21 August 2006

Adelaide Conference on drugs/alcohol in work place. Summary by Richard Hallinan (part 2 of 4).

Work-related Alcohol and Drug use - A National Forum.

29th June 2006.

Session 3 chaired by Dr Neal Blewett.

New NCETA research shows alcohol is the Number One workplace substance use issue, and first good evidence of workplace-related harms from illicit drug use.

Session 3 on Day 1 of the National Centre for Education and Training on Addiction forum on Work-related Alcohol and Drug Use, chaired by Dr Neal Blewett, presented new NCETA research findings on "Patterns and Problems" for alcohol and illicit drugs, based on analysis of the 2004 National Drug Strategy Household Survey.

Professor Ann Roche reminded us of the National Health and Medical Research Council's revised alcohol guidelines for levels of risk ("low, risky, high risk") both for chronic harms and also acute harms (like memory loss, blackouts). Previous guidelines tended to reflect the orientation of treatment services to the chronic harms.

For alcohol, important findings were

  • older people, and those not working, are more likely to abstain from alcohol.

  • where only small numbers of people were at risk for chronic harms, large numbers of people sometimes put themselves at risk of acute harms.

  • workers in their twenties and early thirties are at particularly high risk for acute harms.

  • as are: women in their late teens; women managers and supervisors (?keeping up with men, despite lower defined safe limits based on gender); people working in the hospitality industry (?owing to their youth, availability of alcohol); and tradespersons.

There were disturbing statistics:

  • 7% of people surveyed had attended work/study under the influence of alcohol in the previous year (9% of males, 3% of females); this figure was 13% of 14-19 year olds.

  • "risky" drinkers (whether acute or chronic) took the most time off work for "all causes" ie whether attributed directly to alcohol or to other causes.

  • 10% of absenteeism overall was related to alcohol, but this rose to 50% of absenteeism among low risk drinkers, who are in the large majority.

  • risky drinking is associated with psychological distress, although the causational direction is unclear - it might be bi-directional association.

Some critical propositions came from these data:

  • alcohol is the Number One workplace substance use issue;

  • harms are caused mostly by regular and intoxication, rather than dependency as such;

  • workplace culture plays a large role in alcohol related harms;

  • risk comes from how, where and with whom you drink.

Dr Petra Bywood presented evidence of high prevalence of use of illicit substances in the Australian workforce - overall 37% lifetime use (58% in the 20-39 age group ) and 15% in the last 12 months. The NCETA research looked at 3 outcomes: working under the influence of drugs, absenteeism due to drug use, and absenteeism due to illness or injury (not necessarily in the workplace)

Painkillers and cannabis are the most available illicit substances; cannabis, amphetamines and MDMA are the most commonly used (lifetime use 33%, 9%, 7% respectively). Males use illicit drugs more commonly than females (20% vs 13% in last 12 months) and use declined after age 30. Tradespersons have the highest, and managers and professionals the lowest, rates of use overall. Low illicit drug use was reported in defence and rail transport.

Few people reported going to work under the influence of illicit drugs (overall 2.5%) but rates were higher in some industries (eg hospitality, construction, forestry) and generally in young men. Absenteeism due to illicit drug use was much lower than for alcohol, and again was highest in young men. Illness/injury related absenteeism was also higher in people who used illicit drugs. In summary, this research has provided some of the first good evidence of both direct and indirect harms of illicit drugs in relation to reduced productivity and increased health and safety risks.

Dr Ken Pidd, presented an overview of the key issues and interventions for alcohol and other drug issues in the workplace.

Some key issues are:

  • the identification of groups at high risk: by occupations (tradespersons) and industries (eg hospitality); by gender (males in most age groups) and by age (especially 14-19 year olds); and combinations of these - eg female managers, supervisors and hospitality workers.

  • the duty of care to young people, especially in managing the transition from school to workplace;

  • the importance of a culture where might supervisors traditionally discourage drinking at work but encourage it after work.

  • A characterisation of high risk would be "highly stressed, bored, poorly supervised workers in a confrontational environment with few guidelines".

People are twice as likely to go to work under the influence of alcohol than illicit drugs, yet both are uncommon by contrast with taking days of work due to alcohol use (3.5% in previous 3 months) or illicit drugs (a third as common). Most absenteeism is related to low levels of alcohol use in large numbers of people.

Three overlapping patterns of substance use need to be differentiated in planning interventions: intoxication, regular use, and dependence, with the latter representing a spectrum proportional to the difficulty of abstaining. Two contrasting types of interventions are problem solving (tertiary level care, late) and prevention (with an emphasis on education and risk factors in the workplace).

The elements of comprehensive interventions are:

  1. Workplace policy (should be clear, identify what to do and who should do it, acknowledge the role of workplace environment);

  2. Education & training.

  3. Counselling/treatment (good evidence base)

  4. Employee assistance programs EAP (providing ready access to assessment counselling and referral)

  5. Testing (expensive, poor evidence for benefit, may be largely misdirected ie to illicit drugs)

  6. Health promotion (focusing on general health and well being including drug and alcohol use)

  7. Brief interventions (especially effective in non-dependent and low dependent users).

The NCETA research findings are available in an excellent series of five Workplace Drug and Alcohol Information and Data Sheets.

  1. Workers' Patterns of Alcohol Consumption

  2. Workers Alcohol Use and Absenteeism

  3. Responding to Alcohol and Other Drug Issues in the Workplace

  4. Drug Testing as a response to Alcohol and Other Drug Issues in the Workplace

  5. Illicit Drugs in the Australian Workforce: Prevalence and Patterns of Use

The following is from the information sheet on Drug Testing, which will dealt with in the next part of these summaries.

"A further limitation to testing is the predominant emphasis on illicit drugs. The vast majority of workplace tests are conducted to detect the use of illicit drugs, not alcohol. Recent prevalence data indicate that while 84% of Australians are current drinkers, only 15% are current illicit drug users. ..... Thus, the greatest risk to safety and productivity is likely to come from the much larger numbers of employees who engage in unsafe or risky patterns of alcohol consumption."

The transcripts of these presentations will be available from NCETA in the Proceedings of the Forum. For more details contact NCETA on 08 8201 7535 or nceta@flinders.edu.au or www.nceta.flinders.edu.au.

The forum presentations can be viewed at: www.nceta.flinders.edu.au/events/twenty_four_seven.html#Presentations

Summary by Richard Hallinan