Drug Abuse and Workforce Demographics
According to the most recent Household Survey in 1998, almost 75% of adults (age 18 and up) who reported current illicit drug use (at least once in the past month) are employed, either full or part-time—this number represents more than 8.5 million individuals.
The 8.5+ million workers reporting current illicit drug use represent 6.4% of the 1998 adult workforce. Similarly, 7.8% of the adult workforce reported heavy drinking (5 or more drinks on 5 or more occasions in the past month).
Among employed adults, the highest rates of current drug use and heavy drinking are reported by white, non-Hispanic males, 18-25 years old, with less than a high school education. By occupation, the highest rates of current drug use and heavy drinking were reported by those employed as food preparation workers, waiters, waitresses and bartenders (19%), construction workers (14%), other service occupations (13%) and transportation and material moving workers (10%).
A 1999 SAMSHA study reveals workers reporting current drug use were more likely to have worked for three or more employers, to have voluntarily left an employer in the past year, and skipped one or more days of work in the past month. Employees in three of four occupations reporting significantly lower rates of current drug use and heavy drinking (protective services; extraction and precision productions; electronic equipment assemblers; and administrative support) were employed in those occupations identified with the highest rates of drug information and policies in the workplace.
About one-half of young adults ages 16-17, work during the year. Those working more than 20 hours per week are at high risk for substance abuse and injury. Barry McCaffrey, Office of National Drug Control Policy Director, cautioned that employers will need to be vigilant regarding the next generation of workers. There are signs that youth aged 12 to 17 years use gateway substances—a predictor of future substance abuse—at disturbingly high rates. The number of workers ages 16 – 24 will increase by more than 3 million between 1998 and 2008, making this group the largest it has been in 20 years.
In 1998, 18.2% of unemployed adults (18 and over) reported current drug use a substantial increase over the 1997 rate of 13.8%. 10.8% of this group reported heavy drinking, slightly higher than the 10.1% rate reported in 1997.
Drug-free Workplace Programs: Successes and Future Challenges
Available research demonstrates that comprehensive workplace prevention programs which include: 1) education for workers and training for supervisors; 2) equitable, reliable drug testing; and 3) access to assistance and treatment services can successfully reduce worker substance abuse and improve health, safety, and worksite productivity. Workplaces provide an ideal opportunity to influence individual behavior and community norms. Clear and consistent substance abuse policies and drug education efforts create an aware and informed workforce, can significantly reduce drug and alcohol abuse in workplaces, and reach the families of employees and the communities where they live.
Since 1986, the Federal government has mandated a comprehensive drug-free workplace program for all Federal workers. Implemented in 120 agencies, this model program covers approximately 1.8 million employees. In 1997, the most recent positive drug test rates available, the rate of positive test results for Federal job applicants and employees in designated testing positions (numbering approximately 80,000), was 0.5%; or one-tenth of the 5% positive rate of approximately 4 million tests conducted in 1997 by the largest private sector workplace testing laboratory in the US. As the nation’s largest employer, the Federal program continues to provide leadership by example. In June 1999, President Clinton took another historic step forward to ensuring a drug-free federal workforce by issuing an Executive Order directing the Federal Employees Health Benefit Program, the nation’s largest health insurance plan, to provide full coverage for substance abuse treatment, equal to any other medical condition, by the year 2001.
According to the semi-annual Drug Test Index©, the national rate of positive drug test results among private-sector workers has declined 65% over the past decade, from a high of 13.6% in 1988 to a low of 4.7% for the first 6 months of 1999.(See chart below)
Further data from the 1999 Drug Testing Index© illustrates drug test positivity trends rates among three major testing populations: federally mandated, safety-sensitive workers; the general workforce; and the combined U.S. workforce. Rates of use for cocaine and opiates, showed declines as a percentage of all positive test results. Cocaine use made up 16% of all positive results in the first half of 1999, down from 18% for 1998. The opiate positive test rate declined by almost half from 1998, as predicted following a raise in the federally mandated opiate cut-off level, from 300 to 2000 nanograms per milliliter in December, 1998. This change reduced the number of “false positive” test results due to certain prescription and over-the-counter medications or certain foods, such as poppy seeds. Positive marijuana test results increased nearly 4% as a percentage of all positive results to 63%.
Nearly 2% of positive results in the 1999 Drug Testing Index© showed clear evidence of substances used to adulterate or compromise specimen test results. More specimens tested positive for adulterants and substituted specimens than for either opiates or amphetamines. After initiating adulterant and substituted-specimen testing in April, 1998, the following year Quest expanded adulterant testing to include the oxidizing adulterants, bleach and pyridinium chlorochromate. Oxidizing adulterants, which include nitrites, are used as masking agents in an attempt to defeat the process of detecting drug use.
A 1999 SAMHSA study of workplace substance abuse revealed that the percentage of workers who said they had been provided information, who were aware of written policies regarding drug and alcohol use, or whose workplace provided access to an Employee Assistance Program (EAP) increased with establishment size. Only 27% of workers in small businesses reported having access to an EAP, compared to 61% of workers in mid-size and 75% of workers in large establishments reported that their workplace had EAP programs. Larger workforces were far more likely to have incorporated a comprehensive drug-free workplace program (including a formal policy, employee education, access to an EAP and drug testing) which has resulted in approximately 50% lower positive drug test rates, and 75% fewer self-reports of current drug use among workers compared to smaller worksites (1-24 employees). Workers in small establishments reporting current illicit drug use were less likely to be employed in workplaces with a written policy.
A study released in December 1995, conducted by Houston’s Drug-Free Business Initiative, in collaboration with the University of Houston demonstrated that workplace drug testing reduces injuries and workers’ compensation claims in the workplace. The study found that companies engaged in random drug testing in combination with pre-employment testing reduced their mean workers’ compensation claims per 100 employees per year by 63.7% over a 4-year period while the “control group” of employers (employers not conducting drug testing), experienced a 19% increase during that same time period. The study also found that well over half of the responding employers believed that the benefits of drug testing outweighed the cost and just under half felt that the benefits of an EAP outweighed the cost. When asked to select one strategy over the other, 40.6% of the respondents stated that it was more important to conduct drug testing than have an EAP, while only 7.8% thought it was more important to have an EAP than to test. However, 51.6% thought drug testing and EAPs were of equal importance.
In 1990, problems resulting from alcohol and other drugs use cost American businesses an estimated $81.6 billion in lost productivity due to premature death (37 billion) and illness (44 billion); 86% of these combined costs were attributed to drinking. In 1991, the reported cost of drug abuse to the United States business community was $75 billion annually.
Workplace safety is the most common reason given by employers for drug testing. In 1997, approximately 25% of workers reported having a drug testing policy in their workplaces. Of those employers implementing testing, the majority has adopted urine drug screening as the preferred methodology. In 1997, pre-employment testing was the most common type of testing reported by workers (39%), followed by reasonable suspicion testing (30%), post-accident (29%) and random testing (25%). In addition, current drug users indicate they are far less likely to apply for a job where they know that pre-employment or random drug testing is used.
Results of an extensive U.S. Postal Service study indicate that employees who tested positive on their pre-employment drug test were 77% more likely to be discharged within the first three years of employment, and were absent from work 66% more often than those who tested negative. Had the U.S. Postal Service screened out all drug positive postal service applicants in 1987, the authors estimated this would have saved approximately $52 million by 1989.
According to the American Management Association’s annual Survey on Workplace Drug Testing and Drug Abuse Policies, workplace drug testing has increased by more than 1,200% since 1987. More than 81% of businesses surveyed in 1996 were conducting some form of applicant or employee drug testing. Likewise, the perceived effectiveness of drug testing, as assessed by human resources managers, has increased from 50% in 1987 to 90% in 1996.
Testing for the right reasons has the support of most employees and there is some evidence that drug testing helps prevent illicit drug use. A 1995 Gallup poll of employees found 97% in agreement that workplace drug testing is appropriate under certain circumstances; 85% believed that urine testing may deter illicit drug use.
Referrals to treatment for drug and alcohol abuse and support for employees to change drug use behavior are key. Employee Assistance Programs (EAPs) are increasingly being used by employers to provide a gateway to substance abuse treatment, and reflect cost differences related to the quantity and qualities of services, the size and type of industry and region of the United States. (1995 mean cost per employee $22.19).
Employee assistance programs (EAPs) are growing in popularity in all types of U.S. worksites, according to a 1996 study. In 1993, 1/3 of private, nonagricultural worksites with 50 or more employees had an EAP, a significant increase over the numbers shown in similar studies in 1988 and 1990. Most employers surveyed, especially those with 50 to 99 employees, had implemented an EAP in the 5 years preceding the study. Compared to 1988 results, most of this growth was in external programs: 81% of EAP services in 1993 were provided by external contractors, and 83% at a location outside the workplace. Larger worksites (more than 1000 workers) and certain industries (communications, transportation, finance, realty) were more likely to have an EAP. Demographic findings revealed a greater likelihood of an EAP in workplaces where employees were unionized and relatively more educated, and where there were relatively low numbers of visible minority workers. Geography had no impact on the existence of a program, but program costs did vary regionally, with a median annual cost per employee of just under $22 for internal programs and of $18 for external programs. Based on their survey results, the authors conclude that EAPs will continue to grow in importance, and that health care professionals working in the areas of substance abuse and emotional health will continue to get numerous referrals of clients who have passed through the EAP process. Consequently, research into the costs, characteristics, and results of EAPs will continue to be important. Aiding troubled employees: prevalence, cost, and characteristics of employee assistance programs in the United States. Hartwell, Tyler D. American Journal of Public Health, 86(6): 804-808, 1996.
The Costs to Employers of Substance Abuse Treatment
On average, full parity for substance abuse services is estimated to increase health care premiums by 0.2% based on an updated actuarial model. This translates to approximately $1 per month for most families. Health maintenance organizations and other mechanisms that tightly manage care would have a premium increase of only 0.6% for full parity for both mental health and substance abuse services.
A study of employer-sponsored health plans with “substance abuse” carve-outs (a type of plan that administers mental health and substance abuse care separately from health care) shows removing an annual limit of $10,000 on substance abuse care would increase costs by 6 cents per member per year, and removing an annual limit of $1,000 on substance abuse care would increase costs by about $3.40. Thus, separating substance abuse care from mental health care does not provide substantial cost savings, and may impede coordination of treatment; a significant concern for clients dually diagnosed with mental health and substance abuse problems. An additional negative effect of inadequate substance abuse treatment coverage is the likelihood that clients will leave or discontinue substance abuse treatment early, thus lowering positive outcomes.
In remarks delivered on September 8, 1999, Retired Gen. Barry McCaffrey, ONDCP Director said, “Recovery Month is an important opportunity to highlight the need for greater access to comprehensive workplace drug-free programs that include access to drug treatment. 70% of drug users are employed full time. Workplace drug treatment is a critical way to reach those who need help. The typical drug abuser is not poor and unemployed. He or she can be a co-worker, a husband or wife, a parent.” McCaffrey continued, “We need parity for substance abuse in insurance coverage, where drug treatment is covered at the same benefit level as other chronic relapsing disorders. The Federal government has taken an historic step-the Federal Employees Health Benefits Program will offer parity for mental health and substance abuse coverage by 2001. This is a sound business investment, good drug control policy, and good health policy. We urge other employers to similarly provide parity for their workers.”
Source: White House Office of National Drug Control Policy, 8/24/2001