Workplace Substance Use Climate: Prevalence and Distribution in the U.S. Workforce

Structural sexism moderates work and occupational risks for alcohol consumption and binge drinking among US women, 1989-2016

BACKGROUND

People in the labor force and in high-status careers consume alcohol at high rates. State-level structural sexism (sex inequality in political/economic status) is inversely related to alcohol use among women. We examine whether structural sexism modifies women's labor force characteristics and alcohol consumption.

METHODS

We surveyed frequency of alcohol consumption in the past month and any binge drinking in the past two weeks among women ages 19-45 in Monitoring the Future from 1989 to 2016 (N = 16,571) in relation to occupational characteristics (including employment status, high-status career, and occupational gender composition) and structural sexism (measured using state-level indicators of gender inequality) with multilevel interaction models controlled for state-level and individual confounders.

FINDINGS

Working women and women in high-status occupations had higher risks of alcohol consumption than non-working women; differences were most pronounced in lower-sexism states. At the lowest sexism levels, employed women consumed alcohol more frequently (2.61 occasions of use in past 30 days, 95% CI 2.57, 2.64) than unemployed women (2.32, 95% CI 2.27, 2.37). Patterns were more pronounced for frequency of alcohol consumption than binge drinking. Occupational gender composition did not influence alcohol consumption.

INTERPRETATION

In lower sexism states, working and having a high-status career are associated with increased alcohol consumption for women. Labor force engagement extends positive health benefits to women, but it also confers specific risks, which are sensitive to the broader social context; these findings contribute to a growing literature suggesting that alcohol risks are changing in relation to shifting social landscapes.

Workplace Supported Recovery from Substance Use Disorders: Defining the Construct, Developing a Model, and Proposing an Agenda for Future Research

Substance use disorders (SUDs) represent a critical public and occupational health issue. Therefore, understanding the process of SUD recovery has become an issue of growing importance among substance use and recovery professionals. Nonetheless, despite the acknowledged importance of employment for SUD recovery, little conceptual or empirical work exists on how the workplace might support or undermine SUD recovery. In this article, we address this limitation in several ways. First, to promote a better understanding of SUD recovery for occupational health researchers, we provide a brief overview of the nature of a SUD, prior definitions of SUD recovery, and general themes associated with the recovery process. Second, we develop a working definition of workplace supported recovery. Third, we present a heuristic conceptual model showing how the workplace might impact the SUD recovery process. Fourth, using this model and research from the substance use and occupational health literatures, we develop a series of general research propositions. These propositions highlight broad directions requiring more detailed conceptualization and empirical research to understand better how work conditions may support or undermine the process of employee SUD recovery. Our overarching goal is to motivate innovative conceptualization and research on workplace supported recovery from SUDs. Such research may inform the development and evaluation of workplace interventions and policies supporting SUD recovery and highlight the benefits of workplace supported SUD recovery for employees, employers, and communities. Research on this issue may allow occupational health researchers to impact a significant societal and occupational health issue.

Increasing cocaine use amongst employed Australians: who is most at-risk?

Australian's cocaine use is at record levels. Large increases occurred between 2016-2019, with significant increases predominately found among employed Australians. Patterns, and prevalence of workers' cocaine use were examined using the 2016 and 2019 National Drug Strategy Household Survey data via frequency analyses. Logistic regression modelling identified predictors of employed Australian's: cocaine use (2019); and increased use over time (2016-2019). Workers' cocaine use increased 63% between 2016-2019 (3.8%-6.2%). Predictors of use, and increased use, were age, marital status, state, remoteness, smoking status, alcohol use, and cocaine approval level. Income and psychological distress predicted cocaine use in 2019 only. Highest prevalence in 2019 occurred among workers who approved of regular cocaine use (47.9%), currently smoked (14.9%), were very highly distressed (14.0%), risky alcohol consumers (13.7%), and aged 18-24 years (13.9%). Numerous individual-level characteristics influence workers' cocaine use. Workplace cultural norms and substance use climates may facilitate increased cocaine use. The workplace is a powerful setting for cocaine prevention and intervention efforts. Potential strategies include targeting social norms, shifting positive drug use workplace cultures, and providing health and safety training focussing on the risk of use to self and co-workers whilst also examining demographic subgroups' motivations for use.

Prevalence and sociodemographic factors associated with polysubstance use: analysis of a population-based survey in Jamaica

BACKGROUND

In Latin America and the Caribbean, there is a dearth of research exploring polysubstance use. This study aims to determine the prevalence, varying combinations and associated sociodemographic characteristics of polysubstance use in Jamaica.

METHODS

This study involved a secondary data analysis of the Jamaica National Drug Prevalence Survey 2016 dataset where 4,623 participants between the age of 12 and 65 years from each household were randomly selected as respondents. Statistical analysis was performed to determine the prevalence and the sociodemographic correlates of polysubstance use among Jamaicans.

RESULTS

19.6% of respondents used two or more drugs in their lifetime. Of this amount 68.7% reported past year use and 61.9% reported past month use. Bivariate analyses reported polysubstance use was statistically significantly higher amongst males (U = 54,579, p = 0.000), those living in rural areas (U = 91,892, p = 0.003), non-Christian (U = 89,514, p = 0.014), and married persons (U = 74,672, p = 0.000). Past month polysubstance use was statistically significantly higher among employed persons than unemployed persons were (U = 81,342, p = 0.001). Surprisingly, there was a lack of significant differences between education level, household income and past month concurrent polysubstance use (p = 0.609; p = 0.115 respectively). Logistic regression model indicated males were 3.076 times more likely than females to report past month polysubstance use than females. Also, when compared to those 55-65 years old, participants 35-54 years were 2.922 times more likely and those 18-34 years were 4.914 times more likely to report past month polysubstance use. Additionally, those living in rural areas were 1.508 times more likely than participants living in urban areas to report past month polysubstance use. As it relates to occupational status, when compared to armed forces, skilled workers were 4.328 times more likely and unskilled workers were 7.146 times more likely to report past month polysubstance use.

CONCLUSIONS

One in five Jamaicans identified as polysubstance users, predominated by marijuana as the most common factor amongst the polysubstance combinations examined, signalling the need for early marijuana interventions.

Cannabis use and workplace cannabis availability, perceptions and policies among Canadian workers: a comparison before and after the legalisation of non-medical cannabis

OBJECTIVES

Little data exist examining the impact of non-medical (recreational) cannabis legalisation among a working population. The objective was to compare cannabis use patterns and workplace risk perceptions, cannabis availability and workplace use policies before and almost 1 year after legalisation in Canadian workers.

METHODS

Two overlapping cross-sectional samples of Canadian workers were surveyed 4 months before legalisation (time 1 (T1), n=2011) and 9-11 months after legalisation (time 2 (T2), n=4032), gathering information on cannabis use (overall and workplace use), workers' perceptions regarding risks of workplace use, availability of cannabis at work and awareness of workplace substance use policies. The marginal distributions of these variables at T1 and T2 were compared, adjusting for sociodemographic, work and health and lifestyle factors.

RESULTS

Cannabis use status changed from prelegalisation to postlegalisation (p<0.0001), with fewer respondents reporting former use (ie, more than 1 year ago; 40.4% at T1, 33.0% at T2) and a greater proportion of workers reporting past-year use (30.4% at T1, 39.3% at T2). Never use remained stable (29.2% at T1, 27.6% at T2). Workplace cannabis use also remained stable (9.4% at T1, 9.1% at T2; p=0.4580). At T1, 62.7% of respondents reported being aware of their workplace having a substance use policy, increasing to 79.0% at T2 (p<0.0001). Small magnitude changes occurred in perceptions of risk and workplace availability.

CONCLUSIONS

Results point to a lack of substantive changes in the short-term from prelegalisation to postlegalisation. Longer-term data among workers are needed given the evolving nature of this legislative policy.

Occupational factors associated with long-term abstinence among persons treated for alcohol dependence: A follow-up study

Background

Several studies have examined the occupational factors associated with alcohol use and dependence. However, there are very few studies that investigated the role of occupational factors associated with long-term abstinence among persons treated for alcohol dependence in India.

Aim

To examine the occupational factors associated with long-term abstinence among persons treated for alcohol dependence.

Methods

Sixty in-patients treated for alcohol dependence were selected using inclusion criteria from the Government-run de-addiction center, tertiary care teaching hospital, Bangalore. All patients were followed up periodically for 1 year. The semi-structured interview schedule was used for collecting data on occupational factors associated with long-term abstinence. Descriptive statistics, Chi-square test, and Fisher exact test were used for data analysis.

Results

There was a positive trend showing self-employed (pf = 1.74, P = 0.45), having skilled work (pf = 1.52, P = 0.72), regular pattern of employment (pf = 1.21, P =.60), monthly mode of income (pf = 1.43, P =.76) were factors associated with abstinence. Among eight occupational variables, employment status (x ² = 4.0, P =.04) and having well-defined working hours ((pf = 6.18, P =.04) were significantly associated with long-term abstinence among persons treated for alcohol dependence.

Conclusion

Occupational factors seem to influence the outcome in alcohol dependence and appropriate vocational interventions would be effective in promoting long-term abstinence.

Flying below the Radar: Psychoactive Drug Use among Young Male Construction Workers in Sydney, Australia

Background: Globally, there is growing concern regarding workers' illicit drug use and its implications for health and workplace safety. Young workers in male-dominated industries, such as construction, may be more susceptible to illicit drug use, risky drinking and its associated harms.Purpose/objectives: To investigate drug use and perceptions of risk among male construction workers, drawing comparisons between workers under 25 years with older age groups.Methods: Workers in Sydney, Australia (N = 511) completed a survey measuring past year illicit drug and alcohol use, psychological distress and perceptions of drug-related risks to health and safety. Prevalence in the total sample was compared with national estimates, and differences between younger and older survey respondents were examined using logistic regression models.Results: Survey respondents' cocaine, meth/amphetamine and cannabis use was significantly higher than estimates of male employees nationally (OR = 6.60, 3.58, 1.61, respectively). Young workers ≤24 were more likely to frequently use illicit drugs, drink heavily, and report psychological distress than those aged 35+. Workers ≤24 were least likely to perceive that drug use posed high risks to health or safety when compared with 25-34 and 35+ age groups.Conclusions/importance: The findings highlight the high prevalence of illicit drug use amongst young construction workers, representing threats to workplace safety even if used outside work hours. Greater emphasis on potential adverse effects of alcohol and drug use and closer examination of contributory workplace factors are required. These findings have practical implications to inform occupational health and safety programs and interventions in high-risk workplaces.

Have decreases in young workers' risky drinking resulted in an increase in illicit drug use?

ISSUES ADDRESSED

Recent reductions in young people's risky alcohol use have been widely documented but have not been examined among employed youth. Young workers' risky drinking may have corresponded with increased illicit drug use. This study investigated these issues.

METHODS

Secondary analyses were conducted for 15-24 year old Australian workers using nationally representative data from 2007 to 2016. Frequency analyses examined alcohol and illicit drug use, Z scores assessed differences over time, and logistic regression examined predictors of illicit drug use.

RESULTS

Risky drinking decreased significantly over time whilst low-risk drinking increased. This pattern was observed for both young workers and young employed illicit drug users. Whilst "any" illicit drug use did not change over time, methamphetamine use decreased, and cannabis and hallucinogen use increased. Drinking alcohol at risky levels (monthly) was associated with illicit drug use in 2016, as were being single and having high/very high levels of psychological distress.

CONCLUSIONS

Risky drinking reductions over time have not corresponded with increased illicit drug use. Nonetheless, as risky drinking remains high among young workers, and is strongly associated with illicit drug use, it warrants concerted health promotion efforts that may also help minimise illicit drug use. SO WHAT?: Despite a reduction in young workers' risky alcohol consumption, risky drinking is still high and may impact the health and safety of workers and the wider community. As risky drinking is strongly associated with illicit drug use, workplaces could potentially play a vital role in combating alcohol and illicit drug misuse.

Construction workers' alcohol use, knowledge, perceptions of risk and workplace norms

INTRODUCTION AND AIMS

Globally, there is growing concern regarding workers' alcohol use and its implications for health, wellbeing and workplace safety. Male-dominated industries are more susceptible to risky alcohol consumption and its associated harms. This paper investigated the patterns, prevalence and predictors of risky drinking among construction workers.

DESIGN AND METHODS

Male construction workers (n = 511) completed a survey measuring alcohol-related measures including Alcohol Use Disorders Identification Test - Concise (AUDIT-C), which was compared with population data. Hierarchical multiple regression examined alcohol-related knowledge, perception of risk to workplace safety, psychological distress, job stress, general health, quality of life and workplace alcohol culture variables as predictors of risky drinking.

RESULTS

Prevalence of risky drinking was higher than the national average, particularly for younger (<25 years) and mid-aged (45-54 years) workers. One in six construction workers reported workmates being visibly affected by alcohol in the workplace. Key predictors of risky drinking were perception of alcohol-related risks to workplace safety, general health, alcohol knowledge and descriptive norms regarding workmates' alcohol use.

DISCUSSION AND CONCLUSIONS

These findings provide useful insights into the patterns and predictors of risky drinking in construction and can inform future preventive programs and interventions in high-risk workplaces. In addition to tailoring programs to both young and mid-aged workers, this work highlights the importance of implementing strategies to increase awareness of risks to workplace safety; and the adoption of norms that inhibit the social acceptability of risky drinking behaviour in the wider workplace.

Physicians' norms and attitudes towards substance use in colleague physicians: A cross-sectional survey in the Netherlands

INTRODUCTION

Substance use disorders (SUD) in physicians often remain concealed for a long time. Peer monitoring and open discussions with colleagues are essential for identifying SUD. However, physicians often feel uncomfortable discussing substance use with a colleague. We explored physicians' attitudes and norms about substance use (disorders) and their (intended) approach upon a presumption of substance use in a colleague.

MATERIALS AND METHODS

An online cross-sectional survey concerning "Addiction in physicians" was administered by the Royal Dutch Medical Association physician panel. Overall, 1685 physicians (47%) responded. Data were analyzed by logistic regression to explore factors associated with taking action upon a substance use presumption.

RESULTS

Most physicians agreed that SUD can happen to anyone (67%), is not a sign of weakness (78%) and that it is a disease that can be treated (83%). Substance use in a working context was perceived as unacceptable (alcohol at work: 99%, alcohol during a standby duty: 91%, alcohol in the eight hours before work: 77%, and illicit drugs in the eight hours before work: 97%). Almost all respondents (97%) intend to act upon a substance use presumption in a colleague. Of the 29% who ever had this presumption, 65% took actual action. Actual action was associated with male gender and older age (OR = 1.81; 95% CI = 1.20-2.74 and OR = 1.03; 95% CI = 1.01-1.05, respectively).

CONCLUSIONS

About one-third of physicians reported experience with a presumption of substance use in a colleague. Whilst most physicians intend to take action upon such a presumption, two-thirds actually do act upon a presumption. To bridge this intention-behavior gap continued medical education on signs and symptoms of SUD and instructions on how to enter a supportive dialogue with a colleague about personal issues, may enhance physicians' knowledge, confidence, and ethical responsibility to act upon a presumption of substance use or other concerns in a colleague.

Work-Related Alcohol Use and Harm to Others

Drinking alcohol with coworkers is a common practice in many occupational cultures. This practice may produce negative consequences for some employees. Objectives: We estimate the prevalence of a set of negative consequences of work-related alcohol use and identify risk factors associated with experience of harm from coworkers' drinking. Methods: In an online survey, Norwegian employees (n = 3596) aged 20-69 reported whether they had experienced the following due to coworkers' drinking the past 12 months: (a) felt excluded, (b) experienced unwanted sexual attention, (c) been physically harmed, and (d) been verbally abused. Each outcome was regressed on socio-demographics (age, gender, education, and income), job characteristics (flexibility and autonomy), respondents' alcohol use, and perceived intoxication frequency in work contexts for a typical coworker (perceived coworker intoxication frequency). Results: The 12-month prevalence of experiencing any of the negative consequences was 18%. Having felt excluded (10.7%) and experienced unwanted sexual attention (7.0%) were more common than being verbally abused (4.8%) or physically harmed (1.9%). Perceived coworker intoxication frequency was strongly associated with all outcomes. Respondents' own drinking frequency predicted being verbally abused, being physically harmed, and experiencing unwanted sexual attention. Women experienced less physical harm and more unwanted sexual attention than men. Prevalence also varied by age, education, income, and job characteristics. Conclusions: Each year, approximately one-sixth of Norwegian employees experience harm from their coworkers' drinking. The frequency of intoxication in work contexts is strongly associated with harm to others.

Employee Psychoactive Substance Involvement: Historical Context, Key Findings, and Future Directions

Humans have consumed psychoactive substances for millennia, and these substances have played an important role in human culture and human labor. This article investigates our current understanding of the general association between the workplace and employee involvement with psychoactive substances. I begin by briefly exploring the broad evolutionary and historical intersection of psychoactive substances, human culture, and human labor. I then outline the multidimensional nature of employee psychoactive substance involvement and look at its prevalence. Next, I summarize recent research on workplace antecedents, such as work stressors, substance availability, norms, and social control. I then summarize research on the adverse workplace outcomes experienced by employees who use psychoactive substances as well as the collateral effects of such use on coworkers. Throughout the article, I identify directions for future research.

The Relationships Between Hindrance Stressors, Problem Drinking, and Somatic Complaints at Work

Problem drinking is an important behavioral phenomenon with numerous implications for employees’ health and well-being within and outside the workplace. Although recent research has demonstrated that workplace stressors have effects on employees’ problem drinking, additional research is needed to examine the role employees’ problem drinking plays in the workplace stress–strain process. We draw from the transactional model of stress and the self-medication hypothesis to address this gap in prior research by offering a novel explanation for the indirect effects of hindrance stressors on employees’ somatic complaints at work through problem drinking. Overall, we find support for the hypothesized model using a time-separated data collection with a heterogeneous sample of employee respondents from the United States ( n = 223). This study extends prior stress research by making two important contributions to theory and research. First, we make an empirical contribution by examining problem drinking and somatic complaints at work, which are both understudied organizational phenomena that have importance to numerous organizational stakeholders. Second, we draw from the transactional model of stress and the self-medication hypothesis in a novel way that provides an important explanation for why hindrance stressors in the workplace are indirectly associated with somatic complaints at work through employees’ use of problem drinking as a self-medication coping mechanism.

Perceived physical availability of alcohol at work and workplace alcohol use and impairment: testing a structural model

This study develops and tests a new conceptual model of perceived physical availability of alcohol at work that provides unique insight into 3 dimensions of workplace physical availability of alcohol and their direct and indirect relations to workplace alcohol use and impairment. Data were obtained from a national probability sample of 2,727 U.S. workers. The results support the proposed conceptual model and provide empirical support for a positive relation of perceived physical availability of alcohol at work to workplace alcohol use and 2 dimensions of workplace impairment (workplace intoxication and workplace hangover). Ultimately, the findings suggest that perceived physical availability of alcohol at work is a risk factor for alcohol use and impairment during the workday, and that this relation is more complex than previously hypothesized.