With the UK’s well-developed reputation for heavy drinking, it is not really surprising that employers and occupational health (OH) practitioners may have to deal with some of the work-related consequences of drug and alcohol misuse. With the festive season almost upon us, these issues are more likely than ever to present challenges for business leaders.
Data from the 2006 General Household Survey (which assessed more than 17,000 people) indicated that 73% of men and 57% of women in England had had an alcoholic drink on at least one day during the previous week (The NHS Information Centre 2009).1
In 2006-07, alcohol was associated with more than 500,000 recorded crimes in England, which may also be linked to more than 1.2 million incidences of violence a year.2 Up to 17 million working days are lost annually through absence caused by drinking, and up to 20 million are lost through loss of employment or reduced employment opportunities.3 And the Health and Safety Executive currently estimates that up to 14 million working days are lost each year due to alcohol-related problems, costing British industry an estimated £2bn a year.4
A US government study indicated that those people using illicit drugs were 3.6 times more likely to injure themselves or others at work, and in total it is estimated that drug use cost industry £800m each year through increased absenteeism, insurance costs and lost productivity.5
Obligations
Organisations have a responsibility to comply with legislation that includes the Transport and Works Act 1992, the Road Traffic Act 1988, and legislation covering health and safety at work. Employers must also fully protect against the impact on the individual and any possible effects for co-workers, suppliers or customers who may be affected, often referred to as a duty of care. An addiction to alcohol does not amount to a disability for the purposes of the Disability Discrimination Act 1995. However, alcoholics may be protected if they have an accompanying impairment that satisfies the definition of a disability – for example, liver damage, or depression arising from the addiction.
Any issues relating to drug and alcohol misuse may be identified through company metrics such as sickness absence and accident records. Additionally, it may be a factor of company culture – a ‘work hard, play hard’ environment may indirectly support heavy drinking.
Regardless of whether there is clear evidence or a tangible problem to resolve, perhaps the safest approach is to presume that the figures for drug and alcohol use applied to the population will include a company’s personnel, and therefore it’s appropriate to consider taking action.
Dependency indicators
Indicators of dependency that may be apparent include:
- Sudden and regular mood changes
- Loss of interest and appetite
- Rapid or unexpected loss of memory
- Dishonesty and fraud
- Altered personal appearance
- Increasingly furtive or disruptive behaviour
- Increased tolerance to drink
- Use of drugs and drink to relieve withdrawal symptoms.
Four in 10 employers believe alcohol misuse is a significant cause of employee absence and lost productivity. Also one-third of organisations report that drug misuse has a similarly negative effect in the workplace, according to new research from the Chartered Institute of Personnel and Development (CIPD) and People Management magazine.6 However, despite the damaging impact of drug and alcohol misuse at work, about four in 10 of the 500 organisations surveyed had no policy in place to help them manage the issue.
Policy development
It is important that every business seeks to establish a suitable drug and alcohol policy with a clear purpose and unambiguous definition of terms. A policy should cover the responsibilities of the employer, staff and others such as contractors or suppliers, with a statement that identifies what constitutes the misuse of drugs and alcohol, and any restrictions and prohibitions on the consumption of alcohol or use of drugs.
Not all policies include drug and alcohol testing, but cut-off rates and which drugs are considered under the policy must be included. It should clearly state the consequences of not meeting the policy requirements, and the disciplinary consequences that will be applied.
It is important that the policy should not be at odds with the way staff are normally expected to conduct themselves at work, and should be formulated once a clear understanding has been reached as to the extent, nature and hazards to the company of any drug and alcohol misuse in the workplace.
In formulating a policy, wide-ranging consultation should be considered, as with any important change to company rules. It is recommended that if you want to have a meaningful drug and alcohol policy and successful implementation, the widest discussion and dissemination of information about the reasons behind and impact of drugs and alcohol misuse in the workplace will ensure that there is increased likelihood of acceptance and reduced challenges to any subsequent decisions under that policy.
A Chartered Institute of Personnel and Development (CIPD) survey found that since 2001, the number of organisations with drug and alcohol policies has remained about the same (58%), and that where organisations do have policies, they are doing very little to actively promote them. Simply adding a policy to a rarely-used staff handbook is unlikely to ensure the issue is seen as an ongoing priority. Organisations should engage with their staff to ensure that they are fully aware of the policy’s provisions. This can be done via staff briefings, poster or publicity campaigns, internal notice boards, newsletters and e-mail alerts.
Once a policy has been defined and implemented, it is important to remember that it should be applied fairly to all employees covered, or an organisation may leave itself open to a claim under a tribunal.
Alcohol limits will almost certainly need to be included in the policy. The current legal limit determined by the Road Traffic Act is 80 milligrams (mg) per 100 millilitres (ml) of blood, and employers may wish to apply a more stringent limit, especially in a safety-critical environment. For example, the rail industry has a cut-off for a positive result as more than 29mg per 100ml of blood.
Drug-testing
Estimates for 2009 from the European Monitoring Centre for Drugs and Drug Addiction are that somewhere between 2% and 2.5% of young adults are using cannabis on a daily or near-daily basis, with much higher levels found among young males.7 And around one in three adults between the ages of 16 and 59 living in England and Wales admit to using illegal drugs at some time.7
Many employers, especially where workplace safety is critical, are legally obliged to prevent staff from working while under the influence of drugs and alcohol.
Drug screening is usually performed for the following drugs:
- Opiates
- Cocaine metabolites
- Barbiturates
- Amphetamines
- Benzodiazepine
- Cannabis
- Propoxphene
- Methadone
- And occasionally LSD.
Employers often apply a range of screening approaches to support a policy, such as urine-, oral fluid- or hair-testing. In the first instance, it is important to assess whether the supplier is accredited to undertake the work on the organisation’s behalf, and that they can deliver results under a robust ‘chain of custody’ if the screening results are to be legally defensible.
Types of testing
There are three common types of screening: pre-employment screening, unannounced or random screening, and post-incident screening.
Pre-employment screening would usually be for a drug test only. Increasing numbers of companies take vigilant steps to check a candidate’s history via the Criminal Records Bureau checks, references and security checks going back many years. So why would you adopt a drug test that can only give you a two- to three-day window of detection? In a pre-employment context, many websites exist to help individuals adopt a period of abstinence or suggest ways of ‘beating’ these standard tests.
A recent development in the market, adopted by Bupa Wellness, is the introduction of hair analysis to its portfolio of screening techniques, which last year saw more than 20,000 employees tested for drugs and alcohol, with 100 calls to the workplace per month following drug and alcohol-related incidents. Companies are now looking to hair analysis to give a result which provides a three-month lifestyle history, and is a permanent record which subjects are unable to mask.
Urine and saliva tests are particularly useful when random testing for drugs as the employee has no warning. The advantage of hair analysis is that drugs remain in the human hair shaft for up to 90 days, so even if an employee chooses to abstain from taking drugs for a few weeks before the test, they will still be detected. Such tests are particularly important for people working in the aviation industry, the railway and safety-critical manufacturing companies. Testing hair may also tell an organisation more about an individual who may routinely use drugs as part of a lifestyle choice which may be pertinent to prospective recruitment. However, unless the employer’s policy addresses a specific legal obligation, a substantial safety risk or a public expectation of probity, then denial of employment on the basis of a positive screening may be challenged and found to be unfair.
Unannounced random screening may be used as a deterrent to drug and alcohol misuse. Once again, the policy must include justification that satisfies data protection guidance. Employee acceptance of such a programme is highly desirable before its introduction, and is unlikely to be obtained unless the policy and process are seen as non-discriminatory, so it should not, for example, exclude work-groups such as senior management. The ideal scenario is that the drug test appointment provides little or no notice for the donor, and that there are robust, random selection criteria for the persons chosen.
Post-incident screening, often referred to as ‘for cause’, is vital in safety-critical workplaces, and is used to establish whether drugs or alcohol were a causal factor in an accident or incident. This type of screening may also be considered where an employee appears to be under the influence of drugs or alcohol at work. However, it should not be used unless there is a policy enabling it.
While there is no such thing as an ‘under the influence of drugs’ test, the oral fluid test provides the quickest detection window of up to 48 hours, proving recent active use of a banned substance.
All alcohol testing should be done using an evidential and legally defensible piece of equipment that is calibrated to manufacturer’s instructions. Machines which provide a printed statement which is date and time-stamped, which the donor signs, are the preferred option.
Results
Results for any testing in a chain of custody should normally be available the next working day. Some results may require confirmatory testing to identify the precise substance and this is often available within 48 hours. The nominated manager should in these instances be notified immediately. The provider should also provide the donor with a written report at the same time as the employer.
Positive drug tests are interpreted by the toxicology laboratory undertaking the analysis. In some cases it may be necessary to interview the employee, particularly where medication taken could affect the result. The provider service’s appointed medical review officer (MRO) will undertake the review and assist the employer in reaching a definitive conclusion. The MRO, if required, will also assist, in line with the company’s policy, assess the support needs for the employee, and recommend counselling and appropriate rehabilitative treatment.
Where an employee declares a substance misuse problem, this should be treated as any other illness, and support should be offered. Dependant on the type and severity of the problem, the level and nature of the assistance can vary. Counselling to identify the reasons for the issue and the provision of support is a good starting point, with referrals to the OH service or an employee assistance programme. In cases of severe dependency, it may require a referral to primary care rehabilitation to ensure effective support and treatment. This is often residential, although provision in the home on a one-to-one basis is an option and can be provided a period of many weeks.
Training
Management training and staff briefings are key components to help establish a wide-ranging consultation in the first instance and a successful implementation. Training should help managers to:
- Identify the signs of potential substance misuse
- Understand the manager’s role in policy implementation
- Ensure that the agreed methodology for instigating screening can be applied with confidence
- Brief staff to ensure, as a minimum, that everyone fully understands the policy and is clear about what will happen during the screening process
- Be aware of what support systems are available for employees
- Be clear about the consequences of non-compliance with the policy.
An implementation plan would probably therefore consist of a policy that is accessible to all employees. It should also include amendments to terms and conditions that include the policy as an express term. Clear ownership of the change to policy from the organisation’s leadership should be evident and outline the training and briefing for key staff groups. Communication will be important and may include wallet cards, posters, team meetings and use of a company intranet if widely used to ensure the fullest dissemination possible.
Employers may also wish to consider an amnesty period so that anyone with an existing known problem has the chance to come forward to seek help from OH.
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Graham Johnson is OH nursing development manager, Bupa Wellness.
References
- The NHS Information Centre, Lifestyles Statistics, 2009
- North West Public Health Observatory, 2007
- Prime minister’s strategy unit, the Cabinet Office, 2003
- Don’t Mix It: A guide for Employers on Alcohol at Work. Health and Safety Executive, 1988
- National Institute on Drug Abuse, 2001 www.drugabuse.gov/pdf/mediaguide.pdf
- Managing drug and alcohol misuse at work, CIPD, 2007
- European Monitoring Centre for Drugs and Drug Addiction, 2009
