Category Archives: Enabling

What is yours and what is mine. Enabling hurts an addict and qualifies at bad help.

Doctors Want out of Medical Cannabis when it is legalized

Doctors want medical pot phased out after legalization: Canadian Medical Association

‘There’s definitely some physicians who feel comfortable in that area, but most don’t’

CBC News Calgary
Dr. Jeff Blackmer on medical cannabis after legalization

00:00 05:21

Dr. Jeff Blackmer with the Canadian Medical Association says doctors want medical marijuana phased out after legalization. 5:21

Doctors in Canada want to see the medical cannabis system phased out once legalization happens later this year, says a Canadian Medical Association vice-president.

“The medical profession, as a whole, has really struggled with the whole concept of medical cannabis. There’s definitely some physicians who feel comfortable in that area but most don’t,” Dr. Jeff Blackmer, vice-president of medical professionalism for the Canadian Medical Association, told CBC Calgary News at 6.

“And [that is] primarily because of the lack of evidence, the lack of scientific studies showing it actually works, the lack of knowledge around dosing and interactions with other medications — all these types of things. Our recommendation was that once it is legalized, that there really is no reason for a separate medical system.”

The federal government has tabled legislation that will make marijuana legal in Canada on Oct. 17.

A lack of clinical studies is the reason most healthcare plans in Canada don’t cover the cost of medical marijuana, said Blackmer.

“Right now, the type of evidence, the quality of evidence that we typically look for before approving drugs or before funding drugs, isn’t there for cannabis,” he said. “That’s not necessarily to say that it won’t be there in the future, and certainly that’s something that a lot of physicians are watching carefully.”

Education, said Blackmer, will be important in the lead-up to legalization.

“The reason for that is there’s a lot of misperceptions around cannabis and we know that, from surveys and studies that have been done,” he said. “We really want people, when they’re deciding whether or not to use cannabis once is becomes legalized, to make an informed decision. To understand there are risks associated with that, that there are potential health consequences.”

Dr. Jeff Blackmer says many doctors don’t feel comfortable prescribing marijuana due to a lack of study around the effects of consuming cannabis. (Robyn Miller)

One concern Blackmer has centres around teenagers using cannabis. Some provinces — including Alberta — have set the minimum age for use at 18, while others set the minimum age at 19.

“We know that more young people use this substance than older people. We know it is something teenagers often try in high school and we know that it has a detrimental impact,” he said.

“There’s a difference between a 15-year-old smoking cannabis versus someone who’s in their 40s, where the brain is already fully developed. It does have a detrimental impact [in young people] and we’ve seen that in studies and surveys and other research.”

Cannabis is set to be legalized in Canada on Oct. 17. (THE CANADIAN PRESS/Graeme Roy)

Once legalization happens, Blackmer said, there will be no reason for people to access it through their doctor.

“If anyone can go down to the local dispensary and get cannabis, there’s really no need for a separate medical authorization system. You really don’t need to have people going to their doctors because anyone who has a medical condition and thinks they might benefit from it can go ahead and try it,” he said.

“And there’s nothing to stop them from asking their doctor, ‘might it work for this condition,’ or ‘do you have any idea about what doses I should use,’ or these types of things.”

Doctors want education to be a big component of marijuana legalization. (Ron Ward/Canadian Press )

Blackmer says the number of medical authorizations has gone down in jurisdictions where cannabis has been legalized, something he expects to see here as well.

“The hypothesis is that there’s a lot of people who may have initially turned to the medical system to get access who now don’t need to do that anymore. So the number of prescriptions, or authorizations, seems to go down,” he said. “And that’s sort of what we’re anticipating in Canada, that the system sort of phases itself out over time, as we get more experience with [legalization].

“There will be some physicians who feel that this has a real place in terms of treatment options and will continue to have those conversations with patients. But we’re hoping for the vast majority of physicians who are uncomfortable, it will mean their patients can just seek it out on their own, they won’t have to find another doctor or to go to a cannabis clinic. They can go down to the dispensary and see if it works for themselves.”

Not a typical prescription

And it’s “more accurate to say authorized,” rather than prescribed, says Blackmer.

“It’s not a typical prescription because it’s not something where you’d give it to a patient on a piece of paper and they’d take it to a pharmacy of their choice — that’s really a prescription,” he said.

“An authorization is something the doctor authorizes and faxes it or emails it to a specific distributor of cannabis and then the patient goes through that distributor, so it’s definitely a different process.”


With files from CBC Calgary News at 6

 

https://www.cbc.ca/news/canada/calgary/canadian-medical-association-cannabis-legalization-1.4772000

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Is Addiction a Risk in the Workplace?

Book is finally out

I was talking to a human resource manager a few weeks ago about an employee who worked in his company. This employee was driving a company car and there had been numerous complaints from other employees that this man had alcohol on his breath at various times throughout the day. The HR manager said that the employee was almost ready to admit that he had a problem and that they could finally do something.

I asked, “What if the employee killed a child in a motor vehicle accident before he admitted he needed help and you had prior knowledge of a this serious safety situation?” “I see what you mean,” he said and wanted some advice from me.” I suggested that he should take the employee out of that car immediately until he could get a substance abuse professional (SAP) to assess him for addiction and to see what the SAP recommended. The SAP will either recommend treatment or education depending on the nature and seriousness of the problem. The company will then have a written treatment plan and documentation to promote further action.

The manager was concerned with human rights of the employee. I was concerned for the child or others that could be killed or maimed if nothing was done while people were waiting for this man to get help on his own. My primary concern as a Substance Abuse Professional is the safety of the public and the other employees working with an addicted employee. The employee and his or her rights are secondary to the safety of others. The idea is to address the safety concerns first.

What constitutes reasonable cause to ask an employee to undertake a SAP assessment for addiction. What sort of things should a manager look for while observing or hearing about this employee?

· Alcohol on the breath. (That one is pretty obvious and serious)
· Drunk driving or other charges related to alcohol or drugs.
· There are physiological and physical symptoms one can learn and be attentive to.
· Erratic work performance, especially, from someone who was very good at their job. (Look for changes)
· Absenteeism is especially useful clue that the person has a problem with something.
· Rumours are useful. They can help you to establish a pattern if there are enough of them.
· Unreasonable excuses for being away or not completing tasks on time.
· Moodiness and problems with other employees.
(I have a checklist on my site called Checklist for Managers that lists many subtle clues)

How do you know if it is addiction?  Actually, you really do not know if it is an addiction. You would not know that until the person is professionally assessed. You may suspect but unless you have some sort of specialized knowledge and training you would not be able to diagnose this your self. Besides, you do not want or need all of that personal information that an addiction assessment gains, nor would the employee want to give it to you. That personal information needed for the assessment must stay with a third party for confidentiality reasons. That is another reason to us a SAP.

If you think that something is not right, there is a policy violation or that a person has an alcohol or drug problem, you should be documenting the behaviour. You are trying to build a case that something is wrong and it would be reasonable to assume that it may be addiction. To correct policy violations or improve employee behaviour is one of your functions. That is your job. That is solution-focussed intervention. Whether it is addiction or not you will have to deal with it and take steps to correct it. The SAP interview will move you to a solution. Either the person accepts the help or they do not. Are you going to let someone work with the smell of alcohol or break other company rules without taking action? It is not inhumane to ask people to be responsible for their behaviour, especially, when that behaviour has the potential to harm the employee or others.

In my seminars I hear of some really horrific cases that employees and mangers appear to be putting up with that in my opinion could be solved with some action. My on-site seminar includes a slide that says,” Addicted people do not get help because they see the light but because they feel the heat on their ___. “ In the 32 years that I have been in the addiction business, I have found that to be true especially when the workplace is actively trying to help. Everyone that I have ever personally known or heard about who has recovered from addiction, has done so only when the chips were down never when they were on a roll. Something happened in their life to make them see that there is a problem.

The workplace is uniquely able to influence the employee in such a way as to get them to look at himself or herself long enough to see that there is a problem. The choice is then theirs to do something about it.

 

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Ralph Waldo Emerson

“Men imagine that they communicate their virtue or vice only by overt actions, and do not see that virtue or vice emit a breath at every moment.”

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I got a call from a union representative to call a guy. He never got back to me with the name but the next day a man called me 5 times and left two messages within 45 minutes and the messages said he failed a drug test and to call him right away. It sounded urgent and five calls in a short period seemed excessive. I called within 60 minutes of the last message he left but he there was no answer so I left a message. I imagine that it was the guy referred to by the union man. I found that strange to call so many times in a short period of time, leave two messages and not be there when I call.  Maybe there was an emergency……….?

When the union man called me he asked me if I could help the union member. I said that I could but I would need cooperation.  It is not a one sided thing. I can’t make someone change unless they want to change.

What I mean by this small story that seems to happen allot in one way or another is that every action shows something as Emerson expounds upon in his essay.  Tell me one thing and do another. Don’t show up or be late. It all says something.  I would suggest everone Read Emerson.

 

 

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Returning a worker to Work after Alcohol or Drug Infraction

20170710_114319One day in a shopping mall I overheard a conversation between two young ladies. One was telling the other that she had just failed her driving test because she did not completely stop at a stop sign. Apparently, the examiner immediately cancelled the rest of the test and told her she had failed because of that one action. She told her friend how shocked and hurt she was as she felt she performed pretty well during the other parts of the driving test. She was furious at the examiner for not passing her. She claimed it was all his fault that she didn’t pass.

I thought about how this story relates to my role in the whole return-to-duty process. The driving examiner was preventing unsafe drivers from getting their license. The young woman thought that since she only went through one stop sign and didn’t hurt anyone, she should be forgiven. She reasoned that lots of people go through stop signs without harm. The difference was she was with an examiner trained to spot mistakes. If she was unable to refrain from going through a stop sign with an examiner in the car, what kind of driver would she be when she was by herself? That is basically how I look at return-to-duty as well. If an employee is not going to make the effort to help themselves while they are out of work and being monitored, why would they make any effort to stay well when they are returned to their job functions?

The answer is that they won’t.

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Wait for the Addict to Hit Bottom? Heck No!

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Wait for the Addict to Hit Bottom? Heck No!

Managers have told me that they have to wait for an addicted employee to hit bottom before anything can be done. While it is true that the addict must reach a bottom or place where they do not want to go again, it is not true that you have to wait. You can act now by making boundaries, drawing your own line in the sand, and by having a procedure or process in place to handle the outcome. Whether the addict changes or not, you must change in order to deal with the problem. You eventually find out through the process whether there is a problem and whether the employee will deal with it or not. The beauty of the process is that what you have to do to make the workplace safe is the thing that the addict may need to hit a bottom or a crisis.

Substance dependent individuals recover in different ways. Some stop immediately and never to return to usage. These are the ones that hit a firm bottom, decide they want to change and act on that desire.

On the other hand, I’ve also witnessed a common pattern: a person hits a bottom, but they forget about what caused it, no action is taken and eventually drug use returns. They will either stop before it gets too bad or be lost again. Occasionally I read about individuals I’ve dealt with through their company policy who have died violently or in some other manner related to their addiction. You might as well know what you are dealing with. It is not pretty.

Do you want to go down the tubes with the addicted employee, or give them a firm chance to get and stay clean? If an employee is having addiction affect their work, deal with it now instead of waiting until they get into serious trouble and possibly hurt others in the workplace.

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Alcoholic High Wire Act in the Workplace

The Alcoholic High Wire Act

I have heard it said that watching the alcoholic is like watching the high wire act at a circus. This is a good analogy which explains the relationship that the addict has with people around him or her. There are themes common in all addictions that we can see when we recognize patterns and are looking in the right places.

At the circus the high wire performer climbs the big supports and the crowd gets nervous. “Look how high it is” they exclaim! They are excited to see what he is going to do and how he is going to pull off the next part of the act.  He walks across the small wire balancing a long pole and the crowd’s heart paces. The circus actor who has done this many times before takes the crowd through death defying feats but always winds up fine on the other end. Part of the suspense comes from the observer’s minds knowing that the circus actor could wind up dead on the hard floor if he falls but he never does. He builds his performance and just keeps on doing more and more dangerous things until the act ends in a heart pumping finale. The crowd knows he is on that high dangerous high wire and they know anything can happen but he always comes out of it and they are relax and become relieved.

Here is one of the major points I have been telling people for years. The problem with our society is that it believes it has to wait for the grand finale to play out before anything is done with an addict but society is wrong. You don’t have to wait for disaster to happen. With the correct process you can act now!

This high wire act explains the performance of a drinking alcoholic or drug addict perfectly. Many around the addict know that there is a problem and they also know that maybe the next performance could be bad but they hope it will be better. They look and they wait. Individuals look in anticipation at what the next act will be. He is in trouble again at work or with the police or with his family. She has another divorce and her kids are mad. How will he ever get out of this one? They all watch with wonder at how the addict skillfully guides everyone’s eyes to something other than his/her drug that is causing the problem but never ever the addict themselves. We then question our own sanity because we think we are seeing things. “Maybe it is not the drug at all” we say.

The addict then shows us that it is always someone else’s fault. It may be their bad childhood, terrible life, ex-wife, awful kids, the bad deal at work, the stock market, – something is making this poor person miserable. No wonder they drink we think. You would drink too! Everyone watches with amazement but no one does anything but watch. They sit back and wait for the finale.

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Success With Addiction in The Workplace

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What Constitutes Success?

The benchmarks of a successful alcohol and drug program should be based on safety, not whether the individual causing the problem changes or not. If it is run correctly, no one gets hurt and the person with problems has the opportunity to get help. That is success right there! If the person takes the help and changes that is a terrific bonus but that is not the ultimate goal.

What do you do with someone who does not want to stop drinking or drugging? You will realize with some education that there is nothing you can do to force them to stop. Gentle pressure can be put on people but the main pressure has to come from the person themselves. They have to get to a place where they know deep down that they are the ones that have to change. They begin to understand that they are responsible for their own problems. They see that no one is coming to save them because they have to save themselves.

Firing the person and then rehiring them without some type of verifiable change is not the answer. That happens and it just teaches an addict that they can get their job back without changing so the next time they drink or use they believe there are no consequences. True and long lasting change must come from within. If the desire for change is not there then that is your answer and you may as well know this sooner than later, they are not ready for change at this time.

People with alcohol and drug problems fail to stop drinking or drugging until they come to the realization that their usage will cause them problems. That is just the way it is. For an addict to recover many factors have to come into play and sometimes it is just is not the right time for them to see their part. They are not ready to stop yet and they may never stop. Do you do wait forever until they decide to stop and allow them to become a safety risk and liability for your company?  The whole is more important than the parts. There is a balance between safety and human rights.

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Change Change and More Change

 

change

Change

When dealing with an addict it is important to remember one thing. This also applies to people as well.  Here it is “you cannot change another person.”

Sounds pretty simple but to learn this but how many times in our daily lives are the things we do designed to change others.  Saying something to a family member because you don’t like the way they are. Trying to bend over backwards for someone to get them to not do something. Pretend that you know what they are thinking or can read their mind in order to be ready to counteract what you think they may do or not do. There are tons of ways we try to change others maybe not even realizing it.  Here is an example. I have been married a long time to a woman who when she walks she likes to walk fast. She has a goal and she wants to get there and thinks by walking fast it is healthier. Maybe it is. I don’t know but I like to walk slow and ambling. I like to make it a social time or talk, an experience, a learning or whatever but not a fast walk trying to catch my breath. No matter what I have done over the years makes her walk slowly.

So two different people, to walking styles. I continually ask to slow down and sometimes I drag my own ass just to try to slow it but never have I been able to change her. She walks fast, that is the way she is always was and always will be.

So what to do? I can change myself and walk faster. I can choose not to walk. I can just accept that this is the way she is. I can walk part way and go home. I can go biking instead or on another walk with the dog at my pace. There are lots of things I can do.

I watch Gerry Springer from time to time and I am amazed how when men with a cheating history are caught again the significant other says they will give him one more change because she loves him.  Then they bring out the other woman and there is a big fight. The reason I am interested is that I have seen this in real life. I see that people can have a life but stick with the loser for some reason thinking they can change them. It is amazing but we all do the same thing in less dramatic ways.

As with an addict they are going to do what they are going to do. Only thing you can do is to set your own boundaries and decide what you will tolerate. This includes workplace policies.  Create your own goals, your own hobbies and your own life, follow them and you will be a happier person. Trying to change others does not work. I have tried and tried myself to change addicts. Ha! What a waste of time and whatever will be will be. Get a life of your own maybe the addict will be so shocked they will decide to change themselves.

 

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Enabling, the long road ahead.

So many people that I talk to have told me that they wished that they did not start down that road with an addict. Now they feel it is too late. One friend of mine buys cigarettes, alcohol and grass for his own 20 something son. He also pays his rent, high cell phone charges and hires lawyers to keep him out of jail. He also takes physical and mental abuse from this son he thinks he is helping. He is most times on edge wondering what the next crises will be. I foresee a very bad ending either for the son or my friend. Obscene and crazy you say? Ask yourself if you are doing anything to keep the addict from seeing their problems and try to see how it ended up this way. You see that you willingly let yourself be pulled along a path of bad help. Get some good information and learn how to get out of this trap before it hauls you in and sucks the life out of you like it is doing to my friend.

So, the term co-dependent is apt and accurate. It takes two (there may be many more) to form this sick relationship and it just gets worse and worse. When I question and expose it as bad help sometimes a bull’s eye on my head because I am upsetting strong systems and former beliefs by getting enablers to look at themselves. They don’t ever want to look at themselves because the sick addict has been the patient not them. “Don’t look at me!  I am the good one here! I am the victim, leave me alone!” Normal for a codependent, but yes, wrong if you want the addict to recover. The bad help has to go. They cannot bear that thought that they are perhaps part of the problem. Silly me for suggesting this.

Bosses, supervisors, society, parents, doctors, counsellors, spouses and children can all be sucked into this trap and I find my self fighting with this invisible monster which is helping to keep addicts the way they are. It is awful when it is seen for what it is and it is hard to rally against it without someone getting their feathers severely ruffled.

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