Drug and alcohol policies at work

Problem, what problem?

The first speaker, Howard Mason, a principal scientist at the HSL, advised using the term "substance abuse" rather than "drug abuse". The word "substance" covers legal substances such as alcohol, prescription drugs such as codeine, and workplace chemicals such as solvents, as well as illegal drugs such as cannabis, cocaine and heroin. "Abuse" can be defined as "use likely to cause significant physical, behavioural or psychological impairment". Accurate data on the prevalence of substance abuse in the UK are hard to come by, although it is thought that as many as one in 10 people has a significant alcohol problem.

Research published by the Health and Safety Executive (HSE) in 2004 suggested that 27% of men under 40 years old had used illegal drugs in the previous year². Cannabis is the most widely used illegal drug, followed by cocaine, but by far the greatest problems are caused by alcohol.

Given the widespread prevalence of substance abuse in society, virtually all employers are likely to have experience of an employee with such a problem. Substance abuse is not necessarily a long-standing intractable problem; especially in the case of alcohol, it can be short term and may often be triggered by a non-work problem such as a marital breakdown or bereavement. Further, although an individual may not be under the influence of drugs while at work, the use of recreational drugs at weekends, for example, can have a knock-on effect on an employee's work, with fatigue and tiredness adversely affecting performance and behaviour.

Stereotypical assumptions about drug users are unhelpful and do not reflect the problems likely to be found in the workplace, explained Mason. Someone with serious addiction problems is unlikely to be in employment, while many users of illegal drugs show normal performance and behaviour at work. This raises the question of why employers should be concerned about what employees do outside work if it does not impact on their performance when at work. The extent to which an employer can tackle problems that are embedded in wider society is limited and there is a lack of data on how substance abuse affects individual work performance and whether it has a measurable financial impact on organisations, making it difficult to construct a robust business case for addressing the issue. Nevertheless, a clear policy that reflects the particular workplace situation ensures that an organisation can demonstrate compliance with relevant safety and employment legislation (see below ), protect its reputation and set out what is and is not acceptable behaviour for employees.

Problems normally come to light as a result of behavioural changes (see box 1 ) that are noticed and reported by colleagues and/or managers, as a result of investigations following an accident or near miss, or through self-presentation to a manager or occupational health professional. Mason noted that random drugs testing rarely picks up substance abuse problems. Although work colleagues are likely to be the first to notice the warning signs, it is common for collusion to take place or for signs to be attributed to other causes, particularly where the individual involved is a personal friend or a manager. It is therefore important for any workplace substance abuse policy to apply to everyone in the organisation and for it to adopt a supportive rather than a punitive approach.

The legal position

Apart from certain sectors, such as transport, there are no explicit legal requirements for companies to manage drug and alcohol issues; however, the general requirements of the Health and Safety at Work etc Act 1974 and the Management of Health and Safety at Work Regulations 1999 to ensure the safety and health of workers and to protect the general public from risks arising from work activities may be taken to include risks from substance abuse. The Misuse of Drugs Act 1971 makes it an offence for work premises to be used for the supply, production or misuse of drugs, which makes company managers and directors liable if they know such activities are taking place in the workplace and take no action. Under the Transport and Works Act 1992, operators of railways and other guided transport systems, such as trams, are required to show "due diligence" in trying to prevent an offence such as working while under the influence of drugs or alcohol. The Railways and Transport Safety Act 2003 introduced alcohol limits and related measures for crews on water-borne vessels and certain aviation personnel. These are similar to the provisions in the Road Traffic Act 1988 that apply to motorists.

The second speaker, Dr Anil Adisesh, a consultant occupational health physician, noted that employers also need to be aware of the Disability Discrimination Act 1995 (DDA) which states that, although addiction to alcohol, nicotine or any other substance (including prescribed medication) does not constitute an "impairment" under the Act, the health effects of addiction (for example, mental health problems) may be considered a disability. Since fines under the DDA are potentially unlimited, it is important that employers take this into account when formulating and implementing workplace substance abuse policies and procedures.

European vs US practice

The HSE rejects the US approach, with its focus on extensive testing and immediate dismissal for non-compliance with zero-tolerance standards. Mason explained that the HSE considers this approach inappropriate for the UK where employers are not, in general, responsible for providing healthcare for their employees and where the social climate with regard to drugs and alcohol is more relaxed. The stated aim of a workplace substance abuse policy should be to maintain a healthy and productive workforce by balancing supportive and punitive measures. Help should be offered to those who admit to having a problem and who want to tackle it, but with disciplinary action a last resort for those who fail to address the problem or to cooperate. Policies need to clearly state that intoxication, drug dealing or the production of illegal drugs at work will not be tolerated and will lead to disciplinary action. It is recommended that policies should also:

Testing is not a substitute for, nor an essential part of, a workplace policy and, indeed, can cause significant problems³, particularly with regard to compliance with the Human Rights Act 1998 and the Freedom of Information Act 2000. It may, however, be appropriate for safety-critical industries, such as nuclear and top-tier COMAH (control of major accident hazards) sites, and others with significant reliance on public confidence, such as financial services. For much of the rail, aviation and offshore sectors, testing is an industry requirement.

Testing techniques

The most common types of testing are:

At the workshop, Kate Jones, a principal scientist with the HSL, considered when testing should be carried out and what should be tested. Different laboratories offer different services; the HSL, for example, tests for amphetamines, barbiturates, benzodiazepines, cannabis, cocaine, methadone (propoxyphene for the rail industry), opiates and alcohol. What to test for will depend on the industry sector and any specific company concerns.

Most non-transport companies follow the European Workplace Drug Testing Society guidelines⁴. The most common tests involve samples of blood, urine, hair and oral fluid, and breathalysing for alcohol. Taking a urine sample is the most common method of workplace testing. Oral fluid testing, however, is becoming more widespread, although this method is currently more expensive than urine testing and there are questions over its efficacy. Hair tests, which are mostly used for drug treatment compliance, are expensive and specialised. In addition, they are unsuitable for mainstream workplace testing as employees can simply cut their hair to avoid testing. Blood tests are also unsuitable for most workplace testing, although they may have a place for with-cause testing following an accident. Testing regimes need to take account of "detection windows", for both the substance and the test sample (see table 1 ); this is particularly important for with-cause testing where a cause-effect relationship between substance use and an incident is being investigated. For example, although the driver of the train in the 1991 Cannon Street rail crash - in which two people died when the train crashed into buffers - tested positive for cannabis three days after the accident, the public inquiry ruled this out as a cause of the accident.

Detection windows are also of relevance to pre-employment testing, since a potential employee with a substance abuse problem will simply abstain for a few days before the test. As Mason observed: "Pre-employment testing is really an intelligence test!"

Although widespread in the US, random drugs testing is rare in the UK, with only around 5% of firms adopting this approach. However, it may act as a deterrent, the likelihood of a person with a substance abuse problem being picked up through random testing is small, since a company would normally test only around 5% of the workforce in a year. In addition, great care needs to be taken with interpretation of results. The Faculty of Occupational Medicine (FOM) advises: "Test results must be passed only to the appointed medical review officer who will interpret the test result, taking account of the policy and associated circumstances, and will advise the manager if there is a positive result."⁵ Decisions on fitness for work, however, remain the responsibility of the occupational physician. The FOM recommends using an independent provider to collect and analyse samples for alcohol and drugs testing in order to avoid any ethical problems that may arise for the in-house occupational health function.

Analysis of test results can be carried out immediately on-site or samples can be sent away to a laboratory for analysis. Any positive on-site drug screening would need laboratory confirmation to be legally defensible. HSL occupational health nurse Jacqui Foxlow set out the procedures required to carry out workplace screening, focusing on the most common type of sample - urine. She said that a clear procedure is needed to maintain the integrity of the "chain of custody" and to obtain informed consent from the employee being tested. Information on recent medication is required to eliminate any false-positives, as is photo identification in the form of either a passport or driving licence. Such safeguards are essential to ensure the credibility of the test results.

1. "Drug and alcohol policy workshop", 5 December 2006, Health and Safety Laboratory, Buxton.

2. HSE (2004). The scale and impact of illegal drug use by workers, Research Report 193.

3. Joseph Rowntree Foundation (2004). Drug testing in the workplace: The Report of the Independent Inquiry into Drug Testing at Work (PDF format, 423K), (on the Joseph Rowntree Foundation website) .

4. See www.ewdts.org .

5. FOM (2006). Guidance on alcohol and drug misuse in the workplace, available from www.facoccmed.ac.uk/pubspol/pubs.jsp .

This article was written and researched by Rose Riddell, freelance researcher/writer, Occupational Health Review.

The next "Drug and alcohol policy workshop" will be held at the HSL on 20 March 2007.