Employees who perform safety-sensitive duties under US Department of Transportation rules (such as truck drivers) must have an evaluation by a qualified Substance Abuse Professional when they are in violation of DOT rules (for a positive test or a refusal to test). I am a DOT qualified SAP and can perform these evaluations, which involve specialized assessment and compliance reports, as well as a return to work assessment. The fixed fee for this process in my practice is $475.00, payable at the time of the initial appointment, in cash, a cashier’s check, or a money order made out to me. This fee is not billable to health insurance. Employers may choose to pay for SAP evaluations. I can only work with those arrangements if the employer contacts me directly.
After the SAP evaluation, DOT rules require the employee to complete the course of treatment or education recommended by the SAP. Education (when no substance use disorder has been found) is not covered by insurance. Treatment for substance use disorders may be covered by insurance. I am required to base my recommendations on the clinical assessment, although I will attempt to consider cost and insurance coverage in determining my recommendations.
Ordinarily, a counselor works to meet the needs of the clients seeking services. Employee Assistance Professionals are also helping to serve the needs of the organization, especially when an employee is formally referred due to some sort of job performance issue. The SAP has a third responsibility that overrides the other two: serving the public safety. The rules were written this way so that people with substance abuse problems can get the help they need to turn things around, without fearing the loss of their livelihood. Once they complete the SAP’s recommendations, they may be considered for return to safety-sensitive duty. (However, employers are not obligated to keep them as employees and may choose to terminate their employment even if they are compliant with the SAP process). Employees who are in violation are required to be kept from any safety sensitive duty (with any DOT-regulated employer) until the SAP’s recommendations have been completed and a return-to-duty assessment has been conducted. That assessment must be face to face, and I will ask for evidence from the provider regarding the level of participation and compliance with my recommended services.
The employer and the SAP are responsible for making sure that the employee is not allowed to return to safety-sensitive duty until he or she has followed all the recommendations. Many people with substance abuse problems are very reluctant to admit that they have a problem. Part of the challenge for the SAP is to assess whether the violation was simply a lapse in judgment or a sign of a problem with alcohol or drug use. For me, compassion for the employee is tempered by an awareness of my responsibility as a SAP.
The provider of treatment (who must not have any financial connection with the SAP) needs to stay in communication with the SAP, in order to be able to say with some certainty that any substance abuse problem has been successfully dealt with. This usually means completion of treatment and starting aftercare. This can take time, and employees are often very anxious to return to work. However, the SAP must do everything possible to insure that no employee is allowed to work until the psychological or behavioral issues that have led to the rule violation have been fully addressed in treatment; because future misuse of substances would be likely to result in the employee being impaired or unfit for duty. This could place the employee and the public at risk.
For all these reasons, SAPs must undergo extensive training in addition to their professional training in mental health and substance abuse. Initial training on the DOT process and the challenges facing SAPs is followed by a written exam. Afterward, an additional twelve hours of SAP-specific training is required in each three-year period. Rules do change – for example, since 2009, all return to duty and follow-up drug tests must be observed collections. (This was started due to some people’s attempts to use prosthetic devices to sneak in another person’s urine to the collection site).
The professionals who do SAP evaluations generally do this work because they value the importance of public safety, and also value the importance of helping people who may have problems get the help they need and maintain their livelihood. It takes a toughness of attitude and a knack for sensing when someone may be struggling to control a problem to which they don’t want to admit, but which they really need to accept help to deal with. In spite of their key role in the enforcement of drug and alcohol regulations, SAPs (as counselors) really do want to see people get help when they have problems with substance use and abuse.
I would encourage all employees in DOT safety-sensitive positions to become familiar with the regulations at the DOT website, to be sure that there is no misunderstanding about the testing requirements in particular. Any lack of co-operation with the testing or collection process may be considered a refusal to test, and has the same implications as a positive test. An invalid (potentially adulterated or dilute) specimen requires the employee to submit to a repeat collection. There are very few false positives (in spite of popular myths), and the SAP may ask the medical review officer (MRO) for additional information regarding test results. Alcohol and drug tests are conducted randomly, as well as pre-employment and for reasonable suspicion or after an accident. Follow-up tests (after a violation) are unannounced but are not random tests, because the same employee may be tested randomly while also being tested on follow-up.
Employers with US DOT safety-sensitive employees are required to have drug and alcohol testing and removal-from-duty policies that are compliant with DOT regulations. Supervisors must receive training, and safety-sensitive employees must be tested for drugs and/or alcohol according to the modal rules. Any employee who violates the rules must stand down and be referred to a Substance Abuse Professional for an evaluation and recommended services before returning to duty. I am available to perform these evaluations and coordinate the return-to-duty process. I can offer to schedule employees within three working days at downtown Chicago or Hinsdale office locations. I have developed relationships with numerous local treatment programs and make recommendations designed to help assure that employees gain understanding, take responsibility, and refrain from further prohibited conduct. I use the SASSI and other measures to assess for substance abuse and mental health problems. I send reports promptly to the DER, and maintain close communication with treatment providers.
I am also available to provide training for supervisors on DOT regulations, and to consult on policy development and compliance. I have worked with trucking companies, railroad maintenance firms, public utilities, and municipalities on DOT violation situations over the past ten years. You may refer employees with confidence that their return-to-duty process will be handled responsibly and professionally to help protect the employer – whether the employee demonstrates compliance or not.
Some employers choose to pay for employees’ SAP evaluations, and others leave the cost to the employee’s responsibility. I will work with either arrangement.
If you have an employee who reports a problem with substance abuse and seeks assistance, and do not have an EAP program, I will provide EAP services that meet DOT regulations, so that employee can seek help prior to being tested. Again, the cost for these EAP services may be borne by the employer or the employee, at a reasonable per-session fee.