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We’ve made strides in normalizing mental health conversations, but when it comes to substance use, stigma still speaks louder than support for too many people.
When an employee is diagnosed with a medical condition, they’re offered care and support. But when that condition is substance use disorder (SUD), they’re often met with discipline or shown the door.
Too often, SUD is still treated as a personal failing instead of what it truly is: a medical condition. That misunderstanding doesn’t just hurt individuals. It keeps SUD needs under the surface and quietly drains morale, productivity, increases turnover, and drives up costs.
Our latest analysis at Spring Health found that employees with SUD incur 2.7 times higher healthcare costs than their peers without a SUD. They take nearly 50% more unscheduled leave and are 44% more likely to leave their jobs. But here’s the most troubling data point: only 7% get the treatment they need.
As a psychiatrist and Spring Health’s Chief Medical Officer, I’ve seen how often traditional approaches to SUD fall short. They fail the individuals who need care and the organizations trying to support them.
It’s time to stop treating SUD only as a performance issue and start addressing it like the medical issue it is, because the cost of inaction is far too high.
Explore our full research brief for a deeper look at how stigma, cost, and fragmented care impact employees with SUD, and what organizations can do differently.
The cost of stigma in substance use disorder treatment
Substance use disorders aren’t a failure of willpower. They’re complex medical conditions rooted in the brain, shaped by biology, experience, and environment.
During my time leading SUD treatment programs in the Army, I saw this intertwining of mental health challenges firsthand. Recovery wasn’t just about stopping use—it meant facing the trauma, anxiety, or depression that often drove it. For many, substance use was a form of self-medication for a deeper pain.
And yet, just as the Army has struggled for decades in engaging SUD issues as a personnel issue versus a medical issue, many workplaces also treat SUD as a performance issue that warrants punishment, rather than a health issue that deserves early intervention and support before it becomes a performance issue.
That tension still exists. Even though there are real performance issues to address in many job roles, the heart of the issue is that stigma is still very present and one of the biggest barriers to getting help. People stay silent when SUD is treated as a character flaw, not a condition. They delay treatment. Or they never seek it at all.
This silence is costly. Rates of substance use disorder in the U.S. have more than doubled in recent years, making it one of the most urgent public health challenges of our time. And for employers, the financial impact is significant, with SUD accounting for over 37% of overall behavioral health spending.
The takeaway is simple: People need support, not judgment. They need access to care that addresses both their substance use and their underlying mental health needs. Ignoring this issue in the workplace doesn't just hurt individuals—it affects your entire organization.
Why traditional SUD treatment fails employees and employers
Substance use treatment is often delayed until the breaking point. That means checking into a 30-day intensive outpatient program (IOP), rehab, or inpatient care—an approach that’s not only disruptive to life and work, but financially devastating.
People seeking SUD treatment often find themselves shuttled between multiple providers with
little to no care continuity or follow-up. As a result, costs continue to escalate with frequent ER visits and inpatient stays, with little access to coordinated early outpatient care. Since treatment is so fragmented, 40–75% of people with SUD relapse within six months.
This isn’t a reflection of motivation—it’s a reflection of a broken system. Today’s standard of care is often marked by:
- Long wait times, worsened by geographic barriers
- Out-of-network providers and surprise billing
- A shortage of clinicians with deep SUD expertise
- Ghost networks that make access nearly impossible
- No visibility into clinical outcomes or quality of care
With healthcare costs at all-time highs, fragmented or reactive access is no longer enough. Access alone isn’t the goal—getting better is. The most effective SUD solutions are built around true access to care, clinical quality, sustained engagement, and real, measurable outcomes.
These gaps aren’t just frustrating—they’re costly. However, when organizations take a proactive, evidence-based approach to SUD care, the impact is measurable: healthier employees, stronger teams, and an engaged workforce.
A smarter SUD care model: bridging the gap between cost and recovery
The current approach to SUD in the workplace is reactive, and it’s failing. Employees often don’t receive support until they’re in crisis. By then, organizations are already facing the fallout: absenteeism, short-term disability, high turnover, and rising healthcare costs.
But there’s a better path forward. New research shows that employers who proactively support those with SUD through measurement-based coordinated care programs future-proof their workforces and even see significant financial returns.
What to look for in a high-quality SUD program
Even when leaders want to improve support for employees with SUD, it can be hard to know where to start. Many health plans don’t make it easy to identify effective options. But great care programs do exist, and these five elements set them apart:
- Equitable access: Employees shouldn’t wait weeks or drive hours for help. The right program ensures timely, local access to care because engagement quickly drops when care is hard to reach.
- Team-based support: Recovery is rarely linear and shouldn’t fall on one provider alone. High-quality programs coordinate care across therapists, physicians, recovery coaches, and peer support to meet the full scope of someone’s needs.
- Ongoing engagement: SUD treatment isn’t one-and-done. It takes time, trust, and consistency. Programs that are designed to keep people engaged, especially during vulnerable points in recovery, are the ones that drive real results.
- Evidence-based care: Good intentions aren’t enough. Treatment should be grounded in proven approaches while flexible enough to adapt to each person’s unique path.
- Measured outcomes: Employers deserve to know whether the care they’re investing in is working. That means real-world results and measurement-based systems built into the care itself.
Outcomes must be measured and meaningful
The ultimate test of any SUD program is whether it helps people get better and whether that recovery is sustainable. Yet most traditional care pathways don’t include outcome tracking, making it nearly impossible to know if treatment is working.
That’s where structured, evidence-based care models show a clear advantage. In Spring Health’s claims-based analysis, members who received proactive SUD support saw a 57% drop in total healthcare costs within six months of starting treatment. Employers saved over $35,000 per engaged employee on average in the first year of care, driven by reductions in medical costs, absenteeism, disability claims, and turnover.
The case for a strategic SUD care approach
SUD is a chronic, complex condition that requires a strategic approach. Early identification, sustained engagement, and measurable outcomes aren’t just best practices—they’re essential to building a healthier, more resilient workforce.
The organizations that take this seriously are reducing costs, transforming lives, and rethinking what workplace mental health can and should be.
Rethinking substance use disorder care at work
My message to HR and business leaders is simple: treat substance use disorder like the medical condition it is. Make sure your personnel policies and care resources allow for early identification, proactive treatment opportunities, and a chance for recovery.
When you do, you open the door to evidence-based care that helps employees stay healthy, engaged, and able to contribute fully. This shift also makes business sense. With escalating healthcare costs and growing behavioral health needs, reactive or fragmented approaches just don’t cut it anymore.
By rethinking how we support employees with substance use disorders—through early intervention, continuous care, and real outcome tracking—organizations can reduce avoidable costs and build stronger, more resilient teams.
It’s not just the right thing to do for your people. It’s a strategic investment in the health and future of your workforce.
If you're ready to shift from reactive to proactive support, our executive research brief offers a clearer picture of what’s possible when care is done right.
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