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editors
Washington, D.C. 1994
UNDER THE
INFLUENCE?
NATIONAL ACADEMY PRESS
Committee on Drug Use in the Workplace
National Research Council/Institute of Medicine
DRUGS AND THE AMERICAN WORK FORCE
Commission on Behavioral and Social Sciences and Education
Jacques Normand, Richard O. Lempert, and Charles P. O'Brien,
i
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ii
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NATIONAL ACADEMY PRESS 2101 Constitution Avenue, N.W. Washington, D.C. 20418
NOTICE: The project that is the subject of this report was approved by the Governing Board of the
National Research Council, whose members are drawn from the councils of the National Academy
of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of
the committee responsible for the report were chosen for their special competences and with regard
for appropriate balance.
This report has been reviewed by a group other than the authors according to procedures
approved by a Report Review Committee consisting of members of the National Academy of Sci-
ences, the National Academy of Engineering, and the Institute of Medicine.
This study was supported by the National Institute on Drug Abuse, U.S. Department of Health
and Human Services, under Contract No. 271-90-8203.
Library of Congress Cataloging-in-Publication Data
Under the influence? : drugs and the American work force / Jacques Normand, Richard O. Lempert,
and Charles P. O’Brien, editors.
p. cm.
Includes bibliographical references and index.
ISBN 0-309-04885-0
1. Drugs and employment—United States. 2. Alcoholism and employment—United
States. 3. Employee assistance programs—United States. I. Normand, Jacques, 1954- .
II. Lempert, Richard O. III. O’Brien, Charles P.
HF5549.5.D7U53 1994
658.3'822—dc20 93-44292
CIP
Copyright 1994 by the National Academy of Sciences. All rights reserved.
Printed in the United States of America
Cover: Steelworkers at lunch more than 800 feet above street level during construction of the
RCA building in Rockefeller Center, New York City, September 29, 1932. From UPI/
Bettmann.
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iii
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COMMITTEE ON DRUG USE IN THE WORKPLACE
CHARLES P. O'BRIEN (Chair), Veterans Affairs Medical Center, University
of Pennsylvania
TERRY C. BLUM, Ivan Allen College of Management, Policy and
International Affairs, Georgia Institute of Technology
ROBERT M. BRAY, Center for Social Research and Policy Analysis, Research
Triangle Institute
JAMES H. DWYER, Department of Preventive Medicine, University of
Southern California School of Medicine
BRYAN S. FINKLE, Center for Human Toxicology, University of Utah
MARIAN W. FISCHMAN, Substance Use Research Center, Columbia
University
BRADLEY K. GOOGINS, School of Social Work, Boston University
DANIEL LANIER, JR., School of Social Work, Florida State University
WAYNE E.K. LEHMAN, Institute of Behavioral Research, Texas Christian
University
RICHARD O. LEMPERT, School of Law, University of Michigan
COLLINS E. LEWIS, Washington University Medical Center, St. Louis
JEFFREY A. MIRON, Department of Economics, Boston University
KEVIN R. MURPHY, Department of Psychology, Colorado State University
MICHAEL D. NEWCOMB, School of Education, University of Southern
California, and Department of Psychology, University of California, Los
Angeles
PATRICK M. O'MALLEY, Institute for Social Research, University of Michigan
ADRIAN M. OSTFELD, School of Medicine, Yale University
ANDREW M. WEISS, Department of Economics, Boston University
M. DONALD WHORTON, ENSR Health Sciences, Alameda, California
JACQUES NORMAND, Study Director
ELAINE MCGARRAUGH, Research Associate
CAREY O. GELLMAN, Administrative Assistant
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The National Academy of Sciences is a private, nonprofit, self-
perpetuating society of distinguished scholars engaged in scientific and
engineering research, dedicated to the furtherance of science and technology
and to their use for the general welfare. Upon the authority of the charter
granted to it by the Congress in 1863, the Academy has a mandate that requires
it to advise the federal government on scientific and technical matters. Dr.
Bruce M. Alberts is president of the National Academy of Sciences.
The National Academy of Engineering was established in 1964, under
the charter of the National Academy of Sciences, as a parallel organization of
outstanding engineers. It is autonomous in its administration and in the selection
of its members, sharing with the National Academy of Sciences the
responsibility for advising the federal government. The National Academy of
Engineering also sponsors engineering programs aimed at meeting national
needs, encourages education and research, and recognizes the superior
achievements of engineers. Dr. Robert M. White is president of the National
Academy of Engineering.
The Institute of Medicine was established in 1970 by the National
Academy of Sciences to secure the services of eminent members of appropriate
professions in the examination of policy matters pertaining to the health of the
public. The Institute acts under the responsibility given to the National
Academy of Sciences by its congressional charter to be an adviser to the federal
government and, upon its own initiative, to identify issues of medical care,
research, and education. Dr. Kenneth I. Shine is president of the Institute of
Medicine.
The National Research Council was organized by the National Academy
of Sciences in 1916 to associate the broad community of science and
technology with the Academy's purposes of furthering knowledge and advising
the federal government. Functioning in accordance with general policies
determined by the Academy, the Council has become the principal operating
agency of both the National Academy of Sciences and the National Academy of
Engineering in providing services to the government, the public, and the
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both Academies and the Institute of Medicine. Dr. Bruce M. Alberts and Dr.
Robert M. White are chairman and vice chairman, respectively, of the National
Research Council.
www.national-academies.org
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retained, and some typographic errors may have been accidentally inserted. Please use the print version of this publication as the authoritative version for attribution. CONTENTS
5
4
3
2
1
PART I:
PART II:
TIONS
PREFACE
INTRODUCTION
EFFECTS OF USE
Contents
LABORATORY STUDIES
SIONS OF THE PROBLEM
OBSERVATIONAL/FIELD STUDIES
ETIOLOGY OF ALCOHOL AND OTHER DRUG
EPIDEMIOLOGICAL EVIDENCE: THE DIMEN-
SCOPE OF ALCOHOL AND OTHER DRUG USE
SUMMARY: CONCLUSIONS AND RECOMMENDA-
IMPACT OF ALCOHOL AND OTHER DRUG USE:
IMPACT OF ALCOHOL AND OTHER DRUG USE:
USE: AN OVERVIEW OF POTENTIAL CAUSES
129
107
49
29
15
1
vii
v
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C
B
8
7
6
A
PART III:
INDEX
TIONS
APPENDIXES
PRODUCTIVITY
OTHER DRUG USE
BIOGRAPHICAL SKETCHES
METHODOLOGICAL ISSUES
EMPLOYEE ASSISTANCE PROGRAMS
IMPACT OF DRUG-TESTING PROGRAMS ON
DETECTING AND ASSESSING ALCOHOL AND
EFFECTIVENESS OF WORKPLACE INTERVEN-
THE LEGAL ENVIRONMENT OF DRUG TESTING
313
302
284
271
241
215
177
vi
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PREFACE vii
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Preface
The Committee on Drug Use in the Workplace was assembled in spring
1991 by the Commission on Behavioral and Social Sciences and Education of
the National Research Council (NRC) and the Division of Health Promotion
and Disease Prevention of the Institute of Medicine (IOM). The sponsor, the
National Institute on Drug Abuse (NIDA), asked the NRC-IOM to gather and
analyze the extant scientific knowledge on the prevalence and etiology of drug
consumption by the U.S. work force, the impact of drug use on work
performance, and the effectiveness of work site prevention and treatment
programs. NIDA also requested that the committee provide, on the basis of its
assessment of the available scientific evidence, recommendations for future
research directions.
After carefully reviewing its charge, the committee adopted a more
expansive yet explicit view of its task—a view that is reflected in the title of
this volume: Under the Influence? Drugs and the American Work Force. To
limit its examination to drug use in the workplace, if taken literally, would
exclude issues the committee felt were germane to its charge. That is, the use of
drugs away from the work site, hangover effects, and withdrawal effects—as
well as use by those who are not currently employed but who are available for
employment (e.g., job applicants)—are viewed as important issues that
warranted the committee's attention. In addition, we make it clear throughout
the report that our definition of drug use includes the use of alcohol.
Another point that should be clear at the outset relates to the committee's
perspective in assessing workplace drug use research. This report is concerned
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PREFACE viii
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with the implications of drug use for workplace productivity; it does not focus
on the broader public health perspective. This emphasis on workplace outcomes
rather than social consequences allowed the committee to focus on the issues
specified in its charge.
Another matter that became apparent early in the committee's work was
the need to concentrate on specific research areas. In an effort to provide a
meaningful assessment of the scientific work performed to date, and given the
diverse areas of drug use research that could feasibly be integrated into its
report, the committee decided to rely primarily on the research literature that
targets the work force as the population to be studied. In delineating the
research areas for review, the committee focused on: (1) the etiology and
epidemiology of alcohol and other drug use, (2) the impact of alcohol and other
drug use on job-related behavior, and (3) the effectiveness of organizational
drug intervention programs, with special emphasis on drug-testing programs.
Although our review concentrates on the workplace literature, of necessity it
relies from time to time on other research to address relevant issues. For
example, epidemiological work on drug use abounds, but few surveys have
been concerned with obtaining accurate estimates of the prevalence and trends
of drug use by U.S. workers. Therefore, in the discussion of the epidemiological
data, the report supplements work-force data with additional sources to better
answer specific questions.
The committee wishes to acknowledge that ethical issues—including
conflict of interest, confidentiality, fairness, and other concerns—have
significant bearing on the work of occupational medicine practitioners, drug
abuse professionals, personnel selection specialists, and a range of other human
resources experts. Although the committee's charge and expertise precluded an
in-depth treatment of these issues, a cursory discussion of ethics as it relates to
drug testing is included in Appendix B of this report.
This report was written during a period of change in workplace policies
toward alcohol and other drug abuse and change in the rate of their use in
society, as well as during a period when the responsibility for medical care of
substance abusers is being debated in the context of a national health care
system. The report thus represents a 1993 snapshot of a complex picture in a
state of flux.
During the course of this investigation, the committee was assisted by a
number of individuals who took time to share their insights and expertise. On
behalf of the committee, we extend sincere thanks and appreciation to those
who volunteered to participate in the workshop the committee held on July 20,
1992: Joseph M. Cannella, Mobil Oil; Peter J. Eide, U.S. Chamber of
Commerce; Roberta C. Mayer, National Highway Traffic Safety
Administration; Vernon McDougall, International Brotherhood of Teamsters;
Joel E. Miller, Health Insurance Association of America; John S. Oates,
National Highway Traffic Safety Administration; Robert M. Tobias, National
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PREFACE ix
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Treasury Employee Union; and Ellen Weber, Legal Action Center. The
committee also thanks Linda Kearney of the NRC and Dennis Crouch of the
Center for Human Toxicology for their valuable assistance early in this project.
Steven Gust and Linda Thomas of NIDA were critical in the successful
completion of this complex undertaking.
This report is the collective product of the committee, and its contents
reflect its deliberations. The committee is particularly indebted to one member,
Richard O. Lempert, whose contributions of time, energy, and expertise to the
crafting of the report were indeed extraordinary. In addition, Mary Ellen
Marsden of Brandeis University and James W. Luckey of the Research Triangle
Institute contributed substantially to the chapter on epidemiological evidence.
To assist the committee further, several individuals were commissioned to
provide background materials: Richard W. Foltin and Suzette M. Evans of the
Substance Use Research Center, Columbia University; Michael T. French of
Research Triangle Institute; Andrea Foote and John C. Erfurt of the University
of Michigan; David Wasserman of the Institute for Philosophy and Public
Policy, University of Maryland; and James Jacobs of New York University,
School of Law.
The committee also benefited from the dedication and quality of the NRC
and IOM staffs. These included Suzanne Woolsey, Suzanne Stoiber, Rob
Coppock, Gary Ellis, and Michael Stoto, who provided valuable insights and
suggestions throughout the course of this study. Christine McShane and
Eugenia Grohman provided constructive assistance through technical editorial
work and coordination of the review, editing, and production processes of this
report. Finally, special thanks are due to the committee staff. Carey Gellman,
administrative assistant, coordinated all of our meetings, planned the workshop
sessions, updated successive drafts of the report, kept track of the work flow,
and generally kept our work team organized. Elaine McGarraugh, research
associate, gathered and analyzed research materials, edited numerous drafts of
the report, and was instrumental in preparing the report for production. The
efforts of these talented people ensured the successful completion of this project.
Charles P. O'Brien, Chair
Jacques Normand, Study Director
Committee on Drug Use in the Workplace
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x
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UNDER THE INFLUENCE?
xi
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