Unions Are Working to Reduce Addiction Stigma and Increase Treatment Access

Unions and the leadership responsible for protecting the health and wellness of their members can play essential roles in addressing America’s addiction epidemic and changing public perception about the disease. Since its inception, organized labor has empowered workers to negotiate better wages, insurance benefits, paid leave, and safety standards. In recent years, unions have also begun to tackle one of America’s most formidable health problems — addiction.

The National Labor Relations Act of 1935 legalized unions in the United States. Union density, the percentage of union employees, peaked at 35 percent in 1954, and more than 20 million Americans belonged to a union in 1979. Today, union workers account for just 10.1 percent of workers, representing roughly a twenty percent decline since the early 1980s.

While total union membership has waned, more people are joining, and the desire to unionize is significantly growing. According to the Economic Policy Institute, union petitions increased by 53 percent between 2021 and 2022, and more than 60 million people wanted to join unions but could not do so. It is no secret that some of America’s largest private employers oppose unionization. A May New York Times article detailed efforts by Apple, Trader Joe’s, Starbucks, and REI to stop unionization and their potential use of retaliatory practices and firings to suppress unionization support.

The Writers Guild of America strike (in its third month at the time of this writing) is using its member’s notoriety to draw attention to the stark pay inequity between the front-line workers who produce entertainment and the corporations who reap the lion’s share of the profits. What seems clear is that more people see the benefits of union membership to offset growing income inequality, slow wage growth, reduced paid leave, more costly or limited health benefits, and other workplace challenges.

Organized labor represents more than collective bargaining power. Unions offer a form of community, identity, and safety net. At a time when mental health disorders, substance use disorders, and deaths of despair are at record levels, belonging to an organization that provides a degree of fellowship, protection, and resources may seem more meaningful than ever.

Chris Carlough, a national labor leader, educator, and mental health advocate, comes from a long line of union members. To Carlough, the appeal of unions is fundamentally unchanged — greater negotiating power leads to better contracts, better wages, and a more level playing field. What is new, however, is the ability of unions to make a vital resource available to millions of Americans in need — mental and behavioral healthcare.

“Growing up, I remember my grandfather telling us, ‘Never trust a man who doesn’t drink,’ and that was a message that stuck with me during my formative years,” says Carlough. “The idea that using alcohol or other substances to cope with physical or psychological pain is deeply ingrained in some workplace cultures.” Carlough points to high rates of substance use disorder among some industries with high union representation. The Substance Abuse and Mental Health Administration reports that 17.5 percent of miners and 16.5 percent of construction workers have heavy alcohol consumption or alcohol use disorder. “There is a culture of acceptance, and it is a means of coping with the physical pain that comes with the job and emotional pain that comes from childhood or other trauma picked up along the way. These are careers in which injury is fairly common. Someone may fall from a ladder, for example, and the unspoken response from co-workers is ‘this is a no-pain zone’ or ‘rub some dirt on it’ and get back to work,” says Carlough. “This is exactly the kind of thinking and behavior that leads to substance abuse. People have been injured but feel like they would be considered weak if they saw a doctor. So, they drink, misuse prescription medicines, or take illicit drugs to cope with the pain. But they have not treated with the underlying injury, and the pain persists, and so does the substance use.”

Injury is one of many factors that can lead to substance use and mental health disorders. Many workers are exposed to various stressors, including job insecurity, fear of being replaced by technology or automation, the need to be retrained for new jobs, an inability to save adequately for retirement or to fund daily life and childcare, and more. People are even reporting more anxiety about existential issues like climate change and societal ones like political unrest. Many factors are converging to exacerbate stress and anxiety, leading more people to seek relief through substances or unhealthy behaviors.

Today, Carlough and his colleagues are working to change how union members think about mental health and substance use disorders and improve access to high-quality care. Carlough is the coordinator of the SMOHIT SMART MAP program, a mental health awareness, and peer-led action program that highlights the issues associated with all mental health issues with a particular focus on substance use disorder and suicide prevention and trains union members to help fellow members and their families in need to access those resources. Carlough travels the country, providing education and training and spending time with union leaders and members to dispel old thinking, reduce stigma, and normalize treatment. Another focus is overcoming some remnants of toxic masculinity that can still be found throughout the workforce, which can make it harder for people to admit that they are struggling and seek help. “It helps when I tell people, ‘Me too,’ as in I have struggled with mental health issues, and I share some of that vulnerability relating to my own alcoholism and addiction and how I got the help I needed, so maybe they can too.”

The SMART MAP Peer training takes trusted, respected, and empathetic union workers, from apprentices to long-standing journey-level tradespeople who want to help and enlist them into this service. “Your union brother and sister can make the difference. Part of what we do is train our members to simply ask people how they’re doing and not take someone’s first answer at face value. We want them to dig a little deeper to elicit an authentic response. If someone can feel safe and comfortable telling you that they are feeling down, are in pain, or are having other problems, that is the first step toward getting them help — help that might save their lives and the lives of their family members. We also work to ensure that everyone from peer support to company owners and union representatives are aware of all available resources and how to access them to get people into treatment. Not only can this help people feel that reaching out for help is normal, but that they are supported compassionately throughout the entire process.”

Carlough also connects unions with high-quality treatment providers and employee assistance programs (EAPs) to ensure union members receive the quality and range of services needed. “Not all treatment providers are the same, and people may need access to multiple levels and types of care. Unions control significant health plan funding, and this can be used to create beneficial relationships with the best medical providers. We want to ensure that when members feel comfortable getting help, they get the excellent, evidence-based treatment from experienced caregivers all workers deserve. We need effective treatment that addresses root causes and helps people access the continuum of services and resources they need to get the mental healthcare they need or to enter and stay in recovery.”

When Carlough wanted to increase education efforts for union members, he tapped long-time friend and Foundry Steamboat CEO Ben Cort. Cort and Carlough have collaborated to develop education and find appropriate treatment partnerships for organized labor unions nationwide. Now, Cort is interested in ensuring that Foundry Steamboat’s trauma-integrated care is available to union members who could benefit from it. “Unions are a vital part of this country’s labor force and are lifelines for millions of American families. Union members, including first responders, are at risk for witnessing or experiencing physical and psychological trauma and need appropriate treatment to be easily accessible. I want to ensure that in addition to educating unions about how to connect members to excellent treatment resources, we are doing all we can to make our unique trauma-integrated care model available and accessible to as many union members as possible.”

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