National Institute on Drug Abuse

RESEARCH

MONOGRAPH SERIES

Drugs in the

Workplace:

Research and

Evaluation Data

Volume II

1 0 0

U.S. Department of Health and Human Services • Public Health Service • National Institutes of Health
Drugs in the Workplace:

Research and Evaluation

Data

Volume II

Editors:

Steven W. Gust, Ph.D.

J. Michael Walsh, Ph.D.

Linda B. Thomas, B.S.

Dennis J. Crouch, M.B.A.

Research Monograph 100

1990

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Public Health Service

Alcohol, Drug Abuse, and Mental Health Administration

National Institute on Drug Abuse

5600 Fishers Lane

Rockville, MD 20857

For sale by the U.S. Government Printing Office

Superintendent of Documents, Mail Stop: SSOP, Washington, DC 20402-9328

ISBN 0-16-035869-8
ACKNOWLEDGMENT

This monograph is based upon papers presented at a conference titled,

“Drugs in the Workplace: Research and Evaluation Data,” held on September

25-27, 1989, in Bethesda, MD. The conference was sponsored by the

Division of Applied Research, National Institute on Drug Abuse.

COPYRIGHT STATUS

The National Institute on Drug Abuse has obtained permission from the

copyright holders to reproduce certain previously published material as noted

in the text. Further reproduction of this copyrighted material is permitted

only as part of a reprinting of the entire publication or chapter. For any

other use, the copyright holder’s permission is required. All other material

in this volume except quoted passages from copyrighted sources is in the

public domain and may be used or reproduced without permission from the

Institute or the authors. Citation of the source is appreciated.

Opinions expressed in this volume are those of the authors and do not

necessarily reflect the opinions or official policy of the National Institute on

Drug Abuse or any other part of the U.S. Department of Health and Human

Services.

The U.S. Government does not endorse or favor any specific commercial

product or company. Trade, proprietary, or company names appearing in this

publication are used only because they are considered essential in the context

of the studies reported herein.

NIDA Research Monographs are indexed in the Index Medicus. They are

selectively included in the coverage of American Statistics Index, BioSciences

Information Service, Chemical Abstract, Current Contents, Psychological

Abstracts, and Psychopharmacology Abstracts.

DHHS publication number (ADM)91-1730

Printed 1991

ii
CONTENTS

Introduction and Summary

Research on Drugs and the Workplace:

Introduction and Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3

Steven W Gust, Dennis J. Crouch, and J. Michael Walsh

Nature and Extent of Drug Use by the Workforce

Drug Use Patterns and Demographics of Employed Drug Users:

Data from the 1988 NIDA Household Survey. . . . . . . . . . . . . . .

Andrea Kopstein and Joseph Gfroerer

 11

Drugs in the Military Workplace: Results of the 1988

Worldwide Survey. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Robert M. Bray, Mary Ellen Marsden, J. Valley Rachal,

and Michael R. Peterson

25

Patterns of Drug Use in a Large Metropolitan Workforce. . . . . . .

Wayne E.K. Lehman and D. Dwayne Simpson

45

Drug Use Trends in a Nuclear Power Facility:

Data from a Random Screening Program. . . . . . . . . . . . . . . . . .

Carl E. Osborn and Jacque Sokolov

6 3

Mandatory Post Accident Drug and Alcohol Testing for

the Federal Railroad Administration (FRA). . . . . . . . . . . . . . . . . . .79

David E. Moody, Dennis J. Crouch, David M. Andrenyak,

Rachel P. Smith, Diana G. Wilkins, Ann M. Hoffman, and

Douglas E. Rollins

Drug Use and Job Performance Indicators

Development of Repeated Acquisition Methodologies to

Detect Drug-Induced Disruption in Human Learning. . . . . . . . . . . . .99

Warren K. Bickel, Stephen T. Higgins, and John R, Hughes

Residential Laboratory Research: A Multidimensional

Evaluation of the Effects of Drugs on Behavior. . . . . . . . . . . . . . . .113

Marian W. Fischman, Thomas H. Kelly, and Richard F. Foltin

iii
Effects of Alcohol on Human Behavior: Implications for

Workplace Performance. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .129

Thomas H. Kelly, Richard W. Foltin, and Marian W. Fischman

Impact of Moderate Alcohol Consumption on Business

Decision Making. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .147

Sarah M. Jobs, Fred E. Fiedler, and Chad T. Lewis

Application of Human Laboratory Data for the Assessment

of Performance in Workplace Settings: Practical and

Theoretical Considerations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 167

Stephen J. Heishman and Jack E. Henningfield

Drug Free Workplace Program Research

1988 Bureau of Labor Statistics’ Survey of Employer

Anti-Drug Programs. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Howard V. Hayghe

Reexamining the Role of Supervisor Training. . . . . . . . . . . . . . . .

Bradley Googins, Robert Schneider, and Neil Colan

Commentary

NIDA’s Role in Applied Research. . . . . . . . . . . . . . . . . . . . . . . .

Robert L. DuPont, Jerome H. Jaffe, and Herbert D. Kleber

177

204

225

List of NIDA Research Monographs . . . . . . . . . . . . . . . . . . . . . . . .241

iv
Introduction and Summary

Research on Drugs and the Workplace:

Introduction and Summary

Steven W. Gust, Ph.D., Dennis J. Crouch, M.B.A., and

J. Michael Walsh, Ph.D.

This Monograph contains reports from studies presented at the “Drugs in

the Workplace” conference sponsored by the Division of Applied Research,

National Institute on Drug Abuse held in Scptembcr, 1989. This meeting

was, in many ways, an extension of two earlier conferences held in 1986 and

1988, and had as its goal the advancement and dissemination of scientific

knowledge about the prevalence, impact, and treatment of workplace-related

drug use.

Drug use and its impact on the workplace continues to be a serious but

illusive problem. High visibility events such as the tragic alcohol-involved

grounding of the Exxon Valdez stands as a notorious example of the impact

on society at large and the potential long term economic and environmental

consequences of a single such incident. This and other dramatic examples,

such as the 1986 railroad accident in Chase, Maryland, are only the most

visible instances of how drug and alcohol abuse can impact the lives and

well-being of not only the users but of many others, and ultimately, the

health of our society.

The public response to these tragic and preventable events has continued

to fuel the campaign to reduce drug abuse in this country. The portion of

this campaign with perhaps the greatest overall potential to reduce illicit

drug use is to achieve workplaces free of the impact of drug use. Indeed,

data from NIDA’s National Household Survey on Drug Abuse, which is

representative of Americans over 12 years of age who live in households,

suggest that approximately 70% of illicit drug users are employed. The

Federal government and a large and growing number of private sector

businesses have responded by establishing programs focused on prevention

of drug use and treatment of drug users. Program components include

screening for drug use, providing for treatment and rehabilitation for those

in need, and other prevention and education programs and policies.

-3-
The Division of Applied Research at NIDA has established a research

program to investigate the myriad issues related to workplace-related drug

use. For example, until recently there have been little data available on the

efficacy of Employee Assistance Programs (EAPs) in specifically addressing

drug problems (other than alcohol), or the utility of drug testing at the

workplace. To better understand, define and effectively address drug use and

related problems in the workforce, NIDA is supporting research on the

extent of drug use by the workforce, the impact of drug abuse on productivity

and performance, and the effectiveness, costs, and benefits of various

workplace strategies to deter, detect, prevent and treat drug abuse. The

companion volume to this monograph, NIDA Research Monograph 91, Drugs

in the Workplace: Research and Evaluation Data, was the first attempt to

gather results from a diverse group of studies by scientists with widely

different backgrounds and interests, but sharing relevance to these questions.

This volume is an attempt to continue that effort.

Nature and Extent of Drug Use by the Workforce

There remain relatively few national estimates of the prevalence and

frequency of drug use by employed people, and solid estimates of use while

actually on the job are nearly non-existent. In the first paper, Kopstein and

Gfroerer of NIDA’s Division of Epidemiology and Prevention Research

report data from NIDA’s 1988 National Household Survey on Drug Abuse

(NHSDA). The NHSDA provides perhaps the best national estimates of

overall patterns of drug use in workplace populations. Although the rates

of use were higher in the unemployed, significant levels of use were reported

in the full or part-time employed. An estimated 8.2% of all full-time

employed individuals reported current use of an illicit drug, that is, use at

least once in the month prior to the survey. Rates of use in some subgroups

were much higher. In fact, nearly 1 in 4 (23.8%) of full-time employed

young males, age 18-25 yrs admitted current use of illicit drugs. Among the

full-time employed, current use among males overall was much higher than

for females (9.8% to 5.8%). These data are important in helping to assess

the extent of use in the Nation and, in focusing prevention efforts toward

appropriate high-risk groups.

Bray and co-authors describe data from the recent worldwide survey of

military personnel that show dramatic changes in the admitted recent use

of drugs and alcohol in the armed services. In the data base of over 18,000

service men surveyed, drug use declined from over 36% in 1980 to less than

9% in 1988. Similarly, consumption of alcohol, in the 30 days prior to the

survey, decreased from 27% to 8% during the 8 year period. Other

encouraging trends from the survey were a decrease in reported productivity

losses and a continued downward trend in serious consequences from drug

-4-
or alcohol use. Bray reports that, consistent with the Household Survey,

drug and alcohol use was greater for young males.

Are there regional and local variations in drug use patterns? Are there

good methods for assessing the extent of the problem at the local level?

These questions have not yet been fully explored. In contrast to the prior

papers, which give excellent estimates in large and geographically diverse

populations, Lehman, et al., address the question of local or regional

variations in drug use patterns among 5,800 metropolitan employees.

Lehman studied workers in various job classifications in a large Southwestern

city. Preliminary data from the study showed that 29% of the employees

admitted to being intoxicated within one month of the survey and 17% stated

that this resulted in a job-related problem, such as absenteeism. Selfreported use of marijuana or cocaine was less than in the Household Survey,

at 22% and 6% respectively, in the employee’s lifetime. Only 1% said that

drug use resulted in a drug problem. Phase 2 of the study will include

urinalysis test results from a sample of the employees. It will be important

to examine the correlation between self-report measures and urinalysis test

results for implications for the validity of various measures of drug use.

Drug use by employees or contractors at nuclear power generating facilities

is an important public safety issue. Osborn and Sokolov present data on the

“Two Strike, Random Model” drug testing program at the Southern

California Edison Company. The program was instituted in November, 1988

with the specific aims of detecting and deterring drug use by employees and

contractors. The trend which Osborn and Sokolov report toward decreased

urinalysis positive tests is encouraging and demonstrates that urinalysis data

can be used for prevalence estimation and program evaluation within a

worksite. The program is the result of considerable experience and many

iterations and, therefore, presents a time tested model for managers and

program developers to explore in their operational needs. Because of the

numerous rigorous programs which have been established in the nuclear

power industry, it should be a prime candidate for large scale, cross site drug

program evaluation projects.

The use of drug testing as a prevalence estimation technique may also have

applications in studies of the relationships between drug use and accidents.

Moody and his co-authors report results of the Federal Railroad

Administration’s (FRA) post accident drug testing program. Consistent with

other surveys, Moody and his coworkers found that cannabinoids, followed

by cocaine and then ethanol were the most commonly detected drugs.

Accident investigations by the FRA showed that drug and/or ethanol

impairment was contributatory in 1/3 of the accidents in which they were

detected.

-5-
Drug Use and Job Performance Indicators

NIDA has long supported studies of the behavioral effects of drug

administration which have relevance to the issue of impaired worker

performance. These studies include primarily laboratory studies of the effects

of acute doses of drugs on batteries of cognitive and psychomotor tasks.

More recently, NIDA has supported epidemiological studies examining the

relationships between drug use and other workplace relevant performance

measures. Together these studies are beginning to provide a strong data base

on the relationship between drugs and performance which may be used to

guide and inform program and policy development.

The fundamental behavioral changes that result from drug use may be subtle

and difficult to measure, but must be understood to design and implement

useful and effective treatment programs. The worksite poses a dynamic

environment requiring constant data processing and adjustment by the worker

for optimum performance and productivity. This complexity has made the

study of work performance difficult to study. However, lab studies are more

appropriate than field studies to explore the fundamental behavioral effects

of drugs. The research described in this section illustrates that controlled,

rigorous research on complex behaviors related to work performance can be

conducted.

A related research goal is to develop alternate methods to rapidly and

reliably determine impairment of employees. It may be argued that current

procedures to measure impairment due to drug use are inaccurate,

cumbersome, or overly dependent upon subjective measures. The

development of a reliable, inexpensive, and rapidly administered performance

assessment battery to detect impairment will have significant potential for

application in the worksite. Papers in this section present results of relevant

research on new measures of impairment and explore the potential of such

research for establishing performance assessment batteries.

In terms of actually measuring performance impairment, Bickel, et al., point

out that urinalysis testing does not address the issues of impairment by drugs,

fatigue or emotional problems. An easily administered, reliable, non-invasive

technique to measure such impairment would be a significant improvement

over current technologies. The authors argue that learning a new task may

be a more sensitive indicator of impairment than performance of a welllearned task. They report studies of the effects of diazepam, alprazolam and

triazolam on repeated acquisition tasks. This paradigm appears to possess

several of the characteristics necessary for incorporation into a worksite

application.

-6-
Fischman and co-authors have taken the view that the lab setting needs to

emulate, as closely as possible, the real world environment where drugs are

used. At John Hopkins University, a unique research facility has been

established where drugs can be administered, under controlled conditions,

but in settings which permit a large degree of normal day-to-day activities,

including work. Illustrative data are reported for studies of marijuana and

amphetamine administration. Caloric intake was increased 40% over controls

when 5 marijuana cigarettes/day were self administered and, predictably, 70%

less than controls when amphetamine was self administered. Subjects also

increased their social interactions by 4-fold while in this marijuana smoking

regime. Future studies will examine hangover effects and implications for use

in the workplace.

The next two papers describe studies of the effects of alcohol on workrelevant behaviors. Kelly and his co-workers summarize much of the existing

literature which attempted to measure alcohol’s effects on human behavior.

Several among the many contextual factors that may render a particular

performance measure sensitive or insensitive to alcohol’s effects are discussed.

The profound effect that even moderate amounts of alcohol may have on

social behavior is demonstrated in their studies.

A novel approach taken to assess alcohol’s effects in a workplace setting is

described by Jobs and colleagues. Their study assessed the effects of

moderate amounts of alcohol on a laboratory simulation of business decision

making. Their results stress the importance of examining the setting in

which decision makers consume alcohol, indicating that environmental and

social factors may interact with the pharmacologic effects of alcohol.

Heishman and Henningfield, of NIDA’s Addiction Research Center, explore

a number of issues relating to workplace testing for drug effects on

performance. Questions and concepts typically addressed in human

performance laboratory research arc discussed from a “real world” workplace

perspective. This chapter reiterates the importance of the numerous

variables that may ultimately determine a drug’s overall effect, and cautions

against assessments which are made along limited dimensions.

Drug Free Workplace Program Research

Assessment of workplace programs covers a broad range of research topics.

From surveys of the number, type, and characteristics of programs; to

evaluations and controlled studies of the effectiveness, efficacy, cost, and

benefits of various workplace models are important in our attempts to design

and promote the best programs to minimize the impact of drug use in the

workplace.

-7-
The Bureau of Labor Statistics, Department of Labor, conducted a survey

of business establishments in 1988 which provides the best available

information on the frequency and distribution of workplace drug testing

programs, employee assistance programs (EAP), and/or formal policies on

drug use. Howard Hayghe describes this nationwide study of a sample (N

= 7,500) of non-agricultural establishments which shows, rather surprisingly,

that fewer than half of workplaces had a policy regarding drug use. Hayghe

also found that only 1 in 5 workers were employed in an establishment with

a drug testing policy. Importantly, drug testing programs and EAPs were

more common in larger organizations. Although 3.2% of all establishments

had a drug testing program, and twice as many (6.5%) had an employee

assistance program, the size. of the company greatly influence the likelihood

that either of these program components were in place. The rather startling

implication of these figures is that the large majority of working Americans

have not benefitted from any workplace drug intervention strategy.

Clearly, one key player in the management of “troubled” employees is the

supervisor. It is therefore essential that the supervisor receive adequate

training in order to achieve success in this role. Recognition of the

importance of supervisor training has prompted EAPs to develop and

conduct programs for this purpose. Laying the groundwork for an evaluation

of the efficacy of various existing training program features, Bradley Googins

and colleagues from Boston University present data on the nature and extent

of supervisor training within EAPs. Phase two of their study will examine

these programs with respect to a number of specific outcome measures.

Conclusions

The workplace is increasingly being regarded as the prime focus of drug

abuse prevention and treatment activities. The importance of these activities

is highlighted in the commentaries of Drs. DuPont, Jaffe, and Kleber in the

final section of this monograph. Their comments serve to emphasize the

opportunities which exist in both the Federal and private sectors to

significantly impact the drug abuse problem. To take advantage of these

opportunities we must establish effective programs, by balancing

responsibilities and rights of employers and employees with the need to

improve and protect the Nation’s health and productivity. Adequate design

and implementation of these activities, however, depends largely on the

availability of an existing database of information which provides models that

have achieved a high rate of success. These databases are beginning to take

shape, and NIDA, realizing the importance of empirical data from welldesigned evaluation efforts, has incorporated these types of applied research

areas into its overall research mission. The papers contained in this volume

hopefully contribute to that effort.

-8-
Nature and Extent of Drug Use by the Workforce

Drug Use Patterns and Demographics of Employed Drug Users:

Data from the 1988 National Household Survey on Drug Abuse

Andrea Kopstein, M.P.H, and Joseph Gfroerer, B.A.

Division of Epidemiology and Prevention Research

National Institute on Drug Abuse

INTRODUCTION

Drugs and alcohol in the workplace can interfere with an employee’s

productivity and safe performance of job responsibilities. The use of drugs

can also reduce an employee’s dependability by increasing the number of days

lost from work. Drug use by the members of the American workforce carries

with it all the risks and problems associated with drug dependence. Studies

on the human and economic cost of drug abuse indicate that the direct and

indirect costs of drug abuse to business are substantial. These include

decreased productivity, absenteeism, accidents at the workplace, additional

health care, loss of trained personnel, theft, and the costs associated with

prevention, treatment, and deterrence programs. The 1988 National

Household Survey on Drug Abuse (NHSDA) indicates that there are 14.5

million current illicit drug users in the United States. Of these, 71 percent

are between the ages of 18 and 34. This translates to 10.3 million people.

This age group comprises a major part of our workforce. The 1989 White

House National Drug Control Strategy states that the workplace is a focus

for the prevention of drug abuse for adults. Research on drug use in the

workplace cannot be limited to estimating the magnitude of the problem,

but also must include the identification and examination of variables which

may define and explain behavior patterns. To meet the goals of prevention,

demand reduction and treatment, it is crucial to know the sociodemographic

characteristics of employees who are at increased risk to abuse drugs or

alcohol in order to direct resources within the workforce. This paper will

provide prevalence estimates for drug use among the workforce and some of

the sociodemographic factors associated with working drug users.

- 11 -
DESCRIPTION OF DATA SOURCE

The Household Survey was conducted in the fall of 1988 and included 8,814

respondents aged 12 and older. The sample was a probability based design

that included an oversampling of Hispanics, blacks, and young people.

Hispanics, blacks, and young people were over-sampled in order to get more

stable and reliable national estimates of drug use for these population

groups. Data from the survey were weighted to result in estimates that are

representative of the appropriate population subgroups. To provide as much

anonymity as possible, the data were collected in a household interview which

used self-administered answer sheets for drug use questions.

Estimates of the prevalence of drug abuse obtained from the Household

Survey must be viewed as conservative because, even though great efforts

are made to give the respondents anonymity, drug usage is a sensitive topic

that can be underreported.

Current drug users are defined as those persons who have used an illicit drug

in the month prior to interview. Consistent with published NHSDA data,

drug use measures used in this paper include current (past month) illicit drug

use, current marijuana use, past year cocaine use, weekly use of alcohol, and

heavy use of alcohol. Any illicit drug use includes the use of marijuana,

hashish, inhalants, hallucinogens, cocaine, or heroin, and the nonmedical use

of stimulants, sedatives, tranquilizers, or analgesics. Past year use of cocaine

is used because the sample sizes associated with past month use of cocaine

were not sufficient for stratified analyses. Heavy drinking is defined by

having 5 or more drinks on the same occasion 5 or more times in the past

thirty days.

DRUG USE BY EMPLOYMENT STATUS

Although drug use prevalence is higher among unemployed than among

employed persons, drug use among the employed, as seen in table 1, is

substantial. Drug use prevalence clearly decreases with increasing age among

full-time employed people. Nearly 19 percent of full-time employed 18 to

25 year olds and 13 percent of 26 to 34 year olds had used illicit drugs in the

month prior to the 1988 household interview. The percentage of current

illicit drug users fell to about 2 percent for the oldest employed persons (35

and older). Rate of illicit drug use among the unemployed population

ranged from 28 percent for the 18 to 25 year olds to 5 percent for

unemployed persons 35 year of age and older.

Nearly 17 percent of full-time employed 18 to 25 year olds reported the

current use of marijuana and about 11 percent of 26 to 34 year olds were

- 12 -
current users of this drug. Again, for full-time employed persons 35 and

older, the percentage of current marijuana users was about 1 percent.

Table 1. Prevalence of Substance Use by Selected Types of Use, Employment

Status, and Age: 1988

Employment

Status and

Age Group

Past Month Past Month Past Year Weekly Heavy

Use of Use of Use of Use of Use of

Any Illicit1 Marijuana Cocaiue Alcohol Alcohol

Full-time Employed

All ages 18+ 8.2%

18-34 years 15.2

18-25 years 18.7

26-34 years 13.0

35+ years 2.4

Part-time Employed

All ages 18+ 9.4

18-34 years 15.0

18-25 years 16.7

26-34 years 13.0

35+ years 3.6

Unemployed

All ages 18+ 18.2 14.8 9.5 329 7.9

18-34 years 26.7 228 14.1 38.0 10.0

18-25 years 28.2 25.5 13.4 43.9 10.9

26-34 years 24.8 19.6 15.0 28.1 9.3

35+ years 26.7 22.8 14.1 38.0 10.0

Percent of Population

6.8% 5.7% 39.9% 6.4%

13.4 10.8 42.5 8.8

6.9 14.0 41.6 11.2

11.2 8.8 43.1 7.2

6.8 5.7 39.9 6.4

7.5 4.5 329 5.6

12.2 8.6 35.0 8.4

14.2 10.8 40.6 11.2

9.8 5.9 28.1 5.1

2.7 * 37.2 3.3

1

Includes use of marijuana, hashish, inhalants, hallucinogens, cocaine, heroin, and nonmedical use

of stimulants, sedatives, tranquilizers, or analgesics.

2Heavy drinking is having 5 or more drinks on the same occasion 5 or more times in the past

30 days

*Low precision; no estimate reported

Source: National Institute on Drug Abuse, National Household Survey on Drug Abuse, 1988.

- 13 -
For cocaine prevalence, the data displayed is for past year use. Fourteen

percent of full-time employed 18 to 25 year olds reported using cocaine in

the past year, a higher prevalence than the 13.4 percent of unemployed 18

to 25 year olds that reported using cocaine in the past year. Almost 9

percent of full-time employed 26 to 34 year olds report using cocaine in the

past year. For the unemployed, 26 to 34 year olds had a prevalence rate of

15 percent.

The prevalence patterns for alcohol are quite different than those observed

for illicit drugs. Full-time employed 26 to 34 year olds were more likely

than their unemployed counterparts to drink alcohol on a weekly basis (43

percent compared to 28 percent). Full-time employed 26 to 34 year olds

were the age group with the highest prevalence of frequent drinking. Weekly

use of alcohol prevalence does not decrease significantly with age. As seen

in table 1, heavy drinking has prevalence patterns similar to those observed

for illicit drugs. The age group most likely to drink heavily was the 18 to

25 year olds. Heavy drinking prevalence goes from a high of nearly 11

percent for 18 to 25 year olds to a low of 4 percent for persons 35 years of

age and older. Unlike the weekly use of alcohol, heavy drinking declines

with increasing age.

Sex Differentials for Drug Use by Employment Status

Overall, the 1988 Household Survey indicates that males are more likely

than females to use illicit drugs. As seen in table 2, drug use among

full-time employed males between the ages of 18 and 34 years of age is very

high. Full-time employed males 18 to 25 years of age are almost twice as

likely as full-time employed females of the same age to be current users of

any illicit drug (24 percent of males compared to 13 percent of females).

For 26 to 34 year old persons who are full-time employed, 15 percent of

males reported current use of any illicit drug versus 9 percent of the females.

Unemployed males and females also exhibited large differentials for drug

usage.

The same large sex differentials are observed for the current use of marijuana

where 22 percent of the 18 to 25 year old full-time employed males report

past month use compared to 11 percent of the females. Full-time employed

males in the 26 to 34 year old age category were twice as likely as their

female counterparts to be current marijuana users (14 percent compared to

7 percent). Unemployed male 18 to 25 year olds were more than twice as

likely as their female counterparts to be current marijuana users (39 percent

versus 15 percent).

- 14 -
Very few females report heavy drinking. Among the part-time employed and

unemployed categories, which included many female respondents, there were

not enough women reporting heavy drinking to calculate reliable estimates.

DRUG USE AMONG FULL TIME EMPLOYED 18 TO 34 YEAR OLDS

The balance of this paper will only deal with the full-time employed

population. Because of the low prevalence of drug use among persons 35

years of age and older, a national probability sample like the Household

Survey does not allow for reliable statistical analysis of older employed drug

Table 2. Prevalence of Substance Use by Selected Type of Use,

Employment Status, by Sex and Age: 1988

Employment

Status and

Age Group

Past Month Past Month Past Year Heavy

Use of Use of Use of Use of

Any Illicit1 Marijuana Cocaine Alcohol

Male Female Male Female Male Female Male Female

Percent of Population

Full-time Employed

All ages 18+ 9.8% 5.8% 8.8% 3.9% 6.8% 4.1%

18-34 years 18.3 10.6 16.7 8.6 12.8 8.0

18-25 years 23.8 12.7 22.1 10.6 16.8 10.7

26-34 years 15.4 8.9 13.7 7.1 10.5 6.0

35+ years 2.6 2.0 2.2 1.7 1.0

Part-time Employed

9.5% 1.7%

12.7 2 8

17.8 3.3

10.0 2.5

6.8 1.0

All 18+ ages 13.2 6.8 12.6 4.5 8.1 2 9

18-34 years 15.7 14.6 14.6 10.7 11.1 7.0

18-25 years 13.6 19.9 12.4 16.1 10.0 11.7

26-34 years 21.1 10.4 20.6 6.4 14.2 3.3

35+ years 9.8 1.5 9.8

15.2 

17.6 

18.6 

15.2 

12.3 

Unemployed

All 18+ ages 23.2 13.4 21.9 8.9 11.4 7.7

18-34 years 34.6 20.2 32.5 14.9 17.4 11.4

18-25 years 41.1 18.6 39.2 15.3 16.1 11.3

26-34 year 27.7 22.2 25.4 14.5 18.8 11.5

35+ years 3.9 5.4

13.5

15.3

19.8

10.6

10.1

1

Includes use of marijuana, hashish, inhalants, hallucinogens, cocaine, heroin, and nonmedical use

of stimulants, sedatives, tranquilizers, or analgesics.

2Heavy drinking is having 5 or more drinks on the same occasion 5 or more times in the past

30 days

*Low precision; no estimate reported

Source: National Institute on Drug Abuse, National Household Survey on Drug Abuse, 1988.

- 15 -
users. Therefore, data displays for past month any illicit usage, current

marijuana usage, past year cocaine usage, weekly alcohol use, and heavy

drinking will be for full time employed persons between the ages of 18 and

34 years of age.

Sex Differentials and Substance Abuse for 18 to 34 Year Olds

As was discussed previously, males are more likely than females to use illicit

drugs. The following pie charts further demonstrate the magnitude of the

drug use problem for full-time employed persons 18 to 34 years of age. The

pie charts in figure 1 indicate that nearly 18.3 percent of full-time employed

males ages 18 to 34 are current users of any illicit drug as compared to 10.6

percent of females. For males, this percentage translates to approximately

4.7 million users nationwide and for females, 1.9 million users.

Figure 1.

Full-Time Employed Persons Ages 18 to 34

Years of Age Who Reported Past Month Use

of Any Illicit Drug1, by Sex: 1988

For marijuana, figure 2 shows that 16.7 percent of full time employed males

report current usage and 8.6 percent of full-time employed females report

current use. These percentages mean that there are about 4.3 million

employed male marijuana users and 1.5 million employed female users age

18 to 34 in our country.

- 16 -
Figure 2.

Full-Time Employed Persons Ages 18 to 34

Years of Age Who Reported Past Month Use

of Marijuana, by Sex: 1988

Source: National Household Survey on Drug Abuse

As seen in figure 3, past year use of cocaine also shows a large prevalence

differential between males and females. Employed males show a prevalence

rate of 12.8 percent, which translates to almost 3.3 million employed users.

Females had a prevalence rate of 8.0 percent which translates to 1.4 million

past year working female cocaine users.

Figure 3.

Full-Time Employed Persons Ages 18 to 34

Years of Age Who Reported Using Cocaine

Within the Past Year, by Sex: 1988

Source: National Household Survey on Drug Abuse

- 17 -
Even larger sex differentials were observed for heavy drinking. Full-time

employed 18 to 34 year old males indicated a prevalence rate of 12.7 for

heavy drinking compared to 2.8 percent of females, (figure 4).

Figure 4.

Full-Time Employed Persons Ages 18 to 34

Years of Age Who Reported Drinking

Heavily in the Past Thirty Days, by Sex: 1988

Source: National Household Survey on Drug Abuse

Race/Ethnicity and Substance Abuse for 18 to 34 Year Olds

For all three race/ethnicities, as shown in table 3, males have almost double

the drug use prevalence rates of females. Employed white males have higher

rates of any illicit usage in the past month than their black and Hispanic

counterparts. For males in all three race/ethnicities, the prevalence of past

year cocaine use was similar, ranging between 10 and 11 percent. Employed

black males have the lowest prevalence rates for past year use of cocaine and

the current use of any illicit drug. Hispanic females have the lowest

prevalence rate for all three drug behaviors. White employed males and

females generally had the highest substance use prevalence rates. As seen

with illicit drugs, working males of all three race/ethnicities were more likely

to be drinking heavily than their female counterparts. White females were

more likely to be heavy drinkers than black or Hispanic women. For males,

blacks were less likely than whites or Hispanics to be heavy drinkers.

- 18 -
Personal Income and Substance Abuse for 18 to 34 Year Olds

Evaluation of the relationship between personal income and substance abuse

revealed some very interesting prevalence patterns. For full-time employed

males, a dramatic relationship is displayed in table 3 between income and

prevalence rates for any illicit use and current marijuana use. Prevalence

rates clearly increase with decreasing income. For any illicit drug use,

prevalence goes from about 27 percent for the lowest income group to

almost 11 percent for the highest income category. Current marijuana use

ranges from about 26 percent for those with incomes less than $12,000 per

year to 10.0 percent for personal incomes of $30,000 or greater. A

regression analysis which included controls for age and population density did

show a statistically significant correlation between male usage of marijuana

and income. For male past year cocaine use, the prevalence rates did not

Table 3. Prevalence of Substance Use Among Full-time Employed Persons

Ages 18-34 by Selected Type of Substance, Sex, Personal Income,

and Race/Ethnicity: 1988

Employment

Status and

Age Group

Past Month Past Month

Use of use of

Any Illicit1 Marijuana

Male Female Male Female

Past Year

Use or

Cocaine

Male Female

Heavy

Use of

Alcohol2

Male Female

Percent of Full-time Employed

Annual Income

Less than

$12,000

$12,000 to

S19,000

$20,000 to

$29,900

$30,000

or over

24.8% 10.2% 25.5% 9.3% 17.8% 6.4% 18.5% *%

19.4 12.7 18.9 10.5 10.8 10.9 10.5 5.6

17.8 6.4 14.0 5.6 12.4 5.3 12.8 *

10.5 14.4 9.7 9.3 10.9 12.2 9.6 *

Race

White 19.1 10.7 17.5 8.9 13.0 8.8 13.4 2.8

Black 15.6 9.7 14.0 7.6 11.8 9.9

Hispanic 16.0 7.1 14.6 11.8 10.2

1

Includes use of marijuana, hashish, inhalants, hallucinogens, cocaine, heroin, and nonmedical

use of stimulants, sedatives, tranquilizers, or analgesics.

2Heavy drinking is having 5 or more drinks on the same occasion 5 or more times in the past

30 days

*Low precision, no estimate reported

Source: National Institute on Drug Abuse, National Household Survey on Drug Abuse, 1988.

- 19 -
exhibit a linear relationship and income was not significantly correlated. For

employed females, past month use of any illicit drug ranges from about 6

percent for personal incomes between $20,000 and $29,999 to over 14 percent

for the highest income group. Past month use of marijuana ranges from

about 6 percent for persons earning S20,000 to $29,999 to over 9 percent for

those with the highest and lowest incomes. Past year cocaine use generally

increased with increasing income. A regression analysis showed that income

did not predict current marijuana use for employed females. However,

income was correlated with past year cocaine use, with higher income related

to higher prevalence.

The analysis of heavy use of alcohol by sex and income gave similar patterns

to those seen for drug usage. For males, the lowest income group had the

highest prevalence of heavy drinking (18.5 percent). The males with the

highest personal incomes had the lowest prevalence of heavy drinking with

a prevalence rate of just over 12 percent. For females, the only income

category reporting substantial numbers of heavy drinkers was the $12,000 to

$19,999 category.

As seen in table 4, the prevalence patterns observed for weekly use of

alcohol by income were completely different than those observed for illicit

drug usage and heavy drinking. Overall, between 40 and 50 percent of full

time employed males 18 to 34 years of age drink on a weekly basis. The

Table 4. Prevalence of Weekly Alcohol Substance Use Among Full-time

Employed Persons Ages 18-34 by Sex, Personal Income, and

Race/Ethnicity: 1988

Personal Income Weekly use of Alcohol

and Race/Ethnicity Males Females

Annual Income

Less than $12,000

s12,000 to $19,999

$20,000 to $29,999

$30,000 or over

39.5% 14.3%

38.9 18.2

36.2 19.4

48.6 23.6

Race

White 41.4 18.6

Black 40.8 14.8

Hispanic 33.3 8.7

Source: National Institute on Drug Abuse, National Household Survey on Drug Abuse, 1988.

- 20 -
males with the highest personal incomes did have somewhat higher

prevalence rates for the weekly use of alcohol. Females with the highest

personal incomes were also more likely than their lower income counterparts

to drink on a weekly basis. With regard to race/ethnicity, Hispanic males

were less likely than black or white men to use alcohol on a weekly basis.

White females were more likely than black or Hispanic women to drink

weekly.

Substance Use in Specific Industries for 18 to 34 Year Olds

The data in table 5 show the drug prevalence rates for full-time workers in

specific industries. There are many industries and types of jobs in which

employees have an increased risk for using illegal drugs. Also, accidents in

Table 5. Prevalence of Substance Use Among of Full-time Employed Persons

Ages 18-34 by Selected Industries, Selected Type of Substance and

sex: 1988

Past Month Past Month Past Year Heavy

Use or Use of Use of Use of

Any Illicit1 Marijuana Cocaine Alcohol

1988 1988 1988 1988

Male Female Male Female Male Female Male Female

Construction 23.1%

Manufacturing 14.8

Transportation 18.4

Wholesale

Trade 20.6

Retail Trade 13.0

Finance 25.3

Repair Services 22.7

Professional 21.6

Percent of Full-time Employed

*% 26.2% *% 19.9% * %

12.9 13.4 11.7 11.8 6.0

* 17.3 * 13.3 *

* 20.6 * 10.6 *

13.4 10.8 9.6 9.8 13.1

* 25.3 * 21.7 *

* 19.2 * 16.0 *

11.3 17.3 8.6 9.2 8.4

20.9%

11.1

9.5

7.7

16.0

7.7

16.0

11.4

1

Includes use of marijuana, hashish, inhalants, hallucinogens, cocaine, heroin, and nonmedical use

of stimulants, sedatives, tranquilizers, or analgesics.

2Heavy drinking includes people who have had 5 or more drinks on the same occasion on 5 or

more days in the past 30 days.

*Low precision; no estimate reported

Source: National Institute on Drug Abuse, National Household Survey on Drug Abuse, 1988.

certain industries, such as transportation, increase the likelihood of injuries

to others. Operators of commercial vehicles such as truck drivers, airline

- 21 -
pilots, bus drivers, and train operators have responsibilities which involve the

safety of others. Truck drivers are particularly at risk for using illicit drugs

because almost all of them are paid by the mile or by the load. This creates

an economic incentive to fight fatigue, loneliness, or boredom and keep on

driving. A 1988 Regular Common Carrier Conference (RCCC) Safety Survey

found that marijuana, “speed”, and cocaine were the drugs used most

frequently by truckers. The 1985 Fatal Accident Reporting System (the

National Highway Traffic Safety Administration) showed that about 4,500

people died in crashes involving tractor-trailer trucks. Not surprisingly, only

17 percent of the deaths were to the truck drivers. Truck drivers are only

one example of a high risk occupational group.

Data from the 1988 NHSDA are displayed in table 5. Females generally

exhibit low prevalence rates for drug use and heavy drinking. As was

discussed previously, events which occur infrequently cannot be reliably

estimated by general household surveys. Therefore, for many of the

industries displayed in table 5, there were not reliable estimates available for

females. However, those women working in manufacturing and retail trade

displayed high prevalence rates. For past year cocaine usage, females in the

retail trade industry had an even higher prevalence rate than males in the

same industry. The largest sex differentials for the three drug behaviors

were observed for professionals. Professional males were more likely than

their female counterparts to be current users of marijuana or other illicit

drugs. For past year cocaine use, 8 percent of females reported this drug

behavior compared to 13 percent of professional males. To further evaluate

these large differentials, the age distributions for female and male

professionals were compared. For 18 to 34 year old professionals, the

average age for both male and female workers was about 28. Therefore, the

age distribution was not confounding the observed differences in drug

prevalence.

Of the eight industries displayed for males in table 5, the prevalence rates for

any illicit drug use ranged between 13.0 percent for those working in retail

trade to 28 percent for those working in the construction industry. The

industries which had past month any illicit drug use prevalence rates of over

20 percent for male employees are construction, wholesale trade, finance,

repair services, and professionals. The industries with lower prevalence rates

for any illicit drug use were manufacturing, transportation, and retail trade.

Current use of marijuana was most prevalent among employed males in

construction, wholesale trade, and finance. Past year use of cocaine was

more likely for men in construction or finance, with 20 and 22 percent

reporting cocaine usage, and repair services with 16 percent. Heavy drinking

was most likely for men in the construction industry, with a prevalence rate

of 21 percent.

- 22 -
SUMMARY

This paper has identified some characteristics of full-time working

populations who are at higher risk to be substance abusers. In summary,

employed people who use drugs are generally between the ages of 18 and 34.

Heavy drinkers fall mainly between 18 and 25 years of age. Males are much

more likely than females to use marijuana, cocaine, or other illicit drugs and

alcohol on a frequent basis. For males, past month use of any illicit drugs

and marijuana was higher among those with the lowest personal incomes.

For females, past year use of cocaine was higher among those with the

highest personal incomes. Females and males with high personal incomes

were also more likely than their low income counterparts to use alcohol on

a weekly basis. Industries with high percentages of male substance abusers

were: construction, wholesale trade, finance, repair services and professionals.

Industries with substantial numbers of female drug abusers were

manufacturing, retail trade and professionals.

REFERENCES

Beilock, Richard. 1988 RCCC Motor Carrier Safety Survey, Alexandria,

Virginia: Regular Common Carrier Conference, 1989.

Harwood, H.J.; Napolitana, D.M.; Kristiansen, P.L.; and Collins, J.J.

Economic Costs to Society of Alcohol and Drug Abuse and Mental

Health: 1980. Prepared for the Alcohol, Drug Abuse, and Mental Health

Administration, RTI/2734/00-01FR, Research Triangle Park, North

Carolina: Research Triangle Institute, 1984.

National Drug Control Strategy: September 1989. S/N040-000-00542-1, The

White House.

National Highway Traffic Safety Administration. FARS (Fatal Accident

Reporting System). Washington, D.C.: NHSTA, 1985.

National Institute on Drug Abuse. National Household Survey on Drug

Abuse: Population Estimates, 1988. DHHS Pub. No. (ADM)89-1636.

Washington, D.C.: Supt. of Docs., U.S. Govt. Print. Off., 1989a.

National Institute on Drug Abuse. Drug Abuse Among Racial/Ethnic

Minorities, 1989. Division of Epidemiology and Prevention Research,

1989d.

National Institute on Drug Abuse. 1988 National Household Survey on Drug

Abuse: Main Findings. DHHS Pub. No. (ADM)90-1682. Washington,

D.C.: Supt. of Docs., U.S. Govt. Print. Off., 1990.

- 23 -
AUTHORS

Andrea Kopstein, M.P.H.

Statistician

and

Joseph Gfroerer, B.A.

Chief, Statistical Analysis and Population Survey Section

Division of Epidemiology and Prevention Research

National Institute on Drug Abuse

Rockwall II

Room 615

Rockville, Maryland 20857

- 24 -
Drug and Alcohol Use in the Military Workplace: Findings from

the 1988 Worldwide Survey

Robert M. Bray, Ph.D, Mary Ellen Marsden, Ph.D., and J. Valley Rachal

Research Triangle Institute

Michael R. Peterson, D.V.M., M.P.H., Dr. P.H.

Office of the Assistant Secretary of Defense (Health Affairs)

INTRODUCTION

The military is the workplace for 2.1 million active duty military personnel

stationed across the world. As a workplace, the military is similar to many

places of employment in the civilian sector. The military screens prospective

workers, sets policies regarding appropriate work-related behaviors and

sanctions for their infringement, and offers various incentives to encourage

high-level performance. However, the military is a distinctive workplace in

many other respects. For members of the armed forces and their families, the

military is somewhat akin to a total community. Many military personnel not

only work on base, but they also live on base and raise families there.

Further, they are responsible for preserving and defending the Nation and,

consequently, are subject to additional restrictions on their personal lives.

Drug and alcohol abuse for both civilian and military employees may result

in productivity loss, absenteeism and tardiness, illness and injury, legal

incidents, and problems in family life (Gust and Walsh, 1989). It is estimated,

for instance, that drug-abusing employees are late three times as often as

nonabusing employees, request early dismissal or time off work over twice as

often, have over twice as many absences of 8 days or more, use three times

the normal level of sick benefits, are five times more likely to file a worker’s

compensation claim, and are involved in accidents almost four times more

often (Backer, 1987). Drugs and alcohol impair performance by increasing

reaction times and decreasing visual sensitivity (Linnoila, 1978). These are

serious problems for business and industry, and their impact on the military

may be even greater because they may greatly diminish military readiness.

-25-
Military policy states that “alcohol and drug abuse is incompatible with the

maintenance of high standards of performance, military discipline, and

readiness.” The military, therefore, seeks to prevent the misuse of alcohol and

other drugs, eliminate the illegal use of alcohol and drugs, and rehabilitate

those who need assistance. Programs are set forth to monitor the extent of

drug and alcohol abuse among military personnel, detect and deter abuse,

and provide treatment, education, and training (DoD, 1980).

The relationship between drug and alcohol abuse and the military workplace

is reciprocal. On the one hand, drug and alcohol abuse can negatively affect

the work performance of military personnel. Indeed, marijuana was implicated

in the crash of an airplane aboard the aircraft carrier Nimitz in 1981

(Finegan, 1982). On the other hand, the military as a workplace may create

conditions that affect drug and alcohol abuse. Alcohol or drugs, for instance,

may be one means of coping with job-related stress. Military conditions

such as being away from home and family, being isolated, or being exposed

to high-risk situations may also result in greater use of alcohol and drugs

(Polich, 1979; Holcomb, 1981/82). Military policies and programs may,

however, discourage alcohol and drug abuse. Thus, the relationship between

drug and alcohol abuse and the military workplace is complex and reciprocal.

Drug and alcohol abuse may have negative effects on work performance and

on the lives of military personnel, and military life and military policies may

either encourage or discourage drug and alcohol abuse.

This paper examines some of these reciprocal effects between drug and

alcohol abuse in the military workplace:

the extent of drug and alcohol use among military personnel,

negative consequences of drug and alcohol use among military

personnel,

the effects of drug and alcohol abuse on work performance, and

the effects of the military workplace on drug and alcohol abuse.

This examination will consider some of the distinctive conditions of the

military as a workplace and military policies that seek to limit drug and

alcohol abuse.

DATA AND METHODS

Data are drawn primarily from the 1988 Worldwide Survey of Substance

Abuse and Health Behaviors Among Military Personnel (Bray et al., 1988).

The 1988 Worldwide Survey was sponsored by the Department of Defense

- 26 -
(DoD) and conducted by Research Triangle Institute of Research Triangle

Park, NC. The 1988 Worldwide Survey is the fourth in a series of surveys

that aims to examine the nature, causes, and consequences of substance use

among military personnel and the impact of current and future policies and

programs designed to limit substance abuse. Additional information is

provided from earlier Worldwide Surveys conducted in 1980 (Burt et al.,

1980), 1982 (Bray et al., 1983) and 1985 (Bray et al., 1986, Bray, Marsden,

Guess, and Herbold, 1989).

Sampling and Data Collection

The eligible population for the 1988 Worldwide Survey consisted of all

United States active duty military personnel stationed across the world except

recruits, Service academy students, persons absent without leave, and persons

who had a permanent change of station at the time of data collection. A

probability sample was selected for the survey using a deeply stratified,

two-stage, two-phase design. The first phase involved the selection of the

first- and second-stage sampling units, and the second phase involved the

selection of the nonresponse subsample. First-stage sampling units were

major military installations stratified by military Service (Army, Navy, Marine

Corps, Air Force) and world region (Americas, North Pacific, Other Pacific,

Europe), and second-stage sampling units were individuals located at selected

installations stratified by military pay grade.

The response rate for eligibles was 81%. Of the 18,673 completed

questionnaires, 90% were obtained in group administrations of the survey at

military installations; the remainder were obtained by mailing questionnaires

to a subsample of nonrespondents from the group administrations. Details

of survey methodology are described in Bray et al. (1988).

Sociodemographic Characteristics of Military Personnel

Table 1 presents the distribution of sociodemographic characteristics of

eligible military personnel included in the 1988 Worldwide Survey. As

shown, the military population is largely male, white, and likely to be

married. Almost all population members have at least a high school

education. The majority of active duty military personnel are ages 30 and

younger, and three-quarters of them are stationed in the Americas region.

Measurement Approach

The study uses several measures of reported drug and alcohol use. Drug use

is measured in terms of use of any drugs during the past 12 months and the

past 30 months including marijuana/hashish, inhalants, hallucinogens, cocaine,

heroin, and nonmedical use of prescription psychotherapeutic drugs.

- 27 -
Prescription psychotherapeutic drugs include stimulants, sedatives,

tranquilizers, and analgesics used without a doctor’s prescription for purposes

other than intended. The measure of drug use, thus, includes illicit drugs as

well as licit drugs used for nonmedical purposes.

Table 1. Sociodemographic Characteristics of Military Personnel

Characteristic Percentage Characteristic Percentage

Sex

Male

Female

Race/Ethnicitv

White

Black

Hispanic

Other

Marital Status

Not Married

Married

Regiona

Americas

North Pacific

Other Pacific

Europe

88.8

11.2

69.4

18.5

8.0

4.1

39.5

60.5

74.5

5.1

4.4

16.0

Education

Less Than High School

High School Grad/GED

Some College

College Degree or Beyond

Age

17-20

21-25

26-30

31-35

36 or Older

Pay Grade

E1-E3

E4-E6

E7-E9

W1-W4

O1-O3

O4-O10

0.8

42.1

37.7

19.4

13.8

30.4

22.2

14.9

18.8

21.0

51.9

10.4

1.0

9.6

6.1

Note: Entries are column precentages. Estimates are based on responses from 18,673 military

personnel.

aAmericas includes continental United States (CONUS), Alaska, Canada, Greenland, Iceland,

Antigua, Bermuda, Cuba, Diego Garcia, Panama, and Puerto Rico. North Pacific includes

Republic of Korea, mainland Japan, and Okinawa. Other Pacific includes Australia, Canton

Enderbury, Gilbert Ellice, Guam, Hawaii, Johnston Atoll, Midway, Pacific Trust, Philippines, and

Wake. Europe includes Belgium, Egypt, Greece, Italy, Netherlands, North Africa, Portugal, Saudi

Arabia, Spain, Sicily, Turkey, United Kingdom, and Germany (formerly FRG).

Source: 1988 Worldwide Survey.

The prevalence of any drinking or heavy drinking during the past 30 days are

the alcohol use measures. Any drinking refers to consumption of one or

more drinks of beer, wine, or liquor during the past 30 days, while heavy

drinking refers to consumption of five or more drinks per typical drinking

- 28 -
occasion at least once a week. The heavy drinking definition is based on a

drinking-level classification scheme adapted from Mulford and Miller (1960).

The negative effects of alcohol and drug use experienced by military

personnel are examined using measures of reported serious consequences,

productivity loss, and dependence. These measures are based on occurrences

attributed by the military member to alcohol or drug use in the past 12

months and include:

Serious Consequences--UCMJ (Uniform Code of Military Justice)

punishment, loss of three or more workdays, kept from duty 1 week

or more by illness, hurt in accident (for drugs only), spouse left,

DWI arrest, incarceration, fights, arrest for nondriving drinking or

drug incident, not getting promoted, and being detoxified.

Productivity Loss--being late for work or leaving early, not coming

to work at all, being drunk or high at work, performing below a

normal level of productivity because of alcohol or drug use or the

aftereffects or illness resulting from drinking or drug use.

Dependence--unable to remember some things done while drinking

the day before, had shakes because of drinking or hands shook a

lot after drinking the day before, could not stop drinking before

becoming drunk, took drink first thing when got up.

All three measures were computed for alcohol use. Only measures of

productivity loss and serious consequences were computed for drug use

because the small number of drug users did not yield large enough numbers

for analysis of those who were drug dependent. The indexes of serious

consequences for alcohol use and for drug use show the percentages of

personnel who reported any occurrence of the problems captured by the

items. The productivity loss indexes assess time lost from work due to alcohol

use or drug use and indicate the percentage of military personnel with any

such loss.

The dependence measure is the estimated number of days on which each

symptom occurred during the past year. These frequencies are then summed

over the four symptoms, and individuals with scores of 48 or more are

classified as dependent.

Estimates and standard errors were computed using RATIO2 and

SURREGR, software packages developed by Research Triangle institute to

analyze survey data that use complex sampling designs (Wheeless and Shah,

1982). T-tests were used to assess the significance of differences between

prevalence estimates for the four survey years.

- 29 -
FINDINGS

We examine here the impacts of drug and alcohol abuse on the military

workplace as well as the impact of the military on drug and alcohol use. We

first examine the extent of drug and alcohol use among military personnel

across the world in 1988 and trends since 1980.

Trends in Drug and Alcohol Use

Figure 1 presents the changes in the prevalence of drug use among military

personnel between 1980 and 1988. As shown, the percentage of military

personnel who used any drug during the past 12 months or past 30 days

decreased dramatically over the 8 years. Any drug use in the past year

decreased from 36.7% in 1980 to 8.9% in 1988; 30-day drug use was 27.6%

in 1980 and 4.8% in 1988. The declines in any drug use over the 8-year

period and between each of the survey years were statistically significant for

use during the past 12 months and the past 30 days.

Figure 1. Trends in Any Drug Use, Past 12 Months

and Past 30 Days, Total DoD, 1980-1988

Source: 1988 Worldwlde Survey.

As shown in figure 2, there were also decreases in any alcohol use and heavy

alcohol use between 1980 and 1988, but decreases were relatively small and

occurred mainly during the latter part of the period. The percentage of

military personnel who used alcohol declined slightly over the 8 years, from

- 30 -
86.5% in 1980 to 82.8% in 1988. The percentage using alcohol increased

slightly, but significantly, between 1980 and 1982, declined to the 1980 level

in 1985, and then decreased significantly between 1985 and 1988 to a level

lower than in 1980. Heavy alcohol use followed the same general pattern as

any alcohol use. Over the 8 years, the percentage who were heavy drinkers

decreased significantly from 20.8% in 1980 to 17.0% in 1988.

Figure 2. Trends in Alcohol Use, Past 30 Days,

Total DoD, 1980-1988

Source: 1988 Worldwide Survey.

The 1988 drug and alcohol use levels were the lowest since 1980. While

drug use decreased sharply during the 1980s, alcohol use was more stable,

and most of the decreases occurred during the latter part of the period.

These findings suggest that the intense military effort to eliminate drug abuse

that began during the early 1980s has been largely successful. According to

the Worldwide Surveys, drug use among military personnel, although still a

problem, is now relatively low. The military’s efforts to control alcohol

abuse, in contrast, have been less successful. The finding that the decreases

in alcohol use occurred during the latter part of the period and were less

dramatic than for drug use suggests that military efforts to limit alcohol

abuse have been more recent and perhaps less intense.

Due largely to successes in recruiting and retention, the military force is

somewhat older, has more officers and more married personnel, and is better

educated than in 1980--factors associated with lower levels of drug and

- 31 -
alcohol use. To examine whether changes in use between 1980 and 1988

were related to changes in the demographic composition of the military

population, we standardized rates of drug use and heavy alcohol use in 1982,

1985, and 1988 to the 1980 age/education/marital status distribution of the

military. Standardized estimates were found to be similar to unstandardized

estimates and to show the same patterns of change. Thus, observed changes

among military personnel in drug and alcohol use during the 1980s are not

accounted for by shifts in the demographic composition of the military

population (Bray et al., 1988).

Although changes in drug and alcohol use among military personnel are not

attributable to demographic changes, they partly reflect similar changes

occurring for civilians. The use of most drugs among civilians declined

during the 1980s, while alcohol use was more stable (NIDA, 1989; Hilton

and Clark, 1987). Comparisons of the rate of change among military

personnel and civilians suggest, however, that the rate of change in drug use

was greater among military personnel than civilians during the 1980s (Bray,

Marsden and Wheeless, 1989). The declines in drug use were particularly

large after the institution of the policy of zero tolerance in 1981.

The increases in any alcohol use and heavy alcohol use among military

personnel between 1980 and 1982 may reflect a substitution of alcohol for

drugs. That is, some military personnel may have ceased using drugs when

urinalysis testing began during 1981, but compensated by increasing their

alcohol use. If so, the switch was only temporary because, as shown in

figures 1 and 2, both alcohol and drug use have declined since 1982.

Trends in Negative Effects of Drug and Alcohol Use

Consistent with declines in drug and alcohol use between 1980 and 1988 are

similar declines in the negative effects experienced by military personnel as

a result of their drug and alcohol use. Figure 3 shows substantial declines

in the percentage of military personnel reporting serious consequences and

productivity loss associated with drug use between 1980 and 1988. All but

one change between the survey years was statistically significant. The

percentage of military personnel reporting either serious consequences or

productivity loss associated with drug use during the past year declined from

13 or 14% in 1980 to about 2% in 1988.

Figure 4 indicates that decreases in serious consequences, productivity loss,

and dependence associated with alcohol use were also apparent between 1980

and 1988. The percentage of military personnel experiencing serious

consequences associated with alcohol use declined from 17.3% in 1980 to

9.0% in 1988; the percentage reporting any productivity loss declined from

26.7% to 22.1%; and the percentage reporting symptoms of dependence

declined from 8.0% to 6.4%. The declines for the 8-year period were

statistically significant for all three measures, although not all the decreases

between the individual survey years were statistically significant.

- 32 -
Figure 3. Drug Use Negative Effects,

Past 12 Months, Total DoD, 1980-1988

Source: 1988 WorldwIde Survey.

Figure 4. Alcohol Use Negative Effects,

Past 12 Months, Total DoD, 1980-1988

Source: 1988 WorldwIde Survey.

- 33 -
Effects of Drug and Alcohol Use on Work

Figure 3 illustrates a dramatic decline in drug-related negative effects

between 1980 and 1988. Figure 4 illustrates a less dramatic but by no means

unsubstantial decrease in alcohol-related negative effects. The level of

negative effects associated with alcohol use in 1988, however, indicates that

military personnel still experience substantial work-related problems. Table

2 shows more specific types of alcohol-related negative consequences directly

and indirectly affecting the work performance of military personnel.

Table 2. Alcohol Use Negative Effects, Past 12 Months, Total DoD

Indicator Percentagea

Serious Consequences

Received UCMJ Punishment

Loss of 3 or More Workdays

Illness Kept From Duty 1 Week or More

Spouse Left

Arrested for Driving While Intoxicated

Arrested for Nondriving Incident

Incarcerated

Fights

Did Not Get Promoted

Entered Rehabilitation or

Treatment Program

Any Serious Consequencesb

Average Number of Consequences

Productivity Loss

Any Time Lost

Average Days Lost

Dependence

1.8

2.9

0.5

0.3

2.1

1.3

1.2

3.1

0.8

0.7

9.0

0.15

22.1

0.38

6.4

a

Table values are percentages except for average number of consequences and average days lost,

which are mean values. Estimates are based on responses from 18,673 military personnel.

bOne or more Occurrences of any of the items in the set.

Source: 1988 Worldwide Survey.

- 34 -
As shown in table 2, 22.1% or about one in five military personnel lost

productivity at work because of alcohol use, on average almost half a day of

work a year. Fewer respondents reported specific serious consequences, but

a number of the consequences concerned problems at work, ranging from not

getting promoted to receiving military punishment because of their alcohol

use.

Ten percent of military personnel drink immediately before or during work

hours (table 3). This behavior puts them at risk for alcohol-related

problems. The percentage drinking at such times is slightly lower among

officers than enlisted personnel, indicating officers have a lower risk of

alcohol-related problems at work.

Table 3. Alcohol Use on Work Days, Past 30 Days

Drinking Occasion

Grade

Enlisted Officers Total

Within 2 Hours of Going

to Work 5.5 1.2 4.8

During Lunch Break 6.8 6.6 6.8

During Break or Work Break 2.3 0.9 2.0

Total 10.4 7.9 10.0

Note: Entries are percentages of total personnel. Estimates are based on responses from 18,574

military personnel.

Source: 1988 Worldwide Survey.

Thus, alcohol use has negative effects on the productivity and work behaviors

of military personnel, but drug use is now affecting the work of relatively

few. As shown in table 4, however, the nature and severity of drug use and

alcohol use are predictive of productivity loss in the military workplace. Two

regression analyses that excluded nonusers of drugs and alcohol examined

factors associated with loss of productivity. Independent variables included

either drug use or alcohol use for the respective analyses as well as selected

demographic characteristics and indicators of military life. Military service,

family status, military rank, and drug use were significant predictors of drugrelated productivity loss, while military service, sex, family status, age, stress,

and drinking level were significant predictors of alcohol-related productivity

loss. More specifically, drug use pattern, dichotomized as use of marijuana

- 35 -
Table 4. Parameter Estimates of Regression Models Predicting Productivity

Loss Associated with Drug Use and Alcohol Use, Past 12 Months

Independent Variables

Productivily Loss

Drug Use Alcohol Use

(N=931) (N=15,095)

Service

Army vs. Air Force

Navy vs. Air Force

Marine Corps vs. Air Force

Race/Ethnicity

Black vs. White

Hispanic vs. White

Other vs. White

Sex

Male vs. Female

Education

High School or Less vs. More -0.008 0.010

Family Status

Single vs. Married, Spouse Present

Married, Spouse Absent vs.

Married, Spouse Present

Region

North Pacific vs. Americas

Other Pacific vs. Americas

Europe vs. Americas

Rank

Officer vs. Enlisted

Age

Stress

Drug Use

Marijuana vs. Other

Drinking Level

Heavy vs. Infrequent/Light

Moderate/Heavy vs. Infrequent/Light

Moderate vs. Infrequent/Light

0.081*

0.143*

0.203

0.080 4.024

0.007 -0.007

0.016 -0.054

0.071

0.068

0.174*

-0.059

-0.075

0.036

-0.159**

-0.004

0.045

-0.159*

---

---

___

0.043**

0.087**

0.113***

0.039*

0.093***

0.127**

-0.015

0.008

-0.006

-0.018

-0.008***

0.029***

---

0.338***

0.144***

0.008

Note: Entries are regression parameters that indicate the effects of the independent variables

on the probabilities of productivity loss during the past 12 months due to drug use or

alcohol use.

Source: 1988 Worldwide Survey.

- 36 -
only versus other drug use patterns, was significantly related to productivity

loss attributed to drug use. Those using only marijuana were significantly

less likely than other drug users to report productivity loss. Similarly,

drinking levels were related to productivity loss. Heavy and moderate/heavy

drinkers were significantly more likely than infrequent/light drinkers to

experience alcohol-related productivity loss. Figure 5 illustrates these

differences, presenting the adjusted means for productivity loss for the

various levels of drug and alcohol use.

Figure 5. Probability of Productivity Loss During the

Past 12 Months for Alcohol and Drug Use Levels

Effects of the Military on Drug and Alcohol Use

The military has responded to the negative effects of drug and alcohol use

on work performance and military readiness by issuing a series of policy

directives that set forth the military position on drug and alcohol abuse and

actions to be taken to eliminate abuse. The Services follow a policy of zero

tolerance of illicit drug use and a policy of responsible use of alcohol.

Although alcohol use is legally and socially accepted, on-duty impairment is

not tolerated. Violations of alcohol and drug abuse policies are grounds for

military sanctions, including discharge from the armed forces for drug

offenses. These policies are clearly aimed at eliminating drug use and alcohol

misuse. As noted earlier, the stringent drug abuse policies have likely

resulted in substantial decreases in drug use during the 1980s, but the less

- 37 -
intense efforts directed toward alcohol abuse are reflected in more stable

rates of alcohol use.

Aspects of the military job and military life may encourage drug and alcohol

use, offsetting some of the positive effects of military drug and alcohol abuse

programs. In regression analyses, we examined the relationship between drug

and alcohol use and three conditions of military life: job-related stress,

location of duty assignments, and family status. Personnel may use drugs or

alcohol to cope with job-related stress. For these analyses, the job stress

measure is a five-point scale that indicates the level of stress the respondent

attributed to the job. The scale ranges from none at all to a great deal in

the past 30 days.

Drug and alcohol use may be associated with location of military duty

assignment. Many have argued that being overseas, away from family and

home, creates conditions conducive to drug and alcohol use. Indeed, one of

the major impetuses for the development of military policy on drug abuse

was the concern that U.S. military personnel would continue their drug use

after returning from Vietnam (reviewed in Ritter et al., 1985). Location of

duty assignment is the region where military personnel are stationed: the

Americas, North Pacific, Other Pacific, or Europe.

Both drug and alcohol use are expected to be more common among single

persons and married persons unaccompanied by their spouse on their duty

assignment than among married persons who are accompanied by their

spouse. The stability of marriage, particularly the family support of having

the spouse present, is expected to be related to lower rates of use. Here we

examine the relationship between drug and alcohol use, and family status,

which is defined as being single, being married with spouse absent, and being

married with spouse present.

Table 5 presents the regression analyses used to investigate the relationship

between these indicators of military life and any drug use and involvement

in heavy drinking. Other demographic characteristics and indicators of

military life were included in the analyses to control for certain subgroup

differences associated with use. Results show that certain conditions of

military life are related to greater involvement in use of drugs and alcohol.

Work-related stress, region, and family status are significant predictors of

both any drug use and heavy drinking. More specifically, heavy alcohol use

is significantly greater among those who report feeling greater stress at work,

who are stationed in Europe (compared with the Americas), or who are

single (compared with those who are married with spouse present). The

effects for family status are very large, whereas the effects for region and

stress are relatively small.

- 38 -
Drug use is higher among those who report feeling more job-related stress

or who are single compared with those who are married with spouse present.

Overseas regions show a pattern of lower drug use than in the Americas, but

only drug use in the North Pacific is significantly lower. As with alcohol use,

the effects for family status are large, whereas the effects for region and

status are relatively small.

Table 5. Parameter Estimates of Regression Models Predicting Any Drug

Use and Heavy Drinking, Past 30 Days

Independent Variables

Any Drug Use Heavy Drinking

(N=18,479) (N=18,479)

Service

Army vs. Air Force

Navy vs. Air Force

Marine Corps vs. Air Force

Race/Ethnicity

Black vs. White

Hispanic vs. White

Other vs. White

Sex

Male vs. Female

Education

High School or Less vs. More

Family Status

Single vs. Married, Spouse Present

Married, Spouse Absent vs.

Married, Spouse Present

Region

North Pacific vs. Americas

Other Pacific vs. Americas

Europe vs. Americas

Rank

Officer vs. Enlisted

0.041*** 0.029*

0.018* -0.039

0.001 0.040

-0.010 -0.060***

-0.003 -0.041*

-0.007 -0.032

0.004 0.124***

0.014*

0.042*

0.016

-0.030***

-0.006

-0.004

-0.022***

Age -0.002*

0.008-

0.067***

0.103*

0.031

0.031

0.071

0.041**

-0.083***

-0.003***

Stress 0.012*

Note: Entries are regression parameters that indicate the effects of the independent variables

on the probabilities of any drug use and heavy drinking during the past 30 days.

Source: 1988 Worldwide Survey.

- 39 -
Some of these conditions are amenable to change through military policy

such as the policy of spousal accompaniment. Although the relationships

were not significant, there was a pattern for a greater percentage of married

personnel with spouse absent to use drugs or engage in heavy alcohol use

than married personnel with spouse present. Other conditions, such as the

region of the world in which military personnel are stationed, may not be as

amenable to change; but study results may signal areas that social programs

should target. Both drug use and heavy alcohol use are related to reported

job stress, a condition that may be modified using stress management

techniques.

DISCUSSION

Findings from the 1988 Worldwide Survey on Substance Abuse and Health

Behaviors Among Military Personnel indicate that drug use among military

personnel has declined dramatically since 1980 when the survey series began.

Alcohol use, however, has been more stable. These changes in substance use

have been accompanied by substantial decreases in drug-related negative

effects and smaller decreases in alcohol-related negative effects. In 1988, 2%

or fewer military personnel reported drug-related negative effects, while

approximately 22% reported they had experienced alcohol-related productivity

loss, 9% serious consequences, and 6% symptoms of dependence. Many of

these negative effects are indicators of compromised work performance.

A stringent military policy against drug abuse is often credited with these

decreases in drug use and drug-related negative effects. The military policy

of zero tolerance clearly states that drug use will not be tolerated. Identified

users are subject to discharge from the military. Although there are some

variations in enforcement of the policy among the military Services, officers

and noncommissioned officers are generally processed for discharge for one

drug-positive urine specimen or any drug offense. Junior enlisted personnel

are given one chance to change their drug use behavior and are processed for

separation after a second offense.

Beginning in 1981, the policy of zero tolerance was coupled with urinalysis

testing to monitor and deter drug use. A recent analysis by Bray, Marsden,

and Wheeless (1989) shows that drug use is substantially lower among

military personnel than among comparable civilians. Their study also shows

that drug use among military personnel declined rapidly after urinalysis

testing began, and that drug use among military personnel during the 1980s

declined much more rapidly than among civilians. These results suggest that

the military policy toward drug use has been effective.

- 40 -
The emphasis on decreasing alcohol abuse is more recent, and there have

been sizable decreases in use only in the past few years. Beginning in the

mid-1980s attention was directed to deglamorizing alcohol use. “Happy hours”

that feature reduced prices for alcoholic beverages have disappeared from

service clubs, serving of beer as a reward for good performance is

discouraged, and nonalcoholic alternatives are now provided whenever alcohol

is served. Despite these efforts to discourage alcohol use, military personnel

may receive a mixed message about drinking. On the one hand, use is

formally discouraged in a variety of practices and programs in the military.

On the other hand, the price of alcohol is still discounted at service

exchanges, a practice that may encourage use or increase the frequency or

level of use.

These trends in drug and alcohol use indicate the need for the military to

continue the policies proven to be effective against drug abuse and to

intensify its policies directed toward decreasing alcohol abuse. The military

could examine its policies on spousal accompaniment to provide the stability

of family support whenever practical and evaluate the stress-producing

conditions of certain military jobs. Further, the military could intensify its

efforts toward helping military personnel effectively cope with stress by

offering additional stress management instruction.

These findings indicate the substantial effects that alcohol use, (and to a

lesser degree, drug use) has on military performance and, conversely, the

role that military life and military policy may play in encouraging military

personnel to use alcohol and drugs. The findings suggest the need for more

detailed study of the effects of alcohol and drug use on sensitive or highrisk positions within the military and the ways in which the military can

lower the impact of alcohol and drug use on military preparedness.

REFERENCES

Backer, T.E. Strategic Planning for Workplace Drug Abuse Programs. Rockville,

MD: National Institute on Drug Abuse, 1987.

Bray, R.M.; Guess, L.L.; Mason, R.E.; Hubbard, R.L.; Smith, D.G.; Marsden,

M.E.; and Rachal, J.V. 1982 Worldwide Survey of Alcohol and Nonmedical

Drug Use Among Military Personnel. Research Triangle Park, NC:

Research Triangle Institute, 1983.

Bray, R.M.; Marsden, M.E.; Guess, L.L.; and Herbold, J.R. Prevalence,

trends, and correlates of alcohol use, nonmedical drug use, and tobacco

use among U.S. military personnel. Military Medicine 154, 1-10, 1989.

- 41 -
Bray, R.M.; Marsden, M.E.; Guess, L.L.; Wheeless, S.C.; Iannacchione, V.G.;

and Keesling, S.R. 1988 Worldwide Survey of Substance Abuse and Health

Behaviors Among Military Personnel. Research Triangle Park, NC:

Research Triangle Institute, 1988.

Bray, R.M.; Marsden, M.E.; Guess, L.L.; Wheeless, S.C.; Page, D.K.;

Dunteman, G.H.; and Iannacchione, V.G. 1985 Worldwide Survey of

Alcohol and Nonmedical Drug Use Among Military Personnel. Research

Triangle Park, NC: Research Triangle Institute, 1986.

Bray, R.M.; Marsden, M.E.; and Wheeless, S.C. Military/civilian comparisons

of alcohol, drug, and tobacco use. Research Triangle Park, NC: Research

Triangle Institute, 1989.

Burt, M.A.; Biegel, M.M.; Carnes, Y.; and Farley, E.C. Worldwide Survey of

Nonmedical Drug Use and Alcohol Use Among Military Personnel: 1980.

Bethesda, MD: Burt Associates, Inc., 1980.

Department of Defense (DoD). Directive No. 1010.4. Alcohol and Drug Abuse

by DoD Personnel. U.S. Department of Defense, Deputy Secretary of

Defense, 1980, August 25.

Finegan, J. The Navy’s war on drugs. The Times Magazine, June 7, 4-14,

1982.

Gust, S.W., and Walsh, J.M. (eds.) Drugs in the workplace: Research and

evaluation data. NIDA Research Monograph 91. Rockville, MD:

National Institute on Drug Abuse, 1989.

Hilton, M.E., and Clark, W.B. Changes in American drinking patterns and

problems, 1967-1984. Journal of Studies on Alcohol 58(6), 515-522, 1987.

Holcomb, J.F. Alcohol and the Armed Forces. Alcohol Health and Research

World. Winter, 2-17, 1981/82.

Linnoila, M. Psychomotor effects of drugs and alcohol on healthy volunteers

and psychiatric patients. In G. Olive (ed.), Advances in Pharmacology

and Therapeutics, Vol. 8. Drug Action Modification Comparative

Pharmacology. New York: Pergamon Press, 1978.

Mulford, H.A., and Miller, D.A. Drinking in Iowa II. The extent of drinking

and selected sociocultural categories. Quarterly Journal of Studies on

Alcohol 21, 26-39, 1960.

- 42 -
NIDA Highlights from the National Household Survey on Drug Abuse: 1988.

Rockville, MD: National Institute on Drug Abuse, 1989.

Polich, J.M. Alcohol problems among civilian youth and military personnel.

In H.T. Blane and M.E. Chafetz (eds.), Youth, Alcohol, and Social Policy.

New York: Plenum Press. 1979.

Ritter, C.; Clayton, R.R.; and Voss, H.L. Vietnam military service and

marijuana use. American Journal of Drug and Alcohol Use, 11 (1 and 2),

119-130, 1985.

Wheeless, S.C., and Shah, B.V. RATIO2 and RATIO3. Research Triangle

Park, NC: Research Triangle Institute, 1982.

AUTHORS

Robert M. Bray, Ph.D.

Senior Research Psycologist

and

Mary Ellen Marsden. Ph.D.

Senior Research Sociologist

and

J. Valley Rachal

Director

Center for Social Research

and Policy Analysis

Research Triangle Institute

P.O. Box 12194

Research Triangle Park, NC 27709

Michael R. Peterson, D.V.M., M.P.H., Dr. P.H.

Office of the Assistant Secretary of Defense

(Health Affairs)

Washington, D.C.

- 43 -

Patterns of Drug Use in a Large Metropolitan Workforce

Wayne E. K. Lehman, Ph.D. and D. Dwayne Simpson, Ph.D.

Texas Christian University

INTRODUCTION

Concern over drug abuse in the United States workforce has increased in

recent years because of its serious implications for worker productivity and

health. The root causes of this growing problem are undetermined, but they

presumably involve increased social acceptance of some forms of illicit drug

use, increased availability of drugs, and influential factors in the workplace

such as stress or boredom. Although very little objective data are available,

there is a significant national trend in private industry and in the government

toward implementing mandatory drug-testing programs. More than 25 percent

of major United States corporations currently use some form of employee

screening for illicit drugs, and the President’s Commission on Organized

Crime recently endorsed such testing for government employees as well as for

those companies performing government contracts.

Much of the current attention to drug testing in industry focuses on legal

implications as well as the technical validity and reliability of drug-testing

procedures for laboratory analysis of urine or other body fluid specimens.

Looming behind these concerns, however, are more fundamental questions

about the actual prevalence of drug use in the workplace, its impact on

employee job performance (including health-related costs), the etiological

factors which contribute to drug use in industry, and whether drug-testing

procedures are effective deterrents. Although empirical evidence on these

questions is beginning to accumulate, final conclusions about the

cost-effectiveness and appropriateness of massive drug-testing efforts are still

premature.

The cost of drug use and abuse for industry is thought to be very large, even

though there is no consensus about what that estimate might be. Accidents,

health and welfare services, workman’s compensation, insurance claims, and

property damages are among the major direct costs that are usually

associated with drug abuse (Stephen and Prentice, 1978). Loss of productivity

and thefts result in indirect costs that are difficult to quantify. Without

having reasonable estimates for prevalence of use, however, accurate

computations of related costs to industry become almost impossible. Costs

- 45 -
of drug abuse to industry are also usually quoted for industry as a whole,

without taking into consideration the different types of industries involved.

Several models are available to estimate the prevalence and impact of drug

use in the workplace, although each has its own strengths and limitations.

These models involve: (1) self-report population or household surveys, (2)

urine screen results, (3) EAP referrals, and (4) self-report employee surveys

within an organization. The population survey, which generally uses a

stratified random sampling process of households, is useful for assessing drug

and alcohol abuse across a wide variety of jobs and work situations, but does

not provide prevalence or impact data for single organizations. Although the

data obtained are limited by reliability issues associated with self-reporting

of sensitive behaviors such as drug abuse, responses are not linked to a

specific employer and are not likely to be affected by job security concerns.

The other three models can be used to assess prevalence and impact of drug

abuse within single organizations. Assessment of drug use prevalence via

employee urine testing has the advantages of objective and accurate

classification, but is limited to recent drug use (usually within the last 48

hours, except for marijuana) and does not identify long-term or other

patterns of use or whether intoxication or impairment occurs in the

workplace. Although the model has been successful in some longitudinal

studies of new hires, it is difficult to get current employees to voluntarily

participate in a study that can link urine specimens to individual responses.

The model based on EAP referrals can be used to assess some of the costs

and impact of drug abuse in the workplace by comparing employee costs and

productivity of referred and non-referred employees, or by comparing

histories of referred employees before and after EAP interventions. However,

the model does not assess prevalence or impact of undetected drug use

among employees. It is also strongly dependent on the presence and structure

of EAP’s and on the quality of supervisor training in identifying potentially

impaired employees.

The fourth model relies on self-report surveys within an organization or

group of organizations. A wide variety of drug use patterns, both at and away

from the worksite, can be assessed and related to employee characteristics,

work environment, and job performance. The model is limited, however, by

reliability concerns associated with self-report drug use behaviors, which may

be exacerbated by fears of job security if organization officials gained access

to individual responses.

The self-report survey model described above was chosen for the current

study of municipal employees in a large southwest city because of the interest

in estimating the prevalence of all patterns of drug and alcohol abuse within

a single organization, and examining antecedents and consequences of drug

use in that organization. However, recognition of several inherent reliability

- 46 -
problems associated with self-report data on socially unacceptable behaviors

caused special attention to be given to issues of confidentiality and anonymity

of the surveys and to the need for using multiple methods for estimating

prevalence rates.

The current study, therefore, combines three different methods of assessing

drug and alcohol use prevalence in the workforce: (1) self-report, (2)

perceptions of use among coworkers, and (3) urine screens. The self-report

questions are the most direct way of obtaining information on a variety of

drug use patterns although it is expected that, even with careful assurances

of confidentiality and anonymity of the data, drug use will be under-reported.

Asking respondents about drug use among coworkers gives users a chance

to provide information on drug use prevalence without necessarily implicating

themselves personally, and gives non-users a chance to express their

perceptions on possible drug abuse episodes they have witnessed among

coworkers. And finally, information obtained from urine screens will provide

objective data on recent drug use and can be used to help validate self-report

information.

Using these three means of estimating drug use, the study addresses five

major aspects of drug use, including alcohol, in the work setting of municipal

employees. These include (1) prevalence of drug use by employees while

off-the-job as well as while in the workplace, (2) employee sociodemographic

and background characteristics which are related to drug use, (3) work

environment characteristics which are related to employee drug use, (4)

employee performance indicators which are related to drug use, and (5)

validation of self-reported drug use data via urinalysis. The comparative

influence of selected employee characteristics and work environment measures

on drug use and job performance will also be studied in an analytic model

represented by a system of linear structural equations. The analyses reported

below are from the first phase of this project and emphasize prevalence rates

for several employee characteristics on a preliminary sample.

METHODS

Sample Selection

The survey is being conducted in a large southwest city which employs close

to 10,000 employees in a wide variety of jobs. Of these, more than 4,000 are

sworn police and fire officers who were not included in the study because of

differences in drug policies, job characteristics and requirements, and union

policies as compared with the rest of the municipal workforce. The remaining

population of approximately 5,800 employees was the focus of a stratified

random sampling plan. Data collection involves anonymous self-report

questionnaires, generally lasting up to 1 hour for employees to complete in

- 47 -
group settings. As explained in more detail below, urinalyses to detect recent

drug use are based only on 25 percent of the survey sample.

Of the 5,800 employees in the sampling, 67 percent are male and 33 percent

are female. A large majority of workers (69 percent) are Hispanic, primarily

Mexican-American, 20 percent are white, and 10 percent are black. In terms

of age, 26 percent are between 21 and 30 years, 35 percent are between 31

and 40, 19 percent are between 41 and 50, and 20 percent are above the age

of 50. Overall, the mean salary of city workers is $17,818 and the mean years

of employment with the city is 8.3.

Survey administration began in May, 1989, and will continue until a sample

of 2,000 surveys are completed (expected by the end of October, 1989),

representing about 34 percent of available employees. This sample size is

expected to provide stable prevalence estimates for specific subgroups of

employees and to provide cross-validation samples for hierarchical regression

and LISREL analysis. In an effort to minimize employee reactions or

concerns about being selected for participation in this study, entire working

units were randomly selected rather than designated sampling from individual

employees within departments. For this procedure, the city workforce was

divided into 248 mutually exclusive and exhaustive workgroups (ranging in

size from 5 to 70) based on departmental organizational structure (divisions

or sections within departments). By necessity, the precise definition of a

Workgroup varied across and sometimes within departments and in some

cases was defined by physical location, job types, or shifts. This procedure is

less “discriminatory” from the perspective of individual employees. It is also

efficient in terms of administering self-report questionnaires since the entire

Workgroup (instead of only a small percentage) is included. It likewise

provides more thorough and integrated information on perceptions

concerning coworkers and the work environment within each employee unit

or department.

1. Employee Classification

Employees are currently grouped into eight specific EEO job categories. For

purposes of the sampling plans and data analysis, these categories are

collapsed into four basic job classes--Official/Professional (17 percent),

Skilled/Technical (30 percent), Clerical (17 percent), and

Paraprofessional/Services (36 percent).

Official/Professional -- include department and division heads,

managers, administrators, lawyers, superintendents, and health

professionals.

- 48 -
Skilled/Technical-- include trained mechanics, data analysts, systems

analysts, data processors, appraisers, security personnel, park rangers,

and others.

Clerical -- include secretaries, word processors, stenographers, and

clerks.

Paraprofessional/Services -- include health and legal aides, truck

drivers, sanitation workers, laborers, park attendants, cashiers, and

others.

Employee Questionnaires

The major source of data for the study involves self-report questionnaires

administered anonymously to individual employees in selected workgroups.

Assurances of complete anonymity of employee responses is necessary for

maximizing respondent self-disclosure. Questionnaires are administered in

groups of five to 70 employees at a time (although typically in the range of

10-30) by a representative of the Institute of Behavioral Research (IBR) from

Texas Christian University. In order to ease concerns of employees who may

feel uncomfortable taking a sensitive survey in the presence of their

superiors, supervisor groups are generally surveyed separately. The completed

questionnaires in each session are returned directly to the IBR representative.

City representatives never have access to individual employee responses.

A standard set of instructions is read to respondents by the IBR field

representative to describe the purpose of the study and confidentiality

procedures used to protect employee anonymity. The importance of obtaining

accurate information about drug use, factors related to drug use, and the

effect of drug use on productivity and worker safety is emphasized. Workers

are encouraged to let management know how they feel about drug use in

their workgroups and about their attitudes toward their current drug policies

and sanctions. Confidentiality procedures are carefully explained, and it is

stressed that information will not be released in any way that can identify

individual respondents. Letters of endorsement and support from both

management and employee union representatives have been used to enhance

participation.

The questionnaire addresses eight general content areas: (1) employee

socio-demographic background, (2) perceptions of the work environment, (3)

job satisfaction, (4) psychological well-being, (5) job performance indicators,

(6) perceptions of coworker’s drug use, (7) attitudes towards drug testing and

drug policies at work, and (8) self-reported drug use. Each one is

summarized below.

- 49 -
1. Sociodemographic Background

Sociodemographic data include basic information on age, sex, race,

educational level, marital status, and number of children as well as other

background data on health status and family relations. Data collected on job

background include job classification, salary level, job tenure, tenure with the

organization, and job classification.

2. Perceptions of the Work Environment

Several factors of the perceived work environment are measured which have

been implicated in other research as job-based risk factors in employee drug

use. Measures for the present study have been adapted from pre-existing

scales found in the work environment literature to assess perceptions of

leadership, Workgroup and peer relations, pay equity, loyalty, and physical

working conditions.

3. Job Satisfaction

Assessment with the Minnesota Satisfaction Questionnaire Short Form

(Weiss et al., 1967) uses 20 items, each measuring a different job-related

facet. Areas represented include satisfaction with pay, working conditions,

leadership, co-workers, city policies, and feelings of accomplishment.

Responses to the 20 items sum to form an overall job satisfaction index.

4. Psychological Well-Being

Several measures have been included to measure psychological well-being at

work and at home, adapted from several previously developed scales. These

represent (1) self-esteem at work (Quinn and Shepard, 1974), (2) job-related

tension (Kahn et al., 1964), (3) job involvement (Lodahl and Kejner, 1965),

and (4) powerlessness (Shepard, 1972).

5. Job Performance Indicators

Self-report measures of performance include major withdrawal behaviors such

as absenteeism, lateness, sick days used, and intentions to quit, and

organizational costs such as accidents at work, worker’s compensation, and

health insurance claims. In addition, a variety of items have been included

to assess other forms of psychological work withdrawal, such as moonlighting

on the job, daydreaming and sleeping at work, excessive nonproductive

chatting with other employees, and performing personal tasks at work.

- 50 -
Positive productive behaviors reflect doing more work than expected, staying

late, and obtaining additional training or education.

6. Perceived Drug Use Among Coworkers

Employees are asked about the prevalence and effects of drug and alcohol

use among their unnamed coworkers in their immediate work group.

Questions about drug use by others were constructed to address (1) the

percentage of workers who recognize drug and alcohol use by others in the

workplace, (2) the prevalence of coworker drug use (e.g., alcohol, marijuana,

minor tranquilizers, sedatives, uppers, cocaine, other drugs), (3) consequences

of coworker drug use in terms of the respondent’s own safety and

productivity, and (4) perceived causes of drug or alcohol use in the

workplace.

7. Attitudes Toward Drug Policies and Drug Testing

Attitudes are assessed toward drug testing and various types of drug policies

such as random testing of all employees, pre-employment screening, increased

training and education, and establishing EAP programs. Additional items

measure employee responses to perceived, or known, drug use in the

Workgroup, and satisfaction and knowledge of city policies.

8. Self-Reported Drug Use

Finally, employees are asked directly if they have ever used certain licit and

illicit drugs (e.g., cigarettes, alcohol, over the counter drugs, prescription

drugs, marijuana, cocaine, amphetamines, barbiturates, others) during their

lifetime, in the last year, and in the last month. They are also asked about

personal drug use and being under the influence of drugs while at work in

the last year.

Urinalysis

To verify and validate self-reported drug use and to provide an independent

prevalence estimate of recent drug and alcohol use, urine specimens are

being obtained and tested for a sample of 500 (25 percent) respondents.

Again, to guard against the impressions of selective “discrimination,”

individual employees within departments or workgroups are not being singled

out for urine screens. Instead, a novel method is being tested wherein urines

are requested for entire workgroups, determined on a random basis to insure

representation across departments and employee classifications.

In order to protect and ease concerns about anonymity of results, urine

specimens are not linked to individual questionnaires. Procedurally, all

employee respondents in every session return their completed questionnaire

- 51 -
to the IBR representative located outside of the survey administration room.

For those particular workgroups randomly selected for urine collections, all

employees are given a specimen bottle in a brown paper wrapper before

returning the completed questionnaire. They are then asked to stop by the

restroom (as an incentive, they receive $5.00 to provide a specimen) and then

turn in their completed survey and specimen bottle at a second station. At

the second station, an IBR representative collects the completed survey and

discretely inspects the specimen bottle. All respondents then receive an

envelope containing a letter thanking them for their participation, and a

$5.00 bill if a urine specimen was provided. The completed survey is then

marked according to whether or not a urine specimen was given.

Using these procedures, a group of urine specimens will be linked to a group

of questionnaires from those employees who agreed to provide urines, but no

individual questionnaire can be linked to an individual urine sample (special

precautions are used for small groups). Validation of self-reported use will,

therefore, be restricted only to those employees who agree to provide a urine

sample and will be based on aggregated group percentages. Although the

validation analyses will not be as powerful as if individual questionnaires

were linked to specific urine specimens, these procedures were necessary to

insure adequate protection and gain the necessary participation rate.

Urinalyses are being conducted by the local medical examiner’s office. The

laboratory utilizes an Abbott TDX system which uses fluorescence

polarization immunoassay (FPIA). This system offers relatively high accuracy

and a low incidence of false positives, and is used for initial screens. All

positives are confirmed using gas chromatography/mass spectrometry

(GC/MS). Screens and confirmations are being conducted for marijuana,

morphine, amphetamines, cocaine, benzodiazepines, and alcohol (detectable

for up to 12 hours after heavy use).

Survey Administmtion Procedures

Survey administration procedures were designed to maximize employee

participation, using strict controls on confidentiality and anonymity of survey

responses. All fieldwork activities, including scheduling, survey administration,

and processing of completed forms and collected urines are conducted by

IBR field staff.

All surveys collected are identified only by a Workgroup identification number

never by name or any individual identification number. However, in order to

protect the identities of individuals within small workgroups, data reported

back to city officials will be aggregated by departments, job classifications, or

other factors that would not allow specific identification of these small

departments or workgroups.

Employees are informed by letter and public notices of the purpose of the

study and procedures to be followed at least 2 weeks before being asked to

- 52 -
participate. Only IBR staff are directly involved in the data collection

process, and they carefully explain the study and procedures. The fieldwork

team includes at least two members at each data collection session, and city

employees or Workgroup supervisors are not directly involved in any part of

the data collection or processing.

Participation by employees is strictly voluntary and all questionnaire sessions

are completed during regular working hours. The actual time selected for

completing the questionnaire is determined in part by department and

employee work schedule.

RESULTS

The analyses presented here are based on a preliminary sample of 993

completed questionnaires from 70 workgroups. A total of 195 employees

chose not to complete the survey, resulting in a participation rate of 84

percent. Urines were provided by 126 out of 180 respondents from 15 groups,

for a participation rate of 70 percent (and results from the urinalyses are not

available at this time).

Demographic and job background profiles of the sample are presented in

table 1, grouped by job classification. The overall distribution of job

classifications shows that 21 percent are classified as official/professional, 22

percent are skilled/technical, 16 percent are clerical, and 41 percent are

paraprofessional/service.

Demographic distributions show that the sample is relatively evenly split

between the age groups of 17 to 30, 31 to 40, and 41 to 70 years (29 percent,

36 percent, and 35 percent respectively). The sample was 65 percent male

and predominantly Mexican-American (70 percent), with a lower proportion

of whites (23 percent) and blacks (7 percent). Approximately 21 percent of

the sample had less than a high school education and 22 percent had college

degrees or higher; over one-fourth of the sample (28 percent) earned less

than $13,000 per year and one-third earned in excess of $20,800 annually.

Two-thirds of the sample were paid hourly wages with the remaining

one-third on regular salary.

Cross-tabulations of these variables within job classifications shows that the

official/professional group (compared to others) tends to be slightly older (44

percent over 40), is overrepresented by whites (52 percent), is more highly

educated, and receives higher pay. The skilled/technical classification is

predominantly male (84 percent) with high school diplomas or some college

or technical training (77 percent) who are paid hourly wages (80 percent)

toward the middle of the pay scale. Clerical workers tend to be young (39

percent are 30 or younger), almost exclusively female (89 percent) with high

school educations (98 percent), the majority has some college or technical

training (63 percent), and mostly Mexican-American (81 percent).

- 53 -
Paraprofessional/service employees tend to be Mexican-American (82 percent)

males (82 percent) with relatively low levels of education (45 percent with

less than a high school education). The vast majority of them are on hourly

wages (83 percent) toward the bottom of the pay scale.

Table 1. Sample Characteristics by Job Classification

Job Classification

Offic/Prof Skill/Tech Clerical Para/Serv TOTAL

Age

17-30 Years

31-40 Years

41-70 Years

Gender

Male

Female

Race

Black

Mexican-American

White

Education

Less than H.S.

H.S. Diploma

Some College

College Degree

Salary Level

Under $13,000

$13,000-20,800

Over $20,800

Pay status

Hourly

Salary

13 27 39 35 29

43 34 41 31 36

44 39 20 34 35

53 84 11 82 65

47 16 89 19 35

4 9 9 7 7

44 64 81 82 70

52 27 10 10 23

2 9 2 45 21

7 36 34 30 27

23 41 53 20 31

68 15 10 6 22

3 15 36 44 28

27 48 48 37 39

71 37 16 19 33

20 80 68 83 66

80 20 32 17 34

TOTAL PERCENTAGE OF GROUP

Group 21 22 16 41 100

Total Number

In Sample Size 94 208 149 383 934

- 54 -
SELF-REPORTED ALCOHOL AND ILLICIT DRUG USE

1. Alcohol Use

Distributions on self-report measures by age and job classification groups are

presented in table 2. For alcohol, the frequency of use measure refers to

“any drinking” in the last year. Overall, 23 percent of the sample reported no

drinking at all in the last year, while over half (54 percent) drank at least

once a month. Frequency of heavy use, as reported in table 2, refers to

getting drunk or drinking five or more drinks in a row. Half of the sample

reported getting drunk at least once in the last year, with 29 percent getting

drunk once a month or more.

Admitting problems refers to having any alcohol-related problems in the last

year--that is, DWI, missing work, getting sick, having accidents, getting into

fights or arguments, being arrested, or entering treatment for alcohol use.

Also included were alcohol-related symptoms such as drinking first thing in

the morning, experiencing shakes or tremors, or drinking more than intended.

A total of 17 percent of the sample reported some problems with alcohol use

in the last year. With respect to drinking on the job (although not shown in

the table), 5 percent of respondents admitted to drinking either right before

or while at work during the last year.

Alcohol use distributions within age and job classification show differences

in drinking patterns associated with both age and job classification. In terms

of age, younger employees (17 to 30) were more likely than older employees

(41 to 70) to drink regularly (58 percent versus 50 percent monthly or more),

to get drunk regularly (34 percent versus 26 percent monthly or more) and

to report alcohol-related problems (21 percent versus 12 percent).

Comparisons between job classification groups showed that the

official/professional group was most likely to drink at least some (83 percent),

but was less likely than the paraprofessional/service group to drink monthly

or more (52 percent to 62 percent). The clerical group, which was

predominantly female, had the highest percentage of non-drinkers (28

percent) and the lowest percentage of regular drinkers (40 percent monthly

or more). Comparisons on frequency of getting drunk and on alcohol-related

problems revealed that these more abusive drinking patterns were more

prevalent in the lower job classifications such as paraprofessional/service, and

less prevalent in the higher job classifications (official/professional). A total

of 42 percent of the paraprofessional/service group reported getting drunk at

least once a month and 20 percent reported alcohol-related problems. For

the official/professional group, 16 percent reported getting drunk at least

monthly and 14 percent reported alcohol-related problems. Clerical workers

tended to be similar to official/professionals in drinking patterns and the

service/technician group tended to fall in the middle.

- 55 -
Table 2. Self-Reported Alcohol and Illicit Drug Use, by Age and Job

Classification

Age Group Job Classification

17-30 31-40 41-70 Offic/ Skill Para/

Years Years Years Prof Tech Clerical Serv TOTAL

ALCOHOL USE:

Frequency of Use

None

Less than Monthly

Monthly or More

Frequency of Heavy Use

None

Less than Monthly

Monthly or More

Admitting Problems

17 23 27

24 22 23

58 55 50

41 51 56

25 22 17

34 28 26

21 19 12

ILLICIT DRUG USE:

Lifetime Use

Marijuana 3 6 2 6 7

All Other Drugs117 14 5

Cocaine 10 7 1

Last Year

Marijuana 15 6 2

All Other Drugs18 4 1

Cocaine 6 3 0

7

4

3

TOTAL PERCENTAGE OF GROUP

Actual Number

In Group 29 36 35

Total Number

In Sample Size 271 343 329

17 23 28 23

31 22 32 15

52 55 40 62

59 48 65 40

25 24 20 18

16 27 16 42

14 17 12 20

26 25 21 21

16 13 13 10

6 7 5 6

6 7 6 8

4 5 5 4

2 3 3 3

21 22 16 40 100

191 198 146 360 943

23

23

54

50

21

29

17

22

12

6

1

Includes cocaine, amphetamines, benzodiazepines, tranquilizers, sedatives, psychedelics, inhalants,

and narcotics.

2. Illicit Drug Use

Illicit drug use is reported in terms of lifetime use and last year use of

marijuana and other drugs (including cocaine, amphetamines,

benzodiazepines, tranquilizers, sedatives, psychedelics, inhalants, and

narcotics). Cocaine is also reported as a separate drug category because of

the special current interest and attention given to cocaine use, especially

among young professionals. A measure of drug-related problems, similar to

- 56 -
that for alcohol reported above, was examined but is not reported here

because of extremely low response (less than 1 percent). Tabulations of illicit

drug use measures are shown in table 2 by age and job classification groups.

Overall, 22 percent of employees reported lifetime marijuana use and 12

percent reported lifetime use of other drugs. Lifetime cocaine use was

reported by only 6 percent of the sample. During the last year, 7 percent

reported marijuana use, 4 percent reported other drug use (including,

cocaine), and 3 percent reported cocaine use. Although not presented in

table 2, 2 percent admitted using drugs while at work in the last year.

As expected, younger employees were much more likely to have used

marijuana or other drugs in their lifetime and in the last year. Over one-third

of employees aged 30 or younger used marijuana in their lifetime (36

percent) and 15 percent admitted to use in the last year. For those over the

age of 40, 7 percent indicated lifetime use of marijuana and 2 percent use in

the last year. For other drugs, 17 percent of employees aged 30 or younger

admitted to lifetime use and 8 percent use in the last year; this compared to

5 percent lifetime and 1 percent last year for the over 40 age group.

Group differences according to job classifications were somewhat of a

surprise. For lifetime use, there was a tendency for the higher job levels

(official/professional and skilled/technical) to be more likely to report drug

use than the lower job classifications (paraprofessional/service). For example,

among official/professionals, 26 percent reported lifetime marijuana use and

16 percent reported other drug use, compared to 21 percent and 10 percent

respectively for the paraprofessional/service group. There was virtually no

difference between groups for lifetime cocaine use or any drug use in the last

year.

The higher levels of lifetime marijuana and other drug use among the

official/professional group may also be explained in part by other

demographic variables. As described above, this group was more likely to be

white and have higher levels of education than the other job classifications.

Tabulations of lifetime marijuana use and other drug use by race and

education (not reported in table 2) showed that whites (26 percent) were

more likely than Mexican-Americans (21 percent) and blacks (21 percent) to

report marijuana use and to admit to other drug use (18 percent, versus 11

percent and 9 percent). Education was positively related to lifetime marijuana

and other drug use, as 30 percent of college graduates indicated marijuana

use and 19 percent other drug use (versus 14 percent marijuana and 5

percent other drug use for those with less than a high school education).

- 57 -
PERCEPTIONS AND ATTITUDES TOWARD SUBSTANCE USE AT WORK

1. Perceptions of Coworker Use

Table 3 presents tabulations based on the percentage of respondents who

reported seeing at least one coworker in the last year who used alcohol,

marijuana, or other drugs at work, and either gave or sold drugs (dealing) to

coworkers while at work. A total of 28 percent of respondents reported being

exposed to at least one coworker who drank or was drunk at work in the last

year, 16 percent indicated coworker marijuana use, 13 percent claimed other

drug use among coworkers, and 16 percent reported coworkers giving or

selling drugs in the workplace.

Differences between age groups were found for perceptions of coworker drug

and alcohol use. In general, younger employees were more likely than older

employees to report exposure to alcohol or drug use among coworkers. For

example, 30 percent and 31 percent of 17 to 30 year olds and 31 to 40 year

olds, respectively, reported coworker alcohol use--compared to 24 percent of

those over 40 years. Likewise, 20 percent of 17 to 30 year olds indicated

coworker marijuana use and 21 percent reported dealing among coworkers

(versus 11 percent of the over 40 year age group reporting coworker

marijuana use and dealing among coworkers).

Job classifications differed in their perceptions of marijuana use and dealing

among coworkers, but not in perceptions of coworker alcohol or other drug

use. The paraprofessional/service group was most likely to indicate marijuana

use in their Workgroup (24 percent), followed by skilled/technical (15

percent), and official/professional and clerical (7 percent and 5 percent,

respectively). The same pattern was found for coworker dealing, with 21

percent of paraprofessional/service reporting dealing compared with 15

percent of skilled/technical and 11 percent of clerical and official/professional.

2. Attitudes Toward Policies

Employee attitudes were assessed toward policies they believed should be

used by the city to protect employee safety in relation to alcohol or drug

problems in the workplace. Table 3 shows that 68 percent of employees

believed the city should conduct urine testing of new employees, 61 percent

favored random drug testing of all employees, 91 percent wanted education

programs for supervisors and employees, 85 percent favored improved

working conditions to reduce drug and alcohol problems, 91 percent agreed

there should be supervisor training to recognize and deal with drug and

alcohol problems, and 92 percent would like to see an EAP established for

assessment and referral.

- 58 -
Attitudes toward the more restrictive policies of urine testing of new hires

and random urine testing of all employees differed according to age groups.

The over-40 employees were more likely than their younger counterparts to

favor testing of new employees (74 percent to 63 percent and 68 percent

respectively) and random testing of all employees (71 percent to 52 percent

and 60 percent). The vast majority of employees responded favorably to the

other policies, and so there was little difference between age groups.

Table 3. Perceptions and Attitudes Toward Substance Use at Work by Age

and Job Classification

Age Group Job Classification

17-30 31-40 41-70 Offic/ Skill/ Para/

Years Years Years Prof Tech Clerical Serv TOTAL

(percentages)

PERCEPTION OF COWORKER USE:

Alcohol Use 30 31 24 2.5 34 27

Marijuana Use 20 17 11 7 15 5

Other Drug Use 14 12 12 14 12 15

Dealing of Drugs 21 16 11 11 15 11

ATTITUDINAL SUPPORT FOR GENERAL POLICIES:

Urine Testing

of New Employees 63 68 74 51 75 69

Random Urine Testing 52 60 71 48 65 64

Drug Abuse Education 90 92 91 94 90 93

Improving Working

Conditions 84 86 83 84 84 87

Supervisor Training

To Handle Drug

Problems 88 92 93 95 94 97

Establishing EAP 91 93 93 94 92 98

TOTAL PERCENTAGE OF GROUP

Actual Number

In Group 29 36 35 21 22 16

Total Number

In Sample Size 271 343 329 191 198 146

28 28

24 16

13 13

21 16

74

65

90

84

85

89

40

360

68

61

91

85

91

92

100

943

Examination of attitude differences between job classifications showed that

the official/professional group showed less support for urine testing policies

than did the other three groups. Support for testing of new hires ranged

from 75 percent of skilled/technical employees to 69 percent of clerical

workers, compared to 51 percent of official/professional staff. Random testing

of all employees was supported by less than half of the official/professional

- 59 -
staff (48 percent), compared to 64-65 percent for other groups. There were

not large differences between groups in terms of support for other policies;

however, clerical workers were more likely than paraprofessional/service

employees to favor supervisor training (97 percent to 85 percent) and

establishment of an EAP (98 percent to 89 percent).

DISCUSSION

The results presented above are preliminary data based on approximately

one-half of the targeted sample for this project. Thus, although it is expected

that the overall results are relatively stable, final judgement must await the

full set of data and the more sophisticated analyses planned. However, several

findings merit comment. These include participation rate, the overall

prevalence rate for drug and alcohol use, the relationship between job

classification and lifetime marijuana and other drug use, and the level of

support found for urine testing as well as for other policies to deal with drug

use at the worksite.

The project has been successful in obtaining a high volunteer rate for

participation in the study. This has been achieved by careful planning of data

security issues and high levels of cooperation with city officials and employee

representatives. This level of cooperation has been observed at virtually all

levels of management, down to Workgroup supervisors who are ultimately

responsible for notifying their employees and obtaining their cooperation.

The high rate of supervisor support is highlighted by the fact that 84 out of

195 refusals (from 70 workgroups) came from only 4 workgroups

(contributing only 33 completed questionnaires). Reports from the field staff

indicated that the supervisors for these workgroups actively discouraged their

subordinates from participating in the study.

The findings show, not surprisingly, that alcohol is by far the most common

drug abused by the workforce. Overall, 77 percent of the workforce reported

having used alcohol in the last year, with half admitting to having gotten

drunk in the last year and over one-fourth at least once per month. These

numbers appear consistent with those obtained in the 1988 NIDA Household

Survey on Drugs showing 82 percent of 18 to 25 year olds and 69 percent of

those 26 or older reporting alcohol use last year.

On the other hand, when compared to the 1988 Household Survey,

prevalence of marijuana and other drug use in the current sample appears

lower. The Household Survey showed about 28 percent of 18 to 25 year olds

using marijuana in the last year and 7 percent of those 26 or older. The

numbers presented above for the current survey for last year marijuana use

were 15 percent, 6 percent, and 2 percent for the 17 to 30, 31 to 40, and 41

to 70 year age groups, respectively. These differences may suggest some

under-reporting for the municipal sample, although they may also be

-60-
accounted for by sample differences. Further comparisons with more

equivalent subsamples from the NIDA Household Survey would shed more

light on this issue.

Cross-tabulations of drug prevalence rates by age and job classification

showed that younger age groups were more likely to use drugs than older age

groups. This finding was expected and is consistent with the NIDA

Household Surveys conducted over the years. However, the relationship

between job classification and drug use was not expected. Higher level job

classifications (official/professional) were more likely to report lifetime

marijuana and other drug use than were lower job classifications, but this

relationship appeared to be partially explained by differences in race and

education between job classifications.

Also unanticipated was the relatively strong support for employee urine

testing. Overall, 68 percent of respondents favored the use of

pre-employment testing and 61 percent favored random testing of all

employees. This was much higher than expected for these policies and was

related to both age and job classification; older employees and lower level

job classifications showed the highest levels of support. These same groups

reported less personal drug use but higher levels of coworker drug use.

CONCLUSION

The preliminary results of this study suggest that with careful attention to

data security issues and gaining employee trust, a self-report drug use survey

within an employee’s own organization can be successfully implemented.

Feedback from employees completing the questionnaire has indicated that the

majority describe their participation as interesting and useful. In fact, the

biggest concern expressed by most respondents has been their interest in

getting feedback on findings from the study.

The findings on employee drug use and policy recommendations are

interesting but need to be confirmed and explored further with more

complete samples. Additional objectives of the current project include

detailed work environment and job characteristics related to drug use, the

effect of job satisfaction and job tension on drug use, and the impact of drug

use on a variety of job productivity measures, (including physical and

psychological withdrawal behaviors). These objectives are well-suited for the

methodology employed and provide information not easily obtained from

other data collection models described earlier (e.g., household surveys, urine

screen results, and EAP referrals). It appears that the approach being used

in this self-report study is very promising in terms of feasibility and overall

quality of data. Because of the competing strengths and weaknesses of each

one, however, all four models (including the self-report model used here) are

- 61 -
needed to provide as complete a picture as possible to accomplish the

difficult task of describing and explaining drug use in the workplace.

REFERENCES

Kahn, R.L.; Wolfe, D.M.; Quinn, R.P.; Snoek, J.D.; and Rosenthal, R.

Organizational Stress: Studies in Role Conflict and Ambiguity. New

York: Wiley, 1964.

Lodahl, T., and Kejner, M. The definition and measurement of job

involvement. Journal of Applied Psychology 49:24-33, 1965.

Quinn, R.P., and Shepard, L.J. The 1972-73 Quality of Employment Survey:

Descriptive statistics, with comparison data from the 1969-1970 survey

of working conditions. Institute for Social Research. University of

Michigan, Ann Arbor, MI: Survey Research Center, 1974.

Shepard, J.M. Alienation as a process: Work as a case in point. The

Sociological Quarterly 13:161-173, 1972.

Stephen, M., and Prentice, R. Developing an occupational drug abuse program.

(DHHS Publication No. ADM 85-692). Washington, DC: U.S.

Government Printing Office, 1978.

Weiss, D.J.; Dawis, R.V.; England, G.W.; and Lofquist, L.H. Manual for the

Minnesota Satisfaction Questionnaire. Industrial Relations Center,

University of Minnesota, 1967.

AUTHORS

Wayne E.K. Lehman, Ph.D.

Research Scientist

and

D. Dwayne Simpson, Ph.D.

Director and Professor

Institute of Behavioral Research

Texas Christian University

P.O. Box 32880

Fort Worth, TX 76129

- 62 -
Drug Use Trends in a Nuclear Power Facility:

Data From A Random Screening Program

Carl E. Osborn, Ph.D.

and

Jacque J. Sokolov, M.D.

Southern California Edison

This is the second article describing the results of the ongoing substance

screening program at Southern California Edison’s San Onofre Nuclear

Generating Station (SONGS). The first (Osborn and Sokolov, 1989) detailed

the evolution of substance screening via non-random urinalysis over a four

year period from 1984 through 1988. The present paper describes the

rationale and structure of the latest “Two Strike, Random Model” program

and its results after one year of operation.

The Rationale for the Random Screening Program

The Two Strike, Random Model substance screening program was created for

many reasons, some theoretical, some practical. Although legal and

regulatory mandates specifying the creation of such programs provide basic

structural guidelines, substantial latitude remains concerning their rationale

and form.

Unacceptable Failure Rates

The primary motivation for the development of a random substance screening

program at San Onofre was the simple fact that the overall failure rate under

various non-random programs was too high, averaging about 3.2% (figure 1).

Safety concerns and public confidence issues demand higher standards of

behavior from nuclear workers.

- 63 -
Figure 1.
Under the previous three non-random programs (figure 2), the average

worker with Unescorted Access Authorization (a Red Badge) was screened

only once a year, at the time of badge renewal (Osborn and Sokolov, 1989).

In effect, this provided a full year’s notice of the date of each worker’s next

substance screen. While a few workers were screened more frequently, some

on an unannounced schedule, they first had to fail a routine screen or behave

in such a way as to create a reasonable suspicion of substance use.

Generally, only personnel who were either too unsophisticated or too

dependent to curtail their substance use prior to their scheduled screens were

detected.

Figure 2.

The Historical Evolution of SONGS

Substance Screening Program

September 1964 to May 1985: Idiographic Program

May 1965 lo December 1966 Four-Strike Program

December 1966 lo November 1966: Three-Strike Program

November 1968 to Present: Two-Strike, Random

Model Program

Changing Social Values

Another factor promoting change in the substance screening program at

SONGS was a dramatic shift in social values. Southern California Edison

first began commercial operations at San Onofre in 1968, when public

attitudes toward drug use were considerably different, particularly in Southern

California. Present trends toward the use of highly addictive stimulants has

substantially altered the social image of the drug user. With the

extraordinary addictive potential of these substances, the stereotype has

changed from the “experimenting college student” dabbling on weekends, to

the “desperate addict” willing to risk everything to abuse these drugs.

The highly addictive and dangerous properties of these new drugs underlie

a rationale introduced to support substance screening for nuclear workers.

The Nuclear Regulatory Commission, in its Fitness For Duty Rule, posits a

“trustworthiness and reliability” doctrine (10 CFR 2 & 26). This rationale

- 65 -
rests on the logic that anyone willing to break the law by using an illegal

substance is too untrustworthy and/or unreliable to be granted unescorted

access to a nuclear facility. While such a position can be stretched to cover

any illegal substance, much of its persuasiveness derives from its application

to highly addictive and dangerous substances.

Changing Science

Another factor molding present policy is the scientific state of drug screening

technology. As of this writing, impairment at any particular moment in time

is exceedingly difficult to demonstrate, except in the most extreme cases.

Over the past decade, however, valid and reliable methods of measuring

substances/metabolites have evolved to the point that large scale screening

is practical and accurate. But because these techniques only confirm

substance use, not what effects it had, or is having, it must be somehow

established that even the ingestion of the substance is worthy of action.

Hence, a combination of the “trustworthiness and reliability” doctrine with

the realities of present screening technology provides a basis to act upon the

new social values regarding substance use.

These factors combine to produce a political, legal and pragmatic imperative

- screen for drugs. But this rationale only dictates the creation of a

substance screening program, not its structure.

The Structure of the Random Screening Program

Operationalizing the random screening program at SONGS required answers

to a series of interrelated questions. Each such question had several

alternate solutions, one influencing the other. Nevertheless, choices were

made, some based on hard fact, some on best guesses. The primary

questions were those common to all substance screening programs: Who

should be screened? When should screening occur? What should ensue

from a positive screen?

Screening Subjects

Exactly who should be screened at SONGS was recently defined by the NRC.

“The provisions of the fitness-for-duty program must apply to all persons

granted unescorted access to protected areas, and to licensee, vendor, or

contractor personnel required to physically report to a licensee’s Technical

Support Center (TSC) or Emergency Operations Facility (EOF) in

accordance with licensee emergency plans and procedures.” (10 CFR 26,

Section 26.2, pp. 24495)

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Similar rules mandate screening specified workers regulated by the

Departments of Transportation and Defense. On a broader basis, though,

there has been some difficulty defining the proper substance screening subject

population. With the flurry of legal activity surrounding the issue, trend

spotting is hazardous at best, but it presently seems that personnel

performing “safety or security sensitive” work are evolving as the class most

clearly subject to substance screening, particularly through random selection.

There is little doubt that nuclear workers fall in this category.

Screening Points

Decisions about when to screen necessarily incorporate judgments about two

important constructs - detection and deterrence. While detection might

initially seem to be a concrete fact rather than an abstract construct, such is

not the case. For while the science of toxicology can be quite precise, it is,

and will remain, a human judgement when to label a drug screen result

“positive”. Recognition of this issue is implicit in the creation of both

substance metabolite cutoff points and the Medical Review Officer (MRO)

in recent federal rule making (e.g., 10 CFR 2 & 26, 49 CFR 391 & 394).

While cutoff points can be structured according to a dispassionate

measurement of technical factors such as sensitivity, base rates and

interreactivity, the idea that an experienced physician must be the final

arbiter of detection is an irrefutable acknowledgement of its true nature.

The abstract status of deterrence is more clearly apparent. While its

influence can be measured indirectly by several means, such as detection rates

and subjects’ self reports, it is impossible to assess directly. Ultimately, the

only thing certain is that corporate managers and regulatory agencies

generally agree that maximization of deterrence is a desirable goal.

Initially, Southern California Edison sought to increase the deterrence of its

substance screening program at SONGS in several ways. One method was

the introduction of unannounced testing in 1986. Organized labor quickly

obtained an injunction preventing unannounced testing however, which

remained in effect until November, 1988. Upon its dissolution, the Two

Strike, Random Model program was initiated at SONGS, utilizing the

screening points listed in figure 3. Each point has different aspects that

argued for its inclusion: some are highly deterrent in nature, particularly the

random and periodic substance monitoring tests, while others are largely

protective or punitive, such as pre-employment and fitness for duty tests.

These screening points were chosen to maximize both detection and

deterrence, and thus promote the overall goal of a drug free workplace.

- 67 -
Figure 3.

Two Strike, Random Model Program

Substance Screening Points

1. Initial red badge

2. Random red badge

3. Periodic substance monitoring

4. Investigatory

5. Post suspension

6. Fitness for duty

7. Drug program staff

6. Post incident

Response to Failures

Once screening points are chosen, decisions must be made about the

contingencies associated with failure. Interestingly, some aspects of a much

broader debate are reflected in these contingency choices. That debate has

been characterized as the “disease model” versus the “willpower model” of

substance abuse. While the medical professions have made recent gains in

their efforts to portray substance abuse as a disease entity, there remains a

strong tendency to see substance abuse as a personal failure, characterized

by a lack or failure of willpower. To the extent that substance abuse is

attributed to a failure of willpower, moral judgments about the individual’s

behavior naturally follow. Therefore, if a person is involved in abuse,

discipline seems appropriate.

Presently, a mix of the disease and willpower models predominates in most

corporate substance abuse programs. Depending on professional associations

and personal predilections, individuals charged with determining substance

screening failure contingencies typically include aspects of each. In nuclear

generating facilities like SONGS, this is formally mandated by the Nuclear

-68-
Regulatory Commission. The disease model is supported by requiring

treatment through the licensee’s Employee Assistance Program. The

willpower model is reflected by the disciplinary action of a Red Badge

suspension of at least 14 days. In addition, “Nothing herein shall prohibit

the licensee from taking more stringent action.” (10 CFR 26, p. 24498). The

SONGS Two Strike, Random Model program, therefore, incorporates a two

week suspension and a one year mandatory treatment program.

The rationale and structure of the program at SONGS evolved from careful

consideration of these various issues. The forgoing discussion provides a

background to interpret the results of the Two Strike, Random Model

program after one year of operation. The remainder of this paper will focus

on an analysis of these results.

Results

Analysis of Failures by Personnel

Between November, 1988 and November, 1989, SONGS personnel with

Unescorted Access, a Red Badge, failed 114 substance screens at San Onofre.

This represents all failures at all screening points (see figure 3). A

substantial initial drop following implementation was followed by considerable

month-to-month variability.

The absolute number of screening failures is, of course, related to the

absolute number of screens. In turn, the absolute number of screens

performed during any period is a function of both the screening rate and the

number of Red Badges valid during that period. It is the nature of nuclear

power generation to cycle through periods when large numbers of personnel

are needed to assist with refueling and maintenance needs. This introduces

wide variability in the number of Red Badged personnel, particularly in a

multi-reactor facility like SONGS.

Perhaps the clearest way of expressing the overall relationship is through the

failure rate, or the percentage of test failures occurring during each time

period (figure 4).

Interesting trends become evident when failure rates are compared for the

two major classes of workers at SONGS, employees and contract personnel.

Parallel plots show the recent emergence of contrasting patterns (figure 5).

- 69 -
Figure 4.

Substance Screen Failure Rate at SONGS

Two Strike, Random Model Program
Figure 5.

Substance Screen Failure Rates by Employees

and Contract Personnel at SONGS

Two Strike, Random Model Program
After an initial period of “testing” the program, overall failures dropped off

in the summer of 1989. The failure rate for contract personnel rose again

but the employee rate remained low. There are several possible explanations.

Perhaps some employees involved in substance abuse simply quit abusing,

either out of concern for being caught or, for some, because they actually

were caught. Still others probably made a conscious choice to continue

substance use, transferred out of the Protected Area and retired their Red

Badges, thus avoiding detection. Contractors, on the other hand, continue

to show wide variability.

Given some thought, this divergence between employees and contract

personnel might be expected. The “Two Strike” portion of the SONGS

program is, by necessity, operationalized differently for employees and

contractors. If contract personnel fail a substance screen at any time they

hold a Red Badge, their Badge is immediately lifted and they are denied

reapplication for eight weeks. Effectively, most lose their assignment at

SONGS since the duration of contract work is generally brief. While they

are encouraged to participate in treatment, most do not. Contract personnel

may reapply for a Red Badge after eight weeks have elapsed, through a

process of rigorous multidisciplinary assessment, but if they fail a second

time, the consequences are even more severe.

Unfortunately, a realistic analysis of the common outcomes of substance

screen failures shows that even though SONGS management maintains a very

strict policy, contract personnel failing a screen have less to lose than

employees. Often contract personnel work for firms that simply reassign

them to another work site. Although employment at SONGS is relatively

desirable, skilled personnel can usually find other work in an economy as

broad as Southern California’s. Instead of facing a two-week suspension

without pay, a blemish on their work record and a year-long mandatory

treatment program, contract employees are often working at another site the

same day. Clearly, the deterrence is less.

Another way of looking at these data is through an analysis of screening

failure rates by screening points (figure 6 - Note the small sample size in

some categories). It is particularly interesting that there is little difference

between the failure rates for Random and Investigatory screens, since the

latter are performed only “for cause”. This may be an artifact of a highly

inclusive subject selection process used during investigatory screening. For

example, when a drug find occurs in a limited access area of the plant, all

personnel using that area during a particular time period are often screened.

This obviously includes a fair number of people who produce negative

screens. While resulting in a modest “hit” rate, this approach does have a

strong deterrent effect, even when the results are negative, through a

heightened awareness of screening efforts.

- 72 -
Figure 6.

Substance Screening Failure Rates

by Screening Points at SONGS

Two Strike, Random Model Program
Finally, although the “Two Strike, Random Model” program departs from

previous programs in several ways, the most marked change is the inclusion

of a random screening point. Figure 7 shows the trend of random screening

failure rates for employees and contract personnel.

In sum, several conclusions can be drawn. First, the substance screen failure

rate dropped at SONGS after the implementation of the “Two Strike,

Random Model” program, from over three percent to less than one percent.

Second, that effect is more marked among employees than contract

personnel. This is probably due to the different consequences of failure.

Finally, these substance screening program changes created a natural

experiment of sorts. Unfortunately, this in vivo experiment lacks a control

group and contains several confounds: multiple variables changed

simultaneously with the introduction of the “Two Strike, Random Model”

program. But with these caveats in mind, the most logical attribution of

cause for the marked drop in failure rates would seem to be an increase in

deterrence, due largely to the twin effects of random screening and the

negative consequences of screen failure.

Analysis of Substances Detected

The actual substances detected through the Two Strike, Random Model

follows trends evident in previous programs at SONGS (Osborn & Sokolov,

1989). Figure 8 shows a breakdown of screen failures by substance. In

general, the proportion of 60% stimulants and 40% marijuana is in line with

local trends over the past several years. For awhile now, the illegal drug

market in Southern California has offered inexpensive methamphetamine in

addition to the various forms of cocaine, producing an elevated amphetamine

failure rate at SONGS. This may be aggravated by the fact that many

personnel at SONGS work rotating shifts. The effects of such shifts on

worker fatigue are well known, and a connection might exist between

stimulant abuse and shift-structure induced fatigue. Efforts are underway to

investigate this possibility.

- 74 -
Figure 7.

Average Failure Rates for Random Screening

by Employees and Contract Personnel at SONGS
Figure 8.

Substances Causing Random Screen Failures at SONGS

November 1988-November 1989
Summary

This paper has detailed the creation, implementation and results of the new

Two Strike, Random Model substance screening program at Southern

California Edison’s San Onofre Nuclear Generating Station. This program,

the fourth in an evolutionary process beginning in 1984, shows good results

after one year of operation. Although not without its difficulties, the

reduction in substance screen failure rates achieved thus far provides

incentive to continue the quest for a truly drug free workplace.

REFERENCES

Osborn, C.E. & Sokolov, J.J. Drug use trends in a nuclear power company:

Cumulative data from an ongoing testing program. In S.W. Gust

and J.M. Walsh, eds., Drugs in the Workplace: Research and

Evaluation Data (pp. 69-80). Rockville, MD: National Institute on

Drug Abuse, DHHS Publication No. (ADM)89-1612, 1989.

49 CFR 391 & 394. Federal Register, Vol. 53, No. 224, Monday, November

21, 1988.

10 CFR 2 & 26. Federal Register, Vol. 54, No. 108, Wednesday, June 7,

1989.

AUTHORS

Carl E. Osborn, Ph.D.

Chief, Psychological Services Group

Southern California Edison

Room 115

P.O. Box 800

2244 Walnut Grove Avenue

Rosemead, California 91770

and

Jacque J. Sololov, M.D.

Vice President and Medical Director

Southern California Edison

8631 Rush Street

Rosemead, California 91770

- 77 -

Mandatory Post-Accident Drug and Alcohol Testing for the

Federal Railroad Administration: A Comparison of Results for

Two Consecutive Years

David E. Moody, Ph.D., Dennis J. Crouch, MBA,

David M. Andrenyak, Ph.D., Rachel P. Smith, B.S.,

Diana G. Wilkins, Ph.D., Ann M. Hoffman, B.S., and

Douglas E. Rollins, M.D., Ph.D.

Center for Human Toxicology, Department of Pharmacology and Toxicology

College of Pharmacy, University of Utah

Salt Lake City, UT 84112

INTRODUCTION

The railroads have long been concerned with on-the-job substance use. About

the time the transcontinental rail system was completed, in the l860s, Rule

G was instituted prohibiting on-job use, possession of, or impairment by

alcohol. Implementation and reparation of the Rule was under the authority

of individual railroads. Despite the existence of Rule G, substantial evidence

existed that alcohol was consumed on duty by railroad employees. A joint

railroad-labor-Federal Railroad Administration (FRA) sponsored survey

(Mannello, 1979) in 1978 found:

23% of railroad operating employees were problem drinkers.

5% of workers reported to work “very” inebriated or got

intoxicated on duty at least once during the study year.

13% reported to work at least slightly intoxicated on one or

more times during the study year.

13% of operating employees drank on duty at least once

during the study year.

- 79 -
During the last two decades there has been growing concern not only about

alcohol, but also about drug use in the transportation industry. From 1975

to 1984, the FRA used autopsy findings to document that 48 accidents

resulting in 37 fatalities, 80 injuries, and $34 million in property damage

were caused by alcohol and drug impaired employees (FRA, 1985). In 1983,

the FRA initiated the rulemaking process to address alcohol and drug safety

concerns. This process resulted in formulation of the final Federal Rule (49

CFR) which covered “The control of alcohol and drug use in railroad

operations” (FRA, 1985). The final rule considered several issues including:

Federal Prohibition of Alcohol and Drug Use

Post-Accident Toxicological Testing

Authorization to Test for Reasonable Cause

Identification and Assistance of Troubled Employees

Pre-employment Drug Screening

Improved Accident Reporting

While several aspects of the resulting rule were under direct control of the

railroads, post-accident drug and alcohol testing was to be performed under

the direct supervision of the FRA Mandatory post-accident toxicological

testing, initiated in February, 1986, was a major aspect of the rule. In April,

1987, the analytical testing was transferred to the Center for Human

Toxicology (CHT). A prior report described the program, and presented the

results from the first year of analyses at our facility (Moody, et al., in press).

We have now compiled the results from the first two years of analysis,

allowing for a comparison between these two years.

CRITERIA FOR TESTING

Railroads are required to report all accidents exceeding specified damage

thresholds, and incidents resulting in reportable injuries to railroad

employees. Collectively these are referred to as events. The following define

reportable events (FRA, 1987):

Train Accidents: “A collision, derailment, or other event

involving the operation of railroad on-track equipment

resulting in damages which exceed the reporting threshold.”

($5,200 for 1987)

Impact Accident: “A head-on, rear-end, side, or switching

collision between rolling railroad stock, or impact of rolling

stock with a deliberately placed obstruction, which does not

include impact which follows derailment, or impact with

fallen natural objects, such as trees, rocks, or snow.”

- 80 -
Train Incidents: “Any event involving the movement of

railroad on-track equipment that results in death, a

reportable injury, or a reportable illness, but in which

railroad property damage does not exceed the reporting

threshold.”

Reportable Injury: “Physical harm which requires treatment

beyond first aid, causes at least one day of absenteeism from

work, or results in restriction of employees work

performance.”

Not all reportable accidents and incidents are subject to mandatory

post-accident testing. Those qualifying for testing are presented in table 1.

Table 1. Criteria Which Must be Met for Railroad Accidents and Incidents

to Qualify for Mandatory Post-Accident Testing.

Classification Abbreviation

Major Train Accidents With:

A) A Fatality TA / FAT

B) Damage in Excess of $500,000 TA / 500K

C) Hazardous Material Release resulting in: TA / HMR

Evacuation, or Reportable Injury

Impact Accidents With:

D) A Reportable Injury

E) Damage in Excess of $50,000

IMP / INJ

IMP / DAM

Train Incidents With:

F) A Fatality TI / FAT

The rationale for selection of the test-initiating criteria are more fully

discussed in the proceedings of the rulemaking process (FRA, 1985). In

summary, the 3 categories of accidents and incidents shown in table 1 were

chosen for mandatory post-accident testing based on:

- 81 -
1) prior experience., which suggested that the causal determination of major

train accidents is complex, often involving two or more contributing factors,

2) indication that a large percentage of impact accidents were caused by

human performance factors, and 3) it is rare that the cause of deaths in fatal

train incidents is fully understood. Fatalities involving non-employees or

employees not on duty were exempted from testing because previous

investigations suggested that few, if any of these arose from employee

negligence. Railroad highway grade crossings accidents are also exempted

from testing, as the FRA felt that in most cases the railroad employees could

only be viewed as additional victims in these tragedies, and that the railroads

would have the discretion to conduct their own testing in any instance where

there is reasonable suspicion of employee involvement.

Railroad officials must make an initial decision concerning whether an event

qualifies for testing based on a “good-faith” estimate of damages and injuries

incurred. For major train accidents, all train crew members must be tested.

Operators, dispatchers, signal maintainers, or other employees covered by

the Hours of Service Act will also be tested, if they are determined to be

involved in the circumstances of the event. In impact accidents or fatal

incidents, covered employees whom the railroad immediately determines had

no role in the cause of the accident or incident may be excluded from

testing. The proportion of events within any one test-initiating criteria, and

their change from one year to the next provides insight into the magnitude

of major train accidents occurring on the Nation’s railroads.

EVENTS AND EMPLOYEES QUALIFYING FOR TESTING

The total number of events qualifying for mandatory testing, and the total

number of employees tested for years one and two are shown in table 2, with

the number per test-initiating criteria presented in figure 1. Approximately

50% of the qualifying events were non-fatal major train accidents, with

impact accidents and fatal events comprising approximately 30 and 20% of

the total, respectively.

There were a similar number of qualifying events in both years, but the

number of fatal events and the total number of employees tested declined in

year two. As shown in figure 1, there were only modest changes in the

proportion of events arising from a specific test-initiating criteria. Slight

increases in the proportion of major train accidents with damage or

hazardous material release were coupled with slight decreases in the

proportion of the impact and fatal events. The number of employees tested

under a specific criteria were, however, significantly increased in major train

accidents with damage or hazardous material release, and significantly

decreased in impact accidents with damage. Further, more employees were

tested for certain events than for others, as shown in table 3.

- 82 -
Figure 1. Events and Employees Qualifying for Testing

** - The proportion in year one is significantly

different from the proportion in year two (p<0.05).

- 83 -
Within any one study period (e.g. 1, 2, or 1 & 2 years), there was a

consistency in the ranking of the number of employees tested per event based

on the test initiating criteria. Fatal train incidents and impact accidents had

fewer employees tested per event, reflecting, in part, the discretion railroad

officials may use in deciding which crew members will be tested. No such

discretion is allowed with the major train accidents. Further, most major

train accidents with fatalities involve collisions between two trains, increasing

the number of crew members subject to testing per event. Indeed, the

number of employees tested per major train accident with a fatality was

significantly greater than the other criteria, in all three study periods.

Depending upon the study period, there may have been no other significant

differences (Year l), or an overlap of some categories (Year 2 and Years 1

& 2). There were modest changes from Year 1 to 2 in the number of

employees tested per event (table 3). While there was a slight decrease in

this ratio for all test-initiating criteria, only the decrease in number tested

per impact accidents with damage was statistically significant. This decrease

may have arisen in part, from railroad officials becoming more proficient in

using their discretionary power in deciding which employees must be tested.

Table 2. Number of Events and Employees Qualifying for Mandatory PostAccident Drug and Alcohol Testing

Year 1 Year 2

Qualifying Events

Non-Fatal Events

Fatal Events

Total

145 150

30 26

175 176

Employees Tested

Non-Fatalities

Fatalities

Total

700 635

36 27

736 662

Chi-square analysis of the proportion of fatal events and fatalities revealed

that there were no significant differences (p<0.05) between years 1 and 2.

-84-
Table 3. Employees Tested Per Qualifying Event

Test- Employee / Event

Initiating Year

Criteria 1 2 1&2

TI / FAT

IMP / DAM

IMP / INJ

TA / $500K

TA / HMR

TA / FAT

2.90 ± 0.35a2.89 ± 0.64a2.89 ± 0.35a

3.94 ± 0.34a3.07 ± 0.25a* 3.55 ± 0.23a,b

4.19 ± 0.47a3.60 ± 0.37ab 3.90 ± 0.30a,b

4.31 ± 0.21a

4.03 ± 0.17a,b 4.16 ± 0.13b

4.44 ± 0.43a

4.21 ± 0.29a,b 4.31 ± 0.25b

6.80 ± 0.71b5.50 ± 1.16b6.22 ± 0.65c

Note: Values are presented as the Mean ± SE.

Significant difference between years for a specific test-initiating criteria (p<0.05)

One-Way ANOVA analysis of data in rows initially demonstrated a significant

difference among the values (p<0.05). Specific differences between employees

tested / event were then determined by the Tukey Test. Those which do not share the

same letter in the footnote are significantly different (p<0.05).

SPECIMEN RECEIPT

Under the FRA’s testing regulations, employees must submit both a blood

and urine specimen for drug and alcohol testing following qualifying events.

Specimen collection following a fatality was dependent on the conditions of

the corpse. As can be seen in table 4, there was excellent compliance with

the rule, with only 1% of the employees either refusing to provide, or not

cognizant of the specimen requirement. In fatalities both blood and urine

were obtained in a majority of the cases, but some analyses were performed

on vitreous humour or tissue due to specimen constraints.

Collection of specimens is performed as soon as possible, but not in lieu of

attendance to emergency situations. Specimens collected at medical facilities

distant from the remote sites of the qualifying event do not lend themselves

to efficient collection of forensic specimens. Records from the first year

(Moody, et al., in press) documented that the delay between the time of the

event and the collection of specimens ranged from 1.25 to 12.75 hrs, with

an average of 5.36 hr. Further, the average time to specimen collection varied

with the test-initiating criteria from an average of 4.76 hrs for impact

accidents with injury to 5.79 hrs for major train accidents with damage. While

less than optimal for the evaluation of toxicological results, it is an inherent

difficulty of testing on the rail system.

- 85 -
Table 4. Specimens Received for Testing

Year 1 Year 2

Non-Fatalities: Total 700 635

Blood + Urine 688 629

Urine Only 9 6

Blood Only 3 0

Fatalities: Total 36 27

Blood and Urine/Vitreous 20 14

Blood ± Tissue 13 8

Tissue ± Vitreous 2 0

Tissue Only 1 5

ANALYTICAL PROTOCOL

Specimens received for toxicological testing were subjected to 3 levels of

analysis; 1) a test for urine integrity, 2) initial tests of urine for drugs and

blood for alcohol, and 3) confirmation and quantitative analysis of both

blood and urine if indicated (Moody, et al., in press). To evaluate urine

integrity, the pH and specific gravity were determined. If the specific gravity

was < 1.005, the creatinine content of the urine was also determined. Urine

specimens with a specific gravity < 1.005 and creatinine < 6.0 mg/dl, or with

a pH < 4.0 or > 8.0 were subjected to more stringent screening and

reporting cutoffs. This contingency was required in only a few instances

during the two-year period, and only to allow reporting of urine

concentrations of analyte(s) which were present if reportable blood levels

were found.

Urine specimens were analyzed by immunoassay for eight drug groups, the

benzodiazepines were determined by enzyme mediated immunotechnique

(EMIT) and all other drugs by radioimmunoassay (RIA) using Abuscreen

reagents. RIA was also used when it was necessary to perform the

preliminary analysis on blood or tissue homogenates. Gas chromatography

(GC) / electron capture detection (ECD) was used to screen the blood and

tissue for benzodiazepines if urine was unavailable. Preliminary analysis for

ethanol was performed on blood, (or urine or tissue homogenate if blood was

not available), by GC / flame ionization detection (FID). If any of the

preliminary analyses revealed the presumptive presence of a drug group at

-86-
or above the cutoff concentration (table 5), the blood and urine, or tissue

specimens were submitted for confirmational and quantitative analyses.

All confirmations of drugs and drug metabolites were performed by GC /

mass spectrometry (MS) (Foltz et al, 1980; Crouch et al, 1983). For most

drugs, the confirmation and quantitation was performed simultaneously using

GC / chemical ionization (CI) MS with deuterium labeled internal standards.

The barbiturates were quantitated by high pressure liquid chromatography

(HPLC), and confirmed by GC / electron impact (EI) MS. All the

benzodiazepines, except chlordiazepoxide, were quantitated by GC / ECD.

Chlordiazepoxide and metabolites were quantitated by HPLC, and confirmed

by GC / EIMS. Ethanol was confirmed by GC / FID utilizing a second

column with a different packing material. Positive findings were reported if

any drugs or metabolites were confirmed, and quantitated at or above the

confirmatory cutoffs (table 5). Reports were released only after analysis was

completed for all the employees tested in regard to a single qualifying event.

Table 5. Administrative Thresholds (Cutoffs): FRA vs HHS

Drug Groups

Screening Confirmation

FRA HHS FRA FRA HHS

Urine Urine Urine Blood Urine

(mg/ml)

Cannabinoids (Carboxy)

(THC)

Cocaine Metabolite (BE)

(Cocaine)

Opiates

Phencyclidine

Amphetamines

Barbiturates

Benzodizepines

Methaqualone

Ethanol (mg %)

20 100 20

--- --- ---

300 300 150

--- --- 50

300 300 100

25 25 25

300 1000 100

200 *** 200

300 *** 300

750 *** 500

10 *** 10

2 15

1 ---

50 150

50 ---

100 300

25 25

100 500

200 ***

300 ***

500 ***

10 ***

ANALYTICAL FINDINGS

A positive report could involve a single employee with a single substance, or

multiple employees with one or more substances. Positive test results are

summarized in table 6 by number of drug or alcohol positive events, number

of positive employees, and number of substances detected. Not all positive

specimens resulted in positive reports, since in a few instances, medication,

or alcohol ingestion occurred post-accident. Also, in some fatalities, low

- 87 -
levels of ethanol were detected which were consistent with post-mortem

generation of ethanol. These findings are not presented in this report. Some

positive findings were consistent with the employee’s statement of medication

pre-accident and these are considered in the total positive findings, but not

as illicit positives (table 6).

As demonstrated in table 6, there were incidents where more than one

employee tested positive in a single event. In the first year, there were 5

events with 2 positive employees and 1 event with 3 positive employees. In

the second year, there were also 5 events with 2 positive employees and 1

event with 5 employees testing positive for drugs. Further, there were 3

employees who tested positive for multiple substances in the first year (2 for

2 drugs and 1 for 3 drugs), and (here were 4 employees who tested positive

for multiple drugs (2 each) in the second year. Four and 2 of the positive

substances detected during the first and second years, respectively, were

prescribed medication. There was a modest decrease in the number and

percentage of positive events, employees and substances detected from year

1 to year 2. This decrease, however, was only statistically significant for the

proportion of total positive events.

Table 6. Summary of Positive Findings in Year 1 & 2: Total and Illicit

Positives

Positive Events

Total

Illicit

Positive Employees

Total

Illicit

Positive Substances

Total

Illicit

No. 42 27

% 24.0 15.3”

No. 38 25

% 21.7 14.2

No. 49 36

% 6.66 5.44

No. 45 34

% 6.11 5.14

No. 53 40

No. 49 38

Year 1 Year 2

a - The proportion of positives in the second year was significantly different from the first year.

p<0.05.

-88-
The decrease in positives detected from the first to the second year of

analysis at CHT represents an encouraging trend. However, consideration of

the findings at the initial testing facility to allow comparison of positives over

the calendar year offers another perspective (figure 2). The total number of

illicit positive findings did not vary from calendar year 1987 to calendar year

1988. As seen in figure 2, there is some variance over time in the positive

findings. Therefore, it may be premature to suggest that a decline in the rate

of positive drug and alcohol findings has occurred during the course of

mandatory post-accident testing by the FRA.

Figure 2. Rate of Positive Findings Comparing Calendar Year

versus Analytical Facility Year.

Substances identified in the positive specimens are listed in table 7.

Cannabinoids were consistently the most commonly encountered drug in both

years of the program. Cocaine/metabolite, followed closely by ethanol were

the next most commonly encountered substances. An occasional

non-prescribed benzodiazepine, barbiturate or opiate was detected as well as

singular methaqualone and amphetamine identifications. Consistent with the

decrease in total number of substances noted during year 2, there was a

general decline in the number of specific substances detected.

Cocaine/metabolite, either by itself, or in combination with cannabinoids, was

a notable exception.

- 89 -
Table 7. Comparison of Drug Findings in the First Two Years of FRA Drug

and Alcohol Testing

Drug Group Yr #1 Yr#2

Barbiturates

Benzodiazepines

Cannabinoids

Cocaine

Ethanol

Methaqualone

Phencyclidine

Opiates

Cannab/Cocaine

Cannab/Opiate

Cannab/Cocaine/Amphet.

Barb/Opiate

0

2.b

30

5

5

1

0

3.c

1

0

1

1

4.a

0

17

7

3

0

0

1

3

1

0

0

Total 49 36

a - Two of the positive barbiturates were prescribed medication.

b - One of the benzodiazepines was prescribed medication.

c - Three of the positive opiates were prescribed medication.

In order to facilitate the integration of positive drug or alcohol findings into

accident investigations, blood concentrations of detected analytes are required.

Blood concentrations for the combined positives found in years 1 and 2 are

presented in table 8. The proportion of positive cases with reportable values

in blood varied by drug group. For example, in all cases where both blood

and urine were available, the analyte was detected in both tissues for all cases

involving ethanol and benzodiazepines, and in 80% of the barbiturates. At

the other extreme, only 1 of the 6 opiate positive cases had a positive blood

concentration. Additional differences were observed when both a parent drug

and metabolite were analyzed. For cannabinoids, blood THC and the

carboxy-THC metabolite were observed in 42% and 96% of the positive

cases, respectively. Benzoylecgonine (a metabolite of cocaine) was detected

in the blood of 65% of the positive cases. Parent cocaine was only detected

in 1 blood (6%) and in 53% of the urines. This variation in blood positives

depends, in part, upon the intrinsic pharmacokinetics of the drug, the length

of time to specimen collection, and for cocaine in particular, the in vitro

stability of the drug.

- 90 -
Table 8. Occurrence of Drugs and / or Metabolites in Blood nnd Urine of

Positive Cases

Drug Group

Total /

Drug Group Blood / Tissue Urine

Cannabinoids

THC

COOH-THC

Cocaine/Metabolite

Cocaine

Benzoylecgonine

Opiates

Morphine

Codeine

Amphetamines

Amphetamine

Methamphetamine

Barbiturates

Butalbital

Benzodiazepines

Diazepam

Chlordiazepoxide

Methaqualone

Ethanol

53

17

6.b

1

5.d

2

1

8

22 ND.a

51 53

1

11

0

1

0

0

4

9

17

2.c

5

1

1

5

1

1

1

8

NAf

1

0

6.g

a - ND: not determined

b - 3 of 6 opiates were prescribed

c - There was one morphine only case and it was 6-MAM positive

d - 2 of 5 barbiturates were prescribed

e - 1 of 2 benzodiazepines were prescribed

f - NA: not available

g - Urine NA for 2 cases

RELATIONSHIP OF POSITIVE SUBSTANCE FINDINGS TO ACCIDENT

CAUSATION AND FATAL EVENTS

While the determination of a drug or alcohol presence in blood or urine

specimens is readily performed, a thorough investigation into the causal

factors involved in an event is much more time consuming. Many of the

events which occurred in the first year of analysis at CHT, and were

associated with a positive drug or alcohol finding have undergone a thorough

investigation by the FRA and/or the National Transportation Safety Board

(NTSB). Administrative decisions have been reached concerning the

- 91 -
contribution of substance use to accident causation (FRA, 1989; NTSB, 1988,

Moody, et al., in press). The results of these investigations, including the

extent of the investigation are shown in table 9.

Table 9. Drugs Potentially Related to Accident / Incident Causation in

Qualifying Railroad Events (First Year Data Only)

Extent of Investigation

FRA

& Total No.

Total No. NTSB FRA NTSB Related

Investigated to

/Identified No. Related/No. Investigated Accident

Cannabinoids 22 / 30 2/12 0/l 3/9 5

Cocaine 4/5 3/4 3

Opiates 3/3 0/l 0/l 0/l 0

Ethanol 4/5 l/l 2/3 3

Benzodiazepines 2/2 0/1 0/1 0

Methaqualone 1/1 0/l 0

Cannab. & Cocaine 1/1 1/1 1

Cannab., Coc. & Amphet. 1/1 l/l 1

Barbiturate & Opiate 1/1 l/l 1

Two points of particular interest can be derived from these data. First, while

cannabinoids were the most commonly encountered drug, only a small

proportion of cannabinoid use, in contrast to the relatively high proportion

of cocaine and ethanol use, was associated with event causation. Secondly, all

of the 3 instances of multiple drug use detected during the first year of the

program were associated with event causation. As there was a marked

increase in the number of multiple substance findings in the second year, it

will be of particular interest to monitor this trend.

During our initial evaluation of data from the first year of testing, we noticed

a greater proportion of the total positives in fatal events. We have further

evaluated the data to see if this trend continued, and if it has held for illicit,

as well as, total positive findings (figure 3). While the proportions of total

and illicit positive event findings in fatal events were consistently greater in

the first and second, or combined years of analysis, these proportions were

statistically significantly greater for only the total positives in the first and

combined years. For the first year data, the rate of positives associated with

accident causation could also be determined. In this case, 10.0% and 7.6%

of the fatally and non-fatally triggered events, respectively, were associated

- 92 -
with a positive finding of substance use which was determined to play a role

in event causation. The difference between the two groups was not

statistically significant however (Moody et al., in press).

Figure 3. The Percent Positives in Fatal versus Non-Fatal

Qualifying Events.

*** The proportion of total positives in the non-fatal events was

significantly less than for the fatal evetns, p < 0.05.

- 93 -
COMPARISON TO OTHER TRANSPORTATION STUDIES

Studies on the use of drugs or alcohol in the transportation workplace are

limited. Only two other studies have been published to date concerning the

results of analysis for drugs and/or alcohol by employees within the

transportation industry. These include results of the drug testing program of

a single railroad company (Taggart, 1989), and of a study conducted with

truck drivers who were randomly chosen to volunteer for testing (Lund et al.,

1988). It is interesting that in the study with company sponsored testing of

railroad employees, and in the post-accident testing of a similar segment of

railroad employees there were comparable positive rates of 5.8 and 6.7%,

respectively, in 1987. A higher positive rate was found in the study on truck

drivers. The proportion of cannabinoid and cocaine positives were fairly

similar in all 3 studies, while ethanol was observed more frequently in the

company sponsored testing of railroad employees. Illicit amphetamine /

methamphetamine use was modest in the truck drivers (1.3%), but greater

than that observed in the railroad post-accident testing program.

CONCLUSIONS

The results of two years of analysis of blood and urine specimens collected

after events which qualify for the FRA’s mandatory post-accident testing

program indicate that, as with other segments of the American workplace,

substance abuse is a detectable problem among railroad workers. Specific

points which may be concluded from observation of the data from the first

and second years of the program are as follows:

A decrease in the number of employees tested in year two arose

from decreased number of employees tested per event. In part, from

greater discretion in the number of employees tested for impact

accidents and fatal incidents.

Cannabinoids were the most common positive finding (62.4% of

drugs identified), followed by cocaine (20.0%), and ethanol (9.4%).

Positive findings were more common in fatal than in non-fatal

qualifying events.

In approximately 1/3 of positive events, alcohol or drug usage was

related to accident causation.

A trend towards a decrease in the cannabinoid positives and

increases in cocaine, ethanol, and multiple drug positives was noted

in drug-related accidents.

- 94 -
On-the-job drug and alcohol use is a continuing problem in the American

workplace, and its existence cannot be ignored. One could take the optimistic

view that of 1398 railroad employees tested for drugs and alcohol, only 85

tested positive. However, in eleven events studied during the first year,

substance use was a contributing factor in the cause of accidents which

resulted in the unnecessary loss of property and human life.

REFERENCES

Crouch, D.J., Peat, M.A., Chinn, D.M., and Finkle, B.S. Drugs and Driving:

A Systematic Analytical Approach. J. For. Sci. 28:945-956, 1983.

Federal Railroad Administration. Control of alcohol and drug use in railroad

operations; final rule and miscellaneous amendments. Federal Register

50:31508-31579, 1985.

Federal Railroad Administration. Accident/Incident Bulletin No. 156, 1987.

Federal Railroad Administration. Summary of Accidents Investigated by the

Federal Railroad Administration Calendar Year 1987. U.S. Department

of Transportation, 1989.

Foltz, R.L., Fentiman, A.F., and Foltz, R.B. GC/MS Assays for Abused Drugs

in Body Fluids. NIDA Research Monograph 32, 1980.

Lund, AK.; Preusser, D.F.; Blomberg, R.D.; and Williams, A.F. Drug use by

tractor-trailer drivers. J. For. Sci. 33:648-461, 1988.

Mannello, T.A. Problem Drinking Among Railroad Workers: Extent, Impact,

and Solutions. Washington, D.C., University Research Corp., 1979.

Moody, D.E.; Crouch, D.J.; Smith, R.P.; Cresalia, C.W.; Francom, P.; Wilkins,

D.G.; and Rollins, D.E. Drug and Alcohol Involvement in Railroad

Accidents. J. For. Sci, in press.

National Transportation Safety Board. Safety Study. Alcohol Drug Use and its

Impact on Railroad Safety. Washington, D.C., NTSB SS-88/04, 1988.

Taggart, R.W. Results of the drug testing program at Southern Pacific

Railroad. Drugs in the Workplace: Research and Evaluation Data.

NIDA Research Monograph 91:97-108, 1989.

- 95 -
ACKNOWLEDGEMENTS

This study was supported in part by DOT contract DTFR53-87-C-00016. The

authors wish to thank Walter C. Rockey, Jr., and Grady C. Cothen, Jr., of

the FRA for their useful comments on the manuscript, and Merritt Birkey

and William Zielinsky of the NTSB for provision of investigation reports.

AUTHORS

David E. Moody, Ph.D.,

Associate Director CHT and

Research Associate Professor of Pharmacology and Toxicology,

Dennis J. Crouch, M.B.A.,

Assistant Director CHT,

David M. Andrenyak, Ph.D.,

Assistant Director CHT,

Rachel P. Smith, B.S.,

Laboratory Technician CHT,

Diana G. Wilkins, Ph.D.,

Assistant Toxicologist CHT,

Ann M. Hoffman, B.S.,

Assistant Toxicologist CHT,

and

Douglas E. Rollins, M.D., Ph.D.,

Director CHT, and

Professor of Pharmacology and Toxicology

Center for Human Toxicology

Department of Pharmacology and Toxicology

University of Utah

417 Wakara Way, Room 290

Salt Lake City, UT 84108

-96-
Drug Use and Job Performance Indicators

Development of Repeated Acquisition Methodologies:

Implications for the Detection of Drug-Induced Disruption in

Human Learning

Warren K. Bickel, Stephen T. Higgins, and John R. Hughes

University of Vermont

INTRODUCTION

Drug testing via urinalysis is the most commonly used method to reduce drug

use in the work-place (Walsh and Yohay, 1987). Questions of rights to

privacy, differentiating therapeutic drug use versus drug abuse, the absence

of alcohol in many testing profiles, and difficulties in maintaining the

accuracy of testing programs in populations with a low prevalence of drug

abuse may limit the utility of urine testing (Morgan, 1984; Schnoll and

Karan, 1989). With respect to avoiding accident or injury, test results are

usually not immediately available and indicate only that a drug has been

taken in the last several days, not whether an individual is currently under

the influence or impaired (Marshall, 1988; Schnoll and Karan, 1989). Thus,

urine testing does not test for what is certainly an important concern of

employers and regulatory agencies; i.e., behavioral impairment.

One way to avoid several of the detriments of drug testing may be to

supplement it with a determination of behavioral impairment. Determining

whether an individual is behaviorally impaired at the job-site does not invade

that individual’s right to privacy, but addresses whether their job can be

performed competently and safely. Such a determination could be conducted

on a daily basis with the result being immediately available. Ideally,

impairment resulting from a variety of sources, including alcohol, abused

drugs, and therapeutic drugs producing adverse effects, as well as, sleep

deprivation, and/or negative-life events, would be identified. Once an

individual is identified as behaviorally impaired, then a variety of techniques

could be used to ascertain the cause of that impairment, including field

sobriety tests, urinalysis, and psychological tests.

If a behavioral impairment criterion is to be useful, then there must be

procedures to assess impairment. To our knowledge, an adequate

methodology does not yet exist. Research on the psychopharmacology of

drugs on human performance has often developed batteries of performance

- 99 -
procedures. However, many of these procedures are not well-suited for the

workplace. For example, the procedures may require protracted training,

long periods of time to administer the test, and may not have been developed

for within-subject study, or be adequately sensitive to the wide range of drugs

necessary in a workplace application.

We have been modifying a method that may be useful in determining

behavioral impairment. The procedure is the Repeated Acquisition of

Behavioral Chains (Boren, 1963). This procedure permits learning to be

studied repeatedly in a single individual (an important point for assessing

drug-induced disruption). We selected a procedure to measure learning

because most workplaces require employees to adjust their performance as

environmental demands change; that is, they are constantly learning how to

do their job under the different circumstances that present themselves. We

also study learning because numerous studies have demonstrated that drugs

disrupt learning more easily than performance (Barthalamus et al., 1978;

Bickel et al., 1989; Bickel et al., 1990, Higgins et al., 1987; Higgins et al.,

1989; Thompson and Moerschbaecher, 1979).

The purpose of this paper is to describe this procedure, the results we have

obtained with it, and our development and modification of this procedure to

eliminate undesirable features. Before discussing this work, we would like to

make it clear that several of our results are preliminary, and the final results

or procedure may differ in subsequent reports.

The Repeated Acquisition of Behavioral Chains

In this procedure, subjects have to learn a sequence of 10 responses to 3

keys. Figure 1 illustrates a typical response sequence in which subjects would

have to depress response keys in the order of 3, 1, 2, 3, 2, 1, 3, 2, 1, 3 in the

presence of the video screen numbers 0, 1, 2, 3, 4, 5, 6, 7, 8, and 9,

respectively, for a point to be obtained. For example, as each number

appeared in the center of the video screen, subjects had to depress one of

the three keys to advance to the next step in the 0 to 9 sequence. Incorrect

responses initiate a 2-second timeout: then the subject returns to the step in

the sequence in which the error was made. Responses during the timeout

have no effect. Correct responses increment the numbers in the 0-9 sequence.

Completion of the correct lo-response sequence increments a counter which

awards points redeemable for money (e.g., $0.05/point) and returns the

subject to the beginning of the sequence. Typically, we study this procedure

in a multiple schedule arrangement in which one component is acquisition

(a new sequence of responses is learned each session) and the other

component is performance (the same sequence is always used).

- 100 -
Among the most important measures obtained from this procedure is errors.

Errors are defined as responses on any key other than the one designated as

correct at a particular step in the 0 to 9 sequence and are typically analyzed

as overall percent errors for each component by dividing the total errors in

the component and multiplying by 100.

The development of stability during training for three typical subjects is

shown in figure 2. Percent errors in the acquisition and performance

components reached stability by the fifteenth session in subjects AK and PP.

Illustrative Response Sequence

Figure 1. This figure illustrates the steps involved in moving through a typical lo-response

sequence used in the study. At the top of the figure, the 0 to 9 sequence, which appeared in the

center of the video screen, is presented above the corresponding 10 correct responses on the

numeric keypad. Correct responses advanced the video-screen number to the next step in the

sequence. Incorrect responses initiated a 2-second timeout; completion of the timeout period

returned the subject to the step in the 10 response sequence at which the error was made. Each

completed sequence added one point to a running total and returned the number in the center

of the video screen for the start of the next trial (After Higgins et al., 1987, p. 2).

- 101 -
However, some subjects, such as subject GK required as many as 40 sessions

of training to reach stability. Stability in the acquisition component is

characterized by 2.5 to 7.5 percent errors and in the performance component

by 0 to 1 percent errors.

Figure 2. Percent errors during the first 30 to 45 sessions of exposure to the acquisition and

performance of response chains procedure.

- 102 -
Acute Effects of Benzodiazepines on Repeated Acquisition

We have recently investigated the acute effect of the prototypic

benzodiazepine, diazepam, and two triazolo-benzodiazepines (alprazolam and

triazolam) on the acquisition and performance of response chains. Diazepam,

widely used as an anxiolytic (Greenblat et al., 1983), produces sedation and

decreases psychomotor performance. Alprazolam, an anxiolytic and

antidepressant, has been reported to have fewer side effects than diazepam

(Fawcett and Kravitz, 1982). Triazolam is used as a hypnotic agent and has

been suggested to be the benzodiazepine with the greatest abuse liability

(Crawford, 1981; cf. Griffiths and Roache, 1984).

The effects of these drugs on acquisition and performance of response chains

of three representative subjects are displayed in figure 3. This figure shows

the peak effect of the different doses of these drugs on percent errors from

the acquisition and performance of response chains. In the performance

component, alprazolam at the 2 and 3 mg/70 kg dose and triazolam at the

0.75 mg/70 kg dose produces effects clearly above placebo levels. In the

acquisition component, the drugs could be more easily distinguished.

Alprazolam produced the greatest increase in errors followed by triazolam.

Diazepam produced a more modest increase in errors relative to the two

triazolo-benzodiazepines which is consistent with our previous findings with

diazepam (Higgins et al., 1987).

There are two points to make about these results. First, performance or

performance-like tasks are relatively insensitive for the assessment of

drug-induced impairment. Thus, tests of performance probably underestimate

the degree of drug impairment. Second, diazepam seems less disruptive than

either of the two triazolo-benzodiazepines at equipotent therapeutic doses.

This suggests a structure-function relationship in which the addition of the

triazolo-ring to the benzodiazepine molecule may imbue these compounds

with greater liability for disrupting learning than other standard

benzodiazepines.

With respect to assessment of behavioral impairment, the repeated

acquisition of behavioral chains has several advantages and disadvantages.

Among the advantages is the ability 10 study learning repeatedly in a single

subject, and its greater sensitivity to drug effects than performance. A major

disadvantage of the procedure is the protracted period of time required for

training (up to 40 sessions) which renders this procedure relatively

impractical for the detection of drug-induced disruption in work site settings.

- 103 -
Figure 3. An individual subject’s data for the effects of alprazolam, diazepam and triazolam on

overall percent errors. Each point represents peak effects of that dose.

- 104 -
THE REPEATED ACQUISITION OF STIMULUS TRACKING

To overcome the prolonged training, we have modified the repeated

acquisition methodology to produce a new task--the Repeated Acquisition of

Stimulus Tracking (RAST). This task was designed to reduce the training

period by requiring that only 1 response be acquired relative to the 10

responses acquired in the repeated acquisition of behavioral chains.

Moreover, in order to increase complexity, and hopefully sensitivity, to drug

effects, the number of potentially correct responses was increased.

The RAST presents subjects with five response areas on a video screen (top

left panel figure 4). Within each response area are 5 stimuli for a total of 25

stimuli. Only 1 of the 25 stimuli is correct. If the subject responds (by

pointing with a Macintosh mouse and clicking) to a response area containing

the correct stimulus, then feedback is provided that one of the five stimuli

is correct (i.e., a beep and a point). If none of the five stimuli is correct in

a given response location then the subject receives no feedback. On each

successive trial the five stimuli that were together on a previous trial are

generally not together on the next trial. When the subject has learned which

is the correct stimulus (i.e., acquired the correct discrimination), the correct

stimulus is tracked as it moves from response location to response location.

Similar to the previous procedure, the RAST has acquisition and

performance. In the acquisition component, the subject has to learn which

1 of the 25 stimuli is correct and this changes each session. In the

performance component, the same stimulus is correct each session.

An example of how a subject might respond on the RAST during the first

several trials in the acquisition component is illustrated in figure 4. On trial

1 (upper left panel), the subject might respond to the upper left response

area. However, the correct counter is not incremented. This indicates that

none of the five stimuli in this response location is correct. On trial 2 (upper

right panel), the subject responds to the response area located in the center

of the screen. Again, this response does not increment the correct counter

indicating that none of these stimuli is correct. On trial 3 (middle left panel),

the subject again responds to the upper left response area and does

increment the correct counter indicating that one of these five stimuli is the

correct stimulus. If the subject had learned from trials 1 and 2 which stimuli

were not correct (i.e., the eye and the building), then the subject would have

only three stimuli from which to select to determine which stimulus is

correct. On trial 4 (middle right panel), the subject responds to the lower

right response area, and does not increment the correct counter. This

response area contains both the cross and the eyeglasses that were previously

correlated with reinforcement but on this trial did not increment the correct

counter. Thus, these two stimuli are not the correct stimuli leaving only the

television. On trial 5 (bottom left panel), the subject responds to the

- 105 -
response location containing the television and increments the response

counter. On trial 6 (bottom right panel), the subject tracks the television to

its new response location. In the acquisition component, a new correct

stimulus would need to be learned in the next session and the process

repeated. If this were a performance component, the same stimulus would be

correct each session.

Figure 4. This figure illustrates the six trials during the acquisition of the correct response during

exposure to the RAST. Each response moves the subject to the next trial and increments the trial

counter at the bottom of each screen. Incorrect responses have no effect.

- 106 -
Again, the primary measure for this procedure is errors. Figure 5 shows the

development of stability of the RAST for three subjects. Subjects reach

stability in the acquisition component in two to four sessions with percent

error ranging from 0 to 30 percent error. In the performance component

stability is reached within three sessions and stable performance is

characterized by the absence of errors.

Figure 5. Percent error during the first 15 sessions of exposure to the acquisition and

performance of stimulus tracking procedure.

- 107 -
We then examined the effects of triazolam (0, 0.375 and 0.75 mg/70kg, p.o.)

on the procedure. Figure 6 shows the results of a representative subject who

received triazolam 30 minutes earlier. Triazolam produced a dose-related

increase in errors in the acquisition component of the RAST with 100%

errors being obtained with the high dose. In contract to the acquisition

component, the performance component is very insensitive to triazolam’s

effects.

Figure 6. An individual subject’s data for the effects of triazolam on overall percent errors from

the acquisition and performance components of the RAST. Each point represents percent errors

30 minutes post-drug administration.

CONCLUSION

The RAST is easily learned, quickly administered, sensitive to triazolam’s

effects and may be a useful component of a battery designed to assess

behavioral impairment in the workplace. The development of the RAST

illustrates one approach to the development of procedures to assess

behavioral impairment; that is, a procedure that has desirable features is

modified in an attempt to decrease or eliminate undesirable and enhance

desirable features.

- 108 -
As indicated earlier, the addition of behavioral impairment assessments offers

several advantages over urinalysis testing alone. Perhaps, if such tests of

behavioral impairments were in place, workplace accidents could be

decreased. However, before such a battery can be utilized, a considerable

amount of research will be required specifically directed toward customizing

promising procedures so they are suitable for the workplace environment.

Only when that research has been conducted can the advantages of assessing

behavioral impairment be realized.

REFERENCES

Barthalmus, G.T.; Leander, J.D.; and McMillan, D.E. Combined effects of

ethanol and diazepam on performance and acquisition of serial

position sequences by pigeons. Psychopharmacology 59:101-102, 1978.

Bickel,

Bickel,

Boren,

W.K.; Higgins, S.T.; and Griffiths, R.R. Repeated diazepam

administration: Effects on the acquisition and performance of

response chains in humans. Journal of the Experimental Analysis of

Behavior 52:47-56, 1989.

W.K.; Hughes, J.R.; and Higgins, S.T. The human behavioral

pharmacology of benzodiazepines: Effects on the repeated acquisition

and performance of response chains. Drug Development Research

20:53-64, 1990.

J.J. Repeated acquisition of new behavioral chains. American

Psychologist 17:421, 1963.

Crawford, R.J.M. Benzodiazepine dependency and abuse. New Zealand

Medical Journal 94:195, 1981.

Fawcett, J.A., and Kravitz, H.M. Alprazolam: Pharmacokinetics, clinical

efficacy, and mechanisms of action. Pharmncotherqy 2:243-254, 1982.

Greenblatt, D.J.; Shader, R.I.; and Abernathy, D.R. Current status of

benzodiazepines. The New England Journal of Medicine 309:410-416,

1983.

Griffiths, R.R., and Roache, J.D. Abuse liability of the benzodiazepines: A

review of human studies evaluating subjective and reinforcing effects.

In: Smith, D.E. and Wesson, D.R., eds. Benzodiazepines: Standards

of Clinical Use in Clinical Practice. Lancaster, England: MTP free

Limited, 1984.

- 109 -
Higgins, S.T.; Bickel, W.K.; O’Leary, D.K.; and Yingling, J. Acute effects of

ethanol and diazepam on the acquisition and performance of

response sequences in humans. Journal of Pharmacology and

Experimental Therapeutics 243:1-8, 1987.

Higgins, S.T.; Woodward, B.M.; and Henningfield, J.E. Effects of atropine on

the repeated acquisition and performance of response sequences in

humans. Journal of the Experimental Analysis of Behavior 51:5-15,

1989.

Marshall, E. Testing urine for drugs. Science 241:150-151, 1988.

Morgan, J.P. Problems of mass screening for misused drugs. In: Smith, D.S.,

Wesson, D.R., Zerkin, E.L., Novey, J.H., eds. Substance Abuse in the

Workplace. San Francisco, Calif: Haight-Asbury Publications, 1984.

Schnoll, S.H., and Karan, L.D. Substance abuse. Journal of the American

Medical Association 261:2890-2892, 1989.

Thompson, D.M., and Moerschbaecher, J.M. Drug effects on repeated

acquisition. In: Thompson, T., and Dews, P.B. eds. Advances in

Behavioral Pharmacology. Vol. 2. New York: Academic Press, 1979.

pp. 229-259.

Walsh, J.M., and Yohay, S.C. Drug and alcohol abuse in the workplace: A

guide to the issues. Washington, D.C.: National Foundation for the

Study of Equal Employment Policy, 1987.

ACKNOWLEDGEMENTS

This research was supported by U.S. Public Health Service Research Grant

DA-05538, First Independent Research Support and Transition Award

DA-04545, and Research Scientist Development Award DA-00109 from the

National Institute on Drug Abuse. Portions of this paper are based on an

article to be published in Drug Development Research. The authors thank

Charissa Wieland for her laboratory assistance. Send reprint requests to

Warren K Bickel, Human Behavioral Pharmacology Laboratory, Department

of Psychiatry, University of Vermont Ira Allen School, 38 Fletcher Place,

Burlington, Vermont 05401.

- 110 -
AUTHORS

Warren K Bickel, Ph.D.

Assistant Professor of Psychiatry and Psychology

Stephen T. Higgins, Ph.D.

Assistant Professor of Psychiatry, and Psyhcology

and

John R. Hughes, M.D.

Associate Professor of Psychiatry, Psychology, and Family Practice

University of Vermont

Human Behavioral Pharmacology Laboratory

Department of Psychiatry

Ira Allen School

38 Fletcher Place

Burlington, VT 05401

- 111 -

Residential Laboratory Research: A Multidimensional

Evaluation of the Effects of Drugs on Behavior

Marian W. Fischman, Thomas H. Kelly, and Richard W. Foltin

The Johns Hopkins University School of Medicine

There are surprisingly little published data describing the effects of currently

abused drugs on human performance. Evaluation of such effects remains an

important issue, particularly, for example, where workplace safety and

productivity are at risk. Concerns center both on changes in performance

immediately after drug use as well as decrements in workplace performance

related to drug use outside of the workplace. These decrements have not

been easy to document, in part because contextual issues play a relatively

large role in the manifestation of drug effects. For example, a number of

studies have reported that instructional and social factors can influence the

effects of marijuana (Carlin et al., 1972; Jones, 1971). Given the importance

of contextual factors for the measurement of drug effects, assessment of drug

effects on work performance should be conducted under the conditions in

which the drugs are generally taken and the tasks carried out. Such

evaluations enable us to carry out analyses of the interactive effects of

situational factors and behavioral contingencies with the various drugs in

question.

Another aspect of the complexity involved in assessing drug-related

performance decrements related to drug use is the fact that drug-taking under

social (or nonwork) conditions has the potential to affect workplace

performance. Such effects are difficult to measure. We have little information

on such issues as possible “hangover” or “morning after” effects of the use of

illicit drugs. Several studies have suggested, for example, that marijuana use

may result in subtle behavioral changes the next day (Yesavage et al., 1985;

Chait et al., 1985), but these have not systematically evaluated the relevant

variables under the conditions in which people smoke marijuana.

A broad spectrum of stimulus conditions play a role in drug-taking and its

effects. This paper describes a small group residential laboratory that provides

an opportunity to evaluate this range of variables. Continuous long-term

residence permits control over extraneous influences unrelated to

experimental manipulations and allows for relatively precise description and

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control of stimulus conditions in effect at a given time. Experimental days

can be structured to approximate schedules outside the laboratory, and a

full range of performances can be recorded both automatically and by trained

research assistants using reliable observational techniques. Under these

circumstances, the effects of the drugs being self-administered, as well as the

pattern of self administration of these drugs, can be studied under conditions

closely approximating those in which drugs may be taken outside of the

laboratory.

THE PROGRAMMED ENVIRONMENT RESEARCH LABORATORY

The Programmed Environment is a residential laboratory designed for

continuous observation of human behavior over extended periods of time (see

Brady et al. 1974 for a complete description). The laboratory, diagrammed

in figure 1, consists of five rooms connected by a common corridor. The

three identical private rooms are similar to small efficiency apartments with

kitchen (stove, refrigerator, sink, microwave oven, and preparation area) and

bathroom facilities, a bed, desk, chair and other typical furnishings. The

social area is equipped with tables, chairs, sofa beds, storage cabinets, video

games, a monitor for viewing videotaped movies, and a complete kitchen

facility. The workshop provides additional social space and contains benches,

stools, storage cabinets, tools, exercise and recreation equipment, and a

clothing washer and dryer. A common bath serves all the social areas. Access

to the exterior of the laboratory is provided by a corridor which encircles the

environment between the residential chambers and the exterior building shell.

This permits transfer of supplies and materials through storage facilities

(drawers and cabinets) accessible from both sides of the residential walls.

Figure 1. Diagrammatic representation of the floor plan of the Programmed

Environment Research Laboratory and Its arrangement within the external

building shell.

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Thus, experimenters can introduce or remove supplies and material as

required. Access to supplies, activities or areas can be carefully controlled by

the experimenters. Each room of the laboratory has one door which remains

unlocked at all times in case of emergency or subject termination of

participation.

One subject resides in each of the three efficiency apartments. All have

access to the other areas at programmed times. Subjects remain within the

residential laboratory throughout the duration of the study, coming in contact

only with each other. An experimental control room, containing computers

and audiovisual equipment for monitoring, programming, recording and data

analysis, is linked by video display terminals to each of the private and social

rooms, allowing for communication between the experimenter and each

subject. Audio and video equipment in each room of the programmed

environment permits continuous monitoring of each subject’s activities during

the experiment. Subjects are under continuous observation from the control

room except for periods when they occupy the private space around the bed

and bathroom areas. A computerized observation program provides the

structure for continuous recording and categorization of each subject’s

behavior (Bernstein and Livingston, 1982).

Subjects are awakened at 9 a.m. Each is weighed, washes and dresses, and

receives a box containing a wide variety of snack and meal items which are

available through the day and evening. Each is given the opportunity to

prepare and eat breakfast. The experimental day generally begins at 10 a.m.,

and is divided into two equal parts: a 6 3/4-hour private work day, and a 6

3/4-hour social access evening period. Standardization of session lengths

facilitates experimental observation and data interpretation. Food and

beverages are available at any time during the course of the day and evening.

Between 10 a.m. and 4:45 p.m., the private work period, subjects are required

to remain in their private rooms and engage in one of four work tasks. These

have generally been: a computerized vigilance task, a computerized

digit-symbol substitution task, a colored disk sorting task, and a manual word

alphabetizing task. More recently, we have substituted two more automated

tasks, a learning task and a time estimation task, for the two manual tasks.

Subjects have the option of performing any of the four available tasks,

although they are required to perform one of them at all times other than

during a 30 minute break. Between 5 p.m. and 11:45 p.m., subjects can

remain in their rooms and engage in a variety of individual activities

including reading, writing, artwork, etc., or they can move to the social areas

where interactive group activities, videotaped movies, and games are available.

The experimental day ends at midnight with lights out. Structuring the day

and providing appropriate contingencies are important for keeping volunteers

in studies in which they are expected to maintain continuous residence in the

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laboratory for periods of several weeks. Although this is the general structure

of most studies, it is not difficult to change the structure to address specific

issues (e.g., change the order of the work and social access periods or

manipulate the amount of time apportioned for each of these, or change the

task requirements). We have also manipulated motivational factors by paying

money for specific behaviors or by requiring subjects to engage in low

probability behaviors in order to have access to high probability (and

presumably reinforcing) activities.

As part of the behavioral observation monitoring program, talking is scored

during social access periods. We are thus able to categorize social behavior

as coaction (two or more people present in the same room without any

speech) and interaction (two or more people present in the same room with

one or more of them speaking). Such analyses allow for a fine-grained

description of the effects of various drugs on social behavior, providing the

necessary information for the prediction of these effects in the natural

ecology.

Food intake is also monitored throughout the course of these studies.

Subjects send a message via the networked computer system whenever they

eat or drink anything. Time and amount of all food consumption is recorded.

These data are verified through observation. Previous research in this facility

has shown that food reporting does not disrupt eating patterns and gives

accurate information on pattern and amount of intake during the day (Foltin

et al., 1986). Such data provide information about additional aspects of a

specific drug’s effects, and can verify, in the absence of other generally

observable changes in behavior, that a biologically significant dose of the

drug has been administered.

Tobacco cigarette smokers are free to smoke cigarettes ad libitum during

these studies as long as they do so through the cigarette holders which are

provided (coded for each subject) through the laboratory. These holders

monitor each puff, and the data are automatically collected for later puff

analysis. Changes in patterning and/or number of tobacco cigarettes smoked

while under the influence of an experimentally administered substance

provide additional information about the effects of these compounds on

behavior.

DRUG ADMINISTRATION

Marijuana and amphetamine have been evaluated in the Programmed

Environment laboratory. One-gram marijuana cigarettes, provided by the

National Institute on Drug Abuse, were available in tetrahydrocannabinol

(THC) concentrations ranging from 0 percent (placebo) to 2.8 percent. Only

volunteers with histories of marijuana smoking were accepted for

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participation in the marijuana studies. In general, subjects were given the

opportunity to smoke either the placebo dose or the 2.8-percent dose, under

carefully controlled conditions, four or five times daily. Subjects took five

puffs per cigarette according to a uniform puff procedure signalled by a series

of colored lights. This procedure provides a 5-second warning signal followed

by a 5-second signal to inhale, a 10-second signal to hold the smoke in the

lungs and a 40-second signal to exhale and wait for the next puff. This

pattern of stimulus cues is repeated once a minute for a total of five

inhalations, and in most cases results in complete pyrolysis of the cigarette.

Utilization of the paced smoking procedure produces reliable changes in

heart rate and THC blood levels (Foltin et al., 1987).

An elixir containing lo-milligrams d-amphetamine, or the elixir alone

(placebo) was administered twice daily, at 9:20 a.m. and at 4:30 p.m. Both

daily doses were either active or placebo drug, and subjects were carefully

observed to insure consumption of the entire beverage.

EATING BEHAVIOR

Smoked active marijuana significantly increased total daily caloric intake by

an average of 40 percent above placebo levels in the six subjects whose data

are shown in figure 2 (Foltin et al., 1988).

For five of the six subjects participating in this study, the greatest change in

food intake occurred during the social period, and for four out of six,

differences in caloric intake under placebo and marijuana conditions were

evident on the first day of active drug administration. Active marijuana

significantly increased caloric intake from snack foods (foods requiring no

preparation), nearly doubling the number of snack occasions (figure 3; Foltin

et al., 1988). The main significant increase in snack food consumption was

the increase in intake of sweet solid items.

Unlike marijuana effects on performance (discussed below), these

marijuana-induced increases in food consumption were observed throughout

the day, independent of time of drug administration.

Administration of d-amphetamine, on the other hand, as might be predicted,

decreased food consumption to approximately 70 percent of placebo levels

as a consequence of a decrease in the number of eating occasions per day

across both snacks and meals (figure 4; Foltin et al., 1990b

).

There were significantly greater reductions in solid as compared with

beverage items. In contrast to active marijuana, amphetamine’s effects were

not related to snacks versus meals. The differential effects of marijuana and

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amphetamine on food intake verified the previously reported contrasting

effects of these two compounds (Foltin et al., 1986; Jasinski et al., 1974), and

provided evidence for the biological activity of the doses used.

PERFORMANCE EFFECTS

An example of a relatively easily measured performance is the automated

Digit Symbol Substitution Task (DSST, McLeod et al., 1982). This

computer-presented, perceptual motor task consists of nine random 3-row by

3-column patterns of asterisks and dashes (one asterisk/row) displayed across

the top of the screen. The patterns are labeled l-9 from left to right across

the screen, and the label is centered directly below each pattern. A randomly

generated number, between 1 and 9, is displayed in the center of the

monitor, indicating which of the nine patterns displayed at the top of the

Figure 2. Total daily caloric intake for three subjects in each of two

experiments (1 and 2) as a function of day of the experiment. Placebo

(PBO) and active marijuana (MJ) administration periods are indicated.

Reprinted with permission from Appetite 11:1-14, 1988.

Copyright by Academic Press Inc. (London) Ltd., London England.

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Figure 3. Mean daily caloric intake of six subjects from snacks and meals

during the private work period and social access period following placebo

(open bars) and active marijuana (hatched bars) administration. Error bars

indicate SEM.

Reprinted with permission from Appetite, 11:l-14, 1988.

Copyright by Academic Press, Inc. (London) Ltd., London, England.

Figure 4. Mean daily caloric intake from snacks and meals during the

private work period and social access period following placebo (open bars)

and amphetamine (hatched bars) administration. Error bars indicate SEM.

Reprinted with permission from Appetite 15:33-46, 1988.

Copyright by Academic Press Inc. (London) Ltd., London, England.

- 119 -
screen should be copied by the subject on a particular trial. During each

trial, subjects are required to press only the keys in a 3-row by 3-column

keypad that correspond to the positions of asterisks in the appropriately

labeled pattern. Three responses are required per trial (one response in each

row, corresponding to the single asterisk in each row), and a new randomly

generated number is displayed in the middle of the screen immediately after

each trial. Following completion of 2.5 trials, a new random pattern of dashes

and asterisks is displayed at the top of the screen. Subjects determine the

rate of DSST trial completion, and performance during successive 25 trial

sequences is monitored.

Subjects were given marijuana cigarettes to smoke at 9:45 a.m., 1:30 p.m.,

5:00 p.m., and 8:30 p.m. Cigarettes were smoked immediately before, and

midway through, both the private and social periods each day. They were all

either active (1.3, 2.3, or 2.8 percent 9

 THC) or all placebo. The effects of

smoked marijuana and DSST performance for a single, representative subject

are presented in figure 5.

As shown for this subject, changes in DSST performance were related to

time after smoking, with maximal effects occurring within the first hour.

During the 15-minute interval that immediately followed each placebo

marijuana smoking occasion, subjects completed an average of 25

three-response trials per minute and averaged 1 error every 50 trials. In

contrast, although overall rate did not change after active marijuana

administration, error rates were increased by an average of 40 percent.

SUCCESSIVE 15-MINUTE BINS

Figure 5. Effects of smoked active or placebo marijuana on error rate

during the three hours after smoking a single cigarette.

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DSST performance was also changed when 10 milligrams of d-amphetamine

were administered 30 minutes prior to the work period. Again, overall

response rate was unchanged with the active drug, but error rates were

significantly decreased. Drug effects were observed throughout the entire

work period. Under these circumstances, in which subjects are performing a

relatively boring task, amphetamine facilitated performance. Such effects have

been reported for both amphetamine (Laties and Weiss, 1981) and cocaine

(Fischman and Schuster, 1980).

THE MOTIVATIONAL EFFECTS OF MARIJUANA

Response hierarchies were determined for subjects during their private work

and social periods. This was accomplished by allowing them to choose their

activities freely during baseline periods, under conditions of active or placebo

marijuana. Time spent in each activity was recorded, and based on the

temporal relationships among the various activities, a hierarchy of response

probabilities was determined for each subject, separately for private and

social periods within both placebo and active marijuana conditions. Subjects

were then required to participate on the task with the lowest probability of

occurrence in order to obtain access to the activity with the highest

probability of occurrence, according to contingency procedures established by

Figure 6. Mean change from baseline time spent engaging in low probability

(instrumental) and high probability (contingent) activities under placebo

(open bars) and active marijuana (hatched bars) administration. Error bars

indicate SEM.

Reprinted with permission from the Journal of the Experimental Analysis of

Behavior 53:5-19, 1990. Copyright by Society for the Experimental Analysis

of Behavior Inc. and from Pharmacology, Biochemistry and Behavior 34:871-

877, 1989. Copyright by Pergamon Press, Inc.

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Premack (1965). This was carried out under active and placebo marijuana

conditions (Foltin et al., 1989; 1990a.

Introduction of a contingency requiring subjects to increase the amount of

time spent in a low probability work activity in order to earn time to engage

in a high probability work activity was effective in modifying patterns of work

behavior. During the private work periods, all subjects increased the amount

of time spent engaging in the low probability behavior, with significantly

smaller increases under active marijuana conditions. This difference between

active and placebo conditions, although consistent, was relatively small

(approximately 20 minutes per day). In contrast, however, smoked active

marijuana was associated with a markedly greater increase in the amount of

time spent performing high probability activities during contingency periods,

without a concomitant increase in performance of the available preferred

activity. That is, under active marijuana conditions during the social access

periods of the day, subjects increased their low probability behaviors

significantly more than under placebo conditions, thus earning more time to

engage in their preferred activities. They did not, however, utilize this time

(i.e., consume their reinforcer). This was true despite the fact that the drug

had no apparent effect on the time spent engaging in such high probability

activities under noncontingent baseline conditions or upon the increases in

low probability activity which occurred under contingent conditions. Thus, the

administration of active drug differentially altered the response to the

contingency arrangement under private and social conditions. This alteration

resulted in a suboptimal use of resources during the social periods of the

day. It is possible that this change in behavior may be comparable to the

behavior changes often referred to as an “amotivational syndrome” and may

provide a model for evaluating the change in responsivity to contingencies

anecdotally reported to occasionally occur in marijuana smokers. Importantly,

the data suggest that these possible “amotivational” effects are dependent on

the environmental conditions associated with marijuana smoking.

MARIJUANA SELF-ADMINISTRATION

Laboratory research on drug self-administration has often been criticized

because the conditions are not those most commonly in effect when the drug

is ingested under “natural” conditions. Marijuana, in particular, is frequently

smoked within a social context and the interaction of the marijuana smoker

with his or her extended environment must therefore be considered (Goode,

1969). Experimental studies under these more “natural” conditions, in which

an unrestricted flow of behavior occurs, might well yield results different

from those obtained in relative isolation (Fischman et al., 1988).

Drugs are self-administered under a variety of conditions and according to

a broad range of patterns. The behavioral contingencies in effect when the

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drug is available no doubt determine, to some extent, the amount and

patterning of the self-administration. It is also possible that, under

conditions where subjects are allowed to control the pattern of their drug

self-administration (i.e., frequency and timing), different effects will emerge.

For example, perhaps the drug will not be self-administered when productive

and efficient performance is required, but will be when no consequences are

attached to behavioral output.

Standard l-gram active (1.84 percent THC concentration) marijuana

cigarettes, provided by The National Institute on Drug Abuse, were smoked

in accordance with our experimenter-controlled uniform puff procedure.

Subjects were told that they could request and smoke a marijuana cigarette

at any time during the day, up to the maximum of 5 cigarettes. Cigarettes

could be smoked in the private rooms all day (9:45 a.m. - 11:45 p.m.), or in

the social room during the social access period (5 p.m. - 11:45 p.m.). The

study was divided into three 4-day periods, with no work contingencies in the

first and third periods and a work contingency present during the middle 4-

day period (day 5-8). The work contingency was similar to that described

above. Active marijuana cigarettes were available on the middle 2 days of

each period. Thus, marijuana could be smoked on days 2, 3, 6, 7, 10, and 11.

There was a work contingency in effect during days 6 and 7 of the marijuana

availability schedule.

Despite the fact that no clocks or other indicators of time were available,

subjects generally smoked the maximum number of cigarettes available, in a

regularly spaced pattern (Fischman et al., 1988).

With few exceptions, three cigarettes were smoked during the social access

period and two during the private period. Two of the subjects always smoked

their social period cigarettes in each other’s presence, and marijuana

availability and consumption was associated with substantial increases in time

spent in social interaction. Under conditions of no marijuana availability,

these subjects spent an average of 48 minutes (±4 minutes) interacting, while

during periods of marijuana availability these two subjects increased their

social interaction time to an average of 225 minutes (±5 minutes) or 3 3/4-

hours. The third subject smoked all marijuana cigarettes in his own room,

and rarely interacted with the other two subjects.

Testing of three subjects has been completed in another study currently in

progress in our laboratory. The order of daily exposure to the private and

social periods was manipulated such that the social period occurred between

5 p.m. and 11:30 p.m. or between 10 a.m. and 5 p.m. over 5-day intervals.

The private work period, during which subjects worked for points which

could be exchanged for money, rather than preferred activities, occurred in

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Figure 7. Marijuana cigarette self-administration as of function of time of

day over six days of active marijuana cigarette availability.

- 124 -
the alternate time period every day. Under these experimental conditions,

subjects consistently smoked a majority of marijuana cigarettes during the

social period, regardless of time of day. This behavior suggests that the

combination of a period of social access with no work requirements was

more likely to maintain marijuana self-administration than was a monetary

work contingency under conditions in which subjects were isolated from each

other.

These data indicate that when marijuana is made available under relatively

naturalistic living conditions, subjects will self-administer it in a regular and

stable pattern, with more drug intake during the social portion of the day.

When a behavioral contingency was introduced during this period, selfadministration of active marijuana was unchanged. No monetary contingency

was associated with this behavioral contingency. When a monetary

contingency was introduced, most of the marijuana was requested and smoked

during the social period, during which subjects were not paid for speed or

accuracy of performance.

SOCIAL BEHAVIOR

Marijuana’s specific effect on social behavior appears to be related to

situational factors. Under conditions in which subjects rarely engaged in

coactive (nonverbal) social behavior during placebo marijuana administration,

smoking active marijuana had no effect on this behavior, but did result in

significant increases in interactive behavior, (verbal behavior under social

conditions; Foltin et al., 1987). On the other hand, when subjects readily

engaged in coaction as well as interaction under placebo conditions, smoked

active marijuana had no effect on the total amount of time subjects spent in

the social area but did change the distribution of activity within the social

period by increasing coactive social behavior and decreasing interactive social

behavior (Foltin and Fischman, 1988). These latter data are consistent with

other reports of marijuana-related decreases in verbal responding (Babor et

al., 1978; Higgins and Stitzer, 1986), and suggest the importance of baseline

social conditions in the measurement of drug effects.

SUMMARY

The data presented point to the importance of studying drug effects under

conditions similar to those in which drugs are taken outside of the

laboratory. Interactions between the reinforcing and other direct effects of

these drugs, as well as their interactions with ongoing environmental events

can only be evaluated under such conditions. These data support the utility

of a residential research facility for the investigation of substance use and its

effects under conditions which approximate those in which people live

outside of the laboratory. This unique laboratory, designed for continuous

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observation of human behavior over extended periods of time, provides a

controlled environment with the flexibility for establishing a range of subject

behaviors, and the ability to simultaneously monitor a wide range of

individual and social behavior patterns. We can study regulation of drug

intake and its effects, both within a day and over days, assessing the effects

of experimental manipulations on the patterning of self-administration

behavior as well as the performance of a range of other behaviors as a

function of drug self-administration. The design of such studies is a logical

extension of basic preclinical research, as well as more traditional human

behavioral pharmacology research.

Although little data are yet available on drug-related “hangovers” or “morning

after” effects, it should be clear that this residential laboratory would provide

ideal experimental conditions for such research. We have shown that subjects

will exhibit stable patterns of drug self-administration which are sensitive to

systematic manipulation of variables. Therefore, we are in the position of

being able to evaluate longer term effects on performance of drug-taking

behavior as it occurs under conditions approximating the natural ecology.

The examples of data collected in the laboratory have demonstrated that drug

effects are not a unitary phenomenon, but instead depend on ongoing

behaviors as well as pharmacological variables such as drug and dose. If we

are going to evaluate drugs and the way in which they affect workplace

behavior, we must carry out our evaluation under conditions which

approximate those in which people might be using them, while at the same

time controlling extraneous variables and protecting the participants from

possible deleterious effects. We have shown that drugs, such as marijuana and

amphetamine, have divergent effects that are influenced by both situational

and behavioral factors. A thorough evaluation of the effects of any drug on

behavior is, therefore, dependent on the evaluation of the drug’s effects under

the conditions in which it is likely to be taken.

REFERENCES

Babor, T.F.; Mendelson, J.H.; Gallant, D.; and Kuehnle, J. Interpersonal

behavior in group discussion during marijuana intoxication.

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Bernstein, D., and Livingston, C. An interactive program for observation and

analysis of human behavior in a long-term continuous laboratory.

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programmed environment for the experimental analysis of social

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Evaluation and Applications, Vol. 7: Social Ecology. Milwaukee:

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marijuana intoxication: Impact of social set and pharmacological

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Chait, L.; Fischman, M.W.; and Schuster, C.R. “Hangover” effects the

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Fischman, M.W., and Schuster, C.R. Cocaine effects in sleep deprived

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contingencies and high-probability recreational activities.

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AUTHORS

Marian W. Fischman, Ph.D.

Professor

and

Thomas H. Kelly, Ph.D.

Assistant Professor

and

Richard W. Foltin, Ph.D.

Assistant Professor

Department of Psychiatry and Behavioral Sciences

Division of Behavioral Biology

The Johns Hopkins University School of Medicine

600 North Wolfe Street

Baltimore, MD 21205

- 128 -
Effects of Alcohol on Human Behavior: Implications for the

Workplace

Thomas H. Kelly, Ph.D., Richard W. Foltin, Ph.D., and

Marian W. Fischman, Ph.D.

The Johns Hopkins University School of Medicine

INTRODUCTION

Alcohol exerts a number of effects on human behavior, many of which have

important implications for workplace safety and productivity. One particularly

dramatic effect is on the behavior leading up to alcohol consumption. In

many contexts, alcohol functions as a potent reinforcer (Mello and

Mendelson, 1971; Griffiths et al., 1980); and contingencies associated with

alcohol consumption reliably engender chronic alcohol-seeking behavior in

a subset of those individuals who are exposed to alcohol. Although the

percentage who drink alcohol on a chronic basis is small (e.g., less than 15

percent of full-time employees drink daily), chronic alcohol consumption has

a pervasive economic and social influence on the economy (Miller, 1989;

Erfurt and Foote, 1989). For example, the measurable cost of alcoholism

and alcohol-related problems (i.e., accidents, lost productivity, and health

costs) were estimated to be approximately 90 billion dollars per year in the

United States in 1980. A substantial portion of these costs fall directly on

businesses. Chronic alcohol consumption clearly exerts a significant influence

on the workplace.

In full-time employed populations, occasional moderate alcohol use is more

prevalent than chronic alcohol consumption. In the United States, most

full-time employees have consumed alcohol at some time in their lives, and

approximately 70 percent continue to do so at least once per month (Voss,

1989), including, on occasion, before or while working (Bray et al., this

volume). While most of these individuals are not chronic alcohol consumers,

occasional consumption of substantial amounts of alcohol (e.g., more than

five drinks per episode) does occur in this population. Recent findings

suggest that residual or “hangover” effects can be observed after substantial

alcohol consumption even after blood alcohol levels (BAL’s) have returned

to zero in occasional, moderate drinkers (Myrsten et al., 1980, Yesavage and

Leirer, 1986; cf. Bowden et al., 1988; Collins and Chiles, 1980; Collins, 1980;

Dowd et al., 1973). As such, even if alcohol consumption in this population

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is restricted to personal time, when employees are not working (e.g.,

weekends), recent laboratory research suggests that workplace performance

may be affected. In addition, employees drink alcohol while working, and

such use, even at low levels, can influence performance. Therefore,

conceptualizations of the economic and social consequences of alcohol use

in the workplace must include considerations of chronic alcohol users, as well

as the effects of alcohol on the behavior of occasional, moderate, alcohol

consuming employees. This chapter will review laboratory studies of the

effects of alcohol on dimensions of human behavior that are relevant to

workplace performance.

LABORATORY PROCEDURES FOR MEASURING ALCOHOL’S EFFECTS

The influence of occasional, moderate alcohol use on workplace safety and

productivity can be assessed most accurately by directly measuring alcohol’s

effects in the workplace. However, the workplace is a complex cluster of

physical, social, and environmental factors in which a workforce is required

to maintain consistent productivity. A multitude of factors are involved in

determining the level of performance of any given employee. It is clear that

considerations of both individual and group performance at multiple levels

are required for a complete account of workplace performance. Given these

workplace complexities, monitoring the effects of alcohol directly is difficult.

It is also possible to assess alcohol’s effects in the workplace by measuring

alcohol’s effects on performance dimensions that are relevant to the

workplace in the more highly controlled conditions of the research

laboratory.

A substantial research effort has been devoted to measuring the effects of

alcohol on human behavior, and a number of techniques used for this

purpose have direct relevance to workplace performance. Largely as a result

of concerns over public safety, efforts have been aimed at assessing alcohol’s

effects on human performance, and procedures that have been developed for

this purpose include driving and flying simulators, as well as a range of

psychomotor task batteries, including various vigilance, tracking, digit-symbol

substitution, circular light, and reaction time tasks. In general, human

performance will be altered following alcohol administration, given that a

sufficiently large dose is delivered (Mitchell, 1985); the degree of impairment

produced by alcohol is generally related to the amount of alcohol that is

administered (Evans et al., 1974; Wallgren and Barry, 1970). While consistent

decrements in performance have reliably been observed when BAL’s are

above .10 g/dl (one commercial cocktail will increase BAL by approximately

.025 g/dl in a 150 pound man), decrements in some aspects of human

performance have occasionally been reported at BAL’s below .05 mg/dl

(Hamilton and Copeman, 1970; Moskowitz et al., 1985). Not all measures of

human performance are equally sensitive to the effects of alcohol (Heishman

et al., 1988). The sensitivity of any task can be altered by a number of

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contextual factors, including the nature of the contingencies maintaining task

performance (Bierness and Vogel-Sprott, 1984), whether BAL’s are increasing

or decreasing when the task is performed (Vogel-Sprott, 1979), and whether

the task is performed alone or simultaneously with other tasks (Moskowitz,

1979). Alcohol’s effects on human performance vary as a function of the

dimension of performance being measured and contextual factors associated

with the performance.

While performance is a critical dimension of workplace safety and

productivity, other dimensions of human behavior, such as social behavior,

are also relevant. For example, cooperation among employees, or between

employees and customers is essential for successfully adapting to the

complexities and challenges of the workplace. Dose-related increases in social

and verbal behavior have been reported following alcohol administration in

controlled settings (Griffiths et al., 1978; Higgins and Stitzer, 1988; Stitzer

et al., 1981), but it remains unclear whether these effects are beneficial or

detrimental to workplace productivity and safety. Disruptions of effective

social interaction, such as might occur with increased aggressive behavior,

have clear detrimental consequences. Few studies have examined the

dose-response relationship between alcohol and social behavior, and the

relevance of alcohol’s effects on social behavior for the workplace are less

clear than for performance measures. Since aggressive behavior has clear

implications for the workplace, experimental investigations of the

dose-response relationship between moderate alcohol consumption and

aggressive behavior will be examined in some detail.

EXPERIMENTAL ANALYSIS OF AGGRESSIVE BEHAVIOR

Aggressive behavior has been operationally defined by experimental

investigators as behavior that presents an aversive or noxious stimulus to

another individual (Buss, 1961). Three laboratory procedures have been

developed to investigate human aggressive behavior. The initial procedure,

developed by Buss (1961), was ostensibly concerned with the effects of

punishment on learning. Experimental subjects, cast as teachers, were asked

to provide positive and negative feedback to another subject, cast as a

“learner,” during performance on a discrimination learning task. “Teachers”

could illuminate signal lights following correct trials and deliver electric

shocks from an array of shock intensities following errors. Subjects were

informed that punishment enhanced “learner” performance in other studies.

In reality, the “learners” were experimental confederates whose performances

were predetermined. The selected shock intensities and the durations of

shock presentation served as objective measures of aggressive behavior. A

second procedure, developed by Taylor (1967), involved reaction time

competition trials. Two subjects were seated in front of reaction time

equipment with electrodes attached to their wrists. Sessions consisted of

signaled reaction time trials. Prior to each trial, both subjects selected shock

- 131 -
intensities to be delivered to the other subject; however, only the subject

responding less quickly on a trial received the shock. After each trial, both

subjects received feedback concerning the shock intensity selected by the

other subject prior to the trial. In reality, one subject was an experimental

confederate whose performance was predetermined. As with the Buss

procedure, the intensity of shock selected on any given trial served as an

objective measure of aggressive behavior. Both procedures have been used to

study aggressive behavior in a number of different subject populations and

to study the effects of a range of variables, including drugs, on human

aggressive behavior (Buss, 1961; Taylor and Leonard, 1983). In general,

research on the effects of alcohol on human aggressive behavior, using either

of these two procedures, has consistently reported increases in aggressive

responding following administration of sufficiently high doses of alcohol (Pihl,

1983; Taylor and Leonard, 1983; cf. Bennett et al., 1969). A third

free-operant procedure was developed by Cherek (1981) specifically to

investigate the effects of drugs on human aggressive behavior. The

free-operant laboratory procedure incorporated a number of techniques which

allowed for more precise and selective measurement of drug effects on

human aggressive behavior.

FREE-OPERANT METHODOLOGY

In the free-operant procedure, subjects were typically located in an isolated

room equipped with a counter, two buttons with corresponding signal lights,

and a thermistor. Immediately prior to sessions, the thermistor was attached

to a subject’s nondominant index finger, and skin temperature and heart rate

were ostensibly monitored. Sessions typically lasted fifty minutes. During

sessions, responding on the buttons produced different consequences.

Figure 1. Free-Operant Choice Contingencies

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Responding on one button earned points that were exchanged for money (10

cents per point) at the completion of a session. Points were displayed on the

counter. Responding on the second button ostensively subtracted points from

another research subject, depicted as participating in the same study at

another location. Patterns of responding on the second button (i.e.,

subtracting points, or money from another participant) served as the measure

of aggressive behavior.

The contingencies maintaining button pressing are displayed in figure 1. At

the start of a session, subjects were presented with the option to choose

between pushing a button to earn points, or pushing a button to subtract

points from the other subject. If the right “earn points” button was chosen,

the right signal light was illuminated. When the subject completed 100

responses on the right button, the counter increased by one and the right

signal light was turned off indicating that both buttons were again available.

If the left “subtract points” button was chosen, the left signal light was

illuminated. When the subject completed 10 responses on the left button, a

point was ostensibly subtracted from the other subject and the left signal

light was turned off, indicating that the choice condition was again available.

After a choice was made, and prior to completion of the response

requirement on the chosen button, responses on the unchosen button were

recorded, but had no programmed consequences.

Some provoking event is usually required to set the occasion for aggressive

behavior (Taylor, 1967). To increase the likelihood that subjects would

respond on the point-subtraction button, points previously earned by the

subject were subtracted from the counter, and these point subtractions were

attributed to the second subject. In reality, points were subtracted at random

times during each session. Most subjects responded on the point-subtraction

button immediately following occasional point subtractions during sessions,

and consistent patterns of point-subtraction responding across sessions usually

emerged over the first three to five sessions.

With this free-operant procedure, subjects had a point-maintained

nonaggressive response option and a topographically-similar aggressive

response option available throughout each session. The simultaneous

measurement of topographically-similar aggressive and nonaggressive

responding enabled the assessment of whether drugs had selective or

differential effects on aggressive and nonaggressive behavior.

A second advantage of this procedure is that aggressive responding is not

required during sessions, although the opportunity to do so is available at

any time. The use of free-operant procedures produce measures of behavior

that are more sensitive to drug effects than behavior generated during

experimental trials (Thompson and Boren, 1977). Free-operant laboratory

procedures better simulate the conditions of aggressive responding in the

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natural ecology. The effects of alcohol on aggressive behavior, as measured

by the free-operant procedure, will be examined below.

ALCOHOL ADMINISTRATION

Healthy adult male volunteers reporting occasional alcohol consumption gave

written consent and participated for 1.5 hours per day, Monday through

Friday, over six to eight weeks. Beverages, consisting of 16 ounces of ginger

ale and ice, with 2 drops of peppermint oil and 1 ml of 95 percent ethyl

alcohol floated on top, were administered at the start of the 1.5 hour

interval, if blood alcohol levels (BAL’s) were zero. Subjects were required to

consume the beverage over a 20-minute interval. Thirty minutes after the

beverage was administered, a fifty-minute session began. BAL’s were

measured immediately before and after each session.

Placebo cocktails were administered every session until stable aggressive and

nonaggressive responding was observed from session to session. Once stable

patterns were observed, alcohol doses between 0.12 g/kg and 0.75 g/kg were

occasionally added to the beverage. Placebo sessions always occurred between

successive alcohol sessions to insure that stable patterns of responding were

maintained throughout the study. Doses were initially administered in an

ascending sequence to increase the safety and comfort of subjects. The second

exposure to doses was in a descending fashion, and the final exposure was in

a random order.

RESULTS

The effects of alcohol on the aggressive responding of eight subjects is

presented in figure 2 (Cherek et al., 1985). The four subjects presented in the

top panel, labeled high provocation, were presented with 20 point

subtractions per session, on average, and the four subjects presented in the

bottom panel, labeled low provocation, were presented with five point

subtractions per session, on average. Statistically significant increases were

observed at the .23 and .46 doses (approximately one and two commercial

cocktails). No changes in point-maintained responding were observed at any

dose for these subjects. It is interesting to note the individual differences in

response to alcohol administration. Large increases were observed in two

subjects (S96, top panel, and S68, bottom panel), and little or no change was

observed in three subjects (S78 and S88, top panel, and S61, bottom panel).

Clearly, the effects of small amounts of alcohol (i.e., one to two commercial

cocktails) are sufficient to increase the probability with which humans engage

in aggressive responding. These amounts of alcohol produce blood alcohol

levels that are well within legal intoxication limits, and may be consumed by

employees who are working under the assumption that these amounts will

produce little or no change in job performance. However, to the extent that

- 134 -
aggressive social behavior influences workplace productivity, such assumptions

may need to be reconsidered.

Modifications of the free-operant procedure have been used to study the

influence of contextual factors on the relationship between alcohol and

human aggressive behavior. Additional studies have been conducted to

determine whether the effects of alcohol on aggressive behavior vary as a

function of the situational context in which alcohol is administered.

Figure 2. Aggressive Responding Following Alcohol Administration

Reprinted with permission from Journal of Studies on Alcohol, 46:321-328,

1985. Copyright by Alcohol Research Documentation, Inc., Rutgers Center

of Alcohol Studies, New Brunswick, NJ 08903.

- 135 -
EFFECTS OF PROVOCATION CONDITIONS

Table 1. Provocation Parameters

Component Intensity1

Frequent2Total3

1 0 0 0

2 1 3 3

3 3 1 3

4 1 6 6

5 3 2 6

1Mean number of point subtractions per provocation.

2Mean number of provocations per ten-minute interval.

3Mean number of point subtractions per ten-minute interval.

In one study, the effects of provocation on the relationship between alcohol

and aggressive responding were evaluated (Kelly et al., 1988). Four subjects

were exposed to five lo-minute components during a typical 50-minute

session. Within each lo-minute component, the schedule of point subtractions

was manipulated (table 1). During Component 1, no points were subtracted.

During both Component 2 and 3, an average of three points was subtracted.

During Component 2, one point was subtracted on three different occasions;

while during Component 3, three points were subtracted on one occasion.

During Components 4 an 5, six points were subtracted on average. During

Component 4, one point was subtracted on six different occasions; while

during Component 5, three points were subtracted on two different occasions.

As in the previous study, placebo cocktails were administered until stable

patterns of aggressive and nonaggressive responding were observed within

each component.

Figure 3 presents aggressive responding during Components 2, 3, 4 and 5.

Subjects rarely responded aggressively in the absence of point subtractions

during Component 1. The number of point subtractions varied across

Components 2 through 5, and aggressive behavior is presented as responses

per point subtraction. During placebo sessions, subjects responded fewer

times per point subtraction during Component 2 than during Components 3,

4 and 5. Aggressive responses per provocation increased as a function of

alcohol dose, up to 0.75 g/kg (approximately equivalent to the amount of

alcohol in three commercial cocktails). However, increases were observed in

Components 3, 4 and 5, only. No increases in aggressive responding were

observed during Components 1 or 2.

- 136 -
Figure 3. Effects of Alcohol on Human Aggressive Behavior Engendered By

Varying Point-Subtraction Conditions

Copied from Drug and Alcohol Dependence, 21:109 with permission from

Elsevier Science Publishers.

Figure 4. Effects of Alcohol on Human Point-Maintained Responding

Copied from Drug and Alcohol Dependence 21:110 with permission from

Elsevier Science Publishers.

- 137 -
These data suggest that increases in aggressive responding following alcohol

administration may be related to the level of provocation prior to alcohol

administration. Increases in aggressive responding following alcohol

administration may be more likely in situations in which provocation is

frequent or intense.

Figure 4 presents point-maintained response rates during each component as

a function of alcohol dose. Response rates were similar in each component,

indicating that provocation manipulations had no effect on nonaggressive

responding. Alcohol produced dose dependent decreases in point-maintained

responding, and this effect was observed in each component. Clearly,

alcohol’s effects on aggressive responding were different from those on

point-maintained responding. These results suggest that the

aggression-increasing effects of alcohol are not the result of a non-systematic,

rate-increasing effect.

EFFECTS OF CHANGES IN WORK REQUIREMENTS

In a third study, the effects of work requirements on the relationship between

alcohol and aggressive responding were examined by varying the number of

button presses required of subjects in order to earn points (Kelly et al.,

1989). Subjects were exposed to three different components during each

session. In this study, the schedule of point subtractions remained constant

across components, while the number of responses required for point

presentation were varied. During one component, 50 responses were required

per point presentation. During the other two components, 200 or 500

responses were required per point presentation. Components were presented

in random order twice per session, and each component was presented once

before any component occurred a second time.

Six subjects participated in the study. The aggressive responses per point

subtraction of each subject are presented in figure 5. Diamonds represent the

low-work components (50 responses per point), circles represent the medium

work components (200 responses per point), and squares represent the high

work components (500 responses per point). On placebo sessions, aggressive

responding was directly related to work requirements during components.

Low doses (.12 g/kg, .25 g/kg) had no effect on or decreased aggressive

responding by subjects. The high dose (5 g/kg) produced significant increases

in aggressive responding, and a significant interaction between alcohol dose

and work requirements was observed. In four subjects, substantial increases

in aggressive responding were observed during the high work-requirement

component (500 responses per point). The effects were less dramatic in the

lower work-requirement components. Two subjects (V-79 and V-114)

exhibited no change in aggressive responding as a function of alcohol dose.

- 138 -
Figure 5. Effects of Alcohol on Human Aggressive Behavior During Three

Concurrent Schedules of Point Presentation

Reprinted with permission from Journal of Studies on Alcohol, 50:399-405,

1989. Copyright by Alcohol Research Documentation, Inc., Rutgers. Center

of Alcohol Studies, New Brunswick, NJ 08903.

- 139 -
Table 2. Breath Alcohol Levels (g/dl) Measured Immediately Before and

After Experimental Sessions

Subject Dose(g/kg) Before After

.125 .00 .00

V-79 .250 .30 .10

.500 .80 .40

.125 .10 .00

V-82 .250 .30 .10

.500 .70 .50

.125 .00 .00

V-83 .250 .10 .00

.500 .40 .20

.125 .00 .00

V-84 .250 .30 .10

.500 .70 .50

.125 .10 .00

V-114 .250 .40 .20

.500 1.10 .70

.125 .20 .00

V-120 .250 .70 .l0

.500 .80 .50

The individual subject differences did not appear to be related to blood

alcohol levels. Table 2 presents blood alcohol levels prior to and following

alcohol sessions. Subject V-114, who showed little change in aggressive

responding following alcohol administration, exhibited the greatest increases

in blood alcohol levels, and the blood alcohol levels of the other

non-responder (V-79) were not different from the other four subjects.

These data suggest that increases in aggressive responding following alcohol

administration may also be related to ongoing work requirements prior to

alcohol administration. Alcohol may produce greater than usual effects on

aggressive responding when work requirements, or the amount of effort

required from employees, are temporarily increased.

- 140 -
The effects of alcohol on point-maintained responding are presented in figure

6. Again, no changes or dose-related decreases in point-maintained

responding were observed, indicating that alcohol’s effects on aggressive

behavior are not related to any general systemic effects.

These results clearly indicate that alcohol consumption alters the probability

with which humans engage in aggressive behavior, and that alcohol’s effects

on aggressive behavior are influenced by the environmental context in which

Figure 6. Effects of Alcohol on Human Responding Maintained During

Three Fixed-Ratio Schedules of Point Presentation

Reprinted with permission from Journal of Studies on Alcohol, 50:399-405,

1989. Copyright by Alcohol Research Documentation, Inc., Rutgers Center

of Alcohol Studies, New Brunswick, NJ 08903.

- 141 -
alcohol is administered. The specific dimensions of the environmental context

that are related to these differential results remain speculative, but

provocation conditions and work requirements may be two factors that are

involved. Additional research is required to clarify the status of these

variables. The results also indicate that individual subjects exhibit variability

in response to alcohol. This result has been observed in studies of alcohol’s

effects on measures of performance, as well. Several factors, including

experience with alcohol, tolerance, and biological differences across

individuals, contribute to inter-subject variability in response to a given dose

of alcohol.

As with task performance measures, the effects of alcohol on human social

behavior are dependent on the dimension of social behavior being monitored,

as well as on the contextual factors under which the alcohol is administered.

These results indicate that moderate alcohol consumption can influence the

workplace by disrupting worker performance and by altering social behavior.

Given that the effects of alcohol are related to both the dimensions of

behavior being monitored, as well as the contextual factors under which

alcohol is administered, descriptions of the potential influence of alcohol in

any specific workplace site must take into account the work requirements

and contextual factors present at a given work site.

CONCLUSION

Chronic alcohol consumption exerts a dramatic economic and social influence

on the workplace. Less well described, but also important, is the influence

of occasional, moderate alcohol consumption on workplace safety and

productivity. Occasional, moderate alcohol consumption is substantially more

prevalent in full-time employees than is heavy, chronic use (i.e., more than

5 drinks per day). Moderate alcohol users, on occasion, consume alcohol on

the job, and recent evidence suggests that intermittent heavy alcohol use by

moderate alcohol consumers may result in changes in performance even after

BAL’s have returned to zero (i.e., “hangover” effects). As such, moderate

alcohol use may influence workplace performance. Laboratory studies clearly

indicate that the amount of alcohol in even a single commercial cocktail

affects performance and social behaviors that are relevant to workplace

performance. As such, descriptions of the effects of alcohol in the workplace

must include considerations of occasional, moderate alcohol use by

employees. Contextual factors are also important in determining alcohol’s

effects on human behavior, and other drugs, such as marijuana and

amphetamine (Fischman et al., this volume), as well. It is clear that a

comprehensive account of the effects of drugs in the workplace would benefit

from investigations of alcohol and other drug effects on dimensions of human

behavior that are relevant to workplace safety and performance, conducted

in controlled laboratories that can simulate workplace environmental contexts.

- 142 -
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ACKNOWLEDGEMENTS

The authors thank Lisa King and Michelle Woodland for their assistance.

Preparation of the manuscript was supported by grant AA-07302 from the

National Institute on Alcohol Abuse and Alcoholism.

AUTHORS

Thomas H. Kelly, Ph.D.

Assistant Professor

Richard W. Foltin, Ph.D.

Assistant Professor

and

Marian W. Fischman, Ph.D.

Professor

Division of Behavioral Biology

Department of Psychiatry and Behavioral Sciences

The Johns Hopkins University School of Medicine

600 N. Wolfe Street

Houck Bldg. 2 East

Baltimore, Maryland 21205

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Impact of Moderate Alcohol Consumption on Business Decision

Making

Sarah M. Jobs, Ph.D.

David Dunning & Company

Fred E. Fiedler, Ph.D.

University of Washington

Chad T. Lewis, M.Ed., M.B.A.

Everett Community College

INTRODUCTION

This study investigates the effect of moderate alcohol consumption on

learning and the execution of a business decision making task. Decision

making was evaluated within the framework of Steele and Southwick’s

inhibitory response conflict model. Subjects were randomly assigned to one

of four cells of a balanced placebo design: they expected and received

alcohol, they expected alcohol but received tonic, they expected tonic but

received alcohol, or they expected and received tonic. Within these

conditions, subjects were trained to participate in a business decision making

simulation and then to make three successive pricing and ordering decisions.

Subjects who consumed a moderate amount of alcohol scored significantly

poorer on a short test of recall. Moderate alcohol consumption combined

with high inhibitory response conflict (IRC) led to extreme changes in

decisions made. Significant expectancy effects were also found. Theoretical

and practical implications of these findings are discussed.

Social drinking is considered an acceptable part of the business environment.

Business lunches are often accompanied by a cocktail, a glass of wine or a

beer. After-hours meetings or dinners often begin with libations to facilitate

conversation and to ease the tensions of the day. Alcohol is known to

promote affability, even back-slapping friendliness (Pernanen, 1976).

Not only has social drinking been regarded as acceptable, it is generally

regarded as facilitative rather than as detrimental to subsequent business

decisions and actions of social drinkers. Yet, alcohol has been found to

impair one’s ability to: (1) foresee the negative consequences of a response,

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(2) access inhibiting standards of conduct, and (3) perceive peripheral

inhibiting cues (Pernanen, 1976; Zeicher and Pihl, 1979; Hull et al., 1983).

These impairments could, conceivably, compromise decision making in a

business setting, mitigating perceived benefits of alcohol consumption.

Many effects of alcohol in the workplace are still not known. Although

extensive documentation shows that alcohol impairs perceptual-cognitive

functioning (Kastl, 1969; Tarter et al., 1971) and the ability to derive

meaning from incoming information (Birnbaum et al., 1980), the literature

is silent concerning effects of social drinking on managerial effectiveness.

Available studies deal mainly with the etiology of alcoholism in professionals.

This study tests the effects of moderate alcohol consumption--consumption

which approximates that of the one or two-martini lunch--on subjects’ ability

to recall newly learned information pertaining to a typical set of business

decisions, and on subjects’ actual performance in a simulated business setting.

MODERATE ALCOHOL CONSUMPTION AND RECALL: HYPOTHESIS 1

Alcohol consumption reduces individual ability to perform cognitive tasks.

Subjects experience reduced problem solving ability, (Marlatt and Rohsenow,

1980, Parsons and Leber, 1982; Parker, 1982; Parsons and Fabian, 1982),

reduced ability to encode a large number of situational cues (Washburne,

1956), and reduced ability to use several cues simultaneously (Moskowitz and

De Pry, 1968; Medina, 1970).

Managerial decision making relies directly on such cognitive skills as the

ability to conceptualize, abstract, make judgement calls, remember details,

and to discriminate important from irrelevant information (Katz and Kahn,

1977; Stogdill, 1974; Mann, 1965). Conceivably, the consumption of a

moderate amount of alcohol, as one might drink during a business lunch or

cocktail party with prospective clients, might impair individual ability to recall

newly learned information which could adversely affect subsequent business

decisions. The pharmacological effect of alcohol which compromises simple

recall suggests that:

Hypothesis 1--Subjects who consume a moderate amount of alcohol

will be less able to recall details of newly presented information

pertaining to business decision tasks than will subjects who do not

consume alcohol.

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MODERATE ALCOHOL CONSUMPTION AND INHIBITORY RESPONSE

CONFLICT (IRC): HYPOTHESES 2 AND 3

Sober subjects who are provoked tend to use inhibitory cues and

contingencies to regulate and moderate behavior, whereas intoxicated subjects

tend to plunge ahead with more aggressive behavior regardless of inhibitory

cues (Zeichner and Pihl, 1979; Zeichner and Pihl, 1980, Pihl et al., 1981).

Intoxicated subjects have difficulty processing information pertinent to the

consequences of behavior (Zeichner and Pihl, 1979). Hull, Levenson, Young

and Sher (1983) reported that alcohol reduces self-awareness--an impairment

which contributes to weakening of inhibitions, and leads to more aggressive,

socially unacceptable behavior.

The relaxation of inhibitions as a result of alcohol consumption can have a

profound effect upon behavior when an individual is experiencing inhibitory

response conflict (IRC). The term “inhibitory response conflict” was coined

to define the simultaneous arousal of incompatible response tendencies

(Steele and Southwick, 1985). IRC describes a condition where a response

tendency instigated by one set of cues (internal or external) is opposed by a

tendency to inhibit the response because of other cues (also internal or

external).

An example of appropriately inhibited behavior, when experiencing the effect

of high IRC, can be seen in the decision of a gambler to quit after a

predetermined limit of losses has been reached; the decision of an obese

person on a diet to refrain from eating a banana split; and the decision to

not engage in fisticuffs with a bully twice one’s size. However, under the

influence of alcohol, the drinker experiencing high IRC is unable to process

appropriate inhibitory cues: the gambler keeps gambling (despite his/her

limit); the dieter eats the banana split (despite the need to reduce caloric

intake); and the individual being antagonized takes on the bully despite being

half the antagonist’s size.

Like the gambler who decides to keep gambling in the face of inhibitory cues

to quit, the business decision maker experiencing high IRC may proceed with

high risk decisions while under the influence of alcohol despite inhibitory

cues which suggest the need to proceed cautiously (e.g., past experience

suggesting that attempts to increase sales by 50 percent in one month will

probably result in further losses). High IRC in a business setting occurs

when a business decision maker is faced with instigatory pressures such as the

need to recoup business losses or to correct poor past decisions and is also

faced with strong inhibitory cues, such as the need to avoid further losses

because of hasty or unwise decisions. Under such circumstances, moderate

alcohol consumption could impede the drinker’s capacity to retrieve and to

use appropriate inhibitory cues, leading to higher risk decision making.

- 149 -
It has been suggested that moderate alcohol consumption together with a high

IRC condition are required to cause riskier decision making (Steele and

Southwick, 1985; and Steele et al., 1985). Under a low IRC condition, the

effect of alcohol on inhibitions is not an issue. When inhibitory cues are not

pushed by equally strong instigatory pressures, or if the decision maker does

not feel instigatory pressures at all, decisions tend to be less risky.

We believe that once high IRC conditions are established in a competitive,

simulated business setting that:

Hypothesis 2--High IRC subjects who expect and consume a

moderate amount of alcohol will make riskier business decisions than

will high IRC subjects who expect and consume only tonic.

Hypothesis 3--High IRC subjects who expect and consume a

moderate amount of alcohol will make riskier business decisions than

will low IRC subjects who expect and consume a moderate amount

of alcohol.

EXPECTANCY EFFECT AND MODERATE ALCOIIOL CONSUMPTION:

HYPOTHESES 4 AND 5

Drinking expectancies--belief that one is consuming alcohol independent of

actual consumption--may also lead to risky decision making under a high IRC

condition. The belief that one is consuming alcohol (regardless of actual

consumption) may play a role in reducing inhibitions that affect business

decision making. Steele and Southwick (1985) found that expectancy was

unrelated to IRC. This finding suggests that it is the pharmacological effect

of alcohol, rather than the belief that one is drinking alcohol, which reduces

inhibition. An extension of this perspective posits that the pharmacological

properties of alcohol have more of an effect upon decision making than does

the social setting in which alcohol is imbibed. Consequently we hypothesize

that:

Hypothesis 4--Subjects experiencing high IRC who expect and

consume a moderate amount of alcohol will make riskier decisions,

than will high IRC subjects who expect alcohol but instead consume

tonic.

Hypothesis 5--Subjects experiencing high IRC who expect and

consume tonic will make less risky decisions, than will high IRC

subjects who expect tonic but instead consume alcohol.

- 150 -
METHODS

Subjects

Forty males and 40 females participated in the study. Subjects were drawn

from the psychology department subject pool and from respondents to

advertisements placed in the University newspaper. Subject pool respondents

received credit for a 2.5 hour experiment; other respondents were paid five

dollars for their participation.

One day before the experiment, potential subjects completed a biographical

information questionnaire, the Drinking Habits Questionnaire (Calahan et al.,

1969), and the Michigan Alcohol Screening Test in order to check for signs

of alcohol dependency. Subjects were told not to eat or drink for four hours

prior to the scheduled experiment.

Participation was limited to light to moderate drinkers above the age of 21

who reported no signs of alcohol dependency. Participating men were

somewhat younger than the women (males, x = 22.7; women, x = 25.9, F

= 7.45, 1.79 d.f., p .01). All subjects reported for the experiment as

scheduled.

On arrival at the lab, subjects were weighed, their picture identification

checked, and an initial breathalyzer reading taken to insure they had not

been drinking alcohol. All subjects signed an informed consent form which

described the nature of the experiment and possible risks. Females were

asked to verify that they were not pregnant, and all subjects were required

to verify that they had no pre-existing conditions that would precipitate a

negative reaction to alcohol.

Design

Marlatt and Rohsenow’s (1980) balanced placebo design was used in this

study. Subjects were assigned to same-sex foursomes in which each subject

represented a different experimental group. Assignments to experimental

conditions were made by coin toss. Subjects were informed that one side of

the table was randomly assigned to receive alcohol, and the other side a

non-alcohol beverage (tonic). In fact, in each foursome, expectancy (expect

alcohol; expect tonic) was crossed with actual beverage consumed (get

alcohol; get tonic). One subject expected alcohol, but got only tonic (EAGT);

one subject expected, and got alcohol (EAGA); one subject expected only

tonic, but got alcohol (ETGA); and one subject expected and got tonic

(ETGT).

- 151 -
Drink Administration-- Subjects in EAGA and ETGA conditions received 1.88

milliliters of 80-proof vodka per kilogram of body weight--an amount of

alcohol sufficient to bring subject blood alcohol levels (BAL) to .06. This

BAL is below the level legally defined as intoxicated in the state of

Washington (BAL of .10), and is equivalent to alcohol consumption typical

in a social setting, where one or two drinks would be consumed.

Drinks were mixed according to Marlatt and Rohsenow’s procedure (1980).

Vodka bottles were prefilled either with a pre-mixed vodka and tonic mixture

(1:5 vodka to tonic), or with flat tonic. The two vodka bottles (one

containing vodka and tonic and one containing tonic), and tonic bottles

(some containing vodka and tonic, others carbonated tonic) were brought to

the experiment room in a tub filled with ice. To facilitate deception, an

assistant mixed beverages in full view of subjects.

Subjects were required to consume beverages within 14 minutes; empty

glasses were removed immediately thereafter. Fifteen minutes later, BAL

readings were taken, recorded, and reported to subjects. Subjects who were

being deceived were provided with false readings appropriate to their

condition.

Experimental Tasks

Subjects sat two across a large conference table. At each place were pencils,

blank paper, calculators, and a sheet with information pertaining to the

decision task.

While consuming beverages, subjects received training on how to make

pricing and ordering decisions for “fancy donuts” sold by their donut store

(from The Donut Franchise: A Microcomputer Simulation published by

McGraw-Hill, Lewis and Lewis). Each subject was assigned to one of four

competing donut stores. Training sessions were conducted by one of the

authors of the simulation. Subjects were encouraged to make optimum

pricing and ordering decisions in order to maximize profits, and were

informed that “missed sales” and “excess inventory” were indicators of poor

past decisions which reduced profits. Subjects were also cautioned to make

conservative decisions because radical decision making could accelerate losses.

Immediately following training (which coincided with taking of BALs),

subjects were asked to turn their notes over and to take a short 10-item quiz

(within ten minutes) over material presented during training. As soon as

quizzes were collected, subjects were given 15 minutes to make pricing and

ordering decisions for “fancy donuts” for the first decision period. Subjects

were not allowed to speak to each other while making their decisions or

during any other part of the experiment.

- 152 -
After decision forms for the first decision period were collected, subjects

rated the decisions just made on the basis of the amount of risk they felt

they had taken with regard to the prices charged and quantity of doughnuts

ordered (overall risk), and the extent to which the competitive nature of the

task contributed to making of risky decisions. They then engaged in a filler

task. New management reports were generated after computer processing for

the next round of pricing and ordering decisions. (Management reports

included a simple income statement for the month showing sales, expenses

and profits, and a report of “missed sales” and “excess inventory.“)

Subjects then made pricing and ordering decisions for the second and third

decision periods, each time rating perceived risk of decisions at the

conclusion of each decision period.

Experimental trials concluded with the administration of a post-test

questionnaire. Subjects were then given a final, accurate BAL reading and

were fully debriefed. Two subjects were given rides home because their BALs

still exceeded .05.

Establishing IRC--Experimental conditions created IRC in some subjects, but

not in others. “Missed sales” and “excess inventory” are independent. Subjects

could not incur both conditions at the same time; therefore, a median was

calculated for each distribution, and high IRC was defined as occurring when

subjects’ missed sales or excess inventory exceeded the respective median of

either distribution, and low IRC when the total of missed sales or excess

inventory was below the respective median.

Subjects above the median of either distribution were under instigatory

pressure to improve performance during future decision periods (they had

been trained to recognize either situation as problematic and requiring

change). At the same time, they were also subject to inhibitory pressure

because of cautions received during training.

Analyses

Our primary analysis was a 2 X 2 X 2 factorial analysis of variance

comparing two levels of actual beverage consumption (alcohol, tonic); two

levels of expectancy (expect alcohol, expect tonic); and two levels of IRC

(high, low). IRC was not part of the predictor for Hypothesis 1 (concerning

recall) and, therefore, was not included as a factor in the testing of this

hypothesis.

Unweighted means analyses (Horst and Edwards, 1982) were conducted

because of unequal cell sizes which occurred because two groups (one group

of men and one of women) failed to complete the third decision trial. These

- 153 -
analyses were conducted on the dependent measures quiz scores (for

Hypothesis 1); and absolute changes in pricing strategy between decision

periods 1 and 2 (price change 1); between decision periods 2 and 3 (price

change 2); and the absolute change in quantity of product ordered between

decision periods 1 and 2 (quantity change 1); and between decision periods

2 and 3 (quantity change 2).

RESULTS

Manipulation Check of Deception

An analysis of the post-test questionnaire items indicated that all deceptions

were not wholly successful. Subjects who actually consumed alcohol reported

feeling higher levels of intoxication than did those who actually consumed

only tonic (F = 18.38, 1, 76 d.f., p .001).

Scale averages and standard deviations by group are shown in table 1. The

scale ranged from 1 (very sober) to 7 (very intoxicated).

Table 1. Reported Levels of Intoxication Immediately After the Experiment.

Group n

EAGA 20

EAGT 20

ETGA 20

ETGT 20

mean SD

2.50 1.63

1.55 .998

3.15 1.56

1.45 1.15

Another question concerned whether or not subjects felt deception had

occurred (simple yes or no format). A significant F value indicated that the

groups differed in their perception of whether or not deception had occurred

(F = 3.0, 1,76 d.f., p .035, see table 2). However, subjects were also asked to

report which beverage they had consumed. Interestingly, subjects reported

that they had actually consumed the beverage they had been assigned (F =

33.49, d.f. 1, 76, p .001, table 3).

- 154 -
Table 2. Respondent Beliefs That Deception Was (1) or Was Not (0) Used

During the Experiment.

Group n mean SD

EAGA 20 .316 .48

EAGT 20 .263 .45

ETGA 20 .684 .48

ETGT 20 .368 .50

Table 3. Scale Averages and Standard Deviations Indicating What Beverage

Subjects Said That They Consumed. Responses Coded 0 (Tonic Only) or 1

(Vodka and Tonic).

Group

EAGA

EAGT

ETGA

ETGT

n mean SD

20 .894 .32

20 .944 .24

20 .300 .47

20 .053 .23

To summarize, the ETGA group may have been less “fooled” by the

deception relative to other groups. The length of the experiment (two and

one half hours) may have made it difficult to maintain the deception. Over

time, ETGA subjects may have become aware of their mild intoxication.

However, it is not clear how this awareness influenced performance: the

second manipulation check indicated that subjects appeared to be deceived

because they tended to report consuming the beverage they were assigned

(table 3).

Manipulation Check Of IRC

Responses of those categorized in high versus low IRC groups were

compared on the decision risk-assessment measures (subjects’ perceived risk

and competitiveness) in order to check validity of assignments to high and

low IRC conditions. A Student’s t-test determined that the average rating of

overall risk (“I felt that my decision was...” extremely conservative (coded 1);

- 155 -
extremely risky (coded 9)) was significantly higher after the first decision

period for high IRC subjects than for low IRC subjects (t = -2.73, 78 d.f.,

p .01).

After the second decision period, the assessment of overall risk was not

significantly different between low and high IRC subjects. However, on a

scale which assessed risk due to the competitive nature of the task, decisions

of high IRC subjects were more extreme than those of low IRC subjects (t

= -2.2, 73 d.f., p .05). The second scale stated “The competitive nature of

this task caused me to be . . . than I would be under normal circumstances.”

Responses ranged from “much more conservative”> (coded 1) to “much more

risky” (coded 7).

Other researchers (Steele et al., 1985) tested manipulation of instigatory

pressures, but not inhibitory pressures as we did, using only one manipulation

check. This study used two manipulation checks and repeated these measures

over time. Although after the third decision period, ratings were no longer

significantly different between high or low IRC subjects, the nature of

perceived risk did change in a meaningful way during experimental trials;

there was a significant difference between low and high IRC subjects on the

manipulation check measures.

Test of Hypothesis 1

The first hypothesis predicted that moderate alcohol consumption would

interfere with recall of newly learned information pertaining to a set of

business decisions. The results of a 2 X 2 factorial analysis of variance which

crossed actual alcohol consumption with two levels of expectancy showed a

significant main effect for actual beverage (F = 23.51, d.f. 1, 76, p .00l, table

4). Means and standard deviations of quiz scores show that subjects who

consumed a moderate amount of alcohol were significantly impaired (table

5).

- 156 -
Table 4. Analysis of Quiz Scores Comparing Expected Beverage Conditions,

Actual Beverage Conditions, and the Interaction of Expectancy X Actual

Bevemge Assignment.

Source SS DF MS F

Total 3354.05 79

Expectancy .80 1 .80 NS

Actual beverage 51.20 1 51.20 23.511

Interaction .2244 1 .224

Error 164.51 76 2.165

Table 5. Average Quiz Scores and Standard Deviations by Group.

Group n mean SD

EAGA 20 5.70 2.40

EAGT 20 7.45 1.35

ETGA 20 5.65 1.31

ETGT 20 7.10 1.62

Results of 2 X 2 X 2 Factorial Analysis of Variance

Hypotheses 2, 3, 4, and 5 were tested using a 2 X 2 X 2 factorial analysis of

variance with contrasts as indicated. Two levels of expectancy (expect alcohol,

expect tonic), two levels of actual beverage consumption (consume alcohol,

consume tonic), and two levels of IRC (high, low) were analyzed across four

dependent measures and yielded significant results. Tables 6 through 9

summarize results of these analyses.

The analyses based on Price Change 1 yielded significant Fs for the main

effects of IRC (F = 13.09, d.f. 1, 64, p .00l); expectancy (F = 5.25, d.f. 1, 64,

p .025); and for the interaction between IRC and expectancy (F = 4.436, d.f.

1, 64, p .039). Price Change 2 yielded a main effect for IRC (F = 8.08, d.f.

1, 64 p .006).

- 157 -
Table 6. Results of Factorial Analysis of Variance Comparing Two Levels of

Expectancy (Alcohol, Tonic), Two Levels of Actual Beverage Consumption

(Alcohol, Tonic), and Two Levels of IRC (Low, High) on the Dependent

Measure, Price Change 1 (Change in Price from the First to Second Decision

Period).

Source Sum of Squares DF Mean Sauare F

Total 16.978 79

IRC 2.496 1

Actual Beverage .012 1

Expected Beverage 1.001 1

IRC x Actual .07 1

IRC x Expectancy .846 1

Actual x Expectancy .006 1

IRC x Actual x Expectancy .244 1

Residual 12.207 72

2.496 13.091

.012 .065

1.001 5.2482

.07 .366

.8464 .436

.006 .856

.244 .262

.1695

1

p.01 2

p.05

The analyses of Quantity Change 1 and Quantity Change 2 also yielded

significant Fs for IRC (F = 7.45, d.f. 1, 64, p .01; F = 5.012 d.f. 1, 64, p .03)

as tables 6 through 9 show.

Table 7. Results of Factorial Analysis of Variance Comparing Two Levels of

Expectancy (Alcohol, Tonic), Two Levels of Actual Beverage Consumption

(Alcohol, Tonic), and Two Levels of IRC (Low, High) on the Dependent

Measure, Price Change 2 (Change in Price From the Second to Third

Decision Period),

Source Sum of Squares DF Mean Sauare F

Total 21.614 71

IRC 2.248 1

Actual Beverage .470 1

Expected Beverage .344 1

IRC x Actual .366 1

IRC x Expectancy .234 1

Actual x Expectancy .056 1

IRC x Actual x Expectancy .055 1

Residual 17.816 64

2.248 8.077l

.470 .198

.344 .271

.366 1.313

.234 .840

.056 .201

.005 .889

.278

1

p.01

- 158 -
Table 8. Results of Factorial Analysis of Variance Comparing Two Levels of

Expectancy (Alcohol, Tonic), Two Levels of Actual Beverage Consumption

(Alcohol, Tonic), and Two Levels of IRC (Low, High) on Quantity Change

1 (Change in Quantity of Product Ordered From the First to Second

Decision Period).

Source Sum of Squares DF Mean Square F

Total 1120051.5 79

IRC 112453.45 1

Actual Beverage 2655.86 1

Expected Beverage 7089.66 1

IRC x Actual 2760.146 1

IRC x Expectancy 6555.235 1

Actual x Expectancy 9503.136 1

IRC x Actual x Expectancy 12177.391 1

Residual 965463.05 72

112453.45 7.45l

2655.86 .176

7089.66 .495

2760.146 .670

6555.235 .512

9503.136 .430

12177.391 .372

13409.21

1

p.01

Table 9. Results of Factorial Analysis of Variance Comparing Two Levels of

Expectancy (Alcohol, Tonic), Two Levels of Actual Beverage Consumption

(Alcohol, Tonic), and Two Levels of IRC (Low, High) on Quantity Change

2 (Change in Quantity of Product Ordered From the Second to the Third

Decision Period).

Source Sum of Squares DF Mean Square F

Total 842443.605 71

IRC 57471.409 1

Actual Beverage 12553.942 1

Expected Beverage 1706.936 1

IRC x Actual 17794.834 1

IRC x Expectancy 2397.873 1

Actual x Expectancy 5287.137 1

IRC x Actual x Expectancy 10595.489 1

Residual 733863.196 64

57471.409 5.0121

12553.942 1.095

1706.936 .149

17794.834 1.552

2397.873 .209

5287.137 .461

10595.489 .924

11466.612

1

p.05

- 159 -
Test of Hypothesis 2

Hypothesis 2 predicted that high IRC subjects who expected and consumed

a moderate amount of alcohol would make riskier decisions than would high

IRC subjects who expected and consumed only tonic. Planned comparisons

conducted on each of the dependent measures confirmed the hypothesis for

change in pricing strategies but not for change in quantities ordered.

The planned comparison for Price Change 1 was significant (t = 2.52, d.f. 1,

72, p .02), as was the planned comparison for Price Change 2 (t = 2.22, d.f.

1, 72, p .03).

Test of Hypothesis 3

Hypothesis 3 predicted that high IRC subjects who expected and consumed

a moderate amount of alcohol would make riskier decisions than would low

IRC subjects who expected and consumed alcohol. Again, planned

comparisons confirmed that change in pricing strategies supported the

hypothesis (t = 2.65, d.f. 1, 71, p .01 for Price Change 1; t = 2.31, d.f. 1, 71,

p .02 for Price Change 2). Changes in quantity of product ordered failed to

reach significance for either set of decision periods.

Test of Hypothesis 4

Steele and Southwick (1985) found that IRC was unrelated to expectancy.

Alcohol’s effects were found by these researchers to be due to pharmacology,

rather than to expectation. Consequently, hypothesis 4 predicted significant

differences in pricing decisions between high IRC subjects who expected and

consumed a moderate amount of alcohol, and high IRC subjects who

expected alcohol but actually received only tonic. This hypothesis was not

supported by any of the planned comparisons. The means of dependent

measures for the two groups shows that high IRC subjects who expected

alcohol but received tonic made decisions as risky as those of their

moderately intoxicated counterparts.

Test of Hypothesis 5

Again, attempting to demonstrate that IRC is unrelated to expectancy as

reported by Steele and Southwick (1985), hypothesis 5 predicted that subjects

who expect tonic, but instead consume a moderate amount of alcohol would,

under high IRC, make riskier decisions than would subjects who experience

high IRC but expect and consume only tonic. This result was confirmed for

one dependent measure only--Quantity Change 2. The result was only

marginally significant (t = 1.96, d.f. 1, 71, p =.054).

- 160 -
DISCUSSION

This study is the first of its kind to test the effects of moderate alcohol

consumption on business decisions. As with many “firsts” we are left with

many questions and also with several notable results.

The effect of moderate alcohol consumption on recall was an important

finding. Subjects’ BALs were relatively low ranging from .04 to .075 during

peak intoxication. Yet, even these low BALs were sufficient to impair recall

of newly learned material pertaining to a business decision task

The literature documents the cognitive degradation alcohol causes, and

demonstrates that the effects of alcohol on cognitive ability persist even after

the subject is no longer intoxicated (Parker, 1982; Parsons and Fabian, 1982;

Parsons and Leber, 1982). The tests used by Parsons and associates were

designed to detect very subtle cognitive degradations. The present study

employed a much grosser measure of recall. On both counts, findings suggest

that even moderate alcohol consumption compromises recall--possibly over

an extended time. Depending on the importance or complexity of information

one needs to learn during a business lunch or after-hours meeting, consuming

alcohol during the occasion is not advisable according to results reported

here and elsewhere (Parson and Leber, 1982).

Hypotheses 2 and 3 were confirmed, supporting Steele and Southwick’s

(1985) meta-analysis results which indicated that moderate alcohol

consumption combined with high IRC contributes to risky (i.e., highly

changeable) decision making. High IRC subjects (EAGA) who consumed a

moderate amount of alcohol tended to make riskier pricing decisions over

time, than did high IRC subjects who did not consume alcohol (ETGT), and

low IRC subjects (EAGA) who did consume alcohol. The only exceptions to

this finding were subjects in the expect alcohol, receive tonic (EAGT)

condition who were profoundly influenced by an expectancy effect.

Tests of Hypotheses 2 and 3 suggest that the one- or two-martini lunch, or

the occasional drink from a bottle in the desk drawer, interferes with decision

making primarily when decision makers are experiencing high IRC. Ironically,

having a drink to relax before or during difficult deliberations caused by poor

past decisions could significantly contribute to making future risky decisions.

In this regard, it is important to emphasize that the present study examined

effects of appropriate social drinking upon business decision making.

A question of concern is why the change in price yielded significant results

when changes in quantity ordered, for the most part, did not. One reason

may be that changing price is a more salient and familiar cue with which

moderately intoxicated subjects could relate. (The management report

- 161 -
displayed competitor prices, but not the quantity ordered). Consequently,

changing an order measured in dozens of donuts may have seemed more

abstract, more difficult, or less important for intoxicated subjects to

comprehend. The t values of Quantity Change contrasts for Hypotheses 2 and

3 did approach significance (probability levels ranged from .058 to .09).

The results of this study deviated from Steele and Southwick’s model when

expectancy effects were tested. Subjects in the expect alcohol but get tonic

condition (EAGT) were well deceived by the experimental manipulation and

made decisions as risky as those of their moderately intoxicated counterparts.

Though inconsistent with Steele and Southwick, this finding is consistent with

results reported by Marlatt and Rohsenow (1980) and confirms their

contention that the environment in which one drinks provides cues which

facilitate an “alcohol effect” independent of actual consumption. The setting

in which business decision makers consume alcohol (e.g., a “free-wheeling,”

after hours cocktail party), to the extent it contributes to expectancy effects

associated with consuming alcohol, may have a bearing on decision making

independent of pharmacological effects. Further testing will tell.

A weakness of this study is the relatively small sample size. Although 10

subjects per cell is considered adequate for the tests of significance used here,

the variability of the measures and random nature of our IRC measure is

problematic and would be improved by increasing sample size and by

manipulating IRC.

Also, it is conceivable that the face-to-face competitive environment subjects

experienced in this study affected results. Steele, Critchlow, and Liu (1985)

ran subjects individually. Subjects in the present study were run in foursomes

with the experimenter and/or assistant in the room at all times. Although

subjects were not allowed to speak, move about the room, or communicate

with each other in writing, the group atmosphere of the present study may

have provided nonverbal cues which affected subsequent decision-making

behaviors. Further testing and comparison of settings is necessary to

determine the generalizability of the IRC model to individuals’ behaviors in

nominal groups versus in relative isolation.

The greatest value of this study probably lies in its demonstration that Steele

and Southwick’s model, as it pertains to IRC, can help researchers and

practitioners to better understand conditions in which alcohol consumption

could be a threat to effective decision making. More work needs to be done

to better isolate, quantify, and qualify measures of IRC. For example, a

replication of the present study in which the computer algorithm gives false

feedback regarding decision effectiveness and, thus, truly manipulates IRC

would contribute to a better understanding of this construct.

- 162 -
The effects of alcohol on managerial decision making in the workplace is an

important area for future study. Whether determining the effect of alcohol

on cognitive functioning, or its effect on disinhibition when individuals

experience high IRC, the potential for understanding and improving

workplace effectiveness can only be aided by better understanding alcohol’s

potent but subtle effects.

ACKNOWLEDGMENTS

The authors are indebted to Cheryl Clark who assisted with this study. The

contributions of Professors Alan Marlatt, Claude Steele and Allen Edwards

are also greatly appreciated.

This study was funded by a grant from the Alcohol and Drug Abuse Institute,

University of Washington, Herman R. Samson, Director, Fred E. Fiedler,

principal investigator.

This study was presented by the first author by invitation at the 97th Annual

Convention of the American Psychological Association, Divisions 28, 14, &

38, August 11-15, 1989, New Orleans, LA, and at the NIDA conference,

“Drugs in the Workplace: Research and Evaluation Data,” September 25-27,

1989, Bethesda, MD.

REFERENCES

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elaborative schemes for sentences. Journal of Experimental Psychology:

Human Learning and Memory 6:293-300, 1980.

Calahan, D.; Cissin, I.H.; and Crossley, H.M. American Drinking Practices: A

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Center of Alcohol Studies, 1969.

Horst, P., and Edwards, A.L. Analysis of nonorthogonal designs: The 2k

factorial experiment. Psychological Bulletin 91(1):190-192, 1982.

Hull, J.G.; Leven, R.W.; Young, R.D.; and Sher, K.J. The self-awareness

reducing effects of alcohol consumption. Journal of Personality and

Social Pathology 44:1097-1109, 1983.

Kastl, A.J. Changes in ego functioning under alcohol. Quarterly Journal of

Studies on Alcohol 30:371, 1969.

Katz, D., and Kahn, R. The Social Psychology of Organizations. New York:

Wiley & Sons, 1978.

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Lewis, P., and Lewis, C.T. The Donut Franchise: A Microcomputer Simulation.

McGraw-Hill, 1984.

Mann, EC. Toward an understanding of the leadership role in formal

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Marlatt, G.A., and Rohsenow, D.J. Cognitive processes in alcohol use:

Expectancy and the balanced placebo design. Advances in Substance

Abuse 1:159-199, 1980.

Medina, E.L. The role of the alcoholic in accidents and violence. In: Popham,

R.E., ed. Alcohol and Alcoholism. Toronto: University of Toronto

Press, 1970.

Moskowitz, H., and De Pry, D. Differential effects of alcohol on auditory

vigilance and divided attention task. Quarterly Journal of Studies on

Alcohol 1968. pp. 19-54.

Parker, E. Comments on “Cognitive functioning in men social drinkers; A

replication study.” Journal of Studies on Alcohol 43(1):170-172, 1982.

Parsons, O.A., and Fabian, M.S. Comments on cognitive functioning in men

social drinkers. Journal of Studies on Alcohol 43(1):178-182, 1982.

Parsons, O.A. and Leber, W.R. Alcohol, cognitive dysfunction, and brain

damage. In: National Institute on Alcohol Abuse and Alcoholism,

Biomedical Processes and Consequences of Alcohol Abuse. Alcohol

and Health monograph No.2 DHHS Pub. No. (ADM)82-1191.

Washington D.C., U.S. Government Printing Office, 1982. pp.

213-225.

Pernanen, K. Alcohol and crimes of violence. In: Kissen, R. and Begleiter,

H., eds. The Biology of Alcoholism, Vol. 4: Social Aspects of

Alcoholism. New York: Plenum, 1976. pp. 351-444.

Pihl, R.O.; Zeichner, A; Niaura, R.; Nagy, K.; and Zacchia, C. Attribution

and alcohol-mediated aggression. Journal of Abnormal Psychology

90:468-475. 1981.

Steele, C.M.; Critchlow, B.; and Liu, T.J. Alcohol and social behavior II: The

helpful drunkard. Journal of Personality and Social Psychology

48(1):35-46, 1985.

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Steele, C.M., and Southwick, L. Alcohol and social behavior I: The

psychology of drunken excess. Journal of Personality and Social

Psychology 48(1):18-34, 1985.

Stogdill, R.M. Handbook of Leadership. New York: Free Press, 1974.

Tarter, R.E.; Jones, B.M.; Simpson, C.D.; and Vega, A Effects of task

complexity and practice on performance during acute alcohol

intoxication. Perceptual and Motor Skills 37:307, 1971.

Washburne, C. Alcohol, self, and the group. Quarterly Journal of Studies of

Alcohol 17:108-120. 1956.

Zeichner, A, and Pihl, R.O. Effects of alcohol and behavior contingencies

on human aggression. Journal of Abnormal Psychology 88:153-160,

1979.

Zeichner, A, and Pihl, R.O. Effects of alcohol and instigator intent on

human aggression. Journal of Studies on Alcohol 41:256-276, 1980.

AUTHORS

Sarah M. Jobs, Ph.D.

Consultant

David Dunning & Company

Corporate Leadership Consultants

1420 Fifth Avenue

Suite 2400

Seattle, Washington 98101

Fred E. Fiedler, Ph.D.

Professor of Psychology

University of Washington

Department of Psychology

NI-25

Seattle, Washington 98195

Chad T. Lewis, M.Ed., M.B.A.

Faculty, Business and Social Services

Everett Community College

801 Wetmore

Everett, Washington 98201

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Application of Human Laboratory Data for the

Assessment of Performance in Workplace Settings:

Practical and Theoretical Considerations

Stephen J. Heishman, Ph.D. and Jack E. Henningfield, Ph.D.

Addiction Research Center, National Institute on Drug Abuse

INTRODUCTION

Basic researchers have known for a long time that psychoactive drugs alter

a person’s mood as well as their ability to perform various tasks. Because of

increasing trends in drug use and abuse throughout society over the past

decade, employers have become concerned about drugs in the workplace and

the potential for onsite drug-related accidents and impaired job performance.

Only recently have researchers and employers begun to discuss together the

issue of drug effects on performance. The purpose of this chapter is to

further that dialogue by presenting some thoughts on what laboratory studies

can offer employers or companies interested in workplace performance

testing. The discussion will be centered around the following questions:

Why should we test for drug effects on performance?

What is performance?

What aspects of performance should be tested?

How do drugs affect performance?

How do we test drug effects on performance?

Who is affected by psychoactive drugs?

When should we test for drug effects on performance?

Where do we test for drug effects on performance?

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DISCUSSION

Why Should We Test for Drug Effects on Performance?

The reasons for testing for drug effects on performance can be divided into

two categories: basic and applied research issues. Central to an understanding

of drug abuse and its treatment is a complete knowledge of the behavioral

mechanisms underlying a drug’s effect. This basic question has been the focus

of research by behavioral pharmacologists for many decades. We know that

a drug’s actions are fully manifested only when an organism is interacting

with its environment, which involves antecedent stimuli and consequences for

all behaviors. This theoretical notion is particularly relevant when attempting

to test for drug-induced performance changes in a workplace setting. Other

information that basic research can provide are the time course of a drug’s

effect, including acute and residual effects, and a complete profile of drug

action, including physiological, subjective, and performance effects.

Physiological, biochemical, or subjective correlates of drug-induced

impairment can provide important predictive information in the absence of

direct performance effects. Laboratory studies can also compare effect profiles

across drugs to assess differences and similarities in terms of performance

effects. For example, alcohol may severely disrupt performance of a task that

marijuana only slightly affects. Finally, laboratory research can effectively

examine mechanisms underlying drug interactions, which are critically needed

in this era of polydrug abuse.

The overall applied research goal is the development of an onsite

performance assessment battery that could be used to screen for drug effects.

One of the primary considerations in this effort is matching the performance

battery to the actual work demands of the job. Because of the wide range of

skills within and across jobs, this matching task is complex, yet critical for a

meaningful assessment battery. Other practical concerns, which will be

discussed later, involve whether the assessment battery is valid, reliable,

sensitive, or practical to implement. Broader applied issues involve the loss

of job effectiveness due to drug use, drug-related accidents on the job, and

the heavy toll in human lives that results from public and private

transportation accidents each year. These issues are undoubtedly in the minds

of basic researchers as they develop laboratory models of performance skills;

however, we need input from employers and institutes tracking these

real-world issues in order to effectively incorporate them into assessment

batteries.

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What Is Performance?

Given that it is important to test for drug effects on performance (for many

different reasons), the question of what do we test becomes critical. In

various situations and times, performance has been defined in terms of

physical strength, sensory or perceptual ability, motor ability, psychomotor

skills, ability to learn a new task, memory, or decision making skills.

Obviously, none of these definitions alone fully encompass human

performance, yet they all cannot be included in a single assessment battery.

Thus, it becomes necessary to select one or two aspects of performance that

most closely models the particular onsite work requirement. Again, the

importance of matching the performance assessment battery to the workplace

becomes evident.

What Aspects of Performance Should Be Tested?

To accomplish this matching of the assessment battery to the workplace

requires knowing what aspect of performance various tests measure or are

thought to measure. Table 1 presents the aspects of performance listed in the

previous section and some laboratory tasks commonly used to measure these

components.

Table 1. Components of Human Performance and Specific Laboratory Tests

Performance Component Laboratory Test

Physical strength

Sensory/perceptual ability

Grip strength

Critical flicker fusion

Auditory threshold

Stimulus detection

Motor ability

Psychomotor skill

Balance, Finger Tapping

Circular lights

Digit-symbol substitution

Pursuit tracking

Learning

Memory

Decision making

Repeated acquisition

Matching to sample

Digit Span

Delayed Recognition

Logical reasoning

- 169 -
Obviously, this is not an exhaustive list, but it does indicate that there are

a number of laboratory models for assessing different aspects of human

performance.

Related to the question of selecting the appropriate laboratory task are the

issues of validity, reliability, sensitivity, practicality, and generality of the test.

These issues can be universally applied to all measurement instruments and,

if satisfied, provide the basis for a useful assessment tool. Laboratory tests

designed to measure the presence or absence of drug in urine or other bodily

fluids are also faced with similar issues. Validity, in its broadest definition,

refers to whether the test is measuring what it is intended to measure. For

example, we can be fairly confident that critical flicker fusion is a valid

measure of visual acuity, whereas a logical reasoning task may not be a

completely valid measure of decision making ability.

A test is reliable if it produces consistent results over time. Thus, an

unimpaired person should score about the same during repeated practice

trials of a reliable test. A useful test must be sensitive enough to detect a

drug effect, if one is present, and to show varying degrees of an effect, such

as a dose-response function. On the other hand, a test that is too sensitive,

yielding an effect when an insignificant amount of drug has been ingested,

will be useless in meaningfully predicting impairment.

A test should also be designed so that it can be administered in a practical

manner, whether in the laboratory or the workplace. A practical onsite test

should be easily administered (computer or paper and pencil), of relatively

short duration, involve simple, straightforward instructions, and require

minimal practice for optimal performance. Finally, the results of a useful

laboratory test should generalize to the performance demands of the

workplace. Here, again, the issue of matching the performance assessment

with the components of the actual work requirement is a central concern.

How Do Drugs Affect Performance?

Psychoactive drugs affect behavior or performance either directly through the

central nervous system or indirectly through their interaction with other

behavioral systems or the environment. Ultimately, all drug-induced

performance impairment is mediated through brain mechanisms. The cerebral

cortex is composed of three major functional areas: sensory cortex, motor

cortex, and association cortex. Thus, we conveniently categorize direct drug

effects on performance in terms of impairment of sensory, motor, or

associative (cognitive) abilities. No drug affects only one of these cortical

areas, which implies that a complete understanding of a drug’s effect requires

the use of several tests, assessing various aspects of performance.

- 170 -
Indirectly, drugs can impair performance through at least three mechanisms.

First, drugs may reduce a person’s motivation to perform well. Because drugs

can function as reinforcers, a drug may increase the relative reinforcing effect

of an alternative behavior (e.g., talking with a co-worker or daydreaming),

and thus task performance declines. Secondly, drugs can function as

discriminative stimuli, which serve to signal the person to behave in a certain

way. Thus, drugs can set the occasion for inappropriate behavior, which

results in impaired job performance. Thirdly, drug-induced impairment of

performance can be interpreted in terms of state-dependent learning. This

concept states that performance of a task learned under one set of

environmental conditions can be altered by testing performance in a different

setting. Thus, drugs can indirectly impair performance by altering the

environmental stimuli under which the task was originally learned.

How Do We Test Drug Effects on Performance?

Essentially, there are two ways to test for drug effects on performance: (1)

administer the drug, either acutely or chronically, or (2) deprive a person of

a drug on which they are dependent and observe either short-term or

long-term abstinence responses. The vast majority of human performance

studies have involved acute drug administration, usually testing multiple drug

doses. Typically, such studies have followed the time course of drug effects

for several hours or until responses have returned to baseline levels. Few

studies have investigated the effects of prolonged or chronic administration

of drugs on performance. Additionally, few human studies have focused on

the more subtle impairing effects of drug abstinence, which probably are

more frequently encountered in the workplace than instances of obvious drug

intoxication. Most studies concerned with the effects of drug deprivation have

focused on effects over several hours, rather than long-term abstinence

effects, although many abstinence effects are known to be protracted in

nature.

A final comment regarding testing for drug effects is that assessment batteries

should not be confined to performance tasks. Rather, a complete drug effect

profile should be the goal. This can be accomplished by constructing

assessment batteries that include a wide range of measures, including

subjective, physiological, biochemical, and performance, which provide

potential correlates of drug-induced performance decrements.

Who Is Affected By Psychoactive Drugs?

Obviously, everyone can be affected by psychoactive drugs; however, not

everyone is affected similarly. One factor that greatly determines the nature

and extent of a drug’s effect is whether the person is physically dependent on

- 171 -
or tolerant to the drug. In terms of the two approaches to assess drug effects

discussed in the previous section, physically dependent and/or tolerant

persons would exhibit a relatively small drug effect in an acute drug

administration paradigm, but would show a profound response in a drug

deprivation study. The opposite would be true of a nondependent,

nontolerant individual. Individuals with medical needs would also be expected

to respond differently to a drug. For example, the person self-administering

morphine for the relief of clinical pain would probably experience the drug

effects differently than the person injecting morphine for its euphoric effects.

Finally, a person’s age may influence their response to a drug. Most human

studies involve adults in the age range of 21-45. Thus, we have little

information about drug effects in infants, teenagers, and the elderly, all of

whom may be more or less sensitive to drugs than healthy, middle-aged

adults. That drug use generally begins in the early teen years, and the

disproportionate number of drug-related car accidents among teenagers and

young adults, suggest that this age group may be especially sensitive to the

effects of drugs. The tragic problems of infant addiction and multiple

prescription drug use among the elderly are just now beginning to be

investigated fully.

When Should We Test for Drug Effects on Performance?

This question has implications for both laboratory and workplace testing

situations. By charting the complete time course of a drug’s effect in the

laboratory, we can determine the time to maximal effect and when effects

have dissipated (are no longer measurable). It is also possible to measure any

residual drug effects by testing several hours or days after drug

administration. By simultaneously taking blood samples, the important

relationship between plasma levels of the drug and performance impairment

can be determined. All of this information is potentially important for onsite

testing purposes. The lack of any drug-related performance impairment may

simply be a function of the pharmacokinetics and/or metabolism of the drug.

These are practical considerations for onsite testing; however, there are

broader issues regarding when to test for drug effects on performance in the

workplace. These concern when in a person’s course of involvement with a

drug should performance assessment be instituted. Should everyone be tested

every day? Should performance testing be started after an initial consultation

with the EAP officer, after a job-related accident occurs, after the employee

returns to work following a detoxification treatment period? These are

complex issues that should be seriously considered by all onsite testing

programs.

- 172 -
Where Do We Test for Drug Effects on Performance?

The three arenas in which performance testing could be conducted are the

laboratory, field settings, and the workplace. The ideal progression from

laboratory to onsite assessment allows for basic research questions and issues

such as test validity, reliability, and sensitivity to be dealt with initially. As

assessment becomes more applied in the field setting and workplace, more

complex, real-world variables and situations can be examined. In the

controlled laboratory, computer models of performance and simulators (e.g.,

driving or flight), which more closely approximate the real world, can be used

to assess basic questions, such as mechanisms of drug action, time course of

effect, and drug interactions. Field testing, such as a driving course, adds a

dimension of reality not available in the laboratory, and, as such, constitutes

an important intermediate step prior to onsite testing. Performance

assessment in the workplace is the most applied testing situation and few

such programs currently exist. Ideally, all assessments of performance should

be evaluated according to such a testing progression; however, this rarely

occurs.

CONCLUSIONS

What Information Do Labomtory Studies Have To Offer Onsite Performance

Assessment Efforts?

First, because of the controlled environment in which laboratory research is

conducted, issues of test validity, reliability, and sensitivity can be readily

assessed. More research explicitly examining these testing concepts is needed

to insure that research findings concerning drug-induced performance

impairment are useful and meaningful. Secondly, laboratory studies need to

begin to investigate more carefully the effect of contingencies on task

performance. Currently, we can only assume that weak contingencies will

produce erratic performance, whereas strong contingencies may render an

assessment battery insensitive to drug effects. Finally, laboratory research can

provide information concerning the profile of a drug’s effect, including

physiological, biochemical, subjective, as well as performance assessment and

begin to compare effect profiles across various drugs of abuse. Additionally,

laboratory studies of drug effects are well equipped to investigate interactions

with other drugs or with environmental stimuli (e.g., various stressors), which

more closely model the ways in which drugs are used in the real world.

- 173 -
AUTHORS

Stephen J. Heishman, Ph.D.

Staff Fellow

and

Jack E. Henningfield, Ph.D

Chief, Clinical Pharmacology Branch

Addiction Research Center

National Institute on Drug Abuse

P.O. Box 5180

Baltimore, Maryland 21224

- 174 -
Drug Free Workplace Program Research

Survey of Employer Anti-Drug Programs

Howard Hayghe

Bureau of Labor Statistics

INTRODUCTION

Drug abuse affects our society at many levels--from the urban ghetto, to the

suburban high school, to the workplace. In the workplace, it may influence

attendance, productivity, product quality, and worker safety and morale.

Relatively little information is available on a nationwide basis regarding the

extent of private-sector efforts dealing with drug abuse in the office, factory,

or store. Although a number of privately financed surveys have been

conducted, they focused on relatively small segments of the private sector,

with samples drawn from selective populations which are not representative

of employers as a whole.1

Recognizing the need for comprehensive, scientifically collected information

on the anti-drug efforts in private industry, the Congress, in the Drug Abuse

Act of 1986 (Public Law 99-570), directed the Secretary of Labor to conduct

research into employers’ anti-drug abuse efforts. As a consequence, in the

summer of 1988, the Bureau of Labor Statistics undertook the Survey of

Employer Anti-drug Programs. The objective of the survey was to produce

estimates of the number of private nonagricultural establishments with drug

testing or employee assistance programs by employment size class, major

industry division, and multi-state geographic region. A sample of some 7,500

establishments was selected from the Bureau’s Unemployment Insurance

Address File, supplemented with the Federal Railroad Administrations’s list

of railroad establishments.

Establishments, rather than companies, were the unit of measurement for this

survey. An establishment is defined as an economic unit, usually at a single

location, that produces goods or services. Although a single establishment can

be a company, they are not necessarily equivalent, because companies or

firms often consist of several establishments or workplaces.

The survey was conducted in two phases. First, a survey form was mailed to

each sample unit to determine whether it had a drug-testing or employee

assistance program. From the information gathered, estimates were developed

- 177 -
measuring the prevalence of these programs on a national basis. In the

second phase, establishments identified in the first phase as having

drug-testing programs were asked, among other questions, how many

employees and applicants they tested over the previous year and how many

of that group were identified as having used drugs. Also, those employers

identified as having employee assistance programs or similar benefits were

asked to indicate what features those programs had. Establishments not

responding to these questionnaires, as well as those whose responses required

clarification or more information, were recontacted by computer-assisted

telephone interviewing.

Information on the survey definitions, estimation procedures, survey

operations, and measures of sampling variability used appear in the

explanatory notes.

INCIDENCE OF ANTI-DRUG PROGRAMS

Employer efforts to prevent or reduce the incidence of drug abuse among

employees fall into two basic categories--detection and treatment.2 Detection

of drug use is intended to identify employees with drug problems and also

to identify drug users who are seeking employment. Employer-sponsored

treatment for employees with drug problems frequently takes place through

an employee assistance program. Employee participation in these programs

may be either voluntary or a condition of continued employment with the

firm.

The survey results show clearly that the most important factor with regard

to the incidence of these programs was establishment size--the number of

employees in an establishment. The larger the establishment, the more likely

it was to have drug-testing or employee assistance program. Differences in

the incidence of such programs by industry were much less, and there was

very little difference in the incidence of such programs among geographic

regions.

Size of Establishment

The larger the establishment, the more likely it was to have a drug-testing

or employee assistance program. Thus, for example, 43 percent of the

Nation’s largest establishments--those with 1,000 employees or more--had

drug-testing programs, versus only about 2 percent of the smallest

establishments--those with fewer than 50 workers. The incidence of employee

assistance programs showed a comparable pattern--76 versus 9 percent.

Because these small workplaces comprise the overwhelming majority of the

Nations’s establishments--over 90 percent--only 3 percent of establishments

overall had drug-testing programs, and 7 percent had employee assistance

- 178 -
programs. The small establishments, on the other hand, employ only about

35 percent of all workers. Hence, proportionately more employees worked in

establishments that have testing and assistance programs--about 20 and 31

percent, respectively (table 1).

The fact that a worker is in an establishment that has a drug-testing program

does not mean that he or she will be tested for drug use, however. The

information collected showed marked variation in testing practices. Some

establishments only test applicants; others focus on particular occupations or

suspected substance abuse; still others carry out random testing. For these

reasons, relatively few employees were actually tested for drug use (see

section on test results).

Several factors may underlie the lack of drug-testing or employee assistance

programs among smaller establishments. One is that the owners or managers

of small establishments may have a better opportunity to observe and interact

with their employees on the job--and thus be in a position to observe

possible signs of drug use--than managers in large establishments. Also, the

cost of testing or assistance programs may be prohibitive for a small

establishment. In addition, the pool of workers from which small employers

hire may include friends, relatives, or other members of their community with

whom they are familiar.

Industry

Establishments in mining (including oil and gas extraction), communications

and public utilities, and transportation were the most likely to have testing

programs, partly because of regulatory requirements? Establishments least

likely to have testing programs included those in the retail trade, services,

and construction industries (table 2). Establishments in these industries

tended to be small--76 percent of both construction and services

establishments had fewer than 10 employees, as did 67 percent of retail trade

firms--and they typically experience high worker turnover which would tend

to increase testing expenses.

Region

Geographic region by itself appeared to have relatively little effect on the

proportions of establishments with drug-testing or employee assistance

programs (table 3). For instance, the proportion with testing programs ranged

from 2 percent in the Northeast to around 4 percent in the South and

Midwest. Overall, the incidence of establishments with assistance programs

was somewhat higher in the Midwest than in other regions. When examined

by size of firm, however, there were few, and typically very small, regional

differences.

- 179 -
Table 1. Presence of a drug-testing or an employee assistance program by size of establishment: Private

NOTE: The indivdual categories will sum to more than 100 percent

because many establishments had more than 1 program of policy.
Table 2. Presence of a drug-testing or an employee assistance program by industry: Private nonagricultural establishments

and employees, summer 1988
Table 3. Presence of a drug-testing or an employee assistance program by Census region and existence of State

agricultural establishments and employees, summer 1988
While some regulatory policies require testing in certain industries, several

States have passed legislation restricting drug testing. As of the end of 1987,

these States were: Connecticut, Iowa, Minnesota, Montana, Rhode Island,

Utah and Vermont. Generally, the legislation limits employers with regard

to who can be tested and requires employers as well as laboratories to follow

a testing protocol designed to minimize the chance of error. About 1 percent

of establishments in the States with legislation regulating testing had

drug-testing programs, compared with 3 percent in States without such

legislation. In contrast, a larger proportion of establishments in legislating

States used employee assistance programs to prevent drug use--12 percent,

compared with 6 percent in the nonlegislating States. However, there were

fewer differences in this proportion by firm size than was the case for

establishments with drug-testing programs.

Written Policy

Another facet of employers’ anti-drug efforts is the existence of formal,

written policies regarding drug use by employees. (A formal policy can also

cover other aspects of employee conduct such as alcohol use, dress, etc.) Like

testing and assistance programs, firm size was an important factor in

determining the frequency with which such statements occurred. For instance,

about 6 percent of those with fewer than 10 employees had formal policies,

compared with 83 percent of those with 5,000 employees or more. Overall,

13 percent of all establishments, employing 43 percent of all nonfarm

workers, had formal written policies regarding drug use (table 1).

Plans for Future Program Implementation

At the time the survey was conducted (summer 1988), about 4 percent of all

employers without programs were considering beginning drug-testing

programs sometime during the next 12 months, and 3 percent were thinking

about starting employee assistance programs. In both cases, there was

considerable variation by size of establishment. For example, the proportions

considering drug testing ranged from 3 percent for those with fewer than 50

employees to 14 percent of establishments with 1,000 workers or more. By

industry, the proportions considering drug testing ranged from 2 percent for

establishments in finance, insurance, and real estate and retail trade to 11

percent for those in durable goods manufacturing.

PROGRAM CHARACTERISTICS

Testing Programs

Employers with testing programs appear to place a high priority on keeping

potential drug problems out of the workplace. About 85 percent of

establishments with testing programs targeted job applicants, while 64 percent

focused on current employees (table 4).

- 183 -
Table 4. Drug-testing programs by type of program: Private nonagricultural

establishments and employees, summer 1988.

Most of the establishments with programs for testing applicants tested all

applicants as one of the final steps in the hiring process; the extent to which

this was done on a random basis is unknown. Only 16 percent limited the

testing to persons who were applying for jobs in specific occupations. Among

establishments with programs for testing employees, about two-thirds tested

those suspected of drug use, while about one-fourth had programs under

which all employees were subject to testing. With the exception of workers

suspected of drug use, it appears that employers were most likely to test

persons on a random basis, as only about 9 percent of workers in

establishments with drug-testing programs were actually tested.

Establishments in mining, construction, transportation, and wholesale trade

that had testing programs were about as likely to test applicants as current

employees. All the remainder were more likely to have programs for testing

applicants (table 5).

Test Results

Relatively few workers on private payrolls are actually tested for drugs. In the

12 months prior to the survey, establishments with testing programs reported

testing a little under a million employees--or about 1 percent of all workers.

Of these, about 9 percent tested positive for drug use. Of the 3.9 million

applicants who were tested, 12 percent tested positive for drug use. These

- 184 -
Table 5. Drug-testing programs for job applicants or current employees by size of establishment and

industry: Private nonagricultural establishments and employees, summer 1988
test results should not be generalized as representative of the entire work

force, because only a small proportion of all employers test, and so much

of the testing is performed on persons suspected of drug use (table 6).

Employees in wholesale and retail trade who were tested for drug use had

the highest positive rate--about 20 percent of those tested. The high positive

rate in wholesale trade is probably due to the fact that 90 percent of the

establishments that test employees test those suspected of using drugs.

Among applicants for jobs, the highest positive rates were also for those

looking for jobs in wholesale and retail trade establishments--17 and 24

percent, respectively.

Employee Assistance Programs

Nearly 300,000 establishments had employee assistance programs that could

help workers with drug problems. The overwhelming majority of these

programs (9 out of 10) were management sponsored. The remainder were

sponsored by a union or by both union and management (table 7).

With the exception of mining establishments, half or more of the firms

contracted out their assistance programs. The reasons for the mining

exception are not clear, since these establishments tend to be small, and

small establishments generally have contracted-out programs.

Special Features

Employee assistance programs provide a wide array of assistance services to

employees enrolled in them. The most common services are referrals to

providers of treatment or counseling (provided by 97 percent of the

assistance programs), counseling (77 percent), and follow-up procedures (82

percent) to monitor the success or failure of the individual client (table 8).

Less frequently offered features include a hotline (a telephone number

available to employees enabling them to obtain help in dealing with a drug

crisis), drug education or awareness program, and aid for family members.

These latter features are more dependent on establishment size: less than half

of the establishments with fewer than 10 employees that have assistance

programs provide these features, and the proportions rise considerably as size

increases.

Staffing

Assistance programs that were internally run typically had very few

establishment employees assigned to staff them; the number assigned usually

depended on the size of the establishment. As one would expect, few of the

- 186 -
Table 6. Drug-testlng results for current employees and job applicants by size of establishment and industry: Private

nonagricultural establishments, summer 1988.
Table 7. Employee assistance programs by sponsorship, source of program. size of establishment, and industry:

Private nonagricultural establisihments, summer 1988
Table 8. Employee assistance programs by special features of program, size of establishment, and industry: Private

nonagricultural establishments, summer 1988
establishments with less than 20 workers had an employee staffing their

assistance program; consequently, counseling, referral, and other services were

probably provided by managerial personnel. In contrast, almost all the firms

with 5,000 workers or more with employee-assistance programs had some

staff assigned to the program, including 46 percent which had 2 to 4

employees and 39 percent that had 5 employees or more on the program

staff (table 9).

CONCLUSIONS

Private industry efforts to reduce or eliminate problems in the workplace

caused by drug abuse among workers fall into two categories--identification

and assistance. By means of drug-testing programs, employers seek to identify

drug users among both employees and job applicants. Through employee

assistance programs, they try to help workers overcome drug problems,

thereby reducing the extent of the problem in the workplace.

Such programs are not widespread. Establishments with few employees are

unlikely to have either a testing or assistance program. Only among very

large establishments are these programs common.

Drug-testing programs are aimed more towards job applicants than

employees. Moreover, those programs under which employees are tested for

drug use focus primarily on workers who are suspected of drug use. As a

result, establishments reported testing relatively few of their workers. Of the

applicants and employees who were tested, only about 1 in 10 tested positive

for drug use.

Employee assistance programs were largely referral programs. That is,

employees who were identified as drug users or who voluntarily came to the

program for help were referred to organizations outside the establishment for

counseling and/or treatment.

EXPLANATORY NOTES

Coverage

The Survey of Employer Anti-drug Programs was a one-time probability

survey of private nonagricultural establishments in the United States with one

or more employees in the first quarter of 1987. The sample was comprised

of 7,502 establishments, selected from the BLS Unemployment Insurance

Address File and supplemented with the Federal Railroad Administration’s

list of railroad establishments. Estimates were obtained on the existence and

extent of drug-testing and employee assistance programs by industry, size of

establishment, and Census region, as well as groups of applicants and

employees affected by these programs.

- 190 -
Table 9. Internal employee assistance programs by size of program staff, sire of establishment, and industry: Private

nonagricultural establishments, summer 1988
Survey Definitions

Many of the concepts and definitions used in the Survey of Employer

Anti-drug Programs are comparable to those in the monthly BLS payroll

survey of nonagricultural establishments, the Current Employment Statistics

survey, but many others are unique to this survey. Key definitions are as

follows.

An establishment--is an economic unit, such as a factory, mine, or

store, which produces goods or services. It is generally at a single

location and engaged predominantly in one economic activity. Where

a single location encompasses two or more distinct activities, these

are treated as separate establishments, provided that separate payroll

records are available and certain other criteria are met.

Employees--are persons on the payroll of the establishment. Excluded

are proprietors, contract workers who are not on the establishment’s

payroll, the self-employed, unpaid volunteer workers, unpaid family

workers, and farm or domestic workers.

Applicants--for employment are people seeking employment with the

establishment.

The Unemployment Insurance (UI) Address File--is a microlevel

employer file prepared annually by each State’s Employment Security

Agency and submitted to the Bureau of Labor Statistics. This file

was used as the sample frame for the survey.

Industry classifications--are combinations of the industry groups

described in the 1972 Standard Industrial Classification Manual, Office

of Management and Budget, 1972, as modified by the 1977

Supplement. Industry is classified on the basis of the major product

or activity of the establishment, as determined by total sales or

receipts of the calendar year prior to classification.

Computer-assisted telephone interviewing--provides a

computer-driven script with a link to the survey computer database.

In this survey, the telephone interviewer followed the script on a

computer screen and entered the answers provided by the

respondent. The system edited the responses for consistency and

reasonableness and prompted the interviewee to request any

corrections or clarifications while the respondent was still on the

phone.

- 192 -
Drugs--include drugs classified as schedule I or II under the

Controlled Substances Act--more specifically, opiates, cocaine,

marijuana, hallucinogens, and their derivatives. Excluded from survey

coverage are drugs for which persons have prescriptions (whether or

not the prescription was legally obtained), steroids, and alcohol,

although their metabolites may be detected in drug tests.

A formal written policy regarding drugs--is a written statement

available to all employees stating the establishment’s policy with

respect to the use of drugs by its employees. It may also state the

policy regarding drug testing and employee assistance, if applicable.

This statement may also delineate policy regarding alcohol use or

any other aspect of employee conduct and deportment.

A drug test--is a test designed to detect the presence of drugs or

the metabolites of drugs in urine or blood specimens. Whether

persons were identified as having used drugs was determined by the

testing criteria used at each establishment.

Cannabis and derivatives--includes anything containing

tetrahydrocannabinol.

Cocaine--includes anything containing cocaine.

Employee assistance, counseling, or treatment program--is usually

referred to as an employee assistance program. These programs

enable troubled employees to receive help for a variety of personal

problems. The programs can be run internally by organization

personnel or through an outside contractor. Employee assistance

program counselors assess a worker’s particular problem and then

usually offer short-term counseling, which is followed, if necessary,

by referral to outside counseling or therapy for longer-term help.

The programs are not necessarily restricted to drug problems and

may also deal with a wide variety of the employee’s domestic, social,

or psychological problems.

A drug education or awareness program--may consist of seminars,

films, meetings, lectures, written materials, videos, etc., designed to

acquaint employees with the dangers of drugs and/or to publicize the

establishment’s policy regarding the use of drugs. It may also include

managerial or supervisory training to help managers and supervisors

identify and deal with employees who use drugs.

A telephone hotline--provides a telephone number to employees

which puts them in touch with a counselor or advisor to obtain

assistance in dealing with crises brought on by the use of drugs. It

may also provide help with other problems such as alcohol.

- 193 -
A followup of any kind as part of an employee assistance program-

-includes the monitoring of an employee for a specific period of time

after identification of drug use. This may be required of such

employees as a condition of continued employment. Monitoring can

include testing and counseling.

The Census regions--are defined as follows: Northeast includes

Connecticut, Maine, Massachusetts, New Hampshire, New Jersey,

New York, Pennsylvania, Rhode Island, and Vermont; South includes

Alabama, Arkansas, Delaware, District of Columbia, Florida,

Georgia, Kentucky, Louisiana, Maryland, Mississippi, North Carolina,

Oklahoma, South Carolina, Tennessee, Texas, Virginia, and West

Virginia; Midwest includes Illinois, Indiana, Iowa, Kansas, Michigan,

Minnesota, Missouri, Nebraska, North Dakota, Ohio, South Dakota,

and Wisconsin; and the West includes Alaska, Arizona, California,

Colorado, Hawaii, Idaho, Montana, Nevada, New Mexico, Oregon,

Utah, Washington, and Wyoming.

A legislative region--was defined for purposes of estimation and

analysis, because, at the time of the survey, seven States--

Connecticut, Iowa, Minnesota, Montana, Rhode Island, Utah, and

Vermont--had legislation directly affecting drug testing of employees

or applicants. Some additional States have laws related to drug

testing, such as licensing requirements for testing labs; however,

because these laws do not directly limit drug testing at the

workplace, these States were not grouped separately.

Survey Operations

1. Pretest

Upon completing the initial design of questions for the survey, eight local

business establishments were selected for participation in a questionnaire

pretest. Establishments known to have drug-testing or employee assistance

programs were intentionally included in the pretest. The objective of the

pretest was to determine whether the survey questions:

Were worded in an unbiased way

Would be understood by survey participants as intended

Would effectively capture the information the survey was

designed to collect

- 194 -
Each pretest interview was conducted in a personal visit by two BLS

representatives. After the interviews were conducted, the survey task force

met to discuss the pretest findings. The survey questions and definitions were

then reevaluated and modified to better meet the objectives of the survey.

2. Operations Tests

Following the pretest and subsequent modifications to the questionnaire, an

operations test was conducted using a sample of approximately 100 business

establishments. This trial sample was conducted to test the processing

procedures planned for use in the actual survey through a small-scale

simulation and to identify and correct any weaknesses in the data collection

procedures.

The operations test was conducted by mail, with telephone follow-up for

nonrespondents. The solicitation package consisted of a mailing envelope; a

pre-addressed, postage-paid return envelope; a solicitation letter; and a survey

questionnaire. While the test did not uncover any substantial operational

problems, it did find that many survey respondents did not properly follow

the instructions for completing the questionnaire. As a result, the

questionnaire was modified, and a second operations test was conducted with

the revised questions. No significant changes were made to the operations

plan or to the questionnaire as a result of the second operations test.

3. Conducting the Survey

The survey was conducted in two phases. In the first phase, a potential

respondent was asked to complete a short questionnaire. This questionnaire,

BLS 380A, included questions asking if the establishment had a drug-testing

program and/or employee assistance plan. If the establishment had either, a

second (follow-up) questionnaire was sent to the respondent:

BLS 380B, if there was testing but no employee assistance

program

BLS 380C, if there was an employee assistance program but

no testing

BLS 380D, if there was both testing and an employee

assistance program

Each of the follow-up questionnaires was designed to ask only questions that

were consistent with the respondent’s answers on BLS 380A.

Initial solicitation for the BLS 380A phase of the survey was conducted by

mail. The first contact to solicit follow-up data was usually conducted by

mailing the B, C, or D forms. However, if it was necessary to contact a BLS

- 195 -
380A establishment by telephone--particularly in the case of nonresponse--

the respondents who had these programs were asked to provide the data for

the B, C, or D forms during the telephone interview.

As suggested above, establishments that did not respond to mail solicitation

were contacted by telephone. Recontacts to reconcile questionable or

incomplete responses were also conducted primarily by telephone. Mail

generally was used in these cases only at a respondent’s request or when

telephone contacts were unsuccessful.

Computer-assisted telephone interviewing was used by survey interviewers in

most of the telephone follow-ups. This facilitated telephone interviews in

several ways:

Provided introductory and questionnaire script

Allowed the interviewer to enter the respondents’ data

directly into the survey database

Edited the reported data for consistency with preestablished

criteria and identified potential errors during the interview

Mechanically assigned status codes used to classify sample

records for survey processing and management

Helped interviewers control their assigned samples

Scope and Sample Design

The Survey of Employer Anti-drug Programs was a one-time probability

sample survey of 7,502 private nonagricultural establishments in the United

States with one or more employees during the first quarter of 1987. The

sampling frame used for this survey was constructed from the 1987

Unemployment Insurance Address File maintained by the Bureau of Labor

Statistics and the Federal Railroad Administration’s list of railroad

establishments. The sampling frames contained approximately 4.5 million

establishments, accounting for about 85.0 million employees.

The principal feature of the survey’s sample design was its use of stratified,

systematic sampling with a ratio estimator. The establishments were stratified

into 400 sample strata, defined by 5 geographic regions, 10 Standard

Industrial Classification (SIC) groupings, and 8 employment size classes, as

shown below.

- 196 -
The five geographic regions were:

1. Connecticut, Iowa, Minnesota, Montana, Rhode Island, Utah,

and Vermont. These States were placed into a separate

stratum, because it was determined that they have

drug-testing legislation that might affect the estimates

2. All States in the Northeastern region, except for

Connecticut, Rhode Island, and Vermont

3. All States in the Southern region

4. All States in the Midwestern region, except for Iowa and

Minnesota

5. All States in the Western region except for Montana and

Utah

The 10 SIC groupings were:

Industry 1972 SIC Code

1. Mining. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-14

2. Construction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .15-17

3. Durable manufacturing. . . . . . . . . . . . . . . . . 24, 25, and 32-39

4. Nondurable manufacturing. . . . . . . . . . . . . . .20-23, and 26-31

5. Transportation. . . . . . . . . . . . . . . . . . . . . . .40-42, and 44-47

6. Communications and public utilities. . . . . . . . . . . . .48 and 49

7. Wholesale trade. . . . . . . . . . . . . . . . . . . . . . . . . . 50 and 51

8. Retail Trade. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .52-59

9. Finance, insurance, and real estate. . . . . . . . . . . . . . . . .60-67

10. Services . . . . . . . . . . . . . . . . . . . . . . . . . . . 07, 70-87, and 89

- 197 -
The eight employment size classes were:

Size class

Number of employees,

first quarter of 1987

1 . . . . . . . . . . . . . . . . . . 1-9

2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10 -49

3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50-99

4 ........................................ 100-249

5 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 250-499

6 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 500-999

7 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100-4999

8 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5,000 and above

All of the establishments on the sample frame with 5,000 employees

or more were included in the sample with certainty. Also, if any

sample stratum contained five establishments or less, then those

establishments were also selected for the sample with certainty.

Sample sizes for the noncertainty strata were determined based on a

target standard error of 7.5 percent for an estimate of P (where P is

the estimate of the proportion of establishments with a drug-testing

program or the proportion with an employee assistance program). In

order to be conservative, a value of P=50 percent was assumed in

each sampling stratum. The final sample for the survey contained 480

establishments belonging to the certainty stratum and 7,022

establishments that were selected in each noncertainty stratum, using

a systematic sampling procedure with a random start.

Estimation

1. Weighting

To derive the population estimates, the sample establishments with

usable responses were weighted to represent all establishments in

their sampling stratum. Each sample weight consisted of two factors.

The first factor was the inverse of the probability of selection. The

second factor was a nonresponse adjustment factor used to adjust

estimates for establishments that did not respond to the questionnaire

- 198 -
or did not respond to a particular item on the questionnaire. For

each of the 400 sample strata and for each item on the questionnaire,

a nonresponse adjustment factor was calculated as follows:

Total number of eligible establishments

Total number of usable establishments

An establishment was eligible if it should have responded to the

questionnaire or a particular item within it. The usable sample size

was the number of establishments which provided a response to a

particular item. If the nonresponse adjustment factor for any given

item in a stratum was greater than a predetermined maximum value,

then the stratum was collapsed with other strata in the same SIC

grouping until the nonresponse adjustment factor for the combined

stratum was less than the maximum value.

2. Response Rates

Data collection for the survey was started on June 13 and closed out

on September 9. The usable response rates were 92.4 percent for

BLS 380-A, 88.1 percent for BLS 380B, 88.8 percent for BLS 380C,

and 84.5 percent for BLS 380D. An analysis of usable reports showed

that item response rates to individual questions across all sample

strata were relatively high. They were lower, however, for questions

that requested counts concerning drug-testing results. Survey item

response rates were calculated across all sample strata as follows:

Number of usable responses for the item

x 100

Eligible sample size

As shown in table A, the usable response rates for individual

questions ranged from 71.1 to 100 percent. The eligible sample sizes

used to calculate these item response rates are based on the

following definitions. (Questions from the B, C, and D forms are

designated by their numbering as they appear on BLS 390D.)

- 199 -
Table A. Response rates for individual items

BLS 380

form type

A

A

A

A

A

A

A

A

A

A

A

A

B/C/D

B/C/D

B/C/D

B/C/D

B/C/D

B/C/D

B/C/D

B/C/D

B/C/D

B/C/D

B/C/D

B/C/D

B/C/D

B/C/D

B/C/D

B/C/D

B/C/D

B/C/D

B/C/D

B/C/D

B/C/D

B/C/D

B/C/D

B/C/D

Question

number

1

2

3

4A

4B

4C

4D

4E

4F

5

6

7

1

2

3A

3B

3C

4

5

6

7A

7B

7C

8

9A

9B

9C

9D

10

11

12

13

14

15

16

17

Eligible

sample

size

Number of

usable

responses

6.502 6.502

6.502 6.501

6.502 6.502

1.495 1,495

1.495 1.495

1,495 1,495

1.495 1495

1.495 1.495

1.495 1,495

5,007 4.999

6.502 6.502

4.187 4.171

1.341 1067

1,341 1.043

1.341 954

1.341 958

1.341 957

1.341 1.140

1087 841

1.087 818

1.087 780

1.087 780

1.087 781

1087 890

2.315 2.032

2.315 2.032

2.315 2.032

2.315 2.032

2.315 1.976

2.315 2.031

2.315 2.022

2.315 2.024

2.315 2.023

2.315 2.022

2.315 2.030

2.315 2.014

Response

rate for item

(percent)

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

998

1000

99.6

796

778

71.1

71 4

714

85.0

774

753

71.8

71.8

71.8

819

878

87.8

87.8

878

854

87. 7

87.3

87.4

87.4

87.3

87.7

87.0

- 200 -
Survey question (item)

BLS 380A, 1-3 and 6

BLS 380A, 4A-F

BLS 380A,5

BLS 380A7

BLS 38OB/C/D, 1-4

BLS 380B/C/D,5-8

BLS 38OB/C/D, 9A-17

Definition used to

determine sample size

Units that provided a usable

response for BLS 380A

Units that responded yes to

BLS 380A item 3

Units that responded no to

BLS 380A item 3

Units that responded no to

BLS 380A item 6

Units that responded yes to

BLS 380A item 4A, or 4B

Units that responded yes to

BLS 380A item 4C, D, E,

or F

Units that responded yes to

BLS 380A item 6

3. Benchmark Adjustments

A combined ratio estimator was used to develop the final estimates. The

auxiliary variable used to adjust or benchmark the estimates was total

employment or total number of establishments, depending on the type of

estimate desired. Benchmark factors (BMF) for employment (E) and units

(U), respectively, were calculated as follows:

BMFhi(E) =

Benchmark employment for the i

th employment

size class within h

th SIC grouping

Total weighted, nonresponse adjusted reported

employment for the ith employment size class

within the h

th SIC grouping

Benchmark number of establishments for

BMFhi(U) =

the i

th employment size class within hth SIC grouping

Total weighted, nonresponse adjusted number of

establishments for the i

th employment size class

within the h

th SIC grouping

The employment level from the BLS Current Employment Statistics program

for March 1988 was used as the employee benchmark, and the number of

establishments was taken from comprehensive counts from State

unemployment insurance files (ES-202 program) for the first quarter of 1987.

- 201 -
4. Final Estimate

The weighted, nonresponse adjusted estimates were then multiplied by their

corresponding benchmark factors to obtain the final estimates. Estimates for

percentages were obtained by dividing the final estimates at the estimating

cell level by the appropriate total value.

For each estimate, an estimate of its standard error was calculated using a

random group technique. This technique is based upon dividing the sample

into several subsamples and calculating separate estimates for each

subsample. The standard error estimate is based upon the variability of these

subsample estimates.

Reliability of Estimates

Estimates developed from the sample may differ from the results of a

complete census of all the establishments in the sample frame. Two types of

error, sampling and nonsampling, are possible in an estimate based on a

sample survey. Sampling error occurs because observations are made only on

a sample, not on the entire population. Nonsampling error can be attributed

to many sources, e.g., inability to obtain information about all cases in the

sample; differences in the respondents’ interpretation of questions; inability

of respondents to provide correct information; errors in recording, coding, or

processing the data; and failure to represent all units in the population.

The particular sample used in this survey is one of a large number of all

possible samples of the same size that could have been selected using the

same sample design. Estimates derived from the different samples would

differ from each other. The standard or sampling error of a survey estimate

is a measure of the variation among the estimates from all possible samples.

Estimated standard errors for key statistics appear in table B. Estimated

standard errors for other statistics are available upon request.

The sample estimate, and an estimate of its standard error, enable one to

construct interval estimates with prescribed confidence that the interval

includes the average value of the estimates obtained from all possible samples

that could have been chosen using the same sample design that was used for

this survey.

To illustrate, if all possible samples were selected and if each of these were

surveyed under essentially the same conditions and an estimate and its

estimated sampling error were calculated from each sample, then:

- 202 -
Table B. Standard errors of selected percentages
Approximately 68 percent of the intervals from 1 standard error

below to 1 standard error above the derived estimate would include

the average value of all possible samples. This interval is called a

68-percent confidence interval.

Approximately 90 percent of the intervals from 1.6 standard errors

below to 1.6 standard errors above the derived estimate would

include the average value of all possible samples. This interval is

called a 90-percent confidence interval.

Approximately 95 percent of the intervals from 2 standard errors

below to 2 standard errors above the derived estimate would include

the average value of all possible samples. This interval is called a

95-percent confidence interval.

As an example, the estimate of the percent of the establishments with an

employee assistance program is 6.50 percent, and the estimate of 1 standard

error is .43 percent. The 90 percent confidence interval (1.6 standard errors)

was used for the analysis in this report; In this example, 1.6 standard errors

is .69 percent, and the confidence interval for this estimate is 5.81 percent

to 7.19 percent. Approximately 90 percent of the intervals constructed in this

manner will include the true percentage, and one can say with 90-percent

confidence that the true percentage is in the interval, when the true

percentage is defined to be the average value of all possible samples.

The estimated standard errors primarily indicate the magnitude of the

sampling error. They do not measure nonsampling error, including any biases

in the data. Significant efforts were made to reduce the nonsampling errors

in recording, coding, and processing the data. For example, the completed

forms were checked for data consistency and apparent inconsistencies were

reconciled, but this process probably did not eliminate all recording, coding,

and processing errors in the survey.

In adjusting the strata sample weights for the nonrespondents, nonsampling

error could occur, because it was assumed that the characteristics of the

nonrespondents within the stratum were the same as those of the

respondents. To the extent this is not true, bias is introduced in the data.

The magnitude of this bias is not known.

Where there was a large nonresponse for a particular item, such as with the

results of drug testing, there is greater potential for large nonsampling error.

Thus, the data on table 6 of this report should be viewed with greater

caution than the other tables. In fact, data collected on the questions

concerning drug testing for specific types of drugs (cannabis, cocaine, etc.)-

-based on questions 3 and 7 in forms 380B and 380D--were not tabulated at

- 204 -
all because of the very high rates of nonresponse, as well as other suspected

response errors.

In some instances, respondents may interpret questions differently than

intended. This, too, can introduce a bias. For example, questions 4 and 8 on

forms BLS 380B and BLS 380D were asked to determine whether

confirmation tests were conducted to verify initial test results. However,

comments returned with the questionnaires indicated that at least some

respondents interpreted this as a follow-up test conducted long after a

positive test result to determine whether an employee had stopped using

drugs. Because of this discrepancy, data from those questions were not

tabulated or analyzed.

Nonsampling error also occurs when the respondent does not have the

requested data available. For example, it was learned that at least 10 percent

of the units that responded to the survey questions regarding the total

number of employees or applicants that tested positive for drug use could

provide only estimated responses. The effect this error has on the final

estimates is unknown and would depend on how accurate respondents’

knowledge is of their firms’s drug testing.

Response Analysis Survey

In an attempt to measure the magnitude of nonsampling errors that are

caused by definitional difficulties on the questionnaire, misinterpretation of

questions, the respondents’ recall factor, etc., a response analysis survey was

conducted in conjunction with the Survey of Employer Anti-drug Programs.

This involved a sample of 95 randomly selected sample establishments with

50 employees or more, selected from the usable establishments responding

by mail (with no computer-assisted telephone interviewing follow-up) that

indicated that they had neither a drug-testing nor employee assistance

program. The response analysis survey was designed to: (1) probe these

respondents on their establishments’ programs and policies that may relate

to drug testing or employee assistance and (2) evaluate whether the

definitions of “drug-testing program” and “employee assistance program” were

understood by the respondent in the same way as they were defined in the

original questionnaire. The response analysis survey was also designed to

validate the original responses of these units by verifying that the respondents

had not overlooked some important piece of information that would yield a

change in response.

In the case of the “drug-testing program,” the results from the response

analysis survey indicated that a small source of bias was the respondents’

failure to remember that some drug testing had been undertaken as part of

a physical examination provided or required by the firm. Based on the limited

- 205 -
sample size, it is estimated that the percentage of establishments with a

drug-testing program could increase from 3.2 to 3.3 percent--a change of only

one-tenth of a percentage point--if corrected for this bias. The response

analysis survey also indicated that the respondents understood the “employee

assistance program” to be a very formal and structured benefit available to

the employee. Consequently, the respondents did not change their response

from “no” to “yes,” even though many establishments provided educational

programs on drug abuse and offered referrals to outside agencies.

When examining estimates from the Survey of Employer Anti-drug Programs,

particular care should be exercised in the interpretation of small differences

between estimates, because the sampling errors for them tend to be relatively

large.

ENDNOTES

1

Ten surveys on employee drug testing were summarized in Employee Drug

Testing: Information on Private Sector Programs, GAO/GGD-88-32 (General

Accounting Office, March 1988). Of the 10, 7 were directed at members of

business or professional organizations, 2 at very large companies, and 1 at

Fortune 500 companies. The sample for a more recent survey, conducted in

1988 by the Gallup Organization for Hoffman-La Roche, Inc. consisted of

706 companies with 20 employees or more, selected from Trinet, Inc.'s large

Corporation Database. Companies in this database consist of main offices and

parent companies only. See Drug Testing at Work: A Survey of American

Corporations (Gallup Corporation 1988).

2

For a discussion of drug-testing procedures, see Alcohol and Drugs in the

Workplace: Costs, Control and Controversies, Bureau of National Affairs, Inc.

(Washington, D.C. 1986) pp. 27-38.

3

See, for example, U.S. Department of Transportation, Federal Railway

Administration, Field Manual: Control of Alcohol and Drug Use in Railroad

Operations, pp. A61-A72.

ACKNOWLEDGMENTS

The data in this report are based on information collected in the Survey of

Employer Anti-Drug Programs conducted by the Bureau of Labor Statistics

in the Summer of 1988. This was a nationwide probability sample survey of

private nonagricultural establishments with one or more employees, stratified

by employment size class, major industry division, and multistate region, It

was designed to collect information on the incidence of drug-testing and

employee assistance programs in private industry. In addition, the survey also

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collected data on drug-test results and the characteristics of employee

assistance programs. The survey was sponsored by the Office of the Assistant

Secretary for Policy, U.S. Department of Labor.

The report was prepared in the Office of Employment and Unemployment

Statistics under the direction of Thomas J. Plews, Associate Commissioner.

Survey work was coordinated by George D. Stamas of the Division of

Monthly Industry Employment Statistics. The questionnaires were designed

by Mark Palmisano of the Division of Statistical Methods and Howard V.

Hayghe of the Division of Labor Force Statistics. Sample design and

estimation methods were provided by Michael B. Witt and Shail J. Butani of

the Division of Statistical Methods. Survey operations were conducted under

the direction of Guy A. Toscano of the Division of Federal/State Monthly

Surveys, Office of Survey Processing, and computer programming was directed

by James K. Fox of the same division. Gloria P. Green coordinated the

tabulation and other production services, and Howard V. Hayghe prepared

the analysis.

Author

Howard V. Hayghe

Economist

Bureau of Labor Statistics

Room 2486

441 G Street, N.W.

Washington, D.C. 20212

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Re-Examining the Role of Supervisor Training

Bradley Googins, Ph.D., Robert Schneider, Ed.D.

and Neil Golan, Ed.D.

Boston University

INTRODUCTION

Employee Assistance Programs (EAPs) have long recognized that the

supervisor is crucial to the process of managing troubled employees in the

workplace (Googins and Kurtz, 1980; Hoffman and Roman, 1984). By virtue

of their role in the work environment, supervisors are in a unique position,

not only to identify troubled employees, but also to intervene in a meaningful

way. In light of the pivotal part supervisors play for EAPs, the need to train

supervisors has also been accepted and given high priority (Trice and Belasco,

1968, Trice and Roman, 1972). Yet despite the general acceptance of

supervisors and supervisor training as central to EAPs, there has been very

little research in this area by EAP professionals. Thus, with only a few

notable exceptions (Googins and Kurtz, 1980, Hoffman and Roman, 1984,

Trice and Beyer, 1981), supervisor training remains relatively unexamined

despite its importance to the EAP field. Such lack of research on EAP

training appears to reflect problems reported within the larger management

training field. A recent meta-analysis of the management training research

literature (Burke and Day, 1986) reports that the vast majority of research

on management training is not empirical or based on theory. Instead, most

research remains dominated by anecdotal presentations. This report concludes

that much more research is urgently needed if a better understanding of the

effectiveness of training on various outcome variables is to be achieved.

The data presented here are from the first phase of a NIDA-funded project

to study the effectiveness of supervisor training on several specific outcome

measures. In phase one, a national telephone survey of EAPs was conducted

to obtain a more accurate picture of the extent and nature of supervisor

training within EAPs. These data are useful to establish a baseline of current

supervisor training practices for EAPs, as well as to give EAPs a sense of

where they stand in relation to other training initiatives occurring within the

workplace. These data will also guide the design of experimental groups

employed in the second phase of the study where the effectiveness of various

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types of supervisor training practices will be tested in a controlled

experiment.

METHODS

The sample for the telephone survey was established by first selecting a State

at random from each of the five geographic sections of the United States.

Initially, a letter was sent to all EAPs in each State which were listed in the

ALMACA directory. These EAPs were asked to add to our list those EAPs

which were in their State but not on our list. By this process, we were able

to identify virtually the entire population of EAPs in each State. A total of

114 EAPs were then randomly selected and asked to participate in the

survey. Of these, 94 agreed to take part in the survey which constituted an

82.5 percent participation rate.

A semistructured telephone survey was constructed and employed for data

gathering. This instrument consisted of original items which were generated

by a three-member expert panel of EAP professionals. A pretest was then

conducted in order to rectify any problems before it was used in the actual

nationwide survey. The telephone interviews were conducted by four research

staff who were trained to follow a series of standard procedures which had

been previously established. A copy of the instrument was sent to each

participant prior to the actual interview in order to maximize the quality of

information gathered and minimize the time needed for the actual telephone

interview. Most interviews lasted approximately 40-50 minutes depending

upon the flow of the interview.

The sample, as shown in figure 1, consisted of 94 EAPs which have existed

for an average of 8 years and have a median number of eligible employees

of 5000.

Nearly even numbers of internal programs (41 percent) and external

programs (37 percent) were surveyed, and the remainder (21 percent)

described themselves as combined internal/external programs. The populations

served by these EAPs were reported to be 16 percent suburban, 18 percent

urban, and 66 percent a combination suburban and urban.

RESULTS

Initial questions focused on attitudes of EAP personnel towards supervisor

training. Overall, the results indicated a strong, positive view towards

training. Over 92 percent agreed that “An EAP must conduct supervisor

training to be considered a quality EAP.” In addition, over 94 percent

disagreed with the statement that “Supervisor training is a good idea, but a

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Figure 1.

Description of Sample
luxury in light of other EAP priorities.” Next, respondents were asked to

describe the supervisor training sessions which they conducted during the

previous year. A total of 87 percent reported they had conducted supervisor

training during this time period. The majority of this training was conducted

by EAP staff (91 percent), however, over one-third of these staff (36.8

percent) had never received training as trainers. Figure 2 shows that most

sessions were conducted with fewer than 20 participants (62 percent) in

attendance, although 35 percent of supervisor training sessions had between

21 and 40 participants. The average length of a training session was 2.6

hours. Most EAPs focused their training on job performance (76 percent).

However, 21 percent of the EAPs surveyed focused primarily on substance

abuse instead of a broad-brush approach. Virtually all of the EAPs (97

percent) instruct supervisors in the principals of constructive confrontation.

Training methods were also examined in the survey. All supervisor training

sessions (100 percent) were stand-up presentations and had a question and

answer period. Eighty-nine percent included the total group in some form of

discussion, and 74 percent utilized a video or film as a training component.

As figure 3 illustrates, a variety of other training techniques were also found

to be commonly used. Most popular were the use of small group discussions

(54 percent), self-teaching guides (46 percent), slides/overheads (40 percent)

and role play (29 percent).

EAP personnel were asked how effective they felt supervisor training was.

Figure 4 shows that those surveyed perceive supervisor training to be

effective in achieving a variety of goals including increased referrals, increased

awareness of the EAP, improved attitudes toward the EAP and troubled

employee, and better integration of the EAP into the corporation. When

asked about problems affecting supervisor training, respondents focused on

several barriers to doing more supervisor training. Figure 5 illustrates that

the problems most reported included time constraints of EAP staff, lack of

upper management support, budgetary constraints, supervisor apathy, and

organizational change. In contrast, very few respondents felt that the trainers

themselves or the curriculum employed were problems of any significance.

Preliminary analyses were also conducted to compare EAPs which conducted

supervisor training in the previous year with those which did not conduct

training. EAPs with supervisor training had a higher referral rate (5.2

percent) than EAPs with no training (2.1 percent). This difference was

statistically significant (p <.00l). There were also significant correlations

between supervisor referrals, the amount of training done in an organization,

and the training qualifications of the trainers. These findings are interesting

in that they provide some beginning measures on effectiveness of training and

trainers. However, it must be emphasized that these analyses have not

controlled for a variety of confounding variables. In particular, the definition

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Figure 2.

Supervisor Training Sessions
Figure 3.
Figure 4.

Perceived Effectiveness of

Supervisor Training
Figure 5.
of supervisor referral was not consistent across EAPs making comparisons

difficult to interpret.

Finally, training trends were explored using data from 1985, 1983, and 1992

(projected). Figure 6 reveals that other types of EAP training (e.g., drug

testing, wellness, new employee orientation, AIDS) are increasing and

expected to increase even further in the next few years.

DISCUSSION

Overall, the results of the survey indicate that most EAPs continue to feel

very positive about their supervisor training programs and feel that training

is essential to the mission of the EAP. Those surveyed felt that supervisor

training is effective in achieving its goals, but were concerned that they were

not doing enough training because of limited resources. Problems associated

with training were perceived to be mostly organizational constraints and not

related to the trainers, the curriculum or issues of efficacy. Training is seen

to be mostly free-standing. That is, it is conducted almost exclusively by the

EAP itself, using EAP counselors as trainers. It is also fairly homogenous in

that it primarily emphasizes a job performance model of problem

identification and instructs supervisors in the use of constructive

confrontation. Training sessions typically consist of stand-up presentations

and include question and answer periods. Some changes in supervisor training

practices are seen to be taking place. Generally, these changes reflect the

use of more professional training techniques and some diversification in

terms of training focus and target group.

In many respects, EAP training is similar to other management training

programs which exist within the corporation. For example, in terms of its

objectives, management training programs are, for the most part, designed to

teach or improve management skills and on-the-job performance (Burke and

Day, 1986; Wexley and Latham, 1981; Goldstein, 1980). Similarly, EAP

training is also designed to help supervisors improve their management skills

and monitor employee job performance. There are also many parallels seen

between these training programs in terms of methods and curriculum. Both

employ a prescribed set of curriculum components and a range of techniques

to present information. In a time when there is increased recognition of the

efficacy of training managers and supervisors (Burke and Day, 1986, Wexley

and Latham, 1981; Deming, 1986), one would expect to find well-established

linkages between EAPs and the management training field. Unfortunately,

such linkages are seldom found. The evolution of EAP training has taken a

very distinctive track which has kept it generally quite separate from the

mainstream of corporate training. While this autonomy has enabled the EAP

to deliver what it considers unique EAP material, it has created problems in

several areas as discussed below.

- 217 -
Figure 6.

Training Trends
Training Quality

Because the EAP training evolved as a separate program, it rarely was

conducted or tied to the corporate training department. In addition, the EAP

staff were expected to deliver the training regardless of their skill or interest

in training. Also the training content and curriculum were rarely developed

within a training and education format which examines the learning process.

Most often, EAP staff adopted points of the constructive confrontation

model, drew upon some alcoholism training, and tried to get their message

across despite the apathy or resistance of the supervisors. These are hardly

ideal training circumstances given the importance of supervisors to the

mission of EAPs. While data from the current survey indicates a growing

training sophistication, in contrast to the training of even a decade ago, it is

clear that many EAP staff have little or no training in the development or

deliverance of effective curriculum. If the corporation has recognized the

specialized skills and knowledge necessary for training by creating a training

department or unit, it is somewhat presumptuous, in light of EAP staff

training skills, for EAPs to create a separate training function.

Staffing Costs

Most EAPs have determined that it is essential for EAP staff, rather than the

training unit, to deliver the training since it requires specialized knowledge

and skills. This has placed increased pressure on staff time due to the

multiple role requirements. Training supervisors is an ongoing process and

consequently an ongoing time commitment of the EAP staff. As caseloads

increase, the time requirements for training compete with client hours and

contact. In addition, the necessity of assuming this role precludes other

activities which may be equally important to the EAP, such as follow-up,

organizational integration and attention to corporate-wide problems, such as

drug abuse and managed health care.

Corporate Isolation

The decision to keep EAP training separate from the corporate training

function has generally evolved with the development of the EAP within the

company. This has hindered the ability of EAPs to become fully integrated

within the corporate culture and organization. The cost for maintaining a

separate training activity, rather than coordinating it with the training

department, should be examined carefully by each EAP. To the extent that

any unit, function, or activity stands outside the general structures and

activities of a system, it pays a price for the isolation in how it is perceived

and valued by the members of the system. Since EAP training is isolated

from the general management training of the corporation, it will be cast in

a different light, and its training context altered to reflect the separateness

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and isolation. While a case may be made that within a particular company

this may be functional, for most settings such isolation is more likely to have

negative overtones and unfortunate results.

CONCLUSION

Today’s corporate environment requires very sophisticated operations to

reflect the changing nature of the employee population as well as the vast

array of new technologies. In addition, as new issues such as AIDS, wellness,

and work-family enter the workplace, new information and management

techniques need to be provided to the workforce. Training, whether

conducted by the EAP or by another corporate department, is a crucial

operation charged with facilitating such growth and change. It is clear from

the present study that EAPs are committed to continuing to provide training

within the corporation. However, EAP training is increasingly competing in

a crowded arena for space and attention, and its training efforts appear to

be somewhat lagging behind other training initiatives.

It is probably in the best interests of the EAP to work towards integrating

EAP training more into the corporate mainstream. Maintaining a separate

training program is costly to the EAP especially in these times of diminishing

resources. In addition, the sophistication required for effective training within

the corporation is not easily obtained by EAP staff. The assumptions behind

separating EAP training from other management training need to be

re-examined, as do the benefits of integrating its training into the larger

corporate training function. By moving from an isolated, or free-standing

model, to an integrated model of delivering the training, the quality and

effectiveness of EAP training may actually improve while advancing its own

interests and goals.

REFERENCES

Burke, M., and Day, R. A cumulative study of the effectiveness of managerial

training. Journal of Applied Pychology 71(2):232-245, 1986.

Etchen, L., and Roman, P.M. Models of Supervisory Training for the

Implementation of Employee Assistance Programs. Monograph. Tulane

University, 1977.

Goldstein, I.L. Training in work organizations. Annual Review of Psychology

31:229-272. 1980.

Googins, B., and Kurtz, N.R. Discrimination participating and

non-participating supervisors in occupational alcoholism programs.

Journal of Drug Issues 11(2):1981.

- 220 -
Hoffman, E. and Roman, P. Effects of supervisory style and experientially

based frames of reference on occupational alcoholism programs.

Journal of Studies on Alcohol 44(3):260-267, 1984.

Trice, H.M., and Belasco, J.A. Supervisor training about alcoholics and other

problem employees. Quarterly Journal on Alcohol 29(2):382-389, 1968.

Trice, H., and Beyer, J. A performance based evaluation of the

constructive-confrontation strategy: How effective is discipline? New

York State School of Industrial and Labor Relations, Cornell

University, Ithaca, New York, 1981.

Trice, H.M., and Roman, O.N. Spirits and Demons at Work, Ithaca, New

York: Cornell University, 1972.

Wexley, G., and Latham, K. Developing and Training Human Resources in

Organizations, New York: Scott Forseman and Co., 1981.

AUTHORS

Bradley Googins, Ph.D.

Associate Professor

and

Robert Schneider, Ed.D.

Research Associate

and

Neil Colan, Ed.D.

Research Associate

School of Social Work

Boston University

264 Bay State Road

Boston, Massachusetts 02215

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Commentary

COMMENTARY: NIDA’s Role in Applied Research

Session Chairman: Charles R. Schuster, Ph.D.

Participants: Robert DuPont, M.D., Jerome Jaffe, M.D., and

Herbert Kleber, M.D.

ROBERT DUPONT

We are sharing a remarkable piece of history today. The United States is in

the midst of recommitting itself to dealing with the drug abuse epidemic.

We will find, over the next few years, what we are made of as a nation. Are

we tough enough to deal with the drug problem, and creative enough to use

our antidrug efforts to make our workplaces, our neighborhoods, and our

families better and stronger even than they were before we were hit by the

plague of drug abuse?

Drugs in the workplace has become the critical battleground in the war

against drug abuse. This Conference contains many of the leaders of that

new effort. If we can get it right, here at this meeting, we can go a long way

toward ending the drug epidemic. If we cannot, our country is in for a long,

painful, and inconclusive war.

Let’s start by looking back in time. This panel of the drug abuse

establishment contains the first and the current directors of the National

Institute on Drug Abuse (NIDA), the first Drug Czar in world history, and

the current Deputy Drug Czar with responsibility for all of the non-lawenforcement side of national drug policy. Look at our ages: We are all in

our fifties. Hard as it is to imagine, we were the “bright, young guys” in the

drug abuse prevention field when it got started just 20 years ago. You might

say that we have survived that tumultuous era to become the grey beards of

today. We have other characteristics in common. We are all “doctors” --

three M.D.s and a Ph.D. -- and we are all devoted to the intellectual aspects

of the drug problem. We are all what others call “researchers” and all

professors at medical schools.

We are part of a cohort that was swept into the modern drug abuse field

when it began in the late 1960s. From the beginning there has been an

emphasis in this war, especially on the non-law enforcement side, on

academics. There has also been a remarkable lack of partisanship: None of

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us is a politician or is closely identified with any political orientation. Our

mission through successive national administrations of both parties has been

the same: to do the best job we could to solve the drug problem. In fact,

it is not easy to see differences between our national response to drugs that

relate to partisan politics.

When William Bennett, the latest Drug Czar, became the first non-expert in

the drug abuse field and the first politician to hold that job, he turned to

this same cohort to pick his Deputy for Demand Reduction. He asked Herb

Kleber from Yale to help him.

That was not very different from the experience in 1971 when President

Nixon first made drug abuse a top presidential issue and created the first

Drug Czar. He turned to the University of Chicago and picked Jerry Jaffe

to help him. When I became involved with drug abuse treatment in 1968,

the man I turned to first was also Jerry Jaffe who, almost single-handedly,

invented the multimodality drug abuse treatment program. Jerry also

established a strong and remarkably resilient commitment to research both

in treatment and in national antidrug policy.

The current NIDA Director, Bob Schuster, is the Ph.D. in our little group.

He is one of the world’s top research scientists in the field of drug effects,

especially the effects of cocaine. All four of us have been in the drug abuse

field for over 20 years, we have been friends who have shared in all of the

drug issues in our national history during that time. Collectively, we have

written several chapters of that history.

In looking over the recent past, it is clear that only twice has the drug abuse

issue come to the top of the national agenda: first in 1971-1973, and the

second time from 1986 to 1989. Let’s go back together to 1971 and see what

the drug abuse problem looked like then. What was known about drug

abuse was largely learned at the Addiction Research Center (ARC), the

“narcotics farm” as it was called in Lexington, Kentucky. It had been started

by the Federal Government in the mid-1930s. Today the ARC has moved

to Baltimore, Maryland. One of the central findings from the ARC

experience was made by a young psychiatrist who worked there briefly,

George Vaillant. He showed that not only did involuntary treatment work,

but that it worked better than voluntary treatment for narcotics addicts.

We had our first modern war on drugs in 1971 because American servicemen

in Vietnam were addicted to heroin. This frightening situation, combined

with concern about crime in the streets, again caused by heroin use, led to

the creation of the first White House Drug Office, the Special Action Office

for Drug Abuse Prevention (SAODAP). In those days “drugs” meant

“heroin”. One of the more remarkable aspects of that era was that a strongly

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conservative president made his mark in national drug policy by “balancing”

the nation’s traditional focus on law enforcement with a concern for

treatment and prevention. This became known as the drug abuse policy of

balancing Supply Reduction with Demand Reduction. In practice that meant

balancing the voices of the “cops” with the voices of the "docs" at the

national level. The antiheroin efforts from 1971 to 1973 were remarkably

successful as Turkey, and later Mexico, the leading source countries, were

persuaded to stop supplying heroin to American drug abusers. Even more

dramatic was the unprecedented growth of drug treatment, especially using

methadone, and the explosive growth of drug abuse research, building on the

foundations of the ARC. Drug abuse treatment and drug abuse research

became in the 1970s modest growth industries.

Then the drug issue waned. The White House Drug Office, SAODAP, was

closed in 1975. Although not disappearing from the national political

agenda, the drug problem receded in importance. The early lessons about

heroin addiction and crime were well learned; too well learned as it turned

out. In the mid-1970s policy makers, including those at this table,

emphasized that the serious drug problem was heroin and other “hard” drugs.

This widely held view led to the conclusion that marijuana and cocaine were

relatively benign and not the appropriate subject of major national concern.

The ARC had helped us recognize physical dependence of the morphine (or

heroin) type as the hallmark of drug dependence. Marijuana and cocaine did

not produce this sort of physical dependence. This science set the stage for

an entire generation of Americans who grew up learning that marijuana and

cocaine were not “addicting.” Policy followed and the stage was set for these

two drugs to emerge as the Gateway Drugs in the late 1970s, the most

commonly used illicit drugs in the United States. In 1988, for example, 12

million Americans used marijuana and 3 million used cocaine.

NIDA’s own research in recent years has helped to explain the apparent

paradox that “nonaddicting” drugs are now causing the most serious drug

problems in the country. Addiction has comparatively little to do with

physical dependence. It has everything to do with reward or liking. Drugs

cause addiction because drug users not only like them but because they fall

in love with getting high, and in the process lose control over their drug use

and many other aspects of their everyday behavior. Cocaine in general, and

smoked cocaine or crack in particular, are now known to be uniquely

addicting even though cocaine does not produce physical withdrawal of the

morphine type.

When the drug issue came back to prominence again in 1986, with the tragic

and stunning death of Len Bias and the emergence of crack cocaine as the

only drug epidemic that was then getting worse, it came back in an entirely

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new way. The focus was no longer on heroin and crime, but on marijuana

and cocaine. The focus of national concern about drug abuse was not the

underprivileged or the unemployed, it was not the inner city or the minority

community. Drug abuse in 1986 involved the mainstream of American

society. The principle drugs that now cause alarm are the most widely used

illicit drugs, marijuana and cocaine.

A recent analysis of the 1985 Household Survey showed that current users

of illicit drugs were predominantly male (60%) that 69% were between the

ages of 18 and 34, and that 70% were employed. Only 14% were black. Six

percent were Hispanic and 80% were white. Equally remarkable, only 24%

were from large metropolitan areas or nonmetropolitan areas. This picture

could hardly have been more different from the “typical drug abuser” as seen

in 1971, when criminal unemployed minority young men were the focus of

national drug abuse concern.

What, you are surely asking by now, does this history lesson have to do with

our conference on drugs in the workplace? Responding to today’s concerns,

if we are to curb the demand for illicit drugs, we are going to have to reach

the typical users of illicit drugs and convince them to stop. The key to doing

that is to invoke “job jeopardy,” as the practice was developed over several

decades in the alcohol field in the workplace: “If you come to work you

come drug free. If you use drugs you lose your job.”

That approach, as you have heard at this Conference, is central to the

current national strategy to end the drug epidemic, as well as to efforts to

contain the escalating costs of drugs in the workplace. These costs include

lost productivity, reduced competitiveness, and increased problems of health

and safety. Overall, I have estimated that American workers, whether or not

they use drugs and alcohol, are today paying an Average Chemical

Dependence Tax of $1,000 per year. The workplace drug abuse prevention

programs we are discussing today are the best hope of cutting that tax.

Two final points before I surrender the microphone today. First, the most

remarkable development of the last 20 years in our field of drug abuse

prevention has nothing to do with government action. It is the emergence

of mutual aid, the 12-step programs of Alcoholics Anonymous (AA),

Narcotics Anonymous (N.A.), Al-Anon, and Children of Alcoholics (COA)

and others, as the modern miracle of recovery, as a revolution in our midst.

These programs offer real hope of long-term recovery for individuals, for

families, and for communities.

Second, even as we learn the importance of focusing major antidrug efforts

on marijuana and cocaine, as we retarget on the employed or “casual” drug

user, we need to also remember the problems of drug abuse in the early

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years of the current epidemic. The “underclass” today are suffering from drug

abuse to a disproportionate extent. They are not fully participating in the

remarkable downturn in drug use in the United States during the last decade.

They suffer not only individually but collectively, especially because of the

family disorganization and violence caused by their drug use, especially their

use of crack cocaine, and from the spread of AIDS through needle sharing.

We also need to reemphasize the role of the criminal justice system to

identify and to help end drug problems in this relatively small but terribly

vulnerable segment of our population. Even as we gear up to deal with the

drug problem in mainstream America we need to avoid the mistakes of the

1970s by taking a one-track approach to our drug problems. Drug abuse in

America now has two faces: one in the middle class and the other in the

lower class. We need to have a drug policy that does not favor one or the

other but which pursues both with true commitment.

If we can learn that lesson, and apply it with determination over time, we

have the first real hope that the drug problem can be overcome in this

country. The outcome of this Conference will go a long way to answering

the question of whether, as a nation, we are tough enough to achieve that

goal.

In conclusion, let me salute the real heroes of our Conference, our leaders

Mike Walsh and Steve Gust. As the first Director of NIDA, I may be

forgiven some pride in the accomplishments of this distinguished

organization. None, in my estimation, has had a greater impact on the

national capacity to understand and overcome the drug problem, than have

the efforts of the workplace programs of the Division of Applied Research.

The beginning efforts on modern drug testing were based on the science

pioneered at NIDA. It was developed in the Department of Defense, with

NIDA’s technical assistance, over the last decade. NIDA has in the last few

years taken that experience from the DoD and brought it to civilian

employment. That has been an historic achievement for which NIDA can be

greatly proud.

The task of this “Drugs in the Workplace” Conference is to bring together

the leaders in this still-building field, to organize our current state of

experience and knowledge, and to point the way to the future for research

and practice. The goal is to help our country work drug free. That is a

critical subgoal of our overall objective of ending the drug problem in our

country. Today’s Conference is a giant step toward that goal.

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In 20 years I hope some of you will be at a meeting like this one talking

about what we have learned over those years. If you come to such a

meeting, I predict that you will look back on this Conference as an important

turning point in that effort.

Thank you.

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JEROME JAFFE

I’m glad to be here with these distinguished colleagues who, as Bob Dupont

has indicated, have had, collectively, more experience than we care to admit.

For a brief period of time, NIDA was sleeping, not recognizing the

importance of self-help groups, parents groups and drugs in the workplace,

but Bob DuPont was not. On his own, after he left NIDA, he has been

deeply involved in all of those issues. The bureaucracy is not always able to

respond to new developments or sometimes it just does not see them as

clearly as the private sector does.

I would like to address a few remarks to the concept of technology. At

various points in the history of the country’s social problems you have to

look at what resources or technology you have or should have to deal with

these problems. Then perhaps you need to invent new technology, or use

what you do have in different ways. New technology changes lives. There

is no question about it. New technology certainly changed the way we dealt

with the epidemics of drug abuse in the military in 1971. Just as TV and

computers, have changed lives, the availability of low cost reliable urine

testing, a new technology, is changing lives. We have to recognize that it’s

there.

There is always a question as to whether we can control the impact of a new

technology. It is clear that positive tests for drugs on urine samples are

correlated with poor performance, more accidents, more sick leave, and a

higher likelihood of dismissal whether you look at the military or the private

sector. That has been reasonably well established. Further, random urine

testing imposed upon a workforce results in a subsequent decreased

percentage of positive urine tests in that workforce, and an associated

decrease in accidents. I suppose such testing may even result in decreased

numbers of defects in some kinds of manufacturing situations. Random urine

testing probably brings users to the attention of EAP programs. These seem

to be reasonably reliable results. What are the problems associated with such

testing? Pre-employment testing can screen out the illicit users who are

generally less satisfactory employees, but what happens when we can’t attract

enough employees because the pool of competent people is shrinking? Right

now the President, who wants to be called the Education President, is

meeting with 50 governors talking about, not the drug crisis, although that

was in fact his first major address, but the fact that we are not training

- 231 -
enough people at a high enough level to fill the positions in industry. We

are just not training enough people at a high enough level. Yes, we can

begin to screen out people with pre-employment testing, and we can

discharge those that are positive when tested after employment. It looks cost

effective when you limit your unit of analysis to that particular industry. But

what happens if many industries begin to use the technology for the same

purpose. You do not take these people into the workforce; you have a

shrinking pool of people that you can recruit; the only way you can handle

that is to raise salaries. Over the long term, this is going to change your

cost benefit analysis. So that the time frame of the analysis is always an

issue that one has to look at.

But whether the cost benefit analysis comes out well or not, industry may not

have any choice as to whether to use this technology, because technology

brings with it its own imperatives, and its own standards for corporate

performance. Just as the advent of x-rays made taking an x-ray in certain

situations the minimally acceptable level of care, and just as that technology

has been superceded by the CAT-scan, corporations whose employees can

effect the safety of the public may be expected to take steps to detect and

eliminate drug and alcohol use by their employees whether they find it cost

effective or not. So the lawyers who sue people who don’t live up to a

standard level of performance may eventually dictate how the technology is

used. There are many doctors out there who don’t think we ought to be

using a CAT-scan every time somebody bumps his or her head. But then if

there are enough juries who say maybe you should have used a CAT-scan it

turns out to be cost effective, at least in the short term to do a CAT-scan

after a head bump. Such a process is what the private sector is going to

have to deal with. It is going to be very different for different industries, of

course. But my point here is that there is a new technology; it’s been shown

to effect the number of positive drug users. Now mischief is afoot. Of

course, it is not always mischief, but, in fact, we may not be able to decide

for ourselves just how much urine testing we are going to have to do. But,

for now, it looks like testing is going to be a permanent part of the

corporate American scene, at least I would suspect that this will turn out to

be the case.

NIDA will have a critical role in helping to shape the use of this technology,

primarily by fostering interchanges such as this one, and by continuing to

support the evolution of the technology itself, helping to make it less

expensive, less intrusive, and less subject to error. I don’t think that we

should anticipate that five years from now we will still be talking about urine

testing with all that it implies about intrusiveness. I have a feeling that

other techniques equally reliable, perhaps equally low in cost, may evolve.

- 232 -
I believe that EAP is an area which has major potential for reducing the

demand for drugs and in that I am in absolute agreement with Dr. Dupont.

Such programs are deserving of more investment and research on their

efficacy. I think that it is unfortunate that our universities, (at least most of

those that I am familiar with) feel that if research does not look like it may

yield the Nobel prize, it does not seem to be worthwhile. It is always

difficult to attract the best minds to look at service type research, and it is

going to be a challenge for NIDA to run against that current, to see that

such research is an important part of the National strategy.

I have some misgivings about emphasizing research on drug induced cognitive

psychomotor impairment which we heard about yesterday. I don’t think that

this is the best use of resources. I don’t think we need to demonstrate ad

nauseam that drugs can impair some types of cognitive and psychomotor

performance. I don’t even think that any amount of research in that area

will lead to useful policies in the real world. Now this may seem to be

heresy on the part of somebody working for an agency that funds this

research, but consider the following: the difference between individuals is

probably far greater than the difference between the very competent people

slightly impaired and the least competent people not impaired at all.

Michael Jordan, legally intoxicated, could outplay any two people at the

National Institute on Drug Abuse on the basketball court when they are

stone sober. To show that a half of an antihistamine will reduce somebody’s

performance on a digit-symbol substitution test does not impress me at all

as leading to any sensible kind of policy. Stop every tenth car on Wisconsin

Avenue, and you may find somebody who is driving whose vision is impaired.

You have great difficulty therefore, in justifying your urine testing on the

idea that drugs impair performance. You do not have any difficulty saying

that society has the right to decide what is acceptable behavior, and we

have decided in this country that using illicit drugs is not. That is all you

really need. I do not think that we should be justifying a testing program

on the issue that sometimes if you use a drug a day later you might have an

impaired score on the digit-symbol substitution test. I believe that if we

emphasize this aspect too much, it will lead us into areas that we just won’t

be able to deal with. There are a wide range of therapeutic drugs that are

not illicit but also affect performance. If your real concern is the effect of

drugs on performance what do you expect to do in the workforce about

antidepressant drugs, about anti-epileptic drugs, about drugs used for

hypertension, drugs used for heart disease, drugs used for allergy, and cancer?

Although most of these are not necessarily directed at the central nervous

system, they get into the CNS and they do impair performance. So you have

to be careful walking down that path as a justification.

- 233 -
We should not be required to show there’s impairment to justify a national

concern. I would suggest that the focus should shift more and more to

questions on how EM programs can best alter the behaviors of those found

to be using drugs on the basis of urine testing. However, to say that such

drug use is altered by EAP’s Is not enough. We need to know the relative

contributions of the counseling and of the urine test itself with its impact

and the implied contingency contracts that are associated with it. We need

to know whether cessation of use by an individual is of long duration, and

is associated with increased productivity. And we need to know more and

more about the costs and benefits of the intervention system. Here I want

to come back to the point I made in the beginning. It is critical that you

think carefully about the size of the unit for that kind of cost benefit

analysis. Let me give you an example. You heard about a particular power

company that found that if they detected drug use and they fired everybody

that was positive, it was cost effective. From the perspective of that company

it was cost effective, but if you did the analysis on the basis of how many of

those people that were fired picked up unemployment insurance, how long

it took them to get back to work, and who had to retrain them for other

jobs that they had been trained for, you might have found a very different

kind of cost benefit analysis. In point of fact, even had the cost benefit

analysis shown that you only got back 90 cents on the dollar invested trying

to rehabilitate those people, if you had taken a broader view of the problem

you might have found that it was better to do that than to simply fire them.

Now, if that turns out to be the case when such broad based analyses are

finally carried out, we are going to have to find ways at the National level

to motivate the corporations to invest a dollar when the corporations only

get back 90 cents. Because, if they take the narrow view, which is - let’s

export our problem to the community or to some other corporation,

ultimately this is going to be a vicious circle, in which impaired people are

not going to get jobs at all or they are going to get jobs in other companies

only to get fired again. This does not do anybody any good. This is a

problem that Dr. Kleber I’m sure will address as he thinks of ways to

motivate corporate America to invest in this very important approach to

reducing demand.

These are the kinds of studies that I hope NIDA will get into. I think I

made the point that this is an essential area for reducing demand, but we

need to be very sophisticated about how we analyze our impact and most of

all we need to realize that we are just beginning in the last few years to

build this system of demand reduction. It may take us at least another

decade to understand how best to use this technology. If we are going to do

that we need to be investing more and more in research, on its efficacy, and

the techniques that we can use to improve it.

- 234 -
HERBERT KLEBER

I should like to begin by echoing some of the points that have already been

made. I applied for my first grant in the late sixties to treat drug addicts.

The person I went to for a critique of my first grant before I submitted it

was Jerry Jaffe who I consider the “mavin”. I remember in the mid seventies

being on the first advisory council to NIDA when Dr. DuPont was its

director. I certainly have benefited substantially from the work that Dr. Bob

Schuster has done. So I’m the new guy on the block. I don’t know about

this age thing that Bob DuPont was talking about - all of us being in the

same bracket. I see these three guys in the same bracket and I am the

youngster.

Bob DuPont’s point was very well taken - that involuntary treatment can

work. There is increasing evidence, for example, the civil commitment study

from California that Doug Anglin has described, which indicates that, if

carried out properly, it can work very well.

The new Strategy proposed by the President and the Office of National Drug

Control Policy stresses the importance of the casual drug user as an

important vector for the problem of drug use and abuse. That is, once you

become an addict you are not a very attractive individual. No one wants to

be like the addict - the more burned out he is, the less likely he is to be a

good role model. The casual user, on the other hand, gives the message you

can have it all. You can use drugs, enjoy their pleasurable effects and still

keep your job, your health, your family, and your material possessions. By

the time such persons get into trouble with drugs, they often have lost their

jobs and people don’t see them. The new role model is the new casual user.

In many ways, therefore, the casual user is the vector, the spreader of the

disease, much more so than the addict. It is rare that individuals purchase

their drugs initially. They are usually given to them by someone they know,

a so called friend, an older sibling, someone at the workplace. That is one

of the key reasons why the Strategy says if we are really going to get a

handle on this problem, we have to look at such individuals and, as has been

pointed out, once they are out of school, they are most likely to be in the

workplace. Most poor people don’t use drugs and most of the people that

use drugs are not poor. They are working and you find them in the

workplace. So if we are going to do something about the demand side of

drug abuse, the workplace is one of the most crucial parts of that crucial

part of the Strategy.

- 235 -
We feel it is very important in the private sector that employers establish

tough and yet fair drug policies that communicate expectations of behavior

but also are fair as far as employees’ rights and responsibilities, and describe

what actions will be taken in response to an employee found using illegal

drugs. A drug-free workplace means a number of things. It means that

casual use is reduced or eliminated altogether and it means getting treatment

for those who need it. How are casual users and non-users dissuaded? - by

unambiguously communicated policies and expectations. Surveys tell us that

casual users - not altogether but to a great extent - are dissuaded by fear of

being caught if there are very clear consequences once they are caught. The

likelihood of being caught can be increased in a number of ways - by urine

testing as we have heard, but also by well trained supervisors, and by the

kind of workplace in which peers are comfortable reporting the use of their

fellow workers. I want to return to that as one of the lesser utilized models

in the workplace and one I believe should be given more emphasis. There

is also an important responsibility to get those who are in trouble with drugs

into treatment. Employers have incentive and reasons: it’s the humane thing

to do: if addiction can be prevented it is beneficial for the individual as well

as for the company; economic and social costs are reduced; and, finally it

provides hope for others. Given the contagiousness of drug use, the larger

the number of people who use, the greater the pressure on non-users.

What do I see are the questions that we need to research? Let’s start with

EAPs. How effective are they? How often do they actually refer someone

to treatment for drugs? How many EAP’s do routine screening tests for

drugs? Once they identify individuals as having drug or alcohol problems,

do they get them into the appropriate treatment modality? Prior to my

present position, I served on an IOM (Institute of Medicine) task force

looking at how substance abuse treatments should be funded. I remember

our very first meeting when we heard from one of the largest EAP referral

firms in the country and the woman described how she decided what program

to refer people to. The first item was they had to be a 12-step program and

then went on to list other items. During the question period I asked “...on

what empirical basis do you decide that these programs are the ones you

should refer to? Do you have any follow-up data that the people you refer

to these programs do well? How are they doing six months later? Do you

have any idea how well a program works in terms of the number of people

who remain?” She said “...well. I visit the program and I can tell by the

feeling in the pit of my stomach whether these are good programs”. I

thought “...if this is one of the largest firms in the country and decisions are

being made by what this woman feels in the pit of her stomach, the field is

in trouble...”. We can’t continue to rely on that.

- 236 -
There need to be much better outcome studies. EAPs need to have data on

who they are referring, what happens to them, what kind of programs have

what outcome? Should EAPs be accredited? In the vocational field there

is an organization called CARF which accredits vocational programs. In the

hospital field we have JCAH (Joint Commission on Accreditation of

Hospitals). We ought to have some similar, not for profit, national agency

that evaluates EAPs. That way employers would have a better idea of what

they are paying for and whether they are getting what they need. It is not

clear how best they should be evaluated. I am not an expert on EAPs but

I am sure there are reasonably good ways of doing that. That idea was given

to me a couple of weeks ago by Dale Masi who I believe is one of the

experts in this field. I think it is something the field should go ahead with.

Are supervisors effective in detecting problems or is it more often the fellow

workers? In talking to people working in factories, it seems the people who

know best who are using drugs are the co-workers. They are probably much

more likely to know than the supervisors. What kind of milieu do you set

up that makes it more likely that a peer will refer someone to an EAP, or

to the supervisor? It seems to me intuitively, that peers are more likely to

refer if they believe that the person will get help rather than get fired. And

so employer policies that say in essence "...you will be fired the first time

you are caught...” will probably mean that you get minimal to no peer

referrals. That is what used to happen in the railroad industry before they

instituted the Rule G bypass.

The numbers from the military random drug testing programs are

encouraging as to what can be accomplished in industry. One of the studies,

however, that I would like to see done on a cooperative basis, perhaps

something between NIDA, the Defense Department, and the VA, is what

happens to those individuals who are discharged from the military because

of failing the drug testing. I think that might answer some of the questions

that Dr. Jaffe raised about the civilian workforce. It should be a much easier

group to follow. It is a relatively small group (compared to other

populations) of individuals; we have a fair amount of data on them; about

what their life was like before they went into the military, and we should be

able to find out, what’s happened. I believe it is an important area of data

that we need to find out.

Do we really know how good drug testing that is not random is in terms of

yielding effective results? There are four types of testing: pre-employment,

incident driven, on suspicion, and random. Random is the primary one that

is a lightning rod. In general, both employers and employees can accept the

first three kinds of testing, with some exceptions. It would be nice to have

some studies done. What do you pick up by those first three? How much

do you lose by not having random? As a scientist, I would like to see

- 237 -
decisions driven by data to the extent possible. What is the cost feasibility

of drug testing for average size businesses, and for the small business? We

believe that illicit drug use per se is wrong, and that a positive urine is

grounds for referring to treatment or counseling if the worker has a drug

problem or posing sanctions saying you can lose your job. But for the small

business of fifty to 100 employees, is this cost effective to them? How do

the really small businesses in America, the 10 to 50 employee group provide

for drug free workplaces? Is urine testing the way to go? Or will peer

referral and supervisor training to pick up drug use be more efficient and

cost effective?

Finally, the Federal Government has started to set an example of a drugfree workplace for its own employees. But more needs to be done nationally.

We should be citing model programs as the Department of Labor has begun

to do. What can be done to improve state laws? One of the complaints I

get from large industries that operate in various states is that some of the

laws about urine testing in different states make it very hard to have uniform

policies. A state like Vermont which I understand has very restrictive laws

makes it hard for an interstate company to apply the same policy there that

they apply in a different state. We are working on developing model state

laws that could be used for all states. They may not adopt them but at least

that is an initiative that our office can take.

How can changes in insurance coverage help bring about a drug-free

workplace and insure appropriate treatment? The upcoming IOM study

may give us some answers on that. It is a crucial item. If an individual is

found out to be impaired and needs to be referred for treatment, it is

important there be some way for that person to get treatment either via

insurance or categorical programs provided via the block grant. We know

there are problems with mandated insurance, such as more major employers

dropping out or self-insuring than when not covered by mandates. It is a

tricky issue.

After treatment, how often is there successful reintegration into the

workplace? Again, we do not have enough data. The Exxon Valdez episode

is causing major reverberations across the workplace scene, as employers

ponder the question should they be taking people back into jobs of

responsibility who have had significant substance abuse problems. If the field

wants business to do it, professionals need to provide the appropriate data

on outcome success. Finally, what can be done to improve the likelihood

and success of reintegration into the workplace both for those individuals

who had to be let go because they have failed more times than that company

is prepared to accept or those who are not in the workplace because they

keep failing that pre-screening? Are we going to come up with a large group

of unemployables? Let me stop with those series of questions.

- 238 -
AUTHORS

Robert L. DuPont, M.D.

President

Institute for Behavior and Health;

Clinical Professor of Psychiatry

Georgetown University of Medicine

6191 Executive Boulevard

Rockville, Maryland 20852

and

Jerome H. Jaffe, M.D.

Senior Science Advisor

Office of the Director

National Institute on Drug Abuse

5600 Fishers Lane

Room 10-05

Rockville, Maryland 20857

and

Herbert D. Kleber, M.D.

Deputy Director for Demand Reduction

Office of National Drug Control Policy

Executive Office of the President

Washington, D.C. 20500

- 239 -

While limited supplies last, single copies of the monographs may be obtained

free of charge from the National Clearinghouse for Alcohol and Drug

Information (NCADI). Please contact NCADI also for information about

availability of coming issues and other publications of the National Institute

on Drug Abuse relevant to drug abuse research.

Additional copies may be purchased from the U.S. Government Printing

Office (GPO) and/or the National Technical Information Service (NTIS) as

indicated. NTIS prices are for paper copy. Microfiche copies, at $6.95, are

also available from NTIS. Prices from either source are subject to change.

Addresses are:

NCADI

National Clearinghouse for Alcohol and Drug Information

P.O. Box 2345

Rockville, Maryland 20852

GPO

Superintendent of Documents

U.S. Government Printing Office

Washington, D.C. 20402

NTIS

National Technical Information Service

U.S. Department of Commerce

Springfield, Virginia 22161

- 241 -
For information on availability of NIDA Research Monograph 1-24

(1975-1979) and other not listed, write to NWA Office for Research

Communications, Room 10A-54, 5600 Fishers Lane, Rockville, MD

20857.

25 BEHAVIORAL ANALYSIS AND TREATMENT OF SUBSTANCE ABUSE. Norman

A. Krasnegor, Ph.D., ed.

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26 THE BEHAVIORAL ASPECTS OF SMOKING. Norman A Krasnegor, Ph.D., ed.

(Reprint from 1979 Surgeon Generals Report on Smoking and Health.)

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NTIS PB #80-118755 $18.95

30 THEORIES ON DRUG ABUSE: SELECTED CONTEMPORARY PERSPECTIVES.

Dan J. Lettieri, Ph.D.; Mollie Sayers; and Helen W. Pearson, eds.

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31 MARIJUANA RESEARCH FINDINGS: 1980. Robert C. Petersen, Ph.D., ed.

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32 GC/MSASSAYS FOR ABUSED DRUGS IN BODY FLUlDS. Rodger L. Foltz. Ph.D.;

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36 NEW APPROACHES TO TREA’MENT OF CHRONIC PAIN:AREVIEW OF MULTIDISCIPLINARY PAIN CLINICS AND PAIN CENTERS. Lorenz K.Y. Ng, M.D., ed.

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37 BEHAVIORAL PHARMACOLOGY OF HUMAN DRUG DEPENDENCE. Travis

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38 DRUG ABUSE AND THE AMERICAN ADOLESCENT. Dan J. Lettieri, Ph.D., and

Jacqueline P. Ludford, M.S., eds. A RAUS Review Report.

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40 ADOLESCENT MARlJUANA ABUSERS AND THEIR FAMILlES. Herbert Hendin,

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42 THE ANALYSIS OF CANNABINOIDS IN BIOLOGICAL FLUIDS. Richard L.

Hawks, Ph.D.. ed.

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44 MARIJUANA EFFECTS ON THE ENDOCRINE AND REPRODUCTIVE SYSTEMS. Monique C. Braude, Ph.D., and Jacqueline P. Ludford, M.S.. eds. ARAUS Review

Report.

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45 CONTEMPOBARY RESEARCH IN PAIN AND ANALGESIA, 1983. Roger M.

Brown, Ph.D.; Theodore M. Pinkert, M.D., J.D.; and Jacqueline P. Ludford, M.S.,eds. A

RAUS Review Report.

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46 BEHAVIORAL INTERVENTION TECHNIQUES IN DRUG ABUSE TREATMENT.

John Grabowski, Ph.D.; Maxine L. Stitzer, Ph.D., and Jack E. Henningfield, Ph.D., eds.

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47 PREVENTING ADOLESCENT DRUG ABUSE: INTERVENTION STRATEGIES.

Thomas J. Glynn, Ph.D.; Carl G. Laukefeld, D.S.W.; and Jacqueline P. Ludfoni, M.S., eds.

A RAUS Review Report.

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48 MEASUREMENT IN THE ANALYSIS AND TREATMENT OF SMOKING BEHAVIOR. John Grabowski, Ph.D., and Catherine S. Bell, M.S., eds.

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59 COCAINE: PHARMACOLOGY, EFFECTS, AND TREATMENT OF ABUSE. John

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51 DRUG ABUSE TREATMENT EVALUATION: STRATEGIES, PROGRESS, AND

PROSPECTS. Frank M. Tims, Ph.D., ed.

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52 TESTING DRUGS FOR PHYSICAL DEPENDENCE POTENTIAL AND ABUSE

LIABILITY. Joseph V. Brady, Ph.D., and Scott E. Lukas, Ph.D., eds.

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53 PHARMACOLOGICAL ADJUNCTS IN SMOKING CESSATION, John Grabowski,

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64 MECHANISMS OF TOLERANCE AND DEPENDENCE. Charles Wm. Sharp,

Ph.D., ed.

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66 ETIOLOGY OF DRUG ABUSE: IMPLICATIONS FOR PREVENTION. Coryl

LaRue Jones, Ph.D., and Robert J. Battjes, D.S.W., ede.

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87 SELF-REPORT METHODS OFESTIMATING DRUG USE: MEETING CURRENT

CHALLENGES TO VALIDITY. Beatrice A Rouse, Ph.D., Nicholas J. Kozel, M.S.. and

Louise G. Richards, Ph.D., eds.

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58 PROGRESS IN THE DEVELOPMENT OF COST-EFFECTIVE TREATMENT FOR

DRUG ABUSERS. Rebecca S. Ashery, D.S.W., ed.

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59 CURRENT RESEARCH ON THE CONSEQUENCES OF MATERNAL DRUG

ABUSE. Theodore M. Pinkert M.D., J.D., ed.

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60 PRENATAL DRUG EXPOSURE: KINETICS AND DYNAMICS. C. Nora Chiang,

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61 COCAINE USE IN AMERICA EPIDEMIOLOGIC AND CLINICAL PERSPECTIVES. Nicholas J. Kozel, M.S.. and Edgar H. Adams, M.S., eds.

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62 NEUROSCIENCE METHODS IN DRUG ABUSE RESEARCH. Roger M. Brown,

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63 PREVENTION RESEARCH: DETERRING DRUG ABUSE AMONG CHILDREN.

AND ADOLESCENTS. Catherine S. Bell, M.S., and Robert J. Battjes, D.S.W., eds.

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64 PHENCYCLIDINE: AN UPDATE. Doris H. Clouet, Ph.D., ed.

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65 WOMEN AND DRUGS: A NEW ERA FOR RESEARCH. Barbara A Ray, Ph.D.,and

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66 GENETIC AND BIOLOGICAL MARKERS IN DRUG ABUSE AND ALCOHOLISM.

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69 STRATEGIES FOR RESEARCH ON THE INTERACTIONS OF DRUGS OF ABUSE.

Monique C. Braude, Ph.D., and Harold M. Ginzburg, M.D., J.D., M.P.H., eds.

GPO Stock #017-024-01296-3 $6.50

69 OPIOID PEPTIDES: MEDICINAL CHEMISTRY. Rao S. Rapaka, Ph.D.; Gene

Barnett, Ph.D.; and Richard L. Hawks, Ph.D., eds.

GPO Stock #017-024-1297-1 $11

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70 OPIOID PEPTIDES: MOLECULAR PHARMACOLOGY, BIOSYNTHESIS, AND

ANALYSIS. Rao S. Rapaka, Ph.D., and Richard L. Hawks, Ph.D., eds.

GPO Stock #017-024-1298-0 $12

71 OPIATE RECEPTOR SUBTYPES AND BRAIN FUNCTION. Roger M. Brown,

Ph.D.; Doris H. Clouet, Ph.D.; end David P. Friedman, Ph.D., eds.

GPO Stock #017-024-1303-0 $6

72 RELAPSE AND RECOVERY IN DRUG ABUSE. Frank M. Time, Ph.D., and Carl G.

Leukefeld, D.S.W., eds.

GPO Stock #017~24-01302-1 $6

73 URINE TESTING FOR DRUGS OF ABUSE. Richard L. Hawks, Ph.D., and C. Nora

Chiang, Ph.D., eds.

GPO Stock #017-024-1313-7 $3.75

74 NEUROBIOLOGY OF BEHAVIORAL CONTROL IN DRUG ABUSE. Stephen I.

Szara, MD., D.Sc., ed.

GPO Stock #017-024-1314-5 $3.75

75 PROGRESS IN OPIOID RESEARCH PROCEEDINGS OF THE 1986 INTERNATIONAL NARCOTICS RESEARCH CONFERENCE. John W. Holaday, Ph.D.; Ping-Yee

Law, Ph.D.; and Albert Herz. M.D., eds.

GPO Stock #017-024-01315-3 $21

76 PROBLEMS OF DRUG DEPENDENCE, 1986. PROCEEDINGS OF THE 48TH

ANNUAL SCIENTIFIC MEETING, THE COMMlTTEE ON PROBLEMS OF DRUG DEPENDENCE, INC. Louis S. Harris, Ph.D., ed.

GPO Stock #017-024-1316-1 $16

NTIS PB #88-208111/AS $44.96

77 ADOLESCENT DRUG ABUSE: ANALYSES OF TREATMENT RESEARCH. Elizabeth R. Rahdert, Ph.D., and John Grabowski, Ph.D., eds.

GPO Stock #017-024-1348-0 $4

78 THE ROLE OF NEUROPLASTICITY IN THE RESPONSE TO DRUGS. David P.

Friedman, Ph.D., and Doris H. Clouet Ph.D., eds.

GPO Stock #017-024-01330-7 $6

79 SI’RUCTURE-ACTIVITY RELATIONSHIPS OF THE CANNABINOIDS. Rao S.

Rapaka, Ph.D., end Alexandros Makriyannis, Ph.D., eds.

GPO Stock #017-024-01331-5 $6

80 NEEDLE-SHARING AMONG INTRAVENOUS DRUG ABUSERS: NATIONAL

AND INTERNATIONAL PERSPECTIVES. Robert J. Battjes, D.S.W.. and Roy W.

Pickens, Ph.D., eds.

GPO Stock #017-024-01345-5 $5.50

NTIS PB #88-236138/AS $25.95

81 PROBLEMS OF DRUG DEPENDENCE, 1987. PROCEEDINGS OF THE 49TH

ANNUAL SCIENTIFIC MEETING,THE COMMI’ITEE ON PROBLEMS OF DRUG DEPENDENCE, INC. Louis S. Harris, Ph.D., ed.

GPO Stock #017-01354-4 $17

82 OPIOIDS IN THE HIPPOCAMPUS. Jacqueline F. McGinty, Ph.D., and David P.

Friedman. Ph.D. eds.

GPO Stock #017-024-01344-7 $4.25

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83 HEALTH HAZARDS OF NlTRITE INHALANTS. Harry W. Haverkos, M.D., and

John A Dougherty, Ph.D., eds.

GPO Stock #017-024-01351-0 $3.25

84 LEARNING FACTORS IN SUBSTANCE ABUSE. Barbara A. Ray, Ph.D., ed.

GPO Stock #017-024-01353-6 $6

85 EPIDEMIOLOGY OF INHALANT ABUSE: AN UPDATE. Raquel A. Crider, Ph.D.,

and Beatrice A Rouse, Ph.D., eds.

GPO Stock #017-024-01360-9 $5.56

86 COMPULSORY TREATMENT OF DRUG ABUSE: RESEARCH AND CLINICAL

PRACTICE. Carl G. Leukefeld, D.S.W., and Frank M. Tims. Ph.D., eds.

GPO Stock #017-024-01352-8 $7.50

87 OPIOID PEPTIDES: AN UPDATE. Rao S. Rapaka. Ph.D., and Bhola N. Dhawan,

M.D., eds.

GPO Stock #017-024-01366-8 $7

86 MECHANISMS OF COCAINE ABUSE AND TOXICITY. Doris H. Clouet, Ph.D.,

Khursheed Asghar, Ph.D., and Roger M. Brown, Ph.D., eds.

GPO Stack #017-024-01359-5 $11

69 BIOLOGICAL VULNERABILITY TO DRUG ABUSE. Roy W. Pickens, Ph.D., and

Dace S. Svikir, B.A.. eds.

GPO Stock #017-022-1054-2 $5

90 PROBLEMS OF DRUG DEPENDENCE, 1988 PROCEEDINGS OF THE 50TH

ANNUAL SCIENTIFIC MEETING, THE COMMlTTEE ON PROBLEMS OF DRUG

DEPENDENCE, INC. Louis S. Harris, Ph.D., ed.

GPO Stock #017-024-01362 $17

91 DRUGS IN THE WORKPLACE: RESEARCH AND EVALUATION DATA Steven W.

Gust., Ph.D.; and J. Michael Walsh, Ph.D., eds.

GPO Stock #017-024-01384-6 $10

NTIS PB #90-147257/AS $39

92 TESTING FOR ABUSE LIABILITY OF DRUGS IN HUMANS. Marian W. Fischman. Ph.D.; and Nancy K Mello, PH.D., eds.

GPO Stock #017-024-01388-9 $10

NTIS PB 1190-148941/AS $39

93 AIDS AND INTRAVENOUS DRUG USE: FUTURE DIRECTIONS FOR COMMUNlTY-BASED PREVENTI ONRESEARCH. C.G. Leukefeld, D.S.W.; R.J. Battjea,D.S.W.;

and Z. Amsel. Ph.D., eds.

GPO Stock #017-024-01388-9 $10

NTIS PB #90-146958/AS $39

94 PHARMACOMGY AND TOXOCOLOGY OF AMPHETAMINE AND RELATED

DESIGNER DRUGS. Khursheed Asghar, Ph.D.; Errol De Souza, Ph.D., eds.

GPO Stock #017-024-01386-2 $11

NTIS PB #90-148958 /AS $39

95 PROBLEMS OF DRUG DEPENDENCE, 1989 PROCEEDINGS OF THE 51st

ANNUAL SCIENTIFIC MEETING. THE COMMITTEE ON PROBLEMS OD DRUG

DEPENDENCE, INC., Louis s. Harris, Ph.D., ed.

GPO Stock #017-024-01299-4 $21

NTIS PB #90-237460/AS $67

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96 DRUGS OF ABUSE: CHEMISTRY, PHARMACOLOGY, IMMONOLOGY AND AIDS.

Phuong Thi Kim Pham, Ph.D., and Kenner Rice, Ph.D., eds.

GPO Stock #017-024-01404-4 $8

NTIS PB #90-237678/AS $31

97 NEUROBIOLOGY OF DRUG ABUSE: LEARNING AND MEMORY. Lynda Erinoff. ed

GPO Stock #017-024-01407-9 $8

NTIS PB #90-237-686 $31

98 THE COLLECTION AND INTERPRETATION OF DATA FROM HIDDEN POPULATIONS.

Elizabeth Y. Lambert, M.S., ed

GPO 017-024-01407-9 $4.75

NTIS PB #90-237-694/AS $23

99 RESEARCH FINDINGS ON SMOKING OF ABUSED SUBSTANCES. C. Nora Chaing, PhD.,

and Richard L. Hawks, Ph.D., eds.

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DHHS Publication No (ADM) 91-1730

Alcohol, Drug Abuse. and Mental Health Administration

Printed 1991