Symptoms of Substance Use & Reasonable Suspicion Testing in the Workplace

1. Symptoms of Substance Use &Reasonable Suspicion Testingin the Workplace November 10, 2010 Dan R. Azar MD MPH QME MRO Alliance Occupational Medicine Milpitas & Santa Clara

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6. Drinking, Driving and Death Underground • August 31, 1991 • Lexington Avenue subway derailment under Park Avenue • smoky tunnel • hundreds of tons of mangled metal • dozens of bloodied passengers and • here and there, body parts. Alliance Occupational Medicine

7. Worst New York City Subway Accident in 63 years. • Five people killed • More than a hundred injured • Motorman, 38-year-old had a history of alcohol abuse, • The level of alcohol in the motorman's blood strongly indicated that the motorman had a chronic drinking problem. • Why did supervisors at the NYC Transit Authority continue to allow him to operate trains? Alliance Occupational Medicine

8. Do we need a Substance Abuse Policy and Prevention Program? • Safety Needs to be Every Employer’s Top Consideration • Workers • Clients & Customers • Suppliers • General public • To improve productivity/output • To control input/production costs • To minimize employee theft and other wasteful behaviors. • To increase health and well-being of employees and their families • Health care insurance • Workers' compensation insurance and costs • General Liability insurance premiums; Alliance Occupational Medicine

9. An Effective Workplace Substance Abuse Policy • Applies to everyone, including top managers. • Clearly explains the organization’s drug testing policy. • Outlines which tasks are "safety critical" • Includes information about prevention, identification, treatment and rehabilitation. • Includes information about education and training in the workplace. • Addresses how treatment or evaluation referrals are made. Alliance Occupational Medicine

10. An Effective Workplace Substance Abuse Policy • Encourages voluntary participation in substance abuse treatment, without job loss. • Ensures participant confidentiality • Describes the duties and responsibilities of the individual during and after treatment. • Includes review of the policy at regular intervals. • Consistent treatment from employee to employee Alliance Occupational Medicine

11. What Will the Policy Prohibit? • Obvious: • all illegal drug and alcohol use on company time will be prohibited • Not so obvious: • being at work with illegal drugs in system even though the use took place off the clock and off site? • Same circumstances but with no visible impairment • Criminal drug convictions without worksite use? • What about mood altering prescription medications? • What about OTC medications? • What about medical marijuana? • Hey, what about my 2 martini lunch? Alliance Occupational Medicine

12. What is Reasonable Suspicion? Must be based on • a reasonable and articulated belief that the • employee is under the influence of alcohol or drugs • on the basis of specific observations concerning the • appearance, • behavior, • speech, or • body odors of the employee Alliance Occupational Medicine

13. Worsened Personal Appearance • inappropriately dressed • does not appear healthy • does not appear physically capable • slurred speech • unsteady gait • blood-shot eyes • sleepy • appears unclean or unwashed at the beginning of work • no regular change of clothes • offensive odors • bad breath • body odor Alliance Occupational Medicine

14. Decreased Reliability • extended weekends (Monday/Friday absences) • consistently late • leaves early • absent from work area • excessive sick leave • takes unauthorized leave • repeated absences • misses deadlines • doesn’t follow procedures Alliance Occupational Medicine

15. Loss of Problem Solving • rarely follows through • rarely checks for results • can't handle complex assignments • tends to ignore problems or delegate inappropriately; • relies too heavily on others to complete the work; • cannot define the problem • covers up the problem • blames others • work frequently needs to be redone Alliance Occupational Medicine

16. Decrease in Job Knowledge • skills are not current • doesn't understand regulations • misuses equipment • doesn't retain instructions • needs constant supervision • doesn't understand or follow safety/security procedures • requires frequent instruction or assistance • learns very slowly • unable to work independently Alliance Occupational Medicine

17. Decrease in Productivity • low volume of work • takes many breaks • wastes time • needs constant reminders to complete work • does not complete assigned tasks • overwhelmed by realistic workload • unavailable for extra work • cannot increase workload when needed • volatile and easily upset • inconsistent in the workplace Alliance Occupational Medicine

18. Poor Judgment • makes decisions without regarding available information • will not reverse decisions in face of mistakes • insensitive or tactless • does not use common sense • illogical reasons for behaviors • violates confidentiality • poor ability to size up situations • does not understand the whole picture • takes inappropriate actions • inattentive to safety procedures Alliance Occupational Medicine

19. Difficulty Working With Others • poor listening skills • inability to communicate • uncooperative • projects negative attitude to customers, co-workers, and the public • unable to resolve conflicts • openly mistrusts many people • edgy or easily and frequently angered or hurt by others • slows work of others • complains • hostile and argues frequently • stimulates complaints from co-workers • tends to blame others Alliance Occupational Medicine

20. The Well Intentioned Supervisor or Coworker… • Overlooks the employee’s problem. • Pick up the slack & cover for the employee until he/she gets “their life back together.” • Coworkers pick up the additional workload created by a codependent manager. • These “favors” ultimately hurt everyone including the employee who is using drugs or alcohol. Alliance Occupational Medicine

21. Who is covering up…and why? • Coworkers & supervisors cover up for the substance-abusing employee • Personal friendship or loyalty dissuade us from taking corrective action • Fear of confrontation: crosses personal boundaries • Uncomfortable addressing a personal problem in the workplace – crosses professional boundaries. • We’re all worried about doing “the wrong thing” • Codependency: a tendency to behave in overly passive or excessively caretaking ways that negatively impact one's relationships and quality of life. Alliance Occupational Medicine

22. Lack of ActionIncreases Legal Liability of the Employer • Increased risk for on-the-job accidents. • Increased risk of damaging equipment or property. • Increased risk the employee will engage in inappropriate behavior. • Insufficient response to on the job impairment increases liability based on legal principle of negligence. Alliance Occupational Medicine

23. Codependency No More!* • Do not insulate drug user from the consequences of his/her behavior • Hold the substance user responsible for his/her own behavior thereby promoting personal recovery. • Doing the right thing the right way is challenging but rewarding. • * Author: Melody Beattie Alliance Occupational Medicine

24. Don’t Assume a Job Performance Problem is a Sign of Drug Abuse • Lack of sleep • Other illness or health condition • Side effects from prescription or OTC medication • Anxiety or Depression • Mourning / Personal Loss • Accusing an employee of drug or alcohol use places the employer at increased risk of a lawsuit Alliance Occupational Medicine

25. Don’t Accuse Employee of Alcohol or Drug Use • You are taking an unnecessary legal risk • Instead, ask an employee whether he/she is “feeling all right?” • If you observe questionable behavior the employer is expected to make an inquiry • Record your observations. • Document what you see, hear and smell. • Do not give your opinion or diagnosis. • Do not document that which you do not want read back to you in deposition. Alliance Occupational Medicine

26. One Symptom is Not Enough! • Here are the 5 steps that should be under taken: • Observation (multiple dates okay) • Documentation (same day as observation) • Make a Plan (ask for help from HR) • Talk to the Employee • Follow-up Alliance Occupational Medicine

27. Observation • supervisors are responsible for making sure employees meet certain minimum performance standards • take steps now to develop and communicate a set of objective job performance standards that explain your expectations. • Observe and document any time these standards are not being met (regardless of suspected cause). Alliance Occupational Medicine

28. Documentation • Train managers to document in specifics any time an employee is suspected of drug use while on duty: • appearance • actions • attitude • Complete report within 24 hours of the observed behavior • Focus exclusively on the observed behaviors and the impact of those behaviors on work place or performance. Alliance Occupational Medicine

29. Make a Plan • set your goals for the meeting • plan in advance • anticipate the employee’s possible responses • plan your reply • know what resources are available in advance for treatment Alliance Occupational Medicine

30. Talk to the Employee • have an appropriate second party attend as a witness • preferably someone from employee relations and not a direct supervisor • document your meeting • limit your observations to specifics regarding job performance and/or objective signs of substance use. Alliance Occupational Medicine

31. Pulling the Employee from Service • With obvious signs of impairment (drowsy, careless, inattentive) remove from safety sensitive duties ASAP • The operation of machinery / equipment • Medical or hospice care of a dependent • Use a private office • Always have a witness present who is willing to document separately • Do not confront an impaired employee in public. • Never argue, yell or threaten someone under the influence. • Do explain and reassure. Alliance Occupational Medicine

32. Follow Up When an employee has undergone substance abuse treatment and returned to the workplace: • Offer no preferential or special treatment. • Give the individual plenty of feedback concerning his/her work • Continue to document observed behaviors Alliance Occupational Medicine

33. Useful Internet Sites for Reasonable Suspicion • http://transit-safety.volpe.dot.gov/Video/ReasonableSuspicion-HighQuality.wmv • http://transit-safety.fta.dot.gov/DrugAndAlcohol/TechnicalAssistance/ReasonableSuspicion.asp • http://transit-safety.fta.dot.gov/Publications/order/default.asp • http://workplace.samhsa.gov/FedPgms/Fed_DFWP.aspx • http://www.workexcel.info/reasonable-suspicion-checklist/download.html Alliance Occupational Medicine

34. Signs and symptoms of alcohol and/or drug misuse: • • Odor of alcohol • • Odor of marijuana • • Slurred speech • • Flushed, swollen face • • Red or runny eyes or nose • • Pupils dilated or constricted, or unusual eye movement • • Lack of coordination • • Tremors or sweats • • Weariness, exhaustion • • Sleepiness • • Nausea • • Unauthorized possession of alcohol or illegal drugs • • Any other observation that creates a reasonable suspicion of being under the influence of drugs or alcohol at work Alliance Occupational Medicine

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