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

1. 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

2. Points to be addressed • Background & experience • Premises: What we know • Difficulties, problems • Recommendations • Issues to be resolved or clarified • Final comments

3. 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.

4. 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.

5. 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.

6. 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.

7. 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.

8. 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.

9. 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.

10. 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.

11. 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.

12. 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.

13. Recommendations • National laws should be consistent with WHO’s 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.

14. 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.

15. 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.

16. 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.

17. 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.

18. 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?

19. 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?

20. 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?

21. 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?

22. 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.

23. 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.

24. Final Comments • Brazil’s experience, where the National Confederation of Industrialists developed, with ILO backing, an innovative, creative program to prevent alcohol & drug use in workplace, is invaluable.

25. 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.