OHSU

Substance Abuse in the Workplace

February 11th, 2000

Speakers:

Overview of Substance Abuse Problems:

Gary Joacobsen, MD

Overview of Addiction:

Jerry Schnell, PhD

Contemporary Drug and Alcohol Testing:

Jana Wolfgang, MS, MT (ASCP)

Identifying the Troubled Employee:

Anne Thureson, CSW, CADC

Resolving the Problem:

Anne Thureson, CSW, CADC

Impact of Substance Abuse in the Workplace:

Donald E. Rosen, MD

Issues in Substance Abuse

Scope of the Problem:

A. approximately 70% of heavy drinkers and street drug users age 18-49 work full time
B. about 20% of all 18-24 year old workers use drugs in the workplace
C. Higher risk workers include:

  • those with boring repetitive jobs

  • hourly / temporary workers

  • those with physically demanding jobs

D. Workers that are substance abusers:

  • have four times the number of accidents

  • are five times more likely to engage the workers compensation system

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Substances Definitions:

A. Brain depressants: 

  • alcohol, marijuana, narcotics, tranquilizers, muscle relaxants

B. Brain stimulants:

  • amphetamines, cocaine, diet pills, over-the-counter cold/allergy medicines

C. Alcohol: the most problematic substance, 2-3 more commonly abused than all other drugs combined

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Definitions:

A. Use: casual, social, occasional consumption without significant repercussions.
B. Abuse: more regular use, very often with resultant problems at work or home.
C. Addiction: chronic abuse with dependency- an inability to stop using despite harmful consequences.

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All Drugs of Abuse:

A. Have desired effects (benefits) and undesired effects (costs)
B. If the benefits out weigh the costs, abuse is likely to continue
C. Give pleasure (or relief from displeasure)
D. Can produce a psychological addiction

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Typical Progression of Drug Dependency:

A. Use of substance, often occasional, leads to abuse. Abuse of a substance on regular basis leads to psychological addiction. When abuse continues, then this leads to physiological addiction.
B. Psychological addiction: continued desire for use, despite negative impacts in person's life. Loss of control over substance occurs.
C. Physiological addiction: predictable symptoms and physical signs are present when drug is stopped. The symptoms are relieved when substance is consumed.

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The Steps and Process of Urine Drug Testing:

A. Collection site carefully obtains urine specimen from employee
B. Specimen is shipped to lab (often slowest part of process)
C. Specimen is screened for illicit drugs using immunoassay
D. Any positive specimen is re-tested using more exact technology (GC-MS)
E. A positive test by GC-MS, is reviewed by a Medical Review Officer (MRO). The MRO interviews the donor, and looks for any legitimate medical reason for the substance in question.
F. If no medical explanation is uncovered, then the result is reported to the employer as a positive.
G. Urine drug testing is modeled after the process outlined by the Dept. of Transportation.

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Alcohol Testing:

A. Metabolized and excreted rapidly compared to other drugs, so testing is time critical.
B. Can be tested in saliva, blood, or urine. Urine testing can only tell if any alcohol is present, not how much. Therefore, it is useless to look for impairment from alcohol, based on urinanalysis.
C. Specific machines are available for this testing. They must pass rigorous testing and be certified as "Evidential Breath Test Devices".

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Ways the Impaired Employee May Present:

A. Self-revelation: worker may come forward to management and admit there's a problem. (Tip: Don't punish those honest enough to come forward)
B. Rumor: obviously, not reliable.
C. Reasonable suspicion: Co-workers or manager may notice that an individual is behaving differently today. If safety concerns exist, may consider having them evaluated by an occupational medicine physician. There could be an alternative medical explanation for unusual behavior.
D. Alcohol / Drug tests: Random drug screening is required in the transportation industry. Will sometimes uncover more regular users. Of all types of drug testing, clearly has the greatest deterrent value.
E. Work performance: Deficiencies in performance need to be documented. Again, a medical evaluation can be helpful.

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Impact on Worker Performance:

Substance abuse can effect

  • Individual worker performance

  • Work group performance

  • Corporate performance

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Impact on Individual Performance:

Alcohol or drug abuse can lead to:

  • decreased productivity

  • decreased quality of work

  • increased absenteeism

  • decreased job satisfaction

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Impact on the Work Group:

Group efficiency can suffer by:

  • impaired communication

  • resentment and ill will

  • distraction and decreased morale

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Impact on Corporate Performance:

Corporate performance can be affected by:

  • costs of absenteeism and turnover

  • increased workers' compensation costs

  • increased rates for disability coverage

  • impact on corporate culture

  • productivity / efficiency / earnings

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Resolving the Problem:

A. Look at your company policy
B. Supportive confrontation
C. Partner with an Employee Assistance Program (EAP)

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Company Drug / Alcohol Policy:

A. Your "informal policy" is important. A tradition of alcohol or drug use at company function supports users. Some employers can sabotage their drug free efforts by inconsistent enforcement or substance abuse by those responsible for the program.
B. A written, understandable policy that is shared and promoted with all employees is crucial to developing a work place that is drug free.

  • It should be signed by both company president and union president

  • It must state what is prohibited (drug impairment or drug use?)

  • It must outline the consequences of violation of the policy.

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Supportive Confrontation:

A. Before confrontation, one must monitor performance and act only on "reasonable suspicion". Documentation of the problems will minimize legal liability.
B. At time of confrontation, it must be done in a private setting. Set timeline for improvement, and consequences for failure to improve.
C. At follow up meeting, review performance; take disciplinary steps if needed.

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Employee Assistance Programs (EAP):

A. EAPs can help with supervisor consultation, benefits consultation, and critical incident debriefing. Can conduct prevention and education workshops for employees.
B. EAP counselors provide assessment, some treatment, and act as a referral source.
C. Diagnosis and initial treatment of substance abuse problems are done by professionals.

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