Wednesday, December 19, 2018

#4 of 43 Reasonable Suspicion Signs and Symptoms: The Employee Shows Is Tremulous and Shaking

The alcoholic employee who is in withdrawal, but still at work with a positive blood alcohol level or one that is dropping fast or at zero, may be tremulous. Alcoholics are addicted to ethanol.

Alcoholism is a disease..a physical illness. This disease is hereditary, and addiction to alcohol is not planned, forced, or accidental from careless drinking. It is biogenic because of susceptibility to sedative drug addiction. 

Over time, cells within the body of the alcoholic become accustomed to the efficient at using ETOH as a preferred fuel source. Alcohol is pure calories and water soluble, but with ZERO nutrients....This is a big problem. The cells of the body actually become toxic and start to wall off nutrients as the permit alcohol to pass their membrane to nourish them with energy. Unfortunately, the alcoholic become sick.

These employees may have craving that is so severe that the tremulousness become violent shaking. Employees who enter DTs (delirium tremens)  typically have been shaking violently before they enter this delusional state of mind.

As blood alcohol level drops, an increase in anxiety, nervousness, agitation, and augmented emotions become noticeable. These employees may fly off the handle easily, have anger management issues, or behave explosively.

Tremulousness in the fingers is not necessarily a symptom of alcohol intoxication or withdrawal of course, but let's discuss it. There are differences that distinguish alcohol withdrawal from other neurological conditions. The most important difference is usually age. Not too many 45 year old men have Parkinson's Disease. Also, employees with Parkinson's are typically not keeping it a secret.

Let's also discuss how you should respond as a supervisor and document what you see, despite the fact that shaking could be caused by anything from food poisoning from egg foo yung (happened to me) to Parkinson's Disease.

If you are a DOT Supervisor overseeing an alcoholic mechanic or are an office manager supervising a typist, tremulousness from withdrawal may interfere with fine motor skills and the ability to perform one's work. This is an embarrassing and upsetting condition. The alcoholic is aware that you notice, but denial is a useful defense mechanism at times like these.

Tremulousness is cured by raising the BAC with a drink. Until this point in time, you will the agitation get worse. Employees may leave the job site to consume alcohol and skip out work early.

When you document tremulousness, the language in your documentation should look something like this, "The employee appeared unable to keep her fingers from shaking on the keyboard. This interfered with productivity by making her typing slower and difficult.

Notice the quantifiable documentation above. Many DOT Reasonable Suspicion Training Courses do not discuss how to create documentation effectively although they may discuss drug and alcohol awareness education. Sorry, but education alone won't cut it.

If you see tremulousness, recognize it as a potential sign that the employees drunk. You can see a description of tolerance in part of our video that I posted on YouTube that will you will also see in the DOT Reasonable Suspicion Training Program

Non-DOT one-hour drug and alcohol training for supervisors can be seen in full here.

Monday, December 17, 2018

#3 of 43: DOT Reasonable Suspicion Training - Alcohol on the Breath

Reasonable suspicion training includes the examination of signs and symptoms that are
obviously well known and no-brainers. One of them is alcohol on the breath.

Don't be fooled, however. Alcohol on the breath can be on of the more difficult signs and symptoms to confront. It sounds cut and dry and simple enough, but this symptom has some tricky angles to it.

Did you know that in most workplaces in the the UK, alcohol on the breath cannot be used as a justification for a alcohol testing? Hint: The rate of alcoholism among white males in the UK is enormous compared to their counterparts in the USA.

Can you see why reasonable suspicion testing laws in the United Kingdom might prohibit requiring a urine screen solely become of alcohol on the breath? (Sorry, not sure about airline pilots and train engineers in the UK--but I hope they made an exception to this law  for some occupations. Now let's dive into alcohol on the breath a little bit more.

Companies like to brag about their "zero-tolerance" policies concerning using drugs and alcohol on the job. But regarding alcohol, what does "use of alcohol" on the job mean -- drinking it openly or having it in your  body spiking your BAC? It is important to get clarity on this subject because I have seen enormous confusion that results from reasonable suspicion training when people began asking questions like this in the Q and A session at the end of a DOT PowerPoint Training presentation.

In one training session I did, a discussion arose about whether it was against county government policy to use alcohol at lunch? The policy had no reference to this, but they can't control private alcohol consumption at lunch off the job site. But here's the problem. People come back from lunch after drinking. Some show symptoms -- those with low tolerance and some show none -- those with high tolerance. The high tolerance individuals are more likely drunk.

But then what does drunk mean? Alcohol on the breath? Staggering? Slurring one's words? The drug and alcohol policy may be a zero tolerance policy, but it does not add up.

Many alcoholics in the middle and later stages can be drunk at work and appear normal. They may have a breath smell of alcohol, however. How does the policy of the company deal with this issue? This takes some real thought.

The county government policy stated that employees cannot consume alcohol at work, but its policy fell apart when employees when to lunch and drank. Employees who returned to work with alcohol on their breath were suddenly in violation of the policy, but they had not drank alcohol at work.

One hospital I worked for wrote in their drug and alcohol policy that employees could not consume alcohol during the workday at all nor at any time. Guess who decided to direct the hospital to not include them in the policy -- all the doctors. They wanted to drink during the work day. And the hospital signed off on it.

We have an important section in's Reasonable Suspicion Training program for DOT. It includes a thorough discussion about alcohol, alcohol abuse, and alcoholism.
You can preview the full program here.

So, what about employees who come to work at 11 p.m. to work until 7 or 8 a.m. Does alcohol on the breath mean the same thing for these workers as those who arrive at 7 a.m. to work until 3 p.m. or 4 p.m.? Are you beginning to see how complicated this can get?

Obviously there is plenty to discuss with regard to this sign or symptom. And I will continue this discussion in a second part momentarily.

The Federal Transportation Administration says that signs and symptoms must be articulable and contemporaneous -- use this language in your policy. However, be sure educate thoroughly on signs and symptoms.

But It's Medicine

 You're going to hear this excuse someday: "But it's medicine." Easy answer: "And?"

If it smells like alcohol, even it is medicine, the reasonable suspicion test is warranted. This is articulatable and contemporaneous enough to document. What the employee says you are actually smelling is not part of your decision-making process regarding a decision to test.

Purchase DOT Reasonable Suspicion Training for one person or your entire company at this link - prices vary based on format.

Saturday, December 8, 2018

#2 of 43 Signs and Symptoms for Reasonable Suspicion Training: Difficulty Maintaining Balance

Employees who are "drunk" may appear to have difficulty balancing. This symptom brings to mind the classic stumbling over a chair or when the drunk person stands up, they begin to keel over and everyone reaches to prevent their falling. Snatching the car keys comes next, hopefully. 

Don't be fooled however. Employees who are alcoholic at an office party on New Year's Eve usually will not have any trouble balancing even if they have been drinking all night. In fact, they may be able to drink more than most other employees at the party. Those employees who are losing their balance at a party following heavy drinking are mostly likely not alcoholic, but of course you can't make this diagnosis. The lack of imbalance after heavy drinking is of course explained by drug tolerance. 

The employee's ability to drink and not signs or symptoms can be an adaptive stage of the illness or proof that the body has grown accustomed to the presence of alcohol in the nervous system which no longer cause nerves cells to be anesthetized. 

This is a dangerous sign or symptom of reasonable suspicion, but its absence requires the supervisor to be on guard. You simply are not going to see all the classic signs and symptoms of intoxication that your read or near about. 

Take a look at this chart, and click on it to enlarge it for the following discussion.

Look how alcoholic employees perform. Do you see the pattern that is being described? Employees with severe alcoholism may also be your most valuable workers. May CEOs of companies are alcoholics just like there a many janitors who are also alcoholic. Tolerance is key to explaining why some employee do not lose their balance after drinking heavily.

Some employees you see at social functions my feel less inhibited about drinking heavily at say a holiday party, and over-drinking at such events will cause social drinkers, alcoholics, and alcohol abusers to over-drink to the point of intoxication. This is also a good reason to limit drinking at holiday parties or forego alcohol altogether because of the liability involved in alcohol-related incidents.

Since we are talking about DOT Reasonable Suspicion Training, be sure to write notes about what you see when an employee is losing their balance after drinking.  Record what, when, and the circumstances involved.

Friday, November 2, 2018

43 Signs and Symptoms of Substance Abuse Explained for DOT Supervisors: Staggering and Stumbling at Work (1 of 43)

Staggering and stumbling is human behavior that demonstrates loss of control for some reason and associated
Reasonable Suspicion Training stumbling and staggering as s symptom in DOT
with one's psycho-motor skills. When we think of loss of control, we conjure up engines of tripping over objects, a disheveled look, or other behavior or appearance associated with being under the influence.

Remember however that you can say someone is under the influence, indeed staggering and stumbling could result from many other causes include a stroke, heart attack, or other syndrome associated with the brain and balance.

Staggering and stumbling in the workplace can be a classic symbol of drunkenness or being under the influence of a substance, but you will seldom if ever see an employee in the workplace in this condition as if they are on alley in a Hollywood move scream Stella in the rain.

And there are two reasons why loss of psycho-motor skills is likely to be so severe that it becomes obvious. The first is that most people aren't stupid enough to get so drunk at work that they will actually lose control and stumble--that is, normal social drinkers who know their limits from past drinking experiences, and know the consequences of consuming too much alcohol.

The second reason that you are unlikely is that alcoholics will have such high tolerance to alcohol, that they do not lose control of their psycho-motor functions. An alcoholic in middle stages of the disease can easily leave a building go to lunch, and be so drunk that the average person would stumble down the hallway. However, because tolerance and its increasing capacity is so pronounced with alcoholics, that they will not appear drunk at all.

Wednesday, October 24, 2018

Signs and Symptoms of Drug Using, Alcoholic, or Bombed Employees: Let's Discuss Them

Let's talk about the signs and symptoms of drug using, alcoholic, and bombed employees. Within the scope of this post's title is a lot to discuss, but let's start with some general issues. 

Signs and symptoms may be more complex than they first appear.

Many are impossible to observe unless you are a drug addiction treatment expert, and many that are obvious -- like needle tracks and blood under a white long sleeved shirt--you will never see in a million years.

Not all needle users shoot a hypo in their arm in the same place the nurse draws your blood. Addicts can shoot up anywhere on their body, including the soles of their feet. A high is more important than pain. And there are other places they also use and shoot...but will forgo a discussion about them.

So you see, signs and symptoms require a bit of discussion. Such discussions are critical because all supervisors need the information if they are ever going to spot an at-risk employee.

That is the name of the game--spot the risk and intervene with the proper management tools so you find the truck driver who is going to blow through an intersection and wipe out a bunch people. A short discussion about symptoms allows the supervisor to grasp the true nature of drug use in the workplace.

If you think you are going to spot drug addicts actively using on the job by walking into one in the bathroom, and pushing open the wrong stall door, think again.

The way you prepare to spot signs and symptoms is by engaging frequently with your employees. That's it--getting to know them. You develop relationships with them, and over time develop a sixth sense for when something is wacko or wrong. Then you act.

A word of caution about signs and symptoms. Don't try to determine what kind of drug addict or alcoholic is working in your company. Simply focus on job performance, attendance, quality of work, availability, attitude, conduct, and other behavior. You will go much further.

The employee you refer to an EAP (you do have one right!?!?!) with very stubborn performance problems associated with attendance or disappearing on the job will be an addict about 40-50% of the time. And you will have no idea that was the nature of the performance problem. With this introduction, we will dive into the individual symptoms in the next post. See you then. If you need DOT 2-hour drug and alcohol awareness training for yourself or your company, click here or click picture on the far right of the blog. Talk to you soon.

DOT supervisor training understanding performance measures

Friday, October 5, 2018

Make Sure DOT Drug and Alcohol Training for Supervisors Includes the New Opioid's Addendum

The U.S. Department of Transportation has a new mandatory requirement for drug and alcohol awareness. They want four important opioids mentioned in the education of supervisors.
This new requirement is because the U.S. Department of Health and Human Services
new opioids needed in training of supervisors image
revised the Mandatory Guidelines for Federal Workplace Drug Testing Programs. 

As a result, expanded federal urine workplace drug testing now includes four Schedule II drugs:
and Oxymorphone.  

Each one is used for pain management depending on the needs of the patient or circumstances.

We've included this additional information in the Web Course, PowerPoint, DVD, and Web Video programs.

You can preview the full unabridged complete program for DOT supervisors here.

Tuesday, August 7, 2018

DOT Supervisor Training: Don't Let Supervisor Sabotage Treatment

Reasonable suspicion training is designed to save lives and prevent losses, but supervisors often undermine
Reasonable Suspicion Training
their own role in a drug free workplace after being educated and successfully identifying substance abusing workers who are subsequently referred to treatment for addictive disease. What's going on?
After an employee returns from treatment, the risk is high that relapse will occur. However, most people—and I would  say even some addiction treatment professionals—do not understand the hair-trigger mentality of the recovering patient (employee) and the strong desire they may have to drink or use drugs again. What's missing is an excuse to do so, and one that be rationalized. Who better than to supply this than authority figure like a supervisor.

Alcoholics are magnets for enablers. They love enablers because these individuals can facilitate and support the addicts ready-on-deck and willing to drink or drug fragile state. Without defense mechanism helping the addict to feel less guilt, the alcohol or addict cannot satisfy their desire to use. Unless you understand enabling and its dynamics, the chances of your playing an unwitting role in relapse is high because the addict will consciously or unconsciously signal you to play along, be provocative, or same something inappropriate that will be latched on to as a doorway to facilitate relapse.

The language and behavior of addicts and alcoholics is riddled with defense mechanism dynamics. They are extremely subtle, and often unconscious. Although your psychology 101 class in college may not have more than a a few, there are actually over 40 defense mechanisms exist. You may have heard of denial or rationalizing, perhaps projection and suppression, but there are dozens more. Most escape awareness.

They key point is that supervisors and family members are sitting ducks for being re-hooked into a pathological communication dynamic with employees who have been in treatment because of the alcoholic or addict’s efficient use of their defense mechanisms.
Reasonable Suspicion Training
An example of this subtle and pathological communication and the undermining dynamic is illustrated in the following example:
An employee comes back to work from alcoholism treatment at a local hospital after a positive test that led to his identification, referral to testing, and subsequent treatment.

After a week on the job, the employee appears tired and mentions to the supervisor, “Boy, keeping up with everything the EAP wants me to do, handling this workload, and also going to AA meetings five nights a week is about to kill me.”

What you would say if an employee made such statements? The best answer is to "try harder. You have a lot of responsibilities." Something...anything that does not "buy off the employee" is what your reaction should be. After training in DOT Supervisor Training or Reasonable Suspicion Training, will you sabotage what you learned?

It is unlikely in the moment or within the context of what’s been said, that you would see the relapse bear trap in front of you. However, you are about to spring  it.

Compassion and empathy are the tools for killing addicts. Addicts will manipulate to have you feel sorry for their situation, but more importantly, give them permission to do something less strenuous than the recovery program that has been assigned to them by the treatment provider. Compassion and sympathy are traps. To act on these heart strings is called “killing the addict with kindness.” What's need is tough love. That's what go the addict into treatment in the first place.

If you are a compassionate sort of person, you may fall for this manipulation being described above. The response desired by your employee would be something highly sabotaging like this: “Wow, that’s a lot Jim. Five meetings a week! I hope you aren’t overdoing it. Work-life balance is also important. Will the treatment program let you take a night off from AA? Maybe your should ask."

You have just been suckered.

You have enabled the employee, sprung the trap, helped blow this employee’s recovery program. “Wait you’d say, I didn’t say or do a damn thing! The employee is responsible for their own decisions!”

You’re right, they are. No one is going to blame you for his lack of follow through or subsequent relapse, but here is what’s going to happen: The employee will rationalize a night off from AA after this discussion when they go home. And one night off leads to more. A more leads to all. And all leads to risk. And risk leads to an event. And that event causes a drink.

When you step into an employee’s personal problems, no matter how subtle, you help the employee step away from what is difficult, which is following the instructions. Addicts, like diabetics, who don't follow instructions relapse.

Your statement of empathy and concern has greased the skids for the full blown rationalization of skipping out on a meeting. Relapse is now only a matter of weeks or months at most.