Drinking among U.S. workers can threaten public
safety, impair job performance, and result in costly medical, social, and other
problems affecting employees and employers alike. Productivity losses
attributed to alcohol were estimated at $119 billion for 1995 (1). As this
Alcohol Alert explains, several factors contribute to problem drinking in the
workplace. Employers are in a unique position to mitigate some of these factors
and to motivate employees to seek help for alcohol problems.
Factors Contributing to Employee Drinking
Drinking rates vary among occupations, but
alcohol-related problems are not characteristic of any social segment,
industry, or occupation. Drinking is associated with the workplace culture and
acceptance of drinking, workplace alienation, the availability of alcohol, and
the existence and enforcement of workplace alcohol policies (2,3).
The culture of
the workplace may either accept and encourage drinking or discourage and
inhibit drinking. A workplace's tolerance of drinking is partly influenced by
the gender mix of its workers. Studies of male-dominated occupations have
described heavy drinking cultures in which workers use drinking to build
solidarity and show conformity to the group (4,5). Some male-dominated occupations
therefore tend to have high rates of heavy drinking and alcohol-related
problems (6,7). In predominantly female occupations both male and female
employees are less likely to drink and to have alcohol-related problems than
employees of both sexes in male-dominated occupations (8).
Workplace Alienation. Work that is boring, stressful,
or isolating can contribute to employees' drinking (2). Employee drinking has
been associated with low job autonomy (9), lack of job complexity, lack of
control over work conditions and products (10,11), boredom (12), sexual
harassment, verbal and physical aggression, and disrespectful behavior (13).
Managing Alcohol Problems in the Workplace
One function of employee assistance programs (EAPs) is
to identify and intervene in employees' 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 an internal EAP located on the worksite
than an external program. Leong and Every (27) found that EAP utilization
increased significantly at a nuclear power plant 2 years after an internal
program began compared with the utilization rates when the EAP was located away
from the worksite.
Employees are encouraged to seek EAP services, and
supervisors may refer employees to an EAP based on deteriorating job
performance (26). One survey of 6,400 employees who used EAP services at 84
worksites found that clients with alcohol-related problems were twice as likely
as those with other problems to have received supervisory referrals (28).
Although the services offered vary, EAPs usually train
supervisors to recognize problems and refer workers to the EAP; provide
confidential and timely assessment; refer employees for diagnosis, treatment,
and other assistance; work with community resources to provide needed services;
and conduct followup after treatment (29). EAP professionals may collaborate
with managed care companies and serve as liaisons between managed care
companies and treatment providers (26).
From 1992 to 1993, a national survey estimated that 33
percent of U.S. worksites with 50 or more full-time employees had an EAP (30).
A 1992 survey of the alcohol programs offered through EAPs at 1,507 worksites
with 50 or more employees found that 16 percent offered individual counseling,
22 percent had group sessions, and 41 percent provided employees with written
materials. Unionized and larger worksites were more likely to offer alcohol
programs than were nonunionized, smaller worksites (31).
Effectiveness of EAPs. Although research on the
effectiveness of EAPs is limited, some studies have found that EAPs are
effective in reducing employees' alcohol problems (32). One study of 199
commercial airline pilots who were advised to seek treatment for alcoholism
from 1973 to 1989 found that 87 percent returned to flight duties after
treatment and only 13 percent of those who accepted treatment relapsed (33).
Walsh and colleagues (34) compared the outcomes of 227
employees who were referred to an EAP for alcohol problems and assigned to
either inpatient treatment followed by attendance at Alcoholics Anonymous (AA),
AA alone, or a treatment plan chosen by the employee in consultation with EAP
staff. The employees were seen weekly by the EAP for 1 year, excluding periods
of inpatient treatment. Two years later, all three groups showed substantial
improvement in job measures with no significant differences among them. Fewer
than 15 percent of employees reported job-related problems at the 2-year
followup, and 76 percent of the supervisors interviewed at that time rated the
employees' job performance as "good" or "excellent." The
groups did differ on drinking measures, however. Employees who had received
inpatient treatment were significantly more likely than those in the other
groups to report not drinking and not drinking to intoxication during the
followup period. When employees did relapse, drinking problems preceded
job-related problems, suggesting that treatment followup is important for
detecting relapse before job problems occur (34).
In one study evaluating EAP followup (35), 325 workers
referred to an EAP for alcohol and other drug problems received either the
standard care, consisting of assessment and treatment or referral, or the
standard care plus 1 year of followup with a counselor. Those who were followed
up had 15 percent fewer relapses resulting in hospitalization and 24 percent
lower alcohol and other drug-related health benefit claims, compared with the
group that received standard care alone (35).
Alcohol and the Workplace--A Commentary by NIAAA
Director Enoch Gordis, MD
Occupational alcoholism programs, which evolved into
today's multifaceted employee assistance programs, have been around since the
1940s. Despite the success of early programs in several large American
industrial corporations, the diffusion of the workplace alcohol program concept
was slow. However, as a result of research findings on the effectiveness of such
programs by eminent scientists such as Harrison Trice and Paul Roman, major
scientific and program initiatives in the 1960s by the National Council on
Alcoholism and the Christopher D. Smithers Foundation, and in 1970 by the newly
created National Institute on Alcohol Abuse and Alcoholism, the acceptance of
the value of employee assistance programs gained impetus. It is primarily
because of these pioneering activities that alcohol programs in the workplace
are now the rule, not the exception.
Researchers have begun to look not just at the
effectiveness of workplace alcohol programs in intervening in drinking problems
but also at the culture of the workplace itself as a determinant in both
drinking and nondrinking behavior of employees. This research is providing
management with a powerful tool for preventing drinking problems as well as in
identifying those who are at risk for alcohol problems.
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