UNDER THE INFLUENCE?

DRUGS AND THE AMERICAN WORK FORCE

Jacques Normand, Richard O. Lempert, and Charles P. O'Brien, editors

Committee on Drug Use in the Workplace

Commission on Behavioral and Social Sciences and Education

National Research Council/Institute of Medicine

NATIONAL ACADEMY PRESS
Washington, D.C.
1994



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Under the Influence? Drugs and the American Work Force UNDER THE INFLUENCE? DRUGS AND THE AMERICAN WORK FORCE Jacques Normand, Richard O. Lempert, and Charles P. O'Brien, editors Committee on Drug Use in the Workplace Commission on Behavioral and Social Sciences and Education National Research Council/Institute of Medicine NATIONAL ACADEMY PRESS Washington, D.C. 1994

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Under the Influence? Drugs and the American Work Force 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 Sciences, 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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Under the Influence? Drugs and the American Work Force 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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Under the Influence? Drugs and the American Work Force 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 scientific and engineering communities. The Council is administered jointly by 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.

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Under the Influence? Drugs and the American Work Force Contents PREFACE   vii SUMMARY: CONCLUSIONS AND RECOMMENDATIONS     1   INTRODUCTION   15 PART I: SCOPE OF ALCOHOL AND OTHER DRUG USE     2   ETIOLOGY OF ALCOHOL AND OTHER DRUG USE: AN OVERVIEW OF POTENTIAL CAUSES   29 3   EPIDEMIOLOGICAL EVIDENCE: THE DIMENSIONS OF THE PROBLEM   49 PART II: EFFECTS OF USE     4   IMPACT OF ALCOHOL AND OTHER DRUG USE: LABORATORY STUDIES   107 5   IMPACT OF ALCOHOL AND OTHER DRUG USE: OBSERVATIONAL/FIELD STUDIES   129

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Under the Influence? Drugs and the American Work Force PART III: EFFECTIVENESS OF WORKPLACE INTERVENTIONS     6   DETECTING AND ASSESSING ALCOHOL AND OTHER DRUG USE   177 7   IMPACT OF DRUG-TESTING PROGRAMS ON PRODUCTIVITY   215 8   EMPLOYEE ASSISTANCE PROGRAMS   241 APPENDIXES     A   METHODOLOGICAL ISSUES   271 B   THE LEGAL ENVIRONMENT OF DRUG TESTING   284 C   BIOGRAPHICAL SKETCHES   302 INDEX   313

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Under the Influence? Drugs and the American Work Force 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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Under the Influence? Drugs and the American Work Force 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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Under the Influence? Drugs and the American Work Force 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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