An Industrial Alcohol Policy: The Characteristics of Worker Success

Characteristics associated with success of problem drinkers m workplace treatment settings remain obscure. The development of interventions in such settings tend to rely on generalizations from non-workplace treatment settings and untested assumptions. The present study seeks to ascertain the characteristics of success in a workplace setting. A company with an alcohol policy provided records of all individuals referred for treatment over α 4 year period (N = 48). Analysis of the data indicated that older, longer service employees were likely to be more successful in this company. It was also evident that self-referral was associated with ‘poor’ outcome. The significance of this result is discussed in relation to prognostic factors in the industrial setting and the relevance to future development of industrial alcohol policies.     

Characteristics of Successful Alcoholism Treatment Programs for American Workers

This paper examines the question of determining the component characteristics of successful industrial alcoholism treatment programs by analyzing the findings reported in twenty-four previous studies. The review begins by speaking to methodological problems in comparing reports of treatment outcomes such as comparability of the data measurement problems, and differences in treatment populations. It speaks directly to the importance of coercive and confrontation tactics on the part of management as being necessary to successful identification and referral of problem drinkers in industrial programs. Indeed, the authors conclude that the significance of company identification and referral procedures may play a greater part in rehabilitation than the components of the treatment situation. The paper also describes the unique importance of the industrial setting as having a potentially greater rehabilitative affect than other treatment settings.     

Establishing a workplace antiretroviral therapy programme in South Africa

Ways to expand access to antiretroviral treatment (ART) in low income settings are being sought. We describe an HIV care programme including ART in an industrial setting in South Africa. The programme uses guidelines derived from local and international best practice. The training component aims to build capacity among health care staff. Nurses and doctors are supported by experienced HIV clinicians through telephone consultation and site visits. Patients undergo a three-stage counselling procedure prior to starting ART. Drug regimens and monitoring are standardised and prophylaxis against opportunistic infections (isoniazid and cotrimoxazole) is offered routinely. Laboratory and pharmacy services, using named-patient dispensing, are centralized. The programme is designed to ensure that data on clinical and economic outcomes will be available for programme evaluation. Between November 2002-December 2004, ART delivery has been established at 70 ART workplace ART sites. The sites range from 200 to 12000 employees, and from small occupational health clinics and general practitioner rooms to larger hospital clinics. During this period, 2456 patients began ART. Of those on treatment for at least three months, 1728 (78%) have been retained on the programme and only 38 (1.7%) patients have failed the first-line ART regimen. This model for delivery of ART is feasible and successful in an industrial setting. The model may be generalizable to other employment health services in settings of high HIV prevalence, and as a model for implementing ART in other types of health-care settings.     

Treatment setting and baseline substance use severity interact to predict patients' outcomes

AIMS: This study tested the hypothesis that patients with more severe substance use disorders (SUDs) at intake respond better when treated in more structured and intensive settings (i.e. in-patient/residential versus out-patient), whereas patients with less severe SUD problems have similar outcomes regardless of treatment setting. DESIGN, SETTING AND PARTICIPANTS: Up to 50 new patients were selected randomly from each of a random and representative sample of 50 Department of Veterans Affairs (VA) SUD treatment programs (total n = 1917 patients), and were followed-up an average of 6.7 months later (n = 1277). MEASURES: Patients completed a brief self-report version of the Addiction Severity Index (ASI) at baseline and at follow-up. FINDINGS: In mixed-model regression analyses, baseline substance use severity predicted follow-up substance use severity and there were no main effects of treatment setting. However, interaction effects were found, such that more severe patients experienced better alcohol and drug outcomes following in-patient/residential treatment versus out-patient treatment; on the other hand, patients with lower baseline ASI drug severity had better drug outcomes following out-patient treatment than in-patient treatment. Treatment setting was unrelated to alcohol outcomes in patients with less severe ASI alcohol scores. CONCLUSIONS: Results provide some support to the matching hypothesis that for patients who have higher levels of substance use severity at intake, treatment in in-patient/residential treatment settings is associated with better outcomes than out-patient treatment. More research needs to be conducted before in-patient/residential settings are further reduced as a part of the SUD continuum of care in the United States.     

Outcome predictors for problem drinkers treated with combined cognitive behavioral therapy and naltrexone

Background: The opioid antagonist naltrexone, combined with cognitive behavioural therapy (CBT), has proven efficacious for patients with alcohol dependence, but studies examining how this treatment works in a naturalistic treatment setting are lacking. Objectives: This study examined predictors of the outcome of targeted naltrexone and CBT in a real-life outpatient setting. Participants were 315 patients who attended a treatment program providing CBT combined with the targeted use of naltrexone. Methods: Mixture models for estimating developmental trajectories were used to examine change in patients’ alcohol consumption and symptoms of alcohol craving from treatment entry until the end of the treatment (20 weeks) or dropout. Predictors of treatment outcome were examined with analyses of multinomial logistic regression. Minimal exclusion criteria were applied to enhance the generalizability of the findings. Results: Regular drinking pattern, having no history of previous treatments, and high-risk alcohol consumption level before the treatment were associated with less change in alcohol use during the treatment. The patients with low-risk alcohol consumption level before the treatment had the most rapid reduction in alcohol craving. Patients who drank more alcohol during the treatment had lower adherence with naltrexone. Conclusion: Medication non-adherence is a major barrier to naltrexone’s effectiveness in a real-life treatment setting. Patients with more severe alcohol problems may need more intensive treatment for achieving better treatment outcome in real-word treatment settings.     

Pulmonary infections acquired in the workplace. A review of occupation-associated pneumonia.

The risk of humans acquiring pneumonia as a result of their occupation appears to have declined during the twentieth century in developed countries, such as the United States. Thus, some conditions that are traditionally associated with the workplace, such as woolsorters' disease, represent illnesses that are of historical interest only. Nevertheless, the problem of occupation-associated pneumonia remains substantial. First, large outbreaks of zoonotic infections continue to occur, especially psittacosis among poultry farmers and abattoir workers. Second, clusters of illnesses caused by recently recognized pathogens are now being reported, including legionnaires' disease in industrial workers and Chlamydia pneumoniae infections in military personnel. Finally, epidemics of old conditions are appearing in new settings, such as tuberculosis among nursing home workers. Thus, the transmission, control, and treatment of pneumonias acquired in the workplace represent intriguing and challenging areas of concern to the epidemiologist and clinician.     

Alcohol use disorders: screening and diagnosis

The purpose of this article is to provide an overview of empirically supported, primarily self-report methods of screening and diagnosis related to alcohol use disorders (AUDs). The discussion of screening instruments focuses on the primary care setting, and the diagnosis instruments discussion centers on the alcohol (and other drug) treatment setting. The literature shows that the AUDIT and the CAGE are the most widely validated methods of screening for AUDs in primary care and may be applied readily in that context. Similarly, a number of instruments designed to derive DSM-IV (and ICD-10) AUD diagnoses, as well as constructs related to how AUDs are defined, are available and can meet a variety of clinical needs. Future research priorities include further development of brief methods to identify hazardous drinkers or individuals who have an AUD, as well as refinement of diagnosis instruments to increase their application across treatment settings and subpopulations.     

AIDS,order and 'best practice' in the South African workplace: managers,peer educators,traditional healers and folk theories

This article examines the response of three medium-sized South African manufacturing companies to HIV/AIDS. It is argued that the response is heavily influenced by managerial conceptions of workplace order — sometimes divergent from industrial realities — which results in the selective inclusion and omission of best-practice components. The role of peer educators and traditional healers within workplace programmes, and the handling of folk theories developed independently by workers, are used to illustrate the particular nature of workplace responses. Ideologically based selection of best-practice components is likely to limit the success of workplace HIV/AIDS programmes and result in slow development and improvement.     

The Alcohol Use Disorders Identification Test (AUDIT) and carbohydrate-deficient transferrin (CDT) in a routine workplace health examination

BACKGROUND: Only a few studies on workplaces have examined the Alcohol Use Disorders Identification Test (AUDIT) or carbohydrate-deficient transferrin (CDT) as screening instruments for the early identification of elevated and risky levels of alcohol consumption. The purpose of this study was to compare the performances of AUDIT, CDT, and gamma-glutamyltransferase (GGT) in a routine health examination (alcohol screening) in the workplace. METHODS: The study, carried out over 16 months in a large workplace in the transport sector, was part of an on-going controlled study. Employees who came to the company health service for a routine health examination were offered the opportunity to undergo an alcohol screening and check their alcohol habits. RESULTS: Of the 570 subjects who participated, 105 (18.4%) screened positive according to AUDIT, CDT, or both. Only 7.6% of the persons who screened positive did so according to both instruments. If GGT had been included as a screening instrument, the proportion of positive results would have increased to 22.0%. If we had only used AUDIT in the screening process, the proportion of positives would have fallen by nearly half. CONCLUSIONS: The present findings suggest that AUDIT and CDT are complementary instruments for alcohol screening in a routine workplace health examination, and each has value for identifying a different segment of the risky drinking population.     

The Veterans Administration's Comparison Study: Alcoholism and Drug Abuse—Combined and Conventional Treatment Settings

Traditionally, alcohol and drug abusers have been treated in separate environments. However, due to a growing interest in combined treatment, a 6-mo comparison of patient performance obtained in conventional and combined treatment settings was carried out. While both treatment settings produced sizable improvements in patients, results indicated an improved outcome for alcoholics treated in a conventional setting which, though small, was statistically significant.     

Integrated Management of Physician‐delivered Alcohol Care for Tuberculosis Patients: Design and Implementation

Background: While the integration of alcohol screening, treatment, and referral in primary care and other medical settings in the U.S. and worldwide has been recognized as a key health care priority, it is not routinely done. In spite of the high co‐occurrence and excess mortality associated with alcohol use disorders (AUDs) among individuals with tuberculosis (TB), there are no studies evaluating effectiveness of integrating alcohol care into routine treatment for this disorder. Methods: We designed and implemented a randomized controlled trial (RCT) to determine the effectiveness of integrating pharmacotherapy and behavioral treatments for AUDs into routine medical care for TB in the Tomsk Oblast Tuberculosis Service (TOTBS) in Tomsk, Russia. Eligible patients are diagnosed with alcohol abuse or dependence, are newly diagnosed with TB, and initiating treatment in the TOTBS with Directly Observed Therapy‐Short Course (DOTS) for TB. Utilizing a factorial design, the Integrated Management of Physician‐delivered Alcohol Care for Tuberculosis Patients (IMPACT) study randomizes eligible patients who sign informed consent into 1 of 4 study arms: (1) Oral Naltrexone + Brief Behavioral Compliance Enhancement Therapy (BBCET) + treatment as usual (TAU), (2) Brief Counseling Intervention (BCI) + TAU, (3) Naltrexone + BBCET + BCI + TAU, or (4) TAU alone. Results: Utilizing an iterative, collaborative approach, a multi‐disciplinary U.S. and Russian team has implemented a model of alcohol management that is culturally appropriate to the patient and TB physician community in Russia. Implementation to date has achieved the integration of routine alcohol screening into TB care in Tomsk; an ethnographic assessment of knowledge, attitudes, and practices of AUD management among TB physicians in Tomsk; translation and cultural adaptation of the BCI to Russia and the TB setting; and training and certification of TB physicians to deliver oral naltrexone and brief counseling interventions for alcohol abuse and dependence as part of routine TB care. The study is successfully enrolling eligible subjects in the RCT to evaluate the relationship of integrating effective pharmacotherapy and brief behavioral intervention on TB and alcohol outcomes, as well as reduction in HIV risk behaviors. Conclusions: The IMPACT study utilizes an innovative approach to adapt 2 effective therapies for treatment of alcohol use disorders to the TB clinical services setting in the Tomsk Oblast, Siberia, Russia, and to train TB physicians to deliver state of the art alcohol pharmacotherapy and behavioral treatments as an integrated part of routine TB care. The proposed treatment strategy could be applied elsewhere in Russia and in other settings where TB control is jeopardized by AUDs. If demonstrated to be effective, this model of integrating alcohol interventions into routine TB care has the potential for expanded applicability to other chronic co‐occurring infectious and other medical conditions seen in medical care settings.     

Predicting Treatment Outcome on the Basis of Temperament in Patients Who Are Socially Stable and Alcohol Dependent

The literature on predictors of treatment outcome is relatively extensive, but results on personality factors that predicts treatment outcome among alcohol dependent patients are still inconclusive. The aim of this study was to investigate if the scales of the Temperament and Character Inventory could predict treatment outcome after 18 months in a sample of patients who were socially well adjusted and alcohol dependent (N = 202). Bivariate comparisons indicate that patients with higher levels of harm avoidance showed a lower probability of successful treatment. Further, exploratory analysis of specific configurations associated with treatment success or failure was presented. The results indicate that harm avoidance seem to be a key factor for this specific sample of patients who are socially well adjusted and alcohol dependent, results that might be useful in clinical practice.     

The effectiveness of inpatient and outpatient treatment for alcohol abuse: the need to focus on mediators and moderators of setting effects

Previous reviews have concluded that there was no evidence for the superiority of inpatient over outpatient treatment of alcohol abuse, although particular types of patients might be more effectively treated in inpatient settings. In this review, we first consider the conceptual rationales that have been offered to support inpatient and outpatient treatment. Following that, the results of the relevant research on setting effects are presented. Five studies had significant setting effects favoring inpatient treatment, two studies found day hospital to be significantly more effective than inpatient treatment, and seven studies yielded no significant differences on drinking-related outcome variables. In all but one instance in which a significant effect emerged, patients in the ‘superior’ setting received more intensive treatment and patients were not ‘preselected’ for their willingness to accept random assignment to treatment in either setting. Studies finding significant setting effects also conducted more treatment contrasts (18.6 vs. 4.9), on average, and had a mean statistical power level of 0.71 (median 0.79) to detect a medium-sized effect, whereas studies with no significant findings had an average power level of 0.55 (median 0.57). When inpatient treatment teas found to be more effective, outpatients did not receive a respite in the form of inpatient detoxification and the studies were slightly less likely to have social stability inclusion criteria and to use random assignment to treatment settings. We consider the implications of our findings for future research, especially the need to examine the conceptual rationales put forward by proponents of inpatient and outpatient treatment, i.e. mediators and moderators of setting effects.     

Alcoholism and drug abuse—some legal issues for employers

Three specific areas of the law concern employers faced with problems of addiction at the workplace. At common law an employer may be guilty of negligence where a person has suffered personal injuries or economic loss as a result of an act of negligence committed in the course of employment by an employee. An example would be an employee with a serious addiction to alcohol or drugs who caused an accident in the company car whilst on company business. Employers may also be guilty of a criminal offence for breach of a statutory duty. One such duly is to have a ‘safe system of work’. Other statutory rights guarantee employees a right not to be unfairly dismissed and this includes employees with addiction problems. Lastly, employers must be careful not to break the contract of employment if, for example, an employee with an addiction problem were to be suspended from duty or have his company car withdrawn, even if this was a temporary measure only.     

Alcohol abuse and chronic hepatitis C

AbstractChronic infection with hepatitis C virus (HCV) and alcohol abuse are two of the most common causes of chronic liver disease in the United States. These two entities often coexist and contribute to accelerated development of liver fibrosis, cirrhosis, and hepatocellular carcinoma. Although the effect of one drink per day in the setting of chronic HCV infection is unclear, there is overwhelming evidence for the deleterious effects of heavy alcohol use on HCV liver disease. The mechanisms by which alcohol increases liver injury in hepatitis C are poorly understood. Potential pathways include impaired host immune systems and increased viral replication. Alcohol use may decrease the success of treatment. Physicians should encourage patients with chronic hepatitis C to abstain from regular alcohol use.     

Effect of criminal justice mandate on drug treatment completion in women

Background: Drug and alcohol abuse among women is a growing problem in the United States. Drug treatment is an effective way to manage the psychological, biological, financial, and social cost of drug abuse. Prior research has identified criminal justice referrals or coercion as a predictor of treatment completion among men but questions remain about the same effect in women. Objectives: This study uses the Treatment Episodes Datasets Discharge 2006–2008 (TEDS-D) to explore the association between coercion and treatment completion among women. Methods: Analysis compared primary treatment episodes of coerced women to those who entered treatment voluntarily. A logistic model of the odds of treatment success was performed controlling for race/ethnicity, age, education, employment, primary substance of abuse, number of substances reported at admission, referral source, treatment setting, and treatment duration. Results: 582?671 primary treatment episodes were analyzed comparing women with coercion referrals (n?=?196?660) to those who entered treatment voluntarily (n?=?390?054). Results of multivariable logistic modeling showed that coerced women had better odds of completion or transfer than women who entered voluntarily. However, this association was modified by treatment setting with better odds in ambulatory (OR?=?1.49 [1.47, 1.51]) than in inpatient (OR?=?1.06 [1.03, 1.10]) and worst outcomes in detoxification (OR?=?0.89 [0.84, 0.96]). Conclusion: These results dispute the broad effectiveness of legal mandates across all drug treatment settings among women. They show the need for further recognition of female-specific characteristics that can affect motivation and treatment success to better inform healthcare and judicial policies on drug treatment services for women.     

Occupational risk factors associated with alcohol and drug problems.

Ames and Janes provide a theoretical framework that explains alcohol and/or drug problems among workers. Existing studies of occupational risk factors for alcohol and drug problems across multiple occupations and industries provide mixed findings with respect to Ames and Janes' framework. In a preliminary study, the relationships between occupational characteristics and measures of alcohol and drug problems were investigated among a sample of workers from a variety of occupations and industry settings. Some support was found for all of the major elements of Ames and Janes' framework: normative regulation of drinking, quality and organization of work, workplace factors, and drinking subcultures.     

Occupational Risk Factors Associated with Alcohol and Drug Problems

Ames and Janes provide a theoretical framework that explains alcohol and/or drug problems among workers . Existing studies of occupational risk factors for alcohol and drug problems across multiple occupations and industries provide mixed findings with respect to Ames and Janes' framework. In a preliminary study, the relationships between occupational characteristics and measures of alcohol and drug problems were investigated among a sample of workers from a variety of occupations and industry settings. Some support was found for all of the major elements of Ames and Janes' framework: normative regulation of drinking, quality and organization of work, workplace factors, and drinking subcultures.     

The Alcohol Use Disorders Identification Test and carbohydrate-deficient transferrin in alcohol-related sickness absence

BACKGROUND: Previous studies have shown that elevated, risky levels of alcohol consumption may lead to higher rates of sickness absence. However, no studies have examined the Alcohol Use Disorders Identification Test (AUDIT) or serum carbohydrate-deficient transferrin (CDT) in relation to sickness absence in the workplace. The purpose of this study was to examine the relationship between sick-days, 12 months before screening, and the AUDIT and CDT (CDTect kit). Serum gamma-glutamyltransferase also was used for comparison. METHOD: The study was carried out over 36 months in a large workplace and formed part of an ongoing controlled study. In conjunction with a routine health examination, employees were offered the opportunity to undergo an alcohol screening. Absence data were obtained from the company payroll system, and sickness absence was analyzed by using a three-ordinal level cumulative logistic model on the number of sick-days. Odds ratios (OR) and 95% confidence intervals (CI) are reported. RESULTS: Of the 989 subjects who participated in the study, 193 (19.5%) screened positive in relation to either the AUDIT (>or=8 points) or CDT (<20 units/liter for men, and <27 units/liter for women), or both. Employees who screened positive with the AUDIT had a significantly higher proportion of sick-days (p = 0.047) compared with those who screened negative (OR = 1.4, CI 1.0-1.9). Neither long, continuous periods of sickness absence nor absence on Mondays or Fridays gave a clear indication of individuals who screened positive on the AUDIT or CDT test. CONCLUSION: Our data indicate that individuals with moderately elevated or risky levels of alcohol consumption show an increase in sick-days. Accordingly, workplaces have a good reason for using a more systematic approach to alcohol screening in routine workplace health examinations.     

Matching motivation enhancement treatment to client motivation: re‐examining the Project MATCH motivation matching hypothesis

Aims The current study was designed to re‐examine the motivation matching hypothesis from Project MATCH using growth mixture modeling, an analytical technique that models variation in individual drinking patterns. Design, setting and participants Secondary data analyses of data from Project MATCH (n = 1726), a large multi‐site alcoholism treatment‐matching study. Measurements Percentage of drinking days was the primary outcome measure, assessed from 1 month to 12 months following treatment. Treatment assignment, alcohol dependence symptoms and baseline percentage of drinking days were included as covariates. Findings The results provided support for the motivation matching hypothesis in the out‐patient sample and among females in the aftercare sample: the majority of individuals with lower baseline motivation had better outcomes if assigned to motivation enhancement treatment (MET) compared to those assigned to cognitive behavioral treatment (CBT). In the aftercare sample there was a moderating effect of gender and alcohol dependence severity, whereby males with lower baseline motivation and greater alcohol dependence drank more frequently if assigned to MET compared to those assigned to CBT. Conclusions Results from the current study lend partial support to the motivation‐matching hypothesis and also demonstrated the importance of moderating influences on treatment matching effectiveness. Based upon these findings, individuals with low baseline motivation in out‐patient settings and males with low levels of alcohol dependence or females in aftercare settings may benefit more from motivational enhancement techniques than from cognitive–behavioral techniques.