Shame on You? Shame on Me: Stigmatization and the Invisible Disability of Addiction by Sheryl Thompson, MACP, RRP, RCC
~originally published in the Spring of 2015 edition of REHAB Matters, the quartely newsletter of the vocational Rehabilitation Association (VRA) of Canada
To the World Health Organization (WHO), the term disability encompasses three areas: impairments in body function or structure; activity limitations; and restriction from participating in life situations due to some kind of issue. In Canada, substance addiction, either confirmed or perceived, is deemed a disability under the Canadian Human Rights Act and provincial human rights acts (2). The Act states that employers have a duty to accommodate substance dependent individuals as long as the accommodations do not place undue hardship on the employer or place other workers or members of the general public at risk, similar to other disabilities. Interestingly, even with this designation the federal disability tax credit is only available to individuals suffering from a concurrent disorder, such as depression or schizophrenia, in addition to addiction. Under the 1990 Americans with Disabilities Act (ADA), individuals in recovery from substance addiction are classified as disabled and employers have a duty to accommodate. However, the ADA makes it clear that individuals in active addiction are not automatically granted the same entitlements. This can be confusing for both employers and employees.
There is a residential treatment centre on Vancouver Island that is treating the disease of addiction and the facility’s patients. A comparison of addiction to other diseases— like cancer—is used to help patients understand that addiction is not merely due to a lack of willpower but is a progressive disease with potentially fatal outcomes. Like cancer, addiction is medically diagnosed and then treated by the patient engaging in some form of recovery program (i.e., group therapy and 12-step programs). The patient may go into remission but relapses can occur, resulting in potentially more treatment or, failing treatment, death. Patients may remain abstinent and in recovery for years at a time, then relapse for myriad reasons. Similarly, a cancer patient may be deemed cancer-free only to have malignant cells reemerge years later.
Addiction can certainly be considered an invisible disability. The individuals I encounter as a group facilitator at the same treatment centre's outpatient treatment centre, as well as in my work as a vocational professional, do not look like the caricature of the stumbling alcoholic or raving drug addict unfairly stigmatized in film and television. They are military personnel, health care professionals, lawyers, small business owners, upper level managers, retirees, chefs, and salespeople. Some are also unemployed, having lost their jobs due to their addictive behaviour or a choice to leave an occupation that would threaten their recovery. They are friendly, intelligent, introspective, and frequently stubborn. If you met any of these individuals on the street or in your workplace, chances are you would never know their struggles with what has been deemed a cunning and baffling disease.
At the treatment centre I had numerous opportunities every day to talk with the patients where our conversations naturally steered onto the topic of work. I began to realize how intrinsically tied employment and addiction are. The employment environment may allow easy access to addictive substances; the field of medicine is a primary example. A work environment may also encourage use with long hours, unrealistic expectations, or by fostering a casual attitude towards substance abuse. Some industries encourage employees to engage in addictive behaviours with clients to encourage sales, and some occupations are just hazardous and exciting enough to stimulate the pleasure pathway in the brain—the same brain region implicated in addiction—priming the brain for the use of addictive substances.
At the centre’s outpatient facility where I work, the topic of work continues to emerge: How can I get my boss to trust me again? How do I tell coworkers where I have been for two months? How do I now deal with work stress without turning to my addictive behaviour? How do I navigate social events with clients and coworkers where alcohol is present? Should I disclose my addiction to potential employers? As a vocational practitioner, I also had questions: How does a client explain the large gap in his or her resume after a year off while engaging in treatment and recovery? How does one tactfully arrange for job site accommodations, such as an extended lunch break to attend a lunchtime recovery meeting, without disclosing the individual is in recovery? What is the best way to answer a potential employer who queries why the client left his or her last position if his or her departure was related to the addiction?
Sheryl Thompson, a vocational consultant and vocational evaluator, performs medical-legal and vocational rehabilitation assessments for personal injury, chronic illness and medical malpractice cases, and vocational assessments.