CONTENTS

1 Trainer’s guide
1.1 Learning objectives
1.2 Training other crew members

2 Substance abuse
2.1 Drugs and alcohol tolerance, dependence and addiction
2.2 The risks of smoking
2.3 The health risks of alcohol
2.4 How much is it safe to drink?
2.5 Help with giving up alcohol
2.6 Drug abuse – the risks
2.7 Impairment caused by drugs or alcohol
2.8 Help with drug and alcohol dependency/addiction
2.9.1 Points to remember

3 Where to find out more

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1 TRAINER’S GUIDE
Important notes
The Healthy Living at Sea Series does not provide any form of medical or first aid training.
Nor is it intended for ships’ officers responsible for medical care or first aid as the content
is strictly non-specialist, although they may find it useful as a reference source or
refresher aid.

Advice about emerging diseases and their treatment changes rapidly and you should
check the latest information available from ship agents, national public health authorities
and the World Health Organization (WHO).

1.1 Learning objectives

After using this training package, you will know:
 the risks to your health of smoking and of drug and alcohol abuse
 how you may be affected if you take illegal and legally sold drugs
 the recommended limits for daily alcohol consumption
 how to tell if you’re drinking too much
 what you can do if you think you’ve become dependent on drugs or alcohol

1.2 Training other crew members

If you are responsible for training others then you should aim to follow the instructions in
this section as closely as possible. It will help you to learn how to run effective training
sessions with the crew.

Preparation
Think about the group
How knowledgeable are your trainees about health issues?

Read the Reference

The Reference reinforces the key points from the video and contains reference material
that expands on the learning. You’ll also find lists of organisations’ websites where you
can find out more about the topics covered in the training package.

The training facilities

Make sure that the facilities are adequate for training.

Tips for running an effective training session

Make the best use of the video and Reference
Show the video and open up the session to general questions and discussion. If anyone
was unclear about a particular point, or you would like to reinforce a message, you can
re-play the relevant section(s) of the video and/or refer them to the material in the
corresponding section of the Reference.

Ask questions throughout

Get your trainees to participate from the start by asking for questions. Encourage the
trainees to take an active part. At the end of the session you can use the Tutorial and
Test to check understanding and raise awareness of the issues in trainees’ minds.

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2 SUBSTANCE ABUSE

People who use drugs and alcohol also pose a real danger to themselves and those
around them, and smoking is a major contributor to early death from heart disease and
cancer.

Many shipping companies have a strict no-drugs, no-alcohol policy, or at least strict
controls on alcohol use on board. But problems arise when seafarers go ashore and
bring alcohol or drugs back on board with them, or when they use them on land.

You should be aware of the facts. Not only may addictive substances increase your risk
of damaging your heart, lungs, brain, kidney and liver, even fatally, but you could also
lose your job, as your company may carry out random or other screening programmes
to detect abuse.

2.1 Drugs and alcohol tolerance, dependence and addiction

People take drugs and alcohol because they enjoy the effects. However, they can lead
to tolerance, dependency or addiction.

Definitions
Tolerance is when regular use of a drug leads to the body becoming accustomed to
it and ever larger quantities have to be taken to achieve the desired result. This is
because your body can build up a resistance against the effects of a particular drug.

Physical dependence is when you suffer from withdrawal symptoms if you stop
taking a substance. Physical symptoms might be:
 loss of appetite
 nausea and vomiting
 diarrhoea

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  tremors or shaking
 sweating
 aches and pains
 headaches
 fever
 difficulty in sleeping

Psychological symptoms could be:

 irritability
 mood swings
 anxiety
 depression
 paranoia
 confusion
 inability to concentrate

Addiction is when a person is both physically and psychologically dependent on a

substance, and they may:
 find it difficult to cut down
 become anxious about running out of the substance
 feel guilty about using the substance and start to lie or act secretively
 lose interest in other activities
 continue to use the drug even when it’s causing them money difficulties or
problems with work, family or friends

A small number of people who take drugs become dependent on them. People who are
dependent on, or addicted to, drugs such as heroin, cocaine and alcohol have a serious
problem which is recognised as an illness.

2.2 The risks of smoking

It’s an unpopular truth that every cigarette you smoke is harmful, affecting almost all your
vital organs. Coughs, colds, wheezing and asthma are just the start. Smoking can cause
fatal diseases such as pneumonia, emphysema and lung cancer.

Smoking also damages your heart and your blood circulation, increasing the risk of
conditions such as coronary heart disease and stroke.

A further side effect is the damage that smoking causes in your mouth and throat – an
increased risk of cancer in the lips, tongue, throat, voice box (larynx) and gullet
(oesophagus).

However, all these risks can be reduced or even reversed from the moment you stop
smoking.

Secondary smoking

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 Your smoke is a health risk for other people (family, friends,
colleagues) too, if you smoke in the same room as them. Most ships
will have a smoking policy on board,,and you should only smoke in
the designated areas. If your ship doesn’t have a smoking policy and
you’re a smoker, be considerate to your crewmates and only smoke
in areas where others won’t be affected, such as the upper deck.

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2.3 The health risks of alcohol
Social drinking, often with food, is enjoyable. But any amount of alcohol can impair your
judgement, and if you regularly drink too much you increase your risk of developing
longer term health problems.

Often the damage isn’t noticed until it’s well developed.

Risks of excessive drinking

Brain Memory loss

Depression
Anxiety
Aggressive, violent behaviour

Mouth and throat Cancer

Upper body Less resistance to infection
Heart failure
Breast cancer
Cancer of the oesophagus
Liver cancer or other damage e.g. cirrhosis
Stomach cancer or inflammation or ulcer
Inflammation of the pancreas
Lower body Impaired sexual performance (men)
Reduced fertility
Low birth weight or deformed babies (women)
Limbs Trembling hands
Finger and toe numbness
Falls caused by impaired sensation

About 1 in 25 people in developed countries become alcohol-dependent: drinking takes

control of their lives.

The effect of alcohol on behaviour

Heavy drinking can:
 lead to addiction
 make people aggressive
 produce blackouts, memory loss, mental health problems and permanent brain
damage
 suppress the appetite, which can result in malnutrition

Alcohol can impair your performance, judgement and co-ordination, which is extremely
dangerous for both you and your shipmates. It can produce a false sense of confidence
leading to unwise decisions and failure to take precautions.

‘Binge’ drinking

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Recent years have seen a rise in the number of people who set out to get drunk quickly.
Binge drinking has been defined in the UK as consuming >8 units in a single session for
men and >6 for women.

As well as being hazardous behaviour for the user and the people around them, it’s also
bad for the health because it increases the risk of heart attack. People have also died
after a binge drinking session by breathing in their own vomit and suffocating when they
are semi- or totally unconscious.

When intoxicated, you also run an increased risk of injury, for example from falling over
or from being hit by a vehicle when crossing the road.

2.4 How much is it safe to drink?

There is no ‘safe level’ for drinking alcohol, but most countries have guideline amounts
that are considered low risk, and these are represented by the amount of alcohol in a
drink.

The alcohol content in drinks is measured in ‘units’ in many countries and in ‘drinks’ in
the US. While a standard US drink is considered to contain 18ml pure alcohol, a unit of
alcohol elsewhere is usually defined as 10ml of pure alcohol.

The health authorities in many countries recommend that:

 men should not regularly drink more than 3-4 units of alcohol a day
 women should not regularly drink more than 2-3 units a day
 everyone should have at least 2 days a week when they drink no alcohol

Drinks containers (bottles, cans) usually indicate the amount of alcohol they contain as
a percentage e.g. ‘13% ABV’ (alcohol by volume). This percentage can be used to
calculate the number of units a person is consuming.

The units of alcohol in the drinks listed below is typically:

 500ml (a US pint) of strong lager or beer (5% ABV) = 3 units
 25ml (a shot) of spirits e.g. whisky (40% ABV) = 1 unit
 275ml (a small bottle) of alcopops = 1.5 units
 125ml (a small glass) of wine = 1.8 units

Alcohol is not allowed on many ships, but on those that permit a limited amount it should
never be consumed while on duty or if you may be called on in an emergency.
Beware of drinking on shore and then coming on board to resume duties in the next few
hours – you may fail an alcohol test. Individual ship owners and operators will have very
strict company policy in place regarding alcohol consumption, any breach of which could
cost you your job.

Drinking alcohol ashore

After being at sea for a while it’s tempting to go on a binge when ashore. This may seem
fun at the time, but a large amount consumed after a period of no alcohol at sea can be
very harmful, especially if repeated frequently.

Apart from causing physical damage, getting drunk can make you vulnerable to violence,
theft and fraud, and you could end up in a police station or hospital. If you’re arrested for

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a drink related offence, the shipowner insurance won’t cover it and you may have to cope
with the situation on your own.

Don’t forget that alcohol can remain in the system for up to 24 hours, which means that
as well as feeling ill with a hangover, you could still be technically drunk when returning
to duty, with the risk of impaired awareness and co-ordination.

Some people may say that they can sober up more quickly by drinking coffee or eating
a meal, but in fact nothing can speed up the process of alcohol elimination.

Note: Take care not to buy illegal alcohol or to drink alcohol not meant for human
consumption as these could blind or even kill you.

Combining alcohol with medication

Alcohol may interact badly with medications so it’s important to check the leaflet that
accompanies the medicine. This is particularly so in the case of mixing alcoholic drink
with depressant drugs such as tranquillisers or sleeping pills.
2.5 Help with giving up alcohol
People who drink too much may need help to give up. If you have physical withdrawal
symptoms such as shaking or sweating, or if you feel anxious without that first drink of
the day, you’ve reached the point where you should go to the doctor.

It can be dangerous – even fatal – to give up too quickly without medical advice and
support, as you may suffer from serious symptoms such as hallucinations, seizures
and/or severe agitation or confusion.

Are you addicted to alcohol?

Answer yes or no to each question.

1. Have you ever felt you should cut down on your drinking?
2. Have people annoyed you by criticising your drinking?
3. Have you ever felt guilty or badly about your drinking?
4. Have you ever used drugs or alcohol first thing in the morning, to steady your
nerves, or help with your hangover?

If the answer to only one question is yes, you are 80% on the way to being addicted to
alcohol. If you answered yes to all four questions, you are 100% addicted.

You can also use the World Health Organization’s AUDIT (Alcohol Use Disorders
Identification Test), which is widely available on the internet, to help you decide if you
have an addiction.

What you can do

If you want to stop, or reduce the amount you’re drinking, you should:
 decide on a reasonable daily target which includes 2-3 alcohol free days each
week, and stick to it
 give yourself a (non-alcoholic) reward for meeting your targets
 ask your friends, family or colleagues for support and understanding
 not abandon the attempt if you have the occasional lapse

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You can also help others who are drinking too much.

 Covering up for colleagues is unwise. Instead, you should encourage them to seek
help.
 If you’re in the company of someone who’s drunk, do take care of them. They’re
not in a position to look after themselves.
 If someone says “No thanks” when offered a drink, respect their choice. They may
be on the first steps back from their alcohol problem.

You should look at the arrangements for self-declaration and access to treatment that
should form part of a company alcohol and drugs policy.

Chances of recovery
The International Labour Organization (ILO) have pointed out that if a person with alcohol
problems seeks help while they’re still in employment, there’s an 80% chance of
recovery. If the person loses their job, this chance is halved.

2.6 Drug abuse – the risks

When used to excess, any drug can cause health problems. In the short term, users may
suffer physical injury from accidents, and occasionally sudden death.

In the long term, they’ll be putting stress on other functions of the body such as the sexual
organs, the immune system and the kidneys.

The way the drug is taken can also cause illnesses unrelated to the effects of the drug
itself. Injecting can give you sores and abscesses, and using contaminated equipment
carries the risk of contracting Hepatitis B, Hepatitis C and HIV/AIDS. Snorting cocaine
can damage the nose.

How drugs work on the body

Drugs affect the brain and central nervous system in different ways.

1. Cannabis (also known as marijuana and hashish)

The cannabis user becomes very relaxed and can seem to be in a world alone. This can
lead to poor concentration, forgetfulness, slow reflexes and difficulty in making accurate
assessments of space and distance. These effects may last for a long time and make
cannabis a very dangerous drug for the workplace.

Someone who has ‘come down’ from a ‘high’ may not realise that their work performance
can still be seriously impaired 24 hours later.

2. Depressants
Depressants slow down the central nervous system. They are:
 alcohol
 barbiturates such as phenobarbital. (Street names include barbs, downers,
sleepers, reds and blues, and bluebirds.)
 benzodiazepines, which are often prescribed as sleeping pills or tranquillisers
A low dose of a depressant will relieve tension and anxiety and promote relaxation, but
will also impair mental and physical functions and decrease self-control.

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Higher doses may lead to ‘drunken’ behaviour, drowsiness, stupor or unconsciousness.

This group also includes opioids, which are highly addictive and can easily lead to
physical dependence:
 opium
 morphine
 heroin
 synthetic opioids e.g. methadone

Opioids kill pain and are abused for the feelings of warmth, contentment and euphoria
that they can create.

Injecting opioids intensifies these feelings into a short burst of euphoric sensation – a
‘rush’.

3. Stimulants
Stimulants stimulate the central nervous system. They are:
 cocaine
 amphetamines (including methamphetamine which is also known as Crystal Meth,
Ice, Tina and Glass)
 ecstasy, the slang name for MDMA, MDEA and related compounds (also known
as E, X and XTC)
 khat (also known as Arabian Tea)
 some prescribed medications such as methylphenidate (for Attention Deficit and
Hyperactivity Disorders [ADHD])

A low dose will increase alertness, diminish fatigue and elevate the mood, but can also
lead to over-confidence.

Higher doses can cause nervousness, anxiety, panic and temporary paranoid psychosis.

4. Hallucinogens
Hallucinogens are:
 LSD
 PCP (Angel Dust)
 ecstasy (which is included in this category because it has hallucinogenic as well
as stimulant properties)
 ketamine (also known as K, Special K and Vitamin K)
 naturally occurring examples such as mescaline and ‘magic’ mushrooms

The characteristics of hallucinogens are distorted perceptions, a feeling of unreality and

a lack of co-ordination. The effects can be unpredictable and frightening to the user and
to onlookers.

Ketamine use is now becoming linked to serious bladder problems.

5. New and emerging drugs

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New drugs are becoming available all the time. Often misleadingly called ‘legal highs’,
they are a deliberate attempt to keep ahead of legislation by changing the chemical
composition of existing synthetic illegal drugs. Their ‘legal’ status is often only temporary.

The names of these drugs are changing all the time, but currently the main groups
include:
 synthetic cannabinoids (Annihilation, Black Mamba, Spice, Amsterdam Gold,
Bombay Blue Extreme, X, Karma)
 mephedrone (Meow Meow, Bubble, White Magic, MC, M-Cat, Bounce, 4-MMC)
 2-DPMP (Ivory Wave, Purple Wave, Vanilla Sky, D2PM)
 APB (Benzo Fury)

These new psychoactive substances are sold on the internet as ‘research chemicals’,
‘smoking mixtures’, ‘plant mixtures’ or ‘bath salts’. They vary widely in terms of the
compounds they contain, so shouldn’t be considered safe. Their side effects are
unknown, both to the producers, who don’t care, and to the users, who trust the
expression ‘legal high’.

Be aware that some psychoactive substances may also be present in herbal medications.

Abuse of legal drugs

Certain drugs are available legally in many parts of the world. Also, prescription
medications and some legally purchased medications are increasingly being abused
(used in ways other than intended or without a prescription). These practices can lead to
altered perception, addiction, and in some cases, overdose.

2.7 Impairment caused by drugs or alcohol

People who misuse drugs or alcohol will find that their behaviour changes, that they can’t
work properly and may be careless. Or they may not be aware of the change and may
think that they are performing better than usual. This is dangerous not only for the user,
but also for everyone on board.

In the case of stimulant drugs, work performance may appear to improve in the short
term but the after effects will leave the user exhausted and irritable.

The use of other groups of drugs can leave the user lacking in energy, slow to react to
sudden instructions, inattentive and careless, seemingly indifferent to the importance of
routine safety tasks or even emergency duties.

Other crew members may also resent the extra workload placed on them when their
colleagues who use drugs are unable to carry out their work satisfactorily.

Long term drug use can lead to erratic behaviour and increased sickness absence.

It’s not only drugs and alcohol that are a problem. Some medicines (e.g. cough medicine
or antihistamines) have side effects that could affect your work, and your impairment is
likely to increase when these medicines are taken at the same time as alcohol.

2.8 Help with drug and alcohol dependency/addiction

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It’s in everyone’s interest to keep the crew ‘clean’ and there’s help, counselling and
guidance available. It’s not only the mind and body that’s at risk – it’s also your job.

If you have any concerns about drug use, get advice while you’re ashore. Possible
sources of support are:
 maritime welfare agencies such as International Seafarers’ Welfare and
Assistance Network (ISWAN)
 specialist seafarer help that you can apply for through unions, ITF (International
Transport Workers’ Federation), port authorities or government consulates
 port chaplains
 specialist agencies such as Alcoholics Anonymous or Narcotics Anonymous

You could also go to the officer responsible for medical care. If in any doubt, refer to your
company’s drug and alcohol policy for information and guidance.

2.9 Points to remember

 Substance abuse can affect your work performance, and damage your health,
wellbeing, relationships, finances and career prospects.
 Smoking is a major contributor to early death from heart disease and cancer.
 Binge drinking and mixing alcohol and drugs can both end in death.
 You have a duty of care to yourself, your family and your fellow crew members.
Don’t allow a momentary lack of judgement to let you down.
 Seek help if you think you or a workmate might have a problem with alcohol or
drug dependency/addiction.

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3 WHERE TO FIND OUT MORE
Useful websites
Alcoholics Anonymous www.aa.org
International Seafarers’ Welfare and Assistance
Network (ISWAN) www.seafarerswelfare.org
International Transport Workers’ Federation www.itfglobal.org
Narcotics Anonymous www.na.org
Mission to Seafarers www.missiontoseafarers.org
World Health Organization (WHO) www.who.int

Your national public health service should also have information and guidance about
alcohol and substance abuse, and where to get help.

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