symptoms of substance use & reasonable suspicion testing in the workplace

Symptoms of Substance Use Symptoms of Substance Use &&

Reasonable Suspicion TestingReasonable Suspicion Testingin the Workplacein the Workplace

November 10, 2010November 10, 2010

Dan R. Azar MD MPH QME MRODan R. Azar MD MPH QME MROAlliance Occupational MedicineAlliance Occupational Medicine

Milpitas & Santa ClaraMilpitas & Santa Clara

Alliance Occupational MedicineAlliance Occupational Medicine 22

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Drinking, Driving and Death Underground

• August 31, 1991 August 31, 1991 • Lexington Avenue subway derailment Lexington Avenue subway derailment

under Park Avenue under Park Avenue • smoky tunnel smoky tunnel • hundreds of tons of mangled metal hundreds of tons of mangled metal • dozens of bloodied passengers and dozens of bloodied passengers and • here and there, body parts.here and there, body parts.


Worst New York City Subway Accident in 63

years. • Five people killed Five people killed • More than a hundred injured More than a hundred injured • Motorman, 38-year-old had a history of Motorman, 38-year-old had a history of

alcohol abuse, alcohol abuse, • The level of alcohol in the motorman's blood The level of alcohol in the motorman's blood

strongly indicated that the motorman had a strongly indicated that the motorman had a chronic drinking problem.chronic drinking problem.

• Why did supervisors at the NYC Transit Why did supervisors at the NYC Transit Authority continue to allow him to operate Authority continue to allow him to operate trains? trains?


Do we need a Substance Abuse Do we need a Substance Abuse Policy and Prevention Program?Policy and Prevention Program?• Safety Needs to be Every Employer’s Top Safety Needs to be Every Employer’s Top

Consideration Consideration – WorkersWorkers– Clients & CustomersClients & Customers– SuppliersSuppliers– General publicGeneral public

• To improve productivity/outputTo improve productivity/output• To control input/production costs To control input/production costs • To minimize employee theft and other wasteful To minimize employee theft and other wasteful

behaviors. behaviors. • To increase health and well-being of employees and To increase health and well-being of employees and

their families their families – Health care insuranceHealth care insurance– Workers' compensation insurance and costsWorkers' compensation insurance and costs– General Liability insurance premiums; General Liability insurance premiums;


An Effective Workplace Substance Abuse Policy

• Applies to everyone, including top managers. • Clearly explains the organization’s drug

testing policy. • Outlines which tasks are "safety critical"• Includes information about prevention,

identification, treatment and rehabilitation. • Includes information about education and

training in the workplace. • Addresses how treatment or evaluation

referrals are made.


An Effective Workplace Substance Abuse Policy

• Encourages voluntary participation in substance abuse treatment, without job loss.

• Ensures participant confidentiality• Describes the duties and responsibilities of

the individual during and after treatment. • Includes review of the policy at regular

intervals.• Consistent treatment from employee to

employee


What Will the Policy Prohibit?• Obvious:

– all illegal drug and alcohol use on company time will be prohibited

• Not so obvious:– being at work with illegal drugs in system even

though the use took place off the clock and off site?– Same circumstances but with no visible impairment – Criminal drug convictions without worksite use?– What about mood altering prescription

medications?– What about OTC medications?– What about medical marijuana? – Hey, what about my 2 martini lunch?


What is Reasonable Suspicion?

Must be based on• a reasonable and articulated belief that the • employee is under the influence of alcohol

or drugs • on the basis of specific observations

concerning the – appearance,– behavior, – speech, or – body odors of the employee


Worsened Personal Worsened Personal AppearanceAppearance

• inappropriately dressedinappropriately dressed• does not appear healthydoes not appear healthy• does not appear physically capable does not appear physically capable

– slurred speechslurred speech– unsteady gaitunsteady gait– blood-shot eyesblood-shot eyes– sleepy sleepy

• appears unclean or unwashed at the beginning of appears unclean or unwashed at the beginning of workwork

• no regular change of clothesno regular change of clothes• offensive odorsoffensive odors

– bad breathbad breath– body odorbody odor


Decreased ReliabilityDecreased Reliability• extended weekends (Monday/Friday absences)extended weekends (Monday/Friday absences)• consistently lateconsistently late• leaves earlyleaves early• absent from work areaabsent from work area• excessive sick leaveexcessive sick leave• takes unauthorized leavetakes unauthorized leave• repeated absencesrepeated absences• misses deadlinesmisses deadlines• doesn’t follow proceduresdoesn’t follow procedures


Loss of Problem SolvingLoss of Problem Solving• rarely follows throughrarely follows through• rarely checks for resultsrarely checks for results• can't handle complex assignmentscan't handle complex assignments• tends to ignore problems or delegate tends to ignore problems or delegate

inappropriately;inappropriately;• relies too heavily on others to complete relies too heavily on others to complete

the work; the work; • cannot define the problemcannot define the problem• covers up the problemcovers up the problem• blames othersblames others• work frequently needs to be redonework frequently needs to be redone


Decrease in Job Decrease in Job KnowledgeKnowledge

• skills are not currentskills are not current• doesn't understand regulationsdoesn't understand regulations• misuses equipmentmisuses equipment• doesn't retain instructionsdoesn't retain instructions• needs constant supervisionneeds constant supervision• doesn't understand or follow safety/security doesn't understand or follow safety/security

proceduresprocedures• requires frequent instruction or assistancerequires frequent instruction or assistance• learns very slowlylearns very slowly• unable to work independentlyunable to work independently


Decrease in ProductivityDecrease in Productivity– low volume of worklow volume of work– takes many breakstakes many breaks– wastes timewastes time– needs constant reminders to complete workneeds constant reminders to complete work– does not complete assigned tasksdoes not complete assigned tasks– overwhelmed by realistic workloadoverwhelmed by realistic workload– unavailable for extra workunavailable for extra work– cannot increase workload when neededcannot increase workload when needed– volatile and easily upsetvolatile and easily upset– inconsistent in the workplaceinconsistent in the workplace


Poor JudgmentPoor Judgment– makes decisions without regarding available makes decisions without regarding available

informationinformation– will not reverse decisions in face of mistakeswill not reverse decisions in face of mistakes– insensitive or tactlessinsensitive or tactless– does not use common sensedoes not use common sense– illogical reasons for behaviorsillogical reasons for behaviors– violates confidentialityviolates confidentiality– poor ability to size up situationspoor ability to size up situations– does not understand the whole picturedoes not understand the whole picture– takes inappropriate actionstakes inappropriate actions– inattentive to safety proceduresinattentive to safety procedures


Difficulty Working With Difficulty Working With OthersOthers

– poor listening skillspoor listening skills– inability to communicateinability to communicate– uncooperativeuncooperative– projects negative attitude to customers, co-workers, and projects negative attitude to customers, co-workers, and

the publicthe public– unable to resolve conflictsunable to resolve conflicts– openly mistrusts many peopleopenly mistrusts many people– edgy or easily and frequently angered or hurt by othersedgy or easily and frequently angered or hurt by others– slows work of othersslows work of others– complainscomplains– hostile and argues frequentlyhostile and argues frequently– stimulates complaints from co-workersstimulates complaints from co-workers– tends to blame otherstends to blame others


The Well Intentioned The Well Intentioned Supervisor or Coworker…Supervisor or Coworker…

• Overlooks the employee’s problem.Overlooks the employee’s problem.• Pick up the slack & cover for the employee Pick up the slack & cover for the employee

until he/she gets “their life back together.”until he/she gets “their life back together.”• Coworkers pick up the additional workload Coworkers pick up the additional workload

created by a codependent manager.created by a codependent manager.• These “favors” ultimately hurt everyone These “favors” ultimately hurt everyone

including the employee who is using drugs including the employee who is using drugs or alcohol. or alcohol.


Who is covering up…and Who is covering up…and why?why?

• Coworkers & supervisors cover up for the Coworkers & supervisors cover up for the substance-abusing employeesubstance-abusing employee

• Personal friendship or loyalty dissuade us from Personal friendship or loyalty dissuade us from taking corrective actiontaking corrective action

• Fear of confrontation: crosses personal boundariesFear of confrontation: crosses personal boundaries• Uncomfortable addressing a personal problem in Uncomfortable addressing a personal problem in

the workplace – crosses professional boundaries.the workplace – crosses professional boundaries.• We’re all worried about doing “the wrong thing”We’re all worried about doing “the wrong thing”• Codependency: a tendency to behave in overly Codependency: a tendency to behave in overly

passive or excessively caretaking ways that passive or excessively caretaking ways that negatively impact one's relationships and quality of negatively impact one's relationships and quality of life.life.


Lack of ActionLack of ActionIncreases Legal Liability Increases Legal Liability

of the Employerof the Employer1.1. Increased risk for on-the-job Increased risk for on-the-job

accidents.accidents.2.2. Increased risk of damaging Increased risk of damaging

equipment or property. equipment or property. 3.3. Increased risk the employee will Increased risk the employee will

engage in inappropriate behavior.engage in inappropriate behavior.4.4. Insufficient response to on the job Insufficient response to on the job

impairment increases liability based impairment increases liability based on legal principle of negligence.on legal principle of negligence.


Codependency No More!*Codependency No More!*

• Do not insulate drug user from the Do not insulate drug user from the consequences of his/her behaviorconsequences of his/her behavior

• Hold the substance user responsible Hold the substance user responsible for his/her own behavior thereby for his/her own behavior thereby promoting personal recovery.promoting personal recovery.

• Doing the right thing the right way Doing the right thing the right way is challenging but rewarding.is challenging but rewarding.

• * Author: Melody Beattie* Author: Melody Beattie


Don’t Assume a Job Don’t Assume a Job Performance Problem is a Sign Performance Problem is a Sign

of Drug Abuseof Drug Abuse• Lack of sleepLack of sleep• Other illness or health condition Other illness or health condition • Side effects from prescription or OTC Side effects from prescription or OTC

medicationmedication• Anxiety or DepressionAnxiety or Depression• Mourning / Personal LossMourning / Personal Loss• AccusingAccusing an employee of an employee of drug or alcohol usedrug or alcohol use

places the employer at increased risk of a places the employer at increased risk of a lawsuitlawsuit


Don’t Accuse Employee of Don’t Accuse Employee of Alcohol or Drug UseAlcohol or Drug Use

• You are taking an unnecessary legal risk You are taking an unnecessary legal risk • Instead, ask an employee whether he/she Instead, ask an employee whether he/she

is “feeling all right?”is “feeling all right?”• If you observe questionable behavior the If you observe questionable behavior the

employer is expected to make an inquiryemployer is expected to make an inquiry• Record your observations.Record your observations.• Document what you see, hear and smell.Document what you see, hear and smell.• Do not give your opinion or diagnosis. Do not give your opinion or diagnosis. • Do not document that which you do not Do not document that which you do not

want read back to you in deposition.want read back to you in deposition.


One Symptom is Not One Symptom is Not Enough!Enough!

• Here are the 5 steps that should be Here are the 5 steps that should be under taken:under taken:– Observation (multiple dates okay)Observation (multiple dates okay)– Documentation (same day as Documentation (same day as

observation)observation)– Make a Plan (ask for help from HR)Make a Plan (ask for help from HR)– Talk to the EmployeeTalk to the Employee– Follow-upFollow-up


ObservationObservation• supervisors are responsible for making sure supervisors are responsible for making sure

employees meet certain minimum employees meet certain minimum performance standardsperformance standards

• take steps now to develop and communicate take steps now to develop and communicate a set of a set of objectiveobjective job performance job performance standardsstandards that explain your that explain your expectationsexpectations. .

• ObserveObserve and document any time these and document any time these standards are not being met (regardless of standards are not being met (regardless of suspected cause).suspected cause).


DocumentationDocumentation• Train managers to document in specifics any time an Train managers to document in specifics any time an

employee is suspected of drug use while on duty:employee is suspected of drug use while on duty:– appearance appearance – actionsactions– attitude attitude

• Complete report Complete report within 24 hourswithin 24 hours of the observed of the observed behaviorbehavior

• Focus Focus exclusivelyexclusively on the on the observedobserved behaviors and the behaviors and the impactimpact of those behaviors on work place or of those behaviors on work place or performance.performance.


Make a PlanMake a Plan

• set your goals for the meetingset your goals for the meeting• plan in advance plan in advance • anticipate the employee’s possible anticipate the employee’s possible

responsesresponses• plan your replyplan your reply• know what resources are available in know what resources are available in

advance for treatmentadvance for treatment


Talk to the EmployeeTalk to the Employee• have an appropriate second party have an appropriate second party

attend as a witness attend as a witness • preferably someone from employee preferably someone from employee

relations and not a direct supervisorrelations and not a direct supervisor• document your meetingdocument your meeting• limit your observations to specifics limit your observations to specifics

regarding job performance and/or regarding job performance and/or objective signs of substance use.objective signs of substance use.


Pulling the Employee from Pulling the Employee from ServiceService

• With obvious signs of impairment (drowsy, With obvious signs of impairment (drowsy, careless, inattentive) remove from safety careless, inattentive) remove from safety sensitive duties ASAPsensitive duties ASAP– The operation of machinery / equipmentThe operation of machinery / equipment– Medical or hospice care of a dependent Medical or hospice care of a dependent

• Use a private office Use a private office • Always have a witness present who is willing Always have a witness present who is willing

to document separatelyto document separately• Do not confront an impaired employee in Do not confront an impaired employee in

public. public. • Never argue, yell or threaten someone under Never argue, yell or threaten someone under

the influence. the influence. • Do explain and reassure.Do explain and reassure.


Follow UpFollow UpWhen an employee has undergone When an employee has undergone

substance abuse treatment and returned substance abuse treatment and returned to the workplace:to the workplace:

• Offer no preferential or special treatment. Offer no preferential or special treatment. • Give the individual plenty of feedback Give the individual plenty of feedback

concerning his/her work concerning his/her work • Continue to document observed behaviorsContinue to document observed behaviors


Useful Internet Sites Useful Internet Sites for Reasonable Suspicionfor Reasonable Suspicion

• http://transit-safety.volpe.dot.gov/Video/http://transit-safety.volpe.dot.gov/Video/ReasonableSuspicion-HighQuality.wmvReasonableSuspicion-HighQuality.wmv

• http://transit-safety.fta.dot.gov/DrugAndAlcohol/http://transit-safety.fta.dot.gov/DrugAndAlcohol/TechnicalAssistance/ReasonableSuspicion.aspTechnicalAssistance/ReasonableSuspicion.asp

• http://transit-safety.fta.dot.gov/Publications/http://transit-safety.fta.dot.gov/Publications/order/default.asporder/default.asp

• http://workplace.samhsa.gov/FedPgms/http://workplace.samhsa.gov/FedPgms/Fed_DFWP.aspxFed_DFWP.aspx

• http://www.workexcel.info/reasonable-suspicion-http://www.workexcel.info/reasonable-suspicion-checklist/download.htmlchecklist/download.html


Signs and symptoms of alcohol and/or drug misuse:

• • Odor of alcohol• • Odor of marijuana• • Slurred speech• • Flushed, swollen face• • Red or runny eyes or nose• • Pupils dilated or constricted, or unusual eye movement• • Lack of coordination• • Tremors or sweats• • Weariness, exhaustion• • Sleepiness• • Nausea• • Unauthorized possession of alcohol or illegal drugs• • Any other observation that creates a reasonable suspicion

of being under the influence of drugs or alcohol at work


Thank You for Attending!Thank You for Attending!Please Give us Your Feedback Please Give us Your Feedback

Alliance Occupational MedicineAlliance Occupational Medicine

Milpitas CAMilpitas CA408-790-2900408-790-2900

Santa Clara CASanta Clara CA408-228-8400408-228-8400

symptoms of substance use & reasonable suspicion testing in the workplace

Documents

substance abuse treatment

alcohol use

history of alcohol abuse

consistent treatment

worksite use

level of alcohol

influence of alcohol

employee theft