Key Terms

This site uses the abbreviated phrase 'alcohol and drugs' throughout the WorkLife resource.

Clinicians use the Diagnostic and Statistical Manual of Mental Health Disorders (DSM) to diagnose mental health disorders. The DSM-5 is the most recent version. It was released in May 2013. Prior to this, the DSM-IV-TR was used by clinicians and researchers from 2000-2013. 

The diagnostic criteria for alcohol-related mental health disorders differ significantly between the DSM-IV-TR and the DSM-5. These differences are explained in more detail below.
 

Alcohol Use Disorder 

DSM-5 Diagnostic Criteria

According to the Diagnostic and Statistical Manual of Mental Disorders - 5th Edition (DSM-5), there is one main alcohol-related mental health disorder: an alcohol use disorder.

A mild alcohol use disorder is defined as the presence of 2-3 symptoms.

A moderate alcohol use disorder is defined as the presence of 4-5 symptoms.

A severe alcohol use disorder is defined as the presence of 6 or more symptoms.

Alcohol use disorder is defined by the DSM-5 as:

A problematic pattern of alcohol use leading to clinically significant impairment or distress, as manifested by at least two of the following, occurring within a 12-month period:​​​

1. Alcohol is often taken in larger amounts or over a longer period than it was intended.
2. There is a persistent desire or unsuccessful efforts to cut down or control alcohol use.
3. A great deal of time is spent in activities necessary to obtain alcohol, use alcohol, or recover from its effects.
4. Craving, or a strong desire or urge to use alcohol.
5. Recurrent alcohol use resulting in a failure to fulfil major role obligations at work, school. or home.
6. Continued alcohol use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of alcohol.
7. Important social, occupational, or recreational activities are givent up or reduced because of alcohol use.
8. Recurrent alcohol use in situations in which it is physically hazardous.
9. Alcohol use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by alcohol.
10. Tolerance, as defined by either of the following
    a. A need for markedly increased amounts of alcohol to achieve intoxication or desired effect.
    b. A markedly diminished effect with continued use of the same amount of alcohol.
11. Withdrawal, as manifested by either of the following:
    a. The characteristic withdrawal syndrome (refer to DSM-5 for further details).
    b. Alcohol (or a closely related substance, such as benzodiazepine) is taken to relieve or avoid withdrawal symptoms.

Alcohol Dependence

DSM - IV Diagnostic Criteria [superceded by DSM-V Alcohol Use Disorder - see below]

According to the Diagnostic and Statistical Manual of Mental Disorders - 4th Edition, Text Revision (DSM-IV-TR), there are two main alcohol-related mental health disorders: alcohol dependence and alcohol abuse. The diagnostic criteria for each are presented below.

Alcohol dependence is defined by the DSM-IV-TR as:

A maladaptive pattern of alcohol use, leading to clinically significant impairment or distress, as manifested by three or more of the following seven criteria, occuring at any time in the same 12-month period:

1. Tolerance, as defined by either of the following:
   a. A need for markedly increased amounts of alcohol to achieve intoxication or desired effect.
   b. A markedly diminished effect with continued use of the same amount of alcohol.
2. Withdrawal, as defined by either of the following:
   a. The characteristic withdrawal syndrome for alcohol (refer to DSM-IV-TR for further details).
   b. Alcohol is to relieve or avoid withdrawal symptoms.
3. Alcohol is taken in larger amounts or over a longer period than was intended.
4. There is a persistent desire or there are unsuccessful efforts to cut down or control alcohol use.
5. A great deal of time is spent in activities necessary to obtain alcohol, use alcohol or recover from its effects.
6. Important social, occupational, or recreational activities are given up or reduced because of alcohol use.
7. The individual continues to use alcohol despite knowing that they suffer from a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by drinking alcohol.

Alcohol Abuse

Alcohol abuse is defined by the DSM-IV-TR as:

A maladaptive pattern of alcohol abuse leading to clinically significant impairment or distress, as manifested by one or more of the following, occurring within a 12-month period:

1. Recurrent alcohol use resulting in failure to fulfil major role obligations at work, school, or home (e.g., repeated absences or poor work performance related to substance use; substance-related absences, suspensions or expulsions from school; or neglect of children or household).
2. Recurrent alcohol use in situations inw hich it is physically hazardous (e.g., driving an automobile or operating a machine).
3. Recurrent alcohol-related legal problems (e.g., arrests for alcohol-related disorderly conduct).
4. Continued alcohol use despite persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the alcohol (e.g., arguments with spose about consequences of intoxication or physical fights).

Blood alcohol concentration (BAC) is the amount of alcohol present in an individual's bloodstream. A BAC of 0.05% means that there is 0.05g of alcohol in every 100ml of blood. In general, BAC is measured with a breathalyser. However, it may also be analysed in a blood, saliva, or urine sample. 

Dependence is defined as a maladaptive pattern of use in which the use of drugs or alcohol takes on a much higher priority for a person than other behaviours that once had greater value. The central characteristic is the strong, sometimes overpowering, desire to take the substance despite significant substance-related problems (ICD-10).

Workplace drug testing is a two-stage process:

1. Initial screen to detect the presence of a drug using a point of collection (POCT) device.
2. Confirmatory laboratory analysis using mass-spectrometry techniques to assess the accuracy of any initial positive results from the screening test.

To increase accessibility, we have opted to use the term 'employer/s' in lieu of the defined phrase 'person conducting a business or undertaking' contained in the Work Health and Safety Act 2012 (SA), s5.

Illicit drugs include:

• illegal drugs (cannabis, ecstasy, heroin, cocaine, hallucinogens, barbiturates)
• pharmaceutical drugs used for non-medical purposes (painkillers, tranquilisers, amphetamines, barbiturates, methadone, other opiates, steroids)
• other substances used inappropriately (inhalants, ketamine, gamma hydroxy butyrate (GHB).

All drugs are intoxicating substances as they impact the central nervous system (CNS) to some degree. The impact varies according to the strength and volume of the drug taken, its interaction with other substances (e.g., food), circumstances in which the drug is used, how it is used, and the biology of the individual user.

As such, the meaning of intoxication is not self-evident, and characterisations of intoxication in everyday life are imprecise and highly subjective. Notwithstanding this, a clinical definition is provided in the World Health Organization's (WHO) International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10). Intoxication is: 

'A transient condition following the administration of alcohol or other psychoactive substance, resulting in disturbances in level of consciousness, cognition, perception, affect or behaviour, or other psychophysiological functions and responses.'

Methamphetamine stimulates the brain and central nervous system and temporarily increases alertness and physical activity. There are three main forms:

1. Speed (also known as go-ee, whiz, rev or uppers)
2. Base (also known as pure, point, paste or wax)
3. Crystal methamphetamine (also known as ice, crystal meth, meth or shabu).

Crystal methamphetamine (AKA ice) is usually the purest, most potent, and most common form of methamphetamine used in Australia.

It is acknowledged that the alcohol and other drug treatment and research sector consider the term misuse to have a potentially stigmatising impact. However, we have opted to use the term misuse when describing risky alcohol and other drug use in this package when alternative terms weren't available. When speaking with workers about alcohol and drug use, it is important to adopt a person-centred, non-stigmatising or judgemental approach. See the Language Matters resource for more information about stigmatising terms and alternative phrases to use in sensitive situations. 

A drug used:

• by itself to induce a drug experience or feeling, or
• with other drugs in order to enhance a drug experience.

The National Drug Strategy Household Survey defines pharmaceutical drugs as:

1. pain-killers/pain-relievers/opioids (panadeine forte, nurofen plus, mersyndol, disprin forte, morphine and oxycodone (excluding paracetamol, asprin and ibuprofen where these drugs are the only active ingredients))
2. tranquillisers/sleeping pills (e.g., sleepers, benzos, tranks, temazzies, temaze, rivotril, serepax, serries, xanax, xannies, stilnox, rohypnol, rowies, valium)
3. methadone/buprenorphine (e.g., done, junk, jungle juice, bupe, sub).

Psychosis can be a symptom of a physical illness, serious mental illness, and/or drug use. People experiencing psychosis have an impaired perception of reality. They might:

• have hallucinations, such as hearing and seeing things that are not present
• have delusions with persistent, fixed, false thoughts and opinions (e.g., they are being followed, are of great importance, or have a terminal illness) despite contrary evidence
• lose motivation
• have difficulty concentrating
• withdraw from social activities and family
• feel depressed or manic
• have interrupted sleep patterns (i.e., too little or much)
• anxiety and paranoia
• disorganised speech (e.g., word salad or switching topics erratically)
• suicidal thoughts or actions.

A standard drink in Australia is a drink that contains 10 grams (or 12.5 millilitres) of alcohol.

Stigma is where a person is seen in a negative light because of their alcohol, drug or mental health status. Stigma can make health or alcohol and drug problems worse because it can lead to discrimination, making the process of seeking access to help and support more difficult.

Utilities includes electricity, gas, water, and waste services.

The term workers has been used to align with the defined term used in the Work Health and Safety Act 2012 (SA), s7.

Skilled Workers

The category of ‘Skilled worker’ includes approximately 180 different roles allocated a skill level of 2 or 3 in the ABS Cat. no. 1220.0 ANZSCO -- Australian and New Zealand Standard Classification of Occupations, Version 1.2. It includes:

• Engineering, ICT and science technicians                
• Automotive and engineering trades workers            
• Construction trades workers             
• Electrotechnology and telecommunications trades workers            
• Food trades workers              
• Skilled animal and horticultural workers                   
• Other technicians and trades workers.                     

See http://www.abs.gov.au/ausstats/abs@.nsf/PrimaryMainFeatures/1220.0.55.001?OpenDocument for more information about how skill levels are determined.
 

Low Skilled Workers

The category of ‘Low skilled workers’ includes occupations allocated a skill level of 4 and 5 in the ABS Cat. no. 1220.0 ANZSCO -- Australian and New Zealand Standard Classification of Occupations, Version 1.2. It includes:

• Labourers
• Cleaners and laundry workers
• Construction and mining labourers
• Factory process workers
• Farm, forestry and garden workers
• Food preparation assistants
• Other labourers.

See http://www.abs.gov.au/ausstats/abs@.nsf/PrimaryMainFeatures/1220.0.55.001?OpenDocument for more information about how skill levels are determined.

Professionals

The category of ‘Professional’ includes approximately 250 different roles allocated a skill level of 1 in the ABS Cat. no. 1220.0 ANZSCO -- Australian and New Zealand Standard Classification of Occupations, Version 1.2. It includes:

• Arts and media professionals            
• Business, human resource and marketing professionals                 
• Design, engineering, science and transport professionals               
• Education professionals                     
• Health professionals              
• ICT professionals                   
• Legal, social and welfare professionals.        

See http://www.abs.gov.au/ausstats/abs@.nsf/PrimaryMainFeatures/1220.0.55.001?OpenDocument for more information about how skill levels are determined.

The Work Health and Safety Act 2012 (SA), s4 defines health as physical and psychological health. Part 2 of the Act lists the health and safety duties of employers and workers. Some industries and work tasks (e.g., mining and handling explosives) also have corresponding laws which impose additional work health and safety duties. Further, most Australian workplaces are covered by the Fair Work Act 2009 which provides further guidance about employer/worker relationships.

An integral part of workplace health and safety strategies that:

1. Target the workplace factors contributing to workers' alcohol and drug use
2. Minimise alcohol- and drug-related risk
3. Enhance workers' health, safety and wellbeing.

Workplace Alcohol and Drug Policy Lifecycle: (1) Prepare; (2) Design; (3) Implement; (4) Evaluate.