10.4 Stress Management (M05), Tobacco Cessation (M10) & Substance Use Services (M11)

10.4 Stress Management (M05), Tobacco Cessation (M10) & Substance Use Services (M11)

Core Exam Takeaway: M05 Stress Management (2 pt / Core 1 pt) is a single-part feature requiring assessment of at least three of six metrics plus a plan. M10 Tobacco Cessation (3 pt / Core 2 pt) splits into cessation resources (2 pt) and retail sale and marketing restriction (1 pt). M11 Substance Use Services (2 pt / Core 1 pt) splits into education (1 pt) and services (1 pt). Note the numbering: M10 is Tobacco Cessation and M11 is Substance Use Services — not the reverse.

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Feature M05: Stress Management — Optimization (2 pt / WELL Core 1 pt)

Intent: identify areas of stress within the workplace and create a plan for stress management. Note what the intent does not say: it is not about teaching individuals to cope. M05 treats workplace stress as an organizational property that can be measured and changed.

M05 Part 1 — Develop Stress Management Plan

The project develops a stress management plan by completing all three:

(a) Assess at least three of the following six organization- or project-wide metrics:

1. Frequency of employees working more than 48 hours per seven-day period
2. Frequency of absenteeism, use of sick days and personal days or leave due to disability or illness
3. Frequency of employees not using allocated paid time off
4. Frequency of performance issues
5. Employee retention and turnover rates
6. Employee survey responses

(b) Identify opportunities to address employee stress, covering:

1. Opportunities for organizational change — adjustments to work environment, shifts in work processes, workload, management or staffing
2. Opportunities for employee participation in organizational decisions regarding workplace issues that may affect job stress — work environment, processes, scheduling

(c) Outline a plan for implementation, including:

1. Who is leading the initiative
2. What is to be completed
3. Where in the organization it will occur and who will be impacted
4. When and how it will be implemented
5. Availability of support from key management or leadership

WELL Core guidance: direct staff.

[!IMPORTANT] Metric 1's 48 hours per seven-day period is the number to memorize, and it is not arbitrary — it aligns with widely adopted maximum weekly working time limits and with the epidemiological literature linking long working hours to cardiovascular disease and depression. Note also metric 3: employees not using allocated paid time off. Unused leave is a leading indicator of an unsustainable workload culture, and measuring it catches problems that absence data alone conceals.

[!TIP] Requirement (b)(2) — employee participation in organizational decisions — is the feature's most substantive demand. Job strain models consistently find that low decision latitude combined with high demand is the toxic combination; high demand with high control is not. WELL therefore requires the plan to create participation, not merely to reduce workload. And (c)(5)'s "availability of support from key management or leadership" is what stops the plan being a document with no sponsor.

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Feature M10: Tobacco Cessation — Optimization (3 pt / WELL Core 2 pt)

Intent: reduce the use of tobacco through interventions that support tobacco cessation and prevent the sale and advertisement of tobacco products.

M10 Part 1 — Provide Tobacco Cessation Resources (2 pt / Core 1 pt)

Option 1: Incentive program. A tobacco cessation program for all eligible employees that is:

• (a) Focused on increasing or improving motivation or action to quit, or maintaining quit effort
• (b) Includes incentives or rewards — direct financial payments, lottery for prizes — provided for participation in quit effort or success in abstaining from tobacco use

Option 2: Individual cessation resources. Resources available to all eligible employees at no cost or subsidized, including:

• (a) Resources referring tobacco users to tobacco cessation telephone quit lines or online quitting resources
• (b) Tobacco cessation counseling, in person or virtually, group or individual, through vendors, on-site staff, health insurance plans or programs, community groups or other qualified professionals such as a tobacco cessation specialist
• (c) Prescription tobacco cessation medications and nicotine replacement products — inhalers, nasal sprays, bupropion, varenicline
• (d) Over-the-counter nicotine replacement products — gum, patches, lozenges

M10 Part 2 — Limit Tobacco Availability (1 pt / Core 1 pt)

For retail spaces, where retail products are sold daily within the building site:

• (a) Sale of tobacco products (including e-cigarettes) is prohibited within the building site.
• (b) Tobacco products (including e-cigarettes) are not marketed or promoted.

WELL Core guidance: Part 1 for direct staff; Part 2 whole building.

[!IMPORTANT] Distinguish M10 from A02 Smoke-Free Environment. A02 is a precondition that bans smoking and e-cigarette use indoors and within 25 ft (7.5 m) of entrances, operable windows and air intakes. M10 is an optimization that funds quitting and, in retail projects, bans selling and marketing tobacco. One controls exposure; the other controls consumption and supply. Exam scenarios that mention a convenience store inside a WELL project are pointing at M10 Part 2, not A02.

[!TIP] Option 2 requires all four resource categories, not a choice among them — quit lines, counseling, prescription pharmacotherapy including bupropion and varenicline, and OTC nicotine replacement. The completeness matters clinically: combining behavioural counseling with pharmacotherapy roughly doubles cessation success compared with either alone, which is why WELL bundles them.

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Feature M11: Substance Use Services — Optimization (2 pt / WELL Core 1 pt)

Intent: increase availability and access to substance abuse and addiction support services, resources and care, and prevent the development of substance abuse and addiction.

M11 Part 1 — Offer Substance Use Education (1 pt / Core 0.5 pt)

Option 1: Substance use policy. A policy is in place regarding the use of alcohol and legal, recreational drugs on-site, and is clearly communicated to all regular occupants.

Option 2: Substance use education. Trainings offered at least once per year to regular occupants, addressing all three topics:

1. Management of personal substance use — safe substance use habits, signs of dependency or addiction, and short- and long-term health risks of misuse or addiction
2. Prescription opioid education — questions to ask at point of prescribing, safe use including storage, disposal and driving while using, and risks and signs of dependency or addiction
3. How to appropriately respond to a peer struggling with substance use — how to support recovery efforts and what to do in the case of relapse or a substance use emergency such as withdrawal or overdose

Delivery may be in person or virtually, group or individual, through vendors, on-site staff, health insurance plans or programs, community groups or other qualified practitioners or programs.

M11 Part 2 — Provide Substance Use and Addiction Services (1 pt / Core 0.5 pt)

For all eligible employees:

• (a) Services available at no cost or subsidized, including at minimum:
  1. Clinical screening and referral to licensed mental health professionals and support resources
  2. Counseling services, including telemental health services (e.g., online behavioral therapy)
  3. Outpatient treatment (e.g., day programs)
  4. Inpatient treatment (e.g., residential programs, hospitalization)
  5. Medication-assisted treatment (e.g., methadone treatment)
• (b) Organizational commitment to mental health parity in health service coverage
• (c) Information on benefits coverage and how to access services and community resources such as peer support groups and online support groups is easily and confidentially available
• (d) Confidential benefits consultation available

WELL Core guidance: direct staff.

+-----------------------------------------------------------------------------+
|      M03 AND M11 ARE DELIBERATELY PARALLEL -- LEARN THEM AS A PAIR          |
|                                                                             |
|                        M03 Mental Health        M11 Substance Use            |
|   Screening            Part 1 (own part)        inside Part 2(a)(1)          |
|   Education            -> M04 (separate 2 pt)   Part 1 Option 2              |
|   Services             Part 2                   Part 2                       |
|     clinical referral        yes                     yes                     |
|     inpatient                yes                     yes                     |
|     outpatient / telehealth  yes                     yes                     |
|     prescription coverage    yes                MEDICATION-ASSISTED          |
|                                                 TREATMENT (methadone)        |
|   Parity commitment    Part 2(b)                Part 2(b)                    |
|   Confidential consult Part 2(d)                Part 2(d)                    |
|   Workplace support    Part 3 (own part)        --                            |
|                                                                             |
|   The distinctive M11 elements: SUBSTANCE USE POLICY, PRESCRIPTION OPIOID    |
|   EDUCATION, and MEDICATION-ASSISTED TREATMENT.                              |
+-----------------------------------------------------------------------------+

[!IMPORTANT] Prescription opioid education is M11's most distinctive requirement, and its three sub-topics are precisely targeted: questions to ask at the point of prescribing (because the prescription is where dependency often begins), safe use including storage, disposal and driving (because diverted household opioids are a major exposure route for others), and signs of dependency. It sits in Option 2 of Part 1, so a project taking the policy route under Option 1 does not deliver it.

[!TIP] Medication-assisted treatment (MAT) is required in Part 2(a)(5), with methadone as WELL's own example. Including MAT rather than counselling alone reflects the clinical consensus that opioid use disorder is most effectively treated pharmacologically. Note that M11 Part 2 mirrors M03 Part 2 almost item for item, including the mental health parity commitment and the confidential benefits consultation — so a project structuring its benefits package can satisfy both features' service requirements through one insurance design exercise, and a project that already has M03 Part 2 should look hard at M11 Part 2 as a near-free second point.