Alcohol and Drugs In The Workplace
Alcohol and Drug Use In the Workplace is Far Greater Than You Think. It Is Not a Risk Management Issue
Gene Gilchrist
Louisville, Kentucky
Hopefully, we have reoriented your perspective about alcohol and other drug use, abuse and addiction in America. Yes, substance use disorder lives under the highway, but that is roughly 1% of the problem. Most people with a substance use disorder do not get to this “bottom” stage as Mr. Jellinek (he of the famous Jellinek Curve) defined that place. Most Americans with a substance use issue have a home, family, job, attend a church, but are, nonetheless, suffering from a disease that is treating them poorly on a physical, financial, professional and emotional basis. Let’s now turn our attention to the workplace. If most people with a substance use disorder have a job, then they are in that workplace.
Let us imagine that you are an employer of 100 people in your company (to make the math easy). They arrive at the same time every day, every shift, in a warehouse, manufacturer, service industry, office, outside job like construction or driving. One day you administer a random drug screen to everyone. The screen includes twelve common drugs and alcohol. How many employees are in danger of testing positive? 43. We account for this number from the Substance Abuse and Mental Health Services Administration and our own calculations accounting for gender (the definition of binge drinking and heavy drinking differs by gender), the general age for reducing risk taking behaviors (44), estimated binge drinking and heavy drinking from the Centers for Disease Control and estimates of drug use from the National Institutes for Health. There may be more sophisticated analyses to be had but this is sufficient and honest for our purposes.
The breakdown:
· Binge Drinkers 17.0
· Heavy Drinkers 6.0
· Marijuana Use 13.5
· Prescription Pharmaceuticals 7.1
43.6
That this number is at least double, maybe quadruple your expectation results from two items. First is that you likely do not think of alcohol as a drug. Yet, 56 million Americans abuse alcohol through binge drinking or continuous heavy drinking. Second, we said “were in danger of testing positive”. Not every heavy drinker or binge drinker, nor every marijuana or other street drug user, does so every day. In the case of binge drinkers for example it is four times per month. Note that with the exception of marijuana this list does not include schedule 1 narcotics -- “street drugs”. We assumed here that pre-employment testing screens out those addicted to a street drug but that is certainly not the case entirely. The point is that it’s probably more than 43 who would fail this drug screen.
But, you say, “it’s just a hangover and we have all managed that”. Or, “cannabis stays in the system 30 days so it may not be impacting judgment at the moment”. Or, “those pharmaceuticals were prescribed, right?”. So, that means you are willing to take the risk that someone hungover, high, or under the influence of a pain drug is driving your vehicles, operating your machinery, interacting with your customers. Is that right?
Possibly you think that your industry or your particular business does not have this issue. Certainly, it is the case that the experience with alcohol and other drugs varies by industry you may think. You are correct. However, the experience for even the “best performing” industries is problematic. The most recent data from the Substance Abuse and Mental Health Services Administration from 2015 compares alcohol and drug abuse separately for nineteen categories of employment.
These data should be frightening but not surprising for the “accommodation and food” industry where 30% of employees abuse alcohol or other drugs, and the “arts” industry where one in four employees abuse alcohol or other drugs (likely both by the way so adding them together may be an overestimate).
But, let’s take your point and focus on those “best” performing industries. It may be surprising to public service managers that almost 11% of employees abuse alcohol or other drugs, as well as educational leaders that 9.5% of employees are abusing those drugs. Yes, your industry may have less of this problem but even for the best one in ten employees would be in danger of failing the drug screen.
Further, you say, companies have workplace drug policies and periodic testing. If only that was the norm. According to SHRM less than 20% of companies have a workplace drug policy. These are likely industries with government contracts where some policy is required. One wonders what proportion of these policies are pro forma and/or followed well. Further, SHRM tells us that less than 15% of companies do a pre-employment drug screen and fewer than 10% conduct after employment testing. The American Addiction Centers review by major metropolitan statistical area suggests that pre-employment drug screening is much lower at a little over 2%.
We are not necessarily arguing for drug screens across the board. To be comprehensive in this discussion though we should note that there are many articles that discuss whether or not to drug test pre-employment or during employment. Several of these studies or articles recommend against screening. The reasons are several and some merit consideration. Among them:
· False Positives do occur with onsite testing which can lead to a hostile environment with the employee and her/his close colleagues
· Creating a punitive environment is also an issue when these matters are handled poorly
· There are, in fact, other safety issues of which among them sleep deprivation may be the most prevalent
· Issues surrounding prescription drugs including medical cannabis require a special handling
· The changing landscape surrounding recreational marijuana has made testing more difficult an issue in workplace drug policies
· Again, on marijuana, THC lasts thirty days in the body where the negative workplace impacts last only a few hours
Finally, and worth special attention is the issue of employee shortages generally or in specialized fields of training. This latter area may include valuable trades such as the HVAC technician of which America produces far too few or valuable leaders such as the lead sales person who brings in a large portion of the business. The post-Covid environment has seen very real labor shortages across the board. One loss is in the ability to produce a product. Take the U.S. based business that produces parts for a company in eastern Europe. When the production report sent last night in the U.S. is read in Munich the next morning the headquarters knows only that the parts production was down or up not that employment testing put the employee on the shelf. Similarly, the annual audit knows only that there were excess audit adjustments this year suggesting exposure not that the accounts payable clerk was or was not high on the job.
The cost of all this to business? $442 billion according to the National Safety Council. According to the NSC a manufacturing company of 100 employees in Kentucky (where we are located) is spending $109,000 per year on alcohol and drug use of which $30,000 is in health care and $79,000 in lost time and turnover. Our guess is that this matches your sensibility. The answer is both simpler than you think and the benefits greater than you think. You can obtain your own best estimate from the National Safety Council at www.nsc.org/forms/substance-use-employer-calculator. We encourage you to do so. The results will make our point.
From a bottom line point of view this may be a tough call. Will the cost of insurance be less than the loss of productivity and the image damage caused by a workplace accident or worse a fatality? From a human standpoint, however, this is not a close call. Would a company knowingly fail to remediate a toxic fume on the workshop floor? Of course not. The difference here is that the employee is inducing the harm. Should that matter? Further, our guess is that many companies are already including health care cost reductions through pre-diabetes screening and smoking cessation efforts as well as accruing the salutary effects on morale among the employee cohort. Those approaches save health care costs downstream, reduce health care insurance premiums, and yield workplace culture investments. Should an approach to alcohol and other drug abuse and addiction be different? Yes, there remains a moralistic tone around alcoholism and drug addiction in America and the attendant stigma continues as well. Are you willing to accept that?
The arguments that tend toward staffing and cost are overcome by an effective approach to alcohol and other drug use or impairment in the workplace. According to Mercer, workplace healthcare costs are expected to increase 6% in 2025. A workplace alcohol and drug policy could save that Kentucky manufacturing company $30,000.
Rather than making it more difficult to hire employees, an effective workplace policy reduces absenteeism, tardiness, and turnover the latter through improved retention which is always less expensive than recruitment and hiring. The salutary effects are also real. Let’s say that John or Sally gets taken off the line to go to HR because of a failed drug screen or reasonable suspicion. What are the possible outcomes? Immediately we tumble to punition. The employee reports to colleagues that management is unsympathetic to a few beers or a couple of tokes at lunch. Their colleagues agree. Or, the employee receives a warm welcome for a first offense and returns to the line without punition. Likely a mixed reaction results. Let’s say, though, that on a second or third offense John or Sally reports that they have been required to submit to testing, attend training or even attend counseling. What do their colleagues think? We suggest that at that point all of the close colleagues knew that their friend has a problem and they recognize that management is going an extra yard on the employee’s behalf.
A full workplace drug policy is beyond our ken or the purpose of this article. There are ample recommended policies and good ones at SAMHSA and SHRM. We might suggest guiding principles, however. Your approach should include Expectations, Caring, and Accountability.
Most of us agree that there is a time and a place for alcohol consumption for 90% of Americans who can use that drug safely. In the case of marijuana, which is becoming legalized at a rapid pace, 93% of Americans believe there are circumstances where cannabis use is OK and 66% think recreational use is OK. Pain management is a serious issue, and our physician colleagues are sincerely looking for the best answer, but at the moment most of those solutions involve some level of opioid. However, there is never a good reason to be impaired by the immediate or lingering effects of alcohol and/or schedule 1 (street drugs including marijuana) or schedule 2 (prescription pharmaceuticals) drugs. It is perfectly OK to set that Expectation, and it can be stated in a caring way. The point is to be supportive not punitive.
Establishing a Caring environment is also essential. Drug testing should not be a game of “gottcha”. Further, both SHRM and SAMHSA recommend that reasonable suspicion (both you and Jim know that Jim is hungover) is legitimate and defensible. Though the data is not clear, our bet is that most hungover, intoxicated or high behavior is by younger colleagues who make a mistake. These colleagues need a little attention that helps them understand that their work responsibility requires their capable attention not the distraction of alcohol and drugs. We don’t need to be puritans (a person afraid that someone might be enjoying themselves, per H.L. Menken), but we can help people understand their workplace responsibilities.
Eight of those forty-three employees have crossed over to substance use disorder – alcohol and/or drug abuse and addiction. These colleagues need our Caring in a focused way. These colleagues have a disease as defined by the American Medical Association since 1956. They have a chronic condition for which, like diabetes, there isn’t a cure today but there is successful, continuous treatment. Relapse rates for substance use disorder are very similar to diabetes (diet) and COPD (smoking predominantly). Like diabetes and COPD, the treatment works sometimes with the help of pharmaceuticals, hopefully short term in the case of substance use disorder. We need to remove the shame from having a disease and help these colleagues with our Caring. Getting them to a clinical environment is the path. These days there are plenty of outpatient approaches that do not require 28 days of residential treatment in many cases and increasingly after hours or via telehealth. The business does not need to remove the employee from the workplace in most cases.
Finally, and in concert with Expectation and Caring, we have every right, nay the responsibility, to enforce Accountability. While we do want to have a caring community, we are running a business, and that business needs to succeed. Too, we do our colleagues no favor by proving to them that irresponsible behavior is tolerated. President George W. Bush, speaking about education, spoke about the soft bigotry of low expectations. We need to run a business, and the employees need to face the consequences of irresponsible behavior. The latter is in their interest. Certainly, we should offer support and options about at some point people need to be responsible for their actions.
A quick mention about pharmaceuticals including medical cannabis. Our colleagues need to know that where opioid pharmaceuticals and cannabis are prescribed that we support their use “as prescribed”. They can declare their prescription and they can do so confidentially through the Human Resources office. This might result in temporary or permanent re-assignment where possible. When this happens there should be no appreciable reduction in pay due to a legitimate prescription. HR knows how to manage this situation.
Alcohol and other drug use, abuse and addiction is present in the workplace and likely in proportion to the population as a whole. We need to stop turning our heads. We need to stop treating a natural mistake in behavior and in some cases a disease as a “risk management” problem. This is costly, inhumane and deploying a solution not as difficult as we imagine. We do not need to be puritans, but we can and should set Expectations and Accountability. Yes, get a company drug policy. SHRM, SAMHSA and NIH have good sample policies. Establish it, follow it, enforce it. But in doing so, create a Caring community not a regulatory community.
January 2025
