Module 11: Alcohol and the Commercial Motor Vehicle Driver

Alcohol and Commercial Motor Vehicle Drivers

Goal of the Module

  • Enable medical examiners to:
    • Assess drivers for signs and symptoms of alcoholism.
    • Take appropriate action to confirm or rule out alcohol abuse.
    • Document examination findings and their effect on fitness for duty, in accordance with FMCSA standards and policies.

Alcohol and Drug Impairment

  • Alcohol and other drugs cause impairment through:
    • Intoxication
    • Withdrawal
  • Episodic substance abuse by commercial drivers outside driving periods can cause impairment during withdrawal.
  • When in remission, alcoholism is not disabling unless there are transient or permanent neurological changes.
  • Alcohol and drug dependencies are risk factors associated with personality disorders that may interfere with safe driving.
  • Commercial drivers should be aware of potential effects on driving ability resulting from interactions of drugs with other prescription and nonprescription drugs and alcohol. For example, alcohol enhances hypoglycemic effects of sulfonylureas.

Federal Regulation 49 CFR 391.41(b)(13)

  • States that a person is physically qualified to drive a commercial motor vehicle if that person has no current clinical diagnosis of alcoholism.
  • The phrase current clinical diagnosis of alcoholism is designed to encompass a current alcoholic illness or those instances where the individual's physical condition has not fully stabilized.
  • When in remission, the medical examiner may certify an individual who has a prior clinical diagnosis of alcoholism.

Medical Examiner's Obligation

  • Evaluate a driver to ensure that the driver has no medical condition that interferes with the safe performance of driving tasks on a public road.
  • If a driver has a current diagnosis of alcoholism, the effects may interfere with driving performance, thus endangering public safety.

Driver Health History

  • Did the individual select use of alcohol in the driver health history section of the medical examination report form?
    • If so, what is the frequency and volume of alcohol use?
  • Does alcohol use appear to be excessive and frequent?
  • Is there a consumption pattern that indicates that additional evaluation may be needed based on quantity per occasion or per day or per week?
  • Does the driver pass standardized screening questions such as the CAGE questionnaire?
  • Does the individual show signs of alcoholism on physical examination?
  • If the individual has a history of alcoholism, is there evidence that the individual is in remission?
  • On examination, does the driver have signs of alcoholism or problem drinking, including overall appearance and demeanor, tremor, enlarged liver?
  • Does the individual have residual physical impairment due to past alcohol use that would preclude certification?

Medical Examiner's Determination

  • The FMCSA relies on the certifying medical examiner to determine whether a driver has a current clinical diagnosis of alcoholism.
  • The examination is based on the driver's history, physical exam, and any additional testing deemed necessary by the medical examiner.
  • Examiners should use whatever tools or additional assessments they feel are necessary to determine whether a driver has a current clinical diagnosis of alcoholism, such as the CAGE questionnaire.

CAGE Questionnaire

  • Four questions:
    • Have you ever felt the need to Cut down your drinking?
    • Felt Annoyed by criticism of your drinking?
    • Had Guilty feelings about drinking?
    • Taken a morning Eye opener?
  • The NRCME certification exam typically asks questions about the components of the CAGE questionnaire.

Alcohol Testing

  • Alcohol testing is not required as part of the medical certification process.
  • The medical examiner may request a non-DOT alcohol test to aid in the physical qualification determination, including when the individual discloses excessive alcohol use or the medical examiner observes signs of alcoholism.

DOT vs. Non-DOT Drug and Alcohol Tests

  • DOT drug and alcohol testing is mandated by regulation 49 CFR 382 in specific circumstances.
  • DOT drug and alcohol tests are separate from DOT physicals even though they may be scheduled at the same visit.
  • The medical examiner has the discretion to order a non-DOT drug or alcohol test if they feel the results will help them make a proper certification decision.
  • These results are not formally reported to the FMCSA but are strictly used to help your DOT exam determination.

DOT Drug and Alcohol Testing - 49 CFR 382

  • Mandates the drug and alcohol testing procedures for conducting workplace drug and alcohol testing for the federally regulated transportation industry.
  • Only applicable to drivers who hold a commercial learner's permit or a commercial driver's license.
  • DOT drug testing is completely separate from the DOT exam performed by the medical examiner, which may include a non-DOT drug test at the examiner's discretion.
  • A positive DOT drug test is reported to the FMCSA clearinghouse and requires involvement of a substance abuse professional.
  • Designed to help prevent crashes and injuries resulting from the misuse of alcohol or use of controlled substances by drivers of commercial motor vehicles.

Who Must Be Tested Under DOT Regulations?

  • All drivers, including part-time drivers holding a CDL and operating commercial motor vehicles on the public roadways, must be US DOT drug and alcohol tested.
  • Any driver required to possess a CDL, including:
    • Drivers employed by federal, state, and local government agencies.
    • Owner-operators.
    • Equivalently licensed drivers from foreign countries.
    • For-hire motor carriers.

Circumstances Mandating Drug and Alcohol Testing

  • Pre-employment drug testing:
    • Required prior to the first time a driver performs safety-sensitive functions for an employer.
    • A driver may be exempted from testing if he or she was in a testing program within the last thirty days and tested within the last six months or was in a program for the previous twelve months.
    • Although not required, the employer may require alcohol testing before the driver can perform safety-sensitive functions. The employer may make the job offer contingent upon passing an alcohol test.
  • A test for controlled substances is not required as part of the medical recertification process that you will be performing as a medical examiner.
  • Post-accident drug and alcohol testing:
    • Required for all fatal crashes and when the driver is cited for a moving traffic violation.
  • Reasonable suspicion testing:
    • Conducted when a trained supervisor or company official observes behavior or appearance characteristic of drug or alcohol misuse.
  • Random drug or alcohol testing:
    • Conducted on a random, unannounced basis just before, during, or just after the performance of safety-sensitive functions.
  • Return to duty and follow-up testing:
    • Conducted when an individual who has violated the prohibited drug or alcohol conduct standards returns to performing safety-sensitive duties.
    • This driver is subject to six unannounced follow-up tests in the first twelve months of a safety-sensitive duty following the employee's return to safety-sensitive functions.

Employer Responsibilities Under the Drug and Alcohol Testing Rule

  • Implementing and conducting drug and alcohol testing programs.
  • Providing a list of substance abuse professionals.
  • Ensuring that the driver who is returning to a safety-sensitive position has complied with substance abuse professional recommendations.
  • Conducting follow-up testing to monitor that the driver is compliant with DOT alcohol conduct guidelines and abstaining from unauthorized drug use.
  • Employer responsibilities do not include providing substance abuse professional evaluations and paying for SAP evaluation, education, and treatment.

Medical Examiner and Non-DOT Testing

  • The FMCSA relies on the certifying medical examiner to determine whether a driver has a current clinical diagnosis of alcoholism.
  • The examination is based on the driver's history, physical exam, and any additional testing deemed necessary by the medical examiner.
  • Examiners should use whatever tools or additional assessments they feel are necessary to determine whether a driver has a current clinical diagnosis of alcoholism, such as the CAGE questionnaire previously discussed.
  • The medical examiner may request a non-DOT drug test to aid in the physical qualification determination, including when the driver discloses excessive use of alcohol or the examiner observed signs of alcoholism.
  • The non-DOT alcohol testing process does not require the use of a certified substance abuse professional.
  • The medical examiner certainly has the discretion to require drivers to provide documentation from a professional qualified to render an evaluation that includes an opinion concerning whether a current clinical diagnosis of alcoholism is present or the driver is in remission prior to making a medical certification decision.
  • Ongoing voluntary attendance at self-help groups (e.g., 12-step programs) for maintenance of recovery from substance abuse is not disqualifying.