Substance use impacts more than just those addicted and their loved ones. The enormous costs of alcohol or other drug addiction in the workplace can be measured in lost productivity, as well as in accidents, injuries, and fatalities. What is the scope of the problem, and what can employers do in order to effectively respond to this issue? Pablo McCabe, LCSW, is the director of National and Strategic Accounts for the Hazelden Betty Ford Foundation and has managed wellness and training within internal and external Employee Assistance Programs at Fortune 500 companies, nonprofits, and professional associations. In part one of this two-part Q and A, Pablo focuses on the scope and impact of workplace drug and alcohol addiction. In part two we will address steps employers can take both to identify and support those struggling with addiction. Q. Why is alcohol addiction in the workplace such an important topic? A. Alcoholism in the workplace creates higher healthcare expenses for injuries and illnesses related to substance use, misuse, and dependence. It also creates higher rates of absenteeism, as well as "present-eeism," where folks show up in body but don't have the consciousness at work that they normally would. In addition, substance use reduces job productivity and performance, as well as driving up the costs of workers' compensation and disability. Statistically, workers with alcohol problems are 2.7 times more likely than workers without drinking problems to have injury-related absences. One study of hospital ERs showed that 35 percent of patients with occupational injuries were at-risk drinkers, and breathalyzer tests detected alcohol in 16 percent of ER patients injured at work. Incredibly, one large federal survey revealed that 24 percent of workers reported drinking during the workday at least once in the past year, and an analysis of workplace fatalities showed that at least 11 percent of victims had been drinking. So clearly, alcohol is a problem for the workplace. Q. Is substance use other than alcohol a problem in the workplace? A. Drugs are a huge issue in the workplace, as well. Most people with drug problems work somewhere. Of the nearly 15 million Americans who use illegal drugs, 70 percent are employed. Marijuana, of course, is the most commonly used illegal (though increasingly legal) drug by employees, followed by cocaine and the staggering rise of prescription drug addiction. Q. What are some other ways that addiction hurts companies? A. Additional problems for companies include tardiness. People show up late or try to get out early. Maybe they take more frequent breaks or longer lunches or sleep on the job. We also see the workday impacted by the after-effects of substance use, including hangover and withdrawal. People might have trouble concentrating. They also might be depressed because of drinking's effect on the central nervous system. We see poor decision-making, cloudy judgment and loss of efficiency. We also see a huge amount of theft that occurs in the workplace to support the addiction, along with other illegal activities such as the buying and selling of drugs at work. And, not surprisingly, we see lower morale among co-workers, along with increased conflict between peers and with supervisors. Finally, addiction creates high turnover costs, as new employees must be hired and trained to replace those with substance use issues. One study showed that workers who report having three or more jobs in the previous five years are about twice as likely to be current or past year users of illegal drugs than those who have had two or few jobs. Q. What is the impact on the workplace when employees have a loved one with substance use issues? A. Most of us spend two-thirds of our lives in the workplace. Living with someone with drug or alcohol addiction is bound to spill over into that time and hurt our performance at work. Absenteeism may become an issue because of having to leave during the day to cover for things the spouse, partner, or child was supposed to do. Certainly, it can be difficult for the loved one of an addict to focus on the job. He or she may experience increased anxiety and then related health issues of their own from carrying the stress. Q. What about drinkers and drug users who are not necessarily addicted? A. We call them non-dependent drinkers or users. They don't need alcohol or drugs to function, but they may binge on alcohol or drugs on the weekends or special occasions. That can result in workplace performance issues, as well. Maybe they're coming in late on a Monday and leaving early on a Thursday or Friday to get to the bars. In a similar way, people who do a lot of certain kinds of drugs over the weekend may actually be great performers during most of the week, but they may also experience mid-week depression that impacts their work due to extremely low serotonin levels. Q. Does addiction impact all industries equally or are some harder hit than others? A. Industries hardest hit by addiction include food service, construction, mining and drilling, excavation, and installation, maintenance, and repair. Alcohol and drug consumption seem to be built into the culture of some industries, making it easier for employees to become addicted. In some cases, the sense is that drugs are needed to keep up the pace and focus required by the work. In other industries, down time may be so isolating that drinking becomes a way to blow off steam or try to connect with others. In part two of this Q and A, Pablo will describe what employers can do both to recognize those who are struggling with substance use and to help and support employees into recovery.