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

15. Addictions in the Workplace 345tasks. Cases of acute stress disorder and posttraumatic stress disorder (PTSD)drastically increased on Wall Street after the September 11, 2001, terroristattacks. Disasters, terrorism, and war pose additional workplace stress, and concomitantincreases in abuse of these substances will likely occur with them.TREATMENT AND INTERVENTIONSAddiction psychiatrists may be called upon for preemployment screening,fitness-for-work evaluations, crisis situations, case management, treatment, orto review organizational policy regarding substances. Before any contact with apatient, the addiction psychiatrist working in the occupational setting musthave a clear sense of his or her duty. Interactions between a clinician/consultantand an employee/patient are complicated by the various roles inherent inthe setup. At the least, the patient must be made aware of policy regarding confidentialityand the physician’s dual agency. One SAMHSA-sponsored groupdemonstrated the utility of such an approach when enacted by an EAP(Lapham, McMillan, & Gregory, 2003).Preemployment ScreeningPreemployment screening to identify various potential problems, including substanceabuse, may produce referrals for evaluation. In addition, it is helpful toeducate employers about how to screen and when to refer. Those who performthese screens need to have a low threshold for referral. Important informationcan be gleaned from reference letters, a history of arrests, the admission of medicalproblems, or the applicant’s physical appearance. Special attention shouldbe paid not only to use but also to use in the workplace.Once all the information has been gathered, the question is what to dowith it. There are two important questions for the consultant: (1) Is the behaviora treatable condition, and (2) has it affected occupational function in thepast? With these questions in mind, the psychiatrist may come to a recommendation,especially when considering the type of work being sought. It would befoolhardy to reject every single potential employee simply because he or she hasmisused a substance. Hiring talented persons in stable recovery makes goodbusiness sense.Problem OrganizationsFor the organization that has sought the consultant’s advice, there is an assumptionthat change is sought: that a problem has been identified. The consultantmust gather a bird’s-eye view of the organization, from the demographics of the