Under the Influence? Drugs and the American Work Force (1994) / Chapter Skim
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From page 177... ...
Given the preponderance of drug-testing programs among the drug intervention programs of U.S. corporations, a substantial portion of this chapter is devoted to describing what these programs entail; committee members thought it was critical to provide the reader with a thorough description of the technological issues associated with commonly used analytical methods of urinalysis drug testing.
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From page 178... ...
and were required to be drug free and monitored to confirm that they were not taking additional drugs. In late 1980 the testing industry further expanded as the Navy, following a series of incidents that highlighted the pervasive use of marijuana among their personnel, announced a policy of "zero tolerance" for illicit drugs (Cangianelli, 1989~.
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From page 179... ...
In July 1987 Congress expanded on the executive order by enacting a law that required urine testing for federal employees, including employees of federal contractors, and also required that technical and scientific guidelines and standards of practice be met by all laboratories testing urine specimens covered by the law. Scientists from NIDA and forensic toxicologists worked intensively to define a practical laboratory program that would permit testing human urine for five commonly used illicit drugs and their metabolites, with a minimum of error and a maximum of protection for employees.
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From page 180... ...
At the end of 1989 NIDA's Division of Applied Research sponsored a consensus conference to assess technical, scientific, and procedural issues of employee drug testing after about 18 months of operations following the President's executive order. A report was published early in 1990 (Finkle et al., 1990)
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From page 181... ...
. BIOCHEMICAL METHODS FOR DETECTING DRUG USE Forensic urine drug testing begins with specimen collection from the donor, proceeds to laboratory analysis, and then, in properly run programs, culminates in the interpretation of reported results by a medical review officer.
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From page 182... ...
A minor industry has developed to provide specimen collection services. Managing urine collection systems is not a trivial task.
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From page 183... ...
A consensus conference held under the auspices of the Society of Forensic Toxicologists with NIDA support concluded that the use of hair analysis for employee and preemployment drug testing is premature given current information on hair analysis for illicit drugs (National Institute on Drug Abuse, 1990; Keegan, 1991; U.S. Food and Drug Administration, 1990~.
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From page 184... ...
The initial or screening test is designed to efficiently identify those urine specimens that are negative that is, no drugs or metabolites are detected at concentrations above established cutoff values. Those specimens that test positive initially are subject to a confirmatory test which specifically identifies the drug, metabolite, or both, and assays the concentration.
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From page 185... ...
This approach to forensic, analytical toxicology accords with the recommended guidelines and standards of the best-informed professional societies (American Academy of Forensic Sciences, Society of Forensic Toxicologists, 19913. Despite what careful science demands, there are unregulated drug-testing programs that do not employ confirmation testing, including testing within the penal system for compliance with parole conditions and proba:ion and for prisoner evaluation; testing for compliance in methadone main:enance programs; and some workplace programs that use on-site "laborato"ies." Relying on screening test results is an unacceptable practice that is Particularly serious in contexts in which personal liberty is at stake.
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From page 186... ...
Although the two-stage method approved by NIDA appears well suited to its task, there is a cost associated with rigidly setting the analytical methods to be used in drug testing. Innovation may be stifled, and the drug testing industry may fail to take advantage of new advancements in analytical chemistry or, indeed, of existing methods that might find limited application in some workplace programs.
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From page 187... ...
No matter which analytical methods are used, their reliability depends on laboratory quality control and assurance and demonstrated proficiency in the processes employed. In government-regulated programs, the NIDAcertified laboratory is the only component of the urine-testing process that is tightly controlled and regulated with regard to quality.
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From page 188... ...
Quality assurance programs should at a minimum include: auditing specimen collection and protocols; quality control of laboratory assays; participation in open and external blind proficiency testing programs; and continuous training of laboratory staff. The most complex of these components is the control of laboratory assays.
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From page 189... ...
At the inspection the laboratory director and certifying scientists must be able to demonstrate that their urine-testing methods follow the HHS-NIDA guidelines and NIDA Standard Operating Procedures. This is an exacting, costly, and often stressful aspect of the NIDA Certification Program, but it is absolutely essential to the integrity and credibility of certified forensic laboratories.
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From page 190... ...
The reliability and performance of on-site testing was discussed briefly at the NIDA Employee Drug Testing Consensus Conference (Finkle et al., 19901. The delegates at that conference recommended that facilities performing screening tests only should be subject to basic forensic standards for specimen collection, chain-of-custody documentation, and security.
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From page 191... ...
Establishing impairment due to alcohol is important because the Americans With Disabilities Act (ADA) does not protect current users of illicit drugs, but it does protect those who are diagnosed as alcoholics.
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From page 192... ...
Some employers may expand their definition of a drugfree workplace, but they do so at the risk of inadequate technical and forensic support. Accuracy and Interpretation Given that the current NIDA-specified cutoff concentrations are generous and sensitivity and specificity requirements are high, when a urine specimen is analyzed for the five illicit drugs and their metabolites in strict accordance with NIDA guidelines, including a report to the medical review officer, the likelihood that an individual employee will be falsely accused of illicit drug use in this situation is remote.
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From page 193... ...
Two of the most commonly claimed sources of unintentional exposure are the passive inhalation of cannabinoids from marijuana smoke and the unintentional consumption of morphine and codeine from poppy seeds. Research has shown, however, that the passive inhalation of marijuana smoke is very unlikely to result in a positive urine analysis at the present NIDA confirmation (GC/MS)
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From page 194... ...
When they are, one can expect that past practice will continue and that each contested or alleged false positive will be investigated by NIDA and the matter evaluated following scientific evaluation by the Drug Testing Advisory Board. Other test program errors are false negatives, which means that individuals who have recently used a tested drug are not identified.
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From page 195... ...
INDIRECT METHODS OF ASSESSING ALCOHOL AND OTHER DRUG USE In an attempt to avoid some of the technical measurement limitations of the direct methods as well as the controversial legal issues surrounding drug testing specifically (see Appendix A for a detailed treatment of the legal climate of drug testing) , the development of indirect methods for assessing alcohol and other drug use has been rapidly growing.
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From page 196... ...
High sensation seekers are viewed as more likely to use illicit drugs and drink heavily, and the trait has been correlated with polydrug use (Zuckerman, 1979~. In addition to sensation seeking, which is viewed as a relatively stable personality characteristic and thus one that refers to general tendencies rather than specific behaviors, the DAS also seeks to measure more specific psychodynamic mechanisms that are posited to influence attitudes toward drug use.
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From page 197... ...
They first estimated the combined validity of all integrity test items for predicting the criterion of illicit drug and alcohol use. A total of 35 studies with a combined sample size of 24,488 contributed to the analysis.
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From page 198... ...
Ore rates that might be expected when integrity-type tests are widely used to infer drug use. For purposes of illustration, Figure 6.2 shows the proportion of false positives expected for various population base rates and various test accuracy levels.
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From page 199... ...
In this approach, attitude prototype theory (Lord et al., 1984) is used to develop a series of vignettes in which emolovees are described as using alcohol or illicit drugs at or away from work Attitude prototype theory predicts how general attitudes about social categories, for example illicit drug users, are applied to specific category members.
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From page 200... ...
Results showed that experienced users showed substantially higher tolerance for almost all employee drug use situations, with larger differences for the most extreme behaviors, such as marijuana use at work or cocaine use. Employees who had used illicit drugs during the past year were more
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From page 201... ...
Disruptive alcohol and other drug use was defined as any use or being under the influence of illicit drugs or alcohol at work or at school. Newcomb developed two indices of risk factors, one which included gender, marital status, educational plans, cohabitation history, being fired from a job in the past 4 years, having trouble in an intimate relationship (past 3 months)
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From page 202... ...
used illicit drugs were more likely than nonusers to be younger, have an arrest history, associate with peers who were illicit drug users, work in a safety-sensitive job, and work alone or in a small group. Employees who reported using alcohol or illicit drugs at work within the past year were on average younger than their counterparts and more likely to be unmarried, have an arrest history, have low self-esteem, and to associate with peers who use alcohol and other drugs.
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From page 203... ...
the broad category or combination of drugs likely to have caused the impairment (National Highway and Transportation Safety Administration, 1991~. It is stressed that the process is not a field procedure but takes place in a carefully controlled environment, does not determine exactly what illicit drugs have been used but seeks to narrow the presence of drugs to certain broad categories, and is not a substitute for a chemical test, which is required to secure evidence to corroborate the suspi
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From page 204... ...
A second study involved a field-based evaluation of the DEC program (Compton, 1986~. In this study, adult suspects arrested by regular traffic officers of the Los Angeles Police Department or the California Highway Patrol for driving under the influence, and who were suspected of being under the influence of a illicit drug or combination of illicit drug and alcohol, were examined by drug recognition experts (DRE)
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From page 205... ...
illicit drugs were correctly identified 38 percent of the time, and the DRE failed to correctly identify any illicit drugs 13 percent of the time. If only one illicit drug was present in a suspect, DREs correctly identified it 53 percent of the time.
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From page 206... ...
Another reason to be cautious in the use of such indicators as are now available is the underlying motivation of some organizations to label employees who fail behavioral tests as drug users. Occupational Alcoholism and Employee Assistance Programs Behavioral indicators of alcohol and other drug use are widely used through occupational alcoholism programs (OAPs)
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From page 207... ...
There is, however, room for further improvement along the lines of the recommendations emanating from~the 1989 Consensus Report on Employee Drug Testing and the 1992 On-Site Drug Testing Study. Moreover, more could be learned about laboratory strengths and problems if data already collected in the Department of Defense and NIDA blind quality control and proficiency test programs were properly evaluated.
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From page 208... ...
. Preemployment drug testing may have serious consequences for job applicants.
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From page 209... ...
These drugs may, however, be associated with conditions that the employee for good reasons wishes to keep private. Recommendation: In the absence of a strong detrimental link to job performance, legally prescribed or over-the-counter medications detected by drug testing should not be reported to employers.
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From page 210... ...
:31-33. College of American Pathologists 1990 Forensic Urine Drug Testing Inspection Check List.
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From page 211... ...
Crouch, D.J., and T.A. Jennison 1990 Laboratory aspects of forensic urine drug testing.
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Caudill, and J.D. Boone 1985 Crisis in drug testing: results of CDC blind study.
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Terris 1991 Predicting infrequent behavior: clarifying the impact of false-positive rates. Journal of Applied Psychology 76:484-487.
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From page 214... ...
1986 Drug testing programs.
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From page 215... ...
It is related to the methods and measures used by the studies reviewed here: most drug-testing programs do not include alcohol among the drugs to be tested. Executive Order #12564 signed by President Reagan in 1986 mandated testing for illicit drugs; subsequently, in 1988 the HHS "Mandatory Guidelines for Federal Workplace Drug Testing Programs" limited the number of drugs to be tested to the following commonly used illicit drug classes: (1)
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From page 216... ...
More recent surveys of workplace drug testing indicate that between 50 and 75 percent of medium and large organizations now test current or prospective employees for drugs (American Management Association, l9q2; Axel, 1990; Hayghe, 19911. Preemployment drug testing is the most prevalent form of drug testing: 85 percent of those companies the Department of Labor surveyed with a testing program tested job applicants.
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From page 217... ...
The argument here is that the policies of previous administrations, the legislature, and the judicial systems have all contributed to establishing drug testing as a major component of the nation's "war on drugs." Unfortunately, to date, little consideration if any, has been given to assessing the impact of such programs on public health. Although this chapter Is concerned with the effectiveness of workplace drug-testing programs on productivity, the reviewed literature still provides valuable information to policy makers.
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From page 218... ...
This study focused on the important question, which had not yet been addressed in the literature, of whether preemployment drug test results were associated with job performance indicators. All employees hired over a 6-month period were tested for illicit drug use.
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From page 219... ...
carried out a similar predictive study with U.S. Navy recruits who were screened for illicit drugs before being sent to recruit training.
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From page 220... ...
Postal Service job applicants at 21 sites across the country were tested for use of illicit drugs as part of their preemployment medical examination. Test results were kept confidential and had no bearing on any subsequent personnel actions.
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From page 221... ...
, no significant associations were detected between drug test results and accidents and injuries. In July 1990, after having been on the job for an average of 2.4 years, both the absenteeism and turnover disparities across the two groups had further increased: the positive group's absenteeism and firing rates were found to be 66 and 69 percent higher, respectively, than those of the negative group (Normand and Salyards, 1991~.
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From page 222... ...
Employees who tested positive were 3.47 times more likely to be referred to an EAP for drinking problems and 5.69 times more likely to be referred for drug abuse problems as those who tested negative. A similar pattern was observed when medical claims data were examined (see Figure 7.51.
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From page 223... ...
The proportion of people in the general population who use illicit drugs has been declining relatively quickly since 1980. Such fluctuations in the prevalence of drug use are bound to affect the rate of positive preemployment drug-test results and consequently the effectiveness of preemployment drug-testing programs.
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From page 224... ...
For example, a 77 percent higher rate of firing after 3 years may suggest great benefits to preemployment drug screening and the policy of not hiring positive testers. However, as depicted in Figure 7.2, 76 percent of those who tested positive at preemployment had not been fired after 3 years, compared with 86 percent of those testing negative.
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From page 225... ...
Employees testing positive used an average of 63.8 hours of unexcused leave compared with 18.7 hours for the control group. An analysis of vehicle accidents revealed that the identified drug users were significantly more likely to be involved in an accident compared with the matched control group.
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From page 226... ...
The published literature on the effects of random drug testing consists mostly of descriptive reports of trends. Deterrence effects of random testing programs are often inferred from observed decreases in positive drug test rates, which frequently follow the implementation of such programs (Osborn and Sokolov, 1989; Taggart, 1989~.
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From page 227... ...
The two for-cause drug-testing evaluation studies published to date suffer from serious methodological problems that preclude any scientific assessment of the impact of for-cause testing on work force productivity, and no evidence evaluating the effects of random drug testing on worker productivity has yet appeared in the published literature. Enough studies of preemployment drug-testing programs have been published with sufficiently consistent results that we can conclude that preemployment drug-test results are, in at least some job settings, valid predictors of some job-related behaviors.
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From page 228... ...
A major gap in the extant research is its failure to examine the interaction of recent drug usage and other job-related applicant characteristics. Although the studies show preemployment drug testing to be predictively valid, they also indicate that many applicants who test positive could be hired without producing any job-related difficulties.
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From page 229... ...
The appropriateness of the methods used to assess the efficacy of an intervention program depends on the goals or purpose of the programs and the evaluation. If the primary objective for implementing drug-testing programs is to enhance work force productivity, what is crucial to the evaluation of preemployment testing is the predictive validity of drug test results (Society for Industrial and Organizational Psychology, 1987~.
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From page 230... ...
Moreover, in certain situations, it may be wrong or even illegal to employ valid selection programs. Thus there are reasons for research on drug-testing programs to control for individual variables.
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From page 231... ...
In both instances the findings revealed that preemployment drug testing was a cost-efficient selection program. However, both studies neglected to include some important parameters into their models (e.g., variable cost, cor
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From page 232... ...
. Both the utility and fairness of preemployment drug testing as a selection device depend in part on the type of employment errors that result from implementing such programs.
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From page 233... ...
The apparent efficacy of preemployment drug testing could be illusory if testing programs bias applicant pools so as to overrepresent those with few job options. Influence of,Iob Characteristics Reactions to employee drug testing vary substantially, depending on the job in question (Murphy and Thornton, 1992b; Murphy et al., 19911.
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From page 234... ...
First, employee drug testing may be seen as an invasion of privacy, which is likely to lead to negative reactions (Stone and Stone, 1990~. Urine testing is an especially sensitive procedure; the need to provide urine samples strikes many people as offensive, and the need to do so in front of witnesses or under tightly monitored conditions may seem particularly offensive.
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From page 235... ...
CONCLUSIONS AND RECOMMENDATIONS . The empirical evidence pertaining to the efficacy of preemployment drug testing indicates that such programs may be useful to employers in choosing wisely among job applicants.
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From page 236... ...
· Very little is known about what happens to job applicants who are not hired or to employees who are fired as a consequence of a positive drug test. Recommendation: Research should be conducted on the impact of drug-testing programs with attention not only to those who remain within the organization as well as to those who are not hired or are dismissed.
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From page 237... ...
Nonetheless, drug-testing for safety-sensitive positions may still be justified in the interest of public safety. REFERENCES American Management Association 1992 1992 AMA Survey on Workplace Drug Testing and Drug Abuse Policies.
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From page 238... ...
Reynolds 1990 College students' attitudes toward employee drug testing programs. Personnel Psychology 43:615-631.
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From page 239... ...
Normand, J., and S.D. Salyards 1989 An empirical evaluation of preemployment drug testing in the United States Postal Service: interim report of findings.
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From page 240... ...
Gostin 1992 Worksite drug testing. Annual Review of Public Health 13:197-221.
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From page 241... ...
PREVENTION ACTIVITIES Organizations have attempted to minimize the effects of alcohol and other drug use on work settings through policy design and various health promotion activities. Among the most prominent workplace prevention activities are health promotion/wellness programs that have attempted to alter individual risk factors, such as smoking, obesity, and untreated hypertension, that are often associated with alcohol and other drug use.
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From page 242... ...
Of the responding companies, 66 percent reported offering one or more types of health promotion activities, including health risk assessments, smoking cessation, blood pressure control, exercise/fitness, weight control, nutrition education, stress management, back care, and accident prevention. The average number of activities offered was under three, for those companies that offered any.
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From page 243... ...
The concerned heavy drinkers tended to be overweight and inactive, often got less than 6 hours of sleep, and reported being stressed at work. Nearly three-fourths of them smoked, and over one-third reported having used illicit drugs.
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From page 244... ...
behavior counseling plus incentives in an attempt to evaluate the relative efficacy of these work-site health promotion programs on various disease risk factors. The results showed that higher rates of continuous smoking cessation and weight loss were observed for the two behavioral counseling conditions after 3-, 6-, and 12-month followup.
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From page 245... ...
It also covered a substantially longer time period than most of the other studies, lending credence to the results. As the above review suggests, apart from drug-testing programs, few work site prevention efforts have been directed at illicit drugs.
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From page 246... ...
Supervisors are trained in methods of constructive confrontation and referral to the EAP and are discouraged from attempting to counsel employees regarding their personal problems or overlooking problems until they become so severe that disciplinary action is required. Constructive confrontation involves assembling the evidence of deteriorated performance, confronting the employee with that evidence, describing what will be required to bring job performance back to an adequate level, and referring the employee to the EAP for assistance with any underlying problem that is affecting work performance.
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From page 247... ...
Department of Health and Human Services. The survey revealed that 24 percent of the work sites offered employees an EAP (Kiefhaber, 1987~.
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From page 248... ...
On average, about 30 percent of the caseloads in the EAPs studied stem from employees' problems with alcohol and other drugs. In addition, many cases recorded by EAPs as marriage and family problems, the largest single caseload category, involve the alcohol and other drug abuse of spouses or other family members.
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From page 249... ...
They identified 16 studies that used job performance outcomes as criterion measures. Absenteeism was used more often than other criteria and showed improvements in all the studies in which it was evaluated.
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From page 250... ...
Although a company might ask whether the use of its specific EAP increases work performance, a more promising focus for the research community is on the effects of specific EAP activities and services, not the presence or absence of EAPs. Several studies have been done on specific aspects of employee assistance programs.
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From page 251... ...
Identification based on job performance and constructive confrontation of employees so identified are part of the core technology of EAPs (Roman, 1988)
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From page 252... ...
Impact of Supervisor Training The job performance model developed by the EAP relies on the supervisor to identify troubled employees on the basis of deteriorating job performance and then to intervene with constructive confrontation (Trice and Roman, 1978~. Several studies have examined in detail the effectiveness of the constructive-confrontation strategy and generally conclude that this strategy leads to increased employee acceptance of treatment and a subsequent improvement in overall job performance (Hilker et al., 1972; Trice and Beyer, 1984~.
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From page 253... ...
However, no information was provided as to what constituted a "formal" referral and whether this included either a form of job jeopardy or any further monitoring after referral. In sum, the literature on constructive confrontation and referral by supervisors provides some limited evidence that supervisor referrals are effective in improving job performance compared with self-referral or failures to refer.
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From page 254... ...
The study found that, during the year after EAP intervention, the experimental group had IS percent fewer hospitalizations for treatment of alcohol and other drug abuse than the control group and a 24 percent reduction in alcohol and other drug abuse-related health benefit claims (combining claims for treatment and disability)
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From page 255... ...
A multivariate analysis controlling for age, race, severity, and number of follow-up visits found that being in the special follow-up group was significantly associated with reductions in alcohol and other drug abuse disability, alcohol and other drug abuse treatment costs, and relapse leading to hospitalization for alcohol and other drug abuse. There was no effect on absenteeism or health benefit claims other than substance abuse.
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From page 256... ...
By the end of the study, total costs for the treatment of alcoholism were only about 10 percent lower for the AA-only group than for the hospital group due to the greater amount of relapse in the AA group. The study showed substantial improvements in job performance measures for the EAP clients.
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From page 257... ...
suggests that the work performance and health benefit utilization levels of EAP clients return toward normal after intervention. However, the evidence does not conclusively address the magnitude of the independent contribution (effects)
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From page 258... ...
One fundamental cause of the mistaken perception that treatment for these disorders is ineffective is the tendency to view them as acute problems controllable by will power. Yet from the medical perspective, alcohol and other drug abuse and dependence are chronic disorders much like arthritis or diabetes.
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From page 259... ...
Supervisor Referral As discussed with regard to EAPs, constructive confrontation is one of the mechanisms thought to arouse readiness for treatment in employees. This strategy uses deteriorating job performance to identify alcohol- and other drug-abusing employees.
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From page 260... ...
All treatment groups were comparable at admission and showed a similar decrease in drinking behavior after treatment. After the initial decrease, the level of consumption remained lower during the 3-, 6-, and 12-month follow-up periods.
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From page 261... ...
They concluded that it contributes significantly to positive outcomes in alcoholic clients and that it does so independently of patient prognostic variables (residential stability, interpersonal relationships, social activity, health, employment, and drinking status)
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From page 262... ...
Although it is clear that EAPs and work sites should pay more attention to follow-up and after-care, additional research is needed to determine the best, most cost-effective ways to do this (Foote and Erfurt, 1988~. EAPs have placed their energies in case finding, intake, and referral; most have devoted little time to relapse prevention.
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From page 263... ...
. Given the measurement limitations of drug test results in assessing drug abuse or dependence (see Chapter 6)
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From page 264... ...
Research in Personnel and Human Resource Management 7:259-312. 1992 A description of clients using employee assistance programs.
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From page 265... ...
Gregg 1990 Improving participation in worksite wellness programs: comparing health education classes, a menu approach, and follow-up counseling. American Journal of Health Promotion 4: 270-27 8.
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From page 266... ...
Kiefhaber, A 1987 The National Survey of Worksite Health Promotion Activities.
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From page 267... ...
Roman, P.M., and T.C. Blum 1988 Formal intervention in employee health: comparisons of the nature and structure of employee assistance programs and health promotion programs.
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From page 268... ...
Suurvali, and M Boutilier 1986 Healthier Workers: Health Promotion and Employee Assistance Programs.
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