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Introduction

Rail transport is some of the noblest work of the modern era, bringing civilization to North America and inspiring our nation’s artists to new heights. “Type of the modern—emblem of motion and power—pulse of the continent,” wrote Walt Whitman of the locomotive.

However, with such motion and power comes great sacrifice, especially on the part of railway workers. In 2011, the National Center for Intermodal Transportation surveyed 393 commuter railroad employees and found that more than 40 percent had been involved in at least one critical incident, defined as accidents, near misses, collisions, personal injuries, or contact with people or equipment on the tracks.

In March 2014, the Federal Railroad Administration (FRA) announced a rule that railroads in the U.S. must have in place a “critical incident stress plan” to address the mental health needs of employees after an accident. The mandate was the result of the 2008 Rail Safety Improvement Act, though many railway companies had long offered assistance to traumatized employees.

According to the Brotherhood of Locomotive Engineers and Trainmen, the average railroad worker experiences three traumatic incidents over the course of his or her career, including fatalities and personal injuries. Of those employees, 12 percent reported symptoms consistent with post-traumatic stress disorder (PTSD) following the incident. These effects can last a lifetime, if left untreated.

According to Teamsters Canada, over 65 percent of Canadian locomotive engineers and conductors are involved in tragic incidents, and about 5 percent develop PTSD symptoms. However, due to the stigma associated with mental illness that hinders some workers from reporting their issues, the actual PTSD rate is likely much higher.

What often occurs when trauma leads to a mental health disorder is the person will self-medicate with drugs and alcohol. This dynamic is known as co-occurring disorders.

According to the annual National Survey of Substance Abuse Treatment Services (N-SSATS), nearly half of all Americans seeking substance use disorder treatment have been diagnosed with a co-occurring mental health disorder. Compared to those diagnosed with just a single mental health disorder, patients with co-occurring disorders typically require an integrated treatment approach, where the coordination of substance use and mental health interventions is treated simultaneously.

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Index

Co-Occurring Mental Health Disorders

In many cases, substance use disorders and one or more mental health disorders combine to create co-occurring disorders. Both disorders must be treated simultaneously for the individual to fully recover. Otherwise, the patient is more likely to relapse in the future.

PTSD

PTSD is a psychological disorder that can occur in individuals who have experienced, witnessed, or have otherwise been involved in an event where either death or significant physical injury occurred or was about to occur.

A PTSD diagnosis requires that the railroader experience an event that involves actual or threatened death or serious injury to self or others. The law under the Federal Employers’ Liability Act (FELA) maintains that the railroader does not have to actually suffer physical impact in order to maintain a PTSD claim against the railroad.

However, the railroader must be within the zone of danger, that is, placed in an immediate risk of physical harm because of the claimed unsafe acts of the railroad.

When a person encounters stress—anything from a hectic morning at work to the threat of physical harm—the body’s sympathetic response is triggered, releasing cortisol in preparation for a “fight or flight” response. When the threat passes, the parasympathetic system takes over, restoring the body to normal functioning.

In cases of PTSD, however, the threat proves so traumatic that the body never fully returns to the parasympathetic mode. This leaves the person in a constant state of “fight or flight,” which in turn has the potential to inspire that person to turn to alcohol or drugs to cope.

Anxiety and Depression

There are many different kinds of anxiety disorders, but all combine fear and anxiety with the demonstration of behavioral disturbances. Panic attacks are a feature of many anxiety disorders.

Types of anxiety disorder include specific phobias, or the persistent and excessive fear of certain objects or situations, social anxiety disorder, or the excessive fear of being embarrassed or humiliated in social situations, and generalized anxiety disorder, characterized by excessive worry over events that could have negative outcomes.

Depression is one of the most common mental health disorders in the U.S. Sometimes known as major depressive disorder or clinical depression, it causes symptoms that affect how one feels, thinks, and copes with everyday life. Eating, sleeping, working, social interaction—all aspects of life are affected by depression.

The latest research on depression suggests it is caused by a combination of genetic, biological, environmental, and psychological factors. Still, even in severe cases, both anxiety and depression can be treated with a combination of medication and therapy.

The Dangers of Substance Abuse

According to internal federal documents obtained by The Washington Post, drug testing in 2016 showed that approximately 8 percent of railroad workers involved in accidents tested positive for marijuana, ecstasy, benzodiazepine, cocaine, morphine, and OxyContin. The number of drug-positives test obtained after accidents was ten times higher than ten years ago.

In 2015, the Federal Railroad Administration found that the number of positives in random tests for railway workers—including engineers, dispatchers, and train crew—rose to more than 40 percent in 2015.

Alcoholism

Alcohol abuse among railway workers has been a public health concern since the temperance movement of the late 19th century.

However, in 2015, the Federal Railroad Administration found that, with the exception of those employees who repair rail cars and train engines, alcohol use among railway workers has skyrocketed over the past decade.

According to the National Institute on Alcohol Abuse and Alcoholism (NIAA), an estimated 16 million people in the U.S. have Alcohol Use Disorder (AUD). AUD is a chronic relapsing brain disease characterized by compulsive drinking, with no control over intake.

Around 6 percent of American adults age 18 and over reported having AUD in 2015. Less than 10 percent are treated for alcoholism, which is dangerous to their health, affects work productivity and places a strain on personal relationships.

Opiates

The National Survey on Drug Use and Health concluded that 10.9 million people misused opioids in 2016, and the Centers for Disease Control and Prevention (CDC) attributes roughly 42,000 deaths to opiate misuse. The number of deaths in 2016 from synthetic opiates like fentanyl doubled from the previous year, from well under 9,000 to more than 19,000.

As the opioid crisis has become a nationwide epidemic, the number of transportation workers of all stripes—including commercial pilots, truck and bus drivers, and railroad operators—who have failed federal drug tests has jumped nearly 80 percent since 2006.

How JourneyPure Can Help

JourneyPure is focused on providing railroad workers with quality addiction and mental health treatment. When enrolled with JourneyPure, clients are provided with the tools needed to achieve and maintain sobriety and wellness.

Not only does JourneyPure offer medical detoxification, it also offers residential rehab, partial hospitalization (PHP), intensive outpatient (IOP) programming, outpatient treatment, and medication-assisted therapy (MAT). When a client is brought into the JourneyPure family, he or she is provided with an individualized treatment plan designed to meet his or her unique needs.

Of course, all clients will receive dual diagnosis treatment, if necessary, meaning that not only is the addictive behavior treated but any co-occurring mental health issues as well, along with continued aftercare support to help our clients maintain their sobriety long after treatment has been completed.

Each plan is comprehensive and multidisciplinary, with individual therapy, group therapy, and family therapy–which specifically addresses ways in which the client and his or her loved ones can work through challenges for the purpose of growing even closer— all playing a role.

JourneyPure’s treatment programs are accredited by the Joint Commission and CARF as a rehabilitation facility, providing clients with the assurance that the care they receive is in keeping with the highest treatment standards.

Resources

The National Transportation Safety Board is dedicated to eliminating substance-impaired driving. Read of their efforts here. (https://www.ntsb.gov/safety/mwl/pages/mwl4_2014.aspx).

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