Understanding substance use disorder in the workplace
In the modern world, many of us will spend an enormous percentage of our lives at our workplaces. Whether you are employed as the worker on the floor of a car manufacturing plant or run your own clothing store in the neighborhood, your work will likely consume a significant amount of your time, space, and energy. This is why, when we speak about Substance Use Disorder (SUD), it is imperative that we speak about how addiction, trauma, and treatment affect and are affected by the workplace.
Obtaining tangible research on the prevalence of SUD in the workplace is difficult, as few employees (and even fewer bosses) are willing to honestly admit to abusing alcohol, or prescription or illicit drugs while they are at work. Nevertheless, there is good evidence to suggest that not only is substance abuse at work becoming increasingly prevalent but also that SUD in the workplace is linked to a number of other confounding factors including mental health conditions, environmental stressors, and feelings of usefulness and meaning at work.
Here, we will briefly outline the state of research around Substance Use Disorder in the workplace in the United States and globally as well as explore the complex connections between health and environmental factors and the likelihood of substance abuse at work.
Re-defining Substance Abuse within the Workplace
The stereotype of a frequent drug user – often reinforced by popular culture – is that of an unemployed, often transient or otherwise socially detached individual who relies on others for support. Few would associate successful office employees with substance abuse, much less teachers, doctors, or other professionals. Yet, according to data from the federal Substance Abuse and Mental Health Services Administration (SAMHSA), around 70% of adults with an alcohol or illicit use disorder are employed.  This means that, far from being an issue of the disaffected on the fringes of society, drug and alcohol abuse are extremely prevalent—and relevant—issues that affect all of us in our day-to-day lives.
Another interesting statistic from SAMHSA: in 2020, 40.3 million people in the United States had a Substance Use Disorder; 28.3 million of which were alcohol use disorder and 18.4 million of which were drug use disorder. Together, this data suggest a crisis of untreated SUD within the American workforce.
America is not alone in this. Research published in the 2020 volume Living with Drugs looks at the prevalence of and issues around drug use in the workplace in France.  The author links drug abuse at work to a number of social and psychological factors, including the pressures from periods of intensive work, the desire for a therapeutic or celebratory “release,” and, of course, pre-existing mental health conditions such as anxiety and depression.
Studies conducted among workers in Egypt also indicate a strong link between SUD in the workplace and psychiatric or personality disorders.  “Workers with SUD were 19 times more likely to have psychiatric disorders than workers without SUD,” indicating a shocking correlation between psychiatric disorders and substance use and abuse in the workplace. (244)
All of this indicates that SUD within the workplace presents a major public health problem both nationally and globally. So how can we change our approach to treatment to account for the prevalence of substance use and abuse within a workplace environment?
New Approaches to Workplace SUD
Drugs and alcohol testing have historically been the ways workplaces have addressed SUD within their populations, but they may not be the best way to approach the issue for long-term change. A 2020 study examining drug testing within the airline industry found that when employers tested pilots at a higher percentage per year, a smaller number of them tested positive for alcohol.  However, the authors of this research are quick to point out – and rightly so – that one study alone can’t prove that testing has a deterrent effect.
There is better evidence to suggest that approaches that focus on honesty, support, and the overall self will be more effective in addressing SUD in the workplace. Research conducted by Organizational Wellness Learning Systems has indicated that the best tools to prevent workplace substance abuse are those that use a well-being framework.  This means working from evidence-based models that focus on the whole individual.
Open-door policies – where employees are not punished for speaking about personal problems with drugs and alcohol or for asking for help from an employer – are an excellent approach that foregrounds well-being. This aligns with 2020 research that shows that employer-led interventions into office substance abuse are, in fact, both useful and effective. 
Learning about the nature of treatment for both mental health conditions and for substance abuse disorders is critical for employers who wish to take this approach to interventions in the workplace. By encouraging communication and honesty and by providing a safe space in which to express issues, employers can cultivate a holistic environment which minimizes triggers and maximizes opportunities to change.
 Substance Abuse and Mental Health Services Administration. (2021). Key substance use and mental health indicators in the United States: Results from the 2020 National Survey on Drug Use and Health (HHS Publication No. PEP21-07-01-003, NSDUH Series H-56). Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration. Retrieved from https://www.samhsa.gov/data/
 Fontaine, A. (2020) ’18 – The Issues of Psychotropic Drug Use in the Workplace: Working Drug Users or Workers Who Use Drugs?’ in Stella, A., & Coppel, A. (2020). Living with drugs. ISTE Press Ltd. pp. 259-274. https://doi.org/10.1016/B978-1-78548-317-2.50018-0
 Bassiony, M M.., Ibrahim, A.F. & Youssef, U.M. (2020) Association Between Dual Diagnosis and Drug-Related Problems in Workplace in Egypt: A Case-Control Study in International Journal of Mental Health and Addiction (2021) 19:240–251 https://doi.org/10.1007/s11469-019-00170-6
 Els, C. el al (2020) Random drug and alcohol testing for preventing injury in workers. Cochrane Database Syst Rev. 2020 Dec; 2020(12): CD012921. Published online 2020 Dec 27. doi: 10.1002/14651858.CD012921.pub2
 Bennett, J. (2021) New Study Demonstrates Efficacy of Online Well-Being Program in Preventing Substance Abuse Among Working Adults. Organizational Wellness Learning Systems.
 Akanbi, M.O. et a. (2020) A systematic review of the effectiveness of employer-led interventions for drug misuse. J Occup Health. 2020 Jan-Dec; 62(1): e12133. Published online 2020 Jun 13. doi: 10.1002/1348-9585.12133