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Alcohol, Drugs and Work (1999)

An Expensive Cocktail
Roger F. Peters [RFD, BA, BSc, Hon, MSc, Phd, DACPCP, FEAPAA. Director of Clinical Services, HEAS Pty Ltd].

Contents

Dead Men Don't Tell Lies
The Spectre of Death
The Working Community
Cannabis
Amphetamines
Creating a Paradigm Shift
Employee Assistance Program
Summary
References

Tables

1. Overview of research into workplace injuries and alcohol in Australia and Overseas
2. Cause of death 1987 -1997 from Tobacco, Alcohol and illicit drugs
3. Hospital Episodes related to Tobacco, alcohol or illicit drugs as a primary cause
4. Social Characteristics of Amphetamine Users
5. Social Characteristics of Marijuana Users


Introduction

Any analysis of the patterns of alcohol and drug use in Australia will reveal quite startling facts. For instance last year, an estimated 2,500,600 or 1 in 8 Australians used an illicit drug. When this is then added to the number using prescribed drugs and legal drugs such as alcohol, (15% of Australians consume hazardous amounts of alcohol) then there is a sizeable risk exposure to any organisation. Indeed there is a risk to fellow workers, both in terms of work performance and more importantly safety.

The actual causal affect of alcohol and other drugs in the case of accidents at work remains unclear but especially so in relation to illicit drugs; this is due to the absence of credible research. What isn't so unclear is the connection that alcohol has with fatalities at work. Despite being touted, even as recently as last year, that up to 50% of deaths at work are alcohol related, the researched facts thankfully reveal a more sober picture as indicated in the following table.

Table 1: Overview of research into workplace injuries and alcohol in Australia and Overseas.

Author Principle Finding
Chapman (1995) Canada Binge drinkers more likely to have injury
Dawson (1994) USA Heavy drinking is associated with increased work injury.
Gutierrez-Fisac et al(1992) Spain 19.3% more accident in 16-24 year olds.21.5 % more accident in 25-44 year olds.9.1% more accidents in 45-65 year olds.
Hollo et al (1993) Australia 9.8% fatalities at work BAL >.05%
Lewis and Cooper (1989) USA 9.2% BAL >.01%
Mernagh (1993) Australia 9.8% >.05%
O'Connor (1995) Australia 7.1% >.05%
Webb et al (1994) Australia Problem drinkers more likely to have injuries.

Note (i) Problem drinkers much more likely to have accidents. (ii) 7-10% of fatally injured workers, alcohol was a contributing factor.


Dead Men Don't Tell Lies

The statistics on fatalities at work are much more reliable, as in those cases autopsies are invariably conducted. However, in the case of non-fatal work accidents, while there is an increasing use of drug detection methods, accident victims are not always tested and in the case of minor accidents they may not even be reported at all.

In 1997, the National Health and Medical Research Council, (NHMRC) evaluated this problem, i.e., alcohol and workplace injuries. They and made the following observations:

1. Recent surveys have found that 8-22% of employees drink hazardous or harmful amounts of alcohol. These figures are comparable, (that is they reflect) those of the general population. Information on consumption levels in several presumptively high-risk working populations remains unavailable. Incidentally there have been some poorly based studies, for instance one just a few years ago simply proved the facile finding that probably people who consume large amounts of alcohol don't complete surveys on alcohol consumption! Worse still, the study despite this fatal problem in methodology, then concluded that, "alcohol consumption in the Mining Industry is no higher than the general population". Thus finding credible studies in this area can it self prove to be problematic in discovering the affects in this area.

2. The NHRMRC in 1997 were able to conclude that alcohol related problems are experienced by up to 27% of the working population in any year. This has significant and important implications, and I will take it up again later.

3. As indicated above and commented on again later in this paper, the assertion that up to 50% of fatal injuries and accidents at work are related to alcohol use is not substantiated. Actually the estimate is that between 3% and 11% of fatal injuries in Australia are related to alcohol use.

4. The most consistent individual predictors of hazardous and harmful drinking among the workforce are (i) being single or separated; (ii) low educational levels, and; (iii) high anxiety levels. There is less information on the workplace and environmental factors, but among those considered to be important are: (i) social pressure by peers to drink; (ii) work overload; (iii) easy access to alcohol; (iv) low levels of supervision, and; (v) certain types of shiftwork. Of course whether these workplace factors have a causal relationship to alcohol, misuse is again harder to confirm. There is no information on workplace factors that specifically deal with the influence alcohol has with related workplace injury.

5. Brief, structured interventions have been shown to reduce hazardous and harmful drinking by up to 40% in a variety of non-workplace populations. This again will be addressed in a later section in this paper, "Education". It is likely (but unproven in Australia) that these interventions will reduce the incidents of disease and harm. Several studies of brief interventions among workforces in Australia are presently being conducted.

6. There is no clear evidence that alcohol-testing programs are effective in reducing work injuries. The NH&MRC suggest that there are reasons for drug and alcohol testing of at least certain employee groups on the basis of public safety and liability. It is important to understand that the NH&MRC base their opinion only on scientifically validated studies. Thus the fact that the NH&MRC have suggested that alcohol-testing programs have not been shown to be effective doesn't mean they are not.

Comment:
The drinking habits of many Australians have been influenced by the introduction of random breath tests among the driving population and so it is reasonable to assume that such a strategy may cause a similar paradigm shift when introduced in the workplace. Obviously when you consider that still 450 people in Australia are killed on our roads are involved in a alcohol related accidents, we have a long way to go


The Spectre of Death

Despite our concern about the effect alcohol and other drugs can have on performance, health and indeed subsequent causation of injury, we remain confronted with a far more damaging drug.

Table 2. Cause of death 1987 -1997 from Tobacco, Alcohol and illicit drugs.

Drug Deaths Caused in 1987 Deaths Caused in 1997
Tobacco 18165 18224
Alcohol 6621 3668
All other drugs 709 832
Total 25,495 29,350

As you can see the far more damaging affect of tobacco continues. In the following table these substances have been examined in terms of a primary cause for "hospital episodes", in the year 1996-1997. In short 50 people die from smoking compared to 10 from alcohol related conditions or the 4 who died from road accidents.

Table 3. Hospital Episodes related to Tobacco, alcohol or illicit drugs as a primary cause.

Drug Hospital Episodes 1996-97
Tobacco 149,834
Alcohol 95,917
Illicit Drugs 11,240

We are thus left with the undeniable fact from all of this that tobacco remains by far the most serious threat to employee health. Obviously, smoking does cause personal harm, i.e., a deterioration of personal health, but agreeably doesn't cause injury and harm to others, (incidentally recent research suggests that there is no relationship between passive smoking and cancer or CHD). So then why is an employer responsible?

Should you care if your employees smoke? Aside from altruism, I think the facts that smoking adversely impacts on performance makes a compelling reason. For instance, smokers have 1.8 more sick days than non-smokers do; they have more interruptions to work. In one organisation I worked with we found that in one section there was an increase in number of staff smoking. We discovered that smoking provided an escape from the phones, it was a customer service centre (complaints department!). Likewise research has shown that when smokers are prevented, even for short periods from smoking, then their attention and concentration decreases and thus performance is impaired.

In addition, smoking, like other harmful behaviours, can importantly reflect an attitude, one that can run quite contrary to your corporate culture. In fact does smoking and or the use of any other drug reflect the kind of community you want to be? The idea of community is an area that I would like to move to next.


The Working Community

I thought I would introduce this part of my presentation with some information that adds yet a further dimension to what has so far only been mentioned, ie-illicit drugs. I have selected two of the most commonly used and so-called "recreational drugs". The following tables provide amphetamines and marijuana use and prevalence in Australia.

Table 4: Social Characteristics of Amphetamine User

 
(Percent)
Offered Lifetime Prevalence Annual prevalence
All 10 6 2
Gender
  Male 12 7 3
Female 8 4 1
Age
  14 - 19 10 3 3
20 - 29 22 16 7
30 - 39 13 8 1
40 - 59 5 2 0.3
60 + 3    
Education
  Tertiary 14 9 3
Trade, Diploma 12 6 2
No Qualifications 9 5 2
Social Status
Labour Force
Non Manual 12 7 2
Manual 14 9 3
Unemployed 21 12 7

Table 5: Social Characteristics of Marijuana Users

(Percent)
Offered Lifetime Prevalence Annual prevalence
All 37 30 10
Gender
Male 43 37 13
Female 31 24 7
Age
  14 - 19 49 33 20
20 - 29 69 58 24
30 - 39 51 47 10
40 - 59 22 19 3
60 + 7 2 0.04
Education
  Tertiary 47 40 12
Trade, Diploma 41 36 11
No qualifications 32 26 9
Social Status
Labour Force
Non Manual 45 38 11
Manual 49 43 14
Unemployed 55 49 23
Non Labour Force
Home Duties 24 20 4
Retired 9 5 1


Harmful Effects

I am sure you all are aware of the harmful affects of these so called "recreational drugs", but to refresh your memory the following principle affects should be kept in mind, at least when considering or not whether these drugs are really recreational ie "fun".


Cannabis

Small doses produce:

These effects usually lead later to calm, reflective feelings and sleepiness. These effects may last 2 to 3 hours after smoking. Larger doses of marijuana make these effects stronger and can lead to a distortion in a person's perceptions. Even larger doses can lead to confusion, restlessness, hallucinations and sometimes anxiety attacks and panic.

Cannabis can affect and cause impairment to:

Anyone who uses cannabis regularly and over a long period of time will probably experience some physical, mental or social problems related to their drug use. It is likely that users predisposed to developing a psychosis may find that long-term marijuana use may lead to some condition or mental illness. Researchers have observed some long-term effects in some regular cannabis users including the increased risk of bronchitis, lung cancer, and respiratory diseases. Other effects that have been observed in long-term users include:

It is interesting that when Table 5 is examined above, that the number of users among unemployed people is about double that of employed people. It is true that unemployed people have more opportunity to smoke, but then they have less income. I think one real contributing factor is that being unemployed is de-motivating and that marijuana can also create a sense of de-motivation. This is perhaps characterised in the often more colloquial statement, "I was out of it man!" Indeed this may reveal one agenda for marijuana use, ie, not "life be in it", but life be out of it! In this way the type of circularity of cause and effect can be traced in patterns of abuse.


Amphetamines

The effects of Amphetamines appear rapidly after a single dose and may take anywhere from a few hours to a few days to disappear.

Low doses of amphetamines produce:

Higher doses produce:

Amphetamines, unlike marijuana have been shown to cause psychotic episodes even in a user without a predisposition. It can cause death and the fact that it is most frequently injected then the risk of fatal infectious disease places the person more at risk than the actual drug itself. Likewise needle stick injuries for co-workers are again another hazard that must be managed

Cost Analysis

One way to look at these figures is to take any company of say 200 employees', and examine the impact on the bottom line that could be caused by alcohol and other drug abuse. In the following example I have included you will be able to work out your own exposure.

Average Salary ($35,000) X 10%, (minimum % affected by alcohol or other drugs) = $3500 X 25% (conservative estimate of decrease in efficiency) = $875.00 X 200 (number of employees) = Approximate loss $ 175,000.


Creating a Paradigm Shift

So how do we address this as a problem in our working community? The answer in part lies in another question, i.e., What kind of community do you want to live in? In working with any organisation this is my first and certainly most important question. This may better be explained by the following story. Last year I was in Moranbah in far North Queensland for a mine meeting. I was challenged by an employee with the somewhat tiresome and certainly self-absorbed statement, "what I do in my own free time is my own business". He was referring to the problem of drug testing, more specifically the problems associated with THC detection. My reply to him as always was, "You are putting the cart before the horse". On it's own this question raises a vexatious and quite difficult issue, but not if you clearly establish a standard for your community. Then the answers to his and any other questions become more self-evident.

So, after establishing that the workplace is not a place where drugs are used and that it is agreed that people don't come to the workplace affected by drugs, I then move to a strategy that will encourage a paradigm shift, the "5 E's".

Enthuse

There is so often in our community a negativity, a type of cynicism that acts like a social cancer, "it will never work", "what's the Government doing about it?", "people just will not change", "the unions will never allow for it", "who cares", "that's their problem", the list is quite endless. These attempted obstructions to any change process need to be deflected or challenged. So, deflect those that are emotive and without basis, but challenge those that may appear to have merit. In the case of alcohol and other drugs in the workplace, it is in fact the unions in this country that have led the vanguard in attacking the problem. In fact one of the largest studies ever taken was sponsored and conducted by the BLF.

Challenge those that can not see change as possible by examining the past, eg "Do the right thing", "Buckle up", etc. It is true that people are still vandalising the environment, but many are not. Its true that some still don't wear seat belts, but many more do. This is due to the persistent and consistent, most of all simple messages that has led to a paradigm shift in the ways in which we think and do things in Australia. A community enthused is one that can then co-operate. In 1995 with 2986 car registrations per 100,000 there were 54 fatalities on NSW roads. In 1997 with 3417 registrations per 100,000 there were 525. In just 12 years, halving the fatalities in NSW.

Empower

I would like to emphasise the importance of this part of the formula with a story from two mines. One had a worker organised working committee to develop their drug and alcohol policy and during the process thought it would be a good idea to have a breath testing machine so that workers could get use to the idea. They approached management who then sponsored it. The machine was used and appreciated (measured by the fact it wasn't defaced). In another mine a HR manager working on "her policy" heard of this initiative, ordered a similar unit and placed it in the bathhouse. That afternoon the union delegate told her that the afternoon shift would strike if it wasn't immediately removed. The most important and critical issue is that the community is empowered to develop a policy and then ownership having been clearly established from the outset the enterprise predictably will prove to be a success.

Educate

Ignorance about drugs is the greatest hurdle any paradigm shift faces. The problems the NRL have had over the last two years in part stems from the fact they had a policy then they had education, they had enforcement but no option for rehabilitation and redemption. However I am not just picking on the NRL just making the observation that like so many of us they were reactive not pro-active, in crisis they respond punitively rather than creatively. Drugs like so many problems create stereotypical beliefs. An example outside of this current topic is a useful illustration. How many Asians live in Cabramatta? When I ask this in other courses I get the response between 20-80% with the average being 65%. The actual hard data is 19.6% with Spaniards and Italians still being the predominant ethnic mix. Where does this information we have come from? Alcohol and other drugs so often suffer the same fate. Last year in Newcastle even an EAP provider came and as committed as he was to Drug and Alcohol education he gave quite irresponsible figures for patterns of use, made even worse his material was based on North American research. Everyone in your working community should be given the information that is necessary for them not just to comply with the policy but then be able to make an informed decision not to abuse alcohol and other drugs.

Enforce

No policy no enforcement, no enforcement, then you may as well not have a policy. As indicated earlier, by the startling figures on alcohol related road deaths, some people are never going to make changes in their lives unless there is a punitive consequence. Like children many people's lives continue to be shaped by reward and punishment. For instance if we were to find out today that all the police were off the road, on strike. Further there was no chance of being stopped driving home, would we wear our seat belt? Would we speed? Would we perhaps take the risk and have a couple more at the bar (like we use to)? Hopefully you are committed to your own safety and that of others and therefore the police are not relevant to your driving habits, but is that true of all the people you know?

An example I use when teaching an OH&S course. Lets instead of buying our employees those expensive ear muffs that they demand, the type made in Belgium and are about twice as much as an equivalent Australian made product, we give them the monetary value and then require them to buy their own. What would we find over the next few days? With some we would no doubt find them wearing plugs!

So in the other three stages above we strive to get a commitment to change and you can be assured that most will comply. However the target is only 10-20% in the first place. It is in that group that change will prove to be difficult and the group you will find the most resistance. Any resistance to an enforcement policy, which may include testing, is undoubtedly most likely to be due to the fact that the protester is more concerned about their own chances of failure, rather than some misplaced belief in "civil rights".


Employee Assistance Program

Almost forgotten now is the fact that EAPs find their roots in Alcohol and Other Drugs, ie EAPs respond to alcohol and other drug problems. It is sufficient to say here that while EAPs have become broader in their approach, they are a critical "safety net" for those employees who may have encountered problems with alcohol or other drugs, certainly for those employees who have been detected as having levels contrary to the agreed policy. However the ACTU and the NH&MRC confirm the importance of taking a rehabilitative stance on this issue. The EAP can act as a conduit between the enforcement process and recovery.


Summary

The critical task in this presentation was to provide an over view of some of the current issues in relation to alcohol and other drug use in Australia, more specifically the workplace. It has been suggested that there is a continuing need to address the adverse affects of this problem and indeed be ever vigilant in our commitment to strategies that may eradicate the deleterious and harmful affects of drugs and alcohol from our workplaces. If not encouraged by altruistic reasoning there remains a significant financial consideration for pursuing such an imperative. This paper has provided several ideas about how a paradigm shift could be facilitated; as well emphasised the importance of rehabilitation.

Despite our concerns so far, in all of this we have yet to even touch on the impact of prescription drugs, indeed that could be the basis of a quite separate paper at another time.

Finally I would like to show you the following, it is not directly related to this topic today but hopefully it will help you remember not only the presentation but the importance in considering alcohol and other drugs in the issue of occupational health and safety.

This is the crowd at the Sydney Olympic Stadium watching a game of Rugby League. This is a conservative estimate of how many heroin addicts we currently have in Australia. (110,000)

Thank you!!


References

Australian Institute of Health and Welfare (March 1999). 1995 and 1998 National Drug Strategy Household Surveys.

Australian Institute of Health and Welfare (March 1999). AIHW National Mortality Database.

Chapman - Walsh, d. Rudd RE, Biener, L and Mangione t. Researching and Preventing Alcohol Problems at Work: Toward and Integrative Model. Am J of Hlth Prom. 7(4), 289-295, 1993

Dawson, D.A., (1994) Heavy Drinking and the Risk of Occupational Injury Acid Anal Prev.

Gutierrez-Fisac, J.L. Regidor, E. and Ronda, E. Occupational Accidents and Alcohol Consumption in Spain. Int J Epidem, 1992.

Hollo, C.D, Leigh J. Nurminen, M. The Role of Alcohol in Work Related Fatal Accidents in Australia 1982 1984. J Occup Med. 1993

Lewis, R.J. and Cooper S.P. (1989) Alcohol and Other Drugs and Fatal Work Related Injuries.

Mernagh, A (1993). The Relationship Between Drugs and Alcohol and Occupational Fatalities in NSW. Appendix 3, Workcover authority of NSW Project Team Report, Alcohol and Other Drugs in the Workplace. Workcover authority of NSW, unpublished manuscript.

National Health and Medical Research Council (1997) Workplace Injury and Alcohol. Working Party of the Health Advancement Standing Committee.

O'Connor, C. (1995) The Relationship Between Alcohol and Other Drugs in NSW Work Fatalities. Workcover authority, NSW.

Peters, R.F. (1996) EAPs and the Stress Epidemic. Presented to the international congress of stress and health, Manly, Oct.

Webb, G and Fresta J (1994). Alcohol and Other Drug Problems at the Workplace: Is Drug Testing an Appropriate Response? J Occup Health Safety - Aust N.Z.

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