The problematization of psychoactive substances use in the national. Lemaître Félix Cermes3 Université Paris Descartes. risk management.

Transcription

1 The problematization of psychoactive substances use in the national railwaycompany : suffering at work and Lemaître Félix Cermes3 Université Paris Descartes risk management.

2 Introduction Political and social context, epidemiological datas, Political and social context, epidemiological datas, historical perspective.

3 The psychoactive substances consumersproblem in the workplace. An issue built by authorities since 80 s (MILDT, DGT). Trendingtopic. Objective : usingwork to stop alcoholism and increasing drug use. Stake : inciting companies to act.

4 Public action arguments Corpus : MILDT, DGT, INPES, Groupe Pompidou Problem setting Epidemy Democratization Drug use contagion It crosses all social classes. Target : youngworkers Hypothesis :without screening and preventivemeasuresworkerswillquittheir uses in smallerwaythan former generations. Risks : costs, productivitydecline, security, brand image

5 Plan Santé au Travail (Industrial health Securing employees. plan) Objectives : to increase knowledge and make companies aware of their responsabilities. Addictions are one of priorities.

6 Screening tests Comité Consultatif National d Ethique (French governmental advisory council on bioethics issues, ) : companies should define security clearance jobs (PSS) that will be tested. Urinary test. Research of abuse traces. Companies chose substances and positivity values. Sectors where there is testing : transport and nuclear industry.

7 Why study SNCF? A pioneer company of testing and prevention in France. Ministerial order (2003). Definition of PSS people in security clearance jobs. Security is about reliability of man/machine interface.

8 Substances detected Cannabis 50 ηg/ml Cocaïne 300 ηg/ml Cocaïne 300 ηg/ml Opiates 300 ηg/ml Amphetamines 1000 ηg/ml

9 What substances are used by employees? In interviews: Alcohol : the main issue. An historic problem. Cannabis : a pandemic alert (Wenzek et Ricordel, 2004).

10 HealthBarometer 2010 Important occasional alcohol use in the last month Drunken -ness in a year Cannabis use in a year Cocaïne use in whole life Ecstasy and amphetamine use in whole life Transport 24,2 % 23,0 % 5,0 % 2,7 % 2,5 %

11 Distribution by substances Analyse 2004 : dossiers Analyse 2005 : dossiers 1,80% 1,69% 1,66% Positifs confirmés par CG/MS 1,20% 0,60% 0,23% 0,89% 0,84% 0,01% 0,00% 0,01% 0,17% Cocaïne Amphétamines Cannabis 937 Opiacés

12 Methodology Semi-structured interviews. Ethnographics observations. Analysis of internal documents and archives. Study of electronic discussion forums.

13 History of strugglesagainst uses and preventionparadigms in the SNCF Anti-alcohol movement Alcohol risk prevention Antialcoholism Psychoactive substances risk prevention

14 1. Occupational health : the framing of responsability.

15 1.1 The classification. The Prevention for health and safety at work service : prioritization and management of risks. Two types of risk : occupational/psychosocial. Occupational risk : technical management of hazards associated with machinery and infrastructure. RPS (Psychosocial risks) : negotiations, mobilization of unions. Detection of psychoactive substances use : integrated to the process of security clearance. An occupational hazard of which the employee is responsible.

16 1.2 The communication. SPSST : construct a discourse about prevention. Objective : define a common framing (Entman, 1993). Constitution of prevention groups of employees : the topic is beyond the occupational medicine. Speeches centered on the personal practices = perceived as moralizing. Working conditions remained unspoken. Responsibility is borne solely on the individual.

17 1.3 Training. Make managers prevention specialists. Addictologists- consultants to train team leaders. Learning : identify employees in difficulty, manage crisis situations. Managers : how to prove the consumption of psychoactive substances, and how to force to be treated? The complexity of the intervention. Young team leaders with a contested legitimacy : is the assistance relationship impossible?

18 The suffering of employees : an invisible reality. CHSCT (committee for health and safety at work) : no debate about addictions. Occupational psychologists : selection and victimology. Railway unions and occupational health doctors unionsdefend the independence of the occupational health doctors. No mobilization of employees : security «habitus»/ ethics of safety/ public service values.

19 2.Evaluating the work by the health.

20 2.1 Careers, status, reputations. Employment tests and tests to job retention. The loss of the security clearance : the loss of a symbolic and economic status. Secrets of the person/medical confidentiality/rumors = «Nothing is secret in an establishment.» (an addiction specialist) The discomfort of the uselessness : the enhanced addiction.

21 2.2 Arbitrations and negotiations. Fitness to work/ fitness to safety Temporary/permanent incapacity The return to job Redeploying? = cell of retention in employment. The ultimate limit to unemployment: the «conseil de réforme» ( a disciplinary committee). The contestation of tests results.

22 2.3 The doctor/employee relationship in jeopardy. The fragmentation of medicine. The depersonalization. The impediment to investigate working conditions. The diverted uses of the tests: necessity to build a real follow up care.

23 Is work an effective lever to prevent and treat addiction? The detection of addiction, the pressure on the patient for he to recognize the patient status and encouraging him to heal : are these actions successful? What kind of actors are taking care of people suffering from addiction in the company? How are articulated all those actions?

24 3. The joint labor/health Building the accompaniment.

25 3.1 Professional association to help dependents. La Santé de la famille : anti-alcoholism = a railway workers movement for former drinkers = dependence to other psychotropic substances. The treatment centers, the support groups, the interventions. Partnership with company. The risk of a«signaling policy»

26 3.2.Social assistance. Detection by home visits and by long term sick leaves. Settling the corollary problems to the addiction : problems of finance, of family relationships, of living conditions. Building a network. Social helpers are asking for training about the topic.

27 3.3.The addictology consultation. Exceeding the hierarchical pressure and introducing a true relationship of confidence. Psychoanalytic therapy/work on consumption habits. Rebuild identity without drugs /rebuild identity at work. The difficulty of follow up.

28 Capturing the patients Creating the awareness. Building the status of dependent. Surpassing the shame due to the feeling of guilt /recognition of the disease. Leading to care.

29 Conclusions and prospects

30 Dialectic between work and health : an opposition avoided in the public arena, a difficult balance to accompany Prospective : generalization. The american example (Crespin, 2010).