Psychological First-Aid: Alcohol Use
with Brian Forbes, PhD, R.Psych.
Forbes Psychological Services
Substance use is a major problem. On average five per cent of lawyers seeking assistance from Lawyer’s Assist present with the primary issue being alcohol and/or drug problems. Of the total number of cases served, 40 per cent of these cases identified substance use as an issue, but for the individual seeking help it was not the primary issue identified. Rather, the issue tended to be marital, work, parenting, depression or anxiety.
It is generally believed that 5 to 10 per cent of Canadian employees have alcohol and/or drug-related problems. Many employee discipline cases involve alcohol and drugs, and substance use contributes to accidents, incidents and near-incidents. Employees with alcohol and drug use issues miss work more frequently and take three times as many sick days.
Alcohol use is associated with a significant increase in intensive care unit admissions (pre-COVID), accidents, violence and suicides.
Chronic alcohol users show a higher evidence of brain atrophy primarily involving the frontal lobes. Intellectual deficits involving the frontal lobes include: problems in starting or initiating a task which manifests itself in decreased productivity and loss of initiative, increased distractibility, problems with stopping a wrong (or unwanted) response, and difficulty with or incapable of planning or sustaining good directed behaviour. Social drinking involving even moderate amounts of alcohol, results in mild cognitive impairment involving reasoning, mental flexibility, learning and memory. The good news is, depending on the amount of alcohol consumed over the years used, when individuals quit, the research indicates that cognitive functioning may return to a more normal state. However, with chronic alcohol use over years, the brain becomes permanently and irreversibly damaged resulting in an Alcohol Induced Dementia.
So how do individuals with an alcohol use problem behave in the workplace?
In the early phase they may:
- return to work late from lunch
- leave the job early
- complain of not feeling well
- be dishonest and lie about things
- start to miss deadlines
- make more mistakes through inattention or poor judgement
- overall show decreased efficiency
- have their co-workers notice a change in them
In the middle phase the individual may:
- take an increasing number of days off for vague ailments or for personal reasons
- begin to avoid co-workers
- exaggerate work accomplishments
- experience repeated minor injuries on and off the job
- display increasing irritability and resentment
- show a spasmodic work pace
- display difficulty in sustaining attention and concentration
- have increasing memory problems
In the middle-late phase symptoms may include:
- frequent time off work
- failing to return from lunch
- an increase in aggressive and belligerent behaviour
- domestic problems start to interfere with work
- refusing to discuss problems
- perhaps more trips to the hospital
- possible trouble with the law
- overall work performance is far below the expected level
Finally, in the late phase the individual may:
- display prolonged unpredictable absences
- drink on the job
- display visible physical deterioration
- experience serious marital/family problems
- display an overall lack of competence in the workplace.
Taken together, for professionals, like lawyers, whose job is safety-sensitive and decision-critical, chronic alcohol use would put those they serve at increasing risk. The sad fact is many professionals, including lawyers, and even co-workers often take no action. They either never approach the individual with their concerns or simply stay silent. There are a number of examples where silence has led to catastrophic consequences both for the lawyer and for others.
In a previous article for The Law Society of Alberta, I wrote about the importance of stepping up to the plate and psychological first-aid. If you notice that a co-worker’s demeanor, behaviour or performance has changed it is important to step forward and tell them that you have noticed a change in them and that you are concerned. While the individual you are concerned about may not want to talk at that time your actions will leave a lasting impression and that is somebody actually cares. In stepping forward your goal is to help the person help themselves.
There are a number of key resources available to help the individuals. These include: