Alcohol, Drugs and Smoking
When drugs are referred to in this chapter it is the use of controlled substances and the misuse of over-the-counter or prescription drugs which is meant. Controlled substances include class A, B and C drugs such as cannabis, cocaine, lysergic acid diethylamide (LSD), etc. The term ‘drugs’ is also used to include the abuse of other substances such as solvent abuse. The use of such drugs is illegal and it may seem surprising that this chapter also includes alcohol and smoking when alcohol and tobacco are not in themselves illegal substances. However, all have the potential for addiction and all can have a substantial effect on the workplace. In the context of work, the misuse of drugs and alcohol in particular, can not only damage the health of the user, but also have an impact on the workplace in respect of absenteeism and reduced efficiency. Smoking, while certainly not an illegal activity in itself, is, since 2007 (2006 in Scotland), illegal in the workplace. This is covered in more detail later in the chapter.
While there are no firm statistics on the effects of drug misuse in the workplace, there is evidence to show that the misuse of alcohol is associated with increased costs to the business and an increased risk of injury to the individual concerned and his/her colleagues and patients.
- 20–25% of patients in acute hospital beds have alcohol as a contributory factor in their admission.
- 20% of fatal accidents at work involve people with blood alcohol levels over the legal drink drive limit.
- Between 8 and 14 million working days are lost every year because of alcohol-related absenteeism.
- Costs to industry are estimated at over £2 billion per year.
- Smoking costs the National Health Service (NHS) around £1.5 billion per year.
- Health and Safety at Work etc. Act 1974:
Employers have a general duty to their employees, so far as is reasonable, to provide and maintain equipment and systems of work that are safe and without risks to health. The general duty covers the physical and psychological well-being of employees and the individual needs of each employee should be considered.
- Management of Health and Safety at Work Regulations 1999:
Employers must undertake suitable and sufficient assessments of risks to the health and safety of employees and implement reasonable controls.
- Misuse of Drugs Act 1971:
It is an offence under the Misuse of Drugs Act 1971 for any person to “knowingly permit the production, supply or use of controlled substances on their premises except in specified circumstances (e.g. when they have been prescribed by a doctor).” (Source: HSE.)
- The Health Act 2006:
Employers have a legal responsibility to ensure premises are smoke free, and they are accountable for staff and customers.
- The Smoke-free (Premises and Enforcement) Regulations 2006:
From 1 July 2007 it is an offence to smoke in virtually all ‘enclosed’ and ‘substantially enclosed’ workplaces. The terms are defined in the Regulations.
- The Smoke-free (Signs) Regulations 2007 – (self-explanatory):
Specific smoke-free regulations covering premises, vehicles and signage which were enacted on different dates in 2006 and 2007 in England, Wales, Scotland and Northern Ireland.
Apart from the general duties of employers covered in the legislation above, the Health and Safety Executive (HSE) says that ‘if you knowingly allow an employee under the influence of excess alcohol to continue working and this places the employee or others at risk, you could be prosecuted’. Clearly, the same could be said for allowing an employee to work under the influence of drugs. A dental surgery is potentially a dangerous environment as it contains many items, which, if not used correctly, could injure the user, his/her colleagues or the patient. Misuse of alcohol or drugs means that the judgement of the individual is affected and it becomes more likely that accidents will happen. Apart from the misuse of equipment such as X-ray machines, needles, drills and so on, there is also potential for these items not to be correctly sterilised. There is further information below about the effects that misuse of alcohol, drugs and smoking can have on a business and on an individual. As dentistry is one of the medical professions, it could also be considered to be a stronger reason for misuse to be dealt with, and to be seen to be dealt with, promptly. The main aims of the General Dental Council (GDC) are listed as follows:
- Protect patients.
- Promote confidence in dental professionals.
- Be at the forefront of health-care regulation.
It should be noted that the protection of patients is the first and most important aim listed.
As has been seen above, the misuse of alcohol and drugs can have a significant effect on the behaviour of an individual as well as on his/her health and well-being. However, smoking will also affect the health and well-being of a person, particularly if he/she has been smoking for some time. All three can also have an impact on colleagues and on patients. All three types of substances could be said to be taken for their narcotic or stimulant effect and can lead to addiction if misused.
Many people regard alcohol as a positive and pleasurable part of their lives. It is only when alcohol is abused that it will impact on an individual’s behaviour and on his/her ability to work safely. While there are no known figures on the number of workplace accidents where alcohol consumption is a factor, alcohol is known to affect both judgement and physical coordination. The figures in the introduction to this chapter show how costly alcohol abuse can be in the workplace and the effects on the individual are not only quantifiable in terms of money.
It may be difficult for employers to be sure when they spot the signs of alcohol abuse and when observed it can also be a daunting prospect to deal with the situation. Some of the indications might be
- decreased productivity;
- higher rates of absenteeism;
- being late for work regularly;
- increased aggression;
- bad decision-making.
Some physical signs might be
- slurred speech, increased clumsiness or unsteadiness;
- weight loss (those dependent often drink rather then eat);
- redness in face;
- complaining of tingling in hands and feet.
Observable ‘mental’ signs might be
- increased irrationality, agitation or anger;
- excessive weeping or emotional display;
- unexplained absences during the day.
Of course, the above signs and symptoms could be an indication of a number of illnesses; so care is needed when confronting someone with the employer’s concerns.
Contrary to the popular view that someone who abuses alcohol is out of work and possibly homeless, many such people are employed and so create issues for themselves, their colleagues and their employers. If the person concerned has direct contact with patients, the situation can become very serious indeed for the safety of the patient and the reputation of that dental practice, and ultimately for the profession.
There are no figures available to show how much absenteeism or how many accidents in the workplace have occurred as a result of the misuse of drugs. However, the implications of drug misus/>