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. http://lakesidemilam.com/alcohol-drug-addiction/under-the-influence/a-guide-to-the-myths-and-realities-of-alcoholism/

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.

Friday, January 19, 2018

Tom Petty: What's the Rest of the Story? Truth about His Death -- Is It Acute Chronic Alcoholism.

Alcoholism is a genetic illness.#tompetty Tom Petty is dead, but his overdose was only a dramatic symptom of his illness. Don't be fooled. There is more to the story that you are not reading about. After researching his psycho-social history, I have learned, as suspected that Tom Petty very likely had a biogenic, hereditary illness called acute chronic alcoholism.

He inherited susceptibility to this disease from his father who was an out-of-control physically abusive alcoholic who did not approve of his child's interests in the arts. His mother is what saved him, but later, as result of his illness, he became a drug addict like many alcoholics--nearly a walking medicine cabinet within him of cross tolerant, cross addictive drugs (with alcohol.) An overdose, inevitably killed him like so many other people, including rockers.

There is nothing unusual about Tom Petty's story, except his ability, like Michael Jackson and Prince, to access whatever drugs he wanted.

Don't let the media's glorification of Tom Petty allow you to miss the simple basics -- this drug death is a manifestation of an illness that about 1 out 10/11 drinkers acquire out of no fault of their own whatsoever--who start drinking for same reasons as most people do.

Unwittingly, they are sitting ducks because the earliest symptoms are nothing more than the ability to drink more than most people and feel great, not get drunk, drink more frequently, and have little effects--for years while you acquire tolerance to ethanol metabolization. You will also feel more euphoric than your light weight social drinking friends. You will therefore hang out with folks more likely to drink like you do. You will slowly acquire a definition of alcoholism that does not include yourself. And you will change that definition over time to eliminate the new symptoms you acquire. This is the nature of denial. It's insidious as hell.

There is nothing mysterious about the origin of this disease. You can't even get research dollars anymore to study genetics unless it is really unique in its focus. But proving alcoholism is genetic -- old news.

The media, myths, and misconceptions, and thousand years of competing bogus theories before effective genetic research arrived still breed horrible confusion about this disease. And all of us are victims of this confusion, much of which is linked to economics because different professions both compete for the treatment of people with alcoholism or livelihoods linked to some model of understanding of the illness.

There really is no such thing as prevention of alcoholism unless you simply do not consume alcohol, or consume it so infrequently that you do not tax your genetic susceptibility to it, if in fact your are susceptible to it. That's a tall order for a universally accepted consumer product 80% of the population enjoys. Correction, make that nearly impossible.

Are you the next Tom Petty? Take this quiz--and if you score about 10 points, you get a gold opportunity to save your life. https://www.integration.samhsa.gov/clinical-prac…/…/Mast.pdf

- or give to a friend -- then print this handout: http://www.workexcel.com/content/PDF/V002.pdf - keep them in your medicine cabinet.

For Training Employees in Substance Abuse Awareness: - https://www.workexcel.com/alcohol-and-drug-awareness-education-and-training-for-employees-ppt-dvd-video-web-course/

For Training Supervisors in Substance Abuse  -  https://www.workexcel.com/non-dot-supervisor-training-for-reasonable-suspicion-education-and-awareness/

For Training Supervisors (DOT Mandated Format) - https://www.workexcel.com/reasonable-suspicion-dot-drug-alcohol-training-for-supervisors-2hr-Certificate/

Wednesday, January 10, 2018

Improve Observational Skills to Spot Workplace Substance Abuse as a DOT (or Non-DOT Supervisor)

You can learn all you need to know about signs and symptoms of substance abuse and never spot one of them in a 100 years of supervising workers.

Approximately 7% of your workforce is actively alcoholic (or in recovery completely from a prior addiction,) so the chances are pretty good that you have at least one actively drinking alcoholic if you have 20 employees under your supervision or more.

Of course, you could have one employee, and him or her be the alcoholic, but I am just saying...think 100% certainty if you have say 20-25 employees. That's because 70% of employees drink and 10% become alcoholic. Hence 7%.

These are conservative numbers. Eventually that one employee or two will experinece workplace symptoms that grow over time. Now you see the rationale for properly conducted reasonable suspicion training.

Why is it that many supervisors never report seeing the signs and symptoms of an alcoholic

dot supervisor training in reasonable suspicion observational skills blog note
or drug using employee. In fact, many EAPs are reporting fewer substance abuse employees in their statistics, even after extensive EAP Supervisor Training.

Yet, we know they are there. The answer--or at least part of it--is less than adequate observational skills.

Improving your observational skills as a DOT supervisor (or non-DOT supervisor) is not just about looking for toxic signs. Instead it is about engaging with your employees to know them as workers. DOT training courses should discuss observable performance indicators, but also educate supervisors not to remain behind closed doors.

You will simply will not find substance abusers without engaging with workers up close in a manner that allows you to grasp their unique style of behavior and communication of each one.

Mingle with your employees regularly, say hello, and you will learn subconsciously, as a result, of these interactions how employees behave, how they speak with each other, and what they look like physically. This is not a difficult task. It is quite natural. Your brain will do the work for you by registering tone of voice, appearance, dress, facial expressions, voice volume, etc. When any of these things change, you will be alerted because your brain will notify you that something is out of place.

Supervisors who do not engage with their employees are at greater risk of not spotting signs and symptoms of drug use. In some instances behavior, voice, attitude, and an accumulation of other human affected signs and symptoms that have been occurring recently or in the past that lead the supervisor to make a decision that reasonable suspicion exists.

Let's look at a couple signs and symptoms from a handout within our DOT Supervisor Training Course on substance abuse. Any of the following may be identified by the astute supervisor who engages with employees regularly, and possibly missed if a scant interactive relationship exists.

Remember, the rationale for engaging with employees is that they are indeed your most valuable resource. They must be seen as a resource in order for you to maximize their potential and workplace effectiveness, and consequently, their job satisfaction.

See employees as not just "people" but a valuable resource. It will be to their benefit more than the other way around. It will also diminish the risk of engaging in dysfunctional relationships with them, if you are at risk for such. (Some brute honesty there, but make this about putting the company first, and your employees will naturally benefit as a result.)

Drug and Alcohol Use Signs and Symptoms Spotted While Engaging with Employees

1) Stumbling, staggering. A stumble is not just a stumble. When you have been engaging with employees regularly, you will see a stumble differently, what it looks like as it is happening. People do stumble, but when, what, where, and how are worth considering are what you will document

2) Impaired fine motor skills. When you see tremulousness from drug withdrawal, it can be very subtle. If you are engaging with employees daily, you will notice these hand movements more readily. When, how, and during what activity is the basis of documentation

3) Slurred speech. Slurred speech can be extremely subtle, all words may be slurred or just a few that require finer motor coordination of the tongue. What statement did he or she attempt to articulate? When, where? Your past interactions can help you know what to do next, and whether there is more to consider in making a referral for a drug test.

4) Dramatic weight loss. What has your employees past appearance been? How is different now? Weight loss appears to be how much?

The above are just a few of the many, many symptoms of substance abuse.
In our DOT Supervisor's Training, Reasonable Suspicion Course, there are many more signs and symptoms, but I am hoping you understand the point from this short example.

This course is available free as a preview. Learn more at reasonable suspicion training free, in its entirety.

​Alcohol Awareness Training to Meet DOT: Don't Make It All about Signs and Symptoms

​Alcohol Awareness Training to Meet DOT: Don't Make It All about Signs and Symptoms: Alcohol Training for DOT Supervisor Training, What to Include

Saturday, January 6, 2018

Challenge the Myths About Alcoholism that DOT Supervisors Hold

Stigma of addiction is a roadblock in reasonable suspicion training
You've heard me harp a lot about the myths and misconceptions of DOT supervisors and non-DOT supervisors, and how these must be addressed in DOT training so they do not interfere with the goals of your reasonable suspicion training course. But,  I have not said much about the types of myths you will see among supervisory personnel in these courses and classes that you offer these people who need a DOT certificate.

Some of these myths are quite embedded psychologically. They are not acquired by reading a book or hearing someone's opinion. Instead, they are acquired by life experience from living with or being involved in a relationship with an addict.

You might as well know right now that you will definitely get hostile responses from some supervisors in your DOT training classes when you begin to educate them and provide insight and information that seeks to dispel false models addiction and alcoholism. Anticipating these reactions can help you remain on an even keel in your training efforts.

The impact of myths and false models of addiction is the maintenance of stigma. Stigma is a negative association of character flaws and shame pinned to the person afflicted with an illness that offers a less than attractive explanation for its etiology.

AIDS, for example, was originally linked to homosexual sex acts, later to IV drug users. Because these behaviors had significant societal condemnation, stigma rapidly attached itself to anyone who acquired the disease. The medical director of the hospital I worked for died of AIDS because of a blood transfusion, and until his death, he  openly educated people about it in effort to play a role in reducing stigma about the disease.

One of the most harmful results of myths associated with addiction is decreased effort on the part of supervisors to refer employees with drug and alcohol symptoms to the employee assistance program. 

The EAP referral path is interrupted because of a belief on the part of supervisors that the employee is to blame for their illness, is not treatable, or has character flaws deserving of punishment rather than treatment and the non-stigmatized recovery from addictive disease. It is important therefore to also discuss myths about troubled employees in EAP Supervisor Training Courses.

Many DOT and non-DOT Supervisors in training for substance abuse have a family member, parent, sibling or other loved one who currently possesses an alcoholism problem. These supervisors are victims of the illness and often have an extensive history of enabling, which includes doing many things and thinking and believing many things that amount to dysfunctional ways of coping with their current or past victimization.

Coping with victimization often includes includes leftover anger and and hate, and these human feeling states are not reconcilable against a belief system that says addiction is a disease and its symptoms of over-drinking, grossly disturbing behaviors, and consequent relationship dynamics just mere symptoms of the active illness. Trusting others may be a significant challenge for these people.

The disease model implies an unconditional forgiveness on the part of the enabler and victims, or at least its consideration. This is a tall order. And control issues may also be significant with these groups of supervisors.

Few victims of any abusive relationship are going to readily accept this sort of letting go. So, as you can see, the rejection of the disease or bio-genic model of alcoholism is predetermined for the many DOT Supervisors in your training class. This is made even more difficult for actively drinking alcoholics sitting in your reasonable suspicion training course, or those who are at the moment abstinent for one reason or another. 

These folks usually possess a "willpower model" to explain alcoholism, and they are also fairly guilty as a result of using this model to explain, control, and count on a future of drinking with better control...if and when they figure it out (which they will not because it does not exist.)

Blaming addicts comes with a host of enabling behaviors--from badgering the drinker to shaming him or her. Blaming is a stigma producing blast furnace. Supervisors who are hooked on this model find it difficult to not see termination as the most fitting approach for drug and alcohol problems in the workplace. 

Did you know that the when the Americans with Disabilities Act was passed, that it dealt away with giving actively drinking alcoholics the mandatory opportunity in the federal government personnel system to receive an offer of help before they were fired? Sure, the ADA protects recovering addicts, but an actively drinking alcoholic or actively using drug addicts can be fired with impunity now. So, guess how many addicts now try to cover up their drinking and drug problems, where before 1991 they could volunteer for treatment. Answer: A lot more. Join my twitter feed for dot and reasonable suspicion training

Get Non-DOT or DOT Supervisor Training at the following links:

1. Non-DOT Drug and Alcohol Training for Supervisors in Reasonable Suspicion
2. DOT Drug and Alcohol Training for Supervisors in Reasonable Suspicion

Wednesday, January 3, 2018

Surge in Alcohol-Related Emergency-Department Visits Needs a Different Approach

Surge in Alcohol-Related Emergency-Department Visits Needs a Different Approach: While moderate drinking – up to one drink per day for women, two for men – can be part of a healthy lifestyle, excessive and chronic drinking can contribute to injury and disease. Each year, U.S. patients utilize emergency department (ED) services more than 130 million times, averaging nearly four visits per every 10 people. Alcohol-related injury and disease are commonly the cause of these visits. This study examined trends in ED visits that involved heavy and chronic drinking by age and gender between 2006 to 2014.

Many admissions to ER departments by alcohol using patients are in fact re-admissions that are related to acute chronic alcoholism that remains untreated. In many cases, family members and close friends are motivated at these moments to step in and do something useful to get an alcoholic into treatment. One answer to ER department re-admissions is therefore intervention, but let's forget about your typical and unrealistic approach to intervention that has been see on television and offered at extraordinary expensive by private intervention specialists.

It is not necessary to have a paid intervention training specialist sit with a family on a Sunday morning after a pancake breakfast to guide a planned and rehearsed intervention to motivate an alcohol to enter treatment. What's needed instead is education for family and close friends on the effective use of leverage and influence--two resource tools--that exist in all relationships. These things are why 99% or greater of hospital admissions to treatment programs occur as a result of family members or friends saying that the decision on the part of their addict was NON-NEGOTIABLE. Learn how to intervene with an alcoholic by first, not learning how to do intervention, but by motivating yourself and your family members with accurate information about the disease of drug/alcohol addiction with this video -- www.workexcel.com/content/Low-Country-Intervention/presentation.html 

If you are business owner, you will someday get a phone call about an employee who in the hospital for some drug and alcohol abuse emergency. This individual's absence from your workplace, and sudden unavailability is what you can base a intervention upon. Has this happened before? And are you at the point yet where you would not mind firing this worker? If so, you are ready to roll with a performance-based intervention. In this instance, you are not going to be calling in family members or friends to help you do an intervention. Not at all. And your intervention will not take longer than a few minutes.

When your employee comes back to work, you use the leverage of job security to nothing more than get an employee to agree to a professional assessment with an employee assistance professional.

You can find one by contacting the http://eapassn.org - they will lead you to an EAP company that can guide you further. The intervention in actuality can be done in one minute. This is why I refer to it as the "one minute intervention." The script goes something like this:

John, you have much potential here with our company, but I am going to let you go today because you are unreliable. You are absent and unavailable to work without notice, and other issues like (fill in the blank) .....exist. But listen, there is one condition under which we are able to discuss saving your job. It is this: We would like you to visit with a professional counselor we have have hired...and by the way this is 100% totally up to you... and for the purpose of getting an assessment to see if you possibly have some sort of alcohol related problem. We are not saying you do, but this recent incident indicates that's possible. We want you to decide because we can't diagnose that sort of issue. But if you do visit with this professional, we are willing to guarantee your job if you follow through with their recommendations, if any, to get some sort of help. We will roll out the red carpet for you, guarantee that such help or treatment will not interfere with your job security or promotional opportunities, etc. So, what would you like to do? Would you like to meet with this person confidentially to see if you need some assistance, or would you like to pick up your check and be fired today. It is totally your decision.

Two points: 1) You are ready to let this employee go. And 2) you are offer completely accommodation for their potential medical situation.

Your employee will go to the assessment. If there is no question about it. It is 99% guaranteed in my experience unless they have another job lined up, can retire, or otherwise have another way of supporting themselves. In fact, if the employee does not have an alcohol problem, you could fire the employee after the assessment because there is nothing to accommodate. There is no medical issue that you were willing to support. Why keep this employee? Think about this approach. You have every right to fire the employee based upon performance related issues, but you are also willing to accommodate an active alcoholism problem if there is one. This is called performance-based intervention. We discuss this approach briefly in our Reasonable Suspicion Training program found here.

Tuesday, January 2, 2018

Drug and Alcohol Addiction, Substance Abuse, and Other Terms for the Use of Psychoactive Substances in the Workplace

What terms do you use to describe workplace substance when presenting to DOT supervisors in a reasonable suspicion training class? How about "alcoholism?" Maybe you use "drug addiction," "substance abuse," "addictive disease," "chemical dependency," or "alcohol and other drug users." Are you confused by these terms?
two glasses of martinis
I probably use the term addictive disease quite a bit, but no matter what terms you use, be sure to talk about the nature of the illness called alcoholism. It’s far worse than any drug use addiction with regard to its economic impact and risk to life and limb.

Frankly, I don’t have a recommendation of what term you should use to describer the workplace drug or alcohol user who presents as a possible threat to the organization. But I do recommend two things...to teach in a DOT supervisor training course. These are recognition of addiction as a classic disease syndrome and helping learners understand tha the terms mentioned above are pretty much all the same thing.

Educate DOT supervisors to see all of these terms as interchangeable when referring to the use of psychoactive substances that are addictive and mood changing.

If they do not learn this upfront during your training, they will play a key role in enabling and confusing others with whom they interact. They will also have weaker documentation, generate diagnostic sounding documentation, and increase risk to the organization from each of these things being pretty worthless because they lack more concrete language that documents what can be seen and experienced.

Many alcoholics have used other drugs, legally prescribed or not, that are addictive. These other drugs also serve as  relapse triggers later if they ever seek treatment. And when employee relapse, typically they still look great at work even though they are at-risk for accidents and other horrible drug-related costs.

Side note: I like the terms addictive disease or chemical dependency because they help educate the general public to understand that any mood altering substance is off bounds for those recovering from addictive disease. Any mood altering substance is a relapse. Any employee in a DOT regulated position who goes to treatment for heroin addiction has relapse if they ever pick up a drink of alcohol.

Addiction is a disease process and it is primary.  Patients are therefore taught to manage their disease in order to prevent relapse in the same way diabetics are taught to manage their illness.
Use of alcohol or drugs begins with experimentation or peer pressure for almost any drinker.  Physiologic susceptibility determines from that point forward what the progression of the disease will be.  But other factors can influence severity and course of the disease.

When educating supervisors, discuss that the American Medical Association declared alcoholism a disease in 1957. Alcoholism was declared a disease in 1956 by the World Health Organization, however. This information dispels the myth that is an opinion whether alcoholism is a disease or not.
The good news is that research shows most people believe alcoholism (addiction) to be a disease, however, this belief does not contribute easily to self-diagnosis because of denial. 

Most people attempt to define alcoholism by behaviors (how much one drinks, when, or what). This is a bit misguided. Evidence of the disease on the body’s functions is what make this argument a disease more convincing. Evidence of tolerance, evidence of alcohol's harm, evidence of withdrawal symptoms.

Some occupations are characterized by more frequent opportunity to use alcohol socially or without observation by managers. These positions expose employees to more opportunities to naturally tax their susceptibility. This, and not job stress or other mysterious causes, is what contributes to the high rates of alcoholism found among these population groups. Alcoholics gravitate to these jobs as well, naturally, because they accommodate the drinking pattern