As it happened, Dr. Cunningham hit bottom before professional catastrophe struck. “I got sick and tired of being sick and tired,” he says simply. He started by reaching out to Alcoholics Anonymous (AA), eventually going through several months of residential treatment. The experience led him to retrain in addiction medicine and eventually to relocate to Guelph, Ont., where he now serves as medical director at the Homewood addiction treatment centre.
The Canadian Centre on Substance Abuse (CCSA) defines workplace substance abuse as the use of a potentially impairing substance to the point that it adversely affects performance or safety at work. Note that the definition does not require that the substance be consumed at work. Dr. Cunningham showed up at work with recently consumed alcohol still coursing through his veins, but didn’t actually take swigs while on duty. He met the criterion for workplace substance abuse because the buzz he brought to work could have jeopardized his patients’ safety.
Scope and impact Most people use alcohol. The 2004 Canadian Addiction Survey flagged 79% of Canadian adults as “current drinkers,” with 44% making it a weekly habit and 17% (25% of males) considered high-risk drinkers. The same survey found the number of marijuana users doubling from 7% to 14%, of which almost a fifth used the drug daily, between 1994 and 2004. While the majority of these recreational alcohol and drug users would fall short of meeting abuse criteria, an estimated 10% of the population—including the working population— has substance abuse problems, says Teresa Bennett, executive director of the BC Council on Substance Abuse, noting that “the risk tends to be greater in jobs that have high stress, long hours, isolation and exposure to substances.”
Along similar lines, a 2007 study conducted by the Substance Abuse and Mental Health Services Administration (SAMHSA) in the U.S. concluded that the highest rates of illicit drug use occur among food service workers (17% of the total) and construction workers (15%). Not coincidentally, these jobs often feature long hours, irregular shifts and repetitive duties—elements listed by the Canadian Centre for Occupational Health and Safety (CCOHS) as contributors to workplace substance abuse.
The size of the workplace also matters. In general, “the smaller the enterprise, the greater the risk,” says Dr. Cunningham. “A couple of guys running a gas station may feel less ‘watched,’ and thus freer to indulge, than a middle manager in a large institution.”
Substance abuse is known to fuel absenteeism, raise the risk of accidents, and lower productivity. In 2002, the CCSA conducted a study of the economic burden of substance abuse. Their estimate: $39.8 billion for the year 2002, with productivity losses accounting for $24.3 billion or 42.7% of the total. “A single hangover costs $2,000 per working adult,” says Dr. Cunningham. “People show up at work with hangovers thinking it’s normal behaviour, but the truth is that any alcohol level greater than zero makes you less productive and possibly unsafe.”
Attitudes and policies
While most people experiment with alcohol long before they start working for a company, workplace drinking culture can trickle down to employees and pull them toward or away from the bottle. A 2007 study co-authored by Benjamin Amick, scientific director of the Toronto-based Institute for Work & Health, found that employees at companies that frowned on social drinking were 45% less likely to drink heavily than those in workplaces with liberal attitudes toward drinking.
Workplace culture aside, all experts agree on the importance of having a written company policy that addresses alcohol and drug issues. “Formal policies have become a lot more common over the past several years,” says Barbara Butler, president of Barbara Butler & Associates Inc., a Toronto consulting fi rm specializing in alcohol and drug policies and programs for the workplace. Indeed, a recent Alberta workplace study found that over 60% of employers have such policies in place, compared to just 29% in 1992. “It’s something every employer should have,” says Butler. The reason? “Th e safety bar has gone up. If an incident occurs, people investigating the case will judge it according to the standards and rules in comparable organizations.”
There’s no such thing as a generic policy that will work for every company, cautions Butler. “Each company has diff erent operating requirements and risk levels, along with a unique labour-management environment,” she points out. “The policy has to refl ect the nature of the industry and the specific program requirements of the company.” That said, most policies need to address a few key areas such as company expectations (see sidebar below). Canada Post requires that “employees report to work free from the infl uence of drugs or alcohol so they can perform their jobs in a satisfactory and safe manner”— a proviso it shares with many organizations.
To give teeth to a policy, supervisors must be trained to enforce it. “Our team leaders are given guidelines on how to recognize employees under the influence of drugs or alcohol,” says Albert Lee, Canada Post’s manager of communications. What signs should you look for? Nicholas Barry, a certifi ed alcohol and drug counsellor who runs Addiction Consulting Services in Saint John, N.B., lists alcohol on the breath, erratic work performance, absenteeism, unreasonable excuses for shoddy work, moodiness, and even the rumour mill as possible indicators. “You document the behaviour to build a case for assessment, which will move you toward a solution,” he says.
From suspicion to solution
Sniffi ng out signs is one thing, pointing fi ngers is quite another. “An employer cannot diagnose a substance abuse problem,” notes Dr. Ray Baker, medical director at Healthquest Ltd., an occupational health consulting company in Richmond, B.C. “Th e employer’s only concern is whether the employee is fit for work,” he says. “If a condition doesn’t affect fitness—that is, performance and safety—it’s not the employer’s business. If it does, the employer has an obligation to intervene—and in the case of a substance dependence problem, a duty to accommodate.”
Bearing in mind that the law views substance dependence as a medical condition rather than a moral failing, intervention must follow the protocol used for any illness, says Dr. Baker. “You can’t terminate an employee on the basis of substance dependence,” he cautions. “If you suspect a problem, start by questioning the employee. If not satisfied with his explanation, you can request that he undergo an evaluation.” That’s exactly the procedure followed by Canada Post, says Lee. “When substance abuse is suspected, the employee is questioned privately and, if appropriate, EAP [employee assistance program] services are off ered. It’s also important that impaired employees get home safely; they have the option of taking a taxi or calling a family member or friend to pick them up from the workplace.”
It’s possible you may never find out the precise nature of the employee’s problem. “That’s a confidential issue between the worker and the third-party assessment team,” says Barry. “Technically, all the employer needs to know is that a problem has been identified and the employee has accepted treatment—or not.” The type of treatment will vary from case to case. “Some people do well with just AA, some need AA and counselling, while others need a full inpatient rehabilitation program.”
After completing a treatment program, the employee returns to work—oft en a graduated process monitored by thirdparty professionals. “We send the employer a report stating that treatment has been completed and giving suggestions for relapse prevention,” says Barry Fraser, director of Substance Abuse Professional Services at Integrated Workplace Solutions in Toronto. While the spectre of relapse always looms over such employees, Fraser says “a closely monitored post-treatment plan greatly reduces the odds.”
Nicholas Barry concurs. “The workplace is uniquely qualifi ed to get the employee to look in the mirror,” he says. “The key is to make the employee accountable. In my 22 years in the business, I have found that people are most likely to recover from addiction when they feel some heat, which forces them to acknowledge the problem and do something about it.”
Elements of a substance abuse policy The Canadian Centre for Occupational Health and Safety recommends that labour and management work together to create a company substance abuse policy. Key elements of a policy might include: • Definition of substance abuse • Company expectations with respect to workplace substance abuse • Statement of the employee’s rights to confi dentiality • Statement of the purpose and objectives of the treatment program • Description of arrangements for training staff to identify substance abuse • Description of arrangements for educating employees • Outline of how to deal with impaired workers • Provision for assisting chronic substance abusers • Provision for disciplinary action for employees who fail to follow the treatment plan • If applicable, statement of circumstances calling for drug or alcohol testing |
Testing, one, two…? Random drug testing of employees, a practice condoned in certain U.S. industries, hasn’t gone over too well in this country. “The scientifi c evidence has clearly shown that random drug testing doesn’t work,” says Dr. Ray Baker, medical director of Healthquest Ltd., a Richmond, B.C.- based occupational health consulting fi rm. To boot, “it’s expensive and bad for worker morale.” The Canadian Human Rights Commission has taken a similar stance, deeming random drug testing unacceptable and restricting random alcohol testing to employees with “safety-sensitive” jobs such as long-distance driving or work in oil rigs. Why the special allowance for alcohol testing? “Alcohol testing can detect immediate impairment, whereas marijuana, for instance, can linger in the system for up to 30 days so casual users could get nailed,” says Caroline Ursulak, a Toronto employment lawyer. In 2000, Ontario’s highest court nixed mandatory drug testing on the grounds that it treated casual users as addicts. Seven years later, Alberta’s Court of Appeal upheld Syncrude Oil’s decision to terminate an employee after a preemployment drug test detected marijuana in his system, arguing that the effects of cannabis may linger for several days after its use. The legal dust still hasn’t settled around the issue. Earlier this year, the Commission brought the question of whether mandatory or random drug testing discriminates against drug-addicted and casual users to the Supreme Court of Canada for consideration. |
Commonly abused substances and their effects
| Category | Examples | Effects |
| Alcohol | Beer, wine, spirits | Impaired judgment, slowed reflexes, impaired motor function, drowsiness |
| Cannibis | Marijuana, hashish | Distorted sense of time, impaired memory, impaired coordination |
| Hallucinogens | LSD, PCP, mescaline | Inattention, sensory illusions, hallucinations, disorientation, psychosis |
| Inhalants | Hydrocarbons, solvents, gasoline | Intoxication (as with alcohol), dizziness, headache |
| Opiates | Morphine, heroin, codeine, some prescription pain medications | Loss of interest, “nodding” |
| Stimulants | Cocaine, amphetamines | Elevated mood, overactivity, anxiety, rapid heartbeat |
| Depressants | Sleep medicines, sedatives, some tranquilizers | Inattention, slowed reflexes, impaired balance, drowsiness, depression |
Gabrielle Bauer is a freelance writer in Toronto.
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