From an Internet discussion group -- conversation between myself (screen name "Railroad Rita") in regular font and "Floyd", a physician, addiction specialist, and recovering alcoholic (in italics).

"More information about your case would be most helpful.

Are you saying that alcohol caused you *no* problems of *any* kind in your life at *any* time except for the single work related episode that triggered *Der Prozess*? That it was all peaches & cream -or Scotch and water- before and until that? If such is indeed the case then you have ample grounds for medical malpractice against those who apparently diagnosed and treated you as an alcoholic, for though the fields of psychiatry and A&D are uneven indeed, it is absolutely inconceivable to me that any clinician, even the worst one that ever crawled out from under a rock, could or would have diagnosed you as an alcoholic who required *nine months* of treatment in order to be certified safe to work. It just doesn't make sense.

Therefore I believe, perhaps erroneously, that in Paul Harvey's words we may not have heard 'the rest of the story.' If there is more, would you be kind enough to share it?

Have we? Honest? No alcohol problems of any kind, ever, any time, until the single work episode? No prior work problems of any kind until the alcohol episode? A diagnosis of alcohol dependence based on *that alone*?"

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I feel somewhat uncomfortable being "up front and personal" with you on this list, and I doubt whether other listmembers are at the edge of their seats waiting to hear my history; but it is valid for you to ask, if you wish to understand my position.

As I said earlier, I had no problems on the job of any kind. I am well-liked by my co-workers and supervisors, I enjoy my work, and I have received several safety and attendance awards. I certainly never presented any signs of a "troubled employee" who needed counseling. But I was not mandated to treatment because of any job performance issues. My company is a large state-financed bureaucracy, with rules up the kazoo for everything, and unbelievable as it may sound, it is simply a Rule (E-2, subsection 10.1) that any employee testing "positive" for drugs or alcohol on a random test must enroll in the state-financed and company EAP-directed treatment program, which happens to be 9 months long. Diagnosis is not necessary. It really had nothing to do with me personally; dozens of employees a year go through exactly what I went through. The "relapse" rate is much lower than most addiction tx programs, because such a high percentage of mandated employees have no addiction problem! But the EAP likes to boast about their fabulous "success rate".

No, I never had problems caused by alcohol: no hangovers or health problems, no DWI, no financial problems, no fights with neighbors. My son (who was 10 at the time) is an A student in an honors class.

I suffer from intermittent depression and anxiety problems, and was getting counseling at the time. I did occasionally drink in a way that might be considered peculiar: for instance, for some reason I would get a sudden urge to have a beer or a vodka-fruit juice while doing the laundry. Sometimes I indulged the urge. I never got drunk, and nothing untoward happened because of it. It was ludicrous, though; probably something Freudian. But alcohol was not the problem, and my therapist was more interested in treating the depression than analyzing why dirty clothes tumbling around would have an association with drinking for me.

The first, last, and only time I got in trouble with alcohol was on that "fateful day" -- it was a laundry day, actually. I foolishly chose to have a couple of beers with lunch, finished folding the clothes, and left for work. (I worked evenings at the time.) My number came up that evening in the random testing lottery, and I got caught. That's it. BAC of 0.034 (1/3 of the legally-intoxicated level in this state). In fact, there is a dispute as to whether this level was in violation of company rules. But it was interpreted as "positive" at the time.

I never denied responsibility for my behavior, immediately admitted what I did was wrong, inappropriate, and would never happen again, and would have accepted a lengthy suspension without question. But it was absolutely bizarre for me to be told by the EAP boss, "Ms. K___, you should not feel guilty; you are not responsible for your actions, a disease made you do it". I was "interviewed" for approximately 15 minutes, and he did most of the talking. He clearly intended to mandate me to treatment (as Rule E-2, section 10.1 requires) but needed to go through the farce of an "evaluation", probably as required by a state or federal law. Months later, I was given a copy of his "diagnostic summary", and he apparently didn't think it would raise any eyebrows to write "Client states that she has been getting treatment from a psychologist for depression, but the psychologist has not recommended alcoholism treatment or self-help. Client has no disciplinary or attendance problems, but due to present job jeopardy and shame, should make a good candidate for treatment." My therapist wrote him a letter, but he never responded or tried to contact him in any way. Ignoring another professional's diagnosis and overriding a treatment plan already in progress is a violation of the CEAPA code of ethics, I later found out.

So, yes, I went through the "chemical dependency" treatment in order to keep my job, but no, it wasn't helpful or necessary in any way. It certainly didn't help my depression, and had no effect on my drinking behavior. Getting caught on the test was the only motivation I needed to self-correct my drinking style, which I did before even entering the "treatment". My therapist encouraged me in this self-improvement, but of course the treatment counselors said controlled drinking is impossible and we all must accept our "powerlessness" over alcohol.

I still have a drink occasionally, but only on my days off and with friends. I have no difficulty keeping my commitment to never indulge at inappropriate times or in inappropriate ways. I do my laundry sober these days.

Hope this explains things to your satisfaction.

~Rita

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"Thanks for the straightforward and informative details. It gets curiouser and curiouser - though I am reminded more of Kafka('The Trial') than Carroll. Or Joseph Heller: Rule E-2, Subsection 10.1 sounds like something the author of 'Catch-22' might have helped formulate.

My understanding now is that you were remanded to alcoholism treatment even though you did not, from the account above, come within a kazillion miles of meeting the criteria for alcohol abuse, much less alcohol dependence. So there seems to be a clinical error of the first magnitude here and one that would be a prime candidate for actionable medical malpractice. It it not OK to treat people for what they do not have - especially when the treatment itself may be onerous and possibly harmful!

If it is not too much trouble could you post the relevant parts of Rule E-2, Subsection 10.1? Whose rule is it, exactly? The state's? The organization you work for? What *exactly* does it say? I have no reason to disbelieve your account but I find it difficult to believe that such an asinine policy is actually reduced to writing somewhere: individuals who do not even come close to meeting the criteria for alcohol abuse/dependency must be treated for a condition they do not have for nine months? That has got to be the wackiest and most irrational -and unjust- thing I have heard thus far this morning - and it is already almost 6 am! Based on the data thus far it seems to me your gripe ought to be with Rule E-2, Subsection 10.1, and not with EAPs, A&D treatment, 'AA,' the disease model of addiction, &etc. What seems to have caused your misfortune was an apparently insanely misguided official policy -I am not yet sure just whose it was- that mandates employees to treatment they do not need in order to keep their jobs. Talk about crazy-making!

Real alcoholics like me are hard to miss. We have long and obvious histories of problems with alcohol and, in the latter stages of the disease, tend to be disintegrating right before everyone's eyes. Marriages break up, responsibilities are neglected, laws, e.g. DUI are repeatedly broken, jobs are jeopardized, bones are broken, and mayhem has begun to prevail in multiple areas. Our drinking patterns, even when we try to mitigate and soften them somewhat, are obviously pathological. The diagnosis of true alcohol dependence is not a difficult one to make unless one is an ideologically obtunded Professor. Your account above doesn't come within a trillion light years of meeting the diagnostic criteria for alcohol abuse, much less dependence. I am amazed - aghast - horrified - and guardedly indignant on your behalf. May we see the relevant sections of the nefarious Rule E-2 Subsection 10.1?

Floyd"

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(addressed to the list)

"I have never heard of anything even remotely approximating the tale Rita, like the mariner in the famous rhyme, has unravelled for our ears. If therefore I find it difficult to believe, this is as much because of me as of the tale itself. I have simply never encountered anything like it before, hence it is outside my experience altogether. It is, indeed, wholly Other.

An individual with no personal history of alcohol problems is remanded to nine months of alcohol treatment by their employer because they showed up for work *one time* with a trace of alcohol in their system? This is in fact mandated by the now infamous Rule E-2, Subsection 10.1? A clinician of some kind signed off on this monstrous error? An alcohol and drug treatment facility went along with it?

The facts as presented thus far indicate culpable, actionable, indeed egregious malpractice at every level and point of decision. No one in their right mind would treat someone like Rita for a condition she obviously, by her account, does not suffer from. For there is no room for fudging or interpretation in the facts given to us by Rita. She could not possibly be deemed an alcoholic, not even a substance abuser, based upon what she has told us.

I would like to know more about this startling case - beginning with the exact wording of what appears to be the chief culprit, Rule E-2, Subsection 10.1. What does it actually say? Has someone actually put a policy like the one we have been told about in writing?"

---------------------------------

Floyd, to answer your question: E-2, section 10.1 must be understood in a larger context. Federal Dep't of Transportation regulations prohibit being on duty in my line of work with a BAC above 0.04; anyone randomly testing above this level must at the very least be sent home for the day and evaluated by a professional to determine if he/she requires alcoholism treatment. The DOT specifies that any agency under its jurisdiction can set up whatever rules they wish that go above and beyond this. Thus Section E-2 (Alcohol Policy) of our Collective Bargaining Agreement is interpreted as justified by federal rules. Note that employees cannot ask for counseling for personal problems from the EAP; it exists solely as a required dumping ground for employees who have flunked a d/a test. This E-2 policy, however, gives an inordinate amount of power to the EAP, without requiring diagnosis, without specifying what the program consists of or what the requirements are for being returned to duty, and with no opportunity for second opinion or any system of checks and balances. It provides a safe haven for the unethical and the bullies/control freaks in the counseling profession. Note particularly the sinister subsection 8.3. This is what enables EAP counselors to label people "non-compliant" and threaten dismissal for saying they don't believe they have a disease, or that they don't feel they can relate to the treatment philosophy or to AA. "You want to go back to work? You'd better start admitting that you're powerless over alcohol."

Absolute power corrupts absolutely.

E-2: ALCOHOL POLICY
(selected subsections)

4.1 Definition: unfit due to indulgence in an alcoholic beverage (a positive finding) -- A reading of 0.05 or greater by a blood alcohol test or a refusal as per 5.2.
     (note: superseded in 1994 by Federal DOT regulations lowering the positive level to 0.04.)

5.1 Employees of the ____ Transportation Agency shall submit to alcohol testing in the following circumstances:

5.1.1 When directed by members of supervision or management following any accident or unusual incident;

5.1.2 When supervision or management has reason to believe the employee is impaired; or

5.1.3 When the employee is selected pursuant to the Random Testing Program.

5.2 Refusal to take such tests shall be deemed an admission of being unfit for duty and subject the employee to immediate suspension.
     Refusal to take a random test is treated in accordance with section 10.2.

10.2 Refusal to take a random alcohol test will be deemed an admission of improper use of alcohol and treated as if the employee had been found positive. In addition, the employee will be subject to appropriate discipline for failure to comply with a direct order.

5.3 A breath analysis test shall be used to determine whether a blood alcohol test should be given. If the breath analysis test indicates a reading of 0.02 or greater the empoloyee will be required to submit to a blood alcohol test. However, the employee may waive the blood alcohol test in which case the results of the breath analysis test will be construed as positive as defined by the policy.

*10.1 No disciplinary action will be taken against an employee who tests positive for alcohol in a random test if (i) the employee has no record of prior positive d/a tests and (ii) the employee completes rehabilitation as herein described. (6.2: The employee will be referred to the Employee Assistance Program and will be required to participate in counseling.) The employee will be in a no-pay status, however he/she will be permitted to use accrued leave balances during his/her participation in the Employee Assistance Program.

8.1 The Employee Assistance Program shall provide assistance to employees who are referred to it as provided in this Policy. The EAP program no longer services volunteers.

*8.3 Employees referred to the EAP program under the provisions of this policy must comply in all respects with the directions and program requirements of EAP or be subject to dismissal from service.

- End CBA quotes -

-------------------------

"Thanks for the quotes, which certainly bear out your account.

It is still difficult for me to believe that a string of mental health professionals, commencing with the EAP, would collaborate with such a system. My incredulity on this point is not altogether grounded upon a cheery notion of the ethical caliber of the professions - for any clinician who so blatantly misdiagnosed an illness and recommended unnecessary treatment would expose himself to great legal risk. The instinct of self-preservation ought to have kicked in somewhere on the clinical side of your drama. The facts as you have given them to us indicate material for several malpractice lawsuits against the professionals involved."

Actually most malpractice attorneys woudn't touch this, as inappropriate "alcoholism" diagnosis and degrading, coercive "treatment" are not thought to be big-money "recoverable injuries". Malpractice attorneys prefer things like, the surgeon removed the healthy kidney and left me with one diseased one. Or brain damaged children due to negligence at labor and delivery -- that's a biggie.

My attorney from the federal lawsuit (on the grounds of state-mandated participation in a program with religious content) advised me not to bother with malpractice charges. I might look for a second opinion.

In the meantime I await the ruling of the state labor arbitrator on my collective bargaining grievance. I'm surprised your clinician's observant mind didn't take notice of the fact that my BAC of 0.034 was actually below the prohibited level described in E-2, so according to the sacred E-2 I should never have been mandated to the EAP. A favorable ruling will result in an award of back pay, sick leave, etc. for the 7 1/2 months I was out of service.

" Have you seen all your records? Was any diagnosis *ever* listed? Where were you *treated* for your apparently non-existent alcohol problem? Most facilities are required by state and other law as well as numerous other third parties to maintain clinical records with comprehensive intake assessments, intitial treatment plans, periodic reviews of treatment plans, discharge summaries and discharge diagnosis. What did this material have to say about your supposed alcohol problem?"

I first saw my tx records near the end of the 9 months, after my attorney demanded them in discovery. As Gunnclan has mentioned, there are many ways that required intake assessment forms can be twisted to imply whatever diagnosis the person doing the assessment wants to imply. At the facility I was mandated to, they were clearly expected to do whatever was necessary to OK the tx for all employees sent by my agency; as I've said, this EAP mandate was a goldmine for this facility and they would most likely go bankrupt without it.

I told the social worker doing the intake about my depression and its manifestations. I vaguely remember her asking questions like, did I have trouble sleeping? Did I have anxiety attacks? Did I ever get upset stomachs? and the like. (Yes to all three.) I answered all questions honestly, and I surely said regarding alcohol that though I had been drinking somewhat more than usual of late, I had not experienced any problems related to it.

When I saw the intake summary months later (after the social worker had left the employ of the facility -- there was a huge turnover in this place!) it contained such gems as: "Client gives evidence of increased tolerance." and "Client states she has not consumed ETOH for the past two weeks. Withdrawal symptoms: anxiety, insomnia, stomach upset." She didn't give any definitive diagnosis, but implied that the "symptoms" pointed to "alcohol dependence." Because I already had a clinical diagnosis of depression, she assigned me to a "dual diagnosis" track, which was indistinguishable in requirements from any other group, but probably offered the EAP and the hospital some legal protection against charges of ignoring the documented depression.

The intake summary was just what the EAP wanted, and the hospital was well compensated for producing documents of that type. The entire treatment program was orchestrated by the EAP manager anyway. "This is what Mr. F___ (EAP manager) wants" was a common phrase used by the hospital personnel (mostly CASACs, some CSW's). The "treatment" seemed unfocused and largely filler just made up by whatever counselor was in charge of the group that month (or week), but counselors filled in preformatted reports periodically and sent them directly to the EAP, containing yes/no check-off items such as "Client understands the disease concept", "Client is attending AA/NA", and "client is able to make personal disclosures during each session." (Not "participating enough" by talking about personal matters unrelated to alcohol/drugs or to fitness for duty was considered "non-compliant".) A lot of sessions were devoted to "preparation for return-to-work hearing with Mr. F___". When someone in the treatment group was scheduled for an upcoming return-to-work hearing, the hospital counselor and the rest of the group would try to "prepare" him/her for what to say to impress Mr. F___ so he would allow them back to work. Most were rejected at the first hearing as being "unfit to return to duty" (despite dozens of negative d/a tests done at the hospital). We would then spend the next session commiserating and trying to figure out how to please Mr. F___ better the next time. I was rejected for return-to-work status 3 times, despite recommendations by hospital personnel. (The first time, it was because I said "No, and neither does my doctor" when he asked if I thought I was an alcoholic.) It was Mr. F___'s show all the way.

It was beyond poor treatment, or unnecessary treatment. It was wholesale fraud, and emotional terrorism. It depresses me to think about it, and I was "discharged" 13 months ago.
~Rita

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"You wrote:
     'Actually most malpractice attorneys woudn't touch this, as inappropriate "alcoholism" diagnosis and degrading, coercive "treatment" are not thought to be big-money "recoverable injuries". Malpractice attorneys prefer things like, the surgeon removed the healthy kidney and left me with one diseased one. Or brain damaged children due to negligence at labor and delivery -- that's a biggie.
     My attorney from the federal lawsuit advised me not to bother with malpractice charges. I might look for a second opinion.'

(snip)

Not too long ago I was a witness for the plaintiff in a malpractice action by a former patient against a well-known treatment facility. The patient, a physician, claimed he had been inappropriately diagnosed as an alcoholic, brainwashed into believing it, and suffered economic and professional harm as a result. The jury found the facility guilty of malpractice, insurance fraud, and false imprisonment and awarded the plaintiff upfront damages of one million dollars before adjourning to assess punitive damages. The defendants -there were a number of them, with enough attorneys to form a football team- scurried to work out a negotiated settlement, the exact terms of which are sealed, but which I have been led to believe was substantial, and involved the forfeiture on the defendant's part of future appeals.

Each case has its own merits and demerits from the legal angle. I am not suggesting more lawsuits but noting with surprise that clinicians and facilities would behave the way they evidently did in your case - if for no better reason than fear of legal and professional reprisals. (Another route for redress might be the state licensure boards and various specific professional organizations.) It is not OK to make wrong diagnoses and prescribe unnecessary treatments!

Alcoholism is a specific condition with definite characteristics which can really gum up the works, personal, professional, public and private unless it is identified and treated. A truly alcoholic employee would have been benefited by Rule E-2, Subsection 10.1. The data you have given us certainly do not support a diagnosis of alcoholism in your case, and it surely seems you were harmed by it.

I have been told that much legislation at local, state and federal levels is passed into law without anyone, sponsors including, ever reading it very carefully. Sometimes, indeed, the legislators are drunk. It begins to seem that you and others are indeed the victims of an aberrant and irrational regulation which needs to be revised ASAP.
Floyd"