• Addiction is rising across the US, and it's hitting the workforce harder than ever.

• In corporate America, perfectionism and pressure often mask who's truly at risk.

• Here's how I help companies confront addiction, and what employers can do next.

Shatterproof is a national nonprofit dedicated to reversing the US addiction crisis through stigma reduction, treatment reform, and workplace education.

Business Insider correspondent Reed Alexander spoke with Nicole Fox, vice president of marketing and communications at Shatterproof, who has worked directly with companies to help tackle addiction in their ranks. This as-told-to interview has been edited for length and clarity.

Addiction doesn't always show up in the way that society likes to portray it. Many people are able to maintain their lifestyles without subscribing to what the media tells us addiction looks like. Especially in white collar settings, it doesn't show up like absenteeism or poor performance. On Wall Street, it often hides behind overperformance.

It might be, you know, the analyst who's the first one in, the last one out, the VP who never misses a target; but they might be quietly unraveling after hours.

We partnered with the National Safety Council to create a substance-use cost calculator. Take for example, an employer with 45,000 employees. They will lose $50 million annually in turnover, absenteeism, and healthcare costs related to substance use disorder. And for every employee who's in recovery, that same company can save about $8,500 annually.

We need coworkers and managers to be equipped to step in and have productive, compassionate conversations that prioritize employee mental health. Addiction isn't a failure of character. It's a challenge of our culture.

The hidden crisis

Addiction exists inside every workforce, including white-collar industries. One in six Americans — almost 50 million people over the age of 12 — have substance use disorder. Of that population, 70% are employed.

Overdose is also the No. 1 killer of 18 to 44-year-olds. That cohort alone is over half of America's workforce. It's not a niche health issue. We really see this as the public health crisis of our time.

We conducted a large-scale survey to measure public attitudes, people's beliefs, and their knowledge around substance use disorder. It's called the Shatterproof Addiction Stigma Index. We found that although 70% of adults said that they're willing to have someone with a substance use disorder as a coworker, about half — so 48% — were unwilling to work closely with that person. Even more were unwilling to hire someone with substance use disorder — that's 55% — or to have them as a supervisor — that's 67%.

So while people say the words and check the boxes that they're willing to work with someone with a substance use disorder, it's kind of that "not in my backyard." Like, yes, I'm willing to, but as long as it's not with me personally.

The disparity between people's own understandings and their own belief in their own compassion — that was really surprising.

They say, "Yes, I'm willing to work with someone with a substance use disorder. It's fine if they work at my company as long as they don't manage me, as long as I don't manage them, as long as they don't sit next to me."

Warning signs and behaviors that drive addiction at work

High-pressure cultures glorify burnout: it masks warning signs and it can even reinforce unhealthy coping mechanisms.

Alcohol is a big piece of this. When we talk about substance use disorder, you hear the term addiction — people's first thought isn't always alcohol. It's so deeply normalized. You've got client dinners, you've got team bonding, closing deals, and the low stigma around alcohol use makes it easy for those problems to go unnoticed.

Thirty-four percent of people who need treatment report not getting it because they're afraid that bad things would happen to them — like they would lose their job, lose their home, lose their children. And unfortunately, those fears are really valid concerns. Employees need to know that they can seek help without risking their careers.

We're not expecting managers to be therapists or clinicians; they just need to be recognizers. So teaching them how to spot the subtle changes when someone is withdrawn, if they're defensive, communications shifts, and then equipping them with specific steps to take based on their company's own EAP and benefits — that gives them an action plan to help and to help swiftly.

We've seen the most success when there is true engagement from the top. It's twofold — creating a safe, productive space for their employees, but then also the recognition that ignoring addiction is really expensive.

We've worked with companies — we've called them "courageous conversations" — where the CEO brings this up at an all-staff. We have someone from Shatterproof present to help guide the conversation, and they share how substance use disorder has impacted them personally. HR is there, all the employees are there, and they have this really vulnerable conversation together.

We're setting the stage for education, so we're inviting people to replace judgment with curiosity.

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