Drugs and alcohol in construction

Construction work health forum 2016 podcast

Presenter: Professor Bert Biggs

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Professor Bert Biggs, Presenter:

What I want to talk about today are two separate studies, one of which was funded by the Sustainable Built Environment National Research Centre and that completed about 13‑14 months ago. The second one was funded by what is now Workplace Health & Safety Queensland, but it was then DJAG here in Queensland, looking at partnering with MATES in Construction to see if we could translate some of our knowledge from that previous study on the ground in Queensland with construction workforce. I notice today we've got Jorgen and John both here from MATES in Construction. Thanks for being here. It was a great project so we want to talk a little bit about that as well.

First, the information we got together was from the main project which is the Safety Impacts of Alcohol and other Drugs in Construction. There is a background to this, it's slightly dated though. I was asked to provide the evidence that I did at the time of the research, so that's where it is at the moment.

We know that there are substantial numbers of people involved in workplace incidents and accidents to the order of 638,000 over that period of time, 2009/2010, and 337 people lost their lives as the result of a workplace accident. In the construction sector there were 189 fatalities. Sorry, in 2014 there were 186 fatalities, with 29 occurring in construction. The slightly goodish news there is that those fatalities in construction have dropped a little bit over the last decade. Of course any death is no good at all. A lessening of that is good but we've got a lot more work to do as well. The issue is not as serious as it was but it's still serious and it's a major problem as well.

We don't know, generally, what proportion of deaths or even serious injuries are attributable to AOD issues. Bernie mentioned earlier on that our particular industry in construction is one of the most at risk industries in terms of AOD use, second behind hospitality. In terms of heavy drinking we'd suspected that alcohol and drug use was quite strong and quite heavy within the industry and the sector, but it was all anecdotal. We didn't really have any major hard facts to deal with until some years ago where we got the funding to actually go in and try and get some quantitative data on this issue and see how we went. That's what we did with the first study, so I'm going to present some of that material now so we can have a quick look at that.

We wanted to try and scientifically, as I mentioned, evaluate the relationship between the use of AOD and safety impacts in the construction sector. More importantly we wanted, if we could, to look at a nationally consistent and collaborative approach involving all of the major stakeholders. I think anyone involved in the sector knows that getting all the stakeholders around the table and agreeing on anything is a feat in itself, but in this case we did. We got together and we looked at a whole range of issues as a collaborative team, not always agreeing about the way we should go or the strategies we should pursue, but the overarching umbrella was educative. We weren't in the room to talk about the drug testing elephant, we were there to talk about how can we learn from this? How can we take some thoughts away as to how we understand what's going on with this issue of AOD? How can we internalise that ourselves? How could we train and teach other people to understand what might be a major issue with AOD and take some personal responsibility and some corporate responsibility for those sort of outcomes, rather than in a way becoming reactive and looking at more stick issues rather than carrot issues. That was the whole idea. We acknowledged the fact that there are testing regimes and they are in use across the sector in various ways. We don't disabuse that at all, we think that's probably a decent thing to do in a number of cases, but at the same time we wanted to emphasise the educative processes that could be in play.

We know the cost to society and I've got that up there on the next screen. I won't go into that in great detail. We do know that there's not only economic costs but there are personal and social costs. A lot of the speakers today have referred to the issues of relationship breakdowns and a whole range of social glue issues that really are at risk. That's right across the workforce and particularly in construction. Helen Lingard touched on this this morning, but no‑one's done a particularly good study on issues to do with this sector that really starts work early in the morning when no other services are available for anyone else, finishes work late in the afternoon, works through weekends. All of the support structures that we often think are in place for relationship growth and relationship durability are not available generally to this workforce. That has to be a major issue at play which we didn't investigate in this research, but we know it's an issue and it should be something for future research. Helen Lingard touched on that earlier today and I support that.

The potential dangers with AOD in the workforce, we've pretty well documented. We've talked about absenteeism, presenteeism, interpersonal relationships and so on. There is an issue of AOD use and impairment. They're not to be used in parallel. Certainly excessive AOD use or AOD use can cause impairment, but it's not the only thing that causes impairment in the workforce. They really are separate but related conversations.

Earlier Bernie talked about the problems of staff turnover. It's phenomenal costs, of course, in staff turnover, not only for economic issues but when you look at the issues of somebody leaving the job prematurely and feeling as though they perhaps haven't done a good job, struggling to find another job and so on. There are human considerations as well as economic considerations to staff turnover. That's particularly so in the fly‑in fly‑out, drive‑in drive‑out workforce where a senior executive told me recently that the turnover that they were experiencing on some of their FIFO sites were in the order of 35%‑45%. That's 35%‑45% of your workforce turning over every year. The costs in training and recruitment selection are phenomenal. It's also fairly disheartening to workers to be able to turn up the next day and find out that the worker that they were working with yesterday is gone, they've got a new work team to adjust to or to coordinate with and so on.

A lot of companies also are looking at realistic job previews, trying to ensure that people coming into that area, for example, come into it for the right reasons and have a chance of staying a little bit longer than they normally would. That's another issue. That's a big issue in turnover. It also relates to AOD use in the sector.

One of the major issues is we don't really know about the prevalence patterns and nature of AOD consumption. We've guessed it. We've got some data on it, but not particularly thorough data, and it's not reliable or accurate. A lot of the stuff, material that you read, has methodological issues, they are cross‑sectional analysis rather than longitudinal studies fraught with error. Very difficult to draw any conclusions from some of that sort of data.

The extrapolation, as I mentioned, of use of AOD to impairment in the workforce is not clearly understood and often misused, so we didn't want to go there as well. There's not much data around. A lot of the stuff you get – and it's very valid data – might come from Beyond Blue, MATES in Construction, other support organisations that actually see the damage at the other end, but they're seeing it in an individual or small group basis and it's hard to get the big picture on that. We know it's there, we just don't have any idea of the actual incidence of it. We don't know what sort of program development we can actually do unless we know the extent of the actual problem.

I probably won't go into talking about the Australian Construction Industry. I'm sure you all know what the issues are. It's a high risk, ever changing, dynamic environment and so on. It's dangerous. It's right up there in terms of industry hazard and risk. It's got a very variable, changing workforce. It's got uncertain futures. Once projects close down you're not quite sure where the next trend's going to go. You're not really sure of your next job. Even the big companies don't know whether they're going to get that tender or not. It's quite a changeable and uncertain environment which can cause a lot of strain. Bernie mentioned earlier that spills down to individuals in terms of stress, but companies also experience stress as well. It's all there, it's a variable feast and it's a very difficult working environment.

On that, within that environment you've got the same duty of care obligations as any other organisation. You've got to look after your workforce and provide a safe workplace. You've got all the issues of organisational and safety culture, how you might drive your safety culture, or drive your organisational culture varies between organisations. Everyone seems to have a different view on that. Everyone has a different definition for safety culture versus safety climate. In other words, the conversation is ongoing but not particularly definitive. That's good because all of these concepts do move quite a bit and new ideas come along and should be brought into play.

Developing an organisational culture and particularly a safe culture within the organisation is an ongoing journey. The leadership issues are so important and so incredibly powerful. On top of that, of course we all know that the majority of the workforce are contractors. They're not part of a great machine, they're not part of the ex‑Leighton's Executive Board Table. We know also that only 1% of the entire organisational structure in the construction sector in Australia are large organisations. The rest of them are small to medium organisations. These are very hard issues to come to grips with and develop a consistent overall cultural development program.

Having said all that, I wanted to say that there was no clear evidence in what I'm talking about now as to what the issue might be in Australia in relation to AOD use. So, what do we do about it?

Sorry, I'm a bit behind in my PowerPoints here, I beg your pardon.

We had funding provided by the Sustainable Built Environment National Research Centre which is now based at Curtin University in Perth, but was at QUT when this research was undertaken. We got together a team of people led by an academic project leader, in this case it was me. We had an industry project leader as well from, in this case, John Holland. We had close collaboration with a number of other universities and with a number of construction organisations around Australia. Most importantly, in this type of operation, where you have industry players, university researchers, government organisations, most importantly you have to have an industry steering group to keep us all on track. There's nothing worse than small, highly focused, targeted research like this where the dollar is just so valuable, to lose your way. There's nothing worse than losing your way. The industry steering group was an extremely valuable technique to keep us all on track and make sure we focused on the real targets, got our research goals together, nailed the milestones, got the information, did it all on time.

This was a project that took us around Australia. We did a lot of work in Northern Territory, West Australia, New South Wales and Queensland. We had 18 months to do it, and that's a very short time frame. In addition to that, of course, you've got to get ethics through university. Anyone who works at a university should know, or maybe does know, that that takes quite a long time as well. We were pretty well under the pump in terms of doing it.

Who were our partners? Well, we had a vast range of people, they're all spelt out here, the Australian Constructors Association, APCC, AWU, Austroads, CFMEU, Engineers Australia, John Holland, Master Builders Association, Office of the Federal Safety Commissioner. A lot of these guys are quite divergent and it was very interesting around the board table, I can tell you, at the steering committee meeting. We got a lot of different ideas but the glue that held us all together was avoiding talking about the various, I suppose, foci of each of the organisations. We just concentrated on how can we best find out what really is happening so that we can develop or encourage educational programs to help workers in the industry, to see how we might go in terms of informing them, allowing them to make reasonable choices about AOD use and their own healthy initiatives as well. Once we had that in place as an overarching principle we proceeded pretty well, which was very pleasing.

We actually had a mix of quantitative and qualitative methodologies. One of the things that we did use was the World Health Organisation Alcohol Use Disorders Identification Test, the AUDIT test, which is well known and well cited, well referenced in the literature. We decided we'd use something as standardised as that so that we could (a) get agreement around the table, and (b) publish it so you could actually compare it with other studies that might be in publication. It's a widely used test. We had that, that was our quantitative aspect which was administered to – we were hoping for 500, I think we got 496 so it wasn't too bad. We had those 500 questionnaires, or close on, then we also had a series of structured interviews and focus groups around that as well, to back up the quantitative data with qualitative context.

If any of you have been involved in research and I know a lot of you have, the quantitative stuff's good, the qualitative stuff is better. You get rich context, you get nuance, you get understanding, you get meaning, you get little bits of this and that. If you can interpret that, that's much more meaningful than a number. We had both. We thought that's a good way of doing it. It hadn't been done in Australia before, so we were very pleased to do that that way.

We had the survey, we had approximately 20 structured interviews or focus groups around the country. The whole idea was to – I beg your pardon, I'm just getting behind on this all the time. The outcomes of the study were this, the goals were to develop an appropriate industry policy. We wanted to get data whereby we could go back to the stakeholders and say "Okay, how do we go about doing this in an educative way, given the environment of the day?", which was harmonisation of industrial legislation and also trying to put out a consistent message about this. AOD flows freely across straight borders, right? It's not something that's exclusive to Queensland or New South Wales, or whatever it might be. We had a national issue here, we wanted to have a consistent response.

We also wanted to look at that adjust culture, a non‑punitive and rehabilitation approach. We wanted that to be developed in consultation with employees, employers, trade unions and the industry. I think Bernie touched on that earlier on about organisational justice, I think he mentioned that was one of the important key points in his approach as a psychologist in the industry. We wanted whatever we developed to be developed nationally, not just in one state.

We wanted then to develop an implementation plan. Again, the plan had to be educative in focus with a range of comprehensive, stepped up, onleading interventions used by workplaces. We wanted a web based delivery of programs to aid face to face. In that regard we brought in our partner Swinburne University to look at a web based application and development on the basis of our knowledge, they'd use that to develop the web base. We wanted clear recommendations for industry and we wanted partnerships with industry education and skills organisations to disseminate outcomes, such as, for example MATES in Construction, and I'll talk about that later.

What were the results? Okay. Based on the completion of 494 surveys in three states, oddly enough the majority were male, 36 years. I don't think that's any surprise in this industry at this stage. The survey distributed across roles within the company, with most of them classifying themselves as trades persons, 31%, or labourers, 24%. We got workers on the ground. We didn't just go to board rooms. We wanted to have people who we knew were doing the work.

The scary bit was, and Bernie referred to this earlier, that the audit scale score gives you a maximum cumulative score of 40 when you add up all the questions and the responses, the liquor type responses to it. We had a mean score of 9.98 across those 496 respondents and the scores ranged from 0 to 40. I'm not going to say how many 40s we had, but the median score of 9. Now, of that, and this is where it becomes really slightly problematic, a total of 58% of these respondents scored above the cut off cumulative score for hazardous alcohol use, which is 8 or greater. So 58%‑60% of the population were actually engaging in hazardous drinking behaviours. Now, Bernie also mentioned that earlier, and we'd certainly confirm that with this data. Of those 58%, 15% of those scored greater than 20, which really is significantly at risk. So it's 15% of that population were really at risk, and close to 60% were at risk. That's a lot. That pretty well shocked us actually. We had a view and a thought that alcohol and other drugs were contentious and problematic, and reasonably widespread, but we didn't think to that extent. So we knew we had a problem. How to deal with it's another story, but at least we had the data to do that.

Further results, and I'll just go through these to make sure that you – these just add to the flavour of the thing, to the earlier stuff.

We also asked three questions about other drugs as well. We really wanted to ask about pharmaceuticals but we knew if we did that we'd never get it through the ethics committee at the university, and we wouldn't get it through the AMA. We know however that prescriptive drugs are a major, major issue as well, but that's for another day. In an 18 month program we did what we could.

We did ask questions about other drugs as well in terms of usage and I'll talk about that just now. 33 participants reported they either possibly or definitely had a problem with drinking. A further 19 were unsure. Out of those people that I mentioned, 286 participants, only 33 of those admitted or thought they had a problem. The lack of understanding or the ability to ignore the issue was profound. Now, that's not uncommon, by the way. Anyone working in allied health will tell you that whatever you tell your doctor is probably only partially true, and that's true here as well. Whether it's covert or overt acknowledgement, it's a problem. If it was something that people realised is a problem and didn't acknowledge it, okay, that's one issue. If they didn't realise it was a problem at all, but it was a problem, that's another issue, both of which have an education strain in it and an educational solution in some respects.

We asked people would they be able to cut down and over the next three months 71 participants reported that it would be either fairly difficult or very difficult to cut down or stop drinking. Again, that's a very large chunk of the population.

Of those 496, nearly 300 had used cannabis, overall. We asked for an overall use of that. Of that 46, only 16% said in the last year. We didn't think that was a major issue in that sense because other drugs had come on stream. Nearly 200 stated that they used an Ecstasy/meth type substance and 32% of those said they had in the last year. We know that that proportion of drug use has probably increased, it certainly hasn't gone down. Remember a lot of these self reported reports of self reported data are erroneous. People tend to underplay it all the time, it's just human nature, that's what happens. Even if that was the case, it's a problem. If it's under counted, under related, it's worse. We knew we had an issue.

When we sat down with the focus groups and the structured interviews we asked them a number of questions and of course related to educational initiatives and said "What do you think about that? Do you think it's a useful strategy? Would you support the need for that?" Overwhelmingly we got support for that sort of need. Then we asked people "Okay, well thank you, if you think it's a great idea, what are some of the ideas we could put in force? What could we do to make it translate into action?" Some of the suggestions we got were very practical, things like suggestions for effective communication of AOD education toolbox talks, very clear visual, hard copies. We heard very much this morning about how communication's going from basically written to visual, so much so that when we saw Mark this morning put up the ABC he didn't even put up letters any more, just 'G' for girl. So, visual is very important. They wanted that in brochures and hard copies, videos, and positive performance towards a web based resource.

We asked them "Would you like to have a web based resource that you can access via an app, or via any method you like, on your tablet or your phone at minimal cost. Would you like that? Would it work?" They virtually said "Yes". The whole idea was "Can we have an information base to understand a little bit more about AOD issues and how it affects the body? Can it be updated? Can we access it relatively easily in remote areas? Where would it be situated? Who would take responsibility for it?" Well, while we were doing this, working with the respondents and the construction industry we were also working with Swinburne University saying "Can you help us with the development of a web based information service?" and they did.

The other things they were worried about were the lack of knowledge surrounding the physical effects of AOD. Most people really, and particularly the younger ones, had no idea how alcohol and other drugs affect your body, physiologically, the anatomical issues and what are the long term effects in terms of the long term use of AODs. They wanted to know but they didn't want to discuss it in front of an audience. They were happy to take that information on their own via a tablet or via some other device, and learn themselves. Then they might be happy to talk about it, but they didn't want to discuss it in a group and, I guess, show their ignorance about the whole thing. It's like a lot of things, they wanted the information but they wanted it in a number of modalities. Certainly the personal, confidential, impartial type delivery of that information on an individual basis was something they really wanted. Our website had to be able to both deliver information to an individual without being known by any AP or by the employer, and also allow them to not only know that information but perhaps to try and also locate additional services and support services they might need themselves in an impartial, confidential way.

They did discuss, and we did discuss with them, the implications of AOD for safety on site. Almost universally people could understand the issues, the connection between AOD, impairment, workplace safety, hazard identification, responsibility for their workmates and so on and so on. Everyone understood that, got it, no problems at all. That really wasn't an issue. Generally, I think a big tick to most organisations that we spoke to about obviously letting people know that that was the culture and that's what the connections were. Everyone understood that. They probably didn't understand very well how they were able to do it, but the knowledge was there.

I think I must be pressing this as I'm going. My apologies. Just yell at me, will you? Yeah, I did do that, I'm sorry. I'm sitting here yapping away and pressing this. I'll put that down. Right. That's it.

Interviews. Right. What came out of the interviews were things like the importance of management commitment to AOD and the consistent communication of those policies. It led from the top, they really wanted the CEO and whatever to show leadership and carry on. They understood that. That was important. You have to have alpha leaders to take this through. They were very concerned because most of the workers are contractors, that contractors are made aware of the same policies and practices that employees are subject to. They were very keen to be all on the same playing field and they weren't quite sure generally how that could happen. A lot of the contractors and subcontractors of course don't have the resources of the big companies like John Holland, yada, yada. That was an issue that they wanted us to take on board in terms of making sure the contractors could have access to educational components or derivatives from this research as well.

Of course the old one there that came up in the interviews is everyone's very worried about their job. They don't want to reveal any potential challenges in case they might lose their job or something would happen with that. I might just pass on an anecdote there that some years ago we worked with a particular state police service here that had the same issue with turnover and stress in the staff. Of course they had an EAP provider which was internal, so imagine that. You're a police officer who's stressed and you go and see an internal psychologist, it goes all over the place like wildfire. The solution to that was, of course, to outsource it and to make sure the divisional commanders were the ones responsible for reducing turnover, and all of a sudden stress was an issue they paid attention to. Anyway, won't go into that, but that's something that really needs to be looked at.

Let me very quickly go to the second study, which was the MATES in Construction study. Once we gathered all this information, started developing the website, we thought "How can we actually put this into practice?" Now, DJAG came up and partnered with MATES in Construction and asked to look at developing the material and the curriculum that we – sorry, looking at the results that we got from this study, developing it into the curriculum and the format of delivery that MATES in Construction used very successfully on site with their suicide knowledge and prevention program. MATES in Construction were going to take this material and deliver on site the same sort of program in relation to AOD that they currently do with suicide prevention and mental health. We thought this was a cracker of an idea because they're on the ground, they do fantastic information exchange work there. Everyone knows them, they trust them and this is a great way of putting information across.

Plan A was to take this to a work site at West End and pilot it there, and then take it up to the Sunshine Coast Hospital. That was Plan A. We didn't have the time, ethics took so long, the work in West End started closing down, the hospital was nearly finished up there. We thought "Well, what can we do here?" and together we came up with this idea, particularly MATES in Construction came up with this idea, they were cleverer than we were, and said "Well, let's take it to a bunch of apprentices doing their courses. Let's go to the young. Let's try the educational issue to put the young guys" which we did, they did. So we trialled, and I'll just briefly talk about this – people will get these PPT's won't they? Yes.

The methodology was the same idea that MIC use anyway, pre‑program survey, there's a post program survey, so we did this. We delivered the educational initiative at five apprenticeship sites, total of 33. Very small numbers but this is all we had in terms of time and duration. It was almost over the Christmas/January/February period, so it was pretty difficult to get people. The age range was 15‑24 years, mostly male.

This is going to be hard to read, but we did a pre and post test of knowledge of all the curriculum development and processes that were being used. Prior to talking about AOD workplace health and safety issues we did a pre test, and then after the delivery of that material was given we did a post test. In almost all cases knowledge of those issues rose as a result of the training on site. If they weren't aware of a particular issue, once they'd had the information content delivered, they were then aware of it and made some comment on how important that was, we related those comments back to importance within the workforce. We were targeting the young and we were targeting them in the same manner that MIC use on site, using the same teaching and training methodology. In most cases, all cases with some degree of difference, there were noted increases in knowledge and understanding and an increase in wishing to know more about the subject. These were the young apprentices at block courses. We thought that was an excellent idea rather than the original Plan A, so Plan B turned out to be rather good.

Now, I wouldn't read anything into this very small sample, and it's early days, but we did pilot it and we think the outcome was well worth it. DJAG, or Queensland Health & Safety I think are good. Lastly, just briefly, here are some of the comments the young people made about the educational initiative, and these are some of the systems that came out of the chats. Binge drinking is bad. No drugs at work. Get help. Help others. Simple language, all good themes, all good outcomes. The stuff that, in their language, that they needed to know, express and to embrace, and they did. I think this educational initiative helped them do that because it wasn't something that comes up in normal conversation.

Finally, in conclusion, we didn't have a known study about this prior to this, so this particular study that we did with the SBE was rather good. We're very pleased that we were able to put it at least initially into an educational program run by MIC, and I think we've yet to talk about the full outcomes of that and to develop it further, but we are pretty happy with the initial pilot result. I think it's one way of encouraging and moving towards cultural change within the industry, and particularly so if we can get the message start right at the bottom with the young apprentices and I think that's going to be a good thing, particularly in light of the demographic changes that have been outlined to us this morning.

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