Testing for Alcohol Problems in the Workplace

  • Employees with alcohol problems tend to have more "sick days" than those without alcohol problems
  • Researchers examine the relationship between sick days taken during a 12-month period and three screening methods
  • Employees with moderately elevated or risky levels of alcohol consumption have more sick days
  • Two tests - the Alcohol Use Disorders Identification Test and measuring levels of carbohydrate-deficient transferrin in serum - were particularly helpful in detecting different levels of alcohol use

Previous studies have shown that problem drinkers and alcoholics have higher rates of sickness-related absence from the workplace than do co-workers without alcohol-related problems. A study in the January issue of Alcoholism: Clinical & Experimental Research examines the relationship between "sick days" taken during a 12-month period and three screening methods. One is a psychological measure called Alcohol Use Disorders Identification Test (AUDIT). The remaining two are biological tests: one measures levels of carbohydrate-deficient transferrin (CDT) in serum, believed capable of identifying lower levels of alcohol consumption; the other measures for serum gamma-glutamyl transferase (GGT), elevated levels of which indicate chronic heavy alcohol consumption.

"Studies have demonstrated that problem drinkers and alcoholics have more sickness absence in days and spells compared with individuals without alcohol-related problems," said Ulric Hermansson, project manager and research associate at the Center for Dependency Disorders at Karolinska Hospital, and lead author of the study. "Employees with diagnosed alcohol problems have also confessed to being absent from work as a result of their drinking. Alcohol consumption also seems to vary between different workplaces. Unfortunately, there is a lack of comparability among these studies because of the different tests or instruments that have been used."

AUDIT is a questionnaire developed to identify people who are early problem drinkers as opposed to alcohol dependent. For this study, AUDIT was used to identify alcohol consumption during the previous 12 months. CDT in serum is a laboratory screening test that was used in this study to detect continuous, excessive alcohol drinking during the previous several weeks. Study authors believed that AUDIT and CDT would prove to be complementary tests for alcohol screening in a routine workplace health examination, each able to identify a different segment of the population examined. The GGT test was used primarily for comparison purposes.

Researchers screened 989 (676 males, 313 females) voluntary participants with AUDIT, CDT and GGT measures during 36 months at a large Swedish workplace. The study population comprised approximately 15% of the total workplace population. Test results were compared with absence data, which was obtained from the company payroll system.

"Employees with elevated or risky levels of alcohol consumption showed an increase in sick days," said Hermansson. "As previous studies have shown, AUDIT seemed to be particularly helpful in identifying risk consumption during the previous 12 months, whereas the CDT test was chiefly helpful in detecting those individuals who had been drinking heavily in the previous month."

"I think it's important to realize that these results imply that individuals at the workplace should be offered help to identify risk consumption on a voluntary basis," noted Olof Beck, associate professor and director of the Clinical Pharmacology laboratory at Karolinska Hospital. "This thinking is contradictory to the thinking about use of illegal drugs. The individual should be encouraged to participate because of an interest to improve their own health."

Hermansson strongly concurs. "It is important to note that the setting is of great significance in order to minimize response bias in self-reported drinking habits," he said, "as is the fact that the respondent should experience no negative consequences from giving an honest response. In fact, the basic precondition of the present study was to emphasize and demonstrate to the employees that the screening offered an opportunity for them to check their drinking habits within a health-maintenance perspective. The screening was not a surveillance method, serving the interests of the employer, but was based on voluntary participation."

Hermansson recommended that workplaces educate their employees - especially those responsible for health services - about the harmful effects that risky alcohol consumption can have on a person’s health. "The majority of the problems are perhaps minor," he said, "such as hangovers, loss of energy, diarrhea, cramps/aches, or sickness/nausea. But there are also more serious effects, such as liver and heart disease. High levels of alcohol consumption have also been reported in conjunction with sleep problems."

Hermansson added that sickness absence, as well as alcohol consumption, are what he called "multi-factorial" issues, "influenced not only by poor health, but also by factors such as the social insurance system, the work environment, attitudes, commitment to work, and other medical, social and psychological factors."

Finally, he said, "neither long, continuous periods of sickness absence nor absences on Mondays or Fridays were associated with positive AUDIT and/or CDT screenings. This is another good reason for workplaces to initiate a more systematic implementation of alcohol screening in connection with routine health examinations. However, identifying employees with elevated and risky levels of alcohol consumption who also have high levels of sickness absence is just a first step. More research and knowledge is needed to evaluate which methods lead to modified alcohol use and, hopefully, reduced levels of sickness absence at the workplace."

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:

Hermansson, U., Helander, A., Brandt, L., Huss, A., & Ronnberg, S. (2002, January). The alcohol use disorders identification test and carbohydrate-deficient transferrin in alcohol-related sickness absence. Alcoholism: Clinical and Experimental Research, 26(1), 28-35.