​Alcohol and drug dependency in the workplace: a guide for medical professionals

Our report aims to provide practical advice to medical professionals, employers and employees to help understand and deal with the effects of alcohol and illicit drugs at work.

Location: UK
Audience: GPs Occupational health doctors
Updated: Tuesday 8 September 2020
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Alcohol and drug use increase the risk of absenteeism, presenteeism, low productivity and inappropriate behaviour. It can impair performance at work through poor decision making and impaired reaction times causing lost productivity, inferior goods or services, errors and accidents.


Did you know
  • Approximately one in seven of the workforce has access to a qualified occupational physician.
  • Individuals in managerial and professional occupations are likely to drink more frequently than those in routine and manual occupations.
  • Certain working situations and conditions are associated with the use of alcohol and illicit drugs such as shift or night work, working away from home, working remotely, business meals, poor communication and job stress.
  • Alcohol and illicit drug use are associated with a range of physical, psychological and social harms, which inflict an economic burden on employers, governments and society.
  • Medical professionals who support workplaces are well placed to offer education and training on substance misuse issues.
  • The limited data and lack of accurate or standardised methodologies for measuring presenteeism and accidents linked to alcohol or illicit drug use makes it difficult to estimate these costs accurately. However, the burden is substantial to workers, business, and society and to economies.

What can employers do?

  • Employers have a general duty under the Health and Safety at Work etc Act 1974 to ensure, as far as is reasonably practicable, the health, safety and welfare at work of their employees.
  • It is advisable for employers to have an alcohol and drug (substance use) policy.
  • Managers and supervisors should be trained to recognise the signs of problems with alcohol and illicit drug use. They should know what to do if they suspect an employee has a problem or if they are approached by an employee who declares a problem.
  • Alcohol and illicit drug problems should be health problems and dealt with strict confidentiality. 
  • Sickness absence will be authorised if indicated. Absence relating to alcohol or illicit drug use will be treated no differently to absence from any other cause under absence policies.


What can medical professionals do?

  • Medical professionals who support workplaces are well placed to offer health education for workers and training for managers and supervisors about how to recognise and deal with substance misuse.
  • Workplaces provide venues and captive audiences for health education and opportunities to identify individuals who have problems with alcohol and drug use.
  • Alcohol and illicit drug use are significant contributory factors in serious and fatal road traffic crashes. Workers with illicit drug or alcohol problems who drive (or their doctors) have a duty to declare these to the DVLA.
  • Where a medical professional is asked for advice by an employer, they must establish the capacity in which they are being asked and make clear to patients their professional role.
  • Medical professionals should seek to understand the employer's alcohol and drug use policy (e.g. does it apply to all employees or just those in safety critical roles? what support is available to employees?).
  • Except where they are legally mandated medical professionals should avoid applying arbitrary abstinence periods to people who are returning to work.


What does a drink and drugs policy look like?

Drug policies are more successful when they are a component of a health and welfare policy rather than primarily a disciplinary matter.

A workplace alcohol and illicit drug use policy will normally define what is meant by use, and include statements on:

  • why the policy exists
  • to whom it applies
  • the rules regarding alcohol and illicit drugs
  • the support available to employees who have a drug problem
  • encouraging those with a problem to seek help voluntarily.


What should a policy statement include?

  1. Coverage
    The programme should apply to all employees.
  2. Timely intervention
    Ensure early identification and treatment of problems.
  3. Participation
    Involvement in a treatment programme should be voluntary and should not prejudice an employee's job security or chances of promotion.
  4. Confidentiality
    Personal information on employees undergoing treatment should be kept confidential.
  5. Training, education and communication
    Commit to prevent alcohol- and illicit drug-related problems in the workplace through information, education and training.
  6. Referrals
    Any referrals for medical assessment may be by self-referral or manager-referral.
  7. Reintegration
    This should describe the duties and responsibilities of the worker during and after treatment.
  8. Discipline
    The employee should not be disciplined or discharged if he or she participates in rehabilitation and is progressing towards an acceptable level of job performance. Failure to comply may result in disciplinary action up to and including dismissal.
  9. Legal duty
    A statement that possession or dealing will be reported immediately to the police and that there is no alternative to this procedure.

Workplace screening and testing

A UK independent review identified some uncertainties in the legal aspects of workplace drug testing (employment, health and safety, data protection, human rights and discrimination legislation).

About workplace drug testing in general, the report indicates that testing related to safety-critical activities is defensible.

Alcohol and drug testing are practices commonplace in the USA and elsewhere.

Its effect in reducing occupational injuries remains unclear despite some robust reviews of the evidence.

Advice on workplace screening and testing

  • A robust alcohol and illicit drug use policy needs to be in place to avoid any potential pitfalls and to comply with existing legislation and guidance.
  • Good communication of the policy by employers to employees and potential employees is essential, including guidance on drug and alcohol testing (regarding what, to who and for what purpose), the consequences of refusal and the essential elements of informed consent for that testing.
  • Employers may use alcohol and drug testing at the recruitment stage and to test current employees.
  • Testing samples must be appropriately safeguarded, where appropriate, and tested by appropriate facilities.
  • Interpretation of results must be undertaken by practitioners who have the competence for the task (often referred to as medical review officers).
  • Results and advice should comply with medical best practice and data protection requirements.


Why should you get involved?

A significant number of adults who are at risk of drug and alcohol problems are employed. Therefore the workplace is a good opportunity for public health interventions.

A brief intervention approach that involves a personal assessment of an individual's drinking rates and related problems, as well as feedback about health risks, is likely to be the most successful.

Although employee assistance programmes are commonly used to reduce problems with alcohol and illicit drug use in the workplace, they are rarely evaluated and little is known about their effectiveness.