Years ago, when alcoholism was first being described as a family illness, "Conspiracy of Silence" and "A Merry-Go-Round Named Denial" were phrases used to describe it. These phrases tried to capture the way in which the behavior of all members of the family contributed to the seriousness and chronic nature of the individual's alcoholism.

Throughout the development of protocols to work with "family systems," it became increasingly apparent that members of the family were much more at risk of developing a chronic illness as a result of living in this "toxic" system. They were seen to be more frequently represented on disability rolls, and users of health benefits, than the addicts themselves. This clearly was shown to be a situation where the whole family becomes "sick." Treatment outcome studies repeatedly produce evidence showing that treated individuals who return to a family which has not received any type of family care will relapse with greater frequency and severity. The toxic nature of the system can't be ignored as it is clearly a predictor of future problems - for all of the members.

Working in a treatment facility whose patients are mostly from the ranks of employed people suggests that in terms of early interventions (and prevention), workplaces have not made much progress in 30 years. The staff often wonders how it is that individuals who check in can be in such a state of total medical, psychological, social and spiritual deterioration as a result of his or her "crack" use (or cocaine, alcohol, marijuana, heroin, etc, etc., etc.) when only two days ago were at his or her job at the plant (or insurance company, government office, school where we they teach, or the hospital where they work). Quite often they had been performing, or supposedly performing, in safety-sensitive operations.

Shortly after these patients are stabilized and we can begin to gather information about their addiction and the history of their substance use, it becomes all too apparent that this has been an issue for a long time. What is more telling perhaps is that others have also been at least vaguely aware that there were difficulties. Recently, when helping an organization come to terms with the overdose death of one of its employees, it was frequently stated that "you could see it coming" or that it had been "just a matter of time."

Reducing the tragedies and the increasing risks presented by unrecognized, untreated and under-treated substance use disorders requires that we rethink how this occurs in organizations.

The idea that a policy which includes drug testing in its various forms will effectively resolve this complex health issue is like thinking that charging impaired drivers cures the nation of alcoholism. It may be a necessary piece of policy but it is certainly not a remedy. Employee Assistance Programs gained legitimacy by providing some good work with alcoholic employees over the years. However, most of these programs have evolved to the point to where they provide sound, often effective, voluntary and confidential services to employees and family members - but not to addicts and alcoholics or their families. Recognizing the need and voluntarily seeking help is something that addicts are not fond of doing. In fact, when we get them into treatment centers, they often spend the first two weeks trying to convince everyone they don't need to be there!

Real progress occurs when the organization borrows from family systems work and begins to see that the entire organization is involved in that same old conspiracy of silence and is on its own merry-go-round. After all, workplaces really are much like big families. As such, they are prone to suffering from the same things that cause distress (and illness) in all families. It has also become evident that like all those members of the addicted family who become the "walking wounded" from a host of stress-related illnesses, the inability of an organization to bring resolution to problems in this area results in the same toxic environment with the same results that we see in other families. Namely, other people getting sick and often less than satisfactory treatment outcomes become the norm.

Transplanting the knowledge and protocols that have long been producing outstanding outcomes when professionally applied to families who suffer from an addict's behavior has been done with an organizational strategy called Courage to Care. This process combines family systems work with an understanding of labour relations issues, production values, union mandates, treatment requirements and return-to-work processes into a powerful, comprehensive strategy. This can be a surprisingly quick way to bring resolution to substance use problems and clear the organization of those behaviors and attitudes that contribute to a toxic culture.

The family illness approach to addiction focuses on building a "healthy" family - a family where individual members flourish and the family no longer tolerates an addict who is not willing to recover. Even when the addict does not recover, the family will achieve health, for its members and the family as a whole. It seems to me that the goal for the workplace should be the same.