Alcohol, drugs and ENG1 - and Christmas Article by Doctor Kenneth Prudhoe Club de Mar Medical Centre Palma de Mallorca

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"DOCTOR AT SEA" a monthly Column in The Islander Magazine

Alcohol, drugs and ENG1 - and Christmas!

This time last year the MCA launched their new medical guidelines for ENG1 certification and I have picked my way through some of the changes over the past few months. Alcohol and drugs are perennial issues and even more so over Christmas and New Year.

In general, alcohol is legal and is widely used in the yachting industry whereas drugs are illegal but have also steadily worked their way into the culture.

Alcohol and substance misuse are covered by the MCA under mental disorders together with cognitive and behavioural impairment. It is no surprise that boats on duty are normally dry for alcohol to avoid this type of impairment and the obvious implications for safety at sea. Substance misuse is similarly prohibited but also for legal reasons and the implications for the captain and yacht management (and owner) if illegal substances are found on board. The legal aspect has wider implications covering time off duty because management does not generally want to employ individuals who use illegal substances at any time and this concern is compounded when it is appreciated that some substances persist for several weeks after use.

After nearly four years in the industry, it is becoming clear to me that there is no stereotypical pre-yachting background for yachties – people are drawn from an amazing range of jobs and experience - but the one stereotype to which many pay lip service is the hard drinking, big spending, fast living image that is used to excuse everything, including adding in drugs. Happily this is more spoken in jest by many and there is also a silent majority who have their feet on the ground most of the time – but there are far-reaching implications for some of our friends.

Alcohol is the great disinhibitor which initially disinhibits social reserve but a few hours later suppresses the mechanism which keeps us sleeping soundly so we have unrefreshing sleep – combine this with the diuretic effect of alcohol, and we wake up with the traditional hangover symptoms of headache, dry mouth and weary sleepiness. Repeated hangovers and an effect on work will draw attention to a potential problem onboard. It is not likely to filter through to the medical assessment unless concerns are raised or there is a history of related incidents.

On the other hand, alcohol on duty is a disciplinary issue but also has a direct effect on performance. According to the evidence backing the MCA Approved Doctor’s Manual, November 2009, there is no clear threshold amongst car drivers below which impairment does not occur.

A significant history of alcohol-related performance issues can lead to temporary restriction or shorter time-limited ENG1 certification.

Substance misuse is usually illegal and is a disciplinary as well as a medical issue for seafarers. Drug screening is still not a requirement during statutory seafarer medicals but may be a condition of employment and can be included in the ENG1 if there is a reasonable clinical suspicion of adverse effects from drug use. The use of substances such as stimulants and cannabis during leave periods may not affect fitness on duty later but the commonly used drug tests detect substances up to several weeks after use and becomes a serious contractual issue if detected during an employer’s check. Unfortunately, contracts are ended and lives turned upside down. ENG1 certification can still proceed but more cautiously with an emphasis on rehabilitation.

Using drugs whilst actually on duty has, like alcohol, a much more direct effect on fitness. "Any use while at sea indicates a marked lack of insight and a requirement for demonstrated abstinence before return to work at sea is acceptable" (MCA).

Christmas and New Year is the time of year when sound health advice is honoured more in the breach than the observance but better at least to stay within the law and avoid acting in haste then repenting at leisure.

Dr Ken Prudhoe, MCA Approved Doctor, can be contacted at Club de Mar Medical Centre, Palma de Mallorca. Tel: (+ 34) 639 949 125.