Assess Your Workplace

Workplaces nationwide are affected by alcohol and other drug use. The ways they are affected can be complex and difficult to address. However, many employers have successfully prevented or reduced alcohol- and other drug-related problems in the workplace by taking a few simple, affordable steps.

This section of the Workplace Kit is designed to help you complete a drug-free workplace needs assessment, so you can determine whether alcohol and other drugs are affecting your workplace. It will help you identify your resources and strengths, examine appropriate policy and program options, and begin taking the steps that are right for your workplace to prevent and reduce alcohol- and other drug-related problems.

Does your workplace have problems attributable
to alcohol or other drug abuse?

Most people who abuse alcohol or other drugs are not out of work and living on the streets. They are employed. Therefore, it is entirely possible that workplace alcohol and other drug problems may be affecting your employees’ health, safety, and productivity.

Most Illicit Drug Users and Heavy Alcohol Drinkers Have Jobs

• SAMHSA’s National Survey on Drug Use and Health found that roughly 75 percent of the estimated 16.4 million illicit drug users ages 18 or older are employed full or part time.[1]
  
  
• The same survey found that most binge drinkers and heavy alcohol users are employed. Of adult binge drinkers,[2] 79.3 percent (41.2 million people) are employed either full or part time. Of adult heavy drinkers,[3] 79.5 percent (12.7 million people) are employed.[4]

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Workplace Substance Abuse Can Cause Other Problems in the Workplace

Use of illicit drugs, alcohol abuse, and misuse of prescription drugs can have negative effects on our daily lives. And people with drug and alcohol problems are not likely to leave those problems behind when they come to work.

In a large study of illicit drug use in highly educated employees, 42 percent of respondents reported using mood-altering prescription drugs.[5]

Issues with drug use are not limited to illicit drugs. Nonmedical use of prescription drugs continues to be a concern. In the 2004 National Survey on Drug Use and Health, 6 million people were current users of psychotherapeutic drugs taken nonmedically.[6] SAMHSA’s Drug Abuse Warning Network reported that of the nearly 2 million drug-related emergency department visits in 2004, over 25 percent were related to nonmedical use of prescription and over-the-counter pharmaceuticals.[7]

Workplace alcohol use and impairment affect an estimated 15 percent of the U.S. workforce, or 19.2 million workers.[8]

More than 7 percent of American workers drink during the workday, mostly at lunch. And even more, 9 percent, have nursed a hangover in the workplace.[9]

In a 2002 survey of health-related behaviors among military personnel, 17 percent admitted to loss of productivity attributable to alcohol.[10]

Drinking doesn’t have to occur at work to affect one’s job. Hangovers account for many workplace productivity losses.[11]

On-the-job drug use can lead to an increased risk of accidents and injuries.[12, 13] It can also lead to lower levels of productivity and employee morale, not only for those with substance abuse problems but also those working alongside them.[14]

The addictions of coworkers’ family members may also affect the workplace. In a national survey of employees, more than one third said that at least one of their coworkers had been distracted, less productive, or missed work because of alcohol or other drug addiction in their family.[15]

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Workplace Substance Abuse Can Be Particularly Damaging to Small Businesses

One drug-abusing employee can have a major impact on a small business that has only a few employees. In addition, small businesses are less likely to have drug-free workplace policies or programs (such as drug testing) in place. This may be why many drug users work in smaller establishments. For example, among those who are employed full-time and also current illicit drug users:[16]

• 44 percent work for establishments employing 1–24 persons
  
• 43 percent work for establishments employing 25–499
  
• 13 percent work for establishments employing 500 or more

Workplace Substance Abuse Can Be Particularly Dangerous in Safety-Sensitive Industries

The effects of substance abuse can be life threatening, especially in businesses where safety is a major concern, such as the transportation and nuclear power industries. For this reason, Federal and State laws address drug use in workplaces, especially in the context of safety, and impose requirements for drug-free workplace policies and programs, including drug testing.

Why aren’t alcohol and other drug problems more noticeable?

People Tend Not to Talk About Their Substance Abuse Problems

This is understandable for several reasons. First, the use of illegal substances is, of course, illegal. It
is easy to understand that many people do not want to talk freely and openly about behaviors that can get
them into trouble with the law. Second, substance abuse behaviors can get out of control, especially when
they have become addictive behaviors. Many people do not wish to talk about how they have lost control.
Third, substance abuse can impair one’s mental and physical capabilities. Many workers do not want to talk
openly, especially in front of their supervisors, about their loss of capabilities to do their jobs.
Finally, substance-dependent people are often in denial about their addictions. Thus, they often have
difficulty relating the problems that they are having to the drugs that they are using.

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Alcohol and Other Drug Problems Don’t Always
Look Like Alcohol and Other Drug Problems

On the one hand, absenteeism, tardiness, embezzlement, theft, damaged inventory, production problems,
sexual harassment, violence, and bullying—these may not look like substance abuse problems, but in many
companies they are.

Don’t Be Too Quick to Judge

On the other hand, you should not assume that these other problems are always alcohol and drug problems. For example, if a worker is constantly tired and has bloodshot eyes, he or she may not have an alcohol or drug problem. Instead, that person may be sick, have allergies, or be working a second job. Further, your employee may not be the one using or abusing drugs. He or she may be in a relationship with someone who is. Caring for an addicted person can take a huge toll in terms of stress, time, and money.

Do you think you can identify and reduce
alcohol and drug problems in the workplace?

Ignorance Is Not Bliss

The widespread lack of understanding about how substance abuse can be connected to other workplace problems can make it difficult for employers to even recognize that they have such problems in their workplaces. Such inaccurate or distorted beliefs can also hinder efforts to address and reduce workplace substance abuse problems.[17, 18]

First, Try to Understand

As an employer, you should understand the nature of your workplace, the major problems and strengths that are affecting them, and the possible ways in which alcohol and drug abuse may be contributing to some of those problems. This is not necessarily easy. It requires that you look at your workplace through others’ eyes. You need to see what they see, and try to understand what they are doing and why.

Then, Try to Reduce the Specific Problems You Have in Your Workplace

Armed with this understanding, you will be better able to put into place a drug-free workplace policy and program that will fit the needs of your workplace and employees. And you will be more likely to be effective in dealing with the kinds of substance abuse–related problems you may have.

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A Drug-Free Workplace Can Be a Safe, Healthy, and Productive Workplace

The workplace is not the appropriate setting in which to address all health and behavior problems. But it is an excellent place for addressing problems that are directly affecting the health, safety, and productivity of your employees.

But Try to Balance Workplace Needs for Productivity With
Employees’ Needs for Safety, Health, Privacy, and Confidentiality

There is a delicate line between private behavior that does not affect work performance and private behavior that does. Employers are not law enforcement officers, nor are they family doctors. But employers have broad responsibilities for their employees and workplaces. They need to pay attention to the possibility that alcohol and other drug use could be adversely affecting workers’ health, safety, and productivity. For some workplaces, there are laws that clearly prohibit the use of alcohol or drugs. And some of those laws also prescribe drug-free workplace policies and programs that require drug testing, with clear consequences (such as required treatment or termination of employment) for those who test positive.

What steps can you take to begin to assess
alcohol and drug problems in your workplace?

Here are a few of the major steps you can take to assess the nature and extent of the alcohol and other drug problems (if any) in your workplace:

Don’t Make Snap Judgments

As noted above, drug problems may not look like drug problems, and drug abusers may not look like drug abusers. The converse also is true. What could look like an alcohol or other drug problem, such as red eyes and weariness, may, in fact, be an illness, a response to a prescribed medication, or any number of other things. So don’t jump to conclusions.

Get Help From Others

Because appearances can be deceiving, and because these are complicated issues that play out differently for different people, you probably should get help from others in your workplace. Do not try to do it all on your own. Spend time talking with supervisors and nonsupervisory employees about how best to proceed. Cooperation, collaboration, and shared responsibility are the cornerstones of a successful drug-free workplace policy and program. When doing a needs assessment, you should involve all major segments of your workforce. No one person will understand what is happening throughout the workplace, unless that workplace is quite small (see “Build a Team”). Make sure the members of the team are representative of the rest of your employees, reflecting their racial, ethnic, and cultural diversity. Employees will be better able to cooperate in improving the workplace if they are brought into the process early on.

In addition, if you suspect that there are significant alcohol and drug problems that may be costing the organization a lot of money in lost productivity or absenteeism or damaged products and the like, you may choose to bring in an outside expert. A professional can help you design a formal study that is tailored to the particular circumstances and needs of your workplace.

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Take Your Time

Many of us are in a hurry to get things done. We want a solution to a problem right away, even though the quick solution may not be the correct solution. Taking enough time to understand the situation thoroughly will help you target your efforts and resources where you need them most. Taking enough time can allow you do something that will make a real impact.

Ask Some Key Questions

When you start to assess the drug-related problems in your workplace, you will find it helpful to ask some key questions of yourself. For example:

• “Is there legislation for which I am accountable?” (See “Understand the Legal Requirements.”)
  
  
• “Do I have employees in safety-sensitive roles (or example, employees who drive vehicles, operate machinery, handle chemicals, or work with the public—particularly with children)?”
  
  
• “Do I have employees in jobs that are security sensitive—for example, employees who are responsible for confidential ideas, products, plans, or documents; employees who are responsible for financial accounting, cash, inventory, or stock; or employees who work offsite, such as traveling salespersons, home workers, or home health care workers?”
  
  
• “Do certain employees perform key functions of my organization—such as accountants who handle large sums of money; salespersons who represent the organization; employees who monitor computers, nuclear power dials, and the like; or supervisors who manage many employees?”

Understand the Connections Between Drug Abuse and Other Problems

Because drug abuse can be connected to all sorts of other problems, you may not want to deal with drug-abuse problems in total isolation from the other problems. For example, if drug abuse is being caused or exacerbated by extraordinary stress, whether at work or at home, there may well be something you can do to help reduce the stress, and thus reduce the use and abuse of drugs. You may be able to spot ways in which you can reduce stress at work. And you may be able to suggest resources in the community from which employees can obtain help regarding how to reduce stress at home. And if drug abuse is contributing to other problems—such as tardiness, poor work quality, fights in the workplace, or fights at home—then you will want to address those other problems as well, both as concerns in their own right and as issues that are connected to alcohol and other drug abuse.

Does a Needs Assessment Have to Be Costly?

While a formal assessment conducted by an outside expert may be the gold standard, a drug-free workplace needs assessment does not have to be elaborate or costly. Particularly for workplaces with limited resources, you probably can get the information, insight, and understanding that you need in relatively simple and inexpensive ways. You can do some of this by encouraging employees to explore how you can all work together to improve the health, safety, productivity, and quality of life in the workplace. By concentrating on a set of goals that are broader than just “the reduction or elimination of drug abuse in the workplace,” you may be able to get more cooperation for doing things that actually will reduce or eliminate drugs in the workplace. However, if the problems and the costs seem significant, you may opt to invest more resources in a more definitive study.

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Make It Relevant to the Policy and Program You Later Develop

Try to learn as much as you can about the drug, and drug-related, problems in your workplace. You will then be in a better position to plan and implement your drug-free workplace policy and program, and meet any legal requirements. In addition, you will be better able to significantly improve the health, safety, productivity, and quality of life in your workplace.

If you have legal requirements for a drug-free workplace policy and program, and you comply with those requirements, you will reduce the chances that you will get into legal trouble—for two reasons: First, you will be meeting the requirements of the law. Second, you will be able to reduce drug-related accidents and the liability issues and lawsuits that can arise from such accidents.

If, in addition to meeting the legal requirements, you put in place a drug-free workplace policy and program that are guided by a thorough assessment of the problems and needs in your workplace, you are even more likely to get good results, in the form of reduced drug use and related problems.

Use Quantitative and Qualitative Techniques for a Fuller Understanding

As a general rule, quantitative approaches rely on “objective” survey questionnaires and statistical analyses, while qualitative approaches use observations, in-depth interviews, and focus groups to identify and contextualize” human behavior.

Quantitative approaches have their strengths. Wherever possible, you will benefit by being able to clearly identify and quantify the problems. But many of these problems will be difficult to identify and even more difficult to quantify.[19, 20]

So do not overlook the value of more qualitative approaches, such as talking to people confidentially and in meetings where you can share ideas in more general ways. Specific quantitative and qualitative techniques that you may want to use are briefly described in the next section.

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Why is it important to use systematic quantitative
and qualitative approaches to assess your situation?

Anecdotal Information Will Never Be Enough

One of the most widely used approaches for collecting information about the need for a drug-free workplace policy and program is simply to ask around.[21] However, there are severe limitations to relying on anecdotal information. First, you won’t know if what you hear is true. And, if it is true for the folks you talk to, you won’t know if it is true for others. If you don’t have a more definitive sense of what the problems are, you won’t know how to address them, and you won’t know whether what you are doing is working.

More Systematic Approaches Have Proven Helpful

A more systematic and in-depth examination of the workplace and its operations will prove to be a more effective way of assessing how to approach the issue. Taking steps to gather quantitative and qualitative information from the very beginning will help you identify the issues relevant to your workplace. It will also help you evaluate any activities you have undertaken to address those issues.

Social scientists are finding benefits to using both quantitative and qualitative approaches to develop a more in-depth and authentic understanding of human behavior and experience.

Human resource managers often use quantitative and qualitative methods from social science to identify the strengths and needs of a workplace.[22, 23]

Many employers also have found it useful to gather and analyze both qualitative and quantitative data to assess their workplace’s strengths and to highlight areas for improvement.[24] Using as many information sources as possible—with the goal of targeting resources and specific issues—is the best way to get the results you seek.

What are the basic qualitative methods you can use?

Qualitative methods

• Are usually a good place to start when beginning to assess a situation
  
  
• Can be quite useful for describing a situation and uncovering “unknowns”
  
  
• Can help give the examiner the appropriate language and attitudes not only to describe but also to tailor needed interventions

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Observe Workers and Workplace Situations Directly

While this should not be your only measure, much can be determined by simply watching your employees (see “Prepare the Workplace—What Supervisors Can Do”). When using this method, understand that behaviors may be changed by the very act of observing. The subject who knows he or she is under observation is typically more self-conscious than usual—at least at first. Along with training your supervisors to become more aware of problems and strengths, you may want to bring in a professional who has been trained to do this more objectively.

Discuss the Issues in Regular Management Meetings

You can also talk about drug and alcohol issues in your regular meetings with your managers and other supervisors. Raising the issue of drug use in the context of health, safety, and productivity may help everyone understand that a drug-free workplace can contribute to outcomes that are important to your employees, in both their workday lives and as private citizens. In addition, you can clearly discuss the requirements, if any, of any drug-free workplace legislation or regulations that apply to your workplace, and the importance of a sensible assessment of needs and problems to the development of a policy and a program that actually contribute to the well-being of your employees and your workplace.

Convene Focus Groups

In addition to discussions in regular management meetings, you may want to convene focus groups. The groups could consist of supervisors and nonsupervisory employees, and they could discuss drug and alcohol issues, especially in the context of the promotion of health, safety, and productivity in your workplace. It will be useful, in most cases, to begin with a facilitator and a predetermined set of questions, but then to allow an informal discussion to ensue. This method has two advantages.

First, it allows the facilitator to structure his or her interactions with the group members, by asking a set of agreed-on questions and then following up, as appropriate, based on responses. This allows for in-depth probing of issues that may be specific to your workplace and employees. And it yields greater details in the responses.

Second, it allows for interaction among the members of the group. This interaction often stimulates further discussion and uncovers unanticipated issues and insights.

Have One-On-One Interviews

When conducted by a trained and objective facilitator, one-on-one interviews can often provide a greater depth of knowledge, a richness of real-life experience, and a more honest account of a situation. The disadvantage of this approach is that it offers only one viewpoint. It is important to take this into account. The experience of one person, or of a few persons, may not be the experience of the entire organization, but it may provide extremely useful insights and help in identifying other issues and areas that deserve investigation.

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Consult With Experts

Consulting with experts can be extremely helpful in gaining a broader perspective of the issues you may be facing in your particular workplace. You should consult with people who know your industry well, who are familiar with your employees, and who know the issues surrounding substance use in the workplace. These could include researchers, union representatives, employee assistance representatives, or human resource persons in other companies.

What are the basic quantitative methods you can use?

Quantitative methods are useful in that they often take less time to administer than qualitative methods, and they often are easier to evaluate. They also produce clearer, more objective results.

Review and Analyze Preexisting Records

In the workplace, this type of data gathering usually takes the form of statistics that have already been collected for other purposes. These are easy to obtain and to compare. The following have all been linked to substance use.[25, 26, 27, 28, 29]

• Absenteeism (especially on Mondays, Fridays, and the days after holidays)
  
  
• Turnover (especially for some specific kinds of jobs or workers)
  
  
• Inventory loss (“shrinkage” attributable to theft, damage, etc.)
  
  
• High rates of accidents (resulting in serious injuries or deaths)
  
  
• Workers’ compensation costs
  
  
• Disciplinary actions
  
  
• Garnishment

Conduct and Analyze Self-Report Surveys

Self-report surveys are often used to assess situations—though they have to be correctly designed and administered, to ensure an acceptable degree of objectivity. There are resources that offer well-tested questions that you can access online (usually for a nominal fee). To assess the needs and strengths of your workplace, you might ask questions such as the following (which were adapted from a 1996 survey done by a partnership between the Gallup Organization and the Institute for a Drug-Free Workplace):[30]

• “Do you feel safe at work?”
  
  
• “Have you ever personally seen or heard of any illicit on-the-job drug use by your coworkers?”
  
  
• “Does your employer have a policy regarding workplace drug use?”
  
  
• “Do you think your workplace would benefit from a workplace drug policy and program?”
  

Some researchers use alcohol-screening surveys such as the Alcohol Use Disorders Identification Test (AUDIT), which was developed by the World Health Organization, and the CAGE questionnaire, which was developed by researchers at the University of North Carolina. Both instruments are widely respected alcohol screening tools.

The AUDIT is a short questionnaire that asks about consumption, problems associated with dependence, and other problems that might also be a result of regular use or intoxication.[31]

The CAGE is a four-item questionnaire that measures alcohol dependency. The name of the questionnaire, CAGE, is a mnemonic for attempts to cut down on drinking, annoyance with criticisms about drinking, guilt about drinking, and using alcohol as an eyeopener.[32]

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Researchers interested in exploring issues of illicit drug use in the workplace have long been concerned about the validity of self-reported drug and alcohol use.[33, 34] Despite assurances of confidentiality and anonymity, employees may underreport substance use owing to fears about disciplinary action or job loss.

Test for Drug Use With Chemical Methods

Chemical testing, such as urinalysis, is a more objective approach to assessing whether there is a drug abuse problem in the workplace. For some workplaces, especially those for which there are significant safety or security issues, drug testing is required by law. For most workplaces, drug testing is optional. It can be done at different points in the employment process—for example, for applicants or for those who are already employed. It can be done for some or all workers—for example, for safety-sensitive positions only, or for all workers. Because drug testing costs money, you may choose not to use this method for assessment. (For detailed information on drug testing, see “Identify Issues.”)

How can you do ongoing assessments in an assessment cycle?

Once the guiding principles have been formulated and understood, you can develop an assessment cycle.
For example:

1. Articulate the goals of the drug-free workplace policy and program and develop a set of objectives that should lead to the accomplishment of those goals. The goals may be as simple as responding to the legislation requirements.
   
   
2. Design strategies that will accomplish the objectives with the resources available. (See Plan and Implement a Program.)
   
   
3. Determine the kinds of activities and accomplishments for which you will be evaluating change. Select assessment methods that can measure your workplace’s progress toward achieving your objectives and goals. And measure not only the outcomes but also the processes that contribute to those outcomes. (See “Evaluate the Program.”)
   
   
4. Gather assessment data, and summarize and interpret the results.
   
   
5. Use the results of the assessment to continually improve processes and outcomes.
   
   
6. As appropriate, revise your goals and objectives, review and revise your strategies and approaches, continue to gather qualitative and quantitative data, and assess how you are doing.

For more information about how to assess and evaluate the costs and cost benefits of having (or not having) a Drug-Free Workplace policy and program, see
http://www.dwp.samhsa.gov/YIW/Pages/Cost%20Analysis.aspx.

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References

1. U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Office of Applied Studies. 2005. Results From the 2004 National Survey on Drug Use and Health: National Findings. Rockville, Maryland.
   
2. Binge use—five or more drinks on the same occasion (i.e., at the same time or within a couple of hours of one another) at least once in the past 30 days (includes heavy use).
   
3. Heavy use—five or more drinks on the same occasion on at least 5 different days in the past 30.
   
4. U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Office of Applied Studies. 2005. Results from the 2004 National Survey on Drug Use and Health: National Findings. Rockville, Maryland.
   
5. Robert A. Matano, Stanley F. Wanat, Darrah Westrup, Cheryl Koopman, Shelly D. Whitsell. 2002. “Prevalence of Alcohol and Drug Use in a Highly Educated Workforce.” Journal of Behavioral Health Services Research 29(1):30–44.
   
6. Ibid.
   
7. U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Office of Applied Studies. 2006. Drug Abuse Warning Network, 2004: National Estimates of Drug-Related Emergency Department Visits. DAWN Series D–28, DHHS Publication No. (SMA) 06–4143. Rockville, Maryland.
   
8. Michael R. Frone. 2006. “Prevalence and Distribution of Alcohol Use and Impairment in the Workplace: A U.S. National Survey.” Journal of Studies of Alcohol 76:147–56.
   
9. Ibid.
   
10. Robert M. Bray, Laurel L. Hourani, Kristine L. Rae, Jill A. Dever, Janice M. Brown, Amy A. Vincus, Michael R. Pemberton, Mary Ellen Marsden, Dorothy L. Faulkner, and Russ Vandermaas–Peeler. 2002. Highlights: Department of Defense Survey of Health Related Behaviors Among Military Personnel. Available online at http://www.tricare.osd.mil/main/news/DoDSurvey.htm#pna/.
    
11. Roland S. Moore. 1998. “The Hangover: An Ambiguous Concept in Workplace Alcohol Policy.” Contemporary Drug Problems 25(1):49–63.
    
12. M. Bernstein and J.J. Mahoney. 1989. “Management Perspectives on Alcoholism: The Employer’s Stake in Alcoholism Treatment.” Occupational Medicine 4(2):223–32.
    
13. Michael R. Frone. 1998. “Predictors of Work Injuries Among Employed Adolescents.” Journal of Applied Psychology 83:565–79.
14. Michael R. Frone. 1999. “Work Stress and Alcohol Use.” Alcohol Research and Health 23(4):285–91.
    
15. Hazelden. 2005. “Employees Report Coworkers Are Less Productive Due to Substance Abuse or Addiction Within Family.” Available at http://www.hazelden.org/web/landing.view/.
    
16. U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Prevention, Division of Workplace Programs. 1999. “Annual Survey of Federal Agency Drug-Free Workplace—1997.”
    
17. Thomas W. Mangione, Jonathan Howland, and Marianne Lee. 1998. “New Perspectives for Worksite Alcohol Strategies: Results From a Corporate Drinking Study.” Boston, Massachusetts: JSI Research and Training Institute, Inc.
    
18. Institute for a Drug-Free Workplace. 1996. What American Employees Think About Drug Abuse. Available at http://www.drugfreeworkplace.org/survey.htm/.
    
19. Sandra Lapham, Garnett McMillan, and Cindy Gregory. 2003. “Impact of an Alcohol Misuse Intervention for Health Care Workers—2: Employee Assistance Program Utilization, On-the-Job Injuries, Job Loss, and Health Services Utilization.” Alcohol and Alcoholism 38(2):183–88.
    
20. Rebecca Spicer, Valerie Nelkin, Ted Miller, and Les Becker. 2004. “Using Corporate Data in Workplace Program Evaluation.” American Journal of Evaluation 25(1): 109–19.
    
21. Stephen M. Colarelli. 2003. No Best Way: An Evolutionary Perspective on Human Resource Management. Westport, Connecticut: Praeger.
    
22. Ibid.
    
23. Dana Gaines Robinson and James C. Robinson. 1989. Training for Impact: How to Link Training to Business Needs and Measure the Results. San Francisco, California: Jossey Bass Publishers.
    
24. For more detail about methodological issues regarding substance abuse research in the workplace, see Rebekah K. Hersch, Royer F. Cook, Diane K. Deitz, and James V. Trudeau. 2000. “Methodological Issues in Workplace Substance Abuse Prevention.” Journal of Behavioral Health Services and Research 27(2):144–51.
    
25. William Foster and Roger D. Vaughan, 2005. “Absenteeism and Business Costs: Does Substance Abuse Matter?” Journal of Substance Abuse Treatment 28(1):27–33.
    
26. Robert M. Bray, Laurel L. Hourani, Kristine L. Rae, Jill A. Dever, Janice M. Brown, Amy A. Vincus, Michael R. Pemberton, Mary Ellen Marsden, Dorothy L. Faulkner, and Russ Vandermaas–Peeler. 2002. Highlights: Department of Defense Survey of Health Related Behaviors Among Military Personnel. Available at http://www.tricare.osd.mil/main/news/DoDSurvey.htm#pna/.
    
27. Jeffrey G. Wiese, Michael G. Shlipak, and Warren S. Browner. 2000. “The Alcohol Hangover.” Annals of Internal Medicine 132(11):897–902.
    
28. Thomas W. Mangione, Jonathan Howland, and Marianne Lee. 1998. “New Perspectives for Worksite Alcohol Strategies: Results From a Corporate Drinking Study.” Boston, Massachusetts: JSI
    
29. ———. 1999. “Alcohol and Work: Results From a Corporate Drinking Study.” In Robert Wood Johnson Foundation. Combating Substance Abuse.
    
30. Institute for a Drug-Free Workplace. 1996. What American Employees Think About Drug Abuse. Available at http://www.drugfreeworkplace.org/survey.htm/.
    
31. John B. Saunders, Olaf G. Aasland, Thomas F. Babor, Juan R. De La Fuente, and Marcus Grant. 1993. “Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO Collaborative Project on Early Detection of Persons With Harmful Alcohol Consumption—Vol. 2.” Addiction 88:791–804.
    
32. John Ewing. 1984. “Detecting Alcoholism: The CAGE Questionnaire.” Journal of the American Medical Association 252:1905–07.
    
33. Royer F. Cook, Alan D. Bernstein, and C.M. Andrews. 1997. “Assessing Drug Use in the Workplace: A Comparison of Self-Report, Urinalysis, and Hair Analysis.” In L. Harrison and A. Hughes (eds.). The Validity of Self-Reported Drug Use: Improving the Accuracy of Survey Estimates. NIDA Research Monograph 167. NIH Pub. No. 96–4147. Rockville, Maryland: National Institute on Drug Abuse 247–72.
    
34. Wayne E.K. Lehman and D. Dwayne Simpson. 1992. “Employee Substance Use and On-the-Job Behaviors.” Journal of Applied Psychology 77(3).

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