Returning to Work after Treatment

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Returning to work after treatment can be uncomfortable and awkward. Getting back into a regular routine, however, is a major step towards long-term recovery. Most people also feel great about returning to the security of a regular paycheck.

The first couple of days back are usually the hardest. Once you clear that hurdle,  however, it’s back to business as usual. Day by day, things get easier.

If the idea of returning to work stresses you out, keep in mind that you aren’t alone. You’d be hard-pressed to find a person alive who hasn’t faced difficulties and overcome personal challenges. And it’s likely some of your coworkers have experienced addiction, either themselves or through a close friend, or family member.

While stigmas and stereotypes still abound, more people are coming to understand that addiction is a treatable chronic illness, much like diabetes, high blood pressure, or asthma.

The following information will help you know what to expect on your re-entry to work. We hope it helps smooth your transition from treatment back to your daily routine.


The law requires your employer to maintain confidentiality regarding your medical issues. That includes time spent in residential or outpatient treatment for alcohol or substance use disorders. Rules for handling sensitive employee information are very strict. Employers cannot share any information about your medical information without your written consent.

State and federal discrimination laws protect your personal medical history. The Americans with Disabilities Act (ADA), Health Insurance Portability and Accountability Act (HIPAA), and  Family and Medical Leave Act (FMLA), also safeguard your confidentiality.

If you think your confidentiality has been compromised, talk to your company’s human resource department. If they’re not responsive, you can file complaints directly with the agencies responsible for enforcing the ADA, HIPAA, and the FMLA.

To report problems, follow these links:

Dealing with Gossip and the Rumor Mill

It’s normal for your coworkers to be curious why you’ve been away, and you may receive questions when you return to work. It helps to decide what you’re going to tell people ahead of time. The amount of information and what details you discuss are for you to decide.

One option is full disclosure. Get it all out in the open. This makes sense if you think your coworkers already know about what you’ve been going through, or if they think you’ve been in rehab. You may find that your coworkers respect you, and your decision to improve your life may serve as an inspiration to others.

If you aren’t comfortable telling your coworkers about your alcohol or substance use problems, you can truthfully say you’ve been dealing with some health issues and you’d rather not go into the details. Everyone can and should respect that: it’s a perfectly acceptable boundary to create, which everyone can relate to.

Of course, you can decide to say nothing at all. That’s your choice, but it won’t squelch rumors, especially if you work in a gossipy office environment.

Regardless of which direction you go – full disclosure, no information, or something in between – it’s a good idea to talk to someone you can trust about your situation. An immediate supervisor, a peer, or someone you can rely on to channel gossip away from you or shut down rumors if they start. A few key people on your side, or even just one strong ally, can help relieve the pressure when you’re feeling stressed or overwhelmed.

Return to Work Agreements (RTWAs)

If you’ve taken time off for work for rehab, your employer may ask you to sign a Return to Work Agreement (RTWA). These are common if your alcohol or substance use disorder caused you to miss work or to behave inappropriately while on the job.

Return to Work Agreements vary depending on the situation, but in general, the agreement lays out conditions for your return, as well as the consequences if you fail to hold up your end of the bargain.

The agreement may require you to keep scheduled appointments and to follow all treatment recommendations, and it may ask that you allow your treatment provider to send certain reports to your employer. Most agreements require you to submit to random drug and alcohol screenings.

Most likely, by signing the RTWA, you agree to abstain from any use of substances, unless prescribed by a physician. Usually, failure to comply results in immediate termination.

Some employers call these last chance agreements. However, you shouldn’t take the agreement as a threat. An RTWA can actually be beneficial because holds you accountable and provides a powerful incentive to keep moving forward in your recovery process.

In addition, both the ADA and FMLA place guidelines around what they can include in the RTWA. According to the ADA, employees returning from treatment:

“…must be treated similarly to employees who return to work after taking medical leave for any other physical or mental health condition.”

And according the FMLA, employees returning from treatment:

“…must be restored to his or her former position or an equal position. Equal position means similar title, pay, status, responsibilities, conditions, qualifications, authority, and no significant increase in commuting time or distance.”

If you’re returning to work after rehab and you need to sign a RTWA, understand that the agreement cannot restrict or alter anything to do with your pay, duties, or position within the company. RTWA may only address issues related to your alcohol or substance use, and that’s all.

Managing Work-Related Triggers

Managing triggers is likely one of the most difficult challenges you’ll face on your return to work. Hopefully, your treatment provider addressed some of the most common trouble spots. When you leave rehab, you should be well-prepared with an aftercare plan that includes relapse-prevention techniques and contingencies.

It’s best to avoid people and places that are associated with your past use of drugs and alcohol. You’ll need to say no to martini lunches and Friday happy hour with your coworkers. This is most important in the beginning. Take pride in your recovery, and remember that the first few days and weeks are fragile. You need to give yourself time out in the world. You need to practice your coping skills and see if your trigger management strategies work. In time, you may well be able to go out after work with your peers, but if they’re a drinking bunch, you should not do that until you’re sure you’re ready.

Instead, seek out people who support your commitment to sobriety. If you belong to a 12-step group, you can probably find a lunchtime meeting near your workplace.

Watch out for triggers such as lack of sleep, anger, boredom, stress, and loneliness. Talk to a counselor, recovery peer, or sponsor if things are feeling stressed or overwhelmed.

Addiction Replacement: Workaholism

Trading one addiction for another, also known as an addiction transfer, is a common pitfall for people in recovery. A person who is addicted to drugs or alcohol may substitute addictive behaviors such as binge eating, shopping, sex, or gambling.

Even positive behaviors can become compulsive, and this includes work.

The signs of work addiction are much like any other addiction, and may include:

  • Thinking about work constantly.
  • Losing sleep due to worries or concerns about work.
  • Problems with personal relationships.
  • Work-related stress or anxiety.
  • Depression
  • Loss of interest in activities normally found enjoyable.

If you think you may be transferring your alcohol or drug addiction to work, talk to a therapist who can help you work through stress or emotions that are causing you to allow the patterns of addiction to creep back into your life. Don’t think of this as relapse: think of this as a way to understand and channel your mental, emotional, and spiritual energy in a direction that supports your sustained sobriety and well-being.

You’ve cleared the biggest hurdles: you realized you needed help and got it. Now, you have to learn how to apply everything you learned in treatment to day-to-day life. There will be ups and downs, and you’ll find the old patterns trying to reassert themselves – in the form of workaholism, for instance – but you can counter all of that with your hard-earned awareness, sensitivity, and commitment to recovery.

Finally, if you’re returning to work after rehab, we congratulate you: it’s a big step on the path back to balance and total health. You should believe in yourself. You’ve come this far. The ability to successfully navigate your retune to work is well within your grasp.

The materials provided on the Pinnacle Blog are for information and educational purposes only. No behavioral health or any other professional services are provided through the Blog and the information obtained through the Blog is not a substitute for consultation with a qualified health professional. If you are in need of medical or behavioral health treatment, please contact a qualified health professional directly, and if you are in need of emergency help, please go to your nearest emergency room or dial 911.