Help! The occupational physician wants me to quit smoking or drinking

Many people see their work and personal life as two completely separate worlds. However, health isn’t limited to working hours, what an employee does in their free time directly impacts their performance at work. Persistent sleep deprivation, excessive drinking, smoking, or other unhealthy habits will eventually take a toll on work performance. This is why both employers and employees must recognize the role of lifestyle in absenteeism and productivity.

Despite this, lifestyle and addiction are rarely standard topics in occupational health consultations. As a result, problems often go unnoticed until they are well advanced, making them much harder to address. Aukje Huurman, an occupational physician at Capability, dives deeper into this issue.

The hidden impact of addiction in the workplace

In practice, occupational physicians often only inquire about substance use when there are already signs of absenteeism or underperformance. According to Aukje, this approach needs to change: “Addiction isn’t always top of mind. We don’t routinely ask how much someone drinks or whether they use drugs, but we should. Addiction isn’t just a problem for those who show up to work intoxicated, excessive weekend drinking or chronic sleep deprivation from gambling or gaming can significantly impact someone’s ability to function.”

“People struggling with addiction often show subtle signs that aren’t immediately noticeable. They call in sick more frequently, make more mistakes, become easily irritable, or develop serious physical or mental health issues. In some cases, workplace conflicts or financial problems arise, such as with gambling addiction. Looking back, the warning signs are usually there, but they often go unrecognized.”

Common signs of addiction in the workplace

Identifying addiction in the workplace can be challenging, as it often manifests through subtle changes in behavior and performance:

• Frequent absenteeism without a clear medical reason or giving alternative explanations while the real issues lie elsewhere.
• Decreased concentration and memory problems, leading to mistakes at work.
• Behavioral changes, such as irritability, mood swings, or social withdrawal.
• Irregular work hours, frequently arriving late or leaving early.
• Financial difficulties, visible through wage garnishments or frequent requests for salary advances.
• Physical symptoms, such as fatigue, trembling, or an unkempt appearance.
• Workplace conflicts due to increased stress and reduced emotional stability.

When one or more of these signs are consistently present, it may indicate an underlying addiction. Recognizing these signals early allows for timely intervention. Aukje shares an example: “Addiction often develops gradually, making the signs less obvious. I recall a case of a middle-aged woman who started working more slowly and making more mistakes. Eventually, she called in sick and was admitted to a rehab clinic. It turned out she had a severe alcohol addiction. In hindsight, all the signs were there, but they weren’t recognized as such at the time.”

How to address addiction in the workplace

One of the biggest challenges in identifying addiction is the stigma surrounding it. Aukje explains: “Employees often feel ashamed and fear consequences from their employer or judgment from colleagues. This is why it’s crucial for employers and occupational physicians to foster a culture where health is openly discussed. It’s also important to understand that people struggling with addiction are usually aware of the harm it causes, but admitting it or seeking help can be incredibly difficult. Underlying emotions and thoughts often play a role in both developing and maintaining an addiction, along with the shame of acknowledging it. While you can’t force someone into treatment, most people do want to change their behavior, but they need professional guidance to do so.”

Possible actions to take:

• Standardized lifestyle and substance use questions in occupational health consultations. Occupational physicians should routinely ask about key lifestyle factors such as physical activity, smoking, alcohol use, diet, and relaxation (the BRAVO model). Making this a standard part of discussions normalizes the topic and prevents it from only coming up when problems have already escalated.
• Motivational interviewing techniques. By asking the right questions, actively listening, and encouraging self-reflection, occupational physicians can help employees gain insight into their behavior and its consequences. This approach can support employees in realizing the benefits of change.
• Preventive consultations. Offering employees confidential consultations to discuss lifestyle choices without immediate consequences provides a safe space for seeking advice on improving their health. Employers should ensure all employees know about this option and that they can access it anonymously.
• Raising awareness within companies. Employers can play a key role by addressing addiction openly. This could include organizing workshops on healthy living and leading by example, such as not automatically serving alcohol at company events.
• Appointing a confidential advisor. Having an accessible, internal point of contact allows employees to discuss addiction issues without fear of repercussions, fostering a supportive environment where seeking help feels safe.

A shared responsibility

“Health is an ongoing process that doesn’t stop at the end of the workday,” Aukje explains. “Employees are responsible for taking care of themselves outside of work, but at the same time, employers must recognize and address addiction and unhealthy lifestyle choices. As occupational physicians, our role is to identify warning signs and, without judgment, help employees understand how their choices impact their work and overall well-being. We also collaborate closely with professionals specializing in addiction care.”

“Ultimately, we are all working toward a sustainable and healthy future. A healthy lifestyle not only enhances employee well-being and productivity but also creates a more positive and supportive work environment. More than anything, it’s an investment in people themselves.”