The British Medical Association has updated its guidance on alcohol and drugs workplace policies, including a new chapter on job applicants. Nic Paton looks at the practical implications for recruiters and occupational health practitioners.
In July 2015, Professor Dame Carol Black started a review into how best to support benefit claimants with addictions and potentially treatable conditions back into work.
Although it is yet to be formally published, its recommendations will nevertheless include that the Government works to develop guidance with employers on best practice in recruiting people with alcohol or drug dependency issues.
As a result, the British Medical Association’s (BMA) occupational medicine committee published new guidance on this area in July 2016. The updated guidance, Alcohol, drugs and the workplace – The role of medical professionals, now includes a section (chapter nine) specifically addressing the question of occupational health support for job applicants.
More on alcohol at work policies
Committee chairman Dr Paul Nicholson explains: “The main difference is the new chapter nine, which reinforces the message that health professionals have a responsibility to challenge negative stereotypes and help employers understand that people who have a history of alcohol problems and have successfully taken part in a treatment programme can still be successfully employed. So it is about getting around that stigma.
“One of the features of this guidance is that, while it is really produced for OH professionals, it is also aimed at other health professionals, as well as having relevance for HR managers and employers generally. We’ve made sure it has the most up-to-date statistics and includes evidence from any subsequent papers,” he adds.
Alcohol and drugs can be a real issue for many employers, as research from employment solicitors Crossland argued in March.This poll of 500 employers and 500 employees concluded that more than one-third (35%) of staff knew or suspected their colleagues had a drug problem or had taken illegal substances either during or outside work.
BMA guidance on job applicants
The main adjustment or change to the guidance from the 2014 version is a new chapter on OH support for job applicants.
This chapter examines the use of “abstinence periods”, post-offer health assessments, determining medical fitness to work, and monitoring.
While some laws and regulations specify abstinence periods (for example, for driving), where this is not the case, drug-free periods are “entirely arbitrary and are of little use in determining an individual’s suitability or readiness for employment”, the guidance emphasises. The best guide is either receiving and completing a course of treatment, followed by training, voluntary work, and support to find work.
Post-offer health assessments
The DVLA has specific requirements for alcohol or drug users or past users who need to drive as an essential part of their job.
In general, however, the guidance recommends occupational physicians should consider the following when performing or reviewing a post-offer health assessment of a current or former drug or alcohol user:
- The time the individual has been abstinent is not an indicator of competence.
- Assessments should be considered on an individual basis and not by application of blanket policies.
- People with experience of drug misuse and drug treatment can be effective employees, particularly when they are well supported by management and occupational health services.
On a practical level, clearly there are some instances where prescribed medicines can impair an individual’s ability to carry out a particular task, but this should be factored in to any assessment of employment-related needs.
Questions to ask when determining medical fitness for work
The guidance outlines the following questions to ask a current or former drug or alcohol user to determine the medical fitness to work:
- What are the essential duties of the task?
- What is the person’s current and past history of alcohol or drug use?
- Will their current state of health, including any medication they are taking, present any current or foreseeable risk to the health and safety of themselves or others?
- Are there legal or regulatory requirements – for example, DVLA standards?
- Would a phased introduction to work be beneficial, such as for someone who has been out of work for some time?
- Are there work or workplace factors that, if not managed, could aggravate their condition? These include high stress, long hours or irregular shifts, fatigue, isolation, and easy access to drugs or alcohol.
- Could it be appropriate to obtain, with the patient’s consent, a report from a treatment provider?
Here the guidance sounds a cautionary note: “Return to work can be stressful for anyone, let alone someone who may feel stigmatised by having undergone rehabilitation for dependency.”
Therefore, it argues, it is helpful to review the job applicant in the occupational health department during their return to work in order to ensure they are coping and they have all the necessary support.
“In some cases, and after careful consideration, it may be appropriate to discuss and agree individual monitoring with the applicant as part of that support in the workplace.
“It is important to explain to the individual that early detection of a recurrent problem may offer the best chance of successful medical intervention, and that monitoring is not seen to indicate any lack of trust by occupational health staff,” it adds.
The survey also reported a wide range of approaches in how employers responded to substance abuse at work. A total of 41% of employers said they have an official drug awareness guide detailing company policy and potential disciplinary action; nearly a quarter (23%) said they undertake random drug and alcohol testing on employees; 21% said they had a programme of training for managers or supervisors on recognising the signs of drug misuse; 14% said they allow people time off to get help or encourage them to seek help; and 11% said they just sacked them.
Clarity on screening employees
This variability of approach highlights how employers can sometimes struggle with how best to manage alcohol and drug issues in the workplace, especially outside the relatively clear-cut parameters of safety-critical work. This guidance, therefore, is intended to offer employers much-needed clarity, argues Dr Nicholson.
“The line has always been that, outside of safety-critical work, there is no place for screening of prospective employees or people who are already employed. The employer needs to consider all the factors very carefully in terms of people’s human rights and the ongoing relationship between the employee and the employer.
“The employer also needs to be very clear as to why it is doing it – is it to protect people, because of health and safety, or is it even a concern about reputation and image? Probably, particularly among small employers, most do not have alcohol on site. But what about evenings out or workplace social events? What about, too, the risks or controls you need to put in place in terms of people travelling for business, whether that is driving and just staying in a hotel,” he points out.
“Occupational health professionals have a role in assisting people with a history of abuse back into work because, apart from anything else, being in work in itself can aid their recovery. It is also about reducing the risk of relapse.
“Employees who have successfully been treated for, or overcome, an alcohol or drug problem will often be extremely loyal and productive members of your organisational team because they value the opportunity, the fact they have been given a second chance,” he adds
What the BMA alcohol and drugs guidance says
The guidance highlights that alcohol use increases the risk of problems in the workplace, such as absenteeism, presenteeism, and inappropriate behaviour. The use of alcohol or illicit drugs can impair a person’s performance at work through poor decision making and impaired reaction times, causing lost productivity, inferior goods/services, errors and accidents, it argues.
It states: “It is evident that alcohol and illicit-drug use is prevalent in those who are in work and, as such, is a significant issue for the workplace and is a growing concern for employers. “Individuals in employment are more likely to drink frequently compared to those who are unemployed. Individuals in managerial and professional occupations drink more frequently than those in routine and manual occupations.”
Certain working situations, such as shift or night work, travel away from home, working remotely, business meals and job stress can lend themselves to alcohol or drug consumption. Work and/or peer-group pressures, lack of supervision, physical danger, dealing with a demanding or aggressive public and longer working hours can all be other factors associated with higher rates of alcohol use and related problems.
Employers have a general duty under the Health and Safety at Work etc Act 1974 to ensure, as far as is reasonably practicable, the health, safety and welfare at work of their employees and others who could be affected by their work activities.
At the same time, the guidance argues: “Workplaces provide venues and captive audiences for health education and opportunities to identify individuals who have problems with alcohol and illicit-drug use. Medical professionals who support workplaces are well placed to offer health education for workers, as well as training for managers about how to recognise and deal with alcohol and illicit-drug-use issues.”
From an employer or organisational perspective, it is, at the very least, advisable for employers to have an alcohol and drug (substance use) policy. “These policies are more successful when conceived as a component of health and welfare policy, rather than primarily a disciplinary matter,” the guidance outlines.
It adds: “Where a medical professional is asked for advice by an employer, they must establish the capacity in which they are being asked for advice and make clear to patients their professional role. Medical professionals should seek to understand the employer’s alcohol and drug use policy – for example, does it apply to all employees or just those in safety-critical roles? What support is available to employees?
“Managers and supervisors should be trained to recognise the signs of problems with alcohol and illicit-drug use. They should know what to do if they suspect an employee has a problem or if they are approached by an employee who declares a problem, and arrange a referral to occupational health services.”