Importance of SAP Evaluation in the Return to Duty Process

What is a Substance Abuse Professional (SAP)?  A SAP is someone who evaluates and makes recommendations on employees who have in some way violated a department of transportation (DOT) drug and alcohol program regulation.  The recommendations made would be regarding education, treatment, follow-up testing, and aftercare.

A SAP evaluation or substance abuse evaluation is a face-to-face clinical assessment of an individual to determine what exactly they need to resolve their problems associated with alcohol or drug use.  Face to face is mandatory because this may offer important physical cues vital to the evaluation process.  This may include the following:  tremors, needle marks, dilated pupils, exaggerated movements, yellow eyes, glazed or bloodshot eyes, lack of eye contact, a physical slowdown or hyperactivity, appearance, posture, carriage, and ability to communicate in person.

During the face to face evaluation, the SAP will determine whether the employee has a problem or addiction and to assess the level.  This is done by gathering a myriad of information.  The SAP evaluation will include standardized testing, collection of information regarding history and current drug/alcohol use, mental health history, family history, social and physical health and random drug/alcohol testing.  The drug and alcohol use history will include onset, duration, frequency, amount of use, substance(s) of use, and emotional and physical characteristics of use.   

Attention will be placed upon the rule violation and why the employee is being required to have the SAP evaluation.  Immediate attention must be provided to individuals that are a danger to themselves or others.  Other information that will be obtained during the evaluation is the problems with health, work, family, personal and interpersonal problems caused by use and current mental status.     

Once the evaluation is complete, a diagnosis, course of treatment, and treatment plan is then provided by the SAP and the DOT employee must comply in order to return to work.  Some of the recommendations, based on the evaluation could be for in-patient treatment, partial in-patient treatment, out-patient treatment, education programs, and aftercare.  If education is recommended, this could include education courses on drugs and alcohol, self-help groups, and community lectures. 

The SAP then may assist the employee in finding treatment providers for services since this is not something that is done by the SAP.  This position of the SAP is that of a liaison and guide and therefore cannot refer the employee to their own practice.  This is to prevent a conflict of interest.       

The report provided to the employer cannot be changed by any third party and employees and employers are prohibited from seeking a second SAP evaluation in order to obtain another recommendation.  Once the employee has successfully complied with all recommendations, there will be a face to face follow-up evaluation.  This evaluation will determine if all recommendations have been completed and to determine if aftercare is needed and how many follow-up tests are needed.

The follow-up evaluation will provide the employer with clinically-based information so they can make a determination that the employee is ready to return to their safety-sensitive duties.  This will be communicated with progress reports, a discharge summary, and personal contact between the SAP and the employer.  The SAP will also communicate with the employee if they have successfully demonstrated compliance with the treatment or if they have not.  Follow-up testing may also be administered in order to continue to support the recovering employee and to ensure the employer that they are maintaining an alcohol and drug-free life while performing their safety-sensitive work.  The amount and frequency of testing will be based on what the SAP presents to the employer.