LABOR ORGANIZATIONS

A Guide for Unions to Help Deal With Substance Use Disorders

Substance use disorders affect millions of Americans, many of whom are employed. In 2004 alone, 77.6 percent of adults (or 15.7 million people) with substance use disorders were employed.¹ While companies can offer their employees support and provide an accommodating alcohol- and drug-free workplace, labor organizations can offer assistance to their members on a variety of health, welfare, and safety issues, including substance use disorders.²

I traveled down the road of addiction. For several years, my life revolved around drugs and my addiction. Then I came upon a rehabilitation program and it forever changed my life. After graduating from the program, I knew there was a great need for people who were struggling with a drug or alcohol addiction. That is why I chose to give back to society and be one of the founding members of a rehabilitation program. In 16 years, it has become the premier rehabilitation and international training center. I am proud to be the executive director and help so many people rediscover their lives. Gary Smith Executive Director		In 2004, 12.5 percent of wage and salary workers were union members. Considering the high percentage of employees with substance use disorders, it is likely that union members are affected.3 Yet help is available. People in recovery can and do rejoin their jobs, their families, and their lives in their communities. As union leaders assess how to offer support to union members, it is important to consider ways to protect the health and well-being of members who have, or know someone who has, a substance use disorder or is in recovery. As many as 74 percent of Americans say that addiction to alcohol has had some impact on them at some point in their lives, whether it was their own personal addiction, that of a friend or family member, or any other experience with addiction.4 By understanding the characteristics of substance use disorders and the treatment options that can be offered to members, labor organizations can play a key role in making sure these benefits are available.

Substance use disorders are comprised of the dependence on or abuse of alcohol and legal/illegal drugs. Dependence on and abuse of alcohol and illicit drugs, which include the nonmedical use of prescription drugs, are defined using the American Psychiatric Association's criteria specified in the Diagnostic and Statistical Manual of Mental Disorders, 4^th edition (DSM-IV). Dependence indicates a more severe substance problem than abuse; individuals are classified with abuse of a certain substance only if they are not dependent on the substance.⁵ For more information on the criteria used in defining dependence and abuse, consult the 2004 National Survey on Drug Use and Health, which is available on the Web at www.oas.samhsa.gov/nsduh.htm.

Much has been written about substance abuse, dependence, and addiction; many studies have used different terminology to explain their findings. To foster greater understanding and avoid perpetuating the stigma associated with these conditions, the phrase "substance use disorders" is used as an umbrella term to encompass all of these concepts.

The following sections of this document provide further information about substance use disorders, the role of organized labor in fighting these disorders, and tools to help assist members who need treatment.

The Impact of Substance Use Disorders on Workers and the Effectiveness of Treatment

Substance use disorders affect people from all walks of life, including people who are employed. According to a 2005 Hazelden Foundation survey, more than 69 percent of employed people indicated that if a family member were struggling with abuse or addiction, it would negatively affect their ability to concentrate and be productive at work. In fact, 36 percent of people who are employed admitted that at least one of their coworkers had been distracted, less productive, or missed work because of alcohol/drug abuse or addiction within their family.⁶

Substance use disorders also affect coworkers and other close associates. Everyone in a business, from upper management to entry-level staff, is affected when someone has a substance use disorder:

• Substance use disorders are estimated to cost American businesses approximately $81 billion in lost productivity each year.⁷
• Alcoholism is estimated to cause 500 million lost workdays annually.⁸

Fortunately, treatment can be particularly beneficial, both for employees and their employers. Like other chronic disorders, substance use disorders are medical conditions that can be treated.⁹ A major study published in the Journal of the American Medical Association in 2000 is one of several studies demonstrating the success of treatments for substance use disorders. Treatment of both mental and substance use disorders can help prevent the exacerbation of other health problems, such as cardiac and pulmonary diseases, according to the Substance Abuse and Mental Health Services Administration's (SAMHSA's) Report to Congress on the Prevention and Treatment of Co-occurring Substance Abuse Disorders and Mental Health Disorders in 2002.¹⁰

Additionally, a key message for labor organizations to communicate to employers is that treatment for substance use disorders has substantial benefits for businesses. Reported job problems, including incomplete work, absenteeism, tardiness, work-related injuries, mistakes, and disagreements with supervisors, are cut by an average of 75 percent among employees who have received treatment for substance use disorders.¹¹ Furthermore, treatment has a benefit-to-cost ratio of 7:1, with substance use disorder treatment costing $1,583 on average and having a monetary benefit to society of nearly $11,487.¹²

Despite these benefits, many employees feel that their companies could do more to help with substance use disorders, particularly for employees who have family members who are affected. According to a survey of employees conducted for the Hazelden Foundation:

• 73 percent of employees surveyed believe that employers should offer counseling for family members of people with alcohol or drug abuse or addiction.
• 65 percent surveyed think that employers could provide a more flexible work schedule or time off work so a person could tend to the issues of addiction or treatment of a family member.
• 53 percent surveyed think that employers could be more understanding of the time they would need to spend at work taking personal phone calls that involve a family member's addiction.¹³

While human resources professionals may be aware that treatment for substance use disorders is effective and also know that when employees in recovery return to work, they are productive workers, many companies do not convert this knowledge into action by directing employees to treatment-often as a result of the stigma associated with substance use disorders.¹⁴ This makes labor unions' role all the more important.

Unions Can Help Ensure Access to Treatment

Labor organizations can play a key role in ensuring that union members have access to treatment for substance use disorders. Labor unions have been on the forefront of helping workers into treatment through referral centers since the 1970s.¹⁵ Treatment may be available to union members and their families through various avenues, including when the union has successfully negotiated with employers for health coverage as part of a collective bargaining agreement.^{16, 17}

Collective bargaining consists of negotiations between an employer and a group of employees to determine the conditions of employment. The result of collective bargaining procedures is a collective agreement.¹⁸ As early as 1970, unions launched a campaign to encourage the negotiators of union contracts to include insurance coverage for the treatment of substance use disorders.¹⁹ Through such negotiations, several unions have successfully extended medical plans to cover the treatment of substance use disorders.²⁰

Another way that private sector unionized employees may have coverage for substance use disorder treatment is through benefits provided under a Taft-Hartley Multi-Employer Health and Welfare plan, which is a way to obtain cost-efficient health benefits. The Taft-Hartley Act, officially known as the Labor-Management Relations Act, was passed in 1947 to give employees the right to work through labor organizations to achieve collective bargaining. The union usually negotiates for employer contributions to a Taft-Hartley plan, rather than for specific benefits.^{21, 22}

Additionally, some union members receive medical coverage through their union's health and welfare fund. Because these funds provide coverage to a much larger group of employees than most single-employer plans do, the rates tend to be lower.²³

Understanding the Stigma and Discrimination of Substance Use Disorders

Although treatment is effective, stigma and discrimination continue to affect people with substance use disorders or in recovery. Stigma detracts from the character or reputation of a person and can be a mark of disgrace.²⁴ In a recent study conducted for Faces & Voices of Recovery, 67 percent of people surveyed believe that a stigma exists toward people in recovery from an addiction to alcohol or other drugs.²⁵

This can present a barrier for people with substance use disorders who wish to access treatment, and also inhibit the ongoing recovery process.²⁶ In 2004, in fact, 21.6 percent of the 1.2 million people who felt they needed treatment but did not receive it indicated it was because of reasons related to stigma.²⁷

Stigma affects people in many aspects of life, including the workplace. Stigma may be one reason that union members with substance use disorders may not seek treatment, along with cost and insurance barriers.²⁸ They may be afraid of missing too much work or fear that their employer and friends may discover their substance use disorder.^{29, 30}

Discrimination, on the other hand, is an act of prejudice. It can include denying someone employment, housing, accommodation, or other services based on the revelation that the person is receiving treatment or has previously been treated for a substance use disorder.³¹ Discrimination ignores the fact that substance use disorders can strike people of any age, gender, race, ethnicity, education level, and geographic area.³²

Discrimination also can happen in the workplace. For example, some people who fail to pass an employer-required drug test, violating some companies' drug-free workplace policies, may potentially lose their jobs.^{33, 34} In fact, 19 percent of people in recovery surveyed by Faces & Voices of Recovery in 2001 were afraid of being fired or discriminated against if they entered treatment. And although a significant number of people-27 percent of those surveyed-found it acceptable that companies are less likely to hire people who are in recovery from an addiction, a majority (65 percent) felt that this attitude should be changed.^{35, 36}

When workplace discrimination is suspected, unions can help protect the rights of workers with substance use disorders. Union leaders may be approached by members who believe that they were discriminated against at work because of a substance use disorder. Unions can provide legal counsel if the member decides to sue the company for wrongful termination.³⁷ In certain cases, people in treatment for or in recovery from a substance use disorder may be protected from job discrimination under the Americans with Disabilities Act (ADA).³⁸ For more information on the ADA, please contact the ADA Information Line at 800-514-0301 or visit the Web site at www.usdoj.gov/crt/drssec.htm.

As unions work to protect union members' rights, it may help to consult another resource, SAMHSA's brochure, Are You in Recovery from Alcohol or Drug Problems? Know Your Rights. It provides important contact information and refers you to agencies that can help remedy any discrimination that your members have faced. You can order this brochure for free through SAMHSA's National Clearinghouse for Alcohol and Drug Information (NCADI) on the Web at http://ncadi.samhsa.gov/ or by calling 800-729-6686. In addition, the National Labor Relations Board (NLRB) is another resource to help prevent and remedy unfair labor practices by either employees or unions.³⁹

Although unions may legally represent members who find themselves in trouble after violating a company's policies, once they have offered this support, there is a limit to what unions can do to protect a worker's job.⁴⁰ To help protect workers' health, employees should be encouraged to seek help for substance use disorders before the problem becomes severe enough to be detected by their employers.⁴¹ To encourage this, labor unions can play an important role in educating employers-and advocating on behalf of members-about substance use disorders and treatment.

Labor Organizations Can Work With Employers to Advocate for Union Members

Labor unions have a unique opportunity to offer support for members with substance use disorders by acting as advocates for those who are affected in the workplace. Some unions are not taking advantage of this and are not closely involved with a company's policy and programs for addressing substance use disorders. However, some unions do offer supportive measures to solve substance use disorder-related problems in the workplace, and have their own referral programs in place. ⁴²

In fact, the Union Construction Industry Partnership is one example of how unions can negotiate with employers to develop fair, economical, and standardized substance use testing programs that benefit everyone. Its Construction Industry Substance Abuse Program, developed jointly by unions and management, ensures that unions are involved in a company's drug and alcohol testing process.^{43, 44}

Another example is the Coalition for a Uniform Drug and Alcohol Program, which was formed to bring the Philadelphia Building and Construction Trades and the major Delaware Valley refinery companies together to help them develop mutually agreeable drug testing, rehabilitation, and re-entry policies. As a result, the Addiction Awareness Program was designed for union members who tested positive on drug tests but were not, for various reasons, appropriate for admission to intensive treatment programs. The program is a success:  union members are receiving the type of treatment they need, employees are missing fewer days of work, and the cost of treatment has dropped significantly.⁴⁵

Additionally, federal employees have a valuable resource in the American Federation of Government Employees, the largest federal employee union representing 600,000 Washington, D.C., and federal government workers nationwide and overseas. This union supports federal employees by providing legal representation, legislative advocacy, technical expertise and informational services. Please call 202-737-8700 for information on health benefits in the federal government.⁴⁶

While the previous examples show ways that unions can work together with employers on issues surrounding substance use disorders, unions themselves can also spearhead other programs.

Union-Driven Programs to Address Substance Use Disorders

Labor organizations have an excellent opportunity to provide support to members in need of help. A member assistance program (MAP) can help members with substance use disorders, mental health, family, and other problems that can negatively affect job performance. Unions have a long and distinguished history of addressing health and welfare concerns. MAPs undertake a range of prevention, problem identification, referral, and counseling activities for workers and their dependents.⁴⁷

Programs may be implemented in many ways. For example, referral-only programs provide supervisors and managers with a telephone number to give employees access to in-person and/or telephone referrals to community resources, self-help programs, and treatment providers. In-house programs with outside treatment resources have employees who specialize in crisis intervention, assessment, and referrals to outside sources for assistance.⁴⁸

Unions can contract out for MAPs to provide clinical evaluations and assessments for substance use disorders and mental health issues, at no cost to participants and their dependents. MAPs can help unions' health and welfare funds manage their benefits and control their costs, while also helping laborers and their family members obtain assistance for a variety of personal problems, including addressing alcohol and drug use.⁴⁹

MAPs also can offer union members comprehensive case management and follow-up services. To provide even more services to union members, MAP staff can train supervisors and union officials on drug testing policies and procedures and provide short-term brief resolution therapy and training for other union members.⁵⁰

Union-based MAPs also can offer peer intervention programs and help ensure that people who seek treatment will have their job status protected. For example, PeerCare, a union-run, company-funded program, detects workplace substance use and trains workers to recognize, intervene with, and refer coworkers in need to treatment programs without fear of employer disciplinary action.^{51, 52} This confidential program, which has both union and corporate champions, has successfully:

• Reduced workplace injuries by 50 percent
• Significantly reduced disciplinary actions and job terminations
• Saved one company $28 in injury, disciplinary, and turnover costs for each dollar invested⁵³

Another example of a successful MAP is one employed by the International Brotherhood of Electrical Workers (IBEW) Local 701 Health Fund. IBEW has offered its MAP since 1987. The IBEW's MAP counselors work at the union hall in a close relationship with union officials. Counselors are able to respond immediately to requests by union officials, supervisors, and management for assistance. Additionally, the close relationship of union officials with the MAP staff builds confidence in the program by union membership.⁵⁴

Union officials may also advocate change by expanding their efforts outside their labor organization, as described in the next section.

In December 2002, I arrived at my first rehabilitation program as a completely broken man. After almost 20 years of alcohol and cocaine addiction, two failed marriages, and a failed business career, I had no hope left. I was resigned to drinking my life away and honestly believed that death would have been better than facing life looking up from the bottom of a bottle. I completed my program in February 2003 and decided to stay and train as a staff member. Now 2 ½ years later, I am healthy, happy and a valuable contributing member of society again. In just that short time I have gone from being a trainee to the executive director's personal assistant and right-hand man. Now I am dedicated to helping salvage a planet ravaged by substance abuse, saving lives, reuniting families, and helping to build stronger communities. Kevin Jessup Assistant to the Executive Director

Engaging Legislators

Unions can educate legislators about substance use disorders and partner with local governments to generate positive changes in the community. An example of a union engaging legislators or government agencies is a partnership between the Washington State Labor Council and the state's Division of Alcohol and Substance Abuse and the White House Office of National Drug Control Policy's Northwest High Intensity Drug Trafficking Area. This collaboration provided workplace training sessions for union members, as well as community forums about how to cope with substance use disorders for those who do not have the benefit of unions.⁵⁵

In addition, the American Federation of State, County and Municipal Employees (AFSCME), AFL-CIO, supports public policy initiatives that expand treatment opportunities. It also thoroughly explains to members the seriousness of substance use disorders and how the union provides positive support, including urging long-term in-patient treatment to be covered and reimbursable under insurance plans. For more details, please visit the AFSCME Web site at www.afscme.org/default.htm.⁵⁶

To build relationships with legislators, unions first should determine their legislative targets, then initiate phone calls, personal visits, and letters. As a union representative, you can follow these general guidelines:

• Prepare for visits with legislators by researching their interests and achievements. Have specific goals for the meeting and stick to the point. Always send a thank-you letter.
• Be polite when writing legislators. Always write your points in a clear, concise, and respectful manner. Personalize your message by explaining how one of the legislator's constituents is affected by a substance use disorder.
• Address specific issues with legislators. If you ultimately want them to sponsor a bill, present the facts about how legislation can positively affect union members with substance use disorders.
• Diversify your letters to make the strongest impact on legislators with original letters written by members. While legislators are impressed by a host of letters on a specific issue, it is less effective to send thousands of impersonal and identical notes.

Making a Difference:  What Can I Do?

1. Negotiate with employers to create written policies - Unions should work with businesses to establish comprehensive drug-free workplace policies that include an education component to demonstrate their commitment to an environment free of substance use. Tips to help companies create such policies are available through some of the resources listed at the end of this document.
2. Develop a member assistance program (MAP) - When union members feel they have an option to turn to for support, they will be more likely to step forward. Information about developing MAPs is available at the Workplace Resource Center Helpline, a toll-free telephone consulting service sponsored by SAMHSA that provides technical assistance and guidance in developing and evaluating programs and policies designed to address alcohol and drug problems at work. You can contact the Helpline at 1-800-WORKPLACE or on the Web site at http://workplace.samhsa.gov/. Another resource is the MAP Member Assistance Program Start-Up Manual available through the Laborers' Health and Safety Fund of North America at www.lhsfna.org/index.cfm?objectID=7A8F7224-D56F-E6FA-9A705D40DEA3166A.
3. Inform members how the union and employers deal with substance use disorders - Make sure all members and employees are aware of drug testing and/or drug-free workplace policies and procedures, and ensure they know their rights and what treatment options are covered and available to them. Discuss and provide literature about all of the options for substance use treatment available within the community.
4. Educate members on the long- and short-term health impacts of substance use disorders, as well as the impact of substance use on job safety - Trainings can be developed to review various classes of drugs and the impact they have on members' short- and long-term health. Seminars can be presented on the importance of preventing substance use in the workplace.
5. Create a supportive culture - Eliminate the stigma of substance use disorders by creating a safe environment that encourages union members to intervene rather than ignore the signs of a substance use disorder.
6. Educate union officials - Make sure that union officials understand substance use disorders so they can negotiate for benefits and represent members adequately in grievances, arbitrations and other legal hearings. Union officials should also be taught that substance use disorders are treatable conditions.
7. Foster a confidential environment - If members are concerned about confidentiality regarding their treatment for a substance use disorder, they will be less likely to come forward. Explicitly state what the union's confidentiality clause is and enforce it.

Making a Difference:  How Can I Contribute to Recovery Month?

Help celebrate National Alcohol and Drug Addiction Recovery Month (Recovery Month) this year and support the observance's 2006 theme: "Join the Voices for Recovery:  Build a Stronger, Healthier Community."

1. Educate yourself and your union officials - Consult resources such as the U.S. Department of Labor's Working Partners for an Alcohol- and Drug-Free Workplace. Please visit the Web site at www.dol.gov/workingpartners/welcome.html for more information and tools to address substance use disorders.
2. Encourage members with a substance use disorder to speak out - While respecting the confidentiality clauses of mutual support groups and their members, encourage people with substance use disorders to share their stories with others. They can share either casually with other members or in a more formal setting, such as a large meeting with all members and officials present to remind others that help is available.
3. Partner with other groups, unions, or institutions - Partnering with other groups, such as a local church or religious institution, college, or other union, can help you cast a wider net with your Recovery Month efforts. Join with these groups to plan events in your community to celebrate all people in recovery.
4. Contact local legislators - Work behind the scenes during Recovery Month to reach out to government officials in your area to stress the importance of providing access to treatment services. Discuss the impact that substance use disorders could have on your members and the benefits that treatment can have.
5. Be aware - Use Recovery Month as a time to heighten your awareness of the health of your members. Remind them that they can get help through your MAP or a local treatment center.

For additional National Alcohol and Drug Addiction Recovery Month (Recovery Month) materials, visit the Recovery Month Web site at www.recoverymonth.gov or call 1-800-662-HELP.

For additional information about substance use disorders, treatment, and recovery, please visit SAMHSA's Web site at www.samhsa.gov.

Resources for Labor Organizations

This list is not exhaustive of all available resources. Inclusion does not constitute endorsement by the U.S. Department of Health and Human Services, the Substance Abuse and Mental Health Services Administration, or its Center for Substance Abuse Treatment.

SOURCES

¹  Results From the 2004 National Survey on Drug Use and Health: National Findings. DHHS Publication No. (SMA) 05-4062. Rockville, MD: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Office of Applied Studies, September 2005, p. 72.
²  "MAPs Serve Members, Health & Welfare Funds Alike." Laborers' Health and Safety Fund of North America Web site: www.lhsfna.org/index.cfm?objectID=7A8F7224-D56F-E6FA-9A705D40DEA3166A , p. 1.
³  "Labor Month in Review." Monthly Labor Review. 128(2), February 2005, p. 2.
⁴  Rivlin, A., presentation at Community Anti-Drug Coalitions of America Science Writers' Briefing, Pittsburgh, PA, September 29, 2005, slide #4. Survey data collected August 2005 by Peter D. Hart Research Associates.
⁵  Results From the 2004 National Survey on Drug Use and Health: National Findings, pp. 155, 160.
⁶  "Making Recovery America's Business: Survey Data Tables." Hazelden Foundation Web site:
www.hazelden.org/servlet/hazelden/securefile/
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⁷  Substance Abuse and Mental Health Statistics Sourcebook. Rockville, MD: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, 1995.
⁸  Treatment is the Answer: A White Paper on the Cost-Effectiveness of Alcoholism and Drug Dependency Treatment. Laguna Hills, CA: National Association of Treatment Providers, 1991.
⁹  Pathways of Addiction: Opportunities in Drug Abuse Research. National Academy Press. Washington, D.C.: Institute of Medicine, 1996, Executive Summary, p. 9.
¹⁰  Report to Congress on the Prevention and Treatment of Co-occurring Substance Abuse Disorders and Mental Health Disorders. Rockville, MD: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, 2002, p. ix.
¹¹  Comprehensive Assessment and Treatment Outcome Research. St. Paul, MN: CATOR Connection, 1990.
¹²  Ettner, S., Huang, D., Evans, E., Ash, D.R., Hardy, M., Jourabchi, M., Hser, Y. "Benefit-Cost in the California Treatment Outcome Project: Does Substance Abuse Treatment Pay for Itself?" Health Services Research Journal. Online early edition: www.blackwell-synergy.com/doi/abs/10.1111/j.1475-6773.2005.00466.x. Accessed December 1, 2005.
¹³  "Making Recovery America's Business: Survey Data Tables." Hazelden Foundation Web site: www.hazelden.org/servlet/hazelden/securefile/
mrab2005survey.pdf?content_item_id=31144
&content_item_version_id=31144&directory=docsDirectory&filename=mrab2005survey.pdf , p. 2.
¹⁴  Statement by William C. Moyers, vice president of External Affairs for Hazelden in "Addiction in Your Workplace: A Problem Worth Solving." Hazelden Web site: www.hazelden.org/servlet/hazelden/cms/ptt/hazl_alive_and_free.html?sh=t&sf=t&page_id=28147 . Accessed July 8, 2005.
¹⁵  Gerstein, Dean R. and Harwood, Henrick J. (eds). Treating Drug Problems, Volume 2. Washington, D.C.: Institute of Medicine, Division of Health Care Services. National Academy Press, 1992, pp. 208-209.
¹⁶  "Collective bargaining and labor arbitration: an overview." Ithaca, NY: Cornell Law School, Legal Information Institute Web site: www.law.cornell.edu/wex/index.php/Collective_bargaining, p. 1. Accessed November 21, 2005.
¹⁷  "The IUOE Pipeline Health and Welfare Fund." Washington, D.C.: International Union of Operating Engineers Web site: www.iuoe.org/organizing/HW.htm, p. 1. Accessed November 22, 2005.
¹⁸  "Collective bargaining and labor arbitration: an overview." Legal Information Institute Web site: www.law.cornell.edu/wex/index.php/Collective_bargaining, p. 1.
¹⁹  Gerstein, Dean R. and Harwood, Henrick J. (eds). Treating Drug Problems, Volume 2, p. 209.
²⁰  Kane, M. "Bargaining in 1987; against the wind - includes collective bargaining schedule." The American Federalist, AFL-CIO, April 11, 1987, section entitled "Health Care Changes."
²¹  "All for One and One for All: Taft-Hartley Health Insurance Plans." Washington, D.C.: American Federation of State, County and Municipal Employees Web site: www.afscme.org/wrkplace/cbr300_2.htm, p. 1. Accessed November 21, 2005.
²²  "Taft-Hartley Act -1947." New Rochelle, NY: History Central.com Web site: www.multied.com/documents/Tafthatley.html, p. 1. Accessed November 21, 2005.
²³  "The IUOE Pipeline Health and Welfare Fund." International Union of Operating Engineers Web site: www.iuoe.org/organizing/HW.htm, p. 1. Accessed November 22, 2005.
²⁴  Faces & Voices of Recovery Public Survey. Washington, D.C.: Peter D. Hart Research Associates, Inc., and Coldwater Corporation, May 4, 2004, p. 2.
²⁵  Ibid.
²⁶  Ibid.
²⁷  Results From the 2004 National Survey on Drug Use and Health: National Findings, pp. 78-79.
²⁸  Ibid, p. 79.
²⁹  "The Truth About Substance Abuse Treatment." Washington, D.C.: Laborers' Health and Safety Fund of North America Web site: www.lhsfna.org/index.cfm?objectID=981033B2-D56F-E6FA-980BD6A4097957AD. Accessed August 31, 2005.
³⁰  Roman, P., Ph.D., and Blum, T., Ph.D. "The Workplace and Alcohol Problem Prevention." Alcohol Research & Health, (26)1, 2002, p. 53.
³¹  Concurrent Disorders: Beyond the Label, An Educational Kit to Promote Awareness and Understanding of the Impact of Stigma on People Living with Concurrent Mental Health and Substance Use Problems. Toronto, ON: Centre for Addiction and Mental Health, 2005, slide #7.
³²  Results From the 2004 National Survey on Drug Use and Health: National Findings, pp. 67-72.
³³  "The Truth About Substance Abuse Treatment." Laborers' Health and Safety Fund of North America Web site: www.lhsfna.org/index.cfm?objectID=981033B2-D56F-E6FA-980BD6A4097957AD.
³⁴  Roman, P., Ph.D., and Blum, T., Ph.D. "The Workplace and Alcohol Problem Prevention." Alcohol Research & Health, p. 53.
³⁵  The Face of Recovery. Washington, D.C.: Peter D. Hart Research Associates, Inc., October, 2001, p. 10.
³⁶  Faces & Voices of Recovery Public Survey, p. 2.
³⁷  Continental Airlines, Inc. v. International Brotherhood of Teamsters, No. 04-20136, 2004.
³⁸  Are you in Recovery from Alcohol or Drug Problems? Know Your Rights. Rockville, MD: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Treatment, September 2004, p. 6.
³⁹  "The National Labor Relations Board and YOU: Unfair Labor Practices." National Labor Relations Board Web site: www.nlrb.gov/nlrb/shared_files/brochures/engulp.asp. Accessed October 5, 2005.
⁴⁰  Continental Airlines, Inc. v. International Brotherhood of Teamsters.
⁴¹  The Construction Industry Substance Abuse Committee. The Construction Industry Substance Abuse Program (CISAP). Cleveland, OH: Union Construction Industry Partnership, January 1, 2004, p. 8.
⁴²  United Grocers Case Study, Alcohol & Drugs in the Workplace: Costs, Controls, and Controversies. Washington, D.C.: Bureau of National Affairs, Inc., 1986, p. 120.
⁴³  "Substance Abuse." Cleveland, OH: Union Construction Industry Partnership Web site, http://www.ucipconstruction.com/, section entitled "Construction Industry Substance Abuse Program." Accessed November 22, 2005.
⁴⁴  The Construction Industry Substance Abuse Committee. The Construction Industry Substance Abuse Program (CISAP). Cleveland, OH: Union Construction Industry Partnership, January 1, 2004, pp. 4, 5.
⁴⁵  Dempsey, J., Serviss, K. "The Addiction Awareness Program: A Cost-Effective Modality." EAPA Exchange, May/June 2000, p. 26.
⁴⁶  "AFGE: About AFGE." American Federation of Government Workers Web site: www.afge.org/Index.cfm?Page=AboutAFGE, Accessed October 5, 2005.
⁴⁷  "Employee Assistance Programs." Rockville, MD: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, National Clearinghouse for Alcohol and Drug Information Web site: http://ncadi.samhsa.gov/workplace/fedagencies/employee_assistance_programs.aspx. Accessed December 7, 2005.
⁴⁸  "Employee Assistance Programs." National Clearinghouse for Alcohol and Drug Information Web site: http://ncadi.samhsa.gov/workplace/fedagencies/employee_assistance_programs.aspx.
⁴⁹  "MAPs Serve Members, Health & Welfare Funds Alike." Laborers' Health and Safety Fund of North America Web site: www.lhsfna.org/index.cfm?objectID=7A8F7224-D56F-E6FA-9A705D40DEA3166A, p. 1.
⁵⁰  Substance Abuse Services for Multiemployer Fund Participants. Brookfield, WI: International Foundation of Employee Benefit Plans, Research Department, May 2000, p. 16.
⁵¹  Spicer, R., Miller, T. "Impact of a Workplace Peer-Focused Substance Abuse Prevention and Early Intervention Program." Alcoholism: Clinical and Experimental Research. 29(4), April 2005, pp. 609-611.
⁵²  "Workplace Substance Abuse Prevention Resources." Rockville, MD: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Division of Workplace Programs Web site: www.drugfreeworkplace.gov/Interventions/WPResources020604.htm, section entitled "PeerCare." Accessed November 22, 2005.
⁵³  Ibid.
⁵⁴  Substance Abuse Services for Multiemployer Fund Participants, p. 15.
⁵⁵  "Unions Helping Families Fight Drug Abuse." Rick S. Bender, President of the Washington State Labor Council (WSLC), AFL-CIO, August 2002. WSLC Web site: www.wslc.org/columns/02aug.htm. Accessed November 29, 2005.
⁵⁶  AFSCME Resolution: Substance Abuse. AFSCME Web site: www.afscme.org/about/resolute/1992/r30-075.htm. Accessed November 29, 2005.