Alcohol and the Workplace

Alcoholand the WorkplaceDrinkingamong U.S. workers can threaten public safety, impair job performance, andresult in costly medical, social, and other problems affecting employees andemployers alike. Productivity losses attributed to alcohol were estimated at 119 billion for 1995 1 . As this Alcohol Alert explains, severalfactors contribute to problem drinking in the workplace.Employers are in aunique position to mitigate some of these factors and to motivate employees toseek help for alcohol problems.

FactorsContributing to Employee DrinkingDrinkingrates vary among occupations, but alcohol-related problems are notcharacteristic of any social segment, industry, or occupation. Drinking isassociated with the workplace culture and acceptance of drinking, workplacealienation, the availability of alcohol, and the existence and enforcement ofworkplace alcohol policies 2,3 . WorkplaceCulture.Theculture of the workplace may either accept and encourage drinking or discourageand inhibit drinking.

A workplace s tolerance of drinking is partly influencedby the gender mix of its workers.Studies of male-dominated occupations havedescribed heavy drinking cultures in which workers use drinking to buildsolidarity and show conformity to the group 4,5 . Some male-dominatedoccupations therefore tend to have high rates of heavy drinking andalcohol-related problems 6,7 . In predominantly female occupations both maleand female employees are less likely to drink and to have alcohol-relatedproblems than employees of both sexes in male-dominated occupations 8 . WorkplaceAlienation.

Work that is boring, stressful, or isolating cancontribute to employees drinking 2 . Employee drinking has been associatedwith low job autonomy 9 , lack of job complexity, lack of control over workconditions and products 10,11 , boredom 12 , sexual harassment, verbal andphysical aggression, and disrespectful behavior 13 . ManagingAlcohol Problems in the WorkplaceOnefunction of employee assistance programs EAPs is to identify and intervene inemployees alcohol problems.

EAPs may be provided by labor unions, management as part of the employee benefit package , or through a union-management collaboration 25,26 . Workers may take greater advantage of the services provided by aninternal EAP located on the worksite than an external program. Leong and Every 27 found that EAP utilization increased significantly at a nuclear powerplant 2 years after an internal program began compared with the utilizationrates when the EAP was located away from the worksite.Employeesare encouraged to seek EAP services, and supervisors may refer employees to anEAP based on deteriorating job performance 26 . One survey of 6,400 employeeswho used EAP services at 84 worksites found that clients with alcohol- relatedproblems were twice as likely as those with other problems to have receivedsupervisory referrals 28 . Althoughthe services offered vary, EAPs usually train supervisors to recognize problemsand refer workers to the EAP provide confidential and timely assessment referemployees for diagnosis, treatment, and other assistance work with communityresources to provide needed services and conduct followup after treatment 29 . EAP professionals may collaborate with managed care companies and serveas liaisons between managed care companies and treatment providers 26 .From 1992to 1993, a national survey estimated that 33 percent of U.S. worksites with 50or more full-time employees had an EAP 30 . A 1992 survey of the alcoholprograms offered through EAPs at 1,507 worksites with 50 or more employeesfound that 16 percent offered individual counseling, 22 percent had groupsessions, and 41 percent provided employees with written materials. Unionizedand larger worksites were more likely to offer alcohol programs than were nonunionized,smaller worksites 31 . Effectivenessof EAPs. Although research on the effectiveness of EAPsis limited, some studies have found that EAPs are effective in reducingemployees alcohol problems 32 . One study of 199 commercial airlinepilots who were advised to seek treatment for alcoholism from 1973 to 1989found that 87 percent returned to flight duties after treatment and only 13percent of those who accepted treatment relapsed 33 .Walsh andcolleagues 34 compared the outcomes of 227 employees who were referred to anEAP for alcohol problems and assigned to either inpatient treatment followed byattendance at Alcoholics Anonymous AA , AA alone, or a treatment plan chosenby the employee in consultation with EAP staff.

The employees were seen weeklyby the EAP for 1 year, excluding periods of inpatient treatment.

Two yearslater, all three groups showed substantial improvement in job measures with nosignificant differences among them. Fewer than 15 percent of employees reportedjob-related problems at the 2-year followup, and 76 percent of the supervisorsinterviewed at that time rated the employees job performance as good or excellent.

The groups did differ on drinkingmeasures, however.

Employees who had received inpatient treatment weresignificantly more likely than those in the other groups to report not drinkingand not drinking to intoxication during the followup period. When employees didrelapse, drinking problems preceded job-related problems, suggesting thattreatment followup is important for detecting relapse before job problems occur 34 .In onestudy evaluating EAP followup 35 , 325 workers referred to an EAP for alcoholand other drug problems received either the standard care, consisting ofassessment and treatment or referral, or the standard care plus 1 yearof followup with a counselor. Those who were followed up had 15 percentfewer relapses resulting in hospitalization and 24 percent lower alcoholand other drug-related health benefit claims, compared with the group thatreceived standard care alone 35 . Alcoholand the Workplace A Commentary by NIAAA Director Enoch Gordis, MDOccupationalalcoholism programs, which evolved into today s multifaceted employeeassistance programs, have been around since the 1940s. Despite the success ofearly programs in several large American industrial corporations, the diffusionof the workplace alcohol program concept was slow. However, as a result ofresearch findings on the effectiveness of such programs by eminent scientistssuch as Harrison Trice and Paul Roman, major scientific and program initiativesin the 1960s by the National Council on Alcoholism and the Christopher D.Smithers Foundation, and in 1970 by the newly created National Institute onAlcohol Abuse and Alcoholism, the acceptance of the value of employeeassistance programs gained impetus.

It is primarily because of these pioneeringactivities that alcohol programs in the workplace are now the rule, not theexception.Researchershave begun to look not just at the effectiveness of workplace alcohol programsin intervening in drinking problems but also at the culture of the workplaceitself as a determinant in both drinking and nondrinking behavior of employees.This research is providing management with a powerful tool for preventingdrinking problems as well as in identifying those who are at risk for alcoholproblems.