Transcript of the Expert Interview on “Substance Misuse in the Workplace,” 

May 30, 2018 from the CDC Workplace Health Resource Center.

[BACKGROUND MUSIC]

ANNOUNCER: This expert interview is a product of the Workplace Health Resource Center 

at the Centers for Disease Control and Prevention. 

CASEY: Well, hello folks. Substance misuse, either by employees, or their family members, 

or loved ones, has a tremendous negative impact on American workers, 

workplaces, employers, and really our economy as a whole. So what should 

employers know about substance misuse? And perhaps more importantly, what can 

they do about it? Today we’re going to explore this very important intersection 

between work and the epidemic of substance misuse that is growing in our nation.

My name is Dr. L. Casey Chosewood. I’m the Director of the Office for Total Worker 

Health within the National Institute for Occupational Safety and Health. We’re part 

of the Centers for Disease Control and Prevention, or CDC. And today I’m joining 

you from our CDC headquarters in Atlanta. As I mentioned, the topic for this expert 

interview is substance misuse in the workplace. And today I’m very pleased to be 

talking with you with two very well-informed experts on the subject: Dr. Deborah 

Galvin and Dr. Laurie Cluff.

Let me just start with a brief introduction for each of them. Dr. Deborah Galvin 

works for SAMHSA: the Substance Abuse and Mental Health Services 

Administration. This is part of the U.S. government’s Department of Health and 

Human Services in Washington, D.C. Deborah serves as a federal lead for preventing 

prescription abuse in the Workplace Technical Assistance Center. Dr. Laurie Cluff is 

a workplace health and safety research psychologist at RTI International: a research 

and technical services company located in Research Triangle Park, North Carolina. 

Laurie’s work supports SAMHSA’s projects to prevent substance misuse. Let me 

start now welcoming both you Deborah and you Laurie. We’re so happy that you 

could join today for our discussion.

LAURIE: Thanks, Casey.

DEBORAH: Thank you very much. 

CASEY: Well, let’s get started. It’s certainly no surprise to many in our audience, and 

certainly no surprise at all to our experts, that the nation is really facing a public 

health crisis right now around substance misuse, and unfortunately a rapidly 

escalating increase in overdose deaths. We’re on pace now for more than 65,000

deaths in 2018. We really need your help. Can you both help our employers 

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understand the impact of substance misuse on their own workers and on their 

business as a whole? Deborah, I’m going to ask you to start us off today. 

DEBORAH: Yes, thank you. Well, substance misuse is really a growing challenge for 

American businesses. Over the last five years there’s been a rise in the misuse of 

alcohol and drugs at work, which can potentially lead to negative health, economic, 

and personal consequences for employees and their families such as: addiction, the 

risk of overdose, liver, cardiovascular, and neurological damage, emotional and 

financial stress, injury, and a slew of other harm.

The use of drugs or alcohol by employees inside or outside the office can be costly 

for businesses leading to increased turnover rates, negative workplace incidents, 

poor workplace morale, and unpredictable, defensive interpersonal relations. The 

impact on those having the problem, as well as their colleagues, is huge. According 

to findings of the Hazelden Foundation, six out of ten adults knows someone who 

has reported for work while under the influence of alcohol or drugs.

In financial terms, the National Council on Alcohol and Drug Dependence estimated 

alcohol and drug misuse cost United States businesses over $81 billion annually in 

lost productivity and it causes employers to incur a 300 percent increase in medical 

costs and benefits. In human terms, up to 40 percent of industrial fatalities and 47 

percent of industrial injuries can be linked to alcohol consumption and alcoholism.

And much more when you consider prescription drugs and illicit drugs; indeed it’s 

been estimated that those misusing opiates alone cost employers nearly twice as 

much in healthcare expenses as others: approximately $9,000 a year. Substance 

abusers are five times more likely to file a workers’ compensation claim, and also 

likely to use two and a half times more medical benefits. 

Further, according to a study by the National Drug Intelligence Center at the 

Department of Justice, substance misuse accounts for over $49 billion in reduced 

workdays. Whether in a factory, office, or driving a vehicle, employees under the 

influence of drugs or alcohol can be physically and/or mentally impaired-leading to 

reduced productivity, quality of work, customer satisfaction, and profits. 

Their drug use is related to increased accidents, legal liabilities, medical claims and 

workers’ compensation payouts, sick leave, absenteeism, product defects, misuse –

I mean missed deadlines, incomplete projects, equipment damage, loss, theft, 

selling of drugs on the job, and the cost of diverting company resources to address 

these problems, which could have been used for other purposes.

The preoccupation with obtaining and using substances also interferes with 

attention and concentration. Businesses also bear the cost of recruiting, hiring, and 

training new employees to replace those who can no longer work due to substance 

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misuse or overdose, as well as the cost of supervisors and human resource 

personnel-diverting their focus to address substance misuse issues and many other 

hidden and indirect costs. Laurie?

LAURIE: That’s right, Deborah. And just to say it another way: whether you work in 

an office, in a retail establishment, a restaurant, or a school you’re employs or your 

coworkers may be struggling right beside you with substance use problems. Just to 

throw a couple more numbers at you, about 7.2 million U.S. adult workers 

recording misusing an opioid at some point in the past year. And national surveys 

conducted by the government estimate that about three-quarters of adults who 

have a substance use disorder are employed.

So we’re not talking about people who are not in the workforce. Three-quarters of 

them are employed. Now we know that some industries have higher rates of 

employee substance misuse than others, and some of those higher-rate industries 

include construction, the arts and entertainment industry, and food service. And 

then on the other hand, some industries we know have lower rates, and these 

would include federal, state, and local government, education, and health and 

human services.

But it’s important to remember that no industry is free from these issues. So we’ve 

also done some research and we know that the industries with the highest levels of 

misuse are often male-dominated, and they often have a younger workforce. But 

even when we’ve removed the effects of gender and age, we’ve found that still 

employees in the construction, and entertainment, and food service, and other 

industries still have higher rates of misuse than some of the other industry groups.

And we know that there are factors that are just a part of some occupations that 

are associated with increased substance use risk. So some of these risk factors 

include higher than normal injury rates, high stress, exposure to traumatic events as 

part of the work, variable working hours or sometimes shift work that can disrupt 

sleep patterns, and also having really ready or easy access to drugs and alcohol.

CASEY: Thanks so much to both of you for helping paint a very clear picture of the 

challenges that really are facing employers in this space. I especially like, Laurie, 

your mention of how oftentimes difficult working conditions, really the demands of 

jobs, and how jobs are designed and the requirements of those jobs that are really 

an important risk factor for this crisis. Let’s sort of take a deeper look at this 

challenge.

Let’s sort of move to the role that employers can play in preventing this problems, 

and oftentimes workplaces are having to deal with the issue, but it’s always great 

from a public health perspective if we can swim upstream and think of ways that we 

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can actually prevent substance misuse using the structure and the power of the 

workplace, so Laurie, let me start by posing that question to you.

LAURIE: Okay, great. Well, employers are really in a unique position to help prevent 

substance misuse because work and health, as we’ve talked, about are really so 

connected. The work itself, those working conditions, as well as the opportunities 

that employees have to engage in healthy behaviors at work can affect their health, 

and of course employees’ health affects their ability to be productive while they’re 

at work. 

So one of the most basic things that an employer can do is to increase awareness 

for employees, and then maybe indirectly the employees’ families about substance 

misuse because most adults spend a significant part of their time at work this 

provides a really good opportunity for prevention messages to reach them. 

Employers can provide information to all of their employees about how to do very 

basic things like find out more about substance misuse. 

Even things like basic terminology so that they know if their teenager might be 

talking about something that is a little bit risky. Employers can provide information 

about specific risks associated with different substances as well as signs of misuse. 

They can provide their employees with information about how to get assistance, 

and this might be from an employee-assistance program that is part of the 

workplace, or it may be how to get a referral to a healthcare provider.

Employers can also help employees learn about how they could seek out some help 

to help a friend or a family member. And then if things are a little bit further along, 

they could help employees locate local substance misuse treatment options in their 

community. Deborah, did you want to talk about how workplace injuries can relate 

to opioids?

DEBORAH: Yeah, one of the things we’re really hearing a lot about in the news and 

we’re being faced with today is opioid prescription misuse and other related opioid 

issues. Opioid prescriptions are frequently provided in work-related injuries, and 

can and do frequently lead to addiction. In many cases, the psychosocial work 

environment can also lead to the need for individuals to self-medicate with opioids 

and/or other drugs. 

Other reasons people become involved include peer pressure to fit in with their 

colleagues by using drugs increasingly to relax or keep awake, enhance an activity, 

change a mood, or experiment with mind-altering drugs. Employer-based insurance 

covers a larger portion of the U.S. population than any other type of coverage. As 

payers, employers have influence over pain management treatment options, and 

can work with their benefits plan to cover alternative pain relief treatments like 

physical therapy, massage, meditation, and acupuncture.

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Employers can also work on improving job characteristics and the work 

environment to reduce work stress. In other words, they can ensure job demands 

are realistic, watch for employees working excessive hours, provide adequate pay 

and leave among other things. Employers can integrate substance misuse in a 

broader workplace wellness programming by providing materials and screening 

tools for substance misuse and mental health at health fairs, talking about 

prescription drug use in the context of healthy, sleep and stress management, and 

physical activity.

For example, SAMHSA sponsored a program called Team Awareness, which a 

customizable worksite prevention training program that addresses behavioral risk 

associated with substance abuse among employees, their coworkers, and indirectly 

their families. The training, which was done by Joel Bennett and is also through his 

company, seeks to promote social health and increased communication between 

workers, improve knowledge about and attitudes towards alcohol and drug-related

protective factors in the workplace such as company policy and employee assistant 

programs, or EAPs, that increase peer referral behaviors.

Stigma differentiates substance misuse from other diseases, and is primarily what 

can make seeking assistance and other resources or the return to work so difficult 

for an individual who has become addicted. Persons receiving addiction treatment 

face many challenges in obtaining and maintaining employment, with stigma being 

a major issue. An array of resources are crucial in this area, including funding for 

supportive employment programs and appropriate staff to deliver employment 

services.

Employers can also consider other proactive strategies: supporting a drug-free 

workplace, offering an employee assistance program or an EAP, then preventative 

evidence-based programs including peer support or social health, and health 

promotion, programs such as Team Awareness, which I described previously, Team 

Resilience, Operation RedBlock, and SmartRx. Many of these can be found at the 

SAMHSA website.

Different worksites may have different requirements including positions requiring 

regulated drug testing. So according to the business and what is available through 

that business, a wide variety of programs are out there that can and do act as 

proactive means to reduce substance misuse.

CASEY: Thanks very, very much, Deborah. That’s excellent information. We’re talking about 

how challenging this problem is, but what I’m hearing from you both is there is a 

tremendous amount that employers can do to move to better working conditions 

and appropriate interventions to actually health prevent substance misuse-so really 

valuable information. Deborah, also I appreciate you mentioning stigma because 

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that is oftentimes raised as quite a challenge when employers are ready to take the 

next step.

And perhaps that also applies to the worry that some employers have about, “Oh 

my heavens, and I going to follow all the rules and regulations, and the privacy 

concerns that might come up if I delve into this topic of substance misuse?” So 

Laurie, let me direct this question to you. What regulations or laws should 

employers keep in mind when they’re thinking about intervening around substance 

misuse for their workers?

LAURIE: Alright, well we can kinda scratch the surface here, and I should say I am not 

a lawyer, but a few things to keep in mind: federal worksites and federal 

contractors, as well as some physicians that are safety sensitive or security 

sensitive, are required to have a drug-free workplace policy, but all employers need 

to be aware of regulations related to the Americans with Disabilities Act, the Civil 

Rights Act, the Family and Medical Leave Act, and in some cases other laws that 

may differ by state, for example recreational or medical cannabis laws.

So hiring managers and supervisors also need to be aware at a very basic level of

what they’re even allowed to ask employees about medical conditions they may 

have, and their use of prescription drugs, and what the hiring manager and the 

supervisors are allowed to ask even vary on the stage of the hiring process that the 

employee’s at compared to when they’re actually an employee of the organization.

So there are some clear guidelines on the SAMHSA Division of Workplace Programs

site, but I would say it’s worthwhile when putting a substance use policy or program 

in place to consult with an employment attorney. As with any other workplace 

matter, it’s critical to protect employees’ privacy, to provide training on any policies 

that are put in place, and of course to enforce the rules equally. And again I would 

really suggest taking a peek at the Division of Workplace Programs site because 

they do have some useful details on legal requirements.

CASEY: Thank you very much for that, Laurie. Very, very informative. Let’s imagine now 

that our listeners today are really ready to take that next step. So they’re looking 

for a few key strategies-a handful of things that they can put in place sort of as a 

first step to move in the right direction to help address this crisis. Let me start with 

you, Laurie again: what are some key strategies that employers - really regardless 

size, regardless of industry or occupation, what are some key strategies they can 

implement right away in this space?

LAURIE: Okay, well, one of the first things that we recommend is that if an employer 

doesn’t already have a substance use policy – a written substance use policy, it 

should develop a written policy customized for its organization. So many existing 

policies out there don’t explicitly cover prescription drug misuse or cannabis 

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misuse, and these policies need to be updated. A written policy helps an employer 

have a record of the organization’s efforts, as well as a reference if an employee or 

their legal representation challenges that policy.

So it may also protect the employer from certain kinds of claims made by 

employees. So in brief, a drug policy usually includes the goals or the statement of 

the policy’s purpose, how it defines - how the organization defines substance 

misuse, what behaviors are prohibited, when and where the policy applies, which 

employees are covered – so things may differ based on international employees 

versus domestic, or contractors versus permanent employees. 

And then the policy also would cover what consequences of violating it are. And 

there are templates and examples available online. I kind of did a quick Google and 

several sites came up so it doesn’t have to be something that is really difficult to do 

or that you have to start from scratch on this. So we’ve also touched on this, but all 

employers can also train management and employees on substance misuse risks.

This is pretty low-hanging fruit, I think. Familiarize employees and managers with 

the specifics of any substance abuse policies that are in place, as well as what 

substance misuse prevention strategies and programs are available to them at that 

workplace. Maybe they’re already saying there, for example, an employee 

assistance program that are just kind of under the radar. Employees don’t know 

about it or don’t know how to access it, and it’s really a resource that’s already in 

place. 

The employer is already paying for it, so it’s important for things like in the EAP to 

be promoted, and make sure that employees know that it’s a confidential service, 

and know what services are available and how to access those services. Employers 

can provide training and support to managers and supervisors on how to recognize 

and appropriately address any kind of suspected substance misuse. 

Another thing to consider is to provide training for staff on how to obtain and 

administer Naloxone, which is of course, the opioid overdose-reversible drug, and 

some employers might want to consider having it available on-site, particularly for 

workplaces that have a lot of interactions with the general public-it may be a 

lifesaving small piece of equipment to have on-site if somebody’s trained to use it.

And then to reiterate a point that Deborah made earlier, and that you kind of 

followed up on, Casey, all employers can work to create a workplace environment 

that does not stigmatize substance use or substance misuse. One way to help do 

this is by making substance misuse part of their overall wellness or health 

promotion program-so just kind of building it into something that people are kind of 

already expecting and already used to.

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It’s important to promote any trainings or materials related to substance misuse to 

all employees at all levels so that no group or certain type of employee is singled 

out for this kind of training. And part of getting rid of the stigma is to try to 

normalize discussions about substance misuse because we know and we’re hearing 

more about it every day that misuse and addiction does affect all types of people. 

So Deborah, do you want to talk about structuring benefits packages?

DEBORAH: Sure, thank you. Benefits package needs to cover the misuse of drugs and 

alcohol, and in the past many corporations and businesses just fired people who got 

addicted to an illicit drug and/or a prescription drug. Today we see that it’s to our 

advantage to provide a structured benefit package to shift away from reliance on 

only firing people, but to keep them and to provide the kinds of comprehensive 

management to reduce the problems of opioids and/or other drugs and alcohol. 

There’s growing evidence with opioids for example, that there are evidence-based 

non-pharmacological options that are very good at reducing pain and getting at 

issues where people before got addicted to drugs can now use other resources. 

These treatment management and alleviation of pain methodologies can be used 

on their own or in combination with drug therapies. Therapies which hold promise 

include acupuncture, massage, osteopathic and chiropractic manipulation, 

meditative movement therapies, Tai chi, yoga, mind-body behavioral interventions, 

and dietary components, and self-care and self-efficacy strategies.

Additionally, there is a new to enhance substance misuse support services such as 

confidential screening, counseling, treatment, peer support groups, meditation, 

assisted therapies, and follow up treatment and recovery services. We need to 

provide and enhance return-to-work programs following a drug misuse incident 

including return-to-work agreements, outlining expectations, online training and 

resources, helpline and community resources, collaboration with human resources, 

drug testing specifications, and privacy adherence.

So there’s a whole range of services that can be provided to people who are 

employees to try to reduce the impact of becoming addicted.

CASEY: Wow, thanks so much to both of you. These strategies are exceptional, and it was 

really a lot of information so I’ll take just a moment to help summarize some of 

those key sort of outputs that you mentioned that employers can actually put in 

place. First of all, Laurie, you started off by talking about the importance of a 

workplace substance use policy-sort of just setting the stage for discussion and 

program development in this area.

You talked about training management and employees on substance misuse riskgiving them the skills they need to not only recognize, but to really be able to 

intervene, if they find that the challenge exists. Laurie reminded us that the 

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employee assistance program or EAP programs can play a very valuable role in this 

setting. And making sure employees know about that benefit – it’s quite common in 

most workplaces, promote that benefit and make sure employees know how to 

access the benefit.

You both told us about providing the right training and support to managers and 

supervisors on recognizing suspected substance misuse, and how to address 

working conditions and injury risks so that pain and injury are far less likely to occur 

so there’s no need for as much opioid use in the workplace setting. And then you 

also talked to us about making sure that we’re addressing stigma.

By folding in our programming with ongoing wellbeing and health promotion 

activities within the workplace, and Deborah, you did a great job of reminding us of 

the power of benefits design, and how structuring benefits can also encourage 

people to approach pain and injury with non-pharmacological means, and making 

sure that we enhance the support services that are available for people who make 

be struggling with substance misuse.

And finally, you ended the discussion on these key strategies to everybody by 

talking about giving assistance to those workers who do have injury, or illness, or 

absence, and enhancing our return-to-work strategies. So extremely valuable input 

that I think will definitely be actionable for many of those listening to us today. So in 

our remaining time together, I just have one final question for you.

And Deborah, I will start with you here. What are some key resources that really 

have a strong evidence base that you would consider high-quality resources to help 

employers address this information, and where do they go for more information?

DEBORAH: We have a large number of programs that we’ve funded in the past. Some of 

them have become programs that are well known and have been now utilized 

across the nation in many situations such as Team Awareness. Many of these 

resources have been written up and can be found at the SAMHSA workplace 

website, which is at http://www.samhsa.gov/workplace, and our phone numbers 

are there. People can call us and talk to us about what’s written, and we can 

provide a lot more information for particular types of programs, types of industries, 

specific needs, different drugs, alcohol, and whatever.

Additionally, there are a wide range of federal and nonfederal organizations that 

offer key resources in this area including the Centers for Disease Control, the 

National Institute of Health, the National Institute of Drug Abuse, and places like 

SHRM, which is the Society of Human Resources and Management, along with 

Employee Assistance Program Association, and other places. Many of these can be 

found on the Internet and can be accessed that way. 

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We’re happy to send people off to particular locations if they have specific needs, 

and we’re available to assist in this fashion on any issue related to substance misuse 

in the workplace. 

CASEY: Thank you so much for those great resources, and once again, the website for 

SAMHSA is www.samhsa.gov/workplace. And remember SAMHSA is S-A-M-H-S-A. 

Folks, I have enjoyed our conversation today. I think what you shared is really 

beneficial for employers who are seeking to do the best possible work they can in 

this space for their workers. Taking care of our workers - our people - is a critical

way to make our businesses more successful. 

And you’ve given folks some wonderful ways to intervene today. So, Deborah and 

Laurie, I want to thank you both. This has been so informative. Thank you for joining 

me today. 

DEBORAH: Thank you.

LAURIE: Thanks.

CASEY: Well, folks that concludes today’s interview. I’d like to thank all of you in our 

audience for listening. I hope you use the information shared by Deborah and 

Laurie to take steps to meet head on the challenge of substance misuse among 

workers in our nation’s workplaces. On behalf of CDC’s Workplace Health Resource 

Center, thank you for making workplace health your business. I am Dr. Casey 

Chosewood. Have a great day. 

[BACKGROUND MUSIC]

ANNOUNCER: To find free, credible resources for creating healthy work environments, visit 

CDC’s Workplace Health Resource Center at CDC.gov/whrc. It’s a one stop shop 

with hundreds of resources, including case studies, evidenced based summaries, 

issue briefs, tools for small businesses, webinars, videos, and more.

If you’d like more information about CDC’s Workplace Health Resource Center, 

send an email to workplacehealth@cdc.gov. And we’ll follow up with you.

The opinions expressed in this recorded interview are those of the guest speakers 

and do not necessarily represent the official position of the Centers for Disease 

Control and Prevention.

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