Iran Occupational Health

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Background and aims: Workplace is a unique situation for treating substance abuse issues. Employer as one of the suffering groups can play an important role in treatment of substance abusing workers. Establishing healthcare houses in workplaces provides an opportunity to play such a role. One of the most important interventions in the workplaces is defining and implementing the employee assistance programs (EAP), through which they can support employees in the relatively risky and unstable environment. EAP provides a variety of services for both employees and employers; train supervisors on how to treat with problematic employees; clear referring procedure for their counseling and consider the follow up.
Work Health Promotion (WHP) is another approach which has wide goals for prevention and rehabilitation measurements for all problems of employees; for example, comprehensive and non-punishable actions to improve employee’s health status and their productivity versus drug abusing in workplaces.
Establishing healthcare houses in Iranian workplaces is one of the practical action in the country to contribute employee’s health status.
There are more than 1,000 researches studied on mental health issues and substance abuse in the workplace. Five comprehensive studies of mental health problems have been conducted by reliable sources. The results generally support the need for more services to address the mental problems and addiction of employees and their families. Substance abuse among adults in the workplaces costs millions of dollars for preventive health care services. Therefore, developing an effective prevention programs for drug users are essential for the workplace. Although, applied studies to prevent substance abuse in workplaces encounter many challenges such as employer considerations, data gathering and access to the intended audience of these programs.
In accordance with addiction prevalence study in workplaces which is performing from 2016 throughout the country; three educational packages have been provided and distributed; promoting package (training healthy life style), facilitating package (Providing staff assistant services in healthcare houses for physical, mental and social problems) and health oriented employers package. This Study is going to develop a facilitator and practical pattern to help employers how to treat and face with addictive drug users.
Methods: This is a qualitative study. For data gathering, three methods were used; reviewing the literature, holding focused group discussions and distributing written questionnaires. The methodology followed as these steps:
1- Searching keywords in English and Persian databases; Magiran, SID, Scopus, Google Scholar, Elsevier and PubMed to find a basic model.
2- The model were discussed in three focus group discussion and three main themes as a basic pattern were found; procedures, trends and standards.
3- The pattern as a ‘standard behavior guideline’ was sent to all stakeholders to comment. So the standard behavior guideline has been finalized.
4- To observe executive challenges, the standard behavior guideline was implemented in two workplaces.
Results:

A public call (self-declaration)

Random test

A follow-up test every six months from people identified in steps three and four

Positive test answer

1. Introducing the volunteers to the Commission of Preventing Addiction at workplaces to take permission for one-month off work and the treatment expenses after the approval of employer. 2. Introducing the volunteers to the drug treatment centers in the county (by Behban) 3. Receiving monthly reports about volunteer’s treatment procedures from the centers (by Behban) 4. Tracking the treatment procedures (by Behban)

Negative test answer

Positive test answer

1. Brief Motivating Consultation by Behban* 2. Introducing the drug abusers to the Commission of Preventing Addiction at workplaces to take permission for one-month leave of absence 3. Introducing the volunteers to the drug treatment centers in the county (by Behban) 4. Receiving monthly reports about individual treatment procedures from the centers (by Behban) 5. Getting addiction test from all injured employees in healthcare house.

Repeating the public call after 3 months

Start

 A pragmatic pattern to help employer how to confront substance abuser in workplaces consist of two phases; periodically repeated self-declaration and random test. In case of positive answer, the treatment process will be started. The incentive measurements for treating a substance abusing workers in the self-declaration phase are more than the random test. The implementation of this model requires the provision of legal, physical and ethical considerations. The algorithm is as follow:
 
 
 
 

Avoiding to take a volunteer test

 
 
 

                                                                                                            
 
 
 
 
 
 
 
 
 
 
 
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Conclusion:  Undoubtedly, substance abuse in workplaces is one of the major problems, defining and implementing EAP is the most important interventions. EAP offers different solutions for problematic employees. The result of this study is a standard behavior guideline to help employers how to treat with drug users in the workplaces. In the first step, self-declaration should be applied. In the positive test result, treatment procedure has to be implemented. In the second step, random test should be given and in positive cases the treatment procedure has to be followed. Furthermore, regulatory, physical and ethical infrastructure should be considered in both steps.
In a research which is conducted in 2009 in the United-states, a guideline for appropriate facing with alcohol and substance abusers in workplaces is recommended. Initially, identifying the substance abusers is vital, then set and select a treatment program according to the level of addiction is suggested; treatment and hospitalization, home treatment programs, intensive outpatient care, behavioral therapies, social support programs, recovery care period, a leave of absence and also returning to work plans.
 A national study in 2014 entitled addiction preventive program in Iranian workplaces shows the main direct results from individual’s view which are increasing awareness and sensitivity in employees and employers to addiction, empowering the responsible persons (Behban) in workplaces and the indirect impacts of addiction reduction in workplaces such as an increase in productivity, reduction of taking off and being absent.
The bold specifications of this study are as follow; It is ordered by main policymakers in national level, the stakeholders ideas are considered to finalize the pattern and the other important factor is that incentive behaviors are considered in all procedure rather than punitive treatment.
Approving the proposed pattern in a form of standard behavior guideline by the council of Coordinating of providing health services for insured peoples, the High Council for Health and Food Security, and the High Council of Cultural and Preventive Narcotics Counter Headquarters, and also encouraging top employers would be suggested.

Keywords: workplace, employer, employee, substance abuse, addiction

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