Drugs and Alcohol
in the Workplace
Keeping workforces clean,
sober and straight in a time
of massive consumption
Prof. Craig Jackson
Head of Psychology Division
BCU
craig.jackson@bcu.ac.uk
British 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 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).
Overview
•
Background stats on drinking
•
Alcohol and the workplace
•
Health promotion at work
•
Prevention / rehabilitation
•
Alcohol policies
•
Good practice
Alcohol 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 Statistics
Potential Effects of Excessive Drink
High blood pressure
Cancer
Cirrhosis of liver
Ulceration
Haemorrhage
Neuropathy
Myopathy
Mental ill health
Social decline
Premature death
Alcoholic Liver Disease
Per Capita Consumption
PER CAPITA CONSUMPTION
25
Fr
Litres
20
15
10
It
Ger
Aus B
Den
Fin
Gr
Ire
Sp
1978
Lux
Por
Ne
UK
Sw
5
0
Country
1988
1998
A “Standard” Drink
A “Standard” Drink
EU Drinking Patterns
Alcohol and Eating
“British Government's strategy on alcohol will do nothing to tackle problem
British Medical Journal
British 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
British 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
Alcohol Use and Occupation
Licensees
Hotel & Catering
Seamen
Armed Services
Sales Representatives
Brewers & Distillers
Journalists
Medical Practitioners
Alcohol 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 Performance
Absences and absenteeism
Below-par performance
Interference with training
Higher turnover rates
Accidents
Sickness 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
Productivity
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 of
alcohol at work)
Accidents
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 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 Work
Prevention
Primary (information, culture)
Secondary (observation, screening)
Tertiary (treatment)
Rehabilitation back to work
Advice & Education
“British Government's strategy on alcohol will do nothing to tackle problem
Advice & Education
“British Government's strategy on alcohol will do nothing to tackle problem
Advice & Education
Alcohol & Education
“British Government's strategy on alcohol will do nothing to tackle problem
Legal 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 Morals
Doing good
Avoidance of doing harm
Respect for the individual
Protecting society
Alcohol 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 department
Snashall & Patel 2005
Alcohol Policies in the Workplace
Advice to management
Other disciplinary issues
Responsibilities for implementing the policy
Promulgation
Sources of advice
Snashall & Patel 2005
European 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
European Considerations
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
European Considerations
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 Practice
Involvement of all parties
Formalised and familiar
An alcohol free workplace
Preventive
Detection
Treatment and support
Confidentiality
Equality
Examples of Alcohol and
Drug Abuse
in UK Doctors
GMCCase
Case Review
Caseload
by Impairment
Review
caseload
by lead
impairment
14%
Health
20%
66%
Conduct
Performance
Of the GMC “Health” Caseload . . . .
26%
Suspended
41%
Conditions
Undertakings
33%
Average length of supervision = 5 years
Breakdown by Impairing Conditions
Neuroses
Schizophrenia 2%
4%
Organic
3%
Affective
26%
Personality
2%
S
Substance alcohol
43%
S
A
O
S
N
Substance other
20%
P
Health Impairment Caseload
9%
4%
13%
3%
5%
9%
6%
7%
5%
8%
17%
7%
7%
Doctors with Health Sanctions by Specialty
Gastroenterology
0.7%
Geriatric medicine
0.7%
Cardiology
0.7%
Other
3.3%
Public Health
1.5%
Ophthalmology
1.5%
Obstetrics and
Gynaecology
1.5%
Paediatrics
1.8%
Unknown
1.8%
Accident and
emergency
Anaesthetics
6.2%
6.5%
General Practice
38.9%
Surgical
8.4%
Psychiatric
17.5%
General medicine
9.1%
Common Issues arising from Health Cases
Abstinence & testing
Insight, awareness of extent of illness
Length of supervision
Conditions in remission
Case 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 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 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 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 conditions
2006 started FY1 post. Now in FY2
Clinical, educational and medical s/v all in place and working well
Case 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 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)