advancingwellness-blog.jpg

Blog

Expert Interview: Joel Bennett, Ph.D.

January 22 2019 / by Mari Ryan

In this Expert Interview, AdvancingWellness CEO Mari Ryan and Joel explore workplace approaches to the opioid and prescription drug misuse crisis.

Joel is the president of Organizational Wellness Learning Systems, which goes by the acronym OWLS, a consulting firm that specializes in disseminating evidenced-based wellness and e-learning technologies to promote organizational health and employee well-being.

 Joel Bennett

 

Mari Ryan: Welcome to the Workplace Well-being Essentials Series. I'm Mari Ryan, I'm the CEO and founder of Advancing Wellness. It's my pleasure to welcome you today to this expert interview, where we explore topics that impact employee well-being. My guest today is Joel Bennett.

Joel is the president of Organizational Wellness Learning Systems, which goes by the acronym OWLS, a consulting firm that specializes in disseminating evidenced-based wellness and e-learning technologies to promote organizational health and employee well-being.

Dr. Bennett first delivered stress management programming in 1985 and OWLS programs have since reached close to 150,000 workers in the Unites States and abroad. OWLS clients include corporations, private, and not-for-profit organizations, local, and federal agencies. OWLS has received close to $5 million in federal research grants to access, design, and deliver workplace wellness programs. Dr. Bennett is the author of over 25 peer-reviewed research articles, and has authored or co-authored five books.

When not consulting or writing, Joel can be found spending time with his wife of 24 years in their garden, doing artwork, poetry with his grandchildren, and cooking and meditating. Joel, welcome.

Joel Bennett: Thanks for that introduction. I know you wanted to do that, so, yes. I’m glad to be here, Mari. I’m glad to be with the author of The Thriving Hive. More on that in a minute.

Mari Ryan: All right, thanks. Our topic today that we’re going to explore is one that we’ve been hearing a lot about in the news, and in some cases, has been described as the current public health epidemic in our country. That has to do with the opioid crisis. We’re seeing that from a workplace perspective that this is actually costing employers billions of dollars in lost productivity, and in medical costs. In doing some research in preparation for this, I came across what I thought was some startling statistics. For example, 98.6% of in-patient surgery patients receive opioids to manage post-surgical pain. Also, 92% of post-surgical patients who receive opioids for acute pain report adverse side effects, such as urinary retention, or respiratory depression, and the treatment of which can also be costly.

So, this is an issue that employers need to be taking seriously, but I have a concern that clearly not everybody who takes opioids and who have some sort of post-surgical intervention such as this, is necessarily going to get addicted. I’m curious, from your perspective what do you think is the root cause of this problem, and what do you think are some approaches? Let’s start with the root cause of the problem.

Joel Bennett: Thanks for those statistics; there’s a lot of information on that, and we can talk more about the cost to employers. We do need to talk about the root cause. There’s lots of ways of breaking it down. I will identify … let’s see here; one, two, three, four, five, six [laughs] factors. I have an article I can reference where I talk about this come out where we talk about what we call “pharmaphilia,” which is the love of drugs. There’s been something written about this that humanity, the consciousness of humanity, has throughout history, has always liked the idea of having something that we can take. This goes back many generations and in all cultures. That first thing we need to recognize is there’s something basic, natural, and organic to the idea of give me something to take care of the problem.

Mari Ryan: So, we’re looking for the easy solution, is what you’re saying.

Joel Bennett: Well, it’s now become that way, but in native cultures it wasn’t. It was like, here is the medicine that you need, and here is the ritual around taking that medicine. Here are the spiritual and religious aspects of it, so it was done in a way that was whole, or holistic. There are ethnographers out there, Meg Jordan being one of them, who have studied this kind of thing. What’s happened is pharmaphilia, the love of drugs, has become, if you will, co-opted by technology, commercialism, and capitalism.

The first thing we need to understand is there’s nothing wrong with the desire or need for something, especially when the culture supports it, and I would say a spiritual wrapping to it. It’s like people are getting this, but it’s part of healing. That’s the most root cause.

Of course, what’s happened is we’ve now entered this time in history of humanity with industrialization and commercialism where those types of spiritual wrappers are gone. Not only that, but we have the real second, what I would say root cause, which is this thing called work stress. Here, I’m going to refer to The Thriving Hive. In The Thriving Hive, Mari, there’s this place where … I’ll just read the quote and ask you to give the background. There’s this Natalie who – Natalie is a bee. By the way, the whole book is built around this metaphor of a bee hive, and either the bee hive is working well, or it’s either a “thrive hive” or it’s a … what do you call the opposite?

Mari Ryan: A “dive hive.”

Joel Bennett: The “dive hive.” This is an example coming from the “dive hive.” Natalie, who is a nurse, one of these nursing bees, who has control over the … or as one of the people tending to the young drones, the young babies?

Mari Ryan: Yeah, to the bees as they are developing.

Joel Bennett: They’re developing. She goes, “Overheating! Water shortage! Heat wave! What a catastrophe! And Queen Cruella, she’s demanding more and more.” So, this is Natalie. Then, Nitzi asks “by the way …” -- she’s another nursing bee -- “by the way, has anyone seen Queen Cruella? Where are the leaders when we need them most?” And then Wava, a young worker bee, says “What’s going to happen to us? Is this the end of us in our hive? I heard from another honeycomb that they were grabbing all the honey they could get and are hunkering down to see if they could survive.”

So, this is like a crisis-point in the book. So, can you give a little bit about what happened to lead to this crisis point in this particular honeycomb?

Mari Ryan: Well, the interesting piece is the metaphor of using the beehive is the system to represent the workplace is to be able to show we have these situations that happen in the workplace where employees are being asked to do more with less resources with less support from managers and that’s exactly how it plays out in that kind of scenario. There’s a bunch of external factors that are happening to which the employees feel they have no control or no plan for how to deal with these, and they feel they’ve been abandoned by their leadership team.

Joel Bennett: That’s a great metaphor to flesh out the second root cause, and if your audience have not read Jeffrey Pfeffer’s book on Dying for a Paycheck, I highly recommend it because it does a great job of documenting what we in research have known for years, that there are significant stressors in the workplace and what that results in regarding the topic of opioids is this idea of push through the pain. Don’t get the sleep you need. Work, work, work. We’ll provide you insurance, we’ll provide you with whatever medical needs you have through our benefits package, but it doesn’t matter. Push through it.

The message that workers are getting is that the idea of relaxing, or taking time off, or pacing work, or a more enlightened work environment is less available to them. Of course, the costs of stress overall are quite significant. One of those costs that employers are bearing is an increase in prescription drug pharmacy spending. Employers need to know that when they see those costs, which are influencing their insurance, it’s something they are actually participating in by having the “dive hive” instead of the “thrive hive.” So, that’s the second root cause. Is that clear?

Mari Ryan: Yeah, and that’s clear. Thank you.

Joel Bennett: Now, on the other side to this is the medical community. The medical community has itself been complicit in this, not necessarily willingly. We do a course on resilience and thriving, and recently we’ve had teachers, or advisors, or administrators from various medical schools take our class to help teach medical students how to be more resilient. What they are telling me in these courses – this is coming from five or six different colleges, medical colleges or universities – these students are committing suicide, they are buckling under the pressure, they have depression, and what is starting to happen in the medical education community is people are waking up to the fact that the way medical schools have been training their students is perpetuating this push through the pain. The very people who are there, advising us and helping us to be healthy are saying “here, take the pill, push through the pain.” That’s exactly what they’ve been indoctrinated into.

People are starting to wake up to the fact that this isn’t working. People are really caring about medical students now in a new way. The medical community has part of that culture and who we turn to.

What’s significant about this third root cause is that wellness people – and this is a sort of a co-dependency – when I talk to wellness people about doing prevention, I’ll talk about that in a minute for drugs, they will say, well, that’s not my area of expertise. You need to talk to a doctor. What’s happened is this abdication of empowerment that can come from wellness, which is the heart of the wellness credo that says when it comes to talking about whether a drug is good for you or not, I’m not an expert. I’m not the professional. Go ahead and talk to the doctor. That is what I would say is a co-dependent attitude. I have tried to present on this topic at wellness conferences and I’ve been told we can’t talk about that because that’s not our area of expertise.

That whole third root has to do with how the medical profession has medicalized this idea of treatment for pain and that those of us who are in wellness don’t think that is something we have any responsibility for. So, that’s the third root cause.

The fourth cause is the, and I’m going to get to the final cause, which is the most important one to our work. But the fourth one is the pharmaceutical companies themselves. There’s a book out now, there have been articles out about how the pharmaceutical companies, through very sophisticated sales techniques and very powerful incentive plans for doctors and the way they manufacture drugs, have co-opted the dissemination of opioids. That’s a significant factor, and in combination with that, which I see as, again, we are very clear we are not blaming, when I say this I have to be very careful because I’m not coming out and blaming the pharmaceutical companies in and of themselves. It doesn’t have to be this way. There is a lot of journalism right now that documents that it is happening.

Mari Ryan: It is, and it sounds like it’s the perfect storm, where all of these elements have come together to be able to cause this crisis.

Joel Bennett: Right, and the last piece to this, which is where we come into this conversation is the lack of education. The field of prevention, prevention specialists, tend to work with children, communities and schools. There’s this idea that we need to educate, like DARE drug education in the schools. What we’ve learned is that because of what happens in emerging adulthood, between 18 and 25 years old – in fact, there’s a grant announcement coming out right now out of NIDA – you can train kids all you want on how not to do drugs, but when it comes to prescription drugs and the fact that we’re all socialized into them, and the fact that when you are going into adulthood, other things kick in. What you learn as a child don’t necessarily apply.

We have done a poor job of not only of educating children about the dangers of prescription use of all kinds of prescriptions, but also the medical community itself doesn’t do a good job around training doctors about addiction and risks for addiction. In fact, a leading physician out of Mount Sinai wrote a nice article in The New York Times a few months ago that said hey, it’s not pretty for us to work with people who have these problems. Not many doctors want to do this work. There’s more about how there is a lack of education.

Here we are, we are at a point where the epidemic has hit and we’re like, well, let’s just treat it. NIDA has grants out, let’s find a better pill, let’s do Naloxone, let’s get these people into treatment. But nobody, and it’s very rare for people to talk about primary prevention and education. It’s not happening. That’s where our work is coming up with evidence-based educational tools to help workplaces, the wellness community, providers in HR to start to do the education that is necessary, and the empowerment, the consumer empowerment that is necessary.

I know that’s a lot, but that’s where all that comes from.

Mari Ryan: One of the pieces that I’m curious about is when I quoted a few of those statistics in the early part of our conversation, a lot of it had to do with the fact that surgery patients are getting these opioids as a treatment for post-surgery. I’m curious as to why we don’t hear much more in this whole fight against this epidemic about preventing the original injuries, perhaps, because some portion of this has to be based on injuries, helping people be physically stronger, having safer workplaces. Let’s go further upstream here and prevent people from getting into the situation where they need surgery in the first place, so they don’t end up being on these drugs.

Joel Bennett: Again, it goes back to what Pfeffer talks about in his book Dying for a Paycheck. Employers, like Queen Cruella, are completely tuned out. They are just not aware of the problem. We work with some strong safety-sensitive and safety conscious organizations. I will say in some of these well-endowed organizations, they do a good job, but they are few and far between.

What ends up happening, I think, is yes, some of it is injury, but a lot of it is also not coming to work. When you look into the pattern of behaviors, the American Action Forum, this is a study where they found – studied the number of workers absent from the workforce due to opioid dependency, just to give you an example, and the associated decline in work hours, they found a cumulative loss of $12.5 billion work hours, and $702 billion dollars in real output loss. They studied this economically – this is the American Action Forum – a ten percent reduction between 1999 and 2015 that is overall that is the entire economic output of the United States, ten percent reduction in economic output, just due to this.

So yes, injuries are part of it, but before an injury happens, there are other signs. What they also found, the National Bureau of Economic Research found that longer-term opioid prescriptions triple the duration of temporary disability leave. You seeing that they are absent from work and when they do have recovery, having opioids means they are not going to come back to work.

The whole idea is employers need to understand that they’re getting it from both sides. The idea is that yes, there’s the surgery and to that point, employees need to be empowered on knowing what kinds of questions to ask their surgeon prior to surgery, instead of just going ahead, oh, I need to do this. Employers need to give employees those tools so that they know and are conscious of the risks of what they are getting into.

Mari Ryan: Let’s dive a little deeper into the details of what are some approaches and what is this approach that your group is using, that you are using, so we can think about this from a different perspective.

Joel Bennett: Sure, I just want to make a point here before we talk about that, because it’s not just opioids. We’re seeing an increase in stimulant misuse. There’s much more emerging adult ADHD drug shopping. We now, students are graduating from college … the use of ADHD related drugs in college has skyrocketed in the past decade or two. People are now entering the workforce, they’re drugged for that. Anxiety overdose deaths involving benzos has increased – quadrupled in the past ten or fifteen years.

I just want to clarify, it’s not just opioids. I think we have to be careful because that’s where we are focusing all our attention.

Mari Ryan: If you go back to our original conversation about some of the stressors that people have in their lives, fundamentally many of these things, and you’re talking about various kinds of chemical substances that people use as coping mechanisms, so we’re using these to be able to cope with whatever those stresses may be, whether those are work stresses, life stresses, financial stresses. It comes back, to a certain extent, to we need to help people understand a little better how to cope with things that are coming up in their lives.

Joel Bennett: Yeah, in fact there is some research to show that those who are at most risk for the opioid dependency are those who have been taking things like Xanax and anxiety-related drugs beforehand. We already know that there’s a variety of pre-disposing risk factors that involve stress and anxiety. So to your point, go back to the root cause, and back to earlier, the pharmaphilia, the workplace, the doctors, employers being tuned out; all of these things are coming together.

To go to your question about solutions, I have a list of some of the things that are out there, before we actually talk about what we do. One of the key things that – this is coming partly from advisement from the CDC is – prior authorization for outpatient prescription drug use is they cannot be in excess of a number of days. The employer can regulate in terms of insurance, you cannot get prior authorization for using prescription drugs in excess of two or three days, or whatever it happens to be. That’s how employers can have an influence or an impact.

The other thing is wellness and EAP providers could provide prevention tools. Again, most of those prevention tools are not evidenced-based. There are things like posters, newsletters, things like that, but at least that information is getting out there. Even though it’s cursory, it’s at least something.

Another thing that employers are doing is using pharmacy-based management prescription drug claims to identify potential abuse. These are with an employer. You can look at your claims data and see what are the potential problems. Some employers provide employees directly with written information that is not using their wellness vendor or EAP, but the employer themselves. What we think is the most important is that going back to what you talk about in the “thrive hive,” providing direct lunch and learn communications, getting people engaged, getting them to talk, finding out what they need, and meeting with them.

Another thing that’s offered is alternative pain management, that is, adding a whole variety of other types of pain management strategies, and there is a whole lot out there. In fact, if you look at the medical internet literature, more and more is coming out on pain management tools through smart phones that can be leveraged.

Another one of the anti-stigma campaigns directed to prescription use, prescription drugs, there’s really, it’s sort of become accepted, everyone uses of it. Still, there’s stigma, people feel their coworkers or someone new that they knew were taking Xanax, that they were taking Prozac, then there would be some stigma around that. That part is also important because opioids are also stigmatized. One of the areas that very few people are using, and this is a call out to evidence-based, is SBIRT. SBIRT stands for Screening, Brief Intervention, and Referral to Treatment, which is an evidence-based strategy that could be used, and we’ve developed some tools around that where we found … We just finished a grant with NIAAA where we saw a reduction in prescription drug misuse through an online gameified tool.

The other wide, which is a wonderful one, and this is from Belden. They are a company out of Indiana. Employees who were denied a position because of failed drug tests can participate in a personalized drug rehab program. This company is saying you failed the drug test because of this prescription use; however, if you participate in this rehab program, and we’ll do what we can to support you in that, then coming back to us in the future, we will reconsider you.

Mari Ryan: In terms of the solution that you and your team have been working on in terms of educational and resilience, can you give us a quick summary of what that approach is?

Joel Bennett: I’ll provide all of these tools here so that people can have links to those. What we do, and what we’ve done for years, is we don’t talk about drugs, we talk about wellness. Specifically, we talk about this concept of health consciousness. Health consciousness is so basic. It’s the idea of am I conscious of whether I’m healthy, or not. What are we doing to make people aware of whether or not they have a good level of consciousness? What we do is we educate people on their own health consciousness by guiding them through exercises that have to do with being aware of am I taking time out for my health every day – some basic wellness things. Do I know how to read labels on wellness products in general, not just drugs, and we educate people around that.

We also guide them unhealthy alternatives to all the things that are available regarding not just pain, but there are many alternatives for things that have to do with anxiety, restlessness. Think about it; when of the reasons that people use these prescription drugs have to do with source, psycho-social or psychosomatic issues that the wellness field already has in place. We remind them about these alternatives.

We also spend a lot of time on empowerment, specifically we talk about, like I said before, what are the questions to ask your physician if you get a prescription. Making sure we have these tools, what are questions to ask their surgeon. What if you are a parent? Do you need to know around how you manage prescription drugs in the home, and what we have found that is interesting if you are an adult child of an aging parent, because what we are finding is the senior population, the growing senior population, also misusing prescription drugs. So, what is your responsibility for that?

People think, oh, the opioid epidemic doesn’t touch me. But, until it does touch you, you’re not even going to think about using these types of programs. So, I just wanted to say that. If you are listening to this, think about your family, your community, your children, whoever you are working with, and the potential role that you have in enlightening them. All the information that we have talked about, Mari, it doesn’t make any difference if people don’t feel in a heartfelt way that they have a role to play in dealing with it.

Mari Ryan: Well, such an important reminder for us. Thank you for bringing that point to emphasize that. If our audience wants to learn a little bit more about you, and the work of your organization, where can I find that information?

Joel Bennett: I’ll leave the information, but our website is organizationalwellness.com. I encourage people to get certified as a trainer of the program that I described, and we do offer programs for the National Wellness Institute, as well as privately. We do train the trainer, models, and we adapt them and work with companies of all sizes, communities of all types to disseminate these evidence-based tools.

Mari Ryan: Fabulous tools and resources that can really be helpful. I’m so grateful that we spent some time together discussing this, Joel. Thanks so much for being here today as my guest.

Joel Bennett: Well, thank you. I just want to put a last plug in here, don’t take this out, but if you want to understand how it works … [laughs].

Mari Ryan: Thanks, Joel. I appreciate it. Have a great day.

[End of audio]

Topics: wellness, worksite wellbeing, workplace wellbeing, Worksite Wellness, employee wellness, worksite well-being, Wellbeing, hr, employee well-being, corporate wellness, opioid crisis, resilience, prescription drug misuse

Mari Ryan

Written by Mari Ryan

Mari Ryan is the CEO/founder of AdvancingWellness and is a recognized expert in the field of workplace well-being strategy.