DRUGS IN THE

WORKPLACE

RESEARCH

and

EVALUATION DATA

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Public Health Service • Alcohol, Drug Abuse, and Mental Health Administration
DRUGS IN THE WORKPLACE:

Research and Evaluation Data

Editors:

Steven W. Gust, Ph.D.

J. Michael Walsh, Ph.D.

Office of Workplace Initiatives

National Institute on Drug Abuse

NIDA Research Monograph 91

1989

U.S. Department of Health and Human Services

Public Health Service

Alcohol, Drug Abuse, and Mental Health Administration

National Institute on Drug Abuse

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Rockville, MD 20857

For sale by the Superintendent of Documents, U.S. Government Printing Office

Washington, D.C. 20402
NIDA Research Monographs are prepared by the research divisions of the

National Institute on Drug Abuse and published by its Office of Science. The

primary objective of the series is to provide critical reviews of research problem

areas and techniques, the content of state-of-the-art conferences, and integrative research reviews. Its dual publication emphasis is rapid and targeted dissemination to the scientific and professional community.

Editorial Advisors

Martin W. Adler, Ph.D.

Temple University School

of Medicine

Philadelphia, Pennsylvania

Sydney Archer, Ph.D.

Rensselaer Polytechnic Institute

Troy, New York

Richard E. Belleville, Ph.D.

NB Associates, Health Sciences

Rockville, Maryland

Theodore J. Cicero, Ph.D.

Washington University School

of Medicine

St. Louis, Missouri

Mary L. Jacobson

National Federation of Parents

for Drug-Free Youth

Reese T. Jones, M.D.

Langley Porter Neuropsychiatric

Institute

San Francisco, California

Karat J. Besteman

Alcahol and Dmg Problems

Association of North America

Washington, D.C.

Gilbert J. Botvin, Ph.D.

Cornell University Medical College

New York, New York

Joseph V. Brady, Ph.D.

The Johns Hopkins University

School of Medicine

Baltimore, Maryland

Denise Kandel, Ph.D.

College of Physicians and

Surgeons of Columbia University

New York, New York

Herbert Kleber, M.D.

Yale University School of Medicine

New Haven, Connecticut

Richard Russo

New Jersey State Department

of Health

Trenton, New Jersey

NIDA Research Monograph Series

Charles R. Schuster, Ph.D.

Director, NIDA

Theodore M. Pinkert, M.D., J.D.

Acting Associate Director for Science, NIDA
DRUGS IN THE WORKPLACE:

Research and Evaluation Data
ACKNOWLEDGMENT

This monograph is based upon papers presented at a conference titled “Drugs in

the Workplace: Research and Evaluation Data” which was held on September

15th and 16th, 1988 in Washington, D. C. The conference was sponsored by the

Office of Workplace Initiatives, 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

maybe 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 or company names appearing in this publication are used

only because they are considered essential in the context of the studies reported

herein.

DHHS publication number (ADM) 89-1612

Alcohol, Drug Abuse, and Mental Health Administration

Printed 1989

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

selectively included in the coverage of American Statistics Index, Biosciences

Information Service, Chemical Abstracts, Current Contents, Psychological

Abstracts, and Psychopharmacology Abstracts.

iv
TABLE OF CONTENTS

Introduction and Summary

Research on the Prevalence, Impact, and Treatment

of Drug Abuse in the Workplace 3

Steven W. Gust and J. Michael Walsh

Prevalence of Drug Use by the Workforce

Drug Use Among Working Adults: Prevalence Rates

and Estimation Methods 17

Royer F. Cook

Patterns of Drug Use: Data From the 1985 National

Household Survey 33

Harwin L. Voss

Drug Use by Tractor-Trailer Drivers 47

Adrian K. Lund, David F. Preusser,

Richard D. Blomberg, and Allan F. Williams

Drug Use Trends in a Nuclear Power Company:

Cumulative Data From an Ongoing Testing Program 69

Carl E. Osborn and Jacque J. Sokolov

Drug Monitoring in the Workplace: Results From the

California Commercial Laboratory Drug Testing Project 81

M. Douglas Anglin and Caron A. Westland

Results of the Drug Testing Program at Southern

Pacific Railroad 97

Robert W. Taggart

Relationship of Drug Use to Performance and Productivity

An Empirical Evaluation of Preemployment Drug

Testing in the United States Postal Service:

Interim Report of Findings 111

Jacques Normand and Stephen Salyards

Early Employment Testing for Marijuana:

Demographic and Employee Retention Patterns 139

David L. Blank and John W. Fenton

v
Does Pre-Employment Drug Use Predict On-the-Job

Suitability? 151

Michael A. McDaniel

A Critical Evaluation of the Utah Power and Light

Company’s Substance Abuse Management Program:

Absenteeism, Accidents and Costs 169

Dennis J. Crouch, Douglas O. Webb,

Lynn V. Peterson, Paul F. Buller, and

Douglas E. Rollins

An Evaluation of Drug Testing in the Workplace 195

John R. Sheridan and Howard Winkler

Industry Responses to Drugs in the Workplace

Characteristics of Firms With Drug Testing Programs 219

Helen Axel

Drug Abuse Services and EAPs: Preliminary Report

on a National Study 227

Thomas E. Backer

The Presence and Integration of Drug Abuse

Intervention in Human Resource Management 245

Terry C. Blum

The Use of EAPs in Dealing With Drug Abuse

in the Workplace 271

Paul M. Roman

Emerging Issues / Research Directions

Revisiting the Role of the Supervisor in Employee

Assistance Programs 289

Bradley Googins

State Legislation: Effects on Drug Programs

in Industry 305

Robert T. Angarola and Samia N. Rodriguez

Building a Cumulative Knowledge Base About

Drugs and the Workplace 319

Dean R. Gerstein and Esta Grossman

vi
Introduction and Summary

Research on the Prevalence, Impact, and

Treatment of Drug Abuse in the Workplace

Steven W. Gust, Ph.D. and J. Michael Walsh, Ph.D

Office of Workplace Initiatives, NIDA

The late 1980’s have seen unprecedented growth in awareness and

concern over drug use and its toll on the health and productivity of

Americans. In the last several years this increase in interest has been

fueled in part by societal perceptions. Dramatic incidents of drugrelated violence and death-witness the deaths of sports celebrities Len

Bias and Don Rogers, the sudden and widespread emergence of “crack”

cocaine, and the record-breaking murder rate in the Nation’s Capital—

shape public opinion in powerful ways. There have also been striking

examples of drug-related workplace disasters. In 1987, in Chase MD a

Conrail engineer admitted smoking marijuana just before his train was

involved in a collision with an Amtrak train which resulted in 16 deaths

and scores of injuries. These dramatic drug-related events serve to

highlight a more general societal concern about drugs. Indeed several

public opinion polls over the last several years have found that drugs are

perceived as the number one problem facing the U.S. Workplace-related

drug use and its consequences are obviously important components of

this problem, and the workplace has immense potential as the focal point

of significant activities to decrease drug use and its adverse consequences (Walsh and Gust,1989).

There has been an important public and private sector reponse to these

concerns reflected in a two-pronged strategy to reduce the supply of and

the demand for drugs. Demand reduction strategies hold the most

promise for long term reduction of use and include programs to reduce

workplace-related drug use. Employee assistance programs (EAPs)

have begun to expand their focus to include identification and referral of

drug-impaired employees and offer great potential for reducing workplacerelated drug use. The number of EAPs has grown dramatically until

today approximately 30 percent of employed Americans have access to

an EAP (Bureau of Labor Statistics, 1989). A second and more controversial strategy for reducing demand for drugs is drug testing. The application of urinalysis techniques to detect recent drug use has been

3
adopted by a majority of the largest employers in the U.S. and today

approximately 20 percent of all employed Americans work in a business

with a drug testing policy (Bureau of Labor Statistics, 1989).

Given that a large majority of the adult population of the U.S. is

employed, worksite programs have unique potential for success in

reducing drug use and its adverse consequences in a large proportion of

the drug using population. The social and fiscal contingencies tied to

employment provide the basis for potentially powerful techniques to

modify behavior. Mechanisms are in place for observing performance,

for setting standards for performance, and for establishing sanctions to

enforce those standards.

Missing, however, is the systematic research database on the extent of

workplace-related drug use, its impact on performance and productivity,

and on the efficacy ofvarious workplace-based strategies to reduce drug

use and its consequences. Such a database is required for the sound

design, implementation, and revision of effective workplace drug abuse

policies. NIDA, in its leadership role within the Federal government in

support of research on the causes, consequences, prevention, and treatment of drug abuse, is interested in supporting research to examine

these issues. The Office of Workplace Initiatives, within NIDA, seeks to

focus these efforts by fostering research and evaluation studies on issues

related to drugs and the workplace. Systematic research and evaluation

should provide a scientific base ofinformation which will provide government and private sector policymakers with a sound basis for future

development of workplace drug programs.

This applied research program represents a new direction for NIDA Research in non-clinical, non-laboratory environments has not been a focus

at NIDA primarily due to the costliness and difficulty in designing and

performing scientifically acceptable research in “real world” settings.

However, the application of sound scientific principles to these problems

must be encouraged and supported. This effort promises to provide a

valuable source of valid information upon which policy decisions can be

made. Indeed, the responsibility to address these problems rests

squarely on the shoulders of the behavioral science community.

In an effort to bring together researchers working in the area and to

begin a dialogue between the research community and the business

community, the Office of Workplace Initiatives sponsored a conference

in September of 1988. The research represented here in this resulting

monograph is very much state-of-the-field in this somewhat nascent

area and, as such, may not in all cases meet the most rigorous standards

for research methodology. However, as a body of research it accurately

4
describes the current state of research and evaluation activities going on

in work environments in the drug abuse area and should serve to alert

and motivate the concerned researcher about the need and opportunity

for addressing some of these important issues. The studies contained

herein can be divided into three primary topic areas: prevalence of drug

use by the workforce, drug use and job performance, and workplacebased efforts to prevent drug use and treat drug abusers.

Prevalence of Drug Use by the Workforce

National estimates of drug use in workplace populations have been

difficult to find but represent one of the most frequent data requests from

the Office of Workplace Initiatives. Several papers in this monograph,

utilizing survey data from national samples, demonstrate that drug use

is not simply a problem among unemployed people or students, but that

significant drug use is occurring among employed people. The papers by

Cook and Voss report results from 1985 surveys, providing replication of

findings in two independent samples. Both studies report significantly

more illict drug use in younger employed persons (18 - 34 years), with

highest rates for marijuana. Approximately one in nine employed people

report current use ofmarijuana, with nearly double that rate (one in five)

for younger people aged 18 - 34 yrs. In addition there are significant differences in drug use in different occupational categories, with relatively

lower rates in professional and managerial personnel compared to

skilled and semi-skilled labor categories.

In addition to national estimates of employment-related drug use based

on self-report data, some regional and industry-specific estimates based

on chemical testing are included. While the various forms of drug testing

provide little information on chronic patterns of drug use (except perhaps for marijuana) they do provide valid and objective indicators of

recent drug use. Lund et al., in a previously published report, describe

an Insurance Institute for Highway Safety-sponsored study of 317

randomly selected tractor-trailer drivers who provided blood and urine

specimens for drug analysis. Overall, 20 percent tested positive for

drugs. Of these, 15 percent were positive for marijuana, 12 percent for

over-the-counter stimulants, 5 percent for prescription stimulants, 2

percent for cocaine, and less than 1 percent for alcohol. This study

represents a particularly fine example of the application of rigorous

scientific methodology in afield experiment and demonstrates that valid

estimates of recent drug use in workplace environments are attainable.

The paper by Osbom and Sokolov characterizes drug use patterns in a

nuclear power plant facility in Southern California. Data was obtained

5
from urinalysis tests of employees and is presented for a several year

period. The authors discuss the evolution of the company policy in light

of evidence of drug use provided by the urinalysis program, and also

describe a novel strategy for “random” sampling of employees. For

companies contemplating random drug testing programs this strategy

increases the likelihood that employees will be selected at least once but

a small likelihood they will be selected more than three times. Such a

strategy may offer advantages over simple random sampling.

The paper by Taggart describes trends in drug test positives in a

company representative ofanother regulated industry-railroads. Within

the context of a discussion of the safety driven policy at Southern Pacific,

Taggart outlines the testing policy and describes dramatic decreases in

positive drug tests over a five year period. Perhaps most intriguing is the

negative correlation between number of drug tests and injury rate—

suggesting the need for additional studies of the deterrence effects of

drug testing programs and of the relationship between drug use and

occupational injuries.

Anglin and Westland report on the California Commercial Laboratory

Drug Testing Project, which monitors drug use trends throughout that

State using data provided by commercial laboratories involved in drug

testing. The authors report that levels of drug use among employed

populations were consistently lower than in criminal justice and drug

treatment populations. The employment testing data showed that 4 to

7 percent of employees tested positive for marijuana, 1 to 2 percent for

cocaine, and 1 to 3 percent for amphetamines. Results were relatively

constant over the 12 months of the study.

Data from self-report studies and from various types of workplace drug

testing programs is beginning to fill a need for information on the extent

and nature of workplace-related drug use and provides data which are

critical prerequisites to further study of the effects of drugs on performance and productivity.

Relationship of Drug Use to Performance and Productivity

Laboratory research has demonstrated that basic psychomotor and cognitive skills relevant to job performance are impaired by most drugs

(Nicholson and Ward, 1984). However, research on simulated job performance, as well as field studies of the relationships between drug use

and other indicators of performance, such as absenteeism, accidents and

injuries, job turnover, health care costs, supervisory ratings, and other

measures of productivity are lacking. The impact of drug use on these

measures of performance and productivity in the workplace has been

6
difficult to assess, partially because of the difficulty in defining the

extent of drug use by the workforce, but perhaps more importantly

because of the difficulty in designing and carrying out controlled studies

in workplace environments. Estimates of prevalence, as described

above, can be inferred from self-report data collected in surveys or from

various types of drug testing programs. However, most surveys have not

collected data which addresses the“impact” of druguse in the workplace,

One study projected cost estimates of unrealized productivity due to

drug use, but it was based upon assumptions which need additional

validation and which address a narrow range of performance indicators

(Harwood, Napolitano, Kristiansen, and Collins, 1984). As an initial

attempt to explore these relationships, several studies described here

examine the correlations between indicators of job performance and

measures of drug use in both retrospective as well as prospective

manners.

While a positive urine test for a drug cannot be used to prove impaired

performance, nor can it be used to infer intoxication or being under the

influence, it does prove recent use of that drug. As such, it can he used

as an objective marker of recent use and has considerable research

utility. Several of the studies described below utilize drug test results as

indicators of drug use.

Normand and Salyards describe a multi-phased study of the U.S. Postal

Service intended to assess drug use prevalence in their job applicant

population and to evaluate the relationshipbetween drug testing results

and job performance indicators. A total of 5,465 job applicants at 21 sites

were urine tested for the presence of illicit drugs at the time of job

application. Test results were not disseminated to hiring officials and

had no bearing on these applicants’ success or failure in obtaining a

position with the Postal Service. Overall, 8.4 percent of those hired

tested positive, approximately two-thirds for marijuana, one-quarter for

cocaine and 10 percent for other drugs. Analysis of the data showed a

significant association between test results and each of the targeted

employment measures, absenteeism and job turnover. Employees who

tested positive were found to be absent at a rate 43 percent greater than

those who tested negative. Subjects who tested positive for cocaine were

more than three times as likely to be heavy leave users as their drug free

counterparts. Involuntary job separation measured 40 percent higher

among the drug positive group members. Cocaine-positive applicants

displayed involuntary separation rates nearly twice that of those who

tested negative. Accidents, injuries, and employee benefit claims are additional measures earmarked for analysis in this ongoing study. This

study is the first of its kind, a large-scale prospective evaluation of the

utility of job applicant drug testing, and promises to provide valuable

objective data on a controversial subject.

7
Blank and Fenton describe a study of U.S. Navy recruits which shares

a key design feature with the U.S. Postal Service study-the identification of drug users through urinalysis and subsequent prospective performance evaluation. The report compares a group of approximately 500

male recruits who had tested positive for marijuana (THC) at the time

of induction with a matched group who tested negative for any illicit

drugs. Demographic differences in education level, Armed Forces

Qualification Test (AFQT) scores and race between the THC positive and

negative groups reached significance. While age, marital status and

place of origin, on the other hand, revealed no appreciable differences

between groups. Examination of retention patterns showed that a

greater percentage of the THC negative group (81 percent) than the THC

positive group (57 percent) were still in the Navy after 21⁄2 years. A total

of 14 percent of those from the THC positive group left the Navy for drug

or alcohol related problems and another 21 percent were discharged

early for other behavioral or performance problems. In contrast, only 1

percent of the THC negative group were removed for drug/alcohol

related difficulties and only an additional 8 percent for behavioral or

performance problems.

In a considerably larger military sample, McDaniel examined the utility

of self-report of pre-employment drug use in predicting on-the-job

suitability. Subjects studied were those 10,188 individuals who entered

military service within one year of taking the self-report survey. The employment unsuitability measure was defined as discharge from military

service for reasons classified as “failure to meet minimum behavioral or

performance criteria” on or before September 30, 1987. In the sample

studied, 16 percent were discharged for unsuitability. Results indicated

that in general, the earlier one began to use drugs and the more one used

drugs, the greater was the probability of being unsuitable for employment. However, operational validity of pre-employment drug use

measures was limited, and supplementation of the drug screening

program with other unsuitability predictors was recommended.

Crouch and co-authors describe a model of a cost-benefit analysis of the

Utah Power and Light Co. (UP&L) drug program which provides additional data on the correlation between drug use and job performance.

Drug using employees were found to be absent more often than controls,

with drug-positive employees taking sick leave at a rate 35 percent

greater than control employees and unexcused absences at a rate 240

percent greater than control employees. While medical cost data

analysis was inconclusive, drug positive employees were 5 times more

likely to have a reportable vehicle accident than controls. The authors

provide a detailed cost-benefit analysis in which the program was found

to provide a potential yearly cost savings to the company of $660,000 if

8
the differences in these measures between drug users and non-users

could be eliminated. In addition this paper provides a thoughtful analysis of the potential costs of a comprehensive drug program. The authors

enumerate contributing factors such as planning meetings, legal fees,

analytical testing, quality assurance expenses, implementation of

employee assistance programs (EAPs) and grievance procedures. For

the UP&L Co. these expenses were reported to total $482,327.

Sheridan and Winkler outline an ongoing, NIDA-sponsored, evaluation

of drug use at the Georgia Power Company. Data was derived for a five

year period on employees who 1) drug-tested positive, 2) drug-tested

negative, 3) entered an EAP for drug/alcohol-related problems, 4) obtained medical benefits for alcohol or drug treatment, 5) entered an EAP

for other problems, or 6) were discharged for problems other than drug

and alcohol use. In this report, those testing positive were compared to

those testing negative and to the workforce as a whole on several

measures of job performance and productivity. As in the Postal Service

study, employees who tested positive for drugs had higher rates of

absenteeism. Differences were found both in measures of absenteeism

due to sickness as well as due to various non-paid types of leave (docked

time, disciplinary suspensions, etc.). Employees testing positive averaged 48 hours of sick leave per year, while the workforce as a whole

averaged only 23 hours per year. Even more dramatic differences

existed in measures of non-paid leave, with those testing positive

averaging 75 hours of non-paid leave per year compared to 15 hours for

the entire workforce. Future analyses will compare drug using groups

and other groups of employees mentioned above with matched controls

over a one year observation period on measures of absenteeism, accidents, and medical claims.

Statistics concerning excessive absenteeism, accidents and injuries,

health care utilization, and other counter-productive behaviors of

employed drug abusers have been reported in the popular press, cited by

political leaders, and even mentioned in NIDA publications. These

statistics have been based on little empirical research, however. The

studies described here are beginning to provide such data on the

relationship between drug use and behaviors which have impact in the

workplace. Caution must be used in interpreting these results. While

drug use measures may be correlated with performance indicators, that

tells us little about mechanisms which determine these relationships.

For example, it may be that drug use causes more absenteeism because

of the direct behavior-impairing effects of acute or chronic use of a

particular drug, or drug users may possess certain behavioral or personality traits which make them more likely to be absent from work. From

the pragmatic perspective of a policy maker it may not make much

9
difference. The utility of drug use information is that if individuals who

use drugs cost the company money it is worthwhile reducing the number

o fusers in the workforce (by preventing them from entering the workforce

or treating those already in it). From a scientific perspective, however,

it is important to search for mechanisms which underlie differences in

behavior between drug users and nonusers. This is especially true

because drug use measures may come to be used as “markers” for other

characteristics which may be viewed as being related to adverse or

unproductive behavior in the workplace. The papers in this monograph

show that demonstrable differences exist between users and nonusers in

some measures of work performance. The challenge remains to determine the causative factors underlying these differences.

Industry Responses to Drugs in the Workplace

The business community has responded to real and perceived problems

related to drug use by implementingvarious policies meant to deter drug

use (and related activities such as drug sales) as well as identify and refer

drug abusing employees to appropriate treatment. The most prevalent

components of workplace drug policies are: 1) having formal written

policies on drugs, 2) having employee assistance programs, and 3)

havingdrugtestingprograms. A recent survey suggests that nationwide

about 43 percent of employed people work in an establishment with a

formal policy on drug use, 31 percent work where there is an employee

assistance program, and 20 percent work in an establishment which has

a drug testing program (Bureau of Labor Statistics, 1989). These policy

components, when enhanced with provisions for supervisory training

and employee education, comprise what the Federal government terms

a comprehensive drug-free workplace program. This monograph offers

chapters which describe survey research efforts to begin to characterize

and explore the programs behind these statistics.

Axel offers an interesting comparison of companies that have drug

testing policies and those that do not. She finds that the prevalence of

testing varies by industry and that companies with drug testing programs view drug problems as being worse than those that do not. These

companies are also more likely to employ strategies other than drug

testing to deal with workplace-related drug use. Backer offers a slightly

different perspective and presents data from a sample of employee

assistance programs. His objectives are to describe typologies of drug

abuse services offered through these programs and to identify emerging

issues which may impact future delivery of these services.

10
Blum describes data from four studies that are part of an ongoing

research program on workplace management of health issues, including

employee assistance and drug testing programs. The findings provide a

picture of an organizational reponse to drug use from four different

perspectives-human resource managers, supervisors, employee assistance coordinators, and a cross section of employees. Roman continues

and expands upon the role of employee assistance programs by presenting data from a followup survey of EAPs in six states. He describes how

the drug abuse caseload has changed in the last few years and discusses

how EAPs have responded and should respond to changing societal and

organizational environments.

Emerging Issues

As research data on issues related to drugs and the workplace begin to

emerge there is and will continue to be a need to constantly reassess and

redirect research resources toward new research questions. Several

papers in this monograph provide such assessment and recommendations for future research efforts.

Googins begins with a review of the role of the supervisor in workplace

substance abuse program efforts, emphasizing the integral role which

supervisory involvement has historically played in the process of identification and referral of troubled employees. He goes on to discuss how

that role has become more complex and will continue to evolve as

workplace policies themselves evolve. The early identification and referral of drug abusing employees is key to successful rehabilitation and

return to work. Googins argues that such a process depends on effective

supervisory involvement.

Angarola and Rodriguez remind us that drug abuse policy is not established outside the legal and political environment. Consideration of the

legal environment has obvious relevance to research planning and this

chapter is offered as a summary of existing legislation which may impact

on research study designs. While there has been recent Federal legislation establishing the parameters of drug programs for Federal employees, Federal contractors, and regulated industries, the States have also

begun to adopt laws which define and restrict certain aspects of workplace

drug programs—primarily drug testing. At the time the chapter was

written eight states had adopted comprehensive drug testing laws. The

authors discuss this legislation in terms of twelve basic provisions,

compare and contrast the various State’s legislation, and discuss model

elements and basic principles which other States should consider when

developing such legislation.

11
In the final chapter Gerstein and Grossman offer a framework for

conceptualizing data needs and data sources which can serve as a

blueprint for future research on drug and workplace issues. They

identify three distinct though interrelated concerns about workplacerelated drug use—workplace safety, productivity, and health. They also

identity three sources of data about workplace related drug use—

chemical testing, self report, and observation. They make the point that

a systematic research effort is needed to explore the acceptability, costs,

and utility of each of the three detection methods in addressing the

various concerns. Unfortunately there is not much data yet to begin to

fill the cells in such a matrix and the authors conclude with some

suggestions on how the business and research communities might begin

to work more closely to provide this important data.

Conclusion

NIDA’s mission is to support basic and applied research, disseminate

research findings, and provide scientific leadership in an effort to reduce

drug abuse and its consequences. Research on issues related to drugs

and the workplace is a new endeavor but is a natural outgrowth of

NIDA’s program of research on related topics (e.g., prevention, treatment, drug testing methods, drug effects on performance). A systematic

research database upon which todesign, implement, and revise effective

drug abuse policy is needed. Although there has been growth in the

numbers of workplace programs, there has not been parallel growth in

program evaluation activities.

These papers demonstrate that such activities are beginning and that

data from surveys and drug testing programs has tremendous potential

utility for the researcher and evaluator. Such data will be used to

develop new or modify existing programs to address drug use by the

workforce and its consequences in the workplace.

REFERENCES

Bureau of Labor Statistics. Survey of Employer Antidrug Programs. U.S.

Department of Labor, Bureau of Labor Statistics, Report 760,1989.

Harwood, H. J., Napolitano, D. M., Kristiansen, P. L., and Collins, J .J. Economic

Costs to Society of Alcohol and Drug Abuse and Mental Illness: 1980. Report

by Research Triangle Institute to the Alcohol, Drug Abuse, and Mental

Health Administration, PHS, DHHS, June 1984.

Nicholson, A. N., and Ward, J. (Eds). Psychotropic drugs and performance.

British Journal of Clinical Pharmacology, Vol. 18 (Suppl. 1): 1-139,1984.

12
Walsh, J. M., and Gust, S. W. (Eds). Workplace Drug Abuse Policy: Considerations and Experience in the Business Community. Office of Workplace

Initiatives, NIDA, ADAMHA Pub. no. (ADM) 89-1610, 1989.

AUTHORS

Steven W. Gust, Ph.D. and J. Michael Walsh, Ph.D.

Office of Workplace Initiatives, NIDA

5600 Fishers Lane

Room 10-A-53

Rockville, MD 20857

13

Prevalence of Drug Use by the Workforce

Drug Use Among Working Adults:

Prevalence Rates and Estimation Methods

Royer F. Cook, Ph.D.

ISA Associates

INTRODUCTION

There is little doubt that illicit drugs are used by working adults in this

country. Although employed people may have lower drug use rates than

the unemployed, (Kandel, 1980) employment does not eradicate the urge

to use drugs. Also, drug use among high school students, as reflected in

the National Survey of High School Students (Johnston, O’Malley &

Bachman, 1987), is probably not dramatically different from the young

adult working population. It is unlikely that most youths cease their

drug use upon entering the workplace. These assumptions are supported by empirical evidence gathered primarily from two sources: (1)

self-report surveys, and (2) the results from an increasing number of

drug testing programs in industry. Furthermore, an examination of the

caseload characteristics of Employee Assistance Programs (EAPs) reveals significant percentages of employees seeking help for drug use and

abuse problems (e.g., Blum and Roman, 1986).

Most of what is known about drug use in the workplace comes from

studies that are severely limited by their sampling (confined to a region,

industry or age group) and the variables measured (often merely the

results of a drug test). Consequently, very little is known about patterns,

dynamics and circumstances of drug use in the workplace. Moreover, the

self-report surveys and chemical testing carry their own set of strengths

and weaknesses as methods for estimating drug use prevalence.

This article is intended to: (1) present national prevalence data on drug

use among working adults, and (2) examine the central methods for

estimating the extent of drug use in the workplace.

The first section presents the results of a secondary analysis of a 1985

national household survey. The analysis was conducted on a sub-sample

17
of working adults, focusing on their use of marijuana and cocaine. The

second section contains a review of the principal methods for estimating

drug use prevalence, including a discussion of their strengths and

weaknesses.

SURVEY OF WORKING ADULTS

In 1985, the Gallup Organization questioned 3,006 adults age 18 and

older about their use of marijuana and cocaine on confidential, selfadministered answer sheets. The survey was conducted on behalf of the

Social Research Group of George Washington University in conjunction

with a grant from the National Institute on Drug Abuse. The survey

consisted of face-to-face interviews with members of households throughout the United States. Of those interviewed, 1,716 adults were employed

in jobs outside the home; the balance were students, housewives, or

retirees. This analysis examines the drug use of the sample of employed

adults and attempts to identify the groups of employed adults most in

need of drug prevention, education, and treatment programs.

Two measures of drug use, current use and past-year use, are used in the

analysis. Interviewees were asked, “When was the most recent time you

took (the drug)?” Current users are defined as those who said they used

marijuana or cocaine within the past 30 days. Recent users are adults

who reported use in the past year and current users.

To describe patterns of drug use among employed adults and identify

specific groups of employees with higher rates of drug use prevalence

estimates of marijuana and cocaine use were calculated by: 1) occupational category and 2) selected sociodemographic characteristics of the

employees. The sociodemographic variables examined included age,

sex, and education. Data analyses were done in two steps. First, ChiSquare cross-tabular analyses calculated drug rates, then a multivariate analysis, employing the Automatic Interaction Detector (AID) approach, was used to identify subgroups of the sample with maximally

differing rates of drug use prevalence.

RESULTS

Drug Use by Job Category

Overall, 18 percent of the total sample reported past-year marijuana

use, and 6 percent reported past-year cocaine use. The sample reported

current marijuana and cocaine use of 11 percent and 2 percent, respectively.

18
Current marijuana and cocaine use rates by occupational category are

shown in Table 1. Significant differences were found among occupational categories in current marijuana use; no differences were found in

current cocaine use. Current marijuana use rates ranged from 7 percent

for professional/managerial and clerical personnel to 16 percent for the

skilled trades. Current cocaine use ranged from 1 percent to 5 percent

among laborers. Past-year use rates of the two substances were considerably higher, ranging from 13 percent to 22 percent for marijuana and

2 percent to 11 percent for cocaine, but the differences were not statistically significant.

Table 1. Current Marijuana and Cocaine Use Among

Employed Adults by Type of Employment

Job Category

Marijuana Use Cocaine Use

Current (%) Current (%)

Professional/Managerial

(n = 546)

Business/Farm Owner

(n = 77)

Sales/Manufacturers

Representative

(n = 99)

Clerical

(n = 212)

1

Skilled Trade

(n = 251)

3

Semi-skilled Trade

(n = 19)

1

Laborer

(n = 36)

5

Service Worker

(n = 170)

Other

(n = 68)

7

13

15

7

16

12

10

12 4

24 2

chi sq = 19.5

p < .05

1

2

3

chi sq = 6.6

NS

19
Drug Use by Sociodemographic Variables

Analysis of marijuana and cocaine use by age group, sex, and education

reveal some clear indications of the employees most likely to have used

one of these drugs during the past year.

1. Age

Age is the most significant predictor of marijuana and cocaine use

(Tables 2 and 3). Younger employees, 18 to 34 years old, were more likely

to report drug use than older employees. One-fifth (20 percent) of the 18-

to 34-year-old employees reported current marijuana use, compared to

6 percent of those 35 to 44 years old and less than 2 percent of those 45

and older. Similarly, these younger employees were more likely than

older workers to report past-year marijuana use. The rate of past-year

marijuana use among the 18- to 34-year-old employees was nearly 30

percent, compared to 3 percent or lower among employees 45 and older.

Cocaine use was considerably less prevalent than marijuana use, even

in the high-risk age group. In this survey, current cocaine use among 18-

to 34-year-old employees was 4 percent. However, the past-year cocaine

prevalence rate for this group was 12 percent compared to 2 percent

among older employees, indicating that a significant number of these

younger employees had at least experimented with cocaine.

2. Sex

Marijuana and cocaine use was significantly higher among male than

among female employees. Fourteen percent of the adult men reported

current month marijuana use, compared to 8 percent of the women

(Table 2). Similarly, 8 percent of the men reported current cocaine use,

compared to 4 percent of the women.

3. Education

There were no significant differences in marijuana or cocaine use rates

across the four educational categories (Tables 2 and 3).

20
Table 2. Current Marijuana and Cocaine Use Among

Employed Adults by Sociodemographic

Characteristics

Age Group

18-24

(n = 194)

25-34

(n = 482)

35-44

(n = 412)

45-54

(n = 276)

55 +

(n = 283)

Sex

Male

(n = 950)

Female

(n = 699)

Education

Less than High

School Graduate

(n = 217)

Marijuana Use Cocaine Use

Current (%) Current (%)

19

20

6

2

1

Chi sq = 66.7

p < .001

14

8

chi sq = 8.8

p < .01

4

4

1

1

*

chi sq = 14.1

p < .01

3

1

chi sq = 5.5

p < .05

16 3

High School Graduate 11

(n = 535)

Some College or

Technical School

(n = 437)

11

College Graduate 9

(n = 455)

Chi sq = 4.8

NS

1

3

2

Chi sq = 1.6

NS

21
Table 3. Past-Year Marijuana and Cocaine Use Among

Employed Adults by Sociodemographic

Characteristics

Age Group

18-24

(n = 194)

25-34

(n = 482)

35-44

(n = 412)

45-54

(n = 276)

55 +

(n = 283)

Sex

Male

(n = 950)

Female

(n = 699)

Education

Less than High

School Graduate

(n = 217)

High School Graduate

(n = 535)

Some College or

Technical School

(n = 437)

College Graduate

(n = 455)

Marijuana Use Cocaine Use

Past-Year (%) Past-Year (%)

29

30

11

3

2

chi sq = 100.3

p < .001

21

13

chi sq = 11.5

p < .001

22

17

18

14

chi sq = 4.3

NS

12

12

2

2

*

chi sq = 44.9

p < .001

8

4

Chi sq = 6.0

p < .05

9

4

8

7

chi sq = 4.7

NS

22
Marijuana And Cocaine Use Among Younger

Employees 18 To 34 Years Old

An analysis of the characteristics of the high-risk group (18 to 34-yearolds) reveals significant differences in drug use among sub-groups.

Tables 4 and 5 show past-month and past-year drug use rates ofyounger

workers by sex and education.

Male employees are more likely to report current and recent marijuana

and cocaine use than female employees. For example, current marijuana use among men was 24 percent compared to 14 percent for women.

Employees with less than a high school education have higher rates of

marijuana and cocaine use than employees with higher levels of education. Current marijuana use ranges from 35 percent for employees who

had not finished high school to 16 percent for employees who have

attended or graduated from college.

No significant differences were found in the drug use rates of this highrisk group across occupational category.

Multivariate Analysis Results

Amultivariate AID analysis was used to partition the sample of employees 18 to 34 years old into subgroups with maximal differences in

prevalence rates on each of the drug use indicators. Based on the

prevalence of use, the results identified subgroups at highest and lowest

risk for drug use problems.

Current marijuana use, which averaged 19 percent of this age group,

was 26 percent for the group working as skilled or semi-skilled trade

workers, sales personnel, and business owners. A lower rate was found

among the group consisting of professional, managerial and clerical,

laborers and service workers. Analysis of current cocaine use for

employees 18 to 34 years old did not indicate the presence of sample

subgroups with significantly different rates. This is attributed in part to

the relatively low average prevalence (4 percent) of this kind of drug use.

Past-year marijuana use, which averaged 29 percent for the age group

as a whole, was especially prevalent among certain sub-groups of 18- to

34-year-old employees. Past-year marijuana use among employees who

did not complete high school was estimated to be 63 percent for clerical,

sales and service workers, compared to 35 percent for those working in

other occupations. Among employees with higher levels of education,

men were more likely to have used marijuana in the past year (33

percent) than women (19 percent).

23
DISCUSSION

Data from this national survey of working adults have important

implications for industry’s response to the drug problem. The results

demonstrate that:

There is considerable illicit drug use among working adults.

The most significant indicator of drug use is age.

In addition to age, drug use rates differ greatly according to

sex, education, job category.

In general, marijuana and cocaine use were much more prevalent among

employees under 35 than among older employees and more prevalent

Table 4. Current Marijuana and Cocaine Use Among

Employed Adults 18 to 34 Years Old by

Sex and Education

Sex

Marijuana Use Cocaine Use

Current (%) Current (%)

Male

(n = 390)

24 5

Female

(n = 286)

Education

14 2

chi sq = 7.7 Chi sq = 4.2

p < .01 p < .05

Less than High

School Graduate

(n = 72)

35 7

High School Graduate 19 3

(n = 214)

Some College or

Technical School

(n = 208)

16 4

College Graduate 16 4

(n = 182)

Chi sq = 11.5 Chi sq = 2.0

p < .01 NS

24
among men than women. Current marijuana use was more likely to be

reported by employees who did not complete high school than by

employees with higher levels of education. Current marijuana use was

also more prevalent among skilled trade workers, sales personnel,

business owners and service workers than among other occupational

groups. Current cocaine use was less prevalent than current marijuana

use and there was not a significant indicator of use based on demographic and occupational groups. Therefore, the findings suggest that

industry-based programs focus their efforts especially on marijuana use

of younger employees.

The results also generated important findings about the patterns of

marijuana and cocaine use among working adults. Apparently, marijuana use is more prevalent than cocaine use among employees and is

more likely to be a regular, continuing pattern of use than cocaine use.

Table 5. Past-Year Marijuana and Cocaine Use Among

Employed Adults 18 to 34 Years Old by

Sex and Education

Sex

Marijuana Use Cocaine Use

Past-Year (%) Past-Year (%)

Male

(n = 390)

Female

(n = 286)

Education

Less than High

School Graduate

(n = 72)

High School Graduate

(n = 214)

Some College or

Technical School

(n = 208)

College Graduate

(n = 182)

36 15

23

chi sq = 8.6

p < .01

49

31

25 11

25 14

Chi sq = 12.5

p < .01

Chi sq = 8.5

p < .05

8

chi sq = 4.5

p < .05

22

8

25
Marijuana use tended to become ongoing for those who tried it. In

contrast, cocaine use prevalence was much lower, and its use tended to

be experimental and/or occasional rather than ongoing.

These estimates are quite close to those generated by the 1985 NIDA

Household Survey, which found that 29 percent of workers in the 20-to

40-year-old range reported use of some illicit drug in the past year, and

19 percent reported some illicit drug use in the past month (NIDA, 1988).

Newcomb (1988) conducted one of the most illuminating work force drug

use studies. His research, intended as a longitudinal study of the

etiology of adolescent drug use, surveyed a sample of 1,634 young adults

(739 subjects responded) 9 years after the initial data collection, when

the average age of the respondent sample was 21.9. The subjects were

asked a wide variety of questions regarding drug use, including use on

the job. Marijuana and cocaine were the most frequently used drugs.

During the previous 6 months, 42.8 percent reported using marijuana

and 33.8 percent reported using cocaine. Sixty-four percent of the

sample was employed, 50 percent of whom worked full-time (prevalence

rates are not reported for the working sub-sample). These prevalence

rates are substantially higher than those found in both this study’s

sample and in the 1985 NIDA sample of 20- to 40-year-olds. The two

most likely explanations for the higher rates in Newcomb’s sample are:

1) the entire sample was drawn from Los Angeles County where drug use

is higher than the national rate (Newcomb, 1988); and 2) the young age

of the sample.

The Newcomb study is especially noteworthy for its examination of drug

use on the job (e.g., 20.1 percent of full-time workers reported using

marijuana on the job) and for its identification of correlates of “disruptive” drug use (high while at work). In some important ways this study

stands as an example of the kind of research that the field needs.

However, problematic sampling severely limits its utility as an national

indicator of drug use prevalence.

A REVIEW OF METHODS FOR ESTIMATING DRUG USE IN

THE WORKFORCE

Chief methods for estimating drug use prevalence in the workplace are

selfreports and chemical testing. These two methods are vastly different

from one another. Self-reports can produce drug use data sets rich with

information on frequencies, patterns, consequences, etc., but almost

26
always raise questions about their validity. Chemical testing, on the

other hand, supplies only a single datum for a given drug (i.e., whether

the individual has recently used the drug, irrespective of current intoxication). Despite concerns about the accuracy ofchemical testing (Hansen,

Caudill and Boone, 1985), the basic validity of the chemical testing

methods is rarely disputed.

Chemical testing is seldom employed for the purpose of producing

prevalence estimates. Typically it has been used, in both industry and

the military, as a means of identification and deterrence. However, it is

often the only indicator of drug use prevalence available for a particular

working population.

Self-report techniques are much more widely used for prevalence estimation purposes as exemplified by both the National Survey of High

School Students and the National Household Survey. Self-report methods remain virtually the only means for determining frequency and

patterns of drug use.

Self Reports of Drug Use

Validity of the data is typically the chief problem associated with selfreports of drug use. Validity issues are further exacerbated when selfreport data are gathered in the workplace. Thus, self-reports used to

estimate drug use in the workforce raise serious concerns about their

validity, particularly if such information is used to formulate policy.

In 1985, NIDA published a monograph examining the validity of selfreport methods for estimating drug use (Rouse, Kozel, and Richards,

1985). Although there is no specific discussion of workplace issues, the

reader is referred to the monograph for its detailed examination of the

central issues surrounding self-reports. The general consensus to

emerge from the monograph was that valid drug use data can be

gathered through the self-report method, but there are a broad set of

factors and conditions that can invalidate the data if one is not, as

Harrell(1985) put it, “constantly vigilant.”

Self-report validity is a complex, multi-faceted phenomenon, potentially

affected by a myriad of factors and forces. Moreover, it should be

understood that the validity of any self- report is a precarious condition

governed by a non-compensatory dynamic: All threats to validity must

be recognized and guarded against or the integrity of the data will be

suspect.

27
Researchers might picture the validity of any individual’s response to a

self-report item as a condition suspended at the end of a chain. The links

in the chains represent all the factors that need to be present to obtain

a veridical response from the subject. The length of the chain (the

number of links, or necessary factors) for any given item will vary

according to the nature of the research (respondent characteristics,

mode of self- report, etc.) and the tension on the chain will increase with

the sensitivity of tbe topic. If any of the links are weak, the chain could

break and the response will be invalid. If most of the chains (items)

contain weak links, the validity of the data will be jeopardized, particularly if the topic is a sensitive one. This “chain-link” model captures the

essential dynamics of self-report validity. It recognizes that:

Validity is constantly affected by many factors, that vary in

number and type depending on the nature of the inquiry.

The validity of a given response is absolute, veridical or not,

to a given item, although the validity of the entire self-report

data set is relative.

The more sensitive the topic, the more precarious the validity

of the data.

The chain-link model is also consistent with the recommendations of

Nurco that “researchers in the field steep themselves in the nuances of

veridicality until they appreciate the magnitude of the problem and are

prepared to devise anticipatory strategies to avoid its many pitfalls”

(Nurco, 1985).

A double-blind study of the validity of NIDA’s Household Survey was

conducted and procedures were found to be generally valid (Harrell &

Kapsak, 1986). Assuming (following the chain-link model) all other

safeguards have been observed, people tend to tell the truth about drug

use in the privacy of their homes. In contrast, the author compared the

results of drug use self-reports collected in the workplace with the results

of unannounced chemical testing. Many workers were found to be less

than forthright about their drug use, despite assurances of confidentiality (Cook, 1987). Apparently, assurances of confidentiality were not

strong enough for many of the drug using workers. These results were

not interpreted as evidence that workers will respond dishonestly to

questions about their drug use but were indicative of extreme strain on

thevalidity chain (i.e., data collection in the workplace relied on workers

who were mistrusting of management and fearful of job loss).

28
Chemical Testing

Drug testing, usually in the form of one of the urinalysis techniques, is

being increasingly used by industry as a means for:

Culling out drug users from among job applicants

Deterring use by employees

Or identifying drug-impaired workers (testing for probable

cause) (Axel, 1986).

Drug testing was never intended as a prevalence estimation technique.

However, the relative paucity of self-report data in the workplace,

coupled with the large number of companies that are currently conducting drug testing, have led to the use of chemical test results as an

indicator of drug use prevalence in the workplace.

As currently practiced in most industries, drug testing results typically

provide more shadow than substance. The problem is not one of

veridicality of measurement, but one of sampling. Most of the testing is

conducted not on employees but on job applicants. Random testing is on

the rise, particularly in the public utilities, the transportation industry,

and the Federal Government. Even with “random testing” the samples

are often small and not always truly random (i.e., entirely unannounced). Consequently, with the exception of the results from the

armed forces, drug testing currently tells us very little about even the

single datum asked of it— i.e., the proportion of the work force that has

recently ingested a given drug. Moreover, even in the situations where

drug testing provides that important binary datum on the population in

question, it tells us no more than that. Little can be learned from drug

testing about patterns, frequencies, circumstances, etc. about employee

drug use.

CONCLUSIONS

National data on the prevalence of drug use in the work force are

available from only a few sources, (e.g., the survey data presented herein

and sub-group analyses of the NIDA Household Survey data (Voss, this

volume)). Although these data sets are 3 years old and the current

picture has no doubt changed, the striking similarity between the two

sets is reassuring.

29
Drug testing results provide interesting information on drug use in the

work force by region (Anglin, this volume) and in the military. The

military data are perhaps a bit easier to interpret than the laboratory

data from California, because populations tested, sampling, and particular testing procedures are known and specified. Yet, the military is a

very atypical organization and current drug use data from the armed

forces suggests little about the civilian work force.

These and related data sets (e.g., the Newcomb work) represent an

initial understanding of the prevalence of drug use in the work force.

Clearly, however, much needs to be done if we are to have accurate,

recent drug use data.

At the level of the individual company or industry, prevalence estimates

can probably best be obtained by a combination of survey-interviews and

drug testing (Cook, in press). A representative sample of employees

would be interviewed (preferably off the work site) about their drug use,

and at the same time, urine samples would be collected and analyzed. All

data would be gathered anonymously, and individual results would, of

course, be confidential. This assessment procedure would capitalize on

the complementary strengths of the two procedures: the comprehensiveness of the self report and the validity of drug testing.

To obtain national drug use prevalence data on the workforce, together

with information on drug use dynamics, it is probably best to sidestep the

corporate structure and reach the working population in their homes.

Valid data can be obtained in household interviews (assuming, ofcourse,

that procedures designed to maximize validity are used). NIDA (or a

consortium of business interests) may consider conducting a national

household survey of employed adults on an annual or biannual basis.

Such a survey would be very different from the current NIDA Household

Survey. It would contain less detail on drug use (e.g., fewer drugs

assessed) and would address central issues of workforce drug use

dynamics. A much less costly alternative to a face-to-face household

survey of workers would be to conduct the survey by telephone. Studies

suggest that valid drug use data can be obtained by telephone (Frank,

1985), although procedural validation for collecting workforce data

would be advisable before implementing the telephone survey on a

routine basis.

The last few years have seen the development of a considerable amount

of information about drug use among the workforce. However, the

available data are still only outlines and fragments of the problem. Much

remains to be done.

30
REFERENCES

Axel,H. Drugs of abuse:Publicattitudes,politics,andbusiness. In:Axel,H.,ed.,

Corporate Strategies for Controlling Substance Abuse. New York: The

Conference Board, 1986.3-10.

Blum, T., and Roman, P. Alcohol, drugs and EAPs: New data from a national

study. The ALMACAN 16(5): 20-23, 1986.

Cook, R. An Exploratory Test of Techniques for Assessing Drug Abuse in

Industry. Final Report to the National Institute on Drug Abuse. Washington, DC: ISA Associates, 1987.

Cook, R. Drug and alcohol abuse in the workplace. In: Leaf, A, and Czeisler, C.,

eds. Health Promotion in the Workplace. Baltimore: Johns Hopkins Press,

in press.

Prank, B. Telephone surveying for drug abuse: Methodological issues and an

application. In: Rouse B.; Kozel, N.; and Richards, L., eds. Self-report

Methods of Estimating Drug Use: Meeting current challenges to validity.

Rockville, MD: National Institute on Drug Abuse, 1985.

Gfroerer, J. Influence of privacy on self-reported drug use by youths. In: Rouse,

B.; Kozel, N.; and Richards, L., eds. Self-report Methods ofEstimating Drug

Use: Meeting current challenges to validity. Rockville, MD: National

Institute on Drug Abuse, 1985.

Hansen, H. J.; Caudill, S. P.; and Boone, D. J. Crisis in drug testing: Results of

a CDC blind study. Journal of the American Medical Association 253: 2382-

2387,1985.

Harrell, A. Validation of self-report: The research record. In: Rouse, B.; Kozel,

N.; and Richards, L., eds. Self-report Methods of Estimating Drug Use:

Meeting current challenges to validity. Rockville, MD: National Institute on

Drug Abuse, 1985.

Harrell, A., and Kapsak, K. The Validity of Self-reported Drug Use Data: The

accuracy of responses on confidential self-administered answer sheets. Final

Report to the National Institute on Drug Abuse. Washington, DC: Institute

for Social Analysis, 1986.

Johnston, L.; O’Malley, P; and Bachman, J. National Trends in Drug Use and

Related Factors among American High School Students and Young Adults,

1975-1986. Rockville, MD: National Institute on Drug Abuse, 1987.

Kandel, D.B. Drug and drinking behavior among youth. Annual Review of

Sociology 6: 235-285,1980.

Newcomb, M. Drug Use in the Workplace: Risk factors for descriptive substance

use among young adults. Dover, MA: Auburn House, 1988.

National Institute on Drug Abuse. Capsules: Facts about drugs in the workplace.

Rockville, MD: the Institute, 1987.

Nurco, D. A discussion of validity. In: Rouse, B.; Kozel, N.; and Richards, L., eds.

Self-report Methods of Estimating Drug Use: Meeting current challenges to

validity. Rockville, MD: National Institute on Drug Abuse, 1985.

31
Rouse, B.; Kozel, N.; and Richards, L., eds. Self-report Methods of Estimating

Drug Use: Meeting current challenges to validity. Rockville, MD: National

Institute on Drug Abuse, 1985.

AUTHOR

Royer F. Cook, Ph.D.

President

ISA Associates

1625 K Street

Suite 1000

Washington, DC 20009

32
Patterns of Drug Use:

Data From the 1985 National Household Survey

Harwin L. Voss, Ph.D

University of Kentucky

INTRODUCTION

The 1985 National Household Survey on Drug Abuse was the eighth in

a series of studies whose primary purpose was to measure the prevalence

and correlates of drug use in the United States. The data were gathered

by the Institute for Survey Research at Temple University and analyzed

at the University of Kentucky.

Illicit drug use increased substantially in the United States in the 1970s.

According to the household surveys, for persons under 25 years of age,

the highest levels of use for most drugs were observed in 1979. The 1982

results suggested either a leveling off or the beginning of a decline in the

use rates for most drugs for youth and young adults. The 1985 household

survey was conducted to determine any continuation or change in these

trends.

METHODOLOGY

For the 1985 survey, the household population of the continental United

States, age 12 and over, was sampled using a multistage area probability

design. Blacks, Hispanics, and younger persons were oversampled to

increase the reliability of the estimates of drug use in these important

groups. Housing units were selected in small clusters averaging 16

occupied, nonbusiness households. Screenings were attempted in a total

of 25,968 households. The goal was to interview approximately 4,000

whites, 2,000 blacks, and 2,000 Hispanics. Selections of sampling

locations, households, and eligible respondents within households were

specified in the sampling plan. Interviewers were not permitted to make

substitutions.

33
Pretests of the interview were conducted in early 1985 in Philadelphia

and New York to refine the instrument and the interview. Of the 566

persons trained as interviewers, 50 percent were minority group members, 30 percent were bilingual, and 75 percent were females. Slightly

less than 9 percent (n=700) of the interviews were conducted in Spanish.

The interviews were completed between mid-June and mid-December

1985. Of the 8,038 interviews, 3,949 were with whites, 1,945 were with

blacks, 1,996 were with Hispanics, and 148 were with persons from other

racial or ethnic groups.

Table 1. Percentage and Estimated Number of Users of

Selected Drugs in the U.S. Household Population,

Age 12 and Older

Percentage

Estimated Number

of Users

Marijuana

Lifetime

Past Month

Cocaine

Lifetime

Past Month

Inhalants

Lifetime

Past Month

Hallucinogens

Lifetime

Past Month

PCP

Lifetime

Past Month

Heroin

Lifetime

Past Month

Cigarettes

Lifetime

Past Month

Alcoholic Beverages

Lifetime

Past Month

32.4 61,940,000

9.4 18,190,000

11.6 22,240,000

2.9 5,750,000

6.8 12,940,000

0.9 1,940,000

6.7 12,880,000

0.8 1,460,000

2.8

*

1.0 1,930,000

* 160,000

75.7 144,510,000

31.5 60,280,000

86.1 164,360,000

59.1 113,070,000

5,310,000

700,000

* Less than one-half of one percent.

Source: NIDA, National Household Survey on Drug Abuse, 1985.

34
FINDINGS

The figures in Table 1 are estimates of overall drug use in the Nation’s

household population in 1985. Eighteen million people then used marijuana. The nearly 6 million current cocaine users were, with few

exceptions, a subset of the 18 million marijuana users. The numbers are

smaller for the other illicit drugs. Nearly one-third of the population

smoked cigarettes, and over half (59.1 percent) consumed alcohol.

Marijuana

As Table 2 indicates, almost one-third (32.4 percent) of our citizens over

age 12 used marijuana at least once. The lifetime rates for marijuana use

Table 2. Use of Marijuana, Current Employment, and

Age Group (Percentages)1

A. Use in Lifetime Age Group

Current

Employment 12-17 18-25 26-34 35 + Total

Full-time 51.8 62.5 62.8 25.4 43.0

Part-time 24.5 48.7 55.3 16.4 32.0

Unemployed 49.0 70.3 58.8 16.3 47.4

Other 18.7 57.7 43.6 4.3 15.2

Total 23.6 60.3 58.5 15.9 32.4

B. Use in the Past Month

Current

Employment 12-17

Age Group

18-25 26-34 35 + Total

Full-time 34.4 23.5 17.7 3.7 11.7

Part-time 11.0 15.2 19.5 2.4 10.2

Unemployed 25.6 33.2 27.3 4.8 21.5

Other 9.3 14.3 8.4 * 4.0

Total 12.0 21.8 16.9 2.3 9.4

1

 Other includes students and homemakers and persons who are retired or disabled.

* Less than one-half of one percent.

Source: NIDA, National Household Survey on Drug Abuse, 1986.

35
were approximately 60 percent among 18 to 25 year-olds and 26 to 34

year-olds. Even 23.6 percent of the 12 to 17 year-olds used marijuana;

by contrast, the lifetime rate of marijuana use among persons aged 35

years and older was 15.9 percent. With the exception of older adults,

whites had the highest rate in each age group.

For the current employment category, it is best to ignore the youth since

percentages for full-time employees and unemployed persons were

based on a small effective sample size (60 and 40, respectively). Threefourths of the youth in the sample were classified as “other,” a category

including students (Table 2). Current use of marijuana, or use in the

month preceding the interview, was minimal among persons aged 35

years and older (2.3 percent), but was higher among youth (12 to 17 yearolds—12.0 percent). More 18 to 25 year-olds (21.8 percent) than 26 to 34

year-olds (16.9 percent) used marijuana during the previous month (p <

.001)

Table 3. Occupational Level and Current Use of Marijuana

by Adults (Percentages)

Age

Occupational Level 18-25 26-34 35 + Total

Professional

Technical & Sales

Service

Farming

Production & Craft

Operators & Fabricators

Homemaker

Student

Unemployed

Disabled

Retired

22.0

15.7

18.1

10.6

34.9

28.2

12.9 7.4

11.7 9.4

33.2 27.3

64.9 18.2

—

16.5

15.7

22.8

3.5

21.8

21.2

—

4.8

3.1

4.2

0.7

2.7

2.0

0.5

—

4.8

*

*

9.7

9.4

12.2

4.5

15.8

13.8

3.5

9.9

21.1

4.1

*

*Less than one-half of one percent.

Source: NIDA, National Household Survey on Drug Abuse, 1985.

36
Among youth, more full-time employees were currently using marijuana

than were unemployed individuals; but in the older age categories, the

highest rate occurred among the unemployed.

Farmers and homemakers had the lowest rates for current use. In

contrast, among 18 to 25 and 26 to 34 year-olds, sizable numbers of

production and craft workers were current users. Among older adults,

the highest rates involved a tie between professionals and the unemployed (Table 3).

Overall, more males than females tried marijuana (p <.001), and there

was a similar difference for use in the past month (p <.001). The

differences by sex were substantially greater in the two older age groups

than among the 12 to 17 and 18 to 25-year olds. In the two younger age

groups, the rate was not significantly higher for males than females for

lifetime marijuana use. However, among 18 to 25 year-olds, the difference by sex for use during the previous month (26.5 percent and 17.1

percent) was significant at the .001 level, as was the difference among

the 26 to 34 year-olds. Among persons aged 35 and older, males (21.8

percent) were twice as likely as females (10.9 percent) to have used

marijuana in their lifetime (p <.001).

Except in the oldest age group, lifetime rates were significantly lower for

blacks than for whites. Except in the oldest age category, however, the

rate was significantly higher for whites than for Hispanics.

Many people who tried marijuana used it extensively (Table 4). Approximately one-fifth of the 18 to 25 (18.8 percent) and the 26 to 34 year-olds

(19.6 percent) indicated they had used marijuana 100 or more times. Of

the 12 to 17 year-olds who had ever used marijuana, 17.5 percent used

it 100 times or more. Almost one-third of the 18 to 25 and 26 to 34 yearolds who ever used marijuana had used it 100 or more times.

Daily marijuana use was defined as use of the drug on 20 or more days

during the previous month. Relatively few individuals in the United

States household population were daily marijuana users. Among the 12

to 17 year-olds, 2.1 percent reported marijuana use on 20 or more days

in the past month. The highest percentage was found among 18 to 25

year-olds; 4.7 percent of them used marijuana on 20 or more of the

previous 30 days. Nevertheless, a substantial proportion of the current

users smoked marijuana on a daily basis. In each age group, approximately 20 to 23 percent of the current users had used marijuana on 20

or more days during the previous month.

37
Cocaine

Of all U.S. residents over age 12, 11.6 percent had tried cocaine, and 2.9

percent had used cocaine in the month preceding the interview (Table 5).

For lifetime use, the highest rate was found among the unemployed,

except among older adults. However, the rates are not much lower

among persons employed full-time. The rates for both lifetime cocaine

Table 4. Lifetime Frequency of Use of Marijuana, Current

Employment, and Age (Percentages)

Current Employment for Persons 18-34 Years Old

use of

Marijuana Full-time Part-time Unemployed Other

3-10

None

1-2

11-99

100+

37.4

10.8 

15.7

15.0

21.1

48.7

11.6 

11.1

13.6

14.9

14.6

33.8

10.0

15.1

26.6

13.1

50.3

10.7

13.8

12.2

Current Employment for Persons 35 Years Old and Older

Use of

Marijuana Full-time Part-time Unemployed Other

None 74.8 83.6 83.7 95.7

1-2 9.2 5.9 8.5 2.5

3-10 7.7 6.7 6.8 1.1

11-99 3.6 2.8 * *

100+ 4.8 1.0 1.0 *

* Less than one-half of one percent.

Source: NIDA, National Household Survey on Drug Abuse, 1986.

use and use in the past month were higher among 18 to 25 and the 26 to

34 year-olds than among youth or older adults. Approximately onefourth of the 18 to 25 and 26 to 34 year-olds have tried cocaine, but the

lifetime rates were 4 to 5 percent among youth and older adults.

Approximately 6 to 7 percent of the persons in the two middle age groups

had used cocaine during the previous month.

With the exception of the unemployed, the highest rates for current

cocaine use were found among production and craft workers and operators and fabricators (Table 6). Only among older adults did professional,

38
technical and sales workers have the higher rates, and those rates were

only 1.0 percent. The table indicates a figure of 56.2 percent for disabled

young adults; this figure, however, was based on a small number of cases.

Table 5. Use of Cocaine, Age Group, and Current

Employment (Percentages)

A. Use in Lifetime

Current

Employment 12-17

Age Group

18-25 26-34 35 + Total

Full-time 12.3 27.5 26.2 7.1 16.3

Part-time 3.6 17.5 23.6 2.6

Unemployed 13.4 32.1 26.9 5.0 20.0

Other 4.2 20.0 15.3 1.0 4.5

Total 4.9 25.2 24.1 4.2 11.6

9.6

B. Use in Past Year

Current

Employment

Pull-time

Part-time

Unemployed

Other

Total

Age Group

12-17 18-25 26-34 35 + Total

8.0

0.8 3.9 6.9 * 2.2

0.8

7.6 6.8 1.0 4.0

13.6 3.1 0.7 6.0

1.2 7.4 3.8 * 1.2

1.5 7.6 6.1 0.5 2.9

* Less than one-half of one percent.

Source: NIDA, National Household Survey on Drug Abuse, 1985.

Similar to the marijuana pattern, significantly more males than females

tried cocaine in each age group. Among the young adults, 28.7 percent

of males, compared to 21.6 percent of females, tried cocaine. Similar

significant differences by gender were observed in the two older age

groups.

Ethnic or racial differences in cocaine use were not as clear as gender

differences. Among young adults, lifetime cocaine use was significantly

higher among whites (28.31 percent) than among either Hispanics (15.0

percent) or blacks (13.4 percent). In this age group, rates for blacks and

Hispanics were quite similar. The pattern was similar among the 26 to

34 year-olds, except that the rate was significantly higher for blacks than

for Hispanics.

39
Use of a drug more than 10 times was defined as fairly extensive, rather

than experimental. Four percent of the respondents had used cocaine

more than 10 times, while 7.4 percent had used it 10 times or less. Use

of cocaine more than 10 times was concentrated among the 18 to 25 yearolds (7.7 percent) and 26 to 34 year- olds (10.3 percent). Approximately

1 percent of the youth and older adults had used cocaine more than 10

times. Thus, projected into population estimates, 7.7 million Americans

who had ever used cocaine used it more than 10 times. In each age group,

at least 20 percent of the respondents who used cocaine had used it more

than 10 times.

Table 6. Occupational Level and Current Use of Cocaine

by Adults (Percentages)

Occupational

Level 18-25

Age Group

26-34 35 + Total

Professional

Technical & Sales

Service

Farming

Production & Craft

Operators & Fabricators

Homemaker

Student

Unemployed

Disabled

Retired

5.1 2.8

5.5 9.5

3.8 8.8

2.2 *

10.3 7.5

11.2 8.0

8.4 4.3

4.1 1.4

13.6 3.1

56.2 3.5

— —

1.1 1.9

1.0 4.3

0.5 3.2

* 0.7

* 4.6

1.0 5.5

* 1.9

* 3.1

0.7 6.5

* 1.9

* *

* Less than one-half of one percent.

Source: NIDA, National Household Survey on Drug Abuse, 1985.

In the 1985 survey, data were obtained about the ways cocaine was used

(sniffing, swallowing, freebasing, or injecting). Freebasing involves

processing cocaine to eliminate impurities and to free the more potent

cocaine base, which is then smoked. Almost all (94.7 percent) users

sniffed or snorted cocaine. The most striking finding is that 45.9 percent

of the 12 to 17 year-old cocaine users freebased, compared to approxi40
mately 20 percent of the cocaine users in the other age groups. This

finding probably reflected use of crack. However, when the survey was

conducted, crack was largely unknown or unheard of. Injection of

cocaine was somewhat higher among users in the oldest age group.

Alcoholic Beverages

More than one-half (55.5 percent) of 12 to 17 year-olds have tried an

alcoholic beverage at some time. The figures for the adults were

substantially higher (Table 7). More than 90 percent of the 18 to 25 yearolds (92.6 percent) and 26 to 34 year-olds (93.1 percent)had tried alcohol,

as had 88.0 percent of those over 35. In view of the high rates for lifetime

prevalence, the salient findings were that the rates were consistently but

not substantially higher for males than for females and were higher for

whites than for blacks or Hispanics in each age group. The rates for

previous month use were somewhat lower, but drinkers were a statistical minority only among 12 to 17 year-olds, among whom 31.0 percent

had had a drink during the previous month.

Except for youth, significantly more males than females reported using

alcohol during the previous month. Rates for current drinking were

considerably higher among whites than among blacks and Hispanics in

each of the four age groups. This was especially true among older adults;

59.3 percent of whites, compared to 44.0 percent of blacks and 49.6

percent of Hispanics, are current drinkers.

Almost all adults employed full-time indicated that, at some time in their

lifetime, they had consumed alcoholic beverages. For current use, the

highest rates were observed among persons employed full-time. Approximately 7 of 10 full-time workers drank during the previous month.

Differences in current drinking by occupational level are minimal (Table

8). The figure of 100 percent for retirees who are 26 to 34 years old is

based on a sample of one.

Daily drinking was defined as use of alcohol on at least 20 days during

the previous month. The pattern for daily drinking was different from

marijuana or cocaine patterns (Table 9). Daily drinking was more

extensive in the two older age categories than among youth or young

adults. Males were almost three times more likely than females to report

drinking on at least 20 days during the previous month. Similarly,

whites were almost twice as likely as blacks or Hispanics to report

drinking on 20 or more days in the previous month. Full-time employees

were more likely to drink daily than part-time employees.

41
Table 7. Use of Alcoholic Beverages, Current Employment,

and Age Group (Percentages)

Age Group

A. Use in Lifetime

Current

Employment 12-17 18-25 2634 35 + Total

Full-time 82.3 95.1 95.0 93.5 94.0

Part-time 64.0 90.6 94.6 86.6 83.3

Unemployed 70.4 91.4 88.6 84.3 86.6

Other 48.2 86.6 86.2 82.0 75.6

Total 55.5 92.6 93.1 88.0 86.1

B. Use in Past Month

Age Group

Current

Employment 12-17 18-25 26-34 35 + Total

Pull-time 63.0 76.3 74.2 69.9 72.2

Part-time 38.7 66.0 71.3 60.6 58.2

Unemployed 53.4 70.8 62.8 54.4 62.0

Other 23.2 59.8 54.7 41.4 40.2

Total 31.0 71.4 70.0 57.3 59.1

Source: NIDA, National Household Survey on Drug Abuse, 1985.

Persons who consumed five or more drinks on the same occasion on five

or more days in the previous month were defined as heavy drinkers

(Table 10). Overall, 6.5 percent of the sample met this criterion. Because

the rates are similar, the two middle age categories are combined. As the

Table indicates, 12 percent of the persons between the ages of 18 and 34,

who were employed full-time or unemployed, were heavy drinkers.

Fewer older adults were heavy drinkers, but the 6 percent rate among

older adults who were employed full-time cannot be ignored. Not shown

in tabular form is the fact that males (10.6 percent) were more likely (p

< .001) than females (2.7 percent) to be heavy drinkers.

In Table 11 the respondents were classified according to their current

pattern of drug use. Tobacco was ignored. Except for persons classified

as other in the 35 and older category, the most common pattern involved

alcohol use only. Relatively few people used only marijuana. Alcohol and

marijuana use was more prevalent among the unemployed than among

working persons.

42
CONCLUSIONS

The above findings of the 1985 household survey indicate that illicit drug

use is strongly related to age. Specifically, illicit drug use is extensive in

the baby boom generation. Rates for marijuana, which is the most widely

used illicit drug, cocaine, or other illicit drugs, such as hallucinogens or

PCP, are consistently higher among persons 18 to 34 years of age than

among youth (12 to 17 years of age) or older adults (35 years of age and

older).

Regardless of the drug, rates for males are generally higher than for

females. This difference is also found for measures of quantity or

frequency. However, the gender differences are less pronounced among

youth than among adults. Overall, the gender differences are more

pronounced among older adults. The declining pattern for youth and

Table 8. Occupational Level and Current Use of Alcoholic

Beverages by Adults (Percentages)

Occupational

Level 18-25

Age

26-34 35+ Total

Professional 77.7 73.3 80.4 78.2

Technical & Sales 69.7 72.6 68.5 69.8

Service 72.1 76.8 49.6 62.0

Farming 69.3 66.2 54.4 62.0

Production & Craft 80.9 74.7 64.6 71.3

Operators & Fabricators 77.2 75.8 63.0 70.1

Homemaker 55.5 52.7 37.3 42.8

Student 62.6 61.1 70.2 63.2

Unemployed 70.8 62.8 54.4 62.9

Disabled 69.2 61.3 39.4 42.8

Retired - 100.0 44.0 44.1

Source: NIDA, National Household Survey on Drug Abuse, 1985.

43
Table 9. Days Alcohol Was Used in Past Month, Current

Employment, and Age (Percentages)

3.5

Current Employment for Persons 18-34 Years Old

Days Full-time Part-time Unemployed

None 25.4 32.3 32.3

1-4 days 36.7 39.9 37.1

5-19 days 27.6 21.2 20.4

20+ days 10.3 6.6 10.2

Other

44.2

39.1

13.8

3.0

Current Employment for Persons 35 Years Old and Older

Days Full-time Part-time Unemployed Other

None 31.0 39.5 49.0 59.8

1-4 days 31.8 26.9 33.0 21.4

5-19 days 22.6 21.5 9.1 9.7

20+ days 14.6 12.1 8.9 9.1

Source: NIDA, National Household Survey on Drug Abuse, 1985.

Table 10. Days in Past Month Respondent Consumed Five

or More Drinks, Current Employment, and

Age (Percentages)

Current Employment for Persons 18-34 Years Old

Days Drank 5

or More Drinks Full -time Part-time Unemployed Other

None 62.7 74.6 65.2 82.7

1-4 25.4 17.2 22.9 13.0

5+ 11.9 8.1 11.9 4.4

Current Employment for Persons 35 Years Old and Older

Days Drank 5

or More Drinks Full-time Part-time Unemployed Other

None 78.7 88.4 82.6 93.5

1-4 15.3 8.3 13.6

5+ 6.0 3.3 3.8

Source: NIDA, National Household Survey on Drug Abuse, 1985

3.0

44
young adults has generally continued. On the other hand, among

persons aged 26 and older, most drugs have shown increasing trends.

The only exceptions are cigarettes and alcoholic beverages; the highest

rates for these substances were recorded in 1979, and the rates for these

licit substances have declined slightly. Rates for use of illicit drugs are

not uniformly high for persons aged 26 and older: illicit drug use is

concentrated among those 26 to 39 years-old, while the rates for persons

aged 40 and older are relatively low.

The trend for cocaine is not clear. Among the youth and young adults,

the rate for cocaine peaked in 1982, while in the two older age groups,

1985 was the peak year. The rate for cocaine may be even higher when

the next household survey is conducted. However, for other illicit drugs,

Table 11. Current Pattern of Drug Use and Current

Employment for Adults1 (Percentages)

Current Employment for Persons 18-34 Years Old

Drug Pattern Full-time Part-time Unemployed Other

No Drug Use

Alcohol Only

Marijuana Only

Alcohol & Marijuana

Other

Alcohol, Marijuana,

and Other

23.7 30.9 28.9 41.2

52.9 49.6 37.5 42.6

0.9 1.0 2.0 0.5

11.1 16.0 5.7

3.6 2:6 3.6 5.2

7.8 8.0 12.0 4.8

Current Employment for Persons 35 Years Old and Older

Drug Pattern Full-time Part-time Unemployed Other

No Drug Use 29.1 38.2 43.1 58.6

Alcohol Only 65.0 59.0 51.0 40.2 Marijuana Only 0.7 1.2 1.7 *

Alcohol & Marijuana 1.8 1.3 2.4 *

Other 2.2 * 1.2 1.0

Alcohol, Marijuana,

and Other 1.1 * 0.7 *

*Less than one-half of one percent.

1Other refers to any use of an illicit drug other than marijuana, or use of an illicit

drug and use of either alcohol or marijuana.

Source: NIDA, National Household Survey on Drug Abuse, 1986.

45
the 1985 study shows a continuation of the trend that began in 1982—

rates for illicit drug use have declined slightly or leveled off. Levels,

however, are still high.

AUTHOR

Harwin L. Voss, Ph.D.

Professor of Sociology

University of Kentucky

1537 Patterson Off. Tower

Lexington, KY 40506

46
Drug Use by Tractor-Trailer Drivers*

Copyright

Adrian K Lund, Ph.D.

Insurance Institute for Highway Safety

David F. Preusser, Ph.D. and Richard D. Blomberg, M.S.

Dunlap and Associates

Allan F. Williams, Ph.D.

Insurance Institute for Highway Safety

INTRODUCTION

In 1985, about 4,500 people died in crashes involving tractor-trailer

trucks. Only 17 percent of those deaths were sustained by the truck

drivers; the remainder were sustained by other road users, and about 70

percent were occupants of passenger vehicles in collisions with trucks

(FARS, 1985).

Truck drivers often spend long hours on the road and have to deal with

fatigue, loneliness, boredom, and uncomfortable driving conditions.

There is considerable informal information that many truck drivers use

drugs as a means of coping with their difficult working conditions.

Alcohol, marijuana, cocaine, and amphetamines generally are mentioned as drugs used. In a 1977 mail survey (Wyckoff, 19791, stimulants

such as “bennies, goofballs, and copilots” were the most common drugs

reported by men truck drivers, with 14 percent saying they used such

drugs occasionally or regularly to stay awake while driving. The

percentage reporting the use ofmarijuana or narcotics while driving was

much smaller, although self-reported marijuana use was higher among

younger drivers (about 14 percent of drivers under 25 years of age said

they used marijuana occasionally or regularly just before or while

driving). Use of alcohol while driving was not queried specifically, but

6 percent of drivers reported that they felt they could drive without

problems within 2 or 3 hours of drinking.

*Reprinted with permission from Journal of Forensic Sciences, 33(3): 648-

661, 1988.

Philadelphia, PA 19103.

American Society for Testing and Materials, 1916 Race St.,

47
Other than anecdotes and these self-reports, however, there is little

scientific evidence about drug use by truck drivers. Even in the case of

alcohol, reliable information is limited to postmortem analyses of fatally

injured drivers. Data from 23 States that test 80 percent or more of

fatally injured drivers for alcohol indicate that about 1 in 8 tractortrailer drivers killed in single-vehicle crashes has blood alcohol concentrations (BACs) at or above 0.10 g/dL. About 15 percent have positive

BACs (FARS, 1985). In the much more common multiple-vehicle fatal

crashes involving large trucks, the truck driver is rarely killed, and there

is no systematic alcohol testing of such drivers.

The extent to which truck drivers are operating their rigs under the

influence of drugs, such as alcohol, marijuana, or cocaine, that may affect

their performance is an important question. It is also also important to

know if stimulants, such as amphetamines or their less potent “lookalikes” (for example, phenylpropanolamine or ephedrine), are being used

by drivers to stay on the road for excessive hours. The present study was

designed to gather information on the incidence of drug use by drivers of

tractor-trailer trucks based on blood and urine samples. The study also

gathered information on the general health status of truck drivers, but

the current report is limited to analyses and findings regardingdruguse.

METHODS

Sample Selection

During the week of December 15,1986,359 tractor-trailer truck drivers

who stopped at the westbound side of the Brownsville, Tennessee, truck

weighing station on Interstate 40 were asked to participate in the study.

All trucks weighing more than 10,000 lbs (4,500 kg) are required to pull

into the station and come to a complete stop at the scales. The present

study was coordinated with a series of random log-book inspections

scheduled by the Tennessee Public Service Commission (PSC) for the

Brownsville station. The log-book check typically requires only a few

minutes and consists of checking required documentation. At the start

of each sampling period, the first truck to be given a log-book inspection

was selected randomly. Subsequently, each truck selected for inspection

was the next truck across the scales following completion of the previous

inspection. Because the completion of an inspection is unrelated to the

characteristics of the next truck at the scale, the selection procedure

provides a random sample of truck drivers. A selected truck was

sometimes overweight or had a visible safety defect or both. These

trucks were processed appropriately, then given the log-book check.

48
At the conclusion of the inspection, the driver was invited to participate

in an anonymous and voluntary health survey. The driver was told that

the survey was conducted by a nonprofit research organization which

was not connected with the state of Tennessee, and he could earn up to

$30. Drivers of single-unit trucks were not included because these

trucks were less likely to be involved in interstate transportation.

Tandem or “double-bottom” rigs were excluded because their size would

have been unmanageable within the existing parking facilities, given

the volume of trucks that were being processed. Women drivers were

excluded as were co-drivers not operating the tractor at the time it

entered the station. Thus, the invited drivers were men operating

randomly selected tractors pulling either no trailer or a single trailer.

Sampling was conducted during one 6-hour sampling period and four 12-

hour periods. The 6-hour period ran from noon to 6 p.m. on Monday, 15

Dec. 1986. The four 12-hour periods began at 6 a.m. on Tuesday, 2 p.m.

on Wednesday, 6 p.m. on Thursday, and 6 p.m. on Friday. Sampling was

completed at 6 a.m. on Saturday, 20 Dec. 1986.

Of the 359 drivers asked to participate in the study, 38 declined. The

most frequently cited reason for declining was that they were late or in

a hurry (18 drivers). In addition to the 38 refusals, 4 drivers accepted the

invitation but either could not or would not provide either blood or urine,

for a total of 42 nonparticipating drivers (12 percent). The average age

of the 317 drivers providingblood or urine was 37 years with an average

of 12.7 years of driving experience. Data about the drivers who refused

participation were limited. However, their average age (39 years) and

the condition of their trucks as rated subjectively by the PSC officers

were similar to those of the participants.

Driver Interviews and Testing

The survey team operated in three motor homes parked in the corner of

the weigh station lot as far from the enforcement officers as possible.

Two of the motor homes were used for interviewing and testing, and the

third was used for processing specimens.

Drivers were initially directed by the officers to one of the two motor

homes used for interviews. Each was staffed with a male interviewer

and a female registered nurse. The interviewer greeted the driver at the

door, asked the driver not to reveal his name or the name of his company,

described the study, explained that all information was to be strictly

anonymous and requested that the nurse be allowed to take his blood

49
pressure. The blood pressure test was followed by a driver interview.

The first half of the driver interview consisted of questions concerning

trucks and driving.1 The second half, administered by the nurse,

consisted of health-related questions.

Following the interview, the nurse requested that drivers provide a

urine sample. Urine was provided unobserved in the bathroom of the

motor home. The nurse then requested a blood sample from the driver.

Blood was drawn into one 7-mL tube plus two 13.5-mL tubes. The urine

samples and the 7-mL tube of blood (containing appropriate preservaTable 1. Drugs Tested by SmithKline’s Comprehensive Drug

Analysis

Acetaldehyde

Acetaminophen

Acetone

Amitriptyline

Amobarbital

Amoxapine*

Amphetamines*

Barbital

Benzoylecgonine*

Brompheniramine

Butabarbital

Butalbital

Cannabinoids*

Carbamazepine

Carisoprodol

Chlordiazepoxide

Chlorpheniramine*

Chlorpromazine

Chlorpropamide

Clorazepate

(as Nordiazepam)

Cocaine*

Codeine*

Demoxepam

Desipramine

Desmethyldoxepin

Dextromethorphan*

Diazepam

Diphenhydramine

Disopyramide

Doxepin

Doxylamine*

Ephedrine*

Ethanol

Flurazepam

Glutethimide

Hydrocodone*

Hydromorphone*

Ibuprofen

Imipramine

Isopropanol

Lidocaine

Loxapine

Meperidine

Mephenytoin

Meprobamate

Mephobarbital

Morphine*

Methadone

Methadone Metabolite

Methamphetamine*

Methanol

Methaqualone

Methsuximide

Methyprylon

Nordiazepam

Norpropoxyphene

Nortriptyline*

Oxycodone*

Pentazocine*

Perphenazine

Pentobarbital

Phenacetin*

Phencyclidine*

Phenmetrazine*

Phenobarbital

Phensuximide

Phenylpropanolamine*

Phenytoin

Primidone

Procainamide

Prochlorperazine*

Promazine*

Promethazine*

Propoxyphene

Pyrilamine*

Quinidine

Quinine*

Salicylates

Secobarbital

Thioridazine

Trifluoperazine

Tripelennamine*

*Tested in urine only - not quantitated.

50
tive and anticoagulant) were immediately refrigerated. The two other

tubes of blood were allowed to coagulate, placed in a centrifuge, and the

resulting serum was refrigerated. All specimens were assigned case

numbers and shipped on the same day obtained, by air from Memphis,

Tennessee, to SmithKline Bioscience Laboratories in Waltham, Massachusetts.

Drivers were paid $30 for participating in the study and agreeing to

provide urine and blood. Drivers were also offered a coded envelope,

which their doctor could use to request the results of their tests.

Drug Testing Procedures

SmithKline screened the urine, blood or serum samples, or some combination of these for the substances shown in Table 1. The screen was

performed using SmithKline’s standard procedures for drug analyses

with two exceptions, First, SmithKline’s standard procedure at the time

was to test and confirm the presence of cannabinoids in urine by two independent enzyme multiplied immunoassay tests (EMIT). For this

study positive findings in urine were additionally confirmed by gas chromatography-mass spectroscopy (CC-MS) or high-performance thin layer

chromatography (HPTLC) where there was sufficient urine. The second

exception was an additional test of the urine samples using a new TDx

fluorescence polarization immunoassay for amphetamine and methamphetamine.

When a substance was detected in either urine or blood, the finding was

checked and confirmed, usually by an alternative, chemically independent test procedure; only confirmed findings are presented in the results,

with one exception. Nine cases where cannabinoids were found in urine

had too little urine for alternative tests. However, four of the nine cases

were found to have cannabinoids in the corresponding blood samples,

and the other five were positive on two independent EMIT tests.

Although these last five are unconfirmed by alternative tests, it is

unlikely that they represent false positives, and they are included in the

test results.

When drugs were detected, their concentrations were quantitated in

blood (or serum) wherever possible (for example, alcohol). For several

drugs of interest (marijuana, cocaine, and the sympathomimetic amine

class of stimulants such as amphetamine or phenylpropanolamine)

SmithKline provided only qualitative tests in urine. When these drugs

51
Table 2. Drugs Tested by CTI in 25 Randomly Selected Urine

Samples

Amphetamines

Amphetamine

Ephedrine

Methamphetamine

Phenylephrine

Phenylpropanolamine

Pseudoephedrine

Antidepressants

Amitriptyline

Amoxapine

Desipramine

Doxepin

Imipramine

Loxapine

Maprotiline

Nortriptyline

Trazodone

Antihistamines

Barbiturates

Amobarbital

Butalbital

Butabarbital

Pentobarbital

Phenobarbital

Secobarbital

Cocaine

Cocaine

Benzoylecgonine(metabolite)

Flurazepam

Marijuana

Delta-9-tetrahydrocannabinol(THC)

Carhoxy-THC(metabolite)

Opiates

Codeine

Heroin

Hydrocodone

Hydromorphone

Morphine

Cxycodone

Opioids

Meperidine

Metadone

Pentazocine

Propoxyphene

Phencyclidine

Phencyclidine (PCP)

PHP

TCP

Phenothiazines

were detected and confirmed in urine, the corresponding blood or serum

samples were provided to Chemical Toxicology Institute (CTI) in Foster

City, California, for further testing and quantitation.2 In addition, blood

or serum samples from the 18 drivers who had provided no urine were

analyzed by CTI for evidence of marijuana, cocaine, and sympathomimetic amines, since the comprehensive drug analysis provided no

test for them in the absence of urine.

As a cross-check on laboratory test procedures, CTI reanalyzed all blood

samples for alcohol, and a random sample of 25 urine specimens were

retested for the drug classes described in Table 2. CTI’s results were

essentially the same as those of SmithKline except for minor differences

in the alcohol findings (see Results) and, in one case, phenylpropanolamine was detected and confirmed by SmithKline but not by CTI.

52
RESULTS

A total of 317 drivers provided sufficient quantities of either urine or

blood for analysis. Urine samples, in sufficient quantity for most of the

analyses, were provided by 299 drivers; blood samples were provided by

307 drivers; and 289 provided both substances.

Alcohol

All urine and blood samples were analyzed for the presence of alcohol,

using gas chromatography with a nominal detection threshold of 0.01 g/

dL in blood or urine. Alcohol was detected in the blood of three drivers

and in the urine of a fourth. The alcohol concentrations in the three

positiveblood samples were 0.01,0.02 and 0.03 g/dL. The driver with the

positive urine sample had no detectable alcohol in blood, and the driver

with blood alcohol concentration of 0.01 g/dL had no detectable alcohol

in urine. CTI’s reanalyses of the blood samples (detection threshold of

0.002 g/dL) found slightly lower concentrations of alcohol in two cases

and no alcohol in the third case (BAC = 0.01 g/dL for SmithKline) or any

of the other 304 blood samples. The slightly lower concentrations found

by CTI (0.004 and 0.020 g/dL) probably reflect some evaporation of

alcohol during the repeated sampling from the blood specimens. Only

two cases of detected alcohol are considered confirmed (less than 1

percent of the drivers).

Marijuana and Cocaine

Fifty drivers (16 percent of all 317 participating drivers) had evidence of

marijuana (15 percent) or cocaine (2 percent) use or both in their urine

or blood; four drivers (1 percent) had metabolites of both substances in

urine or blood (Table 3). Among the 47 drivers with evidence of marijuana use in either urine or blood, followup analyses found delta-9-

tetrahydrocannabinol (THC)—the primary psychoactive constituent of

marijuana— in the blood samples of 11 drivers, or 3 percent of the total

sample (five drivers who had cannabinoids in their urine did not provide

sufficient blood for analysis). At the thresholds used in this study,

measurable quantities of THC indicate either recent or relatively frequent use of marijuana (Mason and McBay, 1985); (Willette, 1985);

(Hanson et al., 1983). Thus, at least 3 percent of the drivers appear either

to be frequent users or to have used marijuana recently. Among the

other drivers with evidence of marijuana use, little can be determined

about the recency of use because marijuana metabolites can be detected

even in blood for up to 2 weeks after intake by frequent users (Peat et al.,

53
Table 3. Tractor-Trailer Drivers With Evidence of Marijuana

or Cocaine Use

Drug

Urine Analysis1

Number Percent

Urine and Blood2

Analyses

Number Percent

Marijuana 43 14 47 15

[THC]3

not tested [11] [3]

Cocaine 6 2 7 2

Marijuana or

Cocaine 46 15 50 16

Total Specimens 299 — 317 —

1 Urine samples for 299 drivers were tested for the presence of cannabinoid

metabolites by EMIT with a nominal detection threshold of 50 ng/ml. All

positives were reaffirmed by a second independent EMIT. In all cases where

there was sufficient urine for additional testing, the presence of cannabinoids

was confirmed by chemically independent, alternative tests as well as the second

EMIT. In 32 cases, alternative confirmation was obtained by GC-MS (gas chromatography-mass spectroscopy); two cases with less fluid were alternatively

confirmed in urine by high performance thin layer chromatography. Nine cases

had insufficient urine for alternative testing, but marijuana was found in blood

or serum of four of these cases by GC-MS.

The presence of cocaine or its metabolites in urine was determined by thin layer

chromatography with a detection threshold of 1 μg/ml and confirmed by EMIT.

2 Cannabinoids and cocaine metabolites were tested for and quantitated by GCMS in the blood samples of 38 drivers who were positive in the urine screens (five

drivers with positive urine results did not provide sufficient blood for analysis);

nominal detection thresholds were 2.5 ng/ml for cannabinoids and 50 ng/ml for

cocaine and its major metabolite, benzoylecgonine. Blood samples for an

additional 18 drivers who provided insufficient urine were screened for the

presence of marijuana or cocaine by radioimmunoassay (RIA, detection threshold of 10 ng/ml for cannabinoid metabolites and 50 ng/ml for cocaine and its

metabolites) and positive results were confirmed and quantitated by GC-MS.

3 THC was tested for in the blood samples of 38 drivers whose urine tested

positive for cannabinoids(excluding 5 drivers with no blood for analysis)and four

drivers who provided no urine but whose blood samples tested positive for cannabinoids.

54
Table 4. Test Results for Marijuana

Specimen Urine Results/ Blood/Serum Results**

No. Confirming Test* Substance RIA THC Carboxy-THC

524 +/GC-MS blood +

526 +/GC-MS blood +

527 +/GC-MS blood -

532 +/GC-MS no blood or serum

533 +/GC-MS blood +

535 +/EMIT blood -

536 +/EMIT blood -

543 +/EMIT blood +

544 +/EMIT blood -

548 +/EMIT blood -

550 +/EMIT blood +

553 +/HPTLC blood -

565 +/EMIT serum +

569 +/GC-MS serum +

571 +/GC-MS serum +

574 +/GC-MS no blood or serum

584 +/GC-MS serum +

586 No urine blood +

595 +/GC-MS serum +

596 +/GC-MS serum +

599 No urine blood +

610 +/GC-MS serum +

611 +/EMIT no blood or serum

629 +/GC-MS serum +

640 +/GC-MS serum +

677 +/GC-MS serum +

696 +/GC-MS serum +

698 +/GC-MS serum +

771 +/GC-MS serum +

773 No urine blood +

775 +/GC-MS serum +

780 +/GC-MS serum +

795 +/GC-MS no blood or serum

797 +/HPTLC blood -

808 +/GC-MS blood +

828 +/GC-MS serum +

839 +/GC-MS blood +

841 +/GC-MS no blood or serum

876 +tGC-MS serum +

881 +/EMIT blood +

889 +/GC-MS serum +

890 +/GC-MS serum +

894 +/GC-MS serum +

897 +/GC-MS serum -

899 +/GC-MS serum +

909 No urine blood +

916 +/GC-MS serum +

3.0

2.8

12

<2.5

3.3

<2.5

5.5

11

7.0

2.5

4.6

20

54

66

52

45

15

6.8

17

40

18

16

20

3

7.5

34

62

87

3.9

63

5.6

9

22

31

3.7

67

15

148

8.1

18

55

148

66

13

38

55
Table 4. Test Results for Marijuana (continued)

* All urine tests were positive for cannabinoid metabolites on two independent

EMIT tests (nominal detection threshold was 50 ng/ml). Additional confirmatory tests were CC-MS (gas chromatography-mass spectroscopy) or HPTLC

(high performance thin layer chromatography); where present, these confirmatory tests are indicated by “+/CC-MS” or “+/HPTLC”.

** Blood or serum samples were screened qualitatively by radioimmunoassay

(RIA) and positive results were quantitated for THC and Carboxy-THC by GCMS in ng/ml (nominal detection threshold of 2.5 ng/ml).

Table 5. Evidence of Marijuana and Cocaine Use in Blood

Samples Corresponding to Urine Samples With

Positive Results

Drug

Number Number of

Confirmed Corresponding Number of

Positive in Urine Blood Samples Positives in Blood

Marijuana 43 38 30

Cocaine 6 5 1

Marijuana or 46 41 31

Cocaine

1984). Individual results for all marijuana tests, includingblood concentrations, are in Table 4.

Table 5 shows the results of followup analyses of the blood samples

(when available) from drivers whose urine tested positive for marijuana

and cocaine. Marijuana metabolites were detected in 30 of the 38 blood

samples analyzed. Eight of the drivers whose urine samples had been

confirmed for cannabinoids had no detectable concentrations of THC or

other cannabinoids (for example, carboxy THC) in their blood. This

finding is not unusual, because marijuana metabolites are detectable in

urine for a much longer period (even weeks for frequent users) than in

blood. These drivers, although they had cannabinoids in their urine,

probably had not used marijuana in several days.

56
Table 6. Tractor-Trailer Drivers With Sympathomimetic

Amines (Stimulants)

Drug

Positive Positive

Urine Analyses3 Urine and Blood Analyses4

Number Percent Number Percent

Amphetamine,

Methamphetamine 4 1 7 2

Phenylpropanolamine,

Ephedrine,

Pseudoephedrine 36 12 38 12

Phentermine1not tested 10 3

Prescription-only

Stimulants2

4 1 16 5

All Stimulants 39 13 48 15

Total Specimens 299 — 317 —

l

 Phentermine was not screened in the urine samples and may be underrepresented in the final results.

2

 Amphetamine, methamphetamine, and phentermine are central nervous system stimulants found only in prescription medications. No drivers reported

medically prescribed use of these substances within the previous 48 hours.

Phenylpropanolamine, ephedrine, and pseudoephedrine are central nervous

system stimulants found in many over-the-counter as well as prescription diet

and cold preparations. About half of the drivers positive for these substances

reported taking cold medications that could have accounted for their presence.

3

 Urine samples for 299 drivers were screened initially by thin layer chromatography with a nominal detection threshold of 1 mg/ml and confirmed by EMIT.

Subsequently, 257 samples were rescreened by fluorescence polarization immunoassay with a detection threshold of 0.3 μg/ml and confirmed by gas chromatography-mass spectroscopy (GC-MS).

4

 Sympathomimetic amines were tested for and quantitated by GC-MS in the

blood samples of 35 drivers with positive urine results (four other drivers positive

in urine did not provide sufficient blood for analyses). Nominal detection

thresholds for these substances were 50 ng/ml. Blood samples for 18 drivers who

provided insufficient urine and another 53 drivers with unconfirmed positive

results on the urine TDx assay were screened for sympathomimetic amines by

GC-MS. Positive findings were confirmed by gas chromatography-nitrogen

phosphorus detection method for substances not detected in urine.

57
Among five drivers whose urine showed evidence of cocaine use and who

had provided blood samples, three were positive for cocaine or its

metabolites in blood by radioimmunoassay. However, none had measurable quantities of unmetabolized cocaine in blood as measured by GCMS; one had benzoylecgonine (less than 50 mg/mL), a major metabolite

of cocaine. One additional driver with no urine was positive for cocaine

metabolites in blood; he had no detectable cocaine, and the concentration

of benzoylecgonine was less than 50 mg/mL. These results probably

reflect the rapid metabolism of cocaine. Typically, its use is detectable

in urine for only 2 or 3 days and for even shorter periods of time in blood.

Sympathomimetic Amines (Stimulants)

Central nervous system stimulants of the sympathomimetic amine class

were detected and confirmed in the urine or blood of 48 (15 percent) of all

317 participating drivers (Table 6). Five percent had detectable concentrations in urine or blood of amphetamine, methamphetamine, or

phentermine, drugs that are available only by prescription. Twelve

percent had detectable levels of phenylpropanolamine, ephedrine, or

pseudoephedrine, other sympathomimetic substances that are available

in over-the-counter medications as well as by prescription.

Table 7. Sympathomimetic Amines (Stimulants) Detected

in Blood Sample Corresponding to Urine Samples

With Positive Results

Drug

Number of Number of

Number Confirmed Corresponding Positives in

Positive in Urine Blood Samples Blood

Amphetamine,

Methamphetamine

Phenylpropanolamine,

Ephedrine,

Pseudoephedrine

4 3 3

36 33 18

Phentermine Not tested

Prescription-only

Stimulants 4 3 3

All Stimulants 39 35 20

58
The corresponding blood samples from 35 of the 39 drivers whose urine

tested positive for sympathomimetic amines were analyzed when available (Table 7). All of the drivers who provided blood and whose urine was

positive for amphetamine or methamphetamine had detectable amounts

of these substances in their blood. Eighteen of the thirty-three drivers

whose urine was positive for phenylpropanolamine, ephedrine, or pseudoephedrine had one of these substances in their blood. As with

marijuana and cocaine, these drugs are typically detectable in urine for

longer periods after use than in blood; their absence in blood while

present in urine suggests that they had not been taken in at least several

hours.

Table 8 shows the extent to which sympathomimetic amines were found

in blood, based on testing of three groups: drivers who had positive urine

tests for these substances, drivers who provided blood only, and drivers

whose blood was analyzed on the basis of unconfirmed positive tests for

amphetamine or methamphetamine in urine.3 Thirty drivers (9 percent

of all 317 drivers) had one or more of these stimulants in their blood.

Phentermine was found in 10 drivers; its presence among all 317 is

probably underestimated because it is not included in SmithKline’s

urine test and was thus tested for only in the 106 drivers whose blood

samples were analyzed for sympathomimetic amines.

Reported Use of Sympathomimetic Drugs

All drivers were asked whether they had used prescription or nonprescription drugs during the previous 48 hours. Only one reported

medically prescribed use of drug preparations containing amphetamine,

methamphetamine, or phentermine during the previous 48 hours, and

he indicated he was using drugs to stay awake. However, of the drivers

with only nonprescription sympathomimetic amines (32 drivers), about

half (15) indicated they had used over-the-counter drug preparations for

the treatment of cold or flu symptoms that might have accounted for the

presence of the detected drug; this was judged to be the case if the

reported medication contained the detected substance or another sympathomimetic substance that might have been contained in a medication

similar to that named by the driver (this procedure allowed for unintentional mislabeling of drugs by the drivers). These drivers accounted for

about one-third of the drivers whose urine or blood had contained

sympathomimetic amines, leaving about 10 percent of the total sample

with detectable levels of sympathomimetic substances (prescription or

nonprescription or both) whose use was not explained medically.

59
Table 8. Tractor-Trailer Drivers with Sympathomimetic

Amines (Stimulants) in Blood*

Drug Number Percent

Amphetamine,

Methamphetamine 6 2

Phenylpropanolamine,

Ephedrine,

Pseudoephedrine 20 6

Phentermine 10 3

Prescription-only

Stimulants 15 5

All Stimulants 30 9

Total Drivers 317

* Based on blood analyses of those with positive urine tests (N = 35), blood

analyses of those drivers who provided only blood (N = 18) and blood analyses of

53 drivers who had unconfirmed positives in urine for amphetamine and

methamphetamine (see text) but tested positive in the blood for other stimulants. All blood analyses were by gas chromatography-mass spectroscopy and

confirmed by gas chromatography-nitrogen phosphorus detection method except in 13 cases with positive tests for phenylpropanolamine, ephedrine, or

pseudoephedrine; confirmation was not obtained in these cases because the

blood results were consistent with confirmed urine test results. In all, blood

samples from 106 drivers were analyzed.

Other Drugs

The other most commonly detected drugs were salicylates (aspirin) or

acetaminophen, which were confirmed in 35 drivers (11 percent). No

opioids or hallucinogens were detected, and only one case of a minor

tranquilizer (diazepam-nordiazepam) and one case of a barbiturate

(phenobarbital) were detected. Both of the latter drivers had reported

medically appropriate use of preparations containing these substances,

and the driver with diazepam claimed that he had last used the

medication more than 48 hours earlier (this claim is not refuted by the

positive finding because diazepam and its metabolites are detectable for

several days after therapeutic use).

Seventy percent of drivers said they had been drinking coffee and they

probably had some caffeine in their urine or blood. However, for this

60
study, the detection threshold for caffeine was set at 20 μg/mL in serum

to identify drivers who might be using caffeine pills or consuming very

large quantities of coffee to stay awake. Two drivers had such large

quantities of caffeine, and one other driver had 13 μg/mL in serum; all

three reported drinking large amounts of coffee (more than ten cups

since they last slept) or using diet pills.

DISCUSSION

The effect of the detected drugs on the risk of crashes among truck

drivers is difficult to estimate, even with information about the concentrations of the drugs in blood. Alcohol, the drug whose effects are best

known, was found in less than 1 percent of the drivers, and in every case

ofalcohol use, the concentration was well below state per se or presumptive limits and even below the 0.04 g/dL limit for commercial vehicle

drivers currently under consideration by the National Academy of

Sciences.4 Nevertheless, alcohol, even in low concentrations, has been

shown to produce performance deficits in laboratory tasks (Moskowitz et

al., 1985). Given the large distances typically driven by tractor-trailer

drivers, the combination of even small amounts of alcohol and fatigue

could increase crash risk.

Marijuana and cocaine, one or both of which were detected in 16 percent

of the drivers who participated, are controlled substances that are

legally available to the public only in very rare circumstances; they

should not be present in any amount in truck drivers. The principal

psychoactive constituent of marijuana, THC, was detected in the blood

of 3 percent of the drivers, suggesting they used marijuana frequently

or had used it recently. The effects on driver behavior and crash risk at

the concentrations detected are not known because psychological and behavioral effects of marijuana often occur after the blood concentrations

of THC have peaked and returned to very low levels (Refer to the Mason

and McBay 1985 study for more discussion regarding the complicated

relationship between performance and THC concentrations.)

It also is not known whether the incidence of marijuana and cocaine

among these truck drivers is similar to that among other, similarly aged

males in the general population. However, the presence of these drugs

in truck drivers should still be of concern, because operators of commercial vehicles—airline crews, train operators, as well as truck drivershave special responsibilities for the safety of others. As described in the

introduction, the serious consequences of tractor-trailer truck crashes

occur overwhelmingly to the occupants of passenger vehicles and other

road users, not to the truck drivers.

61
Table 9. Confirmed Test Results for Sympathomimetic

Amines*

Urine Results** Blood/ Serum Results***

Specimen

Number A/MA PPA E PE A MA P PPA E PE

529

531

532

534

536

538

546

553

563

572

576

577 

579** **

584 

586

588

594

637

644

646

648

651** **

653 

680

681

701

779

782

783

792

795

799

804

807

811

815

819

836

839

843

853

no urine

no urine

no blood

no blood

b=283

b=97

b<50 b=243

b=44

QNS s=218

s=116

b=217

b=107

b=320

b<50

s=56 s=99 s=110 s<50

s=243

b=295 b=118

s=59 s=59

b=397

b=80

s=61 s<50 s<50

b=38 b=401 b=41

no blood

s=220 s<50

b=118

no blood

b=58 b=58

b=117 b<50

s=86

s<50

QNS

s<50

s<50 s=197

62
Table 9. (continued)

Specimen

Urine Results** 

Number A/MA PPA E PE A MA P PPA E PE

855****

886

888

893

906 

907

913

b<50

s=120 s=83 s<50 s=73

b<50 b<50

s=55 s=84 s=86 s<50

Blood/Serum Results** *

*Amphetamine (A), methamphetamine (MA), phentermine (P), phenylpropanolamine (PPA), ephedrine (E), or pseudoephedrine (PE).

**All positive urine results except one were obtained by thin layer chromatography with a nominal detection threshold of 1 mg/ml and confirmed by EMIT

(amphetamine, methamphetamine) or gas chromatography (phenylpropanolamine, ephedrine, and pseudoephedrine). Amphetamine in urine for driver 888 was

detected by fluorescence polarization immunoassay (FPI) with a nominal detection threshold of 0.3 μg/ml and confirmed by gas chromatography-mass spectroscopy (GC-MS). Note that in some cases, PPA may have been detected as a

metabolite of ephedrine or pseudoephedrine.

***Blood or serum samples were tested and quantitated by GC-MS; confirmation for substances not detected in urine was by gas chromatography-nitrogen

phosphorus detection (GC-NPD). Positive results are quantitated in ng/ml

(s-serum, b=blood). QNS indicates the quantity of serum or blood was insufficient to test for and confirm the presence of the indicated substance.

****Driver whose blood was analyzed on the basis of an unconfirmed finding of

amphetamine or methamphetamine in urine by FPI.

Estimating the effect of using stimulants, such as amphetamine, phentermine, or their less potent relatives such as phenylpropanolamine is

also complex. It is possible that the occasional use of such substances can

enhance performance on some tasks by increasing alertness. However,

tractor-trailer drivers may use these drugs to continue on the roads even

under conditions of fatigue (Wyckoff, 1979). Use for that purpose is

probably not occasional, but frequent and sustained. Such use is

potentially dangerous, particularly for amphetamine and methamphetamine, because they have a high potential for abuse and the development of drug dependence. The Physician’s Desk Reference (1987) lists

elevated blood pressure, restlessness, dizziness, euphoria, and headache

as side effects and warns that “amphetamines may impair the ability of

63
the patient to engage in potentially hazardous activities such as operating machinery or vehicles.” Cessation of use after prolonged use of large

dosages of amphetamines or phentermine can result in extreme fatigue

and depression, and overdosage may be accompanied by tremor, confusion, and hallucinations. Phenylpropanolamine can also have negative

side effects, such as nervousness, dizziness, headache, and elevated

blood pressure, when dosages exceed 75 mg per day, the dosage found in

one time-release capsule of Contact, an over-the-counter cold medication, or one Dexatrim Extra Strength capsule, an over-the-counter diet

preparation (American Medical Association, 1983). Thus, although the

use of sympathomimetic amines as stimulants may enable drivers to

stay awake for long periods, the potential risk of such use seems quite

high for both the safety of other road users and the health of the driver.

SUMMARY

This study has provided the first objective data regarding the use of

potentially abusive drugs by tractor-trailer drivers. Altogether, 91

drivers, 29 percent of the 317 who participated in the survey had alcohol,

marijuana, cocaine, or prescription or nonprescription stimulants in

their blood fluids. Marijuana, alone or in combination with other drugs,

was detected in 15 percent of the drivers; cocaine was detected in 2

percent, half of whom also had marijuana. Prescription stimulants, such

as amphetamine, methamphetamine, and phentermine were found in 5

percent of the drivers, often in combination with similar but less potent

stimulants, such as phenylpropanolamine. Nonprescription stimulants

were detected in 12 percent of the drivers, about half of whom gave no

medical explanation for their presence. Alcohol was found in less than

1 percent of the drivers.

One limitation of these findings is that 12 percent of the randomly

selected drivers refused to participate in the study or provided insufficient urine and blood for testing; the distribution of drugs among these

42 drivers is unknown. In addition, because phentermine was not

included in the original comprehensive drug analysis, the incidence of

prescription sympathomimetic amines, 5 percent in this study, is probably underestimated. Finally, the results apply to tractor-trailer drivers

operating on a major east-west interstate route in Tennessee. Drug

incidence among other truck-driver populations are unknown and may

be higher or lower than reported here.

64
ENDNOTES

l

 The driver interview form is available from the authors on request.

2

 Blood samples from all drivers whose urine tested positive for amphetamine

or methamphetamine by the TDx assay were analyzed by CTI for sympathomimetic amines whether or not the urine test was confirmed.

3

 The TDx fluorescence polarization immunoassay screening for amphetamine

and methamphetamine produced a large number of positive indications of

amphetamine or methamphetamine as did the radioimmunoassay performed by

CTI on 25 other urine samples. Although most of these results were not

confirmed (in urine) by GC-MS, simultaneously analyses of corresponding blood

samples did find and confirm the presence of other sympathomimetic drugs that

are reported here. In addition, there were occasions when the blood of drivers

whose urine was positive for phenylpropanolamine, ephedrine, or pseudoephedrine were negative for these substances, but positive for phentermine,

or amphetamine/methamphetamine. The cases are also included. Individual

results of the tests for sympathomimetic amines are shown in Table 9, including

blood concentrations of detected substances.

4

 Section 12008 of the Commercial Motor Vehicle Safety Act of 1986 requires the

National Academy of Sciences to study the appropriateness ofreducing the blood

alcohol concentration above which it is illegal for commercial drivers to operate.

The Act requires the per se level to be reduced below 0.10 g/dL by 27 Oct. 1988.

If a reduction is not in effect by then, the per se level for commercial drivers will

automatically become 0.04 g/dL.

REFERENCES

American Medical Association. AMA drug evaluations. Journal of the American

Medical Association, 1983.

Hanson, V.W.; Buonarati, M.H.; Baselt, R.C.; Wade, N.A.; and Yep, C. Comparison of 3H and 125 I-radioimmunoassay and gas chromatography/mass

spectrometry for the determination of 9-tetrahydrocannabinol and cannabinoids in blood and serum. Journal ofAnalytical Toxicology 7(2), March/April

1983.

Mason, A.P., and McBay, A.J. Cannabis: Pharmacology and interpretation of

effects. Journal of Forensic Sciences 30(3), July 1985.

Moskowitz, H.; Bums, M.M.; and Williams, A.F. Skills performance at low blood

alcohol levels. Journal of Studies on Alcohol 46(6), 1985.

National Highway Traffic Safety Administration. FARS (Fatal Accident Reporting System). Washington, DC: the Administration, 1985.

Peat, M.; McGinnis, K.M.; Johnson, J.R.; Foltz, R.L.; and Jones, R.T. Concentrations of 9-tetrahydrocannabinol and its metabolites in plasma and urine in

“light” and “heavy”marijuana users. In: Dunnett, E., and Kimber, K.J., eds.

Proceedings of the International Association of Forensic Toxicologists (XXIst

Meeting). New Market, England: International Association, 1984.

Physician’s Desk Reference. Oradell, NJ: Medical Economics Company, 1987.

65
Willette, R.E. National Highway Traffic Administration, Department of Transportation. Feasibility assessment of chemical testing for drug impairment,

by Willette, R.E. In: Final Summary Report to National Highway Traffic

Administration Pub. No. DOT HS 806888. Washington, DC: 1985.

Wyckoff, D.D. Truck Drivers in America. Lexington, MA: Lexington Books,

1979.

ACKNOWLEDGMENTS

This work was supported by the Insurance Institute for Highway Safety.

Authorized Reprint from Journal of Forensic Sciences May 1988

Copyright American Society for Testing and Materials, 1916 Race Street Philadelphia, PA 19103

The authors gratefully acknowledge the help of the Tennessee Public Service

Commission. In particular, we would like to thank John Goslin, Director,

Transportation Division; Sergeant Richard Galey, Supervisor Drug Enforcement Program; and Sergeant Leon Ring. We would also like to thank Jannette

Harden, Branch Manager, Medical Personnel Pool of Nashville, and registered

nurses Donna Walls, Tracy Love, Mary Moore, Diana Pawlovich, and Odis

Stadom-Overton. The toxicologists assisting this project were Judy L. Bell,

Ph.D., SmithKline Bio-Science Laboratories, and Randall C. Baselt, Ph.D.,

Chemical Toxicology Institute. We are also indebted to Sharon J. Rasmussen of

the Insurance Institute for Highway Safety; Robert G. Ulmer and Carol W.

Preusser of Dunlap and Associates; and Jerry Underwood, who served as a staff

interviewer. Finally, we thank Richard W. Prouty, B.S., D.A.B.F.P., Chief

Forensic Toxicologist in the Office of the Chief Medical Examiner, Oklahoma

City, Oklahoma, for many helpful comments on an early draft of this paper.

AUTHORS

Adrian K Lund, Ph.D.

Director of Human and Environmental Research

Insurance Institute for Highway Safety

1005 N. Glebe Rd. Suite 800

Arlington, VA 22201

David F. Preusser, Ph.D.

Principal Associate,

and

Richard D. Blomberg, M.S.

President,

Dunlap and Associates

17 Washington Street

Norwalk, CT 06854

66
Allan F. Williams. Ph.D.

Vice President of Research

Insurance Institute for Highway Safety

1005 N. Glebe Rd. Suite 800

Arlington, VA 22201

67

Drug Use Trends in a Nuclear Power Company:

Cumulative Data From an Ongoing Testing

Program

Carl E. Osborn, Ph.D. and Jacque J. Sokolov, M.D.

Southern California Edison Co.

INTRODUCTION

Southern California Edison operates the San Onofre Nuclear Generating Station, a multireactor facility which presently produces roughly 20

percent of their total power output. The facility is located on a Pacific

coast bluff overlooking the ocean about half way between Los Angeles

and San Diego. Reactor #1, the first of San Onofre’s three nuclear

generators, began commercial operations in 1968. It required few

personnel and used access control procedures similar to those of a typical

fossil fuels plant. Born in the social environment of California in the late

1960s, a comprehensive substance abuse program for reactor #l’s

personnel was far from anyone’s mind.

As time passed, public awareness of the effects of substance abuse on the

workplace grew. The Employee Assistance Program (EAP) movement

was one response to this recognition. Southern California Edison

established its own EAP in 1977. In certain industries, however, the

effects of substance abuse on operational safety require extraordinary

measures. Such is the case in the nuclear power industry.

Southern California Edison’s EAP was its primary defense against

company-wide substance problems in the late 1970s and early 1980s. In

October 1982, Edison’s management became formally involved in the

effort: the corporate policy statement was revised to establish a policy

on possession or use of alcohol and drugs, and an attempt was made to

define “fitness for duty.” Things were also changing at the San Onofre

site.

In August 1983 and April 1984, reactors #2 and #3 began commercial

operations at San Onofre. Their vastly more complex and powerful

design demanded rigorous security measures and a concomitant assur69
ance of the public safety. So, in January 1984, Southern California

Edison began company-wide pre-employment drug screening via urinalysis and, in September, implemented a drug screen urinalysis for

anyone with unescorted access to Protected and Vital areas at San

Onofre.

EVOLUTION OF DRUG SCREENING

San Onofre’s first effort at drug screening took a moderate line. It might

be called the “California Model,” since it reflected an attempt to strike a

balance between concerns about substance abuse and the personal

liberties addressed in the California Constitution. From October 1,1984

through November 30, 1986, employees granted unescorted access to

Protected and Vital areas were required to submit a urine sample yearly,

at the time they qualified for their Red Badges. This effectively meant

that they had a full twelve months notice of the date they were to be

screened. In the event their annual test revealed illegal drug use, they

were placed on a periodic drug monitoring program, received supervisory counseling and a voluntary EAP referral, and were reassigned

during a “cleanup” period. Employees failing a second drug screen

received a B-day suspension, and a letter encouraging rehabilitative

treatment was placed in their file. A third failure brought a 30-day

suspension and mandatory rehabilitation. The fourth brought severe

discipline, usually dismissal.

It soon became clear that substance abuse was not eliminated at San

Onofre. Screening results began to show that the “California Model” was

an insufficient deterrent to illegal drug use. Thus, on December 1,1986

Southern California Edison instituted a “Three Strike” program.

Originally, the Three Strike” approach included unannounced testing.

This differed from true random testingby relying on a secret anniversary

testing date of which the employee was unaware. Unfortunately, this

unannounced component was quickly blocked by the courts. Other

facets of this program remained in effect until the dissolution of the

court’s injunction in November 1988. Essentially, it was simply a

tougher version of the original “California Model,” mandating treatment

after the second failure and dismissal after the third.

RESULTS OF DRUG SCREENING

The empirical data derived from these two non-random drug screening

programs follow. For simplicity’s sake, the results of both programs are

combined for analysis.

70
Figure 1

DRUG SCREEN FAILURES

EDISON PERSONNEL

As Figure 1 illustrates, no Southern California Edison employee over 40

years old had ever failed a drug screen as of March 1988. It is also clear

that employees born between 1953 and 1960 are markedly vulnerable to

substance abuse problems. (Note the two vertical axes and their

referents.)

Figure 2

DRUG SCREEN FAILURE RATES

(BADGE-RELATED)

71
Figure 2 shows the failure rates for personnel with unescorted access to

the Protected and Vital areas at San Onofre (Red Badge holders). Since

Figure 2 shows a failure rate, it is affected by the absolute number of drug

screens administered during any given time period. For example, if only

two screens were given and both were failed, the failure rate would be

100 percent. In addition, the rates in Figure 2 were generated from the

combined results of drug screens performed for several different reasons. These include routine Red Badge screens, investigatory screens

performed “for cause,” those given as part of periodic drug monitoring

programs, and screens given after accidents on the job. Failure rates for

some of these screening categories are quite high. These facts combine

to give an informative but complex overall picture. Subsequent Figures

will illustrate more specific trends.

Figure 3

DRUG SCREEN FAILURES

(BADGE-RELATED)

In contrast to Figure 2, Figure 3 illustrates actual numbers of failures

rather than failure rates. As in Figure 2, however, the absolute number

of drug screens administered affects the absolute number of failures.

When compared to Figure 2, the contrast between the absolute number

of failures for contractors and employees becomes clearer.

72
Figure 4

UNANNOUNCED TESTS FAILURE RATE

(PDM AND INVESTIGATORY)

(In Figure 4, PDM = Periodic Drug Monitoring; Investigatory = confirmed allegation or observation of drug use or involvement initiating an

investigatory screening.)

As noted above, certain categories of drug screens have high “hit” or

failure rates. This phenomenon is illustrated in Figure 4. The high

failure rates for contractors in August, 1987 and employees in October,

1987 result from the fact that, of the people who were already classified

as “involved” with drugs and who were called in for unannounced tests

during these months, most failed. The actual numbers involved are very

small because, like Figure 1, they illustrate failure rate, i.e., the percentage of those tested who failed.

73
Figure 5

CAUSES OF DRUG SCREEN FAILURES

(BADGE-RELATED)

Figure 5 is a visual representation of the various drugs detected by

Southern California Edison during the first three years of their drug

screening program for Bed Badged workers. While these drugs and their

relative proportions are generally similar to those obtained in nationwide studies of substance abuse, there is a special problem with amphetamines. Unfortunately San Diego has a number of outlaw amphetamine laboratories. The location of San Onofre places its employees within the distribution area for inexpensive, easily purchased

methamphetamine.

Figure 6

PERCENT OF TOTAL DRUGS DETECTED

INDRUG SCREEN FAILURES

BY SCE EMPLOYEES

74
Figure 6 breaks down the commonly abused drugs by year and employer,

showing the yearly toll of Southern California Edison employees. Note

the decreasing use of marijuana, the increase then slight decrease of

cocaine, and particularly the startling increase in illegal amphetamine

use, especially given the short duration of its detectability via urinalysis.

Figure 7

PERCENT OF TOTAL DRUGS DETECTED

IN DRUG SCREEN FAILURES

BY CONTRACTORS

Figure 7 presents the same analytic format as Figure 6, but it illustrates

the drugs abused by contract workers. Generally, the profiles are

similar.

Figure 8

RECIDIVISM IN EMPLOYEES

AFTER ONE DRUG SCREEN FAILURE

(September 1984-June 1988)

75
Figure 8 is most sobering. It reflects recidivism among employees

involved in substance abuse. There is a recidivism rate of 51 percent for

second failures and 36 percent for three or more. In spite of the

employees knowing when they were going to be screened for their access

authorization, a group of them failed. Further, once they had failed their

first test, they knew they would be placed on a periodic drug monitoring

program, yet more than half could not stay drug-free, and over a third

failed three or more times. Clearly, a change was warranted.

RANDOM TESTING PROGRAM

San Onofre Nuclear Generating Station’s random testing program was

implemented on November 7,1988. This “Two Strike, Random Model”

is conceptually quite simple. Drug screens are performed on Bed Badged

employees on a random basis. The first drug screen failure results in a

14-day disciplinary suspension, mandatory rehabilitation, and a periodic drug monitoring program. The second failure brings dismissal.

Figure 9

300% SIMPLE RANDOM SAMPLING

While conceptually straightforward, operationalizing a random testing

program is a bit more complex. The random aspect of Edison’s model is

based on the use of commercially available, random number generation

software. Its accuracy was validated via Chi-square testing performed

76
by their Planning and Research Division. Then, all individuals who had

active Red Badges were included in the universe of possible selections.

While this number varies substantially according to periodic refueling

needs, about 3,000 Red Badges are valid on any given day. Next, a

program was created to match the numbers generated by the random

number generator to a master list of Red Badged employees. Whether

an employee is selected for testing depends on the correspondence

between the random numbers and the employee’s position on the master

list.

Initially, a simple random distribution was chosen as a testing model.

Unfortunately, this model proved very expensive and inefficient. An

annual testing rate of 300 percent of the universe of Red Badged

employees achieved an acceptable probability distribution at the bottom

and middle of the curve (Figure 9, the left and middle of the graph),

However, it created a very high proportion of people who would be tested

so often that severe work disruption and adverse personal reactions

would occur. This approach was also estimated to cost a great deal.

One of Southern California Edison’s statisticians, Dr. Craig Murray,

created an excellent alternative approach he calls Composite Random

Sampling (Figure 10) (Murray and Talley, 1988).

Figure 10

COMPOSITE RANDOM SAMPLING PRINCIPLE

77
His strategy uses two basic groups of Bed Badged personnel. The first

group includes all employees and contractors who have not been screened

within the last year. The second includes all badged personnel, regardless of their screening status. On any given testing day, half the tests are

performed on the members of the first group, the other half on the second.

Group number one is sampled without replacement, meaning that as

people are picked, their names are removed from the group for a year.

This technique increases the chance that the remaining people will be

chosen from this group over time. After the first year, those people not

sampled for a year are returned to group number one in order to insure

a minimal yearly testing rate.

Group number two is sampled with replacement, and includes the entire

universe of Bed Badged employees. Each person chosen from this group

is tested and returned to the group, providing the continued deterrence

of exposure to further testing. The actual selection rate from group

number two can be much lower than with simple random testing, since

the use of group number one establishes an acceptable base probability

rate. After an initial start-up period of a year, the size of both groups

stabilizes.

Figure 11

COMPOSITE RANDOM SAMPLING

(Approximately 130% Sampling)

78
When the sampling parameters are adjusted to meet San Onofre’s needs,

the Composite Random Sampling approach generates the curve above

(Figure 11). It provides a large chance that employees will be tested at

least once per year but small chances that they will not be tested or that

they will be tested more than three times. This approach also has a much

smaller impact on productivity, generates less employee frustration and

resentment, and costs less than one-third as much as simple random

sampling.

While it is too early to present data from the “Two Strike, Random

Model,” preliminary indications look promising. At this writing, it is

running smoothly after about a month of start-up work. While some

difficulty inevitably follows the implementation of a nonvoluntary drug

screening program, the structure and impartiality seem clear to all.

SUMMARY

This article has traced the evolution of Southern California Edison’s San

Onofre Nuclear Generating Station (SONGS) from fledgling nuclear facility to one of the largest nuclear power installations in America.

Paralleling this growth has been an increasing sophistication and commitment to preserving the public trust through efforts to eliminate

substance abuse in the workplace. Southern California Edison’s substance abuse program has grown and changed in many ways. The

results of this change were presented through datagathered at SONGS.

These efforts continue to be directed toward an ultimate goal-the

creation of a truly drug-free workplace. Work continues.

REFERENCE

Murray, L.C. and Talley, A-E. (1988). Compound random sampling: A better

approach to random drug testing. Available from Engineering, Planning

and Research, Southern California Edison, Rosemead, California.

AUTHORS

Carl E. Osborn, Ph.D.

Chief of Psychological Services

Southern California Edison

Boom 115

P.O. Box 800

2244 Walnut Grove Avenue

Rosemead, CA 91770

79
Jacque J. Sokolov, M.D.

Director, Health Care Department and

Corporate Medical Director

Southern California Edison

8631 Rush Street

Rosemead, CA 91770

80
Drug Monitoring in the Workplace:

Results From the California Commercial

Laboratory Drug Testing Project

M. Douglas Anglin, Ph.D. and Caron A Westland, M.A

California Drug Abuse Information

and Monitoring Project (DAIMP)

INTRODUCTION

Drug use in the United States work force has recently become the object

of public and governmental concern. In 1987, the California Department

of Alcohol and Drug Programs provided funds for the UCLA Drug Abuse

Information and Monitoring Project to augment the State’s drug abuse

monitoring systems by compiling and analyzing data from commercial

laboratories that perform urinalysis tests for drugs of abuse. The

California Commercial Laboratory Drug Testing Project (CCLDTP)

receives monthly urinalysis results from four high-volume laboratories.

Test results provide information on drug use trends and patterns in the

criminal justice system, drug treatment programs, the medical community, and industrial employers throughout the State.

First-year results indicate that detected rates of drug use were lowest in

employment samples. Detected rates in these samples were highest for

the most socially accepted drugs such as marijuana and alcohol, and

lowest for less acceptable drugs such as cocaine, opiates, and amphetamines. Although detected rates for drugs that produce medical complications were somewhat higher in the medical samples than in the

employment samples, in general, illicit drug use was low in both

populations. Detected rates for illicit drug consumption were highest for

criminal justice system samples and drug treatment program samples.

The study results indicate the worth of utilizing already existing information from drug testing laboratories to monitor drug abuse trends

across specific populations. However, the low rate of positive specimens

in the work force samples raises questions as to the costs and benefits of

drug testing compared to alternative methods of identifying and assessing drug abuse problems in the workplace.

81
BACKGROUND

Employees with substance abuse problems, including tobacco and alcohol, cost American industry an estimated $60 billion a year. Annual

wages lost to cigarette-related illness alone are about $3 billion, and

about 32 million workdays and $8.6 billion in wages are lost annually to

heart-related diseases (Chadwick, 1979). Chadwick estimates that these

high costs can be attributed to absenteeism, hospitalization, and early

death among executives. It is estimated that premature death alone

costs American industry $19.4 billion per year, a sum which totals more

than the combined profits of Fortune’s top five corporations in 1976.

Chadwick calculates that employers’ costs for life and health insurance

have increased eightfold in the last two decades, and that a disproportionate amount of this increase is related to substance use.

Although these health costs are impressively large, they alone do not

justify testing for illicit drugs; a large part of these costs is generated by

nicotine and alcohol-ironically the drugs our society promotes and endorses.

Public and private employers, from Fortune 500 companies and large

government agencies to small businesses, are scrutinizing drug abuse

problems as they apply to their own employees. Detection mechanisms,

from supervisor or co-worker reports to highly systematic urinalysis

programs, are under development and review. Many companies reject

drug testing because of problems with invasion of privacy, inaccurate

results, use versus abuse issues, cost, and management, employee, or

union opposition.

Despite its controversial nature, drug testing has become overwhelmingly popular in the United States. Urinalysis is currently used to test

individuals for the presence of drugs from a variety of populations.

Individuals tested include job applicants and employees being monitored by their employers, as well as those in the criminal justice system,

drug treatment, and medical settings.

Why has testing become so popular not only in traditional problem

groups but now in the workplace? As drug use has become more

widespread public awareness of its social costs has also grown. Furthermore, recent public and governmental concern over the extent of drug

use in the work force has focused not only on public safety, but also on

the effects of drug use on productivity, profitability, and health care

costs. The apparent failure of numerous anti-drug campaigns has

created a sense of helplessness. Testing and providing consequences for

a positive drug test are tangible acts that the public believes will deter

drug use.

82
The question remains, however, as to whether the financial and social

costs of testing in all these varied groups are justified by the results? Are

we as a society getting what we want from the use of urinalysis to identify

drug users in the work force?

The Controversy Over Testing

The use of drug testing in the Criminal Justice System (CJS), by drug

programs to monitor client compliance, or for medical purposes is relatively well accepted. However, outside of these areas, and especially in

the area of employment, drug testing is viewed as an infringement of the

fundamental right to privacy. Should an employer have the right to test

an employee whenever he chooses to do so, even if there is no reason to

suspect drug use? Should the employer be allowed to use a negative drug

test as a criterion for employment? Do these uses of urinalysis constitute

an infringement of the employee’s rights? On the other hand, does an

intoxicated employee have the right to endanger the public or to cost

taxpayers additional health dollars for the treatment of drug-related

conditions? Should the employer have the right to maintain standards

of public safety and cost-effectiveness? Should alcohol or tobacco be

viewed differently than prescribed medications or illicit drugs? These

are the kinds of questions which surround the drug testing issue.

The reasons for using urinalysis to test employees for the presence of

drugs are varied. Drug tests are used to detect employees who may be

using drugs; deter employees from drug use; or detour employees from

the workplace into treatment or even unemployment.

The central issue is whether drug testing for detection, deterrence, and/

or detouring is an effective way to deal with drug use and abuse in the

work force. This issue can only be resolved by careful cost/benefit

analysis based on empirical evidence. Social and government interest in

deterring drug use in the workplace follows the military’s well-publicized and reasonably effective suppression of drug use by military

personnel with an effective implementation of a testing policy.

Monitoring Systems

To base social policy on empirical evidence, we need to know more about

drug consumption in the population. A number of indirect indicators of

the extent of drug abuse are provided by several epidemiological databases; however, even taken together, the data collected in these databases provides an incomplete picture. The National Institute on Drug

83
Abuse (NIDA) Household Survey, for example, gives probably the best

estimates of drug use in the general population, but this survey omits

several subpopulations such as transients, institutionalized persons,

and the homeless. The Annual High School Survey conducted by NIDA

collects data on drug use prevalence among high school seniors. This

survey is flawed by the fact that a higher proportion of high school

dropouts than of seniors are substance users. Data available from

NIDA’s Drug Abuse Warning Network (DAWN) System on drug-related

emergency room visits and medical examiner reports of drug-related

deaths monitor the severest consequences of drug use, but are not

particularly useful for making absolute prevalence estimates of drug

use. Other indirect indicators are provided by treatment admissions

figures from State and Federal agencies, public health reports, and

records of drug-related arrests. Two recently developed drug surveillance systems are the Centers for Disease Control (CDC) Controlled

Substance Analog Surveillance Committee, which monitors reports of

synthetic drugs, and the National Institute of Justice (NIJ) Drug Use

Forecasting (DUF) project, which monitors drug use trends among

arrestees in major U.S. cities by survey and by urinalysis.

As is evident from this partial list, each of the drug surveillance systems

provides a small piece of the total picture of drug use and abuse in the

United States. However, each has its limits; the information provided

by these systems must be interpreted with caution.

The California Commercial Laboratory Drug Testing Project

The California Commercial Laboratory Drug Testing Project (CCLDTP)

was established in 1987 by the California Department of Alcohol and

Drug Programs to augment the current monitoring systems by capitalizing on the availability of drug testing data from commercial laboratories that perform urinalysis tests for drugs of abuse in different populations. By analyzing urinalysis data from commercial laboratories, the

department was able to add another source of epidemiological data to

contribute to our total picture of the extent of drug abuse. Because

urinalyses are performed for employee and job applicant drug testing, as

well as for criminal justice system and treatment program clients and

medical patients, we can begin to develop accurate information on drug

use and abuse in the workplace.

The epidemiology of drug use in the work force has not yet been

adequately described. Government and industry policies have emerged

more from the current climate of social intolerance for drug use and

apprehension about liability than from empirical knowledge. While

such groundswells of public opinion are necessary to generate a common

84
consensus for action, they do not produce reasonable social policy unless

the action taken is based on appropriate research findings.

The CCLDTP collects the results of completed urinalyses from commercial laboratories and analyzes them to learn what drugs are most commonly used, how many tests are positive, and whether differences exist

in the urinalysis methods used to assess drug use trends among the

populations studied.

The first year’s data collection and analysis from the CCLDTP has been

completed. These data support a comparison of the pattern of consumption in employment populations with those found in the other populations. Findings are presented in the Results section of this paper, and

the implications of these findings for public policy are assessed.

DESIGN AND PROCEDURES

The CCLDTP was designed primarily to establish a cost-effective means

of monitoring drug abuse trends in selected California populations. The

selection of laboratories was based on a number of criteria developed by

the State Department of Alcohol and Drug Programs, the UCLA Drug

Abuse Information and Monitoring Project (DAIMP) research staff, and

drug testing experts. Laboratories were selected for high volume, a

varied client base, and willingness to cooperate with the study. Other

important criteria included specimen handling methods, turnaround

time for reporting results, and general professional standards.

Three major commercial laboratories—American Clinical Laboratory,

PharmChem Laboratory and Reference Laboratory-began contributing data to the CCLDTP in April 1987, and a fourth—BPL Laboratory—

joined the project in June 1987. The four laboratories process approximately 66,000 tests per month, collectively. Each laboratory receives

minimal financial compensation to cover direct labor costs related to the

acquisition and collation of data and the minimal programming costs

required to upload the data to the DAIMP facility. The project does not

interfere with the daily routine of the laboratories.

These four laboratories supply the CCLDTP with data on urinalysis

results for a variety of clients throughout California. It is important to

note that the types of agencies that request urinalysis vary, as do the

types of drug screens they request. The types of clients represented in

the test results include employed individuals, individuals applying for

employment, criminal justice system clients, individuals in drug treatment programs, and hospital and other medical patients.

85
Specifically, the populations for whom test results are analyzed by the

CCLDTP are as follows:

Workplace testing

- Preemployment screening (GS)

- Employment testing for cause (IC)

Drug treatment programs

- Drug treatment programs-general screen (GS)

- Patients in privately-funded methadone clinics

- Patients in drug-free treatment programs (DF)

Hospital Testing

- General hospital screening (preoperative, blood

chemistry, and special requests) (GS)

- Physicians’ office-general screen (GS)

Clinical Laboratories

- Clinical lab—general screen (GS)

Criminal justice system (CJS) testing

- Prison

- Parole

- Probation

- Community treatment (halfway houses, residential

treatment, and work release programs)

Laboratory Integrity and Confidentiality

Under the current format of aggregate data collection, the CCLDTP

obtains no identifying information from the commercial laboratories on

individual urinalysis subjects or on organizations requesting the tests.

Commercial laboratories participating in the CCLDTP maintain the

highest professional standards of confidentiality with respect to their

client test subjects. The CCLDTP also maintains strict security measures in the processing and handling of data. The use of aggregate data

tiles and extensive coding systems ensures that no identifiable or

traceable data can be linked with a particular client name or individual

specimen sample. Furthermore, access to the data files is limited to

authorized personnel.

86
Drug Screens

The CCLDTP receives data for the following classes of drugs: alcohol,

amphetamines, barbiturates, benzodiazepines, cannabinol, cocaine,

methaqualone, opiates, and propoxyphene.1 Due to the varied reasons

for testing, not all drug classes are represented at all laboratories or for

all client organizations. Changing trends in drug use may promote the

inclusion of more drug types and their analogs in general drug screens

at a later date.

Limitations of the Data

Like several other drug indicator systems, the CCLDTP gathers information in the aggregate. This allows investigators to monitor drug

consumption in the groups sampled, but does not support direct estimates of levels of use within the groups or extrapolations of results to

other groups.

One limitation of the CCLDTP data is the lack of complete demographic

information. The data on gender are minimal, and age or ethnicity data

are not available. Where gender information is obtained, the ratio of

males to females is approximately 10 to 1 for populations with significant

drug use levels. When sample sizes differ to this extent, it is difficult to

provide a stable gender comparison. Given these data constraints,

analyses can be reliably conducted on only two variables: client type

(e.g., employees, drug program clients, parolees, etc.) and geographic

location. Geographic location information is so varied and widely

dispersed that reliable analyses must be conducted with predetermined

area groupings. The results of these analyses are still pending.

The generalizability of the client type results is also limited by sample

bias. Bias occurs in part because the sampling is not always random,

since “for cause” testing is common. Some clients also use the laboratory

facilities to confirm results of an earlier drug screen (although approximately 85 percent of the samples are for initial test submissions). Thus,

the data trends may be skewed toward a higher percentage of positive

screens, and these trends must be interpreted cautiously. Inferences

about levels of drug use (i.e., the number of positive samples) can be

made only with regard to these populations and perhaps only for the

clients of a particular laboratory. However, changes in drug trends over

time within each population can be interpreted with confidence.

87
RESULTS

The CCLDTP has completed its first year of data collection (April 1987

through May 1988) and is able to describe drug trends in selected

populations. Figures 1 through 5 present time series data on monthly

results for the five most frequently detected drugs: alcohol, THC (presumably marijuana), cocaine, opiates (presumably heroin), and amphetamines. The categories were arranged to group similar clients.

However, these groupings may not be as homogeneous as they appear,

because of differences in definition of client types between the laboratories. But because the data are reported from consistent cohorts, the

material presented is useful in trend analyses. When comparing results

for drugs examined it is important to note the differences in chart ranges.

Figure 1 displays the percentages of the employment, medical, and

criminal justice populations that tested positive for alcohol. (Drug

programs do not typically test for alcohol). In the employment sample,

approximately 0.5 percent to slightly over 2 percent of the tests were

positive; the medical population shows a positive range of 1 to 7 percent;

and the criminal justice population showed a range of approximately 1.5

to 9 percent—the most activity of the three client populations. Although

alcohol has been described as the most abused drug, the percentage of

alcohol positives in the CCLDTP employment populations was low. It

would seem that for the most part, individuals who abuse alcohol do not

do so at work.

Figure 2 presents positive test results for THC (marijuana) among three

client populations: employment, drug treatment, and criminal justice,

(medical services do not typically test for THC). The employment

population shows positive results from 1.5 to 7.5 percent of the tests. The

drug treatment exhibit, ranging from approximately 3 to 12 percent, is

based on relatively few data points, since marijuana tests are not

requested frequently for the drug treatment population. The criminal

justice population reveals a large amount of activity, ranging from 3 to

34 percent depending on the type of client.

Figure 3 compares the percentages of the employment, medical, criminal justice, and drug treatment populations testing positive for cocaine.

In the employment population, cocaine is at the lowest range detected,

at 0 to approximately 2 percent. Positive test results in the medical

population range from 1 to 6 percent. The criminal justice system

population illustrates very distinct and very steady trends for different

types of clients. The prison population ranges between 0 and approximately 2 percent, the probation population between approximately 2

and 10 percent; the California Youth Authority (CYA) parolee popula88
Figure 1. Percent testing

positive for alcohol

Note: Missing bars indicate insufficient or missing data

89
Figure 2. Percent testing

positive for marijuana

Note: Missing bars indicate Insufficient or missing data

90
tion between approximately 4 and 8 percent while prison parole clients

range between approximately 7 and 9 percent. The drug treatment

samples show consistent positive cocaine test results, ranging between

approximately 5 and 9 percent for general drug treatment and 5 to 12

percent for methadone treatment. Considerable fluctuation occurs in

the drug-free treatment group, with ranges from approximately 2 to 20

percent.

Figure 3. Percent testing positive for cocaine

91
Very low rates of opiates were found for most populations in the CCLDTP

test results, as is shown in Figure 4. Most individuals who tested positive

for opiates (most often heroin) were in treatment programs (16 to 50

percent of the various drug treatment populations), whereas only 0 to 6

percent of the employment, medical, and criminal justice populations

tested positive for opiates.

Figure 4. Percent testing positive for opiates

92
As shown in Figure 5, amphetamine use in the employment and criminal justice populations was low, with a range of 0 to 4 percent. Higher

positive rates are seen in the medical population (2 to 10 percent) and in

the drug treatment population (2 to 12 percent) (Figure 5).

Figure 5. Percent testing positive for amphetamines

93
CONCLUSIONS

The importance of basing social policy on empirical evidence rather than

on a few highly publicized incidents cannot be overstated. As the use and

abuse of drugs has spread throughout our society, public policy for

dealing with drugs has often been based on guesswork and outrage

rather than on solid research. Even with the variety of drug use

monitoring systems we now have available, there is much that we do not

know about patterns of drug use in the general population.

Using existing urinalysis data, the CCDLTP has now established a

baseline of positive tests for various drugs of abuse for four broad

segments of the population: employees, medical patients, drug treatment program clients, and criminal justice system clients. This baseline

information can be used to monitor true changes in drug consumption as

well as to compare annual and seasonable fluctuations of drug use and

abuse. Changes over time can guide agencies in planning their programs, suggest modifications in policy and programs, point to the need

for further education for the medical profession, or suggest the development of more extensive Employee Assistance Programs.

Use, Abuse, and Addiction

It is also important to note that a positive drug test does not necessarily

reflect abuse. Most substance users are not addicts with a physical

dependency. We need methods of dealing with positive test results that

fit the user’s level of drug involvement. For example, drug addicts

require detoxification and treatment, while occasional users may need

drug education. Further, the interpretation of a positive test depends on

the type of drug used and the length of time since last use. For example,

cocaine remains detectable by urinalysis for a maximum of 4 days,

whereas marijuana remains detectable for as long as a month after last

use. Therefore, a cocaine-positive urine is more likely to indicate recent

and possibly dependent use than a marijuana-positive urine, particularly if the individual was aware of the pending analysis and was not able

to abstain.

Employee and Applicant Testing

Despite recent well-publicized speculation, the actual extent to which

the work force consumes illicit substances is relatively unknown, as are

the effects of such consumption. By analyzing existing data on drug test

results, the CCLDTP has begun to collect objective evidence about the

costs and benefits of drug testing in the workplace.

94
The first-year results, however, raise serious questions about the value

of drug testing in the workplace. When we consider that only 1 or 2 out

of each 100 tests in the employee population are positive, and that, due

to the limitations previously discussed, even those 1 or 2 positives may

represent an overstatement of the actual numbers of positive tests in

general, we have to decide whether we really need to test for drugs in

employee populations. Although testing may be a deterrent in drug

treatment and criminal justice populations, its deterrent effects may be

less relevant to employees and job applicants.

Using empirical evidence of drug use trends in the employment populations as a base, we can decide whether drug testing to detect, deter, or

detour employees is the kind of social policy we can accept and support.

ENDNOTE

l

 Quantitative Assay Techniques vary across laboratories and drugs. The

following assay techniques are used by laboratories to test for the presence of

various drugs:

Thin Layer Chromatography (TLC)

Enzyme Immunoassay Technique (EMIT)

Gas Chromatography (GC)

Mass Spectrometry (MS)

Radioimmunoassay (RIA)

High Performance Liquid Chromatography (HPLC)

Flame Ionization Detector (FID)

Nitrogen-Phosphorous Detector (NPD)

Electron Capture Detector (ECD)

REFERENCES

AMA Research Study. Drug Abuse: The Workplace Issues. Saranac Lake, NY:

American Management Association, 1987.

Bensinger, P.B. Drugs in the workplace: A commentary. Behavior Sciences &

The Law 3(4): 441-453,1985.

Blum, T.C. and Roman,P.M. Alcohol, drugs and EAPs: New data from a national

study. ALMACAN: 20-23, May 1986.

Chadwick, J. wealth Behavior Change at the Worksite: A Problem-Oriented

Analysis.” Background paper for the National Conference on Health

Promotion Programs in Occupational Settings, sponsored by the Office of

the Assistant Secretary for Health, Education, and Welfare. Jan 17-29,

1979.

95
Denenberg,T.S. and Denenberg, R.V. Alcohol and Drugs: Issues in the Workplace.

Washington, D.C.: Bureau of Consumer Affairs, 1983.

Diegleman, R. Substance abuse: The business approach. In: Smith, D.E. et al,

Eds. Subetance Abuse in the Workplace. San Francisco: Haight-Asbury

Publications, 1984.

Evans, D.G. Drug testing, work performance and EAPs: Recent legal guidelines.

ALMACAN 16(12): 33-35,1986.

Gold, M.S. Differential diagnosis in the laboratory. Alcoholism and Addiction,

Dec., 1985.

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

Costs to Society of Alcohol and Drug Abuse and Mental Illness: 1980.

Research Triangle Park, NC: Research Triangle Institute, 1984.

Moskowitz, H. Adverse effects of alcohol and other drugs on human performance.

Alcohol Health and Research World 9(4): 11-15, 1985.

Resident’s Commission on Organized Crime. America’s Habit: Drug Abuse,

Drug Trafficking, and Organized Crime. Washington, DC: 1986.

Taravella, S. EAPs cope with growing cocaine use. Business Insurance, Sept. 29,

1986.

Tavris, C. Workers on drugs? Maybe its the work. Los Angeles Times, Oct. 5,

1986.

Vicary, J.R. and Resnik, H. Preventing Drug Abuse in the Workplace. Rockville,

MD: National Institute on Drug Abuse, 1982.

Walsh, J.M., and Hawks, R.L. Q&A: Employee Drug Screening: Detection of

Drug Use by Urinalysis. Rockville, MD: National Institute on Drug Abuse,

1986.

Winski, J.M. Cocaine: White-line fever in the ad industry. Advertising Age: l9, Sept. 23, 1985.

ACKNOWLEDGMENTS

This research was supported by the Department of Drug and Alcohol Programs,

grant #D-0001-8. Special acknowledgements to: Joel Asch, laboratory consultant, American clinical Laboratory, BPL Laboratory, PharmChem Laboratory,

Reference Laboratory, and Kean Mantius.

AUTHORS

M. Douglas Anglin, Ph.D. and Caron A. Westland, M.A

California Drug Abuse Information and

Monitoring Project (DAIMP)

1100 Glendon Avenue, Suite 763

Los Angeles, CA 90024-3511

96
Results of the Drug Testing Program

at Southern Pacific Railroad

Robert W. Taggart

Southern Pacific Transportation Company

INTRODUCTION

In many respects the railroad industry is unique when compared to other

industries in the United States. Although there have been substantial

technological advances over the years, the basic principle of a steel

wheel, being pulled along a steel rail, laid across wooden ties, still

remains.

Unions representing railroad workers are among the most powerful in

the United States. These unions have helped make railroad employees

among the most highly paid workers in the United States. Employees

report for duty at all hours of the day and night, at hundreds of different

locations throughout their company’s rail systems. (Because of this,

direct supervision is extremely difficult).

By their very nature railroads are a dangerous place to work. When an

injury occurs it can be catastrophic. Trains carrying all manner of

potentially hazardous commodities roll through thousands of communities every day and every night of the year. A railroad accident can occur

in the middle of a crowded community just as it can in the middle of the

desert.

Here is what rail management has faced ever since the driving of the gold

spike. Railroad employees:

Constitute a large number of well-paid, skilled, and semiskilled employees

Are away from home for long periods

Work alone or in small unsupervised groups 24 hours a day

97
Engage in tedious and often monotonous tasks

Are responsible for operating large, fast-moving trains containing virtually every conceivable kind of hazardous material that can take up to a mile to bring to a stop

Pass through residential and business areas at all hours of

the day and night

By anyone’s standards, that is a huge safety challenge. Fortunately,

there is a long tradition of dedication, loyalty, and responsibility on the

part of railroaders. However, the opportunities for employee abuses are

endless.

From the beginning of the rail system, management has recognized the

potential for drug use under these circumstances. Accordingly, they

have prohibited employees from reporting for work with drugs in their

systems. This is known as Rule G. Initially, this prohibition was

directed to alcohol, but as other narcotic drugs came into use, the rule

was expanded to include possession or use of illegal drugs on or off the

job and misuse of legal drugs.

Historically, drug testing on the railroad was done by visual and sensory

observation. Alcohol was virtually the only drug used on the job until the

1960s, and was by far the most frequently used drug on the job until well

into the 1970s.

A comprehensive study of alcohol use by railroad employees was conducted by the U.S. Department of Transportation in 1979. That study

found that:

75 percent of railroad employees drink

25 percent were problem drinkers

12 percent drank on duty

10 percent drank while subject to duty

For several years, the railroad industry has used blood tests to a limited

degree to determine Rule G violations based on reasonable suspicion

grounds and following serious accidents. Labor’s opposition to drug

testing has moderated considerably in the past 8 years. Although a

number of unions still strongly oppose testing, more and more are joining

in support of testing programs.

98
Southern Pacific established its present drug testing program in August

1984. Initiation of the present testing plan began after exhaustive

analyses of accident and injury reports on our railroad, and careful

review of comprehensive Federal Railroad Administration (FRA) data

covering the entire industry. It became all too clear that the use of

alcohol and drugs was playing an increasingly significant role in major

accidents and injuries.

A 1979 FRA study of railroad accidents found that, over the previous 10-

year period, alcohol or drugs were involved in:

48 major train accidents

37 deaths

80 injuries

$34 million damage

This study, while significant, probably identified less than half of the

total drug- or alcohol-related accidents during that period. (The tragic

Conrail-Amtrak collision in January 1987, in which 16 people were

killed and 170 injured, is a dramatic example of the catastrophic results

that can occur when drugs are used on the railroad. In that case, the

National Transportation Safety Board (NTSB) found that marijuana

use by the Conrail engineer was a major contributing factor.)

By 1984, we realized that our longstanding reliance on a program based

on trained visual observation of employees and a review of their work

records to detect alcohol and drug use was not working. We felt something more had to be done to protect our employees and the public. On

the recommendation of our Chief Medical Officer we initiated a program

of urinalysis testing. Urinalysis was felt to be the least intrusive and

most accurate and reliable test to determine the presence of drugs and

alcohol.

Our program includes testing for the presence of alcohol—the most

abused drug in the United States. (According to the National Institute

on Alcohol Abuse and Alcoholism, 30 percent of all general hospital

admissions are alcohol-related.) Our testing program was initially

directed to operating personnel, including for example, engineers, conductors, firemen, switchmen, and brakemen. We met with the affected

Union General Chairmen in advance and briefed them on our plan to

test:

99
All applicants for employment, in conjunction with all regularly scheduled physical exams

Whenever there was “reasonable suspicion” of a Rule G

violation. Included in “reasonable suspicion” were all human

factor or human error accidents no matter how minor-or

major—and vehicular accidents

Any personnel whose action or inactions may have contributed to an accident or the severity of an accident

Any personnel involved in a major accident irrespective of

obvious cause

The affected unions chose not to challenge this program, although they

tiled grievances in individual cases. The program may have been

accepted because local leaders and the rank and file generally were

aware of alcohol and drug use on the job, and they wanted something

done as badly as management. Clearly, there was not sufficient opposition by the membership to support a strike call. As the program

progressed, union acceptance grew. Initial concerns of possible harassment proved generally unfounded and operating management voluntarily submitted to testing along with the rank and file, thus dulling the

double standard argument.

From the beginning, all positive tests have been confirmed by one or

more additional tests. At present, the screens are done by EMIT or by

an RIA test. Positive results are confirmed by GC/MS and, for the past

year, a second lab has been testing those same samples by HPLC. We

have experienced a 100 percent correlation between these two tests.

Test Results Over the Past 3 Years

Urinalysis testing was initiated in August 1984 in our Transportation

Department. Three hundred seventy (370) tests were conducted between August-December 1984. Of those tested, 22.9 percent were

positive for drugs or alcohol. In 1985, the first full calendar year of

testing, 11.6 percent of the 1,388 tests conducted were positive. In 1986,

5.3 percent of 1,519 tests were positive, and in 1987,5.8 percent of the

1,524 tests were positive (Figure 1).

In 1985, we began testing personnel in our Engineering Department. A

strikingly similar pattern was revealed. In 1985, 12 percent of 125

Engineering Department personnel tested positive. In 1986, the num100
Figure 1. TRANSPORTATION DEPARTMENT

PERCENT TESTING POSITIVE

Figure 2. ENGINEERING DEPARTMENT

PERCENT TESTING POSITIVE

Figure 3. MECHANICAL PLANTS Figure 4. ALL EMPLOYEES

PERCENT TESTING POSITIVE PERCENT TESTING POSITIVE
ber tested rose to 721 while the percentage of positives dropped to 6.2

percent. In 1987,680 tests were conducted with a 5.1 percent positive

rate (Figure 2).

Later in 1985, we began testing personnel in our Mechanical Department. Twenty-four (24) tests were conducted with a 16.6 percent failure

rate. In 1986,56 tests were conducted with a 16.1 percent failure rate.

In 1987, the number tested increased three-fold to 168 while the failure

rate dropped to 3.6 percent (Figure 3).

The percentage of positive tests shows a steady and dramatic decline

from 1984 through June 30,1988 even though more than six times the

number of people were tested in 1987 as in 1984 (Figure 4).

The decline in personal injuries since the initiation of urinalysis testing

is equally dramatic and appears to be directly correlated to the number

of tests performed. Figure 5 depicts personal injuries per 200,000 man

Figure 5. ALL EMPLOYEES

PERSONAL INJURY RATE vs. TESTS PERFORMED

102
Table 1. Personal Injury Statistics

Transportation

1983-1988

Total %

Incidents Change

1983 2,234

1984 1,929 -14

1985 1,418 -26

1986 834 -41

1987 784 -6

1988* 322

 *For the first six months of 1988

hours worked from 1983, the last full calendar year prior to the initiation

of testing, through the first 6 months of 1988. Personal injuries per

200,000 hours of man hours worked have dropped from 15.5 to 5.8 while

the number of tests performed has risen from 0 to 2,372.

Personal injuries on the railroad have been dramatically reduced since

the initiation of drug testing-from 2,234 in 1983 to 322 for the first 6

months of 1988 (Table 1).

Similarly, train accidents attributable to human failure have dropped

from 911 in 1983 to 54 for the first 7 months of 1988. Stated another way,

in 1983 there were 22.2 human factor tram accidents per 1 million train

miles. During the first 7 months of 1988 there were 2.2 human factor

train accidents per 1 million train miles (Table 2).

Table 3 shows the most commonly detected drugs since the initiation of

our program.

In response to the argument that drug tests should be limited to

individually observed work-related problems, it should be noted that

less than 5 percent of the total tests we have administered were triggered

by observation of physical symptoms or other accepted work performance standards.

103
Table 2. Human Factor Train Accidents

Transportation Department

Southern Pacific collects data on all human factor caused train accidents and uses this

data in its accident prevention program.

Incidents Ratio* % Change Dollar Damage

1983 911 22.2 — $6,439,677

1984 449 10.5 -50.7 $5,490,356

1985 295 8.1 -34.3 $4,076,133

1986 168 4.2 -43.1 $1,204,477

1987 135 3.2 -20.0 $3,119,822

1988** 54 2.2 $902,261

 *Ratio stated in terms of l,000,000 train miles

** For the first seven monthsr of 1988

Table 3. Most Commonly Detected Drugs

1984

1985

Marijuana Cocaine Alcohol Misc.

53.8% 20% 12% 14.2%

55% 17% 15% 13.0%

1986 33% 46% 15% 6.0%

1987 43% 12% 30% 15.0%

1988* 52% 20% 24% 4.0%

* For the first six months of 1988

104
Our program is far from perfect, but through open and continuing

communications with labor leadership and a perceptively even-handed

approach to testing, we have avoided union confrontation. We now have

sufficient statistical data from which we can convincingly show in a court

room that:

Railroad operations clearly present a potential risk to public

safety if not carried on in a safe manner.

Drug use in the workplace is a reflection of drug use in our

society. It is simply not true that a drug user or alcohol

abuser leaves his habit at the factory gate or the office door.

Drug testing does make the workplace safer and increases

overall public safety by substantially reducing accidents and

injuries.

Drug testing does act as a powerful deterrent to drug use on

the job

Random testing in the private sector may eventually be tolerated.

However, it appears, at this point in time, to be tolerated only when

applied to employees engaged in safety-related jobs. Testing must be

directly tied to the safe operation of the entity in question.

The question immediately arises as to what is a safety-related job.

Supervisors are certainly within the scope of coverage, but how far

removed from direct hands-on operation they may be remains to be seen.

REHABILITATION

Employees who test positive for drugs or alcohol are given the opportunity to participate. in a drug rehabilitation program. We view drug use

as a medical problem, and treat it as such. We hope rehabilitation will

free them from drugs and return them to the job and their families as

productive citizens. Our success rate with rehabilitation is most encouraging.

Under our rules, an employee is removed from service for the violation

of Rule G, but may be considered for return to service on a conditional

basis, providing the employee:

Participates in and successfully completes a rehabilitation

program as agreed to with the Employee Assistance Counselor

105
Agrees to:

Return to work with seniority unimpaired but

without compensation for time lost

Probation for at least 2 years, during which time the

employee must abstain from any alcohol or drug use

Automatic dismissal from service if the terms of

probation are violated

Submit to random, unannounced drug tests

At the end of 2 years, the Employee Assistance Counselor makes

recommendations as to whether probation should be continued or

terminated.

Our experience is that the earlier the detection, the better the chance for

successful rehabilitation. Thirty-nine percent of our employees who

have successfully completed a drug treatment program-most of which

are in-patient programs-have tested positive within the 2-year probationary period. Ninety-two percent of these occur in the first year of

probation. That is a disappointing statistic, but medical experts tell me

that our numbers are pretty good.

IMPAIRMENT

A major question is whether or not “impairment” should be the criterion

for whether an individual can be tested or disciplined for drug use.

Urinalysis drug tests show whether or not there are drugs present in the

system of the individual tested. They do not show impairment. An

individual can drink an alcoholic beverage (or several alcoholic beverages) every night of his adult life, and because alcohol leaves the body

within a relatively short time, he or she will never register positive on an

employer-administered drug or alcohol test. However, the cumulative

effects of excessive alcohol use may result in a steady decline in the

employee’s health, safety, and general well-being.

A marijuana smoker-even the occasional or social user—carries the

chemical component of the drug to the workplace. The marijuana

commonly used today is 5 to 10 times stronger than that commonly

smoked in the 1960s. THC will be present in the body for as long as a

week for the occasional smoker, and many weeks for a regular user.

Occasional cocaine users can register positive on a drug test for up to 48

hours following ingestion.

106
One argument in opposition to urinalysis testing is that because drug

tests do not show impairment, they are really a means by which an

employer can spy on the off-duty, and private activities of employees. An

employer has the right to insist that employees report for work with no

illicit drugs in their bodies. There is more than sufficient justification for

such a requirement.

An employer has the right to insist as a condition of employment—no

drugs in the employee’s system! Impairment need not and should not be

the issue. By inference—if you accept the impairment criteria, you are

indirectly accepting the use of drugs by your employees. If an employer

can set work reporting times, vacations, dress codes, etc., he or she

certainly can insist that the employee report for work free of drugs and

drug residues.

There is ample reliable statistical data to prove that an employee who

uses drugs:

Is more likely to be involved in accidents

Is more likely to be injured

Will be absent more than twice as often as the non-user

Will receive sickness benefits many times those of the

non-user

Will exhibit reduced productivity and quality

Will be involved in substantially more grievance matters and

file many more workers’ compensation claims

Is much more likely to steal to support a drug habit

The fact that other factors may cause some of these symptoms in no way

detracts from their validity with respect to drug use.

CONCLUSIONS

We should not lose sight of the fact that the employer’s supposed

intrusion into the employee’s off-duty activities involves conduct which

our society today condemns as unacceptable and illegal, and which

directly contributes to the most serious organized crime problem in the

world today.

107
Business not only has the right, but perhaps even an obligation, to

employ every reasonable means to provide a drug free workplace and to

assist substance abusers in becoming productive members of the work

force, while recognizing an obligation to give due respect to personal

privacy. It is an extremely delicate issue, with no clear-cut answers. Our

personal liberties are not absolute. They are conditioned on what is

deemed to be in the best interests of a safe, moral, and healthy society,

balanced against the degree of intrusion imposed by-in this case-drug

testing.

The drug testing debate and attendant litigation continues to boil. One

thing is clear. Public opinion and worker acceptance of on-the-job drug

testing has shown a decided swing toward the acceptance of testing.

AUTHOR

Robert W. Taggart

Vice President-Public Affairs

Southern Pacific Transportation Company

1 Market Plaza, Room 961

San Francisco, CA 94105

108
Relationship of Drug Use to Performance

and Productivity

An Empirical Evaluation of Preemployment

Drug Testing in the United States Postal

Service: Interim Report of Findings

Jacques Normand, Ph.D. and Stephen Salyards, M.S.

U.S. Postal Service

INTRODUCTION

The use of illicit drugs has been a matter of growing national concern.

According to yearly assessments of American high school students and

young adults, drug use increased steadily through the 1960s and 1970s,

climaxed in the early 1980s, and has remained fairly stable ever since

(Miller and Cisin, 1983; Johnston et al., 1987). The National Household

Survey on Drug Abuse indicated that 19.3 percent of Americans over 12

years of age had used illicit drugs (e.g., marijuana, cocaine, PCP,

hallucinogens) during the past year (NIDA, 1987). In the 18- to 25-yearold adult population, representing the young people now entering the

American workforce, 42 percent had used illicit drugs in the past year,

25.5 percent in the past month. The most recent trends indicate that the

general prevalence of drug use has now stabilized, although at levels

many consider to be alarming (Dupont, 1986; Walsh and Yohay, 1987).

As a result of this national concern with drug abuse, greater emphasis

has been placed on drug use among working adults. For example, Cook

and Harrell(1987) analyzed self-report data from a national sample of

1,716 adults who were employed in jobs outside the home. Overall, 18

percent of the sample had used marijuana in the past year (11 percent

in the past month) and 6 percent had used cocaine during the same

period (2 percent in the past month). Marijuana and cocaine rates of use

were greater among workers under 35 than among older workers and

higher for males than females.

Although there is evidence of substantial drug use among working

adults (Backer, 1987), little empirical information exists concerning the

prevalence of drug use in the workplace. Most studies addressing this

111
issue make reference to general prevalence of drug use and implicitly

assume that this rate applies to drug use on the job (e.g., Cook and

Harrell, 1987). This assumption, while intuitively appealing, is not sub

stantiated by empirical evidence. An exception to this is a study reported

by Newcomb (1988) of young adults (N = 739) reporting general substance use as well as substance use specifically at work or school. The

general prevalence rate for marijuana was 42.8 percent in the past 6

months, compared to only a 16.6 percent rate of use at work. Cocaine was

the next most frequently used illicit drug with a general prevalence rate

of 33.8 percent versus a 9.3 rate of use during working hours. Other

illicit drugs followed the same prevalence pattern. It was concluded that

rates of general drug use and drug use at work parallel one another, but

general prevalence rates are considerably higher in magnitude and

cannot be used as a substitute for assessing prevalence patterns in the

workplace.

The few existing estimates of the economic burden of drug use in the

workplace report direct and indirect costs to employers and their

employees that amount to several billion dollars a year. The figures have

been on the rise for a number of years. For example, the Research

Triangle Institute estimated that drug abuse cost the U.S. economy

$46.9 billion in 1980. By 1983, the revised figure had risen to $57.9

billion, representing a 27 percent increase (Harwood et al., 1984). A

more recent estimate by the Metropolitan Life Insurance Company put

the direct costs to industry at $85 billion a year (as cited in Cohen, 1984).

Included in these estimates are lost time, reduced productivity, lost

employment, injuries, accidents, and crime (Backer, 1987). One difficulty in interpreting these figures noted by Harwood et al. is that the

estimates can increase (or decrease) over time for reasons other than an

increase (or decrease) in the true prevalence of drug use (e.g., inflation,

population growth, sex and age distribution of targeted population).

Crown and Ftosse (1988) also point out that most estimates of this type

are highly speculative and are not specific enough to provide the kind of

hard proof individual employers may need to claim job relatedness.

In response to employee drug use, an increasing number of employers

have adopted drug testing and employee assistance programs (EAPs).

Drug screening, usually in the form of urinalysis, has become common

among Fortune 500 companies (Walsh and Hawks, 1988) and several

government agencies (Gillette, 1986). The widespread use of drug

testing programs has largely been due to technical developments in

urinalysis methods and an increasing awareness of the potential safety

and financial consequences of employee drug use (Schuster, 1986).

Despite the enormous popularity of drug screening programs, a number

of technical, practical, and legal concerns have surfaced regarding their

112
role in reducing the negative impact of employee drug abuse (Dogoloff

and Angarola, 1985; Rosen, 1987; Wrich, 1988). One criticism of particular concern is the lack of systematic evaluation of the efficacy of drug

screening programs. The scientific base of information currently used to

justify the implementation of these programs comes largely from controlled laboratory and self-report studies concerned with the effects of

drug use on various measures of social, cognitive, and psychomotor

functioning.

A number of studies relating to the performance effects of specific drugs

have been conducted in controlled laboratory settings. For example,

laboratory research has indicated that marijuana intoxication impairs

attention, recall, and the psychomotor skills associated with operating

a motor vehicle or flying a plane (Murray, 1986). One critical finding for

industrial operations was that smoking marijuana produced measurable performance impairment on a battery of cognitive and psychomotor

tests the morning after smoking marijuana (Chait et al., 1985). One

study utilizing a highly sophisticated flight simulator showed subtle

(through statistically significant) performance impairment in licensed

pilots 24 hours after having smoked a single marijuana cigarette

(Yesavage et al., 1985). The impairment persisted long after the subjective effects of the initial “high” had subsided. Despite the performance

decrements, the pilots reported no awareness of their impairment.

A number of recent studies have investigated the relationship between

self-report measures of drug use and various work-related variables.

Newcomb (1988) used data from a group of employed young adults

(N=468) to analyze the relationship between use of illicit drugs at work

in the past 6 months and two job-related variables: job separation and

vandalism at work. The illicit drug use categories were cannabis,

cocaine, and hard drugs (a composite of stimulants, hypnotics, and

cocaine). Product-moment correlations were calculated between each

drug use measure and the two work-related measures. Cannabis use at

work was significantly correlated with losing a job in the past 6 months

(.20, p < .001) and vandalism at work (.12, p < .01). Cocaine use at work

was not significantly correlated with job separation or vandalism at

work. The use of hard drugs at work was not related to job separation but

was significantly correlated with vandalism at work (.19, p < .001). The

conclusion was that only certain types of drug use at work were related

to job separation and vandalism.

McDaniel (this volume) used self-reports of preemployment drug use

from 10,188 military applicants to predict unsuitability discharges from

the military. The drug use items assessed the frequency with which

applicants had used illicit drugs or prescription drugs without the

113
permission of a medical doctor. The unsuitability measure was defined

as a discharge from the military for behavioral or performance reasons

such as discipline problems or dismissal from a training program. The

product-moment correlations between frequency of drug use and employment suitability (a dichotomized variable) were extremely small: .07

for marijuana and .04 for cocaine. The validities for the other drugs

included in the study were no better (e.g., .07 for stimulants, .05 for other

narcotics). It was concluded that the low prevalence rates and reliabilities of most of the measures contributed to their low validities in

predicting on-the-job suitability.

Kandel and Yamaguchi (1987) used a continuous-time exponential

hazards model to analyze the time-varying relationships between

monthly self-reports of drug use and job separations. The information

gathered by the researchers covered a S-year period and was based on a

sample of 1,325 young adults aged 24-25. Theresultsindicated that drug

use predicts job turnover and decreased tenure on the job but that this

finding could not be attributed entirely to the effects of the drugs

themselves. A true drug effect would have resulted in the effect of

current use (use within past month) being stronger than the effect of

former use (no use in a period of 1 month or more). However, the

researchers discovered that the effects of former use and current use of

drugs were equally strong. The last time most former users had used

drugs was close to 2 years. It was concluded that for individuals who use

drugs, turnover could be due to characteristics (e.g., attitudes, predispositions, and life-styles) that have little or nothing to do with patterns of

drug use. The point was made that future research aimed at understanding the relationship between turnover and drug use must take

these life-style patterns into account.

Very few studies have investigated the relationship between preemployment urinalysis test results and job performance. Blank and Fenton

(this volume) analyzed demographic and turnover data for 482 male

Navy recruits who tested positive for marijuana at accession and a

comparable group who tested negative during the same period. Though

retained by the Navy, recruits who tested positive were warned, counseled and, in some cases, subjected to regular drug testing. If subsequent

tests were positive for any illicit substance, the recruit was discharged

from the military and sent home. It should be noted that all recruits were

subject to occasional random testing (about three times a year).

Significant differences between the positive and negative groups were

found for education, race, and scores on a qualifying exam. Positives

graduated from high school at a lower rate, were disproportionately

black, and scored significantly lower on the Armed Forces Qualification

114
Test compared to negatives. Turnover data revealed that 43 percent of

the positives and 19 percent of the negatives had separated after a period

of 2.5 years. This difference in turnover rates may be due in part to the

fact that recruits who tested positive at accession stood a much greater

chance of being discharged from the service because of the policy calling

for the regular screening of this group for drugs. In fact, one-third of the

discharges for the positive group were for reasons of “drug abuse,” a

determination more than likely based on the results of drug urinalysis.

To the extent that this contamination was present, the turnover data

will be limited in assessing the relationship between preemployment

drug test results and turnover.

Surprisingly little research has been reported in the literature concerning the relationship between drug test results and job performance

(Crown and Rosse, 1988). Consequently, the job relatedness of preemployment drug testing, at least in the form of criterion-related validity

evidence, has yet to be examined.

Given the current popularity level of urinalysis drug testing programs

among major employers, the amount of popular press coverage, the

sensationalistic and speculative statements made by proponents and

opponents, the substantial amount of legal attention being devoted to

the issue, and the scarcity of scientific studies which have evaluated its

potential merits, the need for empirical research is manifest. In an

attempt to compensate for this lack of data-based knowledge, this study

will systematically evaluate the relationship between drug test results

and job performance indicators within an applied work setting. A second

purpose of this study is to assess the effectiveness of preemployment

drug test results in predicting two of these indicators of successful job

performance: turnover and absenteeism.

This report is the first in a series of interim reports. This report is limited

to examining the relationship between drug test results and two job

performance indicators, based on data from employees who had been on

the job for an average of 8.2 months. Future interim reports will explore

the relationships between drug test results and other outcome measures

(e.g., accidents, injuries, benefit claims).

METHODOLOGY

Subjects

All applicants who applied for a permanent position with the Postal

Service and had their preemployment medical examination performed

115
by a U.S. Postal Service Medical Officer in one of 21 sites across the

country submitted a urine sample at the time of medical examination.

Five main selection criteria were used to identify the participating sites.

First, employment sites with a formal preemployment drug testing

program in place were excluded. Second, only sites with computerized

personnel data bases were considered. This prerequisite was imposed to

enable accurate monitoring of the participants’ Postal Service careers

via existing computerized records, without requiring any local monitoring. Employment sites with relatively high projected hiring activities

were considered for participation in an attempt to obtain a sufficiently

large sample size. In order to ensure a demographically heterogeneous

sample of applicants, diverse geographic locations were selected. All

participating sites had to have a Postal Service Medical Officer perform

the medical examinations in the context of which the urine samples

would be collected. Although all selected sites had computerized records,

some of the applicants who were having the medical examination

performed in those sites were assigned to working sites without such

computerized systems. This logistical constraint prevented the retrieval

of certain types of information (e.g., absenteeism records) on those

employees. Of those sites which met these selection criteria, six were

located on the east coast, eight were in the central part of the country,

and seven were on the west coast. A complete list of these sites is

presented in Table 1.

Drug test results were obtained from 5,465 job applicants. Urine

specimens were collected between September 14, 1987 and May 27,

1988. A total of 4,375 of these job applicants were eventually hired and

made up the study sample. This hiring rate resulted from preemployment screening in determining whether or not a job applicant is fit for

duty. Suitability for employment is based in part on various preemployment evaluation procedures, including a review of previous work recTable 1. Participating Sites

West Central East

Seattle, WA (2 sites)

Oakland, CA

Los Angeles, CA

Long Beach, CA

Santa Ana, CA

San Diego, CA

Milwaukee, WI

River Grove, IL

Chicago, IL

Detroit, MI

St. Louis, MO

Dallas, TX

Fort Worth, TX

Denver, CO

Hartford, CT

New Haven, CT

Trenton, NJ

Atlanta, GA

Orlando, FL

Tampa, FL

116
ords, criminal records, as well as a medical evaluation performed by a

licensed physician.

The demographic characteristics of the sample as well as the national

population of new hires for the same hiring period are given in Table 2.

Breakdowns are provided for sex, age, and ethnicity. The subjects in the

study group did not markedly differ from the U.S. Postal Service

population of new hires. The only differences were that the sample had

a greater percentage of blacks and a slightly lower proportion of new

hires over the age of 40 than the national population. These differences

resulted mainly from the inclusion of sites which were selected in order

to satisfy the study criteria; these sites were concentrated in large urban

areas.

It should be noted that permanent employment with the Postal Service

is contingent upon successfully completing a 90-day probationary period. The probationary period results in a decision to retain or separate

the appointee based on performance during this evaluation period. For

this reason, the probationary period represents a rather atypical phase

of a new employee’s Postal career. For example, employees are encourTable 2. Demographic Characteristics of New Hires

Sex

Male

Female

Missing

Ethnicity

White

Black

Other

Missing

Age

Less than 25 yrs.

26 to 30 yrs.

31 to 35 yrs.

36 to 40 yrs

41 and older

Missing

Sample

No. of Percent

hires of Sample

Population

No. of Percent

hires of Population

2535 60.1 41,134 59.1

1684 39.9 28,497 40.9

1 32

2097 49.8 46,678 67.2

1370 32.5 13,476 19.4

746 17.7 9,285 13.4

7 224

957 22.7 13,353 19.2

1037 24.6 15,971 22.9

848 20.1 14,297 20.5

667 15.8 11,347 16.3

711 16.8 14,695 21.1

0 0

117
aged not to use any leave and are generally expected to be on their best

behavior. When these analyses were performed, 155 active employees

had not completed their probationary periods. The results which follow

were based on those employees who had the opportunity to complete this

critical stage of employment (i.e, 4,220 of the total sample).

Procedure

Standardized collection procedures were established to ensure the

accuracy and integrity of the data recorded in all sites. Participating

physicians and Human Resources representatives from each site attended l-day briefing sessions prior to initiating the study. During these

meetings, each attendee was given a detailed documentation package

describing the study’s methodology and data collection protocol.

During the course of the briefing, physicians were informed that they

would not have access to the drug test results nor would the results be

communicated to those making employment decisions or to any other

local personnel. In order to ensure the objectivity of the study’s results

and the privacy of the individuals involved, the individual drug test

results were made available only to the research team at Postal Service

Headquarters. Not releasing these drug test results to any Postal

Service personnel guaranteed that no future personnel action was

influenced by the test results. This critical design feature was described

in writing in the documentation package. It was also communicated in

a letter to the Human Resources directors of all participating sites. In

order to further protect the confidentiality of study participants, a

Confidentiality Certificate issued by the National Institute on Drug

Abuse (NIDA), under the authority vested in the Secretary of Health

and Human Services, was obtained. This certificate legally protects the

privacy of research subjects from any private or governmental access. In

the orientation, physicians were reminded to follow normal medical

protocol when determining whether or not an applicant was fit for duty,

including drug tests if they would have normally requested such a

diagnostic test. It was clearly communicated to them that they should

not, as a result of the study, deviate from their normal protocol when performing their medical examinations.

Although no individual personnel action was taken as a result of the drug

test results, it was still deemed essential that proper control mechanisms (i.e., chain ofcustody and standard collection protocol) be followed

to ensure the accuracy of the data recorded. Chain of custody forms,

urine collection bottles, and detailed chain of custody instructions were

supplied by the contract toxicology laboratory. The Headquarters

118
research team provided each site with a detailed step-by-step collection

protocol instruction sheet and a urinalysis implementation VHS video.

Since all sites were already collecting a urine specimen from all job

participants as part of the standard medical procedure for the preemployment physical examination, physicians were informed that immediately after having collected the specimen, a sufficient quantity of urine

(i.e., approximately 50 ml) should be transferred to the laboratory’s

collection bottle prior to performing the standard multitest stick for

albumin, sugar, and blood.

In addition to collecting urine specimens, physicians were required to

complete a personal history form (PHF) for all job applicants. The

information collected on the PHF consisted of demographic information

(e.g., name, sex, age) and personal history data (e.g., smoking habits,

exercise habits, use of medication). Physicians were informed both

verbally during the briefing sessions, and in writing (i.e., collection

protocol documentation package), to investigate thoroughly the applicant’s prior use of medication when completing the “current medication

used” section of the PHF. This latter information regarding the use of

over-the-counter drugs or use of prescription medicine was used to

identify justified true positives (i.e., those whose positive test results

could have been caused by the legitimate use of medication) and to

properly code their drug test results for the analysis. Assistance from

toxicologists at NIDA was obtained to ensure that all justified true

positives were accurately identified. The drug test results for these

participants were coded as negative only for individual drug test results

that were due to the legitimate use of prescribed or over-the-counter

medication.

In addition to informing participants in writing (i.e., the standard U.S.

Postal medical assessment form) that a urine sample would be collected

and that part of that specimen would be used for a drug test, physicians

were provided with standard language to verbally inform subjects of

their participation in a drug study. The PHF, which was partially

completed by the job applicants, also informed them of the purpose of the

data collection and how the data would be used.

Finally, as an added feature, 5 of the 21 sites (Trenton, NJ; Tampa, FL;

Chicago, IL; Fort Worth, TX; and San Diego, CA) were used as quality

control sites. In order to evaluate the reliability and accuracy of the

contract toxicology laboratory, 250 quality control urine samples were

submitted “blind” (i.e., without the laboratory’s knowledge) via the

above-mentioned sites. Fifty blank (i.e., drug-free) samples, 100 samples

containing cross-reactive agents, 50 samples spiked with drug metabolites

at concentration levels just below the cutoff levels, and 50 spiked

119
samples with drug metabolites at concentration levels which exceeded

the cutoff levels were purchased. Each of the five participating sites was

given detailed instructions to ensure that these quality control samples

would be submitted blind to the contract toxicology laboratory.

Measures

Under chain of custody procedures, urine samples were sent from the

study sites to the contract laboratory for analysis. Urine samples were

initially screened using the Enzyme Multiplied Immunoassay Technique (EMIT). All specimens identified as positive at the initial screening were confirmed using the Gas Chromatography/Mass Spectrometry

(CC/MS) technique. Quantitative CC/MS readings were reported for all

specimens identified as positive at the initial screening, regardless of the

concentration level detected at confirmation. All specimens were tested

for eight drug types at predetermined levels of sensitivity. Table 3

provides a list of the individual drug types as well as their associated

drug metabolites and the required cutoff levels for positive screening

test results using EMIT. It should be noted that two marijuana

screenings were performed at the preliminary stage. The first screening

used a cutoff level of 20 ng/ml for marijuana metabolites. Specimens

identified as positive at that preliminary stage were then confirmed

using the GC/MS technique and were also submitted to a second

screening using an EMIT cutoff level of 100 ng/ml. The use of two EMIT

cutoff levels for marijuana at the initial screening phase was incorporated into this study design to allow the further exploration of the impact

of the Health and Human Services’recommended 100 ng/ml EMIT cutoff

level.

Four different independent drug test variables were used for this study.

The first variable (i.e., Overall Test) was defined as positive if the urine

specimen was found to contain one or more of the drug and/or metabolites

of the eight parent drugs at predetermined concentration levels using

CC/MS. The confirmation GC/MS cutoff levels used to define a test

result as positive in this study are shown in Table 4. Specimens that

were found to contain none of the drugs and/or metabolites at the

confirmation stage were defined as negative. This operational definition

mimics the definition used by most organizations that have implemented a urinalysis drug testing program as well as the U.S. Postal

Service’s drug testing program. No distinction is made with regard to

individual drug types. A specimen is either positive or negative for

drugs.

In order to assess the impact of individual drugs, three additional

independent variables were used. The variable “marijuana” was defined

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Table 3. Drugs and Cutoff Levels

Drug Type

Drug and/or

Metabolite*

EMIT Screening

Cutoff level

Amphetamine Amphetamine

Methamphetamine

1000 ng/ml

Barbiturate Amobarbital

Butabarbital

Pentobarbital

Phenobarbital

Secobarbital

300 ng/ml

Benzodiazepine N-Desmethyldiazepam

Nordiazepam

Oxazepam

300 ng/ml

Cannabinoid THC-COOH 20 ng/ml

THC-COOH 100 ng/ml

Cocaine Benzoylecgonine 300 ng/ml

Methadone Methadone 300 ng/ml

Opiate Codeine 300 ng/ml

Morphine

Phencyclidine Phencyclidine 25 ng/ml

*Metabolite refers to the biological breakdown product of the parent drug (e.g., THCCOOH and benzoylecgonine am the common metabolites of marijuana and cocaine,

respectively).

as positive only if a urine specimen was confirmed to contain THC

metabolite (THC-COOH) and no other drug metabolites, and as negative if no drug metabolites were confirmed to be present in the urine

sample. The “cocaine” measure was defined as positive if only benzoylecgonine ( a cocaine metabolite) or THC-COOH and benzoylecgonine

were found at concentrations equal to or exceeding the CC/MS cutoff

levels. This cocaine measure was defined as negative if no drug

metabolites were confirmed by CC/MS. The rationale used to define

cocaine as positive if it contained THC-COOH as well as benzoylecgonine

was that since cocaine is a more addictive drug which metabolizes more

rapidly than marijuana, it was most important to consider the results as

effects of cocaine on the outcome measures even when present with a

milder drug. Finally, the measure “other” was defined as positive if the

specimen contained confirmed levels of one or more of the remaining

121
Table 4. GC/MS Confirmation Cutoff Levels

Drug Type

Drug and/or

Metabolite

GC/MS Confirmation

Cutoff level

Amphetamine

Barbiturate

Benzodiazepine

Cannabinoid

Cocaine

Methadone

Opiate

THC-COOH

Benzoylecgonine

Methadone

Codeine

Morphine

Phencyclidine Phencyclidine

Amphetamine

Methamphetamine

Amobarbital

Butabarbital

Pentobarbital

Phenobarbital

Secobarbital

N-Desmethyldiazepam

Nordiazepam

Oxazepam

300 ng/ml

300 ng/ml

300 ng/ml

20 ng/ml

150 ng/ml

300 ng/ml

300 ng/ml

25 ng/ml

drugs, or combinations of any of the drugs except for the “marijuana/

cocaine” combination. If the specimen was confirmed to be drug-free, the

“other” variable was said to be negative.

Two outcome measures were used in this interim phase of the longitudinal study.

Absenteeism—The first measure to be investigated was

absenteeism. For the purpose of this study, absenteeism was

defined as being a function of three different types of leave:

sick leave, leave without pay (LWOP), and absent without

official leave (AWOL). This definition automatically excludes

annual leave, administrative leave, and the like. The total

hours of leave taken under these three types of job absence

were used to compute an absenteeism index for each employee participating in the study. An absenteeism rate was

computed for each employee using the following equation:

122
Absence rate = Sum of (SICK+LWOP+AWOL) hours

Sum of (SICK+LWOP+AWOL+WORKED) hours

Turnover—Individuals whose employment with the Postal

Service was terminated, regardless of reason, were defined

as having turned over. All remaining study participants who

had not experienced any break in service and were still active

employees were said to have not turned over. In addition to

overall turnover, more refined analyses were carried out by

separation type. To do so, turnover was broken down into

voluntary and involuntary separations (Muchinsky, 1987).

The turnover was said to he voluntary if an individual’s

employment was terminated as a result of a resignation or

transfer to another government agency. Turnover was defined as involuntary if the Postal Service initiated the employment termination (i.e., the employee was fired).

Analyses

As stated earlier, the purpose of this study was twofold. The first

intention was to determine if drug test results and outcome measures

are related, and if so, to describe their degree of association. A second

intention was to determine the effectiveness of preemployment drug test

results in predicting turnover and absenteeism as indicators of successful job performance.

First, basic descriptive statistics for all pertinent variables were obtained. Based on a review of the absenteeism descriptive statistics

(Table 5), the non-Gaussian distribution of the absenteeism index and

the severe degree of skewness of that distribution made it obvious that

traditional parametric measures of association and their respective

statistical tests could not be performed on the continuous absenteeism

measure.

Table 5. Absenteeism Descriptive Statistics

N 2,895 STD DEV 0.084

Mean 0.031 Skewness 6.015

Mode 0.000 Kurtosis 44.984

Median 0.007 Range 0.931

123
However, since this study was not limited to investigating measures of

association between two variables, and since differences in mean absence rates between the positive and negative groups would be highly

informative, the disparity in mean absence rates was investigated.

Given the central-limit theorem and the robustness of the t-test (Holden

and Overall, 1987), the difference in group means was assessed via a ttest.

One alternative to the association issue which was investigated and

would have minimized the loss of information contained in the continuous measure, was the use of nonparametric statistics based on ordinal

measurement. However, a disproportionately large number of tied

ranks would have resulted because 37.9 percent of the participants had

not used any leave at the time these analyses were performed; therefore,

such a procedure could have severely biased the results since an

excessive number of tied ranks would be concentrated at one end of the

distribution. The appropriate alternative, in this case, was to partition

the absenteeism distribution into approximately equally-populated class

intervals and perform the statistical analyses on the discrete categories.

In partitioning the absence rate distribution, various considerations

were taken into account. First, categories had to be identified in such a

way as to have approximately equally-populated class intervals. This

identification was necessary in order to minimize the loss of power to

detect differences Williams, 1950). Second, the partitioning had to

result in meaningful absenteeism categories to facilitate the interpretation of the results. The first of these categories included all study

participants who had not taken leave. Given the large number of

subjects with such a leave record, a further breakdown of this category

was not possible. In order to identify the next break point in the job

absence rate distribution, the two previously mentioned considerations

of equally-populated class intervals and meaningfulness were taken into

account. The Postal Service’s targeted annual sick leave rate has been

around 3.0 percent during the last few years. The annual sick leave rate

for 1987 was 3.1 percent. Further, this figure is very close to the 1987

median absence rate of 2.5 percent reported by the Bureau of National

Affairs (BNA, 1988) for service and governmental organizations. Therefore, the use of a 3.0-percent absence rate as a break point was selected.

The use of such a break point resulted in approximately equallypopulated class intervals: 37.9 percent in the “none” (i.e., 0 percent)

category, 39.7 percent in the “moderate” (0 to 3 percent) category, and

22.4 percent in the “heavy” (above 3 percent) category.

The chi-square test of independence was used in this study to assess the

significance of the association between drug test results and the two

124
outcome measures of job absence and turnover. For the purpose of this

study, both the odds ratio and Yule’s Q were adopted to reflect the

strength of the association when a chi-square test revealed the presence

of a significant association. The odds ratio ranges from zero to infinity,

with 1.0 indicating statistical independence. Values less than 1.0 imply

a negative association, while values greater than 1.0 indicate a positive

relationship. Yule’s Q is a function of the odds ratio and consequently

shares its strengths. The values of this measure of association range

from -1 to +1, with 0 implying statistical independence.

In order to investigate whether or not individual drug test results are a

viable predictor of successful job performance in terms of turnover or

absenteeism, a predictive model has to be specified. Since one of the

stated purposes of the study was that of prediction, the linear regression

model would appear to be the appropriate statistical procedure given the

nature of the investigative problem. However, given the noncontinuous

nature of the outcome measures, the use of such a procedure would lead

to biased parameter estimates and invalid significance tests.

As a result of having discrete dependent variables and consequently not

meeting the underlying assumptions of the linear regression model, the

logistic regression model was adopted for investigating the predictive

efficiency of individual drug test results.

One last issue which had to be resolved was to determine what variables

should be included in the logistic regression model. To answer that

question, each potential variable has to be evaluated in terms of its

theoretical merit, preferably based on previous research findings. As far

as absenteeism is concerned, family responsibility has been shown to

have a constraining effect on job attendance (Steers and Rhodes, 1979).

These constraints, as they relate to attendance, are largely determined

by the personal characteristics of the individual (e.g., sex and age). In

general, women as a group are absent more frequently than men

(Hedges, 1973; Flanagan et al., 1974). Available evidence suggests that

the absenteeism rate declines throughout women’s careers and increases with age for males (Nicholson et al., 1977). Since age and sex

appear to influence absenteeism patterns, these two variables were

included in this study’s absenteeism predictive model.

Previous U.S. Postal Service research efforts have revealed (U.S. Postal

Service, 1987) that the nature of a new employee’s position plays a

significant role in explaining the Postal Service’s turnover experience.

In view of these findings, it was determined that the job category for

which a new employee is hired should be included in this study’s

predictive turnover model. Most new Postal Service appointments can

125
be grouped under one of three major job categories. These main entry

positions are: distribution clerks, carriers, and mail handlers. For the

purpose of this investigation, the occupational groups of all new hires

were classified as follows: distribution clerks, carriers, mail handlers,

and miscellaneous.

It should be mentioned at this point that the main concern of this study

is prediction, not explanation. Therefore, the inclusion of these additional variables in the drug test predictive models should be viewed in

that light. They are included in the models to provide more efficient tests

of significance for the coefficient associated with drug test results. This

investigation is not concerned with the magnitude of the individual

effect size of the independent variables relative to one another. The main

question of interest is whether or not drug test results are a viable

predictor of the two outcome measures being investigated: turnover and

absenteeism. The predictive ability of the models were assessed using

the SAS Logist procedure program (Harrell, 1986).

RESULTS

This section summarizes interim findings regarding the prevalence rate

of positive drug test results and data relating to the strength of the

relationships between drug test results and absenteeism as well as drug

test results and turnover.

Prevalence Rates

Table 6 shows that 9.4 percent of all eligible job applicants (i.e., eligible

on the basis of a written test or an evaluation of training and experience)

tested positive for drugs at the time of their medical examinations.

Sixty-three percent of these were found to be positive for marijuana, 25

percent were positive for cocaine, and 11 percent were positive for other

drugs.

The positive rates for new career hires were slightly lower than those of

eligible applicants. The overall positive rate of new hires was 8.4

percent, with 65 percent of the positives testing positive for marijuana,

25 percent for cocaine, and 9.6 percent for other drugs. Given the

extremely low prevalence rate of the “other” variable (i.e., 0.9 percent),

no further analysis was performed for this variable. The data presented

in Table 6 also reveal that 3 1 percent of the eligible applicants who tested

positive were not hired compared to 22 percent of those who tested

negative for drugs. These rates suggest that those eligible applicants

126
Table 6. Prevalence Rates of Applicants and New Hires

Applicants New Hires

Overall Test Positive

Negative

354

(8.4%)

Marijuana Positive

Negative

Cocaine Positive

Negative

8 8

(2.2%)

Other Positive 5 8 34

(1.2%) (0.9%)

Negative

515

(9.4%)

4950 3866

(90.6%) (91.6%)

327

(6.2%)

232

(5.7%)

4950

(93.8%)

3866

(94.3%)

130

(2.6%)

4950

(97.4%)

3866

(97.8%)

4950

(98.8%)

3866

(99.1%)

who tested positive were screened out either during the employment

suitability process (i.e., the medical and the final phases of the personal

check of suitability) or refused appointments at a higher rate than those

who tested negative.

As reported in previous research (e.g., Cook and Harrell, 1987; Blank

and Fenton, this volume; Newcomb, 1988), an analysis of prevalence

rates by race, sex, and age group revealed that the odds of being positive

are higher for blacks, males, and people between the ages of 25 and 35.

One finding worth noting is that the positive rate of blacks was twice that

of whites (14.0 percent vs 6.5 percent respectively). Moreover, with

regard to individual drug test results, blacks were more than six times

as likely to test positive for cocaine than whites, and almost twice as

likely to test positive for marijuana. In addition, although males were

found to be approximately 1.5 times more likely to test positive for

marijuana than females, no such difference was observed for cocaine.

Both males and females tested positive at approximately the same rate

for cocaine (i.e., males 2.25 percent vs. females 2.19 percent).

127
Absenteeism

The mean absence rate of 4.35 percent for those employees who tested

positive for drugs was found to be significantly different from 3.0 percent

for the negative group. The t statistic (t = -2.06, df = 306.9, p = 0.04) was

computed under the assumption of unequal variances using SatterthWaite’s formula (SAS, 1985) for approximation of the degrees of freedom.

Furthermore, Table 7 shows that employees who tested positive are

more than 1.75 times as likely to take leave as those who tested negative.

When these analyses are carried out separately for individual drug

types, an enlightening pattern emerges. Table 8 reveals that marijuana

users are twice as likely to take a moderate amount of leave than

members of the drug-free group. Whereas, as depicted by Table 9,

employees who tested positive for cocaine are more than three times as

likely to be heavy leave users compared to the employees who tested

negative. The chi-square tests and the respective measures of association on which these differences are based are provided in Table 10.

Table 7. Absenteeism by Overall Test

Test

Absence Negative Positive

None 1026

(39.12%)

72

(26.47%)

Moderate 1027 122

(39.15%) (44.85%)

Heavy 570

(21.73%) (28.68%)

78

Table 8. Absenteeism by Marijuana

Marijuana

Absence Negative Positive

None

Moderate

1026

(39.12%) (26.16%)

1027

(39.15%) (51.74%)

Heavy 570

(21.73%)

38

(22.09%)

128
Table 9. Absenteeism by Cocaine

Cocaine

Absence

None

Moderate

Heavy

Negative

1026

(39.12%)

1027

(39.15%)

570

(21.73%)

Positive

(24.32%)

(32.43%)

32

(43.24%)

Table 10. Significance Test and Measures of Association

Variables Chi-Square Odds Yule’s Yule’s

Studied Value df Prob. Ratio Q* Q**

Overall Test 17.72 2 0.001 1.78 0.28 0.26

Marijuana 13.49 2 0.001 1.81 0.29 0.33

Cocaine 19.82 2 0.001 2.00 0.33 0.52

These measures of association reflect the relationships between drug test results

and absenteeism rates based on specific 2 x 2 tables within the overall 2 x 3

contingency tables.

* Reflects the relationship based on the None leave category and the Moderate

and Heavy categories combined.

** For Test and Marijuana these relationships are based on the None leave

category and the Moderate leave category. Whereas, for Cocaine, it reflects the

relationship based on the None leave category and the Heavy leave category.

Given the ordinal nature of the three absence categories, an ordinal

logistic regression model was used to test the significance of the model

and its individual parameter estimates. The solution of the ordinal

logistic regression analysis, presented in Table 11, reveals that the

postulated absence model is viable. Furthermore, it also reveals that

Overall Test is significant in the prediction model, indicating that drug

test results contribute in a statistically significant way to the prediction

of employee job absence.

129
Table 11. Absence Logistic Regression Model

Variable

Regression Chi-square

Coefficient Value DF Probability

Overall Model 84.70 3 0.000

Alpha1 0.6891 13.07 1 0.001

Alpha2 -1.0873 32.23 1 0.001

Test 0.4877 17.21 1 0.001

Age -0.0233 28.96 1 0.001

Sex 0.3675 25.77 1 0.001

Somer’s D = 0.17 Goodman-Kruskal Gamma = 0.17

Turnover

The results of the chi-square test of independence for test results

revealed no significant relationship between drug test results and

overall turnover (x2 = 0.199, df= 1, p > 0.05). Table 12 shows that both

groups (i.e., positive and negative) have almost identical turnover rates

(22.8 percent vs. 21.8 percent respectively).

Table 12. Turnover by Test Results

Test

Turnover Negative Positive

No

Yes

3021 273

(78.2%) (77.2%)

845 81

(21.8%) (22.8%)

Table 13 and 14 show that when separate analyses are performed for

voluntary (Table 13) and involuntary separations (Table 14) (Muchinsky, 1987), a significant association is detected between the test and

involuntary turnover (x2

 = 4.627, df= 1, p = 0.03). The odds ratio reveals

that the odds of being involuntarily separated for applicants testing

positive are approximately 1.5 times those of applicants testing negative. The degree of this relationship is reflected by Yule’s Q, which was

found to be 0.19. Another way of expressing this disparity is that

130
employees who tested positive had a 40 percent higher rate of involuntary separation than those who tested negative.

Table 13. Voluntary Separation by Drug Test Results

Test

Turnover Negative Positive

No 3021 273

(85.2%) (87.5%)

Yes 526 39

(14.8%) (12.5%)

Furthermore, separate analyses by drug type of the involuntary separation data reveals that the strength of the association is stronger for

cocaine (Q = 0.29, x2 = 3.81, df = 1, p = 0.05) than any other individual

drug. Applicants who tested positive for cocaine are almost twice as

likely to be involuntarily separated than those who tested negative.

Although the voluntary separation analysis did not reveal any significant difference in turnover rates between the negative and positive

groups, it is worth noting that those employees who tested negative

resigned at a higher rate than those who tested positive. This finding

would partially explain why the overall turnover analysis did not detect

any significant association. The involuntary separation results would

appear to have been confounded by the type of separation (i.e., voluntary

vs. involuntary) in the overall turnover analysis.

Table 14. Involuntary Separation by Drug Test Results

Test

Turnover Negative Positive

No 3021 273

(90.5%) (86.7%)

Yes 319 42

(9.5%) (13.3%)

Table 15 provides the results of the logistic regression model used to

determine whether or not Overall Test was a viable contributor to the

prediction of the probability of involuntarily separation. The results

131
indicate (x2

 = 80.15, df = 4, p < 0.001) that the proposed model is a viable

model for predicting the probability that an employee will be involuntarily separated. Furthermore, the results show that Overall Test is

significant in the prediction model, which indicates that drug test results

contribute in a statistically significant way to the prediction of employee

involuntary separations.

Table 15. Involuntary Separation Logistic Regression Model

Chi-Square

Variable Value DF Probability

Overall Model 80.15 4 0.001

Intercept -3.3151 177.72 1 0.001

Test 0.4912 7.52 1 0.006

Regression

Coefficient

Job Category

Carriers

0.8599 10.10 1 0.001

1.4484 31.71 1 0.001

Mail Handlers 0.1252 0.13 1 0.721

Somer’s D = 0.26 Goodman-Kruskal Gamma = 0.38

DISCUSSION

The present study examined various aspects of drug testing in an applied

work setting. First, information was developed on the prevalence rates

of eligible job applicants and new hires as well as prevalence rates of

various demographic groups. In addition, data on the type and degree

of association between drug test results and two job performance

indicators (i.e., turnover and absenteeism) were presented, as well as

information relating to the predictive ability of drug test results.

Prevalence Rates

The observed prevalence rate of new hires (i.e., 8.4 percent) was somewhat lower than what previous surveys of working adults (e.g., Cook and

Harrell, 1987) would have led us to anticipate. However, this relatively

lower prevalence rate could be attributed in part to this study’s operational definition of drug use and to the components of the Postal Service’s

selection process, which, in this study, preceded the drug test. The

study’s prevalence rate was based on urinalysis drug test results,

whereas most available prevalence rates reported in the literature are

132
based on self-report survey data. In light of this critical difference in

definition (i.e., testing positive vs. self-report of previous use of a drug),

and the nature of the sample studied (i.e., prospective new hires vs.

employed adults), it is understandable that this study observed a lower

rate of drug use.

Furthermore, the results of this study revealed that eligible job applicants who test positive (i.e., those who survived the first selection hurdle)

are less likely to be hired than those who test negative. Here again, the

nature of the remaining selection components all eligible applicants

must pass may partially explain the higher disqualification rate among

positive applicants. The first of these remaining selection hurdles is a

personal suitability check. This check is basically a review of previous

work records and past criminal records. The last selection component

consists of a fitness for duty medical examination.

The nature of these last selection components and the conclusions

reached by other researchers (e.g., Stein et al., 1988; Kandel andYamaguchi, 1987)—that drug involvement and resulting adverse consequences

are facets of a lifestyle reflecting other possible deviant attitudes and

behaviors besides drug use-point to the following interpretation: job

applicants who tested positive for drugs probably exhibited some other

lifestyle characteristics which disqualified them at a higher rate than

those who tested negative. Also noteworthy from this study’s results is

that not only are positive eligible job applicants disqualified at a higher

rate than negative eligible job applicants (i.e., 32 percent vs. 22 percent),

but the rate of disqualification varies by drug type, with a higher rate of

disqualification among users of harder drugs. The disqualification rate

was 29 percent for marijuana users, 32 percent for cocaine users, and 41

percent for others (which include polydrug users).

The patterns of drug use for various demographic groups reported in this

study are similar to those reported by other researchers: (1) males have

a higher drug use rate than females (e.g., Johnston et al., 1987; Cook and

Harrell, 1987); (2) blacks’ drug use rates are higher than whites’ (e.g.,

Blank and Fenton, this volume; Newcomb, 1988); and (3) workers under

35 years of age have higher rates than older workers (e.g., Cook and

Harrell, 1987). It is therefore not unexpected to see these demographic

patterns reflected in urinalysis drug test results. However, it is surprising that the difference in positive rates observed for males and females

for overall drugs and marijuana vanishes with cocaine, but triples for

blacks compared to whites for the same drug. This finding may be

related to the increase in popularity and availability of cocaine in recent

years among females and minorities (Washton and Cold, 1987).

133
When comparing these prevalence rates to other research findings,

especially self-report studies, it is important to keep this point in mind:

the consequences associated with reporting, for research purposes, for

illicit drug use in the last few months are not as severe as the consequences of testing positive for drugs when applying for a permanent

position with an organization. Therefore, given the context in which this

study was performed, it is understandable that the pattern of use was

replicated in this study, but the magnitude of the prevalence rates were

lower.

Drug Test Results: Relationship to Job Performance Indicators

Drug test results were found to be significantly associated with both

involuntary separation (turnover) and job absence. The degree of those

associations varied from 0.19 to 0.29 for involuntary separation and from

0.26 to 0.52 for absence. For both of these outcome measures, the

association was found to be strongest for cocaine. In addition, drug test

results were also shown to contribute significantly to the prediction of

involuntary turnover and absenteeism as measures of job performance.

The magnitude of the relationships might be underestimated because

drug test results are subject to systematic error. Of concern here is

systematic error of measurement (i.e., measurement validity). With

regard to the drug test measures, according to the quality control study

which was an integral part of this research project, the only errors

observed were due to false negatives (American BioTest Laboratories

Inc., 1988). More specifically, the laboratory results yielded zero false

positives for the blank specimens, zero false positives for the known

cross-reactants, one false negative for phenobarbital, two false negatives

for morphine, and one false negative for marijuana. Based on these

results, it is clear that the source of misclassification is in the direction

of false negatives. The impact of such errors would he underestimations

of the true relationships between the drug test results and the job

performance indicators.

A number of other statistical artifacts may contribute to the underestimation of the relationships. Data comparing the prevalence rates of

eligible job applicants with those of new hires reveals that a sizable

number of positive applicants are not hired. A number of applicants,

when informed that their urine specimens would be screened for drugs

as part of a research study, withdrew from the employment process,

presumably in anticipation of testing positive. The restriction in range

due to this deterrence effect and the differential hiring rates of positives

and negatives resulted in exclusion of a substantial number of drugusers

134
from the study. To the extent of such exclusion, the effect would be an

underestimation of the relationships between the variables under study.

In addition, the observed difference in absenteeism rates between the

positive and negative groups (i.e., 1.3 percent) is probably an underestimate of the real difference in absence rates in the population given the

tenure of study participants. Leave abusers who were on their best

behavior during probation and early employment are anticipated to

eventually revert to their more characteristic modes of behavior. This

reversion will more than likely produce greater differences in absenteeism between the two groups as their careers progress. Finally, the low

prevalence rate of new hires and the low base rate of the outcome

measures contribute to the conservative estimates of the relationships.

The meaningfulness of a statistically valid predictor such as drug test

results may be assessed in light of the type of employment errors

resulting from such a model. Concerning prediction error, the GUMS

confirmation test, when performed by a competent laboratory, has an

essentially zero false positive rate, as was reflected by this study’s

quality control evaluation results. Therefore, a highly controversial type

of employment error—e.g., an applicant who erroneously obtains a

positive test result and would have performed satisfactorily if hired-is

extremely unlikely. Consequently, the question is not whether an

applicant has used an illicit drug, but rather, will information on

whether an individual has recently used an illicit drug reduce employment error? This question is answered by the results which show that

drug test results are a significant contributor to prediction of turnover

and absenteeism as indicators of successful job performance.

Finally, the relatively low observed prevalence rate, as well as the

observed false negative rate, are a direct consequence of the currently

used cutoff levels. Any reduction in the cutoff levels, assuming equal

measurement accuracy, would increase the prevalence rate and consequently, as stated above, affect the magnitude of the observed relationships upward. It would also increase the predictive ability of drug test

results. The impact of using a 20 ng/ml cutoff level for the EMIT

screening test rather than NIDA’s recommended 100 ng/ml is currently

being investigated. To do so, differences in behavioral patterns (as far

as turnover and absenteeism are concerned) are being studied.

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AUTHORS

Jacques Normand, Ph.D.

and

Stephen Salyards, M.S.

Office of Selection and Evaluation

U.S. Postal Service

Room 9671

Washington, D.C. 20260-4257

138
Early Employment Testing for Marijuana:

Demographic and Employee Retention

Patterns1

David L. Blank, Ph.D.

Naval Military Personnel Command

John W. Fenton2

The Boeing Company

INTRODUCTION

As part of a comprehensive drug testing program, the Department of the

Navy tests all recruits for several drugs of abuse within hours after

reporting to a Recruit Training Command. The present study examines

a group of approximately 500 male recruits inducted in 1985 who tested

positive for marijuana (THC) at accession and compares them with a

matched group who tested negative. At that time, Navy policy dictated

that sailors found to test positive for THC be retained in the Navy while

those positive for other drugs be returned home. Significant demographic differences between the two groups were noted in education

level, Armed Forces Qualification Test (AFQT) scores, and race. No

differences were found in age, marital status, or home of origin. Retention data showed that 81 percent of the THC-negative and 57 percent of

the THC-positive group were still in the Navy after 2.5 years. Reasons

for discharge for the THC- positive group were much greater for alcohol

and drug abuse or other behavioral or performance reasons. Sailors

testing positive for marijuana at accession were divided into three

groups depending on the amount of THC present in their urine. Significant differences in retention patterns for these three groups were not

observed.

BACKGROUND

It has been known for some time that a substantial proportion of Navy

recruits have had previous experience with drugs. Crawford et al.,

(1976) reported that 47 percent of those inducted into the Navy in 1975

139
had pre-service experience with drugs, with about 21 percent of the

population using marijuana alone. This and other studies (Bray et al.,

1983) suggested that drug abuse was a problem in the Navy. As a result,

the Department of the Navy (DON) implemented a urinalysis testing program in 1982 to routinely test for most drugs of abuse. In order to ensure

the military fitness and good order and discipline of a unit, random

sampling and unit sweeps are conducted. On the average, all sailors—

from seaman recruit to fleet admiral—are tested three times a year. As

of 1985, this testing program has reduced marijuana use among Navy

personnel to less than 10 percent (Bray et al., 1986). This paper will focus

on one aspect of the overall testing program—recruit testing.

This study’s sample was drawn from recruits tested under the Navy’s

1985 testing policy as shown in Figure 1. At that time, all recruits were

(and still are) tested for all drugs of abuse within hours of arriving at a

recruit training center (RTC). If the results showed they were positive

for anything except tetrahydrocannabinol (THC)—the active ingredient

in marijuana-they were administratively separated from the Navy and

sent home. If the urinalysis was negative, they continued through

school; perhaps they were tested again if their number randomly came

up; ultimately, they went to the fleet without any record of a drug

incident.

Figure 1.

1985 RECRUIT TESTING POLICY

140
If, however, the accession urinalysis test was positive for THC, recruits

were warned, counseled, and perhaps put on a surveillance program of

regular urinalysis. If, in any subsequent urinalysis, service members

were positive for any drug of abuse, they were administratively separated and sent home. If results of subsequent testing were negative, it

might be assumed that their first positive test was an unwanted

hangover of recreational marijuana abuse in civilian life. As a result,

their service record did not contain a drug use incident report.

This policy was predicated on the assumption that a positive test at

accession into the Navy would serve as a stern warning to the sailor, tend

to deter future incidents, and, as a result, performance problems during

their career in the service would not be observed. It should be noted that

this assumption was not supported by some evidence (Kolb et a1.,1975),

which suggested pre-service drug abuse was related to performance

decrements and disciplinary actions.

The purpose of the present study was:

To compare and contrast the demographic characteristics of

two groups of sailors—those who were positive for THC at

accession and those who were negative

To compare the attrition pattern of both groups—how long

they remain in the Navy and why they leave

To specifically examine the extent of drug or alcohol abuse

problems

To evaluate this information to see if it suggests any policy

modifications.

The two latter items will be a continuing effort. Records will be reexamined about every 6 months.

METHOD

The authors visited the Navy Drug Screening Laboratory (NDSL) at the

Great Lakes Recruit Training Center and collected data on 1,052

subjects who were tested for marijuana at accession between January 2

and March 4, 1985. Marijuana (THC) positives (approximately half of

our sample) consisted of all subjects screened positive for THC (THC >

100 ng/mL urine) on a Radioimmunoassay (RIA) (Roche Diagnostics)

screening test only. At that time, gas chromatography and mass

141
spectrometry (GC/MS) confirmation tests were deemed unnecessary

and were not performed on these samples because the results of this test

did not appear on the individual’s permanent record.

THC-positives were divided into three groups based on the RIA calibration table associated with each batch of samples:

Low positive (THC > 100 ng/mL < 200 ng/mL)

High positive (THC > 200 ng/mL)

Very high positive (THC >> 200 ng/mL), i.e., upper approximately 10% of the calibration curve.

The latter group represented approximately 10 percent of all positive

samples. The remaining samples were approximately equally distributed between the other two groups.

In order to match the THC-negative with the THC-positive subjects, an

equal number of THC-negative subjects was selected from the same

batch report from which the THC-positive sample was drawn. The RIA

counts for these individuals indicated the lowest amount of marijuana in

their urine, presumably zero ng/mL THC.

Demographic and attrition data were obtained from either: (1) the Navy

Enlisted Master File, a data base maintained by the DON Bureau of

Personnel of all enlisted personnel currently in the Navy, or (2) from

extracts of this file, maintained at the Defense Manpower Data Center

(DMDC), containing data on all present or former Navy personnel. Data

pertaining to subsequent drug positives were obtained from the Alcohol

and Drug Management Information and Tracking System (ADMITS), a

data base maintained by the Alcohol and Drug Abuse Prevention

Division of DoN. Of the 1,052 all male subjects selected (half THCpositive, half THC-negative), 1,016 were found in the Navy Enlisted

Master File or extracts. Of these, 964 records contained the data

elements required for this study. It is not known to what degree the

missing 88 subjects biased the sample. However, the same number of

individuals seemed to be missing from the THC-positive group as from

the THC-negative group. The point in time at which data bases were

searched was approximately 2.5 years into a 4-year enlistment period for

the subjects of this study.

All differences between groups cited as significant were significant at the

p=0.01 level or better, using Chi square or Student “t” as noted in text or

figure legends.

142
RESULTS

Significant demographic differences between the two groups were noted

in education level, Armed Forces Qualification Test (AFQT) scores, and

race. No differences were found in age, marital status, or home of origin.

Retention data showed that 81 percent of the THC-negative and 57

percent of the THC-positive group were still in the Navy after 2.5 years.

Nonsignificant Differences

Some demographic characteristics did not differ significantly between

the THC-positive and THC-negative groups. There were no significant

differences in age because the age of recruits is quite constant. Average

age was 20 years and median 19 years. More of the THC-positive

subjects were single (95.6 percent) compared to the THC-negative group

(93.3 percent). However, this difference did not approach significance.

Using each subject’s home-of-record zip code, we checked for any differences in the geographic areas from which recruits were drawn. While we

had expected to see some cities or States more highly represented among

the THC-positive group, no clear differences were found. The sample

size may have been too small for such a comparison.

Education

Figure 2 shows that 6 percent of the THC-negative group were not high

school graduates-a statically significant figure compared to 13 percent

of the THC-positive group who did not graduate from high school. Figure

2 also shows that 11 percent of all 1985 recruits were not high school

graduates—a number intermediate between our two groups.

Race

Figure 3 shows that, among the THC-negative group, 83 percent were

white, 13 percent black, and 3 percent other. For the THC-positive

group, 75 percent were white, 23 percent black, and 3 percent other. The

percentage figure for all 1985 recruits is 15 percent black—again

intermediate between our two groups. However, a significantly higher

percentage of the THC-positive group was black when compared to the

THC-negative group.

Occasionally, the Navy is accused of using urinalysis to discriminate

against blacks. Our results do not make it possible to address this

143
Figure 2.

EDUCATION LEVEL

THC NEGATIVE VS. THC POSITIVE

Figure 3.

RACE

ACCESSION THC NEGATIVE VS. THC POSITIVE

144
question directly. However, assuming the reasons for leaving the Navy

are randomly distributed among different races, the pattern of the

relative percentage of people retained after 2.5 years would be expected

to parallel the accession population. Such is the case for the THCnegative group. For the THC-positives, however, a somewhat higher

percentage of those retained are black when compared to the accession

population. This data may suggest that the Navy is not trying to

selectively discharge people on the basis of race.

Armed Forces Qualification Test (AFQT)

Upon entry into the Navy, all recruits are given the Armed Forces

Qualification Test (AFQT). This test correlates highly with intelligence

tests and is often considered an intelligence test. The line in the

background of Figure 4 is the distribution of AFQT scores for all 1985

recruits. The distribution is fairly broad. The black line in the foreground is the AFQT distribution for the THC-negative population. It too

is broad but somewhat skewed to the higher AFQT scores, i.e., higher

intelligence. On the other hand, the distribution for the THC-negative

group is definitely skewed in the other direction, i.e., there is a preponderance of somewhat lower AFQT scores. A “t” test between the THCnegative and THC-positive groups is highly significant.

Figure 4.

ARMED FORCES QUALIFICATION TEST

ACCESSION THC NEGATIVE VS. THC POSITIVE

145
Within each group (THC-positive or negative) there were no significant

differences in AFQT scores between those still in the Navy and those who

had left.

Attrition and Retention

As of September 1987, 81 percent of the THC-negative group and 57

percent of the THC-positive group were still in the Navy. This point in

time occurred approximately 2.5 years after they entered the service and

about 1.5 years prior to the end of their obligated service.

The reasons for discharge are indicated in the first five sets of blocks in

Figure 5. Fourteen percent of the THC-positive group and 1 percent of

the THC-negative left the service for drug or alcohol problems. We have

not yet examined these records in detail to determine the nature of the

problem; however, in most cases, we suspect abuse rather than drug

distribution or manufacturing. The percentage of the accession drugFigure 5.

ATTRITION AND RETENTION

THC POSITIVE VS. THC NEGATIVE

DRUG/ALC = discharge for drug or alcohol abuse, distribution, manufacturing,

etc;

BEH/PERF = discharge for behavioral or performance reasons (see text);

ERR ENLST = discharge for erroneous enlistment; MEDICAL = discharge for

medical reasons;

ALL OTHER = all other discharge codes.

146
positive group with a subsequent lab positive was about 14 percent,

while that for the accession drug-negative group was a little over 1

percent. Twenty-one percent of the THC-positive and 8 percent of the

THC-negative group were discharged for other behavioral or performance reasons. The 25 possible separation codes for this category include

misconduct, commission of a serious crime, security breech, discreditable incidents, fraudulent entry, trainee discharge due to entry-level

performance, and discharge for the good of the service. Far smaller and

approximately equal percentages of individuals left. the service for

erroneous enlistment of induction, medical, or other reasons. The

“other” category included death as the major reason and a few dependency or hardship cases. The patterns of attrition/retention for the two

groups were statistically significantly different from one another.

The attrition data can be examined in a slightly different way. Figure 6

shows the data at a fixed point in time, September 1987. At that point,

for example, 81 percent of the THC-negative group and 57 percent of the

THC-positive group are still in the Navy. However, knowing the exact

date of their separation from the service, it is possible to calculate the

percentage of each group that was still in the Navy for all times since

their entry. Figure 6 shows these calculations. The next step is to project

the amount of people in each group left in the Navy by the end of a 4-year

Figure 6.

RETENTION OVER TIME

ACCESSION THC POSITIVE VS. THC NEGATIVE

PERCENT OF EACH GROUP STILL IN NAVY

Projections are simple freehand linear projections to 4 years.

147
term of enlistment. This calculation is probably a worst-case projection,

just a linear extrapolation. Therefore, at worst, an estimated 79 percent

of the THC-negative group will complete a 4-year term of enlistment,

while about 38 percent of the THC-positive group will complete an

enlistment. In a recent study using 1980-1982 data, the Center for Naval

Analysis calculated that 65.6 percent of all recruits complete their first

term of enlistment—again, a number intermediate between our two

groups.

As noted above, the THC-positive group was divided into three groups

(low positive, high positive, and very high positive). For any of the

comparisons, no significant differences between these three positive

groups occurred on any variable. However, the data suggests some

interesting trends. Figure 7 for example, indicates that 61 percent of the

low positive group are still retained in the Navy at the 2.5-year point,

compared to 57 percent and 48 percent retention for the two higher THCpositive groups. A corresponding increase in discharges for drug or

alcohol abuse or behavioral or performance reasons occurs as the degree

of THC positivity increases.

Figure 7.

ATTRITION AND RETENTION

ACCESSION THC POSITIVE GROUPS ONLY

PERCENT OF EACH ACCESSION POPULATION

See Figure 5 legend or text for explanation of type of attrition.

See text for definition of low, high, or very high THC-positives.

148
CONCLUSIONS

While some demographic variables differ significantly, the variables

themselves are probably not independent. It is tempting to conclude,

based on AFQT scores, that less intelligent sailors are more likely to

abuse drugs; however, AFQT scores surely co-vary with other variables,

such as high school graduation. Each variable may simply be another

way of looking at the same picture. As a result, no conclusions should be

drawn about the etiology of drug abuse.

Care must also be exercised in considering the projections of attrition in

Figure 6. The Naval Recruiting Command has suggested that the closer

an individual gets to the end of his term of service, the more he is

concerned and interested in completing it. Furthermore, supervisor

tolerance of his behavior might also increase towards end of term.

Some results cannot be easily explained. For example, the distribution

of AFQT scores for all 1985 recruits (Figure 4) is intermediate between

the THC-negative and THC-positive groups. This distribution could not

be created by a simple weighted average of the AFQT scores of our two

groups. Similar findings were observed for race and education. It is

conceivable that these differences and, perhaps, some of the attrition

pattern differences could arise from the sample selection process.

Demographic variables have a predictable cyclicvariation, dependingon

the month of induction. Also, only one RTC was chosen—differences

might exist between the populations at different RTCs. Also, higher

drug abuse rates often occur during the months when our sample was

drawn. It is also possible that the particular selection of the THCnegative sample was biased. The THC-negative sample was selected

among individuals with the lowest amounts of THC in their urine,

presumably zero ng/mL THC. The individuals with negative THC

reports who were not selected for our sample might have had some THC

in their urine but were below the NDSL cutoff level for a THC-positive

specimen (100 ng/mLTHC). In other words, while not supported by data

at this time, it is possible that recruits have a random distribution of

THC in urine, closely following the distribution of total population

demographic variables.

Failure to find significant differences in some cases (i.e., Figure 7) might

simply reflect that the sample population selected was too small to make

these comparisons. It might reflect inaccuracies in quantitation of the

RIA screening test for THC. It is our intention to repeat this study with

a larger population and to use GC/MS confirmation data that are

available on samples more recently collected.

149
Since we intend to reexamine the data in March 1989 (the end of the

enlistment period for the subjects of this study), this research report

should be considered a preliminary report.

ENDNOTE

1

 The opinions expressed in this paper are those of the author and do not

necessarily represent those of the author’s organization.

2

 At the time the research for this paper was done the author was with the Naval

Military Personnel Command.

REFERENCES

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 Institute RTI/2317/

01/01F, 1983.

Bray, R. M.; Marsden, M. E.; Guess, L. L.; Wheeless, S. C.; Pate, D. K.; Dunteman, G. H.; and Iannacchione, V. G. 1985 worldwide survey of alcohol and

nonmedical drug use among military personnel. Research Triangle Institute

RTI/3306/06-02FR, 1986.

Crawford, K. S.; Thomas, P. J.; and Thomas, E. D. Pre-service drug usage among

naval recruits: A 5-year trend analysis. NPRDC TR 76TQ-45, 1976.

Kolb, D.; Nail, R. L.; and Gunderson, E. K. Pre-service drug abuse as a predictor

of in-service drug abuse and military performance. Military Medicine 140:

104-107, 1975.

AUTHORS

David L. Blank, Ph.D.

Chief Scientist

Alcohol & Drug Abuse Division

Naval Military Personnel Command

Washington, DC 20370

John W. Fenton

Manager, Employee Relations/Services (Corporate Personnel)

The Boeing Company

P.O. Box 3707

Mail-Stop 10-28

Seattle, WA 98124-2207

150
Does Pre-Employment Drug Use Predict

On-the-Job Suitability?

Michael A. McDaniel, Ph.D.1

Booz , Allen and Hamilton, Inc.

INTRODUCTION

Drug testing is increasingly used in the screening of applicants for

employment. Despite the growth of drug testing, there is little research

which examines the value of pre-employment drug use information in

the prediction of post-employment suitability. Based on a sample of

10,188 young adults, this research examined the criterion-related validity of pre-employment drug use information. For all drugs examined, the

greater the frequency of use and the earlier the age at which the drug is

first used, the greater the probability of a person being classified as

unsuitable after hire. Those who use drugs which are consumed less

frequently by the general population are at much greater risk of being

judged unsuitable after hire. However, the operational validity of each

drug variable is influenced by the base rate of drug use. The low base

rates for some drugs makes their operational validity of limited value.

The operational validity of the marijuana frequency of use measure (.07)

is approximately equal to that of less frequently used drugs (e.g.,

stimulants and depressants). No strong moderators of the validity of a

drug composite measure were found.

Drug use in the work place is a subject ofgrowingconcern. About one half

of work place injuries and nearly 40 percent of work place deaths are

attributed to drug or alcohol use. Furthermore, about two thirds of the

people entering the work force have used illegal drugs (Tyson & Vaughn,

1987). In response to concerns about drugs in the work place, preemployment drug testing has become more prevalent among employers

(Lindquist, 1988).

Although the reliability of drug testing methods is receiving increasing

attention (Council on Scientific Affairs, 1987), little research has examined the criterion-related validity of pre-employment drug use as a

151
predictor of employment suitability. Kagel, Battalio, and Miles (1980,

also see Miles, Battalio, Kagel, & Rhodes, 1975) examined the relationship between marijuana use and job performance in an “experimental

microeconomy.”

The volunteer subjects lived and worked in wings of a hospital facility for

98 days where they earned money by performing manual labor tasks

that were paid for on a piecework basis. Access to almost all consumer

goods during the experiment, including food, was through income

earnings. Marijuana had no effect on work output or hours worked,

although subjects preferred leisure time activities after marijuana use.

Kolb, Nail, and Gunderson (1975) examined 903 Navy enlisted personnel to determine the relationship between pre-employment drug use and

in-service drug use and job performance. The subjects were drawn from

those granted amnesty from prosecution for illegal drug use and who

were admitted to a drug rehabilitation center. After being admitted to

the rehabilitation center, the subjects provided self-report data on their

pre-service drug use. The subjects were provided assurances regarding

the anonymity and confidentiality of the data provided. Those who

reported pre-service drug use advanced less rapidly in pay grade,

incurred more disciplinary actions, and were more likely to use heroin

while in the military service.

The findings of neither the Kagel et al. (1980) nor the Kolb et al. (1975)

studies display much external validity for the question of the effects of

pre-employment drug use on employment suitability. The former study

does not measure pre-employment drug use and uses an artificial work

setting. The latter study suffers from subject selection contaminants

and the collection of pre-employment drug use under anonymous conditions which fail to mirror the testing conditions in a pre-employment

situation. To attempt to address the research gap on the drug use/

suitability issues, the present study provides large-sample evidence

addressing the usefulness of pre-employment drug use information in

predicting on-the-job suitability.

In the present research, self-report survey data were used as the source

of the pre-employment drug use information. Several authors have

reviewed the accuracy of self-reported usage of illegal drugs (Brown &

Harding, 1973; Brown, 1974; Harrell, 1985; Nurco, 1985; Rouse, Kozel

& Richards, 1985). To obtain accurate self-reported drug use information, several conditions are necessary. First, the respondent must know

what was consumed. Illegal drugs are often distributed using colloquial

names (e.g., “black beauties” for amphetamines). If the drug names used

in the self-report questions are not familiar to the respondent, an

152
inaccurate response is probable. Furthermore, illegal drugs may be

misrepresented (e.g., LSD may be sold as mescaline) such that the

respondent does not know the name of the drug consumed. A second

condition for accurate reporting is that the respondent must remember

the drug usage information solicited by the question. Respondents may

not accurately recall the frequency of drug consumption or the age at

which they began their drug use. Third, respondents must be willing to

report illegal drug use. Respondents can be expected to minimize or deny

their socially undesirable behaviors. While some authors have reported

problems with respondents over-reporting their drug use(Petzel, Johnson,

& McKillip, 1973), it is reasonable to expect that most job applicants

would be motivated to under-report their drug use.

Self-report measures can be contrasted with physiological measures

(e.g., urinalysis) of drug use. While the accuracy of physiological measures of drug use is a matter of continuing debate, clearly the effectiveness

of physiological measures available at present is restricted to identifying

recent (e.g., days or weeks) drug use that leaves residual chemical

markers in the user’s body (American Federation of Labor and Congress

of Industrial Organizations, 1987; Rosen, 1987). Thus, the physiological

measures available to date have no value in identifying historical

patterns of drug use. While self-report drug use measures are subject to

the respondent’s intentional and unintentional distortions, they are the

only available method of obtaining historical data on the respondent’s

use of drugs.

The predictive value of pre-employment drug use information can be

evaluated in two ways: 1) the criterion-related validity of the drug use

information, and 2) its usefulness in making employment decisions

about individual drug users. In an operational screening setting, the

value of a predictor is dependent on 1) the relation between the predictor

and the suitability criterion and 2) the variance of the predictor which is

a function of the drug use base rate in the applicant population. If drug

use measures for two drugs have the same magnitude of relationship

with the suitability criterion, they will have the same correlation with

the criterion if the variances of the drug use measures are equal. If the

use of one drug is rarer than another (e.g., stimulants versus marijuana),

the variance of the lesser used drug measure will be smaller than the

variance of the more frequently used drug, and the resulting correlation

between the drug use measure and suitability will be smaller. Thus, for

operational prediction purposes, the use of a less harmful (e.g., less

addicting, less damaging to the body, perhaps more socially acceptable),

but more frequently used drug (e.g., higher base rate) may be a better

predictor of post-employment suitability than a more harmful yet less

frequently used drug.

153
While the base rate of drug use in the population is an important

determinant of its operational criterion-related validity, it is not relevant in evaluating the usefulness of a drug measure in making employment decisions about individual drug users. For example, if heroin

addicts have a 90 percent probability of being fired for poor job performance, an employer making a hiring decision about a heroin-addicted

applicant can use this information in making an informed hiring decision. This information is very useful to the employer for this applicant,

even though the base rate of heroin addicts in the employer’s applicant

pool is so low that the operational validity is near zero. In brief, while

the operational validity is an appropriate index of the usefulness of drug

use measures for the applicant pool, drug use measures with low base

rate and low operational validity can be very useful when making

employment decisions about individual drug users.

METHOD

The drug use items were included in the military’s Educational and

Biographical Information Survey (EBIS) (Means & Perelman, 1984).

During the spring of 1983, the EBIS was administered to approximately

34,800 applicants for the four military services. Those military applicants who entered the military service within 1 year of completing the

EBIS were defined as the study sample (N = 10,188). Ten drug use items

were available. These items covered the age at which one first used 1)

marijuana and 2) hard drugs; 3) whether one had been arrested or

convicted of a drug- related offense; and the frequency with which one

had used, without a prescription by a doctor, the following drugs: 4)

marijuana, 5) heroin, 6) cocaine, 7) stimulants, 8) depressants, 9) other

narcotics, and 10) other drugs. The two questions concerning age at first

drug use had response alternatives of “age 14 or younger,” “age 15-17,

“age 18 or older,” “I never did this,” and “don’t recall age.” For this

variable, the response option “don’t recall age” was considered a missing

datum. Response option “I never did this” was placed at the older end of

the age scale. The drug-related arrest question had response alternatives of “never arrested,”“arrested,” and’convicted.” The response scale

for the seven drug frequency items had six response categories ranging

from “never used” to “used 50 times or more”.

The employment unsuitability measure was defined as discharge from

military service for reasons classified as “failure to meet minimum

behavioral or performance criteria” on or before September 30, 1987.

This discharge category includes unsuitable discharges stemming from

alcohol and drug problems, “discreditable incidents,” and other discipline problems, as well as dismissal from military training programs.

154
Table 1. Pre-employment Drug Use

Means, Standard Deviation, Percent Missing, and Reliability of Drug

Measures

Variable N Mean SD % Missing Reliability

Age Marijuana Use 9,411

Age Hard Drug Use 9,449

Drug Arrest 9,456

Frequency of

Marijuana 9,355

Heroin 9,207

Cocaine 9,224

Stimulants 9,286

Depressants 9,267

Other Narcotics 9,261

Other Drugs 9,262

Unsuitability Discharge 10,188

3.24 1.05 7.6 .60

3.94 .31 7.3 .33

1.02 .16 7.2 .73

.86 1.38 8.2 .54

.01 .12 9.6 -.01

.07 .40 9.5 .23

.23 .73 8.9 .41

.09 .43 9.0 .25

.03 .24 9.1 .16

.04 .31 9.1 .30

.16 .37 0.0 NA

Note: For the age items, a response of:

“Age 14 or younger” was coded 1;

“Age 15-17” was coded 2;

“Age 18 or older” was coded 3;

“never used” was coded 4.

A mean score on the age item near 3.0 indicates that the mean responsewas

approximately “Age 18 or older.”

For the drug arrest item, a response of:

“never arrested” was coded 1;

“arrested” was coded 2;

“convicted” was coded 3.

A mean score of 1 indicates that the average response was “never arrested.”

For the seven drug frequency items, a response of:

“neve” was coded 0;

“1-4 times” was coded 1;

“10-24 times” was coded 3;

“25-49 times” was coded 4;

“50 or more times” was coded 5.

155
The unsuitable discharge category does not include discharge from the

service for medical reasons, dependency or hardship, or pregnancy. The

reliability of this dichotomous criterion is unknown. In this sample of

military accessions, 16 percent were discharged for unsuitability.

The study employed a predictive research design. The drug information

collected from subjects using the EBIS survey was not used in making

decisions regarding service entry. Thus, there is no direct range

restriction on the predictor. In addition, there is no criterion contamination. Those who made decisions about unsuitability discharge did not

have access to this drug use data.

RESULTS

Table 1 presents the sample size, mean, standard deviation, the percentageofmissingdata, and the test-retest reliability for each item. The testretest reliabilities are estimated from a subsample (N = 754) of individuals who completed the EBIS survey twice. The average test-retest time

lapse is 38 days. The reliability for the frequency of heroin use item is

-.01; this scale was dropped from further analysis. The reliability of the

remaining drug variables range from .16 to .73. While the reliability of

some of the items is low, such levels of reliability are not uncommon for

single item measures. The percentage of missing responses ranges from

7.2 percent to 9.6 percent.

Table 2 presents the percentage of persons in each response category in

nine drug variables who were classified on the criterion as unsuitable.

Generally, while there are some departures from linearity, the younger

one begins to use drugs and the more one uses drugs, the greater is the

probability of being unsuitable for employment. Those who refused to

respond to the drug items had unsuitability rates similar to those who

reported drug use. Note that although the unsuitability rates for those

who used drugs at an early age, those who were arrested or convicted for

drugs, or those who have frequently used drugs are always higher than

the rates for who reported no drug use, the number of persons who

reported using drugs, particularly drugs other than marijuana, is small.

A drug composite scale was calculated by summing the drug questions

with the two age questionsbeingreversed scored. That is, those who first

tried using a drug early in life would tend to score higher on the drug

composite scale than those who first used drugs later in life or who never

used drugs. Given that the nonresponders resemble the drug users in

their unsuitability rates, nonresponders were scored as drug users in

calculating the drug composite variable. For the two age-at-first-use

156
Table 2. Pre-employment Drug Use

Percentage of Respondents in Each Response Category Who Are

Classified as Unsuitable. (Sample Size in Parentheses)

Age at First Drug Use

< = 14 15-17 > = 18 Never No Response

Marijuana 21.0 18.2 16.6 14.6 19.6

(150/715) (395/2176) (109/655) (859/5865) (152/177)

Hard Drugs 30.4 26.0 18.7 15.9 19.6

(7/23) (38/146) (23/123) (1452/9157) (145/739)

No Arrest

Drug Related Arrest/Conviction

Arrest

No Conviction Conviction No Response

Drug Offense 15.8 32.2 27.0 21.0

(1472/9329) (29/90) (10/37) (154/732)

Frequency of Drug Use (Times Used)

Never 1-4 5-9 10-24 25-49 >=50 No

Response

Marijuana

14.2 16.4 18.8

(800/5652) (297/1808) (119/634)

Cocaine

15.5 20.2 28.6

(1358/8788) (63/312) (14/49)

Stimulants

15.0 18.9 21.6

(1213/8107) (133/704) (41/191)

Depressants

15.2 22.2

(1331/8784) (70/316)

30.0

(24/80)

Other

Narcotics 15.5 24.3 31.6

(1402/9067)(37/162) (6/19)

Other Drugs

15.5 23.0 25.0

(1391/9000) (41/178) (11/44)

21.1 15.9 23.7 22.1

(117/555) (40/251) (108/455) (184/833)

23.4 33.3 18.8 22.0

(11/47) (4/12) (3/16) (212/964)

23.1 29.2 31.7 22.5

(36/156) (19/65) (20/63) (203/902)

31.4 28.6 46.7 22.9

(16/51) (6/21) (7/15) (211/921)

21.4 50.0 60.0 22.9

(3/14) (2/4) (3/5) (212/927)

26.9 20.0 33.3 22.8

(7/26) (1/5) (3/9) (211/926)

157
questions, the nonresponders were scored as beginning drug use at age

14 or younger. For the arrest and conviction item, the nonresponders

were scored as being convicted for drug use, and for the six drug

frequency items, the nonresponders were scored as using the drug 50 or

more times. In brief, the higher the drug composite scale score, the

higher one’s involvement with drugs through early use, drug-related law

contacts, or greater frequency of drug use. Those who refused to respond

to the drug questions also scored high on the drug composite variable.

Table 3 displays the observed correlations between the drug use items,

the drug composite variable, a measure of general cognitive ability

(AFQT), and the suitability criterion. Also listed is the percentage of

persons, by item, who have used the drug at least once. For the drug

arrest or conviction item, the listed statistic is the percentage of persons

who were either arrested or convicted for a drug-related offense.

Table 3. Pre-employment Drug Use

Validity of Pre-Employment Drug Use Measures for Predicting

On-the-Job Suitability

% used

Variable r at least once

Age at first use of marijuana -.05 38

Age at first hard drug use -.04 3

Drug Arrest/conviction .04 1

a

Frequency of Drug Use

Marijuana .07 31

Cocaine .04 5

Stimulants .07 13

Depressants

Other narcotics

Other drugs

Drug Use Composite

AFQT Percentile

N = 9,207 to 10,188

.07 5

.05 2

.04 3

.08 49

-.06 NA

a

For the drug arrest/conviction item, the listed statistic is the percentage of

persons who were either arrested or convicted for a drug-related offense.

158
Table 4. Pre-employment drug use

Moderator Analyses of the Validity of Pre-Employment Drug Use

Composite Measure for Predicting On-the-Job Suitability

Mean SD %

N r Drug Use Drug Use Unsuitable

Total Sample 10,188 .08 50.0 10.0 16

Testing Condition

Operational

Research

AFQT Category

(High Ability)

I

II

IIIA

IIIB

I v

(Low Ability)

Below IV

Sex

Male

Female

Race

white

Black

Hispanic

Asian

5,515 .07 50.0 9.9 17

4,673 .09 50.0 10.1 16

610 .02 49.0 8.1 9

3,045 .09 49.0 8.2 14

2,067 .06 49.4 9.2 18

3,324 .07 50.6 10.8 17

986 .10 52.5 12.9 18

156 .12 54.4 14.5 12

8,927 .08 50.2 10.2

1,261 .07 48.4 7.8

7,432 .08 49.7 9.4

1,989 .08 50.9 11.6

423 .09 49.7 10.4

96 .06 53.1 13.5

17

14

17

15

14

8

Note: Drug composite expressed as t score. High score indicates frequent drug

use.

159
The validity of the drug composite variable was analyzed to determine

if it covaried with any of four moderators. The results of these analyses

are presented in Table 4. The first potential moderator was testing

condition. About half of the subjects were told that their responses were

for research purposes only and would not be used in screening decisions.

The remaining applicants were permitted to infer that their responses

could be used in screening. The validity of the drug composite was not

strongly moderated by testing condition. There were no differences in

the mean reported drug use levels between the groups.

The second potential moderator was cognitive ability. One may argue

that the more intelligent applicants would be less likely to report illegal

drug use, and the resulting inaccuracy would lower the validity for the

more intelligent applicants. Although the validity varied across cognitive ability groups, no clear monotonic moderating effect was evident.

The mean reported drug use levels did vary monotonicly with cognitive

ability with the most intelligent applicants reporting the least drug use.

The third and fourth potential moderators were sex and race. While

there is no compelling argument to expect either variable to moderate

the validity of drug use measures, the potential moderators were

examined in deference to federal testing guidelines (Uniform Guidelines; Equal Employment Opportunity Commission, Civil Service

Commission, Department of Labor & Department of Justice, 1978). Sex

was not a strong moderator of the validity of the drug composite,

although females reported lower levels of drug use than males. Race also

was not a strong moderator of the validity.

DISCUSSION

Table 2 indicates that the employment suitability rates vary with drug

use patterns. Those who have not used drugs before hire are less likely

to be judged unsuitable on the job. In general, the earlier one begins to

use a drug, the greater is the probability of being classified as unsuitable.

Those who have never been arrested for drug offenses have substantially

lower unsuitability rates than those who have been arrested for a drug

offense; there is no meaningful difference in unsuitability rate for those

who are convicted and those who are not convicted. In general for all

drugs, the more times one uses the drug, the greater the probability of

being classified as unsuitable.

Although those who report substantial drug use are much more likely to

be discharged from the service for unsuitability than those who do not

report drug use, the base rate for drugs, except marijuana, is low. These

160
low base rates contribute to the low predictive validity of the drug

measures. For applicant pools where the base rate of non-marijuana

drugs is higher than in the present sample, one can expect the validity

of the drug measures to increase. In this sample, marijuana has a

moderately high base rate (31- 38 percent), yet its validity is low (.07).

Used alone as a predictor of suitability, self-reported marijuana use has

positive utility but may be less useful than other predictors of unsuitable

employee behavior.

Those persons with high cognitive skills as measured by the AFQT, are

less likely to receive an unsuitability discharge, although the relationship is small (-.06). Since the correlation between general cognitive

ability and job performance is about .50 (Hunter & Hunter, 1984, the

low correlation between AFQT and the suitability criterion measures a

performance domain that is substantially different from those assessed

by supervisor ratings or work samples. Thus, the small correlations

between the self-reported drug use measures and unsuitability may also

be a function of the dissimilarity between unsuitability discharge and

more common forms of employee performance measurement. An alternative explanation is that the validity is attenuated by the skewed

dichotomous split and potential reliability problems in the unsuitability

criterion.

At least two hypotheses can explain the relationship between preemployment drug use and on-the-job suitability. These hypotheses are

similar to two perspectives on the relationship between drug use and

delinquency (“drugs cause crime”, and “common cause” models) as

reviewed by Watters, Reinarman, and Fagan (1975). First, pre-employment drug use may cause lasting physiological and behavioral changes.

Some of these physiological and behavioral changes may cause on-thejob performance decrements that increase the probability of being

classified as unsuitable. The second hypothesis posits that the relationship between drug use and on-the-job suitability is spurious, and that a

number of social and psychological factors (e.g., family and school

factors, psychological adjustment) cause both drug use and employment

unsuitability.

In the present research, some drugs had stronger relationships with onthe-job suitability than other drugs, particularly when controlling for

base rates (see Table 2). These differences in relationship magnitude can

he explained by either of the two hypotheses relating drug use and

unsuitability. First, some drugs, more than others, are likely to cause

severe physiological and behavioral changes that more adversely affect

employment suitability. Second, those applicants whose employment

suitability has been adversely affected by social and psychological

161
factors may be more likely to use one drug over another. For example,

those with severe life adjustment problems may be more likely to use

non-marijuana drugs, while those with fewer life adjustment problems

may be more likely to limit drug use to marijuana.

The limited operational validity of pre-employment drug use measures

found in the present research suggests that employers who presently

rely solely on drug use measures as predictors of on-the-job suitability

will be doing less than an optimal job of applicant screening. Any

predictor with a low operational validity will screen in many applicants

who prove unsuitable after hire while screening out many applicants

who would perform well once hired. For a suitability screening program

based solely on pre-employment drug use, the screening errors will be

predominantly of two types. First, since use of non-marijuana drugs is

relatively low, many screening errors will result from hiring applicants

who do not report drug use, yet who prove unsuitable once hired. Second,

given that the base rate of marijuana is relatively high, while the

relationship between marijuana use and suitability is low, additional

screening errors will result from rejecting applicants who have used

marijuana, but who, if hired, would be judged suitable.

To minimize selection errors, employers who presently rely solely on

drug use measures for screening applicants for suitability should consider supplementing or replacing their drug screening programs with

selection systems that more optimally predict employee unsuitability.

For predicting unsuitability discharge from the military, the predictive

power of the high school graduation dichotomy is higher than the drug

use measures found in the present research. Typically, the discharge

rate for nonhigh school graduates is approximately twice that of those

with school diplomas (Cheatham, 1978; Elster & Flyer, 1981; Flyer,

1959; Flyer & Elster, 1983; Means & Laurence, 1984; Sinaiko, 1977). In

addition, research on several paper-and-pencil employee reliability

measures (Betts & Cassel, 1957; Cough, 1971, 1972; Haymaker, 1986;

Hogan, 1986; Loudermilk, 1966; Paajanen, 1986; Personnel Decisions,

Inc., 1986) show useful levels of validities. Such measures may provide

better prediction of employee unsuitability than drug use measures

because they tap a wider range of background and personal characteristics predictive of unsuitability.

Limitations of the Present Study

This study makes a contribution to the cumulative knowledge on the

effects of pre-employment drug use on subsequent employment suitability. At the same time, however, the limitations of the study should be

162
made explicit and the effect of these limitations on the results should be

estimated. Four caveats are offered.

First, the questions are self-report measures of illegal acts. Once can

expect some systematic distortion of the respondents’ answers. For

example, it appears that the missing data are not random. In this study,

those who provided missing or nonusable responses are consistently

more likely to be classified as unsuitable. For those who provide nonmissing responses, it is reasonable to expect more of their responses to

be underestimates rather than overestimates of pre-employment drug

use. Effectually, this pattern of distorted responses limits the variance

of the questions and thus underestimates the true relationship between

pre-employment drug use and subsequent employment suitability. Note

that a correction of correlation coefficients for unreliability in the drug

measures would not correct this underestimation if the respondents are

consistent in their response distortion.

Second, the unsuitability criterion is of unknown reliability and is

potentially subject to systematic error. While data on this issue are non

existent, it is thought that military discharge categories are sometimes

selected on the basis of administrative ease rather than the accuracy of

their description. Thus, it may be possible that an unsuitable recruit

may receive a fully honorable discharge if it hastens the recruit’s

separation from the service. This unestimated error may cause the

validities to be an underestimate of the true relation between preemployment drug use and on-the-job suitability.

Third, military occupations have important differences from civilian

occupations. For example, in the civilian sector, failure to follow the

instructions of one’s supervisor may result in some adverse action (e.g.,

reprimand, firing). In the military, the same action may result in a court

martial and a prison sentence. Conversely, in civilian firms strongly

motivated by profit making, marginally suitable employees may be fired.

In the military, a person with a similar level of suitability may be

reassigned to a position of less responsibility. In contrast to the civilian

sector, where one may quit one’s job, military personnel who wish to

leave service may have difficulty quitting. A military recruit who would

not normally engage in irresponsible behavior may engage in such

behaviors with the intent of facilitating a discharge from the service.

Fourth, this study’s sample is drawn from a population that differs

systematically from other populations of interest. The population of

military recruits is young, predominately male, and seldom has education beyond high school. Due to military selection practices, those with

higher cognitive ability measures have a slight tendency toward more

163
pre-service suitability problems (traffic offenses, drug use, misdemeanors), than do those with less cognitive ability (Fitz & McDaniel, 1988).

This occurs because “normal waivers” for pre-service suitability problems are more likely to be granted when the military applicant has other

characteristics (e.g., high cognitive ability) that make him or her particularly attractive to the service. The positive correlation between preservice problems and cognitive ability may also be due to self-election.

The military service may not be viewed as the best career alternative by

most cognitively-gifted individuals. However, those cognitively-gifted

individuals who experience pre-service suitability problems may have

more limited civilian-sector opportunities, and thus view military service more favorably.

These data and study design limitations preclude the examination of a

critical issue that warrants future research attention: the effect of

recency of drug use on employment suitability. One might expect that

drug use occurring 10 years ago will have less effect on employee

suitability than drug use occurring last week. Given the increasing use

and debate over drug testing for employment screening, and the lack of

research on the topic, personnel psychologists should devote more

attention to this area.

ENDNOTE

1

 This study was performed when the author was at the Defense Personnel

Security and Education Center.

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ACKNOWLEDGMENTS

Paper presented at the Third Annual Conference of the Society for Industrial

and Organizational Psychology, Inc. Dallas. (1988)

The opinions expressed in this article are those of the author and do not

necessarily represent those of the author’s organization.

166
AUTHOR

Michael A. McDaniel, Ph.D.

Booz, Allen and Hamilton, Inc.

4330 East-West Highway

Bethesda, MD 20814

167

A Critical Evaluation of the Utah Power and

Light Company’s Substance Abuse

Management Program: Absenteeism,

Accidents and Costs1

Dennis J. Crouch, B.S., M.B.A

Center For Human Toxicology

Douglas O. Webb, B.S., R.N. and Lynn V. Peterson

The Utah Power and Light Company

Paul F. Buller, Ph.D.

Utah State University

Douglas E. Rollins, M.D., Ph.D.

Center for Human Toxicology

INTRODUCTION

The substantial economic losses suffered by U.S. businesses attributable

to employee abuse of alcohol and drugs justify drug testing in occupational settings. The Utah Power and Light’s (UP&L’s) management took

an aggressive approach to substance abuse management, and designed

their program with the objectives of making it as progressive and as

technically sound as possible. Consistent with this management philosophy has been a critical review of the efficacy of the program, especially

in light of the fact that little published data exist to substantiate the cost

effectiveness of occupational screening programs. The purpose of this

study was to evaluate organizational costs associated with drug-involved employees and to examine safety records for trends indicative of

the deterrent effect of the program.

Demographic data for the drug positive, Group 1 (Gl), and voluntary

rehabilitation, Group 2 (G2) employees, were statistically evaluated and

compared to frequency matched control groups (CG1 and CG2), selected

from the UP&L employee pool at large, based on age, sex ratio, job

169
classification, years of service, and geographic distribution. Absenteeism data for G1, G2, CG1 and CG2 showed statistically significant

differences, as analyzed by either the Student t-Test or the MannWhitney Test, in the use of sick leave and unexcused absences between

G1, G2, and their respective controls. G1 employee absences averaged

64.6 hours greater than the CG1 mean. G2 absences totaled 47.5 mean

hours/employee greater than the CG2 mean. Estimates of costs associated with these absenteeism abuses were $75,406. (All cost data are

truncated.)

Expenditures associated with medical benefits use indicated that G1

costs to UP&L were actually $215 less than CG1 cost. However, G2 costs

were statistically greater than CG2 costs.

Analysis of the total and mean number of vehicle accidents per month

over the last 5 years showed an increasing trend in 1983 through 1985.

This trend has stopped since the drug testing program was initiated in

late 1985, and there have been statistically fewer accidents in 1986 and

1987. Members of G1 were at fault in 80 percent of the accidents

reported for their group and were five times more likely to be involved

in an accident than their control group.

A major organizational consideration in occupational drug testing is the

cost associated with implementing and maintaining a substance abuse

management program. Estimates of major costs associated with the

initial planning meetings, field site preparation, legal fees, computer

setup, analytical testing, the employee assistance programs, grievance

procedures, and quality assurance expenses totaled $482,327. Potential

savings from the program from decreased vehicle accidents, elimination

of excessive absenteeism, and decreased turnover totaled $662,140.

Many of the items discussed are estimates of costs and savings associated with drug testing at UP&L; these represent tangible results of

UP&L’s program. Decreasing trends in vehicle and medical accidents

demonstrate its effectiveness in providing a safer working environment.

Elimination of problem employees, and identification and rehabilitation

of valued employees with drug- or alcohol-related problems represent

long-term investments by UP&L’s management in the integrity and

viability of the organization.

BACKGROUND

American businesses lose an estimated 50-100 billion dollars annually

due to drug and alcohol use by employees (Hanson, 1986). These

170
staggering figures reflect losses in a variety of areas, from decreased

productivity to outright theft. Productivity losses maybe subtle, such as

tardiness, increased absenteeism, and fewer hours spent per day at the

work station, or, may be as obvious as on-the-job accidents. During the

past 5 to 7 years, there has been an increasing awareness and concern

in the United States about the adverse safety and financial effects of

alcohol and drug abuse in the working environment.

Drug testing was proven to be an effective deterrent to substance abuse

in the occupational setting by the Navy’s response to the 1981 jet crash

on the flight deck of the aircraft carrier Nimitz. Immediately following

the accident, the Navy determined in a survey that 47 percent of their

employees under the age of 25 were admitted drug users. By 1984, after

the initiation of testing, the estimated number of users had decreased to

10 percent, and today it is believed to be less than 5 percent (Willette,

1986). The most important factor contributing to this decline, according

to a 1986 Chemical Engineering News interview, was urinalysis drug

testing (Hanson, 1986). Justification for widespread testing in the

civilian work force has been prompted by the military’s success, the

desire to maintain a safe working environment, and the competitive

need for U.S. industries to eliminate the wasteful costs associated with

drug and alcohol use.

Occupational drug testing has been divided into three areas: preemployment testing, screening applicants as an aspect of prehiring

physicals; for cause testing, screening employees after an accident which

results in medical treatment, significant property damage, or when

abnormal behavior has been observed; and random testing, screening

personnel on a statistically randomized basis such as computer-selected

employee numbers. Preemployment and “for cause” testing have been

supported by labor unions, civil rights groups, and court systems;

random testing, however, has received substantial criticism. In each

testing scenario, the potential for litigation exists, and analytical forensic procedures must be employed. Presently, it is estimated that 50

percent of all U.S. companies are performing preemployment testing

(Frings, 1986).

Although anecdotally and from the safety perspective, substance abuse

testing appears justified, there have been no published cost evaluations

of programs to determine if the 250 million dollars spent annually by

U.S. industries on drug testing is a judicious expenditure (Crouch, 1988).

Thepurposeofthisreportistoreview cost and safety features of the Utah

Power and Light Company’s (UP&L) urine drug testing program and to

determine its effectiveness.

171
Utah Power and Light Company

UP&L was established in 1912 and currently has 5,424 employees. The

utility company serves approximately 516,000 customers in 400 communities. The geographic area served covers over 90,000 square miles in

Utah and portions of Wyoming and Idaho, with a population of approximately 2 million. UP&L realized the importance of maintaining a drug

and alcohol free work force and the potential liability of not performing

substance abuse testing and, therefore, began discussing implementation of a comprehensive program in September, 1985. Preemployment

testing began in November of the same year. By February of 1986, negotiations with union representatives concerning “for cause” testing

were in progress. In March, 1986, policies were in place and a “grace

period” established prior to the actual initiation of testing in July, Urine

screening did not begin in earnest in the Mining Division until October,

1986.

Justification for drug testing came from safety incentives as well as other

power industry concerns, as presented in an article by the Edison

Electrical Institute, Human Resource Management Division (Edison

Electric Institute, 1985). That article provides both the safety and

societal rationale for urine drug testing by electrical power generating

companies.

UP&L and its legal representatives realized the potential legal liabilities of an erroneous test result from the laboratory. Disciplinary action

taken against an employee, or refusal to hire prospective employees,

based on invalid test reports would result in both moral and legal

liabilities. With these concerns in mind, UP&L retained forensic

consultants to assist in identifying target drugs and a high quality

forensic laboratory to perform their analytical testing.

During the initial laboratory evaluation portion of the program, drugs of

potential abuse were identified. Significant classes of drugs identified

included amphetamines, barbiturates, benzodiazepines, cannabinoids

(marijuana constituents), cocaine and metabolites, ethanol, methadone,

methaqualone, narcotics, and phencyclidine. The potential for any of

these drugs to inhibit or impair work performance has been only

marginally substantiated. However, all drugs listed are psychoactive

and, therefore, may affect performance. Documentation of a high

incidence of detecting these drugs in erratic, injured, and fatally injured

drivers substantiates the need to include them in the testing protocols

(U.S. Department of Transportation, 1980).

172
PROJECT OBJECTIVES

The purpose of this study was to research aspects of the occupational

drug testing program at UP&L and evaluate the screening efficacy.

Various drugs may impair work and work-related performance. However, information concerning the effectiveness of civilian drug testing as

a deterrent to drug use and abuse and, therefore, the benefits of such a

program to organizations such as UP&L, have not been demonstrated.

As discussed, the Navy drug screening program is reported to be effective

in deterring drug use; however, the benefits to the Navy have only been

intuitive, and lack empirical evidence. We identified cost and human

resource management parameters to lend insight into the effectiveness

of UP&L’s program. Employee injury and vehicle accidents are a major

expense to any organization. Drug impairment increases the probability

of either vehicle or industrial accidents occurring, therefore, trends in

accident frequencies were monitored.

Although concrete absenteeism parameters have not been documented

in occupational testing, some criteria have been proposed (Austin, 1987),

and utilized in a study at the General Motors Corporation. A study of

absenteeism and the GM drug testing program showed that 90 percent

of the employees in a chosen GM Plant averaged 4 days of paid sick leave

per year, but drug using individuals voluntarily submitting to employee

assistance programs averaged forty days of paid sick leave per year. This

group represented 3.5 percent of the work force. We expanded the GM

model, and identified a number of areas to study in evaluating the

deterrent effect and cost effectiveness of UP&L’s program. Specific

areas discussed in this report include the use of sick leave, unexcused

absences, and, when available, medical benefits usage.

Safety indicators such as the number of on-the-job accidents, month-bymonth and on an annual basis, were compared with accident frequencies

for the 3 years prior to the inception of the program.

A final aspect of the study was to identify costs attributable to UP&L’s

drug testing. To obtain the necessary data, individuals were grouped

together based on whether they had voluntarily submitted to employee

assistance counseling for drug problems or have been identified as drug

positives by the screening program. From these groups absenteeism

frequencies were determined, and financial inferences were drawn

concerning the cost to UP&L. We further identified vehicle and medical

injury accident frequencies and the use of medical benefits by these

groups.

173
METHODS

To obtain and manipulate the necessary information two computer data

bases were established. One contained drug test results and related

screening information. Specific data items included were employee

number, social security number and turn-around time for test results.

Other pertinent data included in the program concerned the basis for

testing (pre-employment, rehabilitation, or promotion) and collection

site. A second data base included items identified from UP&L’s vehicle

accident report form and the employer’s medical injury report form.

These two documents provided details related to the demographics and

geographics of absenteeism and vehicle or medical accidents. Included

were age of the individual, sex, duration of employment, date and hour

of the injury, hour the shift commenced, number of work hours lost for

treatment, extent of the injury, location of the accident, job classification

of the individual, and a general description of the job task. The accident

report form identified the vehicle type, the date, time, location of the

accident, any damages which occurred to UP&L owned vehicles, damages to vehicles of outside parties, and an assignment of fault.

The second major aspect of this study was to evaluate the use of the

Employee Assistance Program (EAP) and to identify, if possible, demographic characteristics of the “high risk”group. Social security numbers

of individuals having either voluntarily or involuntarily submitted to

counseling were obtained. Complete anonymity of all individuals was

maintained. The social security numbers of the control groups discussed

below were added to the volunteer list consisting of 27 individuals.

Thus, when the main frame computer was searched and the PC data

base created, no mechanism existed to identify which individuals had

submitted to the EAP. The total number of social security numbers

submitted was approximately quadrupled, and 135 (27 + 108) were

submitted for searching. A similar technique was used with the drug

positive group, where 59 social security numbers were searched.

Control Groups

To statistically validate our approach to analyzing absenteeism, medical

benefits use, and accident frequencies, two control groups were identified from the employee pool at large. One control (CGI) was established

for those individuals found to have drug screening positive urines (G1).

A second group (CG2) served as the control for those employees who

volunteered for the employee assistance program (G2). A total of 12

utility employees tested positive for drugs during the study period.

Demographic characteristics of this group (age, male:female ratio, job

174
classification, years of service, and geographic distribution) were determined and frequency matched by the control group (Table 1). kequency

matching is a technique which selects the control population in the same

proportions as the target group for the defined characteristics. All data

are tabulated and presented in Table 1. Control groups similar in

demographic and geographical characteristics to G1 and G2 should

accurately reflect cost data associated with absenteeism and use of

employee benefits. These groups were established to include four times

Table 1. Demographic and Geographic Data

Group Control Group Control Total

# l # l #2 #2 Pool

Age (Mean) 32.58 33.06 37.37

Female 27 — 36

Male 34 — 38

Sex

Female (%) 25 26 11 11 23

Male (%) 75 74 89 89 77

Job Classification

1

2

9

1

0

2

3

4

Years of Service 6.95

Average Salary/Mo 2200 —

Geographic Area

Utah

Idaho

Wyoming

Other

9

1

2

0

Racial Distribution

White

Nonwhite

10

2

Total Population 12

36.52 37.2

— —

— —

35

4

0

8

8.8

17

3

2

5

67

12

9

20

10.52

—

—

—

—

12.60

2493 —

9.50

2628

39 19 92 3923

2 1 7 282

6 8 9 297

0 0 0 7

—

—

47

25 — 4234

2 — 275

27 108 4509

175
as many members as G1 or G2, to validate statistical comparisons.

These parameters help remove biases not associated with drug use

which may have affected our data. First, age could relate to increased

medical benefits use. Second, certain jobs have an inherently higher risk

of injury accidents than others, (such as clerical or managerial positions). Third, years of service might be important in establishing

experience on the job, which relates to the probability of having an

accident. Finally, sex differences affect the use of medical benefits for

child bearing and related care.

Job classifications were defined as: Class 1, laborers, operators, and

craftsmen; Class 2, secretarial and clerical workers; Class 3, professional and technical workers; and Class 4, management. Column 5 of

Table 1 contains data on the total UP&L employee pool. The total

employee pool is presented only for comparison purposes and was not

used as a control for statistical testing.

The mean age of G1 was 32.58 years, matched in CG1 by a mean age of

33.06 years. The G1 population was 25 percent female and 75 percent

male; the frequency matched control group was 26 percent female and 74

percent males. Nine of the 12 individuals identified in G1 were from job

class 1; one from job class 2; none from job class 3; and two from job class

4. In the CG1, there were 35 from class 1,4 from class 2, none from class

3 and 8 from class 4. The average years of service for G1 and CG1 were

6.95 and 8.8, respectively. The salary of G1 employees averaged $428 per

month below the total employee pool. Most G1 individuals were from

Utah, which was not surprising since 93 percent of all UP&L employees

are Utah residents. Idaho and Wyoming were somewhat underrepresented in CG1. Demographic data concerning racial distribution were

also included; however, frequency matching was not performed on this

parameter. The total populations of G1 and CG1 were 12 and 47,

respectively.

G2 volunteers for rehabilitation had a mean age of 37.37 years and CG2,

36.5 years. The male:female ratio was exactly matched at 89 percent to

11 percent in both G2 and CG2. All job classifications are represented

proportionately to G2 in the control population. Years of service were

approximately 2 years less in the control than in G2. The mean salary

of those individuals who submitted to rehabilitation was less than the

UP&L mean, but considerably closer to the overall mean than that found

in G1. The majority of the rehabilitation population was from Utah. An

interesting feature shown in the exhibit is that Wyoming was over

represented in both G1 and G2. Although only 7 percent of all UP&L

employees resided in Wyoming, 25.6 percent of G1 and G2 members

176
Table 2. Implementation and Maintenance Costs

Item Description Cost

Potential

Savings

Start Up/

Implementation

Consultants

Initial Meetings

$7,000.00

$750.00

$3,750.00

$2,000.00

$3,500.00

Field Awareness $2,000.00

Legal Fees

Employee Time

Computer Data

Entry

Total

Daily Operation

Testing

Establishing Lab/Drugs of Interest

Consult. Time for Cost Analysis

Travel to Inspect Labs

Instructional Union/Employees

Management/Consu1tants

Educating Collection Sites Travel

UP&L Mgmt/Medical Lab

Evaluation

Drafting Policy

Brochures and Materials

Liability and Policy Questions

Mgrs/Secretarial/Other

Operator and Materials

1036 Tests x $35/Test

Quality Assurance Quality Control Sample

Analytical Misc. Supplementary Tests

Employee Time Health Specialist/Medical

Consultant/Secretarial

Hidden Costs

Lost Time Lost Hrs on Job Awaiting Test

Results 131.40/day x 0.6 days/

Result x 1036 Tests

50% Benefits

Managers’ Time Supervision

EAP 1986 Increase over 1985

EAP 1987 Increase over 1985

Psych Benefits Benefits for Chemical Dependency

Grievance Belated to Increase in Grievances

(12 x $5000 each)

Total

Potential Savings Savings Issue

Accidents Vehicle Accidents 1986

Vehicle Accidents 1987

Absenteeism

Change Over Unexcused

Control + 50% Benefits

Sick Leave Abuse (2X)

+ 50% Benefits

Medical Benefits Group 2

Turnover Est. of Turnover Drug Related

Total Subtotal Without Turnover

Total With Turnover

$2,500.00

$1,000.00

$5,000.00

$5,000.00

$25,000.00

$2,500.00

$60,000.00

$36,260.00

$4,100.00

$450.00

$60,000.00

$81,678.00

$40,839.00

$31,000.00

$39,000.00

$69,000.00

$60,000.00

$482,327.00

$130,152.00

$150,858.00

$21,523.00

$10,761.00

$28,748.00

$14,374.00

$5,724.00

$300,000.00

$362,140.00

$662,140.00

Grand Totals $482,327.00 $662,140.00

177
were from that State. Racial distribution was determined for G2, but not

frequency matched. The total populations of G2 and CG2 were 27 and

108, respectively.

The final aspect of this study was to determine startup and maintenance

costs of the program. Initial startup costs included estimates of the time

involved in researching the feasibility of occupational drug testing at

UP&L; time and material costs for preparing the policy statement and

documentation associated with presenting the program to employees;

cost of sending the Health Services Specialists to educate employees at

the 125 collection sites throughout the UP&L service area; costs of

meetings with consultants to identify a laboratory and monitor laboratory performance; the consultant retainer; the cost of computer time

involved in setup and data entry; and the initial meetings and attorney’s

fees associated with creating a written policy statement and identifying

the drug list. These items are addressed in Table 2. Maintenance costs

were identified from a number of different areas. Salaries of the key

UP&L employees interfacing with the laboratory and disseminating

report information were included. The salary of the secretary, estimates

of the Medical Consultant’s and Health Services Specialists’ salaries,

and a portion of the salary of the Employee Relations Manager, who is

involved in administering disciplinary decisions from the testing procedures, were included along with costs associated with the EAP.

Table 3. Screen and Turnaround Time Data

Item Total 1986 1987

Screens

Preemployment

Promotion

Accident

Performance

Rehabilitation

Volunteers

Other

Quality Control

342 (62%) 162

283 (14%) 36

312 (19%) 50

8 1

28 3

8 5

0 0

55 6

Totals 1036 263 773

Turnaround Time

For Results (Days) 2509

Average/Test 2.42

Lost Work 617

Ave Lost Wrk/Screen 0.6

944 1565

3.59 2.03

139 478

0.53 0.62

(24%) 180

(33%) 247

(35%) 262

(3%) 25

3

0

49

178
Table 4. Drug Distribution and Findings by Indication for

Testing

Item

1986

utility Mine

1987

Utility Mine Totals

Positive Screens 9 4 9 6

Totals Total (13) Total (15) 28

Reason For Positive

Screen

Accident

Preemployment

Rehabilitation

Performance

3 3

6 1

0 1

0 0

5 2

0 3

2 1

2 0

13

10

3

2

Totals 9 4 9 6 28

Drugs Detected

Cannabinoids

Cocaine

Cannab & Cocaine

Cannab and Other

Total (11) Total (14) 25

Total (1) Total (0) 1

Total (1) Total (0) 1

Total (0) Total ( 1) 1

Totals 13* 15 28

Drug Free Total (250) Total (758) 1008

*13 Positives/12 Emp.

RESULTS AND DISCUSSION

During the study period, UP&L’s testing lab performed 1,036 drug

screens (Table 3). These were divided into preemployment, promotion,

postaccident, performance, rehabilitation, volunteer, and quality control specimens. These data were then subdivided into three areas: the

total number of screens performed in each category; the total in 1986;

and the total in 1987. As shown in the exhibit, the majority of screens

over the 2-year period were for preemployment. However, in 1987,

screening “for cause” was the most indicated reason for testing. In fact,

in 1987, approximately 35 percent of all screens were requested following an accident; in 1986, this number was only 19 percent.

Turnaround time was an important factor needed to estimate the cost of

the program to UP&L. Turnaround time was defined as the latent time

179
period from collection of specimen to receipt of the test results. In 1986,

the average turn-around time was 3.59 days. In 1987, this time period

decreased to 2.03 days, but averaged 2.4 days for the 2-year period. A

total of 617 work days were lost while suspended employees awaited test

results. The average number of work days lost per screen performed was

0.6 for the study period. To extrapolate this as a cost item, 0.6 was

multiplied by the average salary per day for UP&L employees ($131.40

per day), resulting in a total cost of $81,678, or $79 per test. The average

charge for collection and analytical testing was $35 per test—$44 per

test less than the lost time figure.

Drug Distribution

Nine positive screens were reported in the Utility Division in both 1986

and 1987, while the Mining Division had four positives in 1986, and six

in 1987 (Table 4). The indication for testing associated with a positive

result was important in assessing the deterrent effect of the program.

Postaccident screens in the years 1986 and 1987, resulted in 13 of the 28

positive screens, representing approximately 46 percent of all positive

findings. Preemployment screening produced approximately 36 percent

of all positive findings, making testing an important de-selection criterion in maintaining a drug free work force at UP&L. The cost of replacing

employees and turnover rates is addressed in Table 2, and later in this

report. Performance-related and rehabilitation screens resulted in two

and three positive findings, respectively, during the study period.

A total of 25 of the 28 drug positive urines contained only cannabinoids

(marijuana constituents). Of the two specimens containing cocaine, one

contained cocaine alone, the other cocaine in combination with cannabinoids. In only one incidence were cannabinoids detected with methadone, opiates, or other drugs. A significant finding was that 27 of the 28

positive employee urines contained cannabinoids. It should be noted

that alcohol testing was not performed on a routine basis during this

study.

Absenteeism

The groups and corresponding controls were used to compare absenteeism, medical benefits use, vehicle accident frequency, and associated

costs. Table 5 shows that, prior to evaluating absenteeism data, population distributions were tested for distribution characteristics. The

value and its significance levels are given; a level of significance of 0.05

was used in all statistical evaluations. If the data were normally

180
Table 5. Absenteeism Data 1986-1987 in Hours

Item/Group Group 1 Control Group 2 Control

Group 1 Group 2

1986-1987 1986-1987 1986-1987 1986-1987

Sick

Mean

Std. Dev.

Range

Normality Stat

75.3

15.2

(40-100)

.11=Normal

Vacation

Mean

Std. Dev.

Range

Normality Stat

108.9

29.5

(32-164)

.18=Normal

Unexcused

Mean

Std. Dev.

Range

Normality Stat

63.8

106.6

(0-420)

.07=Normal

Total Absences

Mean

Std. Dev.

Range

Normality Stat

251.9

108.9

(84-624)

.13=Normal

t-Test Sick vs Cont 0.003

Conclusion Means Nott-Test Vac. vs Cont

Conclusion

0.132

Means=

Mann-Whitney

Unexcused vs Cont 0.00

Conclusion Means Not=

Mann-Whitney

Total vs Cont 0.001

Conclusion Means Not=

55.8 81.7 56.3

30.6 75.2 37.8

(0-220) (0-336) (0-232)

.13=Normal 0.7=Normal .11=Normal

120.4 122.2 138.7

34.3 56.7 42.8

(16-200) (0-240) (16-255)

.12=Normal .14=Normal .09=Normal

18.7 32.2 10.1

66.7 96.6 50.9

(0-456) (0-809.5) (0-616)

.00=Not Norm .003=Not Norm .00=Not Norm

196.2 237.4

86.2 138.1

(56-616) (0-809.5)

.04=Not Norm .14=Normal

0.001

Means Not207.8

74

(51-784)

.04=Not Norm

0.018

Means Not=

0.00

Means Not=

0.09

Means=

distributed, parametric in nature, an independent Student t-Test was

performed to determine the relationship between the control and experimental population. If, however, the data were found to be nonparametrically distributed, a Mann-Whitney Test was performed. Table 5 shows

that the G1 mean number of sick hours accumulated was 75.3, compared

to the CG1 mean of 55.8, a significant difference of 19.5 hours per

individual. This is reflected as a cost and presented in Table 2.

Interestingly, vacation days were found to be equal and probably relate

more to duration of employment or to other factors. Unexcused absences

181
varied from a mean of 63.8 hours for G1 to 18.7 hours for CG1; the

resulting difference was 45.1 hours per individual. The Student t-Test

indicated that means were statistically different. Total absences,

including vacation, were also found to be significantly different. The

total difference in absences between G1 and CG1 was 55.7 hours per

employee and is primarily a reflection of unexcused absences. All

absenteeism information has been transformed into cost estimates and

is discussed below.

Also presented in Table 5 are the absenteeism data for G2 and CG2. The

mean number of sick days were statistically different between the two

groups, with G2 missing 81.7 hours and the control missing 56.3. The

difference was 25.4 hours, or slightly greater than 3 days annually. As

in G1, the use of vacation time was nonparametrically distributed;

however, the Mann-Whitney Test indicated that G2 and CG2 differ. The

difference between G2 and CG2 mean total absences was approximately

2 working days and was the result of unexcused absences and sick day

use. Unexcused absences were statistically different, with G2 reporting

32.2 hours and CG2, 10.1. The Student t-Test indicated that the 22.1

hour mean difference was significant. The mean total number of hours

absent for G2 was 237 versus 207.8 for CG2; these were not statistically

different.

Two major cost items to UP&L were unexcused absences, reflected as

lost productivity and a corresponding increase in the number of employees needed to cover work assignments, and use of sick days. The total for

G1 was 64.6 hours per employee, approximately 8 working days greater

than the control group. For G2,47.5 hours per employee, or 6 working

days greater than the mean of the frequency matched control group were

missed.

Medical Expenditures

An evaluation of medical benefits use data indicated that there was

little difference between 1986 and 1987; therefore, all data were combined for statistical evaluation (Table 6). In G1, total claims for the study

period were $16,251, with a mean of $1,354 per employee, and $677 per

employee per year. UP&L reimbursed approximately 75 percent of the

total employee expenditures, resulting in total cost to UP&L of $12,117,

$1,009 per employee, and an annual expenditure per employee of $504.

The total 1986-87 claims in CG1 were $77,340, with a mean of $1,646 per

employee and total annual claims per employee of $823. UP&L paid

approximately 88 percent of these claims, resulting in a $67,900 expen182
Table 6. Medical Expenditures 1986-1987

Item/Group Group #1 Control

Group 1

Group #2 Control

Group 2

Total Claims

Mean/Employee/2 Years

Mean/Employee/Year

Std. Deviation

Range

$68,465

$2,535

$1,267

$263

2-12076

UP&L Contribution

Mean/Employee/2 Years

Mean/Employee/Year

Std. Deviation

Range

Percentage Covered

$16,251

$1,354

$677

$911

0-3138.80

$12.117

$1,009

$504

$718

0-2372.80

75%

Normality Stat 0.054

Conclusion Normal

Mann-Whitney

PDvsCon Pd

Conclusion

Number of Observations 12

$77,390

$1,646

$823

$2,932

0-27012.60

$67.900

$1,438

$719

$2,675

0-24485.70

88%

0.000

Not Normal

0.031

Means Not=

47

$35,848

$1,324

$662

$1,906

0-111190.80

52%

0.004

Not Normal

27

$122,707

$1,136

$568

$1,371

0-11567.50

$97,077

$898

$449

$1,291

0-11391.50

79%

0.000

Not Normal

0.044

Means Not=

108

diture. Over the 2-year period, this averaged $1,438 per employee with

an annual cost of $719 per employee. These data demonstrate that CG1

expenditures were greater than the drug positive group ($719 per year

versus $504 per year) by $215 per employee.

G2 total claims over the two year period were $68,465. The 2- year mean

claims per employee were $2,535 and the annual mean claim was $1,267.

Of the total claims, UP&L paid 52 percent, placing actual costs at

$35,848, with the mean over the 2-year period of $1,324, and an annual

costs of $662 per employee. Total CG2 claims for the 2-year period were

$122,707, the mean was $1,136 per employee, and mean annual claims

per employee totaled $568. Claims paid by UP&L for the 2-year period

totaled $97,077. The 2-year mean per employee was $898, and annual

expenditure was $449 per employee. Two interesting features are shown

in the table: G2 annual claims of $1267 per employee are much greater

than CG2 claims of $568; and UP&L paid only 52 percent of G2 claims.

This is explained by UP&L’s medical benefits policy which pays a

maximum of $30 per psychiatric visit. Any amount over $30 per visit or

$500 annually must be paid by the employee. A review of G2 records

indicated that psychiatric claims (which might be associated with drug

or alcohol dependency) constituted a major portion of the unpaid claims.

183
FIGURE 1: VEHICLE AND MEAN VEHICLE

ACCIDENTS 1983-87

Table 7. Vehicle Accidents Per Group 1986-1987

Control Control

Group 1 Group 1 Group 2 Group 2

(n = 12) (n = 47) (n = 27) (n = 108)

Total No. of Accidents 5 4 3 11

At Fault (%) 4 (80) 2 (50) 1(33) 4 (36)

Damages to UP&L or

External Vehicle/

Property $49,800 $200 $700 $6,000

184
FIGURE 2: MEDICAL AND FIRST AID

INJURIES 1983-87

Vehicle Accidents - Medical Injury Accidents

Figure 1 displays the frequency ofvehicle accidents for the last five years

at UP&L. Accidents increased in the years 1984 and 1985 above 1983

levels, however, 1986 and 1987 compared favorably with 1983. We were

interested in identifying any significant changes in trends for 1986 and

1987 over previous years. To determine the cost to UP&L associated

with vehicle accidents records were searched, by employee number, for

individuals in all four groups (Table 7). When an accident was identified

which involved a group member, data were obtained concerning damage

to UP&L vehicles, damage to other vehicles or property, and driver

“fault” was assigned. The results were not conclusive. Many vehicle

accident report forms were only partially complete, damages to UP&L or

external vehicles were estimated or not present, and records for at least

one major accident known to involve a G1 individual could not be located.

The data have been included because we were aware that this accident

occurred during the study period, but this example makes the authors

suspect of the validity of the data for statistical comparison; therefore,

the cost data presented are at best an estimate.

185
The “at fault” data show that the drug positive individuals caused 80

percent of the vehicle accidents in which they were involved, compared

to 50 percent for CG1 (Table 7). G2 members were at fault in 33 percent

of their accidents and the CG2 members were responsible in 36 percent

of the crashes. The average cost per accident was $9,960 in G1, less than

$200 for G2, less than $200 for CG1, and $545 for CG2. The G1 data are

skewed by the major accident that totaled $40,000 in damages. However, if this accident is removed from the data, the average cost per

accident from G1 was still $2,450, a tenfold increase over the control

group mean, and an indication that more serious vehicle accidents are

likely to occur in the drug user population.

These data can also be used to calculate the increased likelihood of

having an accident for Groups 1 and 2. Calculations showed that G1 was

five times more likely to have a reportable vehicle accident than CG1. G2

was no more likely to have an accident than CG2.

There were mean decreases in the total number of accidents per month

at UP&L from 16.2 to 11.8 (4.4 accidents per month) in 1986, and a

FIGURE 3: LOST DAYS AND RATE - FROM

MEDICAL INJURY ACCIDENTS

186
decrease from the 1985 mean of 5.1 accidents per month in 1987 (Figure

1). In total, the 1985 to 1986 decrease translated to 52.8 mean fewer

vehicle accidents per year. The average cost per accident for the

accidents investigated over the 2-year period, was $2,465. Therefore, the

accident reduction resulted in a savings to UP&L of $130,152 (Table 2).

Comparing the 1987 mean of 11.1 accidents per month to the 1985 mean

of 16.2 showed a difference of 5.1 accidents per month, or 61.2 fewer

accidents per year and a savings of $150,858 (Table 2). Scientifically, the

authors can not assume that the decrease in vehicle accidents was solely

attributable to the drug testing program, and, although an actual causal

relationship should not be drawn between these data and drug testing,

the trend is apparent.

Trends in reportable medical accidents and injuries requiring first aid

were also evaluated (Figure 2). These data, like the vehicle accident

data, were examined for trends, and should not be used to draw a causal

relationship between drug testing and the decreases. The total number

of accidents increased through 1985. In 1986 and 1987, there was a

decrease.

Not all trends were as readily interpreted. Lost work days and the rate

of lost days per 200,000 man-hours worked, resulting from medical

injuries (grouped and analyzed by quarter), were evaluated for the years

1983-87 (Figure 3). The total number of lost days resulting from medical

injuries increased dramatically in 1985 and remained elevated in 1986

and 1987. There were no obvious reasons for this phenomenon; however, discussions with the Safety Department revealed a change in the

mechanism of record keeping which began in 1986. Prior to that year,

medical injuries were tallied by month, and lost days recorded if the

employee missed days in that period. Currently, when an accident

occurs, the number of days the employee will be away from the job site

is estimated, and the predicted lost days are then attributed to the

accident. In quarters 1 and 3 of 1987, the total number of lost days was

inordinately high as a result of two major accidents with predicted

recuperation periods much longer than the total 80-day working quarter. In addition to the increase from procedural changes, since implementation of the substance abuse program, employees tested for drugs

following accidents are suspended pending receipt of the results. As

stated earlier, the average turnaround time for results has been 0.6 days

and 35 percent of all screens performed in 1987 were requested as a

result of accidents. Therefore, approximately 157 of the lost days are

attributable to this process. For the reasons just stated, lost work days

data do not truly reflect causative effects from the drug screening

program, but demonstrate that data review needs to proceed cautiously

in retrospective occupational studies.

187
Costs

Costs associated with the program such as consultant fees, initial

meetings with unions and employees, education of the field collection

sites, daily operations including specimen collection and testing, quality

control testing, and analytical support by consultants are shown in Table

2. There were many hidden costs in the program, including lost time by

injured employees awaiting drug screening results. Other items included in Table 2 are the retainer for the EAP and the use cost of the EAP.

Listed costs reflect increases over 1985 prices and, therefore, reflect

changes associated directly with the drug screening program. The total

cost of 12 drug positive cases to the third stage of the grievance process

was $60,000.

Potential Savings

To determine the cost effectiveness of the screening program, several

assumptions were used. The following items shown in Table 2 are

estimates representing potential savings to UP&L.

1. Absenteeism

Unexcused absences were 8.4 days (67.2 hours per study period) greater

in G1+G2 than in CG1+CG2, when multiplied by the populations of

G1+G2 (39) and by the average daily salary per employee ($131.401,

represent a cost to UP&L of $21,523 annually, and with benefits a total

cost of $32,284 (annually). If UP&L can achieve a drug free workplace,

a potential savings of $32,284, per annum could be realized. The same

logic was applied to determine the cost associated with excessive sick

time use. The mean total of G1+G2 was 5.61 days (44.9 hours) greater

than CG1+CG2, multiplied by the average salary of $131.40 per day and

by 39 employees, the resulting potential savings was $14,374 in direct

costs, plus benefits for a total of $21,523. Unexcused absences were

considered a loss of productivity and costed at the standard rate.

Elaborate equations have been developed to include managerial and

supervisory time in computing costs due to sick absences (Cascio, 1987).

For this report, however, economic losses due to sick days were considered double jeopardy to UP&L, because the employee was paid sick

benefits and productivity was also lost. Therefore, costs were doubled

resulting in an expense to UP&L of $45,323.

188
2. Vehicle Accidents

A company mean cost per vehicle accident for 1986 and 1987 has not been

established; however, the mean identified from accidents in our four

groups was $2,465. When multiplied by the 52.8 mean vehicle accidents

reduction in 1986, the savings to UP&L was $130,152. Multiplying same

mean cost per vehicle accident by the 61.2 accident reduction for 1987

from 1985 resulted in a savings of $150,858.

3. Medical Benefits

A further potential savings to Utah Power & Light would result from the

reduction of G2’s use of medical benefits, $212 per employee per year

more than their control group. Rehabilitation of this group would save

UP&L $5,724 annually.

4. Turnover

A final and extremely important item in analyzing the cost effectiveness

of the program is related to turnover. Estimates of the cost of employee

turnover to an organization vary considerably, from $13,500 to $418,500

per employee depending on the individual’s job status with the company

(Cascio, 1987). The lower figure reflects replacement of a blue collar

worker, while the larger is an estimate for replacing a sales manager.

Since the majority of UP&L drug positives were in Job Classification 1,

we have assigned the conservative figure of $50,000 for turnover replacement per employee. It is beyond the scope of this paper to do an in-depth

study of drug-related turnover, however, we assumed the six prospective

Utility employees who tested positive in preemployment screening were

“high risk” and likely to be terminated for drug abuse or to leave

voluntarily. The savings to UP&L by not hiring these applicants was

$300,000.

CONCLUSIONS

Demographically, an employee with an admitted or detected drug abuse

problem at UP&L had a 75 percent likelihood of being male. The

individual was further characterized by having a mean age in the range

of 32 to 37 and worked as a laborer, operator or craftsman. He had been

employed at UP&L for 7 to 13 years, but commanded a salary less than

the UP&L mean. His drug of choice, as detected in 27 of 28 positives was

marijuana.

189
Drug users at UP&L abused absenteeism benefits. G1 used approximately 8 days more than their control and G2 6 days greater than CG2.

Conclusions from the absenteeism analysis of groups vs. controls were

that G1 individuals use 19.5 more hours of sick leave per year than their

corresponding control groups. Vacation hours were similar. Unexcused

absences showed a mean difference of 45.1 hours per year. Statistical

analysis determined that sick benefits use and unexcused absence use

were significantly different. A comparison of the same parameters in G2

and CG2, found that G2 used approximately 25.4 more sick hours and

22.1 more hours in unexcused absences. The total excess hours used was

47.5 which is a statistically significant variation from the frequency

matched control group. The conclusions from these data are that drug

and alcohol users have greater uses of employee benefits. The abuse

from absenteeism alone cost UP&L over $75,000.

While medical injury accidents were reduced, the expenditures for

medical benefits showed no clear pattern to distinguished groups and

controls. UP&L expenditures on G1 for medical benefits were less than

CG1. Expenditures on G2 employees were greater than CG2. Information on the costs of medical expenditures by UP&L insurance benefits

was somewhat less conclusive. UP&L actually spent $215 per employee

per year less on the drug abusers in health insurance benefits than on

the control group. Conversely, the drug rehabilitation group used $212

more in medical benefits annually per employee than their corresponding control group. The number of lost work days from medical accidents

and the rate of lost days per 200,000 hours worked, showed increases

over the previous 3 years in 1985,1986, and 1987. This phenomenon was

partially explained by a change in the record keeping procedures and by

the lost days awaiting drug testing results post accident. Perhaps the

best indicators of the trends in medically-related accidents were the

medical and first aid reported injuries; these demonstrate a dramatic

decrease from the peak in 1985 through the last 2 years. Once again

these data should be interpreted cautiously when drawing a causal

relationship between drug testing and the decreasing injury frequency

because numerous external factors not controlled for in our study may

affect accident frequencies. Examples include training, changes in job

type, experience, and changes in equipment used to perform high risk or

dangerous tasks.

Vehicle accident and medical injury accident data were used to draw

inferences about the deterrent effect and efficacy of testing. There has

been a continuing decrease in the number of vehicle accidents and mean

number of vehicle accidents per month over the last 2 years. Not only

does the graph demonstrate the changes, but a statistical evaluation

comparing 1985 to 1986 and 1987 show that statistically a change has

190
occurred in the number and frequency ofvehicle accidents at UP&L. The

detected drug users of G1 were five times more likely to have an on the

job vehicle accident than CG1. Vehicle accident frequencies demonstrated a decreasing trend following the onset of drug testing. Reductions in the number of on the job vehicle accidents have saved UP&L

$281,000. Caution is advised in concluding that the observed trend was

associated with the deterrent effect of drug screening because a number

of uncontrolled external factors such as driving experience, changes in

driving patterns, improved weather conditions, or improved vehicle

safety features could contribute to this decrease. The fact remains,

however, that vehicle accidents have decreased over the last 2 years

since the inception of the substance abuse management program.

The final aspect of the study was to evaluate the cost effectiveness of the

program. Substantiated costs due to accounting or estimates of the cost

for initiation and implementation of the UP&L drug screening program

total $482,327. Estimates of potential savings to Utah Power & Light

total $362,140 without including the estimate of turnover in personnel.

With this estimate, the savings were $662,140. When evaluating these

data, it must be remembered that these are estimates and they assume

that all vehicle accident reduction was based on the deterrent effect of

the drugscreeningprogram. This has not been established. However, in

defense of the estimates, estimates of unexcused absences and sick leave

costs were conservative. The $75,406 expenditure related to these two

abuses of the employee benefits system also reflects a potential ongoing

annual savings. The net present value of cash flows of $75,406 per year

for a time horizon of 10 years at a cost of capital of 15 percent is $378,455,

nearly equivalent to the initial cash outlay for establishment of the

program.

Costs attributable to absenteeism at UP&L clearly demonstrate that

drug abusers pose a potentially significant financial liability to UP&L.

Medical expenditures for these individuals are somewhat mixed and do

not show clear cost patterns. The current health insurance policy, which

limits payments for psychiatric benefits, has resulted in a significant

savings to UP&L as demonstrated by G2 expenditures.

The cost estimate data presented show that initiation of the program

was expensive. Many of the costs were one-time start-up expenses and

will not be incurred again, so that actual operatingexpenses per year will

be approximately $218,713.

Drugtesting has been cost effective at UP&L. Elimination of preemployment drug positives potentially saved UP&L $150,000 per year in the

first 2 years of the program. Reduction of absenteeism by drug using

191
employees to control levels would save UP&L over $75,000 annually.

Vehicle accident reductions have already reduced expenditures $281,000.

From a financial perspective, if the project is evaluated as a capital

budget decision, the initial cash outlay was $60,000, while annual cash

flows to operate the program were $211,000. Potential or positive cash

flows from drug testing without turnover estimates were $180,000,

$30,000 less then the negative cash flows. With turnover estimates,

savings were $362,140 annually. This figure is $151,140 greater than

operating expenses. The pay back period for the initial investment was

less than 5 months and the discounted pay back period at an 8 percent

cost of capital was also less than 5 months. The net present value of the

program at 8 percent with a 5-year time horizon was over $544,000, and

on a 10-year time horizon, over $996,000, making this the program a

sound financial decision. This, with the added feature of reducing the

employee turnover rate by preemployment screening, as a mechanism of

removing drug abusers from UP&L pool, certainly shows strong justification for continuing the program in its present form.

ENDNOTE

1

 This study represents a preliminary evaluation of the UP&L program. Although the N in the positive and rehabilitation groups is small, case controldemographically matched control groups were established to match the populations studied and to statistically validate findings. It was the intent of the

authors to present a working model for occupational drug testing efficacy

studies, and where empirical data concerning the effecte of drug testing were not

available, to observe trends in safety indicators.

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Crouch, D. J., et al. “Criteria for the Evaluation of Occupational Drug Screening

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Edison Electric Institute Human Resource Management Division. “Drugs and

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192
Austin, R. “Drug Abuse in the Work Place: Prevention and Control,” Presented

10th Annual Arnold O. Beckman Conference. Jan., 1987.

Cascio, W. Costing Human Resources: The Financial Impact of Behavior in

Organizations. P.W.S. Kent Publishing Company, 1987.

ACKNOWLEDGMENTS

The authors are grateful to a number of individuals for their assistance in this

project: Mr. Wayne Miya, for his assistance in establishing the computer data

base; Tom Jennison of ARUP, Inc. and Newell McElwee from the University of

Utah, for their assistance in the statistical evaluation of the data; Mr. Mike

Stevenson, Manager, Employee Relations, without whose interest and cooperation, the project would not have materialized.

AUTHORS

Dennis J. Crouch, B.S., M.B.A.

Assistant Director,

and

Douglas E. Rollins, M.D., Ph.D.

Director,

Center For Human Toxicology

417 Wakara Way, #290

University of Utah Research Park

Salt Lake City, Utah 84108

Douglas O. Webb, B.S., R.N.

Health Services Specialist

The Utah Power and Light Company

1407 West North Temple

Salt Lake City, Utah 84140

Lynn V. Peterson

Manager, Employee Services

The Utah Power and Light Company

1605 West North Temple

Salt Lake City, Utah 84140

Paul F. Buller, Ph.D.

Associate Professor, Business Administration

Utah State University

Logan, Utah 84322

193

An Evaluation of Drug Testing

in the Workplace

John Sheridan

Integrated Systems and Applied Technologies, Inc.

Howard Winkler

Georgia Power Co.

INTRODUCTION

In 1987, the National Institute on Drug Abuse (NIDA) sponsored a 2-

year study to “Evaluate Drug Testing in the Workplace.” This study is

being conducted by Southern Electric International, Inc. (SEI) and

Integrated Systems and Applied Technologies, Inc. (ISAT).

SEI is the marketing, research, and consulting arm of the Southern

Company, which is the parent firm of one of the Nation’s largest investorowned electric utility groups, more commonly known as the Southern

Electric System. Alabama Power, Georgia Power, Gulf Power, Mississippi Power, and Savannah Electric Power comprise the operating

companies of the group, while SEI, Southern Company Services, and

Southern Investment Group are also part of the system. Combined, the

group supports 31,700 employees, $18.1 billion in total assets, and a

large and diverse work force ofinservice employees. The group processes

more than 10,000 applicants a year, has hired more than 2,000 new

employees a year, and enjoys the benefits of many thousands of additional contract employees engaged in a wide array of work ranging from

the construction of nuclear power plants to the provision of an Employee

Assistance Program (EAP).

ISAT is a management consulting firm which specializes in research on

and evaluation of health systems and human factors engineering. It

provides services to a wide array of clients in the public sector (Federal,

State, and local governments) and the private sector (corporations and

universities).

195
The purpose of this study is to investigate a series of issues surrounding

drug use and drug testing in the workplace. Of primary interest is the

identification and validation of workplace behaviors that are a clear

indication of drug use. With the identification of useful indicators,

investigations will also be conducted into other areas, such as estimating

drug use prevalence in the workplace, evaluating a drug testing program, and estimating and comparing the costs and benefits of a drug

testing program. To perform these investigations, large volumes of data

are needed on a company’s environment and work force, and, where

possible, drug test results on a sample of employees. To provide these

data, SEI obtained permission to access the rich variety of data files at

Georgia Power. These files contain information describing drug test

results and participation in an EAP. Georgia Power has had a program

with several components— drug education, supervisor training, drug

testing, and an EAP- since 1982. This paper describes Georgia Power’s

program, discusses the studies to be performed in the NIDA-sponsored

project, and presents some preliminary results obtained from Georgia

Power’s data files.

DESCRIPTION OF THE GEORGIA POWER PROGRAM

The history of Georgia Power’s drug testing program dates back to 1972,

when Edwin I. Hatch, then president of the company, sent a letter to all

employees establishing a policy of no drug use on company time or

property. During the next decade, the company continued its efforts to

assess the impact of drug use in its work force and estimate its impact

on performance and productivity. The Georgia Power company program

for preventing alcohol and drug use consists of several activities, including an education and communication component, security activities, an

EAP, and drug testing.

The education and communication component involves employee education and participation, supervisory training, continuing publicity, and

notice to contractors. Initially, 177 employee education sessions were

held at all major work locations. In addition, 53 training sessions were

held to instruct supervisors in applying the policy and recognizing

aberrant behavior and drug usage. The Security Department trained

selected managers to identify and handle contraband.

A number of continuing education and communication efforts have been

undertaken. At management’s request, followup training has been

provided on-site and is included in all Labor Relations classes. Continuing publicity activities—including newsletters, bulletin boards, and the

company’s monthly magazine—have reinforced the program. At one of

196
the nuclear sites, a drug information hotline has been established to

encourage employees to provide anonymous information about suspected drug usage.

As the final aspect of the education and communications component, all

primary contractors and suppliers on major construction sites have been

informed that their employees will be held to the same standard as

Georgia Power employees. The alcohol and drug policy has been

incorporated into general contractor specifications and has become part

of the bid package for work on these projects.

Security activities include the use of drug-detecting dog searches. These

searches are made at the request of division management. Before a new

location joins the program, a live demonstration and information meeting is held for all employees. The company also uses the investigations

section staff in the Security Department who conduct both undercover

investigations and open investigations as followup to specific allegations. These activities are always coordinated with local law enforcement, and the appropriate authorities are notified whenever violations

of the law come to management’s attention.

Georgia Power sponsors an EAP as an integral part of the program. The

EAP provides free counseling and referral services to employees, retirees, and their immediate families. The service is voluntary, confidential, and available through a statewide network at 14 locations. Employees are encouraged to seek assistance for an alcohol or drug problem

before it comes to management’s attention. Once a supervisor initiates

an investigation into an employee’s involvement with alcohol or drugs,

the employee may not use the EAP as a shield against discipline. The

EAP is promoted regularly through mailings to employees’ homes,

information board articles, and other media.

The final component of Georgia Power’s program is the ongoing process

of drug testing. A network of company physicians is used to collect urine

or blood specimens. A central laboratory analyzes specimens for all

major drugs with abuse potential. Positive findings are confirmed at

least once, using Gas Chromatography/Mass Spectrometry. Partial

specimens are retained at the physician’s offices in case employee files

a challenge.

Pre-employment testing is conducted as part of the pre-employment

physical on all prospective employees, including summer and part-time

employees. No exceptions are permitted. Individuals who fail the test

are ineligible to re-apply for 6 months. Upon initial job application, all

applicants are immediately put on notice that they must pass a pre197
employment physical, which includes a drug screening test, conducted

by a company designated physician.

Drug testing may also be required to prove fitness for duty. Such testing

may be triggered by aberrant behavior observed by a supervisor or by

other causes, (e.g., off-duty arrest or reliable information from a coemployee or customer). Refusing to submit to the test is considered

insubordination and carries a uniform discipline of discharge. In

addition, at management’s discretion, an employee may be required to

submit to a test to help determine the cause of an accident.

Finally, two employee groups-nuclear plant and the security personnel-must submit to special drug testing procedures in addition to preemployment and fitness for duty tests. Specifically, all employees who

are badged for unescorted access to Plant Hatch or Plant Vogtle must

take a drug test as part of the clearance process, most often initiated

when an employee transfers to a nuclear plant. Due to its remote

location, Plant Vogtle conducts on-site prescreening using EMIT equip

ment. All positives are then retested off site. Security department

employees are also required to submit to drug testing as part of annual

physical examinations.

NIDA-SPONSORED RESEARCH PROGRAM

Four types of studies are being performed using the range of data sets

available at Georgia Power. Specifically, SEI/SAT plans to: (1) identify

the workplace behaviors and measures that are associated with drug

use, (2) evaluate the impact of drug testing, (3) develop estimates of drug

use prevalence in the Georgia Power work force, and (4) study the costs

and benefits of drug testing. This research will be conducted using

analytic databases constructed by manipulating and concatenating the

various data files available through Georgia Power. The database

development and the four studies are described in the following sections.

Database Development

Creation of a single integrated database is critical in conducting all four

analytical studies. This database will be constructed by manipulating

and joining the various automated and manual data sets available from

Georgia Power and affiliated organizations. The original data sets

available for database development describe the approximately 15,000

Georgia Power employees and comprise the following:

198
The cumulative administrative file (e.g., demographic data,

workplace-related administrative data)

Employment history file (e.g., promotion demotions, transfers, pay increases and reductions

Payroll deduction files (e.g., participation in savings plans,

garnishments)

Insurance files (type of insurance held)

Education files (education history)

Job classification file (job structure of the work force)

Dependent file (demographic characteristics of the employees’ dependents)

Pay history file (seven types of absenteeism by 2-week pay

periods)

Previous employment history file (job history prior to employment at Georgia Power)

Human resources file (e.g., performance evaluation for nonunion employees, merit increases)

Accident file (e.g., accidents per individual by type, severity,

date injury)

EAP admissions file (EAP participation by type of problem:

30 percent automated; 70 percent hardcopy)

Drug test results tile (results of applicant and in-service employee tests: 100 percent hardcopy)

Health insurance file (claims and payments, by type, for

employees and dependents: automated in 1985, hardcopy for

earlier years).

The Georgia Power drug testing program has been in place since 1983,

with the EAP accepting admissions since early 1982. Thus, data are

available for development of the analytic database for the 5-year period

from 1983 to 1987. The primary subject for the database is the problem

199
employee. Such employees include not only persons identified as drug

users, but also those who appear to have problems as identified by the

various data files. This set of individuals comprises the following:

Inservice employees who tested positive for drug use

Inservice employees who were tested for cause and tested

negative

Employees who entered the EAP for drug and alcohol problems

Employees who entered the EAP for other problems

Employees who were discharged for problems other than

drug and alcohol use.

These classes of employees will be compared and contrasted to identify,

if possible, factors related to drug use alone. To complete the database,

the five classes described above will be augmented by matching these

individuals against employees who are not identified with any problem.

This set ofnonproblem employees will be taken from the remaining work

force and matched, as completely as possible, on job classification, length

of employment, sex, race, and age. An episode data item (i.e., test date,

EAP entry date, or discharge date) will be identified for each problem

employee, and his or her behaviors in the year preceding that date will

be considered the measures included in the database. The behaviors of

a matched nonproblem partner will be studied for the same 1-year

period. A database constructed in this manner will have the same period

of exposure for all members of the sample used; it will permit an

examination of behavior preceding the critical events for problem employees and nonproblem matched partners. This preliminary database

will probably number approximately 5,000 employees. Other extended

databases will be constructed as needed.

A Comparison Study to Identity Indicators of Drug Use in the

Workplace

Substance abuse in the workplace is frequently viewed as a hidden

behavior, indirectly manifested by a range of associated, abnormal

behaviors. For example, it has often been stated that substance-abusing

employees have a higher level of absenteeism, utilize more health care

resources, and are involved in more accidents than nonsubstanceabusing employees. Moreover, it is believed that substance abusers

200
experience dysfunctional behavior in other areas, such as interpersonal

skills, financial stability, marital relationships, job performance, and

associations with law enforcement agencies. While these relationships

have been postulated, they have been largely unsubstantiated by data

from the workplace. It is therefore not clear whether or not such

relationships exist, much less if ancillary measures (e.g., absenteeism)

are necessary or sufficient conditions for estimating substance abuse.

Using the database developed in this project, analytic results can be

generated to support or deny the assertions put forth about the symptomatic behaviors related to the substance abuse in the workplace.

Evaluation of a Drug Testing Program in the Context of Other

Programs Aimed at Reducing Substance Abuse (EAP and the

Indicators of Substance Abuse at Georgia Power)

This study will involve a trend analysis of the measures identified as

substance abuse indicators at Georgia Power. These measures will be

identified through the analyses conducted in the comparison study

described above.

In analyzing trends, it must be recognized that substance abuse indicators can be subject to the confounding influence of other internal

programs at Georgia Power. To identify potential sources ofconfounding

influence, Georgia Power records will be searched to uncover programs

which may have influenced measures chosen as substance use indicators. Since the analysis period will cover the years 1978-1987, attempts

to identify confounding influences will also cover that period. The

initiation date and intensity (if possible) of such program influences will

be charted against the values of the indicators across the period of

analysis. The analysis will then attempt to estimate the effect of drug

testing on the indicators by separating out, where possible, the effects of

other programs.

Prevalence Modeling Based on Drug Tests and EAP Data

Using various Georgia Power databases, attempts will be made to

develop models that estimate the overall prevalence of substance abuse.

Development of these models will be based largely upon work performed

in estimating the size of hidden populations (e.g., nonreported medical

problems, undetected infection rates, the number of unserved individuals with disabilities, and drug use in the general population). The size

of hidden populations (i.e, unobserved substance abusers) is estimated

by modeling overt aspects of the problem and extrapolating the size of

the nonovert, or unobserved, portion of the target population.

201
Study of the Cost-Benefit of Drug Testing

A cost-benefit study of drug testing will be conducted to estimate savings

(benefits) ascribable to the impact of testing versus the cost of performing the program. Costs associated with program performance are

readily apparent, yet estimates of the benefits are a more complex

endeavor. Benefits can be measured on a continuum ranging from the

actual reduction in drug use and its associated dysfunctional behavior to

the hedonic values estimated by the work force as a result of their

perception of working in a safer and healthier environment. Development of bases for benefit measurement will depend upon the results of

the baseline, the prevalence study, and the evaluation of the drug

testing policy. These will identify which measures (i.e., behaviors) are

associated with drug use, the effects on these measures, and permit an

estimate of the reduction in drug use. Hedonic measures, if they are

admissible, can be measured through attitude assessment on employee

surveys.

This cost-benefit study will then assemble a list of cost and benefit

elements. Analysis will proceed by assigning dollar values to the units

(i.e., days not absent) of the acceptable elements. The number of units to

be included will be estimated from available results. Given the possible

nontechnical controversy associated with the elements in the analysis,

sensitivity analysis will be performed to identify the range of values the

cost-benefit ratio could take.

PRELIMINARY DATA ANALYSIS

Background

The presentation of preliminary results has been taken from the 1986

and 1987 Georgia Power data and focuses on examining potential

indicators of drug use in the workplace. Useful indicators of drug use are

identified as having the ability to differentiate behaviorally between

individuals who use drugs and those who do not, even if they have other

problems which may also cause aberrant behavior. In this sense, the

focus has been on measuring the extent of the drug use problem as

opposed to identifying extreme behavior, per se.

In identifying unconfounded indicators, preliminary analysis followed

the path of comparing and contrasting measures found in various data

files associated with Georgia Power employees. The initial phase of this

202
preliminary analysis identified individuals with positive and negative

drug test results as the reference groups. In later phases, EAP participation and employees discharged for various reasons will be used as

target and comparison groups. The present analysis was restricted to

employees tested for drug use.

Population parameters of the studied behaviors were used as comparison bases. Relevant statistics were calculated, including population and

behaviorial parameters, for both the positive and negative drug tested

groups.

Methodology

Relevant background variables and distributional characteristics of the

indicators were then chosen and analyzed. A complete analysis of the

data would require a selection of variables based on a comprehensive

statistical analysis. For presentation of preliminary results, background variables were chosen based on the assumption that some

variables are more important than others in the description of a work

force.

For this presentation three variables were selected: job classification,

year hired, and age. The variable, “year hired,” was dichotomized in one

category of being hired before 1983 and another identifying those hired

in 1983 or later. This categorization was constructed because both

applicant and inservice testing for cause was implemented in 1983. This

variable would, therefore, give some indication of the impact of the

testing program on the indicators.We was chosen as a background

variable because it is often related to drug use.

The next aspect of the methodological development was to select comparison indicators and examine their probability distributions. Distributions were examined so that appropriate models could be identified for

specific tests. The purpose of the preliminary analysis was to determine

if it is possible to discriminate, using indicator measures, between those

who tested positive, those who tested negative, and the total work force.

Therefore, it was desirable to use the most sensitive tests possible.

Choosing the underlying theoretical probability models that best fit the

data was essential to identifying the appropriate, derived tests.

Several indicators were selected to perform the comparisons. This

selection was based on measures that had been clearly incorporated into

the databases. The measures selected for examination were:

203
Number of promotions per individual

Number of demotions per individual

Participation in an automatic savings plan

Number of different jobs an individual has held

Total hours per year absent for illness or non-occupational

injury

Total hours per year absent as unauthorized absence.

Multiple comparisons were made based on the average behavior of the

measures in the total work force. The sample means of those who tested

negative, positive, and positive for THC were to be compared to the

population mean. To determine if discrimination existed between those

who tested negative and positive, additional tests were conducted for

each measure, between all who tested negative and all who tested

positive, and between all negatives and positives for THC. The tests to

be used will be based on the configuration of the data.

Results

Descriptive results are shown in Tables 1,2, and 3. Table 1 reflects the

size of the total work force for 1986 and 1987 used in this preliminary

analysis, the number tested in each year, the percent positive for any

drug, and the percent positive for each specific drug. Of the total work

force, 463 and 366 were tested in 1986 and 1987, respectively. In 1986,

13.4 percent of those tested were found to be positive for any drug, while

in 1987, the percentage was 14.8. In the 2 years, 4.8 and 5.2 percent

tested positive for THC, 2.2 and 1.6 percent were positive for cocaine, and

6.5 and 7.9 percent tested positive for other drugs in 1986 and 1987,

respectively.

The results of testing in relation to the work force characteristics explained above are given in Tables 2 and 3. Table 2 gives the 1986 testing

results. The percentage distribution of employees within the three

characteristics is displayed in the first column on the left. In relation to

job classification, the distribution of tests is somewhat out of proportion

with the entire work force. The largest degree of disproportionality is in

relation to semiskilled labor—46.9 percent of the tests versus 24.6

percent of the work force. The disproportional tests occur because this

job class contains security personnel who are routinely tested. In

204
Table 1. The Study Population Summary Findings

1986 1987

Workforce Total 17,244 17,445

Total Number Tested

for Drug Use 463 366

Total 13.4% 14.8%

Positive (62) (54)

THC 4.8% 5.2%

Positive (22) (19)

Cocaine 2.2% 1.6%

Positive (10) (6)

Other Drugs 6.5% 7.9%

Positive (30) (29)

subsequent analyses, these individuals will be largely removed. However, while the tests are taken disproportionately relative to job classification, the results do show that virtually all classes are being tested—

from managers to unskilled labor.

Disproportionate testing also occurs relative to the categories of year

hired and age. Those hired in 1983 or later are tested at a higher rate

than their representation in the work force (32.4 percent tested versus

17.2 percent in the work force). This higher rate of testing may reflect

the age structure of those hired before 1983. This assertion is partially

substantiated by the test distribution relative to age, where the 21-to-30

age category is tested at a somewhat higher rate. But, among the age

groups, those older than 50 years of age are also tested proportionally

higher than their size in the entire work force.

The third column (tested positive) presents the percentage of those in

each work force characteristic category who test positive for any drug.

That is, these percentages are conditional on the number tested in each

category and are, in effect, row percentages. In relation to the job

classification, the highest positive rates are among technicians (38.9

percent) and skilled labor (25.0 percent). This may mean that drug use

is greater in those categories or that it is easier to detect drug-related

aberrant behavior among these groups. Given the type of jobs involved,

205
Table 2. Drug Test Results by Workforce Characteristics

in 1986

Entire Tested Tested THC

Workforce Employees Positive Positive

(17,244) (463) (62)* (22)*

%

Job Classification

Managers 16.5% :

Professionals 16.9% :

Technicians 8.0% :

Sales 0.3% :

Clerical 13.7% :

Skilled Labor 24.6% :

Semi-Skilled Labor 18.4% :

Unskilled Lab 1.3% :

Service 0.3% :

Totals 100.0%

Year Hired

Before 1983 82.8% :

1983 and After 17.2% :

Totals 100.0%

Age

Under 21

21-30

31-40

41-50

Over 50

Totals

1.0% :

25.7% :

45.9% :

13.9% :

8.5% :

100.0%

% (N) % (N)

14.9% (69)

12.5% (58)

3.9% (18)

0.0% (0)

8.4% (39)

13.0% (60)

46.9% (217)

0.4% (2)

0.0% (0)

5.8% (4)

13.8% (8)

38.9% (7)

0.0% (0)

10.3% (4)

25.0% (15)

11.1% (24)

0.0% (0)

0.0% (0)

100.0% n/a

67.6% (313)

32.4% (150)

11.8% (37)

16.7% (25)

100.0% n/a

0.4% (2)

33.3% (154)

36.1% (167)

17.9% (83)

12.3% (57)

50.0% (1)

16.2% (25)

16.2% (27)

8.4% (7)

3.5% (2)

100.0% n/a

% (N)

2.9% (2)

5.2% (3)

16.6% (3)

0.0% (0)

0.0% (0)

11.7% (7)

3.2%(7)

0.0% (0)

0.0% (0)

n/a

4.8% (15)

4.7% (7)

n/a

0.0% (0)

5.3% (9)

6.6% (11)

2.4% (2)

0.0% (0)

n/a

 *The percent column (%) represents the total proportion of individuals who were found

to he positive for drug use either in general or THC specifically.

the latter explanation seems more viable, and testing for cause has a

better hit rate when the job involves skilled behavior.

In relation to age, the rates of positive tests are as expected, while

relative to year hired, the rates of positive tests are rather notable. The

results relative to year hired categories are interesting because the

higher rate of positive tests is among those hired in 1983 and later.

These individuals were hired when an applicant testing program was in

effect. It is unclear how to interpret this result. From one standpoint,

applicant testing is not as effective as desirable. Conversely, these

individuals are probably a younger group and, therefore, more suscep206
tible to drug use. This latter argument could also point out the

possibility that the positive rate could even be higher if the applicant

testing program were not in place. The results in the age categories

would tend to partially support the second argument. In any event, this

is an area which will need further exploration.

The positive test results relative to THC are similar in configuration, if

not in degree, to those for all drugs combined. Technicians and skilled

labor have higher rates of usages (18.2 percent and 10.6 percent,

respectively), and the age groups from 21 to 40 have higher rates. The

exception is seen in relation to year hired. Here, the rate of THC usage

among those tested is virtually the same. One would hope that there

would be a lower rate among those hired in 1983 or later because of the

applicant testing program. The same discussion of results, given earlier,

could also be applied here.

The results in Table 3 are of the same type as those in Table 2, but for

1987. There are some similarities with 1986 along with some differences. The distribution of tests relative to workplace characteristics is

very similar in spread and disproportionality. Positive results for all

drugs relative to age groups are somewhat higher (10.4 percent for the

41 to 50 age group, and 11.4 percent for the over 50 age group). Positive

test results for THC relative to job classification and age are similar to

1986. Technicians and skilled labor have the highest THC-positive rates

(18.2 percent and 10.6 percent, respectively), and the 21-to-30 and the

31-to-40 age groups have the higher rates (6.4 percent and 7.8 percent,

respectively).

Differences between 1986 and 1987 appear in relation to positive results

for all drugs within job classification and year hired, and for THC by year

hired. In the job classification categories, unskilled labor has the highest

rate of positive results for all drugs combined. In 1986, technicians had

that distinction. Relative to year hired, in 1987 the positive rate for all

drugs is lower for those hired in 1983 and later (13.2 percent) versus

those hired before 1983. In this year, the THC positive rate is also lower

(2.6 percent), whereas in 1986 it was the same as between the two yearhired groups. At this stage of analysis, there seems to be some year-toyear variation either in the results or strategies for selecting those to be

tested, or in the behaviors provoking the use of test. This area also needs

further investigation.

Table 4 gives the results for 1986 relative to savings plan participation,

promotions, demotions, and jobs held per year. These results are given

in aggregate form not differentiated by workplace characteristics. The

interesting finding in this Table is clearly that the savings plan partici207
Table 3. Drug Test Results by Workforce Characteristics

in 1987

Entire Tested

Workforce Employees

(17,455) (366)

Tested

Positive

(54)*

THC

Positive

(19)*

%

Job Classification

Managers 16.3% :

Professionals 17.1% :

Technicians 7.6% :

Sales 0.3% :

Clerical 13.5% :

Skilled Labor 24.0% :

Semi-Skilled Labor 18.5% :

Unskilled Labor 2.5% :

Service 0.2% :

Totals 100.0%

Year Hired

Before 1983 80.0% :

1983 and After 20.0% :

Totals 100.0%

% (N) % (N)

14.2% (52) 7.7% (4)

10.9% (40) 17.5% (7)

3.0% (11) 18.2% (2)

0.0% (0) 0.0% (0)

6.0% (22) 13.6% (3)

12.8% (47) 21.3% (10)

48.4% (177) 12.4% (22)

4.4% (16) 31.3% (5)

0.3% (1) 100.0% (1)

100.0% n/a

68.9% (252) 15.5% (39) 6.3% (16)

31.1% (114) 13.2% (15) 2.6% (3)

100.0% n/a

Age

Under 21

21-30

0.9% : 1.1% (4) 0.0% (0)

23.1% : 29.8% (109) 15.6% (17)

31-40 45.8% : 38.8% (142) 17.6% (25)

41-50 20.9% : 18.3% (67) 10.4% (7)

Over 50 9.3% : 12.0% (44) 11.4% (5)

Totals 100.0% 100.0% n/a

% (N)

1.9% (1)

2.5% (1)

18.2% (2)

0.0% (0)

0.0% (0)

10.6% (5)

5.1% (9)

6.3% (1)

0.0% (0)

n/a

n/a

0.0% (0)

6.4% (7)

7.0% (10)

1.5% (1)

2.3% (1)

n/a

 *The percent column (%) represents the total proportion of individuals who were found

to be positive for drug use either in general or THC specifically.

pation differentiates drug users from the total work force and from those

who were tested with negative results. Employees with negative results

may have exhibited aberrant behavior to provoke a test, but the rate of

participation in a savings plan was essentially the same as the total work

force (64.8 percent versus 66.4 percent). Employees who tested positive

for any drug, and for THC in particular, had significantly lower participation rates (41.9 percent and 40.9 percent, respectively). Promotions

and demotions did not significantly differentiate drug users from the

total work force. The rate of demotions for those who tested negative was

significantly higher than for the total work force rate (.055 versus .019).

Although these individuals also had a higher rate of demotions than

those who tested positive (.055 versus .032 and .000), this could be an

208
Table 4. Job Related Characteristics by Drug Test Results

in 1986

Employees Employees Employees

Entire Testing Testing Testing

Workforce Negative Positive Positive For THC

(17,244) (401) (62) (22)

Participation

in Automatic

Savings Plan

66.4% 64.8% 41.9% * 40.9% *

Promotions

Per

Individual

0.171 0.262 0.215 0.200

Demotions

Per

Individual

0.019 0.055* 0.032 0.000

Job Per

Year

Per Individual

0.289 0.332 0.571* 0.340

 * Significant at the 0.06 level.

artifact of having aberrant behavior and staying in the work force; those

who test positive are discharged and have no opportunity to be demoted.

Jobs held per year significantly discriminated between those who tested

positive for any drug from the total work force and from those who tested

negative (.571 versus .289 and .332). Those testing positive for THC do

not have a job-change rate that is significantly different from the work

force in general or from those who test negative.

The results shown in Table 5 are for the same measures as in Table 4, but

generated by 1987 data. The patterns of significance in Table 5 are

similar to those for 1986. Participation in a savings plan is significantly

lower for those who test positive (44.4 percent for all drugs combined, and

36.8 percent for THC). For demotions, those who tested negative are

significantly higher than the work force as a whole at the .10 level (.051

versus .015); although THC positives have a higher demotion rate in this

year (.083), the rate is not significant due to the small sample size (22).

In 1987, the number of jobs held per year by positives (all drugs

combined) is significantly larger than the total work force value (.375

209
Table 5. Job Related Characteristics by Drug Test Results

in 1987

Employees Employees Employees

Entire Testing Testing Testing

Workforce Negative Positive Positive for THC

(17,445) (312) (54) (19)

Participation

in Automatic

Savings Plan

59.8% 60.6% 44.4% * 36.8% *

Promotions

Per

Individual

0.122 0.149 0.129 0.210

Demotions

Per

Individual

0.015 0.051 ** 0.029 0.083

Jobs Per

Year Per

Individual

0.264 0.314 * 0.375 * 0.319

* Significant at the 0.06 level.

 * * Significant at the 0.10 level.

versus .264). However, this does not discriminate this group from those

who tested negative (also significantly larger than the total work force

rate at .314) Those who test positive for THC also had a higher rate

(.319), but it was not significant due to the small sample size (19).

The results for total yearly hours absent for sickness and non-occupational injury are given in Table 6 (1986) and Table 7 (1987). These results

are particularly interesting. When examining the totals for those tested

in 1986, this measure does not discriminate positives from negatives.

While both those who test negative and those who test positive for any

drug have this type of absenteeism at a significantly higher volume than

the work force average (36.7 and 41.2 hours versus 28.5 hours), the two

groups are not significantly different from each other. Those testing

positive for THC have a lower volume ofabsenteeism than the total work

force, although it is not significantly lower.

210
The fascinating aspect of this measure, as shown in Table 6, is the

configuration of the results when examined in the subgroups defined by

work force characteristics. While the overall results do not discriminate

between negatives and positives, discrimination is present in some

subgroups. This suggests that useful findings may be found in the deep

structure of the data. For example, relative to job classification, discrimination occurs in several ways, both useful and not. For managers

and semiskilled labor only, those who tested positive (for any drug) have

significantly higher amounts of this absenteeism (63.9 versus 21.6 hours

and 42.7 versus 31.6 hours). Negatives are absent this way for essentially the same amount of time as the total work force. Here discriminaTable 6. Absenteeism in Hours for Workforce

Characteristics and Drug Test Results in 1986 (1)

Employees Employees Employees

Entire Testing Testing Testing

Workforce Negative Positive Positive for THC

(17,244) (401) (62) (22)

Avg.

Hours

Job Classification

Managers 21.6 :

Professionals 22.6 :

Technicians 18.8 :

Sales 0.0 :

Clerical 35.5 :

Skilled Labor 35.3 :

Semi-Skilled Labor 31.6 :

Unskilled Labor 7.6::

Service 37.6:

0.0 (0)

0.0 (0)

Year Hired

Before 1983

1983 and After

Age

Under 21

21-30

31-40

41-50

Over 50

Totals

25.0

32.4

24.9

0.0

48.1

38.9

37.2

297.0

0.0

(65)

(50)*

(11)

(0)

(35)*

(45)

(193)

(2)*

(0)

63.9

90.1

13.7

0.0

20.8

25.0

42.7

0.0

0.0

(4)*

(8)**

(7)

(0)

(4)

(15)

(24)*

(0)

(0)

29.7 : 41.4 (276)* 53.3 (37)* 20.3 (15)

22.6 : 26.4 (125) 23.4 (25) 11.9 (7)

30.3:

26:9 :

27.5 :

35.9 :

28.5 :

43.0 (1)* 0.0 (1) 0.0 (0)

34.7 (129) 18.9 (25) 17.9 (9)

35.1 (140)* 55.8 (27)** 17.5 (11)

38.3 (76)* 72.9 (7)** 17.0 (2)

43.3 (55)* 32.6 (2) 0.0 (0)

36.7 (401)* 41.2 (62)* 17.6 (22)

Avg.

Hours (N)

Avg.

Hours (N)

Avg.

Hours (N)

5.0 (2)

10.7 (3)

22.0 (3)

0.0 (0)

0.0 (0)

23.9 (7)

16.1 (7)

(1) Sickness and Non-Occupational Injury.

* Significant at the 0.05 level.

 ** Significant (0.05 level) and significantly larger than those with negative results.

211
tion occurs with a clear significance. We will call this a Type-1 discrimination where positives can be separated from others.

A second type of discrimination occurs relative to professionals (Type-2).

While both negatives and positives have significantly more of this

absenteeism than the work force mean, those who test positive (for any

drug) have a significantly higher amount than negatives (90.1 versus

32.4 versus 22.6 hours). In this group, positives are so extreme as to

discriminate themselves from the lesser extreme behavior of negatives.

Discrimination of drug users from others for this measure also occurs

when examined in relation to age groups. A Type-2 discrimination

exists for the 31-to-40 age group (55.8 versus 35.1 versus 26.9) and the

41-to-50 age group (72.9 versus 38.3 versus 27.5). No discrimination

occurs relative to the year hired categories nor for any group relative to

THC positive tests.

The patterns of discrimination seen in relation to absence for illness and

nonoccupational injury in 1986 (Table 6) do not hold for 198’7 (Table 7)

among job classification. For managers, the Type-l discrimination

pattern in 1986 converts to a Type-2 in 1987 (177.0 versus 56.1 versus

18.8). Relative to semiskilled labor, a Type-l discrimination in 1986

changes to extreme behavior, but no discrimination, in 1987. Skilled

labor, which showed no discrimination on this measure in 1986, revealed

a Type-2 discrimination in 1987.

Changes also took place in relation to year hired and age. For those hired

before 1983 no discrimination was evident in 1986, but a Type 2 occurred

in 1987. In age groups, the 41-to-50 group had a Type-2 pattern in 1986,

but no significant differences for either positives or negatives in 1987.

Clearly this type of absenteeism measure has an interesting deep

structure data pattern for identifying drug users, but it is not consistent

across time.

The results of a second type of absenteeism are given in Table 8 for 1986

and Table 9 for 1987 relative to workplace characteristics. This type of

absenteeism is called Docked Time, and relates to such things as nonpaid

sickness, personal time, and disciplinary suspensions. To some degree,

it should be more sensitive to drug use as an indicator. At a first

examination, it may be a sensitive indicator but is not a consistent one.

For example, when looking at the totals for both years, 1986 shows a

Type-2 discrimination for positive results for any drug (83.9 versus 37.8

versus 15.4 hours) and for THC (127.2 hours). This pattern is not

repeated in 1987, where this absenteeism has a Type-2 discrimination

pattern only for THC positives. While consistency in discrimination for

212
Table 7. Absenteeism in Hours for Workforce

Characteristics and Drug Test Results in 1987 (1)

Employees Employees Employees

Entire Testing Testing Testing

Workforce Negative Positive Positive for THC

(17,445) (312) (54) (19)

Average

Hours

Job Classification

Managers 18.8 :

Professionals 22.3 :

Technicians 17.4 :

Sales 0.0 :

Clerical 35.0 :

Skilled Labor 37.7 :

Semi-Skilled Labor 31.3 :

Unskilled Labor 6.8 :

Service 21.3:

Year Hired

Before 1983 28.6 :

1983 And After 25.7 :

Age

Under 21 10.6 :

21-30 31.7 :

31-40 26.9 :

41-50 25.5 :

Over 50 31.9 :

Totals 28.1 :

Avg.

Hours (N)

Avg. Avg.

Hours (N) Hours (N)

56.1 (48)* 177.0

21.0 (33) 15.6

16.1 (9) 0.0

0.0 (0) 0.0

51.6 (19)* 16.0

61.4 (37)* 81.6

41.2 (155)* 58.9

38.6 (11) 0.0

0.0 (0) 66.5

49.7 (213)*

30.4 (99)

68.1 (121)** 18.4 (16)

25.9 (15) 28.7 (3)

15.5 (4)

56.6 (92)*

38.2 (117)*

19.8 (60)

68.6 (39)

43.6 (314)*

24.6 (17)* 0.0 (0)

61.7 (25)* 20.7 (7)

140.9 (7)** 22.0 (10)

19.8 (5) 16.0 (1)

0.0 (0) 0.0 (1)

56.4 (54)* 20.1 (19)

(4)**

(7)

(2)

(0)

(3)

(10)**

(22)*

(5)

(1)

16.0 (1)

0.0 (1)

0.0 (2)

0.0 (0)

0.0 (0)

23.2 (5)

27.7 (9)

0.0 (1)

0.0 (0)

(1) Sickness and Non-Occupational Injury

* Significant at the 0.06 level

 ** Significant (0.05 level) and significantly larger than those with negative results

THC is not present, it does exist in the totals. Therefore, one might

expect it to be present in subgroups defined by the work force characteristics.

Discrimination does occur in subgroups, and to a higher degree than it

did in relation to the first type of absenteeism. However, it is inconsistent across the 2 years. Relative to job classification, managers have

Type-1 discrimination for positive results for any drug in 1986. In 1987,

this changes to a Type-2 for both any drug and for THC. Technicians,

who have a Type-2 for both any drug and THC in 1986, have no type of

discrimination in 1987.

213
Table 8. Absenteeism in Hours for Workforce

Characteristics and Drug Test Results in 1986 (2)

Employees Employees Employees

Entire Testing Testing Testing

Workforce Negative Positive Positive for THC

(17,244) (401) (66) (22)

Average Avg. Avg. Avg.

Hours Hours (N) Hours (N) Hours (N)

Job Classification

Managers 2.9 : 3.6 (65) 20.0 (4)* 0.0 (2)

Professionals 9.5:

63.8 :

26.3 (50)* 29.3 (8)* 23.3 (3)*

Technicians

0.0

107.0 (ll)* 372.0 (7)** 682.7 (3)**

Sales : 0.0 (0) 0.0 (0) 0.0 (0)

Clerical 18.3 : 38.2 (35)* 51.0 (4)* 0.0 (0)

Skilled Labor 9.9 : 26.4 (45)* 39.9 (15)* 39.6 (7)*

Semi-Skilled Labor 17.6 : 49.7 (193)* 61.7 (24)* 57.6 (7)*

Unskilled Labor 2.3 : 161.8 (2)* 0.0 (0) 0.0 (0)

Service 14.6 : 0.0 (0) 0.0 (0) 0.0 (0)

Year Hired

Before 1983 11.7 : 26.8 (276)* 55.0 (37)** 44.3 (15)**

1983 And After 33.5 : 62.2 (125)* 126.8 (25)** 305.0 (7)**

Age

Under 21

21-30

31-40

41-50

Over 50

Totals

78.0 : 3.0 (1) 0.0 (1) 0.0 (1)

32.1 : 53.9 (129)* 129.5 (25)** 270.7 (9)**

8.0 : 28.2 (140)* 50.9 (27>** 27.5 (ll)*

8.6 : 31.4 (76)* 80.3 (7)** 30.3 (2)*

13.2 : 34.3 (55)* 12.5 (2) 0.0 (0)

15.4 : 37.3 (401)* 83.9 (62)** 127.2 (22)**

(2) Docked Time: including non-paid sickness, personal time and disciplinary

suspensions.

* Significant at the 0.05 level

** Significant (0.06 level) and significantly larger than those with negative results

Similar changes take place across the 2 years in relation to year hired

and age. For example, in 1986 there is a Type-2 pattern for both year

hired groups relative to any drug positive and THC positive. Discrimination evaporates for those hired in 1983 or later. In relation to the age

groups, Type-2 discrimination patterns change almost completely from

one year to the next.

CONCLUSION

These preliminary results suggest that the data structure is quite

complex. Not only are discrimination patterns different in subgroups of

214
Table 9. Absenteeism in Hours for Workforce Characteristics

and Drug Test Results in 1987 (2)

Employees Employees Employees

Entire Testing Testing Testing

Workforce Negative Positive Positive for THC

(17,445) (312) (54) (19)

Average

Hours

Job Classification

Managers 2.0 :

Professionals 10.4 :

Technicians 61.1 :

Sales 0.0 :

Clerical 12.8 :

Skilled Labor 11.8 :

Semi-Skilled Labor 16.1 :

Unskilled Labor 5.7 :

Service 4.0 :

Year Hired

Before 1983 8.6 :

1983 And After 38.8 :

(1)**

(1)*

(2)

(0)

(0)

(5)**

(9)**

(1)

(0)

9.2

0.0

(213)* 66.1

(99)* 69.2

Age

Under 21

21-30

31-40

41-50

Over 50

Totals

76.9 :

32.4 :

8.5 :

10.5:

14.6 :

Avg.

Hours

7.5

52.8

528.1

0.0

46.3

31.1

40.7

20.6

110.2

603.0

78.1

25.1

30.0

24.5

(0) 0.0

(17)* 125.1

(25)** 91.0

(7)* 88.0

(5)* 0.0

49.0

Avg.

(N) Hours

(48)* 53.3

(33)* 16.0

(9)* 44.0

(0) 0.0

(19)* 76.7

(37)* 77.1

(155)* 94.8

(11) 0.0

(0) 144.8

(4)* 0.0

(92)* 81.3

(117)* 69.5

(60)* 46.6

(39)* 32.5

(312)* 66.9

Avg.

(N) Hours

(4)** 88.0

(7) 72.0

(2) 88.0

(0) 0.0

(3) 0.0

(10)** 106.4

(22)** 133.3

(5) 0.0

(l)* 0.0

(39)** 113.4 (16)**

(15)* 133.2 (3)*

(54)* 98.6

(N)

(0)

(7)*

(10)**

(1)**

(1)

(19)**

(2) Docked Time: including non-paid sickness, personal time and disciplinary

suspensions.

* Significant at the 0.05 level

** Significant (0.05 level) and significantly larger than those with negative results

the work force, but they change across time. This indicates that time

must be used as a mediating variable in future analyses. In this case, the

question to be addressed involves determining whether deep structure

results have a pattern across time, or if they are largely random.

Deriving meaningful results with these data will require a careful

analytic approach in the future work.

215
AUTHORS

John Sheridan

Director, Evaluation Research

ISAT

Suite 512

2730 University Boulevard

Wheaton, MD 20902

Howard Winkler

Labor Relations Coordinator

Georgia Power Co.

P.O. Box 4545

Atlanta, GA 30302

216
Industry Responses to Drugs in the

Workplace

Characteristics of

Firms With Drug Testing Programs

Helen Axel

The Conference Board, Inc.

INTRODUCTION

A clear majority of corporations responding to a 1988 Conference Board

survey reported they had, or were in the process of implementing, a drug

testing program. The Conference Board is an independent business

research organization whose members are primarily medium and large

corporations. The level of drug testing activity among corporations in

the Board study appears to be consistent with findings from other

surveys conducted among similar companies during the same time

period.

The study was designed to learn about corporate experiences with drug

testing programs and other workplace initiatives for controlling substance abuse. Companies’ perceptions and responses to substance abuse

problems were addressed in the first half of the survey. The remainder

of the survey, not covered in this review, focused on the specifics of drug

testing:

Program administration

Procedures, test results

Consequences for employees with positive tests

Problems encountered

Assessments of benefits to the company

The survey, conducted among 2,675 large corporations included in the

Board’s sampling frame, yielded a 25 percent response rate. This paper

presents preliminary findings of the survey, and compares characteristics and responses of firms with and without drug testing programs. The

complete report, based on a comprehensive analysis of the survey data,

interviews with executives in firms with drug testingprograms, a review

219
of policy statements, and other supplementary materials returned with

the completed questionnaires, will be issued by The Conference Board in

1989.

SURVEY METHODOLOGY

The nation’s largest firms in manufacturing, finance and insurance,

construction, utilities, transportation, trade, and other services, constitute the Board’s sampling frame. Individual business units of some very

large conglomerates, often recently merged corporations, are treated as

separate companies in the sample. Sales, assets or deposits, as appropriate, are used as measures of size for determining inclusion in the

sampling frame.

Conference Board membership was not one of the criteria used in the

sample design. Thus, companies surveyed were not necessarily Conference Board member firms, nor were all Conference Board corporate

associates included in the survey. However, considerable overlap

undoubtedly exists between the survey sample and The Conference

Board’s membership, and the degree of familiarity with the Board is

likely to have affected the response rate.

Firms were surveyed by mail in February 1988, with a follow-up mailing

approximately 6 weeks later. The questionnaires were addressed to the

senior, corporate-level human resources officer. If that individual was

not known by name, and no other names were available on the Board’s

mailing lists for an appropriate job title, the survey was directed to a

generic job title, “Senior Human Resources Officer.”

As in most surveys conducted by The Conference Board, participants

were requested to enter the company’s name and address on the

questionnaire, and provide the name, title and telephone number of the

person completing the form. In return, confidentiality was assured by

the Board, and no company-specific information would be revealed

without prior approval from the participant. Virtually all respondents

to Conference Board surveys provide this information, and the current

experience was not an exception.

PROFILE OF RESPONDENTS

Response rates varied by industry. They were on a par with the overall

rate (25 percent) in the manufacturing, finance and insurance sectors.

However, the proportion of respondents was significantly higher among

220
gas and electric utilities, and significantly lower in other industry

groups. Respondents tended to reflect The Conference Board’s traditional constituencies. Differences in attitudes toward drug abuse problems—and experience in dealing with them—may also have affected a

company’s interest in participating in the study.

Two out of five companies in the survey are manufacturers, somewhat

under a third from financial service firms, one-sixth from utilities, and

the remainder from other industry groups. Over half have more than

5,000 U.S.-based employees, and two-fifths have work forces of at least

10,000. (Although nearly half of the survey participants reported their

firms have employees outside the United States, most drug-abuse

control efforts in U.S.-based, multinational companies are directed only

at their domestic work forces.) Respondents are headquartered in all but

four of the 50 States, with the greatest concentration in the industrial

North Central States and somewhat fewer in the Northeast and South.

FIRMS WITH AND WITHOUT DRUG

TESTING PROGRAMS COMPARED

Just under half the companies studied have active drug testing programs for applicants and/or employees. Another 6 percent indicated

plans were currently under way to implement such a program. The

majority of non-testing firms had either considered and rejected the idea,

or had no plans to investigate drug testing. Although “about-to-implement” companies could also be grouped with those now testing, this

comparative analysis defines testing and non-testing companies according to their experiences at the time of the survey.

Some cautionary notes: This paper looks at corporate response to

substance abuse through only one lens, drug testing. Thus, while this

review makes some broad observations about characteristics and conditions in companies that utilize drug testing, it may overstate some of the

differences that exist between firms that test and those that do not. Drug

testing is a new experience for most employers—well over two fifths of

the programs described by survey respondents were less than 2 years

old. The presence of other initiatives, such as employee assistance

programs, may provide the motivation for employers to deal with

workplace substance abuse. In addition, drug testing itself is a multidimensional program that, in different companies, may involve different

categories of employees, job applicants—or both. For example, for many

employers, drug testing is an “externalized” program, confined to the

preemployment process, and does not involve active employees. The

characteristics of firms that only test applicants may differ substantially

from companies that also include various forms of employee drug testing.

221
Industry and Workforce Profiles

The survey found that 75 percent of the firms conductingdrugtestingare

manufacturers or utilities, while close to half the companies without

these programs are in banking, insurance or other financial services.

Put another way, in most industry categories, drug testing is the rule;

the principal exception being the financial services sector, where only 13

percent of the companies have drug testing programs.

It is not surprising that industries conducting drug testing also tend to

be male-intensive and include a higher proportion of workers in skilled

crafts, production and laborer categories. Unions, too, are far more likely

to be present in the drug testing firms. By contrast, again probably

because of the industry breakout, a majority of non-testing firms have

female- intensive work forces, a high percentage of employees in clerical

jobs, and relatively little unionization.

It also appears that companies conducting drug testinghave large labor

forces located in multiple sites. The higher incidence of drug testing is

not surprising since larger firms are more likely to respond to workplace

problems with “programs.”

Perceptions of Drug Problems at the Workplace

Companies have different views on substance abuse problems in the

workplace. For example, the survey indicates drug testing employers

may perceive substance abuse as a more complex-though not necessarily a more serious-problem than their non-testing counterparts. However, executives in testing and non-testing firms agree that while

substance abuse is not confined to any one group of employees, these

problems tend to be concentrated in certain operations or locations.

Major differences exist in attitudes toward alcohol, illegal drugs and

recent trends. Very few responding firms believe illegal drugs alone are

the primary form of substance abuse problems at the workplace. There

is, however, great disagreement among survey participants regarding

the prominence of alcohol abuse in their work forces. Executives in

nearly two-thirds of the drug testing firms blame alcohol and illegal drug

use for significant problems among their employees; only one in four reported alcohol alone as the most critical problem. By contrast, almost

two-thirds of the employers without testing programs regard alcohol as

the principal substance of abuse, and only about one-third say they have

serious problems with other drugs.

222
Not surprisingly, nearly half the drug testers describe illegal drug

use as a more serious problem than it was 5 years ago, while only 10

percent believe alcohol abuse is increasing. In the non-testing population, a somewhat larger percentage sees alcohol as a growing problem,

and relatively fewer view illegal drugs in that light. Executives in drug

testing firms seem to be slightly more optimistic than non-testers about

trends in alcohol and drug use during the last 5 years. On the other hand,

more officials in the non-testing group responded “don’t know” when

asked about recent trends in their companies.

How seriously employers view drug problems also influences their

decision to implement or reject drug testing as a substance abuse control

strategy. Executives who have launched drug testing programs say the

single most compelling reason for taking action was evidence of drug

problems at the workplace. Many of those who discarded the option,

after investigating the pros and cons, express concern about the negative

impact such a strategy would have on employee relations—particularly

where drug abuse is not deemed to be a significant problem.

Other Initiatives To Control Substance Abuse

Overall, actions of corporations with drug testing programs seem to be

consistent with their executives’ attitudes toward substance abuse.

They see a serious, polydrug problem not under control, and are dealing

with it in a variety of ways. Firms not engaged in drug testing also

appear less likely to undertake other activities to combat drug problems.

The industrial make-up of non-testing firms is a significant factor.

Unlike manufacturing firms, few have the tradition of occupational

alcoholism programs. Without long experience in dealing with employee

substance abuse, many may be feeling their way before developing

specific responses to such problems. Some employers may consider

themselves insulated from substance abuse problems because of what

they view as special circumstances, such as the nature of their work

force, type of industry, or region of the country.

The Conference Board survey found that drug testing firms have a

consistently greater involvement with other substance abuse control

measures than non-testing firms. This would seem to contradict the

view held by some opponents of drug testing that this strategy is often

used as a stand-alone procedure for “curing” workplace drug problems.

Instead, it appears that most companies involved in drug testing move

cautiously before adopting such programs, and put in place or adapt

other measures in an effort to construct a well-defined and coordinated

drug-control strategy.

223
1. Substance Abuse Policies and Procedures

More than 90 percent of the companies with drug testing programs have

written substance abuse policies. Almost 40 percent of those with

policies have had them in place for at least 5 years. A significant number

of these firms indicate, however, that their policies have been updated

within the last several years, often to broaden their focus. Over 70

percent of the drug testing firms’ policies now cover employee use of all

mind- and behavior-altering substances—includingprescription drugs—

and more than 25 percent regulate both on- and off-the-job behavior. By

comparison, nearly half the non-testing group have no written substance

abuse policies, and where such policies exist, they tend to be of more

recent origin and less comprehensive in scope.

Policies express employer positions on substance abuse in general terms.

More detailed procedures to assist supervisors confronted with employee drug problems help clarify responsibilities and outline specific

actions. As drug-testing firms are more likely to have written policies,

a larger percentage of them also prepare written guidelines for their

supervisors.

2. Drug Training and Education

The extent to which corporations communicate their policies determines

their effectiveness. Experts on policy development recommend that

employers take advantage of every available opportunity to inform

employees about the company’s commitment to its substance abuse

policy. Among surveyed firms with drug testing programs, policies are

communicated through:

New-employee training programs

Special training sessions for current employees and

supervisors

Employee handbooks

Company newsletters or magazines

Non-testing firms also rely on new employee orientation and employee

handbooks to inform workers of company policy, but tend to place less

emphasis on training sessions.

224
Companies engaged in drug testing develop or sponsor educational

materials regarding dangers of alcohol and drug use almost twice as

often as non-testing firms. In addition, while employers in both groups

sometimes distribute information prepared by government agencies or

other outside organizations, generic materials are used more frequently

in companies without drug testing.

3. Employee Assistance Programs

Employee assistance and counseling services (EAPs) are considered by

many corporations to be an essential component of a comprehensive

substance abuse control strategy. Over the years, they have evolved

from occupational alcoholism programs to broad-brush services that

deal with employee use of addictive drugs, as well as a wide variety of

other problems encountered by employees and their dependents (e.g.,

other health issues, personal, marital, family, legal, and financial

problems). Their focus has been to help employees overcome problems

that may interfere with their productivity on the job.

EAP services have come to be recognized (and recommended by legal

experts) as a positive indication of company willingness to accommodate

employees with substance abuse or other problems before taking punitive action. The controversial aspects of drug testing have received more

attention as testing has become more popular among employers. Thus,

while EAPs predate drug testing programs in many firms, others started

EAPs when they initiated drug testing. The primary motive of EAPs

may be to assist employees with drug problems, but they also serve as

protection against employee challenges to drug-related disciplinary

actions or discharges.

The survey found that more than 75 percent of the companies testing for

drugs make employee assistance and counseling services available to

their employees. Less than 60 percent of the non-testing companies have

EAPs. Although close to 50 percent of the EAPs reported in the survey

are more than 5 years old, about 20 percent have been operating less

than 2 years. EAPs in non-testing firms are generally of more recent

origin and more likely to be provided by outside contractors.

4. Security Procedures

Few companies surveyed have adopted special security measures, such

as locker and desk searches, searches of employee vehicles on company

225
property, checks on entering and leaving the worksite, or drug-sniffing

dogs, to deal with drug problems on company property. The survey

showed that just 36 percent of employers with drug testing programs

instituted such procedures. The number of non-testing firms employing

any special security measures is very small.

CONCLUSIONS

Drug testing programs are common among major manufacturing firms

and in the utility and transportation sectors, but are far less prevalent

in other businesses. The high incidence of drug testing among firms in

The Conference Board survey is reflective of both sample selection and

response rates. Companies with drug testing programs seem to regard

drug problems as more pervasive and more complex than do non-testing

companies, and are consistently more likely to employ multiple strategies for dealing with workplace drug use.

AUTHOR

Helen Axel

Executive Director

Human Resources Program Group

The Conference Board, Inc.

845 Third Avenue

New York, NY 10022

226
Drug Abuse Services and EAPs:

Preliminary Report on a National Study

Thomas E. Backer, Ph.D.

Human Interaction Research Institute

INTRODUCTION

Since January 1987, the National Study of Workplace Drug Abuse

Programs has been gathering data on drug abuse services in American

Employee Assistance Programs (EAPs). The Study has two main objectives: first, to develop data-based typotogies of EAP drug abuse services

and the organizational contexts in which they occur; and second, to

identify and study emerging issues that will significantly affect future

services development.

In Phase I of the research, survey data were compiled on 1238 EAPs,

based on a questionnaire completed by EAP coordinators and program

administrators in late 1987. All major geographic areas, types of

workplaces, and types of EAPs were well-represented. Because the

survey deliberately excluded coverage of alcohol, the resulting database

is one of the largest and most current that focuses exclusively on drug

abuse services.

Findings from Phase I reported here are preliminary because a number

of analyses of this database were in progress when this report was

prepared. Sample representativeness for the entire population of EAPs

is being examined, along with the influence of variables such as size and

age of the EAP on our findings (see Backer & O’Hara, 1988a,b for a more

detailed presentation).

Phase II of the research involved 201 intensive telephone interviews

with EAP coordinators selected at random from survey respondents.

Findings from this research phase as well as results from several

smaller-scale studies form the total dataset for the study, supported

principally by NIDA

227
Table 1. Portrait of Responding EAPs

Type of EAP

Internal EAP

External EAP

Consortia EAP

Union EAP

Type of Workplace

Health Care

Government

Industrial Manufacturing

Aggregate of 17 other Categories

Age of EAP

Less than One Year

1 to 2 Years

3 to 5 Years

6 to 10 Years

More than 10 Years

Location of EAP

Human Resources/Personnel

Medical Department

CEO or Top Management

Other

% Respondents

47.2

40.8

8.8

3.3

17.0

15.7

15.0

52.3

10.4

21.1

32.6

20.3

15.7

64.3

15.9

12.4

7.4

EAP DRUG ABUSE TYPOLOGIES

Analysis of Responding EAPs and Their Drug Abuse Services

The study categorized the 1238 EAPs into several program types similar

to those used by the Association of Labor and Management Consultants

on Alcoholism (ALMACA) (Table 1). Health care institutions and government had the highest percentage of EAR respondents. EARS of industrial and manufacturing firms had the second highest percentage.

There were 17 other categories of respondents. The largest number of responding EAPs are from 3 to 5 years old, but a sizeable portion have been

in existence for more than ten years. Sixty-four percent of the EAPs are

housed in the organization’s human resources or personnel department,

but a fair number are either in the medical department or report directly

to top management. The study database also includes information on

referral patterns, budget, staffing, and other features of the EAP

operation.

228
Responding EAPs report they deal with a wide variety of drugs of abuse

(Figure 1). As expected, marijuana and cocaine are the two most

frequently reported, and multiple drug abuse is extremely common.

Other late 1987 studies, such as those by Business & Legal Reports

(1987)and by CATOR(Hoffmann & Harrison, 1987) show essentially the

same findings.

The core EAP services of crisis intervention, assessment and referral are

almost universally offered-other data from our study indicate that the

lower referrals to public drug abuse agencies has to do at least in part

with the well-publicized waiting lists these agencies struggle with. Brief

counseling is less common, and in-program treatment even less so,

though about 10 percent of respondents do offer it (Table 2).

Figure 1. DRUGS OF ABUSE

(Excluding Alcohol)

The overwhelming majority of programs serve 1-10 drug abusers per

month (Figure 2). Larger EAPs see more drug abusers, of course, but the

number of drug abuse cases seen across programs of all sizes is still

relatively small. Our telephone interview data agree with other recent

findings that the number of alcohol problems presented to EAPs is much

greater than for non-alcohol drugs (e.g., Roman & Blum, 1987).

While half of the EAPs in this sample always take a drug history,

regardless of presenting problem, a significant minority only take one

when the presenting problem is drug abuse, and almost a quarter take

them only sometimes or not at all (Figure 3). Telephone interview data

confirm that EAP professionals need more education about the problemfinding aspects of drug history-taking.

229
Table 2. Types of Services Rendered

% Respondents

Referral to Inpatient Chemical Dependency Facilities 98.9

Problem Assessment 98.3

Referral to Outpatient Chemical Dependency Facilities 97.8

Referral to 12-Step Program or Self-Help Groups 97.5

Crisis Intervention 94.5

Referral to Family Group Counseling 94.5

Follow-up Monitoring of Workers Referred for Outside

Treatment 94.3

Referral to Public Drug Abuse Agency 86.1

Brief In-Program Treatment (2-5 Sessions) 74.3

In-Program Treatment 9.7

Figure 2.

NUMBER OF DRUG ABUSERS

SERVED/MONTH

Figure 3.

DRUG HISTORY TAKEN

230
Organizational Context in Which EAP Drug Abuse Services

Occur

Three-fourths of the responding EAPs are in organizations which have

a written drug abuse policy (Figure 4). If those who said their workplace

was developing a policy are included, almost 9 out of 10 responding EAPs

are in policy-based organizations,

The incidence of drug testing programs in this sample is generally

commensurate with what has been found in other research of about the

same vintage-the end of 1987 (Figure 5). Findings in this area are being

compared with those in 10 other recent studies documented in O’Hara &

Backer (1989).

Overall, respondents say their top management is quite supportive of

the EAP (Figure 6). This suggests a healthy organizational foundation

for responding EAPs. Our respondents nonetheless have concerns about

how much support of the EAP concept or program filters down into the

day-to-day support of effective management referral and willingness to

reduce the stress in the workplace that places workers at risk for drug

abuse.

Figure 4. Figure 5.

WRITTEN POLICY ORGANIZATIONAL

ON DRUG ABUSE DRUG TESTING PROGRAM

231
Helping employees return to work and providing an employee benefits

are the most important reasons organizations want to have EAPs,

according to our respondents (Figure 7). Relieving supervisors of the

need to deal directly with troubled employees is third. However,

organizationally-focused goals such as cost containment and avoiding

litigation were also cited frequently. The dataset also includes information about the geographic base of the respondent work organization, and

its workforce size, among other variables.

EMERGING ISSUES

The 10 most important emerging issues identified by the 1238 responding EAPs are:

Concern about effectiveness of EAP drug abuse interventions

Impact of drug testing on the EAP

Impact of managed care on the EAP

Response of the EAP to AIDS

Impact of litigation on the EAP

Effectiveness of EAP management training and management referral practices

Development of drug abuse education and prevention activities

Development of drug abuse services by EAP consortia

Development of drug abuse services by small employer EAPs

Unmet needs of EAP professionals as these relate to perceived challenges of drug abuse in the workplace

Key elements for each of these emerging issues follow.

Concern About Effectiveness of EAP Drug Abuse Interventions

Overall, reviews of their own effectiveness by the responding EAPs were

mixed (Figure 8). Only one-third of the respondents felt their program

232
Figure 6. SUPPORTIVENESS

OF TOP MANAGEMENT

Figure 7. REASON ORGANIZATION

HAS AN EAP

233
Figure 8. EFFECTIVENESS

OF EAP DRUG INTERVENTION

had been “fairly effective” or “very effective” in meeting the challenges

of drug abuse in the workplace. Also, only one-quarter reported that

more than 50 percent of the workers they have referred to drug abuse

treatment have been successfully rehabilitated. This is not surprising

in light of the high rates of recidivism quoted by respondents and

reflected in other data sources.

A multiple regression analysis of ratings on a two-factor survey scale of

EAP effectiveness in handling drug abuse cases showed that the level of

support provided by top management was the single most important

factor associated with overall program effectiveness. As might be expected, the number of years the EAP had been in existence also was

important, as was the extent of EAP staff training on drug abuse. Respondents from internally-based EMPs rated themselves significantly

higher in effectiveness in fighting drug abuse than did external EAP

coordinators in a one-way analysis of variance procedure using the twoitem effectiveness scale.

234
Table 3. Drug Testing and EAP Effectiveness and Litigation

% EAPs in % EAPs not in

Drug Testing Drug Testing

Workplace Workplace

Fairly/Very Effective EAP 39.9 30.0

Litigation Against EAP 6.6 2.7

The data analysis is being continued to determine whether size, age of

EAP or other factors may account for some of these findings, but overall

it appears many American EAPs may lack self-confidence where drug

abuse services are concerned.

Impact of Drug Testing on the EAP

Many claims have been made in the last 2 years about possible positive

impact of drug testing programs on other workplace drug abuse services.

Though the data are still being analyzed to look for confounding influences, there is some modest support for these claims. There was a

statistically significant difference in rated effectiveness between EAPs

in organizations with drug testing programs and those without them

(Table 3). This held up across five of our seven effectiveness variables.

On the other hand, EAPs in drug testing organizations also were

significantly more likely to have had experience with litigation unrelated to testing.

There are a number of other important differences between the EAPs in

organizations with and without drug testing. However, we have to be

cautious in interpreting these at present because larger, older EAPs also

are more likely to have drug testing programs.

Impact of Managed Care on the EAP

Professional publications, ALMACA conferences, and some of the largest EAP consulting firms have given much attention recently to managed care and EAPs. This study found that some elements of managed

care—EAP case management, relationships with HMOs and PPOs, and

even benefits certification programs-are already quite common (Figure

9). Telephone interviews in Phase II have gathered a rich array of actual

EAP experiences in managed care which will help determine what needs

235
to happen next in developing effective linkages between managed care

and EAP activities.

Response of the EAP to AIDS

Although EAPs have certainly become involved in the AIDS health

crisis, the level of their involvement is significantly less than that of

other organizational units, such as human resources. About a third have

conducted programs on personal risk reduction, or on workplace issues

such as working alongside a person with AIDS. About 30 percent of

responding EAPs are in organizations with written policies on AIDS, a

rate similar to that found in recent studies by Fortune magazine and

others (Sprinzen, 1988).

However, almost half of the EAPs surveyed have NOT made a response

to AIDS (Figure 10). Phase II telephone interview findings make it clear

that there is a tremendous need for EAP professionals to have the

understanding, the training materials and guidance needed to participate meaningfully in the overall organizational response to AIDS. In

many cases, the telephone interviews revealed that external EAPs had

not made a response to AIDS because it is not part of their contract with

the employer. More and more external EAPs are requesting to become

involved in this area.

Impact of Litigation on the EAP

One in twenty EAPs in this sample has been sued regarding some aspect

of service delivery; even more workplaces have been sued regarding

some aspect of drug testing (Table 4). In addition to raising issues for

individual EAP practitioners such as adequacy of professional liability

insurance, this finding also suggests that some employers may begin

looking askance at the value of employee assistance, if an EAP brings

with it the threat of legal entanglements and costs of legal actions.

Table 4. Litigation and EAPs

% Respondents

Litigation Related to EAPs Services 4.5

Litigation Related to Drug Testing 8.4

236
Figure 9. EAP MANAGED

CARE ACTIVITIES

Figure 10. RESPONSE OF

EAPS TO AIDS

237
Effectiveness of EAP Management Training and Management

Referral Practices

The EAPs in this sample provide a considerable amount of drug abuse

training for managers and front-line supervisors in their organizations

(Figure 11). However, they still cited increased management trainingas

the second “most important development that could improve the effectiveness of the EAP in dealing with employee drug abuse.” Both

telephone interview and survey data suggest that training on referral

practices is the biggest shortfall respondents currently see.

Figure 11. PREVALENCE OF

MGMT/SUPERVISORY TRAINING

Figure 12. EDUCATION AND

PREVENTION ACTIVITIES

238
Table 5. Comparison of EAP Consortia to Other Respondents

% Consortia % Other

Fairly/Very Effective in Fighting

Have Written Policy on Drug Abuse

Have Drug Testing Program

Have Had Litigation Related to Drug

Testing

Have Had Litigation Related to EAP

47.4 33.3

76.0 72.2

34.7 35.4

6.7 8.7

0.0 5.0

Have Had Problems with Drug Sales 17.5 17.4

Development of Drug Abuse Education and Prevention

Activities

In the survey sample, drug abuse education for workers was quite

common, offered by three-quarters of all respondents (Figure 12).

However, community and prevention-oriented activities such as stress

management for those at risk for drug abuse are offered much less

frequently. Clearly, there is still room for significant program development in these areas.

Development of Drug Abuse Services by EAP Consortia

Another subject of emerging concern in our dataset is the consortium. It

is one of the least-documented models for EAP service delivery, yet there

is some informal evidence that consortia have been effective in providing

EAP services for smaller employers (Table 5). Findings from the

subsample of 100 consortia programs were somewhat surprising—

consortium EAPs rate themselves as significantly more effective than do

the other EAPs in our sample. None of this sample reports having

experienced EAP-related litigation.

Development of Drug Abuse Services by Small Employer EAPs

By comparing the small—fewer than 500 employees—with the large—

more than 10,000 employees—organizations in this sample, some rela239
tively dramatic differences emerge (Table 6). While smaller employer

EAPs are much less likely to have experienced litigation or drug sale

problems, they are also less likely to have a written policy on drug abuse,

and rate themselves as significantly less effective in their drug abuse

services. These differences are all statistically significant at the highest

Table 6. Comparison of Small Versus Large Workplaces

% Small % Large

Fairly/Very Effictive in Fighting

Have Written Policy on Drug Abuse

Have Drug Testing Program

Have Had Litigation Related to Drug

Testing

Have Had Litigation Related to EAP

Services

Have Had Problems with Drug Sales

24.3 43.3

59.1 80.0

23.1 54.2

3.0 21.4

1.5 11.6

9.3 25.9

level, and most of them are maintained even when the comparison is

between small firms and all others in the Phase I sample. Yet the data

clearly show that EAP professionals’ needs for education, information

and interventions are largely the same regardless of employer size.

Taken together, these results make it clear that research, and program

and policy development aimed at smaller employer EAPs are needed.

The final report of the White House Conference on Drug Abuse (1988)

states the need for comprehensive drug abuse services for small employers well:

Small businesses employ approximately half the workforce (45 million

persons) and account for half of the gross national product. Companies

with 500 employees or fewer constitute about 70 percent of total US

businesses; four million businesses have 10 or fewer employees. These

figures underscore the need for small business involvement in achieving a drug-free workplace.

Many of the drug policy models used for larger companies will not work

in the small business workplace, and most small businesses do not know

where to turn for assistance in dealing with a drug problem in their

workforce. The SBA, other Federal agencies, and private organizations

240
Table 7. Unmet Needs of EAP Professionals Regarding Drug

Abuse Services

Mean Importance

(4-point Scale)

Provision of Adequate Drug Abuse Services

by HMOs

Workers and Public Safety Related to Drug

3.27

2.90

Provision of a Continuum of Care for Recovering

Drug Abusers

Health Care Cost Containment Related to Drug

Abuse

2.83

2.71

Insurance Coverage for Drug Related Problems

Training Supervisors To Deal with Drug-Abusing

Workers

2.66

2.60

Having Effective Drug Treatment Programs

Available 2.51

Management Commitment to Righting Drug Abuse 2.48

Drug Testing in the Workplace 2.38

Demonstrating Cost-Effectiveness of the EAP 2.35

Increasing Quality of EAP Counseling Services 2.03

Certification of EAP Professionals 1.85

that work closely with the small business community must develop

means to help small businesses respond to the problem of illegal drugs.

“No use” policies, properly implemented in small businesses, can help

assure drug-free workplaces (pp. 89-90).

Unmet Needs of EAP Professionals as These Relate to the

Perceived Challenges of Drug Abuse in the Workplace

The most important challenges the 1238 respondents currently see are

getting HMOs to provide adequate services, dealing with public safety

issues, and providing an effective continuum of care. Insurance coverage, cost containment and training are also important (Table 7). Profes241
Table 8. What EAP Professionals Want to Help Them in

Fighting Drug Abuse in the Workplace

Changes in Attitude of Top Management

Increased Drug Abuse Education for

supervisors

Improvements in Insurance and Benefits

More Resources for the EAP

Changes in the Attitudes of Local Community

More Written Materials on Drug Abuse

Increased Drug Abuse Training for Workers

Increased Drug Testing

Improved Treatment Techniques

Decreased Drug Abuse Testing

Other

% Respondents

25.0

21.7

10.1

9.8

7.6

6.5

4.8

4.6

4.4

0.5

4.9

sional issues such as certification and enhancing EAP counseling fall

much further down the line.

The most important change, cited by a full 25 percent of all respondents,

that would help EAPs in the war against drugs in the workplace, is a

change in top management attitude (Table 8). Since respondents already

rate top management as supportive of the EAP per se, we speculate that

the change they seek has more to do with overall attitudes towards drug

abuse and its rehabilitation. This finding may be related to the perception among some employers that an EAP is a “quick fix” solution which

relieves them of further responsibility to deal with drug abuse such as

reducing the stressful conditions of work that may cause workers to

abuse drugs again despite successful recovery experiences. More education for first-line supervisors was the second most important change

these respondents wanted to see.

There were also a number of write-in responses in the Phase I dataset,

concerning what specific kinds of resources or services respondents felt

would help them deal with the challenges of drugs in the workplace.

242
They particularly wanted standards for evaluating drug treatment facilities, evaluation standards for EAPs, and standards for drug testing

programs, confirming the importance of major elements in NIDA’s

current intramural and extramural programs.

CONCLUSIONS

When asked what NIDA could do to support EAP drug abuse activities,

more than a third of Phase I respondents wanted more informational

materials. This was more than twice the number making the next-mostoften cited request for more training programs for EAP professionals.

Interestingly, only a very small percentage felt that having NIDA

sponsor the development of improved treatment techniques would

benefit them directly. These program and policy recommendations will,

we hope, become more specific and useful as our data analysis proceeds.

REFERENCES

Backer, T.E., and O’Hara, K. Anational study on drug abuse services and EAPs.

The ALMACAN: 24-26, Aug., 1988a.

Backer, T.E., and O’Hara, K. Technical report: Survey of drug abuse services in

EAPs. Los Angeles: Human Interaction Research Institute, 1988b.

Business & Legal Reports. 1987 Survey of Drug Testing in the Workplace.

Madison, CT: Author, 1987.

Hoffmann, N.G., and Harrison, PA. Patient variations in alcohol treatment

utilization. Business and Health: 16-18, Mar., 1987.

O’Hara, K., and Backer, T.E. Index of survey research studies on workplace drug

abuse and EAPs. Employee Assistance Quarterly, 4:79 - 100,1989.

Roman, P.M., and Blum, T.C. The relation of employee assistance programs to

corporate social attitudes: An empirical study. Research in Corporate Social

Performance and Policy: 9:213-235, 1987.

Sprinzen, M. Summary of Business responds to AlDS:A national survey of U.S.

companies. New York: Fortune Magazine, 1988.

White House Conference for a Drug Free America. Final Report. Washington,

DC: U.S. Government Printing Office, 1988.

243
AUTHOR

Thomas E. Backer, Ph.D.

President

Human Interaction Research Institute

1849 Sawtelle Boulevard

Suite 102

Los Angeles, CA 90025

244
The Presence and Integration of Drug Abuse

Intervention in Human Resource Management

Terry C. Blum, Ph.D.

Georgia Institute of Technology

INTRODUCTION

That alcohol and other drug misuse adversely affect job performance and

productivity is not a new idea. There are studies that indicate drug and

alcohol abusers are absent from work more, are involved in more

accidents, use more sick leave, use more medical benefits, and have more

difficulty getting along with their co-workers, than their non-abusing

counterparts. Co-workers, subordinates, and supervisors of chemicallydependent employees are also likely to be less productive on the job. In

addition, the costs of medical benefit usage by dependents of those with

alcohol and drug problems have been shown to be higher than those of

other workers’ family members (Jones and Vischi, 1979; Holder, 1987).

The methodologies of the various studies allow for argument about exact

costs and prevalence of chemical dependency. However, the fact remains

that work organizations, in terms of both economic and human costs, are

significantly affected by alcohol and drug misuse (Bureau of National

Affairs, 1986).

The past few years have seen a renewed interest in constructive initiatives and solutions for realizing a “drug-free workplace.” The two types

of programming that have received the most interest are drug screening

and Employee Assistance Programs (EAPs). This paper presents data

from four research projects that are part of a research program in work

site human resources and behavioral health management. The four

research projects examine the work site management of drug abuse from

the perspective of various “stakeholders” (members of different constituencies) who have an interest in work site prevalence and management

of drug abuse:

Human resources/personnel managers

Supervisors and managers

245
EAP coordinators

Employees

HUMAN RESOURCES MANAGEMENT STUDY

First we consider preliminary results from a stratified random sample

of organizational operating units with 250 or more employees in the

Atlanta, Athens, and Columbus, Georgia Standard Metropolitan Statistical Areas (SMSAs). The Atlanta area ranks seventh in the number of

Fortune 500 headquarters (10), with 431 of the Fortune 500 having

operations in the Atlanta area. It is, thus, a representative location of

major U.S. business interests. The research population from which the

sample was drawn includes these organizations, as well as other private

sector (for-profit) work organizations. Worksites ranging from service

sector organizations to poultry and textile plants to high technology

business and industry are included in the sample.

During 1988, a research team conducted two 2-hour on-site interviews

with personnel/human resources managers and requested the completion of self-administered questionnaires. The data presented here is

based on the first 125 questionnaire responses (representing a response

rate over 85 percent), approximately one-half of which are for work sites

with fewer than 500 employees.

We contend that effective work site responses to drug problems should

be considered within a systems context, with consideration of how

business and industry anticipate and respond to other personnel/human

resources issues. Effective solutions for newly salient problems that

have not been traditionally dealt with through work settings could be

informed by a better understandingofhow organizations deal with their

central or core, as well as with other nontraditional, personnel/human

resources management tasks. This avoids the all-too-common myopic

vision in examining drug problems apart from other management

problems and practices. A broader perspective can lead to more informed

choices, to commitments based on common understanding, and to more

thoroughly implemented and effective practices.

Figure 1 portrays a model of the personnel/human resources management system, which exists within an organization along with other

organizational systems (adapted from Scarpello and Ledvinka, 1988).

The human resources management system deals with the organizational contingencies that are posed by the employee/human interface

with the organization’s core technology, and with the contingencies and

246
FIGURE 1

PERSONNEL / HUMAN RESOURCE SYSTEM

247
uncertainties that are imported into the work organization from the

organization’s external environment. Personal problems of members of

the labor force, including alcohol or other drug problems, are part of the

external environment that impact the organization. Personal problems

of current employees are also a source of potential uncertainty for an

organization, the resolution of which includes the personnel/human

resources management function (Blum and Roman, 1989a).

Table 1 presents data from personnel/human resource managers in our

study, indicating their perceived “strategic uncertainty” with regard to

the 13 human resources issuesrelatingto the task, social, and regulatory

sectors of the personnel/human resources (p/hr) environment. Strategic

uncertainty has three components: the importance of the issue, the

complexity of responses to the issue, and the degree to which the issue is

stable or changing. Each component is ranked from one through five,

Table 1. Perceived Strategic Uncertainty and Perceived

Effectiveness: Descriptive Statistics and Pearson

Correlations

Strategic

Uncertainty* Effective Correlation**

Task (Alpha = .62) 26.4 8.3

Staffing 27.6 9.6

Performance Appraisal 24.6 11.6

Compensation 31.9 12.4

Social (Alpha = .86)

Stress

AIDS

Alcohol Abuse

Drug Abuse

Family Problems

Healthy Lifestyles

Regulatory (Alpha = .70)

Employee Relations

Safety

Government Regulations

Health Care Cost

Containment

X SD

23.3 6.6 .59

20.0 9.3 4% 11% .49

22.4 12.3 7% 26% .56

25.6 12.9 6% 36% .41

26.4 12.6 6% 37% .32

23.2 11.9 2% 26% .57

19.7 9.8 1% 17% .55

34.1 8.8 .48

34.6 11.3 24% 61% .43

26.7 13.9 23% 30% .35

34.1 12.8 39% 66% .32

39.1 11.0

% Strongly % agree

agree

.23

30% 69% .24

21% 41% .20

22% 46% .42

11% 44% .30

*minimum = 2, maximum = 50

**All Correlations are significant at p<.05.

248
with five indicatingmost agreement and one indicating least agreement

on the dimension. Perceived strategic uncertainty about an issue is

measured by: Importance X (Complexity + Bate of Change) (Daft,

Sormunen, and Parks, 1988). Each human resources issue’s perceived

strategic uncertainty has a theoretical minimum score of 2 and maximum of 50.

Generally, human resources issues relating to the regulatory environment yield greater strategic uncertainty while issues relating to the

social environment yield less strategic uncertainty. The average uncertainty in the human resources function of dealing with employee drug

abuse ranks in the middle of the 13 substantive areas. It does, however,

rank highest among the six human resources issues considered as

“social,” with employee alcohol abuse and AIDS in the workplace ranking second and third in this category.

The perceived effectiveness of the human resources management system

in dealing with the various issues is lowest for those issues in the social

environment. Only 5 percent of the human resources managers strongly

agree, and 34 percent agree, that they are effectively responding to the

drug problem. By contrast, their perceived effectiveness in responding

to the regulatory environment is the highest of the three areas. Thirtynine percent strongly agree and 55 percent agree, for example, that the

human resources department is effectively responding to government

regulations. For each dimension and for the three combined areas there

is a positive association between perceived uncertainty and perceived

effectiveness in responding to an issue. This finding suggests that as the

dimension of importance dominates the uncertainty measure, by its

weighting of the complexity and rate of change, it is associated with

effectiveness. If the issue is not considered important, it is an area of low

strategic uncertainty, and is associated with lower levels of perceived

effectiveness in managing the issue. Generally the associations between

strategic uncertainty and effectiveness tend to be highest in the social

environment areas, but the association between perceived uncertainty

and effectiveness with regard to the effects of drug abuse is the lowest of

the p/hr issues in the social environment category, even though it is a

positive association.

Work organizations use a variety of policies, activities, and programs to

respond to drug abuse. The human resources managers report that their

organizations’ responses include: educational campaigns, health promotion/wellness programs, support of community prevention and intervention programs, absenteeism programs, risk identification for high utilizers of health care benefits, changes in health care benefits for alcohol,

drug, and mental health problems, policies concerning drug use on the

249
job or away from the job, penalties for drug dealing, dog-aided searches,

undercover operations, various types of drug screening, policies that

provide for the organization to conduct drug screens, direct referral of

drug abusers to treatment centers by medical or personnel department

functionaries, and EAP policies.

Fifty-seven percent of the organizations provide a formal EAP and 46

percent perform drug testing in at least one of the six types of potential

drug screening situations about which data were collected. The six types

of screening are:

Preemployment screening

Random screening

Screening as part of a routine medical examination

Screening for probable cause or part of a fitness for duty

policy screening based on confidential peer reports

Screening after accidents

Twenty-five percent of the organizations perform drug screening for at

least some job categories in only one of the six conditions, with 13 percent

in two of the conditions, and 7 percent in three of the conditions.

FIGURE 2

TYPES OF DRUG SCREENING

250
As shown in Figure 2, preemployment drug screening is the most

prevalent type of drug screening program, with 29.4 percent of the

sampled employers performing preemployment screening of all prospective employees and another 4.8 percent usingpreemployment screening

in selected employment categories. The second most prevalent type of

drug screening is screening based on reasonable suspicion/probable

cause, with 33.3 percent of the work sites screening all employment

categories under this condition and another 11 percent screening selected employment categories. The other types of screening are notably

rare.

Figure 3 indicates the presence and the overlap in drug screening and

EAPs. Twenty-three percent of the organizations have neither an EAP

nor a drug screening program, 31 percent have an EAP but do not have

a drug screening program, 26 percent have both an EAP and drug

screening of at least selected employment categories in at least one of the

6 conditions, and 20 percent have drug screening but no EAP. Worksites

with EAPs are more likely (39 percent) to have preemployment drug

screening programs than work sites that do not have EAPs (28 percent).

Worksites with EAPs tend to be more likely (47 percent) to screen at least

some of their employment categories for reasonable cause than work

sites that do not have EAPs (40 percent).

FIGURE 3

EAP AND DRUG SCREENING

251
It became evident during the interviews that drug screening was not

routinely used in the vast majority of organizations that have policies

that specify under what conditions they can or will use drug screening

procedures, or in those without specific policies but with some reported

use of drug screening. It also became evident that as one moved away

from central city locations, drug screening programs or lack of drug

screening programs both clustered. That is, in smaller communities, if

one company did preemployment screening, the other employers that

were interviewed also tended to preemployment screen, and vice versa.

In general, work sites reported very few positive preemployment tests.

When found, the preponderance of the positive tests indicated marijuana usage. There were, however, a few work sites where the positive

test rates were relatively high.

Some organizations were experiencing dual problems in drug use and in

staffing the organization. These organizations face particularly difficult

decisions. In at least one instance, a work site that had many openings

for semi-skilled workers performed preemployment screens, but hired

those who came up positive anyway, with the admonition to the new

employee that “that’s two strikes against you.”

However, the extent of difficulty the organization faced with attracting

or retaining qualified employees was not statistically associated with

preemployment nor with probable cause drug screening. Notably,

organizations facing these conditions were significantly less likely to

have an EAP. The extent to which the changing political or social

climates were of concern to the organization were also not related to the

presence of preemployment screening, probable cause screening, nor to

the presence of an EAP. The extent to which absenteeism was a problem

for the work site was not associated with preemployment screening nor

with EAP presence, but was associated with probable cause screening.

The extent to which workers’ compensation claims was a concern to the

work site was associated with probable cause screening; curiously, this

concern was inversely associated with the presence of an EAP. The

extent to which the accident rate was a major concern of the work site

was associated with preemployment screening, probable cause screening, and inversely with the presence of an EAP. Concern about escalating health care costs or levels of work quality and quantity were not

associated with drug screening nor EAP presence. While generally

consistent with images ofdrugscreening, these three findings contradict

perceptions that EAPs are widely seen as mechanisms to prevent or

reduce these costly issues in the workplace. The bivariate associations

are summarized in Table 2.

252
Table 2. Correlations: Organizational Concerns With

Pre-Employment, Reasonable Cause Drug

Screening and EAPs.

Management Concerns

Pre-Employment Reasonable Cause

Drug Screening Drug Screening

EAP

Attracting Qualified Employees ns

Retaining Qualified Employees ns

Changing Social Climate ns

Changing Political Climate ns

Absenteeism ns

Worker’s Compensation Claims ns

Turnover ns

Accident Rate .24

Escalating Health Care Costs ns

Level of Work Quality ns

Level of Work Quantity .18

ns

ns

ns

ns

.20

.30

ns

.29

ns

ns

ns

-.24

-.18

ns

ns

ns

-.21

-.18

-.24

ns

ns

ns

The work site’s concern about the changing political climate and with

workers’ compensation claims were associated with perceived strategic

uncertainty pertaining to the drug abuse issue, but were not associated

with the work site’s perceived effectiveness in dealing with the issue.

The work site’s concern with accident rates was associated with both the

perceived effectiveness and perceived strategic uncertainty with regard

to the drug abuse issue.

Preemployment drug screening and reasonable cause drug screening

are associated with human resource department beliefs about drug

screening. Beliefs about drug screening are not associated with the

presence of EAPs, however. As indicated in Table 3, beliefs that drug

screening is effective for dealing with workplace safety, productivity

problems, public safety, and workplace morale are associated with

preemployment screening. Except for the belief that drug screening is

effective for dealing with productivity problems, each of these beliefs is

also associated with reasonable cause drug screening. Beliefs that drug

screening is an effective means ofgetting public trust are not associated

with preemployment screening, but are associated with probable cause

screening. Beliefs that drug screening is an invasion of privacy, is

inaccurate, is unnecessary, is too costly, is opposed by management, or

253
is opposed by employees are each inversely associated with preemployment or reasonable suspicion drug screening programs. Beliefs that

drug screening provides help to employees who use drugs or that drug

screening has a potentially negative effect on employee morale are not

associated with either type of drug screening activity.

Table 3. Correlations: Drug Screening Beliefs With

Pre-Employment, Reasonable Cause Drug

Screening, and EAPs.

Human Resource Department’s

Drug Screening Beliefs

Reasonable

Pre-employment Cause Drug

Drug Screening Screening EAP

Effective means for dealing with

workplace safety

Provides help to employees that

do use drugs

Invasion of privacy

Effective means of dealing

with productivity problems

Inaccurate

Effective means of dealing

with public safety

Potentially negative impact on morale

Effective means of dealing with

workplace morale

Benefit to employees who do

not use drugs

Is not necessary

Is too costly

Effective means of getting public

trust

Is opposed by management

Effective means of dealing with

national security

Is opposed by employees

.33 .25 ns

ns ns ns

-.33

.29

-.35

ns

ns

ns

-.42 -.22 ns

.23 .21 ns

ns ns

.23 .29

ns

ns

.35 .26 ns

-.50 -.33 ns

-.42 -.21 ns

ns .24 ns

-.52

ns

-.37

ns

ns

ns

-.36 -.22 ns

254
Reasonable cause drug screening, preemployment drug screening, and

the presence of an EAP are each related to the perception of effectiveness

in dealing with the impact of drug abuse in the workplace. Regression

analyses presented in Table 4 indicate that when all three programs are

in the equation, only the presence of an EAP and reasonable cause drug

screening are significantly related to the perception of effectiveness with

regard to drug abuse. The association between preemployment screening and perceived effectiveness becomes not significant when both EAP

and preemployment screening are in the equation, but the association

between EAP and effectiveness remains significant. When both EAP

and reasonable cause drug screening are in the equation, both are

significantly related to the perception of effectiveness with regard to

drug abuse, Analyses of interaction effects did not produce consistent

results. However, there is some indication that organizations with both

EAPs and reasonable cause screening have perceptions of greater

effectiveness with regard to drug abuse issues.

Table 4. Regressions of Perceived Effectiveness on EAP,

Reasonable Cause, and Pre-Employment

Drug Screening

Perceived Effectiveness Perceived Effectiveness

in Responding to the in Responding to the

Impact of Drug Abuse Impact of Alcohol Abuse

b p (2-tail) b p (2-tail)

EAP .34 .033 .59 .000

Reasonable Cause .21 .024 .07 .445

Pre-Employment .06 .537 .01 .898

R

2

 = .10 R

2

 = .12

EAP .33 .040 .59 .000

Pre-Employment .15 .095 .04 .63

R

2

 = .06 R

2

 = .11

EAP .35 .027 .60 .000

Reasonable Cause .23 .006 .07 .370

R

2

 = .10 R

2

 = .11

255
As with drug abuse, the perception of the effectiveness of dealing with

alcohol abuse is significantly associated with the presence of EAPs.

However, preemployment and reasonable cause screening for drug

abuse are not significantly associated with the perceived effectiveness

for alcohol abuse. These drug screening variables are not associated

with the presence of EAPs in the bivariate case, and in the instances

where they are in the same equation as EAP, they remain nonsignificant

but do not affect the association between EAP and perceived effectiveness in dealing with the impact of alcohol abuse on the workplace. The

lack of a significant association between drug screening and perceived

effectiveness for alcohol abuse was expected; it may be seen as a

validation check on the association between drug screening and perceived effectiveness in dealing with the impact of drug abuse. EAP

presence on the other hand was expected to be associated with both

perceptions of effectiveness, with the association found to be stronger for

alcohol abuse than other drugs of abuse.

Types of drug screening other than preemployment or reasonable cause

screening are rare in policy, even rarer in actual practice, and are

unrelated to perceptions of effectiveness in dealing with drugs. Thus,

the above analyses were limited to only the two types of screening, and

these types of drug screening in either some or all employment categories

were counted as drug screening programs.

SUPERVISOR AND MANAGEMENT AUDIT

Next we report preliminary analyses of survey data collected from 1,981

supervisors and managers of diverse occupational groups employed at

multiple locations of a major corporation. The survey was conducted as

part of an audit of an internally based multi-location corporate employee

assistance program that covers approximately 55,000 employees and

their family members. The program was initiated in 1975 and is based

in the corporate medical department. The audit consisted of on-site

interviews with eight EAP administrators, top and middle management

at each of seven corporate or area headquarter locations, medical

directors, and employees who used the EAP. Archival data on EAP

utilization supplemented the interviews and surveys. The response rate

to the mail survey that is the basis of this report was about 65 percent,

which is approximately double the response rate that we expected based

on the past experience of the organization in conducting its own internal

surveys.

We contend that personnel/human resources policies and programs,

including EAPs or drug screening, which are isolated from and not

256
integrated into their work organization’s operations, particularly their

performance management systems, will not be very effective in responding to the target problems. This is particularly true for problems, such

as drug abuse, about which troubled employees are likely to try to avoid

detection, unlikely to admit a problem solely on their own, or be

ambivalent about seeking help, whereas they may seek help for selfdefined problems which they deny are related to drug use. The knowledge of supervisors and managers about a policy/program and their

accountability in fulfilling policy guidelines and requirements are crucial to the successful implementation of programs to help troubled

employees and their co-workers. The role of supervisors is important in

documenting behavior problems and in making a formal documented

referral to the appropriate help agents. The formal documented referral

can serve to “raise the bottom” to which a person may fall before an

attempt at intervention is made. Such a referral can also provide

motivation to a drug abuser who is ambivalent about getting help.

With regard to the issue of program integration and the role of supervisors, it is suggested that the ineffectiveness of some EAPs in responding

to an organization’s possible drug problem might be a result of the

ineffectiveness of the performance management and operations management of the organization rather than a problem specific to the

staffing or operation of the EAP. A similar statement might be made

conceming “Fitness for duty”or reasonable-cause drugscreeningpolicies

which depend heavily on the role of supervisors and managers. Thus, a

potential weak link in the EAP, the supervisor/manager, is also a

potential weak link in a reasonable-cause drug screening program.

While some individuals with drug abuse problems will self-refer to an

EAP, many of the cases that are recorded as self-referrals are really

individuals who drag themselves into the EAP after a period in which

their personal problems and deterioration were clear to people around

them who did not intervene, including their supervisors. While selfreferral is a possibility, alcohol and other drug problems are fraught with

denial by the individual, their family members, and their co-workers.

There are cases where supervisors and managers will not take the

necessary steps to make an EAP referral when it is appropriate to do so.

In some instances,it is because they donothave theknowledge and skills

necessary to make a referral. It is also possible that performance

problems, including demeanor and getting along with co-workers in a

constructive fashion, occur only after the problem is clearly evident to

family members. But is also well-known that family members can be

enablers, and thereby part of the problem, rather than individuals who

will intervene and refer the individual to help. It is because so many

individuals with problems do not get help from family members that the

257
workplace is an important route to help for so many who “fall through”

the family net. Minimizing enabling behavior by supervisors is critical

if their constructive roles in intervention are to be effective (Blum,

Roman, Bennett and Weubker, 1988). The analyses that follow address

the importance of supervisors relative to the EAP.

The EAP client database and interviews with the EAP coordinators at

the various corporate locations indicated minimal supervisory or managerial referrals to the EAP. The survey data, however, presented a more

complicated picture of the perceptions and role of the supervisors/

managers vis a vis the EAP.

Of the respondents, 37 percent reported that they have made referral to

the EAP, over the time of the program’s existence, with another 16

percent reporting that they have encouraged an employee to go the EAP

but did not make a formal referral, indicating a majority of the supervisory staff had some association with an EAP referral.

This data reveals that the EAP staff underestimated the extent to which

clients who were recorded as “self referral” in the data collection system

were actually undocumented supervisory “nudges.” While the fact that

supervisory referrals are not necessarily recorded as such may not seem

that important, it can prove vital in the accurate assessmentandreferral

of individuals with drug abuse problems. Drug-abusing employees may

“self refer” themselves to an EAP. However, contrary to the popular

image, they are unlikely to have “earlier stage” problems than employees

who are “supervisory referrals” (Amaral and Cross, 1988). One recovering cocaine abuser who was interviewed referred herself to the EAP for

a very late stage problem because she “was sick and tired of being sick

and tired.” None of her co-workers nor her supervisor were willing to

take the steps necessary to put a constructive stop to her performance

and demeanor problems through formal EAP referral. If an EAP selfreferral denies any drug usage, any job-based problem, or any supervisory motivation to contact the EAP, it is possible that the EAP coordinatormight refer the individual to a community resource that does not have

the capacity to identify or deal with drug problems. While it is possible

that drug abuse may be revealed through diagnostic tests performed by

the EAP, if the staff is qualified or inclined to perform subtle or

standardized tests, or by a clinician in the community who has experience with drug abusers, this is no certainty. It is likely that EAP

coordinators who do not have access to full information, especially

information that there was some impetus from the job situation for the

employee to come to the EAP, will make less accurate assessments about

drug abuse than EAP coordinators with access to better information that

comes through supervisory involvement.

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Supervisor/manager referral of subordinates to the EAP is associated

with perceptions about the EAP. As shown in Figure 4, referrals are

slightly more likely when they perceive top management support, with

42 percent of those who have such a perception having made referrals as

compared to 37 percent of those who do not have such a perception. A

stronger relationship is observed for the perception of whether one’s

immediate supervisor supports the EAP, 46 percent of those having such

a perception refer as compared to 26 percent of those who do not have

such perception. Thus, while other studies have confirmed that top

management support of an administrative innovation, such as an EAR,

is important at the program adoption stage (Beyer and Trice, 1978; Blum

and Roman, 1989b), this data indicates that middle management support is very important during the continuing implementation and

program evolution stages.

A strong relationship is observed between the belief that the EAP is

integral to the company, with 45 percent of those who have such a belief

having made referrals to the EAP as compared to 31 percent of those who

do not have such a belief. A weak association between referral and the

perception that the EAP helps improve the company’s productivity is

evident with 48 percent of those with such a perception having made

referrals, as compared with 42 percent of those without such a perception.

FIGURE 4

SUPERVISOR/MANAGER PERCEPTIONS AND EAP REFERRAL

259
Knowledge of EAP and disciplinary policies seem crucial for formal,

documented supervisory EAP referrals. Of those who are familiar with

the EAP policy, 53 percent have referred subordinates to the EAP as

compared to 23 percent of those who are not familiar with the policy. A

similar association is found between familiarity with the disciplinary

policy, with 41 percent of those who are familiar with the policy referring

to the EAP as compared to 15 percent of those who do not report

familiarity with the disciplinary policy. Caution is necessary in interpreting the causal direction of policy knowledge and referral behavior,

since policy knowledge can obviously result from program utilization. To

assume that policy knowledge should lead to program utilization is

however a more appropriate design for program implementation. It is

important to note that 87 percent of the respondents reported familiarity

with the company’s disciplinary policy, whereas 56 percent reported

familiarity with the EAP policy. This represents a difference of 31

percent. Of the respondents, 60 percent indicated that they had a copy

of the EAP policy statement.

While almost half of the respondents reported that they were unfamiliar

with the details of the EAP policy and procedures, the data reveal a

readiness on the part of the respondents for training about the EAP. Of

the respondents, 68 percent agreed that a 2-hour training course about

the EAP would be valuable to them as supervisors. Moreover, 59 percent

agreed that they would like to improve their skills and confidence in

suggesting the EAP to a troubled subordinate; 56 percent agreed that

they would like to increase their skills and confidence with regard to

coordinating EAP and discipline; and 70 percent agreed that they would

like to improve their skills in recognizing an employee who is a candidate

for the EAP.

These data indicate a willingness for supervisors and managers to

improve their skills with reference to appropriate utilization of EAPs.

The supervisors and managers in the company where the survey was

conducted do not get any specialized training about the EAP, but they do

get training about a range of other topics, some of which mention EAP

“in passing.” This information is important in combination with the information that there is a relatively low percentage of the employees and

a relatively low percentage of the EAP caseload that is represented by

alcohol or other drug problems. The overall utilization rate (the percentage of employees who use the EAP in a 12-month period), however, is

comparable to the average utilization rate of other large organizations

with primarily internal EAPs. The audit revealed, however, that

utilization data alone do not adequately describe a program’s dynamics.

260
EAP STUDY

This section of the paper reports results from a longitudinal study of

EAPs. During 1984-85, we conducted on-site visits to 439 operating

units of organizations, in 66 percent of which we interviewed the internal

EAP coordinator/administrator. Of the remaining 34 percent, which

were essentially externally contracted EAPs, we interviewed the individual internal to the work organization who was responsible for maintaining and/or monitoring the linkage with the external provider. The

data set is based on a carefully selected sample from which we were able

to collect some data from over 95 percent of the eligible respondents. The

data is representative of EAPs in 1984-85, both internal and external, in

private sector operating units (establishments) with 500 or more employees in California, Michigan, Minnesota, New York, North Carolina,

and Texas. In 1988, we mailed questionnaires to the internally-based

programs, and have been able to account for over 70 percent of the

internal programs that we studied in 1984-85 (Blum, Roman, Bennett

and Weubquer, 1988).

The data set is very extensive and represents information collected from

3-hour on-site interviews in 1984-85, questionnaires that were left at the

interview for self- administration and returned by mail to the investigators, and 1988 mail questionnaires. Only a small portion of the information is reported here. This presentation includes information about the

utilization rates and drug screening.

The average overall 12-month utilization rate is 4.5 percent, which is

skewed a bit to the right, meaning that the median is less than the mean.

On average, 1.5 percent of the work force uses an EAP for their own

alcohol or other drug problem in a 12- month period. Two-thirds of the

cases list alcohol as the primary drug of choice, but abuse of more than

alcohol is common, particularly among employees under 40 years of age.

These rates are an underestimate of the portions of the work force that

have used the EAP at any point in time. Given low turnover of employees

and/or low reutilization of the EAP by the same clients, the EAP

utilization rate over a few-year period would be much higher than the

average 12-month rate reported here. This is especially relevant when

addressing the question of whether EAPs can address workplace drug

problems. Given the point prevalence of drug use, EAPs do not seem to

scratch the surface of the problem. Such a statistic embodies the rather

absurd assumption that all drug cases would be dealt with over a short

period of time or simultaneously. However, EAPs appear more effective

when examining the number of drug problems EAPs address, on average, over a period of time.

261
Much prevalence data about drugs confounds “use” and “abuse.” EAPs

cannot thoroughly address drug use, in other than the prevention in

which they engage in through education programs and through dealing

with clients who are at high risk for drug abuse but are not abusing at

the time they are in contact with EAP. EAPs can, however, address drug

abuse and problems related to drug usage, if the EAP is adequately

implemented and integrated into the employee culture, the line management, and the human resource management function of the organization. The data indicate that supervisory training and program integration are related to greater utilization for all problems as well as greater

utilization rates of EAPs for alcohol and other drug problems. The

relationship is greater for training of first line supervisors than of

middle managers.

The interface between drug screening and EAPs has been a subject of

controversy, with concerns among the EAP community that drug screening in organizations with EAPs would interfere with the EAP’s ability to

gain the trust of employees and to maintain a caseload. Essentially from

this and other studies we find very little drug screening in organizations,

other than preemployment applicant drug screening. As in the first

study described in this paper, drug screening is relatively rare in actual

practice, even in organizations that have policies that permit the

screeningofcurrent employees in certain situations, such as reasonablecause screening, screening after accidents, or screening as part of

routine medical examinations.

Preemployment screening does not seem to affect the average rates of

drug and alcohol cases dealt with by the EAP. The 1984 data indicate

that organizations did not differ significantly in either the proportion of

employees or EAP alcohol and drug abuse caseload. Preemployment

screening also has limited effects on the 1988 EAP utilization patterns.

Preemployment screening in 1984 is associated with a lower overall

utilization rate in 1988. There is no significant difference between 1984

preemployment and non-preemployment screening organizations in the

1988 percent of employees who use the EAP for alcohol and other drug

problems. The proportion of females who use the EAP for their own

alcohol or other drug problem is, however, lower in 1984 preemployment

screening organizations. The 1988 utilization rate for cocaine as a

primary drug of choice also does not vary with whether there was

preemployment screening in 1984-85. The percent of the 1988 caseloads

that comprised alcohol and other drug problems does not differ between

companies that preemployment screen or screen as part of medical

examinations. Marijuana tends to be the drug of choice in the 1988 drug

caseload of companies that do drug screen, while cocaine and alcohol as

drugs of choice do not systematically vary by whether the organization

drug screens or not.

262
The prevalence of drug screening is not associated with organizational

decline in profits nor in numbers of employees. Furthermore, drug

screening, either preemployment or of current employees, is not associated with indicators of the relative presence of the “core technology” of

EAPs (Roman and Blum, 1988), nor with the EAP's integration into the

organization.

OPINION SURVEY

While the previous sections of the paper report information collected

from personnel/human resource managers working in a variety of

organizations, supervisors/managers employed in multiple locations of

a major corporation, and EAP coordinators of internal EAP's and human

resource liaisons to external EAP providers, this section of the paper

addresses the opinions about drug screening collected from randomly

selected individuals. During November-December 1986, a representative sample of 524 adults residing in Georgia were interviewed in a

telephone survey. These individuals, 18 years of age or older, represented a 67.5 percent response rate.

Respondents were asked the following item: “It has been suggested that

employers should routinely choose employees at random and require

that in front of a witness each of these employees would provide a urine

specimen which is to be tested for evidence of the employee’s drug use.”

While this item is somewhat double- barreled in terms of drug screening

and the witnessing of the specimen collection, NIDA guidelines have

included witnessed collection to ensure the chain of custody. Even in this

stringent category, half of the respondents either strongly approved or

approved of the theoretical practice, 12.6 percent and 37 percent respectively. Among respondents, 28 percent disapproved and 18 percent

strongly disapproved, with 4 percent respondingthat they did not know.

Employed individuals were less likely to strongly agree than those who

were not employed. Homemakers and retired people are the most likely

to agree or strongly agree. We found that sex, race, religion, recency of

moving to Georgia, blue collar versus white collar occupations, having

closely known someone who was dependent on alcohol or cocaine,

education, and income are all unrelated to variation on the opinion. Age,

however, is linearly associated with the opinion. Older people are more

likely to favor such policy. A discriminant analysis with all of the above

variables indicates what is evident in the bivariate analyses, namely

that age is the only significant predictor and explains about 10 percent

of the variation in the opinion.

263
Approximately 75 percent of the employed individuals responded affirmatively to the question: Would you be willing, in front of a witness,

to provide a urine specimen to a representative of your employer for the

purpose of drug screening?” Virtually all of those who strongly agreed

with the question above about a drug screening policy, said they would;

96 percent of those who agreed said they would; 67 percent of those who

said they disagreed said they would; and 32 percent of those who strongly

disagreed said they would. Age is the only variable significantly

associated with the willingness to comply with an employer’s drug

screening request, with older people more likely to say they would be

willing to comply.

These data are revealing in the high portions who agree with a hypothetical policy and their willingness to comply. While the data can

technically only be generalized to the Georgia population from which the

sample was drawn, limitations of generalization from a survey of

Georgia adults because of beliefs about the conservatism on these issues

of southern residents does not seem warranted. Other opinions in the

survey about the disease concept of alcoholism and cocaine dependence

were associated with sociodemographic variables in predicted directions, with the magnitudes of agreement with various other opinions

consistent with those reported for an earlier study (Caetano, 1986) of

Contra County, California residents (Blum, Roman and Bennett, 19891.

The lack of expected demographic associations points to the multidimensionality of the drug screening issue. It means different things to

different people. It also means that should a workplace screening

program be adopted, it is difficult, though not impossible, for employers

and managers to know who will accept or oppose such a policy. Appropriately implemented drug screening programs require that management have information about the opinions of their employees.

Drug screening is not necessarily a technological shortcut to a drug-free

or safe workplace. Acceptance of the program by supervisors, managers,

and other employees is necessary for it to be effective. A systems

perspective of a drug program which is informed about employee opinions may be useful in avoiding pitfalls of isolated programs. Wellplanned communication about the aims, procedures, and protections

included in drug policies and programs can mitigate against negative or

build upon positive sentiments toward drug screening among the employees.

It may be useful to note here that the military has reported decreased

rates of those testing positive for illicit drug use over the years that their

drug screening program has been in place, and has pointed to this

264
decrease as evidence of the success of drug screening. Yet worldwide

surveys based on self- reported use of alcohol in the military have shown

that the consumption of alcohol and alcohol-related problems have not

similarly decreased over time. While there are some significant decreases in the self-reports between 1982 and 1985, the larger increases

in alcohol-related productivity loss between 1980 and 1982 (Bray et al.,

1983; 1986) should be considered by those responsible for implementing

policies and programs. Further, the evidence from the treatment

community of polydrug use and the switching of drugs of choice as

different chemicals are more readily available or culturally acceptable

should have some influence on the design and implementation of human

resource management programs dealing with workplace effects of alcohol and other drug problems.

CONCLUSIONS

This paper has presented data from four projects that are part of a

research program on work site management ofbehavioral health issues,

of which the research about EAPs and drug screening form major

components. A systems perspective for understanding the problems and

the management of the solutions, with emphasis on the personnel/

human resources function of organizations and the sociocultural environmental domain in which they operate, was presented. The structural

change represented by EAPs and drug screening programs, as well as

other organizational responses, can be understood within the context of

how organizations perceive and respond to other types ofintrusionsfrom

their environment.

The findings from the four studies, some of which are still in progress,

represent a picture of work site responses to drug abuse, as represented

by several stakeholders, or actors in the system. These actors include

personnel/human resource managers, supervisors and managers, EAP

coordinators, and a cross-section of employees.

The study of human resource managers suggests that perceived strategic uncertainty with regard to drug abuse and other issues in the

sociocultural environmental domain is related to perceived effectiveness

in responding to these contingencies, with the associations in this

domain stronger than in the regulatory or task domains of human

resources management. These data, though preliminary, with more

being collected from other organizations, reveal the extent of EAPs and

drug screening in one southern State. These data also show that beliefs

about the effects of drug screening are associated with the two most

prevalent kinds of drug screening programs, preemployment and rea265
sonable-cause, but are not associated with the presence of EAPs. EAPs

are associated with the perceived effectiveness in dealing with drug

abuse and with alcohol abuse, with reasonable-cause drug screening associated with perceived effectiveness in dealing with drug abuse, but not

with alcohol abuse. Preemployment screening is not related to perceived

effectiveness in either area.

Surprisingly, there are a substantial portion of organizations that have

drug screening programs, albeit mostly preemployment screening programs, but do not have EAPs. Some of these situations may reflect the

“managerial macho” a utility company executive is concerned about

when organizations rush to adopt drug testing without thinking through

the implications and limitations. As this executive who was quoted in

Fortune magazine parsimoniously states: “If all you do is drug testing,

if you don’t train your supervisors to spot problems, or promote your

employee assistance program, or communicate clearly and sympathetically with your employees, then you don’t have a drug program” (Kupfer,

1988).

Data from the EAP study suggest that organizations that preemployment screen should not get a false sense of security from preemployment

screening programs because drug problems do emerge among employees

and their family members, the effects of which are not left outside the

work site, and show up in EAP caseloads even in organizations that

preemployment screen.

This study also indicates the stability and institutionalization of EAPs.

EAPs have a core technology that defines them in their organizations

and translates into constructive solutions to problems for impaired

individuals and others at their work site, in addition to their family

members. The data indicate that the more EAPs are integrated into

their organizations, the more effective they are in dealing with problems

related to drug abuse.

The study of managers and supervisors indicated that the lack of

supervisory training and EAP integration into the performance management subsystem of the personnel and line management functions can

result in fewer individuals being helped with alcohol and other drug

problems through the EAP. The study also showed the readiness of

supervisors and managers to improve their skills and knowledge with

regard to EAP policy and procedures. Not only could these supervisors

be provided with the tools necessary to do their jobs, it would also make

sense to hold them accountable for doing their jobs as supervisor/

managers in adhering to and implementing organizational policy. While

EAP utilization is ultimately voluntary for troubled employees, volun266
tary and discretionary utilization of organizational policy by supervisors

should be discouraged and sanctioned.

Supervisors/managers make more EAP referrals when they are familiar

with EAP and disciplinary policy; think the EAP is integral to the

organization; and perceive that their own immediate supervisor supports the EAP. While top management support is certainly necessary for

the adoption and implementation of an EAP, middle and line management, as well as rank and file support is crucial for an effective program.

While the causal direction between EAP referral and program knowledge and support is unclear from these data, the association is clear.

The survey of opinions about drug screening indicates that employees

are stakeholders who are apparently ready to participate in organizational responses to drug abuse. These energies can be used as part of the

solution in implementing constructive solutions that make sense for

particular work settings. Implications from the findings about the lack

of predictability of who is in favor of and willing to participate in drug

screening suggest managerial attention to the potential pitfalls of drug

screening, so as not to underestimate the complexity of the nontechnical

issues (i.e. the social issues and opinions of employees), that may lead to

hidden and unanticipated costs of drug screening. While public opinion

may be favorable toward drug screening, it should not be assumed to be

a simple technological shortcut to productivity improvement, nor an

alternative to or excuse for bad management.

A systems perspective which views drug abuse within the context of

other environmental intrusions that the organization must routinely

address to protect its technical core is superior to the perspective of drug

abuse as an isolated problem requiring unique and unprogrammed

responses. A systems perspective can encourage decisionmakers to

adopt and implement comprehensive programs that make sense within

the context of their organization’s culture, structure, and functioning.

While many contingencies must be taken into account before a rational,

useful, and cost-effective alcohol and drug use policy and program can be

developed, implemented, and integrated into work organizations, there

is enough information available to suggest that good comprehensive and

effective programs are worthwhile and attainable.

REFERENCES

Amaral, T.M., and Cross, S.H. Cost benefit of supervisory referrals. In: ALMACA

Research Presentations: Balancing Empathy and Economics. Arlington,

VA: ALMACA, 1988.

267
Beyer, J.M., and Trice, H.M. Implementing Change: Alcoholism Policies in

Federal Work Organizations. New York: Free Press, 1978.

Blum, T.C., and Roman, P.M. Employee assistance programs and human resources management. Research in Personnel and Human Resources Management Vol. 7, Greenwich, CT: JAI Press, in press.

Blum, T.C., and Roman, P.M. Purveyor organizations and the implementation

of employee assistance programs, Journal of Applied Behavioral Science

24(4), 1989.

Blum, T.C.; Roman, P.M.; and Bennett, N. Public images of alcoholism: Data

from a Georgia survey. Journal of Alcohol Studies 50,(1):5-14, 1989.

Blum, T.C.; Roman, P.M.; Bennett, N.; Weubker, L. A Longitudinal Analysis of

Internal EAPs: A preliminary report. In: ALMACA Research Presentations:

Balancing Empathy and Economics, Arlington, VA: ALMACA, 1988.

Bray, R.; Marsden M.; Guess, L.; Wheeless, S.; Pate, D.; Duntemen, G.; and

Ianacchione, V. 1982 Worldwide Survey of Alcohol and Nonmedical Drug

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

Triangle Institute, 1983.

Bray, R.; Marsden M.; Guess, L.; Wheeless, S.; Pate, D.; Duntemen, G.; and

Ianacchione, V. 1985 Worldwide Survey of Alcohol and Nonmedical Drug

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

Triangle Institute, 1986.

Bureau of National Affairs. Employee Assistance Programs: Benefits Problems

and Prospects. Washington, D.C.: Bureau of National Affairs, 1986.

Caetano, R. Public opinions about alcoholism and its treatment. Journal of

Studies on Alcohol 48:153-160, 1987.

Daft, R.L.; Sormunen J.; Parks, D. Chief executive scanning, environmental

characteristics, and corporate performance: An empirical study. Strategic

Management Journal 9:123-139,1988.

Holder, H.D. Alcoholism treatment and potential health care cost savings.

Medical Care 25(1):52-71,1987.

Jones, K.R., and Vischi, T.R. Impact of alcohol, drug abuse and mental health

treatment on medical care utilization: A review of the research literature.

Supplement to Medical Care 17(12), 1979.

Kupfer, A. Is drug testing good or bad? Fortune 118(4):133-140, December 19,

1988.

Roman, P.M., and Blum, T.C. The core technology of employee assistance

programs: A reaffirmation. The ALMACAN August, 1988, pp: 17-21.

Scarpello, V., and Ledvinka, J. Personnel / Human Resource Management:

Environments and Functions. Boston: PWS-Kent Publishers. 1988.

ACKNOWLEDGMENTS

Portions of this paper were presented at the National Institute on Drug Abuse

conference, Drugs in the Workplace: Research and Evaluation Data, September,

268
15, 1988, Ritz Carlton, Washington, D.C. The author acknowledges support

from the National Institute on Alcohol Abuse and Alcoholism grants, AA-07192,

AA-07250, and AA-07218 for data collections reported in this paper. The author

also acknowledges the partial support from the National Institute on Drug

Abuse, Office of Workplace Initiatives, for the presentation and preparation of

this manuscript.

AUTHOR

Terry C. Blum, Ph.D.

Associate Professor

College of Management

Georgia Institute of Technology

Atlanta, Georgia

269

The Use of EAPs in Dealing With

Drug Abuse in the Workplace

Paul M. Roman, Ph.D.

University of Georgia

INTRODUCTION

Employee Assistance Programs (EAPs) provide the workplace with

systematic means for dealing with personal problems that affect employees’job performance (Blum and Roman, 1989). In this context, “personal

problems” refer to alcohol and other drug abuse, psychiatric illness,

marital and domestic problems, and, to a limited extent, financial and

legal difficulties. Frequently such problems are multiple and interrelated.

Usually based on a written policy statement, EAPs provide a means for

supervisors, managers, and union shop stewards to access appropriate

expertise and consultation for guidance and help in dealing with subordinates or co-workers whose performance is affected by such problems.

Such expertise is present either in the form of an internal EAP coordinator or a staff member at an external contract agency who may be

contacted either in person or by telephone. EAPs also provide for

employee self-referral, and in numerous instances extend their services

to dependents of employees. The purpose of this paper, similar to that

of several other papers in this monograph, is to consider the utility of

EAPs for dealing with employee drug abuse problems and to examine

other aspects of the interface between drug abuse problems and EAPs.

At the outset it is important to note several basic reasons why EAPs have

very important roles in dealing with problems of drug abuse in the

workplace. First, as has been confirmed in several independent surveys,

EAPs of some form are currently in place in work settings that employ

at least a third of the United States work force. This estimate is probably

low since the survey data do not include public sector employees.

271
Second, as is indicated in the introductory overview of the nature of

EAPS, they offer constructive techniques for dealing with employees’

problems. They are fundamentally oriented toward conflict reduction in

the workplace. They show strong concerns toward avoiding turnover

and replacement costs which fall heavily upon management, labor, and

the community.

Third, through a foundation in clearly stated policies and procedures,

EAPs also minimize litigation. Their orientation is toward providing

due process to employees afflicted by personal troubles.

Fourth, EAPS enjoy the support of both management and labor. From

the earliest days of EAP implementation, care has been taken to consult

with labor representatives in implementing management-sponsored

programs. Labor organizations, both at international and local levels,

generally show supportive attitudes and behavior toward EAPS, viewing

them as accomplishing their own goals of conserving workers’ jobs and

careers. Additionally, numerous labor organizations have initiated

EAPS and work cooperatively with management through this base of

implementation (Roman, 1988).

Finally, and perhaps most importantly, EAPS’ emphasis upon constructive rather than punitive treatment of the substance abusing employee

is a concept consistent with public attitudes and preferences (Blum et al.,

1989).

While EAPS have been designed to function as comprehensive mechanisms for dealing with a broad range of employee personal problems,

there has been considerable confusion over applying them to drug abuse

in the workplace. Much of this confusion stems from the multiple

organizations that have shown concern over the issues of drugs and the

workplace. These organizations and individuals represent multiple

definitions of drug abuse problems as well as multiple solutions for

dealing with these problems.

Attention to employee drug abuse was briefly prominent during the

early 1970s, although the concerns were diffuse and not well-defined.

(For an elaboration of the events during this period, see Roman and

Blum, 1989.) The issue of employee drug abuse was not ignored by

employers concerned with job performance and safety issues, and was

considered within both fitness-for-duty and assistance-oriented policies.

However, as an issue “in its own right,” it was relatively dormant during

most of the decade of the 1970s and into the early 1980s, the period

during which EAPS diffused rapidly and the number of EAP workers

expanded geometrically (Blum, 1988; Roman, 1988).

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When attention to employee drug abuse was renewed in the mid-1980s,

largely under the banner of creating a “drug-free workplace,” the

proffered solutions to the problem centered on urine-based screening

and testing. There were both explicit and implicit assumptions that the

goals of dealing with workplace drug abuse problems were to: (1)

minimize the entry of illegal drug users into employment and (2) remove

from the work force those current employees who were users of illegal

drugs. More recently, that position has been moderated. Many discussions about drug abuse in the workplace include suggestions for referrals

of employees with positive drug tests to EAPs. They encompass the

broader concept that a comprehensive workplace drug abuse policy

should include access to EAP services,

METHODOLOGY

In this paper we consider the use of EAPs for dealing with employee drug

problems. The basis for the data used here is a 1988 followup of a field

study of EAPs carried out in 1984 and 1985. The goal of the initial study,

supported by the National Institute on Alcohol Abuse and Alcoholism,

was to examine the characteristics and correlates of a sample of EAPs

based in private sector company locations. The sampling frame was

limited to sites with at least 500 employees. Through a census technique, population lists of all EAPs meeting these criteria were constructed for the six States with the highest level of EAP activity. This

activity level was based on a 1981-82 study that focused on external

consultants developing EAPs and provided estimates of the numbers of

EAPs in each State (Kinman and Roman, 1982).

The six States are: California, New York, Texas, Michigan, North Carolina, and Minnesota. Data were collected from all sites except in

Minnesota and New York, where samples of 50 and 80 percent, respectively, were drawn. The research team conducted on-site data collection

through interviews with EAP managers or internal liaisons assigned to

supervise external EAP contracts. A total of 439 interviews were

completed, representing 97 percent of those contacted for an interview

appointment. In addition, each of the respondents was given a mailback

questionnaire, which included numerous materials to supplement data

collected in the interview, and 77 percent returned usable instruments.

In 1988, we supplemented this data foundation with a mail questionnaire to the respondents who were responsible for operating internal

EAPs. The purpose was to obtain followup information on program

evolution and change. At the time of this writing, this data collection is

273
not fully complete in that all respondents, or their replacements, have

not yet been “tracked down.” However, complete information on 115

internal EAPs constitutes the data base for this report.

FINDINGS

At the outset, two points should be noted which indicate the growing

importance of drug abuse problems in EAP caseloads. First, speaking

only in terms of central tendencies in the data, the drug abuse caseload

is, on average, more than a third of the total substance abuse caseload.

Conversely, employee alcohol problem cases represent slightly less than

two-thirds of the substance abuse caseload.

Therefore, since the average representation of substance abuse overall

in these EAP caseloads is between 30 and 40 percent, employee drug

abuse cases represent at least 10 percent of the overall EAP caseload.

Based on averages rather than on descriptions of specific programs, the

composition of the employee substance abuse caseload in 1988, by

primary substance of choice of the employee referral, is:

Alcohol problems-between 60 and 65 percent

Cocaine or crack-between 21 and 26 percent

Marijuana-between 8 to 10 percent

Other illegal drugs-between 6 to 8 percent

Diazepam (Valium)-between 2 to 4 percent

Other prescription drugs-between 3 to 5 percent

Cocaine is clearly the major nonalcohol drug EAPs deal with. This point

is extremely important in light of the pervasive image that EAPs’

substance abuse focus is exclusively upon alcohol and that mechanisms

other than EAPs must be designed and implemented in order to effectively deal with employee drug abuse problems. Indeed, as we pointed

out when examining data from the initial survey (Blum and Roman,

1986), EAPs contrast with random drug screening. EAPs are not merely

identification and referral mechanisms available within a work group

only “at random”— they are available every working day of the year.

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In terms of statistical central tendencies, a comparison of the 1988 data

with that collected in 1984-85 indicates an approximate doubling of

nonalcohol drug representation in the substance abuse caseload. This

figure demonstrates that EAPs can be and have been responsive to drug

abuse problems in the workplace and that their potential in this regard

is underestimated.

The research variable of focus in the remainder of this paper is the

proportion of employee drug problem cases in the EAP caseload during

the 12 months prior to the 1988 data collection. This measure may be

seen as the “drug abuse emphasis” within the EAP. It represents both

the extent to which EAP is seen as viable for dealing with employee drug

abuse cases as well as the extent to which it is penetratingthe drug abuse

problem within the organization.

Several caveats should be kept in mind when reviewing these materials.

The data are preliminary, and only bivariate relationships

are reported; these could disappear when controls are introduced once the complete data set is collected and analyzed.

The data are based only on internal EAPs, and thus may tend

to overestimate the extent of EAP attention to drug abuse.

The logic behind this supposition is that drug abuse emphasis is associated with supervisory involvement in EAP referrals, which generally tends to be less in externally based

EAPs.

The variable under examination does not indicate the extent

to which EAPs effectively reach employed drug abusers in

particular settings; the measure used here is not based on

the size of the caseload, nor does it reflect the actual presence

or distribution of drug abuse problems in a particular work

force.

The measure used here is only an indirect index of effectiveness; our other research has shown that alcohol and drug

abuse cases generally are back on the job and performing

adequately at about a 70-percent rate at 1-year followup from

the time of referral. The measure used here thus offers a

rough guide to the extent to which resources are being

allocated toward providing services to aid in such rehabilitation for employees who are abusing drugs other than alcohol.

Indeed, there is a significant positive association between the

extent to which the EAP deals with nonalcohol substance

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abuse cases and the extent to which substance abuse is

represented in its overall caseload

The data presentation that follows is centered on the Pearson correlation

coefficients between the proportion of the caseload that comprises nonalcohol employee drug abuse problems and several other sets of variables: general workplace characteristics, drug screening experiences

and attitudes, structure and change found within the EAP, the core

technology of EAPs, and clinical and referral features of EAPs. The term

“drug abuse caseload” refers to the proportion of drug abuse cases in the

EAP’s substance abuse caseload. Statements of statistical significance

indicate that the correlation is significant at the 0.05 level or better. A

trend refers to a relationship that approaches but does not meet this level

of statistical significance, i.e., between 0.06 and 0.10. Concluding comments follow regarding the interface between EAPs and employee drug

abuse issues.

General Workplace Characteristics

Workplaces undergoing either growth or decline in their work forces

might be expected to emphasize drug abuse problems. This is not the

case. In terms of change in overall work force size, there is a trend toward

a greater drug abuse caseload in companies with work force stability.

A similar pattern is found in the organization’s economic position. There

is a trend toward a greater drug abuse caseload when the company’s

profitability is growing or stable rather than declining.

There is a strong positive correlation (.30) between drug abuse caseload

and the proportion of the work force that is unionized. This correlation

may reflect the cooperation of labor unions with management in dealing

with drug abuse problems.

Many surveys indicate that concern with drug abuse issues appears to

be positively related to organizational size. In these data, however, there

is no relationship between drug abuse caseload and the size of the work

force eligible for the EAP’s services.

There have been many concerns that EAPs dealing with drug abuse

problems tend to be more oriented toward male than female employees.

In these data, however, there is no relationship between drug abuse

caseload and the gender makeup of the work-force.

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Associations With Drug Screening and Testing

The drug abuse emphasis in the EAP is related to drug screening and

testing. Drug abuse caseload is significantly higher when a drug

screening policy is present, and when some or all job applicants undergo

urine screens for drug use.

There is a trend toward lower drug abuse caseloads when random

screening of all or some employees is mandatory. There is also a trend

toward lower drug abuse caseloads when urine drug screening is part of

current employees’ routine medical examinations. These findings could

be interpreted in several different ways. They may indicate random

screenings effectiveness in deterring employee drug use. They may

indicate a lower use of the EAP when these mechanisms are in place,

These relationships are evidently complex, for there is a larger drug

abuse caseload when the company performs urine drug screening “for

cause,” i.e., when there is reasonable suspicion that an employee is not

fit for duty. Furthermore, there is also a larger drug abuse caseload

when the company routinely performs tests for drug use of accident

victims after workplace accidents. Finally, while a relatively rare practice in these survey data, in those few instances where confidential peer

reports are used as the basis for performing drug tests, there is a trend

toward a larger drug abuse caseload.

The data collection also involved consideration of employers’ attitudes

toward several drug screening issues. The data reveal a combined

profile. Positive attitudes toward use of the EAP in conjunction with

drug screening were coupled with fairly tough attitudes toward employee drug abuse. Thus, the image that EAPs and drug testing represent distinctively different ideologies toward employee drug abuse may

be incorrect. Drug abuse caseload is significantly positively associated

with agreement with the statement, “Drug abuse is a major problem

among employees in organizations today.” There is a positive association between the caseload and agreement with the statement, “Positive

drug screens of current employees should be referred to the EAP.”

Further, drug abuse caseload is significantly positively associated with

agreement to the statement, “Publicity about drug screening has increased self-referrals for alcohol and drug problems.”

This latter finding is qualified, however, by the significant positive

association between drug abuse caseload and agreement with the

statement, “Publicity about drug screening has decreased employee

trust of the EAP.”

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There are also significant positive associations between drug abuse

caseload and agreement with each of the following statements:

“Employers should dismiss employees who refuse to submit

to drug tests.”

“Employers should refuse employment to any job applicant

who refuses to submit to a drug test.”

Companies with no drug screening whatsoever reported a significant

negative association between drug abuse caseload and agreement with

the statement, “The company does not screen because of the potential

negative impact on morale.” In other words, when this reason is present

as a basis for not having drug screening, drug abuse caseload declines.

Similarly, there was a negative association approaching statistical

significance (.08 level) between drug abuse caseload and agreement with

the statement, “The company does not screen because of employee

opposition.”

EAP Characteristics and Change

Generally, we find a higher drug abuse emphasis within EAPs that are

integrated into supervisory management. There is a distinct trend

toward an increased drug abuse caseload when respondents report that

EAP training of first line supervisors has improved over the past 4 years.

This trend also holds true for reported improvement in training middle

managers about the EAP. There is also a trend toward an increased drug

abuse caseload with reported improvement in top management support

of the EAP.

Drug abuse caseload is not, however, affected by reported change in

union support of EAPs in locations where a union is present. But the

perceived adequacy of union support for the EAP in these locations is

positively related to drug abuse caseload. Improved EAP case recordkeeping is positively associated with drug abuse caseload.

In spite of concern that inadequate insurance coverage is a barrier to use

of the EAP for substance abuse problems, drug abuse caseload is not

related to reported improvements in insurance coverage for substance

abuse treatment or to perceived adequacy of this insurance coverage.

Drug abuse caseload is also not related to reported improvements in

education of the work force about the EAP. However, there is a positive

trend toward such a relationship in the reported adequacy of such

education.

278
Drug abuse caseload is significantly but inversely related to reported

improvements in EAP staffing. Larger drug abuse caseloads occur when

staff adequacy reportedly deteriorates. There is no relationship between

drug abuse caseload and reported current adequacy of EAP staff to cover

EAP services.

While drug abuse caseload is not related to improved medical department support, it is strongly and significantly related to reported current

adequacy of medical department support. Support from personnel/

human resources appears equally, if not more, important. There is a

distinctive positive relationship between drug abuse caseload and reported improvement in support for the EAP from the organization’s

human resources function.

Drug abuse caseload is markedly larger where there are formalized

Preferred Provider Organization (PPO) arrangements, and where there

are formal strategies in place for the managed care of alcohol, drug

abuse, and mental health problems.

Respondents were also presented with a series of items in which they

were asked to estimate the importance of various factors in their

organizational decisionmakers’ continued support of the EAP. Only one

of these items showed a significant positive association with drug abuse

caseload: “Preventing litigation in regard to wrongful discharge.” A

second item approached statistical significance (.07 level): “Providing

management of health care costs related to employee alcohol, drug

abuse, and mental health problems.”

The Core Technology of EAPs

The “core technology” of EAPs comprises six strategies or techniques

regarded as the central defining features of EAPs. Knowledge of these

strategies forms the basis for the credentialing of EAP professionals.

These techniques are: (1) use of job performance deterioration to identify

troubled employees, (2) availability and provision of consultation to

supervisors and managements about EAP policy, (3) constructive confrontation, (4) microlinkage of employees with appropriate help-sources,

(5) integrating relationships between the workplace and treatment/

counseling providers, and (6) a constructive organizational emphasis on

dealing with substance abuse problems (Roman, 1988; Roman and

Blum, 1988). Several items were included to measure the association

between the presence of EAP core technology and of drug abuse caseload.

Significant positive associations were found between drug abuse caseload

and the following statements:

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“Supervisors and managers readily contact the EAP staff for

consultation about how to use the EAP policy and procedures

when they believe they have a case appropriate for the EAP.”

“EAP staff coaches supervisors, managers, or union reps in

the use of constructive confrontation.”

Within the boundaries of confidentiality, an effortismade to

prepare the supervisor for the employee’s return to work.”

‘The EAP is an integral part of the system of progressive

discipline.”

Within the organization, EAP staff are routinely called upon

for advice about issues other than those directly involving the

EAP.”

A significant negative association was found between drug abuse caseload

and the statement: “Various community resources are considered for an

employee referral to maximize the match between a resource and the

employee’s problem.”

There was distinctively no relationship between drug abuse caseload

and these other aspects of supervisory relationships and the EAP:

When an employee does not readily admit to a problem,

constructive confrontation is used by supervisors and managers to motivate the employee’s use of the EAP.”

“Constructive confrontation involves the presentation to the

employee of documented evidence of substandard performance.”

These data indicate the importance of EAPs’ integration into supervisory management for an emphasis on drug abuse within the substance

abuse caseload. The distinctive element of the core technology is the

availability and provision of consultation to supervisors/managers by an

EAP professional. Constructive confrontation did not emerge as important. This finding may reflect either the relatively low extent to which

such a formal procedure is used, or the extent to which supervisory

consultation may sidestep the need for a constructive confrontation.

There is no clear interpretation of the negative relationship between the

microlinkage of employees to treatment and the drug abuse emphasis

within the substance abuse caseload.

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Clinical and Referral Aspects of the EAP

An EAP’s dealing with drug abuse is related to its overall dealing with

substance abuse. Drug abuse caseload is significantly positively associated with the total substance abuse caseload. There is, however, no

relationship between drug abuse caseload and the EAP’s success at early

identification, since drug abuse caseload is not associated with substance abuse caseload in the early, middle, or late stages of substance

abuse problems.

Reported time required to deal with substance abuse cases is distinctly

related to drug abuse caseload. Respondents were asked how much of

their time was required to deal with substance abuse cases relative to

nonsubstance abuse cases. The data indicate that the more time

substance abuse cases reportedly require, the more likely drug abuse

cases are found in the substance abuse caseload. This finding may reflect

the greater “payoff ” EAP professionals feel they receive by devoting

greater time to serious employee problems such as illegal drug abuse.

There is a trend toward a positive association between drug abuse

caseload and the proportion of substance abuse cases that come to the

EAP via supervisory referral based on a performance problem. There is,

however, a significant negative association between drugabuse caseload

and the proportion of substance abuse cases that come to the EAP

through informal supervisory referral without a documented performance problem. This finding appears to further support the importance

of the EAPS’ integration into supervisory management for employee

drug abuse cases to be a meaningful part of the EAP caseload.

Although only approaching statistical significance (.06 level), there is a

parallel negative relationship between drug abuse caseload and the

proportion of nonsubstance abuse cases that come to the EAP through

this informal supervisory referral route.

There is no relationship between drug abuse caseload and the proportion

of substance abuse cases that enter the EAP via self-referral.

There is, however, a positive association at the .08 level of significance

between drug abuse caseload and the proportion of substance abuse

cases coming to the EAP via union referrals.

There is essentially no relationship between drug abuse caseload and the

proportions of substance abuse cases associated with varying outcomes

(e.g., return to the job with satisfactory performance, left the company,

etc.).

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These data provide an overall profile of the factors associated with the

level of “drug abuse emphasis” in the caseload of a sample of internallybased EAPs. The pattern suggests that the more the EAP is geared

toward involving supervisory management, the greater the extent of

drug abuse emphasis. This finding confirms our general impressions

from research that it will be very difficult to obtain significant numbers

of employee drug abuse referrals through EAP mechanisms that are not

integrated into organizational management and that rely primarily on

self-referral.

The significant exception to this generalization stems from our observations of a number of self-referred drug abusing employees within a large

firm. In these instances, the self-referral reflected:

Supervisors and peers confronting or referring the employee

for assistance

A self-survival move by the drug abusers, who in these

instances had reached fairly late stages of addiction.

Thus, rather than representing the supposedly desirable early-stage

problem, where the social audience has no awareness, self-referrals can

represent severe late-stage difficulties, where the social audience is

aware of the problem but reluctant to take action.

Such a situation describes an EAP that is not well-integrated into

organizational functioning.

CONCLUSIONS

Building on the above data bases, we offer concluding comments about

three general areas of confusion and ambiguity associated with the

relationship between EAPs and workplace drug issues.

One of the most obvious problems in dealing with drug abuse in the

workplace is the mixed messages offered to both employers and employees regarding the intentions, philosophy, and assumptions underlying

efforts to deal with work site drug abuse.

We have conducted other research focused on public attitudes toward

drug use and abuse, and toward its treatment and management. These

data, reported in detail elsewhere (Blum, 1989; Blum et al., 1989),

indicate that the public is unexpectedly receptive toward dealing with

drug abuse problems constructively. Readiness to generalize and

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expand the EAP solution beyond alcohol was unexpectedly supported in

a 1986 survey conducted among a stratified random sample of 564 adults

representative of the State of Georgia. In that survey, we asked whether

the respondents believed that alcoholism could be treated successfully;

93 percent responded positively. A follow-up question asked whether

individuals dependent on cocaine could be successfully treated; fully 82

percent of the respondents responded positively. As researchers, we

were genuinely surprised to see this level of positive reactions to

constructive interventions directed at drug abuse problems. We have, in

fact, been told by treatment professionals that the level of such optimism

would probably have been considerably lower had we surveyed a sample

of their fellow practitioners. This finding indeed describes a readiness

to use the already successfully diffused and adopted EAP model to deal

directly with drug abuse in the workplace. By inference, there may be

considerably more public support for constructive approaches to deal

with employee drug problems rather than removing these individuals

from the workplace, and essentially, from work roles.

Second, workplaces are increasingly shying away from random drug

screening and its various legal implications, accepting instead a yetevolving philosophy of “screening for cause.” This strategy strikes close

to EAPs’ core technique of identification on the basis of deteriorating job

performance, but it is not an identical strategy. Depending upon how the

policy is introduced, it may suggest that supervisors step out of their

normal routines of monitoring performance and output, The search for

a “cause” to trigger screening of a suspected drug abuser can become a

primary motive rather than a routine supervisory matter. This can occur

within or can create a highly charged atmosphere which contrasts

sharply with the “crucial balance” of identifying a work problem while

offering constructive and humane assistance. The encouragement of

suspicion borders on a police model rather than a supervisory model. It

recalls concerns in the earliest days of EAP diffusion that they could be

inadvertently designed or perceived as “witch hunts” among the work

force. Such a design and/or perception may in turn encourage grievance

and litigation rather than joint efforts toward problem resolution and

employment maintenance.

Finally, preemployment screening for illegal drug use has become very

widespread. This increase affects drug problems for which the community will become ultimately responsible, likely in a manner that will far

exceed the costs of early intervention. The philosophy and assumptions

ofpreemployment screening curiously contradict the assumptions of onthe-job screening “for cause.” To an extent, preemployment screening

without informing or re-testing the prospective employee with a positive

illegal drug screen result is a regression to a philosophy of corporate non283
responsibility for the welfare of the community. As preemployment

screening becomes increasingly widespread, the wisdom of such a

strategy without concern for who might eventually pay for problems of

the chronically unemployed and disenfranchised deserves more thought,

In sum, EAPs can offer much in dealing with drug use and abuse

problems in the workplace. Much progress has been made in broadening

the understanding of the need to incorporate solutions beyond drug

screening. The following implications and recommendations can be

drawn from these observations and from available data:

EAPs have diffused successfully in a context of voluntarism;

and employers have adopted them without external constraints. The merits of this voluntary strategy should be

carefully considered before moving EAPs into a regulatory

environment.

Standards for EAP quality should be further developed and

enforced through EAP professionals, who are rapidly emerginginto a recognized paraprofessional group including recognized professionals.

Communication among NIDA policy professionals, those

involved in the refinement and diffusion of drug testing

technology, and the EAP community (with particular attention to including EAPs in research designs) should be facilitated through conferences, shared publications, and other

communications.

Research projects should be developed to assess the potentials of different strategies with the “hard-to-reach” work

forces(e.g., construction, mining, service workers) that likely

employ larger proportions of drug users.

Carefully designed research on the modes of referral most

effective for reaching employed drug abusers should continue and develop further. It should use samples upon which

the appropriate scope of generalization is clear.

Efforts should be developed and supported to upgrade the

quality of existing EAPs. A related goal should be an increase

in employers’ consciousness regarding the value of dealing

directly with employed drug abusers within the EAP context.

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Research should carefully assess the programmatic designs

whereby drug screening efforts are most successfully integrated with EAP activities, with a goal to maximizing organizational productivity and predictability as well as employee

welfare.

REFERENCES

Blum, T.C. New occupations and the division of labor in workplace alcoholism

programming. In: M. Galanter, ed. Recent Developments in Alcoholism.Vol.

6. New York: Plenum Press, 1988.

Blum, T.C. Chapter in this volume, 1989.

Blum, T.C. and Roman, P.M. Alcohol, drugs and EAPs: New data from a national

survey. The ALMACAN 16(5):33-36, 1986.

Blum, Terry C. and Roman, P.M. Employee assistance programs and human

resources management. In: G. R. Ferris and K. W. Rowland, eds. Research

in Personnel and Human Resources Management Vol. 7. Greenwich, CT: JAI

Press, 1989 (in press).

Blum, T.C.; Roman, P.M; and Bennett, N. Publicimagesofalcoholism: Data from

a Georgia survey. Journal of Studies on Alcohol 50,(1):5-14, 1989.

Kinman, M.L. and Roman, P.M. EAP consultants in 1982: An overview profile.

Labor-Management Journal on Alcoholism 12:65-76, 1982.

Roman, P.M. Growth and transformation in workplace alcoholism programming. In: M. Galanter, ed. Recent Developments in Alcoholism. Vol. 6, New

York: Plenum Press, 1988, pp. 131-158.

Roman, P.M. and Blum, T.C. “Drugs, the Workplace and Employee Assistance

Programs,” Paper prepared for the Committee on Substance Abuse Coverage, Institute of Medicine, National Academy of Sciences, 1989.

ACKNOWLEDGMENTS

Revised and expanded version of a presentation at the Research Conference on

Drugs in the Workplace: Research and Evaluation Data, sponsored by the

National Institute on Drug Abuse, Washington, September 16,1988. The author

acknowledges support from Grants R01-AA-07218 and R01AA-07192 from the

National Institute on Alcohol Abuse and Alcoholism for the collection, analysis

and interpretation of data included in this paper.

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AUTHOR

Paul M. Roman, Ph.D.

Professor of Sociology and Director

Center for Research on Deviance and Behavioral Health

Institute for Behavioral Research

University of Georgia

540 Boyd Graduate Studies Center

Athens, GA 30602

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Emerging Issues/Research Directions

Revisiting the Role of the Supervisor

in Employee Assistance Programs

Bradley Googins, Ph.D.

Boston University

INTRODUCTION

Since the early conceptualization of occupational alcoholism programs,

supervisors have been at the heart of the unique identification, confrontation, and intervention that we have now come to call Employee

Assistance Programs (EAPs). However, workplace strategies for intervening with drug and alcohol problems are entering new phases of

development. As the EAP field evolves over the next decade, it has an

excellent opportunity to revisit the dogma surrounding the supervisor

role, and examine its efficacy. Numerous anecdotal accounts suggest the

demise of constructive confrontation, supervisor referrals, and supervisor training. No adequate empirical data are present to prove or disprove

these claims; however, it is apparent that supervisors’ roles and involvement in EAP strategy have diminished in many quarters. The EAP,

therefore, faces at least a conceptual challenge: How essential is the

supervisor to the EAP and to what extent can we conceptualize and

operationalize an EAP without active supervisory participation? Will

the traditional models of constructive confrontation hold up, or will

supervisors become inconsequential and unnecessary to the overall EAP

strategy?

There has been unparalleled growth and development of EAPs over the

past several years, while at the same time supervisor involvement in

EAPs has diminished considerably. More intense involvement of the

supervisor is essential to the success of the EAP and the role of the

supervisor must be considerably broadened as the EAP matures and

develops. These contentions are based on conceptual clarity and empirical findings. This paper summarizes the essential research on the role

of the supervisor and the issues and obstacles they face in their essential

EAP role. The final sections will explore future directions for supervisor

participation in EAPs.

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CONCEPTUAL FOUNDATION OF SUPERVISOR

INVOLVEMENT IN EAPS

The conceptual core of the EAP was constructed within a unique

environment containing a set of elements and characteristics valuable in

identifying and moving the alcoholic (employee) into treatment. Unlike

other settings-such as the health and social service system, or even the

family—work environments, formal organizations have existing mechanisms of (1) observing performance, (2) setting standards relative to

performance, and most importantly, (3) possessing the sanctions to

enforce unacceptable behavior. Thus, work settings possess relatively

powerful tools with which to take action against drug and alcohol

problems. By contrast, other institutions must rely almost exclusively

on informal and effective relationships. EAPs have used these tools and

environmental context to identify and intervene in deteriorating job

performance through “constructive confrontation” (Trice, 1966; Trice

and Roman, 1978). When facing evidence of impaired employee performance, supervisors—as managers and overseers of productivity standards-can use constructive confrontation to identify and confront

affected employees. Through the EAP, they can offer these employees

rehabilitation for their substance abuse problems.

Identification, documentation, and referral are thus central to the role

of the supervisor. Supervisors, therefore, have constituted an essential

core of the EAP (Googins and Kurtz, 1980; Hoffman and Roman, 1984).

The “model” within which the supervisor role is depicted, appears to

constitute an ideal match between the natural structures and operations

of the workplace, and the needs of the drug and alcohol field to have a

sanctioned form of early identification and intervention. Such a sanctioned intervention provides a mechanism for breaking down denial

which is at the heart of the addiction problem and tends to impede

normal intervention.

Contructive intervention recognizes the key role of the supervisor in

work organizations. It offers a progressive process for getting at drug

and alcohol problems. The supervisor is the gatekeeper and, thus, is

ideally positioned and charged by the organization to guide the employee

toward achievingits goals. Problems such as drug and alcohol use, which

spill over into normal workday routines and impact both individual and

work group performance, need correction through supervisor intervention. The EAP and its constructive confrontation strategy, while developed for the benefit of the employee, are at the same time an alternative

resource for the supervisor in managing the problem. Without the EAP,

the supervisor and organization must rely either on a disciplinary route

or a strategy of benign neglect—neither of which offers the organization

much return on their investment in that employee.

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The strategy of supervisor involvement opens up an alternative

manner for dealing with performance problems. A progressive series of

steps begins with the supervisor identifying a performance problem,

then sitting down and discussing it with the employee. Next, depending

on the readiness and willingness of the employee, the supervisor moves

through the progressively tougher steps of constructive confrontation

and discipline. Trice and Sonnenstuhl (1987) concisely summarize the

process.

The constructive part of the informal discussions: (1) expresses emotional support and group concern about the employee’s welfare; (2)

emphasizes that group membership can be maintained if the employee

conforms in the future; and (3) suggests an alternative course of behaviors the employee can take to regain satisfactory performance.

The confrontational part of such discussions: (1) reiterates internalized

values upheld by the working groups (in this case, expectations of work

performance); (2) reminds employees that they are not fulfilling these

expectations and that sanctions will follow if expectations continue to

be violated; and (3) establishes some social distance between the

deviant employee and those group members who are meeting expectations.

Constructive confrontation, therefore, relies on the presence of a supervisor who is: (1) knowledgeable, (2) ready to exercise the role of supervisor/manager in confronting poor job performance, and (3) constructively

offers the rehabilitative assistance provided through the EAP. By

working with both the EAP and the organization’s disciplinary procedures, the supervisor is both equipped and positioned to successfully

resolve drug and alcohol problems in the best interests of both employee

and employer. This delicate balance between discipline and rehabilitation is a unique feature of intervention in substance abuse, and it

appears to be working with some degree of success. A number of studies

report that the supervisor does react to employees whose work performance is deteriorating (Trite, 1965; Kurtz et al., 1980), and, when adequately trained and knowledgeable about the program, the supervisor

does intervene and carry out the proper role (Googins and Kurtz, 1981).

Without the supervisor, the EAP becomes a counseling program similar

to any community-based program dealing with emotional, family, and

substance abuse problems. What differentiates the EAP is not only its

organizational identity and location, but its incorporation of the unique

properties of the work environment, which allow a more effective

identification and intervention with substance abusers. However, work

institutions and their policies are not the ones responsible for such

intervention-rather, supervisors are charged with the role and responsibility for monitoring and evaluating job performance. Take away the

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supervisor and you have but a traditional counseling program limited by

its reliance on the willingness of the individual to seek help. To those in

the substance abuse field, this in effect eliminates the majority of those

addicted and unable to get beyond the denial stages of the problem.

In summary, the appeal of the EAP rests largely on the logic and

simplicity on which the programs are based. Supervisors, in line with

their primary roles and responsibilities, monitor and evaluate performance. To the extent that drug and alcohol problems enter into the

workplace from external environs (and there is ample evidence this does

occur on a regular and predictable basis), the supervisor is positioned

and charged to identify and intervene along procedures carefully proscribed by corporate and legal policy. If the employee’s job performance

becomes impaired, that employee is identified and referred to the EAP

for treatment. Virtually no EAP today would dispute the centrality of

this conceptualization or deny its importance.

RESEARCH FINDINGS ON THE ROLE OF THE SUPERVISOR

A relatively healthy body of research exists within the EAP field on the

role of supervisors. In the context of EAP research, the depth and

breadth of studies focusing on the supervisor is quite robust. However,

much of the research took place in the early stages of the occupational

alcoholism and EAP movement, and few additions to this body of

knowledge have been made in the past 5 years. Moreover, the nature of

EAPs has changed dramatically during this same period. Consequently,

a paucity of research exists today on the supervisor role. This scarcity

is problematic, considering the reputed decline in supervisor referrals

and participation in EAPs. Perhaps the best method of reviewing the

existing literature is to examine two major areas: (1) the role of the

supervisor and (2) the job performance/constructive-confrontation models.

Role of the Supervisor

The role of the supervisor is one area where research has shed considerable light. The supervisor has been identified as the pivotal individual

in identifying, confronting, and referring employees whose work performance has deteriorated (Googins, 1978; Googins and Kurtz, 1980;

Trice and Beyer, 1984). However, while supervisors are a crucial link

between employees and EAPs, they have often been reluctant to refer

employees to programs. Trice (1966) identified three barriers to supervisors referring employees. They are: (1) a desire by supervisors to help

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the alcoholic worker on their own, (2) a belief that formal policy should

only be used as a last resort, and (3) supervisors’ personal attempts to

help the troubled worker.

Another study also identified several barriers to supervisors’ use of an

alcoholism program (Googins, 1978). This study, which focused on two

domains of variables—knowledge and attitude—identified three barriers to the supervisor referring problem employees to an alcoholism

program: (1) supervisors’ attitudes towards perceived effectiveness of

the EAP, (2) factual knowledge of the alcoholism program, and (3)

attitudes towards the supervisor role. Similarly, Hoffman and Roman

(1984), collected data from 84 supervisors and examined the effects of

supervisory style and experientially-based frames of reference on organizational alcoholism programs. They found that supervisors’ attitudes

towards an EAP and their supervisory style were significantly associated with the perceived degree of help given individuals referred to the

alcoholism program.

Bayer and Gerstein (1987) have recently considered ways to adapt

traditional psychosocial models of prosocial behavior to assist the supervisor overcome barriers to using EAPs. They contend that EAPs are only

effective to the extent employees utilize their services. They further

contend that supervisors, in their role as referral agents, are primarily

charged with the responsibility of identifying and intervening with

problem employees. The authors propose a bystander intervention

model (Piliavin et al., 1981) and an equity model of supervisor behavior

(Walster et al., 1978) as frameworks for better understanding some key

variables in supervisor intervention practices. The key variables which

impact supervisors’ likelihood to intervene include: (1) the nature of the

situation, (2) characteristics of the supervisor and employee, (3) the costs

of helping, and (4) the techniques used by supervisors during the

intervention.

The Job Performance/Constructive Confrontation Model

Considerable research literature has also focused on the basic model

underlying supervisor training—the job performance model. The job

performance model consists of: (1) defining program policy, (2) emphasizing the degree of management support for it, (3) explaining the role of

the supervisor in implementing it, and (4) demonstrating how it can be

integrated into supervisors’ existing responsibilities for employee job

performance(Sonnenstuhl and Trice, 1986). The rationale for this model

lies in previous attempts to train supervisors in the symptomatology of

alcoholism. These attempts failed to adequately identify alcoholics

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exhibiting symptoms. They frequently led to conflict between supervisors and employees. In addition, they did not help supervisors identify

other problems areas (i.e., marital, family, emotional, financial) which

also contribute to poor performance (Martin et al., 1986; Roman, 1981).

Within the job performance model, the supervisor is trained to identify

troubled employees on the basis of deteriorating job performance, and

then intervene with constructive-confrontation (Donovan et al., 1977;

Kellerman, 1970; Paredes, 1974; Trice, 1962; Trice and Roman, 1978).

Several studies have examined, in detail, the effectiveness of the constructive-confrontation strategy (C.F. Hilker et al., 1972; Trice and

Beyer, 1981; Trice and Beyer, 1984). Generally, these studies conclude

that this intervention strategy leads to increased employee acceptance

of treatment and a subsequent improvement in their overall job performance.

Groenveld and Shain (1985) examined constructive confrontation on a

more microscopic level by analyzing outcomes in 37 confrontation

processes. The study revealed wide disparities between the problem

employees and their supervisors. The overall supervisor-subordinate

appraisal demonstrated major disagreements between the two groups

on job performance assessments at the corrective interview and at the

follow up. Generally, supervisors continued to perceive the performance

of their employees as more impaired than did the employee group. This

ineffective communication between the two groups opens up a number

of future research projects, particularly ones that would be able to link

the absence of training to poor communication and ineffective intervention by supervisors. If nothing else, it focuses more closely on the

corrective interview at the heart of the EAP process.

Certainly, one of the strongest set of arguments favoring constructive

confrontation is its reported success. Despite the repeated flaws of the

design and methodology reported by Kurtz et al. (1985), efficacy of these

coerced or supervisory referrals have been consistently reported as high.

Franco (1960), using a time series (before-after) design to assess outcome, compared indices of job maintenance, supervisor ratings of performance, and sickness and absenteeism 3 years before and 4 years

following EAP intervention. His reported improvement rate of 72

percent has been repeated in other studies (Hilker et al., 1972; Asma et

al., 1971). In later studies, Smart (1974) and Moberg (1974) compared

groups of employees who voluntarily referred themselves for treatment

with those who were pressured by their supervisor. Both studies

reported that the coerced employees had the same outcomes as the

voluntary group. Heyman (1976), examining a group of employees from

five different work organizations with varying degrees of coercion,

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reported a significant relationship between constructive confrontation

and improved work performance “for those whose pre-program performance had deteriorated.” These findings were virtually repeated by

Freedburg and Johnston (1979) in their study of 365 alcoholic clients in

a Canadian Study.

EFFECT OF CHANGING EAP ENVIRONMENT

ON SUPERVISOR INVOLVEMENT

Research findings clearly point to the necessary and effective role of the

supervisor in EAPs. However, the changing nature of the EAP and its

work environments forces the EAP field to restudy the supervisor role in

new contexts. The traditional model that worked well under the

industrialized workplace of the 1960s may not be adequate for the

workplace of the 1990s. To better understand some of these new

dimensions, it might be helpful to examine two major issues of particular

interest to the EAP and supervisor involvement: self-referral and drug

testing.

Self-Referral

Despite the near-sacred role of the supervisor in the EAP, a growing

phenomenon has been observed over the past several years; supervisor

referrals have apparently declined dramatically, both in percentage of

cases and in absolute numbers. Self-referrals, by contrast, have increased.

The literature describes several different types of referrals. Erfurt and

Foote (1977) described supervisor referrals as a formal arrangement by

a supervisor: 1) who is not satisfied with an employee’s job performance,

and 2) wants the employee to receive help from an EAP. Informal

referrals, on the other hand, occur when supervisors, who are uncomfortable with the formal referral process, refer employees informally to the

EAP (Heyman, 1976). Finally, self-referrals occur when employees initiate their own contact with an EAP (Martin et al., 1986).

Martin et al. (1986) studied the relationship between referral types,

work performance, and employee problems. This descriptive study of

1,340 clients who used an EAP program during a 3-year period, found

that supervisor referrals accounted for only 4.7 percent of the total

referrals to EAPs; informal referrals, however, accounted for 9.6 percent. The largest number of referrals to EAPs were self-referrals,

accountingfor 85.7 percent of the total referrals. The mostcommon work

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performance problem cited through supervisor referrals was absenteeism. For informal supervisor referrals, awareness of slipping performance was the most commonly noted reason. For self-referrals, interpersonal relations problems were most frequently cited. Among employees

with alcohol and drug problems, more were self-referred than either

formally or informally referred by supervisors.

The trend away from supervisor referrals and towards self-referrals is

confirmed in a recently conducted informal telephone survey with five

EAPs: Digital, Honeywell Bull, New England Telephone, N.B.C. at

Burbank, and the National Maritime Union. Supervisor referrals at

these locations average 30 percent; 3 to 5 years earlier, 70 percent of

referrals were supervisor initiated. Despite the phenomenon’s universality, little is known about this process. Some question exists whether

there is genuine self-referral.

Obviously self-referrals were motivated to seek help by other forces. In

some cases, their supervisors leaned on them for impaired performance

that could not easily be ignored. In other cases employees may have

asked their supervisors’ or fellow workers advice and were indirectly

referred. Many observers agree that there is a high likelihood that the

majority of self referral clients actually come from supervisors or union

stewards (Trice and Beyer, 1981).

Sonnenstuhl’s process research into self-referral is one of the few

explorations into this phenomenon. He theorized that the decision to

refer oneself to the EAP resulted from “a complex network of both formal

(i.e., supervisory discussions, medical routines) and informal (i.e., cultural triggers, employee network) social controls.” In effect, the notion

of a self- referral appears to reflect socialization andinteraction between

the employee and other people.

Research literature on constructive confrontation presupposes the

supervisors’ readiness and ability to carry out their appropriate roles.

However, EAPs have had only limited success in getting supervisors to

intervene and refer employees to the EAP. Only 2-3 percent of troubled

employees are currently estimated to ever receive EAP services, leaving

the remaining 8-10 percent of the affected workforce untreated (Wrich,

1980; Both, 1981; Masi, 1984). While Bayer and Gerstein (1987) hypothesize that a lack of information and access to EAPs contribute to this

low referral and utilization rate. No research data as yet support their

contention.

Thus, self-referral has apparently become the model referral type in

most EAPs. However, the acceptance and rationale for the primacy of

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the self-referral has become troublesome to some within the EAP field.

Critics state that current trends are likely to impact program effectiveness. They suggest the traditional emphasis of EAPs—that of alcohol

and drug abuse—is being supplanted and diminished by the increasing

broadbrush approach (Roman and Blum, 1985). As a result, employees

who are becoming dependent on alcohol and drugs are now less likely to

be identified (Roman, 1981). This criticism can be linked to studies from

other settings of coercion in alcoholism. For instance, in driving-underthe-influence programs, the voluntary or self-referred client is much

more likely to drop out of treatment than the coerced client (Rosenburg

and Liftik, 1976). Heymen’s study of coercion with employed populations cast even more serious doubt about the concept of self-referral

itself:

The concept of self-referral itself is a muddied one and in the general

casework literature no significant relationship has been found between

self referral and continuance. A person referred involuntarily to an

alcoholism program must sooner or later achieve his own motivation to

remain in the program. But even if “self-referred”, he may have taken

this step only to escape coercion with his supervisor . . . Or he may refer

himself under pressure from family and friends.

Determining the motivation for referral—if left solely to a person’s

expressed reason for seeking treatment—is impossible. This obstacle,

coupled with the psychodynamics of denial, casts considerable doubt on

any possibility of true self-referral for substance abuse. Trice and

Sonnenstuhl(1987) see the concept of self-referral as a cultural distinction basic to the functioning of groups which serve as “a face saving

mechanism and an administrative category through which employees

are allowed to evade some of the pressures of the social controls that

surround them.”

Thus, self-referral is a crucial element to be examined in the role of the

supervisor for two reasons: (1) it has become widely accepted, and (2) it

has been subject to little research. By directly or indirectly promoting

the self-referral, work cultures and EAPs pass an organizational and

cultural message of a diminished supervisory role. On the other hand,

if the self-referral is a false and misleading concept, it will be even more

important to reposition and reinforce the constructive confrontation

strategy.

Drug Testing

Drug testing is a second issue directly affecting EAP referrals and the

supervisor role. The last several years have given rise to an expanding

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war on illicit drugs which has spilled into the workplace in the form of

drug screening and testing. While much attention has focused on

effectiveness, legality, and acceptance, little attention has focused on

drug testing strategies in light of EAPs. Although ideology and goals

have generated numerous conflicts, this discussion will focus on the role

of the supervisor.

To develop an approach for supervisors, the EAP had to overcome early

problems. Over the preceding decade, supervisor involvement often

exceeded the supervisor’s competence and appropriate role behavior.

Early occupational alcoholism programs had trained supervisors to

observe the early signs of alcoholism, such as bleary eyes and alcohol on

the breath. Supervisors, therefore, mistakenly began to diagnose alcoholism instead of relying on the more appropriate job performance

deterioration. Unions strongly objected to this approach, fearing witch

hunts, other misdiagnoses, and labeling. Consequently, the EAP movement developed policy, procedures, and training to reflect more appropriate identification and confrontation based on job performance measures.

Drug testing, however, partially reawakened this flawed approach of

focusing on the drug. It highlighted testing—urine analysis—thus,

separating strategy from job performance. Supervisors became part of a

system that tested employees without any linkage to the employee’s job

performance. Even the training accompanying drug testing taught

supervisors only the effects of drugs, the more technical aspects of drug

testing, and their role in preserving the chain of custody. The job

performance model so carefully crafted through the experience of the

EAP was now contradicted. The new approach required supervisors to

become more involved with drug abuse problems and less with monitoring and evaluating job performance.

The emerging drug testing strategy also created confusion for supervisors. Often, the same organization had two separate and distinct

programs for alcoholism and drug abuse. Supervisors now had to

distinguish between the two. For one drug there was an EAP, for the

others a drug testing program. The EAP as a rehabilitation component

was generally overshadowed by the attention given to testing. After

years ofeducation about the false dichotomy between alcohol and drugs,

the program now focused on drugs other than alcohol. It discounted

alcohol as if it were not a drug. Adding to the confusion, supervisors now

faced competing strategies for the same problem. The EAP had taught

supervisors to place the drug problem within a job performance framework. Drug testing, by contrast, suggested an approach that used

chemical testing, rather than job performance, to determine use. These

parallel programs may well provide more confusion than clarity. They

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may be an obstacle to any integrated program. In addition, drug testing

programs may generate distrust between employees andemployers. The

controversy may spill over into the supervisor utilization of the EAP. So

far, however, the experience is too recent to provide reliable answers to

these questions.

FUTURE DIRECTIONS

The issues above may challenge the traditional supervisor role within

the EAP. The supervisor role, as originally conceptualized within the

EAP framework, may be diminished if: (1) self-referral predominates,

and (2) the EAP continues to downplay supervisor training, while

relying more on drug testing as a primary identification of employees

with substance abuse problems. Despite these developments, there is

insufficient evidence to warrant burial of the supervisor. Certainly, the

conventional wisdom within the EAP field continues to embrace the role

of the supervisor. Perhaps both the practice and research communities

may better reexamine the role of the supervisor within a broadened

framework. Constructive confrontation alone may be inadequate to deal

with the complexity of the workplace and the dynamics of substance

abuse within this context. The role of the supervisor might best be seen

in the context of organizational integration and its evolution into a

broadened conceptualization.

Integration of EAPs

The RAP exists and operates within work organizations. Consequently,

its effectiveness is tied directly to its being perceived as an integral and

important part of the organization. On the informal level, employees

who have positive experiences in using the program help solidify its

image. However, it is the interface and use by supervisordmanagers

that integrate the program into the organization. The program’s most

important ally is the supervisor who has a positive experience in

referring an employee. Its staunchest supporter is the supervisor who

sees the EAP as an essential aid to overall management strategy. If

supervisors are ignorant of the EAP or are not sufficiently convinced of

its ability to help them achieve business goals, then the EAP will

probably remain on the organization’s periphery. While it may provide

help for individuals who reach out for it, it will not be integrated into the

organization’s mainstream.

Viewing the supervisor as a mere potential source of referral misses the

context within which supervisors and EAPs co-exist. Roman (1988) has

recently reiterated that an EAP cannot remain a program—it must

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become its own unit or department to achieve integration into the

organization. This development does not occur by rational planning

process, but through political processes. Valued members of the organization (supervisors) must be educated about the EAP’s importance to its

human resource mission and strategy. This recognition may come from

observation, program use, and training. Training produces supervisors

who are knowledgeable and ready to use the EAP; it also gains their

support, thus maximizing the influence and importance of the EAP

within the organization. Without this conscious agenda and the presence

of supervisor training, few opportunities may arise to constructively coopt the management system in integrating the EAP into the organization.

Broadened Concept of Supervisor Role

The continuing evolution of the EAP as a unique work-based intervention requires a broadened concept of supervisor participation. A number

of potentially negative factors, such as (1) the rise of the self-referral, (2)

the increase in caseloads of emotional, family, and marital problems, and

(3) the introduction of drug testing programs, may appear to work

against the basic strategies upon which the EAP was based. However,

the EAP may be evolving within a context where a range of strategies

and interventions may be appropriate for certain organizations, or for

certain subcultures or work groups within the organization.

The organizing principle for the EAP is not just the problem (drug) or the

role (supervisor)—it is the work organization as a social system. Within

that organization are multilevel drug and alcohol problems. For employees in late stages of denial, the constructive confrontation model maybe

the only effective intervention. Other employees, after confrontations by

their spouses, are ready to appear at the EAP if an outreach program is

designed for them.

Alcohol and drug abuse may often be discovered only through the

employee’s self-referral to the EAP. The alcoholic and drug abuser often

appear in community-based agencies not for treatment of the drug

problem, but for help in marital, legal, or emotional problems. If the

intake counselor can skillfully conduct an adequate drug history and

assessment, then denial of the drug problem can be dealt with, and the

real problem can be identified and treated. Thus, EAPs need not fear

self-referrals, since they can be useful in getting to the more difficult

drug problems which are mired in denial.

Self-referral versus supervisor referral through constructive confrontation may be a false dichotomy. More likely, employee problems exist

300
along a continuum. The emergence of a particular problem will probably

be determined by factors such as the nature and severity of the problem,

the cultural norms within the organization, or the readiness and awareness of the supervisors to constructively intervene. In other companies,

several work groups may operate in close systems of interdependence—

in such cases, peer referral may be the best model. Occupations and

organizations have unique cultural and structural properties which

must be respected and incorporated into EAP strategies. Similarly, the

EAP’s particular evolution within the organization also must be incorporated into the strategy. In one company, for example, where the EAP

has just been announced, it will need to build trust and awareness-thus

its ability to offer a broad set of interventions and approaches is limited.

In another company, however, where the EAP has matured over a

decade, a more sophisticated need targeting may be possible for different

sectors of the company. Recognizing the particular nature of the

organization and the evolution of its EAP enables the role of the

supervisor to be put within a broader context.

Finally, the role of the supervisor might well be placed within a context

of social networks, While work organizations are widely accepted as

social systems, EAPs have rarely utilized them to design and operate

programs. The interventions, such as education and supervisor training, have generally focused on the individual. They generally have not

recognized the social relationships and interactions cutting across the

workplace. Problems with drugs and alcohol are not simply individuals’

problems-they affect the total system. Thus, problem identification is

not just the individual supervisor’s responsibility—the natural work

group must identify, confront, and refer to treatment employees with

drug and alcohol difficulties. This method has been previously suggested

for supervisor training (Googins and Kurtz, 1982) and was well recognized in Sonnensthul’s exploration of self-referrals (1982). However,

forcing an arbitrary strategy on all workplaces may not only be ineffective and inappropriate, but ignores the basic dynamics of the social

system in the workplace.

Organizing the EAP within the framework of a social network is a more

comprehensive and realistic approach to drug and alcohol problems. It

incorporates many interventions or program types without touting one

over the other. Not unlike treatment modalities, self-referral versus

supervisor referral is not a question of preference but of appropriateness

for a particular person in a particular work setting. Supervisors should

be knowledgeable and ready to confront employees whose job performance is impaired. But union members, too, should be ready to refer their

fellow members within a peer context. Individual employees, exercising

their insight and other forms of informal coercion, should also be able to

refer themselves. All these measures can take place within the same

301
EAP and under the same EAP umbrella. If the EAP takes advantage of

the natural work and social systems already in place, it may broaden the

role of the supervisor and incorporate it more effectively.

CONCLUSIONS

The role of the supervisor today is considerably more complex than in

earlier occupational alcoholism days. Within the quickly changing

environments of the corporation and the EAP, the role of the supervisor

in EAPs has shifted, and continues to shift. However, despite these

changes, the importance of the supervisor’s role has not diminished. If

anything, it has become more important. To carry out its mission, the

EAP will require an even closer working relationship with supervisors.

This relationship will not focus exclusively on the referrals to EAP

services. The supervisor will also assist the EAP become more integrated into the corporation. The supervisor’s broader range of services

will reflect not just constructive confrontation, but more preventative

strategies that rely on informal supervisor referrals and self-referrals.

Moreover, these self-referrals may well originate from other employees

and people outside the workplace.

Despite the conceptual centrality of the supervisor, additional research

is needed to better understand the supervisor’s role within the EAP and

the particular dynamics of that role. Many questions await. What

factors encourage and discourage supervisor participation within the

EAP? How do drug testing programs affect participation? How effective

is supervisor training on referrals? To what extent are self-referrals a

product of informal supervisor activities? To what extent are self- or

supervisor referrals affected by organizational variables and organizational culture? Which factors account for successful organizational

integration of the EAP? By focusing on such research, the EAP field can

better understand and utilize the resource of the supervisor’s role within

the structure and the supervisor can more effectively assist the EAP in

realizing its mission and goals of identifying and rehabilitating employees with substance abuse problems.

REFERENCES

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of alcoholic employees. Journal of Occupational Medicine Vol. 13,1971.

Bayer, GA, and Gerstein, L. Supervisor interventions. Journal of Applied

Social Psychology, 1987.

Donovan, D. et al. Defensive style in alcoholics and non-alcoholics. Journal of

Studies on Alcohol Vol. 38,1977,

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Erfurt, J., and Foote, A. Occupational employees assistance programs for substance abuse and mental health problems. Ann Arbor Michigan: Institute

of Labor and Industrial Relations, The University of Michigan, 1977.

Franco, S.C. A company program for problem drinkers: Ten-year follow up.

Journal of Occupational Medicine Vol. 2,1960.

Freedburg, E.J., and Johnson, W.E. Changesin drinkingbehavior, employment

status, and other life areas for employed alcoholics after treatment. Journal

of Drug Issues Vol. 9, 1979.

Googins, B. “The Use and Implementation of Occupational Alcoholism Programs

by Supervisors: An Analysis of Barriers.” Ph.D. Dissertation, Florence

Heller Graduate School of Advanced Studies in Social Welfare, Brandeis

University, 1978.

Googins, B., and Kurtz, N.R. Discriminating participating and non-participating supervisors in occupational alcoholism programs. Journal of Drug

Issues 11(2), 1981.

Googins, B., and Kurtz, N.R. Factors inhibiting supervisory referrals to occupational alcoholism intervention programs. Journal of Studies on Alcohol

4(11): 1196-1208,1980.

Groenveld, J., and Shain, M. The effects of corrective interviews with alcohol

dependent employees: A study of 37 supervisor-subordinate dyads. Employee Assistance Quarterly Vol. 1(1), Fall 1985.

Heyman, M. Referral for alcoholism programs in industry: Coercive confrontation and choice. Journal of Studies on Alcoholism Vol. 2(3), 1976.

Hilker, R.J.; Fern, E.A.; and Eggert, R. A company sponsored alcoholic rehabilitation program: Ten year evaluation. Journal of Occupational Medicine Vol.

14, 1972.

Hoffman,E., and Roman, P. Effects of supervisory style andexperientiallybased

frames of reference on organizational alcoholism programs. Journal of

Studies on Alcohol 44(3): 260-267, 1984.

Kellerman, J.H. Alcoholism: A merry-go-round named denial. Addictions Vol.

17(4), 1970.

Kurtz, N.R.; Googins, B.; and Williams, C. Clients’ views of an alcoholism

program. Larbor Management Alcoholism Journal 10(3):102,107-113, 1980.

Kurtz, N.R.; Googins, B.; and Howard, W. Measuring the success of occupational

alcoholism programs. Journal of Studies on Alcohol 45(1):33-45, 1984.

Martin,D. et al. Therelationshipbetweenreferral types, work performance, and

employee problems. Employee Assistance Quarterly Vol. 1(2), 1986.

Masi, D. Developing Employee Assistance Programs. New York: American Management Associates, 1984.

Moberg, P. “Follow-up Study of Persons Referred for Inpatient Treatment from

an Industrial Alcoholism Program.” Paper prepared at Occupational Program Section, Alcohol and Drug Problems Association, Annual Meeting,

San Francisco, 1974.

Paliavin, J.J.; Dovidio, J.; Gaertner, S.; and Clark, R. HI. Emergency Intervention. New York: Academic Press, 1981.

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Parades, A Denial, deceptive maneuvers and consistency in the behavior of

alcoholics. Annals of the New York Academy of Science Vol. 233, 1974.

Roman, P.M. Corporate pacesetters making EAP progress. Alcoholism 1(4),

1981.

Roman, P.M. The necessity of integration. Employee Assistance Vol. 1(1), p. 33,

June 1988.

Rosenberg, M., and Liftik, J. Use of coercion in the outpatient treatment of

alcoholism. Journal of Studies on Alcohol 37:58-62, 1976.

Roth, R. The EAP works: A profitable new tool for the private sector. Alcoholism,

1981.

Smart, R. Employee alcoholics treated voluntarily and under constructive

coercion. Quarterly Journal of Studies of Alcoholism Vol. 35, 1974.

Sonnestuhl, W., and Trice, H. Strategies for employee assistance programs: The

crucial balance. Key Issues No. 30, ILR Press: New York State School of

Industrial and Labor Relations, Cornell University, 1986.

Trice, H. The job behaviors of problem drinkers. In: Pettman, D., and Snyder,

C., eds. Society, Culture and Drinking Patterns. New York: John Wiley and

Sons, 1962.

Trice, H. Alcoholism in America. New York: McGraw-Hill, 1966.

Trice, H. Reactions of supervisors to emotionally disturbed employees. Journal

of Occupational Medicine pp. 177-188, 1965.

Trice, H., and Beyer, J. A performance based evaluation of the constructiveconfrontation strategy: How effective is discipline? Ithaca: New York State

School of Industrial and Labor Relations, Cornell University, 1981.

Trice, H., and Beyer, J. Employee assistance programs: Blending performanceoriented and humanitarian ideologies to assist emotionally disturbed

employees. Research In Community and Mental Health Vol.4, 1984.

Trice,H.,and Roman, P. Spirits and Deamonsat Work: Alcohol and OtherDrugs

on the Job. Ithaca: Cornell University, New York State School of Industrial

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Allyn and Bacon, 1978.

AUTHOR

Bradley Googins, Ph.D.

Associate Professor

School of Social Work

264 Bay State Road

Boston University

Boston, Massachusetts 02215

304
State Legislation:

Effects on Drug Programs in Industry

Robert T. Angarola and Samia N. Rodriguez

Hyman, Phelps & McNamara, P.C.

INTRODUCTION

Recent opinion polls indicate that drug abuse is the number one concern

of the American public.1 Substance abuse not only harms the user, but

has many spillover effects: drunk drivers make lethal weapons of motor

vehicles; alcoholics cause untold misery in their homes; intravenous

drug users contribute to the spread of AIDS; criminal activity and

violence accompanies illicit drug use. The list goes on and on.

Employers are deeply concerned about the effects of substance abuse in

the workplace. Absenteeism increases; work performance is poor;

injuries on the job increase; health care costs rise; equipment is damaged

through improper operation; and non-abusing workers and members of

the public are injured. Employers are, therefore, increasingly recognizing and fulfilling a responsibility to try to ensure a drug-free workplace.

In response to these health, safety and productivity concerns, employers

have begun to set up comprehensive drug abuse prevention programs

which have, as one component, some form of employee drug testing.

Almost all major corporations now have formal substance abuse policies

and, by 1987, nearly half of the Fortune 500 companies conducted some

form of drug testing of their employees or applicants.2

But drug testing in the workplace has given rise to other concerns that

conflict with the public’s and the government’s “get tough on drugs” and

“user accountability” attitudes. Employees fear losing their jobs due to

an incorrect test result. They fear damage to their reputation and the

embarrassment of being tested for drugs. There is a sense of personal

privacy relating to activities done outside the workplace: What I do on

my own time is nobody’s business but my own.” Civil liberties organiza305
tions are concerned over invasions of privacy and possible violations of

the Constitution. Some unions fear harassment of their members.

Although it is recognized that drug testing does deter substance abuse,3

there is also an awareness of the legitimate concerns of employees. The

dramatic increase in workers’ use of drugs such as cocaine and the large

number of companies conducting testing have spurred state legislators

to introduce bills and enact laws aimed at regulating, and at times

prohibiting, some forms of drug testing in the workplace. These State

laws cover not only government employees, but private sector workers

as well. How have these States chosen to deal with the concerns over

widespread drug abuse and the use of testing to reduce this problem?

BASIC PROVISIONS OF COMPREHENSIVE STATE DRUG

TESTING LEGISLATION

As of September 1988, eight States had enacted comprehensive drug

testing laws.4 A number of these statutes were patterned after a model

bill drafted by the American Civil Liberties Union. The governors in at

least two States, Wisconsin and Maine, have vetoed legislation which

would restrict drug testing because they were concerned that these laws

would impede efforts to reduce drug abuse.5 The comprehensive State

drug testing laws have 12 basic provisions (Table 1).

1. “For Cause” Testing

With the exception of Louisiana6 and Utah, all States require that the

employer have either “probable cause” or a “reasonable suspicion” to test

an employee for the presence of drugs. Iowa not only requires that the

employer have “probable cause to believe that an employee’s faculties

are impaired on the job,” but also that the employee be “in a position

where such impairment presents a danger to the safety of the employee,

another employee, a member of the public, or the property of the

employer.”7Vermont requires “probable cause to believe the employee

is using or is under the influence of a drug on the job.”8

Minnesota requires that the employers have a “reasonable suspicion” for

drug testing, and defines it as “a basis for forming a belief based on

specific facts and rational inferences drawn from those facts”9 Rhode

Island uses the term “reasonable grounds” which must be based on

specific objective data and must lead to the belief that “the employee’s

use of controlled substances is impairing his ability to perform his job.”10

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Table 1. Comprehensive State Drug Testing Laws

Requires probable cause

or reasonable suspicion

Regulates preemployment

testing

Prohibits random testing

test

Requires confirmatory

Requires state-certified

laboratories

Requires chain of

custody procedures

Requires confidentiality

of test results

Requres pricacy in

testing process

Requires employee

assistance programs

Requires notice to

employees

Provides civil remedies

Criminal penalties

The statutes provide no guidance on the nature and quantity of the

“objective” and “specific” facts that will constitute sufficient probable

cause or reasonable grounds for testing. Stats courts or regulatory

agencies will have to provide more guidance on the meaning of these

terms.

A “Model Drug Testing in Employment Statute” considered by an

American Bar Association Committee,” lists the following as examples

when an employer may have a reasonable suspicion to conduct a test:

Direct observation of drug use and/or the physical symptoms

or manifestations of being under the influence of a drug

Abnormal conduct or erratic behavior while at work

Absenteeism, tardiness or deterioration in work performance

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A report of drug use provided by reliable and credible sources

which has been independently corroborated

Evidence that an individual has tampered with a drug test

Information that an employee has caused or contributed to

an accident while at work

Evidence that an employee is involved in the use, possession,

sale, solicitation or transfer of drugs while working or while

on the employer’s premises or operating the employer’s

vehicle, machinery or equipment.

Some State legislation does not require the existence of probable cause

or reasonable suspicion if the drug testing is part of a regularly scheduled

physical.12 However, the employee must receive advance notice that

drug testing will be part of the physical.13

2. Preemployment Testing

Five State laws also restrict preemployment testing.14 Obviously, there

cannot be a probable cause or reasonable suspicion requirement for

applicants for employment since the prospective employer has not had

the opportunity to observe the applicant. Those State legislatures that

have regulated preemployment drug testing have fashioned other types

of employer constraints.

Minnesota provides that the employer may require a job applicant to

undergo drug testing if “a job offer has been made to the applicant and

the same test is . . . required of all job applicants conditionally offered

employment for that position.”15 Vermont requires that the applicant

‘has been given an offer of employment conditioned on the applicant

receiving a negative test result” and that the applicant be given a written

notice 10 days before the test. l6 Vermont requires also that the test be

given as part of a comprehensive physical examination.17 Iowa requires

that the employer inform applicants that a drug test will be part of a

preemployment physical by including a notice in any advertisement

soliciting applicants or in the application for employment.18 In addition,

the employer must personally inform the applicant of the drug test

requirement at the first interview.19

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3. Random Testing

A minority of the States that require the existence of probable cause or

reasonable suspicion permit random drug testing under certain circumstances. Minnesota permits random testing for employees in “safetysensitive” positions20 and defines these as those “in which an impairment

caused by drugs or alcohol usage would threaten the health or safety of

any person.

”21 Connecticut permits random testing if the employee is in

a high-risk or safety-sensitive job as determined by regulations adopted

by the State’s Commissioner of Labor.22 Connecticut and Minnesota also

permit random testing if Federal law authorizes it.23 Iowa and Vermont

permit random testing only when Federal law authorizes it.24 Louisiana

and Utah impose no restrictions on random testing.

Legislators appear to have inserted these “safety-sensitive” and Federal

law exceptions to the random testingprohibition in response to concerns

over the effect that drug abuse by workers in the transportation sector

could have on public safety. The 1987 Conrail tragedy in which 16 people

were killed in a train wreck caused by a drug-impaired engineer clearly

contributed to these concerns. Many State legislators recognize that

employers should have more freedom to test when the use of drugs

carries a high risk of injury to the public at large.

4. Confirmatory Tests

All State drug testing laws require that laboratories confirm test results

before a company may discharge or otherwise discipline an employee for

testing positive for the presence of drugs. Iowa requires one confirmatory test using an alternative method of analysis and, “when possible,”

the second test should use the same test sample used for the first test.25

Connecticut and Montana require two confirmatory tests.26 Minnesota

requires one confirmatory test and provides that the employee or

applicant may request a second confirmatory test at his or her expense.27

Connecticut, Iowa, Minnesota, Montana and vermont extend the confirmatory test requirement to preemployment testing.28

5. State-Certified Laboratories

Four States require that laboratories licensed or otherwise regulated by

the State conduct the tests.29 The Minnesota and Vermont statutes

contain provisions authorizing the State Department of Health to

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license laboratories that perform employee drug tests.30 There is

pending Federal legislation to license and regulate clinical laboratories.

If enacted, this law will preempt State regulations in this area that are

less stringent than the Federal regulations implementing the law.31

6. Chain-of-Custody

Five of the eight States require the employer to follow reliable chain of

custody procedures to ensure proper recordkeeping, handling, labeling

and identification of the samples.32 Minnesota has chosen to set forth the

chain of custody procedures by regulation.33

7. Confidentiality of Test Results

Seven of the eight States require that the employer keep the test results

confidential. Iowa provides that the employer may record the test

results in the employee’s personnel record but they must be kept in

confidence.34 In addition, once the employee leaves employment, the

Iowa employer must expunge from the personnel record any reference to

the test or its results if the employee successfully completed a treatment

program for substance abuse.35 Minnesota allows the use of evidence of

a positive test result in an arbitration proceeding pursuant to a collective

bargaining agreement or in a judicial proceeding and the result may be

disclosed when Federal law requires it.36

Vermont prohibits any type of disclosure except when a court compels it

in connection with an action brought under the drug testing statute.37

The Vermont law also provides that the evidence will not be admissible

in any judicial or quasi-judicial proceeding unless the proceeding is

brought under the drug testing statute.38

Five of the eight States prohibit the use of evidence of a positive result

in a criminal proceeding against the employee.39

8. Privacy in Testing Process

Six of the eight States address the question ofprivacy when the employee

provides the testing sample. The Rhode Island statute indicates that the

employee may provide the test sample “in private, outside the presence

of any person.”40 Utah requires that samples be collected “with due

regard to the privacy of the individual.”41 Connecticut provides that no

one can directly observe an employee in the process of producing a urine

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specimen.42 The Minnesota statute directs the Department of Health to

promulgate regulations governing procedures for taking a sample “that

ensure privacy to employees and job applicants to the extent practicable,

consistent with preventing tampering with the sample.”43

Although the majority of States recognize the importance of employee

privacy in the sample collection process, they also recognize that the

employer may implement reasonable and non-intrusive procedures to

prevent tampering with the sample.

9. Employee Assistance Programs

Four States require that employers establish employee assistance programs for the treatment and rehabilitation of employees who test

positive. Iowa requires the employer to provide substance abuse evaluation and treatment (if recommended after evaluation) at the employer’s

expense.

44 The employer cannot take disciplinary action the first time

the employee tests positive if the employee undergoes a substance abuse

evaluation and successfully completes the recommended treatment.45

Minnesota also prohibits discharge before giving the employee an

opportunity to participate in a counseling or rehabilitation program, at

the employer’s expense.46 Vermont provides that the employee may be

suspended for the period of time necessary to complete the program, but

in no event longer than 3 months.47

10. Notice to Employees/Opportunity to Explain Test Results

Five States require employers to provide employees a written statement

on the employer’s substance abuse policy and drug testing program.48

When the drug testing is done as part of a regularly scheduled physical

examination, Iowa requires that the employer give the employee at least

30 days notice that a drug test will be part of the physical.49 Minnesota

requires 2 weeks written notice.50 In addition, five States also require

employers to give to the tested employee an opportunity to rebut or

explain positive test results5l

11. Civil Remedies

Five State laws provide civil remedies for the employee if the employer

fails to comply with statutory requirements. Connecticut provides that

“any aggrieved person” may enforce the statute and recover special and

general damages, attorney’s fees and costs.52 Iowa grants a cause of

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action for “affirmative relief including reinstatement or hiring, with or

without back pay, or any other equitable relief . . . including attorney fees

and court costs.”53

The Minnesota statute creates a cause of action “for any damages

allowable at law.”54 The employee may recover attorney’s fees if the

employer’s violation was knowing and reckless.55 Minnesota also authorizes the court to grant “any other equitable relief it considers

appropriate,” including reinstatement with back pay.56 Rhode Island

provides for punitive damages, actual damages, attorney’s fees and

costs.57 Vermont also provides for damages, court costs and attorney’s

fees, in addition to a civil penalty of not more than $2,000.58

Louisiana and Utah have chosen to narrow any civil remedies that may

be available to the employee. Louisiana does not create a cause of action

for damages. It does, however, recognize that a cause of action for

defamation may arise but it is limited to unauthorized disclosures based

on a false test result.59 Utah requires that any cause of action for

damages be based on a false test result, but provides that the employer

is not liable if his or her reliance on the false test result was reasonable

and in good faith. 6 0 Utah also creates a rebuttable presumption that the

test result was valid if the employer complied with the statute.61

12. Criminal Penalties

Four of the eight States make it a misdemeanor to violate the statute,

punishable by imprisonment, a fine, or both.62

General Comments on Statutory Provisions

The basic provisions of the State drug testing laws contain two underlying principles of constitutional dimensions. Although the U.S.

Constitution does not regulate the conduct of private parties, these

statutes extend the constitutional constraints imposed on government

employers to private employers as well.

The first principle is the protection of the employee’s privacy, that is, the

fourth amendment right to be free from an “unreasonable” search. It is

reflected in such provisions as the requirement of probable cause or

reasonable suspicion before testing and the provision that only employees in safety-sensitive positions be subject to random testing.

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The Constitution does not prohibit all searches, but only those that are

“unreasonable.” Drug testing in the workplace can be reasonable when

conducted pursuant to appropriate policies and procedures. Indeed, a

majority of government drug testing programs have withstood challenges that they violate the fourth amendment.63 On March 21, 1989,

the U.S. Supreme Court held that an employer in the safety-sensitive

railroad industry need not have individualized suspicion to conduct postaccident drug testing.64 The Court also upheld the constitutionality of a

drug testing program for customs employees seeking transfer to a

position involving interdiction of illegal drugs or requiring them to carry

firearms.65

The second principle embodied in the drug testing laws is fairness to the

employee. This is akin to the constitutional due process requirement. It

is reflected in such provisions as certification of testing laboratories,

chain of custody requirements, confirmatory tests and opportunity to

explain test results.

Due process arguments made against government drug testing programs generally claim that the tests are inaccurate; that the results are

insufficiently related to work performance; or that the employee was

punished without being afforded an opportunity to contest test results.

A large majority of government drug testing programs have also survived due process challenges.66 Indeed, there appears to be no question

legally that courts will accept the accuracy and reliability of test results

when employers use appropriate procedures.

CONCLUSIONS

As Table 1 indicates, five of the eight States which have enacted drug

testing laws have adopted more than half of the basic provisions

intended to protect employees, with four States adopting almost all of

them. The majority of the statutes are, therefore, focusing more on

employee rights than on the drug abuse problem. Some States have

imposed formidable barriers to drug testing, including the prohibition of

random testing for almost all job classifications and the limitation of

even “for cause” testing to only those in safety-sensitive positions. These

laws have affected some employers’ use of drug testing as one element of

a comprehensive substance abuse prevention program.

Statistics show clearly that properly instituted comprehensive substance abuse prevention programs which couple drug testing with high

313
laboratory standards, education and training programs for workers and

supervisors, and treatment and rehabilitation services for those workers

who need them, do reduce drug abuse and improve health, safety and

productivity. On the other hand, it is equally clear that companies

should not be permitted to cut comers in setting up programs which

could affect employees’ reputations and livelihoods.

No State has prohibited drug testing in the workplace. This is a

recognition that, in certain instances, employers, employees and the

public can benefit from this method of deterring drug abuse. There needs

to be a balance between the need to reduce drug abuse with the need to

protect against unreasonable actions on the part of employers. Legislators should, therefore, considerhowbest to ensure that appropriate drug

testing is not unnecessarily curtailed while encouraging employers to set

up comprehensive substance abuse prevention programs aimed at

providing a healthier, safer, and more productive workplace for all

employees.

ENDNOTES

l

 ABC News Poll, September 1988.

2Watson, “Drug Testing Laws Are Catching On,” Governing 61 (June 1988).

3

 For example, in 1981 the U.S. Navy found that 48% of its enlisted men under

25 were using drugs illegally. After implementing a comprehensive substance

abuse program which included random drug testing, drug use fell to about 3%.

See “Urine Testing for Drugs of Abuse,” NIDA Research Monograph Series No.

73, Hawks, R.L. and Chiang, C.N. (eds.) (1986).

4Connecticut, Iowa, Louisiana, Minnesota, Montana, Rhode Island, Utah and

Vermont have enacted comprehensive laws which include provisions relating

not only to testing standards but also to factors such as confidentiality, privacy

and employee assistance programs. Oregon amended its Public Health and

Safety laws to require that all drug testing be done in licensed laboratories and

that a confirmatory test be conducted in a licensed laboratory when the test

results are to be used to deprive a person of employment or benefits. Ore. S.B.

478, L.1987. In 1988, Maryland and Nebraska enacted laws similar to the

Oregon law. Maryland H.B. 1186 (signed into law on May 27,1988); Nebraska

L.B. 582 (signed into law on January 29,1988).

5

 Watson, “Drug Testing Laws Are Catching On,” Governing 61 (June 1988).

6

 The Louisiana drug testing provisions are part of that State’s workers’ compensation statute and affect only employers who have fired an employee and are

forced to defend their action when the employee files an unemployment compensation claim.

7

 Iowa Code sec. 730.5(3)(a) and (b). An alternative to the latter requirement

is if the impairment is “due to the effects of a controlled substance in violation

of a known rule of the employer.” Iowa Code sec. 730.5(3)(b).

8

 Vt. Stat. Ann., Tit. 21, sec. 513(c)(1).

314
9

 Minn. Stat. sec. 181.950(12).

10 R.I. Gen. Laws sec. 28-6.5-1(A).

11 The Alcoholism and Drug Law Reform Committee. Neither the ABA

Individual Rights and Responsibilities Section nor the American Bar Association has endorsed this model drug testing statute.

12 See, e.g., Iowa Code sec. 730.5(7); Minn. Stat. sec. 181.951(3).

1 3Id.

14 Conn. Gen. Stat. Ann. P.A. 87-551 sec. 3 (West 1988 App.); Iowa Code sec.

730.5(7); Minn. Stat. sec. 181.951(3); Mont. Code Ann. sec. 39-2-304(l)(b); Vt.

Stat. Ann., Tit. 21, sec. 512.

15 Minn. Stat. sec. 181.951(2).

16 Vt. Stat. Ann., Tit. 21, sec. 512(b)(1) and (2).

17Vt. Stat. Ann., Tit. 21, sec. 512(b)(3).

18 Iowa Code sec. 730.5(7)(a).

19 Id.

20 Minn. Stat. sec. 181.951(4).

21 Minn. Stat. sec. 181.950(13).

22 Conn. Gen. Stat. Ann. P.A. 87-551 sec. 7(2) (West 1988 App.).

23 Conn. Gen. Stat. PA. 87-551 sec. 7(1) (West 1988 App.); Minn. Stat. sec.

181.957(1).

24 Iowa Code sec. 730.5(2); Vt. Stat. Ann., Tit. 21, sec. 513(b).

25 Iowa Code sec. 730.5(3)(d).

26 Conn. Gen. Stat. Ann. P.A. 87-551 sec. 2(2) and (3) (West 1988 Supp.); Mont.

Code Ann. sec. 39-2-304(2)(e).

27 Minn. Stat. sec. 181.953(3) and (9).

28 Conn. Gen. Stat. Ann. P.A. 87-551 sec. 3(2) (West 1988 App.); Iowa Code sec.

730.5(7); Minn. Stat. sec. 181.953(3); Mont. Code Ann. sec. 39-2-304(2)(e); Vt.

Stat. Ann., Tit. 21, sec. 514(6)(A).

29 Iowa Code sec. 730.5(3)(c); La. Rev. Stat. Ann. sec. 23:1601(10)(b); Minn. Stat.

sec. 181.953(1)(a); Vt. Stat. Ann., Tit. 21, sec. 514(4).

30 Minn. Stat. sec. 181.953(1)(b)(1); Vt. Stat. Ann., Tit. 21, sec. 518.

31 H.R. 5471, 100th Cong., 2d Sees. sec. 2(p) (1988) (“Clinical Laboratory

Improvement Amendments of 1988”).

32 La. Rev. Stat. sec. 23:1601( 10)(c)(iv); Minn. Stat. sec. 181.953(5); Mont. Code

Ann. sec. 39-2-304(2)(d); Utah Code Ann. sec. 34-38-6(4); Vt. Stat. Ann., Tit. 21,

sec. 514(5).

33 Minn. Stat. sec. 181.953(1)(b)(6).

34 Iowa Code sec. 730.5(8).

35 Id.

36 Minn. Stat. sec. 181.954(3).

37Vt. Stat. Ann., Tit. 21, sec. 516(b).

38Vt. Stat. Ann., Tit. 21, sec. 516(c).

315
39 Conn. Gen. Stat. Ann. P.A. 87-551 sec. 5 (West 1988 App.); La. Rev. Stat. sec.

23:1601(10)(e); Minn. Stat. sec. 181.954(4); Utah Code Ann. sec. 34-38-13(1);Vt.

Stat. Ann., Tit. 21, sec. 516(c).

40 R.I. Gen. Laws sec. 28-6.5-1(B).

41 Utah Code Ann. sec. 34-38-6(2).

42 Conn. Gen. Stat. Ann. P.A. 87-551 sec. 4 (West 1988 App.).

43 Minn. Stat. sec. 181.953(1)(b)(3).

44 Iowa Code sec. 730.5(3)(f).

45

 Id.

46 Minn. Stat. sec. 181.953(10)(b)(1).

47 Vt. stat. Ann., Tit. 21, sec. 513(c)(3).

48 La. Rev. Stat. sec. 23:1601(10)(a); Minn. Stat. sec. 181.952(2); Mont. Code

Ann. sec. 39-2-304(2); Utah Code Ann. sec. 34-38-7; Vt. Stat. Ann., Tit. 21, sec.

514(2).

49 Iowa Code sec. 730.5(7)(b).

5o Minn. Stat. sec. 181.951(3).

51 Iowa Code sec. 730.5(3)(e); Minn. Stat. sec. 181.952(1)(5); Mont. Code Ann.

sec. 39-2-304(3); R.I. Gen. Laws sec. 28- 6.5-1(F); Vt. Stat. Ann., Tit. 21, sec.

515(a).

52 Conn. Gen. Stat. Ann. P.A. 87-551 sec. 11(a) (West 1988 App.).

53 Iowa Code sec. 730.5(9)(a).

54 Minn. Stat. sec. 181.956(2).

55 Id.

56 Minn. Stat. sec. 181.956(4).

57 R.I. Gen. Laws sec. 28-6.5-1.

58 Vt. Stat. Ann., Tit. 21, sec. 519(a) and (c).

59 La. Rev. Stat. Ann. sec. 23:1601(10)(f).

60 Utah Code Ann. sec. 34-38-10(1) and (2)(b).

61 Utah Code Ann. sec. 34-38-10(2)(a).

62 Iowa Code sec. 730.5(11); Mont. Code Ann. sec. 39-2-304(5); R.I. Gen. Laws

sec. 28-6.5-1; Vt. Stat. Ann., Tit. 21, sec. 519(d).

63 See Policeman’s Benevolent Ass’n of New Jersey v. Township of Washington,

850 F.2d 133 (3d Cir. 1988) (random testing of police does not violate fourth

amendment); Rushton v. Nebmska Public Power District, 844 F.2d 562 (8th Cir.

1988) (random testing of personnel in state-owned nuclear plant is constitutional);

Jones v. McKenzie, 833 F.2d 335 (D.C. Cir. 1987), pet. for cert. filed, Apr. 15,1988

(No. 87-1706) (where there is a clear nexus between drug testing and legitimate

safety concern, employer may test employees whose duties require direct contact

with school children as part of routine, annual physical); Shoemaker v. Handel,

795 F.2d 1136 (3d Cir.), cert. denied, 107 S.Ct. 977 (1986) (state racing commission’s random testing of jockeys does not violate fourth amendment). But see,

Luvvorn v. City of Chattanooga, 846 F.2d 1539 (6th Cir. 1988), panel decision

vacated and rehearing en banc ordered (6th Cir. Aug. 3,1988) (universal testing

of city fire fighters violates fourth amendment).

316
64 Skinner v. Railway Labor Executives Ass'n, 109 S. Ct. 1402 (1989).

65 Nat’l Treasury Employees v. von Raab, 109 S. Ct. 1384 (1989).

66 See Copeland v. Philadelphia Police Dept., 840 F.2d 1139 (3d Cir. 1988) pet.

for cert. filed, July 2,1988 (No. 88-26) (no violation of due process where officer

was aware of reason for test, was advised that he had tested positive, and was

afforded notice and hearing on charge of illegal drug use before written charges

were prepared); Everett v. Napper, 833 F.2d 1507 (11th Cir. 1987) (no due process

violation where firefighter received adequate notice and full hearing prior to

termination for failure to submit to reasonable suspicion urinalysis); Nat’l

Treasury Employees Union v. Von Raab, 816 F.2d 170 (5th Cir. 1987), aff’d on

other grounds, 109 S. Ct. 1384 (1989)(drug testing program for Customs

employees seeking transfer to sensitive positions not so unreliable as to violate

due process where follow-up test almost always accurate, Customs used proper

chain of custody procedures, and employee entitled to resubmit specimen to

laboratory of his own choosing for retesting). But see, Banks v. FAA, 687 F.2d 92

(5th Cir. 1982) (disciplinary action overturned for failure to preserve urine

sample).

AUTHORS

Robert Angarola, Esquire

Member

and

Samia N. Rodriguez, Esquire

Associate

Hyman, Phelps & McNamara, P.C.

1120 G Street, N.W.

Washington, D.C. 20005

317

Building a Cumulative Knowledge Base About

Drugs and the Workplace

Dean R. Gerstein, Ph.D.

National Academy of Sciences

Esta Grossman, M.A., M.S.W.

Washtenaw Community College

INTRODUCTION

The largest drug problem for U.S. workers and employers is the widespread overuse of two licit drugs: alcohol and tobacco (Harwood et al.,

1984; Rice, 1986). These are familiar, quotidian evils, well-known to all

generations presently living in the country. The law hedges them in but

is committed to coexistence, though the boundaries of acceptable use

vary with time. Another truce-policed by health professionals and drug

enforcement bureaus-exists with respect to prescription psychoactive

medications, which have medically accepted purposes but are also

widely abused (e.g., tranquilizers, sedatives, antidepressants, and

analgesics).

Marijuana, heroin, and cocaine are a different matter; these drugs are

emphatically proscribed. Because more urgent attention is now being

focused on these and other illegal drugs, they are the main concern of this

discussion. However, much that is said about illicit drugs is also

applicable when discussing alcohol, psychoactive medicines, and (to a

lesser extent) tobacco (Levison et al., 1983).

THE NATURE OF THE PROBLEM

The evidence on how widespread drugs are in the workplace, what the

consequences of drug use are, and what measures are effective in

preventing or reducing either drug use or its consequent problems, is

fragmentary (Backer, 1987). The research is impressive on some points

and virtually nonexistent on others. It is threatened by obsolescence due

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to the continually changing nature of drug markets, the work force, and

the workplace. Appropriate responses should be based on a consensus

about objectives and on a coherent and continuously improving body of

theory and data. Our knowledge base should cover the extent of the

problem, its individual and local impacts, and its overall systemic effects

on the workplace and on society. Recognizing all the above, dealing with

the multitude of relevant variables is a strenuous challenge to clear

thinking and rigorous investigation.

Time and place are two confounding variables. When and where drugs

are taken and manifest their effects-in what behavior patterns, in what

industry or occupation, on the job or off the job-makes a big difference

to an employer or other agent in deciding whether (and how) to intervene.

Short and Long Term Effects

Drugs have both short- and long-term effects that must be taken into

account. A sudden inability to meet minimum job requirements may

indicate the presence of drug-induced impairment, However, since

drugs often work subtly and gain control of behavior gradually, the effect

of drug consumption may be that a very promising performer stays on

the job but never reaches his or her expected potential.

Workers can also be impaired by drugs without being obviously intoxicated. Often chronic users show significant secondary effects like

depression, isolation, motor dysfunction, and family difficulties that

seriously affect job performance. Such chronic effects are often not

detected until a major incident occurs. These effects may be even more

pronounced between episodes of intoxication than during them, and they

may persist long after drug use has ended. Workers not directly under

the influence of a substance may exhibit decreased performance because

of work time spent worrying about or arranging to obtain drugs for offsite use. Individuals who enforce drug prohibitions, such as police,

prosecutors, or supervisors, but who are themselves users off the job,

may be motivationally impaired in their job performance.

The consequences of drugs depend not only on the generic effects of the

specific drug but also on the individual user, (including behavioral tolerance and genetic factors) and on the relevant job requirements, level

of supervision, and possibility to use alternative non-impairedbehaviors

to do the work. Some drugs in some individuals may produce an

increment, not a decrement in performance. For example, stimulants

may improve vigilance or reduce sensitivity to discomfort in some

320
circumstances. Other drugs, at appropriate doses, are likely to impair

the ability to detect novel events or respond rapidly or effectively to

them; but such dose levels may not degrade well- practiced routines at

all. The frequency of changes in job requirements, as well as the

seriousness of an error or delay in responding to these changes, are

important determinants of how seriously drugs may effect a workplace

setting.

Interaction Between Drug, Person, Job

It is difficult to quantify what drug levels are objectively significant in

looking at their effects in the workplace. Adverse effects result not from

one factor (the drug) alone, but from interaction between the drug, the

person, and the job. A 10 percent impairment in performance might not

be sanctioned or even noticed in a generally outstanding performer, or

in a low demand occupation, but might be job-jeopardizing or life

threatening for an individual in a high risk job (Landy, 1985).

The relation between drug use and workplace performance may also be

a two-way street. While workers may resort to drugs because of

problems outside the workplace, some kinds of workplace settings, and

specific jobs in particular, may themselves contribute to increased drug

use. For example, the prevalence of stimulant drug use among long-haul

transportation operators is legendary. In this context, the work site

might be looked at as a place to understand why people use drugs, and

how job redesign might significantly affect this behavior. It is problematic whether specific subgroups of workers are more prone to drug use,

or whether certain jobs are likely to have high drug use prevalence no

matter what type of worker fills them (Cf. Parker and Farmer, 1988).

To understand the interplay of these variables and hence the ultimate

impact of drugs on the workplace, one must be able to detect and measure drug use and drug effects in a workplace setting. This has proven to

be a difficult and challenging task for technical, social, and legal reasons.

If the proximate goal is to discover reliable connections between drug use

and changes in job performance, then a multi-step discovery process

must be completed, each step of which requires validation:

drug use other factors

behavioral changes other factors

performance impairment other factors

negative effect on work

321
Even if it is reliably established that a given type of drug use results in

a package of behavioral changes, it is still necessary to validate that such

changes result in performance impairment, and that these impairments

are not negated by other factors, but actually have a negative effect on

work. When adverse job effects are evident, it is often necessary to investigate backwards to validate that such changes were engendered by

drug use.

In sum, the problem of drugs and the workplace is very complicated. The

phenomena are not unitary, and the scientific and practical concerns are

far-ranging. Little progress can be made on the basis of individual

research efforts unless they can be cumulated. A preliminary step

toward organizing the knowledge base and developing research agendas

to fill the gaps in our understanding is to break down the subject along

two dimensions: 1) the specific practical concerns that bring govemments, corporations, and the public to support research and intervention

on these issues; and 2) the principal methods available to increase the

knowledge base. These dimensions intersect to form a matrix of important research opportunities (Figure 1). Acquiring information to fill in

this matrix will require an increased level of commitment from the

research and business communities.

Figure 1. Sources of Knowledge About Drug Use and

Consequences in the Workplace

Specific Physical

Concerns Testing Self-report

Observation

and Referral

SPECIFIC CONCERNS

Three analytically distinct, though concretely interrelated, concerns

drive the interest in drugs and the workplace: workplace safety, productivity, and health.

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Safety

Real and imaginary images of train wrecks, botched surgeries, poisonous leaks, or explosions due to drug-impaired workers highlight the

safety problem. The presumption is that drug use is strongly correlated

with impairment and poses a risk not only to the individual employee but

also to his or her coworkers and society at large. Concern is concentrated

largely in high-risk or high-precision occupations prevalent in industries such as transportation, energy, and medical care.

Productivity

Images of loose fender bolts, badly considered investments, and slow

moving, understaffed sales counters tell the productivity story. Lackadaisical attitudes, foggy thinking, and impaired physical abilities attributed to drug use may create a cumulative drag on company and

household earnings. Drug influenced increases in absenteeism, sickness, and worker turnover affect both worker output and the overall

quantity, quality, and salability of products. Drug induced mood

changes affect worker interaction. A worker who thinks that coworkers

are on drugs and hence less reliable may be unwilling, especially in high

risk, coworker-dependent occupations such as law enforcement, firefighting, and the military, to take the risks inherent in doing a good job.

Health

Finally, the health of the work force, and, by extension, society at large,

is also a driving concern. Increasing use of sick leave, skyrocketing costs

of medical benefits and disability, and high early retirement due to druginduced illnesses have a telling systemic effect on the workplace, and on

the economics of health care in general. The cost of caring for druginduced illness and disability should encourage evaluation by employers

and employees even if the specific effects of drugs on job performance are

unknown, From this perspective, the workplace may be conceived as a

powerful lever to decrease drug use in the population generally, by

encouraging or requiring healthy behavior on the job, and by encouraging the extension of these behaviors to the community. Workplace

detection programs and intolerance of drug use, as well as rehabilitative

attempts by employers, may have a measurable effect on those in the

population for whom steady work is a priority.

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DETECTION METHODS

Whatever the basis of concern about drugs, it is difficult to act on it unless

drug use can be evaluated, measured, or observed. There is currently no

universal method for detecting or documenting the effects of specific

drugtakingbehavior on specific task capabilities. Quite different methods of assay have been developed and arebeingfurther refined, but these

have varying suitabilities and limitations in illuminating the problem.

The three principal methods currently in use are physical testing, selfreport, and on-the-job observation and referral.

Testing

Urinalysis testing is currently the most widely used method for detecting

individual drug users. It is currently used to deter, prevent, and control

drug use in the workplace setting (General Accounting Office, 1988a).

Routine pre-employment drug testing or “screening” is most common,

accounting for an estimated 4 million such tests annually (versus about

1 million tests for current employees) (Bureau of Labor Statistics, 1989).

Eliminating employment of those who test positive can substantially

reduce employee applicant pools—in some sites by more than half. On

average, about 12 percent of pre-employment tests are positive, versus

about 9 percent of tests on current employees. The latter are of two

kinds. “Random” tests of full-time employees are controversial. These

kinds of testing programs generally detect drug metabolites in as few as

<1 percent or as many as 30 percent of those tested. “Probable cause” or

“incident driven” testing is carried out to confirm strongly suspected intoxication, and yields the most frequent positive results. But no epidemiological generalizations can be based on such non-routine testing(General

Accounting Office, 1988b; Bureau of Labor Statistics, 1989; Lund et al.,

1987).

Drug testing is seen as an important method of deterrence, as a way of

gaining access to problem employees in order to offer rehabilitation

programs, and as a research tool to study and understand the parameters of the problem. Although prevalence figures often decline in the

wake of screening programs, it is not clear if this is due to a real change

in drug-taking behavior or to successful methods of evasion. Testing is

very difficult to evade when it is conducted at random and wellmonitored by direct observation or by temperature measurement (Person and Ehrenkrantz, 1989).

The ability of a drug screen to demonstrate impairment is limited. A

positive drug test does not predict or prove that there are or will be

specific behavioral deficits that will affect job performance. Further324
more, the accuracy of field tests has been seriously questioned and may

make companies vulnerable to legal challenges (Council on Scientific

Affairs, 1987).

As a method of preventing drug use in the workplace, preemployment

screening may discourage drug-using applicants from applying for jobs.

From a treatment perspective, however, screening may simply engender

agrowingpool of unemployed drug users who have no access to workplacesponsored rehabilitation programs and who increase the already great

pressure on public treatment programs. Data are needed on what

happens to those excluded from work opportunities by preemployment

screening.

In sum, although urine testing is widely used by employers, especially

large ones, there is limited agreement as yet on the rationale for its use,

its legal status, the appropriate responses to positive tests, or the

epidemiological significance of these findings.

A different approach to testing for drug impairment is the performance

test. The ideal test would be a brief, readily administered task or battery

of tasks, which would evaluate performance efficiency quickly and

accurately and tell an observer whether drug intoxication is present. An

example is the recently standardized “Field sobriety test battery” used in

traffic law enforcement, with which police officers can learn to detect the

presence of moderate to high levels of alcohol or sedative drug intoxication (Bums, 1985). Unfortunately, no ready analog to these measures for

low-level alcohol/sedative presence, other drug classes, or other skills is

available.

Self-Report

Confidential self-report of drug use and its related effects by using

surveys and interviews is a major research tool. When done properly,

this method can be remarkably useful and accurate in discovering

overall rates and patterns of drug use. However, since its effectiveness

is largely predicated on anonymity, it cannot be used to deter individual

drug use or to generate referral to treatment for users. Self-report

surveys can also give some very suggestive indications about job impairment or health problems. However, these leads need to be expanded and

supplemented by an extensive research program in order to validate and

calibrate these items and their correlational significance to drug use. (A

different, non-anonymous kind of self-report is derived from individuals

who have recovered from drug dependence and as their personal responsibility seek to educate and motivate others to enter treatment for drug

problems.)

325
Observation and Referral

A very promising but sporadically utilized method of detection is observation and referral by supervisors and peers (Backer, 1987). Daily

interaction between people at work can be a powerful and abundant

source of information about drug induced impairment. It allows the

detection of subtle kinds of behavior differences that may not show up

in aggregate accident or incident data. Such incremental, early degradations of day-to-day performance over time are often characteristic of

sustained or intensifying drug use.

Awareness programs, aimed at sensitizing supervisors and workers to

the presence of drugs, may provide a checklist of “standard indicators of

difficulty” to help them recognize changes in behavior and job performance resulting from drug use. These could include task deficits as well

as more subtle impediments such as hostility, social maladaptivity, absenteeism, and stress. Without being called on to be full-fledged diagnosticians, supervisors or coworkers observing such indicators would then

have the knowledge necessary to confront a worker and refer him or her

to an agency which, using appropriately trained personnel, can better

explore the causes of the changed behavior and the relation, if any, to

drug use.

Detection by observation and referral may provide: 1) an efficient means

of early detection of drug use, and 2) a chance to prevent both future use

and performance problems on the job. Maintaining adequate records

may provide data which links specific behavioral changes and drug use

by correlating actions of referred workers and independent documentation by the agency that the impaired worker has a drug problem.

Correlations utilizing data collected in referrals can provide assessments of drug risks for specific workers and specific jobs.

The success of such an approach is based on several assumptions.

Supervisors and peers must be willing to take responsibility for evaluating each others’ performance, and must be motivated and unafraid to

assume this detection role. Four issues need to be addressed here if

intervention is to occur on a regular basis:

What are the behaviors which signal impairment?

What should be done if the marked behavior occurs?

Whose responsibility is it to notice and to respond to the

problem?

What consequences might there be for the one who does

notice and respond?

326
Supervisor and workers need the tools to detect behavior changes and

they must be convinced of the need to use them. Several factors mediate

against this. Being a taleteller is unacceptable in our culture. Although

supervisors and coworkers certainly notice changes in worker behavior,

they often do not want to consider drug use as a cause. Supervisors are

often drawn from the ranks of the workers and realize their own

vulnerability to the same problems. Poor performance evaluations may

result in punitive measures against a worker whom the supervisor and

other workers must confront on a daily basis. Appropriate referrals are

more likely when there is a therapeutic, and not simply a punitive,

component to the response.

ENHANCING THE RESEARCH BASE

The three main avenues of drug detection all provide for a better

understanding of drug abuse in the workplace. Well-designed programs

can provide both an early warning system for detecting drug abuse and

the chance to plan and initiate prevention measures. Workers, under

threat of physical drug testing or under informed scrutiny of supervisors

and coworkers, may make safer, more healthful, and more productive

decisions about drug use. Knowledge about specifics of drug use in a

given type of job or cohort of workers may be very useful as risk indicators and as a tool for redesigning parts of the workplace that may contribute to these problems. Workplace research may help us understand why

people use drugs and how the workplace might encourage or prevent

that use.

We can conceive of the concerns and methods reviewed above as forming

the intersecting rows and columns of a research grid, as in Figure 1. A

systematic research program would explore the acceptability, costs, and

utility of each of the three detection methods—actually, three constellations of methods—in addressing the respective concerns. The program

would aim to assemble cumulative findings and use this intelligence to

guide more research into those channels that prove most productive. Of

course, the productivity ofdetection leads directly to the question of what

interventions result from detection, and how effective those interventions are.

At present, there is not much data to fill in most of these cells. Data about

the incidence and effects of drug abuse overall and in particular industries and companies is not yet available. Most responses to drug and

workplace issues by industry are not based on sophisticated empirical

analyses of the problem. Instead they arise from particular incidents

327
that may dramatize the problem or from an ethical conviction or

business judgment by a company or a union that something should be

done.

Since, asnotedabove, methods of detection and correlations with specific

performance decrements are still problematic, evaluating the systemic

effects of workplace drug abuse may be best served by looking at the

changes that occur in the workplace when drug use issues are addressed.

Such outcome data dealing with overall productivity considerations and

the health of the work force may be the most useful indicator on the near

horizon about responses needed to control the problem.

Cost-Benefit Analyses

Careful cost-benefit analyses can have an important effect on business

concerns. Companies are likely to act on data that reflect costs of

untreated drug abuse among their workers. Management can be expected to ask whether it costs less to treat drug abuse than to accept or

ignore it. If a company sees that a given intervention program will

increase productivity or decrease personnel costs (e.g., less absenteeism,

health problems, or turnover) by a predictable percentage, it is more

likely to initiate that program. The technique of utility analysis may be

used to calculate the dollar payoff of having a drug detection and rehabilitation program as opposed to firing an employee and training another. Such information would seem a powerful incentive toward taking

appropriate actions.

How to best conduct such a cost-benefit analyses is still under debate. It

is far from certain that the most reliable data will indeed support the

contention that drug interventions reduce personnel costs. Even so,

intervention programs may be desirable even if there is a net cost

increase. Employees themselves may underwrite a large share of the

costs of rehabilitation through their compensation packages, and altruistic or good will motives may bear heavily on corporate personnel

decisions. Some researchers believe EAPs and related programs save

substantial amounts of money in the near term, not only by raising

productivity, but also by reducing absenteeism and health care claims,

and avoiding replacement, recruitment and training costs. Other researchers believe these types of human resource improvement programs

provide long-term payoffs and are not cost-saving for many companies

due to intrinsically high employee turnover rates and high return-oninvestment criteria.

323
Unfortunately, industry is currently not computerizing or compiling

data on drug use and drug programs, or looking for useful correlations

with specific jobs, workers, demographics, etc. Although initial EAP

referrals may be recorded, many EAPs simply close their case records

after a recovered worker has returned to the job. An encouraging change

in this situation is shown by some current efforts to link EAP data to

workers’ compensation cases. This may yield information on what types

of specific jobs and injuries may be drug-related as well as how large the

problem is in a given company, and whether rehabilitation programs can

ultimately reduce industry costs.

Licit drugs should be included in cost-benefit analyses. In 1985, there

were about 12 million users of cocaine. However, there were 140 million

users of alcohol (National Institute on Drug Abuse, 1987). Alcohol is the

critical drug in terms of workplace absenteeism and undoubtedly accounts for the majority of intoxication and addiction-related problems in

the labor force. Despite this knowledge, industry does not screen for

alcohol or for prescription and over-the-counter drugs. Most users of

illicit drugs also use licit drugs in excessive or inappropriate ways.

A possible way to circumvent some of the detailed cost-benefit issues

may be to subsume drug programs under the umbrella of “positive

health enhancement” in the workplace (Fielding and Piserchia, 1989).

In this context, drug use is not isolated behavior, but rather falls under

the category of disruptive, risk-taking behavior. This approach would

obviate the need to determine how much drug use costs the organization

in terms of dollars and organizational effectiveness, since the response

is addressed to individuals with many kinds of problems that affect the

workplace. This approach might be more attractive to employees and

supervisors. One would still, however, have to document effective

reasons for management to support general health enhancement as a

reasonable expenditure and to accept future cost-effectiveness estimates of such programs.

CONCLUSIONS

It is essential that the flow of information between researchers and the

workplace be improved and expanded. The number of appropriately

trained researchers in industrial employment is small; most academic

researchers have found it difficult to develop the necessary linkages; and

the funding for this kind of research is beginning to appear, but in small

amounts. Employees and employers need to become more knowledgeable about, and committed to, workplace research. Researchers need to

329
become more sensitive to field conditions and applications, and they

must address the differentiated concerns of workplace safety, health,

and productivity. Methods for doing extensive on-site research must be

clarified and related more systematically to these concerns.

One useful step for advancing this agenda might be to organize a council

on drugs and the workplace, which would Cross disciplinary lines and

include management, unions, clinicians, and consultants, as well as the

research community. Such a council could assist in the design and

dissemination of research applications and facilitate dialogue over the

relevant issues, not only between researchers and industry, but also

between different corporate departments and different industries.

Interactive Nature of Drugs, Individual, and Workplace

A major task for such a council would be to underscore the interactive

nature and context of drugs, individual, and workplace. It would be very

useful, for example, to disseminate effective, standardized instruments

to collect and interpret data on job performance and correlate it with

drug prevalence and intervention outcome measures. This would

include:

Developing indicator menus for performance difficulties that

can be used by peers and supervisors (e.g., ways to recognize

changes in performance over time);

Demonstrating that peers and supervisors can reliably observe such signs (with appropriate training) and will record

them, for example, in response to special keys on annual

performance reviews;

Demonstrating that many workers identified by such means

indeed have problems with drugs, using, for example, a

separate agency like an EAP to provide independent and

accessible diagnostic expertise;

Incorporating and tracking different kinds of effective,

humane systems oftreatment and discipline so that fair tests

of costs and benefits can be made.

While cross-sectional data on drug prevalence and impairment is valuable, longitudinal studies that show patterns of use might be more

helpful in differentiating how often use can be contained and how often

it leads to damages in specific work settings. Research programs should

330
be designed to investigate each link along the causal chain that connects

drug use with individual, local, and societal consequences. This kind of

systematic research might not only answer cost-benefit questions about

intervention approaches but also lead to early warning systems and

improved modes of prevention.

Cooperation of Companies in Drug/Workplace Research

A second major area to address is how to gain the cooperation of a wider

variety of companies in drug/workplace research programs. More intense study of drug effects in specific occupational and industrial

categories is needed, with a commitment to over-sample those categories

having the highest safety concerns. Feasibility considerations here

include:

Planning to ensure industry participation

Agreement on key occupational groups

Consultation with relevant regulatory and other agencies

Identification of core variables to be measured

Attention should be given to how the workplace itself affects drug use,

including how variables such as job type or design (e.g., high demand,

low resource positions) may create pressures that engender drug use. It

would be valuable to explore the possibility of subsuming drug use,

detection, and intervention under broader workplace programs of health

promotion and disease prevention. Perhaps lessons learned from successful disease- risk-reduction efforts in nutrition, exercise, and smoking cessation programs can be applied to this realm.

REFERENCES

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ACKNOWLEDGMENTS

This paper was developed largely from ideas discussed at a meeting on May 19-

20, 1988 at the Institute of Medicine, National Academy of Sciences and was

presented at the 1988 NIDA/OWI “Drugs In The Workplace”conference. We are

grateful to the participants in that meeting, who have been generous with their

time and thinking: Donald Whorton (who served as chair), Terry Blum, Enriqueta Bond, Robert Bray, Patrick Cleary, Thomas Delaney, Michael Eckert,

Steven Godwin, Steven Gust, Fred Hegge, Stephen Motowidlo, Judith Peterson,

Marty Russell, Judith Vicary, Harwin Voss, and J. Michael Walsh. We are

especially indebted to Marcelline Bums, Bruce Karrh, Frank Landy, and

Charles O’Brien, who participated in the meeting and later provided detailed

commentary on a draft of this paper. Neither the participants nor the Institute

of Medicine necessarily endorses any specific points herein; the interpretations,

opinions, and conclusions, including any errors or omissions, are the responsibility of the authors.

332
AUTHORS

Dean R. Gerstein, Ph.D.

Study Director

National Academy of Sciences

Institute of Medicine

2101 Constitution Avenue

Washington, D.C. 20418

Esta Grossman, MA., M.S.W.

Department of Biological Sciences

Washtenaw Community College

P.O. Box D-l

4800 E. Huron River Drive

Ann Arbor, Michigan 48106

333

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