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CRICOS No. 00213JHerbert C Biggs PhDWA Safety in Construction Conference 201224th - 25th May 2012, Perth Alcohol and Other Drugs in ConstructionBackgroundEstimated 640,700 persons suffered a work-related injury or illness in 2009-2010 and 444 lost their lives as a result in 2008-2009, in Australia

Very little is known about what proportion of accidents are directly attributable to the effects of AOD

Anecdotal evidence highlights issues of AOD and its association with safety risk on construction sites

Improving workplace OHS is important for this arena given the current size, economic value and expanding nature of the Australian construction industry

Such developments should be grounded in an accurate understanding of the aetiology, impact and consequences of AOD within the industry

Tailored and effective interventions designed to target the problem within the cultural and operating context of the industry

Research ObjectiveTo scientifically evaluate the relationship between the use of AOD and the safety impacts within the Australian construction industry to engender a cultural change in the workforce

A nationally consistent and collaborative approach involving government, employers and employees, unions and other key industry stakeholders

AOD in the workplace today?Consideration of AODs in the workplace is significant: In addition to the personal and social costs, the economic costs of work-related injuries and illnesses are substantial: estimated $75.1 billion in the 2008/2009 financial yearPotential dangers of AOD are well documented with links to absenteeism, interpersonal problems, poor job performance and productivityImpaired coordination, judgement and hazard perception Increased staff turnover, increased lateness for work, machinery damage and litigation costsThe prevalence, patterns and nature of AOD consumption in the workplace are not reliably or accurately understoodLimited and inconclusive evidence Methodological issuesExtrapolation of AOD use by employed individuals to the use of AODs and impairment in the workplacePaucity of dataSuch limitations have clear implications for the development of effective programs and highlight the need to gather accurate and reliable data

What has been done? Widespread development and implementation of workplace AOD policies in large organisations and where safety sensitive work is undertakenQuestions remain regarding the best approachWide variety within and across industriesMerit in examining more contemporary approaches Internet e-TherapyJourneys and practise seen in other industries

Australian construction industryHigh risk, dynamic and ever changingCurrently governed by state-based OHS legislationOrganisational safety cultureExtrinsic vs. intrinsic pathways Construction industry relies heavily on an educative approach built around intrinsic motivation Currently no clear evidence on the prevalence and risk of AOD use among Australian construction workers

MethodLed by an Academic Project Leader in partnership with an Industry Project Leader from a major Australian construction company

Close collaboration with academic leaders and experts in the area, from around Australia

Guided strategically by an Industry Steering Committee with membership comprising representatives from key government, industry and union groups

Drugs and alcohol consumption and behaviour assessment

National qualitative and quantitative assessment of the use of AODs in the industryHeadquarters and operational site visits around AustraliaSurvey using WHO AUDIT (Alcohol Use Disorders Identification Test) customised with key stakeholdersStructured interviews with management and employees, to supplement survey data

2. Development of an appropriate industry policy

Just culture, non-punitive and rehabilitative approach will be developed in consultation with employers, employees and unions across the industry

Aim that it be adopted nationally

Series of workshops designed to inform all stakeholders as to current research and best practice 3. Development of a cultural change management program

Together with government, lead industry associations and key stakeholder groups, the research team will initiate an industry-wide nationally consistent collaborative approach to reduce the risk of impaired performance on construction sites and increasing workers commitment to AOD safety

Partnerships with industry education and skills organisations to disseminate outcomes

4. Development of an implementation plan

To be designed and developed from steps 1-3

Clear recommendations for industry

Educative in focus with a range of comprehensive stepped interventions to be used by workplaces

Face-to-face as well as web-based delivery of programs

Final results: surveyBased on the completion of 494 surveysSites visited in VIC, SA and NTMajority male (464), mean age = 35.7 years Most (398) were employees, 85 employed as a contractor Survey distributed across all roles with most classifying themselves as a tradesperson (155) or a labourer (117)Of a possible maximum cumulative score of 40, participants recorded a mean score of 9.98. Total of 286 participants (58%) scored above the cut-off cumulative score for hazardous alcohol use of 8, with 15% at significant risk of harm

Mean total score 9.98Median score9 Range0-40Above the cut off of 8286 (58%)8-15185 (65%)16-1958 (20%)20+43 (15%)Subsequent analysis focused on the three domains identified within the AUDIT:

Domain 1: ConsumptionMaximum possible score = 12 (scores 6 indicating a risk of alcohol related harm)

Mean score = 6.17

300 (61%) at or above cut off Domain 2: DependencyMaximum possible score = 12 (scores 4 indicating possible alcohol dependence)

Mean score = 1.38

79 (16%) at or above cut off Domain 3: Alcohol related problemsAny scoring warranting further investigation

Mean score = 2.48

291 (59%) at or above cut off

Four additional questions related to self-rated dependency and past other drug use:

33 participants reported that they either possibly or definitely had a problem with drinking. A further 19 reported that they were unsureOver the next 3 months, 71 reported that it would be either fairly difficult, or very difficult to cut down or stop drinkingOf those who scored above the cumulative score for hazardous alcohol use (n=286), 212 (74%) reported that they do not have a problem with drinking and 157 (55%) reported that it would be either very easy or fairly easy to cut down or stop drinking.

A total of 292 participants (59%) had used marijuana/cannabis, with 46 in the last year (16%)

A total of 196 participants (40%) had used ecstasy or meth/amphetamine type substances, with 8 (32%) in the last yearWhat does this mean?Is there evidence to suggest that a proportion of the sample is at risk? Yes.

As in the general population, a proportion of those sampled in the construction sector appear to be at risk of hazardous alcohol consumption.

Is there evidence to suggest that this risk translates to the workplace? No.

Survey results do not tell us about when those in the at risk group are drinking. A proportion of those at risk will consume alcohol in private, in their own time, whereby their behaviour has no relevance to their performance at work. For others, of course alcohol risk will translate into workplace risk. This evidence does not allow any accurate indication of what this risk might be.

Do these results support the need for mandatory testing? No.

Results support the need for evidence-based, comprehensive and tailored responses in the workplace, and in the broad community, so that those who may be at risk are provided with accessible and relevant information and/or help if necessary and any environmental or structural contributors to risk are addressed. Once risk is identified, the next step is to identify factors that might contribute to risk and then to design specific interventions based on each organisations/locations need.

What does past research suggest the best strategies are? The evidence base is limited but includes: Strategies to reduce workplace factors that increase risk (e.g. low levels of supervision; easy access to alcohol; stress; workplace cultures that encourage risky alcohol use)Strategies that support low-risk use (e.g. investment in safety cultures and systems)Online brief interventions for those at riskInitiatives such as Not at Work, MatePeer support programmesAccess to rehabilitative support

Structured interviewsWhile current policies are generally seen as effective, there is support for the need for further educational preventative initiativesSuggestions for effective communication of AOD education at training sessions i.e. clear visual hard copy brochures or posters, videos + positive feedback towards a web-based resourceLinks to reduced safety and productivity levels are confirmed by those in safety advisory positions. In terms of prevalence, AOD use is perceived as a major issue that is only getting worse, particularly drugs because they are harder to detect and deal with immediately.

Lack of knowledge surrounding the physical effects of AOD; with clear implications for safety despite the attitude that AOD use is detrimental to workplace productivity, safety and the risks that it may pose both for ones self and co-workers Importance of management commitment to AOD and the consistent communication of policiesEnsuring that contractors are made aware of the same policies and practices that employees are subject to in their regular pre-start and tool box talks

Job security highlighted as a common fear when it comes to seeking help or advice at work about AOD The culture of certain occupational groups warrants further investigation in that the nature and pressures of the job (and specific skills and hazards) have a huge effect on employees lives and relationships Educating younger employees about how to cope with the lifestyle that can accompany a high-salary, project-to-project, transient type job and getting in before having to deal with the aftermathThe idea of a mentoring type initiative was suggested as one way of contributing towards this education

Where to next?Researchers and the Steering Committee will work in consultation with industry representatives, including employers and employees to develop an appropriate industry policy and cultural management program. Utilising expertise from project partners at Curtin University (NDRI) and Swinburne University of Technology (e-Therapy) to develop a web-based AOD resource, tailored for the industry.Further funding required for full implementation and evaluation. ConclusionsNo known study has scientifically examined the strength of the relationship between the use of AODs and safety impacts in the construction industryMany in the current sample appear to be at risk of hazardous alcohol consumption. A large proportion of these respondents claimed not to have a drinking problem and indicated that it would be fairly easy to cut back or stop their drinking behaviour. These results suggest that those who may be at risk are unaware that a problem may exist, further highlighting the need for educational programs to increase knowledge and awareness of the effects of AOD.

This research will contribute to a cultural change towards improving internal safety culture across the workforce, using a nationally consistent and collaborative approach

Anticipated reductions in economic, health and social costs associated with injuries to workers and their families, with outcome applicability for other sectors

Of major significance for Australia within the context of harmonisation of industrial legislation in OHS and Federal and State Government investment in improving workplace safety and overall population health