Workplace Prevention in Practice Pt.3: Policy, Ethics, and Compliance in Workplace Prevention

In this episode, Associate Professors Goodman Sibeko and Nadine Harker unpack how workplaces can uphold legal and ethical standards while promoting mental health and preventing substance use.

Prof. Harker discusses what makes a workplace policy both lawful and humane, stressing that alignment with national legislation must go hand in hand with fairness and inclusion. She also underscores the value of collaboration, bringing HR teams, trade unions, and leadership into the same conversation from the outset.

Their discussion moves beyond policy design to the practical realities of putting it into action: how managers can overcome financial and cultural barriers, and why reintegration and aftercare are essential for employees returning from treatment.

Featured Voices 

Host – A/Prof. Goodman Sibeko 

ISSUP Global Scientific Advisor.

Head of Addiction Psychiatry, University of Cape Town.

LinkedIn: goodmansibeko

Twitter/X: @profgsibeko

Guest – A/Prof. Nadine Harker

Specialist Scientist in the Alcohol, Tobacco and other Drug Research Unit of the South African Medical Research Council. 

Time Stamps

A/Prof. Goodman Sibeko (00:00)
Nadine, thanks so much for joining us again for this third episode. Colleagues, welcome back to this episode with Dr. Nadine Harker. I'm Goodman Sibeko the ISSUP Global Scientific Advisor and your host. You can find me on LinkedIn and all the socials at the handle profgsibeko. You can find ISSUP on LinkedIn, X and Blue Sky. Just type in ISSUP and you'll find us easily.

We just had a really great discussion about early identification and support in the workplace. If you haven't had a chance to listen, be sure to go back and check out that episode. Today, we're gonna talk about navigating the legal, ethical, and human rights dimensions of prevention and intervention work within the workplace. So Nadine, to get us started, what are the policies that every employer should have in place to address substance use and mental health in the workplace?

A/Prof. Nadine Harker (00:46)
So, Prof Goodman, one of the things that I think we should all understand is that the substance use health policy that resides within the organization needs to fit into the regulatory framework of every country. So every country would potentially and presumably have, for instance, a Labour Relations Act. A basic conditions of employment act and OHS act, a road traffic act. So once an organization embarks on developing their policy, their policy needs to fit squarely into the ambit of the broader national regulatory framework. For example, in South Africa, it is quite clear that if someone in the workplace presents with a substance use problem, and it is known, you cannot just dismiss that employee, you need to refer the employee for or to employee wellness. So those frameworks are then embedded into the workplace policy that an organization would develop, but that policy that they develop does not just look at the legal applications to it, but should also include things that would relate to employee assistance programs, prevention programs, or health promotion programs that happen within the organization. Very there's a zero tolerance within the workplace, because remember we spoke about safety-sensitive jobs, an organization their scope that, no amount or any traces of substances can be in anybody's body at any point in time. That needs to be embedded. And then taken a further step, it has to be grounded in the national regulatory framework.

One of the things about navigating the policy, the workplace policy in itself, is that at the table, when these policies and drafted, it cannot only be managers at the table.

Ideally, trade unions need to be represented, occupational health and safety. And any other divisions within that organization such as HR would have to be present because they do sit with information that can be used to flesh out components of the workplace policy. Small and medium enterprises, I'd also like to highlight whilst bigger corporations, most of them would probably have such policy in place, but there needs to be a little bit of a push towards the smaller organisations that actually don't have these policies in place. people are just dismissed after perhaps even just one incident of being intoxicated or under the influence when they could safely have been navigated to treatment or to other services. As far as occupational health and safety relates to all of this, occupational health and safety plays a role when it comes to certain aspects of what gets screened for within the workplace. And that can also be safely integrated into a policy to include mental health screening and substance screening.

A/Prof. Goodman Sibeko (04:08)
Nadine, workplaces vary in staff complement. So how do we go about ensuring that policies are not only compliant, but also ethical and address specific communities and needs?

A/Prof. Nadine Harker (04:20)
It is important, Goodman, that these policies be workshopped across the organization. And by workshopping it across the organization, various voices will be heard to make sure that it is fair and supportive in its nature, that it addresses risks safely because the whole organization needs to be protected, but also safeguards the employee, from being unfairly treated and that approaches used by the organization are supportive to the individual that has a substance use or mental health problem. And this is why I mentioned at the start that very often we see a policy as a very negative document, but a policy is meant to be protective to the employee and protective to the employer. And they feed back into each other.

A/Prof. Goodman Sibeko (05:16)
Do you have any specific suggestions, Nadine, for how some of these workshopping activities might take place? Does it look like bringing everyone into a room and having a presentation? Does it look like having specific groups engaged with differentially? What's the best strategy for doing that?

A/Prof. Nadine Harker (05:33)
The best strategy is organisations first need to commit. Committing to prevention is like getting a tattoo on your face. You have to be serious about it. So once the organization commits to a prevention strategy, they would have to embark on a universal prevention program within their organization. That is starting from the bare bones of making the policy workshopping the policy with all staff, creating awareness around it, early prevention programs, not early intervention programs, sorry, awareness programs around what is in existence for people. And built into that is destigmatizing substance use, destigmatizing, not affirming anything, but just destigmatizing that there are ways that one can overcome and there are ways that the organization can assist. And that is where the leadership support comes in. So off the bat, that happens together at the universal level, at the level of the entire organization. And it rides on this premise that you'd rather want to invest in the health of all as opposed to just dealing withtrying to figure out a way to put it, fighting the fire. You want to prevent those that are healthy by virtue of people living very difficult lives as to what we perhaps 50 years ago, it was a little bit easier, but you want to create systems and mechanisms within your organization to help people cope with difficult life challenges. 

And the only way to do that is through consistent, ad hoc, consistent, not ad hoc, committing to programs for the entire lifetime of that organization. And interestingly, I work for an organization that has now started adopting that. There's an emphasis on wellness, there's an emphasis on health, there are fitness workshops, there are lunchtime programs that are being offered that range from how you budget to how you deal with a difficult co-worker, where to go should you need help for problems. But it isn't something that happens at a set time and a set place every five years. It's continuous. And it is part of an agenda that the bigger organization adopted, and leaders, senior leaders are part and parcel. I myself, if I can share, try and attend the exercise class that happens on a Tuesday for 45 minutes. And that is what we speaking about. It's not ad hoc. It's consistent, it's sustainable, and it's engaging. And that is how ideally at the universal or the whole organization level you would I think I digress there a little bit with my own little story.

A/Prof. Goodman Sibeko (08:32)
It's perfectly all right. So Nadine, now the organization has committed. They are very interested in having a prevention strategy. They're ready to embark. But the reality is that organisations have differing structural and operational requirements and impediments. So given that consideration, what challenges in your view do HR managers and managers in general face in implementing these policies?

A/Prof. Nadine Harker (08:56)
I think the challenges would possibly be, from my point of view, ignorance, Prof. Goodman. Not understanding. That seems to be the major barrier. The other barrier would be financial incentives. Not enough financial incentives, sorry. A financial aspect to it.

But if you could get a good economist involved, you'd find that for every dollar you spend on preventing poor health now I speak about things like NCDs, your diabetes, cardiovascular disease risks, you make possibly $1.89 back in the long term because you have less medical costs you have less having to replace people because they either pass away or they leave or they are sick leave, et cetera. So there's a clear return on investment when faced with the question of is prevention or health promotion worth it? But that is the barrier. the other barrier is obviously not understanding and not embracing. it's this whole concept and mind shift that needs to happen, Dr. Goodman, which I call enough. I learned this actually through one of my PhD, not a supervisor, but someone that was integral to my study at the time is we have illness and the capital letter in illness is I. We have wellness. The capital letter there is W and the second is we. And that is where the shift needs to happen from not addressing the I, which is the individual in the illness, but the we towards wellness.

A/Prof. Goodman Sibeko (10:30)
Nadine, great. So first of all, I'm going to have to now start also toggling between calling your doctor and prof Nadine because you're putting me under pressure now.

So, Prof. Nadine, finally for this particular section, how do we handle cases where substance use intersects with workplace safety?

A/Prof. Nadine Harker (10:47)
Again, all of this rise or rides within the policy that the organization sets. an individual would know and if the policy, if there's an existing policy and we're working off the premise that there's a policy, the policy would clearly state that no substances are allowed within the workplace, right? Or the policy would say there's a zero tolerance on substance use.

Some organisations, you would pitch up in the morning and there are random urine analysis or random breath checks or breathalysers for alcohol. And that is based on a policy. In the event that it is detected in your system, you would then be sent immediately. There's no informal process there again. That is straight through to a formal process where you are referred to the employee wellness service. You are then assessed and screened. will determine whether you need further interventions. But ideally, what should happen within organisations is that the regular, as part of occupational health and safety practices, that when you go for your blood checks and your cholesterol checks, that occupational health and safety practitioners also screen for mental health and substance use disorders. Using basic screening tools that, Prof. Goodman, are well versed with, the SIST or whatever the case may be, to early on screen for any issues, including mental health screeners.

Because what we don't want is everybody wants to be alarmed when the catastrophe happens, when it could have been prevented. And that I think, and I hope it has come through strongly, that a lot of emphasis needs to be placed on prevention, because a lot of harm can be deferred if we do that. So there is a need for brief and early interventions to check even before you are caught having had alcohol the night before and you caught at the checkpoint when you have a random test or forced test, et cetera. And the other issue that comes into play there is also obviously as part of occupational health screening, you'd also have the safety risk assessments. And those alcohol screening brief interventions can be incorporated into that space as well, which is important. But what is also of concern and that is missing to a certain degree is that in the event that the substance person that uses the substances has now been sent for treatment, they are back at work, that there's not sufficient accommodation being made for these individuals. So for instance, they have come through may be structured or unstructured program. are in the recovery. Reasonable accommodation is not always necessarily made for them at the workplace. So a missing gap is reintegration into work. 

And peer support and peer care becomes important than organisations as part of their policy and as part of their prevention or as part of their reintegration to work program for when people come back from treatment should actually cover reintegration of work. That is work modifications if needed or alternative work if required to accommodate the individual for a set time as determined by the practitioner who treated them and not the supervisor, of course, and aftercare support. I know of big organisations, I'm talking corporates, that have standing organization, standing agreements with places like AA that come to the workplace during a lunchtime. And they have an AA session there for those that are in the recovery. And I see no problem with any of this because it really just provides the next level of support an individual has. The problem has traditionally been people are sent away, they come back, they are left without any support. And you and I both know how addiction works. There's still a cycle of care that is needed beyond, and that needs to be sustained and again, that can safely be incorporated into the policy.

A/Prof. Goodman Sibeko (15:21)
Nadine, thank you. So, clearly we need to really incorporate mental health screening and make sure that we incorporate screening, brief intervention and referral to treatment as a solid evidence-based strategy. And overall, you really helped us start to think about how all these interventions are meant to drive the design of healthy work environments. And that's what we're gonna be focusing on in our next session. So Nadine, thank you for giving your time for this session. Colleagues, please join us for the next session where we are gonna focus on, building resilient and healthy work environments.

Thank you for spending this time with us. We hope you enjoy that as much as we do. Be sure to hop on over to our website, isop.net, where you'll find information on how to sign up for free membership. Take care and catch you on the next one.

About the ISSUP Exchange 

The ISSUP Exchange podcast series explores the evolution of responses to the challenges of substance use—from research and training to ethics, quality standards and evidence-based practice. We connect the dots so you can see the big picture. 

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About ISSUP 

ISSUP is a global network that unites, connects, and shares knowledge across the substance use prevention, treatment, and recovery support workforce. Our mission is to make our members’ work as effective as possible—by providing access to training, resources, and a vibrant professional community.