Clinical Textbook of Addictive Disorders 3rd ed - R. Frances, S. Miller, A. Mack (Guilford, 2005) WW

CHAPTER 15Addictions in the WorkplaceAVRAM H. MACKJEFFREY P. KAHNRICHARD J. FRANCESClinicians are frequently asked to address addictions in the workplace, includingprevention, treatment, assessment of performance, benefit structure, disability,and risk management. Anyone involved with these topics must recognizeissues of importance to the organization, the individual, the public safety,and the relevant laws and ethics (Kahn & Langlieb, 2002). And, as in any situationin which the clinician is a third party, privacy, confidentiality, and otherethical considerations must be appropriately addressed. This chapter serves asan introduction to this complex task. We begin by exploring the problemsposed by substance use, abuse, and dependence in the workplace, the laws thatgovern the organizations roles, and the issues faced by psychiatrists involved inthese situations; we then describe aspects of management of the problems and,finally, address a number of specific occupations in which particular issues areimportant. Chapter 4 in this volume, on drug testing, covers its use in the workplaceand highlights these issues as related to sports and professional athletes.THE PROBLEM: EXTENT AND CAUSESThe use of illicit or addictive substances in the workplace can have devastatingeffects, including accidents, injuries, disability, lateness/absenteeism, theft,reduced performance, and reduced morale. By 1998, the societal cost of drugabuse was $143.4 billion, with lost productivity accounting for around $100 bil-340