Substance abuse disorders in Industrial workers , the causes ,prevalence and prevention strategies especially in Indian setting

1. 
SUBSTANCE USE DISORDER:
An Unnoticed Essentiality in
Railways Occupational Scenario
Dr. Imran Khan
DMO(Psychiatry)/DRH/AII

2.  "I have always believed in the supremacy of the human
resource. For me, my employees, and not the
customers, come first. But at the same time we have to
deal with corruption, sexual harassment at workplace
and alcohol abuse while on duty. These are social evils
and need to be dealt with iron hand,"
 ( Former Railway Board Chairman Shri
Ashwani Lohani )

3. Brain imaging studies show physical
changes in areas of the brain when a
drug is ingested that are critical to:
• Judgment
• Decision making
• Learning and memory
• Behavior control
These changes alter the way the
brain works and help explain the
compulsion and continued use
despite negative consequences
(National Institute on Drug
Abuse, 2018b)
Drug Use and Addiction

4. American Society
of Addiction
Medicine (ASAM)
“Addiction is a primary, chronic
disease of brain reward, motivation,
memory and related circuitry.
Dysfunction in these circuits leads to
characteristic biological, psychological,
social, and spiritual manifestations.
This is reflected in an individual
pathologically pursuing
reward and/or relief by substance use
and other behaviors.”
(American Society of Addiction

5. The terms “substance abuse” and “substance dependence” are
sometimes used interchangeably, but they’re actually two different
conditions.
Substance abuse is a pattern of drug or alcohol use that leads to
negative consequences. It often brings about problems in work or
school, impacts relationships with friends or family members, and
introduces dangerous or potentially life-threatening situations.
Dependence, however, is a physical and mental reliance on drugs or
alcohol. People who struggle with substance dependence are unable to
stop using despite the negative consequences, and experience cravings
and withdrawal symptoms when they do.

6.  566. All drunkenness cases to be examined carefully:-(1)
Every case of drunkenness is a potential medico-legal case
and the railway doctor called upon to certify such a case
should make a careful examination and should note down
every important particular. (2) Railway doctor may also
have to issue drunkenness certificates to persons presented
by police at places where there is no civil hospitals or
dispensaries and only a Railway hospital or health unit
exists. (3) In places where prohibition is in force, it is an
offence even if one has imbibed alcohol, let alone getting
drunk. When such a case is brought, the Railway doctor
should carefully examine the case and certify as to whether
(a) the person has imbibed alcohol but not drunk or (b) the
person is actually drunk. i.e. under the influence of
alcohol.

7.  Substance use negatively affects an industrial set
up including Indian Railways through lost
productivity, workplace accidents and injuries,
employee absenteeism, low morale, and increased
illness.

8.  As per Ministry of Railways letter no. 2021/H-
1/18/2/Misc. Dated 31.10.2022 addressed to all PCMDs
regarding recovery from alcoholism through specific
programme .
 A reference has been received from Chairman of
Alcoholic Anonymous (AA) group dated 23.09.2022
addressed to the Hon’ble Minister of Railways and
Chairman & CEO Railway board for permission to
conduct Alcoholic Anonymous meetings in Railway
Hospitals and Railway Colonies and conducting public
information work with railway hospital doctors ,
nurses, patients and staff.

9.  Employee heavy alcohol use, use of illicit drugs, and
substance use disorder are associated with negative
work behaviours such as absenteeism and frequent job
changes.
 Employers in industries that have higher or lower rates
of heavy alcohol use, use of illicit drugs, and substance
use disorder that can be attributed to the demographic
composition of their industry can use this information
when developing prevention/education programs.

10. Prevention in the employees at the workplace is a vital
component in substance use disorder treatment and
management.
Mobilizing the workforce, creating awareness that
addiction to substances is a disease, that it is treatable
and that treatment is available are all essential.
Workplace prevention policies to prevent and manage
substance use disorders leads to safer work
environments, better motivated teams of workers and
a productive workforce.

11.  When a loco pilots and co-pilots turn up for duty
under the influence of liquor, either they deny it or
tend to justify the same saying they are forced to drink
because of overstress. This trend came to light after
many of them failed the alcohol test. This is a clear
indication that these drunk drivers put thousands of
lives at risk.

12.  Railway rules say every loco pilot must undergo a
breathalyser test while signing on and signing off duty.
Failing a test can lead to removal from service, though
most offenders are let off with temporary removal
from rosters or denial of increments. Even statistics of
the Indian Railways claims that more than 800 railway
crew members have been penalised since 2014 for
violation of rules. As per available reports, 662 railway
staff were penalised while 147 were summarily
dismissed from service.

13.  Every train driver and his assistant will have to take a
breathalyser test every time they sign in for duty. All
senior supervisors in the Railways will have to
maintain a special list of those known for their
drinking habits or those who have had a history of
drinking or other substance abuse.
 These are part of the Railways’ new policy to check
alcohol consumption among staff on duty, particularly
those directly responsible for running trains,
managing stations and offering services on trains.

14.  Definition of "drunk":- A person is 'drunk' when
he is so much under the influence of an
intoxicating drink or drug as to loose control of his
faculties to such an extent as to render him unable
to execute safely the occupation at which he is
engaged at the material time. ( Ministry of
Railway's letter No.69/H/3/26 dt. 03/01/1970)
Revised Policy on ‘Drunkenness on duty’.
 Board has approved the revised policy on
drunkenness( No.2009/ Safety (DM)/6/12/Commitee
/2.11.2012) in order to make it more effective for
controlling drunkenness amongst staff, particularly
safety categories.

15.  (4) The proforma for recording of particulars of a suspected
case of drunkenness is given in annexure XXI to this
chapter. This form should always be kept handy as the
Railway doctor may be called upon to certify drunkenness
at any moment and sometimes away from his head
quarters. (5) It is desirable that a Railway doctor, when
certifying cases of drunkenness, should base his opinion on
the following considerations.:- (i) Whether the person
concerned has recently consumed alcohol. (ii) whether the
person concerned is so much under the influence of
alcohol as to have lost control of his faculties to such an
extent as to render him unable to execute safely the
occupation in which he was engaged at the material time

16.  (iii) Whether his state is due, wholly or partially, to a
pathological condition which has caused symptoms
similar to those of alcoholic intoxication, irrespective
of the amount of alcohol consumed.
 (6) He should not certify the case as drunk just
because the patient is smelling of alcohol. The
quantity taken is also no guide, but the fact of
impairment of his capacity to perform his duties has to
be taken into account.

17.  567.Instructions regarding issue of certificate of drunkenness:-
 (1) When a railway doctor is called upon to certify a case of
drunkenness in a Railway employee, he should after careful
examination, immediately report by a telegram or urgent
letter his opinion to the immediate superior or Divisional
Officer of the employee concerned intimating whether the
employee has to be put off duty or not.
 (2) When a Railway doctor is asked to certify the crew of a
running locomotive and if on examination he finds a member
of the same under the influence of alcohol, he should
immediately issue a memo to the authority concerned to put
the person off his duty.
 (3) As far as possible, a senior doctor should undertake to
examine such cases of drunkenness rather than depute the
juniors, and in case of doubt, should refer the case to the
C.M.S/.M.S in-charge of the division.

18.  1. Aim of the Revised Policy:
 Ensuring that staffs who are having a drinking
problem are identified.
 Protect the health and welfare of staff by offering
counselling and rehabilitation to those with alcohol
related problems.
 Prevent risks to staff, passengers and the general
public from abuses of alcohol.
 Prevent the damaging effects of alcohol on optimum
operational efficiency.
 Take up action against staff who are incorrigible and
are a danger both to themselves and also to the system.

19. Staff Covered under Revised Alcohol Policy
 Category I :
 The staff who are directly involved in train
operation/train passing
 (i) Train Running Staff : Drivers/ Motormen/ Asstt
Drivers/ Guards etc
 (ii) Train Passing Staff : ASMs/SMs/Yard Staff
 (iii) Pointsmen/Levermen/Cabinmen/Switchmen etc.

20. Category 2 :
 On board staff which is not directly involved in train
operations or train passing. These railway staff in
drunken condition brings dishonour and disrepute to
the railways but do not endanger safety.
 (i) On board Mechanical, Electrical, Commercial,
Opearting, RPF Staff etc
 (ii) Other on board non railway staff including private
categoring staff

21. Preventive Strategy
 (i) Mandatory breathalyzer test for running staff both
at the time of Signing ON and Signing OFF
 (ii) Surprise breathalyzer test for category 1 & 2 staff
 (iii) Maintain a list of staff who are habitual drinkers
 (iv) Services should not be confirmed if initial training
staff is found habitual of drinking
 (v) Reporting of habitual drinkers by all railway staff
 (vi) Counselling of habitual drinkers regarding ill
effects of alcohol and de addiction benefits

22. (vii) All crew lobbies must be provided with state of art
breathalyzer capable of indicating exact level of alcohol
content
 (viii) In case the result of breathalyzer test is positive
then a print out of readings must be obtained for
further D&AR action and endorsement should be
made in service records
 (ix) In case the staff refuses to co operate in
undergoing breathalyzer test, he should be taken up
under D&AR treating it to be a case of positive
breathalyzer test and action should be taken
accordingly.

23. Reformative Strategy
 (i) On the recommendations of Doctors such
identified habitual staff may be sent to de addiction
camps
 (ii) Organizing de addiction camps at Zonal levels at
regular intervals
 (iii) Provision of taken off the staff from the list of
habitual drinkers on completion of de addiction
treatment followed by a watchful period of 6 months
 (iv) Staff who refuse to undergo de addiction should be
denied of further promotion and special checks to be
kept on their working.

24.  6. Punishment Norms:
For Category I Staff
 Norms
 (A) Alcohol level between 1-20 mg/100 ml of blood:
Action to be taken : Staff should not be allowed to
perform duty and endorsement should be made in his
service records
(B) Alcohol level more than 21 mg/100 ml of
blood or 2nd occasion of alcohol level between 1-20
per 100 ml of blood : REMOVAL FROM SERVICE


25.  Punishment for category 2 staff ( para 172 of Indian Railway
Act )
“ if any railway servant is found in a state of intoxication
while on duty, he shall be punishable with fine which may
extend to five hundred rupees and when the performance
of any duty in such state is likely to endanger the safety of
any person travelling on or being upon a railway, such
railway servant shall be punishable with imprisonment for
a term which may extend to one year or with fine or both
Breath Alcohol Estimation to be supplemented with Blood
Alcohol Test till the calibrated state of art breathalyzers
are available all across Indian Railways

26.  Changes required in Manual and Rule books :
 The directorate concerned of Railway board will
review following Manuals/Rule books according to the
revised alcohol policy for the Indian Railways and
make amendments if any:
(i) Indian Railway Act
(ii) Medical Manual
(iii) General and subsidiary rules

27. Prevention in the employees at the workplace is a vital
component in substance use disorder treatment and
management.
Mobilizing the workforce, creating awareness that
addiction to substances is a disease, that it is treatable
and that treatment is available are all essential.
Workplace prevention policies to prevent and manage
substance use disorders leads to safer work
environments, better motivated teams of workers and
a productive workforce.

28. 1. Addiction is a complex but treatable disease that
affects brain function and behavior
2. No single treatment is appropriate for everyone
3. Treatment needs to be readily available
4. Effective treatment attends to multiple needs of
the individual, not just his or her drug abuse
5. Remaining in treatment for an adequate period of
time is critical
6. Behavioral therapies are the most commonly
used forms of drug abuse treatment
7. Medications are an important element of
treatment for many patients, especially when
combined with counseling and other
behavioral therapies
Principles of Effective Drug Addiction Treatment:
A Research Based Guide
(National Institute on Drug
Abuse, 2018c)

30. A Treatable Disease
 Substance use disorders are
preventable and treatable
 Successful substance use disorder
treatment is highly individualized and
entails:
 Medication
 Behavioral interventions
 Peer support
- Dr. Nora Volkow,
National Institute on
Drug Abuse
"Groundbreakin
g discoveries
about the brain
have
revolutionized
our
understanding of
addiction,
enabling us to
respond
effectively to
the problem"
(National Institute on Drug Abuse, 2018c;
Longo, 2016)

31.  THANK YOU