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

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slide1

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

slide2

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

slide3

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).
slide4

Overview

  • Background stats on drinking
  • Alcohol and the workplace
  • Health promotion at work
    • Prevention / rehabilitation
    • Alcohol policies
  • Good practice
slide5

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)

slide7

Potential Effects of Excessive Drink

High blood pressure

Cancer

Cirrhosis of liver

Ulceration

Haemorrhage

Neuropathy

Myopathy

Mental ill health

Social decline

Premature death

slide13

Alcohol and Eating

“British Government's strategy on alcohol will do nothing to tackle problem

slide15

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

slide16

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

slide17

Alcohol Use and Occupation

Licensees

Hotel & Catering

Seamen

Armed Services

Sales Representatives

Brewers & Distillers

Journalists

Medical Practitioners

slide18

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?
slide19

Alcohol and Performance

Absences and absenteeism

Below-par performance

Interference with training

Higher turnover rates

Accidents

slide20

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
slide21

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)
slide22

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
slide23

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
slide24

Health Promotion at Work

  • Prevention
    • Primary (information, culture)
    • Secondary (observation, screening)
    • Tertiary (treatment)
  • Rehabilitation back to work
slide25

Advice & Education

“British Government's strategy on alcohol will do nothing to tackle problem

slide26

Advice & Education

“British Government's strategy on alcohol will do nothing to tackle problem

slide28

Alcohol & Education

“British Government's strategy on alcohol will do nothing to tackle problem

slide29

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)

slide30

Ethics and Morals

Doing good

Avoidance of doing harm

Respect for the individual

Protecting society

slide31

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

slide32

Alcohol Policies in the Workplace

Advice to management

Other disciplinary issues

Responsibilities for implementing the policy

Promulgation

Sources of advice

Snashall & Patel 2005

slide33

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
slide34

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
slide35

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.
slide36

Good Practice

Involvement of all parties

Formalised and familiar

An alcohol free workplace

Preventive

Detection

Treatment and support

Confidentiality

Equality

slide37

Examples of Alcohol and

Drug Abuse

in UK Doctors

slide39

Of the GMC “Health” Caseload . . . .

Average length of supervision = 5 years

slide41

Health Impairment Caseload

9%

4%

13%

7%

3%

5%

9%

5%

8%

17%

7%

6%

7%

slide43

Common Issues arising from Health Cases

Abstinence & testing

Insight, awareness of extent of illness

Length of supervision

Conditions in remission

slide44

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
slide45

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
slide46

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
slide47

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
slide48

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
slide49

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)