There are both medical and psychological conditions that frequently co-occur with substance use disorders, and often prompt those who suffer from addictions to seek physical and behavioral health care.

As alcohol and drug use proliferate in the wake of COVID-19, organizations across the country are experiencing the impact of substance use issues among workers. In fact, according to a recent International Foundation report, Employee Benefits in a COVID World – 6 Month Update, 63% of the organizations surveyed reported that mental or behavioral health claims have increased since the pandemic began. In light of reports by nearly one-third of employers that mental/behavioral health disorders are among their costliest health conditions, identifying the extent of addiction's impact on employees is a critical step towards developing mitigation strategies.

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Despite the increasing availability of digital health solutions to make addiction treatments accessible, employers face a significant challenge to implementing these approaches effectively: identifying the extent of addiction issues in their workforce. Largely in the absence of in-house clinical addiction experts, employers must find a method to assess the presence of alcohol and drug misuse and addiction in their organization.

One well-established approach to this problem is to conduct a claims analysis; however, according to the 2019 Workplace Wellness Trends report, only 3 in 10 organizations surveyed in recent years have undertaken this method for understanding the prevalence of the conditions that impact their overall health care costs the most.

One of the reasons that claims analysis may be underutilized, especially for highly stigmatized conditions such as addiction, is because such a small percentage of those who suffer from substance use disorders access addiction care (<10% of those who need it). As a result, focusing on diagnostic codes for substance use disorders alone is likely to underestimate the true prevalence of addiction in an employee population. However, there are both medical and psychological conditions that frequently co-occur with substance use disorders, and often prompt those who suffer from addictions to seek physical and behavioral health care.

Conditions that bring those with substance use disorders into the health care system

So, what types of health problems could be the focus of an organization's claims analysis to help identify the frequency of substance use disorders in their employee population? Here are four categories of ICD 10 codes to examine:

1. Substance use disorders: Aside from the obvious claims involving Substance Use Disorders (ICD-10 diagnostic codes from F10 (Alcohol Use Disorder) through F15 (Stimulant Use Disorder), given the rise in drug overdoses in recent years, there are a variety of codes that are indicative of accidental or intentional poisoning resulting from opioid (T40.1X through T40.4X), stimulant (T43.621A through T43.694A), and alcohol use (X45, Y15, T51.0-T51.9).

These codes are helpful in identifying those who have either an early-stage substance use disorder in which they took more of a substance than they meant to or planned to without realizing how it might affect them, or those with a severe substance use disorder, who have escalated their use in a way that led them to a nonfatal overdose.

2. Cardiovascular conditions: Most substances that are misused are associated with cardiovascular disease and injury, including alcohol, stimulants such as cocaine and methamphetamine, and opioids. Over time, use of these substances can cause cardiomyopathy, or a disease of the heart muscle that makes it hard for the heart to deliver blood to the body. This can be coded as I42.6 (Alcoholic Cardiomyopathy), I42.7 (Cardiomyopathy due to drug and external agent) or I42.8/I42.9 (Other Cardiomyopathy or Cardiomyopathy, Unspecified).

A range of other conditions are frequently linked with alcohol and drug use, particularly among those who use stimulants, including arrhythmias, or irregular heartbeats (codes I49 through I49.9), and myocardial infarction, or heart attack (code I21.9), though these conditions are more common and can have many root causes. Linking these conditions to substance use disorder codes will be important as a means of identifying those that are causally related to alcohol and drug use.

3. Liver disease and related conditions: Years of excessive alcohol and drug use can take a toll on the liver, causing it to become inflamed and scarred, which is clinically known as cirrhosis. Liver conditions affect people who use heroin and steroids as well. The range of liver disease-related diagnoses that are linked with alcoholism and drug use are represented by codes K70 through K70.4 as well as K70.9, which correspond to conditions including alcoholic fatty liver, hepatitis, cirrhosis, and liver damage, unspecified.

As part of the biliary system, the pancreas works alongside the liver in the digestive process, producing enzymes to break down proteins, fats and carbohydrates, while the liver breaks down fats, vitamins, and minerals. Heavy alcohol use, and in rare cases, cocaine use, can lead to acute pancreatitis, or inflammation of the pancreas (code K85); a subgroup of those with this condition can go on to develop chronic pancreatitis (code K86). Another digestive problem that brings chronic and heavy drinkers into the health system is alcoholic gastritis (K29.2), an inflammation of the stomach lining.

4. Mental health: Addiction and mental health problems frequently co-occur, with nearly 40% of those with substance use disorders struggling with one or more mental health diagnoses. Compared with the general population, people who suffer from addiction are twice as likely to experience mood and anxiety disorders, which are among the most frequent psychiatric complaints across a range of substance use disorders (including alcohol, stimulant, and opioid addictions).

With that in mind, assessing the prevalence of mood disorder diagnoses including major depression (F32 through F33) and bipolar disorder (F30, F31), and anxiety disorder diagnoses (F41.0 through F41.9) including panic disorder, social anxiety disorder, generalized anxiety disorder, and post-traumatic stress disorder, may provide some helpful insights concerning the presence of conditions that pose heightened risk for addiction.

Simple approaches to claims analysis

The calculation of health costs associated with addiction using a claims analysis approach does not need to be overly complex. A few simple metrics to provide an overall sense of the extent of addiction in your workforce include:

  • Evaluating diagnosis prevalence, which is the number of individuals with a particular ICD-10 substance use disorder diagnosis divided by the total employees with health insurance coverage.
  • Examining health care costs, both in terms of total costs (summing the health care expenditures for all employees with a substance use disorder diagnosis), and per capita costs (total cost divided by number of employees with a substance use disorder diagnosis).
  • Procedure or diagnostic codes associated with the above addiction-related conditions, even without a corresponding substance use disorder code, can be used to augment the substance use disorder prevalence rates. This will improve the accuracy of your estimate of the extent of addiction in your workforce.

Organizations that see a growing number of claims indicating substance use disorders should take immediate action. Findings indicating widespread substance use disorders would warrant immediate implementation of Employee-Assistance Programs (EAPs), including addiction recovery programs, for those who don't already have robust programs in place.

Those who already provide EAPs should review their offerings in light of COVID-19 to ensure that digital/online options exist–the industry has made great strides in this regard over the past year. And employers should regularly communicate the availability of these programs in a non-judgmental, supportive manner to facilitate employees' good health.

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