PRACTICAL ISSUES CONCERNING IMPLEMENTATION OF POLICIES AND PROGRAMS TO PREVENT THE USE OF ALCOHOL AN

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PRACTICAL ISSUES CONCERNING IMPLEMENTATION OF
POLICIES AND PROGRAMS TO PREVENT THE USE OF
ALCOHOL AND OTHER PSYCHOACTIVE SUBSTANCES IN THE
WORKPLACE

• Guillermo Alonso Castaño Pérez
• M.A. in Addictions Studies
• Coordinator, Graduate Program in Addictions
  Studies
• Luis Amigó University
• Medellín Colombia

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Points to be addressed

• Background experience
• Premises What we know
• Difficulties, problems
• Recommendations
• Issues to be resolved or clarified
• Final comments

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BACKGROUND AND EXPERIENCE

• Former coordinator, Municipal Drug Plan of
  Medellín
• Creator of initiative to develop workplace drug
  abuse prevention programs in the economic
  consortium Sindicato Antioqueño, with support
  of UN
• Advisory services on implementing programs to
  prevent use/abuse of alcohol other drugs in the
  following companies
• Milk cooperative of Antioquia COLANTA-
• Central Airlines of Colombia ACES-
• Civil construction company CONCONCRETO-
• Private security firms
• Trucking and cargo haulage companies
• Speaker at seminars and conferences on topic of
  drugs and the workplace
• Scientific Director, Drocheq Ltd., distributor
  of ROCHE DIAGNOSTIC products for urinalysis and
  saliva testing.

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PREMISES What we know

• Drugs most often used by workers are tobacco,
  followed closely by alcohol, then marijuana,
  less frequently, cocaine derivatives.
  Tranquillizers designed to combat stress and
  abused by employees also a major problem.
• Research shows that prevalence of drug use is
  systematically higher among working-age
  population.
• Alcohol prevalence of use among working
  population higher than among general population.
• Latin America Caribbean have not systematically
  conducted epidemiological studies showing
  prevalence incidence of use of psychoactive
  substances in workplace.

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PREMISES What we know

• With some exceptions. Governments have not
  promoted development of polícies programs to
  prevent use/abuse of drugs in workplace. Those
  that have done so have been timid. Initiatives
  primarily by non-governmental organizations
  (Brazil, Chile, Colombia, Argentina, México).
• Occupational health in business industry has
  been concerned primarily with physical issues
  (noise, light, ergonomics, gases, air-borne
  particles, etc.). Psycosocial concerns have
  barely been addressed, and if they have, are
  related to prevention and management of stress.
  Drug issue ignored.
• Those few studies conducted (Chile, Brazil,
  Colombia, Spain) show employers and workers
  unaware of risks and problems of use/abuse of
  alcohol and other drugs in workplace.

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PREMISES What we know

• Corporate and business responses vary
• No program offered.
• Enforce the law dismiss employee involved
• Exceptionally, and for essential workers with a
  problem, time off given for treatment and rehab.,
  do not pay their social security nor salary. For
  other cases, so long as not problematic,
  permissiveness and complicity.
• Medical screening and urine testing.
• Sporadic, isolated actions dealing with use of
  licit substances, primarily for full-time staff.
• Prevention programs addressing use/abuse of
  alcohol other psychoactive substances offered.
  Some also include treatment, rehab, social
  reintegration and aftercare.

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PREMISES What we know

• Recommendations to justify and develop workplace
  prevention programs have been purely from an
  economic point of view.
• Despite criticism and resistance to start-up of
  prevention programs, particularly those that
  include urine testing, difficult to dispute that
  it is currently absolutely necessary to have drug
  abuse prevention programs in the workplace.
• Indisputable that without workplace prevention
  programs, businesses run unacceptable risk, from
  standpoint of lower productivity, labor disputes,
  individual health problems, including accidents
  on the job, and public health problems.

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Problems and Difficulties

• Systematic denial and/or rejection by business
  owners workers of idea that their businesses
  have or may have problems related to use/abuse of
  alcohol other psychoactive substances. If
  problems exist, not discussed out of fear.
• With some exceptions, culture of alcohol is
  sponsored in workplace itself. Recreational
  and social events often include alcohol, with few
  restrictions.
• Idea exists that if businesses conduct drug and
  alcohol prevention programs, they will be
  invading individuals private lives.

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Problems and Difficulties

• With exceptions, laws are ambiguous. Are not
  silent on mandating implementation of prevention
  programs. Laws ARE clear when it comes to
  permitting dismissal and penalties for habitual
  or non-habitual drunkenness or drug dependence,
  when they have negative repercussions on the job.
  Those few laws that promote prevention are
  unknown to employers.
• Even though WHO recognizes alcoholism drug
  dependence as illnesses, national laws unclear on
  these problems. Therefore, use of disability and
  subsidies for participating in treatment not
  allowed.

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Problems and Difficulties

• Internal corporate rules mirror regulations
  contained in substantive labor codes. With some
  exceptions, businesses do not have clear policies
  on use of alcohol other psychoactive substances
  on the job.
• Lack of awareness of problem by health care
  personnel, whether staff personnel or from the
  outside, means that many health problems related
  to use/abuse of alcohol and/or drugs are covered
  over to protect patients job stability and
  minimize the problem.

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Problems and Difficulties

• With some exceptions, business owners workers
  have differing views about the workplace
• Unions and workers as a whole are more sensitive
  to issues that affect their personal risk,
  employment rights, employment and job security.
• Management is more concerned about on-the-job
  risks, collective security, on-the-job
  performance, productivity.
• These are the two elements most difficult to
  sensitize when trying to implement a prevention
  program, particularly so if urine testing is
  involved.

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Problems and Difficulties

• With some exceptions, few studies exist in the
  Americas on the cost/benefit of drug use
  prevention programs in the workplace. (Almost all
  conducted in the 1980s in US, and some in Chile
  Brazil in the 1990s). Since for many business
  owners, conducting prevention programs is
  justified in economic terms, not having studies
  available represents a problem or difficulty.
• In Colombia, Administrators of Professional Risk
  of National Health System do not promote nor
  offer development of drug use prevention
  programs, only respond to requests by members.
  Very few businesses request implementation of
  this type of programs. Educational programs are
  more concerned with licit substances.

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Recommendations

• National laws should be consistent with WHOs
  acceptance of alcoholism drug dependence as
  illnesses. This would allow for implementation of
  action programs and demystification of the
  problem in workplace and general population.
• Laws should be made clearer on the mandatory
  nature of prevention of use/abuse of psychoactive
  substances in the workplace.
• Going beyond the purely economic which does not
  mean the economics are neglible -- justification
  of prevention programs in workplace, with value
  added such as individual health, avoidance of
  collective risk, preserving the structure of
  society, etc, is advisable and defensible. This
  type of study, not only economic, but also
  humanist and social, should be promoted.

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Recommendations

• It is recommended that drug use prevention in
  workplace be included in occupational health
  programs, dealing particularly with all issues
  related to industrial safety and preventive and
  worker medicine.
• Promote creation of the culture used in the
  prevention of on-the-job accidents to apply also
  to use/abuse of drugs in workplace risk mapping,
  operating procedures, etc.
• Programs should be specific geared to employees
  of individual business, bearing in mind their
  characteristics, work, context, risk factors.
  When a worker sees himself reflected, he says
  this is for me, rather than generalized
  messages, often out of context.

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Recommendations

• Urinalysis is an important tool in prevention
  programs, but the corporation must have a clear
  policy on what to do in the case of a positive
  test. Policies must be known to and approved by
  employees.
• Given importance of optimizing economic,
  logistical and human resources always scarce in
  Latin America Caribbean -- interventions must
  be tailored to characteristics of each workplace.
  Some workplaces will require in-depth action or
  regulatory methods not justified in other
  workplaces.
• The situation in each business must be
  investigated if not on drug use, then certainly
  on attitudes and knowledge of both business
  owners and workers the information they have,
  the importance they give to topic, whether there
  is concern about it or not, etc.

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Recommendations

• Actions should be directed both to changing
  individual attitudes behaviors, and to changing
  the contexts intervening on risk factors, and
  strengthening and/or promoting protective
  factors.
• Any intervention on use of alcohol other
  psychoactive substances in corporations must be
  carried out on the basis of corresponsibility
  participation of all actors.
• Corporate human development and health
  professionals must be given training, including
  supervisors, Heads of personnel security.
  Business owners employees must be sensitized,
  as the only way of ensuring that interventions
  can take place and be successful.

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Recommendations

• Programs should involve the workers families,
  because it is in family environment that problems
  of use/abuse by workers is first noted and
  detected.
• Workers themselves should be involved in the
  design, execution and evaluation of prevention
  and intervention programs on drug and alcohol use
  in workplace, in order to ensure success.
• Interventions on use/abuse of drugs in the
  workplace should be part of health and labor
  welfare education programs. Specific programs are
  not well received by workers.
• Businesses should be encouraged to establish
  clear policies and stronger internal rules about
  use of psychoactive substances in the workplace.

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Issues to be resolved or clarified

• If businesses carry out primary substance abuse
  prevention programs, what should be done with
  workers already consuming and having problems?
• Should businesses conduct both prevention and
  treatment and rehab. programs?
• Who should assume the cost of treatment?

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Issues to be resolved or clarified

• Do all employees require prevention programs?
  What types of interventions should be proposed,
  and for what jobs?
• Can workplace prevention programs be generic?
• Should workplace prevention programs include
  urine testing? What type of jobs should be
  covered by urine testing?

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Issues to be resolved or clarified

• Can urine testing be part of personnel selection?
  What type of job should include urine testing?
• Where in the company should responsibility lie
  for prevention programs? Should a specific
  committee be created?
• Which government entity should monitor compliance
  with laws on prevention programs in the
  workplace? Labor Ministries? Ministries of Health?

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Issues to be resolved or clarified

• For some jobs businesses-- tobacco companies
  and vendors, wineries distilleries -- is it
  possible to view problems caused by use/abuse of
  alcohol tobacco as professional, job-related
  illness?
• If alcoholism drug dependence considered as
  illness, possible to grant full disability to a
  worker with clinically diagnosed dependence?

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Final Comments

• Workplace occupies importance time in
  individuals lives, and therefore, is ideal space
  and context for preventive interventions for
  substance use and abuse.
• Workplace is ideal because
• Captive audience
• Long hours that individuals spend in workplace
• Special emotional link of workers with the source
  of their livelihood
• Influence that business or corporation can have
  on its workers.

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Final Comments

• Employee Assistance Programs (EAPs) have been
  evaluated as good strategy for workplace drug
  use/abuse prevention intervention programs.
  Advantages
• low cost
• allow for several businesses to join together
• greater attendance because employees do not feel
  stigmatized
• address other types of psycho-social problems.

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Final Comments

• Brazils experience, where the National
  Confederation of Industrialists developed, with
  ILO backing, an innovative, creative program to
  prevent alcohol drug use in workplace, is
  invaluable.

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Final comments

• New need of Latin American and Caribbean
  businesses to implement ISO Standards,
  particularly companies looking to export market,
  represents important moment for implementation
  development of a prevention culture some
  standards, including NTC 18.001, equivalent to BS
  OHSAS 18.001, include indicators on welfare of
  internal clients, thus making possible
  introduction of prevention of use of alcohol
  other psychoactive substances, as basic tool for
  implementing a management system in occupational
  health and safety.