Off-the-job drinking predicts subsequent on-the-job injury for up to five years

  • Urban transit operators have one of the most stressful jobs in the United States.
  • Prior research showed that some bus drivers use after-hours alcohol to cope with work-related stress.
  • A new study has found that off-the-job drinking can have a significant impact on subsequent claims of work-related injury.

Numerous studies have established a link between on-the-job alcohol impairment and occupational injury. In fact, between five and 20 percent of occupational injuries or mortality likely involve alcohol. However, less is known about what impact general drinking patterns – that is, alcohol consumption away from the workplace – may have on occupational injury and mortality. A study in the September issue of Alcoholism: Clinical & Experimental Research has found that transit employees with heavier weekly drinking rates were more likely to subsequently experience some trauma on the job.

“In general,” observed David R. Ragland, research professor of epidemiology in the school of public health at the University of California - Berkeley and lead author of the study, “the job of urban transit operator is one of the most stressful jobs in the United States. “We had found in a previous study that some bus drivers use after-hours alcohol to cope with work-related stress. In this study, our findings imply that off-the-job drinking can have costly impacts for the worker and the transit agency. This suggests that factors such as occupational conditions, stress and off-the-job drinking need to be considered together when analyzing work outcomes such as workers’ compensation injuries.”

Ragland and his colleagues reviewed three sources of data. The first was a cross-sectional study of 1,871 transit operators employed by the San Francisco Municipal Railway (MUNI) from 1983 to 1985 that examined alcohol consumption, demographic variables, and medical histories. “It should be noted that we did not choose MUNI for study,” said Ragland, “because of any particularly high prevalence of job-related alcohol problems.” Employment data were also gathered on MUNI employees through to the end of 1988. A third source was workers’ compensation injury claims due to any cause by this group from 1983 through to the end of 1988. The final tally examined consisted of 1,836 transit operators.

Of these, 983 (53.5%) had filed a workers’ compensation claim during the approximately five-year period of examination. Individuals with higher alcohol consumption were more likely to be male, have more years of driving, and a higher job-stress score. After adjustment for these variables, individuals with higher alcohol consumption were more likely to have a workers’ compensation claim during this time.

“This means,” explained Ragland, “that after holding constant those factors that might be associated both with drinking and injury – that is, being male, having more years of driving, and greater job stress – the results indicate that the more one drinks, the more likely one is to have an injury. These findings have implications for prevention, including not only changing at-work factors that affect off-work drinking but also strategies for decreasing off-work drinking.”

“This study shows us several things,” said Joel B. Bennett, consultant and president of Organizational Wellness and Learning Systems. “First, we learn that alcohol consumption is significantly related to work-related stress and to having worked more years on the job as a municipal driver. Second, it appears that 10+ drinks a week is the cutoff point for increased and subsequent compensation claims. Third, although compensation claims were also predicted by age, stress, and other factors, controlling for these variables left a significant relationship between the 10+ drinks/weekly and compensation claims. In short, the findings strongly suggest that frequent drinking is a risk factor for safety problems on the job and for increased compensation cost claims for employers, especially those working in public service.”

Although the risk of injury attributable to alcohol consumption was a mere three percent, Ragland said it was nonetheless notable. “A conservative estimate based on three percent in the context of this study would translate into approximately $250,000 in workers compensation claims for just MUNI. Clearly, while the attributable risk due to alcohol may seem low, the associated monetary costs can be high.”

Bennett added that social programs designed to address heavy or uncontrolled alcohol consumption among employees tend to focus on controlling medical and productivity costs for individuals and society while underemphasizing the prevention of costs for employers and their insurance providers.

“This study is important for two reasons,” he said. “First, it provides a controlled analysis of such employer/insurance costs, in terms of compensation claims. Second, it is a predictive study; employees with heavier drinking rates were more likely to have accidents/injuries up to almost five years after they reported such drinking rates. This is important because it shows employers and business owners why they should take an interest in doing something to prevent as well as control heavy or problematic drinking among their workers. Most importantly, when at-risk drinking is identified, employers must take measures to prevent its impact on safety/injury. Currently, only a small proportion of businesses provide any alcohol testing to help control the problem. The number of businesses that do anything to prevent the problem is substantially less than this.”

The most prevalent types of claims were “sprains and strains” (36.4%), “pain” (27.1%), and “contusions” (20.9%). Ragland called these types of injuries “fairly typical for the transit industry.” Although the rate (53.5%) of workers who filed a claim may seem high, Ragland noted that when viewed over a five-year period, the rate is equivalent to about 10 percent per year.

“Statistical rates for injury claims are usually given per 100 full-time employees per year,” he said. “The all-industry average in 1997 was 6.6; the lowest average rate of 2.0 was observed in the finance, insurance and real estate sector, and the highest rate of 9.3 was observed in construction. Rates are somewhat higher in MUNI partly because MUNI includes cable cars, which require considerable physical exertion on the part of the operators, and therefore lead to higher workers’ compensation claims. Thus, the yearly MUNI rate of about 10 percent per year is generally in line with these figures.”

Ragland and his colleagues hope to examine in greater detail how occupational conditions, work stress, and beliefs about ‘drinking to unwind’ may impact transit operators’ off-the-job drinking. They also want to determine if worksite interventions aimed at modifying stress and norms about drinking may reduce harmful drinking-related outcomes. Bennett noted that one prevention effort, called “Team Awareness,” has been federally identified as having effectively reduced problem drinking among municipal workers.

Funding for this Addiction Science Made Easy project is provided by the Addiction Technology Transfer Center National Office, under the cooperative agreement from the Center for Substance Abuse Treatment of SAMHSA.

Articles were written based on the following published research:

Ragland, D.R., Krause, N., Greiner, B.A., Homan, B.L., Fisher, J.M. Cunradi, C.B. (September, 2002). Alcohol consumption and incidence of workers’ compensation claims: A 5-year prospective study of urban transit operators. Alcoholism: Clinical & Experimental Research, 26(9), 1388-1394.