Reducing Workplace Impairment
Ray Baker MD
Associate Clinical Professor UBC Medicine
IMA Solutions
Alliance Medical Monitoring
Points
— Addiction: chronic brain disorder
— Detecting workplace impairment
— Remission/recovery? The
evidence
— The mentally healthy/safe
workplace and substance use
disorders
—  10 % of employees will experience a substance
use disorder (NIDA – 2009) [This number could
double with DSM 5 criteria]
—  Substance use disorder is second highest
prevalence mental health diagnosis in Canada
—  Addictions mimic mental disorders: (depression,
stress-related conditions, anxiety, panic, bipolar,
psychosis)
The Nature of Addictions
—  Addictions are self inflicted. People with
addictions misbehave. They are too weak to
control their impulses. If they just changed
their behaviours and lifestyle they’d be
fine.
—  Yep, just like other genetically influenced
chronic progressive diseases: type 2
diabetes, coronary heart disease, morbid
obesity and many types of cancer
Neurobiology of Addiction
Addictions: ASAM/CSAM
chronic progressive brain disorder
Addiction: a primary, chronic disease of
brain reward, motivation, memory and
related circuitry. Dysfunction in these
circuits leads to characteristic
biological, psychological, social and
spiritual manifestations. This is reflected
in an individual pathologically pursuing
reward and/or relief by substance use
and other behaviors.
Alcohol & Drug Use
Dependence
Zero
use
20%
Regular
Use
65%
Abuse
Early
Mid-stage
Late
5-10%
“Pickle Line”
Workplace
becomes
aware
Treatment Intensity?
—  Most people with addictive disorders find
help and get well (EFAP, counsellor, AA,
church, etc.) before it affects the
workplace
—  By the time addiction affects workplace
attendance performance behaviour or
safety the disorder is at a later more severe
stage and the person has failed prior
attempts to control/treat the problem
Behaviours
—  Isolation & social withdrawal
—  Forgetting previous conversations
—  Irritability & mood swings
—  Mood changes after breaks
—  Angry outbursts & interpersonal conflict
—  Defensiveness, blaming
—  Unreasonable resentment
—  Increased absenteeism, lateness & schedule confusion
Employer Dilemma
(multilemma?)
— Civil/criminal Liability
— Employee privacy rights
— Duty to accommodate employees
with disabilities
— Duty to provide mentally safe
workplace
— Performance management
Drug Testing?
— Substances are far from commonest
cause of impairment
— Do employers perform other medical
investigations to detect diabetes,
seizure disorder, narcolepsy etc?
— Drug testing does not prove
impairment (except brthlzr)
— The question to answer: Is this worker
fit to safely work?
Occupational Addiction Medicine
Evaluation
BIO
Multiple
Diagnoses
Treatment/
Relapse prevention
Plan
Evidence
Evidence
Substance dependent physicians
medically monitored using
contingency management
techniques achieve rates of longterm stable abstinent remission
greater than 80%
Long-Term Recovery
What happens after “treatment”
much more important than what
happens during “treatment”
Spend resources accordingly
Contingency Management
— Sustains motivation to adhere to
relapse prevention plan
— Links benefits to adherence to
treatment plan
— The single most important
predictor of successful recovery
Medical Monitoring
— Essential for reinstatement of
personnel with disorders for which
high relapse risk is likely to endanger
workplace or public safety
— Monitor records/reports
1.  adherence to relapse prevention
plan
2.  abstinent remission
The Safe and Healthy Workplace:
—  Will implement National Standard on
Psychological Health and Safety in the
Workplace (CMHA)
—  Will train personnel on its substance use/
substance use disorder policy
—  Will ensure risk sensitive employees receive
effective treatment and relapse prevention,
contingency management and medical
monitoring
Summary
— Addictions: common chronic progressive
brain disorders with biopsychosocial/
spiritual symptoms
— Comprehensive, long-term treatment based
on thorough diagnostic evaluation results in
high recovery rates
—  The workplace can be the most effective
resource in helping personnel with addictive
disorders