The FTA regulations require that any safety-sensitive individual who refuses a test, tests positive for drugs or has a breath alcohol concentration of 0.04 or greater must be immediately removed from duty and referred to a Substance Abuse Professional (SAP). An SAP is “a licensed physician” (Medical Doctor or Doctor of Osteopathy); or a licensed or certified psychologist; social worker; or employee assistance professional; or an addiction counselor (certified by the National Association of Alcoholism and Drug Abuse Counselors Certification Commission or by the International Certification Reciprocity Consortium/Alcohol and Other Drug Abuse). All must have knowledge of and clinical experience in the diagnosis and treatment of alcohol and controlled substance-related disorders.

   The SAP has four primary functions. First, the SAP must provide a comprehensive face-to-face assessment and clinical evaluation to determine what assistance, if any, the employee needs in resolving problems associated with prohibited drug use or alcohol misuse. Second, the SAP must recommend a treatment or rehabilitation program as necessary and monitor the individual's progress through the treatment program. Third, the SAP must determine when the individual has successfully completed the recommended treatment program and when they are ready to return to a safety-sensitive position. Finally, the SAP must determine the frequency and duration of follow-up tests beyond the minimum required in the regulations.

   Most SAPs understand and adequately perform the first two functions with few problems. However, the audits have found that transit system program managers have failed to adequately convey their expectations to the SAP for the performance of the last two functions. This misunderstanding of the SAP’s role may compromise the integrity of the return-to-duty process. Specifically, many SAPs are returning employees to duty as soon as possible; that approach is consistent with their training as counselors that emphasizes getting the person back into a stable work environment where they must be accountable. This philosophy, however, may be contrary to the basic premise upon which the SAP’s function was established. Due to the safety-sensitive nature of the positions the individuals fill, the SAP should be very careful in his/her assessment of the employee and the progress made in the treatment program. “Putting in the time” is simply not enough for an individual returning to a safety-sensitive position. Similarly, if the SAP rushes the return-to-duty test or if multiple attempts are made before achieving a negative return-to-duty test result, the employee may be putting the transit system at risk. The SAP must not release the individual to come back to work until the SAP has a reasonable level of assurance that the individual will stay drug and alcohol free based on the individual’s attitude, support structure, participation in the treatment program, and motivation.

   Similarly, the duration and frequency of follow-up testing should also reflect the SAP’s honest assessment of the employee’s recovery progress. Follow-up testing must be unannounced and frequent enough to deter use. To be effective, the employee should expect that a test could occur at any time. In the event that the individual relapses and continues to use again, the tests should be frequent enough to detect the usage. SAPs that routinely make the same recommendation are not fulfilling their integral role in protecting public safety. Each case should be reviewed independantly and a course of treatment recommended based on the specific, unique circumstances of each individual’s situation.

   SAPs should also be monitored to ensure that they are using the full complement of treatment options available in the area. A SAP that repeatedly recommends the same program should be scrutinized. The SAP should have no conflicts of interest or receive any monetary gain from referrals.