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.

Thursday, July 12, 2018

DOT Supervisor Training---Is Fentanyl Abuse a Concern for Management?

Unless you’ve been living under a rock, you are aware that the United States is in the midst of an unprecedented opioid crisis.

Pain medications like hydrocodone have long been the focus of news, but a much stronger version of the pain killer, fentanyl, has begun stealing the spotlight. It’s important for supervisors to be informed about his drug, because lives of unsuspecting employees could be at stake if fentanyl is in your workplace.
Fentanyl is a prescription pain killer that’s 50 to 100 times more potent than morphine. It’s most often used for post-surgical pain and extreme chronic pain. When prescribed by a doctor, it’s taken as a lozenge, injection or a patch. However, illicit drug manufacturers have made fentanyl a street drug. Street fentanyl can be ingested as a tablet or blotter paper, or snorted as a powder.

The problem with fentanyl is that overdose risk is very high, not only for the drug user, but for anyone who comes in contact with it. First responders have overdosed on fentanyl simply by having some of the powder rub off their skin. Without a quick dose of naloxone, a drug that reverses fentanyl’s affects on the respiratory system, people exposed to it can die.

A recent report from the Centers for Disease Control and Prevention stated that between July 2016 and September 2017, opioid overdoses rose 30 percent in the U.S. Although this statistic includes all opioids, including heroin, it shows that the epidemic is getting worse.
Tougher prescribing guidelines for opioids have driven some addicts to the street to get pain relief or a high. It’s more difficult to judge the strength of street fentanyl, making overdose risk very high.

Unless you’ve had recent DOT supervisor training or reasonable suspicion training, you may not be aware of symptoms related to fentanyl abuse. Watch our for employees who seem very lethargic, suffer mood swings or seem to be packing on the pounds. Fentanyl abusers also can hallucinate or have abnormal thoughts. Employees complaining of pounding in the ears, chest tightness or a rapid heartbeat could be on fentanyl.

If you suspect an employee is abusing fentanyl, be very cautious touching his clothing or belongings. Make sure that employees know to avoid touching or inhaling any powdery substance that they encounter.

If an employee stops breathing, call 911 immediately. Fentanyl affects receptors in the brain linked to respiration, and an overdose usually involves respiratory arrest or distress. Follow the 911 operator’s instructions until help arrives.

For DOT Reasonable Suspicion Training, visit

Thursday, April 12, 2018

Relationships with Problem Drinkers

If one of your employees is in a relationship with a problem drinker, they may have behavioral symptoms that could lead you to believe that they--themselves--have a drug or alcohol problem! These employees in relationships with addicts slowly acquire problematic ways of managing communications, social interactions, behaviors, and uncertainties that create conflict with those around them. These are normal responses to addiction-affected relationships. As the disease advances and they may find yourself having to manage these things more often and experiencing emotional stress, creating health issues that contribute to absenteeism. They may have physical symptoms like stomach problems, depression, and sleep problems. If you are a DOT Supervisor, talk to a counselor or your EAP if your company has one, and things appear confusing. A professional will help decide what's going one and suggest options for you to consider. DOT Reasonable Suspicion Supervisor Training for Drug and Alcohol Awareness can be found here.

Monday, April 9, 2018

Federal Railway Administration Post-Accident Drug Testing Training Now Mandatory for 60 Minutes

The Federal Railway Administration now mandates post-accident testing training for supervisors.

This is pretty complex stuff, but all supervisors on railroads and related contractors must be trained. Not to worry. When you purchase our FRA Post Accident Training, you will get the complete Web Course that you keep and  own and install on your own company server. Supervisors can return any time to review the details, even after an accident.

Location of the Training Link:
The program to assist railroads and contractors in meeting mandatory training requirements for the U.S. Federal Railway Administration post-accident training for supervisors is now available at here. These are supervisors who are responsible for regulated service employees per Part 219.11 (g). Specifically, the requirement is to provide training on the qualifying criteria for FRA post-accident testing, and the role of the supervisor in post-accident collections.

Training above is in addition to the one hour of drugs of abuse education and awareness and the one hour of alcohol misuse education and awareness that has been around for quite a while. This makes training for Railway supervisors three hours, instead of two.

This training mandatory and regulated by the U.S Federal Railway Administration as authorized and required under Part 219, Subpart C Testing Requirements.

Background of this Requirement
In 1985, to further its accident investigation program, FRA began conducting alcohol and drug tests on railroad employees who had been involved in serious train accidents that met its specified criteria for post-accident testing (see 49 CFR 219.201). Since the program’s inception, FRA has routinely conducted post-accident tests for alcohol and for certain drugs classified by the Drug Enforcement Administration (DEA) as controlled substances because of their potential for abuse or addiction.

What's Covered in the Program

+ History of railroad accidents and rationale for drug testing
+ Understanding the contents of "Tox Boxes" - the materials
+ Qualifying and non-qualifying events for post-accident drug testing
+ Flow chart representing to successful Post Accident Testing action steps
+ Evacuation to prevent exposures
+ Definition of impact accidents
+ Which crew members to have tested
+ Other regulated employees to test for five qualifying events
+ Refusal to test issues, questions, actions
+ Recalling employees who must be tested
+ Review of Toxicology Boxes, contents, and purpose
+ Paperwork associated with post-accident testing
+ Timely collection
+ Medical treatment priority over testing
+ Where to collect urine specimens in odd situations
+ Sealing and transporting, managing and shipping toxicology specimens
+ Death and post-mortum testing
+ Resources
+ Contacts an the U.S. Railway Administration for Questions
+ Test Questions
+ Handouts
+ Certificate Printable
Discussion of Required Training

We discuss the circumstances associated with different accidents like major train accidents where testing is required; what happens when there is a fatality; impact accidents, fatal train incidents, passenger train accidents, human-factor highway-rail grade crossing accidents and incidents and how drug testing relates to these events. 

We cover the issues associated with the use of “Tox Boxes”;what a regulated employee is; exceptions to training under a multitude of circumstances; responding to incidents; how to obtain specimens; roles and responsibilities; penalties for refusal to test; communications; shipping specimens; how to decide if an employee or employees need to be tested; responsibilities of railroads and employees; requirement by employees to participate in testing; testing of fatalities; time frames within which testing must occur; who must be tested for what; timely specimen collection; breath testing issues; recalling employees for testing after a qualifying event; status of injured employees and post-accident testing; place of specimen collections; consent to be tested is implied for all employees, and no special permission is required; obtaining cooperation of a facility for the purpose of testing; the role of the National Response Center and reporting employees who refuse testing; specimen collection and handling; handling of specimens; forms and proper completion; shipping specimens; FRA access to breath test results; mandatory testing and specimen collection from fatalities; notification of authorities and coroners and medical examiners;

Monday, April 2, 2018

Reasonable Suspicion Training for DOT Supervisor Drug and Alcohol Awareness Education for Mandatory Compliance for the Drug Free Workplace

Observing employees on the job and spotting the signs and symptoms of possible
Stumbling is a documentable behavior if done correctly

impairment that could result from use of alcohol or other drugs is a legitimate concern of business.

A reasonable suspicion checklist that includes a comprehensive listing of possible warning signs and symptoms can help you decide whether to act in accordance with your organization’s reasonable suspicion testing and drug-free workplace policy.

It can also aid you in constructing documentation that is effective and useful. But a list is only half the help you need. The rest is a comprehensive discussion of what all these signs and symptom mean, how to document them properly, what your own myths and misconceptions are about addiction and substance abuse, sub-questions to consider in gathering information, and adopting a mindset that will help you assemble documentation that useful for its administrative purposes, whatever those might be.

When can reasonable suspicion be substantiated? Reasonable suspicion that an employee is using alcohol or other drugs exists when “specific, contemporaneous, “articulable” (able to clearly describe and quantify with senses) observations concerning the appearance, behavior, speech, or body odors of the employee demonstrate the possible use of substances.”

Let’s Hit Every Sign and Symptom from a Checklist for DOT Reasonable Suspicion Training

Employee stumbles and staggers….

When employees stumble or stagger, such a condition represents an unusual level of intoxication resulting from the use of psychoactive substances that also affect psychomotor skills. But not so fast! Most DOT supervisors might think that this is an alcoholic symptom. Most alcoholics on the job never drink so much that the stumble. Because their tolerance is so high, they can drink the amount of alcohol that would cause a non-alcoholic to stumble.

When it comes to an employee who is drunk and stumbling, typically they will be young men who have been drinking alcohol at some social event, party, or reunion. Such a person needs referral, but in most cases—in my experience—these are alcohol assessment and alcohol/drug education referrals, not treatment referrals.

Many alcoholics or drug addicted person can consume psychoactive substances that affect mood and visual or auditory senses, but addicts who have consumed enough of substance that even tolerance does not prevent them from being spotted, is indeed remarkable. Most substance abusing employees do not want to stagger, so doing so means they are out of control.

When your employee stumbles should be recorded. Also record what he or she was doing at the time of observing the stumbling. Also record where they were when the stumbling and staggering occurred, and how you were able to see this behavioral symptom happen. 

Sunday, March 25, 2018

DOT Supervisor Training: Handling Hangovers at Work

It happens to most people some of the time. We have a little too much to drink and wake up
DOT Truck Driver is hung over
feeling foggy, achy and sluggish. Some have pounding head, others throw up all morning. But is a hung-over employee something to worry about? It depends. It all boils down to productivity, workplace disruption, and patterns of frequency, impact on coworkers, and more.

The problem is, it’s difficult to say if someone with a hangover is a safety risk. Although researchers know that coordination, decision-making and memory can be affected by abusing alcohol, it’s unclear how long these effects last. It depends on body weight, amount consumed, and whether the liver of the drinker is working optimally.

There are so many variables at play: the amount of alcohol consumed, the gender of the drinker, the drinker’s weight, the time of the last drink and more. Some people experiencing a hangover may have alcohol in their system because their liver is diseased, meaning that it works slower. This means that alcohol will hang around in the system longer.
Even managers with reasonable suspicion training may not know all the symptoms of a hangover. They include:

  • ·         Difficulty concentrating
  • ·         Trembling hands
  • ·         Sensitivity to light and noise
  • ·         Irritability
  • ·         Nausea or vomiting
  • ·         Clammy skin
  • ·         Sluggishness
  • ·         Slurred speech
  • ·         Faint smell of alcohol on skin and maybe breath
  • ·         Headache

DOT Supervisor Training
If you suspect an employee is hung-over, first refer to the company’s alcohol and drug policy. Do not let the employee with a DOT regulated position climb behind the wheel of a vehicle.

Different organizations handle hangovers differently or not all. What you do next depends on how well you know the employee and how frequently he comes to work hung-over. Safety and security are important, so consult with your supervisor to determine what your next move should be. Most employees who are hung-over will not be noticeable to those around them.

An occasional hangover may result in a less than stellar performance from the employee for a day. However, if every Monday the worker arrives at work hung-over, there’s a problem. Employees sometimes believe that anything they do on their own time is their business, but with a considerable number of hangovers the worker isn’t living up to his potential on the job.

Not only is production an issue, frequent hangovers may also indicate that truck drivers or other transportation employees may be drinking on the job, too. A little bit of “the hair of the dog” may help with shaking hands or other hangover symptoms, but it’s not conducive to a safe and happy work environment.

Long-term employees who show up on a Friday morning moving slowly after a big game the night before may not be a problem. Depending on how he feels, you may suggest he go home and sleep it off. However, problem drinking can develop at any age, so keep an eye on the occasional hangover, too. DOT Supervisor Training teaches managers to avoid letting employees drive who appear under the influence, but a hangover is evidence of recent alcohol consumption, so sending an employee for a reasonable suspicion drug test is a legitimate management decision.

Employee assistance programs are essential in getting help for workers who may have a drinking problem. Suggest the EAP if an employee seems to be struggling with any kind of addiction. 

Monday, March 5, 2018

Six Ways to Sabotage Your Employee's Recovery

Six Ways to Sabotage Your Employee's Recovery: DOT Supervisor Training tips for managers to help them avoid practicing behavior or initiating discussions with recovering addicts that will sabotage their addiction recovery program

Friday, February 16, 2018

DOT Supervisors: Are Your Addicted Employees Gaslighting You?

Use a checklist with quantifiable signs and symptoms DOT supervisors Training
Have you heard the term "Gas-lighting?"

One of the most effective manipulations that addicts use is called gaslighting. Named after a popular film in the 1940s, gas-lighting refers to someone convincing you that your perceptions, thoughts and memories are incorrect. Abusive spouses do this to domestic abuse victims. And, it is a classic defense used by employees when supervisors do not document effectively, yet attempt to confront them about past job performance problems issues conduct or attendance issues.

Children are famous gas-lighting when confronted about behavioral problems by parents. Adults can be no different, so in DOT Supervisor Training, it makes sense to spend a few minutes on this commonly used defense. The idea is to impress supervisors with the need to use documentation in supervising employees. Any drug and alcohol training program you develop internally or purchase (like the one at should have a solid checklist of quantifiable performance indicators.

Back to the 1940's movie where gas-lighting was made popular. In the movie, a woman is convinced that she is mentally ill by constant lies that her experience of the world around her is faulty.

How do you know your employees are gaslighting you? Here are the top three manipulations to detect:

  • 1.      Obvious lies. Your worker tells you one thing and then tells you the opposite a couple of days later. You begin to wonder if you heard correctly the first time.

  • 2.      Saying one thing and doing another. Addicts tell you what you want to hear and then do whatever they want. They’ll try to convince you this isn’t true.

  • 3.      They personally attack you when you confront them about their lies. They’ll call you crazy or accuse you of lying
  • 4.    Finding others nearby who will be unable to verify the truth, but the active asking a stander's by makes it appear that an alibi obviously exists somewhere.

You need an approach to this disturbing behavior. What do you do if an employee with drug or alcohol addiction is gaslighting you?

  • Do not place your focus on prior incidents. Right now you have reasonable suspicion. Stick with that, and document it.

Good reasonable suspicion training and DOT supervisor training will address issues around gaslighting. Knowledge is power in this situation. This handout in particular is highly recommended, and it's reproducible.

  • Write everything down. If you commit your perceptions to paper, you have proof, at least for yourself, what you said and did. But this documentation will always be considered as strong evidence that you have no axe to grind and are documenting effectively.
  • Recording your interactions also helps you connect with your intuition. Gaslighting, especially over time, teaches you to not trust your instincts. Remember our example of an abused spouse? They also begin to doubt their own sanity, and you will also begin to doubt yourself. A written record will help you regain confidence in your gut feelings.

If you are confused about whether your perceptions are accurate, run them by someone you trust, confidentially of course and without using names of employees you supervise. Your spouse, a longtime friend or a therapist can help you sort out what is true about yourself and your actions, and what isn’t. This is not rocket science. What it takes is objectivity.

Gaslighting makes you doubt yourself and may even be frightening. Take these concerns to the people you love and trust and allow them to help you become grounded in the truth again.

Have others present when you confront the addict who regularly attempts to gaslight you. When someone is attempting to gaslight, there’s safety in groups. Having someone from HR or another supervisor will help you identify inconsistencies in the worker’s story as well as a witness who can collaborate statements made earlier in the conversation.

Addicts who attempt to gaslight their supervisors have a good chance of talking their way out of a situation that calls for a referral to testing. With training and taking steps to combat this destructive behavior, you can make your organization a better place to work.

Get DOT supervisor training for reasonable suspicion of substance abuse.

#dot #dottraining

Tuesday, February 13, 2018

Top Seven Ways Employee Addicts Play Their Supervisors

You’ve finally got the goods on an employee who is coming to work drunk, and you appropriately confront him about his behavior. You may not know it, but you’ve just put yourself
You can be manipulated so stay attention in reasonable suspicion training
in the sights of a master manipulator.

Will you understand the disease of addiction properly or will you be hoodwinked by enabling?

Addicts are experts at pulling at your heartstrings, lack of self-confidence or your common sense. Through reasonable suspicion training, you’ll learn how to spot the following manipulative behaviors and techniques to stop them.

 “     But I haven’t had a drink since last night.” Your employee smells like a distillery, but he tries to convince you that you can’t trust your own perceptions. Point out what you are seeing, hearing and smelling.

 “    I thought we were friends.” Playing on your loyalty is a classic manipulation. Remind him that you’re his boss first. And even if you are his pal, true friends confront each other with bad behavior.

       “It’s medicine.” Even If bourbon was prescribed by a doctor (which it won’t), no one is allowed by policy to come to work with alcohol in their system. Keep hammering home his coming to work “medicated” is the problem.

        “You’ll ruin my career.” Addicts often take no responsibility for their actions by blaming others. They can’t perceive that their drinking may possibly ruin their career. His behavior has created your response.

 “    What you’re smelling is mouthwash.” Heck, it may be. But your employee may have used enough of it to get drunk. Many cold medications and mouthwash contain copious amounts of alcohol, and they can and will get someone drunk. It doesn’t matter whether your employee has been drinking mouthwash or champagne. It all causes the same behavior when it’s not used responsibly.

 “    Yes, I did drink, but I’m an alcoholic.” It may sound noble that your employee realizes he has a problem, but it’s important to remember it’s not an excuse for being intoxicated at work. The issues his condition cause in the workplace are the real problem.

“    Give me a pass this time. I’m going through something at home.” Again, the employee is blaming his wife leaving him, his father dying, his child not speaking to him, etc., for his drinking. Your giving him a pass isn’t going to the solve the problem: He’s drunk at work. 

Through DOT supervisory training, you will earn how to be assertive, firm and respectful when confronting an employee about coming to work impaired. It’s important to learn these skills, as well as de-escalation techniques, to keep your workplace safe and productive for your other employees.

Sunday, February 11, 2018

Inhalant Abuse Among Employees: Should DOT Supervisor Training for Reasonable Suspicion Include This Substance?

For some, getting high is as close as a can of spray paint or a few ounces of gasoline. Inhalant abuse, often called “huffing, or “sniffing,”” generates a quick high from breathing a variety of easy-to-acquire chemicals. From nail polish remover to solvent glue, some people will seek out this cheap and easy method to change the way they feel -- get high. But will it happen in the workplace? Or will you see its effects in an employee who has brain damage from the practice of huffing volatile chemicals? And is it important to put in DOT Supervisor Training.

Inhalant abuse was once thought to be prevalent among teens and young adults, especially those who lived in poverty. After all, things to sniff like gasoline and paint solvent are virtually everywhere.

Solvent glue, also called airplane glue, was one of the most common inhalant substances,

image of different types of inhalants useful for reasonable suspicion training class
along with spray paint. Lawmakers made it difficult for anyone under legal age to buy these items, which many believed solved the problem. But inhalant use has never gone away completely.

In reasonable suspicion training or DOT supervisor training, you will rarely hear anything about inhalant abuse for one reason--it is not required by the U.S. DOT. Is this a reason for supervisors not to have the information?

It is not one of the key drug categories for which the DOT requires education and awareness. However, some programs will mention it, and in my opinion they should because it only takes a few seconds to educate supervisors, and frankly, you may see evidence of inhalant abuse in some companies. Here is a video below that shares in a few minutes what inhalant abuse symptoms possibly exist in the workplace

566 teenagers trying inhalant abuse in order to get high EVERY DAY! (

Learn how important it is to be aware of inhalant abuse in the workplace. When speaking of abuse, we mean "symptoms of use" and actual use on the job. The former could be physical neurological deficits the origin of which are inhalant abuse.

Industries that require employees to frequently use paints or solvents are usually on the lookout for the signs: paint on an employees’ face, plastic bags that contain paint or solvent, or a strong smell that is out of place for its location in the workplace, to name a few. In these workplaces employees may gradually get addicted to the items they use constantly to do their jobs.

Here's a shocker: For children under 12 the most commonly abused substance after Alcohol, marijuana, and tobacco are inhalants! 13% of teens have tried  huffing inhalants.

In other industries people most likely to abuse inhalants are those who are attempting to stay away from street drugs. The guy trying to stay clean for a drug test may get desperate and alleviate his cravings through inhaling diesel fumes or a chemical used by your organization. Your company could be liable for accidents related to inhalant abuse, especially if the employee gets the means from your facility.

Be on the lookout for behavioral changes. Inhalant abusers can appear drunk, euphoric, drowsy or seem to be experiencing hallucinations. It’s important to address this type of abuse early because the effects can be devastating. Misuse of flammable inhalants could put your entire workplace in danger of fire or explosion. There are also the risks associated with inhalant abuse that you see with drugs and alcohol, such as on-the-job accidents.

Anyone who abuses inhalants set themselves up for serious illness and even death. Only one instance of abuse can lower the user’s oxygen level to deadly levels or disrupt heart rhythm. Long-term abuse can lead to organ failure and brain injury. Many of the substances used are known to cause cancer with long-term exposure.

Don’t let inhalant abuse fly under your radar. Receiving adequate training and passing it on to line supervisors can help your organization stay vigilant against this disturbing menace. Keep your workplace safe and healthy for all of your employees.

Preview in full the DOT Drug and Alcohol Training Program for Supervisors

#dottraining #inhalants - Learn more about teen drug abuse awareness and training

Tuesday, January 30, 2018

"Blackouts, and Excuses" in Reasonable Suspicion Training

Most supervisors in a reasonable suspicion training class would like to learn about drug and alcohol signs and symptoms and then hope to never use the material in any sort of incident. And who can blame therm. Confronting an intoxicated employee is not a pleasant experience, especially when they sit there arguing and getting belligerent. And employees can come up with incredible excuses to avoid confrontation, referral, or being fired for using drugs and alcohol on the job.

After such excuses and sending them home escorted, they can in some instances, return the next day to discuss their circumstances and have no memory of being in your office or a single thing you said in the confrontation.  

That's right. They were in a blackout the entire time. I have had such employees in my
reasonable suspicion training tip on handling employees witih blackouts
office. It's quite amazing.

Here are the most common excuses DOT supervisors hear, and ones that should be included in a reasonable suspicion training program. I will discuss on in particular.

These are classic manipulation strategies employees will use with the DOT supervisors, and it's important to know what they are. So we will cover them in a series for the ten posts or so -- you will find them all presented in the DOT Supervisor Training course PowerPoint, DVD, Online Video, and Web Course.

“I haven’t had a drink since last night!”
An employee with a high tolerance to alcohol could have their last drink late at night and still be under the influence well into the next morning. They don’t have to drink just before coming to work or first thing in the morning. Don’t let this statement convince you that a test is unnecessary.

Some DOT supervisors think that if the employee did not have a swig of liquor out in the parking lot, then any other drinking that occurred off site, like at a bar last night is not a confront-able offense of the drug-free workplace policy. If the employee looks like a million dollars, you may not assume he or she is drunk. However, they could be well over the limit.

As employees age and become sicker, their liver become damaged. They may or may not have a cirrhosis, but the liver's scarring prevents the breakdown of toxins. Alcohol is therefore slow to breakdown in the body, and the alcoholic will remain drunk on less booze.

You can imagine how many years skid row drunks have consumed alcohol. Some drank 2 fifths a day in their peak. In later years, four of these alcoholics could share a pint of booze. Why? The alcohol stays around longer in the system is answer. It is not necessary to drink as much because the liver does not function as well.

Employees with liver problems may drink until midnight and come to work stoned drunk 8 hours later. Also, be mindful that memory loss while drinking is a profound and frequent occurrence for late stage alcoholics. Many simply do not recall anything during this drinking period. Have a witness that will vouch for the employee in your office. And also be ready to confront them the next day if the blackout excuse is used.

Alcoholic employees in a blackout in your office know the next day when confronted that they were in a blackout primarily because they have had these experiences before. So, confront them about this reality, and say "you've had blackouts before now", so let's get on with the interview.

Some employees have gray-outs. This means they do remember something about the behaviors they experienced while drunk, but perhaps not all. Although we do not go into depth about the various aspects of blackout dynamics in a reasonable suspicion training class, printing this post may be a good one to supplement your reasonable suspicion training.

#blackouts, #drugabuse, #reasonablesuspiciontraining

Thursday, January 25, 2018

No drug and alcohol training program should show its first slide to classroom full of DOT supervisors or other supervisors unless it has first decided that alcoholism and addiction are biogenic illnesses.

During or at the end of a DOT supervisor training course, supervisors will ask questions. When they do, you better have solid answer. Here is one guide on alcoholism you should read. Then you will be well equipped to educate and training managers""


The Alcoholism Revolution

A landmark position paper by the author of Under the Influence

Dr. James R. Milam

“This conformity make them not false in a few particulars, authors of a few lies, but false in all particulars. Their every truth is not quite true… so that every word they say chagrins us and we know not where to begin to set them right.” Emerson

No problem in America has been more costly in lives, misery, and money than alcoholism, and no problem has generated more stubborn conflict and confusion in all areas of society. In a historic development during the 1970s, the intense focus on alcoholism research exposed the underlying polarity, the clash of irreconcilable premises that has always generated so much conflict. Although not yet widely known, by the early 1980s this root conflict had been resolved by a scientific and professional revolution, a paradigm shift.

This paper describes the polarity and the shift to the new model that is transforming our entire view of alcoholism (and other drug addictions). I have adapted the terms “psychogenic” (of psychological origin) for the old paradigm and “biogenic” (of biological origin) for the new.

The psychogenic model is based on the nearly universal belief that alcoholism is a symptom or consequence of an underlying character defect, a destructive response to psychological and social problems, a learned behavior. The biogenic model recognizes that alcoholism is a primary addictive response to alcohol in a biologically susceptible drinker, regardless of character and personality. It will help at the outset to realize that compromise is not possible, that the two are not complimentary but mutually exclusive alternatives, like a perceptual figure-ground reversal.

The contrast between the two paradigms can be illustrated by Robert Louis Stevenson’s classic parable of addiction, Dr. Jekyll and Mr. Hyde. In the psychogenic view, the insane, murderous Hyde is the real person, with Jekyll merely a facade. It taps into deep currents in American thought—the notions of original sin and the Freudian Id—that beneath the inhibiting veneer of civilization man is inherently evil. Alcoholism merely releases this deeper ugliness by removing the inhibitions. In vino veritas [“in wine is truth”]. The task of therapy is to engage and civilize Hyde. Treatment fails because the contemptible Hyde is willfully incorrigible. He deserves the stigma and scorn of society.

Within the biogenic paradigm Jekyll is the real person, and Hyde is a neuropsychological distortion created by the addictive chemical. Hyde exhibits the same kind of deterioration of personality and character as victims of such other progressive brain pathologies as brain syphilis or a brain tumor. Body, mind, and spirit (including willpower) are biologically compromised and subverted to serve the addiction. Given time for healing, in alcoholism the brain syndrome is reversible. The task of therapy is to restore Jekyll to sanity and self-hood, and to start him on a path that will preclude a return to the addictive, transforming chemical.

Although it is conformity to the psychogenic belief that continues to distort and falsify all scientific and clinical knowledge of alcoholism, as the given truth throughout history it has had the advantage of being invisible, of not appearing to be a belief system at all, but simple reality. This was the fatal flaw in the Jellinek “disease concept” of alcoholism. For all his helpful descriptions of the progression of the disease, he endorsed the false belief that alcohol is primarily a sedative drug, and that alcoholism is caused by excessive “relief drinking,” drinking to relieve psychosocial stress. Thus, as secondary consequence or symptom, the biology of alcoholism could be largely ignored by the establishment in its diligent search for the presumed primary psychiatric cause of the relief drinking.

Following Jellinek, many leading proponents of the disease concept still try to have it both ways, to assimilate the fragments of biological knowledge within the lingering psychogenic hegemony. This conformity necessarily condones the misinformation that continues to tear the country to pieces and helps to delay the emergence of the biogenic paradigm.

By 1960, research studies had determined that the rate of mental illness among pre-drinking alcoholics was the same as among non-alcoholics. During the 1960s and 1970s, a great many additional research studies confirmed that the defective character, the mental illness of alcoholism, is not primary, or underlying, or a “dual diagnosis,” but the neuropsychological consequence of the alcoholism.

When controlled for heredity (abundant independent evidence makes this mandatory), no pre-drinking psychological or social variable of any kind could be found to correlate with later alcoholism—not child abuse, depression, antisocial attitude, poor self-image, or any other. These problems are familiar consequences and complications of alcoholism, but research clearly showed they are not contributing causes or “risk factors.” Also, the persistent belief in an “alcoholic (or addictive) personality” was found to be false.

The search was broadened in the vain hope of finding some other kind of evidence to validate the psychogenic paradigm. None could be found. Responsible drinking could not prevent alcoholism, and alcoholic drinking could neither be learned or unlearned. All prevention and treatment efforts to modify the alcoholic’s progressive response to alcohol failed.

Deep, broad, and powerful vested interests in the philosophy of environmental determinism were increasingly threatened by the mounting evidence against the psychogenic paradigm. In their desperate effort to forestall its collapse, defenders of the paradigm resorted to an increasingly blatant double standard, a kind of artificial life support system. Editors, reviewers, critics, and other guardians of the academic alcoholism literature increasingly rejected, distorted, minimized, lacerated with extreme criticism, and ignored—one at a time—the thousands of research and clinical reports that, only when allowed to freely come together, form the biogenic paradigm, a complete definition and explanation of alcoholism. Only small fragments of biological data, out of context, have gotten into the communications media.

In contrast, thousands of inadequate, shoddy, or even fraudulent studies were uncritically approved and widely cited if they but seemed to support the psychogenic premise. As an aid in warding off the troublesome biogenic research evidence, alcoholism was renamed “alcohol abuse,” a psychogenic term of denial and moral censure. The word “addiction” was then degraded and stripped of its profound biogenic meaning by applying it to all manor of excessive or repetitive behaviors. Of course it became impossible to identify or diagnose alcoholism, and many researchers resorted to drink counting instead, with arbitrary amounts of consumption to identify alcohol “abusers.” Alcoholism was trivialized out of existence as the academic literature became a literature not about alcoholism but about itself.

In spite of this concerted attempt to disguise the fact, by the early 1980s the psychogenic premise had been totally discredited and dismantled by legitimate research. This is the documented conclusion of, among others, one of its most distinguished former advocates, philosophy professor emeritus Herbert Fingarette. It is only from the biogenic perspective that his landmark contribution can be fully appreciated.

In 1988, in his notorious book, Heavy Drinking, Fingarette declared, from within the psychogenic paradigm, there is no such thing as alcoholism. In his world he was right. The biogenic model has never been assembled within the academic alcoholism literature because it is impossible to do so. Its parts are either distorted or missing. With no direct clinical experience of his own, Fingarette’s 15-year investigation was limited to what he found in this mandarin literature, and he didn’t find alcoholism. He unwittingly wrote the obituary not for alcoholism but for the psychogenic model in which alcoholism in fact does not exist.

There is a wry humor in this whole academic spectacle. It has been a kind of acting out on a grand scale of the old joke about the specialist: one who learns more and more about less and less until eventually he knows everything about nothing. But these misguided academic reveries have had devastating effects on public understanding of alcoholism. For example, with Fingarette as its official consultant on addictions, the U.S. Supreme Court wistfully argued in 1988 that “…apparently nobody understands alcoholism…it appears to be willful misbehavior.”

Overshadowed by the multitude of researchers who were busy confirming that the psychogenic paradigm is devoid of any data base, many others were compiling evidence that alcoholism is a primary, biogenic disorder. However, the task of assembling the biogenic paradigm is elusive and difficult because not only the academic literature but the whole of society has been limited by the psychogenic view. It is impossible to see out of it. As Thomas Kuhn explained, and Fingarette demonstrated, a new paradigm and its supporting evidence are invisible from within the old. Be forewarned that, because the dominant premise is false, “…every truth is not quite true.” It is impossible to assemble this myriad of half-truths into a coherent perception of alcoholism.

To discern the biogenic model, a substantial amount of valid research evidence and clinical knowledge must be winnowed from the psychogenic chaff in the alcoholism literature and gleaned from original sources scattered throughout the life sciences. It can then be transformed and assembled in the new biogenic configuration, much as all knowledge of geography and navigation were transformed for the earth to become a globe after being flat for so long. No flat fields were lost, but it was necessary to ignore them long enough to form the new model. Once the global perception came together, there was a certainty and finality about it, which to those still in the other paradigm seemed totally unjustified by the obvious facts. It couldn’t be helped. The flat earth was gone.

Similarly, the biogenic paradigm includes and is shaped by all valid knowledge of alcoholism. It has an extremely broad data base. Nothing is forced in or left out to argue about. And because all parts are valid, the whole is also validated by internal consistency. It is not a philosophy or a theory. It is a new gestalt, a compelling total perception.

Data is found in many areas in many disciplines. Both animal and human studies have shown repeatedly that alcohol addiction is hereditary. A number of inborn, pre-drinking biological differences have been discovered in alcoholics, along with many initial and progressive differences in their biological responses to alcohol. Differences have been found in brain wave patterns, in various enzymes, in nerve transmitters, in liver functions, in alcohol metabolism, and in the effect of alcohol on performance, mood, and mental abilities.

The problem is not a shortage of data, as frustrated researchers suppose, but the fact that they have not been able to integrate the abundance of scattered data. Both gathered and viewed within the compromising psychogenic paradigm, each cluster of research data stands alone in the scientific literature as an isolated anomaly, barely acknowledged in the academic alcoholism literature. Because it seems so self-evident that psychosocial factors must be contributing causes, even biological researchers still think there must be more than one kind of alcoholism.

Once all the biological data is assembled within the biogenic paradigm, it explains why all learning theories have failed to distinguish alcoholics from non-alcoholics, why alcoholic drinking can be neither learned nor unlearned. It is the unconditional response to alcohol that is different, initially and progressively. Alcohol is selectively addictive, and the selection is biological.

Regardless of why, how, or how much an alcoholic initially drinks, the addiction neurologically augments his original reasons for drinking, pushing him to drink amounts consistent with his rising tolerance, and beyond. In human experience there is nothing unusual about physiological imperatives, like hunger for sex, creating mental obsessions and driving and shaping behavior. There are not two or more types of alcoholism. There are merely different complications and different types of people who are alcoholic, with different levels of concern and strategies of damage control.

All of the psychopathology of alcoholism, as alcoholism, is of neuropsychological origin, but this fact is disguised because alcoholism is never diagnosed until after character and personality are distorted and normal emotions are neurologically augmented to abnormal levels of chronic anguish, fear, resentment, guilt, and depression. It is these distortions that clinically identify alcoholism, not the original character and personality.

Most often alcoholism is hereditary, but many individuals become chronic alcoholics through cross-addiction to other drugs (prescription or illicit), or as the result of other brain or liver insults. Whether or not accelerated by the potentiation of other drugs or injuries, organic deterioration causes a loss of tolerance and substantially reduced alcohol intake. To the drink counters, both alcoholics progressing into the more ominous low-tolerance stages of their disease and those who necessarily reduce their alcohol intake while using substitute drugs are counted as cases of “spontaneous remission” or improvement.

In addition to the early acute affects of alcohol—the mind-expanding, life-enhancing stimulation and energy—three kinds of progressive brain impairment participate in the personality and character transformation, while augmenting the strength of the emotions and of the addiction. Between drinking episodes:

All brain cells are in a toxic, malnourished state. Their detoxification and stabilization take several weeks of total abstinence from alcohol and other drugs.
Billions of brain cells are damaged. Repair and healing take several months of abstinence.
Many millions of brain cells die. The loss is permanent, but during a period of some four years of total abstinence surviving cells compensate for those that are lost.
Ameliorating during the first several weeks of abstinence, the three kinds of impairment have a combined effect on overall brain function, producing both first-order psychological symptoms:

First-order symptoms are the direct neuropsychological disturbances, such as mental anguish, memory defects, mental confusion, disorientation, and emotional augmentation.
Second-order symptoms are the patient’s psychological reactions to the first-order symptoms and include fear, denial, projection, rationalization, depression, personality distortion, deteriorating self-image and self-confidence, regressive immaturity, and other mental and emotional aberrations.
A third order of symptoms is imposed by the psychogenic paradigm, the cultural heritage of both patient and family members, the mistaken belief that the first- and second-order symptoms are caused not by the brain disorder but by an underlying or concomitant psychiatric problem. Both subjectively and to the untrained observer, the symptoms are the same. This wrongly places the blame for the abnormal behavior on the person rather than on his organic disease (hence the term “alcoholic abuse”) and draws the family into sharing the blame. Third-order symptoms include feelings of guilt, shame, remorse, alienation, resentment, helplessness, despair, and depression. Complex states, such as fear, depression, and regressive immaturity are composites of first-, second-, and third-order factors.

When alcoholics quit drinking on their own, as many do, they must live with the cultural stigma and the unrelieved symptoms of anguish, guilt, shame, remorse, and depression. In this troubled state, without an enlightened support group, it is not surprising they so seldom achieve a lasting sobriety. These interludes “on the water wagon” between drunks are also included as spontaneous remissions or improvements by the drink counters.

The attempt to force research findings into the psychogenic mold has been paralleled by a similar distortion and suppression in clinical practice.

Psychiatrists have always been regarded as the ultimate authorities on alcoholism in spite of the fact they have never had academic courses or field training in alcoholism. The credibility has always depended entirely on the culturally shared premise that alcoholism is secondary to psychological and social problems, areas in which they are qualified.

Surveys during the 1960s found that alcoholics consulted psychiatrists from 40 to 100 times as often as non-alcoholics and were hospitalized some 12 times as often. They were never given a primary diagnosis of alcoholism. There wasn’t a hospital in the United States that would admit a patient under a diagnosis of alcoholism, and health insurance would not pay for alcoholism treatment. Alcoholism recovery rates were acknowledged to be zero for all types of psychiatric treatment. Alcoholic drinking, obvious “psychiatric” disorders, and failure to recover were all regarded as evidence of a mysterious perversity in the patient’s character. Alcoholics were considered hopeless, pending further psychiatric research.

Still under the psychogenic paradigm, the whole of the healthcare and social service establishment, public and private, continues to be a gigantic revolving door for undiagnosed and untreated, or wrongly treated, alcoholics and drug addicts, who, together with their victims, comprise conservatively 60 percent of all caseloads. The vast majority of all prison inmates are there for crimes secondary to addiction. The annual cost to society of tending to the multiple effects of addiction—rampant “psychiatric” problems, family neglect and abuse, poverty, violence and other crimes, illness and organ and system failures, accidental injuries and deaths—is in the hundreds of billions of dollars.

Because psychiatrists and other mental health specialists have such an enormous vested interest in the psychogenic paradigm, it could be anticipated that they would be among the last to discover the biogenic alternative. But this alone does not explain why they continue to be such stubborn believers in the face of the mountain of evidence that they are wrong. Their most stultifying problem is that they are trapped in a vicious circle, a self-fulfilling prophesy, that can be seen only from the perspective of the other paradigm.

Alternative states of being supplant each other. The person as transmogrified, transformed by the brain syndrome, enters treatment alone. The original, authentic person is not present. He or she has been superseded, replaced. All therapeutic dialogues with patients during the first weeks of treatment, until Jekyll is allowed to reappear, are dialogues with Hyde, through his “mask of sanity.”

Within the psychogenic paradigm, both therapist and patient mistake the characteristics of the wretched, contorted self of the brain syndrome for attributes of the real self. After a few days of acute detoxification, this miserable self-image is further authenticated as the focus shifts to psychiatric treatment. The third-order symptoms of guilt, shame, denial, defensiveness, resentment, and depression, created by the psychogenic paradigm in the first place, are not dispelled by healing and reeducation but are reinforced as emanating from deep sources in the patient’s character and personality, an underlying or concomitant psychiatric problem. It’s a self-validating practice. The patient now has an iatrogenic (therapist-induced) disease.

By locking the patient into this mistaken identity, the therapist creates the chronic psychiatric problem that he then thinks he has merely uncovered. Therefore the dual diagnosis rate is very high, and the recovery rate is near zero. Of course, the patient gets the blame for the treatment failure, the continuing “willful misbehavior,” and the therapist feels justified in his contempt for these uncooperative patients.

In a sense, the recovery rate is worse than zero as many alcoholics die of the iatrogenic disease. They are destroyed by the potentiation of their alcoholism with routinely prescribed addictive drugs, in combination with psychotherapy, which converts the otherwise reversible organic insanity into a hopeless “mental illness” (Judy Garland, Marilyn Monroe).

The biogenic approach is entirely different. By the 1940s Alcoholics Anonymous had clearly demonstrated that alcoholics could stay sober and be restored to sanity with continued total abstinence from alcohol and all other addictive drugs. Special treatment programs came into being to meet the need that AA was not designed to address, the need for control and professional treatment during acute detoxification and the troublesome early weeks of recovery.

The therapist is a kind of midwife in the rebirthing of the patient into sanity and true selfhood (Jekyll). With medical management, directive counseling, appropriate nutritional therapy, regulated rest, moderate exercise, and complete reeducation to the neurological origin of the “mental illness,” within a few weeks the brain syndrome and the craving subside. Understandably, in varying degrees all patients experience a crisis of identity during the transition into unfamiliar selfhood. Patients are extremely unstable, biologically and psychologically, during this period. The four-week inpatient program evolved to facilitate the healing and to protect patients from an otherwise high probability of relapse during this period. There is no attempt to reform or to do psychotherapy with the fading, counterfeit self (Hyde). Like a bad dream, it is discredited as “unmanageable” (AA’s first step), left behind, and disowned by the patient as not-self (Betty Ford, Elizabeth Taylor).

Restored to sanity, and reeducated to the permanent nature of addiction and how to recover, the alcoholic for the first time has a valid moral choice. He can see that he has a moral imperative to live the way of life that will assure his continued sobriety and recovery. He must understand why he cannot rely on willpower alone. Willpower is a fickle servant that can be quickly redirected at its biological source to serve an awakened Hyde instead of Jekyll. As patients stabilize in sobriety, they are ushered into Twelve Step programs for long-term sobriety maintenance and self-realization. It is this unbroken sequence that works so well with both alcoholism and other drug addictions.

There is no question that in early recovery patients must face the very depressing psychological and social damage caused by alcoholism—their own and often that of their parents. But this is reality, not mental illness. With proper addiction treatment, and continuing in health and sanity within a Twelve Step program, patients can cope with the damage and outgrow it. Reality-centered counseling and other ancillary services may be needed or helpful during this difficult period. As with all other chronic diseases, even with the best of treatment relapses are often part of the recovery process. Nonetheless, with this treatment model the addiction recovery rate is high, and the actual rate of mental illness, the true dual diagnosis rate, is low, around 5 percent.

From within the psychogenic paradigm the special treatment model is incomprehensible, and the sequence seems arbitrary. Both AA and treatment programs have been endlessly misrepresented in the academic literature. AA is not a “treatment program,” and special treatment programs are not “Twelve Step programs.” While AA properly stayed true to its original nonprofessional form, by the 1970s, after several decades of evolution, treatment programs had become fully professional, multidisciplinary, and highly cost effective.

But the form and content of treatment evolved out of trial and error experiences of tens of thousands of professionals treating hundreds of thousands of patients in thousands of treatment programs over a period of several decades. Born of the psychogenic paradigm and guided by Jellinek, the movement of these programs toward the biogenic model was not by central control or conscious design, but by the grass-roots discoveries of what worked and what didn’t work in producing recoveries. Those who have more coherently grasped the biogenic paradigm have been rewarded by a quantum improvement in the rate and quality of recoveries.

Nothing is arbitrary. The common sequence of four weeks minimum of intensive inpatient treatment, followed by outpatient aftercare and a start in a Twelve-Step fellowship, is simply an optimum program to enable the wisdom of the body and the reeducation process to resurrect the real person from the ashes of the disease, and to prepare him or her to start life in sobriety. Effective alcoholism treatment is hard work, and it takes time.

Through the special treatment programs, millions of alcoholics and other addicts have escaped the revolving doors of the establishment into total abstinence from alcohol and other drugs. After successful addiction treatment, their social service and health costs drop to levels below those of the general population. Cumulative costs saved have been in the tens of billions of dollars. Of course, costs saved by the special programs have been revenues lost to the establishment, which, together with the threat to the psychogenic paradigm, explains the hostile rejection of this major breakthrough in public health. Because referral for effective treatment has become a very real option, the traditional professions and agencies must now be seen as primary “enablers” and the endless problems they subsidize as iatrogenic.

Unfortunately, the success and high profile of the special addiction treatment programs during the 1980s attracted investors and professionals who brought into the field the psychogenic paradigm. Their low rates of addiction recovery, their “discovery” of a high rate of co-occurring disorders, and their extraordinary high costs of vainly treating the iatrogenic disorders have created major public relations problems for the whole field of addiction treatment.

Not knowing that the dual diagnosis problems they find so prevalent and so frustrating are iatrogenic, mental health professionals imagine that special programs must also be confronting these same psychiatric problems. It is therefore inconceivable to them that “Twelve Step” programs could be having any more success with these stubborn patients than they are. They even imagine that the special programs need their expertise to better treat the difficult psychiatric problems. They don’t. They don’t create them.

Whatever their assumptions, some mental health professionals have diverted attention away from their own failure to get recoveries (e.g., the Rand report) with outrageous allegations that enlightened treatment programs also fail to get recoveries, calling them a “rip-off industry.” This loud minority has jeopardized the lives of untold millions of alcoholics and drug addicts and inflated healthcare costs by shifting public attention away from effective addiction treatment over to a preoccupation with redesigning the whole health care establishment to more broadly serve the endless iatrogenic problems. It has also helped to unbalance the drug war by justifying the neglect of intervention and treatment (of Jekyll) in favor of an almost exclusive reliance on interdiction and punishment (of Hyde).

Citing the failure of alcohol prohibition in the attempt to justify legalizing other drugs seems reasonable only from the psychogenic premise—the denial of physical addiction that created and still nurtures the drug epidemic. Again, the biogenic view is entirely different. The 10 percent alcoholism rate among drinkers in America always has been a marginally acceptable rate of addiction, barely tolerable by society. Witness the anguish of prohibition and its repeal. Using the disaster of alcoholism to justify legalizing brain-damaging drugs with addiction rates edging toward 100 percent is totally irrational.
The End Game

That there is no legitimate research evidence available to support the psychiatric premise is highlighted by the fact that bogus research reports are being cited in the media as part of the current political battle to regain control of the patient population. A couple of recent examples:

A report of drinking by fathers and sons purporting to show that alcoholism is not a primary hereditary disorder. This was a ridiculous drink counting study, not an alcoholism study. Alcoholism was not diagnosed in either father or sons. It was found that amounts consumed by sons were not affected by whether their fathers usually drank two or more drinks per drinking occasion or customarily drank one drink or less. Abstaining genetic alcoholic fathers whose sons are drinking alcoholics are—of course—placed in the “one drink or less” group.
Psychiatrist Frederick Goodwin, then director of the Alcohol Drug Abuse and Mental Health Administration, has co-authored a report alleging that about a third of alcoholics have a dual diagnosis, a psychiatric problem along with their alcoholism. Patients in an alcoholism treatment program were merely asked if “ever in their lifetime” they had been given a psychiatric diagnosis. Thus the rate of historic and continuing misdiagnosis of alcoholics in the revolving doors became, for these authors, a measure of the rate of dual diagnosis.

In recent congressional testimony, psychologist Michael Hogan has inflated this contrived statistic. Arguing that alcoholism funds should be put back under mental health jurisdiction, he stated that “…in over 60 percent of all people with a substance abuse disorder, there is a concomitant mental illness.” It is a frightening prospect for the still sick alcoholic and drug addict that these agents of iatrogenic disease aim to control and “improve” the special addiction treatment programs.

It is impossible to counter the outrageous “research” reports one at a time as they flow into the national communications media from the professional and political high ground. No single research study can refute a non-study, and the network of research knowledge that shows it to be absurd is too complicated for a brief rebuttal. Only the familiar standoff can be achieved: “Apparently nobody understands alcoholism.” Once and for all, it is the whole biogenic paradigm that must be communicated.

Some steps have been taken in the right direction. During the early 1980s, the National Institute on Drug Abuse shifted their funding emphasis to support research in the biology of addiction. It is hoped they will finally recognize the effectiveness of nutritional therapy and the wisdom of the body in healing the brain syndrome and craving, and not just narrowly search for yet another toxic drug for psychiatrists to prescribe. The destructive methadone program for heroin addicts was never a legitimate model. It seemed promising only in relation to the zero recovery alternatives known to its instigators.

For the longer term, it is encouraging that in 1986 Harvard, Dartmouth, and Johns Hopkins broke with academic tradition and announced the were going to inaugurate courses in alcoholism in their medical schools. In the same news release they frankly acknowledged that none of their faculty, including their many psychiatrists, were qualified to teach such courses. The word “inaugurate” underscores the fact that the many thousands of psychiatrists already on university faculties and out in society as authorities are not qualified in alcoholism either by academic courses or clinical training where they could witness recoveries. They are only authorities in the psychogenic paradigm in which alcoholism does not exist. Deeply understood, this paper is an attack not on these untutored professionals, but on the destructive cultural paradigm that has held them in thrall.

Facing up to their deficiency, a significant number of physicians, psychiatrists, and psychologists have already defected to the enlightened treatment programs and organizations, first to learn and then to provide professional leadership. They have been generally ignored by mainstream professionals but will form an important nucleus for education and training as larger numbers come over to join them. Until the countless revolving doors are cleared of alcoholics, there will be plenty of productive and highly rewarding work for all who are willing to learn. As their numbers grow, they will finally provide the legitimate clinical window that has been so urgently needed both to guide and to integrate scientific research.

The biogenic paradigm has not yet been systematically articulated by any major organization or presented to the public through any of the national communications media, but having reeducated themselves to the realities of addictive disease, these professionals are now leading the inevitable movement towards the biogenic paradigm.

Two enlightened organizations, the American Society of Addiction Medicine and the National Council on Alcoholism and Drug Dependence, have jointly formulated a new definition of alcoholism that is consistent with the biogenic paradigm, as follows: “Alcoholism is a primary, chronic disease with genetic, psycho-social and environmental factors influencing its development and manifestations.” The definition is further elaborated, but note especially that psychosocial and environmental factors are no longer primary, contributing causes of alcoholism.

Meanwhile, the ugly battle for control will continue in the political arena. The public has recently heard the hostile allegations that nobody understands alcoholism, that alcoholism does not exist, that it is merely willful misbehavior, that since treatment doesn’t work anyway, only the briefest and least expensive should be funded. “…every word they say chagrins us…” because all of these criticisms are true of the bankrupt psychogenic approach to alcoholism; none, however, is true of the biogenic.

These attacks on the “treatment industry” are merely a reactionary attempt to regain in the social and political arenas control over alcoholism that has been irretrievably lost in scientific research and clinical practice. Their effectiveness depends entirely on public ignorance of the fact that the paradigm shift has already occurred.

With many millions of lives and hundreds of billions of dollars in the balance, surely it is time to embrace and reveal the whole truth about addictive disease to decision makers and the public, to present the biogenic paradigm as the comprehensive successor to the disastrous psychogenic model. It will be quickly validated and ratified by an enormous latent fund of public experience and knowledge. Virtually everyone has witnessed the reality of addictive disease and the effectiveness of treatment, both first-hand and in media reports of the lives of a multitude of recovering celebrities.

*** This paper is both a summary and a manifesto, a blueprint for action. The discerning reader will realize that every valid piece of addiction research evidence in every discipline has a vital place within the biogenic paradigm when reviewed from this new perspective. A monumental interdisciplinary task will be to scan, reevaluate, winnow, and assemble the entire research literature in this new configuration, and to publish this information in a series of reports. To this end and to inspire and support the participation of others, a nonprofit organization, The Biogenic Addiction Institute, is being created.

*** To all who read this paper: please photocopy or otherwise reproduce this monograph and circulate it as widely as possible. You will probably want to save a copy for your own reference. While I have copyrighted this work, I nonetheless grant permission for unlimited reproduction in the interest of advancing the biogenic paradigm.