This guide aims to provide practical advice to medical professionals to help you to understand and support working patients and employers to address alcohol and illicit drug use by people that work.
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What problems can illicit drink and drug use cause in the workplace?
Alcohol and drug use increases the risk of problems in the workplace such as absenteeism, presenteeism, low productivity and inappropriate behaviour.
It can impair a person's performance at work through poor decision making and impaired reaction times causing lost productivity, inferior goods or services, errors and accidents.
It is evident that individuals in employment are more likely to drink frequently compared to those who are unemployed.
Did you know?
Only about 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 use of alcohol and illicit drugs such as shift or night work, travel away from home, working remotely, business meals, poor communications and job stress.
Alcohol and illicit drug use is associated with a range of physical, psychological and social harms, which inflict an economic burden on employers, governments and society.
Did you know?
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 as a whole.
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 considered to 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 employees do?
- Employees should not attend work under the influence of alcohol or illicit drugs.
- An employee is expected to comply reasonably with the management of his or her condition.
- Employees with alcohol or drug related problems should have access to occupational health services.
What can you do as a medical professional?
- 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 use problems.
- 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 conceived as a component of 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
A policy statement should include the following elements:
The programme should apply to all employees.
Ensure early identification and treatment of problems.
Involvement in a treatment programme should be voluntary and should not prejudice an employee's job security or chances of promotion.
Personal information on employees undergoing treatment should be kept confidential.
Training, education and communication
Commit to prevent alcohol- and illicit drug-related problems in the workplace through information, education and training.
Any referrals for medical assessment may be by self-referral or manager-referral.
This should describe the duties and responsibilities of the worker during and after treatment.
The employee should not be disciplined or discharged as long as 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.
A statement that possession or dealing will be reported immediately to the police and that there is no alternative to this procedure.
What about workplace screening and testing?
A UK independent review identified some uncertainties in legal aspects with workplace drug testing (employment, health and safety, data protection, human rights and discrimination legislation).
In regard to workplace drug testing in general, the report indicates that testing related to safety-critical activities is defensible.
Alcohol and drug testing has grown as a result of practice transferred from the USA and elsewhere, and it may become more commonplace in the UK.
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 exiting legislation and guidance.
- Good communication of policy by employers to employees, and potential employees, is essential; including guidance on drug and alcohol testing regarding what, to whom and for what purpose, and 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 for testing of current employees.
- Samples for testing 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 is it important for you to get involved?
A significant proportion of adults who are at risk for problems with alcohol and illicit drug use are employed. The workplace provides good opportunities for public health interventions.
Did you know?
GPs are often the first port of call for workers wanting advice on alcohol and illicit drugs
Web-based approaches that include alcohol and illicit drugs as part of a general health promotion allow employees to access the intervention when they want, and in private, and have been shown to be effective.
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 have the most potential to be successful.
Although Employee Assistance Programmes (EAPs) are commonly used strategies to reduce problems with alcohol and illicit drug use in the workplace, these programmes are seldom evaluated, and little is known about their effectiveness.
Improving and protecting health - Alcohol
In depth - Drugs of dependence
Good Medical Practice
Driver and Vehicle Licensing Agency
DVLA - Publications
Health and Safety Executive
Driving at work - Managing work-related road safety
Faculty of Occupational Medicine
Health at work