Drug Use in the Workforce: Substances

Implications of Drug and Alcohol Use for Employers

Alcohol

According to the National Survey on Drug Use and Health, about one in 13 working adults has an alcohol use disorder. Additionally, 13% of men and 5% of women reported binge drinking at least once a week. Nearly one in four people over age 12 reported binge drinking in the past month.

Long work hours in professions such as nursing or midwifery have been associated with harmful levels of daily alcohol consumption. Other occupations at increased risk include hospitality, agriculture, manufacturing, construction and retail industries, armed forces, emergency workers such as police and fire personnel, and healthcare workers. In addition, shift work has been associated with binge drinking. Employers in these industries should offer support and treatment.

An estimated $74 billion is lost every year in reduced work productivity due to alcohol consumption, from absences, reduced output, premature retirement or death, or reduced earning potential. Although small- and medium-sized businesses are less likely to have programs to combat alcohol use, they are more likely to employ workers who struggle with alcohol use than larger businesses.

Employees with an alcohol use disorder miss on average 34% more days than other workers and are more likely to experience a workplace injury. In addition to missing work, workers who engage in heavy or addictive drinking are more likely to be fired or laid off than other employees. Employees with alcohol use disorders have 16% more work turnover every year than other employees. Healthcare costs for employees with an alcohol use disorder are estimated to be twice that of other employees. Those with alcohol use disorders make more emergency room visits and spend more days in the hospital.

Few people who need treatment for a substance use disorder receive it. Of the 21.6 million people who needed treatment for an illicit drug or alcohol use problem in 2011, only 2.3 million received substance use treatment. For employers, providing access to treatment can produce substantial savings, exceeding costs by a ratio of 12 to 1.

Employers should make screening, brief intervention and referral to treatment a part of their health plan. A recommended practice for primary care providers, this can catch people before they develop serious alcohol use problems and help those in need of treatment. The most effective interventions are brief (up to 15 minutes) and multi-contact in their frequency.

When individuals with substance use disorders receive treatment and recover, absenteeism decreases by 36% and work turnover decreases by 13% compared to a person with an active substance use disorder.

Opioids and Heroin

Depending on the job, some employees may be more likely to misuse or abuse drugs than others. In part, this can be explained by higher rates of on-the-job injuries in some industries, which are frequently treated with prescription pain medications. Workers in construction and extraction experience the highest rates of substance use disorders, with 15.6% of employees on average living with a substance use disorder. The highest rate of prescription pain medication disorders were among people in the services sector. Prescription drug misuse may be a particularly pressing issue for rural-based employers. Prescription pain medications tend to be more readily available in rural areas, in part, because many industries located in these regions, like mining, have high rates of on-the-job injuries that are frequently treated with opiates.

Estimates for the total costs of lost productivity due to prescription drug misuse in the United States vary widely, from $25.6 billion to $53.4 billion. One study found drug misuse was responsible for a 17% reduction in productivity for men and an 18% reduction in productivity for women. Worker productivity can be affected by prescription drug misuse or prescription medication use disorders because of more frequent absenteeism, job turnover and presenteeism.

One estimate found the annual cost of unscheduled absenteeism – which can be a sick day, an unplanned personal day, or an unexplained absence - was $660 per employee. These costs can include losses in productivity and profitability, as well as indirect costs like an additional administrative burden for supervisors and increased tension between employees who suspect absenteeism due to drug use. Altogether, people who have opioid use disorders miss an extra 18.5 days of work – or more than three work weeks each year compared to the general workforce. Excess job turnover also contributes to these costs. Only 58% of people with opioid use disorders had the same employer throughout the previous year, compared to 75% of the general population.

Employers face significant healthcare costs associated with opioid misuse and dependence, including disability payments and contributions to health insurance plans for their employees. Compared to the general working population, people with opioid use disorders spend five times as many days in the hospital each year and are 4.5 times more likely to visit the emergency room. Altogether, this adds up to about $11,000 per person diagnosed with an opioid use disorder each year and is comparable to business costs associated with other disorders like depression. Another analysis found that the average person who misuses opioids has annual direct healthcare costs that are 8.7 times higher than those of a non-user. These costs are borne in part by employers, who face higher premiums because of the additional healthcare costs of their employees.

Marijuana

Marijuana is the most frequently used illicit drug in the United States, and about 7.8% of people 12 or older report using marijuana in the past month. Among working adults, nearly 2% were dependent on marijuana. Though marijuana is currently considered an illicit substance by the federal government, attitudes toward de-criminalization are shifting quickly towards support. In 2016, about 57% of Americans thought that marijuana should be legal, almost double the 32% who supported in 2006.

Changing public attitudes make marijuana an issue for employers. Legalization of marijuana at the state level, whether medical or recreational, has brought on many new marijuana-infused foods, drinks and gadgets in addition to smoking. Workers can now use marijuana in more discrete ways which can make it difficult to tell if employees are using on the job or come into work impaired.

The short-term effects of marijuana that impact job performance include impaired coordination, difficulty thinking and problem-solving, memory problems, and altered sense of time. Marijuana use has been linked to increased accidents, injuries, mistakes and absenteeism, impacting employer liability, worker-compensation, and health-insurance costs. Legalization may also create challenges to drug free workplace policies. Employees let go for failing drug tests may be able to win reinstatement or damages in court. Conversely, employees impaired by marijuana use who injure others may open employers to legal liability. To address marijuana in the workplace, employers must remain up to date on the laws and adapt company policies accordingly. Employee education programs should also focus on educating staff and management on issues with marijuana to minimize misinformation in the workplace.

Other Drugs

Limited research has been conducted on the costs employers may experience when their employees are misusing cocaine, hallucinogens, inhalants and other drugs. About 18% of Americans 12 and older report misusing illicit drugs in the past year, with marijuana accounting for about three-quarters of the total (13.5%). Another 1%-2% report using or misusing cocaine, hallucinogens, tranquilizers or stimulants.

There are two ways in which illicit drug use can cause challenges for employers: when employees use drugs before or during work (using drugs during lunch, for example), and when employees use drugs during non-work hours and experience after-effects, like hangovers, during the work day. Costs to employers associated with drug use and its after-effects can include decreased productivity, higher rates of workplace injuries and more frequent absenteeism. Presenteeism, in which the employee is physically present in their place of work but is not mentally engaged in the job, can be even more expensive to an employer than absenteeism. Researchers have found that an employee experiencing presenteeism may see his or her productivity drop by one third.

Depending on the substance, users may also be more likely to experience after-effects from drug use, like hangovers, that may impair their abilities on the job. For workers in occupations that require driving vehicles or heavy machinery, this issue may be of particular concern. For example, people using hypnotics like benzodiazepines may still experience an increased risk of traffic accidents and reduced cognitive functioning the morning after using the drug. Furthermore, workers who are skipping work due to drug use are more likely to experience workplace conflict with supervisors or peers. Such conflict may damage morale and create an uncomfortable work environment for other employees.