When I meet with newly hired employees, I suggest they make a note to themselves and keep that note at their desks throughout their employment. The note says, “Remember, you are saving lives every day.”
T
he delivery of SAP services is a challenging endeavor. Te SAP is a multi-tasking polymath who applies
in-depth knowledge of addictionology, psychology, social work, complex federal regulations, legal contingencies, treatment options and substance use testing to the business of helping an individual successfully comply with DOT return-to- duty requirements. It’s a lot of work and a lot of responsibility. What can easily get lost in the complexity of the job is the fact that lives are being saved. Every day. We are all familiar with the costs in lives,
dollars and lost-productivity that substance use impresses upon the American workplace, taxpayers and ordinary citizen: $453 billion in lost dollars, 40,000 lives annually lost to drug overdoses and more than 10,000 lives annually lost to alcohol related traffic accidents. Te list of losses goes on. Te answer, they say, is beter detection of
Substance Use Disorders (SUDs) and beter access to good treatment. Tis can hardly be disputed. Te problem is that SUDs can be complicated diseases and individuals who suffer from them have unique psychologies, physiologies, social stresses, family profiles, genetic histories and medical histories. One treatment does not fit all; in fact, good treatment nuances the process, constantly course-correcting and re-fiting according to individual needs. Te DOT’s “Procedures for
Transportation Workplace Drug and Alcohol Testing Programs” mandates a rigorous detection program that requires pre- employment, random, reasonable suspicion, post-accident and follow-up testing. When a DOT covered employee registers a positive test, he/she is referred to a qualified SAP. Te SAP evaluates the individual and recommends suitable treatment and/or education. Ideally, the recommendations will
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be to treatment programs that recognize the shape-shiſting nature of SUDs and help the individual successfully navigate the twisting route to recovery. Treatment success, as measured by
national treatment completion records and reported in 2011 by SAMHSA (Substance Abuse and Mental Health Services Administration), averaged 59 percent. Tere is a good probability that, even at this level, too many lives are still being lost. On the other hand, treatment success
rates among those who participate in the DOT return-to-duty process are astoundingly and consistently high (in the 80 percent–86 percent range in our experience)! Te DOT expressly does not endorse, prescribe or require any particular type of treatment, yet practically any type of treatment recommended by a SAP seems to thrive within its structure. Why is this? A key to understanding the success of the
DOT model is to remember a basic behavioral tenet of SUDs, A.K.A. addiction: repeated use despite negative consequences. Negative consequences, in the case of SUDs, do not deter use. In fact, negative consequences alone are associated with high treatment drop-out rates and higher levels of use. Te “secret sauce” of DOT return-to-
duty success is in the selection and timing of imposed consequences. Yes, negative consequences are used; the violating individual is either suspended from employment or fired, but positive consequences are used too. Tis ‘carrot and stick’ formula has a formal name, Contingency Management (CM). CM, in the broadest sense, describes any intervention that drives behavior change by way of rewarding desired behavior and punishing behavior that is undesirable. You will recognize CM as representing the principles of B.F. Skinner’s “operant conditioning”: rewarded behavior is the behavior that is most likely to be repeated. Te DOT return-to-duty process is actually a highly sophisticated and effective CM superstructure that can contain and empower virtually any treatment or treatment program prescribed by the evaluating SAP.
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