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Substance Abuse Resource Guide:
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Employers have increasingly become concerned about the negative consequences that occur to their businesses as a result of employees who abuse alcohol or other drugs. Many have learned that people who have alcohol or other drug problems are less productive, use sick leave more often, and are more likely to injure themselves or others on the job. Considering that 70 percent of all illegal drug users in the United States are employed, businesses are justified in their concern.
The listing of materials or programs in this resource guide does not constitute or imply endorsement by the Center for Substance Abuse Prevention, the Public Health Service, the Substance Abuse and Mental Health Services Administration, or the Department of Health and Human Services. The materials have been reviewed for accuracy, appropriateness, and conformance with public health principles.
This Substance Abuse Resource Guide was compiled from a variety of publications and data bases and represents the most current information to date. It is not an all-inclusive listing of materials on this topic. This guide will be updated regularly, and your comments or suggestions are welcome. To suggest information or materials that might be included in future editions, please write to the National Clearinghouse for Alcohol and Drug Information (NCADI), P.O. Box 2345, Rockville, MD 20847-2345, or to ncadi-info@samhsa.hhs.gov.
Produced by the National Clearinghouse for Alcohol and Drug Information, Adele Marley, editor.For further information on alcohol, tobacco, and illicit drugs, call 800-729-6686 or TDD 800-487-4889.
Please feel free to be a "copy cat," and make all the copies you want. You have our permission!
Inventory Number MS704A
Contents
Section 1: Prevention Materials
Section 2: Studies, Articles, & Reports
Section 3: Studies, Articles, & Reports: Employee Drug Testing
Section 4: Groups, Organizations, & Programs
Section 5: Internet Sites
This video accompanies the "America in Jeopardy: The Young Employee and Drugs in the Workplace" training program. This fast-paced video contains interviews of recovering drug users that warn viewers that taking drugs is a dead end, but mixing drugs and work is a big mistake. The host of the video explains how drugs affect the body and the mind. The host encourages viewers to get help for themselves if they have a drug problem or to talk to someone if they think a coworker is having a problem with drugs.
This fact sheet for employers contains information about avoiding substance abuse problems in the workplace. The sheet lists actions for employers, including hosting alcohol-free events and being a positive role model for employees.
This fact sheet for employers contains information about the components of a drug-free workplace. These components are: (1) Needs Assessment, (2) Policy Development, (3) Employee Education, (4) Supervisor Training, (5) Employee Assistance Program (EAP), and (6) Drug Testing.
This brochure explains why drugs and alcohol are a workplace issue. Substance abuse and how it threatens jobs is discussed. Readers are presented with signs of abuse and are urged to prevent abuse through a comprehensive drug-free workplace program. Ways the reader can do something about substance abusers in the workplace are listed. These include: "Don't be an enabler" and "Don't look the other way."
This CD uses multimedia technology to present information geared toward corporations, including information for the employees, supervisors, and managers. The information presented is arranged by the following main topics: "general information," "a guide for supervisors," "family issues," and "drugs of abuse." A training guide, is included. The CD presents information about drugs, explains the damage drugs can do in the workplace, lists the stages of chemical dependency, suggests how to confront employees, and offers tips on how to help employees. The section on drugs of abuse describes the following drugs: depressants, alcohol, cannabis/marijuana, stimulants, hallucinogens, narcotics, inhalants, and methamphetamines.The Drug-Free Workplace Employer's Manual: A Guide to Establishing a Comprehensive Drug- Free Workplace Program
This manual assists employers who wish to establish a drug-free workplace program. Section I-"Assessing Your Situation"-helps employers assess their workplace for drug use, provides cost estimates of workplace drug abuse, and provides an employee survey. Section II-"How to Establish a Drug-Free Workplace Program"- explains the components of such a program, discusses treatment issues, and explains the implementation process. Section III-"Resources"-provides resources and contacts as well as a sample drug-free workplace policy, drug and alcohol testing procedures, and a drug and alcohol testing request form.
This guide provides supervisors and managers with the information they need to improve productivity and protect the health and safety of their staff. The guide lists the supervisors' responsibilities within a drug-free workplace program, ways to assess employees' performance and confront them with performance problems, and do's and don'ts for supervisors.
The video describes the options available for designing a drug testing component as part of a comprehensive drug-free workplace program. It demonstrates specimen collection and laboratory analysis procedures and gives special attention to the needs of both employer and employee in ensuring the accuracy and reliability of test results. A facilitator's guide accompanies the video.
This fact sheet for employees explains various drug tests, lists reasons employees could be asked to take drug tests, relates the accuracy of drug tests, and contains answers for various questions employees may have.
This poster reads, "EERF GURD. Don't get turned around." The poster depicts an aerial illustration of a few factories and a farm.
This fact sheet for employers contains information about creating an employee assistance program (EAP). The sheet explains the types and costs of EAPs, the benefits of EAPs, and ways to find a qualified EAP provider. It also includes a checklist for starting an EAP.
This fact sheet for employers presents the best ways to educate employees about alcohol and other drug abuse. The fact sheet describes the most effective ways to set the tone of the program, including when and where, and who to educate.
This video contains excerpts from employers who have successfully implemented comprehensive drug-free workplace programs and employees who have benefited from them. How drug use affects the entire community is demonstrated by discussing the issue of violence. In addition, the video explains why it is everyone's responsibility to get involved to prevent drug use and help persons using drugs get help.
This fact sheet for employers contains information about successful drug-free workplace programs. Suggestions from employers who have successfully implemented a drug-free workplace program include: "think things through," "involve employees," "protect confidentiality," "ask for legal review," "stay current," and "pay attention to the human factor."
This fact sheet for employees presents ways to determine if a fellow employee is having problems with drugs or alcohol. The sheet explains how to help the employee, reasons to take action, and where to find further help.
This fact sheet for business presents 18 ways to prevent alcohol, tobacco, or other drug (ATOD) abuse in the workplace and in the community. The pointers offered include: (1) Host alcohol-free events, noting company commitment to prevent injury or death associated with drinking and driving, especially around the holidays, and (2) Develop and implement a model alcohol/ smoke/ drug-free workplace policy and fully explain the benefits and procedures to all employees.
This kit offers guidance, specific strategies, and steps for creating a drug-free workplace program, or for enhancing one. It contains employer materials about topics such as drug testing and supervisor training. It also contains employee materials about topics such as why it's important to have a drug-free workplace and how to recognize if someone is in trouble with drugs. A packet of supervisor and manager materials contains a guide about responsibilities in a drug-free workplace, two posters, and a sticker.
This poster depicts a frazzled man at a desk and a group of four adults and one young boy outside of his office. Each person has a thought written above their head, beginning with "I wish." Some wishes include "I wish Lee would come to work on time;" and "I wish Lee would get some help."
This video tells the stories of two employees who have substance abuse problems. In one story, an older man has a drinking problem and his coworkers must decide how to help him. They do not want to get him fired, but they eventually force him to seek help when his inability to perform his forklift duties endangers their lives. In the other story, a woman has a problem with drugs and her supervisor has to confront her. He eventually learns to be firm, discusses with her the goals she must meet to keep her job, and offers his support when she seeks counseling for her problem.
This fact sheet for employers contains information about training supervisors to assist in implementing a drug-free workplace program. How the supervisor can act as an enforcer and advocate for employees, what they need to know, and how to provide supervisor training are explained.
This booklet provides employees with information they need to know about smoking and the workplace. Topics covered include: "Nonsmokers and Workplace Rights in General," "The Americans With Disabilities Act," "Sensitive Behavior Towards Nonsmokers," "Filing for Worker's Compensation," "How to File an OSHA Complaint," and "Additional Landmark Cases on Workplace Smoking Issues."
This turquoise and white sticker says, "Welcome to a drug-free workplace."
This is a series of cards that are to be distributed to employees to promote health throughout an organization. Each week a different card is distributed. These cards contain information about the health hazards of smoking, the harmful effects of drinking, recovery and the goals associated with recovery, codependency, the dangers of drug abuse, and the tenets of a drug-free workplace.
This fact sheet explains why organizations need to be drug-free. Two stories, from former substance abusers who were helped by workplace programs, are included. The fact sheet explains the benefits of a drug-free workplace for employees, how employees in other companies have responded, and the role of each employee in a drug-free workplace.
This fact sheet explains ways employees can contribute towards keeping a workplace drug-free. Features include a self-assessment test, an explanation of the options for getting help, lists of related hotlines and publications, and a description of why it is risky to use alcohol or drugs. You Can Contribute also lists ways to spot abuse or addiction, explains the costs associated with substance abuse, and describes the damaging effects of drug use.
This study reports on relationships between alcohol use and occupational injury among workers aged 51-61. It was designed to validate findings from the 1988 National Health Interview Survey, which showed high injury rates among employees who reported drinking five or more drinks a day.
Analyses were based on data collected under the Health and Retirement Study, involving the interview of a nationally representative sample of older Americans (aged 51-60) in 1992. The response rate was 82 percent. Researchers selected 6,857 individuals who were not farmers-and who were employed during the year prior to the survey-for the study (farmers were excluded because they have been shown to have different patterns of risk). Participants responded to four questions of an alcoholism screening questionnaire, as well as to a question regarding typical daily alcohol consumption.
Other potentially confounding independent variables in the regression equation included occupation, physical demands of the job, age, gender, marital status, education, and smoking. Smoking was included as a surrogate for risk-taking behavior because of its association with sensation seeking, perceived risk taking, and failure to use seat belts. Persons drinking five or more drinks per day were more likely to have blue collar jobs that were identified as physically strenuous. Researchers found a positive association between having had an injury on-the-job in the past year and answering "yes" to some of the alcohol screening questionnaire questions. Moderate drinkers (one to two drinks per day) had the lowest injury rates, while the injury rate for teetotalers and those drinking five or more drinks per day were considerably higher. Including specific impairments, such as hearing, eliminated alcohol as a predictor in the regression equation. Impairments were associated with a higher incidence of heavy drinking.
Based on these data, it is unclear whether drinking causes impairments, and thus affects injury rates, or whether impairments are independently associated with both injuries and drinking.
Assessing Costs identifies methodological and conceptual issues and problems with assessing the costs associated with workplace substance abuse. The authors argue for using economic models of addiction rather than the older, more basic neoclassic economic models of rational consumers.
The authors address several issues about defining, measuring, and quantifying alcohol and other drug abuse costs within the workplace. These issues include: identifying the range of health, safety and other negative consequences related to workplace substance use; estimating the prevalence of workplace substance abuse problems; classifying social and economic costs; identifying the causal relationship between substance abuse and the development of workplace problems; employing attribution factors in estimating workplace costs; and using the human capital approach in cost estimation.
The literature review reveals three major problems in determining costs: (1) the variability in the vocabulary used to describe costs; (2) the confusion created by lack of consistency and cohesiveness; and (3) the inconsistent logic regarding including or excluding an item as a cost under various circumstances.
This article describes basic economic theory and the cost estimating process, and it presents a good critique of the neoclassical model of consumer choice. The authors argue for using an addiction model in which the individual, and not the family, is the unit of analysis, and the purchase of goods does not increase benefits, utility, or satisfaction to the consumer, but only reduces the level of dissatisfaction.
The article summarizes economic theories and techniques for calculating costs of substance abuse and the major problems involved.
Although there has been considerable progress in providing workers protection from the toxins in secondhand tobacco smoke, there is much work left to be done. Most workers report that their employers have a policy addressing smoking in the workplace; however, only 46 percent report having completely smoke-free policies. Food service occupations have the lowest rate of coverage by smoke-free policies among different occupations; these workplaces also have the highest rate of lung cancer among nonsmokers. A regulation proposed by the U.S. Occupational Safety and Health Administration (OSHA) would make all workplaces smoke-free; however, it is likely that an OSHA standard would preempt State local clean indoor air laws, and if only OSHA is permitted to enforce the law, it eliminates local and State authorities from a productive role in implementing smoke-free workplaces and public places. The tobacco industry is using the pending OSHA rule as a reason that local governments should not pass clean indoor air laws, since it is not clear that OSHA could allow for local enforcement.
Despite the recent medical legalization of marijuana in Arizona and California, the Department of Transportation (DOT) still bans this and other drugs; no worker in a DOT-regulated safety sensitive position can use these drugs and remain employed. Federal officials say that the use of marijuana and other illicit drugs is incompatible with transportation safety. The DOT encourages non-regulated employers to follow its lead and not allow the use of marijuana in the workplace. The scientific medical process by which drugs are certified safe and effective must continue to be employed in looking at the safety and efficacy of marijuana. It is further contended that primary prevention is the key to future drug safety, and that the California and Arizona laws are sending the wrong message: that drugs are not harmful. Under Federal laws, doctors in both States are still prohibited from prescribing marijuana or any other Schedule I drugs.
Some problem drinkers who refuse to abstain from drinking or participate in spiritually based 12-step programs would accept moderate consumption of alcohol as a harm reduction and treatment strategy. This article attempts to demonstrate (by means of interviews, anecdotes, and limited statistics) that moderation in consumption, while controversial, is an important and underutilized treatment strategy for "problem drinkers," who are defined as heavy drinkers who do not become addicted to alcohol.
The problem centers on how to draw the line between problem drinking and alcoholism. The medical and alcohol treatment community in the United States advises abstinence because moderation is too risky for alcoholics. Moderation is believed to be ineffective because it feeds into denial of the biologically based addiction, which can be deadly.
Proponents of the moderation strategy claim that alcohol abuse is a behavioral problem and moderation is effective for the majority of problem drinkers. Persons who are unable to drink moderately can be referred to Alcoholics Anonymous (AA), the most common abstinence program.
The article is critical of the current status of abstinence-based alcohol treatment in the United States, noting that it is "unscientific." It further notes that moderation strategies are in place in Canada and Europe, and that cognitive behavioral interventions have been shown to work more effectively than the 12-step programs that emphasize abstinence, group psychotherapy, educational lectures, confrontational counseling, and referral to AA. Finally, the article references several promising studies that have shown the potential of moderation as a treatment strategy. This author presents arguments for a moderation approach instead of abstinence treatment for the majority of problem drinkers; however, there is no discussion about the relative merit of treatment with haltexone, antidepressants, therapeutic communities, brief cognitive-behavioral therapies, or family treatment.
Several previous studies have demonstrated a favorable relationship between participation in a worksite health promotion program and reduced absenteeism. However, this previous research has focused exclusively on the effect of fitness programs. The purpose of this study was to determine the effects of comprehensive worksite health promotion programs on absenteeism.
Studies were conducted at the Michigan, Indiana, and Northern Ohio Blue Cross and Blue Shield Plans. The authors discuss the findings within the context of the health promotion program's content and the nature of the absenteeism data collected.
All of the worksites offered comprehensive programs addressing multiple risk reduction behaviors. All of the studies employed a quasi- experimental design. Individuals were not assigned randomly to the treatment and comparison groups. Each study conducted its own analysis. In all of the studies, absenteeism data were obtained from company records.
In the Michigan study, four groups were created to determine if a dose-response relationship existed between the comprehensiveness of the program and its effect on absenteeism. One group received a health risk assessment (HRA) screening, counseling, and an intervention program; another received the HRA, screening, and counseling; another received only the HRA; and a fourth received no treatment but completed a health and attitude survey.
In the Ohio study, the authors examined the effects of each of their program components (physical conditioning, nutrition and weight control, and stress management) on three kinds of illness-related absenteeism hours. Absenteeism data were collected for 4 years, including the intervention year, and pre- and post-tests were administered to program participants and non-participants.
In the Indiana study, the long-term effects of its program were examined for a cohort of workers employed in an 8-year period. Three study groups were created: program non-participants, who did not participate in either health screening or an intervention program; screening-only participants, who completed physiologic screening but did not participate in an intervention program; and program participants, who completed the health screening and participated in an intervention program.
In the Michigan study, only the group that received the comprehensive program showed a significant progressive decline in aggregate absenteeism (30 percent over 3 years).
In the Ohio study, none of the three programs resulted in decreased illness absenteeism for the group as a whole, although some findings were positive.
In the Indiana study, program non-participants had more illness absenteeism hours than the two participant groups; absenteeism levels tended to increase for all three groups over the study period.
The article recommends that successful programs be comprehensive, have strong management support, and be ongoing. Some general research recommendations were made, including that program evaluations need to more fully incorporate program process examinations, address the bias of program participation by assigning employees randomly to groups, and attend to the statistical properties of the absenteeism variable, including that typically a majority of employees in a worksite incur little absenteeism.
While brief interventions have been shown to be effective in decreasing unhealthy behavior and lifestyle choices, these techniques are not routinely applied in primary care settings for high-risk populations. This article tests the effectiveness of education and a new screening instrument as brief interventions to decrease tobacco, alcohol, and other drug use in a diverse at-risk primary care population. A screening tool called the Substance Use Screening Instrument (SUSI) was given to 565 patients at three primary care clinics to identify what individuals were at risk for substance abuse. Individuals with a clearly defined substance abuse problem were excluded from the study. Adult patients were separated into control or treatment groups according to medical record number (adolescents were randomly assigned). Individuals in the treatment group received a brief educational or a brief solution-focused intervention lasting 10-15 minutes. The control group received no intervention. Follow-up assessment with the SUSI was performed at 1 month, and again at 3 months.
Thirty-one percent of male and female adult patients in Clinic A were at risk; 18 percent of the adolescent patients at Clinic B were at risk; only 5 percent of the female adult Hispanic patients were at risk in Clinic C. The reason behind the low rate of eligible participants at Clinic C was the large number of pregnant women at that site. The percentage of participants lost to followup was 39 percent, 24 percent, and zero percent of the respective samples. There were 13 patients in each of the intervention groups in Clinics A and B, and 18 and 16 patients in the respective control groups. No significant reductions existed in Clinic C. Researchers attributed this to the low number of patients screening positive in that site (n=6 intervention and n=7 control) and the low amount of substance use reported at baseline. Thus, in a sample of diverse (ethnicity, gender, age) primary care adolescent and adult patients in urban Michigan clinics, screening and brief intervention was associated with a 3-month decrease in substance use among at-risk adults and adolescents. This article thus describes a promising prevention intervention for primary care.
One way to justify the cost of drug screening procedure is to avoid negative employment outcomes for employers. The Efficacy of Pre-employment Drug Screening looks at the degree in which pre-employment drug screens predict employment outcome and are therefore a useful procedure for employers. The article describes a prospective, controlled study of the association between drug screening results and employment outcomes in 2,537 postal employees.
Employees, management, and medical personnel were unaware of the results of the drug screen. Employees were followed for an average of 406 days.
For identified marijuana users, relative risk for turnover was 1.56 (95 percent Confidence Interval (CI), 1.17 to 2.08); accidents, 1.55 (95 percent CI, 1.16 to 2.08); injuries, 1.85 (95 percent CI, 1.30 to 2.64); and discipline, 1.55 (95 percent CI, 1.03 to 2.32. Their mean absence rate was 7.1 percent, compared with 4.0 percent for nonusers. For identified cocaine users, relative risk for turnover was 1.15 (95 percent CI, 0.65 to 2.05); accidents, 1.58 (95 percent CI 0.95 to 2.67); injuries, 1.85 (95 percent CI, 1.01 to 3.39); and discipline, 1.40 (95 percent CI, 0.62 to 3.17). Their mean absence rate was 9.8 percent.
In the study, those with marijuana- positive urine samples had 55 percent more industrial accidents, 85 percent more injuries, and a 78 percent increase in absenteeism. People with cocaine-positive urine samples, had a 145 percent increase in absenteeism and an 85 percent increase in injuries.
The study shows that a pre-employment drug screen that positively indicates marijuana or cocaine use is associated with adverse employment outcomes, but that the level of risk appears to be less than previously estimated.
An analysis of medical claims for Chevron, a company with 37,000 employees, shows that more is spent on smoking-related illness than any other single health risk factor-approximately $4 million annually. The Agency for Health Care Policy and Research (AHCPR) found that only half of smokers who visit a clinician each year report being urged to quit smoking. The AHCPR smoking cessation guideline has tremendous value; it collects and synthesizes the data for different audiences, then proposes simple, straightforward steps that can be integrated into clinical practice, where they are likely to have the greatest impact. One way to reinforce the guideline is through employee communication. The main challenge is to communicate the smoking cessation guideline more broadly to employers, because they can have a powerful impact on the way it is implemented.
The report describes a project that addresses knowledge, attitude, and cost barriers, which prevent small employers from purchasing Employer Assistance Programs (EAPs) and related services. The Robert Wood A. Johnson Foundation funded the Corporation Against Drug Abuse for 3 years to plan and implement the Washington Employer Resource Consortium (WERC). By creating a membership of smaller employers (less than 500 employees) in the Washington, DC metropolitan area, the WERC attempted to promote EAP purchases and achieve economies of scale. To its member companies, the WERC provided technical assistance, consultation, training, and education services, as well as reduced-cost EAP and drug testing services. The WERC also developed baseline data on the prevalence of EAPs in the marketplace and on attitudes about EAPs among small businesses. At the end of the grant period, economic self-sufficiency had not been established. The authors concluded that for the group purchasing, the consortium approach does not always provide the assumed economies of scale, particularly in a recession economy with a limited product and insufficient demand. Some difficulties were identified that prevent the WERC from establishing and maintaining financial self-sufficiency; these difficulties include the fact that the EAPs, as marketed, were not integrated with other health or human resource benefits programs, and the small firms wanted tailored, individualized programs that were relatively expensive to provide on a small scale.
Pacific Telesis, a company with more than 40,000 employees and 44,000 retirees, integrates all health care, including substance abuse. Instead of focusing on the benefit program itself, this kind of plan (called health and productivity management) focuses on employees or retirees. Services include managed mental health and substance abuse, group health, disability (occupational and nonoccupational), absenteeism, EAP, and disease management. Part of the program is based on linking mental health and substance abuse problems with productivity and then identifying ways of dealing with these problems, always with the aim of improving productivity. It remains important to monitor the providers, with independent evaluations of cost, utilization, access, employee satisfaction, and performance. It is also important to monitor disability costs.
In Ontario between 1975 and 1991, it appeared that alcohol consumption had decreased and rates of problem indicators such as liver cirrhosis deaths, hospital admissions, and drinking and driving charges and deaths all declined. These changes occurred at a time when real prices of alcoholic beverages were stable and physical availability, as indicated by numbers of drinking establishments, was increasing. During the same period, treatment for alcoholism and Alcoholics Anonymous (AA) membership increased greatly, as did prevention measures such as alcohol education in schools and workplace Employee Assistance Programs (EAPs). EAPs are designed to encourage alcoholics and problem drinkers to seek treatment at an early stage. To the extent that they encourage such people to seek treatment, they will succeed in contributing to the numbers of alcoholics successfully treated and, therefore, not developing liver cirrhosis at all or at least delaying its occurrence.
Although much is known about the characteristics of employees who smoke cigarettes, very little is known about workers who use smokeless tobacco. The study was designed to understand the characteristics of smokeless tobacco users in relation to their performance at work, and compare them with smokers and former tobacco users.
Data were collected via interviews and questionnaires from a random sample of 146 employees working at Pacific Lumber Company, the largest single-site lumber mill in California. A total of 63 smokeless tobacco users (21 of whom also smoked cigarettes), 43 cigarette smokers, and 40 employees who had successfully quit using tobacco (34 of whom previously used cigarettes only) provided information about their health behavior, quality of work life, and performance at work.
Analysis of covariance (ANOVA) tests revealed that smokeless tobacco users reported less healthful sleep patterns, drank alcohol more often, were intoxicated more often, and reported less job satisfaction and organizational commitment than the other groups.
Furthermore, analyses revealed that both tobacco chewers and smokers do not work as hard and they take more breaks than do tobacco-free employees (quitters). The study notes three limitations: the data reported are cross-sectional, and leave open the possibility of a third variable explanation and/or reverse causality; only 45 percent of the employees who used both tobacco products agreed to participate in the study, and it is plausible that the group was not representative; and sole reliance was placed on self-report measures.
Women in the workplace represent an important target for prevention efforts because previous studies have revealed that employed women drink more heavily than women who are unemployed. This article presents an evaluation of a primary prevention program designed to help non-alcohol-abusing working women maintain safe behaviors and avoid behaviors leading to problems with alcohol.
Four-hundred and fifty-three women recruited through professional organizations were randomly assigned to experimental or control groups. Both groups received 12 newsletters over 2 years. The newsletters contained information of interest to professional women; only the experimental group received newsletters containing information on alcohol use and abuse. Alcohol consumption and negative consequences from drinking were measured at baseline, 2 years later, and 3 years later. The baseline, post, and followup questionnaires were completed by 453,290, and 218 women, respectively. Analyses showed no statistically significant change in alcohol consumption. The experimental group showed immediate (2-year) increases in knowledge about drinking and decreases in the negative consequences of alcohol use and reasons for drinking. The control group showed similar, significant increases in knowledge and decreases in negative consequences, but this change was attained over the full 3-year period. In contrast, there was no change reported in the control group regarding reasons for drinking.
In summary, alcohol-related messages in the newsletter seemed to accelerate the increase in knowledge of alcohol use and abuse that seemed to occur without specific intervention over the 3 years. Because the individuals in the control group did not get worse, the study suggests that women's alcohol consumption patterns remain fairly stable. There may be a significant bias in the study, however, due to the very high dropout rate for followup.
Little information is available to employers about the prevalence and consequences of substance use in their workplaces. This paper examines the prevalence of smoking, alcohol use, and drug use as self-reported among 1,200 employees in five worksites and the implications of alcohol use for work performance as reported by these employees.
In this study, 1,200 employees were surveyed onsite, with special attention to confidentiality. Descriptive statistics revealed that the participants had substance abuse profiles similar to-or slightly lower than-estimates from large national surveys. A multivariate analysis revealed that reports of higher amounts of alcohol consumption were related to an increased probability of self-reporting poor job performance due to alcohol.
As managed care organizations become the major providers of health care for private employers and public programs, opportunities are created for collaboration between public health agencies and managed care organizations for the purpose of prevention. The Centers for Disease Control and Prevention formed a working group to develop recommendations for the incorporating population-based prevention programs into managed care. This report includes their recommendations, along with helpful definitions, examples, and a bibliography.
The paper presents existing models and strategies for dealing with issues related to delivering substance abuse treatment under managed care. The lack of evaluation data, clear criteria, and cost/benefit research is discussed, and directions for research are suggested.
The authors sought to determine whether different psychosocial work environments predict increased risk of illegal drug dependence. The study assessed individuals and their jobs in terms of a demand/control model found to be useful in prior work on cardiovascular disease, distress, smoking, and other health outcomes.
Adult participants were selected by probability sampling from households in five metropolitan areas of the United States. Subjects were sorted into risk sets defined by age and census tracts. Incident cases were identified using case definitions for drug abuse/dependence syndromes involving controlled substances. Participants were assessed by the Diagnostic Interview Schedule (DIS) administered during a baseline interview and at followup 1 year later. When the data were adjusted for baseline sociodemographic risk factors, history of alcoholism, and selected work conditions. The authors observed an increased risk of drug abuse/ dependence in subjects having two kinds of jobs. Individuals with "high strain" jobs characterized by high levels of physical demands and low levels of skill discretion (with fewer kinds of tasks and fewer opportunities for on-the-job learning) were at higher risk.
Unexpectedly, risk was also greater for workers having jobs characterized by high levels of decision authority, meaning that the worker had the ability to make decisions on the job, particularly concerning self- management and personal use of time. The largest risk was associated with active jobs combining high physical demands with high decision authority.
These findings underscore the importance of previously observed relationships between certain psychosocial work environments and poor mental health. This study extended the range of findings to drug dependence syndromes.
The authors noted that the observed associations might not be causal, but they might arise because vulnerable people gravitate toward job conditions that provide a person/environment fit with regard to drug dependence (i.e., a social drift into excessively risky occupations). The authors note also that the DIS relies heavily on self-report answers.
Furthermore, greater precision in the study's estimates and greater confidence would have been achieved had the samples included more incident cases. The authors note the need for further research, notably into dimensions of decision authority and skill discretion as they relate separately and in combination to risk of drug dependence syndromes among women versus men.
This article reports on the relationship between drinking patterns and workplace problems in a manufacturing facility operated by a Fortune 500 industry. The data come from a survey of 832 hourly employees (88 percent male) and from ethnographic research in the plant.
This study is distinctive because it examines a large random sample of workers, rather than an impaired subpopulation. Moreover, the study is among the few that has asked employees how much they drank prior to and during working hours and how frequently they had been hung over at work. Respondents were also asked about their overall alcohol consumption and their experience of various problems in the workplace. Bivariate analyses indicated that overall drinking, heavy drinking outside of work, drinking at or just before work, and coming to work hung over were related to the overall number of work problems experienced by respondents and to specific problems such as conflicts with supervisors and falling asleep on the job.
Multivariate analyses revealed that workplace drinking and coming to work hung over predicted work-related problems even when usual drinking patterns, heavy drinking, and significant job characteristics and background variables were controlled.
Overall drinking and heavy drinking outside the workplace did not predict workplace problems in the multivariate analyses. The analyses show that workplace problems are also related to age, gender, ethnicity, work shift, and departments. Although the relationships are modest, they support the hypothesis that work-related drinking and hangovers at work are related to problems within the workplace and may lead to lowered productivity and morale.
Because of changes with the economy and with business organizations, the survival of Employment Assistance Programs (EAPs) is being threatened. This article underscores a potential expanded role for EAP professionals, including a wellness focus.
Some additional, expanded roles for EAPs could include (1) conflict resolution; (2) team building; (3) expanded involvement with employees' families; (4) increased corporate community involvement; and (5) consulting for corporate benefits programs.
The article addresses the Substance Abuse and Mental Health Services Administration's (SAMHSA's) effort to convince managed care organizations that preventing addictive and other mental disorders is as important as preventing other diseases or disabilities. The article offers and details the SAMHSA/CSAP (Center for Substance Abuse Prevention) definition of the role of substance abuse prevention in the managed care continuum of service, contrasting the medical model of illness with the public health model of wellness, health promotion, and early interventions targeted at specific populations.
The benefits of instituting a drug-free workplace program in the small business environment are reviewed. While many large employers have comprehensive workplace substance abuse policies in place, their small business counterparts tend to wait for a crisis before taking action. Drug use is greatest among employees in the construction, wholesale trade, and retail trade industries, many of which are small businesses. The article outlines steps small business owners can take to institute a drug-free workplace program and summarizes the benefits of such programs.
Smoking regulations at the workplace have been found to be acceptable and effective in many studies conducted in the United States. There is limited knowledge, however, on acceptance and effects of smoking regulations in European countries, particularly among blue collar employees. Researchers conducted a survey on smoking behavior and attitude toward smoking regulations and passive smoking in a South German metal company.
A self-administered questionnaire was mailed to 1,500 predominantly blue collar employees of whom 974 participated in the study (response rate 64.9 percent). About 30 percent of the employees were not allowed to smoke at their immediate work area. Among them, about 95 percent of both smokers and nonsmokers agreed with this smoking policy.
More than 60 percent of nonsmoking blue collar workers were bothered by passive smoking at work regardless of whether smoking was allowed at their immediate work area. In contrast, the proportion of nonsmoking white collar employees who were bothered by passive smoking varied from 52 percent- if smoking was allowed at their immediate work area-to 18 percent if smoking was not allowed. Prevalence of active smoking and average amount of smoking among active smokers were considerably lower among employees who were not allowed to smoke at work than among other employees. These differences were partly due to confounding by occupation, however, which was strongly related to both smoking habits and smoking policy. The results, which confirm and extend previous findings, give further support to the acceptability and potential effectiveness of smoking regulations at the workplace. Particular efforts should be devoted to limit both active and passive smoking among blue collar employees.
The effectiveness of prevention efforts can be enhanced by Employee Assistance Program (EAP) professionals. These professionals can show that alcohol, tobacco, and other drug (ATOD) problems have become a major corporate focus. EAP professionals can help employers learn to be aware of the potential risks of use for businesses of every size, develop and implement a model of drug-free workplace policy; provide training to managers and supervisors on how to prevent ATOD problems in the workplace, and encourage employees to seek help through the EAP, provide information to employees about the connection between alcohol and other drugs and higher health care costs, teenage pregnancies, domestic violence, and other crime, and the spread of sexually transmitted diseases; provide educational information about ATODs in the workplace; sponsor prevention programs that benefit employees, their families, and the community; and host alcohol-free company events.
Eagle Insurance Co. prepared this Web site paper in 1994 as a response to "Frequently Asked Questions." This paper summarizes how and why a supervisor needs to address substance abuse problems in the workplace. Drug testing is specified as an early intervention tool. Key steps for developing a prevention program are listed, including:Some useful statistics are provided from an American Management Association Study, a recent (1994) Gallup Poll in Washington State, and the Chamber of Commerce publication Drug Abuse in the Workplace: An Employees Guide for Prevention.
- Developing a written management policy about substance abuse
- Consulting with lawyers about the policy to ensure that it is within legal guidelines and (that it is in accordance with employment and labor contracts
- Determining the screening/testing program to be used
- Providing substance abuse prevention education to employees
- Providing training to supervisors and managers
- Establishing an EAP or other treatment plan
- Receiving input from labor unions affected by the program.
The necessity for supervisor training is discussed, and an important differentiation is made between supervisory functions appropriate to being a manager and counseling functions that are inappropriate to the managerial role.
Ten tips provide assistance in smoking cessation. It is contended that smokers can quit successfully if they are prepared. It is further contended that nicotine replacement therapy is very helpful, providing just enough nicotine to help relieve cravings.
Non-prescription nicotine comes in two forms, gum and a patch, so smokers should evaluate their smoking habits and history to choose the right therapy for them. The gum provides active craving control and the patch provides a steady, continuous dose of nicotine for either 16 or 24 hours.
This publication consists of papers delivered during a 1986 conference on legal, scientific, and labor relations issues encountered by companies as they established and implemented drug abuse policies and drug testing programs. Papers were presented based on the experiences of the Federal Railroad Administration, United Auto Workers, Ford Motor Company, United Steel Workers of America, Mobil Corp., Westinghouse Corp., American Airlines, Ozga Operations, Washington Metropolitan Area Transit Authority, Cornell University, and the Universities of Maryland, Utah, and Cohen and Marks.
This conference was the first major federally funded meeting of private sector representatives to discuss the problem of drug abuse in the workplace and to set down ground rules for future policy development. The meeting produced recommendations for future research. The publication presents a 1986 perspective of a changing approach to substance abuse in the workplace and, thus, has historical value for managers and researchers.
The benefits of a workplace alcohol intervention cannot be realized without managers adequately identifying and referring impaired employees. This articles examines managers' perceived barriers to intervention for alcohol abuse and evaluates the impact of these perceived barriers on the interventions themselves.
Data were collected by means of a survey from 7,255 supervisors at 114 worksites. There was a 79 percent response rate, with barriers reported by most respondents. Three categories of barriers were identified by cluster analysis: organizational, interpersonal, and individual. The degree of barrier reported was related to specific job and environmental factors; female managers, managers in larger worksites, and first-line supervisors reported greater barriers. There were also more barriers perceived in initiating formal interventions as opposed to informal ones.
The authors conclude that managers face significant obstacles in effectively handling substance abuse problems in the workplace, and that the most pervasive obstacles are those related to individuals skills, and attitudes, and the perceptions of the managers. The article thus presents a strong argument for the focused training of managers at the job level, rather than a general corporate level program. Without such training, Employee Assistance Programs will be underutilized, and problems in the workplace will persist.
This article presents a thorough, comprehensive study of work-related alcohol abuse in which work alienation is related to the extent and consequences of alcohol use. Work alienation is defined as low job autonomy, minimal use of capacities, and lack of workplace decisionmaking. This study examines the relationship between alcohol use and job dissatisfaction, as well as both aspects of work alienation: (1) Skill (skill level, substantive complexity, degree of challenge), and (2) Control (autonomy, decisionmaking). These relationships were examined at the company level (through policies) and at the worksite level (through conditions).
Data were collected from 15 wood mills similar in size, range of skills, and demographics. Site visits and numerous worker interviews were conducted. A questionnaire was designed and mailed in two waves with a reminder. The response rate was 68 percent. Self-reports of attitudes, beliefs, behaviors, alcohol consumption, negative consequences of alcohol use, and workplace experiences were collected.
Experimenters hypothesized that work alienation, lack of autonomy, and job dissatisfaction would correlate directly with heavy drinking and negative consequences. The study revealed a more complex relationship.
Alienating work seems to increase problem drinking indirectly through contribution to job dissatisfaction-this happens only when workers believe that alcohol is "an important and efficacious coping mechanism." Job autonomy was associated with increased alcohol problems, suggesting that there may be increased risks for work requiring a great deal of responsibility. As expected, participation in decisions regarding local working conditions was associated with lower incidence of alcohol problems.
The findings suggest that two simple measures are likely to reduce alcohol problems: Give workers increased control over plant floor-level working conditions, including safety; and provide interventions to dissuade any belief that alcohol is helpful in coping with stress.
The study is limited in that the sample was restricted to unskilled and blue-collar workers. A study based in manufacturing plants would have given a greater range for variables of skill, complexity, and policy.
Similarly, the study population was not diverse in gender, culture, or other demographics. Participation required a high level of English literacy, and all variables were limited to self report.
Safe Streets, an anti-drug group, was founded in the late 1980s; the first thing it did was create a business-labor coalition to work on drug-testing issues, and unions were enthusiastic.
Nonunionized businesses, especially small ones, were slow to offer support but gradually came to see that the unions and the employers were indeed working together on this issue.
Employers have learned the importance of fairness in implementing drug testing, with the result that the process is less antagonistic. Unions have worked with the Portland Regional Drug Initiative to develop a guide book on drug testing and other drug-free workplace issues. It is contended that since this guide book provides the basis for a drug testing policy, it can lay out avenues for protecting workers.
An employee originally hired as an electrical engineer on an at-will basis in 1984 by Mustang Fuel in Oklahoma (which did not have a drug testing program), was later subjected to drug testing when the company was bought by Enogex. Under this program, employees who tested positive were not fired if they agreed to go into drug treatment. The employee, however, refused to give a urine sample under hospital supervision as the company required, and then refused again when the company relaxed its standard to allow him to give an unobserved sample at the hospital. He was fired as a result. He later tested negative at the same hospital for drug use in order to prove his system had been free of alcohol and other drugs and subsequently sued Enogex for wrongful discharge. He based his charge on a public policy exception to the at-will employment doctrine (which says that the public policy of a right to privacy was guaranteed by the United States and Oklahoma constitutions), and breach of employment contract (saying that the Enogex employee manual was an implied contract). Enogex asked that the case be dismissed, arguing that the man was an at-will employee subject to at-will termination, that he had no claim to a right to privacy in terms of the drug test, and thus was not protected from termination by any public policy. Both the District Court of Oklahoma and the Supreme Court of Oklahoma (on appeal) ruled that the company was within its rights to fire the employee. Under Oklahoma's version of the law, no discharge is actionable unless it can be characterized as rooted in the breach of public policy; within this protection, however, are only those employee activities in which the employer can claim no legitimate stake. The employer is free to advance any legitimate interests except those which might collide with the employee's rights that are explicitly shielded by law. Because Enogex's program allowed the extraction of urine samples only with an employee's consent, the employee could not show a nonconsensual intrusion, nor could he show that either the manner or reason for the testing program was objectionable. The court further concluded that in the employee manual (certain provisions of which the employee argued provided contractual protection from discharge) there was not a level of implied contract that would protect him from discharge.
Workplace alcohol and drug abuse on the job is a problem because it has been linked to absenteeism, higher accident rates, and increased health costs. Employers have sought to deter substance use by creating drug testing procedures and coercing employees who test positive into treatment with the threat of job loss. This paper describes the attributes of persons who were so coerced and reports whether the treatment was effective for this population.
One hundred and eleven "coerced" participants were compared to 193 people who self referred and were employed at the same institutions over the same time period. Coerced participants had tested positive in a random test for drugs (alcohol was not included). Participants were treated at two inpatient and two outpatient treatment programs in Philadelphia; the major components of treatment were education, group psychotherapy, individual counseling, and Alcohol Anonymous or 12-step meetings. The Addiction Severity Index (ASI) was performed as part of an initial assessment interview and at a 6-month followup by a blind interviewer. An unexpected urine test confirmed most self-reports of drug use. Only 8 percent of the sample declined or dropped out of the study.
The coerced group was significantly more likely to be older, African American, male, and had no prior alcohol or drug treatment experience when compared to the self-referred group. Though coerced participants reported lower levels of problem severity related to their substance abuse, the problems they reported were clinically significant.
Both coerced and self-referred patients showed significant statistical and clinical improvement during the course of the study. Because of the lower severity level of their problem, coerced patients were more likely to be treated in an outpatient setting. It is surprising, therefore, that the coerced patients were more likely to complete treatment in this setting usually associated with greater dropouts.
One limitation to the study is that outcome was measured by self report, and coerced patients may be under more pressure to report improvement than individuals who were self-referred.
The study raises some important questions about coercion and motivation. Contrary to expectation, it appears that the coercive referral condition did not hinder the chances for successful treatment; mandatory referral to treatment and the risk of job loss may serve as a significant motivator for treatment compliance in this population of patients with a less severe drug problem. Furthermore, the fact that persons with relatively low problem severity should show significant change challenges the notion that substance- dependent individuals have to "hit bottom" before becoming motivated for effective treatment.
One important question related to understanding the effectiveness of coerced intervention is whether individuals testing positive represent a sample at an earlier stage of addiction than that of the self referred group, or whether they are a different population altogether. In the absence of intervention, do patients with positive tests become worse, so that they later refer themselves to treatment? Or do they self treat and become abstinent without intervention? This study is important because it begins to describe persons who should be targeted for secondary prevention activities. It supports the idea that risk of job loss provides incentive to get well. If drug testing is seen as an early intervention, this article helps justify this approach.
The best workplace programs are comprehensive, include testing (when appropriate), early identification, and referral into assessment services such as Employee Assistance Programs. These programs give employees the option to use treatment benefits on demand, and a last-chance agreement, which gives an employee the option to seek treatment or to be dismissed. Though random drug testing is an effective tool for identifying problem employees, it is not effective for encouraging them to come forward for help. For drug testing to be effective, it needs to be part of a comprehensive program so that employees understand that they will be treated fairly, offered help and education, and won't automatically be dismissed. Guidelines are provided for the following components of a comprehensive program: education; testing; treatment through the employee benefits package; and clear policies supported by disciplinary action. Education and comprehensive benefits offer employers a tremendous untapped potential for savings-education can limit costs through prevention or early intervention, while extended follow-up care also will mean a much healthier bottom line. Communication materials, including brochures, videos, and optional or required orientation programs, can help employees overcome any reluctance they have to talk to fellow employees about drug abuse. It is also critical to get these materials to family members. The real savings come from acting before drug abuse causes obvious problems in the workplace.
Previous research suggests that employees are often unaware of or ambivalent toward substance abuse policies. These studies focus on one policy component-drug testing. The current study explored a broader view of policy and examined both personal and situational factors that may determine attitudes towards drug abuse policies. Survey data from employees in three municipalities support a distinction among five attitude categories: those who are (a) dissatisfied with efforts to control employee abuse, (b) satisfied, (c) anti-policy, (d) pro-policy, and (e) uninformed. Discriminant analyses suggest that different profiles characterize these attitude groups. For example, dissatisfied employees report low personal alcohol use, high coworker alcohol use, and low self-referral whereas anti-policy employees report high personal drug use, high coworker use, and low job identity. Discussion focuses on policy as a social construction and the implications of attitude distinctions for employee training.
Drug testing programs are expensive and intrusive. This article provides a good overview of the social, political, and economic issues that shape the development of the programs, and argues that testing may be more effective for drug use deterrence and the detection of social deviance than for ensuring job safety. Important issues discussed include the differences between pre-employment and random testing, the need for further research to document the effectiveness of drug testing, the economic and ethical concerns involved, and the differentiation of worker impairment from worker substance use.
Simple breath or urine tests that employ commonly accepted measurement standards are effective in letting employers discover immediately whether an employee is impaired on the job or was drunk at the time of an accident. Drug testing for such drugs as marijuana, cocaine, or heroin, however, only allow an employer to determine that the person has used a substance in the past few days. Hair testing allows an employer to determine if an employee has used a substance in the prior 90 days, but still does not address impairment. Since the methods that test for impairment are so limited, the ethical issue of how far companies should be allowed to go to promote safety and control costs comes into question.
An employer needs to have a clear policy in place for the first time an employee tests positive on a drug test. The action taken is determined partially by whether the employee is covered by Department of Transportation (DOT) regulations. The DOT has a clearly indicated procedure, including the kind of testing that is done, the use of a Medical Review Officer (MRO), and the requirement that anyone who tests positive be removed from any safety sensitive position until they are cleared to return to work. Even companies not covered by the DOT testing rules should follow some of DOT's basic guidelines, including the use of certified laboratories and MROs who interpret the test results, ensuring proper testing. After employees are told they tested positive by the safety manager or human resources manager, they should be sent to a professional for an assessment to determine if they are using drugs occasionally or if they are chemically dependent or addicted. Addicted workers need treatment. A program called Positively Negative is for recreational users; it helps prevent further positive drug tests by changing the workers' attitudes through 16 hour-long interactive learning session meetings twice a week. Each session costs from $40 to $60. Pre- and post-treatment testing is used to show employers whether an attitude change has taken place.
Two Boston-area employees, fired from a telecommunications company after refusing a hair test on the grounds that it violated their genetic privacy, said they feared their hair would be used for more than drug testing. They believed the results would be used in genetic testing that could reveal confidential information, such as sexual orientation or predisposition to diseases that could be used to deny them insurance coverage. The two employees agreed to give urine samples but refused to submit to the hair test, especially after they learned that the sample would be coded by name and Social Security number.