EAPs may "say things" as well as "do things." They may express the confidence that lower-level managers have in higher-level managers in their organizations; reassure rank-and-file employees and union officials that something concrete is being done about severe personal problems; and symbolize to the community that the corporation is meeting its social obligations and to the employees that management cares enough about them to try to help in difficult situations by providing professional people to deal with their problems (see Sonnenstuhl, 1986, for discussion of some social consequences of EAPs). In short, EAPs may produce "double payoffs," that is, help improve the performance of impaired workers and, at the same time, express a series of managerial sentiments and legitimacies. At the same time, EAPs could fail to achieve any significant change in the performance of the troubled workers and be dysfunctional in an expressive way by disguising other sources of poor performance that exist in the workplace: poor supervisory tactics, bad labor relations, or technical bottlenecks in the production process. Nevertheless, if future evaluations look at both possible technical outcomes, such as changes in performance, and possible expressive ones, such as symbolizing managerial sentiments, the evaluations will be more likely to assess the "full range of their program's activities" (Chen and Rossi, 1980:120). In this sense, programs may be found to be producing double payoffs that are not accounted for in present evaluations. Unintended consequences other than expressive outcomes are seldom included in program evaluations, but recent spotlighting of EAPs makes such assessments not only relevant but essential. For example, in their classic textbook on personnel management, George Strauss and Leonard R. Sayles (1967) suggested that counseling may act for some employees as a way to escape from work and stay at a

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marginal level of productivity for a significant period of time. In other words, rather than improving performance,11a counseling program could encourage the contrivance of "personal problems that need attention, thus justifying poor performance that has already occurred and setting the stage for paid sick leave and further poor performance. The reasonableness of such concern rests on the recognized psychodynamics of emotional illness. In this view, EAPs can become "godsent" for such maneuvers unless proper precautions are built into the program. So far, program evaluators appear to have failed to consider such possible dysfunctional consequences. Evaluations have also failed to look closely at the possibility that an intervention technique-especially constructive confrontation-could play a part in suicide or suicide attempts. For example, the developing alcoholic may see the confrontation process as a threat to his or her long-standing self-perception as a productive person. Especially if the constructive theme is passed over lightly, or ignored completely, and crisis precipitation in the form of formal discipline is overdone, such shocks could lead to suicide attempts. Thus, although there are no documented instances (of which we are aware) that directly connect suicide attempts or completions to any form of EAP effort, the possibility should not be ignored. Information on suicide rates furnishes some rationale for including this item in EAP evaluations. For example, there is considerable evidence that alcoholics as a group are "exceptionally suicidal," while the abuse of barbiturates has become a "major means by which to commit suicide" (Cuskey, 1978:208). Other studies show that attempted suicide rates tend to be significantly higher among females than males. Ronald L. Akers (1977:273) reviewed the existing data and concluded that "although 70 percent of the completed suicides were male, this sex ratio was almost exactly reversed among attempters; the suicide rate is highest among older age groups, but suicides attempted are most apt to be made by younger men, and especially women." In short, the risks may be greater among women employees, but there is no empirical, published evidence that intervention strategies in job-based programs have actually triggered suicides or suicide attempts among women or men employees. Nevertheless, well-designed studies need to include data on the relationship between job-based programs and suicidal behavior. Future evaluations should also include an estimate of the likelihood that favorable changes would have been effected by spontaneous recoveries, unaided by professional help (Stall, 1983), or that return to acceptable levels of performance might have resulted solely from the exercise of influences in the workplace. For example, since it is not usual to make a record of the discussions between employees and their supervisors, the constructive confrontation strategy when used alone may have unrecorded results unless the employees involved subsequently receive therapy or counseling. Obviously, these considerations must take into account the overall costs of waiting for such improvements to happen, if they actually do occur. The idea that considerable improvements in some cases of alcohol abuse occur with little or no treatment is widely accepted, although "the figures are not as stable as for treated groups" (Blane, 1977). Generally speaking, the same point can be made for the neuroses that trouble many workers. For problem drinkers,

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spontaneous recovery rates for those not seeking treatment range from 4 percent to 31 percent (admittedly a wide range) with a median of 12 percent (Trice, 1983). In all likelihood, a somewhat similar rate could be applied to many cases involving other personal problems that become well defined-phobias, depressions, gambling addiction, and substance abuse. To be realistic about program effectiveness, these features of spontaneous recovery must be incorporated into program evaluations.

Future Studies EAPs possess a valuable asset, an intervention strategy that has been tested and found to workman unusual occurrence in evaluation research, since the effectiveness of a majority of program strategies is considered questionable. The findings on the effectiveness of a balance between constructive confrontation and counseling in alcoholism-EAP studies is a base on which researchers and practitioners can continue to build. This effort requires that researchers, work organizations, and counselors cooperate and recognize that they have a common stake in protecting employees1 rights to privacy and the anonymity of the programs studied. Reputable researchers, like responsible counselors, practice codes of ethics supporting confidentiality and anonymity. Given this basis for a working relationship, several other recommendations for research should be considered. First, researchers should be invited to study programs. This elementary step is necessary because without access to the everyday experiences of managers, employees, and counselors, researchers cannot understand what happens in EAPs and cannot develop concepts reflective of reality or useful to practitioners. Accepting such invitations obliges researchers to act as "welcome guests11 and to learn from their hosts (Wax, 1980). Once they have gained access to programs and have established rapport with their hosts, researchers can begin to address the evaluation issues raised in the preceding pages. Second, researchers and practitioners should use both qualitative and quantitative methods to study and evaluate programs. Qualitative field methods are appropriate for developing descriptions of programs (Geertz, 1973) and for generating insight and theory (Glaser and Strauss, 1967; Spradley, 1979). Quantitative methods are most appropriate for testing generated theory. Each method has an important function in developing a body of dependable information, and researchers and practitioners must be willing to use each of them appropriately. Practitioners must also recognize the dangers of excessive reliance on the descriptive statistics and anecdotal materials that characterize much of the literature and that lack the descriptive power of qualitative fieldwork and the analytic power of multiple regression and experimental design. Third, EAPs by their peculiar position within an organization call for practitioners with knowledge from a variety of disciplines, including industrial and labor relations, organizational theory, and medical sociology. Consequently, researchers and practitioners studying EAPs need to incorporate insights from these other disciplines into their work. To move beyond where EAPs are now may require courage, but to integrate an understanding of different points of view and new insights emerging from qualitative and quantitative research is essential to building knowledge for the future.

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Integrating Research into Practice

If EAPs are to operate effectively, utilization findings need to be integrated into practice. To ensure that this happens, researchers and practitioners have important linking roles to perform (Trice, 1990; Beyer and Trice, 1982b). Both must recognize, however, that evaluation results are likely to affect the behavior of practitioners and their organizations through the gradual diffusion of new ideas, metaphors, and rationales for explaining human behavior. First, researchers should develop, as a vital part of their evaluations, bases of participation and support among potential users of the findings. In this regard, evaluators need to be their own advocates and disseminate their findings in whatever practical ways are available to them. For example, if findings are written in nontechnical language, presented in brief paragraphs, and published in practitioner magazines and journals (e.g., The EAPA Exchange, Employee Assistance, EAP Digest, Employee Assistance Quarterly), they are more likely to be read and considered for use than if they are confined to publication in scientific journals. Moreover, these findings will have greater legitimacy if they are generated by qualified, outside researchers who use both qualitative methods (observations over time) and quantitative methods (statistics within some form of variable control design). When these two methods result in the same conclusions, the findings will be more readily accepted if the qualitative data are the major materials disseminated. A second way to integrate research into practice is for occupational associations such as EAPA and EASNA to work with local colleges and universities to develop courses for their members. Interdisciplinary courses taught by faculty from business, industrial relations, sociology, psychology, and so on would familiarize members with information from other disciplines as well as from current research on EAPs. This process, so vital to the professionalization of EAP work, has already begun. Currently, EAPA, through its local chapters, is working with schools to develop courses that will enable its members to satisfy its certification and recertification standards, which emphasize core tasks and the crucial balance. Developing an educational program for EAP practitioners involves a number of things (e.g., Quick, Sonnenstuhl, and Trice, 1987; Trice, 1990). First, the basic and applied research on EAPs must be located and integrated into the relevant academic courses comprising the curriculum. Such courses might include labor history, organizational theory and behavior, and the sociology of alcohol and drugs. Second, well-qualified instructors in the various disciplines must be recruited and prepared to teach the revised courses along with the EAP materials. Third, the program should be designed to attract students willing to commit themselves to a rigorous curriculum. The Crucial Balance: A Summary The need for balance in EAPs, which we have emphasized throughout this monograph, is grounded in research. Balance is particularly important for resolving many of the issues that come up in relation to EAP strategies, management-labor cooperation, and program adoption.

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EAP Strategies: Constructive Confrontation and Counseling

Constructive confrontation and counseling make independent contributions in EAPs. Either strategy used alone may help some employees to resolve their troubles and improve their job performance; however, when both strategies are used, more employees will make greater progress. Maintaining a balance between the two strategies may be difficult. First, many managers when adopting programs may opt for an emphasis on counseling because they mistakenly believe that it will relieve supervisors of the burden of dealing with troubled employees and that supervisors might be reluctant to do so. Second, many practitioners drawn to EAPs from counseling occupations may not know about, or may ideologically oppose, the constructive confrontation strategy. In either case, balance will depend on an understanding of the contributions made by constructive confrontation and counseling and that counselors cannot substitute for supervisors, or vice versa. Research shows that supervisors familiar with the EAP policy and the constructive confrontation strategy have little difficulty implementing it. Program Adoption The rapid expansion of EAPs appears to have been due, to a considerable degree, to organizational mimicry; that is, when some organizations adopt innovative programs and bring in staff members from particular occupations, other organizations may well do the same to demonstrate that they are up-to-date and progressive (Tolbert and Zucker, 1983). Such motivations are limited to particular periods of time, however, and many employers will continue to adopt EAPs on the basis of ideologies that blend concerns for compassion and productivity. Supervisors are also compassionate people, and it is their job to be concerned about productivity. At the same time, as was pointed out by C. Truax and R. Carkhuff (1967), effective counselors not only empathize with their clients but also confront them about their performance. Thus, by filling their respective roles in the EAP, supervisors and counselors maximize the focus on compassion and productivity. Labor-Management Cooperation In unionized companies, EAP practitioners also must ensure a balance between the concerns of management and labor. Common sense and research tell us that program effectiveness is increased when both labor and management actively offer constructive help to employees within a context of denial-busting confrontation (Beyer, Trice, and Hunt, 1980). Unfortunately, the tendency may be for each side to press for domination of routine administration of the program-for management to press for final control and for unions to resist any form of discipline. Research data clearly show that both management and labor are partially correct. Formally disciplining alcoholic and other troubled employees can be counterproductive; however, when supervisors constructively confront employees early with the possibility of discipline, employees are likely to resolve their troubles (with counseling help if necessary) and improve job performance. EAP practitioners need to find ways to maintain the balance between management and later concerns. One way is to make sure that both parties understand the roles of constructive confrontation and counseling and that the strategies are based not on beliefs about who should control work but on data from research.

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Appendix A Constructive Confrontation and Its Effectiveness Several studies examine the job performance of alcoholics who were referred to treatment by their supervisors (see, for example, Asma, Eggert, and Hilker, 1971; Franco, 1960; Hilker, Asma, and Eggert, 1972). These studies use a variety of criteria to measure job performance that include indices of job maintenance, supervisory ratings, absenteeism, use of sickness and accident benefits, visits to the medical department, and number of grievances. Typically the studies measure employees' performance several years before and several years after rehabilitation. All report that the employees1 supervisors rated their work better after treatment than before and that the employees were absent from work less often after treatment than they were before it. On the average, these studies also report that 70 percent of the employees recovered from their alcoholism. Other studies use a comparison group to evaluate the constructive confrontation strategy. Ross Alander and Thomas Campbell (1974) used a comparison group made up of hourly employees who did not participate in the program but were known to have drug or alcohol-related problems. The company used a version of the constructive confrontation strategy to motivate employees to use the program; their report concluded that those in the program were very successful following the intervention. Other researchers (such as Chopra, Preston, and Gerson, 1979; Moberg, 1974; Smart, 1974; Schramm, Mandell, and Archer, 1978) compared employees who were pressured into alcoholism treatment by their employers with individuals who went to treatment "voluntarily." The results from these studies are mixed. For example, Schramm and his colleagues (1978) conclude that while their findings appear to indicate little difference between self-referrals and coerced referrals either in job retention or clinic attendance, it should be remembered that some self-referrals also perceive themselves at risk of job loss.* Overall, however, these studies suggest that those employees who are pressed into treatment are slightly more likely to recover from their alcoholism and improve their work performance than those who are not. Margaret Heyman (1976, 1978) interviewed alcoholic employees who had received constructive confrontation and had experienced varying degrees of coercion. Her data show a significant relationship between constructive confrontation and improved work performance for those whose preprogram performance had deteriorated. Similar findings have been reported in studies carried out with Canadian workers (Finlay, 1972; Freedberg and Johnston, 1979). ^Generally, researchers have categorized referrals as either voluntary (i.e., self-referrals) or coerced (i.e., supervisory referrals). This dichotomy is overly simplistic and obscures employees' true motivations for using a program. For example, many so-called self-referrals come to the program either because they fear that their problems are interfering with their job performance and their supervisors will suggest it or because the supervisors have suggested it. See Sonnenstuhl, 1982 and 1986, for more detailed discussion.

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Other studies have attempted to sort out whether the constructive confrontation that alcoholics receive on the job or the alcoholism treatment that they ultimately receive accounts for improvement in job performance and drinking behavior. Carl J. Schramm and R. DeFillippi (1975) report that constructive confrontation accounts for a greater proportion of improvement than the characteristics of treatment programs themselves. Griffith Edwards and his associates (1977) reached a similar conclusion in their studies of alcoholism treatment. They compared a group who received "advice" with those who received intensive alcoholism treatment. The method used in advising the first group was remarkably similar to the constructive confrontation strategy of job-based programs, and Edwards et al. concluded that the "advice" with its minimal intervention had been as effective as a more costly, elaborate, and intense treatment program. While the evidence for the constructive confrontation strategy in these studies is encouraging, it is more suggestive than definitive because much of the research cited has been conducted with only treated employees and, consequently, lacks adequate control groups. To show that the constructive confrontation strategy both deters unacceptable behavior and motivates employees to do well in treatment, researchers would have to undertake studies that used several comparison groups: a group of alcoholic employees who received neither constructive confrontation nor treatment, a group of alcoholic employees who received constructive confrontation but no treatment, a group of alcoholic employees who did not receive constructive confrontation but did receive treatment, and a group of employees who received both constructive confrontation and treatment. Research with similar groups also would have to be conducted with "troubled employees." Alcoholic and troubled employees would have to be randomly assigned to these various groups. Such research would furnish the best proof of the effectiveness of the constructive confrontation strategy, but in the real worlds of work and treatment, it would be an impossible research design to maintain. Supervisors would balk at being unable to confront employees; alcoholic and troubled employees would not like being randomly assigned to groups; and counselors would see withholding treatment as unethical. Consequently, the cited research is more suggestive than definitive and is open to debate.

Appendix B Counseling and Its Effectiveness Within the psychotherapy community a heated debate over the effectiveness of psychotherapy has raged for over thirty years. The debate focuses on two questions: (1) Is receiving treatment more or less effective than receiving no treatment? and (2) How effective are different kinds of psychotherapy compared to one another? Currently, there are two sides to the debate. One side claims that all forms of psychotherapy are equally effective and that all are more effective than no treatment. The other claims that some forms of therapy are no more effective than receiving no treatment and that some forms of therapy are more effective than others. The lines of debate are tangled with complex methodological questions and

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strong feelings about what treatment ought to be. Here we can only sketch the most salient points in the debate and urge the still curious reader to consult some of the primary sources on outcome studies (for example, Rachman and Wilson, 1980; Smith, Glass, and Miller, 1980). Is therapy more or less effective than no treatment? In 1952, Hans J. Eysenck reviewed twenty-four existing studies of psychotherapy and concluded, "They show that roughly two-thirds of a group of neurotic patients will recover or improve to a marked extent within two years of the onset of their illness, whether they are treated or not" (p. 322). The majority of these will recover or improve within one year. Eysenck reexamined the psychotherapy literature again in 1960 and 1969 and reached much the same conclusion with one exception. There was, he believed, some evidence suggesting that behavioral psychotherapy may be more effective than no treatment. Eysenckfs comments created a furor in the psychotherapeutic community. Some therapists suggested ignoring him (for example, Sanford, 1953); others criticized the limitations of his data (for example, Rosenzweig, 1954). Other therapists took more fruitful approaches to his conclusions. Alan E. Bergin (1966), in an attempt to reconcile differences, argued that some patients do well in therapy while others do not and that averaging these effects together, as Eysenck did, obscured therapy's true effect. Bergin's comments encouraged researchers (such as Truax and Carkhuff, 1967) to look for those treatment factors that improve some patients and make others worse. Eysenck's comments also encouraged researchers to search for alternative forms of psychotherapy. The ability to recover or improve without treatment is called "spontaneous remission," and Eysenck's estimate of spontaneous remission among neurotic patients has stood up well. Several researchers (Bergin, 1971; Bergin and Lambert, 1978; Lambert, 1976) argue that the remission rate for neuroses is nearer 30 or 50 percent than 67 percent, but their data are seriously flawed because they include non-neurotic categories such as stomach ulcers, ulcerative colitis, and drug and alcohol abuse in their analyses. According to J. J. Rachman and G. T. Wilson's (1980) review of the literature, the overall rate of remission remains at 67 percent within two years but varies for different kinds of neuroses. While actual rates are still unknown, a table, in descending order, for spontaneous remission of neurotic disorders may look like this: affective neurotic disorders, anxiety states, hysterical disorders, phobias, obsessional illnesses, sexual disorders, and hypochondria disorders. The majority of remissions probably occur within one year of onset of neurosis and generally are the result of fortuitous life events such as supportive help from family and friends, financial gains, improvements in work, and amelioration of pressing difficulties. Ideally, psychotherapy outcome studies would control for spontaneous remission by randomly assigning patients to either a no-treatment group or a treatment group; at the end of the study, outcomes for the two groups would be compared to see whether psychotherapy made any difference. In the real world, however, such a research design is difficult to maintain because patients balk at not receiving therapy and therapists see withholding treatment as unethical. Consequently, most outcome studies compare different types of psychotherapy

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with one another (for example, psychodynamic versus behavioral) and do not use a no-treatment group. This is unfortunate because, without the no-treatment group, it is impossible to know whether the psychotherapies are more or less effective than not receiving therapy. Even when studies do include a no-treatment group, their findings remain difficult to interpret because of other methodological flaws. The most serious of these are (1) selection biases whereby people who are expected to do well in therapy are included in the study and those who are expected to do poorly are excluded, (2) poorly defined therapies so that different therapists using the same treatment may actually be doing different things with patients, and (3) nonstandardized outcomes, which make it difficult to compare one therapy with another. Despite the flaws, many authors have attempted to make sense of the hundreds of outcome studies (see, for example, Luborsky, Singer, and Luborsky, 1975; Rachman and Wilson, 1980; Smith and Glass, 1977; Smith, Glass, and Miller, 1980). Mary Lee Smith and her colleagues (1977, 1980) used a statistical technique called "meta-analysis" to evaluate 475 studies. They concluded that all forms of psychotherapy are more effective than receiving no treatment and that all forms of therapy are equally effective. Their findings have been replicated (by Landman and Dawes, 1982; Shapiro and Shapiro, 1982) but remain in dispute. The central problem is that no one knows the probability of an outcome study being published and subsequently included in the meta-analysis. Without knowing that possibility, it is impossible to know what the statistics mean. In effect, the researchers may be playing with stacked decks. Behaviorists also criticize meta-analysis as being based on a misconceived aggregation of data from unsound research and claim that meta-analysis findings are contradicted by the results of well-done studies (see, for example, Eysenck, 1978; Kazdin and Wilson, 1978). Behaviorists Rachman and Wilson (1980) have conducted their own exhaustive study of the outcome research. They have reviewed the substantive studies on psychoanalytic, humanistic, and behavioral psychotherapies and attempted to integrate those findings into a logical coherent whole with recommendations for future research. In regard to psychoanalysis, they lament the scarcity of controlled research but acknowledge that "modest evidence now supports the claim that [psychodynamic] psychotherapy is capable of producing some beneficial changes -but the negative results still outnumber the positive findings, and both of these are exceeded by reports that are beyond interpretation" (p. 259). They also find little empirical support for the claims of Rogerian person-centered therapy. In regard to behavioral therapy, they report that (1) there are well-established methods for reducing anxieties and fears, (2) good progress has been made in treating obsessive and compulsive behavior, (3) significant advances have been made in dealing with sexual dysfunctions, (4) slow progress has been made in improving people's deficient social skills, and (5) little progress has been made in shaping up rehabilitation programs for people with chronic and disabling disorders. Cognitive behavioral therapy has scored some limited but significant successes, and they expect it to develop into a valuable method for helping people in trouble. Similar conclusions have been reported by other researchers (see, for example, Bellack and Hersen, 1980; Frank, 1979; Garfield, 1983; Goldenberg, 1983.)

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