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Under the Influence? Drugs and the American Work Force Index

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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 A Absenteeism, 7, 130, 134-144, 169, 220-222 and employee assistance programs, 249-250, 253 and wellness programs, 244, 245 Abuse of drugs definition, 2, 21 progression to, 3, 31-32, 36, 43 Accidents, 7, 11, 129, 144-152, 169, 216, 237 alcohol-related, 19, 129, 148, 149, 150-151, 159 testing after, 75, 78, 114, 285, 288 transportation, 7, 144, 145-149, 158-159, 169 Accuracy of testing procedures, 7-8, 179, 192-195, 207-208 personality profiles, 10, 209-210 urinalysis, 8, 10, 207, 210 Adulteration of specimens, 182-183, 195 After-care, 261-263 Age-related differences, 5, 6, 35, 58, 99, 123 Alcoholics Anonymous (AA), 256, 257 Alcohol use, 2, 5, 15, 19, 31, 34, 37, 42, 56, 57, 90, 95-97, 99, 131 and accidents, 19, 129, 148, 149, 150-151, 159 deaths, 15, 18n and early intervention, 260-261 and employee assistance programs, 255-256, 257 and employment status, 5, 58, 61, 94, 98, 99 heavy drinking, 4, 5, 32, 41-42, 52-53, 56, 66, 67, 98, 99, 163 and job satisfaction, 154-155 by military personnel, 66, 67, 69-70 performance effects, 6, 69-70, 73, 112-113, 123, 157, 163-164 and polydrug use, 3, 36, 43 residual effects, 113, 114-115 social attitudes toward, 15-16, 41, 42 testing for, 51, 75, 81, 149, 191, 215-216 and wellness programs, 242-243

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Under the Influence? Drugs and the American Work Force Americans With Disabilities Act (ADA), 191, 299 Amotivational syndrome, 112 Amphetamines, 19, 20, 42-43, 75, 118, 148, 184, 194, 215 Applicant testing, 8, 9, 10, 11, 12, 52, 75, 77, 208-209, 216, 218 -224, 227-228, 235, 286, 296, 300 consequences of positive results, 12, 236 personality profiles, 202-203 and self-selection, 233, 235 Arrestee studies, 72-73 Attitudes of employees, 33, 38, 39-40, 157-158 toward testing, 12, 158, 233-235, 236 Automobile accidents, 148 Aviation accidents, 149 B Behavioral effects, see Performance and productivity effects Benchmark measures behavioral effects, 6, 122, 123 usage rates, 5, 100 Blood testing, 183 Breath testing, 183, 191 C Caffeine, 2, 19n, 22 Case-referent studies, 272 Causes and risk factors, 3-4, 29-34, 119-120, 273 individual traits, 3-4, 29, 30, 37-39, 43 initiation, 3, 31, 32, 43 and intervention effectiveness, 3 progressive severity, 3, 31-32, 43 role of workplace, 3-4, 37-40, 41, 43 Certification of laboratories, 8, 50, 51, 179, 180, 188, 207, 285 of test result reviewers, 13, 264 Cigarettes, see Smoking and tobacco use Clinical diagnostic criteria, 22 Clinical Laboratory Improvement Act (CLIA), 190 Cocaine, 15, 19, 31, 36, 37, 41, 61, 72, 75, 80, 94, 96, 116, 184, 215 performance effects, 6, 123, 164-165 Collective bargaining, 294 College of American Pathologists, 180 Combinations of drugs, see Polydrug use Community factors, 29, 30 Comparability and differences among studies, 5, 35, 89-98, 99-100, 272 Conrail-Amtrak train crash (Maryland), 16, 129 Consensus Report on Employee Drug Testing, 1989, 8, 180-181, 207 Constitutional issues, 286-296, 299 Construction workers, 4, 61, 79-80, 98 Constructive confrontation, 246, 252, 253-254, 257, 259 Costs of drug use, 16, 17-18 employer-provided health care, 18, 244-245, 250, 255-257 field studies, 7, 160-166, 169 illegal drugs, 18, 160-161 testing, 24n, 231-232 Counseling, 243-244. see also Employee assistance programs (EAPs) Coworker relations, 37, 38, 157-158 Crack cocaine, 15, 31, 32 Crime-related costs, of illegal drug use, 18, 161 Cross-sectional studies, 272 Cultural factors, 29-30 Customs Service, 289-291 D Deaths, 15, 18 accidental, 148, 150 Deaths from substance abuse, 15, 18 Decongestants, 194

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Under the Influence? Drugs and the American Work Force Definitions of ''drug," 1-2, 18, 19-21 for epidemiological issues, 273 of use, abuse, and dependence, 2, 18, 21-22 of work force, 2, 18-19, 22 Demographics, see Age-related differences; Ethnic groups; Individual traits; Sex-related differences Department of Defense (DoD), 8, 178, 179, 186, 207 usage surveys, 42-43, 49, 50, 52-53, 65-71 Department of Justice, 291-292 Department of Transportation (DOT), 180, 285-286 Dependence on drugs, 2, 3, 21-22, 43, 114 Deterrence, testing effects, 11, 149, 151-152, 177, 180, 226-227, 235-236, 299n Deviant behavior, 7, 32, 33, 39, 130-133, 169 Diagnostic and Statistical Manual (DSM-III-R), 22n Dismissals, for positive results, 12, 236, 293, 295 Dosages, 6, 116-117, 123 Drug Abuse Scale (DAS), 196-197 Drug Abuse Warning Network (DAWN), 71-72 Drug Evaluation and Classification Program (DEC), 203-206 Drug Free Workplace Act (DFWA), 285, 294 Drug recognition experts (DREs), 204-206 Drug Use Forecasting (DUF) system, 72-73 E Early intervention, 259-261 Educational status and problems, 29, 30, 33, 67 Emergency room visits, as epidemiological data source, 4, 71-72, 98 EMIT, 179, 185 Empirical studies, see Field studies Employee assistance programs (EAPs), 12-13, 206-207, 246-257, 263-264, 285 supervisor training, 205, 246, 251-254 Employment status and patterns studies of, 4-5, 58-65, 99, 165-166 turnover, 152-154, 220-221 Ephedrine, 194 Epidemiological studies, 4-5, 49-52, 98-100 as basis for test battery additions, 9, 208 biochemical testing, 49, 50-51, 73-81 large-scale surveys, 49, 52-73 limitations, 50-52, 89, 273-275 methodology, 272-275 national panel surveys, 4, 99 organization-specific, 49, 81-89 Ethical issues, 299-300 Ethnic groups, 5, 35, 38, 58, 61, 67, 99 Etiology, see Causes and risk factors Executive Order 12564, 19, 178, 179, 215, 285 Experience with drugs, 6, 31, 33, 123 Experimental studies, 13-14, 273, 275-278, 283 External validity, 115, 278 Exxon Valdez oil spill, 16, 129 F False negatives, 194-195 False positives, 9, 185, 192, 193-194, 195, 208-209, 298 personality profiling, 197-199, 202-203 Family relationships, 18, 29, 30, 33, 248-249 Federal contractors, 179, 285 Federal employees, 19, 179, 247, 285

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Under the Influence? Drugs and the American Work Force Federal Railroad Administration (FRA), 288-289 Field studies, 7, 129, 133-160, 169 absenteeism, 7, 134-144, 169 accidents, 7, 144-152, 169 cost-of-drug use, 7, 160-166, 169 experimental, 13-14, 273, 276-278, 283 interpretation of, 161-162, 166-168 job satisfaction, 154-155 limitations of, 130-133, 159-160, 166-168 research base development, 7, 169 turnover, 152-154 Firings, see Dismissals, for positive results Fluorescence polarization immunoassay (FPIA), 185 Follow-up, 75, 261-263 employee assistance programs (EAPs), 12, 254-255, 257, 261-263, 285 Fourtune 500 corporations, 247 Fourth Amendment issues, 286-294 G Gas chromatography (GC), 179, 184, 185-186 Gender, see Sex-related differences Genetic factors, 29, 31 H Hair testing, 9, 177, 183-184, 208, 299 Hangover effects, 2, 6, 22, 113, 123, 124 Hard-core and heavy users, 5, 37, 99 alcohol, 4, 5, 32, 41-42, 52-53, 56, 66, 67, 98, 99, 163 Health care costs, 17, 161 for employers, 18, 244-245, 250, 255-257 Health maintenance organizations, 255 Health promotion and wellness programs, 241-246 Heroin, 15, 19, 178 High performance liquid chromatography (HPLC), 186-187 High School Senior surveys (HSS), 42-43, 49, 52, 53-56, 95-96, 235 Hospital employees, 85, 90 Hospitalization, 255-257 Housing authority employees, 86, 135 I Illegal drug use, 4, 16, 19, 31-32, 53, 56-57, 71-73, 75, 80-81,94, 95-96, 98, 135 deaths, 15, 18, 161 and employment status, 4, 5, 58, 61, 73, 94, 99 hard-core users, 4, 71-72, 73, 98 by military personnel, 67, 70-71 and polydrug use, 3, 43 societal costs, 18, 160-161 Immunoassays, 179, 185 Income level, 61, 163-164 Indirect assessment of drug use, 178, 195-207 Individual traits, 3-4, 29, 30, 37-39, 43 Initiation to drug use, 3, 31, 32, 43 Integrity testing, 10, 196-199, 209 Interaction effects, 4, 33, 43 International Classification of Diseases (ICD-10), 22n Interpersonal factors, see Family relationships; Peer relationships Intervention programs, national, 4. See also Workplace intervention programs J Job satisfaction, 37, 38, 154-155 Justification for testing, 12, 233-234, 236, 237, 289-291, 292-293 of rarely used drugs, 9, 191-192, 208 L Laboratory studies, 6, 107-115, 121-124 limitations, 107-108, 111, 115, 118-121 methodology, 115-118, 278

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Under the Influence? Drugs and the American Work Force Laboratory testing, see Testing procedures and results Law enforcement agencies, 290-291, 292, 293 Legal issues, 284-299 Limitations of studies laboratory-based, 107-108, 111, 115, 118-121 observational, 130-133, 159-160, 166-168 self-reports, 50, 89, 130, 177, 281-282 Longitudinal studies, 274, 275, 280 deterrent effects of testing, 11, 236 of usage, 4, 32-33, 100 LSD, 20 justification for testing of, 9, 159 M Managed care, 246 "Mandatory Guidelines for Federal Workplace Testing Programs,"; 19, 179, 215, 285 Mandatory testing, 19, 179, 284-286, 287-294, 298 Manufacturing, 61, 88, 90 Marijuana, 19, 31, 36, 37, 38, 42, 61, 75, 80, 94, 95, 96-97, 215, 293 accidents involving, 114, 129, 148, 149, 150 passive inhalation, 193-194 performance effects, 6, 112, 117-118, 121, 123, 164, 219-220 residual effects, 114 and urine tests, 51, 114, 149, 184 Marital status, 38, 39, 67 Mass spectrometry, 179, 185-186 Measurement artifacts, 273-274, 277 Measurement errors, 281-282 Metabolites of drugs, 6, 123, 193 Methamphetamines, 19, 20, 184, 194, 215 Military personnel, 4, 98, 178 Navy recruit testing, 86-87, 152-153, 219 usage surveys, 42-43, 49, 50, 52-53, 65-71 Minority groups, see Ethnic groups Morphine, 19, 194 Municipal governments employees, 85-86, 94, 134-135 laws, 297 N National Household Surveys on Drug Abuse (NHSDA), 4, 49-50, 52, 56 -65, 79-80, 99 National Institute on Drug Abuse (NIDA), 8, 9, 74, 179, 207, 208 testing standards, 7-8, 9, 179-180, 184, 186, 186-190, 207, 208 National Laboratory Certification Programs, 8, 179, 189-190, 207 National Treasury Employees Union v. Von Raab, 287, 288-291 Navy, 178 recruit testing, 86-87, 152-153, 219 Nuclear Regulatory Commission, 180, 186 O Observational studies, see Field studies Occupational alcoholism programs (OAPs), 206 Occupational differences in use, 5, 35, 40-43, 61-65, 90, 94, 99 Omnibus Transportation Employee Testing Act (OTETA), 215-216, 285286, 294 On-Site Drug Testing Study, 8, 207 On-site testing facilities, 8, 185, 190-191, 207 Opiates, 19, 75, 113, 184, 215 in poppy seeds, 194 Over-the-counter drugs, 6, 20, 124, 191 residual effects, 6, 123 test result reporting, 10, 191, 209 P Paper-and-pencil tests, 10, 196-197, 209, 210

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Under the Influence? Drugs and the American Work Force Peer relationships, 29, 30, 32, 33, 37, 38, 155, 157-158 Performance and productivity effects, 16-18, 95, 219-226 laboratory studies, 6, 107-123 legal medications, 6, 20, 124, 191 of testing, 11-12, 227-231, 236 see also Field studies Performance testing methods, 10, 195, 203-207, 209-210, 299 Periodic medical testing, 75, 77-78 Personality testing and profiling, 10, 52, 195, 196-203, 209-210, 282 Phencyclidine, 19, 75, 184, 215 Physiological effects, 2 Policies, see Public policies; Testing programs and policies Polydrug use, 3, 36-37, 43, 115-116 performance effects, 6, 123 Poppy seeds, 193, 194 Positive results consequences of, 12, 236, 293-294 and treatment referral, 13, 263-264 Postal employees, 81, 85, 134, 152, 219-224 Practical importance, of study results, 278-279 Prescription drugs, 6, 20, 124, 191 residual effects, 6, 123 test result reporting, 10, 191, 209 Prevalence, 35-36, 98, 273 as basis for test battery additions, 9, 208 and employment status, 5, 98, 99 see also Epidemiological studies Prevention programs, 3, 43, 241-246 Prison testing, 185 Privacy issues, 9-10, 191-192, 209, 234, 285, 286-299 Private-sector drug testing, 286, 294-295, 298-299 Probable cause, 286-287 Productivity, see Performance and productivity effects Professional occupations, 4, 61, 65, 98, 234 Prohibition, 15 Prospective panel studies, 272-273 Protective factors, 33-34 Psychological testing, see Personality testing and profiling Public policies, 16, 19, 216-217, 231, 284-286 savings assessments, 7, 161-162, 169 Q Quality control, testing procedures, 8-9, 75n, 187-190, 207-208 Quality of research, 11, 23, 159-160, 236 and policy decisions, 7, 278-279 Quasi-experimental studies, 275-276 R Racial and ethnic groups, see Ethnic groups Radio immunoassay (RIA), 185 Railroad accidents, 16, 129 testing after, 148-149, 288-289 Randomized field studies, 13-14, 273, 276-278, 283 Random testing, 75, 77, 78, 81, 88-89, 216, 226-227, 291-292, 293 Reagan and Bush administration policies, 16, 19, 178, 179, 215, 216 -217, 285 Reasonableness standard, 287, 290, 291-292, 295, 296 Referral for treatment, 13, 246, 252-254, 257, 258-261, 263-264 Regional variation, 58, 79 among treatment programs, 273 Regulatory requirements for employee assistance programs, 247-248 mandatory testing, 19, 179, 284-286, 287-294, 298 testing procedures, 8-9, 186-191, 207-208 Relapse, 261-263 Residual effects, 2, 6, 22, 34, 113-115, 123, 124

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Under the Influence? Drugs and the American Work Force Retail employees, 94 Reverse causation, 4, 43, 273, 274, 276 Risk factors, see Causes and risk factors S Safety-sensitive positions justification of drug testing, 12, 233-234, 237, 289-291, 292-293 and legal medications, 6, 123, 124 mandatory testing, 285-286, 297 Saliva testing, 9, 183, 208 Samples and sampling methods, usage studies, 5, 51-52, 100 see also under Testing procedures and results; Urine testing; and other specific testing methods Sedatives performance effects, 6, 113, 118, 121, 123 testing of, 9, 191, 208 Self-esteem, 38, 39, 274 Self-referral, for treatment, 242, 245, 246, 253, 258-259 Self-report studies Self-report surveys, 4, 5, 35, 74, 98, 99-100 large-scale surveys, 49, 52-73 limitations, 50, 89, 130, 177, 281-282 Self-selection, by job applicants, 233, 235 Sex-related differences, 5, 35, 37, 38, 42-43, 58, 61, 90, 95, 99, 165 Skinner v. Railway Labor Executive's Association, 287, 288-291, 293 Smoking and tobacco use, 2, 4, 19n, 22, 53, 56, 57, 98, 99 among military personnel, 66, 67, 70 among teens, 4, 31, 98 deaths, 15, 18n and polydrug use, 3, 36, 43 and wellness programs, 243-244 Social attitudes and norms, 15-16, 32, 33, 43 Specimens for testing, see under Testing procedures and results; Urine testing; and other specific testing methods Spuriousness, of causal relationships, 273, 277, 280-281 Standards and guidelines diagnostic criteria, 22n employee assistance programs, 246, 257 for test result review, 13, 264 State laws, 180, 296-298 Statistical modeling, 274, 275, 280-282 Statistical significance, 278-279 Stimulants, 6, 111-112, 115, 116, 121, 123, 148 Stress, work-related, 4, 37, 43, 130 Studies comparability and differences among, 5, 35, 89-98, 99-100, 272 design issues, 228-231, 271-283 see also Epidemiological studies; Field studies; Laboratory studies Supervisor intervention constructive confrontation, 246, 252, 253-254, 257, 259 employee assistance programs, 205, 246, 251-254 Supplemental Appropriations Act of 1987, 285 T Tampering with specimens, 182-183, 195 Temperance movements, 15-16 Temporal sequence, 280-281 Testing procedures and results, 24n, 178-195 accuracy and reliability, 7-8, 179, 192-195, 207-208, 281 costs, 24n, 231-232 as epidemiological data source, 49, 50-51, 73-81 false positives, 9, 185, 192, 193-194, 195, 208-209, 298 GC/MS technology, 9, 179, 184, 185-186, 209

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Under the Influence? Drugs and the American Work Force interpretation of, 13, 180, 192-195, 264 laboratory certification, 8, 50, 51, 179, 180, 188, 207, 285 limitations of, 130, 177-178 nonurine specimens, 8, 9, 183-184, 208 on-site facilities, 8, 185, 190-191, 207 privacy issues, 9-10, 209, 285 quality control, 8-9, 75n, 187-190, 207-208 regulation and standards, 8-9, 74, 75-77, 179-181, 185, 186-191, 207 -208 selection of drugs for analysis, 9, 191-192, 208 specimen collection, 9, 181-184, 208 see also Performance testing methods; Urine testing Testing programs and policies, 11, 12, 177-178, 216-218, 236, 284299 applicant testing, 8, 9, 10, 11, 12, 52, 75, 77, 208-209, 216, 218 -224, 227-228, 235, 286, 296, 300 attitudes and morale impacts, 12, 158, 233-235, 236 deterrent effects, 11, 149, 151-152, 177, 180, 226-227, 235-236, 299n ethical issues, 299-300 evaluation, 11, 228-232, 236 for-cause, 75, 88, 216, 224-226 mandatory, 19, 179, 284-286, 287-294, 298 productivity effects, 11-12, 227-231, 236 random, 75, 77, 78, 81, 88-89, 216, 226-227, 291-292, 293 Theft, 155, 156 Therapeutic drugs, see Over-the-counter drugs; Prescription drugs Thin-layer chromatography (TLC), 179, 186-187 Timing of consumption, 6, 123 Tobacco, see Smoking and tobacco use Tranquilizers, 43 Transportation industry, 4, 61, 65, 98, 112, 191, 247 accidents, 7, 144, 145-149, 158-159, 169 mandatory testing, 285-286, 292-293, 298 Treatment, assessment of, 273. See also Employee assistance programs (EAPs) Truck drivers, 19, 94-95, 116, 145, 148 Turnover, 152-154, 220-221 U Unemployment, 4, 5, 58, 61, 98, 99 Unionized industries, 294-295 Urine testing, 4, 8, 9, 10, 50-51, 98, 180, 181, 208 accuracy, 8, 10, 207, 210 limitations and contraindications, 80, 177, 191, 193-195, 281 privacy issues, 234, 288, 293, 299 specimen collection, 9, 181-183, 208, 285, 293 U.S. Government, see Federal employees; Public policies; names of specific agencies U.S.S. Nimitz accident, 129 Utility employees, 87-88 V Validity of studies, 177, 281-282, 282, see also Limitations of studies Vandalism, 155 Vicks inhaler, 194 Vignettes, 200 Violence, 18 W "War on drugs," 34; 15, 16, 216-217 Wellness programs, 241-246 Wholesale trae workers, 4, 61, 98 Withdrawal effects, 6, 19n, 21, 31, 113-114, 123, 124 Work force, definition, 2

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Under the Influence? Drugs and the American Work Force Workplace intervention programs, 3, 5, 99, see also Employee assistance programs (EAPs); Health promotion and wellness programs; Testing programs and policies Worldwide Surveys of Substance Abuse and Health Behaviors Among Military Personnel (MWS), 42-43, 49, 50, 52-53, 65-71 Y Young adults, 4, 53, 57, 94, 98, 135 Youth, 29-31, 131 smoking, 4, 31, 98