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Drugs and Alcohol in the Workplace: A Problem of Impairment Dr. Brendan Adams Medical Occupational Services Team October 6 , 2003 Edmonton
What impact does impairment have on work? n n Talk overview Common points of confusion: p Speaker n n n Bias Lawyer/Human Rights Rep. Union/Employer Physician/Psychologist/Counselor Drug testing company Law enforcement Effects of use in general population v. Alcohol/Drug Addicts
Why impairment is a problem: o Drug use, especially alcohol, is common. o Impairment secondary to drug use often is unrecognized by everyone, including the employee. o Drug use is part of our culture, and we have many “blind spots” – (mythology) o Impairment can, and too often does, have lethal consequences. o These losses, both financial and medical, are entirely preventable.
The obligatory statistics! o Worker absenteeism attributed to substance abuse costs Alberta economy approx. $720 million/year (1996). o More than 12, 000 Alberta workers yearly know of a workplace injury(ies) that they believe were related to drug or alcohol use. o Direct losses in the Canadian workplace in 1992 were $4. 2 billion. o In Alberta, 1995, 20. 4% of all drivers in fatal crashes had been drinking.
Behind the statistics - Why you should care, because: o You are the one who gets killed or mutilated. o Accidents affect a whole lot more than just your job. o You have a family or loved ones who care about you, and depend on you. o If you are young, you may be making choices which will affect the rest of your life. o What do you care about? You will lose it. Addiction/abuse is a spiritual illness. First the drinker takes a drink…
Psychoactive substances o Why do we use them? o Concept of neurotransmitters o Concept of brain anatomy n Pleasure centers o “Dopamine” disease o Brain signals: n “Gotta have it” n “Got it” o Drugs and Behaviours are similar at neuron level eg. Food, sex, gambling, risk-taking
Alcohol o Basic facts: p Sedative/hypnotic p Rapidly absorbed, slowed by food, water soluble p Eliminated by zero order kinetics, one ounce per 3 hours (slower in women) p Converted to acetaldehyde then to acetate p One drink in North America = 12 grams Et. OH p Amount of pure ethanol calculated by %abv x. 78 = gm Et. OH/100 ml p Advise maximum 2 standard drinks/day for men, 1 for women = low risk drinking
The basic problem of street drugs is not knowing what you’re putting in your body…. not like alcohol, right? o Wine p 1 standard drink (12 gm) = 130 ml (4. 5 oz) of 12% wine = 110 Cal. p 118 ml of 13%; 109 ml of 14%; p How many standard drinks in a bottle? p In a litre? p Does champagne have more or less % Et. OH? p What percentage of alcohol in fortified wines? (eg. Sherry, Dubonnet? ) p How much does a wine glass hold? Let’s find out!
Wine o One 750 ml bottle of wine contains 76 gm Et. OH o o (13%) or 82 gm (14%), 6. 3 or 6. 8 standard drinks A litre of wine contains 8. 4 or 9. 1 drinks Sparkling wines are typically 10 -11% abv Wine glasses typically range from 4 -12 oz (114342 ml) i. e. 1 -3 standard drinks Sherry is 20% abv, Dubonnet = 16%; 1 standard drink is 76 ml (2 shot glasses) and 100 ml respectively
Ok…I don’t drink wine, but beer, I know. o Beer p What % abv is beer? Strong beer? Lite beer? p How many drinks is one bottle of beer? p What if you drink supercans? p How much beer in a pint? p How much beer in a pitcher? p What’s a “depth charge”?
Beer Standard beer is 5% abv, 355 ml bottles which is 13. 8 gm/bottle; 1. 2 standard drinks. p 5 bottles = 6 drinks p Strong beer = (6 -11%) 8. 5% abv; 23. 5 gm/bottle; 2 standard drinks p Lite beer = 4% = 11 gm/bottle =. 9 standard drinks p Supercans = 473 ml; 1 supercan of Wildcat = 22. 3 gm, approx 2 standard drinks p Also available in 650 and 950 ml cans p 1 pint = 2 cups = 455 ml = 17 gm Et. OH = 1. 5 drinks; 2 pints = 3 standard drinks p Pitcher = approx 1. 5 litre = 58 gm = 5 drinks p Depth Charge is 1. 5 oz Vodka added to beer; 17 gm + 13. 4 gm = 30 gm = 2. 5 drinks p
Confused? Don’t worry, spirits are much more complicated! o What does ‘proof’ mean? o What % abv is typical for spirits? How about o o single malt scotch? How many drinks in 750 ml (26 oz) bottle, how about 1. 14 l (40 oz)? How about liqueurs? Bailey’s vs Grand Marnier? How about Alcopops? Where do they fit in? Mike’s Hard Lemonade, Cider? How much is in that glass? How many standard drinks is that? Does the amount of mix matter? How about ice? Let’s find out!
Spirits Proof is 2 x abv. Most spirits are 40% abv One standard drink is 38 ml, 1. 4 oz Shot glass holds approx 50 ml, 1. 3 drinks 750 ml bottle holds 234 gm, 19. 5 drinks; 1. 14 l bottle holds 355 gm, 30 drinks o Liqueurs range from 16% (Bailey’s) to 40% (most) o Studies show most people err by 2. 5 to 3 times in optical volume measurements o Alcopops – 7% abv. Eg Mike’s = 18 gm/bottle = 1. 5 standard drinks. Not the same as beer! o o
Alcohol p BAC – Blood Alcohol Concentrations. Measured in grams/100 ml blood. p. 01 – marked increase in sleepiness. Impairs sleep. p p p p . 02 – decreased ability to understand commands, esp. radio. . 05 – too impaired to operate a vehicle. 24 hour suspension. Poor speed/distance perception. Poor problem solving skills. . 08 – “legally” impaired. . 1 -. 19 – neurologic impairment, reaction time, ataxia. . . 2 -. 3 – severe impairment. 4 – hypothermia, stage 1 anaesthesia, aspiration. 5 -. 8 – onset of coma, death
Alcohol o Metabolism decreases BAC by. 015 per hour o A typical “night out” sees a BAC of. 1 to. 2 (10 -20 standard drinks) o Return to BAC of 0 will take more than 10 hours after last drink. o Impairment will last 20 – 30 hours o See next slide for a “typical day”
Alcohol Facts o 1 a. m. Drives home drunk o o o o o BAC. 165 2 a. m. Worker goes to bed. 15 3 a. m. Sleeping. 135 4 a. m. Bathroom. 120 5 a. m. Restless. 105 7 a. m. Alarm goes off. 075 8 a. m. Drives to work impaired. 060 8: 30 a. m. Begins work impaired. 055 Noon 0. 0 Afternoon – hung over impairment continues
Impairment o Hung over state: p Dehydration p Metabolic Acidosis p Hypoglycemia p Disequilibrium p Sleep debt p Cognitive Impairment
So, if I carefully measure my drinks, I should know what my BAC is right? Um… not exactly. o The Globe and Mail’s “Gord Campbell experiment”
Failing to plan is planning to fail! The Teen Party Plan o 55% of people under age 19 drink alcohol o What is your party plan? n Decide whether you are going to drink. (It’s okay not to). n Decide what, when, where and how much. n Plan how to stop, what to say etc. Pour your own! n Plan on what to do if you/your friend makes a mistake. p Surrender car keys p “Safe Ride” contract – “Code Red” p Have you ever called a cab? p What do you do with someone who is “passed out”? p Think about other alcohol influenced risky behaviours (sex, drugs, water, machines)
Marijuana - devices
Marijuana o THC – delta 9 tetrahydrocannabinol o MJ in 60’s typically 3 -5%, now typically 10%, o o o can be 40% (hash oil, BC bud) Fat soluble (vs. Et. OH) Long ½ life Binds to brain receptors, esp cerebellum (driving) and hippocampus (learning); cumulative drug load Extreme tolerance develops quickly Effects: next slide n n Physical Psychological
Effects of Marijuana Use o Physical: p Some estimates 20 x carcinogenicity of cigarettes; (and additive to) – 60 -70% more carcinogenic hydrocarbons p CAD, cardioacceleration, MI risk 4 x in first hour p Anti-androgen, anti estrogen p THC crosses placental barrier, milk
Effects of Marijuana Use o Psychological p Perceptual distortion, esp time/distance, peripheral vision, colour, attention. p Learning impaired – lasts 4 weeks. p Addiction liability – similar to opiate w/d, less than coc. p Classic W/D syndrome, esp. aggression, peaks @ 1 wk. U of Vermont study 6. 3/9 criteria DSM IV
“Reefer Madness” – the ultimate irony n The marijuana – schizophrenia link n n n Swedish study – 50, 000 men followed for 27 years 50 x by age 18 increased schizophrenia by 30% 13% of all cases could be prevented by eliminating marijuana British study – 1/10 smokers dx schiz by age 26 The depression link n n 6 year study of 2000 adolescent girls in NZ Daily users 5 x likely to become depressed o Gateway drug – myth or fact?
Marijuana Myths o It’s my own !* business what I do in my own time… p Impairment can be chronic o It’s a blue collar/cultural problem o It’s less impairing than booze… p Wrong o It’s safer than booze… p Wrong o Doctors have found many medical uses for marijuana… o It’s a “soft” drug…. o It’s not addictive…
Cocaine (crack, snow, blow, C, flake) o “God” drug p One of the oldest known drugs p Extracted from leaf of coca bush p HCl salt or “freebase” (smokable – crackles) n Produces rush lasting 5 -15 minutes, euphoria for 2 -4 hours p Talkative/overconfident/irritable/energized p Often use another drug to counter side effects of jitteriness, irritability, depression n One dose alters brain response (acute tolerance) (next slide)
Cocaine o Faster route – more intense effects p Initial impairment through euphoria/ poor judgment – to paranoia – to acute psychosis p Secondary impairment through “crash” and craving p Tertiary impairment through brain chemistry alteration and rapid development of addiction n n Massive cardiac and respiratory side effects esp malignant arrythmia (risk 24 x normal in first hour after use) Seizures, (sensitization), sudden death
Cocaine and Alcohol o “One plus one equals three!” o New compound – cocaethylene p Manufactured in the liver p Increases impulsivity p Profoundly impairs judgment and memory p Increased risk of sudden death o The most common two drug combination that results in death o Memory impairment vastly potentiates relapse
“Crystal Meth”(Methamphetamine) (meth, crystal, ice, jib, crank, speed)
“Crystal Meth”(Methamphetamine) (meth, crystal, ice, jib, crank, speed) o Man made analog of amphetamine. Smokable. Made in basement labs. o Triggers massive release of dopamine – intense “rush” o Neurotoxic in animal models – destroys dopamine and serotonin neurons (next slides). Long term damage o Predisposition to neurodegenerative diseases later in life?
Crystal Meth Impairment o Impairs tests of perceptual speed, manipulation of information o Impairment of coordination o Violent behaviour more common with this drug than others “tweaking”
Ecstasy MDMA – “E” p Methylenedioxyamphetamine p Hallucinogen, (euphoria, depression) p Effects last 4 -6 hours, after effects last weeks to months p Works on serotonin system (mood) p May damage neurons permanently after 1 use p Addictive potential like very weak cocaine p Malignant hyperthermia, chronic paranoid psychosis, cardiac arrest, coagulopathy
A Drug is a Drug! o Prescription Drug Abuse o 3 Major Categories n n n Opioids (Tylenol #3) Depressants (Valium, Imovane) Stimulants (Dexedrine, Ritalin)
Drug Myths o I am stronger than the drug – I can control what o o o o others cannot. I’ve quit before, I can again. Drugs make me more creative/social etc. Life is better stoned. Drugs do no permanent harm. What I do in my own time is my own business – the company doesn’t own my soul! Don’t tell me what to do! Doctors/counselors/authorities are liars. *** is way safer than alcohol. I know a guy who’s been doing this for years and he’s fine…
Summary of First Section Alcohol is alcohol. Alcohol is a drug A drug is a drug There are no “safe” or “soft” drugs. Just different. Impairment is quite different than intoxication All psychoactive drugs impair an person’s ability to work/learn safely – sometimes for several weeks after ingestion. Sometimes permanently. o Almost everyone is unaware of the extent of their impairment o There are no easy answers to drug use in society o o o
Summary – some suggestions from what we’ve learned so far: o o o o Know more. Talk more. Use/buy smart. Decrease your use. Shandys, spritzers It’s okay not to use. Support those who don’t. Some people should never use psychoactive drugs of any kind. Avoid early introduction of alcohol in a child’s life “Just say no” is not an effective strategy for kids Consequences for use are essential. Avoid normalizing abnormal. Do you, or a love one, have a problem? Next section…
Section 2 – Alcohol and drug addiction o Addiction is a very distinct entity from use or o o o o abuse It is a disease with well recognized symptoms Hallmark symptoms are loss of control and tolerance Addiction involves changes in brain chemistry/structure, and is irreversible 2/3 of alcohol addiction is genetic Addiction is a family disease There are only 4 outcomes to drug/alcohol addiction There is only one treatment - abstinence
Addiction in the Workplace o This is a whole separate topic o Consider: n n n n Not all users are abusers/addicts! Detection/ Performance Management Intervention, progressive model Bipartite approach essential Policy/procedure addressing each step Re-integration and aftercare the most critical stage Relapse prevention and safety
Alcohol addiction o Affects 6% general population, (10 -12% of oil o o patch as industry) Reasons for increase is industry codependency*, lack of direct supervision, irregular hours, ability to shift employers Typically takes 5 -10 years to develop (see following slides). Follows typical course The Alcoholic is impaired from chronic alcohol effects in addition to acute effects already discussed Chronic effects: hepatitis, hypertension, “wet brain”, blackout, DT/w/d seizures, chaotic life syndrome
Enabling/co-dependency o “We enable another person when we protect them from experiencing the consequences of their behaviour” p Accepting excuses p Making excuses for another’s behaviour p Covering up for those experiencing problems p Giving people “breaks” p Ignoring or avoiding the problem p Treating the problem as a joke
o Enabling is usually well intentioned o Reasons: p To avoid conflict p Because we feel helpless p To avoid embarrassment or stigma p Because we feel the problem is somehow a reflection of our own competence p Because we might have to face our own problem o Enabling results in the person’s death o After spouses and co-workers, Doctors are often prime enablers!
Drug Testing `No, no!' said the Queen. `Sentence first-verdict afterwards. ' Alice in Wonderland by Lewis Carroll
Drug Testing o Really, a whole separate lecture. Briefly: o What are you trying to accomplish? n Model of change o Consider examples of n Traffic radar n Prohibition o Must be part of an effective, enlightened policy/process o Must be used in concert with performance management/ other HR tools
Information Sources o National Institute on Drug Abuse www. drugabuse. gov o Substance abuse network of Ontario o o o http: //sano. camh. net/ National Institute on Alcohol Abuse and Alcoholism www. niaaa. nih. gov The National Council on Alcoholism and Drug Dependence www. ncadd. org AADAC www. aadac. com/ AA/NA/CA www. aa. org/ etc. Recovery www. recovery. org/ Literature www. hazelden. org/ Local expert: Dr. Dan Ryan, 2835 Millwoods Road NW, 450 -4550