1. tolerance as defined by a need for increased amounts of the sub- stance to reach the desired effect or markedly decreased effect of the substance with continued use;


2. manifestation of withdrawal syn- drome marked by increased tol- erance as defined above or the taking of the same or a closely re- lated substance to relieve or avoid the symptoms of withdrawal (e.g., substitution of heroin with Percocet);


3. taking of a substance in larger amounts or over a longer period than intended thereby demon- strating the inability to control consumption of the substance;


4. a persistent desire or unsuccess- ful efforts to cut down or control one’s use of the substance;


5. either reducing or the abandonment of important social, occupational or recreational activities; and


6. the continued use despite experi- encing or knowledge of the physi- cal and psychological problems.


Work Performance Indicators of Possible Substance Abuse Substance abusers frequently show similar unusual behavior. The follow- ing behaviors might indicate that a colleague has a substance abuse dis- order, according to a January 2008 article in Substance Abuse Treatment, Prevention, and Policy. 1. Reduced job efficiency: unre- alistic explanation for lowered work quality and increased care- lessness or mistakes;


2. Inconsistent work patterns: al- ternating periods of high and low efficiency and becoming less de- pendable;


3. Absenteeism: patterns of call- ing out on Mondays, Fridays and after holidays. Excessive use of sick time;


General Guidelines for Reporting Substance Abuse


Know the signs and symptoms of substance abuse.


Accurate, clear documentation of evidence is important. Write an unambiguous, concise summary of observable performance issues and the source of that observation.


While anonymity may not be possible, confidentiality must be maintained at all times.


There might be retaliation by the substance abuser or others. Sub- stance abuse affects the abuser and those around them. Be prepared to hold debriefing and support groups for co-workers who have been af- fected by the situation.


Do not gossip.


To avoid libel and slander, pro- vide objective information. Do not focus on the person, but on the performance and behavioral issues that manifest as a result of substance abuse.


Verify evidence with co-workers to lend objectivity.


Follow organizational, state and federal policy, procedure and reg- ulatory rulings.


8. Difficulty in concentration: as- signments take more time despite having the required skill and ex- perience. Omitted, illogical, in- complete or illegible charting;


9. Medication-centered problems: increased use of p.r.n. psycho- active or narcotic medications charted for patients. Spending a lot of time around the medication storage and preparation areas. Patient complaints of inadequate pain relief; and


10. Other areas: excessive time with personal phone calls and exces- sive talkativeness, according to the US Drug Enforcement Ad- ministration’s information and le- gal resource “Drug Addiction in Health Care Professionals.”


Intervention Some co-workers, managers and organizations avoid dealing with a health care worker with substance abuse


problems entirely. Others


4. On-the-job absenteeism: extend- ed lunch breaks or unexplained disappearances on the job;


5. Attitude/mood swings: dramatic mood shifts, tendency to isolate or irritability;


6. Physical/emotional problems: mark ed nervousness on the job. Reports to duty despite physical or emotional contra-indications;


7. Impaired interpersonal relationship: frequent arguments with co-work- ers, excessive blaming of others. Complaints by patients, co-work- ers of irritability, physical rough- ness or verbal abuse;


immediately dismiss an employee thought or known to have a substance abuse issue, but immediate dismiss- al without appropriate intervention helps no one. Failure to intervene may simply displace the employee with a substance abuse problem. Moving the problem from one orga- nization to another without any as- sistance to the employee may have negative effects on the employee’s colleagues, friends, family members and future patients. With the privileges associated with licensure to practice as health care professionals comes the legal obligation to abide by rules, regu- lations and organizational


policies


that govern our practice. Some state boards require that a person be re- ported when there is evidence, proof or suspicion of impairment. Penal- ties and disciplinary actions may be imposed. These may include fines,


ASC FOCUS APRIL 2013 9


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