Anybody who drinks regularly is at risk of becoming dependent on alcohol. For example, in terms of jobs, the level of alcohol-related death is twice the national average among bar-staff and publicans, whereas that risk is lowest among farmers and professional drivers.*

Now, obviously alcoholism and alcohol dependency walk together. Because of the dysfunctional way that alcoholics end up drinking they are very likely to become dependent on alcohol. However, they are not the same thing. An alcoholic may be treated for alcohol dependency, get through alcohol withdrawal safely, and feel ‘a million dollars’ as a result. However, the alcoholic is still an alcoholic, and has not been cured. Even a single drink is liable to take the alcoholic crashing back to alcohol dependency as a result of relapse.

*Institute of Alcohol Studies: Alcohol and the Workplace (2009).

Russell Brand, the actor and comedian, has spoken honestly about his own drug addiction as well as his opinion on drug addiction recovery and society’s attitudes towards drug addicts.

Brand, 36, addressed the Home Affairs Committee on 24^th April and said that he believed that drug addiction should be tackled head on in a compassionate way and shouldn’t be a police or legal matter.

Like many in the industry, rehabilitation rather than incarceration is the actor’s belief, as well as an abstinence-based approach rather than, for example, putting heroin addicts on methadone for years as a harm reduction solution rather than recovery.

He said: “It is something I consider to be an illness, and therefore more of health matter than a criminal or judicial matter.”

Ultimately, Brand called for a drug policy rethink as his own addiction has put him into rehabilitation services which often have their hands tied due to a political or legal stance.

He told MPs that he was “sad, lonely, unhappy” before and during his drug-taking era and that it would be “a brilliant idea” if the policing costs of “nicking people for possession” were instead used to fund treatment.

In its simplest definition, rehabilitation (rehab) is the process of restoring to good health and or useful life through therapy and education.

Although this definition can be used for rehabilitation in the wider sense, including injury and incarceration, its meaning applies directly to drug and alcohol addiction, where users can be restored to good health AND useful life.

By restoring individuals to good health, rehabs usually use a detoxification, healthy eating and holistic treatment regime to rid the body of the addicted substance without severe withdrawals and to regenerate and replenish it with vital vitamins and nutrients.

With regards to useful life in the definition, all rehabs should – and make sure you check they do – offer therapies and treatment to restore people’s minds, give them confidence, drive and self-worth with the aim to not only cope with life without substance abuse, but live life to the max!!

What is in-patient rehab?

In-patient rehab is a period of time spent in a residential facility that offers drug and alcohol services to kick-start the recovery from addiction, and includes detoxification and a programme (treatments and therapy services) in order to restore addicts to good health and life. We know from research that in-patient rehab is the most successful form of rehabilitation for alcohol and drug addictions, and, although it should be the first port of call for all addicts, it is often left as a last resort after other forms of intervention – outpatient, home or community-based treatments – have failed.

Do I need rehab?

While the path to addiction begins with the voluntary act of taking a substance or behaving in a certain way, over time a person’s ability to choose not to do so becomes compromised, and seeking and consuming the drug becomes compulsive. This behavior results largely from the effects of prolonged drug exposure on brain functioning. Addiction is a brain disease that affects multiple brain circuits, including those involved in reward and motivation, learning and memory, and inhibitory control over behavior.

Because addiction has so many dimensions and disrupts so many aspects of an individual’s life, treatment is not simple. Effective treatment programs typically incorporate many components, each directed to a particular aspect of the illness and its consequences. Addiction treatment must help the individual stop using their maladaptive behaviour or substance, maintain a habit-free lifestyle, and achieve productive functioning in the family, at work, and in society. Because addiction is typically a chronic disease, people cannot simply stop using their substance or behaviour for a few days and be cured. Most patients require long-term or repeated episodes of care to achieve the ultimate goal of sustained abstinence and recovery of their lives.

What therapies and treatments do rehabs offer?

Therapy and treatment programmes vary from rehab to rehab. Some offer an eclectic, holistic, whole-person approach to the physical, mental and spiritual components of people, while others focus on one or two specific treatments.

The response to the various treatments and therapies available naturally differs from person to person, so at Rehab Guide, we advise people to try and attend a rehab that has good all-round therapies and treatments and also to ensure that the rehab provides them with what they need to heal and recover from their drug or behaviour that is causing problems.  We advise that as people respond differently, it’s also a good idea to try and experience as many as therapies as possible until the client responds in a positive manner and is satisfied that they have found a pathway to recovery that will work and sustain them on their journey.

Very common therapies and treatment models include:

• 12 Step (NA/AA based)
• Cognitive Behavioural Therapy (CBT)
• Motivational Interview (MI)
• Therapeutic communities (TCs)
• Relapse prevention
• Meditation

Individual and group counselling are an integral part in almost all inpatient programs regardless of the model used. Rehabs usually also help integrate external sources of help into the lives of addicts such as Alcoholics or Narcotics Anonymous which are highly important in remaining abstinent after release from rehab.

What kind of rehab should I go to?

In-patient rehabs vary in the types of addictions they treat. Many offer services to people regardless of their addiction, be it a substance based such as alcohol, drugs, food or behavioural based including gambling, shopping, love, and sex. Others provide services for a smaller group of addictions, such as a specific substance or behaviour only.

Many people suffer from more than one addiction or may have other health or mental health issues (often referred to as dual diagnosis) which may affect recovery, so it is always advisable to find out if the intended rehab can offer multi-addiction or dual diagnoses treatments.

To find out which type of rehab suits you best, why not speak to Rehab Guide – it’s our role and we have a wealth of experience of finding the correct treatment facility for people.

Why choose in patient rehab over out patient?

There is sound evidence based research that shows how rehab’s effectiveness is measured. For decades, a bounty of studies on how well rehab treatments work have been conducted, and what they’ve shown is that the most effective treatment is a combination of different treatment types.

Using Cognitive Behavioral Therapy counseling along with medications, for example, has provided higher success rates than either of the two alone. The research tells us that the most effective treatment combination is a treatment regimen consisting of a treatment program along with attendance of a 12-step program, and weekly counseling sessions, either individual or group.

­A study conducted in 1994 called the Target Cities Project showed that people who had completed a treatment program, attended one 12-step program per week and had one counselling session per week had an 87 percent chance of abstinence six months after completion of treatment.

It is very worthy to note though that chief among the reasons why people didn’t seek treatment was the financial cost of rehab. This seems incredibly short sighted and devastatingly sad when we consider it may well be the best investment ever made for the individual, their family and their community.

In-patient treatment allows intensive therapies as the programmes are very structured and offer a sound framework. It also removes clients from their ‘comfort zones’ – the place addicts are in when they are using or performing and allows change in behaviour to occur quicker. Removal from the pressures of everyday life including work and family life allow individuals to concentrate on their recovery. The secure, focused environment of rehab allows particularly vulnerable people to feel safe and ultimately removes addicts from the source of their habits.  It is particularly important that if clients need a detoxification – need to slowly be removed from their substance abuse – that a supervised medical detox take place where there are health care and trained specialist around 24 hours a day.

Where are rehabs located in the UK?

While many people prefer to find inpatient treatment close to home, it may be useful to look to other rehabs that are far away from their everyday lives for a variety of reasons. At Rehab Guide, we have an extensive network of rehabs to suit all tastes, addictions and budgets and we endeavour to match the patient with the rehab that will suit them based on their individual needs.

What is rehab aftercare?

Although rehab is a highly important stage in overcoming addiction and many people recover directly from a spell in rehab, for most, it is only the beginning of their journey to freedom from the chains of their addiction. Aftercare is offered by many rehabs and can take the form of individual counselling, group therapy and other treatments. Each rehab differs. We can offer all the advice and guidance on aftercare at rehabguide.

More Information on rehabs

To find out more about rehabs in general, specific queries about how they can help you kick-start a life of freedom for you and your family, or if you want to ask any other question related to your addiction or for someone close to you, why not contact us for confidential, clear and impartial information.

London Mayor, Boris Johnson, has approved the testing of electronic alcohol monitors to help persisent offenders stop drinking to curb crime.

Although exact details of the electronic alcohol monitoring device have yet to be determined, similar systems in use in the US monitor the perspiration of an individual using an e-bracelet or e-anklet to detect alcohol levels.

London will be the first city in the UK to test the scheme although Glasgow has applied to the Scottish Government for a licence to test the system to curb its own alcohol related crime and help rehabilitation.

Last year, the London Ambulance Service dealth with over 52,000 alcohol-related incidents.

Several US states already use an electronic system to capture repeat offender who break the no alcohol rule, with many being sent back to the slammer. Statistics from South Dakota show that 77% of offenders who wore the detection bracelet remained abstinent.

“The success of South Dakota proves that removing alcohol really reduces violent crime,” said Kit Malthouse, London’s deputy mayor for policing.

“Although criminals may protest, this may be the short sharp shock they need,” he added. “Offenders will have to ask themselves if a drink is really worth a night in jail?”

If you’ve ever attended an AA or NA meeting and heard someone say: “I became an alcoholic the first time I picked up a drink” or “I’m an addict because I’m just wired differently”, then, they might be right, according to new research undertaken by the University of Cambridge.

Researchers at the University studied the brains of addicts and the brains of their non-addicted brothers or sisters and findings suggest that addicts may have a ‘disorder of the brain’.

When the addicts and the non-addict siblings were studied, it was found that each had an ‘abnormality’ in the part of the brain which controls one’s behaviour – the fronto-striatal systems.

Researchers said that not only did this help to suggest that addicts brains were hard-wired to be addictive in the first place, but also that the same abnormalities found in the non-addict siblings means that one day we might have a ‘cure’ for addiction, by studying the differences in their behaviours.

A leading academic told the BBC: “It shows that drug addiction is not a choice of lifestyle, it is a disorder of the brain and we need to recognise this.”

Although the research is far from over into exactly why some people become addicts and others don’t – even with similar upbringings and genetics – it offers great hope for the future.

Dr Paul Keedwell, a consultant psychiatrist at Cardiff University, said: “Addiction, like most psychiatric disorders, is the product of nature and nurture.

“We need to follow up people over time to quantify the relative risk of nature versus nurture.”

Source BBC.

Residential (or inpatient) rehabilitation means being away from your home, your family and your friends for a while. Rehab is a place for getting well again, so you have to devote all your time and attention to that one matter.

That being so, why pay the extra cost to be near Central London? There really is no need to.

You don’t need to be near home, and you don’t have to be handy for regular visits. If you have young children, the time you spend in residential rehab is an investment for their future. By spending time away now, and of course you can see them during your treatment if you wish, means that after your treatment, you can be there for them all the time.

You might have read stories about celebrities in Rehab and often it’s touted that places in London are more discreet than elsewhere. This is complete nonsense. The guiding principles for rehab are the same everywhere in the UK. Any worthwhile treatment centre offering residential rehab must first gain your confidence and then safeguard your wellbeing.

If we have reason to believe a treatment centre is not entirely discreet with regard to its clients, Rehab Guide would not recommend it to you.

We, at Rehab Guide, will never direct you to treatment centres which offer inferior or inadequate treatment. Part of our commitment is that we will always guide you towards the treatment you need to get well again, irrespective of cost or location. We have a duty of care to you to help you get better. We want you to get well. It’s our reason for being.

Contact us and get on the road to recovery. We’re here for you.

Opioids are a kind of drug that is often used for controlling pain. Opioids can be highly addictive if a person doesn’t take the medicine as prescribed by their doctor or if they take the drug illegally. Opioid drugs include; codeine fentanyl heroin hydrocodone hydromorphone methadone morphine oxycodone oxymorphone paregoric sufentanil tramadol Heroin use has always accounted for the largest share of drug-related diseases and deaths in European countries.

The European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), have estimated that there are over 1.3 million regular opioid users in the EU & Norway. Also, around half (51%) of the drug users entering specialised treatment in Europe report opioids as their main problem drug. The EMCDDA launches its Annual report 2011 (the state of the drugs problem in Europe in Lisbon) stating that the average prevalence of problem opioid use in the EU and Norway (between 3.6 and 4.4 cases per 1 000 adults aged 15–64) is slightly lower than in Australia (6.3), the USA (5.8) and Canada (5.0), and considerably lower than in Russia (16) and Ukraine (10–13).

Injecting drug use is on the decline. People injecting have the highest risk of obtaining blood-borne infections such as HIV/AIDS and hepatitis B or C. Over-dosing is also a high risk when injecting. Levels of injecting among opioid users entering treatment vary considerably between countries, from under 10 % in the Netherlands to over 90 % in Latvia and Lithuania. However, data from treatment clients indicate an overall decrease in opioid injection (In particular heroin injection) in Europe.

A five-year analysis of trends in heroin users entering treatment shows that the proportion of those reporting injecting is declining in most European countries. And in the most recent data, under half (40 %) of all those entering treatment for opioid problems are regular injectors. Rising concern over synthetic opioids An increase has occurred in the misuse of opioids other than heroin in Australia, Canada and the USA. These include pain relievers (Morphine, fentranyl and codeine) and Substitution drugs for heroin dependence (methadone and buprenorphine).

There is also a concern that synthetic opioids are produced illegally. Several countries in Europe have reported that these synthetic opioids have over taken heroin in the marketplace. For example, in Estonia, three-quarters of those entering treatment now report that fentanyl is their main drug. Fentanyl is a similar to morphine but much more potent which is why it is greatly linked to overdoses.

Currently in Europe, around 5 % of those entering treatment for drug problems report opioids other than heroin as their primary drug, amounting to around 20 000 patients. Overdose deaths Over 7,600 fatal overdoses were reported in the EU and Norway in 2009, with opioids associated with the majority of these. According to the agency, many of these deaths could have been prevented. In a special review on drug-related mortality, the EMCDDA estimates that for the first time, there may be around 10 to 20,000 problem opioid users dying each year in Europe.

Users are mainly dying from overdosing, but also from other causes such as disease, suicide and trauma.

Most users who pass away are men and, on average, are in their mid 30’s.

The review looks at the ‘excess mortality’ in regular opioid users (risk of death compared with the general population) and finds that their risk of dying is 10 to 20 times higher than for their non-drug-using peers.

The report underlines the role that services, particularly opioid substitution treatment, can play in saving lives and reducing the human costs of long-term drug problems. Finding from the Annual Report 2011 ‘Reducing the mortality and morbidity related to drug use is central to European drug policies’, states the Annual report. Under evaluation in some countries are programmes targeting periods known to be risky for opioid users (e.g. leaving prison, dropping out of treatment). Innovative interventions in this area, such as overdose training and take-home doses of naloxone (which blocks the effects of opioids) are now becoming more common in the EU.

Risk of HIV outbreaks among drug injectors Over the last decade, gains have been made within the EU in addressing HIV infection among injecting drug users — these include a greater availability of prevention, treatment and harm-reduction measures. Latest European data show that the average rate of newly reported HIV cases continues to fall in Europe, reaching a new low of 2.85 new cases per million population (in total around 1 300 cases).

Here the overall EU situation compares positively, both in a global and a wider European context. Nevertheless this year’s report reveals worrying new developments. HIV epidemics among drug injectors continue to pose a major public health problem for many countries bordering the EU and with budgets for drug services across Europe becoming overstretched in the economic downturn, a danger also exists that countries may be less able to provide adequate responses to those most at risk of infection.

‘Over the last 10 years a proactive, pragmatic and evidence-led approach has delivered real gains in reducing drug-related HIV infection across the EU’, says EMCDDA Director Wolfgang Götz today. ‘We cannot forget, however, that injecting drug use still accounts for over 2 000 HIV/AIDS-related deaths in the EU every year’. Given the problems facing many EU countries, Götz underlines the need for vigilance in this area:

‘Policymakers must not take their eyes off the ball when it comes to this primary public health objective, especially as conditions for future drug-related outbreaks may now again exist in some Member States. The historical evidence is clear that without effective interventions, HIV infection can, and does, spread quickly among people who inject drugs’.

In July 2011, Greece — historically a low HIV-prevalence country — reported a large outbreak of new HIV infections among drug injectors (170 cases at the time of writing) (8). Recent increases in newly-reported infections have also been noted in Bulgaria, Estonia and Lithuania indicating continued potential for HIV outbreaks among injecting drug users in some countries . 

A recent EMCDDA expert meeting (October 2011) also identified further HIV increases among drug users in Romania and worrying changes in risk factors in Hungary. The rate of reported new HIV diagnoses (per million population) in 2009 related to injecting drug use remained relatively high in Estonia (63.4), Lithuania (34.9), Latvia (32.7) Portugal (13.4) and Bulgaria (9.7). Some 700 000 in substitution treatment in Europe Around 1.1 million Europeans are estimated to have received treatment for illicit drug problems in the EU, Croatia, Turkey and Norway in 2009. For opioid users, both drug-free and substitution treatment are available in all of these countries.

Five EU countries (Denmark, Germany, Spain, the Netherlands and the UK) offer heroin-assisted treatment for a small number of chronic heroin users who have failed in other treatment approaches (see box, Chapter 6).

Some 700 000 opioid users received substitution treatment in Europe in 2009, compared with 650 000 in 2007.

’While levels of treatment provision for opioid users are impressive in some countries, coverage still varies greatly and is very low in other countries’, says João Goulão, Chairman of the EMCDDA Management Board. Around 95 % of these treatments are provided in the 15 pre-2004 EU Member States .

The EMCDDA estimates that about half of Europe’s 1.3 million problem opioid users have access to substitution treatment, a level that is comparable to those reported for Australia and the United States and higher than that reported for Canada. China reports much lower levels, while Russia, despite having the highest estimated number of problem opioid users, has not introduced this type of treatment .

Treatment costs and quality assurance through guidelines Ensuring the highest treatment quality and best treatment outcome for the lowest possible cost are priorities in the current financial climate. A special EMCDDA review out today  states that treatment is cost-beneficial from the societal perspective. The review maps the main funding sources for drug treatment in a number of European countries and summarises the available data on this issue. Also published today is a review of guidelines for the treatment of drug dependence. It shows how almost all European countries now have drug addiction treatment guidelines, illustrating a growing commitment to developing evidence-based practice in this area.

Over 140 sets of guidelines were identified from across Europe in 23 European languages. These focus largely on opioid substitution treatment and aim to help practitioners make informed choices.

Commenting today, EMCDDA Director Wolfgang Götz says: ‘Our report clearly shows the value of European cooperation and coordination in the drugs field. We see this in many areas: information sharing and joint actions are increasingly impacting on the cocaine and heroin markets; developments in public health responses are allowing more drug users than ever before to access services.

 This progress is real and has been underpinned by a strong EU strategy which has allowed Member States to identify priorities, share knowledge and act collectively. Such an outlook is essential if Europe is to continue to respond to the new challenges that the evolving European drug problem now presents’ .

Drug misuse at work

IS IT MY CONCERN?

Basically Yes. Drug misuse can be a serious problem not only for the misuser but also for the business where they work and, sometimes, for their co-workers. The possession of some drugs is illegal, exposing the misuser to the risk of criminal charges as well as causing harmful effects to their health. You could be breaking the law if you knowingly allow drug-related activities in your workplace and you fail to act. It is just as important to know the implications to both your employees and business of not tackling drug misuse, particularly where safety is involved.

Successfully tackling drug misuse can benefit both your business and your employees. For example by:

saving on the cost of recruiting and training new employees to replace those whose employment might be terminated because of untreated drug misuse;

• reducing the cost of absenteeism or impaired productivity;
• creating a more productive environment by offering support to those employees who declare a drug-related problem, improving employee morale;
• reducing the risk of accidents caused by impaired judgement;
• enhancing the public perception of your organisation as a responsible employer;
• contributing to society’s efforts to combat drug misuse.

• SO WHO IS AT RISK?

All kinds of people are involved in drug misuse – they do not conform to any stereotype. A lot of people who are involved in drug misuse are in work.

TAKING DRUGS – WHAT ARE THE SIGNS?

If you are going to tackle drug misuse at work effectively, you may want to start by examining your own knowledge about the types of drugs available and the harmful effects they can have on the misuser and your business. So your first task will probably be to gather information to raise your awareness and that of your managers or supervisors. This booklet can be a starting point but you may also want to approach our organisation for useful reading material, educational videos and other information.

Drugs can affect the brain and the body in a number of ways. They can alter the way a person thinks, perceives and feels, and this can lead to either impaired judgement or concentration. Drug misuse can also bring about the neglect of general health and well-being. This may adversely influence performance at work, even when the misuse takes place outside the workplace.  

Signs of drug misuse which you might look for include:

• sudden mood changes;
• unusual irritability or aggression;
• a tendency to become confused;
• abnormal fluctuations in concentration and energy;
• impaired job performance;
• poor time-keeping;
• increased short-term sickness absence;
• a deterioration in relationships with colleagues, customers or management;
• dishonesty and theft (arising from the need to maintain an expensive habit).

Remember: all the signs shown above may be caused by other factors, such as stress, and should be regarded only as indications that an employee may be misusing drugs.

THE LEGAL POSITION

You have a general duty under the Health and Safety at Work etc Act 1974 (HSW Act) to ensure, as far as is reasonably practicable, the health, safety and welfare at work of your employees. You also have a duty under the Management of Health and Safety at Work Regulations 1999, to assess the risks to the health and safety of your employees. If you knowingly allow an employee under the influence of drug misuse to continue working and his or her behaviour places the employee or others at risk, you could be prosecuted. Your employees are also required to take reasonable care of themselves and others who could be affected by what they do at work.

The Transport and Works Act 1992 makes it a criminal offence for certain workers to be unfit through drugs and/or drink while working on railways, tramways and other guided transport systems. The operators of the transport system would also be guilty of an offence unless they had shown all due diligence in trying to prevent such an offence being committed.

The Road Traffic Act 1988 states that any person who, when driving or attempting to drive a motor vehicle on a road or other public place, is unfit to drive through drink or drugs shall be guilty of an offence. An offence is also committed if a person unfit through drink or drugs is in charge of a motor vehicle in the same circumstances.

The principal legislation in the UK for controlling the misuse of drugs is the Misuse of Drugs Act 1971. Nearly all drugs with misuse and/or dependence liability are covered by it. The Act makes the production, supply and possession of these controlled drugs unlawful except in certain specified circumstances (for example, when they have been prescribed by a doctor). If you knowingly permit the production or supply of any controlled drugs, the smoking of cannabis or certain other activities to take place on your premises you could be committing an offence.

The Act lists the drugs that are subject to control and classifies them in three categories according to their relative harmfulness when misused.

CLASS A -includes ecstasy, cocaine, heroin, LSD, mescaline, methadone, morphine, opium and injectable forms of Class B drugs.

CLASS B -includes oral preparations of amphetamines, barbiturates, cannabis, cannabis resin, codeine and methaqualone (Mandrax).

CLASS C -includes most benzodiazepines (eg Temazepam, Valium), other less harmful drugs of the amphetamine group, and anabolic steroids.

The penalties for offences involving controlled drugs depend on the classification of the drug. Penalties for misuse of Class A drugs are more severe than those for Class B drugs which in turn are more severe than the penalties for Class C drugs. The Act also distinguishes, in terms of the penalties that may be imposed, between the offences of possession and drug trafficking or supplying, with the latter attracting higher penalties.

It is possible that in certain circumstances charges may be brought against an employer or an employee under either this Act or the Health and Safety at Work Act or both. It would be up to the courts to decide on the circumstances of each case.  

WHAT CAN I DO?  

A policy on drug misuse  

All organisations – large and small – can benefit from an agreed policy, applying to all staff, on drug misuse.

As with alcohol, such a policy should form part of your organisation’s overall health and safety policy. Many large organisations have policies that describe their position on drug misuse. A written drugs policy has many advantages, for example leaving less room for misunderstanding than an informal ‘understanding’. The key elements of a policy on drug misuse are described below.  

A straightforward four-step process to establish and implement a policy for dealing with drug misuse at work is set out below.  

Remember: it is good practice to have a policy even if you do not find any evidence of current drug misuse. A policy which is in place will enable you to deal with any future problems which may arise. Follow the complete four-step process.

 Step 1 – Find out if there is a problem

You may want to explore carefully some key areas of your business:

• sickness record – are there any periods of unexplained or frequently taken absence?
• behavioural changes – what behavioural changes have you noticed in any employee
• productivity – are there any unexplained dips in productivity?
• accident records/near misses – have the number of accidents or near misses increased or involved particular employees?
• disciplinary problems – have you noticed particular performance or conduct problems with any employees?  

These may help you to find out if drug misuse is harming your business.

Step 2 – Decide what to do 

Following Step 1 allows for a better understanding of the many aspects of drug misuse at work. It will provide you with a clearer picture of how drug misuse affects your business. But how do you make this work in practice?

You may want to think about the following:  

• A programme of awareness for all your staff using the same information described in Step 1. There are many ways to provide such training: group sessions, seminars etc. This programme may also cover an explanation of your drugs policy (see Step 3) so you may want to incorporate it into your induction process for new employees.  
• A programme of training for managers or supervisors on recognising the signs of drug misuse. This could be the most crucial part of managing drug misuse at work as they will need to be clear about the business’ rules about drug misuse. They will need to know what to do if they suspect an employee is misusing drugs or if they are approached by an employee who declares a drugs problem. Local drug or health advisory services may be able to help train managers to recognise the signs of misuse and how to handle the situation. The service may charge for training.  
• Encouraging those with a drugs problem to seek help. 
• The need for confidentiality if an employee admits to a drugs problem. People with a drugs problem may be persuaded to come forward if they are assured that their problems will be dealt with discreetly. However, you will also have to consider your own legal position, if evidence or information supplied to you suggests that an employee’s drug problem has involved breaking the law at work.
• The nature of the work you do. Are there any aspects of the work that are safety-critical, eg: using machinery, electrical equipment or ladders, as well as driving or operating heavy lifting equipment, where instances of drug misuse could have serious consequences?  Consulting others  

In deciding what to do, you will almost certainly need to consult others, particularly your employees. You should consult safety representatives appointed by recognised trade unions under the Safety Representatives and Safety Committees Regulations 1977. If your employees are not covered by such representatives, you should consult them either directly, or indirectly through elected representatives of employee safety, according to the Health and Safety (Consultation with Employees) Regulations 1996.

 In larger organisations, good practice would be to set up a working party led by a senior manager to look at the issue of drug misuse as it affects the business. You need to involve the occupational health physician or nurse and personnel managers also where available, as well as workers’ representatives.  

This may not be feasible for smaller businesses, but you may find it useful to talk to:

other managers or supervisors;

• national or local drug misuse agencies (some of them are listed at the end of this booklet) for advice;
• the local business forum or health promotion unit to get an idea of what other businesses have done in your area. 

Remember, getting the support of your workforce for any change in company rules will be much easier if staff or their representatives have been involved.

 WHAT CAN I DO IF I SUSPECT AN EMPLOYEE HAS A DRUG PROBLEM?

Employees with a drug problem should have the same rights to confidentiality and support as they would if they had any other medical or psychological condition.  

What if they won’t admit that they have a problem?

It may be very difficult for people to admit to themselves or others that they have a drug problem. They may feel there is a stigma attached to drug misuse and they may well fear reprisals if they admit to taking illegal drugs. Whilst your freedom to act may be limited if it becomes clear that an employee has broken the law at work, you should let staff know that you will, as far as possible, treat drug misuse as a health issue rather than an immediate cause for dismissal or disciplinary action.

Should I dismiss them? Disciplinary action may be taken as a last resort. You could be judged (by an industrial tribunal) to have unfairly dismissed employees whose work problems are related to drug misuse if you have made no attempt to help them. However, you may need to temporarily move them to another job if their normal work is safety-critical.

 Should I allow them time off to get help?

The cost of recruiting and training a replacement may be greater than the cost of allowing someone time off to get expert help.

 Who else can help them?

If one of your employees is misusing drugs, you should encourage them to seek help from your organisation’s occupational physician or nurse (if you have one), their GP or a specialist drug agency.  

In taking action, you need to ensure that you have the support of other managers and gain the support of your employees. When you have gathered together your information and consulted relevant people you will be ready to take action.  

Step 3 – Taking Action  

Implement your agreed policy on drug misuse.

BOX 3 KEY ELEMENTS OF A POLICY ON DRUG MISUSE

A model workplace policy on drug misuse may cover the following: 

Aims

A statement on why the policy exists and who it applies to.

(Note: the policy must be seen to apply equally to all staff,including managers, and types of work.)

 Responsibility

Who is responsible for carrying out the policy.

(Note: all managers and supervisors will be responsible in some way, but it will be more effective if a senior employee is named as having overall responsibility.)

Definition

A definition of drug/substance* misuse.

The rules

How your organisation expects employees to behave to ensure that drug misuse does not have a detrimental effect on their work.

• Solvents at work can be misused.

Safeguards  

Statements which make it clear that:

• absence for treatment and rehabilitation will be regarded as normal sickness;
• you recognise that relapses may occur;
• the policy will be monitored and reviewed regularly in consultation with workplace representatives.

Confidentiality

A statement assuring employees that a drug problem will be treated in strict confidence, subject to the provisions of the law.  

Help

A description of the support available to employees who have a drug problem. (Note: this might include local advisory services.)

A statement encouraging those with a drug problem to seek help voluntarily.

 Information

A commitment to providing employees with general information about the effects of drugs on health and safety.  

Disciplinary action

The circumstances in which disciplinary action will be taken. You mig h t :

• explain that if help is refused and/or impaired performance continues disciplinary action is likely;
• explain that dismissal action may be taken in cases of gross misconduct;
• state that possession/dealing will be reported immediately to the police and that there is no alternative to this procedure.  

Step 4 – Checking what you have done

You should regularly check to see if the policy is working and whether any changes need to be made. You may need to look again at the aspects set out in Step 1 and see if the situation has changed, eg has sickness absence or the number of accidents altered? You might also want to check whether your employees are still sufficiently aware of the issue of drug misuse and its consequences.  

DRUG SCREENING AND TESTING

Drug screening or testing is a sensitive issue because of the many employment implications involved. Securing the agreement of the workforce to the principle of screening is essential (except in cases of pre-employment testing), partly because of the practical and legal issues involved. These might include:

• How much will a screening system cost?
• What type of testing is needed?
• How will test samples be collected?
• How will test samples be kept secure to ensure they cannot be tampered with?

? What action will be taken if a positive result is given?  

Screening can be used in various ways, for example:

• as part of a selection process for job applicants;
• testing all or part of the workforce routinely, occasionally or on a random basis;
• in specific circumstances, such as after an accident or incident or as part of an aftercare rehabilitation programme.  

More organisations – particularly those in safety-sensitive industries -are using screening and testing as a way of controlling drug problems. There may be a case for considering the introduction of screening, particularly in certain critical jobs (eg staff who have responsibility for making safety-critical decisions such as drivers, pilots and some machinery operators) in which impairment due to drugs could have disastrous effects for the individual, colleagues, members of the public and the environment.

Screening is only likely to be acceptable if it can be seen to be part of an organisation’s occupational health policy and is clearly designed to prevent risks to the misuser and others.

Screening by itself will never be the complete answer to problems caused by drug misuse and its results must always be supplemented by a professional assessment of the employee. Prevention is just as important and the guidance set out earlier in the booklet is relevant to all businesses, whether screening is introduced or not.

Laboratories that are accredited by the United Kingdom Accreditation Service (UKAS) will have satisfied assessors that they provide a service that meets all testing criteria.  

The Scottish Government has released a statement saying that the rise was due to a rise in administration costs rather than an increase in the overall number of users. The latest figures from 2007 show that there were 21,00 methadone users in the country specifically using the drug to get off of heroin. Statisticians only count the number of prescriptions being written, which rose from 90 per 1,000 head of population in 2005-06 to 98 per 1,000 head of population in 2009-10. In 2009-10, a total of 10,325 people sought addiction treatment in Scotland, with two thirds of them seeking help for heroin addiction. 750 people sought help for Cocaine addiction in the same time period.

Another, separate, report has been released by the Information and Statistics Division on the time it takes to receive treatment once presenting to their doctor. The results were pleasing, showing that three quarters of people attempting to access treatment were seen by a specialist within a fortnight. This is an improvement and should do to dampen the protests heard recently in local government that patients were often having to wait over a month. Communities Minister (SNP) Fergus Ewing: “We all know that Scotland has a historical and very distressing problem with drug abuse… …I am convinced that we are following a path that will get people off drugs and into recovery… …Since 2008, we have invested a record £81 million in local drug treatment services to enable them to help make that possible”.

The move was particularly aimed at the drink Four Loko, a favourite of American students. The fruit flavoured drink comes in a can at ABV 12%. The caffeine content of a single can (694ml, approximately the size of a standard lager can in the UK) is the same as a large store bought coffee. Attitudes to the drink differ; while some say that it is quite tasty and can make the drinker feel good, others describe it as a “blackout in a can”, blaming it for landing many consumers in the A&E. The FDA wants Four Loko and it’s peers, such names as Joose and Core El Jefe, off the shelves by today, the 13th December. It is not the first time that caffeine mixed alcoholic beverages have courted controversy in the States. Four Loko was banned in the entire State of Washington after being blamed for a series of hospital admissions – including nine students from Central Washington University in one month.

One student from another college described his friend as having ‘no motor skills and no ability to communicate’ after just three drinks. The drinks advertising is aimed primarily at young people. It is cheap and readily available which is criticised as being irresponsibly targeted at ‘inexperienced drinkers’. Washington State Attorney General, Rob McKenna: “…they have such high levels of stimulants that people have no idea how inebriated they are.” A University of Florida survey of over 800 students found that those that had drunk a mixture of caffeine and alcohol over the night were three times more likely to leave the bar highly intoxicated (possibly the desired effect), but four times more likely to want to drive while intoxicated (dangerous side effect?)

Also, the depressive aspect of the alcohol, one of it’s self-regulators, is masked by the stimulant effect of the caffeine. This means that drinkers want to drink for longer because they are in effect ‘high’, and therefore consume massive amounts of alcohol. This can in turn lead to problems like sickness, alcohol poisoning or hospitalisation and become the base for the long term drinking problems of addiction, abuse and dependency. The new stance on caffeine laced alcoholic drinks is also taking root in Scotland, where the Tonic Wine, Buckfast, has been repeatedly linked to violence and other anti-social behaviour because those that drink it simply cannot stop. In a statement defending the drink the manufacturers, Phusion Projects, said: “If it were unsafe, popular drinks like rum and colas or Irish coffees that have been consumed safely and responsibly for years would face the same scrutiny that our products have recently faced.”