oversight

Most Agency Programs for Employees with Alcohol-Related Problems Still Ineffective

Published by the Government Accountability Office on 1977-09-07.

Below is a raw (and likely hideous) rendition of the original report. (PDF)

                                                                     M?&7?-75
                             &. , ,                                  -b-       7   7
REPORT                     T                          CQNGRESS


BY THE COMPTROLLER GENERAL
OF THE UNITED STATES
                                                      111111111111111811
                                                          LM103492




Most Agency Programs For
Employees With Alcohol-Related
Problems Still Ineffective
In December       1970 a law was enacted re-
quiring Federal agencies to establish programs
to assist civilian     employees  with alcohol-
related problems.      The agencies have made
relatively little progress.

Officials at most of the 81 installations of 12
agencies reviewed support Government         assis-                        /
tance to civilian employees with alcohol-re-
lated problems.       Nevertheless  management
attitudes   concerning    problem alcoholism    at
their installation   was the major reason for a
general lack of emphasis on alcoholism        pro-
gram activities.




HRD-77-75
                                                  SEPi.        ?, I. 977
             --Agencies        and departments          should  (1) take
                more care        in selecting      coordinators        inter-
                ested in       the programs      and qualified         for the
                positions,         (2) arrange     training,     where
                necessary,         for those coordinators          already
                assigned,        and (3) make sure that coordina-
                tors have        enough time and resources             to
                carry    out     their   responsibilities.           (See
                ch. 5.)
             --Agencies     and departments      should do more to
                educate   supervisors     about program operations
                and to inform     nonsupervisors      about the pro-
                gram.    This should    include    a mechanism for
                making sure that new employees          are trained
                or informed.     (See ch. 6.)
             --Where    applicable,     the Civil   Service    Commis-
                sion,   the Office     of Management and Budget,
                and heads of agencies         and departments     should
                develop    cooperative     programs   serving   more
                than one agency in a common area.             (See
                ch. 8.)
             --The Civil        Service   Commissission        and the
                agencies       and departments     should      put more
                emphasis       on program monitoring.           (See
                ch. 9.)
              If department      and agency heads do not
              take the necessary        actions     to develop      effec-
              tive programs      after    a reasonable     period      of
              time the Congress should explore             legislation
             giving    the Civil      Service    Commission     more'
             authority    to require        agencies   to do so.
             (See p. 66.)
             AGENCY-COMMENTS
                                                                   ~~~664     27
             Written   comments from the Office        of Management
             and Budget,   National    Council     on Alcoholism,     iXeQSG3%-
             and the Civil    Service   Commission,      and informal
             comments of the agencies       visited,     were con-
             sidered   in this report.      (See app. VI
             to VIII.)
             The Civil   Service    Commission  stated   that
             studies   of the type recommended by GAO to
             more accurately     define  the extent    of the

Tear Sheet                                   iii
problem will    be discussed   with the National
Institute    on Alcohol   Abuse and Alcoholism.
(See p. 8.)
The Commission      advised        GAO that   it
--is    developing     guidelines    for employee
    assistance     programs     (see p. 22);
--agrees      that the dual assignment          of discipli-
   nary and program responsibilities              may:appear
   to be a conflict         of interest,     but believes
   organizational        placement     cannot always be
   centrally      decided     (see p. 22);
--does    not see the need to develop                a uniform
   recordkeeping    system throughout              the Govern-
   ment (see p. 41);
--agrees  that coordinators    are a pivotal,        and
   often weak, part of a program's      operation
   but is not certain    that more uniform      training
   is the correction   needed (see p. 42);
--recognizes      that unions can have a marked
    effect   on programs   and advises agencies to
    seek union involvement     (see p. 32);
--agrees     with the need for agencies     to take
   more care in selecting     coordinators,
   arranging     training for them, and making
   sure they have enough time and resources
   to carry out their     work (see p. 41);
--agrees   that cooperative      programs could work
   for some locations      and is working  with
   local Federal    Executive    Boards to establish
   these programs     (see p. 63); and
--has   instituted  yearly  evaluation      visits      to
   the headquarters    of Federal    agencies      that
   employ 1,000 or more people.         (See p. 66.)
The Office      of Management and Budget agrees
that the program needs improvement         and that
closer     adherence  to Civil  Service   Commission
guidelines      would greatly  help program effec-
tiveness.       (See app. VI.)


                              iv
COMPTROLLER GENERAL'S                                         MOST AGENCY PROGRAMS
REPORT TO THE CONGRESS                                        FOR EMPLOYEES WITH
                                                              ALCOHOL-RELATED PROBLEMS
                                                              STILL INEFFECTIVE

             DIGEST
             ------
             How many civilian        employees     in the Government
             have alcohol-related         problems?      No one knows
             precisely,      but experts     generally    agree that
             the problem      is major.       In 1971 agencies       and
             departments      were required      to start    programs
             to help employees with alcohol-related                prob-
             lems.      Congressional     hearings     in April    1974
             showed that,       in general,     agencies   and depart-
             ments had done little          to get effective       pro-
             grams started.
              Although    almost.all   81 installations          reviewed
              had programs,      many improvements       are necessary
              before   they can be considered         effective.
              Many programs     emphasized   alcoholism and drug
              abuse problems.       A large number were designed
              to help employees      with any problem that
              could affect    their   work.
              Most installation          directors      agree with having
              a Federal       alcoholiSm      program;     however,    some
              did not see alcoholism             as a problem at their
              installation.           (See ch. 4.)       This attitude
              appeared      to be a major reason for the slow
              start     of, and a general          lack of emphasis on,
              some programs.
              Problems          are        related   to the
              --organizational                  placement     of the   program
                  (see ch. 3),
              --selection            and qualifications           of coordinators
                  (see ch.          S),
              --time         and resources           spent    on the   programs
                  (see       ch. S),
              --efforts     to train   supervisors                and educate
                 nonsupervisors      about program                activities
                  (see ch. 6),

Tear Sheet.  Upon removal,    the report              i                             HRD-77-75
cover date should be noted    hereon.
            --appropriateness        of each        installation       con-
               ducting     its   own program        (see ch. 8),       and
            --emphasis      on monitoring         the program       (see
               ch. 9).
            While programs varied           among agencies    and
            within    the same agency,        the Defense Department
            agencies     generally      appeared   to do more to                       /
            conduct     effective     programs.      This report     +4Gc"'0bs
            discusses      some of the more successful           Federal
            and non-Federal        programs.      (See ch. 7.)
            RECOMMENDATIONS
            --The Civil      Service   Commission    should take the
f+ Lx          initiative      in conducting    or sponsoring
 mo,    3      studies    to more accurately      define   the extent
               of alcohol-related       employee problems.       (See
               ch. 2.)
            --Agency     and department         heads should strongly
               consider     establishing        broad-based         employee
               assistance       programs within        the scope of
               services     permitted       by current      Civil      Service
               Commission       guidelines.        Further,       if organi-
               zation    location       is considered       a problem,
               managers should consider             removing        these
               programs     from the personnel           department        or
               taking    other actions        to alleviate          employee
               concerns     about program location.                 (See ch.     3,)
            --Agency     and department         heads should actively
               and positively        support     the agency's  program
               and guarantee       that program directors
               reinforce     their    position.       (See ch. 4.)
            --The Civil      Service    Commission   and the agency
               and department       heads, were applicable,
               should encourage       more active    consultation
               with employee unions on policy           and program
               formulation     and encourage      employee labor
               organizations       to take a more active        role
               in these programs.         (See ch. 4.)
            --The Civil     Service     Commission   should develop
               more specific      guidelines     for the type of
               training    coordinators      should receive   and
               the information       that should be included      in
               client   records.       (See ch. 5.)

                                            ii
                    COMPTROLLER     GENERAL     OF      THE   UNITED   STATES
                                  WASHINGTON,    D.C.     20548




B-164031(2)



                                                                                    \
                                                                                 oa”
                                                                            o”
To the President of the Senate and the                                 CJ-?
Speaker of the House of Representatives
       This report       describes      the Federal         departments'     and
agencies'     efforts     to establish           programs    to assist    civilian
employees     with alcohol-related               problems.       These programs
are to be established            pursuant        to title    II of Public       Law
91-616.      The report      describes         the programs       being developed,
the resources        devoted     to those programs,            and program-activ-
ities   at various       Federal     facilities.           The report    also ex-
plores    the attitudes        of agency officials             toward alcoholism
and the programs         established         to combat it.
       We made our review pursuant  to the Budget and Accounting
Act   of 1921 (31 U.S.C. 53) and the Accounting   and Auditing
Act   of 1950 (31 U.S.C.  67).
       We are sending    copies of this     report to the Director,
Office   of Management and Budget;       the Chairman,   United   States
Civil   Service   Commission:   and the heads of the departments
and agencies    included    in our review.


                                                          i!fiL4        nw
                                                        Comptroller   Generil
                                                        of the United   States
             The Office    of Management and Budget endorsed
             GAO's suggestion     that cooperative programs
             serving    more than one agency in a common area
             be developed.      (See p. 63.)
             The National      Council    on Alcoholism         agreed with
             the conclusion      that alcohol        abuse and alco-
             holism    among Federal      civilian      employees     seems
             to be prevalent.          (See p. 8.)        The National
             Council    on Alcoholism      disagreed        that employees
             suffering     from alcoholism         would be more will-
             ing to seek assistance           in a broader-based
             program and that strong            consideration       be given
             to establishing       broader      employee assistance
             programs.       (See pp. 22 to 24.)




Tear Sheet
                                            V
                         Contents
                                                                  Page
DIGEST                                                              i

CHAPTER
   1      INTRODUCTION                                              1
              Prior  review of Federal    efforts            to
                 combat employee alcoholism                         1
              Scope of review                                       2

   2      EXTENT OF ALCOHOLISM PROBLEMS AND
            NEED TO DEVELOP PROGRAMS FOR FEDERAL
            CIVILIAN     EMPLOYEES
               Extent    of the problem
               Need for programs
               Conclusions
               Recommendation     to CSC
               CSC and NCA comments
                  CSC comments
                  NCA comments
   3      TYPES OF PROGRAMS BEING DEVELOPED AND
            THEIR EFFECTIVENESS                                    10
              Types of programs             being developed        11
                 Comparison        of programs                     11
                 Employee assistance             programs:
                    differing        views                         13
              Programs'       effectiveness         in getting
                 alcohol      abusers       into treatment         17
              Organizational           location     may deter
                 program use                                       18
              Have employees           benefited      from
                 treatment?                                        19
              Conclusions                                          20
              Recommendations            to department      and
                 agency heads                                      21
              CSC and NCA comments                                 22
                 CSC comments                                      22
                 NCA comments                                      22

   4      MANAGEMENT AND UNION PROGRAM SUPPORT                     26
              Management's     attitude:    a factor  in
                effective    programs?                             26
              Resources    and space utilized      by
                programs                                           27
                                                                  Page
CHAPTER
               Coordinators'        and union representa-
                 tives'      perceptions    of management
                 support                                           28
               Supervisors'       and nonsupervisors'     per-
                 ceptions       of management support              29
               Union support        of employee alcoholism
                 programs                                          30
               Conclusions                                         31
               Recommendations         to department  and
                 agency heads                                      31
               CSC and NCA comments and our evalua-
                 tion                                              32
                 CSC comments                                      32
                 NCA comments                                      32

  5       COORDINATORS--SELECTION,            QUALIFICATIONS,
            AND RESPONSIBILITIES                                   34
              Coordinator      selection                           34
              Coordinator      qualifications                      35
              Time spent on program activities                     37
              Liaison     with community-based
                 organizations                                     38
              Recordkeeping                                        39
              Conclusions                                          40
              Recommendations         to department     and
                   agency heads and CSC                            41
              CSC comments                                         41
  6       EFFORTS TO INFORM AND TRAIN THE WORK FORCE               43
              Coordinator     awareness                            43
              Coordinators'      efforts     to educate and
                train     the work force                           43
              Supervisors'     responses       concerning
                awareness     and training                         44
              Nonsupervisors'       responses      to awareness
                and education       efforts                        47
              Nonsupervisors'       willingness       to
                participate      in program                        48
              Conclusions                                          49
              Recommendations       to department        and
                agency heads                                       49
              NCA comments and our evaluation                      49
  7       SUCCESSFUL PROGRAMS                                      51
              Effective   programs outside  the
                 Federal  sector                                   54
              Conclusions                                          56
              NCA comments and our evaluation                      56
                                                                      Page
CHAPTER
   8         ALTERNATIVES TO EXISTING PROGRAMS                         58
                 Cooperative        efforts    not considered          58
                 Officials'       views concerning       coopera-
                     tive programs         in Federal   buildings      59
                 Possible     alternative        to separate
                    programs                                           60
                 Federal    Executive        Boards and Federal
                    Executive       Associations                       60
                 FEB local      initiatives                            61
                 Conclusions                                           62
                 Recommendations           to CSC, OMB, and
                    department        and agency heads                 62
                 CSC and OMB comments                                  63
                    CSC comments                                       63
                    OMB comments                                       63

             CSC'S ROLE IN IMPLEMENTING AND EVALUATING
               ALCOHOLISM PROGRAMS                                     64
                 CSC's responsibility            and authority         64
                 CSC monitoring       activities                       65
                  Conclusions                                          66
                  Recommendation      to Civil      Service    Com-
                    mission   and department         and agency
                    heads                                              66
                  Recommendation      to the Congress                  66
                  CSC comments                                         66

APPENDIX
         I   Agencies    reviewed                                      67

    II       Signs   of deteriorating          job    performance      69
  III        Flow of typical        employee      through    the
                program                                                70

    IV       Effectiveness      of programs          reviewed   in
                getting    alcohol   abusers         into treatment    71
        V    GAO reports  on Federal           activities      to
               combat alcohol  abuse                                   72

    VI       Letter   dated April     14, 1977, from Assist-
                ant Director,     Executive   Development  and
                Labor Relations     Division,   OMB                    73

  VII        Letter   dated May 13, 1977, from Director,
                Bureau of Retirement,   Insurance, and
                Occupational   Health, CSC                             75
                                                                               Page
  APPENDIX
   VIII      Letter    dated April    5, 1977, from Managing
                Director,    Washington   Office,  NCA                          79
        IX   Principal     OMB and CSC officials          respon-
                sible   for administering      activities
                discussed    in this    report                                  86
                               ABBREVIATIONS

  AFL-CIO    American     Federation     of Labor-Congress             of
               Industrial      Organizations

  csc        Civil      Service      Commission
  FEA        Federal      Executive        Association
D FEB        Federal      Executive        Board
  GAO        General      Accounting        Office
 GPO         Government        Printing      Office
  HEW        Department        of Health,       Education,      and Welfare

 NCA         National      Council        on Alcoholism
 NIAAA       National       Institute       on Alcohol       Abuse   and Alcoholism
 OMB         Office      of Management         and Budget
                                       CHAPTER 1
                                    INTRODUCTION
        Alcoholism      and alcohol      abuse are among the biggest                social
and economic problems          in the United         States      today.      It is
estimated       that there are 9 million            chronic      alcohol     abusers.
Alcohol      is a factor    in half the highway             fatalities       each
y-r r    and    40  to  50 percent     of   all   arrests.          The cost of lost
productivity        due to alcohol       abuse    is estimated         at $10 billion
yearly,      which    does not   include      the   immeasurable         social   costs
of broken families         and poor physical           and mental health.
         To provide       a comprehensive         Federal    program for the
prevention         and treatment       of alcoholism        and alcohol      abuse, the
Congress enacted            Public    Law 91-616 i/       (42 U.S.C. 4551).
Title     II of the law made the Civil                Service    Commission        (CSC),
in cooperation          with the Secretary          of Health,       Education,        and
Welfare      and other        Federal    agencies     and departments,         responsible
for developing           and maintaining        appropriate      prevention,         treat-
ment and rehabilitation               programs     and services       for Federal
civilian      employee alcohol           abusers.      In July 1971, CSC issued
guidelines         to the heads of each department               and independent
agency requiring            them to issue implementing             internal      in-
structions         consistent      with the guidelines.            The guidelines
were purposely           broad to permit        program development          by each
department         and agency that would most likely                 provide     effec-
tive     rehabilitation         opportunities        to employees with alcohol-
related      problems.
PRIOR REVIEW OF FEDERAL EFFORTS
TO COMBAT EMPLOYEE ALCOHOLISM
       At the request       of the Chairman,         Special  Subcommittee
on Alcoholism       and Narcotics,       Senate Committee      on Labor and
Public    Welfare,     we issued a report         entitled   "Substantial
Cost Savings       From Establishment         of Alcoholism    Program For
Federal    Employees"     (B-164031(2),        Sept. 28, 1970).        We stated
that,    based on various        estimates      of the number of employees
with alcohol-related          problems,     the cost to the Federal
Government      due to alcoholism        ranged from $275 to $550 million
annually.

L/The Comprehensive  Alcohol     Abuse and Alcoholism   Prevention,
   Treatment, and Rehabilitation      Act of 1970, approved   December
   31.,   1970.




                                              1
        We also estimated     that for a cost of $5 per year for
each employee --an annual investment            of $15 million--the
Government     could save between $135 and $280 million                  each
year by establishing       programs     for Federal     civilian       employees.
While the $5 estimated        cost that was developed             by the
National    Council    on Alcoholism      (NCA) excludes        the cost of
treatment,     it includes    informing      employees,     training       super-
visors,    and referring     employees     to outside     sources      for
treatment.
        In April     1974 the Special        Studies    Subcommittee      L/ of
the House Committee         on Government        Operations     held hearings
to determine       the progress     made by the Federal           departments
and agencies       in implementing        alcoholism      programs    for civilian
employees,       and programs'     effectiveness        in getting      employees
into treatment.          The subcommittee         found that the programs
ranged from effective          to nonexistent         and that wide variations
existed    among agencies        and among elements          of the same agency
in implementing        these programs.
       The subcommittee       also found that in many cases program
staff   and financial      resources    were insufficient          for effective
program operations.          Although   estimates     of the size of the
problem were not precise,           the subcommittee        concluded    that
most Government       agencies     were reaching    only a small fraction
of the employees       who have performance       difficulties         due
to alcohol    abuse.
       This report   deals with the activities         of the Federal
agencies    in implementing      programs    to assist  employees
with alcohol-related       problems     that have taken place since
the 1974 subcommittee       hearings.
SCOPE OF REVIEW
       We reviewed     the activities         of 26 agencies      at the
Washington     headquarters        level.    (See app. I.)     For each agency
we obtained     information        on the agency's     policy     and proce-
dures,   the resources       devoted      to the program,      the number
of alcohol     abusers    identified        and helped in fiscal       years
1974 and 1975, and the amount of training                 and education
received    by supervisory         and nonsupervisory       personnel.
        For 12 selected    agencies     we visited     a total of 81
installations     located   in various     regions     of the country.
(See app. I.)       At each installation,         data similar   to those

A/Now the    Manpower     and Housing        Subcommittee.

                                         2
at headquarters            were obtained.      In addition,     we spoke to the
installation          director      or his designee,     the coordinator,       and
other      interested       parties    such as union officials,        chaplains,
and medical         officers,       who could have input     into an installa-
tion's       policy     and program.
         We also sent questionnaires          to a random sample of 2,817
supervisors        and 1,599 nonsupervisors         to determine     their
awareness      of the installation's        program,     their   familiarity
with the installation's            policy and procedures,        the extent
of their      education     and training    about the program,          and
their     perception    of management's       program support.         We re-
ceived     responses     from 2,660 supervisors        (94.4 percent)        and
1,456 nonsupervisors           (91.1 percent)     at the 81 installations
visited.
       We also contacted    officials      from the Office      of.Manage-
ment and Budget (OMB), CSC, NCA, the National              Institute     on
Alcohol   Abuse and Alcoholism        (NIAAA),  and experts       in the
field   of alcohol   abuse.
        Finally,     we (1) visited       five programs         outside    the
Federal     Government       considered     by NCA officials          to be effec-
tive    in reaching       and treating      alcohol      abusers     and (2)
discussed        the possibility       of agencies       conducting     cooperative
programs       with various      agency officials         located     in Federal
buildings        in Atlanta,     Kansas City,       Philadelphia,       and
San Francisco.
                                  CHAPTER 2
      EXTENT OF ALCOHOLISM PROBLEMS AND NEED TO DEVELOP
             PROGRAMS FOR FEDERAL CIVILIAN            EMPLOYEES
       In September  1970 we reported         that,    among those inter-
viewed,    there was a  difference      of  opinion     on the prevalence
of alcoholism    and alcohol     abuse,    but   general    agreement    that
the problem was significant.          Estimates      ranged    from  4 to   8
percent    of the Federal    work force.
       Although     we were unable to identify       any studies  esti-
mating the number of Federal           civilian   employees with
alcohol-related       problems,  officials      at CSC and NCA believed
6 percent       was a reasonable  estimate.
       At the installations          visited   estimates     of the extent
of the problem were usually              based on observation.        Based on
their   job-related      experience,       many installation      coordinators
estimated      the problem     to be greater      than that estimated         by
the installation       directors.
EXTENT OF THE PROBLEM
        During our review NCA and CSC officials          said that 6
percent.of      the Federal  civilian   work force    is a reasonable
estimate     of the extent   of the alcoholism     problem today.
That is, of the approximately         2 million  Federal     civilian
employees,      about 120,000 suffer    from alcoholism      or alcohol-
related     problems.
        We discussed      this estimate     with program administrators
from 26 departments           and agencies   at the headquarters       level.
Fourteen     agreed that the number of employees             with job-related
alcohol    problems     was at least      6 percent.      Some estimates      were
as high as 10 percent           of the total    population;     others   stated
that 6 percent        was too high for their         agency.    Some reasons
for the lower estimates           were (1) large numbers of law
enforcement       personnel     in their   agency,    (2) high-level
security     clearance      needed for employment,        or (3) general
experience      with agency personnel.
        CSC guidelines        state    that each agency should compile
sufficient      statistical       data to provide        the basis for evalu-
ating      the extent     of alcoholism      problems      and the effective-
ness of their        counseling      program.      Studies    on the extent
of alcohol      abuse among uniformed           personnel     have been
conducted      by some Defense Department             agencies.     These

                                         4
studies   have    shown alcohol      abuse     to be a significant          problem
among military      personnel:
       --One Navy study,       based on responses     from 9,508 sub-
          jects,    showed that 15.6 percent      of the enlisted
          women and 24.3 percent       of the enlisted     men reported
          at least     some lost work time or inefficiency        at
          work during     the 6 months preceding      the study because
          of drinking     or its aftereffects.     For officers,     the
          percentages     were 17.5 for females      and 17.7 for males.
       --An Army study,      based on responses     from 9,910 subjects,
          showed that 20 percent     of officers      and 32 percent  of
          enlisted   men are heavy or binge drinkers         A/, and an
          additional    17 and 35 percent,     respectively,     have
          drinking   problems.    2/
We were unable to identify               similar   studies      conducted   for
civilian        personnel     in any agency.       Some installation        offi-
cials      indicated      that there was little        or no problem at their
installation         because their       employees    were either       (1) more
professional,          (2) located     in geographical        areas where there
was less pressure,             (3) more technically        oriented,     or (4)
more health         conscious.
      For the purpose of our review,    we categorized                    the   extent
of the alcoholism   problem at the various    installations                     as
       --minimal      - 0 to 2 percent        of    total    employees    having
          alcohol-related     problems,
       --moderate       - 3 to 8 percent       of    total    employees    having
          alcohol-related      problems,

L/Classification        of drinking     behavior     was based on responses
   to questions       concerning    the individual's      drinking   behavior
   within      the last   3 years.     "Heavy drinkers"      were defined
   as individuals       who consumed five or more drinks           on 4 or
   more days per week; "binge drinkers"               were defined   as in-
   dividuals      who had been drunk continuously          for more than 1
   full    day at a time.
z/Individuals       with "drinking      problems"     were defined         as those
    who, as a result     of drinking,        encountered    serious        diffi-
    culties    in their  personal     relations      or with their         health,
    jobs,    or the law.




                                          5
         --significant           - 9 percent   or more of employees                     having
             alcohol-related         problems.
The table   below summarizes   how coordinators                          and installation
directors   characterized   the extent   of the                       alcoholism     problem
at their  installation:
                                  Perception    of       the Extent
                                   of Alcoholism           Problems
                                                                                            Do not
        Respondents                   Significant            Moderate         Minimal        know
Installation          director                2%               38%              51%               9%
Coordinator                                  13                42               44                1
        In many instances,   the i:lstallation                      officials   estimated
that the problem was less extensive            than                 the coordinators
thought    it was,    For example:
         --At    five of eight Navy sites,     top management officials
            estimated   the problem to be no more than 3 percent
            percent   of the workforce;    coordinators'  estimates
            ranged from 5 to 15 percent.
         --At    four of nine Air Force installations         and four of
            eight    Veterans   Administration      sites the coordinators'
            estimates      were at least     double those of top installa-
            tion officials.
         At a few sites,           top management officials,                   and in some
cases     the coordinators,           advised that:
         --there      was no problem         at their         installation,
         --no      one admitted       that   they      had a problem,           or
         --they      had not      seen anyone         with    a problem.
       Some specific             installation  official         responses      about
the   extent of the            problem at their      installation         follow:
         --At a western      Veterans      Administration      regional                  office
            the installation       director     stated    that he felt                   per-
            sonnel at the location          did not have a drinking
            problem    because he had an "open door" policy,                             and no
            one had identified        themselves       as an alcoholic.


                                                  6
       --At    a midwestern      Army base, the commanding officer
          stated     that alcoholism    was not a significant        problem
          among civilians        because the civilian     workforce     in
          the midwest       is composed of hard-working       people who
          are not under the same pressures            as people    in dense
          population      areas.
NEED FOR PROGRAMS
       Most installation        officials      (over 85 percent)      believed
that employee alcoholism            problems     should be the focus of a
Federal   program,      however,      half of them perceived       the alco-
holism   problem at their         installation       to consist  of 2 percent
or less of their        total   workforce.
       The table    on page 6 shows that half        the coordinators
believed    that there was at least        a moderate   alcoholism      prob-
lem at their     installation.     Ten coordinators       estimated     at
least    10 percent     of their workforce    had problems      related
to alcohol     abuse.
       Perhaps more significantly,           almost 25 percent  of the
2,660 supervisors         who responded    to our questionnaire    said
they had encountered         a subordinate      with an alcohol problem
at their    installation.        Many of these also said they had
handled more than one case.
CONCLUSIONS
        While studies     on the extent     of alcohol-related   problems
among military      personnel     in the Defense Department     show the
problem     to be significant,       we were not able to identify
similar     studies   among civilian     employees.
        In     our opinion,     the above data and the information
that we        had previously      obtained     from experts     indicates   that
there     is     a need to develop       programs      to assist   employees   with
alcohol        problems    that adversely       affect    their  job performance.
         Based on discussions         with NCA, CSC, and agency officials,
the extent       of alcoholism      and alcohol      abuse among Federal
civilian      employees     appears to be significant.             Although     no
one knows precisely           how many civilian       employees      in the
Federal      Government     have alcohol-related         problems,       more than
half     the officials      responsible     for program development            at
headquarters         agreed that at least        6 percent     of their      employ-
ees have alcohol-related            problems.      Furthermore,        the fact
that 25 percent          of the supervisors       said they have dealt
with a subordinate          who had an alcohol-related           job performance
problem may indicate           that alcohol      abuse is significant.


                                           7
Regardless   of the problem's   size,   effective    programs must
be developed   by the agencies    to identify     and assist  those
employees   who have job performance     problems    that are related
to alcohol   abuse.
RECOMMENDATION-TO CSC
       Since no accurate       data is available       on the extent      of the
problem among Federal         civilian    employees,    we recommend that
CSC take the initiative           in conducting    or sponsoring      studies
to more accurately       define      the extent   of the problem as it
exists    among civilian      employees     in the Federal    service.
CSC AND
      - NCA COMMENTS
CSC comments
       Commenting on our draft    report,    CSC agreed that there
have been no studies    on the prevalence       of alcoholism   among
Federal   employees.   The Commission     stated   that there is
also a lack of similar    studies    among private     or other
public   employees.
        According      to the Commission         studies     cutting   across all
occupational        categories,      grade levels,         geographic   regions,
and sex, age, and minority              groupings      would be useful       in fore-
casting      prevalence      among Federal       employees      and measuring
Federal      program effectiveness.             Further,     the Commission
stated     it believes       similar    studies     among private      and other
public    employees      would also be useful            for comparative
purposes.
         The Commission  said that due to its limited     expertise
to conduct     studies  of this nature,   it would discuss    the
feasibility     of such studies   with NIAAA.
NCA comments
         NCA agreed that the extent               of alcohol      abuse and alco-
holism      among Federal      civilian       employees       appears to be sig-
nificant      regardless      of the fact that over 50 percent                 of the
installation       directors       surveyed       perceived     the alcoholism
problem at their          respective      installations         to be 2 percent
or less of the total           workforce.           NCA stated     that the per-
ceptions      of the installation           officials       are quite     common and
should not necessarily             be viewed as a valid            assessment      of
the extent       of alcohol      abuse and alcoholism             among Federal
civilian      employees.         According        to NCA, installation         offi-
cials     and their     counterparts        in the private         sector   often


                                          8
lack a basic understanding              of alcoholism       and therefore         dis-
count its presence          because they can't          readily     observe     it.
NCA said that if these individuals                 possessed       a better
understanding         of alcoholism,       they would recognize           that,
although      alcoholism      in itself      is not readily        observable
until    its late or chronic           stages,   it will,       even in its early
stages,     produce     a pattern     of deteriorating          job performance
readily     observable      to any reasonably         alert     supervisor.




                                           9
                                      CHAPTER
                                      --------- 3
                     TYPES      OF PROGRAMS BEING DEVELOPED
                     ---1-------------------------
                             AND     THEIR EFFECTIVENESS
                             --------------------
        CSC guidelines        prepared     in July 1971 required            agencies
to establish        programs     to assist      employees with alcohol-related
problems.         These guidelines      were updated          in June 1974 to
include      drug abuse problems.            The guidelines        are purposely
broad to enable each agency to develop                    its own program to
assist     individuals      who have these problems.               The alcoholism
program supplements           existing     disciplinary        procedures       for
dealing      with problem employees.              The program's       objective     is
to rehabilitate,          in a nondisciplinary           environment,       employees
who have a disease.             CSC, however,        did not remove the agencies'
prerogatives        to discipline      an employee if his job performance
continued       to decline      and he refused         to enter a program.
       Employees enter a program either        voluntarily    or by being
sent to the coordinator        by a supervisor    who noticed    (and
should have documented)        a deterioration    in the individual's
job performance.      Specific    examples of deteriorating       job
performance    can include:
       --increased        tardiness       and absenteeism;
       --missed       deadlines,      lack         of concentration;        and/or
       --overreaction         to criticism,             unreasonable       resentment.
Other signs of deteriorating                  performance           are discussed        in
appendix  II.
      The employee's     immediate    supervisor    plays the key role
in the program.      Since the supervisor        is the individual     who
has the most direct      contact   with employees,       it is his/her
responsibility   to:
      --detect       deteriorating           job     performance;
      --document      specific     instances    where an employee's  work
         performance,       behavior,     or attendance  fails  to meet
         minimum standards;
      --confront      the     employee,        focusing       on poor      work
         performance;         and



                                              10
         --inform     the employee of available    counseling services
             in the event poor performance      is caused by a personal
             problem,    and refer him to the installation's   program.
It is not the           supervisor's      responsibility         to diagnose       the
problem --only          to identify      and document        deteriorating       job
performance.
       Once the employee is referred            to the coordinator,          it is
the coordinator's        responsibility      to identify     the problem's
cause   or refer      the employee to someone who can..            After     the
problem    is identified       the coordinator       may be able to counsel
the employee or offer          in-house   treatment.      Otherwise,       the em-
ployee would be referred            to a community-based       organization.
Appendix     III diagrams      the flow of major program activities
after   deteriorating       job performance       has been identified.
TYPES OF PROGRAMS BEING DEVELOPED
         Installations    included             in our   review     were   implementing
these      types of programs:
         --alcohol       abuse     programs;
         --alcohol       and drug      abuse     programs;       and
         --employee     assistance       programs designed         to handle a
            wider range of employee problems;               including     alcohol,
            drug abuse,     marital,       financial,   and emotional        problems
            that negatively       affect      an employee's      job performance.
         Alcohol   abuse  and alcohol    and drug abuse programs  often
place     secondary    emphasis   on those other problems   that nega-
tively      affect  an employee's     job performance.
         In characterizing        the programs    at the various      instal-
lations,     we relied       on the responses     we received     from coordi-
nators     and other officials           involved in program operations,
and the policy         statements      that were established     and in effect
at the installations.             We did not attempt      to determine      what
operational      differences,        if any, existed     among the various
programs.
Comparison           of programs
      The June 1974 supplement                   to the CSC guidelines          requires
Federal  agencies  to implement                  and maintain  combined         alcoholism




                                                11
and drug abuse programs       for civilian      employees.       This guide-
line,    however, does not preclude        an agency or installation
from conducting    an expanded program.          Of the 12 agencies
visited,    the Departments     of the Navy and Interior,           the De-
fense Logistics    Agency, L/ and CSC have issued instructions
for broad-based    employee assistance        programs.       Although
the Departments    of Health,     Education,     and Welfare       (HEW)
and the Army have issued instructions            for alcohol       and
drug abuse programs,      four of eight      Army installations,
and five of eight     HEW sites    were conducting       broad-based
programs.
          The following       table shows, by agency for the 81 instal-
lations      visited,      the types of programs   being implemented:
                                  Type of Program    by Agency
                                      Employee      Alcohol    Alcohol      Other
Agency                    Total      assistance        only   and drugs    (note a)
Defense Logistics
   Agency
Army
Navy
Air Force
HEW
Justice                                                                           4
Agriculture                                                                       1
Interior                                                                          3
csc
Veterans
   Administration           8                          3          5
Treasury                    6              1           2          3
Transportation             -6             -1          -1         -4
                           81  -28          =12        33                         =8
a/At three    installations no program existed.        At five
   others  the program that was in-place        was so informal
   that it did not lend itself     to classification.


A/Formally       Defense        Supply Agency.  This agency      was officially
    renamed      Defense        Logistics Agency on January      5, 1977.




                                               12
        The table    shows that installations              within       the same agency
are implementing        different      programs.        Some program administra-
tors at headquarters           said that installation             directors        or com-
manders are given some discretion                to implement           the program
that will     best serve the needs of their                employees.           One head-
quarters    administrator         said that the bureaus             in his agency
are rather     autonomous       and program design          is determined           at
the bureau level.           At the time of our review,                the Department
of Justice     had not developed          and implemented           any specific
policy.     Nevertheless,         four   of  six   Justice      sites      visited
had implemented       programs       of some type.
       The table    also shows that 12 installations                  were still
implementing     alcohol-only   programs and therefore                 were not       in
compliance    with CSC guidelines.
Employee         assistance --   programs:
                                        -
differina
-              - ---views

       NCA estimates         that over half the employees          referred
to a counseling        program will     have alcohol-related          problems,
and believes      that these problems          are deemphasized       when the
term "alcohol"       is removed from the program title.                 NCA advised
that it is not opposed to program labels                 or titles      which do
not contain     the word "alcoholism“           provided   that such programs
contain    a clearly       identifiable    alcoholism     component.        It be-
lieves   a clearly       articulated    policy     and set of procedures
for alcoholism       is essential.       The American      Federation       of
Labor-Congress       of Industrial      Organizations       (AFL-CIO)      believes
that calling      a program designed         to combat alcoholism          by any
other name clouds         the issue.
      To emphasize this position     both the Labor-Management
Committee  and the Labor-Management       Council of Alternates                     of
the NCA issued the following     resolution:
        "1 .      The most effective    method of counteracting
                  the social   and moral stigma associated      with
                  alcoholism   is to forthrightly     identify  it
                  by name in all preventive,      educational   and
                  program activities.
        "2 .      Alcoholism  is a specific    clinical entity     and
                  should be identified     as such in occupational
                  alcoholism  programs.
        “3.       The primary  objective    of the NCA Labor-
                  Management Committee    is to deal construc-
                  tively  with the problem of alcoholism.                 It

                                             13
              is beyond the scope of the Committee's              work
              to attempt    to deal with the broad range of
              non-alcohol     related     problems  which lie outside
              the recognized       professional    qualifications
              and experience       of the National     Council    on
              Alcoholism."
        On the other hand, CSC officials          believe     that additional
benefits     can be derived      from the adoption       of broad-based
employee assistance       programs.      Although    alcohol-related       job
performance     problems   may be the most common, a large number
of Federal     employees    suffer   from other physiological,
psychological,      and sociological      problems     that can . affect
job performance.
         Because of stigmas      attached     to alcoholism,       CSC officials
 said that employees        with alcohol-related         problems     would be
.more willing      to seek assistance       in a program that handled            a
 variety    of employee problems.         Broad-based       programs would
 be better     able to serve employees with problems               other than
 those related       to alcohol,    and those with alcohol-related
 problems     would have less fear of being stigmatized                and would
 be more willing       to seek assistance.
        In a 1974 report,        the Manpower and Housing Subcommittee
concluded       that the most successful        programs were those de-
signed to assist        employees whose work was affected             by non-
alcohol-related        problems,     even though CSC guidelines          did not
call    for programs      of this nature.       In addition,      the subcom-
mittee     determined     that over half the employees          referred     to
these programs        had alcohol-related       problems.      Based on its
findings,       the subcommittee       recommended that CSC encourage
Federal     agencies    to adopt programs       utilizing    the broader
approach.
       CSC is currently        in the process      of preparing  guidelines
for the development         and implementation       of employee assistance
programs   at Federal       installations.
      A study of 15 occupational     programs was conducted       under
an NIAA grant   to determine   the impact of these programs        on
the employees   and the companies     implementing    these programs.
The study indicated    that  in recent    years there has been a
trend toward the development      of broad-based    employee assist-
ance programs   as opposed to alcoholism-only       programs.
       The study's    findings     permit  some comparison   of alcoholism-
only   and broad-based      programs.     Under both approaches    the age


                                        14
distribution     of clients      was found     to be similar       as was the        use
of in-house     counseling.
       Several    differences        between program approaches          were found.
For example,        broad-based       programs    appeared    to attract     a re-
latively      greater     proportion       of female clients;      nearly    twice
as many self-referrals             as alcoholism-only       programs;      and a
substantially         greater     proportion     of skilled     and clerical
workers.
        The study indicates        that the distinction         between the two
program approaches        may exist     only in theory.         That is, although
most clients       of alcoholism-only       programs were found to have
alcohol     problems,    about 10 percent       of the clients       of alcoholism-
only programs       had nonalcohol-related          problems.      About 50
percent     of the clients      of broad-based       programs     had alcohol-
related     problems.     Thus in practice        the distinction       between
alcoholism-only       and broad-based       programs may be one of degree
rather    than kind.
        While only one-third         of the installations         had imple-
mented broad-based        employee assistance          programs,    almost three-
fourths     of the installation          officials    felt   that such programs
should be implemented          to'assist        their employees.
       We compared supervisory          responses     at installations
conducting     alcoholism     and drug abuse programs with supervisory
responses    at sites     conducting      broad-based     programs     to determine
if the level      of program awareness          and familiarity,       training
received,    and the extent        supervisors     perceived     alcoholism
problems   differed      between the two groups.
     We found little   difference     between           the   two groups     in
any of the areas explored.        For example:
       --About     93 percent     of the supervisors      at installations
          conducting       employee assistance     programs      responded
          that they were aware of the installation's                  policy.
          At installations        conducting   alcohol    and drug programs,
          about 94 percent        were aware of their       installation's
          policy.
       --At locations        with employee assistance         programs,      63
          percent    of the supervisors           who were aware of the
          agency's    policy       responded    that they were at least
          moderately      familiar      with the program guidelines.            At
          locations    with alcohol         and drug programs,      67 percent
          of the supervisors           responded    as moderately    familiar.


                                       15
       --About       72 percent     of the aware supervisors     at
          installations         with employee assistance     programs   had
          received      training;     66 percent  of the supervisors     at
          sites     with alcohol      and drug programs    had been trained.
       --Twenty-six     percent   of the supervisors       at locations
          where broad-based      programs were implemented         believed
          that the extent      of the alcohol     problem was at least
          moderate.     At sites    with alcohol      and drug programs
          28 percent    of the supervisors       believed    the problem
          was moderate.
CSC data related  to the installations               visited  show that
some employee assistance   programs             have handled more non-
alcohol-related  cases than alcohol              abuse cases.     For example
       --two Army installations        with employee populations             of
           3,236 and 3,049 reported       a total      of 25 alcohol-related
           cases and 4 drug-related       cases in fiscal       year 1975.
          These installations      also reported         152 and 140 cases,
           respectively,     that were related       to employee problems
           other than alcohol     and drugs.      .,
       --a      southern  Transportation      Department    site with pro-
             gram responsibility       for the entire    region    reported
             only 5 alcohol-related       cases in fiscal      year 1975,
             but reported      78 cases involving     employees    with prob-
             lems other than alcohol.
In addition,      fiscal      year 1975 agencywide         reports--for      the 20
largest    departments        and agencies,      employing     over 96 percent       of
the civilians       in the Federal       workforce--showed          that there were
6,527 alcohol-related           cases,   618 drug-related         cases, and 5,396
other cases not related            to alcohol     and drug problems.           An
official     at CSC said that the "other"             cases could be under-
stated    because at some locations            the alcohol-only         or alcohol
and drug program could be organizationally                    separate    from
the counseling        function     that handled other problems.              In these
cases the number of employees              counseled     for other problems
might not be reported           to CSC. The official,            however,    could
not estimate      how significant        the number of nonreported             cases
might be.




                                        16
PROGRAMS'
____ ---m--- EFFECTIVENESS---P--mIN GETTING
ALCOHOL
-----       ABUSERS
            ------------ INTO TREATMENT
       At the installations           visited,     where caseload      data was
available,        419 alcohol     cases were reported        from a population
of 161,000 for fiscal            year 1974, versus        612 cases among
193,000 employees          in fiscal      year 1975.     While   total    cases
increased       in fiscal     year 1975, more must be done if the
Government        is to identify      and help employees with alcohol
abuse problems.           Our analysis       showed that in fiscal        year 1974
40 installations          with 30,500 employees         did not report       a single
alcohol-related         case.     In fiscal      year 1975, 31 installations
with over 25,600 employees              did not report      a case.
      NCA believes    that an effective     program should reach and
treat  about 1 percent     of the total    employee workforce    each
year I starting    in the second year of program operation.          The
first  year is used to formally       adopt and establish     the pro-
gram.
       Based on NCA's guidelines--         and considering       that most of
the programs      had been in operation        for more than a year--none
of the 12 agencies,         when all their     installations       were com-
bined,    reached the number of employees             necessary    to be
considered     "effective."        (See app. IV.)        On an installation
basis,   only 5 of the 81 locations          visited       met or surpassed
NCA's guidelines         in fiscal   year 1975.
          The table below shows the relative                    effectiveness       of     the
various      types of programs seen during                   our review:
                          Effectiveness by Program Tye
                          -------
                                  Fiscal ------
                                  em--      Year 1975
                                                 NCA         Actual number      Percent of
                      Number of      Popu-     expected        of alcohol       expected
         Type of        instal-      lation     alcohol          cases          alcohol
         program-      lations
                       ---          (note
                                     --     a) caseload        (note
                                                                se-- a)          cases
                                                                                 ---
   Employee
      Assistance        26           83,696            837        260               31
   Alcohol & Drug       32           90,309            903        343               38
   Alcohol only         12
                        --           15,116        --- 151          8                5
   All     programs
         (note b)       70          189,121        1,891         -611               32
  a/See footnote      A/ appendix     Iv.
 b/Three installations    did not have programs,   3 did not have case-
    load information,   and the 5 informal  programs with a population
    of 2,009 had a total   of 1 case in fiscal   year 1975--5 percent
    of the NCA expected caseload.


                                              17
       The table  shows that,             based on NCA's         guidelines,        the
programs   have been relatively               ineffective        in identifying
employees    with alcohol-related               problems.
         In fiscal      year 1975 the Army and Defense Logistics                   in-
stallations        reviewed      counseled       the largest    percentage      of em-
ployees      with alcohol-related             problems,     and the Departments
of Treasury,        Transportation,           and Interior     counseled     the
smallest      percentage.          While the percent         of employees      counseled
at the 81 installations              visited       was comparable    to CSC's fis-
cal year 1975 data for all agencies,                     CSC's report    shows that,
for the agencies           reviewed,       the Departments      of Navy and In-
terior      had counseled        the largest        percent   of the employee work-
force,      and Justice       and the Air Force had counseled              the smallest
percent.        (See app. IV.)
ORGANIZATIONAL
--___----         LOCATION
                      --
MAY DETER PROGRAM
-----         ----   USE
         About 60 percent       of the programs        reviewed     were located
 in the installation's          personnel     office.       Although    CSC guide-
lines      state    that the personnel      director      and his organization
should be assigned          key program responsibilities,             the location
of the program in the personnel              department        may deter program
utilization.           At 12 of the 50 sites         whose programs were located
in personnel,          the coordinator    was also responsible           for dis-
ciplinary        action.   These locations,        with about 36,000 employees,
reported        only 18 cases in fiscal        year 1974 and 43 cases in
fiscal       year 1975.
         The following  examples            illustrate       instances      where    con-
flicts     appear to exist:
         --At a southern          IRS site,      the local       union president
            expressed      concern     about the alcoholism             coordinator
            being in the personnel             department.          In this     instance,
            the coordinator         also has the responsibility                 for dis-
            ciplinary      action     against      employees.         The employees
            with alcohol-related            problems       are counseled        in
            the installation's          health      unit.       A psychologist
            is available        on a part-time           basis to see employees
            with problems.          A monthly       list     of employees       visiting
            the psychologist,          however,       was sent to the personnel
            department       where personnel          management assistants
            attempted      to determine        the nature        of the employees'
            problems,      if work-related,           and the actions         that
            were taken or needed to correct                   those problems.



                                             18
         The health     unit's  head nurse said           that she believes
         employees    are skeptical    about the          program because of
         its relationship      with personnel.
      --The alcoholism       coordinator       and union local         president
         at an eastern      Department      of Agriculture         site both
         expressed    concern about a possible            conflict      because
         the alcoholism      coordinator       was also a personnel           officer
         responsible     for taking      disciplinary      actions      against
         employees.
        In addition,       some nonsupervisors     who responded    to our
questionnaire        indicated   that they would not be willing         to see
the coordinator         on a voluntary     basis if they had an alcohol-
related     problem because they feared not getting            promoted   or
losing    their    job.
        Fear of personnel        actions     appears to indicate     that some
nonsupervisors     perceive       a conflict      between the nondisciplinary
function    of the employee assistance             program and the discipli-
nary functions     traditionally         associated      with the personnel
department.
       A conflict     does not necessarily        exist  at all    installa-
tions    where programs       are located    in the personnel      depart-
ment.     However,    the fact that some nonsupervisors            believed    that
they would not get promoted            or would lose their      jobs if they
admitted     a problem     indicates    that a perceived    conflict       of
interest     (whether    or not the conflict       does in fact exist)        may
deter program utilization.
HAVE EMPLOYEES BENEFITED
FROM TREATMENT?
        Fifty-eight       coordinators     said    that an employee was
successful        in treatment      if (1) job     performance       improved,
(2) job absenteeism           decreased,     or   (3) an overall       change in
attitude       occurred.      Some coordinators         either    had no criteria
for success or cited           various    other    factors     for measuring
improvement.
       Coordinators       from 34 of the 54 locations            that had cases
believed      that more than 50 percent          of the employees        seen by
the program had improved            as a result     of treatment.        At 11 of
these installations          coordinators     estimated      that over 90
percent     of the employees        improved.      In addition,      nine other
coordinators       estimated     that between 25 and 50 percent             of the



                                         19
cases they handled    were helped;    and three others              said that
nobody had improved.      The remaining   coordinators              did not know
how many were helped.
       Coordinators          based their    estimates     on followups   with
either    the clients         themselves,    supervisors,      or community
treatment     facilities.           Since many of the installation's
programs     had either         inadequate   or no records       we were unable
to substantiate           the coordinators'      opinions.
       In addition,     of the 701 individuals      identified          by
supervisors      as having   alcohol-related   problems,       the      super-
visors    believed   that after     treatment
      --25         percent    had greatly      improved,
       --30        percent    had somewhat         improved,
              -
       --22        percent    had not     changed,      and
       --6        percent    had gotten     worse.
In the remaining   17 percent               of the cases the supervisors
indicated  that it was either                 too early   to tell or they   did
not know the results   of the               treatment   program.
CONCLUSIONS
        Using NCA's guidelines,            none of the three programs--
employee assistance,            alcohol,    alcohol   and drugs--were
particularly         effective     in getting    alcohol  abusers     into treat-
ment.       Overall,      the program only reached about one-third
the number of clients            that NCA estimated      could be expected.
        None of the 12 agencies     and only 5 of the 81 installations
visited    achieved NCA's guideline     for program effectiveness--
1 percent    of the total  employee workforce      per year.
       The extent    to which installations'       programs         may have
influenced    abusers   to voluntarily       seek assistance         from other
sources    is unknown.
        CSC and the subcommittee      support     the adoption    of broad-
based programs     to combat employee alcoholism           as well as other
employee problems.      NCA and AFL-CIO believe          removing    the
term "alcohol"     from program titles       will    deemphasize   the
severity    of the alcoholism    problem.



                                              20
       In our opinion,      broad-based     employee assistance       programs
have certain     advantages     over the more narrowly        based alcohol
or alcohol     and drug programs.         Employee assistance      programs
have the capability       to (1) deal with a broader          scope of employee
problems,     (2) reduce employee apprehension           about seeking
treatment,     and (3) increase        the number of voluntary       referrals.
Consequently,     we believe      strong   consideration     should be given
to their    use.
         We were unable to state              conclusively      that programs
located       in an installation's            personnel     department    adversely
affected        program use.        There were some indications,            however,
that a conflict           existed    between the nondisciplinary             functions
of the employee assistance                program and the disciplinary              func-
tions      traditionally        associated       with the personnel       department.
While this conflict             did not necessarily          exist   at all instal-
lations       where the program was located                in the personnel      depart-
ment, there were indications                  that some employees       perceived
a conflict.            In such cases,       this perception        may deter program
utilization.
RECOMMENDATIONS TO DEPARTMENT
AND AGENCY HEADS
         Since broad-based        employee assistance        programs      (1) seem
to be reaching         approximately      the same percentage         of alcohol
abusers      as programs dealing         solely  with alcohol        abuse,    (2)
have the advantages           of being able to deal with a much broader
range of employee problems             in a less stigmatized          environment,
 (3) were favored         by almost three-fourths          of the installation
officials      interviewed,       and (4) were considered          to be the
most successful         by the Subcommittee        on Manpower and Housing,
we recommend that agency officials               give strong       consideration
to establishing         this type of program within            the scope of
services      permitted     by current      CSC guidelines.
       In those cases where programs    are located    in personnel
departments,     we recommend that department    and agency heads
determine    the extent   to which such location    is deterring
employees    from using the program.
       In cases where a program's      location  is found to be a
problem because personnel       have conflicting   responsibilities
or because employees     perceive   that such a situation         exists,
department    and agency heads should consider       the following
courses    of action
       --reassign       personnel      responsibilities,


                                            21
      --remove     the program     from    the personnel    office,    or
      --develop     an education  program to alleviate            employee
         concern    about program location.
CSC AND NCA
         ---- COMMENTS
CSC comments
        In commenting   on our draft     report,     CSC stated   that
it is in the process      of developing      guidelines     for employee
assistance    programs.     It stated    that Federal      agency heads
have the authority      to adopt such programs under Public
Law 79-658,    which encourages      agencies    to promote both
the physical     and mental health     of the work force.
        However,   since research    indicates       that the organizational
structure     at each individual     installation        may influence     the
appropriateness       of such programs,       the Commission      believes    that
the decision     to adopt such programs          should be made at the
installation     level.
        Concerning      the organizational        location     of programs   to
combat employee alcoholism,              the Commission      said that the dual
assignment      of disciplinary        and program responsibility          may
appear to be a conflict            of interest      but the decision     on
program placement          cannot always be centrally           decided.    The
Commission      stated     that current     guidelines     give agencies     and
installations        wide latitude       in determining      program location
and the Commission will            continue    to allow that latitude.
         We agree with the Commission         that the dual assignment      of
disciplinary       and program responsibility        may give the impression
of conflict      of interest.     In our opinion,       if program location
is determined       to be a deterrent    to effective      program operations,
appropriate      measures should be taken by installation           management
to alleviate      employee apprehensions.          If this   is not done, we
believe      the number of persons willing         to use the program will
be adversely       affected.
NCA comments
       In commenting  on our draft     report,    NCA stated   that under
alcohol-only   or alcohol    and drug programs we implied         that
employees with other problems        would be ignored.       NCA indicated
that these programs      are designed    to detect   any employee problem
which causes deteriorating       job performance.-

                                      22
       We agree that deteriorating              job performance     should be the
primary    criteria       for identifying       problem employees.       However,
as stated      on p. 11, alcohol          abuse and alcohol      and drug pro-
grams often place secondary               emphasis on those other problems
that negatively          affect    an employee's      job performance.     Since
alcoholism      and drug abuse would be given primary               emphasis   in
supervisor       training       and program publicity       it could be expected
that the majority           of cases in programs         of these types would be
alcohol-     or drug-related.
      NCA disagreed     with our position                 that broad-based   programs
had certain    advantages    over alcohol                and combined alcohol-drug
programs.     They believe    we implied               that the most effective     way
to counteract     the stigma associated                  with alcoholism   is to
obscure   it.
        We disagree         that the material            presented      in this chapter
implies      this.       We agree with NCA that an individual'with                          an
alcoholism         problem must accept the fact that he has such a
problem before           it can be effectively              treated.       However,       in
order to get such persons                  to enter treatment,            agencies      must
offer     programs which minimize,                 to the extent        possible,        an
employee's         apprehensions         and fears.         Once an individual            faces
the fact that he has a job performance                         problem and expresses
interest       in receiving          assistance,        steps can be taken to de-
termine      the problem's           cause and to get the individual                   to
accept the fact that he is an alcoholic                           or alcohol      abuser
if that is the case.                We believe        the broad-based         employee
assistance         programs     offer      a more neutral          and less threatening
environment          that increases          the possiblity         that problem
employees,         including       alcohol      abusers,      will    seek assistance.
Our primary          concern     is the development            of programs        that
will     encourage       the greatest          possible     numbers of employees
with job-related            problems       to seek assistance           and the
creation       of effective         methods to deal with these problems,
 including       alcoholism.
          NCA believes        our conclusion    that employees         suffering        from
alcoholism       would be more willing          to seek assistance            in a
broader-based          program indirectly       implies   that supervisors
initially      refer       employees    to an "alcoholism      counselor"          or
"alcoholism        facility."        Further,   NCA believes       that the general
practice      should be to refer           the employee to a qualified
diagnostic       resource       which should be in a nonstigmatizing
environment.           While we agree with the general             practice        referred
to by NCA, our experience               at many Federal     installations,
particularly         the smaller      ones, shows the "alcoholism               [and
drug abuse] program coordinator"                to be the primary           point     of



                                             23
contact       at many locations;        thus the employee is immediately
labeled       "alcoholic"      whether    or not the problem          is alcohol-
related.         As stated     on p.   11   this    individual     is   not necessarily
the diagnostician           but is responsible           to obtain    a diagnosis
 if he does not have the expertise                  to do so himself.         A smaller
 installation         could not be expected           to have a staff      with suf-
ficient       expertise     to diagnose       all types of problems         but must
rely on the community            to offer       that service.
        We agree with NCA that a qualified            diagnostic       resource,
placed    in a nonstigmatizing       environment,        should be the
focal    point  of program operations.           In this     regard we are
recommending      in chapter    5 that installation          officials      as-
sign program responsibilities           to individuals         who are quali-
fied for those positions.           As stated      above, we believe         the
establishment       of broad-based    programs      should enhance the
nonstigmatizing       environment    so critical       to programs       of
this nature.
        Finally        NCA believes    that
        "The recommendation       to establish     broader-based
        programs because they would supposedly             be better
        able to serve employees with non-alcohol-related
        problems   is inconsistent      with the finding       that
        only 5 of 81 installations         were considered       'effec-
        tive'   in identifying      and referring     to treatment
        a large percentage      of alcoholic      employees."
        It   further      believes    that
        "TO recommend the establishment           of a certain    type
        of 'program'       because of its alleged     greater    appeal
        to individuals       with problems   that are not alcohol-
        related      appears to be inconsistent      with the major
        finding      of the study and potentially       counter-
        productive."
        The fact that only five programs were considered                       effec-
tive    demonstrates  that all program types experienced                     diffi-
culty    in reaching  employees with alcohol problems.
       As stated     above, we are recommending          consideration        of
broad-based     programs    because of the advantages            inherent
to programs     of this    nature,    primarily     the reduced personal
stigma attached       to all problem employees,          including      those
with alcohol-related        problems.      Further,    broad-based        programs
were found to be more effective            by the Subcommittee          on


                                             24
Manpower and Housing       in its report    on occupational        programs
and were favored      by a majority    of agency officials.           We
believe   the appeal of these programs will          be to all employees,
including    alcohol   abusers,    and should  increase     self-referrals
as evidenced     in the study referred      to on p. 14.




                                    25
                                         CHAPTER 4
                          MANAGEMENT AND-UNION PROGRAM
                                          SUPPORT
         CSC states    that an official      program policy,       issued by
top management and understood             by all employees,      is a vital
step toward obtaining          optimum program operation.            According
to an NCA official,         top management support        is the most crit-
ical     factor   in the operation      of an effective     program.        If
top management supports           a program,    makes its position        clearly
known to all employees          by means of education       and training
activities,       and follows     up its support     with sufficient        staff
and resources,       the program should work.
       In addition      to management support,          CSC and NCA believe
the support       and active    participation        of labor   organizations
is critical       to the program's        success.     They believe      that
management should coordinate              with the unions     in policy       and
program formulation          and that lines        of communication      should
remain open so that unions and management clearly                    understand
their    respective     responsibilities.
        In assessing   top management support,            we found that the
attitudes     of top installation       officials      varied   significantly
from installation      to installation,          and that many coordinators
felt    that they had inadequate        budgets     for program operation.
We also found that
        --most     coordinators          perceive   management     support    as
           strong,
        --some union officials      doubted management's                objectives
           in establishing    a program,   and
        --a      large    portion   of those who responded   to our ques-
              tionnaire      did not know the strength    of management's
              support     for the program.
        Management's         selection    of coordinators,         another    indi-
cator    of support,         is discussed    in the next         chapter.
MANAGEMENT'S ATTITUDE:
A FACTOR IN EFFECTIVE PROGRAMS?
       Installation         officials'       attitudes   toward alcoholism       and
the programs        established          to combat alcoholism   varied     consid-
erably    among installations.               Officials  at some installations



                                              26
 appeared     to be highly        supportive     of the program and believed
 their   installation         benefited     because employees       were returning
 to full    productivity.           On the other hand, some officials             said
 that alcoholism          should not be the focus of a Federal            effort,
 that employees        should be responsible          for recognizing      their
 own problems,        or that too much time and money was spent on
 programs of this          type.      We found that less than 45 percent
 of the installation           directors     had attended    training    courses
 concerned      with alcoholism.
        At several    installations,        top management officials
 expressed   negative      attitudes      concerning  the program.           For
 example:
        --The commander of         a midwestern Defense Logistics
           Agency site said        that he was "not in the hand holding
           business."
        --The personnel       director       at a western   Air Force base
           expressed    his concern        that so much money was being
           spent on social        actions      such as alcohol,  drugs,    and
           employment    equality,        as opposed to the installation's
           primary   mission--"fly         and fight."
        --The commanding officer      at a western      naval shipyard
           said his main job was overhauling         ships,    not reforming
           drunks.  The director    of civilian      personnel    told us
           that management at this      installation     views alcoholism
           as a weakness,   not a disease.
  Chapter   7 discusses    how management attitudes  and other   fac-
, tors affect    the programs we found to be relatively     successful.
 RESOURCES AND-SPACE
 UTILIZED-BY-PROGRAMS
         In our opinion,       the amount of resources          allocated      to
 the program and the type of space assigned                  are other     indica-
 tors of top management support.               Of the 77 coordinators
 interviewed,       21 percent    felt   that the budget for the alco-
 holism program was no better            than somewhat adequate           while
 30 percent      of the coordinators        indicated     that budget alloca-
 tions     were substantially       adequate     to operate     the program.
 Most coordinators        spent 5 percent        or less time on alcohol-
 related     matters.
        Some coordinators    said that they did not use their
 office   for counseling   employees    with a problem.    Twenty-
 nine believed     that employees   were reluctant    to be seen in



                                         27
their  offices,    apparently    due to the lack of privacy   and/or
the organizational      location   of the program.  For   example:

       --The coordinator      at a western    naval facility      said his
          office    was in the personnel    department      and employees
          would feel reluctant       to be seen there.       While he
          counseled    in his own office,     he also used other
          locations    at the installation     for counseling.
       --At    a midwest Defense Logistics     site, the coordinator
          said the employees     could be observed   entering   or
          leaving    her office,  which was in personnel.     She
          said that employees     had talked   with her on the street
          because they were hesitant       to be seen in her office.
       --Finally,    the coordinator       of a western   Justice  site
           said that he shares his office        with the district
          director   and that the only contact         he had with
          employees    in his office     was when he set up appoint-
          ments for counseling       sessions   held elsewhere.
COORDINATORS' AND~UNION REPRESENTATIVES'
PERCEPTIONS OF-MANAGEMENT SUPPORT
        Almost all coordinators--94             percent--believed          that
management's       program support         at their    installation        was
at least     moderate.        Coordinators      at Army, Air Force,           and
Agriculture      installations        generally     perceived       management's
support     of their     program to be the strongest,               while Depart-
ments of HEW, Justice,            and Transportation          coordinators
generally     perceived       only moderate      support      of their     programs.
         On the other hand, some union officials                 did not    believe
management was really       supportive of programs               at their    instal-
lations.       For example:
       --A union representative         from a midwestern     Department
          of Transportation       site  said that the program did
          not get enough publicity         and characterized      the instal-
          lation's     effort   as 11* * * another    program buried     in
          the archives."        The coordinator    for that same site
         -characterized       management support     as moderate.
       --One union representative         at a western     naval facility
          told us that the union had offered           its assistance
          in getting  the installation's        program established.
          The union president      said that the unions offered
          counseling  assistance,       advice,  and overall     program



                                         28
         support,      but    all offers    were disregarded by either  the
         individuals         operating   the program or top management.
       Some union officials       expressed   concern    about manage-
ment's   objectives     and motives    in establishing     alcoholism
programs     and were convinced     that the programs were a means
for identifying      problem employees      to terminate     their   employ-
ment.    For example:
       --At   a western     naval   facility    one local   union president
          said that reprisal        for alcoholism     was a way of life
          at this   installation       and the alcohol    program was not
          important    there.
       --A union president          of one HEW site        felt      that super-
          visors    would take disciplinary           action       instead   of
          offering     assistance      to employees      with a problem.         As
          a result,     the union sends employees              directly    to
          community-based        treatment   facilities          instead   of
          risking    job loss if management's            program is used.
SUPERVISORS' AND NONSUPERVISORS'
PERCEPTIONS OF MANAGEMENT SUPPORT
       At those installations        that were relatively       successful
in getting    employees with alcohol         problems    into treatment,
supervisors    and nonsupervisors        generally    perceived    stronger
management support.         The following      table  shows the extent
of management support        perceived    by the workforce:
                        SUPERVISORS AND NONSUPERVISORS
                           PERCEPTION OF MANAGEMENT
                           SUPPORT FOR THE PROGRAM
    Ranking of                         At least
 installations            Total        moderate              Some support    Do not
    (note a)           responses        support              or no support    know

    Top 5                  242                    65%              12%          23%
    6 - 10                 260                    65                9           26
   11 - 81              3,614                    -52              -13           35
       Total            4,116                    53               --13          --34
                                                 =c
a/In   terms   of NCA criteria        for        effectiveness.




                                            29
        Supervisors      at Army, Navy, and Defense Logistics                   instal-
lations     perceived      the greatest       amount of support        from top
management.         Supervisors      at Justice     and Transportation            sites
perceived      the least       amount of support       from top management.
Nonsupervisors        at Defense Logistics          and VA sites      generally
perceived     greater     management support         for the program,           while
at the Departments           of Transportation       and Interior        installa-
tions    the nonsupervisors          perceived    the least       amount of
management support           for the program.        We also noted that 23
percent     of all supervisors          and almost half        the nonsupervisors
said that they did not know how much support                      management gave
to the program at their            respective     installations.
UNION SUPPORT OF EMPLOYEE
ALCOHOLISM-PROGRAMS
       CSC and NCA believe        that union-management         cooperation
is vital   to the success of alcoholism           programs.       NCA believes
that successful    rehabilitation        requires    motivating      an em-
ployee   to accept treatment         and neither   management nor the
unions alone can maximize motivation.
        Although    half    the installations        had union agreements
which covered       the majority       of employees,      most unions had
little     to do with the establishment             of program policy.    At
some locations        unions were not consulted           by management con-
cerning      program and policy        formulation.       In other cases,  the
unions seemed disinterested              in the program.
        For example,        when asked to comment on the alcoholism
policy,    a union official            at an HEW site   responded       that the
program was not necessary               because there was no problem.           At
a Treasury      installation         a union official     responded       that she
had no input       to the program because she had not been urged
to do so by the national               office.   At another    installation      a
union official         replied      "no comment" when asked to review
the installation's           policy.
      We found that the unions and top management did cooper-
ate in the implementation   of some alcoholism programs.  For
example:
       --At     a western    Army installation,      union and management
          officials      work together       through an advisory  council.
          The union believes        they have a voice in program
          activities      and the installation's        program is good.
       --At    a western     Defense     Logistics     site   and a southern
          Agriculture      location,      we found     that   provisions



                                          30
          concerning      the rehabilitation        of employees with
          alcohol-related       problems     were   included  in the
          agreements      between the unions        and management.
         In hearings   before   the subcommittee     in June 1976,            a CSC
official     estimated    that only 10 percent     of about 2,900             formal
management-union       agreements   contained    a section  on the            imple-
mentation     of these programs.
CONCLUSIONS
        Top management support       is critical        for effective     program
operation.       Although   most coordinators         believed     top manage-
ment support      was adequate,   other     information        appears to indi-
cate that management was not fully               supporting     programs.      Fund-
ing and office        space were often    limited      and inadequate.        At
many installations,        management's     attitudes       toward alcoholism
and the program established          to combat the problem appeared
to deter program use.
       About one-fourth      of the supervisors        and nearly       one-half
of the nonsupervisors        did not know management's           position       on
the installation's       program.    This appears to indicate              that
management has not made its position            clearly     known to em-
ployees.       In our opinion,    the employee's       perception       of
management support       is a factor    in the decision         to voluntarily
seek assistance.
       Union activity          appeared limited.       At some locations          the
unions were not asked to participate                 in policy     and program
formulation:       at other sites        the unions    seemed disinterested.
At some locations,           however,    labor and management appeared to
cooperate       in program operations         either   by joint      representa-
tion on steering         committees     or by including        provisions      con-
cerning      the installation's        program in labor agreements.
        Labor unions,      by their      relationship    with their     members,
are able to offer         assistance       to employees.     Management can
still     take corrective       actions     when an employee's       job per-
formance      continues    to fall      below acceptable     levels.     Program
effectiveness        is enhanced if the union is made fully              aware
of the basis of the actions              taken by management with respect
to an employee with a problem.
RECOMMENDATIONS TO DEPARTMENT
AND AGENCY HEADS
      To increase the effectiveness              of established  programs
we recommend that the department               and agency heads:

                                         31
       -Take whatever          actions     are necessary        to make clear       to
         all employees         the level      of positive       support   given to
         installation       programs.         For instance,        management
         could      (1) be more vocal in support              of the program
         at general      employee or upper level              staff    meetings,
         (2) issue memorandums regularly                 to constantly        rein-
         force      the position       taken,   or (3) make use of other
         communication         resources      available      (such as bulletin
         boards and employee newsletters)                  to keep employees
         constantly      aware of the support            given to programs.

      --Devote      sufficient        resources    to enable     programs      to
         function      effectively.
      --Require       that installation        directors    receive   specific
         training       on alcoholism       and the efforts     needed to
         combat     it.
      --Where applicable,    encourage    more active  consultation
         with employee unions concerning       policy and program
         formulation   and encourage    employee labor organizations
         to take a more active     role in these programs.
CSC AND NCA COMMENTS AND OUR EVALUATION
CSC comments
      Commenting on our draft      report,    CSC recognized      that
unions can have a marked impact on a program and stated
that agencies   are advised    to seek union involvement.            csc
said that union participation        has increased      since the June
1976 hearings   before  the Manpower and Housing Subcommittee
of the House Committee      on Government     Operations.     They also
said that four major Federal       unions are cooperating         in on-
going research   on Federal    program effectiveness.
NCA comments
       Commenting on our draft             report,   NCA said that manage-
ment's position        concerning      employee programs may not be
clear    to all employees because of either                ambiguous or
unclear    policy     statements      or ineffective       mechanisms to
communicate       that policy     to all employees.           Further,  it
believes    that a clearly        articulated       policy    statement
is a necessary        component to any effective            program.
         It was our experience    throughout    the review      that agency
policies     were developed    in accordance    with CSC guidelines
which clearly      state  the Federal    Government's    position,

                                           32
as an employer,    concerning     alcoholism       and alcohol     abuse.
That is, that alcoholism       is a treatable         disease    and programs
should be established,       in a nondisciplinary          environment,
for the prevention     of alcoholism       and the treatment        and
rehabilitation    of those employees        suffering       from alcoholism.
     As discussed   in chapter     5, efforts           to inform  and edu-
cate the workforce    vary among agencies              and improvements
are necessary   in many instances.
       Our primary        concern    in this chapter        is management's
support    for programs        to assist      employees     with alcohol      prob-
lems.     Even if the mechanisms to inform                the workforce       became
more efficient        we believe,       without    the firm top management
support    both in making clear pronouncements                  of its intent
to support      established       programs      and in allocating      sufficient
resources     to allow programs          to operate     effectively,      programs
of this nature        will    not be effective        in the Federal      sector.




                                         33
                                       CHAPTER 5
                         COORDINATORS--SELECTION,

                QUALIFICATIONS,          AND RESPONSIBILITIES
        One of the more important    decisions  that top management
has to make in implementing       an effective  program is the
selection    of a coordinator.     In this regard
       --over   70 percent      of the coordinators     were assigned                      to
          that position       as opposed to volunteering     or being
          hired  specifically      for that position;
       --coordinators'          qualifications                varied      significantly;
       --many coordinators             spent        little       time     on program
          activities:   and
       --coordinators,          for    the most part,                 had not developed
          adequate     referral        or recordkeeping                 systems.

COORDINATOR SELECTION
       CSC guidelines   state      that individuals       should be desig-
nated at each field     installation         to coordinate     the program.
Of the 81 installations        visited,      6 did not have a coordinator
on site.     We were, however,        able to discuss      program activi-
ties with two regional       office      coordinators     who were respon-
sible    for three of these installations.
        Management had appointed            many installation         coordinators
with little       or no consideration           for the individual's          quali-
fications       or program interest.            Although    CSC guidelines
describe      the coordinator's        duties      and activities      and state
that a coordinator          should be an experienced              and effective
administrator,        the guidelines        do not specifically          mention
the attributes        or the training         required    to enable coordina-
tors to do their         job effectively.           Of the 77 coordinators
interviewed
       --57    were assigned          to the        position,
       --11    had volunteered          for        the position,           and
       --9    were   specifically        hired          for     the    position.
        Of the 57 individuals      assigned      to the coordinator's
position,     21 had no job-related       training     or education.



                                              34
In addition,         few of     these   appeared       to have qualifying
experience.
       The following     examples illustrate     some of                  the     attitudes
of   coordinators    assigned   to the position:
       --An Interior          coordinator said that she had spent little
          time on the         program and did not want to get involved.
       --A     Department   of Transportation               coordinator   said that
             she was assigned   to the position               because-she    "got the
             short  straw."
       --Another   Department     of Transportation      coordinator                      said
          that he had only bad experiences          with alcoholics                       and
          he rl* * * can't    stand drunks."
At these three  locations,               with a combined workforce                  of   9,800
employees,  no cases were               reported in 1975.
        Although    57 coordinators     were assigned       to their   posi-
tions,     45 stated   that,    if given the choice,        they would con-
tinue    to be coordinator.         It appears that once assigned           as
coordinator,       some individuals     receive    training     and take an
interest      in successful     program operation.
COORDINATOR QUALIFICATIONS
       Coordinators        are     responsible        for
       --bringing        education       and information           to the       workforce;
       --arranging        or conducting           supervisory       training;
       --developing           and maintaining         diagnostic       counseling
          capability;
       --establishing        liaison     with community-based      facilities
          that could offer          education,  diagnosis,    treatment,
          and rehabilitation          services;   and
       --evaluating        and reporting           to management         on program
          results       and effectiveness.
         In our opinion,    to carry     out the activities           above and
effectively     implement     an installation's         program,      coordinators
should have an interest         in the program and should be quali-
fied with the proper educational               background     or specific
training.      Coordinators     at the installations           visited     had
qualifications      that varied     significantly.
                                             35
        Seventy percent          of the coordinators            believed      that they
had special       qualifications           to carry out their          duties.        Quali-
fications      most often        cited     by these individuals            were training,
experience,       and program interest.                 In this    regard,      73 percent
(56 of the 77 coordinators)                  either     had received       formal     edu-
cation    or were trained            in areas that included            alcoholism       or
counseling-related            subjects.         Training     and education        for
these coordinators            ranged from doctoral             degrees in psychology
to supervisory         training        that included       information        on an
agency's     alcoholism        program.
        Other coordinators        believed     that they had special
qualifications         because they (1) enjoyed working         with people,
(2) were related          to an individual       who had an alcohol  problem,
(3) worked in the agency's             personnel    office, or (4) were
recovered      alcoholics.
        The following      table   shows the          relationship        between the
length     of time a person.had        served         as coordinator         and the
likelihood      of his-being     trained:
             Length of
              time as                 Number of               Coordinators
            coordinator             coordinators           with no trainina       <
                                                           Number      Percent
         Less than
         6 months                          13                 10            77
         6 months        to
         1 year                            10                   3           30
         1 year to
         3 years                           35                   a           23
         3 years      to
         5 years                           14                   3           21
         More than
         5 years                           -5                                 0

                 Total                77
                                      =              -24

        As would be expected,       the coordinators         who served
longest     were more likely     to have received        training.       This
appears to indicate        that training      is a function        of the
coordinator's     position     and not necessarily         a criteria     for
selection.      Most coordinators        with no specific        program


                                             36
training   did not have educational   backgrounds                       that         could       be
considered    helpful in program operations.
        Although      62 percent     of the coordinators        acknowledged       a
need for additional          training     to better     perform    their   duties,
we noted that a number had already                obtained     education    or
training      in subjects      that included      alcoholism     or counseling-
related      matters.     Of the 24 coordinators           who stated    that
they had not received            any training     in the area of alcoholism,
19 indicated        that they wished to remain the installation's
coordinator.
TIME SPENT ON PROGRAM ACTIVITIES
         Although     CSC guidelines         specifically          state     that coordi-
nators      should be allotted          sufficient        official       time to im-
plement       an agency's     program,       more than half the coordinators
were spending         5 percent     or less of their             time on program
matters.        As a result,      efforts       to implement          viable     programs
generally       varied    considerably.           Most coordinators             spent a
relatively        small portion      of their        time on alcohol-related
activities.
       Of the     77 coordinators
       --47 spent between 0 and 5 percent                    of     their          time     on
          alcohol-related activities,
       --7      spent between      6 and 10 percent          of     their          time   on
             alcohol-related       matters,
       --11 spent between            11 and 50 percent  of             their         time
          on alcohol-related           activities,  and
       --12 spent more than 50 percent                   of their           time     on
          alcohol-related activities.
For those installations           where broad-based   employee assistance
programs     are being implemented,        the time spent by coordinators
as recorded         above represents   only the time spent on alcohol-
related     activities.       Factors  that influence   the amount of time
coordinators         spend on the program are the size of the instal-
lation's     workforce      and staff  support.
        An NCA official    said that an installation        of 4,000 or
more employees       could probably  support   one full-time        staff
person to deal with alcohol-related          matters.      Although       an
installation     with less than 4,000 employees        would not require


                                             37
 a full-time         coordinator,         the NCA official       believed      that it
 may be necessary             for the coordinator        to spend considerable
 time on the program in its initial                   years of operation,
 principally         to train        and educate   the workforce         and to estab-
 lish     relationships          with community      organizations.          In sub-
 sequent years,            the coordinator's       time would be devoted
 primarily        to training         new employees     or new supervisors,
 counseling,         client      followup,    and distributing         information.
 The following           table     shows the relationship         of installation
 size to coordinator's                time spent on the alcohol           portion
 of the program.
                                Total    number    of         Percent   of time
 Installation       size           coordinators              spent on program
                                                         O-5% 6-10% ll-50%    51-100%
,Under   250 employees                    10              lo-               -        -
       251 - 500                           9                a-              -        1
       501 - 1,000                        16              14      -         1        1
    1,001 - 2,000                         16                a     4         :        1
    2,001 - 4,000                         14                3     2                  5
    4,001 - 8,000                          6                2    -         1         3
    8,001 and over                        -6              I 2    -1       -2        -1
         Total                            77            --47    7         --11       12
                                          =                    =                     z
          The reason that coordinators             at some of the larger           in-
 stallations--     4,000 or more employees--spend               less than full-
 time on alcohol-related            matters     was that they had staff            avail-
 able to assist        in program functions.           However,      the majority
 of coordinators         spent less than a third           of their     time on
 alcohol-related        matters,       had no counseling      staff,       and did
 not utilize      outside     referral      sources.
     Generally     the most effective  programs   of the ones visited
were those at which the coordinator       and his staff  were able
to spend sufficient     time on the program.     (See ch. 7.)
LIAISON WITH COMMUNITY-
BASED ORGANIZATIONS
       Although      most installations        provided     some in-house       coun-
seling     to employees,      most installations         were also relying
on community-based         organizations       to supplement         their in-house
capabilities.         It is the coordinator's           responsibility       to
either      identify    the employee's     problem      (or problems)      or refer
the employee to an individual             or agency that is capable of



                                           38
identifying       problems.          In any event,         once the problem
has been identified,             the   coordinator         should   be able either
to make in-house           treatment      available        or to refer      the employee
to the proper         community-based          organization       that is able
to deal with these problems.                   Typical       community-based
resources      that coordinators            should be familiar          with include:
alcohol     detoxification           centers,     public      and private      alcoholism
programs,      hospitals,        private      practitioners,        Alcoholics
Anonymous,       and Al-Anon.
       The number of community-based            organizations        that coor-
dinators    had contacted        ranged from 0 to 50.          Most coordinators
that had contacted         these organizations       had identified        at least
three agencies       that could be used to provide             treatment    to
their    employees.       One Air Force coordinator           said that he
had contacted       over 50 community-based         agencies      and had used
6 of them.       Of the 30 coordinators         who had not contacted          any
community-based        agencies,     17 did not report        any cases in
fiscal    year 1975.       We did not attempt       to determine        the sever-
ity of employee problems            nor did we review       the quality     of
care or the effectiveness            of treatment    provided       by the
community     organizations.
RECORDKEEPING
      About 55 percent          of the installations        visited  had record-
keeping    systems that        were used either      to keep track    of clients
or provide      information       to management.       We found that
       --client      records    maintained       by many programs
           were   informal;
       --the   installations       that had a very small number
           of cases--O      to 2--generally  did not maintain
           any records;       and
       --for    fiscal  years 1974 and 1975,              two installations
           with caseloads    of 56 and 30 did             not maintain      records.
While CSC guidelines       state   that records  should assure client
confidentiality,      no information    on a specific   type of record-
keeping      system has been developed.
         Some installations        had developed         recordkeeping       systems
that could provide          useful    information        to management       on program
activities,        For instance:




                                           39
       --The coordinator      at a western     Defense Logistics
          location   monitors    the leave taken by his clients
          before   and after   they enter the program to monitor
          employee progress      in treatment.      These records   also
          enable the coordinator       to develop    partial   cost savings
          data.
       --The coordinator           at an eastern         Army site keeps client
          files    which include        employee consent            to treatment
          forms,    client      alcohol      history      records,    and records
          of all counseling           sessions.         In addition,      monthly
          status    reports       are received        from supervisors        con-
          cerning     the client's         job performance.           This system
          enables     the coordinator           to monitor       the current
          status    of all clients           in the program.          Formal sta-
          tistical      reports      are filed       with management on the
          status    of employees         in counseling.
       --At    a midwestern       Air Force installation          the coordinator
          keeps client      files     which contain      records     of all client
          contact     while    in the program,      including       medical    diag-
          nosis and documentation           on all followup         activities
          after   clients      have left    the program.        In this case
          reports     are also transmitted        to the installation's
          top management.

CONCLUSIONS
      One of the more important     decisions   top management has
to make to implement   an effective     program is the selection   of
a well qualified  coordinator.
        It appears that many managers selected                    coordinators         with
little     regard    to their      qualifications        or interest.         Over 70
percent      of the coordinators           were assigned       to the position
and more than a third            of these had no specific             training       or
education      for the position.            Some coordinators        appeared to
have little       or no interest          in the program or their            position,
or they did not like            alcohol       abusers.    Coordinator's        quali-
fications      varied    significantly          among agencies.       Qualifications
for those that had training                 or education     ranged from doctorate
degrees      in related     fields      to supervisory       training      on alcoholism
and alcohol       abuse.
        In general,   coordinators           spent little     time on program
operations.       Over 70 percent           spentbless    than 10 percent   of



                                           40
their    time on alcohol-related              activities.          We believe       this
could    deter effective     program          operations.
       Nearly     40 percent       of all coordinators           had not contacted
a single       community-based       treatment     facility--one        of their
responsibilities         under     CSC guidelines.
      Although   over        half the coordinators             kept records         on
program operations,           many record   systems           were informal.
       We believe  that, in general,   records    kept were inadequate
as an aid to counseling    and treatment     and/or   as a tool to
inform   management of program operations.
RECOMMENDATIONS TO DEPARTMENT
AND AGENCY HEADS AND-- CSC
       Heads of departments          and agencies     should make certain
that    (1) selected     coordinators      are interested        in the program
and qualified        for the position,       (2) coordinators         receive  the
necessary     training     to enable them to function            effectively
in their    positions,       and (3) coordinators          have sufficient     time
to carry    out their      programmatic     responsibilities.            CSC should
develop    more specific       guidelines     on the training         that coor-
dinators    should receive,         and the information        that should be
included    in client      records.
CSC COMMENTS
        CSC concurred             with our recommendation                that agency heads
take more care in selecting                      coordinators,          arranging    for
training       when necessary,               and making sure that coordinators
have sufficient              time and resources            to carry out their            re-
sponsibilities.                Further,       CSC stated       that these points          are
often    stressed          in its agency evaluations.                    The Commission
is continuing            its work with the agencies                   to improve the
quality      of their          coordinators         through      participation       in
agency-sponsored               training       programs     for coordinators          and
Commission-sponsored                  training      both in Washington            and its
regional        offices.
        Commenting on our recommendation               to develop    more specific
guidelines          for the information       that should be included       in
client      records,       the Commission     stated   it does not believe       un-
iformity         throughout      the Federal    Government    is necessary    at
this     time.        The Commission     said that installations       must keep
records        that will      satisfy  both the Commission's        and the



                                             41
agency's  internal   evaluation   requirements.               Consequently,
it has not attempted     to impose a uniform              recordkeeping
system on Federal    agencies.
        Commenting on our recommendation                to establish       guide-
lines    for the type of training             coordinators        should receive,
the Commission          agreed that coordinators           are a pivotal       and
often    a weak part of program operations.                   CSC stated,
however,      that it is not certain           uniform     training      is the
necessary       action     to increase     the effectiveness          of program
coordinators,          and at this     time it is reviewing           our recommen-
dation.




                                         42
                                       CHAPTER 6
                              EFFORTS TO-INFORM AND
                              TRAIN THE WORK FORCE
         Most installations           have made some effort         to make employ-
ees aware of the problems                  related   to alcohol    abuse and the
 installation's          program to combat this problem.               Many instal-
lations        have distributed         literature     to employees,     posted ma-
terial       on bulletin       boards,       and spent a portion     of the time
alloted        to supervisory       training       to a discussion     of alcohol
abuse and the alcoholism               program.
        At selected    installations, efforts   to inform the work
force    about the program increased     at about the time of our
visit    to the installation.
COORDINATOR AWARENESS
        Most coordinators           were familiar         with CSC guidelines
concerning        the proper procedures               to follow      when working      with
an employee with a problem.                    Coordinators        learned    about their
installation's          program in many different                ways.      For example,
some received         memorandums or newsletters                 prior    to becoming
coordinator;         others-learned          about the program through              dis-
cussions       with higher       level     officials,        previous     alcoholism
coordinators,         or others        (such as base chaplains).
         In addition       to CSC guidelines,      many agencies             and instal-
lations       have issued supplementary         instructions        on       program
operations.          About two-thirds      of the coordinators               said that
additional        guidelines    for implementing         the policy          at their
 installation        had been developed.
COORDINATORS' EFFORTS-TO EDUCATE
AND TRAIN THE-WORK FORCE
        Most coordinators           believed     they had made at least         a
moderate       effort      to inform     supervisory      personnel    about the
installation's          program.       Over 75 percent        of the coordinators
said that supervisors              had received      written    materials     about
the program.           Fifty    percent    of the coordinators         stated   that
supervisory         personnel      had attended      a meeting      to discuss    the
program.
     With respect   to supervisory     training, 23 of 31 coordina-
tors at Defense installations      said that at least  76 percent     of
all supervisors   were trained.     Only 15 of 46 coordinators     in

                                             43
civilian    agencies    could make this claim.                Furthermore,        coordi-
nators    at 10 installations--all       civilian            agencies--said         that
supervisor    training      had not taken place             at their    installation.
         While efforts          to inform      and train     supervisory        personnel
were moderately             successful,      efforts     to inform      and educate non-
supervisory          personnel      were not as great.            Seventy-one       percent
of the installations              had distributed          educational       material     to
employees         or informed       all new employees          about the installa-
tion's      program for helping            alcohol     abusers.        A slightly
greater       percentage        of Defense installations             (61 percent)       than
civilian        agencies       (52 percent)       had distributed         educational
material        to their       employees.       Nonsupervisory         personnel      were
generally         informed      by newsletters,        other    inhouse publications,
and posters          displayed      at the installation.            Of the installa-
tions     visited,        the Departments         of Justice      and Interior        had
generally        made the least         effort      to inform     nonsupervisory
personnel         about the program.
        Interestingly,       some installations       intensified their
efforts      to make employees      aware of the program either        just
before     or just     after  our visit      to the installation.    For
example:
       --At   a western  Transportation  Department   installation,
          a memorandum was issued to all employees       on March 26,
          1976, advising    them of the alcoholism  program.        The
          memorandum was dated after    we made arrangements        for
          a visit.
       --About     3 weeks before our visit    to a southern    Treasury
          site,    all managers were notified    to review   the agency's
          alcoholism    program in preparation     for our impending
          visit.
       --Finally,   a western Air Force base began briefing                        all
          new employees   about their program on April   14,                     1976--
           the date of our visit.
SUPERVISORS'-RESPONSES-CONCERNING
AWARENESS AND-TRAINING
        While over 85 percent        of the 2,660 supervisors      that
responded      to our questionnaire        were aware of their   installa-
tion's    policy,    only 56 percent       were at least moderately
familiar     with the guidelines        for implementing  the policy.       Almost
all Army supervisory        personnel--99      percent-- were aware of
the policy,       compared to less than half of the Justice           Depart-
ment supervisors--48        percent.

                                            44
         There was little         difference      between the military          and
civilian      agencies      in the distribution         of written       material
to supervisors--        75 percent        of the supervisors        in the military
agencies      indicated       they had received        material     compared to
66 percent        in the civilian         agencies.     Also,   almost     65 percent
of the supervisors            in the military        agencies    indicated      they
had attended         meetings     or briefings       to discuss     the instal-
lation's      policy    compared to only 36 percent              in civilian
agencies.
       The following  tables    show the percent   of sampled super-
visors   in each agency that had attended       meetings  or had
received   training  on alcoholism     or employee assistance    pro-
grams:
                     Supervisors-Who-Have-Attended            Meetings
                               Number responding            Percent    responding
         Agency                  that they had                that they had
        (note-a)                attended  meeting            attended-meeting

Army                                        226                          77
Navy                                        171                          64
Air Force                                   182                          60
Defense Logistics                            94                          55
Transportation                               67                          44
Treasury                                     80                          44
Agriculture                                 120                          40
HEW                                          94                          39
Interior                                     29                          30
Justice                                      21                          28
Veterans     Adminis-
   tration                                   63                          25
csc                                           5                          17
a/See     app.     I for   number   of   installations     visited.




                                            45
                         Supervisors    Who Have Been Trained
                         Concerning-the    Alcoholism-Policy
                               Number responding          Percent   responding
         Agency                   that they had               that they had
        (note a)               received-training           received    training
Army                                      263                        90
Navy                                      212                        80
Air Force                                 235                        78
Defense Logistics                         112                        66
HEW                                       148                        63
Transportation                             89                        60
Agriculture                               172                        59
Treasury                                                             53
Interior                                   iii                       44
Veterans     Adminis-
   tration                                101                        41
Justice                                    26                        35
csc                                         9                        30
a/See     app.   I for   number   of   installations     visited.
       In most cases       the training  was conducted  as part           of a
supervisory    training       program sponsored  by the agency.
        Further      analysis      of the data showed that trained         super-
visors    were more in favor of alcoholism               or other   types of
employee assistance             programs,     more in favor of supervisors
receiving       training      in these matters,      and more likely     to
utilize      the installations'           programs when dealing    with prob-
lem employees.
       Supervisors     demonstrated      a high degree of familiarity
with program guidelines          at installations       where the majority
had been trained,       attended    meetings,      or received   written
materials    concerning      the program.        For example:
        --At a western Army installation                100 percent    of the
           supervisors       responded      that they were aware of the
           program,     and over 80 percent          were at least     moder-
           ately    familiar     with the procedures         for implementing
           the program.         Further    analysis     shows that    (1) 90 per-
           cent had received         written     material    on the policy,
            (2) 87 percent       had attended       meetings    where the policy
           was discussed,        and (3) over 97 percent          had been
           trained.       Most supervisors         had also discussed      the
           policy    with their       subordinates.


                                          46
       --At    a western   Defense Logistics        site 100 percent
          of the supervisors      responded      that they were aware
          of the program and three-fourths             were moderately
          familiar    with agency guidelines.           Over 85 percent
          stated   they had received      written      material,   two-
          thirds   had attended     a meeting,      and 80 percent      had
          been trained.
       --Finally,      of the supervisors      at an eastern       Navy
          facility,     97 percent    were aware of the program
          and about three-fourths          were moderately      familiar
          with the policy.        Additional    analysis     indicated
           that 88 percent     had received     training    concerning
           the policy,    76 percent     had received    written      material,
          and 85 percent      had attended     meetings    concerning
          the policy.
     In addition,    officials     at all the above installations
said that their   program had received        extensive publicity
in employee newspapers        or newsletters.
       A study conducted        among Federal           supervisors      under a
grant awarded by NIAAA in 1974 has shown the impact of var-
ious kinds of information             supplied        to supervisors.         According
to this    study,    the materials          distributed        to supervisors      will
have more impact if distribution                   is followed      up with a meet-
ing and training         to discuss       the materials          or vice versa.
Through a reinforcement           process,         supervisors      who have been
informed    by both media will           be better        informed,     more willing,
and better     prepared     to utilize         the installation's         program if
the opportunity        presents     itself.
NONSUPERVISOR'S-RESPONSES-TO
AWARENESS-AND-EDUCATION‘EFFORTS
        While most nonsupervisors           were aware that their     instal-
lations     had an alcoholism       policy,     they were not as aware as
supervisory     personnel,      Only two-thirds        of the nonsupervisors
said they were aware of the policy,                as opposed to 85 percent
of the supervisory        personnel.        The primary     means by which
nonsupervisors      were informed        were agency memorandums and
newsletters.       The table    below shows the percent          of nonsuper-
visors    who were aware of their           agency's   policy.




                                          47
                                Nonsupervisors      Who Were
                                Aware-of-Agency-Policy
                                    Number responding         Percent  responding
         Agency                       that they were            that they were
        (note a)                     aware-of-policy           aware of-policy
Army                                            120                    90
Defense Logistics                                89                    84
Air Force                                       128                    81
Agr'iculture                                    123                    74
Navy                                             98                    72
Treasury                                         82                    70
Veterans     Administration                      83                    59
HEW                                              90                    58
Transportation                                   64                    58
csc                                               8                    53
Interior-                                        45                    43
Justice                                          48                    46
a/See     app.   I for   number    of   installations    visited.
        The table    shows that nonsupervisors         at military     instal-
lations     are generally     more aware of the program than non-
supervisors      at civilian     agencies.      We also found that more
than half the nonsupervisors            in the four agencies       with the
largest     percentage     of aware nonsupervisors       had received
specific     educational     materials     about the program.
     Furthermore,   while 65 percent    of the supervisors                  were
aware that there was a coordinator      at their  installation,
only 48 percent   of the nonsupervisors    were aware.
NONSUPERVISORS“WILLINGNESS
TO-PARTICIPATE-IN  PROGRAM
      Seventy-four        percent     of   the nonsupervisors     said they
would be willing         to voluntarily       see the coordinator      if they
had an alcoholism          problem.
          The primary   reasons   for not wanting     to see the
coordinator        were (1) desire    to go to a community     treatment
facility,       (2) fear of not getting     promoted,    and (3) fear of
job loss.
        Although nearly  three-fourths        of nonsupervisors      said
they    would see the coordinator,        only 18 percent      responded
that    more than half of their      fellow    employees would go to


                                           48
the coordinator       voluntarily       if they had a problem.        This may
indicate     a lack of awareness          of the program's   objectives      and
may also indicate         some mistrust      of management's    motives    for
establishing      alcoholism      programs.
CONCLUSIONS
        In general,    installations       have made some effort           to
inform    and train    personnel      about alcoholism         and the services
available    for treatment         and rehabilitation.           The Defense
agencies    appear to be making a greater              effort     to train    super-
visors    and inform     nonsupervisors        than the civilian         agencies
reviewed.      Supervisors       who have received        training     appear to
be better    prepared      to use the programs         if the situation         pre-
sented itself.
        The data from nonsupervisors      on other employees'      will-
ingness    to voluntarily     use the program may indicate      that
nonsupervisors       are suspect  of managements'  motives    for estab-
lishing    programs.
RECOMMENDATIONS TO DEPARTMENT
AND AGENCY HEADS
        Although     supervisors        are aware of the programs            being
established,       we recommend that department                  and agency heads
increase      supervisor      familiarity         with program procedures
using additional         training,        written     materials,     or meetings
at which supervisory            personnel       may discuss       the policy    and
resolve      any questions.
       Further,     we recommend that heads of departments            and
agencies     take the necessary      steps to inform      nonsupervisory
personnel      about alcoholism     and agency alcohol      programs.       This
could be accomplished         by making greater    efforts     to distribute
educational      materials    on alcoholism   and alcohol      programs,
and by briefing       all new employees     on the installation's
program.
NCA COMMENTS AND
OUR EVALUATION
       NCA stated       that our recommendations         concerning     super-
visory   training       imply the sole purpose of that training               is
to ensure that supervisors             are familiar    with the programs.
They believe      that,     for training     to be truly     effective,     super-
visors   must be motivated          to implement    the program.




                                         49
        We believe    one of the primary       purposes     of supervisory
training    must be to better       inform   the supervisor      about the
problems    that can affect      employee job performance,          including
alcoholism      or alcohol   abuse.      In addition,     this training
should make the supervisor          knowledgeable      about the programs
available     at his location     that can assist       him in dealing       wit1
a troubled      employee and aware of the steps that should be
taken within       the framework    of that program.

       We agree that motivating     a supervisor     to implement   any
program is important.      Supervisors    should be appropriately
motivated    if top management makes its position        clear   on
the program's     intent and its support     for it.
       NCA believes   our findings    on nonsupervisors'  willing-
ness to participate      in the program might be indicative        of an
unclear   or ambiguous     statement  of policy.
       As stated     earlier    in the report   (see p. 32),         we believe
the policy     statements      were clear  about the intent          of estab-
lished   programs.
        Data in this chapter      indicates     that only about two-
thirds    of the nonsupervisors        in our sample were aware that
an alcoholism     policy  existed      at their    installation.          This
indicates    that more effort       is necessary      to inform        the entire
work force about programs         that have been established              to assist
employees    with problems     that negatively        affect     their    job
performance.
       Data in chapter       3 indicates   that some nonsupervisors
could be skeptical       of the nature     of these programs because
of their     location   within    the personnel   office  and we recom-
mended, in part,      that this could be overcome by better         edu-
cating    the work force on the nondisciplinary          nature  of these
programs.
        We stated    above that management must make its position
clearly     known if supervisors        are to be motivated        to implement
these programs.        We believe     this will      further   enhance the
nonsupervisors'       willingness     to participate.         Even if all
employees      are made aware of existing          programs,    the lack of
strong    management support       for these programs         could undermine
their    credibility      and deter participation          of employees   at
all levels.




                                        50
                                             CHAPTER         7

                                      SUCESSFUL           PROGRAMS

         Some relatively          successful      programs were found among the
installations        visited.         Characteristics      of these programs
were generally
       --strong         management         support,         which       included      a formal
          policy        statement;
       --specific         procedures         for        handling        cases;
       --effective     in-house   treatment     and referral                          system
          administered      by competent    personnel;
       --access         to community         treatment             facilities;
        --supervisory           training       programs;
       --employee         education         programs;
        --where     applicable,            labor-management                 cooperation;       and
        --an   adequate         recordkeeping             system.
     These characteristics     have also been identified        by NCA
as necessary  for the operation     of an effective    program.     csc
has mentioned   these elements    in its guidelines.
       Most of the installations       selected    in our sample were
not as effective     in getting   alcohol     abusers   into treatment
as could be expected,       based on NCA's guideline         of reaching        1
percent   of the work force per year.           Several   installations,
and the Government     Printing   Office     (GPO) in Washington,           how-
ever, appeared     to be doing a good job operating            their     pro-
grams and illustrate      what can be accomplished          by an effective
program.
       At a western       Army installation         with a work force of
about 2,800 civilians,            25 alcohol-related      cases were handled
in fiscal     year 1974 and 35 cases were handled              in fiscal    year
1975.     The installation         operates     an employee assistance      pro-
9-w     which appeared        to have the enthusiastic         support    of both
the installation         commander and the Washington          headquarters
commander responsible           for this activity.




                                                   51
       The installation        program coordinator          believes      that be-
tween 9 and 12 percent          of the employees         at his installation
suffer   from alcohol-related           problems.       The commander also
believes    the problem      is significant         at his installation,          and
stated   that whatever       the program cost he believed               it would
be recovered      through    savings      realized     by increased       produc-
tivity   of those persons         helped.        In his opinion      any commander
who objected      to initial      program costs was not really               con-
cerned with cost but simply was not supportive                     of the program.
        The program operates           with a formal     budget and utilized
a coordinator         full time, and a secretary           and chaplain    part
time.       In addition,     the program uses 23 volunteer            parapro-
fessional      counselors      distributed     around the installation.
Alcoholics      Anonymous meetings          are frequently     held at the
installation.
         Installation           officials      said that 100 percent            of the
employees        and supervisors            have received       some literature          con-
cerning       the program,            which is highly      publicized        in the
installation           newsletters.          All supervisors        and employees
contacted        stated       they were aware of the agency's                  policy.
In addition,           most supervisors           said that they were at least
moderately          familiar        with the installation's           guidelines        and
would probably             refer      employees    with problems       to the coor-
dinator       if the situation             ever arose.      This indicates           an
acceptance         of the program by supervisory                 level    personnel.
        Further,     the union at the installation     is supportive       of
the program being conducted.          Th,e union president    stated     that
employees do not fear job reprisal           if they request    treatment.
He also said that the union does have a voice             in program
operation      through   membership  on a labor-management      advisory
board.
        The coordinator      stated     that the program is strictly
voluntary    for civilians,        but disciplinary        action is taken if
a problem employee's         job performance        does not improve and
the employee is unwilling           to accept the services        the program
offers.     The coordinator        estimates     that more than 50 percent
of those entering       the program in fiscal           years 1974 and 1975
have made adequate        progress      in counseling     or have improved
their    job performance.
        The GPO in Washington,       D.C., established    a program for
alcohol    abusers   in 1971.     This program appears to have been
highly    effective    in getting    alcohol  abusers  into treatment.
GPO's program,      which serves more than 8,000 employees,


                                             52
operates on a budget of about $36,000 a year.    In fiscal   year
1975, 94 alcohol  abusers were identified, and the coordinator
believes about 65 percent  were helped.
      The coordinator  said                that there are nine                  basic   criteria
necessary  for his program                 to work effectively:

        (1)    top management             support;

        (2)    support        from    lower      level      management          and union
               officials;

        (3)    extensive         and accurate            documentation           of employee
               behavior         by supervisors;

        (4)    location         in the medical     department      to remove                 it
               from the         sphere of disciplinary        action;

        (5)    communication            between the client,                the supervisor,
               the counselor,            and the treatment               facility;

        (6)    strict        confidentiality             of all     records;
        (7)    no effect         on the        employee's         job   level     or pro-
               motability:
        (8)    enc?uragement            to the        abuser to develop    new
               and different            social        relationships;   and

        (9)    a formal  program structure                    which includes    a
               written  policy,  training,                   diagnosis,   and therapy.
         Many of the same factors              were evident         at some other
 installations          which were effective           in getting        alcohol
abusers        into treatment.          High level       management support             was
apparent.           An adequate       and well-qualified           staff     conducted      the
program.           Supervisors      were aware of the program and familiar
with the guidelines,               and most had been trained.                  Employees
also demonstrated             a high degree of awareness.                  In addition,
at least         three locations        made medical       facilities          (located     on
the installation)             available     to employees with alcohol                 prob-
lems.
        It appears    that         installation    size could               also be a factor
that affects     program           operations.     At smaller               installations,        an
effective    coordinator             could be sufficient,       in            some cases,      to
overcome the lack of               other desirable      program             characteristics.
For example,     a western            HEW facility    was highly               effective     in


                                                 53
getting    alcohol     abusers     into treatment.           The coordinator       said
that management support            was strong,       but the program was in-
formal.      No policy     statement        or procedure      documents     existed.
The program had little            publicity     and many supervisors           and
employees      were informed       by word of mouth.             The coordinator
believed     that his program was effective                because he has good
rapport    and working      relationships         with supervisory         personnel.
In addition,       the installation's          medical     facilities      were made
available      to employees       with alcohol       problems       on both an in-
patient    and outpatient         basis.
        During our review we saw little          difference       between the
employee populations         and the duties    they performed         at instal-
lations     with more successful      programs     and installations         whose
programs were not as successful.            The basic difference           that
could be seen between the more effective                and less effective
programs were the attitudes          of management and the coordinator
toward alcoholism       programs    and alcoholics,       and the support
perceived      by employees.
EFFECTIVE PROGRAMS OUTSIDE
THE FEDERAL SECTOR
        We visited        five non-Federal     programs     to determine       whether
successful       programs      conducted    by non-Federal      entities     had any
special      characteristics.          These programs      considered     effective
by NCA included           three at industrial      operations,        one at a pub-
lic utility,        and one at a municipal         government      agency.
Employee populations            served by these programs ranged from
about 1,200 to about 40,000,
        Site visits    were conducted      in much the same manner as
the visits     at the 81 Federal      installations      included     in our
review.      We spoke with management personnel,            coqrdinators,
union representatives,         and other interested        parties,     and sent
a limited     number of questionnaires           to both supervisory      and
nonsupervisory      personnel.
         The programs     appeared to have a number of common charac-
teristics.       All the coordinators       said that management was
strongly     supportive      of the programs being conducted         (four
are broad-based        employee assistance      programs,   the remaining
one is alcohol        and drugs).    At one facility      we learned     that
the corporation        president   was the force behind the program's
establishment.
     Supervisors        who responded  to our questionnaire,    for the
most part,   also     felt  management support  was substantial    or



                                         54
great.     Four of five program coordinators      indicated      that
resources     for their  programs were very adequate,        which is
another    indication   of top management support.        Program staff
ranged from one part-time        to as many as nine full-time
personnel.       Yearly program costs ranged from $2,000 to
$200,000 per year.
        Most coordinators        were hired    for that position    and most
had prior       experience     in alcoholism    programs   or had received
special     training      in alcoholism     or counseling.
        Coordinators        said that most of their      supervisory       person-
nel had received          training     about the programs.      During this
training,       supervisors        are informed  about the program and
their     responsibility         in the program.    At four of five loca-
tions,      supervisors       are instructed    not to diagnose      problems
but to recognize          poor job performance.
       One coordinator      particularly       stressed     the necessity     of
adequately    documenting       the employee's       performance.      One
coordinator      said that without       specific     documentation      the
supervisor     loses the leverage        he has with the employee and
it becomes more difficult            to get an employee into the pro-
gram.     With documentation         the employee is more likely           to
admit a problem exists          and is more willing         to enter    a program
for treatment       and rehabilitation.          The employees      generally
get these options:
       --Submit        to inpatient    hospital    care or other pre-
          scribed        treatment   (paid by the company while     also
          paying       the employee's     full  salary).
       --Submit        a resignation.
       --Be   fired.
         The other four programs      also offer   treatment    and reha-
bilitation        to every employee who enters     the program.     However,
strict     disciplinary    actions   are taken if the employee refuses
to enter the program or fails           to improve job performance
following       counseling  and treatment.
     The coordinators     have contacted   a minimum of 6 and as
many as 50 treatment    facilities    and utilize  many of them
when referring   employees.
        With one exception,     formal       case files     were   kept.   Four of
the   five coordinators     said they        generally    follow    up with both



                                        55
the community    facility       and supervisors        to determine      the
employee's   progress     in    treatment.
      The coordinator's         estimates    of the program's     success
in returning    employees       to effective    production    ranged from
50 to 90 percent.
CONCLUSIONS
         An alcoholism      program's     effectiveness         varies      among in-
stallations        of similar     characteristics       within       the same agency.
We believe       that in many cases this            is attributable          to the
support      given and resources         made available         to the program by
installation         top management.        This includes         qualified     staff
with sufficient         time to carry out their            duties      and adequate
support      resources.
        It appears that the major features            of effective     Federal
programs-do       not vary significantly        from those reviewed      out-
side of Government.         The, key factors       of management support,
adequate     staff   and resources,      supervisory      and employee
training     and education,     and an effective        referral   system are
present    in most situations.
       Although    program location    and procedures     may vary some-
what, the end result       is a program that can reach and success-
fully    treat  alcoholic    employees  and return    them to effective
productivity.
NCA COMMENTS AND
OUR EVALUATION
      Commenting on our draft     report,   NCA stated             that another
element   of successful   programs not cited     in our            report  is
the availability     of adequate  insurance   coverage             for alcoholism.
      We agree that this       is an important     factor.      We did not
cover the insurance       coverage  area in this      report.     However,
in a report   to the Congress entitled         "Progress      and Problems
in Treating   Alcohol     Abusers"  (HRD-76-163,      Apr. 28, 1977), we
did address   this    issue.
        In that report     we recommended that NIAAA continue                to
develop    alcohol    abuse treatment       cost data and disseminate
that data to public        and private      third    party  payers.       Until
adequate     cost data on the provision           of treatment      services
for alcoholism      is developed,      third     party payers will        be
reluctant     to reimburse    providers       of such care.



                                        56
       Finally,      we recommended that the Congress explore           the
need for legislation         that would require   fuller     Medicaid     and
Medicare      coverage    of alcoholism treatment     services    delivered
by programs meeting         established standards     for alcoholism
programs.




                                      57
                                      CHAPTER     8
                    ALTERNATIVES       TO EXISTING       PROGRAMS

        The installations         visited    have generally         developed
programs designed         to serve their         own employees.         In many
cases,    these    programs     did    not  serve    an    employee   population
that was large enough to warrant                 a full-time      coordinator
who would counsel         employees,       educate and train         staff,    and es-
tablish     communications       with community-based            agencies     used
for referral       purposes.       We found that,          while coordinators
and top manangement were generally                 receptive      to the idea
of cooperative        programs,      consideration         or development      of
cooperative     efforts      have been minimal.
       A cooperative      program is one in which a number of dif-
ferent     agencies   combine to establish         an effective      program
to serve the employees           of each agency.       In our opinion,
this approach       is particularly     advantageous       in situations
where there are many agencies           in the same general          area but
each agency does not have a sufficient               number of employees
to justify      the appointment      of a well-trained        coordinator    who
would be able to spend substantial             time on the program.
COOPERATIVE  EFFORTS
NOT CONSIDERED

         Over 80 percent       of the 81 installations          visited    were
employing      less than 4,000 persons,          the minimum number that
an NCA official         believed     would be necessary       to justify       a
full-time      alcoholism      coordinator.      Officials      at most of
these locations         and officials       from selected     regional     offices
stated     that they had not considered            developing      cooperative
programs.
        Understandably,         officials       at the larger         installations--
4,000 or more employees--              believed     that there was a sufficient
number of employees           located       at their     facility       to justify    a
separate      program.       Commments of officials               from the other
installations        and from the regional             offices       on the development
of cooperative        efforts      were generally          as follows:
       --Little    or no thought   had been given             to operating
          a program in conjunction     with other             agencies    in
           the immediate   area.
       --Little     or no need existed          for   a cooperative       effort.




                                         58
        --Installations             had a sufficient        number     of employees
            to justify         their   own programs.
OFFICIALS' VIEWS CONCERNING COOPERATIVE
PROGRAMS IN FEDERAL BUILDINGS
        Although   most of the interviewed         officials    from Federal
buildings      had not considered       or were not considering        any
type of cooperative        effort    with other agencies      located    nearby,
they believed      that the concept       of interagency     cooperative     pro-
grams warranted       consideration.
       A combined effort    offers  the following                    advantages  when
agencies   have a small work force and cannot                        devote a large
amount of resources      to the program:
        --availability    of trained   personnel      to discuss  problems
           with employees   and coordinate     training     and education
           activities,
        --better          knowledge     of community-based        programs     avail-
           able     for     referral     purposes,   and
        --less      reluctance     by employees           to contact     someone out-
            side    their    agency.
        According  to some officials                the following        problems
could    impede the effectiveness                 of a cooperative        effort:
        --Agencies  with larger             numbers of employees would
           get the most attention             in a cooperative  effort.
        --Funding          mechanisms     would    have    to be developed.
        --Employees    would be uncomfortable                 in dealing   with         a
           nonagency employee who may not                   understand   specific
           job problems.
        --Employee     unions would           be unlikely       to support     a
           cooperative     effort.
       Despite    these problems,   most agency officials      said that
they would be willing       to consider  developing     a cooperative
program,    particularly     if a more specific    proposal   was
presented.
POSSIBLE ALTERNATIVE
TO SEPARATE-PROGRAMS

      CSC guidelines   state    that the Federal         Executive    Board
(FEB) and the Federal     Executive     Association       (FEA) should be
used in furthering   the concept      of a united       Federal    effort   to
cope with problem drinking        and alcoholism.         In our opinion,
these organizations    could act as focal         points     in the develop-
ment of interagency    cooperative      efforts     in those locations
where there are many Federal        agencies     each with a relatively
small employee population.
Federal    Executive       Boards-and
Federal-Executive          Associations
        FEBs were initially        established       in 1961 to emphasize
management skills         in support     of improved economy, efficiency,
and substantive      effectiveness         of the executive    branch of the
Government.      FEBs are expected           to strengthen   coordination
of Government     activities       across agency lines.        There are
currently    26 FEBs located        in major metropolitan        areas of
the country.
        OMB provides       overall     policy    direction     and guidance      to
FEBs.      National     objectives      of the FEBs are suggested            by a lead
agency     in Washington        and are approved by OMB. Past national
objectives       have been in energy conservation,               minority     busi-
ness enterprise,         assistance       to the elderly,       and personnel
management practices.              According      to an OMB official,        CSC has
not suggested        that OMB establish--for             FEBs--a national      objec-
tive for promoting          or developing        coordinated     interagency
alcoholism       or employee assistance            programs.     Officials     from
FEBs in three cities--Atlanta,                Kansas City,      and Philadelphia--
said that they could recall               discussions      of programs     to help
employees      with alcohol-related           problems     when CSC announced
that employee alcoholism             programs would be established             by
each agency.         However, no action          was taken to develop         coopera-
tive programs designed             to serve the employees          of more than
one agency.
        Another     mechanism for developing               cooperative      programs
are FEAs.        FEAs have been established                in about 100 communities
where a number of Federal             installations            are located.       FEAs
generally      represent      fewer Federal         installations        and employees
than FEBs.        Although      their   activities         are oriented       toward the
objectives       and activities       of FEBs, they are not required                   to
participate       in the implementation            of the national          objectives
established       for FEBs.


                                           60
FEB~local      initiatives
        In addition        to FEB national   objectives,   local    FEBs devote
considerable        effort     to unique needs in a community       or geo-
graphic    area. OMB, CSC, and NIAAA officials            said one such
effort    currently        being conducted   by the Boston FEB shows how
a cooperative         approach    for employee assistance     programs   can
work.
        Boston College     is conducting     broad-based       employee assis-
tance programs      at five locations      in the Boston area--one            is
located     in the John F. Kennedy Federal           Building.      Although
the program is being conducted           under a NIAAA training           grant,
 it offers    the full   range of services,        including
       --training        supervisors     and educating      nonsupervisory
           personnel,
       --training        coordinators,
       --counseling          employees   with   problems,    and
       --referring           these employees    to community-based
           treatment         facilities.
In total, some 4,000 employees   from 14 agencies   located   in the
John F. Kennedy Federal Building    are covered  by the program.                          .-

        The program in Boston is being conducted         under the spon-
sorship    of FEB, and the FEB official       there believes   it has
the cooperation     of the American    Federation    of Government
Employees and the National      Association      of Government   Employees,
two of the larger     Federal employee unions.
        A FEB Boston official          believes    that,    because of FEB
sponsorship,       the program has caused top management of the
various    agencies      to become more concerned           about alcoholism
as a problem.         He stated     that most agencies        have made training
mandatory     for supervisory         personnel.      The training       offered     by
Boston College        is an initial        2-hour session     with a followup
course 3 months later          which discusses        the concept       of an
employee assistance         program and-the        services     available,       the
scope and nature        of alcoholism         and other problems,         and the
role and responsibilities             of a supervisor       in an employee
assistance      program.      The training       course also explains
what actions       a supervisor       should and should not take in
dealing    with an employee with a problem.



                                           61
       The fact that most agencies     have made training   mandatory
appears to indicate    that management in the John F. Kennedy
Building   is giving  some support   to the ongoing efforts    to
combat alcoholism    and other problems.
         Based on information            obtained      from the program,           the
program appears to be moderately                    successful       in getting        alco-
hol abusers        into treatment         compared with the 81 installations
visited     during      our review.         Although      fiscal     year information          is
not available,          the latest       data developed          shows that,       during     an
8-month period,           the John F. Kennedy Federal                Building      program
reached 21 persons with alcohol-related                        problems,      slightly       more
than half      the number of clients              that could be expected               in
an entire      year under the guidelines                 established        by NCA. The
81 installations            reached only about one-third                 of the expected
caseload.        In addition,         the Boston program handled                57 other
cases ranging         from drug abuse to marital                 and financial         pro-
blems.      The program at the John F. Kennedy Building                           only
operates      on a part-time          basis--3      days a week.          Program
officials      stated,        however,    that they believe            there is a need
for a full-time          program at that location.

CONCLUSIONS
        Most installation  officials   had not considered       conducting
a program in cooperation      with other   installations.       Many per-
ceived no need for a cooperative       program or believed        their
installation     was large enough to operate        its own program.
        Cooperative       programs      appear to benefit          groups of smaller
agencies    located       in the same building           or geographic         area.
These programs         are valuable       because agencies            can jointly
utilize    qualified        staff   to train      supervisors         and educate
employees,      to offer       counseling     services,       and to maintain
liaison    with community-based            treatment      facilities.          Further,
these programs can often provide                  a neutral       counseling
environment       outside      the agency,      thus reducing          employee reluc-
tance to seek assistance.
RECOMMENDATIONS TO CSC, OMB,
AND DEPARTMENT AND AGENCY HEADS
     We recommend that   CSC and OMB support   the development
of consolidated  employee assistance  programs    through  FEBs.
        Since FEAs are not as formally      establised as FEBs we
further     recommend that OMB urge FEAs to consider     establishing
cooperative      programs where applicable.




                                            62
        Finally,   in areas where FEBs and FEAs do not exist,           we
recommend that the department           and agency heads take the ini-
tiative     and play an active     role in establishing    cooperative
employee assistance       programs    to better   serve employees    in
those locations.
CSC AND OMB COMMENTS
CSC-comments
       Commenting on our draft       report,    CSC agreed that cooperative
programs   are a viable    method of offering        services     to employees    in
the same geographic     location.       In addition     to the program
discussed   in the report,      CSC stated    that similar      efforts   are
being undertaken    at other locations        across the country.         In
most cases, CSC representatives           are working     in cooperation     with
the local   FEB to develop      these cooperative       programs.
OMB-comments
       OMB endorsed     our recommendation     that they support           and
develop   consolidated     programs  to assist     employees with          pro-
blems through      FEBs.
        Commenting on our draft         report,      OMB stated    that fiscal
year 1977 guidance        to FEBs contains         such encouragement.
FEBs are encouraged         to sponsorl     as a supplement        to existing
health    services,    a comprehensive        series     of interagency
education      and screening    projects,       including     screening    for
alcoholism      and drug abuse.
      OMB   further     stated that national   objectives    and priori-
ties  for   FEB activities     are determined   by the Federal     agen-
cies and    FEB would be responsive       if CSC and the other agencies
choose to     promote alcoholism    programs   as a national    objective.




                                        63
                                         CHAPTER-9


                        EVALUATING ALCOHOLISM-PROGRAMS
      While CSC has been given responsibility          for assisting
Federal   departments     and agencies   in developing    and maintaining
programs   for Federal     employees   who are alcohol    abusers,   it
has only limited      authority   to make sure that such programs
are implemented.
       CSC evaluations,    which have been limited    primarily   to
describing   program activities,      are declining.   In the future
more emphasis will      be placed on self evaluations     by agencies
responsible    for administering    the programs.
CSC'S-RESPONSIBILITY
AND AUTHORPTY
         A CSC official,       testifying       before    the Manpower and Housing
Subcommittee,        stated    that under Public          Law 91-616 CSC shares
responsibilities,          in cooperation        with Federal         departments      and
agencies,        for developing       and maintaining        programs       for Federal
civilian       employee alcohol         abuse.     He also testified           that the
statute      gives CSC no authority            or means of assuring            that the
other agencies         implement      these responsibilities.              Another     CSC
official       told us that CSC views this             responsibility          sharing
as appropriate.
         As a consequence     of its limited   authority,    CSC cannot
promote the program based on legal           sanctions.     For example,
the Department       of Justice    has not yet developed     a depart-
mental policy      for alcoholism     and drug abuse programs nearly
6 years after      the issuance     of CSC's program guidelines.         csc
testified     that they were not in the position          to force   the
Justice     Department    to comply with the law.
       CSC, however,         believes:
       --It       has general     authority    and responsibility        for
              developing    Federal    personnel     management policies;
              therefore,    through     the administration        of these
              programs,   it can guide and monitor         the implementa-
              tion of these programs.




                                            64
       --Agencies       will    deal with alcoholic       employees   in
          accordance        with the guidelines       rather    than with
          inappropriate         disciplinary    actions,     because CSC
          adjudicates        employee appeals.
       --Agency     program activities       can be effectively
          monitored     through    the collection   of program
          data and onsite       evaluations.
        A CSC official      stated    that CSC is scheduling         visits     to
45 headquarters        agencies     to determine      their programs'
status,     and reviewing       the possibility      of preparing      a Presi-
dential     statement    to stimulate       more effective     programs.
Until    these reviews      are complete,       they would not suggest
the need for any additional             CSC authority.


        CSC performs     onsite      evaluations       of personnel     management
functions     at Federal      installations.           This includes     monitoring
the implementation        of the installations'             alcoholism    programs.
CSC conducts      two types of evaluations:                (1) special     evalua-
tions--   conducted    if a particular           problem    is brought     to its
attention     and (2) general         evaluations--designed           to review
all aspects      on the installation's            personnel     management
function.
        CSC reports      on an exception        basis.     The status       of an
installation's        program will      usually     be included      in the eval-
uation      report  only if there is a problem with the program's
implementation        or if the program is particularly                effective.
CSC testified       that,     under the present        evaluation      system,
the alcoholism        program would not be reviewed               in sufficient
depth to determine          its effectiveness.
        A CSC official         testified     that CSC evaluated         about 500
programs       that assisted        employees     with alcohol-related
problems       in fiscal      year 1974 and about 270 in fiscal                year
1975.       Information       on the first      three quarters       of fiscal
year 1976 indicated            that the number of program evaluations
will    further      decline.       He also stated     that the decline           in
CSC evaluations           is due to a shift        to self evaluation          by
each agency.          Instead     of having larger       CSC field      office
staffs,       CSC issued guidelines          for agency self evaluation
in April       1975, and encouraged          the agencies     to incorporate
the self evaluation            functions     into internal      audits.




                                          65
CONCLUSIONS
       If heads of departments            and agencies     do not take the
necessary   actions   to develop          effective    employee alcoholism
programs within     a reasonable          period    of time, we believe    CSC
should assume this      responsibility.             It appears,  however,
that CSC may need additional              authority    to do so.
        Also,   unless Federal agencies   and CSC direct    their
efforts     toward evaluations  of program activities,      they
will    not be able to know how effective     programs   really              are.
RECOMMENDATION-TO CIVIL SERVICE-COMMISSION
AND DEPARTMENT AND AGENCY HEADS
         CSC and the department        and agency heads should concen-
trate      on reviewing    programs    to make sure that they are not
merely      implemented    but effective     in identifying and reha-
bilitating       employees    with problems.
RECOMMENDATION-TO
THE CONGRESS
         If department      and agency heads do not act within      a
reasonable      period    of time to develop   effective   employee
alcoholism      programs,     we recommend that the Congress explore
legislation      giving    CSC more authority    to do so.
CSC COMMENTS
         Commenting on our recommendation             on program monitoring
activities,       CSC stated     that yearly     evaluation       visits     to the
headquarters       of each agency employing           more than 1,000 persons
have been established.             According   to CSC one item usually
covered during        these visits      is the agency plan for self
evaluation      of their     program.      CSC further      stated      that it
strongly      encourages     a more clearly      defined     system of
accountability        and feedback      within   agencies      to stimulate
more effective        programs.




                                          66
APPENDIX I                                                               APPENDIX I


                                    AGENCIES -_----
                                    ---        REVIEWED
                                                                   Total
                                                            installations
              Agencies   reviewed:                              visited
    Headquarters
    p--1_----------    and installations--                       (note
                                                                   --_--- a)
      Agriculture                                                    9

      Air     Force                                                  9

      Army                                                           8

      Civil       Service         Commission                         1

      Defense         Logistics                                      6

      Health,         Education,          and Welfare                8

      Interior                                                       6
      Justice                                                        6

      Navy                                                           8
      Transportation                                                 6
      Treasury                                                       6
      Veterans           Administration                              8
                 Total

-a/Programs     were located      in the following        States:    Pennsylvania,
    New Jersey,     Maryland,     Virginia,      District    of Columbia,
    South Carolina,      Georgia,      Florida,     Alabama,    Tennessee,
    Missouri,    Kansas, Oklahoma,          Texas, Nebraska,      and California.




                                               67
APPENDIX I                                                          APPENDIX I



             OTHER
             ----- AGENCIES WHERE    INFORMATION
                              ------_---
             WAS OBTAINED AT HEADQUARTERS
             P--P------          ------   ONLY
               Commerce
               Defense      Communications            Agency
               Energy Research            and Development
                 Administration
               Environmental           Protection        Agency
               Federal   Deposit          Insurance
                 Corporation
               Federal      Energy      Administration
               General      Services       Administration
               Government       Printing       Office
               Housing      and Urban       Development
               Labor
               Office      of the      Secretary       of Defense
               Selective       Service
               Small     Business       Administration
               State




                                 68
APPENDIX II                                                                APPENDIX II


                    SIGNS OF DETERIORATING
                    ----es-         ---------- JOB PERFORMANCE

Early
-----_1    stage    alcoholism
                                       Tardiness   (at lunchtime)
          Attendance                   Early departures    from work
                                       Absent from work station
                                       Occasional        lapses  in fulfilling
                                          responsibilities
          Performance                  Errors     due to poor judgment
                                       Spasmodic work pace
                                       Minor decline         in quality      and
                                          quantity       of work
Middle      stage      alcoholism
                        --_I
                                       Longer lunch periods
          Attendance                   Frequent   days off for vague               causes
                                          or implausible   reasons
                                       General   deterioration
                                       More pronounced        spasmodic work          pace
          Performance                  Lapses of attention
                                       Inability    to concentrate
                                       Changes in work relationships
Late      middle    stage     alcoholism
                                       Generally       unreliable
                                       Frequent      time off (sometimes            for
          Attendance                      several      days)
                                       Does not      return     from lunch
                                       Avoids supervisor      and associates
                                       Overall    performance    unsatisfactory
          Performance                  Changes in work pace become more
                                         pronounced      and more frequent
                                       Excuses for failures       become
                                         elaborate      and sometimes     bizarre
Qproaching
  I__-              late    or terminal      stage    alcoholism
          Attendance                   Prolonged      unpredictable        absences
          Performance                  Uneven
                                       Generally      incompetent


                                            69
APPENDIX               III                                                                                                    APPENDIX   III

                     TYPICAL          FLOW         OF EMPLOYEE              THROUGH              THE      PROGRAM




                                                             SUPERVISOR  DOCUMENTS
                                                               POOR PERFORMANCE




                     WHERE    APPLICABLE    THIS             EMPLOYEE CONFRONTED
                     SHOULD    BE DONE IN THE                   BY SLlPER”lSOR TO
                     PRESENCE    OF A UNION        --        DISCVSS PERFORMANCE
                     STEWARD

                                                                                                                  EMPLOYEE
                                                                                                                PERFORMANCE
                                                                                                                   IMPROVES

                                                                PERFOkMANCE
                                                                CONTINUES        TO
                                                                    DECLINE




                                                               REFERRED     TO THE
                                                                   COUNSELING




                                                                COORDINATOR
                                                                   OR EXPERT
                                                                  DIAGNOSES
                                                                 THE PROBLEM




  SUPERVISORS          CAN BE                                                                           TREATMENT
  EVOLVED
  Cl
                  IF THE ,__
  __.-...IFNT GIVES
  PERMISSION
              -.    ~. HIS       t
                                     SUPERVISORS
                                                         H            FOL.LOWS
                                                                    ON TREATME
                                                                                 U




                                                                                                 JOB
                                                                                          PERFORMANCE

                                           I       IMPROVE      I                     I
                                                                                             IMPROVES
                                                                                                            -




                                                                          70
APPENDIX IV                                                            APPENDIX IV


                   EFFECTIVENESS OF PROGRAMS -----
                   ------------              REVIEWED IN
                   GETTING
                   ----     ALCOHOL ABUSERS INTO TREATMENT
                         ---m--P--_                   ----
                    Number of      FY 1975          Total           Percent    of
                     instal-      population       caseload        NCA expected
Agency
---                  lations       (note
                                    --       a)    (note
                                                    --     a)        caseload-
Army                  b/7          b/22,837            192               84.2
Defense
  Logistics                  6          9,974            46              46.0
Navy                         8        39,942           155               38.8
Agriculture                  9          6,530            24              36.9
Air    Force          b/f3         b/48,684            115               23.6
csc                          1          6,600            14              21.2
Veterans     Ad-
  ministration               8          7,199            14              19.4
Justice                      6          2,189             4              18.2
HEW                          8        27,298             42              15.4
Treasury              b/5               6,701             4                  6.0
Interior                     6          3,498             1                  2.9
Transportation          -6            11,351              1              -- . 9
       Total            c78             192.803         612              31.7

-a/As reported        by installation        directors.     This   figure   does not
    include    tenant     organizations       or other onsite      employees    under
    the installation's          program.
b/Caseload     data unavailable         at one installation;         these     popula-
   tions   were excluded.




                                        71
APPENDIX V                                                        APPENDIX V


                   GAO REPORTS ON FEDERAL
                   l_---             -------- ACTIVITIES
                           TO COMBAT ALCOHOL ABUSE

                                                       Report
                   Title
                   --                                  number         Date
                                                                      ---
Substantial      Cost Savings      from
Establishment      of Alcoholism
Program for      Federal  Civilian
Employees                                           B-164031(2)      g/28/70

Alcoholism      Among Military        Personnel     B-164031(2)     11/02/71
Difficulties   of Assessing      Results
of Law Enforcement     Assista_nce
Administration   Projects     to Reduce
Crime                                               B-171019         3/19/74
Veterans      Administration     Program
for Alcoholism        Treatment   Often
Insufficient:         More Action    Needed         MWD-76-16        g/02/75
Alcohol    Abuse is More Prevalent             in
the Military    than Drug Abuse                     MWD-76-99        4/08/76
Progress      and Problems       in Treating
Alcohol      Abusers                                HRD-76-163       4/28/77




                                          72
APPENDIX VI                                                                          APPENDIX VI


                    EXECUTIVE         OFFICE     OF THE PRESIDENT
                        OFFICE   OF   MANAGEMENT            AND     BUDGET
                                  WASHINGTON.        D.C.   20503


                                  April         14, 1977



Mr. Gregory J. Ahart
Director,   Human Resources Division
U.S. General Accounting    Office
Washington,   D.C.  20548
Dear Mr. Ahart:
This refers   to your request for review and comment on your
draft  report   entitled "Most Agencies'  Programs to Assist
Employees with Alcohol-Related    Problems Are Still  Ineffec-
tive".
We generally    agree that the report   presents   good evidence
that the program is in need of improvement,        and closer
adherence to Civil     Service Commission guidelines     would
greatly  assist    in making the program more effective.
The recommendations   appear to be well-taken                                and, if followed,
should contribute   to achieving the program's                                objectives.
One of the recommendations    relates    to Office    of Management
and Budget support in the development         of cooperative  programs
serving more than one agency in a common geographic          area.
We endorse the recommendation      as stated.
In fact,   fiscal    year 1977 guidance to Federal Executive
Boards contains      such encouragement.     Presently,   FEES are
encouraged to sponsor,        as a supplement to available    health
unit services,      a comprehensive   series of education    and screen-
ing projects      on an interagency   basis.   Health problems cited
as examples include       alcoholism  and drug abuse.
While these programs are neither    mandated nor administered     by
FEBs because of funding and organizational       management problems,
FEBs are responsible   for ensuring  coordinated    Federal response
to programs they sponsor.
Federal      Executive     Associations     are very loosely     organized
efforts      which serve principally          as interagency    communication
vehicles       for their members.        FEAs, nevertheless,      tend to
pattern      local initiatives        to activities     of FEB systems.
Therefore,        some FEAs may assume similar          employee health    respon-
sibilities        in the future.


                                                73
APPENDIX VI                                                   APPENDIX VI

                                                                  2

We would like to add that the major impetus for FEB program
initiatives   comes from priorities      of Federal agencies.      csc
and the other Federal agencies may choose to promote the
alcoholism   program initiative     as a national   objective    if the
necessary resources    can be identified      to mount this effort
where applicable.     Undoubtedly,    the FEB system will     be
responsive.
We thank you for the opportunity          you have afforded   us to
comment on the draft report.
                                         Sincerely,




                                      Edward F. Preston
                                      Assistant Director
                                      Executive Development and
                                        Labor Relations  Division




                                    74
                                                                                                      APPENDIX          VII
APPENDIX   VII


                                                                                                          INREPLY
                                                                                                               PISAY
                                                                                                                   REFER
                                                                                                                      TO
                     UNITED       STATES        CIVIL      SERVICE        COMMISSION
                   BUREAU    OF RETIREMENT.     INSURANCE,      AND    OCCUPATIONAL     HEALTH

                                                                                                          IWI MllElKE



     Mr. H. L. Krieger,  Director
     Federal Personnel  and Compensation                   Division
     U. S. General Accounting     Office
     Washington,  D. C. 20548




     Dear Mr. Krieger:

     This is in response to your March 10, 1977 letter    enclosing   a draft of
     your proposed report to the Congress on the Federal Civilian        Employee
     Alcoholism   Program.  We would like to take this opportunity     to commend
     GAO on the thorough and comprehensive    manner in which the review was con-
     ducted.    Below are our comments on your recommendations    to the Commission.

           Recommendation:   The Civil   Service Commission should take the
           initiative  in conducting   or sponsoring studies to more accurately
           define the extent of problems Federal employees experience.

     The draft    report is correct     in stating  that there have been no studies
     on the prevalence      of alcohol    problems among Federal employees.      The
     counseling    data accumulated     so far does not enable us to make a rea-
     sonable estimate      of the extent of the problem.       To our knowledge,   there
     is a similar     lack of data and valid studies      on the prevalence   of alco-
     hol problems among private        or other public   employers.

     Studies such as you recommend would be useful particularly                                  if    there   are
     representative and random samples cutting  across all:
                       -      occupational        categories

                       -      grade levels

                       -      geographic        regions
                       -      sex and age groupings
                       -      minority        groups

     This type of depth and detail        would be useful in allowing       us and the a-
     gencies to more accurately       forecast   prevalence     at specific  locations   based
     on the characteristics     of individual     employee populations.        This would
     allow some differential     use of penetration        rates as a measure of program
     effectiveness.      For comparative    purposes,    it would be most useful if similar


             THE     MERIT     SYSTEM-A        GOOD       INVESTMENT        IN   GOOD   GOVERNMENT




                                                           75
APPENDIX       VII                                                                    APPENDIX          VII


     studies      were undertaken     among private     and other     public   employers.

     Given our limited     expertise   to perform this type of sophisticated                  re-
     search, we will    discuss the feasibility     of such a study with the
     National Institute     on Alcohol   Abuse and Alcoholism   (NIAAA-HEW).

           Recommendation:     Heads of agencies and departments       should
           give strong consideration     to establishing     broader employee
           assistance   type programs.     Further,   if program location     is con-
           sidered to be a problem, they should give consideration            to re-
           moving these programs from the personnel         department or taking
           other actions    to alleviate   employee concerns about program lo-
           cation.

     As indicated    in Chapter three of the proposed report,    the Commission is
     developing   guidelines   for the development and implementation   of employee
     assistance   programs at Federal installations.     The authority  for agency
     heads to adopt such programs has long existed     in PL 79-658 dated
     August 8, 1946 which encourages agencies to promote both the physical        and
     mental health fitness     of the workforce.

     The research reported       by Professor   Harrison  Trite  to the Subcommittee
     on Manpower and Housing, House Committee on Government Operations               at
     their    June 1976 hearings,     suggests that differences    in organizational
     structure     may influence   the appropriateness    of such a program at in-
     dividual    installations.      Thus the selection   of a specific  program model
     may best be made locally.

     Similarly,     CSC guidelines        permit agencies and installations            to determine
     the organizational          placement of the program's        operation.      We agree that
     dual assignment        of disciplinary       and program responsibilities           may give
     at least the appearance of a conflict               of interest.      We do believe,        how-
     ever, that the best organizational              placement of the program at an in-
     dividual    installation        cannot always be centrally       decided.        Therefore,
     we will    continue      the latitude     given in our current       guidelines.

               Recommendation:   ,CSC should develop more specific     guidelines              for
               (1) coordinator    tra-ining, (2) recordkeeping systems


                                    (See   GAO note)

     We have not attempted        to impose a uniform recordkeeping         system on Federal
     agencies.      Two years ago, we established         an annual reporting      requirement
     for a minimal amount of statistical          data collected      from all installations
     with fifty     or more employees.      Hence, agencies and installations           must keep
     records necessary to meet our reporting            requirement     and their   own internal
     evaluation     requirements.      If our reporting     requirement    becomes more
     sophisticated,      it may require    a more sophisticated       recordkeeping     system
     on the part of agencies and installations.               But at this time, we do not
     see a need for uniformity        throughout   the Federal government.




                                                  76
APPENDIX VII                                                                        APPENDIX VII


 We are advised however that Army has instituted   a department-wide                  record-
 keeping system and we expect to examine the results   of that effort                   as
 part of our future planning.

 We are aware that the coordinators   are a pivotal,      and often weak,             part
 of the program's  operation.   We are not certain     that more uniform
 training  is the correction  needed but we are reviewing      your rec-
 ommendation on the issuance of training   guidelines.

       Recommendation:   CSC and the heads of agencies and departments
       should encourage employee organizations   to take a more active
       role in the formulation  and operation  of programs.

 We recognize,   and Professor Trite's testimony     to the Subcommittee   con-
 firmed,  that unions can have a marked impact on the program.         Our pro-
 gram guidelines   to agencies advise that labor participation     is a key
 element in program success and their    involvement    should be sought.

 Growing union participation      in the program is evident in the latest       sta-
 tistics  from the Commission's     Labor Agreement Information    Retrieval
 System.    Of the 3,032 labor-management      agreements now on file,    13.5%
 have alcoholism   program provisions.      This is a 3.5% increase in the nine
 months following   our testimony    before the House Subcommittee     last June.

 Since the hearings,we    and four major unions,    AFGE, NAGE, NTEU and NFFE,
 have cooperated with Professor    Trite   in extending  and verifying his
 original   research in this area.    We look forward to the results   of this
 added effort    and will be making agencies aware of the results.

       Recommendation:     Agencies and departments            should (1) take more
       care in selecting     coordinators       who are interested     in the programs
       and who are qualified      for the position,         (2) arrange training   when
       necessary   for those coordinators         who are already assigned,      and
        (3) insure that coordinators         have sufficient      time and resources
       to carry out their     responsibilities.

 We concur in the need for agencies to take these actions                   and have stressed
 them in many of our agency evaluations.
                               --
 In addition,      we continue     to work with agencies in their efforts            to upgrade
 the quality      of their    coordinators.       In the past two months alone, we have
 participated      in agency-sponsored       training   programs for coordinators           with
 three different        agencies.     More than 200 coordinators        have received
 additional     training    as a result     of this effort.      We will    continue     this
 activity     and also continue       to offer    the Commission-sponsored        coordinator
 courses here in Washington and in our regional               training     centers.

       Recommendation:     Where applicable,  the CSC, the Office  of Manage-
       ment and Budget and heads of agencies and departments      should de-
       velop cooperative     programs serving more then one agency in a com-
       mon geographic    area.




                                                   77
APPENDIX VII                                                                           APPENDIX VII


 The draft    report describes       the encouraging     results     of the Boston Employee
 Assistance    Program.    We have also been reviewing            periodically      the ex-
 periences    of a consortium      in Austin,     Texas that has been in operation            for
 almost four years.       We agree that it represents            a viable     approach for
 other locations.       Similar    efforts    are already underway in New York, Dal-
 las-Forth    Worth, Detroit,      Chicago and Denver.         In most cases, our regional
 occupational     health representatives         are working with committees           of the
 local Federal Executive        Boards in considering         options for developing         co-
 operative    programs.    We will      continue    to explore this as a means to pro-
 mote effective     programs in the field.

       Recommendation:   CSC and other agencies and departments                     should
       place more emphasis on monitoring  program activities.

 Using the results     of the annual reporting      requirement     as the basis of
 our evaluation,     we have instituted     yearly evaluation     visits    to the head-
 quarters    of each agency or department with 1,000 or more employees.                  Our
 evaluation    emphasis concentrates      on the penetration     and.rehabilitation
 rates indicated     by the reports.      However, we also cover a variety           of pro-
 gram actions    needed to improve those rates.         Among the items usually
 covered are the agency's plans for self-evaluation             of their programs.
 We are strongly     encouraging    more clearly   defined systems of account-
 ability    and feedback within     agencies to stimulate     more effective        programs.

 We appreciate     this   opportunity     to comment on the draft         report.




                                     Thomas A. Tinsley
                                     Director




GAO note:          The deleted    comments relate                     to matters             which
                   were discussed    in the draft                     report  but
                   omitted   in this   report.




                                                 78
APPENDIX        VIII                                                                                    APPENDIX         VIII




                                                                                    Washington            Office
    DONATA      BUILDING       *    1925 N   LYNN     STREET,        ARLINGTON.   VIRGINIA      22209   17031 527.7800

                                                     April      5,     1977




   Mr. Gregory   J.         Ahart,     Director
   U. S. General           Accounting       Office
   Human Resources            Division
   441 G Street,           N. W., Room 6864
   Washington,   D.         C.       20548

   Dear   Mr.     Ahart:

   Attached       are NCA's comments            concerning      the GAO draft       report     entitled        "Most
   Agencies'        Programs       to Assist     Employees      with Alcohol-Related           Problems        Are
   Still     Ineffective."            The comments       are intended        to beconstructive          and are
   based solely           on the draft       report    as written.        There has been no attempt                to
   inject      ancillary       information        or knowledge      relevant     to the Federal          civilian
   employee        programs      into    the attached       comments.

   I would like    to thank     you for the opportunity      to review     and comment on the
   report  in question.       If I can be of any further        assistance     to you, please
   don't  hesitate    to contact    John Codington      of my staff     or me.

                                                                                   Sincerely,




                                                                                   John M. Pinney
                                                                                   Managing Director

   Enclosure

    cc:    Ross     Von Wiegand
  APPENDIX                               VIII                                                                                                                                           APPENDIX                       VIII



                                                                (See             GAO note                            1.)


  Chapter               2

* While           I would                 assume         that        the         recommendation                           is        referring               to     data           and      studies            on
  the       prevalence                     of     alcohol            abuse            and       alcoholism                      among          Federal             civilian                employees,
  it     is      somewhat                  vague         as written.


* Regardless                      of      the     fact        that         over         50% of               the       Installation                        Directors                   surveyed         per-
  ceived             the          alcoholism              problem               at      their             respective                       installations                     to        be 2% or         less
  of     the         total             workforce,               I would               concur              with         the          GAO's          conclusion                  that        the       extent
  of     alcohol                  abuse          and     alcoholism                   among           Federal                 civilian                employees                appears            to    be
  significant.                            The preceptions                        of     the          installation                      officials                  are        quite         common          and
  should             not          be viewed              as necessarily                         a valid                assessment                     of    the         extent           of      alcohol
  abuse           and alcoholism                         among          Federal               civilian                 employees.                      Installation                      officials             I
  and       their             counterparts                    in     the         private              sector              often             lack       a basic               understanding                    of
  alcoholism                       (as      reflected              in      the        comments                 on pages                8-10)           and        therefore                discount            its
  presence                  because              they     can't            readily              observe                it.            If      these         individuals                    possessed               a
  better             understanding                       of     alcoholism,                     they           would               recognize               that         although                 alcoholism
  per se is                 not        readily           observable                   until           its          late         or         chronic          stages,               it     will        however,
  even          in      its         early         stages,            result             in      a pattern                     of      deteriorating                      job           performance
  which           is        readily              observable                to        any reasonably                           alert           supervisor.                      In       this      respect,
  it     is       critical                  to    bear        in     mind            that       it        is     not           the         supervisor's                  responsibility                       to
  diagnose                   the         cause      of    deteriorating                         job         performance,                        but        only         to     continually                 observe
  job       performance                         and make           referrals                  in       the         prescribed                   manner.


  Chapter               3

* The         initial               recommendation                      contained                    in      this         chapter               appears            to        be somewhat                incon-
  sistent               with             Congressional                  intent              as embodied                        in     P.L.         91-616          and,           upon          close      exami-
  nation,               may not                 be supported                by the              findings                     set      forth           in    this         report.                 The    following
  considerations                           pertain            to     this            recommendation                           as well              as the          findings                and       conclusions
  offered               in         support         of     it:




                                                                                                            80
     APPENDIX                 VIII                                                                                                                                                    APPENDIX                        VIII



1.     Section              201      (a)     of      P.L.        91-616                calls          for        the       development                      and maintenance                          of         , . ."
       appropriate                  prevention,                  treatment,                     and         rehabilitation                        programs                 and         services                for
       alcohol              abuse          and      alcoholism                   among          Federal                 civilian              employees,                   consistent                    with
       the      purposes              of     this        Act."               This         would             appear           to        be a mandate                       for         the     implemen-
       tation           and maintenance                         of     programs                 and         services               which          are         most         effective                    in     the
       early          identification                     and          referral                 to     treatment                  of      large             numbers              of     Federal               civil-
       ian      alcoholic                  employees.

2.     Approximately                       54% of        the          program              administrators                          from         26 departments                              and agencies
       at      the      headquarters                    level,              40% of             the      installation                      directors,                      and         55% of            the        pro-
       gram          coordinators                   perceived                 the        extent             of      alcoholism                   in        their          respective                    employee
       populations                   to     be moderate                     or        significant.

3.     Over          85% of          the         installation                     officials                 who responded                        to        the      GAO survey                  believed
       that          employee              alcoholism                 problems                 should             be the              focus       of        a Federal                  program.

4.     Approximately                       25% of         the         2,660             supervisors                     who responded                        to     the         GAO survey                    indi-
       cated           that       they        had       encountered                      a subordinate                       with         an alcohol                      problem             at        thier
       installation.




                                                                      [See                GAO note                          1.1




 6.    Many of              the      statements                  in         Chapter            3 concerning                        alcoholism                     programs              or     alcohol                and
       durg          programs              imply        that          individuals                     with          problems               other             than          alcoholism                    (or       drug
       abuse)           would             be ignored                 under            these          types          of      programs.                      The job               performance                    approach
       is       designed             to      detect         3               employee                problem              which          causes             deterioriating                          or        substand-
       ard       job        performance.                    If         it        is     determined                      by the         diagnostic                    resource                 that           the      prob-
       lem       is     nonalcohol-related,                                  the        employee                 will       be referred                      to      an appropriate                            resource
       in       a manner             consistent                  with            the      procedures                     previously                   utilized                  for     such         problems
       prior           to     the         implementation                         of     the         alcoholism                program                 or     alcoholism                      component                of
       an overall                   benefits            program.                       This         approach               ensures             that          not      only            will         individuals
       with          nonalcohol-related                              problems                 be identified                        and        referred               to         treatment,                   but      that




                                                                                                        81
APPENDIX                       VIII                                                                                                                                            APPENDIX                         VIII



     they         will              be handled                     in      a manner             consistent                 with             the      appropriate                 provisions                of
     the     existing                   union-management                                contractual                     agreement                  (if        an organized                 setting).

7.   The assumption                               that         employees                suffering                  from       alcoholism                      would       be more             willing
     to     seek          assistance                          in        a broader-based                      employee               assistance                   program            is     question-
     able         for          the      following                        reasons:

     a.      It          implies              that             the         most        effective              way to               counteract                  the      social           and moral
             stigma                  associated                         with      alcoholism                 is     to     obscure                 it,        rather        than         to     forth-
             rightly                  identify                     it      by name            in     all      preventive,                         educational              and       program             efforts.

     b.      It          implies              indirectly                        that        supervisors                   initially                  refer           employees             to    an
             "alcoholism                           counselor,"                       an "alcoholism                       facility,"                     or    a door          labelled            "alco-
             holism."                      To the                  contrary,                an employee                   should             not         be initially                referred              to
             an."alcoholism"                                   or        any      other         specialized                   medical                or       treatment             resource             until
             his/her                  problem                  has         been        identified.                      The        general               practice           should            be to
             initially                     refer               the         employee             to     a qualified                     diagnostic                    resource            to     determine
             whether                  or      not         alcoholism                    exists.               While           it       is         important             that        this        resource
             (especially                           if      in-plant)                   be located                  in     a neutral,                     non-stigmatizing                       place,           it
             is          far        more           important                    to     ensure          that         this           resource               includes             demonstrated                  ex-
             pertise.in                       the         diagnosis                    of     alcoholism.                     This           element             is     critical              given        the
             unique                  nature              of        alcoholism                 and      the         alcoholic                 employee.                  Based        on the             findings
             set          forth              in         Chapter                5 concerning                  the        selection,                   qualifications,                       and     responsi-
             bilities                   of         program                 coordinators,                     the        availability                      of     this      demonstrated                    exper-
             tise              in     Federal                  civilian                employee              programs               is       expremely                 dubious           and     therefore
             could              be a critical                              factor           militating                  against              the         success          of       these        programs.




                                                                                     [See            GAO note                            1.1




                                                                                                      82
      APPENDIX                          VIII                                                                                                                                                      APPENDIX                                  VIII


10.         The CSC data                         cited              on page               21 regarding                        the         number            and      types            of         cases           handled
              by thebroader-based                                   employee               assistnace                    programs                   raises           serious                questions                    about
              the      effectiveness                              of     these            programs                in      fulfilling                      their       intended                    purpose                - the
              early          identification                              and       referral                 to        treatment                 of        employees               suffering                      from
              alcoholism.                        In         turn,           the         findings               raise           serious                questions                 about                 the    appropri-
            ateness                of      the         GAO recommendation                                   encouraging                       the         establishment                          of     broad-based
              employee                 assistance                      programs.

    11.       The recommendation                                    to      establish                 broader-based                           programs               because                they            would            suppos-
              edly      be better                      able            to    serve           employees                    with            nonalcohol-related                                problems                   is        in-
              consistent                   with             the        finding             that            only         5 of          81 installations                            were            konsidered
              "effective"                    in        identifying                        and      referring                    to        treatment                a large                 percentage                    of
              alcoholic                  employees.                         Despite              the        comparability                            between           program                   types            in     the
              percentage                   of        alcoholic                    employees                 identified                      and referred                    to        treatment,                       the            fact
              of      the     matter                  is      that          76 of          the         81 programs                        are        ineffective                     in     accomplishing
              their          primary                 purpose                as      set      forth               in     the         authorizing                    legislation.                             To recommend
              the      establishment                              of     a certain                 type           of      Rprogram"                   because              of        its         alleged               greater
              appeal              to     individuals                        with          problems                that          are         not       alcohol-related                                 appears               to        be
              inconsistent                        with            the       major          finding                of      the         study           and         potentially                         counterproductive.

    12.       In      response                  to         statements                   regarding                 NCA's              position                appearing                 on pages                   17,         18 and
              28,      NCA is              not             opposed             to program                    labels             or         titles           which          do not                necessarily                          con-
              tain          the         term          "alcoholism,"                        provided                    that          any        such         program             contains                    a clearly
              identifiable                        alcoholism                      component.                          A clearly                 articulated                  company                    policy              and         set
              of      procedures                      for         alcoholism                    are        essential.                        The          eight       criteria                    set        forth               in     the
              NCA publication                               entitled                "A Joint                Union-Management                                 Approach                to Alcoholism                               Recovery
              Programs,"                   and             particularly                     the        first             two,         are           the      elements                which              determine                     whether
              or not              an identifiable                              alcoholism                    program                 or      component                of        an overall                       benefits
              program                  exists.


      Chapter           4

l     The      indication                   that            management                     has not               made          its         position               clearly                 known             to     its           employees
      could          be the             result               of        one or            both         of     the         following:
      a.       The      statementof                          policy              itself           isambiguous                        and        unclear.
      b.      The mechanisms                               utilized                to      convey            the         statement                   of      policy             to         the         employees                      are
               ineffective.




                                                                                                                       83
        APPENDIX                              VIII                                                                                                                                                        APPENDIX                         VIII

        Needless                  to         say,        if         the         policy            statement                    itself              is        unclear,                the    quality                 of      commun-
        ication               devices                   is     irrelevant.                           In        that        all          the        recommendations                          contained                    in     Chapter
        4 are           for            the      most           part             mechanical                     in     nature,                 they           ignore            the     possibility                       that        an
        unclear               or ambiguous                           policy              statement                    may have                 been           promulgated                       initially.                    Further-
        more,       being                    that        a clearly                     articulated                        statement                  of       policy            relative                  to    alcoholism
        is      a necessary                         precursor                     to     an effective                          program,                 it        would         seem appropriate                              to
        include               in        the         report                language                raising                 this        as a consideration.


    l   While       the             findings                   contained                     in      Chapter               4 clearly                    point            out         the    lack              of union             involve-
        ment       in         the            foumulation                        and operation                         of       programs,                     the      final           recommendation                          seems
        rather           myopic                    in    that             it      implies              that           organized                    labor's               lack         of    involvement                       is     due
        only       to         its        own passiveness.                                      This         tends              to       ignore               those         situations                     in    which           organ-
        ized       labor's                    active                participation                         in        the        program               may be impeded                         or precluded                        by
        management                      or         some other                     factor.


        Chapter               5 _



                                                                                      [See             GAO note                           1.1


l       Critical                  to         the        success                 of     any        occupational                        alcoholism                      program              is       the        assurance               that
        the      diagnostic                         resource                    used         possesses                    a demonstrated                           expertise                in          the     diagnosis                 of
        alcoholism.                      This            is         a critical                    element                 which          has been                  typically                unavailable                       in     most
        such       diagnostic                           resources                     and,        based             upon         the          findings                of       this        chapter,is                    more        than
        likely           unavailable                           in      many            of      the        Federal                civilian                    employee                programs.


        Chapter               6

l       The conclusions                                 and         recommendations                             concerning                     supervisory                       training                 seem to             imply
        that       the            sole          purpose                of         such         training                   is     to      ensure               that         supervisors                        are     familiar
        with       the            program.                     If         supervisory                     training                  is        to     be truly                  effective                  and result                 in
        the      early              identification                                and referral                        to       treatment                     of    large             numbers              of    alcoholic
        employees,                      supervisors                            must      not         only           be familiar                      with          the         program             but         must         be mo-
                                                                                                                                                                                                                               -
        tivated               to        implement                    the         program.                   The most                    effective                  form         of     motivating                     the     super-
        visor       to            implement                    the             program            is      to make program                               implementation                           an integral                    part        of
        the      supervisor's                            job         responsibility.                                  Line          management                     thus         holds             the        motivational                   key
        for      ensuring                     that            supervisors                      implement                   the        program.




                                                                                                                          84
            APPENDIX VIII                                                                                                                                                APPENDIX VIII



l           The findings                         concerning             nonsupervisors'willingness                                  to    participate               in      the    program
            might         possibly                    be indicative                of     a statement               of   policy           which       is    either           unclear          or
            ambiguous.                      However,              the     accompanying                 recommendation                    seems      to     ignore           this     possibility
            in     that         it         is      restricted              to     improving            the      distribution                of     program          information.                   The
            recommendation                            therefore            runs         the     risk      of    focusing            on the         symptoms              rather      than       the
            cause         of         the         problem.


            Chapter              7

    . There               exists                 one     element           of     an effective                 private         sector            employee        alcoholism                 program
            that       is        not            cited      as a characteristic                         of      Federal         civilian            employee              programs           - the
            availability                         of     adequate           health             insurance         coverage            for     alcoholism.                    The     entire          GAO
            report             is       mysteriously                    silent          on this        critical            factor          in     occuaptional                programming.


             Chapter                8

    l       No comments


             Chapter                9

        l    No comments




             GAO notes:
                            1.              The deleted     comments relate    to matters    which were
                                            discussed    in the draft   report   but omitted     or changed
                                            in this   report.
                            2.                  Page references   in this appendix    refer to the draft
                                                report  and do not necessarily    agree with the page
                                                numbers in the final    report.




                                                                                                               85
 APPENDIX IX                                                    APPENDIX IX


                   PRINCIPAL
                   -----------   OMB AND CSC OFFICIALS
               RESPONSIBLE FOR ADMINISTERING
               -------------_--                      ACTIVITIES--
                        DISCUSSED IN THIS REPORT
                        ------                -
                                                   Tenure     of office
                                                                  ---
                                                   FrZm
                                                   we-                    -To
 DIRECTOR, OFFICE OF MANAGEMENT
   AND BUDGET
     Thomas B. Lance                         Jan.      1977      Present
     James T. Lynn                           Feb.      1975      Jan.           1977
     Roy L. Ash                              Feb.      1973      Feb.           1975
     Caspar W. Weinberger                    June      1972      Feb.           1973
     George P. Schultz                       July      1970      June           1972
COMMISSIONER, UNITED STATES CIVIL
  SERVICE COMMISSION
    Alan K. Campbell,  Chairman              May       1977      Present
    Jule M. Sugarman                                   Designate
    Ersa H. Poston                                     Designate
    Robert E. Hampton, Chairman              Jan.      1969      Jan.           1977
    L. J. Andolsek                           Apr.      1963      May            1977
    Georgiana  Sheldon                       Mar.      1976      May            1977
    Jayne B. Spain                           June      1971      Jan.           1976
   EXECUTIVE DIRECTORS
     Raymond Jacobson                        July      1975      Present
     Bernard  Rosen                          June      1971      July    1975
     Nicholas  J. Oganovic                   June      1965      June    1971
   DIRECTOR, BUREAU OF RETIREMENT,
      INSURANCE, AND OCCUPATIONAL
     HEALTH (formerly   Bureau of
     Retirement  and Insurance)
     Thomas A. Tinsley                       Jan.      1974      Present
     Andrew E. Ruddock                       Sept.     1959      Dec.    1973




(10232)


                                   86
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