# Presentation: 055538

## Methamphetamine and   the Workplace

*A Department of Labor initiative engaging partners to make America’s workplaces safe, healthy and drug free*

- U.S. Departments of Justice and Labor

## Adult Illicit Drug Use:  A Workplace Concern

**14.1% (17.7 million) of working adults in the U.S. reported using illicit drugs in the past year:**
**11.23% (14.1 million) reported using enough to get high**
**3.1% (3.9 million) reported using before arriving at work or during working hours **
**2.9% (3.6 million) reported working under the influence of illicit drugs**

**Notes:**
As the statistics on this slide show, recent research demonstrates that there is illicit drug use in the workplace.  This reality poses a serious danger to not only those who report using illicit drugs, but also the co-workers who work alongside them.  And in many occupations, it also jeopardizes the safety of the general public.  Perhaps this is best exemplified by the image of someone working under the influence in industries such as construction or transportation.  But the danger is there in all industries.  

<Note to presenter>:  
Source for statistics is:  Frone, M. R. (2006). Prevalence and distribution of illicit drug use in the workforce and in the workplace: Findings and implications from a U.S. national survey. Journal of Applied Psychology, 91, 856-869.

## Methamphetamine 

**Schedule II drug under Controlled Substance Act of 1970**
**Abused by many, creating problems for families, workplaces and communities**

**Methamphetamine **
**Overview**

**Notes:**
Use of all drugs causes concern in the workplace, but of particular concern is the use of methamphetamine.  Meth is a powerful, highly addictive stimulant that affects the central nervous system. 
Meth is a Schedule II drug under the Controlled Substance Act of 1970, which means it is currently accepted for legitimate medical use in treatment in the U.S.  However, and regrettably, meth is misused by some, creating serious problems for themselves, their families and their employers and co-workers.   

## Workplace Impact 

**of Meth**

**Occupational injuries and fatalities **
**Absenteeism and employee turnover**
**Increased illness rates and health benefit utilization**
**Lost productivity**
**Low employee morale**
**Workplace violence**
**Identity theft**

**Notes:**
Like other drugs, meth affects a person’s behavior.  It seriously impedes a person’s coordination and ability to practice good judgment and decision-making.  Thus, it can significantly impair one’s ability to perform on the job. Meth use among workers contributes to:

Occupational injuries and fatalities 
Absenteeism and employee turnover
Increased illness rates and health benefit utilization
Lost productivity

In addition, meth use often results in paranoia, which can lead to violence and seriously jeopardize safety in the workplace.   

Meth use has also been linked to identity theft.  Meth acts on the brain to increase the desire to repeat actions.  With added energy, increased focus, no need to sleep, and the need for repetition, the set-up is prime for a meth user to figure out ways to steal an identity, especially via the computer.

## Forms of Meth and        How it is Taken

**Comes in many forms and colors**
**Powder that looks like granulated crystals**
**Tablets (yabba)  **
**Rock or crystal, also known as “ice”**
**Ranges in color from white to yellow to dark red and brown**
**Can be smoked, snorted, orally ingested and injected**

**Notes:**
Meth can be smoked, snorted, orally ingested and injected.  It comes in many forms and can be identified by color, ranging from white to yellow to darker colors such as red and brown.  Its form is either powder that looks like granulated crystals, tablets (called “yabba”) or rock (also known as “ice”).  Rock can be smoked, producing a faster, stronger effect.  

## Forms of Meth

**Forms of Meth**

**Notes:**
Here are pictures of the various forms of meth.  

## Effects of Meth

**Increases energy and alertness; decreases appetite**
**Causes release of high levels of dopamine, creating intense rush that can last many hours **
**Can cause side effects such as convulsions, dangerously high body temperature, stroke, irregular heartbeat**

**Notes:**
Because it is a central nervous system stimulant, meth increases energy and alertness and decreases appetite.  It causes high levels of dopamine to be released into the section of the brain that controls the feeling of pleasure.  The result is an intense rush.  The effects can last up to 12 hours and are almost instant when smoked or injected.  If snorted, the effects can take up to five minutes to occur, and if ingested, up to 20 minutes.  There are several possible damaging side effects to taking meth, including convulsions, dangerously high body temperature, stroke and cardiac arrhythmia (an irregular heartbeat).  

## Consequences of                  Chronic Meth Use

**Psychotic behavior, including paranoia, hallucinations and violence**
**Tooth decay, known as “meth mouth”**
**Cardiovascular problems**
**Increased risk of contracting HIV/AIDS and Hepatitis B and C**

**Notes:**
Chronic use of meth definitely has serious consequences.  As with other illicit drugs, chronic use of meth can result in a higher tolerance for it, causing users to take higher doses more frequently and/or changing their method of ingestion.  This eventually leads to addiction.  Long-term use also leads to psychotic behavior, including intense paranoia, visual and auditory hallucinations and out-of-control rages that result in violent episodes.  Hallucinations can contribute to forming body sores as a result of a delusion that bugs are crawling under one’s skin.  These sores are known as “crank sores.”Chronic meth use also leads to tooth decay known as “meth mouth.”  This results from the chemicals used in making meth decreasing a person’s ability to make acid-fighting saliva and increasing their thirst.  There is also reduced blood flow to the gums.  

Because meth is a stimulant, anxiety and insomnia are also problems, along with cardiovascular problems, prenatal problems in the case of pregnancy, and an increased risk of developing HIV/AIDS and Hepatitis B and C by those who share needles to inject the drug.
Of course, as with any addiction, social and occupational connections also begin to deteriorate with chronic meth use.  

## Meth Abuse & 

**Addiction**

**Highly addictive**
**Initial intense rush is followed by high lasting 6-8 hours; then comes a devastating low, causing user to chase the initial rush**
**Meth has neurotoxic effect on brain and damages cells; continuous use of meth does not let brain recover**

**Notes:**
As I’ve said, meth is highly addictive.  This is especially so psychologically.  After smoking or injecting meth, the user experiences an intense sensation called a “rush” or “flash.”  While that sensation is described as pleasurable, it only lasts a few minutes.  It is then followed by a high that can last six to eight hours.  Then comes a devastating low—often so uncomfortable that the user begins to chase the initial rush, which of course will never again be attained.  In doing so, they enter the cycle of abuse and eventually addiction.
That initial rush first felt from meth will never be attained again because of how the substance affects the brain.  As we touched on earlier, meth releases high levels of the neurotransmitter dopamine, which stimulates brain cells and enhances mood and body movement.  However, it also has what is called a neurotoxic effect, which means it damages brain cells that contain dopamine as well as serotonin, another neurotransmitter.  These brain cells do not die after meth use, but their nerve endings (called “terminals”) are cut back and re-growth appears to be limited.  So after the initial release—and accompanying wave of pleasure—the dopamine is depleted and brain cells require time to recover before normal dopamine flow can resume.  In other words, continuous use of meth does not give enough time for the brain to recover.  

## Three Stages in Pattern of Abuse

**Low-intensity**
**Psychological addiction**
**Preferred form of use is swallowing or snorting**
**Binging**
**Psychological addiction with a continuation of the high**
**Preferred form of use is smoking or injecting**
**High-intensity**
**Same as binging with focus on preventing the crash**

**Notes:**
There are three stages in the pattern of meth abuse – low intensity, binging and high intensity.  The patterns differ from one another in the form of meth taken and the amount of meth used.  

The low-intensity pattern does not involve a psychological addiction and the preferred form of use is usually swallowing or snorting which does not produce the rush that smoking or injecting gives.  Low-intensity abusers want the extra stimulation the methamphetamine provides so they can stay awake long enough to finish a task or a job, or they want the appetite suppressant effect to lose weight. These people frequently hold jobs, raise families, and otherwise function normally. They may include people such as truck drivers trying to reach their destination or workers trying to stay awake until the end of their normal shift or an overtime shift.  Because low intensity users are often employed, workplace prevention/intervention efforts targeting this group can be critical to keep a user from becoming addicted.  Low intensity abusers are only one step away from becoming binge abusers and it may take only one exposure to smoking or injecting to make the transition to a binge pattern of abuse.  

The methamphetamine rush can continue for 5-30 minutes and is so intensely pleasurable that the user attempts to maintain it through binging and tweaking.  The binge is a continuation of the high but with diminishing effect.  Binge abusers smoke or inject methamphetamine and experience euphoric rushes that are psychologically addictive. The abuser maintains the high by smoking or injecting more methamphetamine. Each time the abuser smokes or injects more of the drug, a smaller euphoric rush than the initial rush is experienced until finally there is no rush and no high. During the binge, the abuser becomes hyperactive both mentally and physically. The binge can last 3-15 days.

The high-intensity abusers are the addicts and their existence focuses on preventing the crash.  With high-intensity abuse, each successive rush becomes less euphoric, and it takes more methamphetamine to achieve it. Each high is not quite as high as the one before. During each subsequent binge, the abuser needs more methamphetamine, more often, to get a high that is not as good as the high he wants or remembers.

## Patterns

** ****of Abuse**

***The low intensity pattern of use does not include the rush of binge use***

**Notes:**
These charts of binging and high intensity use help illustrate the extreme swings meth puts the body and mind through. 
As you can see, within binging there are seven stages in the cycle of abuse:  rush, high, binge, tweaking, crash, normal and withdrawal.  Of most concern is tweaking, the time just prior to crashing, when the user is trying desperately and without success to hang on to the high.  During this stage the user is often overwhelmed with feelings of anxiety and emptiness and people can be extremely irritable and paranoid – which can erupt in violent behaviors.

## Meth is Spreading Nationwide

**Higher rates of use in rural areas, but increasingly present in cities as well**
**Has spread from west to east in U.S.**
**Concentrated enforcement efforts have decreased domestic production in small labs, but trafficking from Mexico has increased**
**Imported meth is purer and may have contributed to a rise in meth addiction and treatment admissions**

**Notes:**
Geographically, meth appears to be spreading from the west coast, southwest and mid-west to the southeast and northeast of the country.  High rates of use are associated with rural areas, but it is finding its way into our cities as well.  Certain states have been hit harder than others, and certain population segments as well.  

Efforts to stop the use and spread of meth appear to be working.  Production in domestic makeshift labs (often homes) has decreased in recent years, attributable to effective law enforcement as well as new laws making it more difficult for meth manufacturers to get their hands on the ingredients needed to make meth.  Perhaps you’ve noticed that over-the-counter decongestants (such as Sudafed®) are no longer available off the shelf at your local pharmacy or grocery store?  This is the case in many states, because these products contain pseudoephedrine, a key ingredient needed to make meth.  In many states, pharmacies and other retail distributors are now required to maintain a logbook of purchases of such products.  Buyers must present ID and sign this logbook.  Limits on daily and monthly mail order and internet sales may also apply.

Unfortunately, while these developments have made a dent in supply, trafficking from Mexico appears to have increased.  This latter fact is alarming because the meth imported from Mexico is often purer than that made domestically and thus even more damaging, and is believed to be behind a rise in meth addiction and treatment admissions.  

## Demographics of Meth

**Though traditionally associated with white males in their 20s and 30s:**
**Most meth users are 18-25 years old**
**Average age of first use is 20-24**
**Women make up 45% of those in treatment for meth addiction**
**Individuals often start using meth to:**
**Help alleviate stress**
**Help lose weight**
**Increase energy and productivity**
**Intense high/euphoric effect**

**Notes:**
There is no typical meth user although there are some segments of the population who appear to be more likely to use it.  Meth has traditionally been associated with white males in their 20s and 30s who live in rural areas.  But, rates of use also appear to be up among women and individuals between the ages of 18 and 22.  The typical age that users start to take meth is between 20-24.  

Different people start to use meth for different reasons, such as stress, weight loss and to increase their energy.  Others will start to use meth to obtain the intense high/euphoric effect the substance provides.  However, we know all too well that meth is not a solution to these or any other problems.  In fact, it’s quite the contrary and has devastating effects.  

## Click box to view

***Vicki:  *****One woman’s story of use and recovery**
**Video Courtesy of ****Community Anti-Drug Coalitions of America (CADCA)**

**Click box to view**

**Notes:**
When someone is addicted to meth, it affects every aspect of life—health, safety, relationships with family and friends, and the ability to work.  In fact, someone addicted to meth is not really in control of his or her life.  Essentially, the drug is in control.  

The good news is that meth addiction can be treated, and many people in recovery from meth abuse become successful, productive members of their communities.  In this short video clip, one woman shares her story of overcoming meth addiction.  

## Construction
Manufacturing
Mining
Retail and sales
Food services
Certain sectors of transportation
White collar jobs
Athletics

**Manufacturing**
**Mining**
**Retail and sales**
**Food services**
**Certain sectors of transportation**
**White collar jobs**
**Athletics**

**Hard-Hit Industries and Occupations**

**Notes:**
Any industry where long hours, fatigue and productivity play a role in job success can create a temptation to turn to drugs such as meth.  Workers may be tricked into believing that meth reduces stress by increasing their performance by giving them the energy to take on additional work or meet a deadline.  And indeed someone can become “super productive” when he or she first takes meth.  However, that worker will never reach that kind of productiveness again due to its impact on the brain, as I discussed earlier.

Listed are industries and occupations that the Substance Abuse and Mental Health Services Administration (SAMHSA), among others, have been hardest hit by methamphetamine use.  Examples of “white collar” jobs include computer programmers, attorneys, accountants, etc.

Although there is limited industry- specific information available, these are some of the industries and occupations that seem to have been more hard hit by meth use than others.  Some of these, especially construction, manufacturing and mining, may be partially explained by the fact that they employ high concentrations of males in their 20s and 30s.  As I mentioned earlier, this demographic seems to have higher rates of meth use than other populations. 

## Meth at Work

**Research shows that meth use among workers does appear to be decreasing**
**Recent Drug Testing Index**® **showed decrease in workplace drug screens testing positive for amphetamines**
**When meth is used at worksites, it is likely to be taken orally, mixed in a drink or snorted**
**Worker use before “on the clock” is also of serious concern**

**Notes:**
On a positive note, meth use among workers appears to be on the decline.  The latest Drug Testing Index, a semi-annual report published by the large workplace drug-testing company Quest Diagnostics, showed that the positive rate for meth among workers decreased in 2005.  This may be attributed, in part, to workplace drug-testing programs, which may be deterring people from initiating use.  

While this is good news, we do know that meth is being abused by some workers, and in some cases, even in the workplace.  When meth is used at a worksite, it is likely to be taken orally or mixed in a drink or snorted.  Injection and smoking would be less common.  
Of course, worker use of meth outside of the workplace is also a serious concern.  Meth’s effects last many hours and, as we discussed earlier, can seriously impair someone’s ability to work safety and productively.  

## Dealing with Meth                     in the Workplace

**Employers, supervisors or managers should not attempt to diagnose a “meth problem”**
**Focus should always be on work performance **
**Recognizing the signs and symptoms of meth will prepare/equip employers to confront behavior and intervene appropriately**

**Notes:**
When thinking about drug use in the workplace environment, it is important to always make work performance, being at work and paying attention the focus.  Many things, not just drug abuse, can interfere with a person’s ability to competently do the job.  So it is important to remember that if an employee displays signs and symptoms of meth use, it does not necessarily mean there is a meth problem.  However, knowing the signs and symptoms of meth use can help prepare employers or supervisors to confront and intervene when appropriate.  

## Signs & Symptoms of Meth Use in the Workplace

**Initially can cause high level of productivity, but this will not last  **
**While on meth individuals tend to be:**
**Careless; unreliable **
**Involved in numerous accidents which damage equipment or property or injure themselves or others**
**Unable to focus on details of routine duties or follow directions**
**Argumentative**
**Risk takers who disregard safety**

**Notes:**
As I touched upon earlier, meth can lead to an initial high level of productivity, but as we know, this will not last.  Instead, the user is likely to spend more and more time chasing that original high—not being productive on the job.  

Ways meth use may manifest itself in the workplace include:

Carelessness and unreliability
Accidents and injuries
An inability to focus on details or routine duties or follow basic directions
Argumentativeness

Many of these signs can be signs of other drug use (and indeed signs of problems other than drug use).  But one in particular—argumentativeness—is heavily associated with meth use.  Meth users are particularly argumentative and can event resort to physical violence as a result of coming down from the meth high.  

## Meth Prevention in the 

**Workplace Setting**

**Best deterrent is a drug-free workplace, one where:**
**All employees understand that substance abuse while working is not acceptable; and**
**Workplace policies and programs discourage substance abuse and facilitate treatment and recovery**

**Notes:**
Clearly, meth and the workplace is a dangerous combination.  In fact, many meth addicts are not employed because they burn out and deteriorate so rapidly.  They are not able to both hold down a job and maintain their meth habit for long. 

When employers are considering a new hire, they may want to pay attention to the candidate’s job history and consider a background check and possible pre-screening with drug testing, if these are not already standard practices.

One of the best ways to prevent the use of meth—and all illicit drugs—among workers is to maintain a drug-free work environment.  A drug-free work environment is one where:

All employees understand that the use of drugs while working is unacceptable; and 
Workplace policies and programs discourage drug use, while at the same time supporting those with drug problems.  

## Five-Step Approach to a 

**Employee awareness and education**
**Supervisor training**
**Employee assistance program**
**Drug testing**

**Five-Step Approach to a **
**Drug-Free Workplace Program**

**Notes:**
So what exactly makes a drug-free workplace?  A comprehensive drug-free workplace program generally has five components, as listed on this slide. The first, a drug-free workplace policy, is really the foundation for a drug-free workplace.  Effective policies should clearly state why the policy is being implemented, describe prohibited behaviors and explain consequences for violation.  It is essential that the policy be shared and understood by all and consistently applied.  

Employee education provides employees with information they need to adhere to and benefit from the drug-free workplace program and informs them about the nature of addiction; its effect on work performance, health and personal life; and the help available for those with problems.  

Supervisor training teaches supervisors, managers and foremen to enforce the policy and helps them recognize and deal with employees who have performance problems stemming from substance abuse.  Supervisors must not, however, be expected to diagnose or provide counseling.

An Employee Assistance Program (EAP) offers free, confidential services to help employees, including supervisors, managers and foremen, resolve personal and workplace problems—such as alcohol and drug abuse—that can interfere with job performance.  EAPs provide workers, and often their family members, with assessment, short-term counseling and referrals to treatment or other community resources.  They may also provide training, education and consultation on a variety of topics such as how to handle difficult co-workers/employees. 

Drug testing provides concrete evidence for intervention and/or disciplinary action.  Drug-testing policies must clearly stipulate who will be tested, when tests will be conducted, which drugs will be tested for, how tests will be conducted and the consequences of a positive test.  Legal counsel should be sought before starting a drug testing program.  Local, state and Federal laws, as well as collective bargaining agreements, may impact when, where and how testing is performed.

It is important to note that drug testing is only one component of a drug-free workplace program and may not be suitable for all employers.  When considering these five steps, employers should really examine the needs of their workforce and organization.  Because every business is unique, there is no one right way to establish a drug-free workplace program.  

## Meth Treatment

**No “anti-meth” medication exists**
**Studies show that behavioral therapy is helpful**
**Outlook is becoming more positive as more studies are conducted and the drug’s effects are better understood**

**Meth Treatment**

**Notes:**
As the video clip we saw earlier shows, recovery from meth addiction is possible.  It can take time, though, since meth damages brain cells and they need to recover.  As a result, there is a high rate of relapse with methamphetamine due to the recovering addict’s inability to feel pleasure or have a sense of hope.  Furthermore, there is no “anti-meth” medication available.  Some studies indicate that types of behavioral therapy, such as incentive-based contingency management or motivational incentives where people receive rewards for being free of drugs, are helpful in meth treatment.  With new treatment techniques and more research, there is help—and hope—for people addicted to meth.  

## Meth Treatment in the Workplace Setting

**Workplace practices can help meth users get to treatment:**
**Drug-free workplace programs that includes assistance for employees**
**Coverage for drug treatment in group health insurance plans**
**Follow-up is essential**

**Meth Treatment in the Workplace Setting**

**Notes:**
With treatment and support, people in recovery from meth addiction can lead successful, productive lives, contributing to their workplaces and communities.  The workplace also has an important role to play in getting people help for meth addiction.  Workplaces practices that can help include drug-free workplace programs that provide assistance to employees with drug problems and coverage for drug treatment in health insurance plans.  

When a person returns to work following treatment, follow up is essential to help him or her stay clean and comply with any “return-to-work” agreement.  In addition to assistance from the treatment/rehab center and an EAP or other workplace representative, follow-up could include workplace drug testing combined with therapeutic tests, such as functional magnetic resonance imaging (fMRI) to improve odds of a positive outcome.  fMRI is a new technology that can predict whether a person will relapse after for methamphetamine abuse.

## Drug-Free Workplace Resources

**Department of Labor’s Working Partners for an Alcohol- and Drug-Free Workplace Program:  www.dol.gov/workingpartners**
**Center for Substance Abuse Workplace Helpline:  1-800-WORKPLACE**
**Employee Assistance Professionals Association (EAPA): **_[www.eapassn.org](http://www.eapassn.org/)_
**Drug and Alcohol Testing Industry Association (DATIA):  www.datia.org**

**Notes:**
The resources listed on this slide can help employers and employees interested in setting up a drug-free workplace program for their organization.  

## Slide 24

**Notes:**
This is the Web site for the first resource listed on the previous slide – the Department of Labor’s Working Partners for an Alcohol- and Drug-Free Workplace program.  

This site includes a variety of tools and resources, including a Special Issues section on Methamphetamine and a policy/program development tool called the Drug-Free Workplace Advisor.  This tool actually walks someone through the various components of a comprehensive drug-free workplace policy, giving options to pick and choose from along the way to create a tailored policy.

It has a page of training and educational materials, which includes presentations and posters.

Also useful is the list of Frequently Asked Questions (FAQs) about drug-free workplace issues.

Another item of interest is a section that addresses the value of hiring people in recovery and how to create a recovery-friendly workplace.

The site also offers technical assistance via e-mail and has a subscription list through which periodic e-mail updates are sent out.

## Meth-Specific Resources

**MethResources.gov                                   www.methresources.gov**
**National MethWatch Program    ****	****      www.methwatch.com**

**Meth-Specific Resources**

**Notes:**
These are some resources from which you can learn more about meth issues.  The third one specifically addresses the issue of retail sales of ingredients used to make meth.  It’s a program that helps retailers understand and play their part in the fight against meth.  

## Sources of Help for 

**Substance Abuse Treatment Locator  **_[www.findtreatment.samhsa.gov](http://www.findtreatment.samhsa.gov/)_** Phone:  1-800-662-HELP**
**Partnership for a Drug-Free America  www.drugfree.org**

**Sources of Help for **
**Individuals**

**Notes:**
The resources listed on this slide are sources of help for individuals who have (or know someone who has) a problem with meth.  The first is specific to meth, but the second and third can also provide help to people who have problems with other drugs and alcohol.  

## www.dol.gov/workingpartners

**www.dol.gov/workingpartners**