#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.

#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 WorkExcel.com'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.

#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.