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BESH Core Process 318: Drug and Alcohol Abuse Testing

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1 BESH Core Process 318: Drug and Alcohol Abuse Testing
Non-Manual Supervisors Partnering for an Alcohol- and Drug-Free Workplace

2 Safety is Our Value -Riley Bechtel August 15, 2001
“We measure safety performance by the number of incidents. But let’s be clear… it’s really not about incident rates…it’s about people. People who have faces, names, families, hopes, and dreams.” -Riley Bechtel August 15, 2001

3 Learning Outline Supervisor training objectives
Scope of problem in United States Specific drugs of abuse Substance abuse signs and symptoms Overview of CP-318 Employee responsibilities Supervisors’ responsibilities Employee Assistance Program Protecting confidentiality References

4 Objectives of Non-Manual Supervisor Training
BESH Core Process 318: Drug and Alcohol Abuse Testing Supervisors should have a working knowledge of: The effects of substance abuse The requirements of CP-318 Their role in the process Employee Assistance Program provisions How to intervene in problem situations

5 Scope of the United States’ Alcohol Problem
More than half of the adult U.S. population drank alcohol in the past 30 days. Approximately 5% of the total population drank heavily, while 15% of the population binge drank (Centers for Disease Control) Excessive alcohol use is the 3rd leading lifestyle-related cause of death for people in the United States each year (Centers for Disease Control) Productivity and health- and crime-related costs: $235 billion (National Institute on Drug Abuse) $120 billion annual cost of alcoholism and drug addiction to U.S. businesses (National Institutes of Health) Construction has the highest rate of heavy alcohol abuse at 15.9% (Substance Abuse and Mental Health Services Administration) Nearly 75% of all adult illicit drug users are employed, as are most binge and heavy alcohol users (National Institute on Drug Abuse) Binge drinking is a common pattern of excessive alcohol use in the United States. The National Institute on Alcohol Abuse and Alcoholism defines binge drinking as a pattern of drinking that brings a person’s blood alcohol concentration (BAC) to 0.08 grams percent or above. This typically happens when men consume 5 or more drinks, and when women consume 4 or more drinks, in about 2 hours. About 75% of the alcohol consumed by adults in the United States is in the form of binge drinks. (US Dept of Justice) Tobacco and poor diet/lack of exercise are #1 and #2 leading lifestyle-related causes of death 5

6 Scope of the United States’ Drug Problem
19.5 million Americans aged 12+ are current users of an illicit drug (National Institute on Drug Abuse ) 14.6 million Americans are marijuana smokers, making it the most-commonly-used illicit drug (National Institute on Drug Abuse) Non-medical use of prescription pain-relievers is now the second most prevalent form of illicit drug use in the nation (Substance Abuse & Mental Health Services Administration) Drug-related illness, death, and crime cost the nation approximately $66.9 billion (National Criminal Justice Reference Service) Absenteeism is 66% higher, health benefit utilization is 84% greater in dollar terms, disciplinary actions are 90% higher, and there is significantly higher employee turnover (National Institute on Drug Abuse) (6.2% of the population) US total pop = 311 million Abuse of prescription pain relievers rose by over 400 percent from 2.2 percent in 1998 to 9.8 percent in 2008 (Substance Abuse and Mental Health Services Administration) This number of "past-month" drug users has declined by almost 50 percent from the 1979 high of twenty-five million -- a decrease that represents an extraordinary change in behavior. Approximately a third used cocaine or took a prescription type drug for nonmedical reasons. About a fifth used LSD. Prescription Drug Abuse Alert: Vicodin is one of the drugs most commonly abused by high school seniors. Nearly one in ten 12th graders reported non-medical use of Vicodin in 2004; one in twenty 12th graders reported non-medical use of OxyContin. Inhalant use has increased in 8th graders with 17.3% reporting use at least once in their lifetime. These drugs are particularly dangerous because they can damage the nervous system even after a single use, and they can be fatal. 6

7 Impact of Substance Abuse in the Workplace
Safety Security Employee health Productivity Decision making Employee morale Bechtel’s image and community relations Let’s talk about the impact of substance abuse in the workplace: Safety – Common effects of substance abuse include impaired vision, hearing and muscle coordination and low levels of attention, alertness and mental acuity. Its impact on the workplace includes increased accidents; and more workers’ compensation claims. Security – Employees with drug and/or alcohol problems often have financial difficulties, and employees who use illegal drugs may be engaging in illegal activities in the workplace. In this area, substance abuse’s impact on the workplace can include theft and law enforcement involvement. Employee Health – People who abuse alcohol or other drugs tend to neglect nutrition, sleep and other basic health needs. Substance abuse depresses the immune system. Its impact on the workplace includes higher use of health benefits; increased use of sick time and higher absenteeism and tardiness. Productivity – Employees who are substance abusers can be physically and mentally impaired while on the job. Substance abuse interferes with job satisfaction and the motivation to do a good job. It’s impact on the workplace includes reduced output; increased errors; lower quality of work and reduced customer satisfaction. Decision Making – Individuals who abuse alcohol and/or other drugs often make poor decisions and have a distorted perception of their ability. Here, substance abuse’s impact on the workplace includes reduced innovation; reduced creativity; less competitiveness; and poor decisions, both daily and strategic. Employee Morale – The presence of an employee with drug and/or alcohol problems creates a strain on relationships between coworkers. Organizations that appear to condone substance abuse create the impression that they don’t care. Impact on the workplace includes higher turnover; lower quality; and reduced team effort. Finally, substance abuse impacts Bechtel Image and Community Relations – Accidents, lawsuits and other incidents stemming from employee substance abuse problems may receive media attention and hurt an Bechtel’s reputation in the community. The impact on the workplace includes reduced trust and confidence; and reduced ability to attract high-quality employees.

8 Specific Drugs of Abuse
Alcohol Marijuana (THC) Opioids most often prescribed to treat pain prescription narcotics include morphine, codeine, oxycodone (e.g. OxyContin, Percocet), hydrocodone (Vicodin) Heroin, methadone, hydromorphone Amphetamines commonly referred to as "speed“ prescription stimulants treat sleep disorder narcolepsy and attention-deficit hyperactivity disorder (ADHD) (e.g. Adderall; Benzedrine; Dexedrine; DextroStat) Cocaine PCP Alcohol is metabolized at the rate of .015 of blood alcohol concentration (BAC) every hour. Thus a person with a very high BAC of .15 will have no measurable alcohol in the bloodstream after ten hours (.15 divided by .015 = 10). Here are some other examples: BAC Level Metabolism Time in Hours , , , Urine tests for marijuana can detect the presence of the drug in the body for 2-90 days, dependent on how often the person smokes, how much they smoke and how long they have been smoking. Opioids 1-2 days Methadone 1-2 days Oxycodone (Percocet) 8-24 hours Hydromorphone (Dilaudid) 1-2 days Heroin 2-4 days Codeine 1-2 days Hydrocodone (Vicodin) 1-6 days Amphetamines detectable in urine 1-2 days included in the expanded panel are methamphetamines, MDA, MDMA (2-5 days) MDMA (3,4-methylenedioxymethamphetamine) is a synthetic, psychoactive drug that is chemically similar to the stimulant methamphetamine and the hallucinogen mescaline. MDMA produces feelings of increased energy, euphoria, emotional warmth, and distortions in time, perception, and tactile experiences. methylphenidate (e.g., Ritalin and Concerta) not detectable as amphetamine Cocaine (coke, snow, flake, crack) is detectable in urine for 2-4 days. Phencyclidine (PCP, Angel dust) detectable in urine 2-8 days. PCP is a synthetic drug sold as tablets, capsules, or white or colored powder. It can be snorted, smoked, or eaten. Developed in the 1950s as an IV anesthetic, PCP was never approved for human use because of problems during clinical studies, including intensely negative psychological effects. Benzodiazepines such as Xanax, Ativan, Diazipam, Valium, Versed are NOT included in this 5-panel drug test. 8

9 Defining ADDICTION The irresistible compulsion to use alcohol and other drugs despite adverse consequences. It is characterized by repeated failures to control use, increased tolerance and increased disruption in the family. For one in ten people, abuse leads to addiction. Addiction to alcohol and other drugs is: Chronic Progressive Primary Terminal Characterized by denial Addiction. A number of individuals occasionally use or abuse alcohol or drugs without becoming addicted, but for many, abuse continues despite repeated attempts to return to more social or controlled use and leads to addiction. Addiction is the irresistible compulsion to use alcohol and drugs despite adverse consequences. It is characterized by repeated failures to control use, increased tolerance and increased disruption in the family. Unfortunately, it is not possible to tell early on whose use may lead to abuse and/or addiction. For one in ten people, abuse leads to addiction. Addiction to alcohol and other drugs is: Chronic – Once you have developed an addiction, you will always have to deal with it. You may manage to stop using alcohol or other drugs for significant periods of time, but for most, the disease doesn’t disappear but rather goes into remission. Should you attempt to resume ‘normal’ use, you will rapidly return to addictive, out of control use and abuse. Progressive – Addiction gets worse over time. With some drugs, the decline is rapid; with others, like alcohol, it can be more gradual, but it does get worse. Alcohol and other drugs cause a biochemical change in the nervous system that can persist even after the substance leaves the blood. Repeated use causes progressive damage. Primary – Addiction is not just a symptom of some underlying psychological problem, a developmental stage or a reaction to stress. Once your use of alcohol or drugs has become an addiction, the addiction itself needs to be medically treated as a primary illness. Terminal – Addiction to alcohol and/or other drugs often leads to disease and possibly death. Characterized by Denial – One of the most disturbing and confusing aspects of addiction is that it is characterized by denial. The user denies that his/her use is out of control or that it is causing any problems at home or work. The user often seems to be the last to know that his/her life is out of control. There are effective strategies employed by professionals for helping to break through this denial, which must be overcome before treatment can take place. The diagnostic criteria for Addiction or Substance Dependence is defined as a pattern of substance use, leading to clinically significant impairment or distress, as manifested by three (or more) of the following, occurring at any time in the same 12-month period: Tolerance as defined by either of the following: (1) The need for markedly increased amounts of the substance to achieve intoxication or the desired effect; or (2) A markedly diminished effect with continued use of the same amount of the substance. Withdrawal, as manifested by either of the following: (1) The characteristic withdrawal syndrome for the substance; or (2) The same (or closely related) substance is taken to relieve or avoid withdrawal symptoms. Substance is often taken in larger amounts or over a longer period of time than intended. There is a persistent desire or unsuccessful efforts to cut down or control substance use. A great deal of time is spent in activities necessary to obtain the substance, use the substance or recover from its effects. Important social, occupational, or recreational activities are given up or reduced because of use. The use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the use (i.e. continued drinking despite recognition that an ulcer was made worse by alcohol consumption).

10 Defining Substance ABUSE
Using a substance to modify or control mood or state of mind in a manner that is illegal or harmful to oneself or others. Abuse of alcohol and other drugs affects people: Emotionally Behaviorally Physically Another form is “Abuse.” When the use of a substance to modify or control mood or state of mind is in a manner that is illegal or harmful to oneself or others, it is considered problematic use, or abuse. Examples of potential consequences of harmful use are: Accidents or injuries; Blackouts; Legal problems; Poor job performance; Family problems; and Sexual behavior that increases the risk of HIV infection. The diagnostic criteria for Substance Abuse is defined as a maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifested by one (or more) of the following, occurring within a 12-month period: Recurrent substance use resulting in a failure to fulfill major role obligations at work, school, or home (i.e. repeated absences or poor work performance related to substance use; substance-related absences, suspensions, or expulsions from school; neglect of children or household). Recurrent substance use in situations in which it is physically hazardous (i.e. driving an automobile or operating a machine when impaired by substance use). Recurrent substance-related legal problems (i.e. arrests for substance -related disorderly conduct). Continued substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance (i.e. arguments with spouse about consequences of intoxication, physical fights). Absence of dependence has been established.

11 Emotional Effects of Substance Abuse
Aggression Burnout Anxiety Depression Paranoia Denial While the initial response to ingestion of an addictive substance may be a rush of pleasure and feeling of well-being, extended substance abuse ultimately impairs control of the emotions. Central nervous system depressants, such as alcohol and barbiturates, frequently cause impaired judgment and attention spans. Both amphetamines and opioid drugs may produce an exaggerated perception of euphoria, leading to a need for more drugs to maintain the emotional high. Paranoia, delusional behavior and panic attacks are associated with hallucinogenic drugs. 11

12 Behavioral Effects of Substance Abuse
Drop in attendance or performance Poor motivation or lack of energy Slowed reaction time Impaired coordination Slowed or slurred speech Irritability Excessive talking Inability to sit still Limited attention span Behavioral signs of drug abuse Drop in attendance and performance at work Unexplained need for money or financial problems. May borrow or steal to get it. Engaging in secretive or suspicious behaviors. Sudden change in friends, favorite hangouts, and hobbies. Frequently getting into trouble (fights, accidents, illegal activities). 12

13 Physical Effects of Substance Abuse
Weight loss or gain Excessive sweating Shaking hands Puffy face, blushing or paleness Red, watery eyes; dilated or constricted pupils; blank stare Distorted vision, hearing, coordination Skin problems Reduced immunity/prone to infections Smell of substance on breath, body or clothes Runny nose; hacking cough Most abused drugs have some affect on the cardiovascular system, according to the National Institutes on Drug Abuse. Drugs can increase heart rate and cause heart attacks. Cocaine is known to cause heart arrhythmias and deaths from cardiac arrest. Tobacco is a legal drug that is known to cause the blood vessels to constrict, leading to high blood pressure and hardening of the arteries. Drugs that are injected intravenously can damage the blood vessels, causing veins to collapse. Dirty needles and contaminated drugs can introduce bacteria into the bloodstream that damage the heart valves. Certain drugs have demonstrated the ability to cause brain damage in users. Inhalants, for instance, have been shown to damage areas of the brain that control cognition, movement, vision and hearing. These substances, which include solvents and aerosol sprays, may provoke varying degrees of destruction to the brain tissue, resulting in cognitive abnormalities ranging from mild impairment to severe, permanent dementia. When it comes to brain damage, legal drugs are not safe either. Chronic alcohol abuse can cause a syndrome known as "wet brain," or Wernicke-Korsakoff syndrome. A thiamine deficiency linked to alcoholism causes brain cell death and alters brain structure. The liver is faced with the task of removing the drugs from the body. As a result of chronic drug use, the liver can become damaged and diseased. Alcoholism is a known cause of cirrhosis of the liver, a disease where the liver becomes filled with scar tissue that impedes its ability to function. Injected drugs can expose the user to hepatitis C, HIV and other infectious pathogens. A 2008 study by A. Monto and colleagues in the Journal of Addictive Diseases explains that after years of deterioration, hepatitis C infection can transition into liver cirrhosis, and that HIV infection is associated with the progression of liver disease. Physical Signs Loss of appetite, increase in appetite, any changes in eating habits, unexplained weight loss or gain. Slowed or staggering walk; poor physical coordination. Inability to sleep, awake at unusual times, unusual laziness. Red, watery eyes; pupils larger or smaller than usual; blank stare. Cold, sweaty palms; shaking hands. Puffy face, blushing or paleness. Smell of substance on breath, body or clothes. Extreme hyperactivity; excessive talkativeness. Runny nose; hacking cough. Needle marks on lower arm, leg or bottom of feet. Nausea, vomiting or excessive sweating. Tremors or shakes of hands, feet or head. Irregular heartbeat. 13

14 Family and Coworker Enabling
Action that someone takes to protect the person with the problem from the consequences of his or her actions Unfortunately, enabling actually helps the person to NOT deal with his or her problem Examples Covering Up Rationalizing Withdrawing/Avoiding Blaming Controlling Threatening Families and coworkers can have a significant impact on substance use and abuse. One way is through “enabling” – an action that someone takes to protect the person with the problem from the consequences of his or her actions. Unfortunately, enabling actually helps the person to NOT deal with his or her problem. Examples of enabling include: Covering Up – Providing alibis, making excuses or even doing an impaired worker’s work rather than confronting the issue that he/she is not meeting his/her expectations. Rationalizing – Developing reasons why the person’s continued substance abuse or behavior is understandable or acceptable. Withdrawing/Avoiding – Avoiding contact with the person with the problem. Blaming – Blaming yourself for the person’s continued substance abuse or getting angry at the individual for not trying hard enough to control his/her use or to get help. Controlling – Trying to take responsibility for the person by throwing out his/her drugs, cutting off the supply or trying to minimize the impact by moving him/her to a less important job; and Threatening – Saying that you will take action (ceasing to cover up, taking formal disciplinary action) if the employee doesn’t control his/her use, but not following through. 14

15 Bechtel’s Drug & Alcohol Program
Sends a clear message that alcohol and drug use in the workplace is prohibited Complies with local laws and requirements Imposes discipline on those who violate rules Encourages employees who have problems with alcohol and other drugs to voluntarily seek help Provides assistance to employees who want help for an abuse problem Safeguards employee confidentiality

16 BESH Core Process 318 exists to:
Protect the health and safety of all employees, customers and the public Maintain product quality and company integrity and reputation Comply with the Drug-Free Workplace Act of 1988 or any other applicable laws Safeguard Bechtel assets Protect trade secrets

17 CP-318 Answers the Questions
What is the purpose of the policy and program? What behavior is prohibited? Who is covered by the policy? When does the policy apply? Does the program include random drug testing?

18 Bechtel’s Drug & Alcohol Abuse
Forbids working under the influence Prohibits the possession, use or sale of drugs or alcohol on company property Applies to all Bechtel Employees and candidates applying for positions, designated contractors and temporary agency personnel Effective during: All working hours When conducting company business or representing the company While on Bechtel property When driving while on company business When riding in a company-provided vehicle

19 Testing for Drug & Alcohol Abuse
Testing Program essentials derived from 2 sources: Bechtel Policies – HR Policy 409 (Redbook) A401-1 (Greenbook) and Principal 300 (Becon) ES&H CP-318 – Drug and Alcohol Testing Testing procedures include: Pre-employment screening Reasonable suspicion testing Post-accident (work-related) testing Random testing Unannounced follow-up testing for previous positives Compliance with a recognized standard

20 Employee Responsibilities Outlined in CP-318
Report to work free of the influence of drug or alcohol Consent to testing as established in CP-318 Comply with work rules regarding submission of documentation Review medications with personal physician to ensure safety Notify supervisor in writing of any criminal drug arrests, as may be required by client organizations

21 CP-318 Answers Additional Questions
Who is responsible for enforcing the policy? What should a supervisor do if they suspect an employee is under the influence? Does the policy include searches? What are the consequences for violating the policy?

22 Supervision’s Role & Responsibilities
Department Supervisors are responsible for being thoroughly familiar with CP-318, enforcing work rules, evaluating employee performance, and taking action as required Reasonable suspicion testing requires two trained Supervisors concur on the decision for testing and each independently complete a Reasonable Suspicion Report Form Searches of employees, subcontractors, and visitors, their personal property, vehicles, and work areas may be conducted by site Security Violation of any part of this program will result in disciplinary action up to and including termination through Human Resources

23 Reasonable Suspicion Testing Procedure
Based on specific, objective facts and reasonable inferences drawn from observations Two trained supervisors each independently complete a Reasonable Suspicion Report Form (CP-318 Exhibit F) Forms must be completed as soon as possible after observing a suspected behavior Maintain confidentiality and conduct the investigation in private The forms must be completed prior to testing Medical Services will perform the testing

24 Bechtel Employee Assistance Program (BEAP)
Can help employees decide what to do if they have a problem with alcohol or other drugs Can help an employee decide what to do if someone in his/her family or workgroup has a problem Conversations with BEAP are CONFIDENTIAL BEAP records are separate from personnel records and can be accessed only with a signed release from the employee BEAP professionals are bound by a code of ethics to protect the confidentiality of the employees and family members that they serve In the US: Regardless of where you work in the world, you may need help from time to time in dealing with life’s challenges. When you are faced with issues, concerns and questions that you have never had to deal with before, you may not know where to turn for help. Fortunately, Bechtel has made Employee Assistance Program (EAP) services available to you. Everyone needs a little help now and then. Change can create stress. Routine can create stress. Life is full of challenges and surprises, ups and downs, highs and lows. It’s natural to feel sometimes like there’s just too much to handle. You’re not alone. Your program can help. Easy to find, confidential assistance is available every hour of every day. Offered by Bechtel at no cost to you, services are available to you and members of your household. Australia In Australia: In New Zealand: Outside Australia/New Zealand: dial your country code followed by   Canada English: French:   India Toll Free: (within India only) Direct: (outside India - caller pays phone charges) UK In the UK: Outside the UK: US In the US: Outside the US: call Collect: Other Toll-Free Number: Collect Number:

25 Additional Resources Personal Physician Community hotlines
Self-help groups such as Alcoholics Anonymous, Narcotics Anonymous, Al-Anon, etc. Community mental health centers Private therapists or counselors Addiction treatment centers

26 Supervisors and Confidentiality
Problems will not be made public When an employee tells his/her supervisor something in confidence, supervisors are obligated to protect that disclosure All information related to performance issues will be maintained in employee’s personnel file Information about referral to treatment, however, will be kept separately If an employee chooses to tell coworkers about his/her private concerns, that is his/her decision It is an employee’s responsibility to decide whether or not to seek help However, there are some limits on confidentiality that may require: Disclosure of child abuse, elder abuse and serious threats of homicide or suicide as dictated by state law; Reporting participation in an EAP to the referring supervisor; Reporting the results of assessment and evaluation following a positive drug test; Verifying medical information to authorize release time or satisfy fitness-for-duty concerns as specified in company policy; and Revealing medical information to the insurance company in order to qualify for coverage under a benefits plan. 26

27 Supervisors Supporting a Safer, Drug-Free Workplace
In summary: Understand and follow Core Process 318: Alcohol and Drug Abuse Testing Communicate the policy clearly Recognize the indications and symptoms that are consistent with impairment Follow intervention actions according to policy Treat all employees fairly Share Employee Assistance Program provisions Safeguard employee confidentiality Direct questions to your Human Resources Representative All drugs, including alcohol, chemically alter the mind and body. As a result, use of drugs and/or alcohol can impair motor skills, hinder judgment, distort perception, decrease reaction time and interfere with other skills necessary to do a job safely and efficiently. It is your responsibility, as a Supervisor, to: Maintain a safe, secure and productive environment for employees Evaluate and discuss performance with employees Treat all employees fairly Act in a manner that does not demean or label people Safeguard employee confidentiality Ensure the policy is clearly communicated It is NOT your responsibility to Diagnose drug and alcohol problems Have all the answers Provide counseling or therapy Be a police officer 27

28 Learn More Bechtel University
Online Course: ESH0010-X1 - Bechtel's Drug and Alcohol Program - What Supervisors Need To Know Online Course: ESH0001-X1 - Bechtel Drug and Alcohol Program - What Employees Need to Know Centers for Disease Control National Institute on Alcohol Abuse and Alcoholism National Institute on Drug Abuse Substance Abuse and Mental Health Administration The National Center on Addiction and Substance Abuse

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