Alcohol Use Disorders
Excessive alcohol consumption costs the US $240 billion annually, 72% of which is due to lost wages from reduced work productivity (Sacks et al., 2015). A vast majority—80%—of US adults who binge drink or drink heavily are either employed or are dependents of someone employed (Substance Abuse and Mental Health Services Administration [SAMHSA], 2007). By developing and enforcing a workplace plan that stresses early identification and quick referral, businesses can help reduce costs associated with hazardous drinking while assisting workers in getting the help they need.
What is Alcohol Use Disorder?
Alcohol use disorder (AUD) refers to severe and harmful drinking in which symptoms cause problems with everyday functioning and are often a source of great concern to others. These symptoms include, but are not limited to, drinking alcohol to excess; experiencing a craving or deep need to drink; an inability to cut back on drinking even though the individual wants to or needs to; and altering one’s daily routine or activities in order to drink, like calling in sick to work or skipping social activities (American Psychiatric Association, 2013). Alcohol use disorder is a medical illness, not a condition of weak character or willpower. The National Institute on Alcohol Abuse and Alcoholism estimates that 17 million US adults have AUD.
How Does AUD Affect the Workplace?
Approximately 6% of working adults report drinking to intoxication 1-3 times per month, and nearly 3% report doing so 1 or more times per week (Frone, 2008). Furthermore, about 15% of US working adults say that they have used alcohol before or during work (Frone, 2006a). Problematic alcohol use can lead to a host of negative work-related outcomes. Health care costs for employees with AUD are double that of workers without alcohol use problems (Schneider Institute for Health Policy, 2001). Employees who use alcohol or illicit drugs are 3.5 times more likely to be involved in workplace accidents than those who don’t abuse substances and are more likely to file workers compensation claims (SAMHSA, 1999). And overconsumption of alcohol means a greater likelihood of being unproductive on the job, including exhibiting poor work quality, taking excessive breaks, leaving work early, and sleeping on the job (Harwood & Reichman, 2000). These same workers are also more likely to call in sick or arrive to work late (Harwood & Reichman).
It has been estimated that AUD accounts for 500 million lost workdays each year (SAMHSA, 1999). Industries with the highest rates of excessive alcohol use by workers include mining, construction, accommodation, and food service, while the lowest rates appear to be among education, health care, social work, and public administration industries (Bush & Lipari, 2015). Age-wise, employees 18 to 25 years old are 2.5 times more likely to engage in heavy drinking than workers age 26 and older (World Health Organization, 2014). Businesses with less than 25 employees have the highest percentage of workers engaging in problematic drinking, while companies with 500 or more workers have the lowest (Frone, 2006b).
Given the staggering statistics on the effects of substance use disorders in the workplace, how can employers make a difference? Businesses such as General Motors, Xerox Corporation, and Chevron Texaco, as well as the federal government, have developed and implemented effective models of AUD screening and brief interventions. These efforts have led to employee-reported reductions in alcohol use, lower health care costs and health insurance expenditures, greater employee retention (and therefore less workforce turnover), and favorable returns on investment (Heirich & Sieckm, 2000; Musich et al., 2001; Selvik et al., 2004; Fleming et al., 2000). Alcohol education and employee assistance programs (EAPs) appear to be particularly effective for helping workers self-identify as having problematic alcohol use, access treatment, and prevent relapse (Kelly-Weeder et a., 2011).
Based on the success of these programs and on the recommendations of prominent substance abuse and health care agencies, such as SAMHSA, employers should consider the following strategies:
Workplace testing for illicit drug and alcohol use is mandatory in some industries, such as certain government contractors or employees in public transportation, but is not required by everyone. Consider enacting drug testing policies, which allow employers to identify workers with AUD earlier and may help reduce employee turnover and worker compensation spending (Fortner et al., 2011).
Know what your state does and does not permit when it comes to workplace drug testing. For instance, some states may require testing take place in a certified lab. (See Resources, below, for more information.)
While businesses can offer voluntary alcohol testing, no testing—voluntary or otherwise—should be conducted without a written substance use policy first being in place. Make sure all employees are aware of the policy, that it is written clearly, and that it is readily accessible (e.g., through the company’s Intranet, on public display). Have your policy reviewed by a legal consultant to be certain it is in compliance with your state’s mandates.
If possible, get an EAP in place. Leveraging your company’s EAP is one of the simplest and most cost-effective ways to reduce AUD-related expenditures and negative outcomes by referring those struggling with AUD for diagnosis and treatment by a health care professional. If an EAP is not a part of your health plan, have resources on hand to help employees find local assistance. (See Resources, below, for more information.)
A vast majority of EAP referrals for alcohol assistance are self-referrals (Roman & Blum, 2002). Educational efforts to inform workers about AUD and its consequences increase the potential for self-referral (as well as peer-referral) and help create an environment that feels supportive rather than punitive or judgmental.
Managers who display a positive attitude toward EAP use also foster greater acceptance and willingness on the part of employees to utilize your EAP’s valuable services.
Employee education can be informal, such as through the placement of posters or other signage in common areas (e.g., kitchens, hallways), or can be more structured, such as through health promotion programs or mandatory employee information sessions
The goal for supervisors is not to be able to diagnose AUD but to effectively recognize when the disorder may be present and quickly refer to the EAP (or to the community) for possible intervention. Mandatory training can ensure that your managers know what symptoms to look for and are familiar with your company’s EAP coverage and procedures.
Supervisors also should speak with human resources personnel to make sure they are aware of the company’s policies regarding fitness for duty and disciplinary consequences for workers who fail to comply with these policies.
National Eating Disorders Awareness Week is an annual campaign to bring public attention to the critical needs of people with eating disorders and their families, hosted by the National Eating Disorder Association.
National Eating Disorders Association (NEDA) provides programs and services to give families the support they need to find answers for these life-threatening illnesses.
American Psychiatric Association (APA) Find answers to your questions written by leading psychiatrists, stories from people living with mental illness and links to additional resources.
National Institute on Mental Health (NIMH) offers authoritative information about mental health disorders well as information on a range of mental health topics and the latest mental health research.
- Bush DM, Lipari, RN. (April 16, 2015). Substance Use and Substance Use Disorder by Industry. Substance Abuse and Mental Health Services Administration Short Report. Available at: http://www.samhsa.gov/data/sites/default/files/report_1959/ShortReport-1959.html
- Fleming MF, Mundt MP, French MT, Manwell LB, Stauf-facher EA, Barry KL. (2000). Benefit-cost analysis of brief physi-cian advice with problem drinkers in primary care settings.Med Care, 38:7–18.
- Fortner NA, Martin DM, Esen SE, Shelton L. (2011). Employee Drug Testing: Study Shows Improved Productivity and Attendance and Decreased Workers’ Compensation and Turnover. Journal of Global Drug Policy and Practice. Available at: http://www.globaldrugpolicy.org/Issues/Vol%205%20Issue%204/Basic-11-22Efficacy%20Study%20Publication%20Final.pdf
- Frone MR. (2008). Employee alcohol and illicit drug use: Scope, causes, and organizational consequences. In: Barling J, Cooper CL, editors. Handbook of organizational behavior: Vol. 1. Micro approaches. Thousand Oaks, CA: Sage, pp. 519–540.
- Frone MR. (2006a). Prevalence and distribution of illicit drug use in the workforce and in the workplace: Findings and implications from a U.S. national survey. Journal of Applied Psychology, 91:856–869.
- Frone MS. (2006b). Prevalence and Distribution of Alcohol Use and Impairment in the Workplace: A U.S. National Survey.
- Harwood HJ, Reichman MB. (2000). The Cost to Employers of Employee Alcohol Abuse: A Review of the Literature in the USA. Bulletin on Narcotics, LII, Nos. 1 & 2, Geneva: United Nations Office on Drugs and Crime.
- Available at: http://www.unodc.org/unodc/en/data-and-analysis/bulletin/bulletin_2000-01-01_1_page005.html
- Heirich M, Sieck CJ. (2000). Worksite cardiovascular wellness programs as a route to substance abuse prevention. J OccupEnviron Med, 42:47–56.
- Kelly-Weeder S, Phillips K, Rounsaville S. (2011). Effectiveness of public health programs for decreasing alcohol consumption. Patient Intelligence, 3:29-38. Available at: https://www2.bc.edu/kathryn-phillips-2/Katys_Site/Research_files/PH%20Alcohol%20programs%20article.pdf
- Musich S, Napier D, Edington DW. (2001). The association of health risks with worker’s compensation costs. J OccupEnviron Med, 43:534–41.
- National Institute on Alcohol Abuse and Alcoholism (n.d.). Alcohol Use Disorder. Available at: https://www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/alcohol-use-disorders
- Roman PM, Blum TC. The Workplace and Alcohol Prevention Problem. (2002). National Institute on Alcohol Abuse and Alcoholism Report. Rockville, MD: National Institute on Alcohol Abuse and Alcoholism. Avaiable at: http://pubs.niaaa.nih.gov/publications/arh26-1/49-57.htm
- Sacks JJ, Gonzales KR, Bouchery EE, Tomedi LE, Brewer RD. (2015). 2010 National and State Costs of Excessive Alcohol Consumption. Am J Prev Med, 49:e73-9.
- Schneider Institute for Health Policy. (February 2001). Substance Abuse, The Nation's Number One Health Problem, Princeton, NJ: Robert Wood Johnson Foundation, 70.
- Selvik R, Stephenson D, Plaza C, Sugden B. (2004). EAP impact on work, relationship and health outcomes. J Employee Assist, Second Quarter:18–22.
- Substance Abuse and Mental Health Services Administration (2007). Results from the 2006 National Survey on Drug Use and Health: National Findings (Office of Applied Studies, NSDUH Series H-32, DHHS Publication No. SMA 07-4293). Rockville, MD.
- Substance Abuse and Mental Health Services Administration. (2000). National Household Survey on Drug Abuse, 1999. Rockville, MD: Office of Applied Studies.
- Substance Abuse and Mental Health Services Administration. (1999). Worker Drug Use and Workplace Policies and Programs: Results from the 1994 and 1997 National Household Survey on Drug Abuse. Rockville, MD: US DHHS.
- World Health Organization. (2014). Global status report on alcohol and health. Geneva, Switzerland: World Health Organization. Available at: http://www.who.int/substance_abuse/publications/global_alcohol_report/en/ Accessed September 18, 2016