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Substance abuse is a major problem in the United States and therefore a major problem in the US workforce. More than 42 million binge drinkers, 11.5 million heavy drinkers, and 13 million illicit drug users are employed in the United States. Nearly 10 million adult US workers meet the diagnostic criteria for substance use disorders. Alcohol is the most widely abused substance; whereas marijuana and opioid analgesics are the most widely used illicit drugs. The cost of substance abuse in the United States is staggering. Most of these costs are due to lost productivity, including $161 ­billion of lost productivity due to alcohol and $120 billion due to illicit drugs.

A large majority of people with substance abuse ­problems are employed and bring their substance abuse into the workplace in a variety of ways. It is estimated that 1.7% of workers are under the influence of alcohol while at work, and over 9% are working with a hangover from alcohol. The majority of workers report that they could easily bring alcohol into work, use alcohol while working, use alcohol during lunch and other breaks, or obtain alcohol at work. The majority of workers also report that they could easily engage in the same behaviors with illicit drugs.

Substance use disorders cause absenteeism, safety ­problems, poor-quality workmanship, friction with coworkers, and liability to the organization. Behavioral problems, including unscheduled absences, unsafe actions, and ­irritability, create a strain between substance abusers and their coworkers, supervisors, and customers. Erratic and unsafe work practices while under the influence may expose the organization (and the public) to significant liability, such as the cases of the Exxon Valdez or the Staten Island Ferry crash.

Dealing with substance abuse in the workplace is a challenge for occupational physicians, requiring special knowledge of the diagnosis and treatment of substance use disorders, the clinical presentation of substance abuse syndromes as they appear in the workplace, the pharmacologic and legal aspects of alcohol and drug testing, and the legal aspects of patient confidentiality and reporting requirements. Health and safety professionals should consult with management to develop an approach in the workplace that places an emphasis on prevention of substance-related problems. Occupational physicians should consult with and refer worker patients to psychiatrists who are experienced in substance abuse and are willing to participate in an industry program. Occupational physicians play an important role when working with personal physicians to identify, diagnose, and effectively treat substance-abusing employees.

The workplace offers advantages as a setting for interventions that result in primary prevention of alcohol and drug abuse. Such programs have the potential to reach broad audiences and populations that would otherwise not receive prevention programs and, thereby, benefit both the employee and employer. A wide variety of workplace alcohol and drug use prevention efforts have been instituted in recent years, including programs focused on health promotion, social health promotion, brief interventions, and ...

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