Ask OH: supporting someone with alcohol dependency and managing return to work after a heart attack


An experienced OH adviser answers readers’ questions on supporting someone with alcohol dependency and managing a return to work after miocardial infarction (heart attack). This regular column is aimed at occupational health (OH) nurses working in isolation and those new to the profession. Email your own questions to [email protected]

Dear OH,

An employee has an alcohol dependency and I am not sure where to start to support him fairly. How far does the employer have a duty to provide support to him and what happens if he does not follow the suggested guidance?

Dear reader,

This is a very tricky situation. The way that the business acts in relation to an employee with alcohol dependency ought to be based on the company’s drug and alcohol policy. I hope that the company you are working for has one. If it does, then it should be upfront about expectations and make clear what happens if a person is found to be under the influence of alcohol at work. A balanced approach offering support as well as disciplinary action is important in situations where an employee’s behaviour breaches their employment contract in this way.

There is clearly a very big difference between a person coming to HR or occupational health and asking for help and advice, and a person who is found to have been under the influence of alcohol at work or following an accident or incident. Whatever the scenario, the company policy will always underpin the outcome.

If the policy does not include provisions for such situations, the company might consider whether or not it is fit for purpose. It is not for occupational health to decide this, but it is in the remit of HR. However, you can offer advice to the individual and the business. In my opinion, a good business will allow an individual who asks for help to attend treatment or therapy. They could be required to use annual leave or unpaid leave to do this. By showing a fair and supportive approach, a business will encourage employees to seek support and not try to hide the problem. The latter is likely to affect both their performance and attendance at work.

Drugs and alcohol awareness training should be offered to managers, and, if training managers in this area is within your OH remit, you could offer a “lunch and learn” session. Great advice on this can be found at

Another way to raise awareness in the workforce is through a wellbeing initiative.

Once managers are trained and employees understand their role, it is then for the business to decide how to manage those who come to them with an alcohol problem. One option HR could consider is a contract they can draw up with the individual, stating, for example, if the employee does x then they will do y. If the employee breaches the contract, it is down to the business to manage the situation and not OH. Find out what local resources are available so that you can ensure employees have easy access to them, eg Addaction or Alcoholics Anonymous.

Do not forget that an employee with an alcohol addiction is not protected by the Equality Act 2010 but, if they have another underlying condition such as a mental health issue, then they may be. This could arise in a tribunal if a person makes a claim of discrimination.

Dear OH,

A man has been referred to me who is eight weeks post-miocardial infarction and he is reluctant to return to work. His role is office based with no manual handling. What should I do?

Dear reader,

The best document I have found is Returning to work after a heart attack from the British Heart Foundation. It is clear that work can act as part of an individual’s recovery, provided that the work is risk assessed and a clear vocational rehabilitation plan is put in place. I would also liaise with the local cardiac rehabilitation team as they will be able to give an insight into the employee’s specific issue and progress.

I would also suggest that you write a report detailing the available return-to-work options, and ask the employee if they are content to give OH permission to ring them and discuss the situation. Many people have fears about returning to work, and so it is important to consider psychosocial issues. Employees may also have other concerns, such as being unable to drive, so these need to be addressed as part of the programme to facilitate the return to work. Guidance on driving can be found in the Driving and Vehicle Licencing Agency’s At a glance guide to the current medical standards of fitness to drive. If the employee needs to travel on public transport then you can advise them to consider changing their start and finish times.

The information sheet After a miocardial infarction from is reliable, written in plain English, and may address some employee fears. Ultimately, the OH role is to advise on functional fitness to work and, if the employee refuses to follow recommendations, this becomes an issue for line managers. Sometimes fear prevents an employee from returning to work after an miocardial infarction and sometimes it is because they are on full pay and the GP has provided a fit note that the company is reluctant to challenge.

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