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).
Workplace Culture. 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
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
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.