Section 2:

Extent and Impact of Substance Abuse

Contrary to some stereotypes, the overwhelming majority of individuals who experience

problems with substance abuse are employed members of the workforce. Thus, the extent and
impact of substance abuse has a direct bearing on employers and their workplaces, as well as on
other communities, such as the substance abuse prevention and treatment community and the
workforce investment system pursuing related objectives—helping people overcome substance
abuse and helping people get jobs. Because of these interrelated effects of substance abuse, this
conference and briefing book focus on how employers, the workforce investment system, and the
substance abuse treatment system can join forces to address the intersecting needs for job
training and substance abuse services in the context of working toward a drug-free workforce.

As background to discussions on how these systems can combine their efforts, this section
introduces various definitions and measures of substance abuse and explores the extent of
alcohol and other drug use, abuse, and dependence within the workforce and the general
population. It also summarizes research findings on the negative impact of substance abuse on
workplace productivity. Specifically, this section covers:

• Extent of the Substance Abuse Problem

• Workplace Impact of Drug and Alcohol Use

2.1 Extent of the Substance Abuse Problem

This section summarizes the prevalence of this substance use in the workforce and the general
population.

The most comprehensive and current source of national data on the use of alcohol and other
drugs is the annual National Household Survey on Drug Abuse (NHSDA), which began in 1971
and in 2002 was renamed the National Survey on Drug Use and Health (NSDUH). Unless
otherwise noted, the prevalence data in this section came from the 2001 NHSDA.1

It should be noted that the NHSDA/NSDUH measures self-reported substance use, which may
underestimate the real prevalence and extent of substance use.2 When asked to self-report their

1
Substance Abuse and Mental Health Services Administration. (2002). Results from the 2001 National Household
Survey on Drug Abuse, Volume I: Summary of National Findings (Office of Applied Studies, NHSDA Series H-17,
DHHS Publication No. SMA 02-3758). Rockville, MD. Available by calling (800) 729-6686 or at
http://www.samhsa.gov/oas/nhsda/2k1nhsda/vol1/toc.htm.
2
The NHSDA employs techniques to encourage honest responses to sensitive questions. When paper-and-pencil
interviewing was used, respondents used a separate answer sheet for sensitive questions instead of answering aloud
to the interviewer. Since 1999, the NHSDA/NSDUH has used computer-assisted self-interviewing for most
questions. For more information, see http://www.samhsa.gov/oas/Dependence/chapter1.htm#1.1.

Section 2: Extent and Impact of Substance Abuse Page 2-1

TATC Consulting June 24, 2003
substance use, many people may under-report it, out of denial that their use is a problem or due
to fear of punishment.3

The substance use levels discussed in this section include much more than substance use
disorders, substance abuse, or substance dependence as defined below. The broader definitions
of substance use levels are included because many workplace problems result from less severe
substance use, as discussed further in Section 2.2.4.

2.1.1 Definitions

“Substance abuse” is a general term commonly used to describe a range of alcohol and other
drug use that has negative effects and consequences—up to and including addiction. Although
this term will be used throughout the Briefing Book in this manner,4 this section and the next will
use other operational definitions consistent with the data sources being discussed.

Many of this section’s definitions and measures of various levels of substance use and misuse
come directly from the NHSDA/NSDUH. The following NHSDA/NSDUH definitions are most
useful to this discussion:
• Current illicit drug use: Using an illicit drug (marijuana, cocaine, heroin, hallucinogens,
inhalants, and non-medical use of prescription-type pain relievers, tranquilizers, stimulants,
and sedatives) in the past 30 days.
• Binge alcohol use: Consuming five or more servings of alcohol on the same occasion at least
once in the past 30 days.
• Heavy alcohol use: Binge alcohol use on at least 5 of the past 30 days.

The NHSDA also defines and measures the abuse of and dependence on alcohol and other drugs
as follows:
• Substance abuse: Substance use that, in the past year, caused problems at work, school, or
home; problems with family or friends; physical danger; or trouble with the law.
• Substance dependence: Substance use for which the respondent reported addiction
symptoms, such as health problems, emotional problems, tolerance to the substance,
withdrawal syndrome, and attempts to cut down on use, in the past year.

3
For example, in 1998, the New Jersey Department of Health completed a comprehensive study of substance use
among welfare recipients, using administrative database analysis, questionnaires, and physical testing of hair
samples. While the self-reported use rate in the past 18 months was 32% of respondents for any illicit drug and 16%
for cocaine, the hair test results indicated that in the past three months, 22% of respondents had used any illicit drug
and over 25% had used cocaine. Source: Kline, Cruzios, Rodriguez, and Mammo, 2000. 1998 New Jersey
Substance Abuse Needs Assessment Survey of Recipients of Temporary Assistance to Needy Families (TANF). New
Jersey Department of Health, Division of Addiction Services, and the Eagleton Institute of Politics, Center for Public
Interest Polling, Rutgers University. Available at http://www.state.nj.us/health/as/tanf.
4
In this context, substance abuse means inappropriate, illegal, or problematic use of either illegal or legal drugs
(such as use of prescription drugs contrary to medical advice, or recreational use of over-the-counter products);
binge use of alcohol; or use of alcohol in a prohibited place (such as at work) or manner. When using the phrase
“drugs and alcohol,” “drugs” refers to illegal drugs but does not imply that alcohol itself is not also a drug. When
the term “drug” stands alone, it should be interpreted to also include alcohol unless specified otherwise.

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TATC Consulting June 24, 2003
In addition, the NHSDA defines substance abuse treatment as any service utilized in the past
year (including self-help groups) to reduce or stop drug or alcohol use or for medical problems
associated with drug or alcohol use.

2.1.2 Workforce Prevalence of Substance Use and Abuse

Substance use and abuse are clearly present in the U.S. workforce and workplace, although
workplace prevalence is much more difficult to measure than workforce prevalence.

The data captured in the NHSDA and many research studies on employee substance use include
overall substance use across all contexts, most of which likely occurs away from the workplace
and outside work hours. Few credible data exist on the prevalence of on-the-job substance use or
impairment, and these prevalence estimates have varied widely, from less than 1% to about
39%.5 One reason for the lack of data is that workplace drug tests neither indicate whether a
drug user is drug impaired nor distinguish between on-the job and off-the-job drug use.
Moreover, workplace alcohol testing, which can provide an indication of current impairment, is
not as widespread.6

According to the 2001 NHSDA, the overall workforce prevalence of substance use varies by the
type of use. A relatively small proportion of full-time workers said they engage in illicit drug use
(6.9%) or heavy alcohol use (7.2%) or have substance abuse or dependence (7.9%). In contrast,
a greater percentage (26.2%) of full-time workers said they had engaged in binge alcohol use in
the past month.

Although the proportion of substance abusing workers is relatively small, efforts to reduce drug
use as a nation cannot succeed without employers’ attention because, by far, most substance
abusers are in the workplace. The 2001 NHSDA found that the vast majority of substance users
work at least part-time.7 This includes illicit drug users as well as substance abusing or
substance dependent adults, at least three of every four (76%) of whom are employed. Likewise,
at least four of every five binge alcohol users (81%) and heavy alcohol users (80%) are
employed. Also, substance abuse that is technically off the job can still negatively affect the
workplace, as is discussed in Section 2.2.3.

Finally, several past NHSDA reports have found significant occupational differences in illicit
drug use and heavy alcohol use. For example, in the 1997 NHSDA, illicit drug use was 10.8-
18.7% among workers in restaurant-related (food preparation, bartending, and wait staff),
construction, and transportation occupations, compared to the 7.7% rate across all occupations.8
5
Frone, M. “Alcohol, Drugs, and Workplace Safety Outcomes: A View from a General Model of Employee
Substance Use and Productivity,” 2003. To appear in: Barling and Frone (Eds), Psychology of Workplace Safety,
American Psychological Association (in press).
6
Ibid.
7
2001 National Household Survey of Drug Abuse, Tables 1.30A, 2.54A, and 5.31A. Available at
http://www.samhsa.gov/oas/nhsda/2k1nhsda/vol3/FrontMatter_W.pdf.
8
Substance Abuse and Mental Health Services Administration, Office of Applied Studies. Chapter 2: “Current Illicit
Drug Use and Heavy Alcohol Use by Demographic and Workplace Characteristics,” Worker Drug Use and
Workplace Policies and Programs: Results from the 1994 and 1997 National Household Survey on Drug Abuse,
1997. Available at http://www.samhsa.gov/oas/nhsda/A-11/toc.htm or (800) 729-6686.

Section 2: Extent and Impact of Substance Abuse Page 2-3

TATC Consulting June 24, 2003
These and other data suggest that workplace or occupational cultures may account for significant
variation in prevalence.

2.1.3 Substance Use and Abuse in the General Population

Table 2A, drawn from the 2001 NHSDA, shows the general prevalence of various categories of
substance use among adults (age 18 and older). This table shows that the most common type of
potentially problematic substance use is binge drinking.

Table 2A: Overall Prevalence of Various Substance Use Categories

Adults (age 18 or older) who are: Number % of age group

• Current illicit drug users 13.4 million 6.6%9
• Binge alcohol users 43.9 million 21.7%
• Heavy alcohol users 12.4 million 6.1%
• Substance abusing or substance dependent 14.7 million 7.3%

In addition, the NHSDA found that 3.1 million persons age 12 or older had received substance
abuse treatment in the past year. (The number of adults who received treatment was not readily
available.) Given that the 3.1 million persons receiving treatment is less than one-fifth of the
number of substance abusing or dependent persons (16.6 million persons age 12 or older), the
data imply that there is a substantial unmet need for substance abuse treatment.

Table 2B: Substance Use by Age Group

Percentage of each age group who are: Teenagers10 Young adults Adults age
(age 12-17) (age 18-25) 26 or older
• Current illicit drug users 10.8% 18.8% 4.5%
• Binge alcohol users 10.6% 38.7% 18.8%
• Heavy alcohol users 2.5% 13.6% 4.8%
• Substance abusing or substance dependent 7.8% 18.4% 5.4%

As shown by Table 2B, all categories of drug and alcohol use vary widely by age group and are
highest among young adults age 18-25 and lowest among adults age 26 or older. For example,
compared to those over age 26, adults under 26 have more than four times greater rates of illicit

9
Some adult percentages are presented in the 2001 NHSDA main report; others were calculated from the total
estimated adult population of 202,036,000 from Table 7.14A, “Estimated Numbers (in Thousands) of Persons Aged
18 or Older, by Probation Status and Demographic Characteristics: 2000 and 2001,” available at
http://www.samhsa.gov/oas/nhsda/2k1nhsda/vol3/Sect7v1_PDF_W_1-16.pdf.
10
Substance use by teenagers grows dramatically with age. For example, only 3.8% of youth age 12-13 engaged in
past-month illicit drug use, jumping to 10.9% of youth age 14-15 and to 17.8% of youth age 17-18. Likewise, the
prevalence of binge alcohol use is less than 1% for 12-year-olds but more than 24% for 17-year-olds, and heavy
alcohol use is 0.1% of 12-year-olds but 7.2% of 17-year-olds. For more information, see
http://www.samhsa.gov/oas/NHSDA/2k1NHSDA/vol2/appendixh_1.htm and
http://www.samhsa.gov/oas/NHSDA/2k1NHSDA/vol2/appendixh_2.htm.

Section 2: Extent and Impact of Substance Abuse Page 2-4

TATC Consulting June 24, 2003
drug use, nearly three-and-a-half times the rate of substance abuse or dependence, nearly three
times the rate of heavy alcohol use, and more than twice the rate of binge alcohol use.

The Youth Employment and School study, which examined high school students’ alcohol use and
its relationship to school and work, indicates that a significant share of adolescent workers,
particularly males, engage in work-related alcohol use. As shown in Table 2C, more than one in
5 of the boys surveyed, and one in 20 of the girls surveyed, said they had been intoxicated at
work at least once during the school year.11

Table 2C: Work-Related Alcohol Use Among High School Students

% of teen workers who did the following at least once

Males Females
during the school year:
• Used alcohol before starting work shift 13% 3%
• Used alcohol during lunch breaks 7% 1%
• Used alcohol during work hours 9% 1%
• Used alcohol after work hours on company property 20% 5%
• Were intoxicated at work 21% 5%

These age group differences in substance abuse behaviors indicate that ages at which people are
most likely to engage in substance abuse are also the ages at which most people enter the
workforce. Thus it may be especially important for workplace prevention and intervention
efforts to reach young workers.

2.2 Workplace Impact of Drug and Alcohol Use

As stated previously in Section 2.1, more than three-quarters of the people who use illicit drugs
or engage in binge or heavy drinking are employed, according to the 2001 National Household
Survey on Drug Abuse (NHSDA). Because most substance users and abusers have jobs, it may
be inevitable that the consequences of their substance use will be felt in the workplace. Although
recent data on the impact and costs of workforce substance abuse are scarce, the data presented
demonstrate the nature of the impact. It is difficult to determine whether the costs have risen,
leveled off, or decreased given the wider acceptance of drug-free workplace strategies, but there
is little reason to suspect that the types of impact have changed.

According to estimates by the Office of National Drug Control Policy, in 1998, the illegal use of
drugs caused the following productivity losses:12

11
Research Institute on Addictions, University at Buffalo, State University of New York. YESS News, Youth
Employment and School Study, Fall 1997, p. 4.
12
Office of National Drug Control Policy (Executive Office of the President), September 2001. The Economic Costs
of Drug Abuse in the United States, 1992-1998, pp. 6, 35. Report prepared by The Lewin Group based on estimates,
analyses, and data reported in Harwood, Fountain, and Livermore, The Economic Costs of Alcohol and Drug Abuse
in the United States 1992. Report prepared for the National Institute on Drug Abuse and the National Institute on
Alcohol Abuse and Alcoholism, National Institutes of Health, Department of Health and Human Services. NIH
Publication No. 98-4327. Rockville, MD: National Institutes of Health, 1998.

Section 2: Extent and Impact of Substance Abuse Page 2-5

TATC Consulting June 24, 2003
• $16.6 billion due to premature death.
• $23.1 billion due to illness related to substance abuse.
• $1.8 billion for 122,580 drug-related institutionalizations and hospitalizations.
• $30.1 billion due to incarceration.

Similarly, estimates by the National Institute on Alcohol Abuse and Alcoholism show that in
1998, alcohol abuse caused significant economic losses, including:13
• $36.5 billion in lost earnings due to premature death.
• $86.4 billion in lost productivity due to alcohol-related illness.
• $15.2 billion for medical consequences of alcohol consumption.
• $9.1 billion in lost productivity due to incarceration.

2.2.1 Substance Abuse and Workplace Safety

One of the most serious work-related consequences of substance abuse is its effect on workplace
safety. There are few recent data on the role of substance abuse in workplace accidents;
occupational health and safety agencies are not required to collect such statistics. The evidence
linking substance use to workplace accidents is stronger for alcohol than for other drugs.

Toxicology reports on workers involved in occupational injuries and accidents can give some
indication of whether alcohol or other drugs were involved. There are significant limitations on
toxicology data. For example, testing procedures are not uniform in all states and jurisdictions
that collect these data. In addition, toxicology reports are not available on all fatal work-related
injuries, or on persons who were not fatally injured but may have contributed to the accident.
Despite these data limitations, the numbers of on-the-job accidents in which substance abuse
may be implicated are significant. For example, the Bureau of Labor Statistics analyzed 1998
data from the Census of Fatal Occupational Injuries and estimated that 10-20% of the nation’s
workers who die on the job test positive for alcohol or other drugs.14

Similarly, a 1993 analysis of toxicology data on injured workers’ blood alcohol concentration
estimated that 10% of fatal work injuries and 5% of non-fatal work injuries overall involved
acute alcohol impairment.15 While these are not large percentages, when applied to the total

13
Harwood, H. Updating Estimates of the Economic Costs of Alcohol Abuse in the United States: Estimates, Update
Methods, and Data, p. 13. Available at http://www.niaaa.nih.gov/publications/economic-2000/alcoholcost.PDF.
Report prepared by The Lewin Group for the National Institute on Alcohol Abuse and Alcoholism, 2000. Based on
estimates, analyses, and data reported in Harwood, H.; Fountain, D.; and Livermore, G. The Economic Costs of
Alcohol and Drug Abuse in the United States 1992. Report prepared for the National Institute on Drug Abuse and
the National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Department of Health and
Human Services. NIH Publication No. 98-4327. Rockville, MD: National Institutes of Health, 1998.
14
Weber, W. and Cox, C. “Analysis of Toxicology Reports: Work-Related Fatal Injuries in 1998,” Compensation
and Working Conditions, Spring 2001, pp. 27-29.
15
Zwerling, C. “Current Practice and Experience in Drug and Alcohol Testing.” Bulletin on Narcotics, vol. 45
(1993), pp. 155-196.

Section 2: Extent and Impact of Substance Abuse Page 2-6

TATC Consulting June 24, 2003
number of workplace accidents estimated for 1992, they translate into 653 fatal and 662,500 non-
fatal injuries related to alcohol use, at a cost of $14.5 billion.16

In addition, these statistics focus only on acute alcohol impairment. “Hangovers” can also affect
workplace safety and productivity, as discussed in Section 2.2.4. The proportion of alcohol-
related accidents can vary widely among individual workplaces. For example, a 1990 study
found that among workers in a shipyard where alcohol was readily available during work, an
estimated 37% of non-fatal work injuries involved alcohol consumption.17

Data about the role of other drugs in workplace accidents and injuries are less definitive than
data on alcohol. According to 2001 data from Quest Diagnostics (a laboratory chain that
conducts more than 10 million drug tests each year), the proportion of test results that were
positive for at least one drug did not differ significantly between post-accident versus random
tests.18 Unlike alcohol tests, which measure the level of alcohol in the body at the time of testing,
a positive drug test does not indicate when or how much of the drug was consumed or the level
of impairment at the time of the accident or injury.19

2.2.2 Employee Turnover and Absenteeism Linked to Substance

Abuse

Drug and alcohol use correlates with employee turnover and absenteeism. According to the
2000 NHSDA (the most current one in which work-related outcomes were reported), full-time
workers with self-reported illicit drug use or heavy alcohol use in the past month, or dependence
on alcohol or other drugs in the past year, had significantly more job turnover and work absences
than other full-time workers, as shown in the following figures.20

Figure 2A shows the percentage, by substance use category, of full-time workers who said they
had worked for more than three employers in the past year. Respondents who used alcohol
heavily were more than one-third more likely to have this level of job turnover than those who
did not. Respondents who used illicit drugs or were abusing or dependent on alcohol or illicit
drugs were more than twice as likely to have this level of job turnover than persons outside these
substance use categories. All of these differences were statistically significant at the .05 level.

16
Leigh, Markowitz, Fahs, Shin, and Landrigan. “Occupational Injury and Illness in the United States: Estimates of
Costs, Morbidity, and Mortality.” Archives of Internal Medicine, vol. 167 (1997), pp. 1557-1568.
17
Moll van Charante and Mulder. “Perceptual Acuity and the Risk of Industrial Accidents,” American Journal of
Epidemiology, vol. 131 (1990), pp. 652-663.
18
Quest Diagnostics Incorporated. The Drug Testing Index, 2002.
19
Frone, 2003.
20
“The NHSDA Report: Substance Use, Dependence or Abuse Among Full-Time Workers.” U.S. Department of
Health and Human Services, Substance Abuse and Mental Health Services Administration, Office of Applied
Studies, September 2002. Available at http://www.samhsa.gov/oas/2k2/workers/workers.htm or (800) 729-6686.

Section 2: Extent and Impact of Substance Abuse Page 2-7

TATC Consulting June 24, 2003
 Figure 2A: Job Turnover and Substance Use
7 6.6
% full-time 6 5.7
5.1
workers 5
who worked for 4 3.6
>3 employers in
3 2.4 2.3 2.3 2.5
past year
2
Yes 1
No 0
Heavy Alcohol Illicit Drug Use? Alcohol Abuse/ Illicit Drug Abuse/
Use? Dependence? Dependence?

Employee turnover is costly for employers. The U.S. Department of Labor estimates that on
average it costs a company between one-fourth21 and one-third of a new hire’s annual salary to
replace an employee, which is up to $4,350 for an employee who earns only $7 an hour.22
Supervisory, technical, and management personnel cost even more to replace, with cost estimates
ranging from half to several times their salaries.23 Other corporate data show a negative relation
between employee turnover and profitability.24
• One large fast food company compared its low-turnover stores with its high-turnover stores
(with 100% versus 150% annual turnover) and found that the former had more than 50%
higher profit margins.
• A large retail chain determined that stores with less turnover had 22% higher sales per
employee.
• A trucking company increased profits by 50% by cutting turnover in half.

Figure 2B shows the percentage, by substance use category, of full-time workers who said they
missed more than two days of work in the past month due to an illness or injury. Workers with
heavy or abusing/dependent levels of alcohol use were about 1/4 more likely to have this many
health-related work absences than those without these levels of alcohol use. Workers who used
illicit drugs were more than four times more likely than non-users to have had more than two
health-related work absences in the past month. Workers who abused or were dependent on
illicit drugs were nearly twice as likely as those who were not to have had this many health-
related work absences. These differences were statistically significant at the .05 level for illicit
drugs but not for alcohol.

21
Grensing-Pophal, L. “Creative Approaches to Employee Retention” (SHRM White Paper). Society for Human
Resource Management, May 2000, reviewed October 2002. Available at
http://www.shrm.org/hrresources/whitepapers_published/CMS_000115.asp for SHRM members only.
22
Galbreath, R. “Employee Turnover Hurts Small and Large Company Profitability” (SHRM White Paper). Society
for Human Resource Management, November 2000, reviewed October 2002. Available at
http://www.shrm.org/hrresources/whitepapers_published/CMS_000117.asp#P4_60 for SHRM members only.
23
Galbreath, R.
24
Galbreath, R.

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TATC Consulting June 24, 2003
 Figure 2B: Health-Related Work Absences & Substance Use

14 12.9
% full-time 12 11.6
workers missing 10 8.7
8.4
>2 work days in 8 6.8 6.8 6.8
past month due 6
to illness or injury 4 2.5
2
Yes 0
No Heavy Alcohol Illicit Drug Use? Alcohol Abuse/ Illicit Drug Abuse/
Use? Dependence? Dependence?

Figure 2C shows the percentage, by substance abuse category, of full-time workers who said they
skipped more than two days of work in the past month. Compared to workers who did not
engage in each substance use category, skipping work was more than twice as common among
heavy alcohol users, nearly three times more common among illicit drug users, nearly four times
more common among workers who abused or were dependent on alcohol, and nearly five times
more common among workers who abused or were dependent on illicit drugs. All of these
differences were statistically significant at the .05 level.
Figure 2C: Work Truancy and Substance Use
10
% full-time 8.3
8
workers 5.7
6
who skipped 3.9 4.4
>2 work days 4
1.7 1.6 1.5 1.7
in past month 2
0
Yes Heavy Alcohol Illicit Drug Use?Alcohol Abuse/ Illicit Drug
No Use? Dependence? Abuse/
Dependence?

Because the NHSDA data provide general prevalence data measured at a single point in time,
they do not necessarily prove that the above substance use patterns cause the above workplace
outcomes. For example, it is also possible that some workers use alcohol and other drugs in
response to job instability or poor health, or that substance abuse and work absences both result
from other factors, such as job dissatisfaction or a rebellious personality.25 Still, the strong
association of job turnover and work absenteeism with substance use among full-time workers
indicates that alcohol and illicit drug use is a significant issue in the employed workforce and
that employers have a stake in preventing and treating substance abuse problems.

2.2.3 “Secondhand” Workplace Impacts of Substance Abuse

25
Frone, 2003.

Section 2: Extent and Impact of Substance Abuse Page 2-9

TATC Consulting June 24, 2003
Substance abuse impairs not only the workers who engage in it; it can also place a heavy
economic burden on their families, co-workers, employers, and society as a whole in terms of
decreased productivity and increased health care costs.

• A 1998 study funded by the Robert Wood Johnson Foundation and the National Institute on
Alcohol Abuse and Alcoholism found that:26
 21% of workers reported that a co-worker’s alcohol use had injured or endangered
them or forced them to redo work, “cover” for the co-worker, or work harder or
longer.
 31% of workers who considered their jobs to be dangerous, and a similar share of
transportation workers, reported “secondhand” effects of co-workers’ drinking.
• Research from the 1970s indicates that supervisors of substance-abusing employees often
adopt troubled behavior patterns that lead to costly problems in their own job performance
and relations with other subordinates.27
• Alcohol abusers spend four times more days in the hospital than the national average.28
• Health care costs for employees who have alcohol problems are about twice as high as for
those who do not.29
• Non-alcoholic members of alcoholics’ families use 10 times as much sick leave as members
of families in which alcoholism is not present. 30
• 20-30% percent of all trips to hospital emergency rooms are alcohol related.31
• In developed countries, alcohol use is the leading cause of disability among men and the 10th
leading cause among women.32

26
Mangione, Howland, and Lee. Perspectives for Worksite Alcohol Strategies: Results from a Corporate Drinking
Study, December 1998. Highlights available at
http://www.whitehousedrugpolicy.gov/prevent/workplace/research.html.
27
Phillips and Older. “A Model for Counseling Troubled Supervisors.” Alcohol, Health, and Research World, vol. 2,
pp. 24-30, 1977. Cited in Roman and Blum, “Employee Assistance Programs and Other Workplace Interventions”
(Chapter 37, pp. 423-435), The American Psychiatric Textbook of Substance Abuse Treatment, Second Edition
(Washington, DC: American Psychiatric Press), 1999, p. 427.
28
National Institute on Alcohol Abuse and Alcoholism. Tenth Special Report to the U.S. Congress on Alcohol and
Health, 2000. Available at http://www.niaaa.nih.gov/publications/viewinfo10.htm.
29
Ibid.
30
Bernstein and Mahoney. “Management Perspectives on Alcoholism: The Employer’s Stake in Alcoholism
Treatment,” Occupational Medicine, Vol. 4, No. 2, 1989, pp. 223-232.
31
Centers for Disease Control and Prevention. Alcohol Problems Among Emergency Department Patients:
Proceedings of a Research Conference on Identification and Intervention, 2000.
32
World Health Organization. Global Burden of Disease, 1996. Cited in Ensuring Solutions to Alcohol Problems,
George Washington University Medical Center, “Seven Tools to Lowering the Business Costs of Alcohol Problems,”
December 2002. Available at http://www.ensuringsolutions.org/pages/reisbr.html#ib1.

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2.2.4 Workplace Impact of Substance Use “Off Hours” and by Non-
Addicted Users

While it is important to identify and assist workers with drug or alcohol addiction, recent
research on job-related alcohol effects indicates that employers must also pay attention to non-
addicted users and to substance use outside the workplace.

In a large-scale 1998 study of 14,000 employees in seven large corporations, the majority (61%)
of alcohol-related performance problems were associated with non-dependent drinkers.
Although alcoholic employees had higher rates of work performance problems, non-dependent
drinkers were three times more numerous than dependent drinkers, and thus contributed a greater
share of work performance problems in the aggregate.33

Alcohol-related work performance problems are linked not only to the workplace, but also to off-
site drinking during the workday (such as at lunch), as well as “off hours” drinking. A 1997
study of workers at one large manufacturing plant found that being “hung over” at work had an
equivalent or greater impact on self-reported work performance problems than drinking at
work.34 Heavy drinking several hours before work (such as the night before coming to work in
the morning) can impair job performance, even with no alcohol detectable in the blood and no
physical symptoms of hangover.35 A 1983 study found that 76% of alcohol-related work
accidents occurred during the hours of 8-10 a.m. and 1-2 p.m., which suggests that most on-the-
job alcohol impairment resulted from drinking just before work or during lunch, or heavily
drinking the night before work.36

These research findings show that impairment due to substance use, and substance abuse itself,
should both be thought of in terms of a continuum rather than an either/or state. Impairment
from substance use increases gradually at any amount of use, not just above a certain threshold
level of exposure.37 Similarly, it is possible to have substance abuse problems without being
addicted.

2.2.5 Employment Failure of Substance Abusing Individuals

The 2001 NHSDA found that although the majority of persons in all categories of alcohol or
illicit drug use are employed, drug and alcohol use is more prevalent among unemployed persons
than among full-time workers. As with other NHSDA prevalence data, these differences do not
necessarily establish substance abuse as a cause of unemployment; it is also possible that people
develop alcohol and other drug problems in response to unemployment or that both the substance
abuse and the unemployment are influenced by other factors. These data illustrate that substance
abuse is likely to be a significant issue among unemployed persons seeking services from the
workforce investment system.

33
Mangione, Howland, and Lee, 1998, p. 6.
34
Ames, Grube, and Moore. “The Relationship of Drinking and Hangovers to Workplace Problems: An Empirical
Study.” Journal of Studies on Alcohol, vol. 58 (January 1997), pp. 37-47.
35
Mangione, Howland, and Lee, 1998, p. 7.
36
Frone, 2003.
37
Mangione, Howland, and Lee, 1998, p. 7.

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TATC Consulting June 24, 2003
As shown in Table 2D, differences in use rates by employment status varied by the type of
substance use. The prevalence of binge drinking was only slightly higher among unemployed
adults than among full-time workers, while the difference in heavy alcohol use rates between
these two groups was almost 50%. Illicit drug use and substance abuse or dependence shows
much greater differences in prevalence by employment status. Compared to full-time workers,
unemployed adults were nearly twice as likely to be substance abusing or dependent and more
than twice as likely to use illicit drugs.

Table 2D: Substance Use Among Unemployed Adults Versus Full-Time Workers

Share of unemployed Share of full-time

adults38 with: workers with:
Past-Month Illicit Drug Use 17.1% 6.9%
Past-Month Binge Alcohol Use 30.2% 26.2%
Past-Month Heavy Alcohol Use 10.4% 7.2%
Past-Year Substance Abuse or Dependence 15.4% 7.9%

Unemployment among substance abusers carries a significant cost to society. In 1998, an

estimated $484 million in social welfare costs for public assistance payments was attributed to
alcohol use,39 while another $249 million was attributed to other drugs.40

2.3 Conclusion

The research summarized in this section indicates that substance abuse has significant negative
impacts in the workplace. It also shows that these negative workplace impacts can result even
from substance use that does not constitute abuse or addiction. The next section describes the
benefits of efforts by employers, the substance abuse treatment community, and the workforce
investment system to lessen these impacts.

38
The NHSDA definition of unemployment is consistent with that used by the Bureau of Labor Statistics. NHSDA
respondents were counted as unemployed if they did not have a job, were on layoff, and were looking for work and
had made specific efforts to find work in the past 30 days. See the 2001 NHSDA, volume 2, Appendix D: “Key
Definitions, 1999-2001 Survey Years” at http://www.samhsa.gov/oas/NHSDA/2k1NHSDA/vol2/appendixd.htm.
39
Harwood, 2000, p. 13.
40
Office of National Drug Control Policy, September 2001, pp. 8, 43.

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TATC Consulting June 24, 2003