Drugs and Alcohol in the Workplace Keeping workforces clean, sober and straight in a time of massive consumption Prof. C

1. 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

2. 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

3. 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: • where employees are engaging in illegal activities in the workplace; • where employees are actually intoxicated in work hours; • 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).

4. Overview • Background stats on drinking • Alcohol and the workplace • Health promotion at work • Prevention / rehabilitation • Alcohol policies • Good practice

5. 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)

6. Alcohol Statistics

7. Potential Effects of Excessive Drink High blood pressure Cancer Cirrhosis of liver Ulceration Haemorrhage Neuropathy Myopathy Mental ill health Social decline Premature death

8. Alcoholic Liver Disease

9. Per Capita Consumption

10. A “Standard” Drink

11. A “Standard” Drink

12. EU Drinking Patterns

13. Alcohol and Eating “British Government's strategy on alcohol will do nothing to tackle problem

14. British Medical Journal

15. 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

16. 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

17. Alcohol Use and Occupation Licensees Hotel & Catering Seamen Armed Services Sales Representatives Brewers & Distillers Journalists Medical Practitioners

18. 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?

19. Alcohol and Performance Absences and absenteeism Below-par performance Interference with training Higher turnover rates Accidents

20. 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

21. 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)

22. 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

23. 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

24. Health Promotion at Work • Prevention • Primary (information, culture) • Secondary (observation, screening) • Tertiary (treatment) • Rehabilitation back to work

25. Advice & Education “British Government's strategy on alcohol will do nothing to tackle problem

26. Advice & Education “British Government's strategy on alcohol will do nothing to tackle problem

27. Advice & Education

28. Alcohol & Education “British Government's strategy on alcohol will do nothing to tackle problem

29. 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)

30. Ethics and Morals Doing good Avoidance of doing harm Respect for the individual Protecting society

31. 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

32. Alcohol Policies in the Workplace Advice to management Other disciplinary issues Responsibilities for implementing the policy Promulgation Sources of advice Snashall & Patel 2005

33. 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

34. 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

35. 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.

36. Good Practice Involvement of all parties Formalised and familiar An alcohol free workplace Preventive Detection Treatment and support Confidentiality Equality

37. Examples of Alcohol and Drug Abuse in UK Doctors

38. GMC Case Review Caseload by Impairment

39. Of the GMC “Health” Caseload . . . . Average length of supervision = 5 years

40. Breakdown by Impairing Conditions

41. Health Impairment Caseload 9% 4% 13% 7% 3% 5% 9% 5% 8% 17% 7% 6% 7%

42. Doctors with Health Sanctions by Specialty

43. Common Issues arising from Health Cases Abstinence & testing Insight, awareness of extent of illness Length of supervision Conditions in remission

44. 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

45. 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

46. Case 3 • 32 year old male UK PMQ 1999 • 2001 was on Deanery Surgical rotation • Personal problems led to anti-depressants & Zolpidemprescription 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

47. 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

48. 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

49. 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)