Facts About the Impact of Substance Use Disorders

Seventy-seven percent of individuals with a substance use disorders (abuse or dependence) are employed. In fact, nearly 14 million people or 9.2 percent of full-time or part-time workers ages 18 and above use alcohol or drugs ways that put them at high risk for substance-related health problems and reduces their productivity on the job.

Just look at the facts. According to the National Survey on Drug Use and Health, employees with substance use disorders:

• say they call in sick or skip work almost fifty percent more often than those who don't have substance use problems
• seek emergency room attention 25 percent more often than the rest of the population
• are over eleven times more likely to report driving under the influence of alcohol or drugs than are other employees

Who are people with substance problems? More often than not, they're young and male, but substance-related problems affect people of all ages and women as well as men. Workplaces that actively discourage employees from heavy drinking and substance use experience fewer substance-related problems. Excess alcohol and drug use at night or on weekends often means that employees call in sick, arrive late, leave early or fall asleep on the job. If they work in safety-sensitive positions, impaired job performance due to hangovers can endanger their own lives or those of their colleagues and the public.

Excess alcohol and drug use also affects employee health. It greatly increases the chances of unintentional injury—both on and off the job. Over time, excess drinking and drug use can contribute to many serious medical problems including cardiovascular problems, neurological impairments, liver disease, stroke and cancer. In fact, according to government estimates, alcohol and drug problems add $61 billion (or approximately $200 for every man, woman and child in the United States) to the nation's health care bill. American business absorbs much of this cost in the higher premiums it pays for employer-based health insurance as a result of unidentified and untreated alcohol and drug problems.

By identifying and addressing substance abuse early, employers can realize savings, better manage their own risk and build a healthy, productive workforce.

How Much Do Substance Use Disorders Cost?

Employers may recognize that excess alcohol and drug use can harm their business. But until now they've had difficulty quantifying its cost.

Substance use disorders cost the nation an estimated $276 billion a year, with much of the cost resulting from lost work productivity and increased healthcare spending. Given that 77 percent of people with drug or alcohol problems are employed, employers have a major stake in ensuring that employees have access to substance abuse treatment.

How Substance Use Disorders Impact Employers

• Increased healthcare and insurance costs
  • Individuals with untreated substance use disorders have significantly higher heath care costs and utilization than individuals without a substance use disorder.
  • Family members of employees with substance use disorders have more health problems, and higher health care costs, than family members of employees without substance use disorders.
  • People who abuse drugs or alcohol are three and one-half times more likely to be involved in a workplace accident than other workers. 
• Reduced productivity
  • Employees who use drugs, consume alcohol at work, or drink heavily away from work are more likely than other employees to exhibit job with­drawal behaviors, such as spending work time on non-work-related activities, taking long lunch breaks, leaving early, or sleeping on the job.
  • Did You Know?
  • Investing in substance use treatment can yield savings that exceed costs by a ratio of 12 to 1 (National Institute on Drug Abuse, 1999). Savings are greatest when treatment is tailored to the individual’s needs.
  • Providing employees with comprehensive health plan benefits that support a broad range of services, including screening, brief intervention, counseling and medical services, promotes customized treatment for alcohol problems.
  • Light and moderate alcohol users, higher in number than alcoholics, cause 60 percent of alcohol-related absenteeism, tardiness, and poor work quality (Mangione, Howland, & Lee, 1998).
  • Employees who drink heavily off the job are more likely to experience hangovers that cause them to be absent from work; show up late or leave early; feel sick at work; perform poorly; or argue with their coworkers.
  • Increased worker turnover
    • People with drug or alcohol problems were more likely than others to report having worked for three or more employers in the previous year.
      

  Increased safety risks

  Up to 40 percent of industrial fatalities and 47 percent of industrial injuries can be linked to alcohol consumption and alcoholism. Alcohol-related accidents contribute to more workers’ compensation claims, and more claims mean higher insurance premiums.

  Additional costs include:

  • increased use of worker's compensation and disability benefits
  • diverted supervisory, managerial and coworker time
  • friction among workers
  • damage to a company's reputation
  • increased liability theft and fraud

  The profound effect of problem drinking and drug use on family life also shows up in the workplace. If an employee lives with someone who has a substance use disorder, his or her job performance and attendance may suffer. Problem drinking and drug use can lead to higher employer health care costs for covering the entire family, not just the person with the substance use disorder.

  The Substance Use Disorders Cost Calculator for Business uses prevalence rates of problem drinking and drug use for various industry sectors to broadly measure its impact on specific workplaces.

  Learn what you can do to reduce the business costs of substance use disorders

Alcohol, Family Problems and Work

Many families face a host of difficulties closely associated with problem drinking, and these problems quite often spill into the workplace. By encouraging treatment for problem drinking, employers can contribute to improvement in other, co-occurring illnesses, including depression; and ease violence and injury due to suicide, domestic abuse and accidents

Alcohol Problems and Other Mental Illnesses

Many working people who have serious drinking problems also suffer from mental illnesses such as depression. When these two health problems exist simultaneously, a person is said to have co-occurring disorders. More than a third of adults with alcohol problems also have depression.¹ Phobias and post-traumatic stress disorders also commonly co-occur with alcohol problems.² When the illnesses occur at the same time, the symptoms become more severe, more disruptive to everyday life and more complicated to treat.^{3 4} People with co-occurring alcohol problems and mental illnesses are more frequently hospitalized, require longer hospital stays and have poorer outcomes.⁵ As employers look to their health plans and disease management programs to help manage the care of employees and their families with chronic illnesses, it is important that the frequent co-occurrence of alcohol problems be addressed.

Depression

Many businesses recognize that treating depression can yield substantial benefits in reduced absenteeism. Such treatment can lower the costs of short- and long-term disability and workers’ compensation.⁶ Depressed workers miss an average of 19.2 workdays each year.⁷ Depression reduces at-work productivity, according to national survey data, by 3.3 to 5.3 hours/week.⁸ Experts estimate the cost to businesses for each depressed worker at $600 annually, with two-thirds of these costs related to absenteeism and lost productivity.⁹ Depressed employees also have a greater number of injuries on the job. A large body of research shows that high quality treatment of depression can reduce days of work missed and cut low productivity days.¹⁰

For one-third of depressed workers with a co-occurring alcohol use disorder, treatment of the depression with medication alone has little or no effect on problem drinking.¹¹ The combination of antidepressant medications and a type of psychotherapy called cognitive behavioral therapy may reduce both depression and substance use.¹²

As business leaders seek ways to improve the care of their employees with chronic illnesses such as depression, it is important that they keep in mind the frequent co-occurrence of alcohol problems with these disorders. Health plans, disease management programs and Employee Assistance Programs should screen for and treat these co-occurring illnesses.

Suicide and Alcohol

Suicide is the eleventh leading cause of death in the U.S. About one in five of these victims had alcoholism.^{13 14} Suicide rates for people with alcoholism are 30 times greater than for the general population.¹⁵

People with the co-occurring alcohol use disorders and depression are at high risk of suicide,¹⁶ because alcohol use can increase impulsivity at the same time that depression reduces feelings of self-worth and optimism about the future.^{17 18}

As nearly two-thirds of all suicides, almost 20,000 deaths each year, occur among 26- to 65-year-old adults, people who make up the core of the U.S. labor force, businesses can help reduce risks of employee and employee family suicide. Effective Employee Assistance Programs (EAPs) and health insurance programs can increase screening and treatment for alcohol problems and depression.

Domestic Abuse

Domestic violence costs businesses more than $3 billion annually from increased health care costs, lost productivity, increased absenteeism and employee turnover.¹⁹ And violence in the home – one of the nation’s most pervasive forms of criminal activity, affecting between two and four million women and children each year²⁰ – is closely linked to drinking. Sixty percent of batterers are drinking when they are beating their partner.²¹ The repercussions of alcohol-related domestic violence reverberate far beyond the home.

Batterers sometimes subject victims and their coworkers to violence in the workplace. Seventy-four percent of employed battered women are harassed by their abusive partners at work by phone or in person. Between 1993 and 1999, an average of 1.7 million domestic victimizations of people 12 and older occurred at work.²²

Domestic violence affects businesses through increased health care costs and reduced productivity. Researchers believe that treatment of injuries caused by family violence cost $857 million in 1997.²³ Over 7.9 million paid workdays are lost each year to domestic violence, costing American businesses an estimated $727.8 million.²⁴ Fifty-six percent of women abused by their partners are late at least five times a month, 28 percent leave work early five times a month, 54 percent miss at least three full days each month.²⁵ Each year, about one woman in five subjected to domestic violence quits or loses her job.²⁶

The personal trauma and the business costs of domestic abuse could be reduced if alcohol problems were more readily recognized and treated. Batterers are three times more likely than nonbatterers to be problem drinkers.²⁷ Which comes first, serious alcohol problems or serious domestic conflicts, has not been settled by researchers. However, what is not ambiguous is that the more alcohol a batterer drinks, the greater the severity of a given incident.²⁸

Businesses, through their Employee Assistance Programs and health insurance programs, can help break the cycle of violence and alcohol use.

Problem Drinking Increases Risk of Injury

Young people face a higher likelihood of dying from accidents than from any other single cause, with alcohol consumption substantially increasing the likelihood of injury or death. Alcohol use is closely linked to car crash injuries, falls, assaults, burnings and drownings.²⁹ Drinking accounts for as much as one-third of all accidental deaths.³⁰ Participation in the workforce does not make people immune to alcohol-related accidents and injuries, which can occur when workers drink heavily off the job, or drink before or during work hours.³¹

One study found that workers with alcohol problems were 2.7 times more likely than workers without drinking problems to have injury-related absences.³² A hospital emergency department study showed that 35 percent of patients with an occupational injury were at-risk drinkers.³³ Breathalyzer tests in another study detected alcohol in 16 percent of emergency room patients injured at work.³⁴ Analyses of workplace fatalities showed that at least 11 percent of the victims had been drinking.³⁵

Large federal surveys show that 24 percent of workers report drinking during the workday least once in the past year.³⁶ Drinking outside work hours can cause problems on the job. Employees may show up to work hung over.³⁷ One-fifth of workers and managers across a wide range of industries and company sizes report that a coworker’s on- or off-the-job drinking jeopardized their own productivity and safety.³⁸

Employers can increase workplace safety by improving employees’ access to treatment for alcohol problems and through other actions. For more information, see Seven Tools to Lower the Business Costs of Alcohol Problems.

Notes

• 1 Carpenter, K.M., and Hittner, J.B. 1997. Cognitive Impairment Among the Dually-Diagnosed: Substance Use History and Depressive Symptom Correlates. Addiction, 92(6): 747-759.
• 2 Back, S.E., Sonne, S.C., Killeen, T., Dansky, B.S., and Brady, K.T. 2003. Comparative Profiles of Women With PTSD and Comorbid Cocaine and Alcohol Dependence. The American Journal of Drug and Alcohol Abuse, 29(1): 169-189.
• 3 Virgo, N., Bennett, G., Higgins, D., Bennett, L., and Thomas, P. 2001. The Prevalence and Characteristics of Co-Occurring Serious Mental Illness (SMI) and Substance Abuse or Dependence in the Patients of Adult Mental Health and Addictions Services in Eastern Dorset. Journal of Mental Health, 10(2): 175-188.
• 4 Carpenter, K.M., and Hittner, J.B. 1997.
• 5 Mason, B.J., Kocsis, J.H., Ritvo, E.C., and Cutler, R.B. 1996. A Double-blind, Placebo-Controlled Trial of Desipramine for Primary Alcohol Dependence Stratified on the Presence or Absence of Major Depression. The Journal of the American Medical Association, 275(10): 761-767.
• 6 MacArthur Depression in Primary Care Calculator. 2004. Available at: www.depression-primarycare.org/organizations/employers/calculator/
• 7 Kessler R.C., Frank R.G. 1997. The Impact of psychiatric disorders on work loss days. Psychiatric Medicine 1997; 27:861-873.
• 8 Stewart, W.F., Ricci, J.A., Chee, E., Hahn, S.R., Morganstein, D. Cost of lost productive work time among U.S. workers with depression. Journal of the American Medical Association 2003; 289:3135-3144; Lerner, D. Workplace Limitations Questionnaire National Survey. 2004.
• 9 Greenberg, P.E., Stiglin, L.E., Finkelstein, S.N., and Berndt, E.R. The Economic Burden of Depression in 1990. Journal of Clinical Psychiatry, 2: 32-35; Stewart W.F., Ricci, J.A., Chee, E., Hahn, S.R., Morganstein, D.
• 10 Rost, K. et al. 2003. The Effect of Improving Primary Care Depression Management on Employee Absenteeism and Productivity: a Randomized Trial. Medical Care 42: 1202-1210.
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• 12 Hesse, M. 2004. Achieving abstinence by treating depression in the presence of substance use disorders.
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• 18 Cornelius, J.R., Salloum, I.M., Mezzich, J., Cornelius, M.D., Fabrega, Jr., H, Ehler, J.G., Ulrich, R.F., Thase, M.E., and Mann, J.J. 1995.
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