drugs and alcohol in the workplace keeping workforces clean, sober and straight in a time of massive...

Drugs and Drugs and Alcohol in the Alcohol in the

WorkplaceWorkplace

Keeping workforces clean, Keeping workforces clean, sober and straight in a time sober and straight in a time

of massive consumptionof massive consumption

Prof. Craig JacksonHead of Psychology Division

[email protected]

British Medical JournalBritish Medical Journal

“British Government's strategy on alcohol will do nothing to tackle problem drinking in Britain”

Increased alcohol consumption per capita in UK in last 20 years

Reduced price of alcohol

Availability

Marketing of alcohol

Deregulation

Hall. British drinking: a suitable case for treatment? 2005;331:541-544

Workplace Action on AlcoholWorkplace Action on Alcohol

Employers have a legitimate interest in drug and alcohol use amongst their employees in a restricted set of circumstances only. These circumstances are:

(i) where employees are engaging in illegal activities in the workplace;

(ii) where employees are actually intoxicated in work hours;

(iii) where drug or alcohol use is (otherwise) having a demonstrable impact on employees' performance that goes beyond a threshold of acceptability;

(iv) where the nature of the work is such that any responsible employer would be expected to take all reasonable steps to minimise the risk of accident;

(v) where the nature of the work is such that the public is entitled to expect a higher than average standard of behaviour from employees and/or there is a risk of vulnerability to corruption (for example, in the police or prison service).

OverviewOverview

• Background stats on drinking

• Alcohol and the workplace

• Health promotion at work

• Prevention / rehabilitation

• Alcohol policies

• Good practice

Alcohol StatisticsAlcohol Statistics

Alcohol misuse costs NHS £1.4 – 1.7 billion per year

£95 million on specialist alcohol treatment

1 in 6 A&E admissions

3.6% adults are alcohol dependent

6% population excessive drinkers (23% men;9%women)

Alcohol StatisticsAlcohol Statistics

Potential Effects of Excessive DrinkPotential Effects of Excessive Drink

High blood pressure

Cancer

Cirrhosis of liver

Ulceration

Haemorrhage

Neuropathy

Myopathy

Mental ill health

Social decline

Premature death

Alcoholic Liver DiseaseAlcoholic Liver Disease

Per Capita ConsumptionPer Capita Consumption

A “Standard” DrinkA “Standard” Drink

EU Drinking Patterns EU Drinking Patterns

Alcohol and EatingAlcohol and Eating

“British Government's strategy on alcohol will do nothing to tackle problem



drinking in Britain”

Increased alcohol consumption per capita in UK in last 20 years

Reduced price of alcohol

Availability

Marketing of alcohol

Deregulation

Hall. British drinking: a suitable case for treatment? 2005;331:541-544

Alcohol Use and OccupationAlcohol Use and Occupation

Licensees

Hotel & Catering

Seamen

Armed Services

Sales Representatives

Brewers & Distillers

Journalists

Medical Practitioners

Alcohol Use and OccupationAlcohol Use and Occupation

Availability at work

Social pressure to drink

Self-selection?

Freedom from supervision

Doctors

Drinking culture

Access to drugs

Obtaining help without destroying career?

Alcohol and PerformanceAlcohol and Performance

Absences and absenteeism

Below-par performance

Interference with training

Higher turnover rates

Accidents

Sickness AbsenceSickness Absence

Sickness absence

11 - 17 million days lost per year

Cost £1.2 - 1.8 billion

Additional 2 days absence per year (Heavy vs. Light drinkers)

30% excess rates of absence in dependent drinkers

ProductivityProductivity

Moderate drinking linked to higher wage earners

Adverse effects above current drinking limits

Effect of hangovers ?

(12% male light drinkers & 9% female light drinkers noticed effects ofalcohol at work)

AccidentsAccidents

Strong link between alcohol consumption and fatal accidents

16% fatal accidents in Australian study non-zero blood alcohol (median concentration 104 mg%)

Vehicle accidents blood alcohol >50 mg%

Less clear for non-fatal accidents

Alcohol and AccidentsAlcohol and Accidents

Driving accidents:

3, 10, 40 Times increased risk for blood alcohol levels of 80, 100, 150 mg/dl

Impaired cognitive function at 50mg/dl

Blood levels 30-60 mg/dl impaired ability to negotiate course

Health Promotion at WorkHealth Promotion at Work

Prevention

Primary (information, culture)

Secondary (observation, screening)

Tertiary (treatment)

Rehabilitation back to work

Advice & EducationAdvice & Education


Alcohol & EducationAlcohol & Education


Legal ConsiderationsLegal Considerations

Health and Safety at work act (1974);

Management of Health and Safety at work regulations (1999)

Road traffic act (1988)

Transport and works act (1992)

Human rights act (1998)

Data protection act (1998)

Ethics and MoralsEthics and Morals

Doing good

Avoidance of doing harm

Respect for the individual

Protecting society

Alcohol Policies in the WorkplaceAlcohol Policies in the Workplace

Aims / purpose / objectives

Applicability

Scope

Responsibilities

Regulations and standards

Definitions

Identification of problems

Management protocols

Employee rights

Potential role of an oh departmentSnashall & Patel 2005

Alcohol Policies in the WorkplaceAlcohol Policies in the Workplace

Advice to management

Other disciplinary issues

Responsibilities for implementing the policy

Promulgation

Sources of advice

Snashall & Patel 2005

European ConsiderationsEuropean Considerations

Austria

Phase 1: confidential conversation

Phase 2: involve head of department

Phase 3: case conference; submit to residential treatment

Phase 4: dismissal

Allowances for relapse

Re-integration procedures


Netherlands

Focus on prevention with shared responsibilities

Additional measures for safety critical jobs

Bans and controls must not be part of the core policy

Drug and alcohol tests are violations of private life


Netherlands

The NVAB is of the opinion that tests in which the company doctor is

involved should only take place on industrial medical grounds. If

agreements have been made between the employer and the

representation of the employees about random tests for risk

functions, then this does not need to be contradictory with the

fundamental issue of industrial medical grounds.

The registered company doctor determines the grounds on the basis of

his professional expertise and may in some cases appeal to the

privilege of non-disclosure if to his judgement no industrial medical

grounds can be established.

Good PracticeGood Practice

Involvement of all parties

Formalised and familiar

An alcohol free workplace

Preventive

Detection

Treatment and support

Confidentiality

Equality

Examples of Alcohol andExamples of Alcohol andDrug Abuse Drug Abuse in UK Doctorsin UK Doctors

GMC Case Review Caseload by ImpairmentGMC Case Review Caseload by Impairment

Of the GMC “Health” Caseload . . . .Of the GMC “Health” Caseload . . . .

Average length of supervision = 5 years

26%

33%

41% Suspended

Conditions

Undertakings

Breakdown by Impairing ConditionsBreakdown by Impairing Conditions

Health Impairment CaseloadHealth Impairment Caseload

9%4%

13%

5%

5%9%

7%

8%

7%7%

6%

3%

17%

Doctors with Health Sanctions by SpecialtyDoctors with Health Sanctions by Specialty

Common Issues arising from Health CasesCommon Issues arising from Health Cases

Abstinence & testing

Insight, awareness of extent of illness

Length of supervision

Conditions in remission

Case 1Case 1

25 year old SHO working in A&E, UK PMQ

Theft of pethidine and morphine notified to GMC

Tested positive for MDMA, cannabis, cocaine, codeine during GMC health assessment

Suspended by GMC for 12 months

Review hearing imposed conditions, including prescribing and possession restrictions

Referred to Deanery, now working in F1 post in different hospital within same region

Case 2Case 2

44 year old staff grade A & E, PMQ India

Referral from NHS Trust – concerns re clinical competence and health

Performance assessment – deficient in number of areas

Undertakings agreed autumn 06

Personal visit to GMC offices Spring 07

Notification from employers that had attended for work whilst intoxicated, sought to evade detection

Referred to IOP and FTPP

Case 3Case 3

32 year old male UK PMQ 1999

2001 was on Deanery Surgical rotation

Personal problems led to anti-depressants & Zolpidem prescription from GP

Started to overmedicate, then turned to alcohol when Zolpidem ran out

Stole prescription pads, altered GP prescriptions, presented forged prescriptions to Pharmacists

Convicted in 2003 on 6 counts

Panel imposed conditions 2005 – medical s/v and clinical attachments only.

Relaxed in 2006 to include training posts but prescribing restrictions

Now in 2nd training post

Case 4Case 4

40 yr old male, UK PMQ 2000

Personal problems led to opiate use

Drink driving conviction and referral to GMC 2002

Low point - buying street heroin, attempted suicide

2 x health assessments – opiate addiction and harmful alcohol use

Undertakings breached. Suspended. Now on conditions2006 started FY1 post. Now in FY2

Clinical, educational and medical s/v all in place and working well

Case 5Case 5

58 yr old male, Orthopaedic Surgeon UK PMQ

History of cocaine use dating back to 1997, following personal problems

Referral to GMC 2002 by employer

Agreed health undertakings 2002

Breached 2003, suspended by FTPP

Suspension relaxed to conditions 2005, including urine testing by OHP

Hair tests found cocaine and heroin

Disputed test results at Panel

Suspended

Further SourcesFurther Sources

Addiction at work. Ed: Hamid Ghodse. Gower, 2005.

Alcohol and the workplace. A european comparative study on preventive and supporting measures for problem drinkers in their working environment. European commission.

Drug testing in the workplace. The report of the independent inquiry into drug testing at work. Joseph Rowntree Foundation / Drugscope / NEF 2004.

• Alcohol concern

• Institute of alcohol studies

• Health and safety executive

• International Labour Organisation

• World Health Organisation (dept of mental health and substance dependence)

drugs and alcohol in the workplace keeping workforces clean, sober and straight in a time of massive...

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