Iran Occupational Health Journal

fa الگوی عملی مواجهه کارفرمایان با کارگران مصرف کننده مواد اعتیاد آور A practical patternl for employers to face with drug addicted workers روانشناسی سازمانی Organizational Psychology پژوهشي Research <span style="font-family:B Titr;">چکیده</span><span dir="LTR"></span><br> <span style="font-family:B Titr;">مقدمه:</span> <span style="font-family:B Mitra;"><span style="font-size:12.0pt;">اعتیاد به مواد مخدر امروزه بصورت یک بلای اجتماعی است و بدون تردید مصرف مواد در محیط کار یکی از اصلی‌ترین معضلات محیطهای کاری است زیرا کارفرمایان را با هزینههای زیادی مانند کاهش بهرهوری و افزایش نیاز به مراقبتهای سلامتی روبرو میکند. مصرف مواد مخدر به کاهش بهره وری، غیبت از کار، جراحت در محیط کار، افزایش هزینههای درمان سلامتی، فساد در محیط کار و نیز مشکلات فردی و مضرات اجتماعی منجر می شود. </span></span><span style="background:white;"><span style="color:#222222;"><span style="font-family:B Mitra;">محیط کار موقعیت</span></span></span> <span style="background:white;"><span style="color:#222222;"><span style="font-family:B Mitra;">منحصر به فردی در درمان افراد مصرفکننده مواد اعتیادآور می باشد بنابراین کارفرما به عنوان یکی از گروههای متضرر میتواند نقش منحصربه فردی در درمان کارگران مصرفکننده داشته باشد.</span></span></span> <span style="background:white;"><span style="color:#222222;"><span style="font-family:B Mitra;">راه اندازی خانه</span></span></span> <span style="background:white;"><span style="color:#222222;"><span style="font-family:B Mitra;">بهداشت کارگری در محیطهای کاری فرصتی برای ایفای چنین نقشی فراهم می آورد . هدف این مطالعه تعیین الگوی عملی مواجهه کارفرمایان با</span></span></span> <span style="background:white;"><span style="color:#222222;"><span style="font-family:B Mitra;">کارگران مصرفکننده مواد اعتیادآور است</span></span></span><span dir="LTR" style="background:white;"><span style="color:#222222;">.</span></span><br> <span style="font-family:B Titr;">روش: </span><span style="background:white;"><span style="color:#222222;"><span style="font-family:B Mitra;">این مطالعه از نوع کیفی است. برای جمعآوری دادهها از سه روش مرور منابع ، برگزاری جلسات بحث گروهی متمرکز و نظرخواهی با پرسشنامه کتبی استفاده شده است. ابتدا </span></span></span><span style="font-family:B Mitra;"><span style="font-size:12.0pt;">کلید واژههای اصلی این پژوهش در پایگاههای  </span></span><span dir="LTR"><span style="font-size:12.0pt;">Magiran</span></span><span style="font-family:B Mitra;"><span style="font-size:12.0pt;"> و </span></span><span dir="LTR"><span style="font-size:12.0pt;">SID</span></span><span style="font-family:B Mitra;"><span style="font-size:12.0pt;">، </span></span><span dir="LTR"><span style="font-size:12.0pt;">Scopus</span></span><span style="font-family:B Mitra;"><span style="font-size:12.0pt;">، </span></span><span dir="LTR"><span style="font-size:12.0pt;">Google Scholar</span></span><span style="font-family:B Mitra;"><span style="font-size:12.0pt;">، </span></span><span dir="LTR"><span style="font-size:12.0pt;">Elsevier</span></span><span style="font-family:B Mitra;"><span style="font-size:12.0pt;">، </span></span><span dir="LTR"><span style="font-size:12.0pt;">PubMed</span></span><span style="font-family:B Mitra;"><span style="font-size:12.0pt;"> مورد بررسی قرار گرفتندو پس از بررسی مطالعات بدست آمده، مدل مفهومی اولیهای طراحی شد. سپس این مدل مفهومی طی سه جلسه بحث گروهی متمرکز با خبرگان در قالب مراحل، روالها و استانداردها تدوین شد. حاصل این جلسات شکل گیری شیوه نامه رویارویی کارفرمایان با کارگران مصرف کننده مواد بوده است. حاصل این جلسات شکل گیری شیوه نامه رویارویی کارفرمایان با کارگران مصرف کننده مواد بوده است. در مرحله نهایی شیوهنامه با استفاده از پرسشنامه به تمامی ذینفعان جهت نظرخواهی ارسال و پس کسب و اعمال نظرات آنها، نهایی شد.</span></span><span dir="LTR"><span style="font-size:12.0pt;"></span></span><br> <span style="font-family:B Titr;">یافته ها:</span> <span style="background:white;"><span style="color:#222222;"><span style="font-family:B Mitra;">الگوی عملی رویارویی کارفرمایان با کارگران مصرفکننده مواد اعتیادآور به ترتیب شامل دو مرحله خوداظهاری و سپس تست تصادفی است که به شکل دورهای تکرار میشود . در صورت خوداظهاری و یا مثبت بودن تست تصادفی اعتیاد، فرایند درمان اجرا میشود. شرایط تشویقی برای درمان کارگر مصرفکننده مواد در مرحله خوداظهاری بیشتر از مرحله تست تصادفی مثبت است. اجرای این الگو نیازمند فراهم شدن زیرساختهای قانونی ، فیزیکی و </span></span></span> <span style="background:white;"><span style="color:#222222;"><span style="font-family:B Mitra;">رعایت ملاحظات اخلاقی است</span></span></span><span dir="LTR" style="background:white;"><span style="color:#222222;"> .</span></span><br> <span style="font-family:B Titr;">نتیجه گیری:</span><span style="font-family:B Nazanin;"><span style="font-size:12.0pt;"> از ویژگیهای مهم این مدل این است که با درخواست سیاستگذاران امر تدوین شده است، نظر همه ذینفعان در آن اعمال شده است و همچنین این مدل شیوهای از برخورد تشویقی و نه تنبیهی را ارائه میدهد که به دنبال درمان کارکنان معتاد است. لذا </span></span><span style="background:white;"><span style="color:#222222;"><span style="font-family:B Nazanin;">پیشنهاد میشود این الگو به شکل شیوهنامه در شورای هماهنگی ارائه خدمات بهداشتی به بیمهشدگان، شورای عالی سلامت و امنیت غذایی و </span></span></span> <span style="background:white;"><span style="color:#222222;"><span style="font-family:B Nazanin;">شورای فرهنگی و پیشگیری ستاد مبارزه با مواد مخدر تصویب شده و کارفرمایان برتر در اجرای آن تشویق شوند</span></span></span><span dir="LTR" style="background:white;"><span style="color:#222222;">.</span></span>  <br> <strong>Background and aims:</strong> 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.<span dir="RTL"></span><br> 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.<span dir="RTL"></span><br> Establishing healthcare houses in Iranian workplaces is one of the practical action in the country to contribute employee’s health status. <span dir="RTL"></span><br> 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.<br> 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.<br> <strong>Methods:</strong> 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:<br> 1- Searching keywords in English and Persian databases; Magiran, SID, Scopus, Google Scholar, Elsevier and PubMed to find a basic model.<br> 2- The model were discussed in three focus group discussion and three main themes as a basic pattern were found; procedures, trends and standards.<br> 3- The pattern as a ‘standard behavior guideline’ was sent to all stakeholders to comment. So the standard behavior guideline has been finalized.<br> 4- To observe executive challenges, the standard behavior guideline was implemented in two workplaces.<br> <strong>Results:</strong> <table cellpadding="0" cellspacing="0" width="100%"> <tbody> <tr> <td> <div><span dir="LTR">A public call (self-declaration)</span></div> </td> </tr> </tbody> </table> <table cellpadding="0" cellspacing="0" width="100%"> <tbody> <tr> <td> <div><span dir="LTR">Random test</span></div> </td> </tr> </tbody> </table> <table cellpadding="0" cellspacing="0" width="100%"> <tbody> <tr> <td> <div><span dir="LTR">A follow-up test every six months from people identified in steps three and four</span></div> </td> </tr> </tbody> </table> <table cellpadding="0" cellspacing="0" width="100%"> <tbody> <tr> <td> <div><span dir="LTR">Positive test answer</span><br>  </div> </td> </tr> </tbody> </table> <table cellpadding="0" cellspacing="0" width="100%"> <tbody> <tr> <td> <div><span dir="LTR">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.</span><br> <span dir="LTR">2. Introducing the volunteers to the drug treatment centers in the county (by Behban)</span><br> <span dir="LTR">3. Receiving monthly reports about volunteer’s treatment procedures from the centers (by Behban)</span><br> <span dir="LTR">4. Tracking the treatment procedures (by Behban)</span><br>  <br>  </div> </td> </tr> </tbody> </table> <table cellpadding="0" cellspacing="0" width="100%"> <tbody> <tr> <td> <div><span dir="LTR">Negative test answer</span></div> </td> </tr> </tbody> </table> <table cellpadding="0" cellspacing="0" width="100%"> <tbody> <tr> <td> <div><span dir="LTR">Positive test answer</span></div> </td> </tr> </tbody> </table> <table cellpadding="0" cellspacing="0" width="100%"> <tbody> <tr> <td> <div><span dir="LTR">1. Brief Motivating Consultation by Behban<sup>*</sup> </span><br> <span dir="LTR">2. Introducing the drug abusers to the Commission of Preventing Addiction at workplaces to take permission for one-month leave of absence </span><br> <span dir="LTR">3. Introducing the volunteers to the drug treatment centers in the county (by Behban)</span><br> <span dir="LTR">4. Receiving monthly reports about individual treatment procedures from the centers (by Behban)</span><br> <span dir="LTR">5. Getting addiction test from all injured employees in healthcare house.</span></div> </td> </tr> </tbody> </table> <table cellpadding="0" cellspacing="0" width="100%"> <tbody> <tr> <td> <div><span dir="LTR">Repeating the public call after 3 months</span></div> </td> </tr> </tbody> </table> <table cellpadding="0" cellspacing="0" width="100%"> <tbody> <tr> <td> <div><strong><span dir="LTR">Start</span></strong></div> </td> </tr> </tbody> </table>  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:<br> <span dir="RTL"> </span><br> <span dir="RTL"> </span><br> <span dir="RTL"> </span><br> <span dir="RTL"> </span> <table cellpadding="0" cellspacing="0" width="100%"> <tbody> <tr> <td> <div><span dir="LTR">Avoiding to take a volunteer test </span><br>  </div> </td> </tr> </tbody> </table> <span dir="RTL"> </span><br> <span dir="RTL"> </span><br> <span dir="RTL"> </span><br> <br clear="ALL" >                                                                                                              <span dir="RTL"></span><br> <span dir="RTL"> </span><br> <span dir="RTL"> </span><br> <span dir="RTL"> </span><br> <span dir="RTL"> </span><br> <span dir="RTL"> </span><br> <span dir="RTL"> </span><br> <span dir="RTL"> </span><br> <span dir="RTL"> </span><br> <span dir="RTL"> </span><br> <span dir="RTL"> </span><br> <span dir="RTL"> </span><br> <a href="#_ftn1" name="_ftnref1" title="">[1]</a><span dir="RTL"></span><br> <span dir="RTL"> </span><br> <span dir="RTL"> </span><br>  <br> <strong>Conclusion:  </strong>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.<br> 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.<br>  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.<br> 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.<br> 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. <div>  <hr align="left" size="1" width="33%" > <div id="ftn1"><span dir="LTR">*</span><span dir="LTR"> Behban is a person who is responsible for healthcare houses in workplaces</span></div> </div> کلید واژه‌ها: محیط کار, کارگران, مصرف مواد اعتیادآور workplace, employer, employee, substance abuse, addiction 370 381 http://ioh.iums.ac.ir/browse.php?a_code=A-10-3360-4&slc_lang=fa&sid=1 behzad damari بهزاد دماری bdamari@gmail.com 13600319475328460039960 13600319475328460039960 Yes 1- Associated Professor, Department of Governance and Health, Neuroscience Research Center, Tehran University of Medical Sciences, Tehran, Iran دانشیار، ، دپارتمان حکمرانی و سلامت، پژوهشکده علوم اعصاب، دانشگاه علوم پزشکی تهران، ایران Fereshteh Taheri فرشته طاهری fereshtehtaheri61@gmail.com 13600319475328460039961 13600319475328460039961 No 4- PhD Student of Cognitive Psychology, Occupational Health Research Center, Iran University of Medical Sciences, Tehran, Iran. مرکز تحقیقات بهداشت کار، دانشگاه علوم پزشکی ایران، تهران، ایران. hosein almadani حسین المدنی hosseinalmadani@yahoo.com 13600319475328460039962 13600319475328460039962 No 2- PhD of Psychology, Researcher, Department of Governance and Health, Neuroscience Research Center, Tehran University of Medical Sciences, Tehran, Iran. دپارتمان حکمرانی و سلامت ، پژوهشکده علوم اعصاب، دانشگاه علوم پزشکی تهران، ایران roya noory رویا نوری roya_noori2020@yahoo.com 13600319475328460039963 13600319475328460039963 No 3- Psychologist, Addiction researcher, Department of Governance and Health, Neuroscience Research Center, Tehran University of Medical Sciences, Tehran, Iran. دپارتمان حکمرانی و سلامت، پژوهشکده علوم اعصاب، دانشگاه علوم پزشکی تهران، ایران Hooman Narenjiha هومان نارنجی ها 13600319475328460039964 13600319475328460039964 No Psychologist, Addiction researcher, Department of Governance and Health, Neuroscience Research Center, Tehran University of Medical Sciences, Tehran, Iran. پزشک و پژوهشگر اعتیاد، مرکز تحقیقات سومصرف مواد و وابستگی، دانشگاه علوم بهزیستی و توانبخشی، تهران، ایران.