The 40 percent linkage to alcohol in both workplace and road fatalities is strong evidence that alcohol abuse is pervasive.

The Business Case for Workplace Alcohol Prevention

Workplace alcohol abuse need not be accepted as an inevitable cost of doing business.

Our workplaces and roads are safer now than they have been in two generations. Reported worker deaths in America declined 29 percent from 6,632 in 1994 to 4,690 in 2010.1 During the same period, total traffic related deaths fell by 20 percent, from 40,716 to 32,708.2 The progress on both fronts is impressive considering the growth of the American workforce and the increase in the number of licensed drivers over the past several decades.

Less impressive is the progress made in reducing the proportion of alcohol-related workplace and traffic fatalities. Forensic evidence collected by the National Highway Traffic Safety Administration (NHTSA) shows that alcohol-related traffic fatalities as a percentage of total traffic fatalities have improved only modestly, from approximately 41 percent to 38 percent, between 1994 and 2010.2 Alcohol also remains the third-leading cause of preventable deaths in the United States behind tobacco use and poor diet/lack of exercise.3

One of the few workplace studies conducted in this area, not surprisingly and not coincidentally, suggested that 40 percent of all industrial fatalities (and 47 percent of industrial injuries) are also linked to alcohol consumption.4

The 40 percent linkage to alcohol in both workplace and road fatalities is strong evidence that alcohol abuse is pervasive. Forty percent is also a powerful statistic to impress upon management, safety professionals, and our workforces the extent of the problem and the corresponding opportunity for improvement. Workplace alcohol abuse need not be accepted as an inevitable cost of doing business.

How Does Your Industry Fare?
The percentage of heavy alcohol varies use across major occupational categories, including the Manufacturing, Service, and Public Administration categories. "Heavy" was defined in a SAMHSA study as drinking five or more drinks at the same time or within a couple of hours of each other on five or more days in the past 30 days.5

Consumption varies considerably by industry and by establishment size. The highest percentage of workers abusing alcohol were found in establishments of less than 25 employees (9.7 percent), while organizations of 500 or more employees had the lowest worker abuse (6.8 percent).6 Clearly, smaller organizations have the greater opportunity for improvement. Small firms are perhaps less likely to have an employee alcohol policy, proactive alcohol education, and EAP programs in place. Firms without substance abuse programs tend to attract those with substance abuse problems, further driving their numbers. At the same time, the results from the large organizations also leave considerable room for improvement.

Alcohol versus Illegal Drugs
Alcohol is by far the most widely used drug in the United States. Estimates are that 11 percent of workers have a problem with alcohol.7 The International Labor Organization estimates that 3 to 5 percent of the average workforce globally is alcohol dependent, and up to 25 percent drink heavily enough to be at risk of dependence.8

According to the National Institutes of Health, in 1998, alcohol abuse alone cost American businesses roughly $86.3 billion in lost productivity due to alcohol-related illness and death. Of the total $185 billion economic costs of alcohol abuse cited in the study, less than 1 percent was spent on alcohol prevention programs and training.9

While the illegal use of drugs gets most of our collective attention, alcohol abuse is the greater driver of harm and cost in the workplace. The economic cost to society from both alcohol and drug abuse was estimated at $246 billion in 1992. Alcohol abuse and alcoholism alone cost an estimated $148 billion, while drug abuse and dependence cost an estimated $98 billion.10 A similar Canadian study reported that in 2002, the estimated cost of alcohol abuse was $14.6 billion in Canada and the cost of drug abuse was approximately $8.2 billion.11 Workers with alcohol dependence or abuse outnumber workers with substance dependence/abuse (including marijuana) by a factor of almost 3 to 1.12

Do You Have a Drug and Alcohol Testing Program?
Twenty-nine percent of the 1,058 HR professionals reporting in a 2011 cross-industry survey by DATIA (the Drug and Alcohol Testing Industry Association) do not have pre-employment or post-employment drug testing programs.13 The chart below shows the reasons given by this group for not conducting testing. Only 2 percent of those not currently testing plan to do so in the future. The responses reinforce the need for more compelling communications to business owners and managers on the business case for drug testing. The responses also hint at the "can't be bothered" attitude that substance abuse professionals sometimes encounter.

My organization does not believe in drug testing: 24%
Not required to do drug testing by the state: 18%
No return on investment: 16%
Too costly: 16%
Not applicable/not necessary: 11%
Administratively difficult: 7%
Planning to conduct drug testing in the future: 2%
Other: 5%

Alcohol Abuse and Productivity
The benefits of workplace alcohol programs are most often summarized in order of greatest benefit as increased productivity, reduced costs, greater employee retention and better morale, job satisfaction, and employee retention. On-the-job alcohol abuse and heavy drinking outside the workplace significantly affect worker productivity as a result of absenteeism, accidents, poor job performance, disability, and premature death.

While it is commonly observed that the vast majority (70 percent-plus) of problem drinkers are employed, it does not follow that most of the negative outcomes are primarily from chronic drinkers. Greater productivity losses may come from occasional alcohol abusers because their numbers are so large. A 2006 national survey indicated that work-related impairment directly affects an estimated 15 percent of the U.S. workforce. From the survey results, it was estimated that 2.3 million workers drink before work, 8.9 million workers drink during work hours, and 11.6 million workers come to work with a hangover.14

There's no substitute for the basics in addressing alcohol abuse in any workplace:

  • Have and enforce an alcohol policy. There is considerable variation in the existence and enforcement of alcohol policies in workplace, in employees' awareness of them, and in their enforcement.
  • Restrict alcohol availability. You might be surprised at how easy is it for employees to bring alcohol into the workplace, to drink at workstations, and to drink during breaks. Late shifts with minimal supervision are even more vulnerable.
  • Good work practices lessen the chances of on-the-job drinking. Workplace stress, boredom, and isolation have been observed to contribute to employee alcohol abuse, as have sexual harassment, verbal abuse, and unprofessional behavior.

Medical Costs
It is well known that heavy alcohol use contributes to many medical problems and increases the chances of unintentional injury both on and off the job. Problem drinking by a family member also can contribute to negative outcomes in the workplace.

American businesses absorb much of the health-related costs of heavy drinking in the form of higher health insurance premiums for employees and their families. In the 2011 DATIA study referenced earlier, 14 percent of organizations reported high workers' compensation incidence rates prior to implementation of drug testing programs, whereas only 6 percent of organizations reported similar rates after implementation, a decrease of better than 50 percent.13

Most states offer workers' compensation discounts in the range of 5 percent to employers upon certification as a drug-free workplace. Progressive insurance companies may offer similar discounts.

A majority of states allow an insurance company to deny workers' compensation benefits to employees who test positive for alcohol (and drugs) following an accident, provided the employer has a workplace substance abuse program in place allowing it to arrange for post-accident testing.

The Morning After: Hangover and Withdrawal
The two main factors behind hangovers are dehydration and the toxic effects of ethanol in the body. Dehydration can be short term, but only time can reverse the toxic effects of alcohol. Alcohol-induced sleep may not be restful and can lead to the fatigue that often accompanies hangover.

It can take up to one hour for the body to rid itself of the alcohol in just one standard drink. A late night of heavy drinking can easily find the reveler in the morning with a BAC over the legal limit. Even modest alcohol impairment combined with a lack of sleep makes for a deadly combination on the road and possibly at work. Early studies into the effects of hangovers on work performance "concluded that hangovers are a significant contributor to job performance problems, yet discussions of alcohol's impact on the workplace rarely recognize the costs of hangovers."15

Hangovers affect cognitive and motor functions. Cognitive problems include poor concentration, possibly leading to slower work speeds, poor judgment, and mistakes. Tiredness and feeling ill frequently lead to sick days, late arrivals, long lunches, early departures, and falling asleep on the job. Employees with alcohol problems are also more likely to spend work time on non-related work activities. Impaired motor skills can cause accidents and injuries, which in safety-sensitive positions can endanger the lives of work associates and the public.

Alcohol misuse is a leading cause of disciplinary procedures.16 In a 2007 UK survey, one-third of workers admitted to being hung over on the job; 15 percent had been drunk at work, and 10 percent reported having a hangover at work at least once per month.17 It is not unusual for employees to admit to having covered for someone suffering from a hangover or correcting mistakes they have made. The "hangover cost" to employers is sustained through reductions in the quantity and quality of work and indirectly through the impact on company morale and job satisfaction.

The Holiday Party
Alcohol at work celebrations can be well-intended but an expensive mistake. In some states, social host laws can find the company responsible if an employee drinks too much at the company social event and then injures himself or another person. Employers also need to be concerned that they may be facilitating sexual harassment.

If you are planning to serve alcohol at a company sponsored event, then follow some basic rules:

  • Check your insurance to see whether it covers third-party liquor liability.
  • Have and enforce a drink limit. Serve food. Have plenty of soft drinks available.
  • Have the party outside the office in premises with licensed servers.
  • Ensure your employees know your alcohol policy and that it covers office parties.
  • Consider limiting drinks to a specific number of pre-issued drink tickets.
  • Arrange for designated drivers or free taxi rides home for any employee desiring or needing such.

Driving Under the Influence
Employers, especially those with large driving fleets, recognize vehicle crashes as the leading cause of occupational fatalities in the United States.18 Contributing factors include fatigue, stress, extended hours, prescription drug use, and alcohol consumption. Employers without fleets and not subject to DOT regulations often perceive a DUI as an "off the job" problem and not part of the employer's business. However, employers often pick up the consequences of DUI in medical costs, work loss, higher insurance, a reduced workforce pool, and concern about the company's reputation.

Opportunities for improvement in this area include:

  • Establish a driver safety program at work. An excellent starting point is the whitepaper "Guidelines for Employers to Reduce Motor Vehicle Crashes," a joint effort by NETS, NHTSA, and OSHA to reduce motor vehicle-related deaths and injuries in the nation's workforce. (
  • Increase employee knowledge of the personal and employer cost of road crashes. Focus on drunk driving because of its large role in on-the-job and off-the-job road crashes.
  • Alcohol and Drug Testing in the United States
    Workplace alcohol and drug testing in the United States has over 20 years of administrative, technical, and legal practice. Internationally, U.S. programs are widely regarded as best in class and often emulated where permitted by local laws and rights. Below are several examples of government attention given to the subject during the past 25 years.

    In 1986, President Ronald Reagan issued the "Drug-Free Federal Workplace" executive order decreeing, "Drug use is having serious adverse effects upon a significant proportion of the national work force and results in billions of dollars of lost productivity each year."19 The order mandated government agencies and certain government contractors to test employees for the use of illegal drugs in safety-sensitive positions. The executive order was followed up with the Drug Free Workplace Act of 1988.

    In 1991, "The Omnibus Transportation Employee Testing Act" required drug and alcohol testing of safety-sensitive transportation employees in aviation, trucking, railroads, mass transit, pipelines, and other transportation industries. These regulations cover all transportation employers, safety-sensitive transportation employees, and service agents.

    OSHA, MSHA, and Working Partners for an Alcohol-and Drug-free Workplace (Working Partners) have signed an alliance to focus on educating construction workers on the safety and productivity hazards created by the abuse of alcohol and other drugs in the workplace.

    Elements of an Alcohol- and Drug-Free Workplace Program
    Today a "Drug-Free Workplace" is characterized by organizations where the employer has specific policies and procedures to make sure employees are not using illegal drugs or under the effect of substances, legal or illegal, during their working hours. The five elements of an effective Drug-Free Workplace are shown here and discussed below.

    Elements of an Alcohol- and Drug-Free Workplace:

    • An alcohol/drug-free workplace policy
    • Supervisor training
    • Employee education
    • An employee assistance program
    • Drug and alcohol testing

    Drug-free workplace Substance Abuse Policy Development
    Don't assume you can adopt a generic policy. Consider your program goals, the unique nature of your work, the environment, and other relevant business conditions in your policy development. A best practice is to develop your policy in consultation with employee and/or union representatives. All employers must ensure that their policies and practices comply with local state and federal laws to avoid penalties.

    There is considerable state to state variation in rules and regulations. Review your policy with a legal consultant, such as a labor attorney. Your policy should address the following:

    • Who will be covered and what is the effective date of the policy?
    • What are the prohibited behaviors and consequences of violation?
    • How will you treat job applicants and current employees?
    • Will you conduct searches and drug/alcohol testing?
    • Who is authorized to enforce the policy?
    • How will you ensure privacy and provide employee assistance?
    • How will the policy be communicated?

    Supervisor Training
    "It's only when employees think their supervisor knows how to detect substance use ... and is willing to do something about it ... that employees' drinking and drug use on the job decreases," according to Michael Frone, Ph.D., senior RIA research scientist and research associate professor of psychology at the University of Buffalo.20 Supervisors can't be expected to do this without the proper training.

    Supervisor training, often referred to as "Reasonable Suspicion" training, can be conducted on site, off site, or via web-based programs that allow supervisors to progress at their own pace. DATIA ( and many of its members offer comprehensive training in this area.

    Supervisor substance abuse training should include the following:

    • The effects of drugs and alcohol in the workplace
    • The supervisor's role and responsibilities in a testing program
    • The drug and alcohol testing process
    • The effects of common drugs and alcohol
    • The physical, behavioral, speech, and performance cues of substance abuse
    • Detailed descriptions and images of prohibited drugs
    • Scenarios and guidance on dealing with an employee suspected to be under the influence
    • Interaction and communication with personnel

    What Supervisors Learn in 'Reasonable Suspicion' Training

    • Understand the key role you play as a supervisor in a drug-free workplace
    • Recognize the signs, symptoms, and effects of the five drugs specifically prohibited by DOT
    • Recognize the signs, symptoms, and effects of alcohol abuse
    • Provide your employees with the information they need to know working in a drug-free workplace
    • Explain the basics of the DOT transportation workplace drug and alcohol testing program
    • Know how, when, and why to take action when an employee is suspected of substance abuse in the workplace

    Employee Assistance Program (EAP)
    EAPs offer professional and confidential counseling to employees on a wide variety of personal concerns, including substance abuse. Costs can be less than $50 per employee per year. Many health plans now provide employee assistance counseling. Through an EAP, businesses demonstrate a commitment to helping employees with substance abuse issues and strengthen their legal positions. Employer savings from EAPs derive from the early contact and treatment they offer troubled employees. Later incidences of absenteeism, employee turnover, and workers' compensation costs are avoided.

    The U.S. Department of Labor reports that for every dollar invested in an EAP, employers generally save anywhere from $5 to $16.21 Most of the published research reports similar positive ROI for EAPs. Testing Alcohol and drug testing is an essential element of a drug-free workplace program. DOT, in support of mandated drug and alcohol testing in the transportation industry, publishes rules on who must conduct drug and alcohol tests, how to conduct these tests, and what procedures to use when testing. Private industry has adopted many of these protocols for its own drug and alcohol testing programs because they are clearly documented, proven in practice, and supported by program administrators.

    For many businesses it will be cost effective to outsource employee testing to companies that specialize in screening and testing services, as well as program management. Considerations for your testing program are:

    • What type of testing will be performed? Options include pre-employment, reasonable suspicion, post-accident, rehabilitation, and random testing. Random testing creates a strong post-hire deterrent.
    • Which substances will you test for? Alcohol most certainly and illegal drugs, as well as prescription drugs, which is a rapidly growing problem.
    • Who will do the testing, where, and how?

    There is no doubt that productivity and health care costs are negatively impacted by both episodic and chronic heavy drinking. The evidence is also compelling that workplace alcohol testing and EAPs reduce the negative outcomes of problem drinking. Common sense also supports the notion that a drug-free workplace is good for employee morale and retention. As with safety, becoming a drug-free workplace requires effective policy, employee training, supervisor vigilance, and culture change. Addressing alcohol-related problems inside and outside of the workplace is good for your workforce and good for your business.

    Recommended for Further Information
    1. "Making Your Workplace Drug Free, a Kit for Employers," Division of Workplace Programs, Center for Substance Abuse Prevention, Substance Abuse and Mental Health Services Administration (SAMHSA).
    2. International Center for Alcohol Policies, ICAP Bluebook, Chapter 22.
    3. Drug Free Workplace Policy Builder, Developing a Policy Statement, United States Department of Labor.
    4. Executive Order 12564 – Drug-free federal Workplace, 1988 Federal Register, National Archives.
    5. The Alcohol Cost Calculator for Business, Ensuring Solutions to Alcohol Problems, The George Washington University Medical Center.
    6. "EAP Buyers Guide," Donald Jorgenson, created for the Employees Assistance Professionals Association, 2005.
    7. Alcohol, Work and Productivity, Scientific opinion of the science group of the European health and Alcohol Forum, September 2011.

    1. Number of fatal work injuries, 1992–2010, U.S. Bureau of Labor Statistics, U.S. Department of Labor, 2012.
    2. Fatality Analysis Reporting System (FARS) online database, National Highway Traffic Safety Administration.
    3. "Excessive Alcohol Use, Addressing a Leading Risk for Death," Chronic disease and Injury, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, 2011.
    4. "Management Perspectives on Alcoholism," by M. Bernstein and J.J. Mahoney, published in Occupational Medicine, 1989.
    5. SAMHSA Analytic Series: A-29. Larson, S. L.; Eyerman, J.; Foster, M.S. and G.froerer, J.C. Worker Substance Use and Workplace Policies and Programs (DHHS Publication No. SMA 07–4273, Analytic Series A–29). Rockville MD: SAMHSA, Office of Applied Studies, 2007.
    6. "Prevalence and distribution of alcohol use and impairment in the workplace: a U.S. national survey," J Stud. Alcohol, M.R. Frone, Research Institute on Addictions, State University of New York at Buffalo, January 2006.
    7. Ibid.
    8. Code of Practice on the Management of Alcohol and Drug Related Issues. International Labor Organization, 1995.
    9. Harwood, H., Updating Estimates of the Economic Costs of Alcohol Abuse in the United States: Estimates, Update Methods, and Data. Report prepared by The Lewin Group for the National Institute on Alcohol and Alcohol, 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. National Institutes of Health, 1998.
    10. Economic Costs of Alcohol and Drug Abuse, National Institutes of Health, 1998.
    11. "The Cost of Substance abuse in Canada 2002," J Rehm et al. March 2006.,%202002.pdf
    12. National institute of Alcohol and Alcoholism National Institute of Health, Harwood, H.; Fountain, D.; and Livermore, G. The Economic Costs of Alcohol and Drug Abuse in the United States 1992. Rockville, MD: National Institute on Drug Abuse, 1998.
    13. "Employee Drug Testing: Study Shows Improved Productivity and Attendance and Decreased Workers' Compensation and Turnover," DATIA, Neil A. Fortner, David M. Martin, S. Evren Esen, and Laura Shelton, 2011.
    14. "Prevalence and Distribution of Alcohol Use and Impairment in the Workplace: A U.S. National Survey," Michael R. Frone, Research Institute on Addictions, State University of New York at Buffalo, 2006.
    15. "The hangover: An ambiguous concept in workplace alcohol policy," Contemporary Drug Problems, R.S. MOORE, 1998.
    16. Institute of Alcohol Studies. "Alcohol and the Workplace" IAS Factsheet, 2009.
    17. Findings from a report compiled from research carried out by Vanson Bourne and YouGov and commissioned by Norwich Union Healthcare, 2007 as reported in Institute of Alcohol Studies. "Alcohol and the Workplace" IAS Factsheet, 2009.
    18. "10 Facts Employers Must Know, for any organization with employees on the roadway," NETS – Network of Employers for Traffic Safety.
    19. "Executive Order 12564-Drug-free Federal workplace," National Archives, Federal Register.
    20. "New Study of Employee Substance Use Shows the Need for Supervisor Training," News Release, March 27, 2012.
    21. U.S. Department of Labor, What Works: Workplaces without Drugs, 1990.

  • This article originally appeared in the October 2012 issue of Occupational Health & Safety.

    About the Author

    Barry Knott is president and CEO of Lifeloc Technologies (, a trusted U.S. manufacturer of DOT-approved breath alcohol testing instruments for mandated and non-mandated workplace alcohol testing and a provider of on-site and web-based substance abuse training programs. He is also on the board of directors of DATIA, the Drug and Alcohol Testing Industry Association, whose mission is to provide education, resources, and advocacy to those involved in and interested in drug and alcohol testing.

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