In contract negotiations, the limitations of the technique will come out. The contractor's delivery is limited by the cooperation given. Behavioral safety is remarkably like a delicate hothouse flower. It takes constant attention if it is to bloom. Neglect precedes failure here as elsewhere. A review of a small study might add light for insight into the reactions of people and their behaviors.
Liver transplant patientsA recent article in Gut (1998; 43:140-145) titled, "Patterns of alcohol consumption after liver transplantation" is enough to catch one's attention. The transplant researchers would not extend their results to occupational loss control, but their experience should stimulate thought about success in permanently changing behavior. It was a limited study - but then all studies are limited.
Seventy-one patients with primary Alcohol Liver Disease (ALD) had a liver transplant. The median age was 48 with a range from 29-68. Fifty-nine of these patients survived more than three months after their liver transplant and 56 were successfully interviewed.
The particular ALD patients were chosen for transplant because:
it was unlikely that the patient would live for a year without a new liver;
no alcohol had been consumed for six months prior to the transplant; and
a psychiatrist had given the opinion that the patient was not alcohol dependent and would not go back to alcohol consumption.
Of the 56 patients interviewed in the follow-up study, 31 (52 percent) claimed that they were abstinent. Nineteen (32 percent) admitted to some alcohol on special occasions but never more than 200g in a week. Nine patients (15 percent) were classified as heavy drinkers from their own description of their consumption habits. All of these patients claimed to be alcohol-free for six months prior to the transplant. The median time for relapse for the heavy drinkers was six months.
The threat recedesThis study represents a cautionary warning against over-optimism for behavioral safety. Seriously threatened people had been given a life extension. They started to feel better and no doubt in their minds the death threat receded. Nearly half (47 percent) of them resumed drinking to some degree after a rather close brush with death. If people can be casual about an actual brush with death, the mere threat at work of an amputated hand or finger sort of pales into insignificance.
On the job, it is imperative to follow up on employees to make certain that any behavior change is maintained. Workers do not expect injuries to occur to them. Injuries are rare and that fact is repeatedly confirmed in their own experience. Which adult has not had a near hit while driving beyond the speed limit and slowed down for at least a mile after the occurrence before resuming the preceding excessive speed? Since people do not expect injuries, loss control programming and follow-up has to make up for the lack of individual bad experience. When it can be demonstrated that people who experienced a near death threat returned to alcohol consumption, it is easy to become pessimistic about the lasting success of behavioral safety change techniques. All of which is a reminder that behavioral safety is an arrow, not the arsenal.