Substance Abuse Clinicians and researchers commonly divide drug and alcohol consumption into three levels or stages of use: use, abuse, and dependence. While the use of drugs and alcohol does not generally rise to the level of an impairment that constitutes a disability, abuse and dependence do. Drug and alcohol abuse is characterized by intensified, regular, sporadically heavy, or "binge" use, and dependence is characterized by conpulsive or addictive use. Under the Americans with Disabilities Act (ADA) employers are specifically permitted to ensure that the workplace is free from the illegal use of drugs and the use of alcohol. An employer may prohibit the use of drugs and alcohol in the workplace and may require that employees not be under the influence of alcohol or drugs. At the same time, the ADA provides recovering drug addicts and alcoholics some limited protection from discrimination. However, employees who use drugs or alcohol may be required to meet the same standards of performance and conduct that employers set for other employees. Unsatisfactory behaviour such as absenteeism, tardiness, poor job performance, or accidents caused by alcohol or illegal drug use does not need to be accepted or accommodated. Current illegal users of drugs are not "individuals with disabilities" under the ADA, and thus, the obligation to provide a reasonable accommodation would not exist. However, individuals addicted to drugs, but who are no longer using drugs illegally and are receiving treatment for drug addiction or who have been rehabilitated successfully, are protected by the ADA from discrimination on the basis of past drug addiction. A person who currently uses alcohol is not automatically denied protection simply because of the alcohol use. An alcoholic is a person with a disability under the ADA, and may be entitled to some form of accommodation, if they are qualified to perform the essential functions of the job. Alcoholism Currently, nearly 14 million Americans abuse alcohol or are alcoholic. Several million more adults engage in risky drinking that could lead to alcohol problems. Alcoholism, also called "alcohol dependence," is a disease that includes four symptons: craving - a strong need or compultion to drink; loss of control - the inability to limit one's drinking on any given occasion; physical dependence - withdrawal symptoms, such as nausea, sweating, shakiness, and anxiety, occur when alcohol use is stopped after a period of heavy drinking; tolerance - the need to drink greater amounts of alcohol in order to "get high". (National Institute of Health, 2001) Alcoholism is characterized by preoccupation with alcohol, and distortions in thinking, most notably denial. Alcohol abuse is a pattern of problem drinking that causes health problems, social problems, or both. According to the Equal Employment Opportunity Commission (EEOC), alcoholism is an impairment, and, therefore, people with alcoholism who are substantially limited in a major life activity will have a disability under the Americans With Disabilities Act. However, individuals with current alcohol related disabilities, like any other individual with a current disability, must be able to perform the essential functions of the job to be protected against discrimination. At the same time, even if a person with alcoholism meets the definition of disability, an employer can discipline, discharge, or deny employment to an alcoholic whose current use of alcohol negatively affects job performance, or conduct to the extent that s/he is no longer a "qualified individual with a disability". Accommodation solutions The workforce includes many individuals with some form and degree of alcoholism who, with the appropriate accommodations, can be both successful and productive on the job. Accommodations will not always be necessary, nor will they always be effective. As with all employees, employers need to assess the qualifications and performance of workers who are alcoholic on an individual basis, and accommodations need to be made on a case-by-case basis, taking into consideration each employee's individual limitations and accommodation needs. Workplaces and jobs vary, and so do people with disabilities, And as usual, the person with the disability will generally be our best resource for identifying potential barriers and the accommodations that eliminate them. Accommodations for individuals in recovery from an alcohol problem will vary depending upon the requirements of the job and the individual's length of time in recovery. For example, individuals who have recently completed a rehabilitation program may need to participate in a structured, outpatient continuing care program on a regular basis. Others who have been sober for a long time may participate in self-help groups, such as Alcoholics Anonymous, in order to prevent relapse. Involvement in this kind of continuing care may require some accommodation. Examples of accommodations to deal with attendance issues include: * Allowing use of paid or unpaid leave for medical treatment. For individuals with current alcohol impairments who are able to perform their job effectively and safely, employers are required to consider providing unpaid leave to permit that individual to attend an in-patient treatment program. In addition, if the employer provides paid leave to individuals who are obtaining medical treatment for a disability, s/he must provide the same benefit to an individual who is obtaining treatment for an alcohol problem. Allowing use of paid or unpaid leave or flexible scheduling for counseling. Examples of accommodations to assist with maintaining concentration include: Reducing distractions in the workplace. Providing space enclosures or a private office. Allowing for frequent breaks. Dividing large assignments into smaller tasks and steps. Examples of accommodations to assist with staying organized and meeting deadlines include: Providing clerical support. Making a daily to-do list. Scheduling weekly metings with supervisor to determine goals and address the employee's questions, concerns, and work progress. Establishing clear expectations of the employee's responsibilities and the consequences of not meeting them. Establishing written long term and short term goals. Examples of accommodations to assist with handling stress include: Providing praise and positive reinforcement. Referring the employee to counseling and employee assistance programs. Not mandating job-related social functions where there would be exposure to alcohol. Encouraging the employee to use company sponsored health programs. Issues employers should consider when beginning to explore the accommodation process include: 1) What limitations is the employee with alcoholism experiencing? 2) How do these limitations affect the employee and the employee's job performance? 3) What specific job tasks are problematic as a result of these limitations? Drug Abuse Drug addiction is a chronic, relapsing, and treatable disease. Addiction begins with a conscious choice to use drugs. According to the National Institute on Drug Abuse, recent scientific research provides overwhelming evidence that not only do drugs interfere with normal brain functioning creating powerful feelings of pleasure, but they also have long- term effects on brain metabolism and activity. At some point, changes occur in the brain that can turn simple drug abuse into an addiction. Individuals addicted to drugs suffer from a compulsive drug craving and useage and cannot quit by themselves. A variety of approaches are used in treatment programs to help individuals deal with cravings and possibly avoid drug relapse. Through treatment that is tailored to individual needs, individuals can learn to control their condition and live realtively normal lives. Some of the behavioural characteristics that may occur on the job, with drug addiction, include: absences without notification and an excessive use of sick days; frequent disappearances from the work site, long unexplained absences, and improbable excuses; work performance that alternates between periods of high and low productivity; unreliability in keeping appointments and meeting deadlines; confusion, memory loss, and difficulty concentrating or recalling details and instructions; progressive deterioration in personal appearance and hygiene; a tendency to wear long sleeves when it is inappropriate to do so; increasing personal and professional isolation. It is important to understand that these behavioral characteristics do not always indicate drug addiction, but they may indicate the need for further investigation by employers. According to the Equal Employment Opportunity Commission, current illegal users of drugs are not "individuals with disabilities" under the Americans with Disabilities Act. However, individuals addicted to drugs, but who are no longer using drugs illegally, and are receiving treatment for drug addiction or who have been rehabilitated successfully, have protections under the ADA from discrimination based on their past history of drug addiction. Only individuals, who are addicted to drugs, have a history of addiction, or who are regarded as being addicted have an impairment under the Americans with Disabilities Act. In order for an individual's drug use to be considered a disability, it must pose a substantial limitation on one or more major life activities. Defining Illegal Drug Use The illegal use of drugs includes the use, possession, or distribution of drugs that are unlawful under the Controlled Substances Act. It also includes the illegal use of prescription drugs that are "controlled substances". The illegal use of drugs does not include drugs that are taken under the supervision of a licensed health care professional. This includes experimental drugs for individuals with AIDS, epilepsy, or mental illness. Current drug use means that the illegal use of drugs occurred recently enough to justify an employer's reasonable belief that the individual's use of drugs is an on-going problem. The problem is not limited to the day of use, or to recent weeks or days, in terms of being able to take an employment action. Whether or not to take action must be determined on a case-by-case basis. Accommodation solutions The workforce includes many individuals with some form and degree of drug addiction who, with the appropriate accommodations, can be both successful and productive on the job. Accommodations will not always be necessary, nor will they always be effective. As with all employees, employers need to assess the qualifications and performance of workers with drug addiction on an individual basis, and accommodations need to be made on a case-by-case basis, taking into consideration each employee's individual limitations and accommodation needs. Workplaces and jobs vary, and so do people with disabilities, And as usual, the person with the disability will generally be our best resource for identifying potential barriers and the accommodations that eliminate them. Accommodations for individuals in recovery from a drug problem will vary depending upon the requirements of the job and the length of time the individual has been in recovery. As with alcoholics, drug addicts who have recently completed a rehabilitation program may need to participate in a structured, outpatient continuing care program on a regular basis. Others who have been drug-free for a long time may still need to participate in self-help groups, such as Narcotics Anonymous, in order to prevent a relapse. Participating in such continuing care may require some form of accommodation. Examples of accommodations to help facilitate treatment needs include: Allow the use of paid or unpaid leave for inpatient medical treatment. Allowing use of paid or unpaid leave or a flexible work schedule for counseling or to attend support meetings. Examples of accommodations to assist with handling stress include: Providing praise and positive reinforcement. Refering to counseling and employee assistance programs. Allowing frequent work breaks. Reassignment to a less stressful job. Allowing for a flexible work schedule and flexible use of leave time. Examples of accommodations to assist with maintaining concentration include: Providing space enclosures or a private office. Developing a plan for uninterrupted work time. Dividing large assignments into smaller tasks and steps. Restructuring the job to include only the essential functions. Issues employers should consider when beginning to explore the accommodation process include: 1) What limitations is the employee with drug addiction experiencing? 2) How do these limitations affect the employee and the employee's job performance? 3) What specific job tasks are problematic as a result of these limitations? Additional Resources The Job Accommodation Network (JAN) is a service of the Office of Disability Employment Policy of the US Department of Labor. JAN's mission is to facilitate the employment and retention of workers with disabilities by providing employers, employment providers, and people with disabilities with information on job accommodations. JAN represents the most comprehensive resource for job accommodations available. Click here http://www.jan.wvu.edu/media/alco.htm to get accommodation and resource information on alcoholism. Click here http://www.jan.wvu.edu/media/drug.htm to get accommodation and resource information on drug abuse. The Job Accommodation Network's Searchable Online Accommodation Resource (SOAR) system is designed to assist users in exploring various accommodation options for people with disabilities in work settings. These accommodation ideas are not all inclusive, however. The SOAR system allows the user to search by disability to get information on corresponding limitations, job functions, and accommodations. Click here http://www.jan.wvu.edu/soar/disabilities.html to begin your accommodation resource search. The Equal Employment Opportunity Commission (EEOC) Title I Technical Assistance Manual provides technical assistance to help employers, other covered entities, and persons with disabilities learn about their obligations and rights under the employment provisions of the Americans with Disabilities Act. Click here http://www.jan.wvu.edu/links/ADAtam1.html#VIII to go to the manual section on Drug and Alcohol Abuse. The School of Industrial and Labor Relations Program on Employment and Disability, at Cornell University, serves as the Rehabilitation Research and Training Center for economic research on employment policy for persons with disabilities. In that capacity they have developed several informational brochures on working effectively with people with various kinds of disabilities. Click here http://www.ilr.cornell.edu/extension/files/download/Alcohol.txt to download their brochure on Employing and Accommodating Individuals with Histories of Alcohol or Drug Abuse.