Addiction and Industry

Alan De Sousa, M.D., D.P.M., Ph.D. Hon. Prof. and Head, Department of Psychiatry, J.J. Hospital and Grant Medical College, Bombay, India. (Guest Lecture at the Third National Conference of Industrial Psychiatry, Ranchi, 29th Dec. 1988)

Having obtained this data the next assault will be to call for particular industrial workers who from the data obtained show evidence of physical or psychological illness or any other evidence which are pointers to Alcohol or Drug Addiction as detailed earlier. They should undergo a through physical and psychological assessment, which should be supported by appropriate laboratory tests. The laboratory tests are detailed in Table 3. The psychological tests are detailed in Table 4. After these assessments, the extent of the problem of Addiction in industrial workers and the extent of damage done by alcohol or drugs would be known. The psychodynamics in some of those cases would also be clear. Industrial workers who still deny they are taking Alcohol or Drugs would have to undergo (Serum) Alcohol or Drug Estimation at the appropriate time, together with ancillary tests, which are confirmatory evidence.

Table 3: Management of the Alcoholic State 1. Assessment of: Physical functioning by means of a throughPhysical examination, followed by: a. C.B.C. and E.S.R. estimation b. Urine (Routine) examination c. Fasting blood sugar estimation d. Blood urea estimation e. Serum cholesterol estimation f. Serum creatinine estimation g. Serum amalyse estimation h. Liver function tests:   i. SGOT   ii. SGPT   iii. Serum bilirubin   iv. Serum proteins i. ECG j. X-ray chest k. EEG l. Any other investigations deemed necessary.

Next comes the most difficult part of the programme, which is one of Motivation. The family and the industrial worker will have to be taken into confidence and explained that Addiction is a problem that can affect any individual and the idea of therapy is to assist the industrial worker to shed his problem and that nothing will be used against him and he has nothing to fear. In this manner his motivation will be assured and he will submit for treatment.

Table 4: Psychological functioning by a thoroughpsychiatric examination, following if necessary by: i. The Rorschach test ii. The Bender Gestalf test iii. The Thematic Apperception Test iv. The M.M.P.I. The management of Alcohol withdrawal is as follows: 1. Tranquillisers: Diazepam - 10-20 mg orally daily. 2. Hypnotics a. Flurazepam - 15-30 mg orally at bed time, or Nitrazepam - 10-20 mg orally at bed time. b. Amitriptyline - 25-75 mg orally at bed time. 3. Antiepileptics Diphenylhydantion 100 mg orally 3 times a day. 4. Nutrients and Correctiveness: a. Dextrose (5%) - 2000 cc. I.V. b. Vitamins - B-complex group orally andintramuscularly. c. Electrolytes d. Liv.52 - 2 tablets 3 times a day. e. Inj. Vitamin K-1 Ampoule intramuscularly for 3days. f. Other medications as required. 5. Antibiotics – to prevent infection. 6. Psychotherapy – to improve motivation and explorepersonality configuration. The Management of Drug Withdrawal should be asfollows: 1. Hospitalisation in a secure institution with adequatesafeguards. 2. Complete withdrawal of the drug. 3. Tranquillisers: Tablet Trihexyphenithyl 2 mg, three times a day.

If required – Capsule Doxepin 25-75 mg three times a day. 4. Hypnotic – Tablet Amitriptyline 50-75 mg at bedtime. Capsule Flurazepam 15-30 mg at bedtime. If the patient is severely hallucinated during thewithdrawal, give a barbiturate preparation atbedtime but for no longer than 5. Antiepileptics – Capsule Diphenylhydantion 100-200 mg three timesa day is very useful to prevent convulsion spasms,irritability, restlessness, etc. 6. Antibiotics should be given to prevent chestinfection. Any patient suffering from PulmonaryTuberculosis should be adequately treated. 7. Antacids, cough expectorants analgesics etc.,may be necessary to reduce particular symptoms. 8. Nutrients and Vitamins should be given in plentydepending on the patients, individualrequirement, about 2000 of Injection IVDextrose 5% is essential for the first ten days toassist nutri 9. Psychotherapy for the patient and his familymembers should be started early and continuedeven after the withdrawal phase. The utility of organisations like the AlcoholicsAnonymous. Al Anon, Narcotics Anonymousshould not be forgotten and efforts made to utiliseand principles of these organisations forimplementing Follow-up Therapy in an industrialunit. The Follow-up Therapy for Alcoholism in anindustrial un 1. Individual Psychotherapy with the patient, hiswife and family members. 2. Group Psychotherapy with other alcoholics andthe wives of alcoholics separately. 3. Monitoring of Disulfiram Therapy throughcareful supervision of administration andestimation of serum levels. For the persistentdrop-outs Disulfiram implants are advised. 4. Policing of the alcoholic and even alcoholicprisons are at times useful. 5. Alcoholics Anonymous programming whereavailable may be useful but this form of therapycannot be used on its own.

Denial may not only be at the level of the industrial worker but also at the level of the employer. Thus the survey attempted by the Directors of the large industry among industries in Britain and reported Glatt (1957) revealed that problem drinking among industrial workers was denied by Managers and Directors. The advanced alcoholic is generally totally incapacitated or is found out early and fired because of absenteeism, inefficiency, etc., but the less advanced one continues to attend work with fits and starts, and to be inefficient and serve as a burden to industry. The wastage in terms of lost man-power hours, faulty decision making, loss of efficiency and production, psychological and physical absenteeism, accidents to the self and others, loss of years of training all contribute a mammoth loss to industry. Braine, B. (1980) reported that the estimated annual loss to industry in this fashion in the U.K. was £350 million. No estimates are available in India, as the effects of Alcohol and Drug Addiction are not sufficiently appreciated, but in time this realisation would be clear. Before an alcoholic loses his job it must be realised that he continues to work well below his potential for at least 10 years. Alcoholics and drug addicts are generally covered up by their managers, their colleagues and their families for fear of them losing their jobs.

Refference: http://www.himalayahealthcare.com/pdf_files/liv188.pdf