Alcohol Addiction and the Workplace: Missed Days Add Up

The Connection Between Alcohol Use Disorder and Workplace Absenteeism

When we write articles about addiction, we take a person-first approach. That means our primary goal with all our published material is to help people diagnosed with substance use disorder (SUD) and/or alcohol use disorder (AUD). We want to help these people because they need help. We want to help their families, their workplaces, and their communities, too. That’s why we rarely write articles about what many people call the financial burden of addiction. We often see peer-reviewed journal articles that attach a dollar amount – a lost dollar amount – to the nationwide phenomenon of addiction.

This is known as the cost of addiction – and as we mentioned, there’s a significant amount of research available that calculates the cost of addiction in terms of dollars and cents. For instance, data from the Department of Health and Human Services (HHS), the Centers for Disease Control (CDC), and the National Institute on Drug Abuse (NIDA) estimates the following:

The Cost of Addiction: Dollar Amounts

• Alcohol Use Disorder (AUD):
  • $249 billion per year
  • For perspective, we’ll write that out: $249,000,000,000.
• Opioid Use Disorder (OUD):
  • $1,021 billion
  • Yes, that’s over a thousand billion
• Illicit Drug Use:
  • $193 billion per year
• Prescription opioids:
  • $78.5 billion per year
• Tobacco:
  • $300 billion per year

When economic analysts calculate these costs, they use phrases we rarely use when we discuss treatment, like these:

Economics of Addiction: Terms and Metrics

• Lost productivity
• Reduced labor participation
• Legal expenses
• Law enforcement expenses
• Medical expenses associated with:
  • Overdose
  • Intoxication-related injury
  • Intoxication-related accidents
• Premature mortality (early death)

We understand why these reports exist and we understand why they frame addiction in economic terms. We know they’re persuasive documents that serve as tools to convince policymakers that money spent on addiction treatment and prevention is money well spent, because the quantifiable costs associated with addiction add up to billions of dollars a year. A policymaker who does not buy in to the modern approach to addiction treatment – i.e. integrated treatment, medication-assisted treatment (MAT), harm reduction – is, however, likely to respond to the idea they can reduce an overall budget by billions by allocating millions to addiction treatment.

These reports are valuable – we don’t question that. We simply avoid talking about the money in favor of talking about the people. But this article addresses the financial burden of addiction in a way that aligns with our person-first approach thanks to a study published recently called “Association Between Workplace Absenteeism and Alcohol Use Disorder From the National Survey on Drug Use and Health, 2015-2019.”

We’ll explain what we mean, and then take a look at that study.

Addiction in the Workplace: The Negative Consequences

Right now, we’re talking to people who work for a living, and need to work to live – which means most humans on earth. We don’t have data on that, but we feel safe in saying that on balance, the majority of adults work. What we want to do – and what the study we introduce above does – is inform people with alcohol use disorder (AUD) or people at-risk of developing AUD about the negative impact AUD has on employment.

The short version is that people with AUD miss far more work than people without. As adults, we all know less work means less income. Less income means decreased ability to meet the financial responsibilities of adulthood. These include buying food, paying rent, managing transportation, and covering expenses related to family life or life in general. Any adult reading this also knows there are probably twenty or more items we left off that list.

Therefore, this study speaks to us – and to people with AUD – on a personal level. It discusses one very real consequence of AUD that has a quantifiable impact – lost income – which can lead to severe and disruptive circumstances: financial hardship, and everything that entails.

That’s the why. Now let’s look at the what.

Alcohol Use Disorder and Workplace Absenteeism: About the Study

The study authors began with a simple research question:

What is the association between alcohol use disorder (AUD) and workplace absenteeism?

To explore and answer this question, researchers at Washington University School of Medicine in St. Louis analyzed data from 110,000 U.S. adults with full-time jobs. They collected information on employment status, AUD status, and workplace attendance. Let’s get into the details on how they set up their study.

First, the demographics:

• Total participants employed full time: 110,701
• By gender:
  • Men: 53.2%
  • Women: 48.6%
• By race/ethnicity:
  • Black: 11.5%
  • Hispanic: 16.3%
  • White 62.8%

Researchers counted full-time employment by calculating yes answers to the following question:

“Do you usually work 35 hours or more per week at all jobs or businesses?”

Next, they determined the prevalence of AUD in their sample set. They divided prevalence into four categories: any AUD, mild AUD, moderate AUD, and severe AUD.

Prevalence of AUD in the Study Group

• Any AUD: 9.3%
• Mild AUD 6.2%
• Moderate AUD: 1.9%
• Severe AUD: 1.2%

Experts define mild, moderate, and severe AUD on a continuum determined by individual answers to a specific set of questions about alcohol use. The questions and distinctions are related to the amount of alcohol an individual consumes in a given day, week, or month. Here’s how the National Institute on Alcohol Abuse and Alcoholism (NIAA) and the Substance Abuse and Mental Health Services Administration (SAMHSA) define and moderate, binge, and heavy drinking:

• Moderate drinking: 1 drink per day for women and 2 drinks per day for men.
• Binge Drinking:
  • NIAAA defines binge drinking as a pattern of consumption that brings blood alcohol concentration (BAC) up to 0.08 g/dl. That means:
    • Around 4 drinks in about 2 hours for women
    • Around 5 drinks in about 2 hours for men
  • SAMHSA defines binge drinking as:
    • 5 or more alcoholic beverages on the same occasion on at least 1 day in the past 30 days
  • Heavy Drinking: SAMHSA defines heavy drinking as binge drinking on each of 5 or more days in the past 30 days

People with low risk of developing AUD are those who drink at the amount defined as moderate above, or women who consume three of fewer drinks a day and seven or fewer drinks per week, and men who consume four or fewer drinks a day and 14 or fewer drinks per week. To determine vulnerability to AUD, the AUDIT self-assessment, designed by the World Health Organization (WHO) and used by addiction professionals worldwide since 1989, is free and available online.

Now let’s look at the results of the study.

Alcohol Use Disorder and Workplace Absenteeism: The Results

First, to put this data in context, here are the national prevalence rates for AUD, as reported by study authors, based on data from the 2019 National Survey on Drug Use and Health:

• Adults age 18-25: 9.3% – around 3.1 million people – met criteria for AUD
• Adults age 26 and over: 5.1% – around 11 million people – met criteria for AUD

That’s the big picture/ Those statistics refer to an adult population of 260 million, according to the 2020 U.S. Census. Remember, the study we’re discussing included data from 110,000 people over a five year period, from 2015-2019. That’s a large enough sample and a long enough study period to make population-level generalizations, which is one reason this study caught our attention: studies of this size and scope, based on reliable sources, and in our area of expertise, are few and far between – but we digress.

To the results.

To determine work absenteeism, researchers asked study participants the following two questions:

1. During the past 30 days…how many whole days of work did you miss because you were sick or injured?
2. During the past 30 days…how many whole days of work did you miss because you just didn’t want to be there?

Researchers then analyzed the answers, completed statistical analyses, and published the following results.

AUD and Average Missed Days of Work: Illness, Injury, or Skipping

• No AUD: 13 days of missed work per year
• Mild AUD: 18 days of missed work per year
• Moderate AUD: 24 days of missed work per year
• Severe AUD: 32 days of missed work per year
• People with AUD:
  • 3% of the full-time workforce
  • 1% of workplace absences
• Approximately 232 million absences reported each year among people with AUD:
• Mild AUD: 133.3 million
• Moderate AUD: 53.3 million
• Severe AUD: 46.6 million

In addition, people with AUD had an increased likelihood of missing three or more days of work per month due to illness, injury, or skipping work without a reason. Two important takeaways from this set of data are that people with severe AUD miss more than twice as many days of work than people with no AUD, and people with moderate AUD miss almost twice as many days of work than people with no AUD.

We share this data so people with AUD can understand that risks they face are not only to their physical and emotional health, but also to their work performance. As the data clearly shows, the number of missed work days increases with the severity of the AUD: we want people who need help to get help as soon as possible, and hope this information will help convince people with untreated AUD to seek help as soon as possible.

We’re sure the study authors want the same thing. However, they frame their results in a big-picture, structural manner:

“The large fraction of work absenteeism associated with AUD in this study is important to public health and to our economy, and provides a strong rationale for increasing investment in strategies to prevent and treat AUD.”

That brings us to the topic we’ll close this article with: treatment for AUD.

Treatment for Alcohol Use Disorder: What Works?

Experts on addiction agree that the most effective approach to the treatment of AUD is a comprehensive treatment model that includes the following components:

1. Talk therapy approaches like cognitive behavioral therapy (CBT) can help people with AUD learn coping skills, develop trigger management strategies, and address mental health issues that may contribute to addiction.
2. Community and Peer Support. Mutual self-help groups like Alcoholics Anonymous (AA) and SMART Recovery help people with AUD in informal, free, peer-led group sessions. Talking to and listening to people facing similar challenges can help people with AUD feel less alone, develop a recovery friendly social network, and learn new ways to address AUD from people with firsthand experience.
3. Prescription medications such as Naltrexone, Acamprosate, and Disulfram can help people with AUD reduce heavy drinking and manage cravings. These medications block the metabolism of alcohol and cause unpleasant symptoms when people on these medications consume alcohol.

We advise people concerned they may have an alcohol use disorder to seek a full addiction assessment administered by a licensed medical professional. An assessing professional can confirm or rule out the presence of AUD, and then make a referral for treatment. Depending on the severity of the disorder, treatment for AUD can occur at the following levels of care:

• Outpatient treatment
• Intensive outpatient (IOP) treatment
• Partial hospitalization (PHP) treatment
• Residential/Inpatient treatment

To learn more about levels of care in addiction treatment, click here.

We’ll end by reminding people this important fact: treatment works – and the sooner a person with AUD gets the evidence-based treatment they need, the better the outcome. That’s important for mental health, physical health, emotional health, and, as the study we discuss at length in this article indicates, treatment for AUD is important for overall vocational health, too.

By Thomas Delegatto MS, CADC, Executive Director, Recovery Works Merrillville in Indiana

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