Why Business Leaders Should Care About Problem Drinking

According to government statistics, 75 percent of heavy drinkers are employed. In fact, nearly 9.6 million people or 11.1 percent of full-time workers ages 18 to 49 drink in ways that put them at high risk for alcohol-related health problems and reduces their productivity on the job.

Just look at the facts. According to a federal government survey¹, people with alcohol problems:

• call in sick or skip work an average of 11 days per year, almost twice as often as those who don't have drinking problems
• seek emergency room attention 33 percent more often than the rest of the population
• stay in the hospital over a day and a quarter longer

Who are people with alcohol problems? More often than not, they're young and male, but alcohol-related problems affect people of all ages and women as well as men. Heavy drinking 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. These consequences of heavy drinking are pervasive: 20 percent of workers say they have been injured, have had to cover for a coworker, or needed to work harder because of coworkers' drinking.

Heavy drinking also affects employee health. It greatly increases the chances of unintentional injury—both on and off the job. Over time, heavy drinking contributes to many serious medical problems including liver disease, stroke and cancer. In fact, according to government estimates, alcohol problems add $36 billion 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 problems.

1. U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Office of Applied Studies. 2004. National Survey on Drug Use and Health, 2002. Research Triangle Park, NC: Research Triangle Institute

How Much Is Problem Drinking Costing Your Business?

Employers may recognize that problem drinking can harm their business. But until now they've had difficulty quantifying its cost. Ensuring Solutions to Alcohol Problems offers a simple calculator for this purpose using data from federal government sources.

The Alcohol Cost Calculator uses prevalence rates of problem drinking in eleven industry sectors to broadly measure its impact on specific workplaces. However, problem drinking has many other costs not included in the calculator. Among them:

• increased use of worker's compensation and disability benefits
• accidents and damage
• increased worker turnover and replacement costs
• 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 on family life also shows up in the workplace. If an employee lives with someone who has a drinking problem, his or her job performance and attendance may suffer. Problem drinking can lead to higher employer health care costs for covering the entire family, not just the person with the drinking problem.

Why Business May Be Overlooking Problem Drinking

Identifying and treating alcohol problems can produce dramatic benefits for both employees and employers. In addition to restoring the health and productivity of valuable workers, identifying and treating alcohol problems soon pays for itself in reduced health care costs, studies have proven time and again. These reductions begin as soon as treatment is initiated. Alcoholism treatment also helps reduce health care costs among all family members.

Yet employers are spending less than ever on treating alcohol and drug addiction. Over the last decade, private and independent sector spending on addiction treatment has declined by an average of 0.6 percent annually while health care costs in general increased by 5.4 percent. Streamlining under managed care is partly responsible for this trend, but the fact remains that few American workers use their job's health insurance benefits to access alcoholism treatment.

Why? Anecdotal evidence suggests several reasons. Since alcohol treatment represents such a tiny fraction of their overall health care costs — most estimates suggest less than 0.1 percent — employers may not be paying it much attention, especially if they fail to consider the additional costs associated with absenteeism and decreased productivity.

If companies have a well-established Employee Assistance Program (EAP), they may believe they are doing everything that they can. Focus group research conducted by Ensuring Solutions to Alcohol Problems indicates that many business leaders believe that an EAP is sufficient to address alcoholism in the workplace.

A strong EAP is a good start but the services it can provide often are underutilized. One study indicated that just 1.5 percent of workers use their EAP for an alcohol or drug problem. Unless an employer fosters a culture that supports identification and treatment and reduces stigma and fear of retribution — such as being passed over for a raise or a promotion — many workers can be discouraged from seeking help.

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.
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• 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.
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