Substance Abuse in the Workplace Reginald LCampbell R. Everett Langford Boca Raton London New York CRC Press is an imprint of the Taylor & Francis Group, an informa business First published 1995 by Lewis Publishers Published 2018 by CRC Press Taylor & Francis Group 6000 Broken Sound Parkway NW, Suite 300 Boca Raton, FL 33487-2742 © 1995 by Taylor & Francis Group, LLC CRC Press is an imprint of Taylor & Francis Group, an Informa business No claim to original U.S. Government works ISBN 13: 978-0-87371-131-9 (hbk) This book contains information obtained from authentic and highly regarded sources. Reason- able efforts have been made to publish reliable data and information, but the author and publisher cannot assume responsibility for the validity of all materials or the consequences of their use. 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Our appreciation is expressed to many people —Jon Lewis of Lewis Publishers, the editors at CRC Press, especially Helen Linna, as well as the students we tested this material on. Both of us would like to express deep appreciation for the under standing of the ladies in our lives, Renee Scudder and Cecilia Son-Hee Langford, during the many hours in front of the word processor away from them. This book is dedicated to them. To all others who have helped us in this endeavor, thank you. Any errors, omissions, and other mistakes belong to us. Reginald L. Campbell Sierra Vista, Arizona R. Everett Langford Dayton, Ohio THE AUTHORS Mr. Campbell was bom in Hartford, Connecticut. His undergraduate degree was from Fairmont State College, Fairmont, West Virginia, and Yale-New Haven Hospital, New Haven, Connecticut. He received his M.S. from Marshall University, Huntington, West Virginia. He is currently complet ing requirements for a Ph.D. in ergonomics and safety. Mr. Campbell has attended a number of educational and training courses in drug abuse, chemical substances, industrial hygiene, and hazardous materials man agement. He was an Assistant Professor of Medicine, Hahnemann Medical College of Allied Health Sciences, Philadelphia, and Instructor of Occu pational Health at the U.S. Department of Labor’s National Mine Health and Safety Academy, Beckley, West Virginia. He has served as Indus trial Hygienist for the U.S. Army Medical Department Activity, Fort Huachuca, Arizona. He is presently Chief Executive Officer of Campbell Associates, Inc., Sierra Vista, Arizona, a consulting firm specializing in safety and health issues. Campbell Associates, Inc. has assisted a number of companies, governmental agencies, and labor unions in matters relating to hazard communication, hazardous materials management, and drug abuse edu cation. Mr. Campbell is co-author of Fundamentals of Hazardous Materi als Incidents (Lewis Publishers, 1991) and has published numerous ar ticles on substance abuse in the workplace. He is noted in a number of biographical references, including Who’s Who in the Southwest, Who’s Who in the World, and Personalities of America. Dr. Langford was born in Owensboro, Kentucky and grew up in Sa vannah, Georgia. He received an A.A. from Armstrong State College in 1965, a B.S. in chemistry and physics from Georgia Southern College in 1967 and an M.S. in solution thermodynamics in 1971 and a Ph.D. in physical geochemistry in 1974, both from the University of Georgia under a National Defense Education Act Fellowship. He taught chemistry, geology, environmental chemistry, and physi cal science at the Savannah Science Museum, Bainbridge College, Georgia Military College, and Georgia Southern College before becoming the Chief of Clinical Chemistry at the U.S. Army Academy of Health Sci ences. Following that assignment, Dr. Langford served as a consultant in hazardous waste management at the U.S. Army Environmental Hy giene Agency and then as Commander of the Environmental Sanitation Detachment in Taegu, Korea for the U.S. Army’s 5th Preventive Medi cine Unit. In Korea, he served as an adjunct faculty member to the University of Maryland. Upon his return to the U.S. he became Chief of Environmental Health at Fort Huachuca, Arizona and Preventive Medi cine Officer for the U.S. Army Information Systems Command, followed by an assignment as Commander, U.S. Army Medical Research Detach ment at Wright-Patterson Air Force Base, Dayton, Ohio. Dr. Langford has served as a Judge at the Westinghouse Interna tional Science Fair, a member of the review panel for the National Sci ence Foundation’s Comprehensive Assistance to Undergraduate Science Education, a member of the scientific review panel for the Hazardous Substances Data Bank of the National Library of Medicine, and a con sultant to the International Union of Operating Engineers. He is a Cer tified Industrial Hygienist (CIH), Registered Hazardous Substances Pro fessional (RHSP), Registered Sanitarian (RS), Fellow of the American Institute of Chemists (FAIC), Diplomate of the American Academy of Sanitarians, and Engineer-in-Training (EIT). He is author or co-author of some twenty papers in thermodynamics, geochemistry, and hazard ous materials, and is co-author of Fundamentals of Hazardous Materi als Incidents. He is listed in some fifteen biographical references, in cluding Who’s Who in the World, Who \s Who in Science and Engineering, and Who’s Who of Emerging Leaders. Dr. Langford also completed three years of postgraduate study at the University of North Carolina - Chapel Hill in radiological hygiene. CONTENTS 1. Introduction 1 1.1. Who is This Book For? 1 1.2. Importance of the Problem 1 1.3. Paradigms and Politics 3 1.4. Purpose of This Book 4 2. Brief History of Substance Abuse 5 2.1. Introduction 5 2.2. Chemical Dependency and Substance Abuse 5 2.3. Early History 6 2.4. Opium 7 2.5. Coca and Cocaine 8 2.6. Khat 9 2.7. Alcohol 10 2.8. Mushrooms and Other Fungi 10 2.9. Cacti 11 2.10. Marijuana 11 2.11. Nineteenth- and Twentieth-Century Drugs 11 2.12. Summary 12 3. How the Human Body Works 15 3.1. Introduction 15 3.2. Definitions 15 3.3. Introduction to Anatomy and Physiology 15 3.4. Respiratory System 16 3.5. Digestive System 17 3.6. Nervous System 19 3.7. Reproductive System 20 3.8. Endocrine System 22 3.9. Blood Circulatory System 22 3.10. Lymphatic System 24 3.11. Urinary System 25 3.12. The Liver 25 3.13. Summary 27 4. The Chemistry of Medicinal Substances 29 4.1. Introduction 29 4.2. Definitions 30 4.3. Classes of Common Chemical Substances 30 4.4. Commonly Abused Chemicals 31 4.5. Alcohol 31 4.6. Amphetamines 33 4.7. Barbiturates 33 4.8. Phenothiazines and Benzodiazepines 34 4.9. Alkaloids 34 4.10. Opiates 36 4.11. Cocaine and Cocates 37 4.12. Hallucinogens 38 4.13. Salicylates 40 4.14. Aspirin Substitutes 41 4.15. Marijuana 42 4.16. Steroids 43 4.17. Antihistamines 44 4.18. Bromides 45 4.19. Lithium 45 4.20. Diet Medications 46 4.21. Laxatives 46 4.22. Vitamin Abuse 47 4.23. Designer Chemical Substances 48 4.24. Commercial Products 48 4.25. Over-the-Counter Chemical Substances 49 4.26. Unusual Drugs 49 4.27. Mixing Drugs 49 4.28. Summary 50 5. Toxicology of Chemical Substances 51 5.1. Introduction 51 5.2. Definitions 51 5.3. Health Hazards 52 5.4. Acute Exposures 52 5.5. Chronic Exposures 52 5.6. Toxic Classes 53 5.7. Poisoning Potential 54 5.8. Dose Response 55 5.9. Animal Models 55 5.10. Response Curve 56 5.11. Distribution Curve 56 5.12. Cancer and Birth Defects 58 5.13. Teratogens 58 5.14. Mutagens 58 5.15. Carcinogens 59 5.16. Mixtures of Substances 60 5.17. Summary 6l 6. Interactions with Occupational or Environmental Chemicals 63 6.1. Introduction 63 6.2. Synergistic and Antagonistic Effects 64 6.3. Occupational Exposures and Substance Abuse 64 6.4. Environmental Exposures and Substance Abuse 66 6.5. Summary 66 7. Identification of the Substance Abuser 69 7.1. Why Do People Misuse Chemical Substances? 69 7.2. Peer Pressure 70 7.3. Maladapted Response to Stress 73 7.4. Is the Abuser “Different”? 74 7.5 Identification and Recognition of the Substance Abuser 74 7.6. Drug Testing 77 7.7. Summary 78 8. Employee Assistance Programs 79 8.1. Introduction 79 8.2. What Is an EAP? 80 8.3. Types of EAPs 81 8.4. Elements of the Program 82 8.5. Administrative Functions 82 8.6. How the Program Works 84 8.7. Five-Step Program to Assist the Employee 85 8.8. Cost Effectiveness of an EAP 87 8.9. National Institute on Drug Abuse Assistance to EAPs 88 8.10. Summary 88 9. Laws and Regulations Governing Substance Abuse 91 9.1. Introduction 91 9.2. Early Legislation 91 9.3. Recent Legislation 93 9.4. Physician Licensing and Prescription System 94 9.5. Role of the Food and Drug Administration (FDA) 95 9.6. Drug Schedules 95 9-7. Role of the Drug Enforcement Administration (DEA) 96 9.8. Drug-Free Workplace Act of 1988 97 9.9. Requirements under the Act for Employers 98 9.10. Requirements under the Act for Employees 98 9.11. Summary 99 10. Substance Abuse in Specific Work Settings 101 10.1. Introduction 101 10.2. Substance Abuse in the Medical and Allied Sciences Professions 101 10.3. Substance Abuse in the Transportation Industries 102 10.4. Substance Abuse in the Mining and Petroleum Industries 104 10.5. Substance Abuse in the Construction Industries 105 10.6. Substance Abuse in the Clerical Professions 106 10.7. Substance Abuse in the Law Enforcement and Firefighting Professions 107 10.8. Substance Abuse in the Military 108 10.9. Substance Abuse in the Entertainment Industries 109