DOT return to work evaluation

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lstudt

DOT return to work evaluation

Post by lstudt » Tue Nov 27, 2018 7:04 pm

I was sent a 40 yr old driver for a return to work, DOT exam. His visit was preceded by records and a phone call from the company provider letting me know that the driver had been in rehab for alcohol use twice, with the most recent being two months ago. They "wanted me to know" the history before I saw him.

I saw the driver and he had no issues on exam, no physical exam findings consistent with alcohol use, etc. I sent him to an SAP. The SAP, after an interview, etc., recommended that he schedule for biweekly, outpatient sessions. The driver state he has not had alcohol for 2 months and he has signed up for appointments with the SAP. I has a diagnosis of alcohol use disorder, moderate. I discussed the case with the SAP who suggested allowing a one month card and, if the driver complies with the required appointments, extending the card. The company provider was upset. There is also an issue of whether the records they sent me prior to the exam were properly released by the driver (which is another story all together).

I have reviewed what I have available and realize we cannot certify a driver with a diagnosis of alcoholism. My question is, when does that end? 90 days of abstinence? 60 days? SAP recommendation?

Thank you in advance for your comments.



Robert Swotinsky MD
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Re: DOT return to work evaluation

Post by Robert Swotinsky MD » Thu Nov 29, 2018 9:38 pm

The scenario is a DOT driver who is being (re)evaluated for medical qualification to drive. As I read it, this is not a scenario where the driver had an alcohol test violation, had initial and follow-up evaluations by the SAP (with treatment in between), and the SAP has determined that the driver satisfied the treatment recommendations but should participate in aftercare.

The DSM-V Diagnostic Criteria for alcohol use disorder are based on pattern(s) of alcohol use within a 12-month period. The DSM-V allows that the patient can be in early remission if the criteria for alcohol use disorder were previously met, but none of the criteria for alcohol use disorder have been met for at least 3 but for less than 12 months. In this respect, your driver carries the diagnosis of alcohol use disorder for at least 12 months. While the driver and the SAP may consider this harsh, we also know that:
- Relapse is typical
- Relapse is not something you can monitor as part of a DOT exam. If the employer were to install an ignition interlock or perform frequent urine or blood tests for alcohol biomarkers, that would however allow for closer monitoring.
- Most fatal driving events are alcohol-related.

A hair test for EtG could indicate if the driver has consumed alcohol within the past ~3 months.

lstudt

Re: DOT return to work evaluation

Post by lstudt » Fri Nov 30, 2018 11:38 am

Thank you Dr. Swotinsky.

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