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

15. Addictions in the Workplace 343benefits officers should be trained to recognize the importance of physical, historical,or social signals of misuse, and this should, with a low threshold of suspicion,lead to further inquiry, including, for example, direct questioning, professionalevaluation, or request for records of prior treatment.Once the individual is an employee, sources include physical findings (e.g.,stench of cannabis, bottles of alcohol, change in work performance, reportsfrom others; ideally, confidential or anonymously), violence or legal problems,or the development of associated medical problems. The extent to which thedependent or abusing worker spends most of his or her time thinking about(obtaining, concealing, using) the drug leaves less time for work or anythingelse. Many addicts in the workplace are able to conceal their drug use for years!Supervisors should be trained to spot problems, and workers should also be providededucation for self-diagnosis.A tenet of addiction is continued use despite adverse consequences. Denialof a problem is a challenge, and confrontation is often part of the intervention.The first steps to recovery are recognition of a problem and agreeing to a needfor help. The addict is unwilling (earlier in the course of addiction) or unable(in the later stages) to stop use. Sadly, the employer who says “Get help oryou’re fired” often has more leverage than family or friends.Loss of control is an important criterion for addiction, and one of the moreconfusing aspects for employers to comprehend. Over time, untreated drug useprogresses from social and recreational use to more problematic heavy use, andfinally to out-of-control addiction. In order to understand the loss of control,addiction must be presented to third parties as a progressive, not static, illness.Of course, denial of this progression is characteristic: It is difficult to accept theeventual loss of control. The addict at first minimizes the damage, then blamesothers as justification for continued abuse, which may be followed by rationalizinghis or her behavior.In this progression, the first step toward successful treatment of alcohol ordrug addiction in the workplace is the direct confrontation of denial. Theemployer or partners often have more leverage and more emotional neutralitythan a family member. The supervisor does not make a diagnosis but does recommendan evaluation by a professional. The substance abuser is usuallyunwilling to seek help on his or her own, and must be made to see the adverseconsequences of not stopping drug use (e.g., loss of job, divorce). The employeeis given the choice of treatment or termination, and the usual result is a referralto an Employee Assistance Program (EAP).Diagnosing Specific Substances in the WorkplaceIt is important to remember that each drug may have a different course in theworkplace, and relapse depends very much on the drug being used.