VALLEY HEALTH EMPLOYER SUMMIT 2014
Is my Employee Impaired?
What Do I Do Now?
Pamela Reiman, JD, MSW, CADC, CSAC
Executive Director
Bridging the Gaps, Inc.
423 West Cork Street
Winchester, Virginia 22601
(540) 535-1111
preiman@bridgingthegaps.com
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But, He Used to Be Such a Good Employee…
Identifying Changes in Workplace Behavior that Signify a Potential Substance Use
Disorder.
Early Intervention is Key – Identify a problem before it can cause harm.
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The earlier the intervention, the better the prognosis
Most often, the workplace is the last place that addiction manifests
ANYONE who uses substances in the workplace is of concern
The high cost of doing nothing – Action or inaction directly impacts the course
of the illness
 No one is immune – Addiction affects all walks of life and at all levels of the
workforce
o Construction, hospitality, warehousing and sales rank highest in incidence
of substance abuse
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Avoid making any assumptions or judgments; keep it concrete and factual
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Signs & Symptoms in the Workplace
Physical Appearance
• Deterioration of hygiene, grooming, or dress
• Sudden weight gain or loss
• Bloodshot or glassy eyes
• Trembling or shaking
• Slurred speech
• Running nose, frequent sniffing
• Dilated or pinpoint pupils
Behavioral Changes
• Shifts in personality (normally reserved, becomes talkative)
• Mood Swings
 unusual irritability, withdrawn, depressed or particularly
energetic
• Temper Outbursts
• Frequent text messaging or phone calls made in private
• Nervousness, fidgeting, paranoia
• Inconsistent energy levels ( energetic, then sluggish)
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Signs & Symptoms in the Workplace
Work Performance
• Increasing frequency of tardiness or calling in sick
• Inconsistent quality of job performance
• Increased incidence of mistakes in work or injuries on the job
• Loss of focus and concentration
• Conflicts with colleagues or customers – argumentative, uncooperative,
accusative
• Money or property missing from the workplace
• Projects or tasks taking longer time to complete; extensions being requested
more often
• Request for pay advances
BE CAREFUL – Suspicion of Substance Use should NOT be presumed by a
single event, sign, or symptom; But rather by a pattern confirming a
significant change in behavior.
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How Bad is Bad?
What Does a Positive Urine Screen Mean?
Substance Use Disorders – A Progressive Continuum
• Terminology – Variations with a Difference
 Recreational/Social use -- Abuse – Unreasonable use that causes harm or injury
 Dependence – Compulsive or chronic need or active addiction to
substance
– New Diagnostic Manual -- “Small”, “Medium” or “Large”
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Where do Urine Screens Fit In?
• Positive screen only indicates that an individual has the metabolites of a
substance in their system
• Does NOT provide any indication of present impairment or when the
substance was used
• Point of Care Testing – subject to false positives (10-30% depending upon
manufacturer)
 Consider confirmatory testing if using screen results as basis for
adverse employment action
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An Employer’s Choice - Reaction or
Response
Reaction: “Zero Tolerance” -- Positive Screen = Termination from
Employment
• Punitive Model inconsistent with Disease Model
• “Bad employee” versus individual suffering from a treatable disease
• Risks to Work Force – Loss of Quality Employees, Morale, Productivity
OR
Response: Intervention towards Treatment and Rehabilitation
• The “Firm Choice” --Treatment as a Condition of Continued
Employment
• Treatment does work and can be cost-effective
 $1.00 spent on treatment saves $2.00-10.00
o Improved quality of life, higher productivity, loyalty, morale
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Beware of Common, but Unhealthy
Reactions
• Denial & minimization
• Fear
• Lack of Knowledge and bias
• Enabling
 “Turning a blind eye”
 Making excuses, covering, trying to protect
 Doing nothing – “Not my problem”
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Any Employer Can React or Respond In
Either Way; BUT Have a Plan
• Ensure you have a written policy to this effect
 Stated Purpose of promoting workplace safety, health, and productive
environment
 Consider all applicable laws (consult with an attorney/union rep)
 Clear statement of expectations, prohibitions and consequences
• Educate and inform the employees of the policy
 Provide copy of policy
 Obtain signature acknowledging employee has read and understood
and received a copy
• Train the supervisors and managers as to the policy
• Document, document, document
• Maintain confidentiality and privacy
• Fair, Even-handed and Equitable
• Use confirmatory testing for positive screens, strict chain of custory,
accredited labs, and certified medical review officers.
• Always make it about performance – OBJECTIVE, CONCRETE, & FACTUAL
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When Concerned Enough to Consider
Addressing Employee Substance Use –
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Seek Professional Help – Leave Diagnosing to the Experts
Employee Assistance Programs & Mental Health Professionals
 Starting Point – Bio-Psycho-Social Assessment for accurate diagnostic and
treatment recommendations
 Treatment Continuum
o Individualized treatment plan based on least restrictive level of care
o Proper client-treatment matching enhances success of outcome
 Treatment Resources
o EAP
o Health Insurance with comprehensive SA treatment benefits
o Community Resources
o 12-Step/Self-Help programs
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Employer Safeguards if Employee is Retained
 Return to Work Agreements
 Routine Monitoring/Contract for Abstinence as condition of retention
 Continuing Care Responsibilities
 Performance Standards and Evaluations
 Reasonable Accommodations
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Legal Concerns
Americans with Disabilities Act
• Discrimination and the Definition of Disability –
 “In recovery” versus “current” user of “illegal substances”
o What’s illegal?
o What about alcoholics?
o Limited protections against discrimination specific to those in
“recovery”
 Can you ask?
 Yes, to questions of use
 No, to abuse, addiction or previous treatment
o It’s all in the timing
 Definition of “current” is “recently enough” to reasonably
believe that drug use is an ongoing problem
 What if employee decides to seek treatment prior to adverse
employment action?
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Legal Concerns (continued)
• Prescription Medication
 Can you ask?
o Only if employee is acting in a way that compromises safety or
suggests they cannot perform job for a medical reason.
o “Reasonable belief”
 Medically Prescribed medications may have the potential for impairing
performance
 Slippery slope -- When a drug test of an applicant may become a
“medical examination”
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Legal Concerns (continued)
Family Medical Leave Act
• Up to 12 weeks unpaid leave in a 12-month period for conditions defined
as “serious health condition”
• Leave must be taken in order to receive treatment by a health care
provider
• Does not prohibit employer from taking adverse employment action for
violations of stated policies
• Does not require employer to allow opportunity for treatment and
reinstatement
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It is an Employer’s Choice.
But Through Simple Steps and a Sense of
Compassion, the Course of an Individual’s
Addiction can be Positively Altered and Health
and Productivity Restored.
What We Cannot Afford, Is the Cost of Doing
Nothing
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RESOURCES
Regional Resources
Alcoholics Anonymous
(540) 662-0322 – Blue Ridge AA Hotline
1-800-835-6130
A 12-Step mutual support group for alcoholics. Call for meetings in the Blue Ridge area.
http://www.aavirginia.org
Alanon/Alateen
A 12-Step mutual support group for family and friends of alcoholics.
http://www.alanonva.org
Blue Ridge Counseling Center
(540) 662-7555
http://www.blueridgecounselingcenter.com/
Private counseling on range of issues. One counselor specializes in alcoholism.
Boxwood Treatment Center
(540) 825-3100 ext. 3600
www.rrcsb.org
Boxwood Recovery Center is a residential alcohol and other drug treatment program. *Must first be
prescreened by the Community Services Board in the area of residence. The CSB will refer the client to
Boxwood for admission.
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RESOURCES
Regional Resources (continued)
Bridging the Gaps
(540) 535-1111 or (866) 711-1234
www.bridgingthegaps.com
Integrative alcohol and drug addiction treatment program. Residential, outpatient, and support group
programs. Provide licensed substance abuse treatment.
Celebrate Recovery (Support Group)
(540) 667-8017
http://www.wincog.com/groups
A Christian-based recovery program using 12-steps to help with all kinds of addictions. Meetings are held at
Winchester Church of God.
Council on Alcoholism
(540) 662-8877 (24/7)
http://lordfairfaxhouse.com/Home.html
Residential 30+ day Halfway House program for recovering substance abusers that have completed a treatment
program.
Eastridge Health Systems
(304) 263-8954
http://eastridgehealthsystems.org
Outpatient substance abuse treatment including Suboxone and Adult Outpatient Services. Martinsburg, West
Virginia.
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RESOURCES
Regional Resources (continued)
Edgehill Recovery Retreat Center
(540) 662-8865
www.edgehillrecovery.org
Residential Recovery Retreat Center – provides supportive housing and facilitated introduction into the 12-Step
recovery program.
Northwestern Community Services Board
(800) 828-1120
www.nwcsb.com
Offers an array of outpatient, case management, day support, residential and emergency programs that are
designed to enhance the quality of life for both children and adults affected by emotional/behavioral disorders,
mental illness, and substance use.
Old Dominion ASAP – Alcohol Safety Action Program
(540) 665-5633
Provides probation, education, and rehabilitation of those charged with or convicted of driving under the
influence of alcohol and/or drugs, and/or first offense drug possession.
Shenandoah Community Health
(304) 263-7023
www.svms.net
Outpatient substance abuse and mental health services in Martinsburg, West Virginia.
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RESOURCES
National Helplines
The Workplace Helpline of the Center for Substance Abuse Prevention (CSAP)
U.S. Department of Health and Human Services.
1-800-WORKPLACE
Free consultation and advisory service for employers and union representatives wishing to learn about
workplace substance abuse programs. Provides sample policies, lists of certified laboratories, and other
materials, including a free kit for employers, “Making Your Workplace Drug Free”
National Clearinghouse for Alcohol and Drug Information
1-800-729-6686 (English and Spanish)
1-800-487-4889 (TDD)
Clearinghouse offers free of charge or at very low cost more than 10,000 educational and informational items
on alcohol and other drug abuse, including pamphlets, books, posters, videotapes for both employers and
employees, and a computer disk version of the U.S. Department of Labor’s Substance Abuse Information Data
Base, giving information on workplace programs.
Drug information, Treatment and Referral Hotline of the Center for Substance Abuse Treatment (CSAT) U.S.
Department of Health and Human Services
1-800-662-HELP
This hotline provides free information, advice, and local referrals for substance abuse treatment nationwide.
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RESOURCES
National Organizations
Employee Assistance Professionals Association
101 Wilson Boulevard, Suite 500
Arlington, VA 22201
(703) 522-6272
Can provide referrals to employee assistance professionals and information on EAPs and substance abuse.
National Drugs Don’t Work Partnership/Community Anti-Drug Coalitions of America
901 North Pitt Street, Suite 300
Alexandria, VA 22314
(703) 706-0560
This public-private coalition of business, labor, and national, state and local prevention groups helps businesses
seeking EAP and drug-testing consortia and provides other services.
U.S. Department of Transportation
Office of the Secretary
Drug Enforcement Program and Program Compliance
400 Seventh Street, SW, Room 10200
Washington, DC 20590
1-800-225-DRUG or (202) 366-DRUG
Provides information about Department of Transportation regulations on drug abuse.
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