Feature Article

Project 95-Broadbrush: Lessons for Today, Part I

By Jim Wrich

Forty-five years ago, two representatives from each state traveled to Pinehurst, North Carolina to participate in a three-week training program that was to ultimately change the landscape of workplaces in America and around the world. In time, this disparate group came to be known as “The Thundering 100”. 

They were called upon to meet a challenge which had long vexed medical professionals, corporate managers, and the criminal justice system. It had ruined millions of families and careers, created consternation in the workplace, swelled jail cells and hospital emergency rooms and left lasting scars on both the individuals who were afflicted and their loved ones. The challenge was to intervene earlier in the progression of alcoholism. That meant not waiting until an alcoholic had gone all the way to the bottom of the heap, through hospitals, jails, and mental institutions. They would be trained to recognize the earlier, subtler signs and symptoms to trigger an intervention while the alcoholic still had a job, a family and some modicum of self-respect. The setting would not be the streets or courtrooms but the workplace. 

Several years earlier, a terminally ill alcoholic truck driver in Iowa in the depths of despair, was slumped down in his bathtub with water up to his throat and the barrel of a loaded pistol in his mouth. For reasons not entirely understood, he decided to give life one more chance. After finding God and AA. he went on to ultimately serve three terms as Iowa’s governor and one term in the US Senate. As a recovering alcoholic, Harold Hughes became a bigger than life figure. While only a freshman Senator, he was the prime mover in establishing the Comprehensive Alcohol Abuse and Alcoholism Treatment and Rehabilitation Act of 1970 – Public Law 91-616. Known as the Hughes Act, it established The National Institute on Alcohol Abuse and Alcoholism (NIAAA). In the following session, he shepherded PL 92-255 through congress to create the National Institute on Drug Abuse (NIDA).

The training at Pinehurst was part of a grand scheme launched by NIAAA to earlier identify alcoholics nationally. By then research was confirming the incidence and prevalence of the problem in the general population, its enormous public costs and its wide swath of personal and family destruction. In contrast to this bleak picture, there was a growing belief among a small group of pioneer treatment providers and recovering alcoholics that recovery was not only possible but likely if the disease was treated earlier and as a primary illness using a multi-disciplinary approach that addressed its physical, emotional, and spiritual dimensions. 

Developed in the 1960s by Dan Anderson, PhD. and Nelson Bradley, MD, this approach later became known as the Minnesota Model of addictions treatment. It departed from typical treatment practice at that time, which was largely based on false assumptions. Each of the major disciplines had their own take on alcoholism and how to treat it:

* The psychological approach saw alcoholism as a symptom of a deeper underlying disorder needing to be addressed first before the alcoholism could be successfully treated. 
* The medical approach subscribed to the disease concept provided there was tissue damage, such as cirrhosis of the liver or brain damage. 
* The social work model viewed alcoholism as the result of sociological conditions – poor parenting, bad environment, and other factors – all of which were largely beyond the ability of either the patient or therapist to change. 
* Finally, there was the psychiatric approach, which for all practical purposes viewed alcoholism as a valium deficiency.
All of these methods mistook the effects of the disease for its causes while seeing the alcoholism as second or third in importance behind whatever disorder the practitioner had been personally trained to treat. And that disorder was never alcoholism.   

The Multi-disciplinary Treatment of Addiction
By 1972, outcome data from Hazelden and other treatment programs began to accumulate on the multi-disciplinary approach that reinforced long-held anecdotal information from members of Alcoholics Anonymous: recovery was possible and the right kind of intervention worked. The Minnesota Model utilized all of the essential professional disciplines organized in a coherent protocol. It focused first on alcoholism as a chronic, primary disease and second on the medical, psychiatric, psychological, spiritual, and sociological features which attended it. It also recognized that some people had what would later be termed a comorbid disorder – two or more primary illnesses which exacerbated each other, each of which needed to be addressed if recovery from the others was to be fully realized. When acute medical and psychiatric conditions were present, they were addressed beforehand to avoid a crisis and better enable the patient to respond to the alcoholism treatment protocol.  

This protocol translated into a new kind of treatment team that included medical staff, a psychologist, a clinical social worker, and clergy. Most notably, the leader of the treatment unit itself was a recovering alcoholic who had been trained in effective counselling techniques and who through first-hand experience was intimately familiar with the ways alcoholics could deceive themselves and others in order to continue drinking. Anderson and Bradley recognized the critical importance of modeling recovery and knew that the experience of a recovering person could not be replicated in a classroom. 

From the Streets to the Workplace
Prior to Pinehurst, NIAAA had put together a crack team of professionals and lay people who really understood the disease of alcoholism and how alcoholics were accessing both to AA. and formal treatment. Self-proclaimed as “The Dirty Thirty”, one member was Don Godwin who was to become the Chief of the Occupational Programs Branch of NIAAA. In the forward to my first publication, “Project 95-Broadbrush”, he wrote: 

“The statistics are staggering and, sadly, the increased number of people becoming afflicted each year exceeds the number…who begin a recovery program for the first time.” He continued, “Unfortunately, AA. and other programs have no choice but to deal with people who have reached the acute stages of the illness because our current system takes so long to identify the problem. The reason…is that fewer than five percent of the alcoholic population fit the skid-row derelict stereotype which is the current image the general public has of an alcoholic.” 

He went on to say that the employment setting offered a new approach which could provide the earlier identification so badly needed. The premise was that only five percent of alcoholics were on skid-row, the other 95% were in the workplace, thus the term “Project 95.” More important was the belief that by the time someone had lost their family, health, job and often their freedom, they had largely lost their motivation to stop drinking even if they realized it was slowly killing them. 

Of all the referral resources – family, friends, clergy, medical professionals, therapists, courts – far and away the one which “The Dirty Thirty” considered most promising was the employer. For starters, the last thing an alcoholic wanted to lose was his job because it not only represented the last vestige of self-respect but provided the money needed to continue to drink. Moreover, the disease had often progressed to the point that there were serious money problems. With the prospect of getting fired, the idea of quitting drinking became more palatable and the involvement of a recovering person in the workplace helped light the lamp of hope. 

The employer, on the other hand, had a vested interest that other institutions such as courts and churches did not have – the bottom line. As the research rolled in, the impact of alcoholism on corporate profit was stunning. On the level where the work was performed, enlightened managers and their union counterparts had long recognized that a small percentage of employees were causing the preponderance of their headaches. Usually excessive drinking was involved and customary disciplinary measures seldom yielded a permanent solution. Most importantly, the structured characteristics of the workplace provided defined boundaries, which employees without personal problems could work within, but which alcoholics found increasingly difficult to navigate. 

So there we were at Pinehurst, roughly one hundred of us.  NIAAA offered Single State Agencies created by the Hughes Act grants of $50,000 per year to fund two Occupational Program Consultants, one for the private sector and the other for the public employers. About half of us were recovering alcoholics who knew a lot about alcoholism and little about anything else while the other half were professionally trained—nurses, clinical social workers, psychologists, MAs in counseling, medical doctors -- who knew a lot about a wide range of personal problems but very little about alcoholism.

Getting Acquainted
At first, there was competition and suspicion with each group enamored of its own rectitude and painfully eager to teach the other what it absolutely knew they needed to know. This was especially true of the recovering folks, of which I was one. It may have been the only place on earth where a group of drunks could feel superior to professionals and we were enjoying our moment. When we had been in the throes of our disease, many of us had personally experienced the futile efforts of professionals untrained in alcoholism.  We were true believers: We knew that we knew!  And we certainly knew that they didn’t know. On the other hand, some of the professionals had trouble fathoming how anyone could even dream of sending an unpolished motley crew like us out to meet captains of industry. 
Fortunately, we had a splendid leader who saved us from ourselves. A silver-haired father figure who was the Acting Chief of the Occupational Programs Branch of NIAAA, Will Foster, was a recovering alcoholic himself and read the scene perfectly. A few days into the training, he addressed “... the alkies in the room …” at a plenary session. Noting our “… superiority complex …” and using biological terms that had no medical significance, he told us to knock it off. He told us that we were experts only about our own recovery.  With greater refinement, he also told the professionals to learn from the alkies because, theories aside, we had “… been there …” They needed what we had to offer – our experience, strength and hope – and above all our commitment. And, no course of study could impart that to them. 

There is nothing like a good shot of humility to clarify things and engender appreciation for the views of others. We jelled as a group and the divisions evaporated. Together, we developed the quiet sense of urgency that is felt by recovering people who know what the end will be for the suffering alcoholic who struggles in a downward cycle trying to use their own unaided will to reduce the consequences of their disease. We couldn’t be casual about alcoholism – untreated a tragic end was inevitable. At the same time, as a group we broadened and deepened our awareness of the many psychiatric and social factors that would affect our main objective to not just get a person on the road to recovery but to keep them there. This would require dedication and a depth of study that went beyond any narrow, personal anecdotal experiences. 

Above all, we needed to be professional, and we had great instructors from labor, industry, and the field of alcoholism who pointed us in the right direction.  Looking back, we were giving each other the best we had of ourselves. By the time we completed our formal NIAAA training 18 months later in New Orleans, we had become so close that we didn’t want it to end. So we formed OPCA – the Occupational Programs Consultants Association – which met as a group for many years thereafter at the annual EAPA convention.  

The Challenges and the Excitement
In the months and years that followed we addressed many crucial questions all the while sharing what we were learning through direct experience. Paul Roman, a young PhD from Tulane University, followed our progress from the beginning and developed what was to become the CORE technology for the field. It was ultimately incorporated into the program standards of both professional associations, EASNA and EAPA. In 1972, led by Maryland and Minnesota, state legislatures began to mandate treatment of alcoholism, drug addiction, and mental health issues. Until then, insurance companies refused to cover “mental and nervous disorders” and alcoholism was one. And in 1974, the Joint Commission on Accreditation of Hospitals promulgated alcoholism treatment standards, which brought respectability to the treatment field. 

Alcoholism Only or Something More?
The first major issue we wrestled with at Pinehurst and throughout the 1970s was the type of program we would promote. A number of companies had tried with varying degrees of success to address workplace alcoholism by training first-line supervisors in the signs and symptoms of the disease, using them to intervene directly and to refer those whom they thought were alcoholics to an in-house recovering AA member. Pioneering companies such as DuPont and Eastman Kodak had experienced the remarkable transformation AA could make in a person’s life, this approach was known as a “Straight Alcohol Identification Program.” 

As time passed, it became apparent that while dramatically helping some alcoholics there were problems with this strategy. First, supervisors were hard to train and it didn’t last long. It wasn’t a natural part of their function as managers. They did not have occasion to use what they had learned often enough to get good at it. Not wanting to “accuse” someone of being alcoholic, they usually waited until late stage symptoms emerged. Then, in spite of the training, the decision to intervene was largely subjective and its implementation was inconsistent. Supervisors with strong religious beliefs regarding drinking might see a problem everywhere, while those who had a drinking problem themselves did not see it anywhere. Of equal importance, even though alcoholism afflicts employees from top to bottom in an organization, no one above the first-line supervisory level was ever identified. First-line supervisors simply do not confront senior executives on personal matters. Finally, threatening to fire someone because of a medical condition was illegal and led to the possibility of a lawsuit or union unrest. 

Eventually the strategy moved towards identifying job performance and attendance problems and using these as the trigger to refer people. We thought supervisors would be comfortable in an area consistent with their natural role. More than anything, the appearance of a “witch hunt” could be avoided. Referred to as the Job Performance Alcohol Identification Program, it too was fraught with problems. Supervisors were admonished not to diagnose alcoholism or even discuss it but to stick strictly to job performance. But, the person to whom they were to refer the employee was an alcoholism paraprofessional. Moreover, it didn’t take into account that not all employees with performance problems suffered from alcoholism – in fact, at least half did not. But there was another alternative presented to the OPCs at Pinehurst. This model will be discussed in part two of this three-part article. 

NEXT ISSUE: An enduring model, accountability, mountains and valleys.

Jim Wrich is one of the pioneers of Employee Assistance Programs (EAPs) - one of the original Thundering 100 who launched the modern EAP movement through Project 95-Broadbrush. In 1972, Jim implemented some of the first EAPs in the country. An early member of ALMACA, (later the Employee Assistance Professionals Association,) he served as First Vice President and was the founding President of the Employee Assistance Society of North America (EASNA). Since 1987, he has managed his own firm, J. Wrich & Associates, LLC. (JWA), a health systems performance company that provides a broad range of consulting and cost analysis services to businesses and unions.