I
SCOPE OF ALCOHOL AND OTHER DRUG USE



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Under the Influence? Drugs and the American Work Force I SCOPE OF ALCOHOL AND OTHER DRUG USE

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Under the Influence? Drugs and the American Work Force This page in the original is blank.

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Under the Influence? Drugs and the American Work Force 2 Etiology of Alcohol and Other Drug Use: An Overview of Potential Causes The underlying causes of alcohol and other drug use and abuse are many, varied, and not well understood. Hundreds of variables have been studied as potential predictors of the onset of alcohol and other drug use. While most alcohol and other drug use initiation occurs with friends or peers who are also using drugs, the stage for this event has been set much earlier by parents, the community, and society. OVERVIEW This chapter provides some insight into the causes of alcohol and other drug use and proceeds to focus on the potentially different causes of off-and on-the-job alcohol and other drug use. Finally, it examines the potential influence of environmental factors on workers' alcohol and other drug use. The individual and social influences that have been investigated can be classified into four categories: (1) the cultural/societal environment, (2) the immediate community, (3) interpersonal forces such as school, peers, and family, and (4) individual factors, including genetics, personality, and attitudes. An individual can be considered ''at risk" because of factors or forces within each of these areas. Considerable theoretical and empirical attention has been devoted to each of these possible influences (e.g., Glantz and Pickens, 1992; Galizio and Maisto, 1985; Lettieri, 1985; Lettieri et al., 1980). Hawkins et al. (1992) reviewed the possible risk factors for youth-

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Under the Influence? Drugs and the American Work Force TABLE 2.1 Summary of Risk Factors for Drug Use Domain Risk Factor Culture and Society Laws favorable to drug use Social norms favorable to drug use Availability of drugs Extreme economic deprivations Neighborhood disorganization Interpersonal Family use Positive family attitudes toward drug use Poor/inconsistent family management practices Family conflict and disruption Peer rejection Association with drug-using peers Psychobehavioral Early/persistent problem behavior Academic failure Low commitment to school Alienation Rebelliousness Favorable attitudes toward drug use Early onset of drug use Biogenetics Inherited susceptibility to drug use Psychophysiological vulnerability to drug effects   SOURCE: Adapted from Hawkins et al. (1992). ful alcohol and other drug use and identified 20 potential causes reflecting the 4 general areas listed above (see Table 2.1). Cultural/societal factors include laws and norms favorable to drug use, the availability of drugs, extreme economic deprivation, and neighborhood disorganization. Interpersonal factors include family alcohol and drug use behavior and attitudes, poor and inconsistent family management practices, family conflict, peer rejection in elementary grades, and association with drug-using peers. Psychobehavioral influences include early and persistent problem behaviors, academic failure, a low degree of commitment to school, alienation and rebelliousness, attitudes favorable to drug use, and early onset of drug use. And biogenetic factors include the possible heritability of a vulnerability to drug abuse and a psychophysiological susceptibility to the effects of drugs. In a comprehensive review of the "risk factor" literature, Clayton (1992) provides a tabulation of the primary topologies and concludes that there is an emergent consensus on the most important risk factors for drug use and abuse.

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Under the Influence? Drugs and the American Work Force Within the behavioral sciences it is often stated that the best predictor of future behavior is past behavior. The study of alcohol and other drug use behavior is no exception to this rule. For any given individual, the strongest predictor of current use is past use. Other potential predictors are relatively more important in predicting the initiation of use or the progression of alcohol and other drug abuse. If, however, the question is whether a particular individual is likely to use or abuse drugs in the future, the individual's past history of use and abuse will tell us more about future prospects than the incremental contributions of other variables related to alcohol and other drug use. The risk for initiating alcohol and other drug use increases for most drugs to a peak during mid-to late adolescence and decreases thereafter (Kandel and Logan, 1984). Tobacco has the youngest age of highest vulnerability, usually in early adolescence. Increased likelihood for beginning alcohol, marijuana, and psychedelics typically occurs in mid-adolescence. Interestingly, the most hazardous age for experimenting with cocaine has typically been young adulthood—about the mid-twenties; however, this pattern for cocaine may be changing due to the emergence of crack, the inexpensive and smokable form of cocaine, which may be more available and alluring to teenagers. Some types of alcohol and other drug abuse appear to have a genetic component (Cadoret, 1992; Merikangas et al., 1992; Vaillant and Milofsky, 1982), although environmental, social, and psychological factors have received primary attention as causes of the initiation of alcohol and other drug use and progression to abuse (e.g., Sadava, 1987; Zucker and Gomberg, 1986). Attention to the latter factors is appropriate, for biogenetic influences are shaped and modified by personal attributes and environmental conditions (e.g., Marlatt et al., 1988). An important question concerns what precisely is inherited if there is a genetic influence for alcoholism or other drug abuse. Research evidence, primarily but not exclusively based on animal models, suggests at least two mechanisms (e.g., Bardo and Risner, 1985). Those at genetic risk for alcohol and other drug abuse may inherit a biological vulnerability to the hedonic effects of the drug, so for them drug effects are more attractive than for others. They may also not experience the withdrawal effects as severely as those not at risk (i.e., less likelihood of hangover). However, these proposed mechanisms and perhaps others (e.g., inherited behavioral traits; Tarter, 1988) must be evaluated more conclusively in further research (Schuckit, 1987). Some have suggested that involvement with alcohol and other drugs progresses in a fixed sequence, moving from licit drugs to illicit substances (e.g., Kandel, 1975; Kandel and Faust, 1975). An individual's drug-using career might start with beer, wine, or cigarettes, move to hard liquor, then to marijuana, and subsequently to other illicit drugs, such as amphetamines,

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Under the Influence? Drugs and the American Work Force cocaine, and heroin. Desistance may occur at any point (O'Donnell and Clayton, 1982), meaning that involvement at one stage does not necessarily lead to involvement at the next stage, but rather that involvement at the next stage is unlikely without prior involvement in the previous stage. Results in various cross-sectional and longitudinal studies have generally confirmed the stage hypothesis with some variations (e.g., Hays et al., 1987; Mills and Noyes, 1984; Newcomb and Bentler, 1986a). Donovan and Jessor (1983), for example, found that problem drinking occurred higher in the progression than general alcohol use, and Newcomb and Bentler (1986a) found that, when the role of cigarettes and nonprescription medications was included, several mini-sequences accounted for drug involvement from early adolescence to young adulthood. Social factors that determine the availability and the attractiveness of alcohol and other drugs to particular individuals are important to this progression, and highly addictive drugs, such as crack cocaine, may alter this sequence of drug progression. Thus it may be that the severe addictive potential and wide and inexpensive availability of crack may lead to its being used earlier in the sequence than other less addictive illicit drugs or even licit drugs. There are, however, few data currently available to test this notion. The mechanism that drives staging, such as availability, anxiety reduction, peer groups norms, and physiological vulnerability, are not known, but these factors may not be the same at all stages. Peer group norms, for example, might be of vital importance to initiation, while individual psychopathology may figure more in shifts toward the end of the involvement sequence. Some research suggests that the reasons people begin using alcohol and other drugs are different from the reasons they continue or escalate their use, which is to say, the factors that influence initiation are different from those that influence progression to more serious use. Several researchers have found that initiation is often strongly tied to social and peer influences, whereas biological and psychological processes appear to be associated with abuse (Carman, 1979; Kandel et al., 1978; Newcomb and Bentler, 1990; Paton et al., 1977). Even though data may as yet be too sparse to establish firmly that the causes of use are different from the causes of abuse, the evidence consistent with this hypothesis is accumulating (Glantz and Pickens, 1992). A wide range of correlates with the initiation of alcohol and other drug use have been identified. They tend to overlap substantially with predictors of general problem behavior or deviance, which is not surprising given the correlation of other problem behaviors with alcohol and other drug use. The primary mechanism for establishing unique predictors of alcohol and other drug use has been longitudinal studies, controlling statistically for other deviant behaviors and attitudes using structural equation modeling

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Under the Influence? Drugs and the American Work Force methods (Bentler, 1980; Newcomb, 1990). These studies suggest that peer influences (such as modeling use, providing drugs, and encouraging use) are the most consistent and strongest predictors. In addition to the role of prior behavioral experience with alcohol and other drugs and peer influences, other factors associated with initial involvement with drugs include social structural variables, such as socioeconomic status (with heavier use among more disadvantaged groups), family role and socialization variables (with greater use in families with adult drug users, dysfunctional family structures), educational variables (with poor school attachment and performance associated with greater drug use), psychological variables (such as a high need for stimulation), attitudinal variables such as tolerance for deviance (with nontraditionalism associated with greater drug use), behavioral variables such as deviant behaviors and low law abidance (implying greater substance use), emotional variables (such as anxiety and need for excitement), psychopathology (with greater depression and antisocial personality related to higher drug use), temperament and exposure to stressful life events (see Hawkins et al., 1992; Clayton, 1992). While influences like these have been related to involvement with alcohol and other drug use or abuse, none has ever been found to be a single primary factor that causes alcohol and other drug use or abuse. Indeed, it seems highly unlikely that any one factor or even a few factors will ever be found to account fully for all variations in drug involvement. Because the range of variables leading to initial involvement in alcohol and other drug use is so large, recent views of this phenomenon have emphasized the risk factor notion that is often used in medical epidemiology (Bry et al., 1982; Schreier and Newcomb, 1991a,b). Risk factors include environmental, behavioral, psychological, and social attributes. Viewing alcohol and other drug involvement as multiply determined suggests that the more risk factors someone is exposed to that encourage use, the more likely he or she is to use or abuse alcohol and other drugs. Exposure to a greater numbers of risk factors is not only a reliable correlate of use, but it also influences the increase in alcohol and other drug use over time, implying a true causal role for those variables that together make for increased risk (Schreier and Newcomb, 1991b). It appears from this approach that the presence of particular factors that can encourage drug use are not as important as the accumulation and interaction of such factors in a person's life. Protective factors, in contrast to risk factors for alcohol and other drug use, reduce the likelihood and level of drug use and abuse. Protective factors are those psychosocial influences that limit or reduce drug involvement (Newcomb, 1992). Only recently has the risk factors approach to drug use and abuse been expanded to test for multiple protective factors as well (Newcomb, 1992; Newcomb and Felix-Ortiz, 1992). Protective factors may

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Under the Influence? Drugs and the American Work Force operate through mechanisms other than simply by a direct reduction of alcohol and drug involvement. For example, protective factors have been shown to buffer or moderate the association between risk factors and drug use and abuse (Brook et al., 1992). Recent examples of protective factors that have been found to mitigate the risk of alcohol and other drug use or abuse involve aspects of the environment (e.g., maternal affection—Brook et al., 1989) and the individual (e.g., introversion or self-acceptance—Stacy et al., 1992). ALCOHOL AND OTHER DRUG USE ON THE JOB As we discussed in Chapter 1, the definition of terms can significantly shape the problem under study. More specifically, with respect to on-the-job versus off-the-job drug use, Chapter 1 indicates the importance of such a distinction in the study of alcohol and other drug use by the work force. The term on-the-job drug use is ambiguous and can mean different things in different studies. Taken literally, the phrase refers only to drugs used at the work site while work is or should be going on. By this definition, a three-martini lunch or a two-joint break would not be considered drug use on the job. Yet many drugs affect work performance for hours, if not days, after consumption. Several self-report measures of workplace drug use ask respondents whether they have used a particular drug on the job. It is unclear whether employees interpret this question to include alcohol and other drugs used just before work, during breaks, or at lunch. Alcohol and other drugs used at these times could lead to workplace impairment even though they do not involve "drug use on the job" if the term is taken literally. The more relevant question might be whether employees have ever been drunk, high, or stoned at work, but this is rarely asked. It is well known that small differences in question wording or even question order can affect survey responses, and attention should be paid to this dynamic in future surveys of workplace drug use. Patterns of Alcohol and Other Drug Use on the Job Employers have often been plagued by the occasional alcoholic employee who is frequently absent or tardy or may drink or be drunk on the job. Some employers believe that such behavior is increasing and extends to drugs other than alcohol. However, no large-scale surveys of adult workers exist to substantiate such conclusions. Alcohol is believed to be the most frequently used drug in the workplace (apart from nicotine and caffeine), but precise comparisons with other drugs and evaluations of their relationship to alcohol cannot be made (Cohen, 1984, 1986). The few surveys that attempt to assess the prevalence of

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Under the Influence? Drugs and the American Work Force alcohol and other drug use in the work site typically report estimates from management or union sources rather than from employees (e.g., Schreier, 1987; Steele, 1981). Such surveys report the perceptions of knowledgeable observers who are close to the problem, but as a measure of actual alcohol and other drug use they are obviously flawed. Nevertheless, as discussed in more detail in Chapter 3, a few studies designed specifically to estimate rates of alcohol and other drug use on the job provide tentative estimates of work force alcohol and other drug use. Those studies vary greatly in terms of methods used to assess alcohol and other drug use and when similar methods are used, they often define their measures of alcohol and other drug use differently (e.g., on-the-job drug use). Although these studies do not provide precise estimates of the rate of alcohol and other drug use by the work force, they do, however, provide information concerning which members of the work force are more likely to use drugs and what drugs are most likely to be used. Rates of self-reported alcohol and other drug use on the job vary according to occupation, age, gender, and ethnicity. Excluding tobacco and caffeine, most surveys find that fewer than 10 percent of workers report having used alcohol or other drugs while on the job during the prior year. Some studies, however, report significantly higher use rates. Much of the difference in the rates reported appears attributable to differences in samples surveyed and questions asked. It appears that a sizable number of people use alcohol or other drugs regularly, but not at work; others use alcohol or other drugs both at work and away from work. Some use alcohol or other drugs only when they are away from the workplace, and others use alcohol or other drugs only when they are at work. There may also be a group of individuals who use one drug at work and other drugs at home or away from the work site. Researchers have only begun to confront the degree of correspondence between a general proclivity to use alcohol and other drugs and the use of alcohol or other drugs on the job. Often implicit is the yet unproven assumption that the association is quite high, if not perfect. For instance, many discussions of on-the-job drug use cite statistics of general drug use of various populations and argue that alcohol and other drug use in the workplace must be rampant (e.g., Backer, 1987). Since people can choose where to use alcohol and other drugs and what drugs to use, heavy off-the-job use of specific drugs does not mean that those drugs will be used at work. The "weekend drunk" is an example. It is, however, reasonable to assume that at least some general drug use must precede on-the-job use for most people. Newcomb (1988) found that alcohol and other drug use at work and general alcohol and other drug use were highly, but not perfectly, related (i.e., high general use of drugs did not mean drugs would necessarily be used in the workplace, but the two were clearly associated). In most cases,

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Under the Influence? Drugs and the American Work Force knowing the extent of general alcohol and other drug use among a sample of individuals predicted less than 50 percent of the variance of on-the-job alcohol and other drug use. Thus the propensity to use alcohol and other drugs on the job varied with the degree of off-the-job alcohol and other drug involvement, but the relationship was not so strong as to justify treating overall alcohol and other drug use prevalence rates as indicators of the likely extent of different types of drug use on the job. The association that Newcomb found between the use of drugs at and away from work varied by drug combination. For instance, those who reported using marijuana off the job were twice as likely to use alcohol and seven time more likely to use cocaine on the job than those who did not report off-the-job marijuana use (Newcomb, 1988:72-73). Similarly, cigarette smokers were twice as likely to use alcohol on the job and over three times as likely to use marijuana, cocaine, or other hard drugs on the job, as those who did not smoke cigarettes. Moreover, previous research has revealed that a person's drug use is typically not limited to one specific substance, but often involves the use of various drugs, sometimes more or less simultaneously. This is particularly true for teenagers and for those who use illicit drugs (i.e., marijuana, cocaine), but it has been documented among young adults (Newcomb and Bentler, 1998a,b) and adults (Newcomb, 1992) as well. Clayton and Ritter (1985:83), after examining many studies, concluded that "more often than not, the persons who are using drugs frequently are multiple drug users." Cocaine users, for example, reported significantly higher rates of use for all other types of drugs, including cigarettes, alcohol, marijuana, over-the-counter medications, hypnotics, stimulants, psychedelics, inhalants, narcotics, and PCP, compared with those who had never used cocaine. These large differences were found for both men and women and were prevalent during adolescence as well as young adulthood (e.g., Newcomb and Bentler, 1986b). The association between various types of drug use is so high that common underlying constructs of general polydrug use (Newcomb and Bentler, 1986b) and polydrug use in the workplace (Newcomb, 1988; Stein et al., 1988) have been distinctly and reliably identified. In an extensive series of analyses of alcohol and other drug use, one of the overriding conclusions reached by Newcomb (1988) was that alcohol and other drug use in the workplace was not typically restricted to single drugs but was highly related to the use of other drugs of both similar and different types. Thus someone caught using marijuana at work is more likely than a random worker to have also used alcohol on the job and far more likely to have used harder drugs. Indeed, Newcomb's study suggests that substance use in the workplace is best characterized as polydrug use at work. The use of one substance at work increases the likelihood of using other drugs in that context.

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Under the Influence? Drugs and the American Work Force As we already noted, it appears that alcohol and other drug involvement progresses by stages (Kandel, 1975; Kandel and Faust, 1975). Newcomb (1988) reports data suggesting that using alcohol and other drugs at work reflects a relatively high level of drug involvement. Newcomb's data indicate that using drugs at work is located after both alcohol and marijuana use on the drug involvement continuum for men and subsequent to cocaine use for women. Thus it appears that workplace alcohol and other drug use implies a degree of drug involvement somewhere between that implied by marijuana and cocaine use, on one hand, and cocaine and harder drug use, on the other. The different scaling results for men and women suggest that using alcohol and other drugs at work occurs earlier in the sequence of drug involvement for men than women. This may help explain the gender differences in the prevalence of alcohol and other drug use in the workplace that is reported in Chapter 3. The polydrug use concept is consistent with the view of drug involvement as a staged process defined in large measure by the types of drugs used (e.g., Newcomb and Bentler, 1986b). Those who have tried drugs high in the progression of drug involvement may also continue to use the drugs that do not by themselves characterize high involvement. Indeed, a more elaborate stage model might identify certain configurations of polydrug use as separate stages in the progression of drug involvement. Predictors of Alcohol and Other Drug Use on the Job Evidence of social-environmental influences on drug use have led many to believe that job conditions constitute important risk or protective factors with respect to alcohol and other drug use. Among the characteristics of the work environment that have been posited to influence employee alcohol and other drug use are organizational frustration and job stress (Milbourn, 1984), distancing forces, attractions, and constraints (Gupta and Jenkins, 1984), occupational and coworker norms (Shore, 1986), and alcohol and other drug use "enabling" aspects of the work environment (Ames, 1990; Roman et al., 1992). In empirical tests of these expectations, the primary focus has been on correlates with alcohol and other drug use in general and not specifically with alcohol and other drug use on the job. Markowitz (1984), for example, found that indicators of general alcohol misuse were significantly correlated with less responsibility and autonomy in the workplace. Martin et al. (1992) found that some form of alcohol use was significantly associated with more pressure and fewer extrinsic rewards, although demographic factors (divorced and urban residence) were far more important than these job characteristics. A few studies have directly examined the relationship of job character-

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Under the Influence? Drugs and the American Work Force representing three occupational groups and found that: (1) 8 percent of retail employees reported some drug use on the job; (2) 13 percent of manufacturing employees reported such behavior; as did (3) 3 percent of hospital employees. Lehman and Simpson (1992) found that 10 percent of 1,325 municipal workers admitted using some illicit drug on the job. Results showed that 8 percent of 1,239 men and 3 percent of 556 women reported using alcohol on the job, while 3 percent of the men and 1 percent of the women reported some illicit drug use in the workplace. Mensch and Kandel (1988) studied data from large samples of young adults. Among the 5,299 men, 5 percent admitted using alcohol in the workplace, 8 percent had used marijuana, and 2 percent had used cocaine. Of the 4,860 women, 1 percent reported being high on alcohol on the job, 3 percent on marijuana, and 1 percent on cocaine. Martin et al. (in press) also examined national samples of youth, looking separately at part-time and full-time employees. Those who were employed full time reported higher rates of using alcohol, cocaine, and marijuana on the job than those who worked part time. Unfortunately, sample sizes were not provided in this report, although based on the data set used, the numbers should be in the thousands. Estimates of drug use on the job for men (4 percent for alcohol, 7 percent for marijuana, and 1 percent for cocaine) were consistently and substantially higher than those for women (2 percent for alcohol, 3 percent for marijuana, and 1 percent for cocaine). Schneck et al. (1991) examined responses from about 120,000 transportation employees and found that 6 percent had used alcohol at times that would interfere with their job, and 3 percent reported a similar use of illicit drugs. Newcomb (1988) studied a community sample of 739 young adults and found that among the 221 men, 39 percent reported being "high, drunk, or stoned" on the job at least once during the past 6 months: 29 percent had used alcohol, 23 percent marijuana, 10 percent cocaine, and 6 percent other stimulants. Among the 518 women in the sample, 27 percent reported having been high, drunk, or stoned on the job: 14 percent had used alcohol, 14 percent marijuana, 9 percent cocaine, and 5 percent other stimulants. This same sample was assessed 4 years later with substantially reduced rates of being high, drunk, or stoned on the job (Newcomb, 1989). Of the 154 men whom Newcomb was able to follow, 27 percent had been high on a psychoactive drug in the workplace, with 24 percent reporting alcohol use, 13 percent marijuana use, 8 percent cocaine use, and 3 percent other stimulants. Among the 391 women in the follow-up survey, 13 percent reported using any psychoactive substance on the job, with 5 percent reporting use of alcohol, 6 percent marijuana, 3 percent cocaine, and 1 percent other stimulants. The different prevalence rates reported by different studies are probably due to the variations in questions asked, samples used, and occupations

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Under the Influence? Drugs and the American Work Force represented. For instance, long-distance truckers who are paid for the miles they drive may be particularly susceptible to using drugs that will keep them awake, help them drive farther, and earn them more money. Similarly, some of the samples surveyed may consist of people who hold nontraditional attitudes and engage in more atypical behavior than other adults. Newcomb's particularly high prevalence rates may not only reflect the nature of his sample but may also have been due in part to asking participants whether they have been "drunk, high, or stoned," on the job rather than whether they "had used drugs" on the job. This question captures people who while on the job felt the effects of drugs taken before work, during breaks, at lunch, as well as those affected by drugs taken during work hours. If so, this question more adequately assesses the proportion of the work force whose performance might be affected by drugs than does the more commonly asked inquiry into on-the-job drug use. This is one reason that may explain why White et al. (1988) obtained such high rates of workplace drug use, since their items asked respondents whether they had gone to work "high" on alcohol or marijuana during the past year. Of employed men who used marijuana during the past year, 32 percent reported going to work high on marijuana at least once in the past year, whereas only 7 percent of men who reported drinking reported going to work high on alcohol in the past year. Rates for women were substantially smaller, with 23 percent of current marijuana users admitting to having gone to work high on marijuana and 2 percent of current drinkers reporting showing up at work high on alcohol. Since these figures are based only on users of the particular drug, they do not mean that a large proportion of workers in general show up for work high. Often data from the HHS and the MWS (discussed earlier in this chapter) also report drug use on the job. Since those studies have been discussed earlier, they are not repeated here. They showed, however, that alcohol use was the most commonly used drug at work and that illicit drug use at work is relatively low. The HSS survey assessed alcohol and other drug use at work by asking respondents in the follow-up surveys if they had used a given drug at work during the past year. Unfortunately, the meaning of the term at work was not further specified. Table 3.10 reports data on substance use at work from the 1987 through 1991 follow-up surveys. As depicted in Table 3.10, alcohol is the substance most often used at work. More specifically, in 1991 alcohol had the highest on-the-job prevalence rate, with 8 percent of the men and 5 percent of the women reporting having used alcohol at work in the past 12 months. Illicit drugs have never been used at work by a large proportion of the work force, and the proportion has decreased substantially in recent years. Marijuana was the second most prevalent drug, with use at work reported by 5 percent of the men and 1 percent of the women in 1991. Less than 1 percent of this sample used any

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Under the Influence? Drugs and the American Work Force TABLE 3.10 Trends in Alcohol and Other Drug Use at Work, Past 12 Months, Young Adults Aged 19-28 (in percent)   Year of Survey Substance/Sex 1987 1988 1989 1990 1991 Alcohol           Male 12.2 7.0 9.0 8.8 7.6 Female 7.7 6.3 5.4 6.0 4.6 Marijuana           Male 8.0 5.6 5.1 4.6 4.5 Female 1.5 1.6 1.5 1.2 0.9 Cocaine           Male 2.9 2.7 1.5 1.6 0.5 Female 1.0 2.3 0.5 1.1 0.3 Amphetamines           Male 2.9 2.8 1.5 1.6 0.4 Female 3.0 2.0 2.0 1.3 0.8 Tranquilizers           Male 0.8 0.3 0.5 0.3 0.2 Female 1.0 0.5 0.1 0.4 0.3   SOURCE: Unpublished data from the High School Senior Surveys (1992). other illicit drug on the job. Cocaine use at work was reported by 0.5 percent of the men and by 0.3 percent of the women. Corresponding figures for amphetamines were 0.4 and 0.8 percent and for tranquilizers, 0.2 and 0.3 percent. The figures from the HSS follow-ups are likely to underestimate true prevalence of drug use in the work force, since high school dropouts are not in the sample and, like all longitudinal studies, the HSS suffers from attrition; however, the trends nevertheless seem clear: drug use is declining among the broad spectrum of youth, both in general and at work. The HHS follow-ups show that alcohol and other drug use at work also varies with occupation. In general, protective services workers (police, fire fighters) show very low rates of use at work, and skilled workers show relatively high rates, with little variation across the other categories (Table 3.11). Alcohol use at work (at least once in the previous 12 months) is highest for men in the skilled and managerial categories; professionals and semiskilled workers are also high in their use rates. Controlling for occupation, women are only slightly less likely than men to have used alcohol at work, and among clericals female use rates are slightly higher. The findings in several studies that more respondents admit to using

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Under the Influence? Drugs and the American Work Force TABLE 3.11 Use of Alcohol and Other Drugs at Work in Past 12 Months, Young Adults Aged 19-28 by Occupational Category (in percent) Sex/Occupation Alcohol Marijuana Cocaine Amphetamines Tranquilizer Males Semiskilleda 9.6 9.5 2.6 3.4 0.8 Clerical, salesb 4.2 3.4 1.8 1.4 0.5 Police, firec 3.6 1.3 0.0 0.9 0.0 Militaryd 5.8 1.1 0.7 1.4 0.0 Skillede 11.3 9.2 3.6 2.4 0.5 Manager, sales repf 10.1 2.8 0.8 1.4 0.4 Professionalg 8.5 2.8 1.4 0.5 0.3 Females           Semiskilleda 6.8 2.7 1.2 3.0 0.5 Clerical, salesb 6.0 1.6 1.6 1.9 0.2 Police, firec 0.0 0.0 0.0 3.2 0.0 Militaryd 5.4 0.0 0.0 3.2 0.0 Skillede 7.0 4.8 1.0 4.0 2.9 Manager, sales repf 7.9 0.5 1.1 0.0 0.9 Professionalg 5.0 0.2 0.1 0.6 0.4 a Semiskilled: laborer (car washer, sanitary worker, farm laborer); service worker (cook, waiter, barber, janitor, gas station attendant, practical nurse, beautician); operative or semi-skilled worker (garage worker, taxicab, bus or truck driver, assembly line worker, welder). b Clerical, sales clerk: sales clerk in a retail store (shoe salesperson, department store, drug store); clerical or office worker (bank teller, bookkeeper, secretary, typist, postal clerk or carrier, ticket agent). c Police, fire; protective service (police officer, fireman, detective). d Military; military service. e Skilled; craftsman or skilled worker (carpenter, electrician, brick layer, mechanic, machinist, tool and die maker, telephone installer) .f Manager, sales rep; farm owner, farm manager; owner of a small business (restaurant owner, shop owner); sales representative (insurance agent, real estate broker, bond salesman); manager or administrator (office manager, sales manager, school administrator, government official). g Professional: professional with doctoral degree or equivalent (lawyer, physician, dentist, scientist, college professor). SOURCE: Unpublished data from the High School Senior Surveys (1992). marijuana than alcohol in the workplace is surprising, since alcohol is in general the most frequently used drug at the work site. This discrepancy is probably a sample artifact, as in the White et al. (1988) study in which respondents were limited to those who had used the illicit drug.

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Under the Influence? Drugs and the American Work Force Summary Prevalence estimates vary greatly across studies, although alcohol or marijuana are consistently the most prevalent drugs used in the workplace. Nevertheless, three conclusions can be drawn that are also consistent with findings from large-scale survey findings. First, according to employee reports, drug use in the workplace ranges from a modest to a moderate extent (although much of the reported use may be single incidents, perhaps even at events like office parties). Second, men are more likely than women to use drugs in the workplace. And third, the highest rates of workplace drug use seem to be among young adults, with use decreasing substantially with increasing age. CONCLUSIONS AND RECOMMENDATIONS Data sources ranging from self-report questionnaires to urinalysis testing to emergency room visits provide important insights about the use of alcohol and other drugs among members of the general population and the work force. Taken together, the data indicate that, since the late 1970s: The prevalence of illicit drug use among members of the general population and the work force has been decreasing, but continues to affect a sizable proportion of the population, especially young adults. Illicit drug use may be decreasing among occasional users, but it may be stable or even increasing among hard-core users who are generally not well represented in surveys. Heavy alcohol use has been relatively stable over the past several years; rates of heavy drinking have been notably high among young adult men, especially those in the military and among workers in such industries as construction, transportation, and wholesale goods. Cigarette smoking has been declining during the past decade for those 18 and older, but has been relatively stable for youths ages 12 to 17. Illicit drug use is more common among unemployed than employed persons, and weekly alcohol use is highest among young employed workers. Illicit drug use is relatively high among male workers in certain industries, such as construction, but relatively low among professionals. Given these long-term trends, we must be cautious in attributing short-term changes in alcohol and other drug use in either society or the work force to specific national efforts to stem the use of drugs. Few epidemiological studies are targeted directly at the work force, leaving researchers to rely on data sources designed for other uses.

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Under the Influence? Drugs and the American Work Force Recommendation: More focused epidemiological studies, including longitudinal studies, are needed to assess the magnitude and severity of alcohol and other drug use among the work force. As a first step, the National Household Surveys on Drug Abuse should be modified to provide specific information about job characteristics, job-related behaviors, and alcohol and other drug use at work. Ultimately a national panel survey devoted to this topic should be instituted. In addition, other studies are needed that provide better information about: (1) employment patterns among persons who use alcohol and other drugs; (2) patterns of alcohol and other drug use among workers; (3) patterns of use in heavily using populations to better understand the employment history and work experience of these individuals; and (4) the impact of illicit drug use and heavy alcohol use on work activity. Although the workplace offers a unique opportunity to obtain leverage on the alcohol and other drug problems of some users, there are many serious alcohol and other drug abusers who are not regularly employed, if they are employed at all. In 1990 approximately 7 percent of workers reported having used an illicit drug and approximately 6 percent reported having drunk heavily in the past month, compared with 14 percent and 6 percent, respectively, for the unemployed. Given the relative low base rate of alcohol and other drug abusers in the employed segment of the work force compared with other selected populations, postemployment workplace alcohol and other drug interventions may help a limited number of abusers, but workplace-oriented interventions cannot solve society's problems with alcohol and other drugs. Alcohol and tobacco are the drugs most widely abused by members of the U.S. work force. The adverse health consequences of these drugs are well known. In terms of prevalence rates of work force use and perceived effects of use on performance, alcohol is more likely to have adverse consequences. Recommendation: Any program that addresses drug use by the work force should include alcohol, the drug most associated with perceived detrimental job performance, as a priority. Rates of self-reported alcohol and other drug use on the job vary according to occupation, age, gender, and ethnicity. Excluding tobacco and caffeine, most surveys find that fewer than 10 percent of workers report having used alcohol or other drugs while on the job during the prior year. Some studies, however, report significantly higher usage rates. Much of the

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Under the Influence? Drugs and the American Work Force difference in the rates reported appears attributable to differences in the samples surveyed and the questions asked. Recommendation: It is important to investigate alcohol and other drug use in different well-specified samples and to develop benchmark measures to allow findings that are comparable across studies. REFERENCES Alden, W.F. 1986 The scope of the drug problem: a national strategy. Vital Speeches of the Day 751-756. Backer, T.E. 1987 Strategic Planning for Workplace Drug Abuse Problems. Rockville, Md.: National Institute on Drug Abuse. Blank, D.L., and J.W. Fenton 1989 Early employment testing for marijuana: demographic and employee retention patterns. In S.W. Gust and J.M. Walsh, eds., Drugs in the Workplace: Research and Evaluation Data. NIDA Research Monograph 91. Rockville, Md.: National Institute on Drug Abuse. Bray, R.M., M.E. Marsden, and M.R. Peterson 1991 Standardized comparisons of the use of alcohol, drugs, and cigarettes among military personnel and civilians. American Journal of Public Health 81:865-869. Bray, R.M., L.A. Kroutil, J.W. Luckey, S.C. Wheeless, V.G. Iannacchione, D.W. Anderson, M.E. Marsden, and G.H. Dunteman 1992 1992 Worldwide Survey of Substance Abuse and Health Behaviors Among Military Personnel. Research Triangle Park, N.C.: Research Triangle Institute. Canadian Facts 1991 Substance Use and the Work Place Survey of Employees. Ottawa, Canada: Canadian Facts. Cook, R.F., and A.D. Bernstein 1991 Assessing Drug Abuse in the Workplace: A Comparison of Major Methods. Paper presented at the Drug-Free Workplace Conference, Washington, D.C. Crouch, D.J., D.O. Webb, L.V. Peterson, P.F. Buller, and D.E. Rollins 1989 A critical evaluation of the Utah Power and Light Company's substance abuse management program: absenteeism, accidents, and costs. In S.W. Gust and J.M. Walsh, eds., Drugs in the Workplace: Research and Evaluation Data. NIDA Research Monograph 91. Rockville, Md.: National Institute on Drug Abuse. Decima 1990 Final Report to Transport Canada on the Results for the Substance Use and Transportation Safety Study. Toronto, Canada: Decima Research. Gerstein, D.R., and L.W. Green, eds. 1993 Preventing Drug Abuse: What Do We Know? Committee on Drug Abuse Prevention Research, Commission on Behavioral and Social Sciences and Education, National Research Council. Washington, D.C.: National Academy Press. Gleason, P.M., J.R. Veu, and M.R. Pergamit 1991 Drug and alcohol use at work: a survey of young workers. Monthly Labor Review August:3-7.

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Under the Influence? Drugs and the American Work Force Gordon, J. 1987 Drug testing as a productivity booster? Training 24:22-34 Guinn, B. 1983 Job satisfaction, counterproductive behavior and circumstantial drug use among long-distance truckers. Journal of Psychoactive Drugs 15:185-188. Gust, S.W., and J.M. Walsh, eds. 1989 Drugs in the Workplace: Research and Evaluation Data. NIDA Research Monograph 91. Rockville, Md.: National Institute on Drug Abuse. Gust, S.W., J.M. Walsh, L.B. Thomas, and D.J. Crouch, eds. 1990 Drugs in the Workplace: Research and Evaluation Data, Vol. II. NIDA Research Monograph 100. Rockville, Md.: National Institute on Drug Abuse. Holcom, M.L., W.E.K. Lehman, and D.D. Simpson 1991 Employee Accidents: Influences of Personal Characteristics, Job Characteristics, and Substance Use. Unpublished manuscript, Institute of Behavioral Research, Texas Christian University, Fort Worth. Hollinger, R.C. 1988 Working under the influence (WUI): correlates of employees use of alcohol and other drugs. Journal of Applied Behavioral Science 24:439-454. Johnson, L.D., P.M. O'Malley, and J.G. Bachman 1992 Smoking, Drinking, and Illicit Drug Use Among American Secondary School Students, College Students, and Young Adults, 1975-1991, Vol. I and II. Rockville, Md.: National Institute on Drug Abuse. Kopstein, A., and J. Gfroerer 1990 Drug use patterns and demographics of employed drug users: data from the 1988 Household Survey. Pp. 25-44 in S.W. Gust, J.M. Walsh, L.B. Thomas, and D.J. Crouch, eds., Drugs in the Workplace: Research and Evaluation Data, Vol. 2. NIDA Research Monograph 100. Rockville, Md.: National Institute on Drug Abuse. Lehman, W.E.K., and D.D. Simpson 1992 Employee substance use and on-the-job behaviors. Journal of Applied Psychology 77:309-321. Lehman, W.E.K., M.L. Holcom, and D.D. Simpson 1990a Employee Health and Performance in the Workplace: A Survey of Municipal Employees of a Large Southwest City. Institute of Behavioral Research, Texas Christian University, Fort Worth. 1990b Employee Health and Performance in the Workplace: A Survey of Employees of the Housing Authority in a Large Southwest City. Institute of Behavioral Research, Texas Christian University, Fort Worth. Levy, S.I. 1973 A case study of drug-related criminal behavior in business and industry. In J.M. Sher, ed., Drug Abuse in Industry. Springfield, Ill.: Thomas. Martin, J.K., J.M. Kraft, and P.M. Roman in press The extent and impact of alcohol and drug problems in the workplace. In S. McDonald and P. Roman, eds., Drug Screening in the Workplace: Research Perspectives . Washington, D.C.: Hemisphere. McDaniel, M.A. 1988 Does pre-employment drug use predict on-the-job suitability? Personnel Psychology 41:717-729. Mensch, B.S., and D.B. Kandel 1988 Do job conditions influence the use of drugs? Journal of Health and Social Behavior 29:169-184.

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Under the Influence? Drugs and the American Work Force National Institute on Drug Abuse 1991 National Household Survey on Drug Abuse: Main Findings 1990. Rockville, Md.: National Institute on Drug Abuse. Newcomb, M.D. 1988 Drug Use in the Workplace: Risk Factors for Disruptive Substance Use Among Young Adults. Dover, Mass.: Auburn House. 1989 Drug Use and Sensation Seeking: Latent-Variable Comparisons Among Adolescents. Paper presented at the Western Psychological Association meeting, Reno, Nevada. Normand, J., and S.D. Salyards 1989 An empirical evaluation of preemployment drug testing in the United States Postal Service: interim report of findings. In S.W. Gust and J.M. Walsh, eds., Drugs in the Workplace: Research and Evaluation Data. NIDA Research Monograph 91. Rockville, Md.: National Institute on Drug Abuse. Normand, J., S.D. Salyards, and J.J. Mahoney 1990 An evaluation of preemployment drug testing. Journal of Applied Psychology 75:629-639. Osborn, C.E., and J.J. Sokolov 1989 Drug use trends in a nuclear power company: cumulative data from an ongoing testing program. In S.W. Gust and J.M. Walsh, eds., Drugs in the Workplace: Research and Evaluation Data. NIDA Research Monograph 91. Rockville, Md.: National Institute on Drug Abuse. 1990 Drug use trends in a nuclear power facility: data from a random screening program. In S.W. Gust, J.M. Walsh, L.B. Thomas, and D.J. Crouch, eds., Drugs in the Workplace: Research and Evaluation Data, Vol. II. NIDA Research Monograph 100. Rockville, Md.: National Institute on Drug Abuse. Parish, D.C. 1989 Relation of the pre-employment drug testing result to employment status: a one-year follow-up. Journal of General Internal Medicine 4:44-47. Parker, D.A., and T.C. Harford 1992 The epidemiology of alcohol consumption and dependence across occupations in the United States. Alcohol Health & Research World 16(2):97-105. Rosenbaum, A.L., W.E.K. Lehman, E.K., Olsen, and M.L. Holcom 1992 Prevalence of Substance Use and its Association with Employee Performance Among Municipal Workers in a Southwestern City. Institute of Behavioral Research, Texas Christian University, Fort Worth. Schneck, D., R. Amodei, and R. Kernish 1991 Substance Abuse in the Transit Industry. Washington, D.C.: Office of Technical Assistance and Safety. Sheridan, J.R., and H. Winkler 1989 An evaluation of drug testing in the workplace. In S.W. Gust and J.M. Walsh, eds., Drugs in the Workplace: Research and Evaluation Data. NIDA Research Monograph 91. Rockville, Md.: National Institute on Drug Abuse. Substance Abuse and Mental Health Services Administration 1993 National Household Survey on Drug Abuse: Main Findings 1991. Rockville, Md.: Substance Abuse and Mental Health Services Administration. Taggart, R.W. 1989 Results of the drug testing program at Southern Pacific Railroad. In S.W. Gust and J.M. Walsh, eds., Drugs in the Workplace: Research and Evaluation Data. NIDA Research Monograph 91. Rockville, Md.: National Institute on Drug Abuse.

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Under the Influence? Drugs and the American Work Force Washton, A.M., and M.S. Gold 1987 Recent trends in cocaine abuse as seen in the cocaine hotline. Pp. 10-22 in A.M. Washton and M.S. Gold, eds., Cocaine: Clinicians Handbook. New York: Guilford Press. White, H.R., A. Aidala, and B. Zablocki 1988 A longitudinal investigation of drug use and work patterns among middle-class, white adults. The Journal of Applied Behavioral Science 4:466-469. Wish, E. 1990U.S. drug policy in the 1990s: insights from new data from arrestees. 1992 International Journal of the Addictions 25:377-409. Zwerling, C., J. Ryan, and E.J. Orav 1990 The efficacy of preemployment drug screening for marijuana and cocaine in predicting employment outcome. Journal of the American Medical Association 264:2639-2643.

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