The alcohol problems of workers and their families cost employers hundreds of dollars per affected individual in avoidable outpatient, emergency and inpatient hospital costs and in absenteeism, disability and turnover.¹

What Are the Hidden Costs of Alcohol Problems?

Health care spending as been soaring since the late 1990s. Employers are scrambling for ways to manage these costs and the underlying causes of the increases. Many employers are unaware that alcohol use is one of those factors. In fact, health care costs for employees who have alcohol problems are about twice as high as for those who do not.²

• In 2000, the total cost of alcohol-related problems manifesting in productivity loss, premature death, disability, automobile accidents and other problems was $683 for every person in the United States.³

• Problem drinkers – people who drink in ways that endanger health and well-being – spend four times as many days in the hospital as the national average, mostly as the result of drinking-related automobile accidents. ⁴

• Almost half of all trauma and injury visits to hospital emergency rooms,⁵ and between 20 and 30 percent of all trips to the emergency room are alcohol-related.⁶

• In a company employing 200 workers, employees and their family members are likely to have 40 alcohol-related emergency visits⁷ and 121 alcohol-related ambulatory care visits yearly.⁸

How Else Does Alcohol Take a Toll on Business?

Employers' primary costs related to alcohol are not for treatment of the alcohol problem. Instead, they are direct health care costs for related injuries and health problems, and indirect costs for absenteeism, productivity, workplace injuries, workers compensation and disability claims. Employers incur significant disability and workers compensation costs because of alcohol use.

• In developed countries, alcohol use is the leading cause of male disability and the tenth leading cause in women.⁹

• Light and moderate alcohol users, higher in number than alcoholics, cause 60 percent of alcohol-related absenteeism, tardiness and poor work quality. Dependent drinkers cause 40 percent.¹⁰

• Heavy drinkers – people who drink five or more drinks on five or more occasions in a 30-day period – are much more likely than average workers to miss days for injuries, illnesses and unexcused absences.¹¹

• Heavy drinkers have higher rates of job turnover than average workers.¹²

• Alcohol use on and off the job causes problems for nondrinking co-workers: a study found that one out of five employees reports that alcohol problems of people they work with caused them to fear injury, work harder, redo work or cover for the drinker.¹³

What Can Employers Do?

Employers with success in preventing and treating alcohol problems sponsor a range of employee resources and programs. Alcohol in the workplace is a costly problem affecting all employers. These seven actions can be taken (most at low to no cost) to minimize the impact of problematic, dependent and risky alcohol use on the workplace.

1. Offer Comprehensive Health Insurance

A first tool for employers is to offer comprehensive health insurance. Ensuring Solutions to Alcohol Problems published a December 2002 report that analyzed employment-based insurance. The report found that there are significant gaps in alcohol coverage in many health plans. Nonetheless, it also found that some companies can and do purchase insurance that covers the range of needed alcohol services.

2. Monitor and Maintain Standards of Care

Another important tool for employers is to work with their health plans to establish and monitor standards of care that meet the needs of problem drinkers and alcoholics. The health plans should treat alcoholism as a disease and manage it accordingly. The path to recovery is a well coordinated plan involving a multidisciplinary treatment team.

Employers who want to provide quality treatment for employees and their dependants should seek out and purchase those plans that improve access to treatment. Furthermore, plans can be designed to improve communication between health plans, vendors and providers by using incentives to improve the quality of care. Coordination of the Employee Assistance Program (EAP), behavioral, and medical services is value-added service for both employer and employee. This ensures that a patient's care is coordinated and hence much more cost effective.

3. Enact Treatment-Oriented Workplace Policies

Strong, clear workplace policies can reduce alcohol problems and reduce legal liability. Policies must be nonpunitive and encourage employees to seek treatment. Some occupations such as construction and transportation are especially vulnerable to hazardous alcohol use. Company policies and culture need to be in step with occupational considerations. Many companies address these hazards by implementing strict alcohol policies. Furthermore, companies and workers subject to U.S. Department of Transportation regulations must adhere to stringent alcohol policies that include mandatory testing of employees involved in any accident or injury situation.

4. Intensify Health Education

Health education programs that address risks of alcohol use, alcoholism and off-the-job drinking are vital. They reduce stigma, eliminate barriers to treatment and can minimize the impact of alcohol on the workplace. Several studies have monitored the impact of education programs on employees' alcohol use and have found that employees where such programs are in place reported lower alcohol consumption and lower incidences of negative work performance related to alcohol use.¹⁴

5. Promote Confidential Screening

When screened for alcohol problems, one in five men and one in ten women who visit their primary care providers meet the criteria for at-risk drinking, problem drinking or alcohol dependence.¹⁵ In the last few years many employers began sponsoring confidential programs in which employees self-assess their drinking during National Alcohol Screening Day, a nationwide program to encourage confidential screening for alcohol problems held each year in April.¹⁶ Confidential screening often opens the door for intervention and treatment.

6. Offer/Expand Employee Assistance Programs

Parts of an effective EAP include:

• Confidential screening and counseling

• Worksite awareness programs

• Web-based information, referrals to treatment

• Recovery support for workers in treatment

• Supervisor training to spot productivity problems¹⁷

7. Manage Employees' Time Off and Return to Work

Employers can take an active role in managing employees who are temporarily off the job while receiving treatment for alcohol problems by coordinating with care providers, managers and the employee to expedite the employee's return to work. By making reasonable accommodations and by easing the return through flexible scheduling, allowing for time to go to medical appointments and receive continuing care, the company can retain trained employees.

Footnotes

¹ Harwood, H., Fountain, D. Livermore, G. 1998. The Economic Costs of Alcohol and Drug Abuse in the United States. Rockville, MD: National Institute on Drug Abuse.

² National Institute on Alcohol Abuse and Alcoholism. 2000. Tenth Special Report to the U.S. Congress on Alcohol and Health. Washington: U.S. Department of Health and Human Services.

³ op.cit.

⁴ ibid.

⁵ Centers for Disease Control and Prevention. 2000. Alcohol Problems Among Emergency Department Patients: Proceedings of a Research Conference on Identification and Intervention. Atlanta.

⁶ McDonald, A.J., Wang, N. & Camargo, C.A. 2004. US Emergency Department Visits for Alcohol-Related Diseases and Injuries Between 1992 and 2000. Archives of Internal Medicine. 164: 531-537.

⁷ Centers for Disease Control and Prevention. 2000.

⁸ U.S. Statistical Abstracts. 2000

⁹ World Health Organization. 1996. Global Burden of Disease. Geneva.

¹⁰ Drug Strategies. 1999. Millenium Hangover: Keeping Score on Alcohol. Available from World Wide Web: http://www.drugstrategies.org/keepingscore1999/recovery.html

¹¹ Zhang, Z., Huang, L.X., Brittingham, A.M. 1999. Worker Drug Use and Workplace Policies and Programs: Results from the 1994 and 1997 NHSDA. Rockville, MD: U.S. Substance Abuse and Mental Health, Office of Applied Studies.

¹² ibid.

¹³ Mangione, T.W. et al. 1998. New Perspectives for Worksite Alcohol Strategies: Results from a Corporate Drinking Study. Boston, MA: JSI Research and Training Institute.

¹⁴ Roman, P., Blum, T. 2002. The Workplace and Alcohol Problem Prevention. Bethesda, MD. National Institute on Alcohol Abuse and Alcoholism.

¹⁵ Manwell, L.B., Fleming, M.F., Johnson, K., Barry, K.L. 1998. Tobacco, Alcohol and Drug use in a Primary Care Sample: 90-day Prevalence and Associated Factors. Journal of Addictive Diseases 17(1): 67-81.

¹⁶ For more information, visit www.alcoholscreening.org or www.mentalhealthscreening.org. Ensuring Solutions to Alcohol Problems neither sponsors nor endorses either program.

¹⁷ The Council on Accreditation (COA) and the Employee Assistance Society of North America (EASNA) have developed principles and accreditation standards for EAPs. Information is available at http://www.coanet.org/EASNAstandards.html.

Eve Raskin and Lynora Williams, December 2002 (revised 2004)

Working with policymakers, employers and concerned citizens, Ensuring Solutions to Alcohol Problems at The George Washington University Medical Center in Washington, DC, provides research-based information and tools to help curb the avoidable health care and other costs associated with alcohol use. The project works to improve access to treatment for Americans who need it. It is supported by a grant from The Pew Charitable Trusts.