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The premier resource for hospital professionals from Relias Media, the trusted source for healthcare information and continuing education.

Your employee might be a drug or alcohol abuser – What do you do?

Cecil A. King was a drug and alcohol abuser for 33 years, and he worked in healthcare.

"I had become physically very ill and depressed," says King, an RN medical case manager for Infectious Diseases Clinical Services at Cape Cod Healthcare. "A dear friend and colleague convinced to contact the EAP. That intervention allowed me to see how sick I was and assisted me to go to detox and later to inpatient treatment for 28 days."

Once he mustered the courage to share his situation with coworkers, they were overwhelmingly supportive. King shared his story of recovery at a recent meeting of the Ambulatory Surgery Center Association that I attended. Members of the audience were mesmerized by his message.

He pointed out the long intertwined history of addition disorders and healthcare. William Stewart Halsted, the “father of modern surgery,” was addicted to morphine until he died. The cofounder of Alcoholics Anonymous (AA), Dr. Bob Smith, was a surgeon and alcoholic. Probably 10-20% of healthcare providers have a substance abuse disorder, King said. The cost? Absences, increased costs to treat related illnesses, lost wages, lost productivity, crime, etc.

Despite these serious consequences, only one hour in medical school is focused on addiction, King said. For that reason, he covered the work performance indicators of a possible addiction:

  • reduced job efficiency;
  • inconsistent work patterns;
  • absenteeism. Patterns of being absent Monday/Friday or around days off;
  • on-the-job absenteeism. Extended lunch breaks and unexplained disappearances on the job;
  • attitude/mood swings or problems. A tendency to isolate;
  • physical/emotional problems. Marked nervousness on the job.
  • impaired interpersonal relationships. Frequent arguments with co-workers. Excessive blaming of others. Complaints by patients and/or co-workers of irritability, physical roughness, or verbal abuse;
  • difficulty in concentration. Omitted, illogical, incomplete, or illegible charting;
  • medication-centered problems. Increased use of prn psychoactive or narcotic medications charted. Patient complaints of inadequate pain relief;
  • Other areas: Excessive time with personal phone calls. Excessive talkativeness.

Despite the list of potential indicators, King said to keep this in mind: “A lot of people with substance abuse issues are extremely high performers.” Listen to your gut, he said. Also watch for a patterns of subtle signs, such as complaints from physicians and omissions in charting, he said.

When you have an employee who has a substance abuse disorder, bring in HR, King advised. He offers these other suggestions: “Document, Document. Document.” Maintain confidentiality, even if anonymity isn’t possible. Verify the evidence with coworkers. Focus on the performance and behavior not meeting professional or institutional standards, rather than the person, by providing objective information.

You might be required to report when there is evidence, proof, or suspicion of impairment, King said. However, most states refrain from formal action if the employee is willing to seek voluntarily treatment and make contractual agreements.

Resources for impaired professionals include your drug-free workplace policy, EAPs, state peer assistance programs, state alternative to discipline programs, treatment programs, 12-step programs (AA and NA), support groups, and crisis lines. The bottom line: Treatment works. King shared a quote from the RWJ Foundation that said the improvement rate for people who complete substance abuse treatment is comparable to people treated for chronic, relapsing health conditions, such as asthma.

King emphasized these key points:

• Addiction is a chronic relapsing illness, like diabetes or cancer, except for the overwhelming stigma on people with this disease.

• Non-judgmental attitude is critical to persons in recovery so they can continue to seek help, even after relapse.

• Support systems understanding the dynamics of addiction and recovery are essential.

• A nurse who suffers from addiction is not having a good time getting high.

* Addiction is a complex disease that has neurochemical and biological causes as it foundation, not moral failure or character deficits.

We salute King and others who are in recovery and sharing their stories. Their willingness to be vulnerable and share information saves dollars, jobs, and most importantly, lives.