Skip directly to search Skip directly to A to Z list Skip directly to navigation Skip directly to site content Skip directly to page options
CDC Home

Alcohol and Substance Misuse

Once a company has conducted assessment and planning for alcohol and substance misuse programs, and developed the specific tasks of implementation for these programs, it is time to develop the evaluation plan. This evaluation plan should be in place before any program implementation has begun. 

Metrics for worker productivity, health care costs, health outcomes, and organizational change allow measurement of the beginning (baseline), middle (process), and results (outcome) of workplace health programs. It is not necessary to use all these metrics for evaluating programs. Some information may be difficult or costly to collect, or may not fit the operational structure of a company. These lists are only suggested approaches that may be useful in designing an evaluation plan.  

These measures are designed for employee group assessment. They are not intended for examining an individual’s progress over time, which would raise concerns of employee confidentiality. For employer purposes, individual-level measures should be collected anonymously and only reported (typically by a third party administrator) in the aggregate, because the company’s major concerns are overall changes in productivity, health care costs, and employee satisfaction.

In general, data from the previous 12 months will provide sufficient baseline information and can be used in establishing the program goals and objectives in the planning phase, and in assessing progress toward goals in the evaluation phase. Ongoing measurements every 6 to 12 months after programs begin are usually appropriate measurement intervals, but measurement timing should be adapted to the expectations of the specific program.

Alcohol misuse can result in a number of adverse health and social consequences.

  • More than 700,000 Americans receive alcoholism treatment every day, but there is growing recognition that alcoholism (i.e., alcohol dependence or addition) represents only one end of the spectrum of “alcohol misuse”1
  • There are approximately 79,000 deaths attributable to excessive alcohol use each year in the United States2

Many problem drinkers have medical or social problems attributable to alcohol (i.e., alcohol misuse or "excessive drinking") without typical signs of dependence, and other drinkers are at risk for future problems due to chronic heavy alcohol consumption or frequent binges. Nondependent drinkers who misuse alcohol account for the majority of alcohol-related disability and death in the general population.3

Alcohol misuse is associated with high costs to employers including absenteeism, decreased productivity (due to poor work performance), turnover, accidents, and increased health care costs.

  • The cost of alcohol misuse in the United States was estimated to be $185 billion in 1998. About $16 billion of this amount was spent on medical care for alcohol-related complications (not including fetal alcohol syndrome [FAS]), $7.5 billion was spent on specialty alcohol treatment services, and $2.9 billion was spent on FAS treatment. The remaining costs ($134 billion) were due to lost productivity. Lost productivity due to alcohol-related deaths and disabilities impose a greater economic burden than do health care costs4
  • Over 15% of U.S. workers report being impaired by alcohol at work at least one time during the past year, and 9% of workers reported being hung-over at work5

Many substances, both illegal and legal, have the potential for misuse. Common examples include cocaine, ecstasy, heroin, inhalants, marijuana, methamphetamine, PCP/Phencyclidine, and prescription narcotics. Workplace approaches for employees with alcohol or substance misuse problems are similar.6

Top of Page

Worker productivity measures for alcohol and substance misuse7-14

Healthier employees are less likely to call in sick. Companies can sometimes assess sick day use as the most direct measure to determine whether health programs are increasing worker productivity.

Baseline
  • Determine the average number of sick days per employee over the previous 12 months related to alcohol or substance misuse
    • It will be difficult to measure when employees take sick leave directly related to alcohol or substance misuse, since employees are unlikely to report the causes of such illness. It may be more useful to measure sick leave clearly related to formal rehabilitation services
    • Increased employee absences on Monday may be a sign of alcohol and/or substance misuse
    • This measure may be less useful if there has been a large increase or decrease in numbers of employees over the past 12 months
  • Determine costs for worker absenteeism related to the complications of alcohol and substance misuse such as high blood pressure, heart disease or liver disease, including costs of replacement workers, costs in training replacement workers, and lost and delay in productivity if possible
  • Determine time employees spend during working hours participating in worksite supported alcohol or substance misuse-related worksite programs. As noted above, identifying absenteeism related to the effects of alcohol and substance misuse is challenging. Each employer will need to consider whether there are effective measurement options in their employee population
  • Additional validated surveys have been developed to provide employers with information about the indirect costs of untreated or undertreated employee health issues such as alcohol and substance misuse. Employers who use these health and productivity surveys on an ongoing basis can begin to evaluate the return on investment (ROI) of offering alcohol and substance misuse programs on employee absence or productivity. These surveys may be proprietary and may require a modest fee to use. Two examples are provided below:
Process
  • Re-assess the average number of sick days per employee at the first follow-up evaluation (see limitations on this measure described above)
    • If employee education programs are successful, these measures may increase in the short term as screening and detection rates increase (This only applies to using leave to obtain clinical preventive and treatment services)
  • Periodic repeats of other baseline measures
Outcome
  • Assess changes in the average number of sick days per employee in repeated follow-up evaluations
  • Assess changes in time employees spend during working hours participating in worksite supported alcohol or substance misuse-related worksite programs
  • Assess changes in costs from baseline

Top of Page

Health care costs measures for alcohol and substance misuse7-10

In contrast with the worker productivity costs described above, health care costs are measures of the direct medical expenses of providing employee health care and preventive health programs.

Baseline  
  • Determine costs and use for health care, such as screening, disability, hospital costs, inpatient and outpatient counseling, and treatment (e.g., medications) for alcohol and substance misuse related illness and disability
  • Determine health care use and costs of participants before education and other programs are initiated and after operation of these programs
Process
  • Periodic repeats of baseline measures
Outcome
  • Assess changes in health care use and costs from baseline
  • Compare health care use and costs of participants before education and other programs are initiated and after operation of these programs
    • These measures may be affected by other circumstances, such as national education programs or changes in operation at the worksite, so they should be interpreted with caution

Top of Page

Health outcomes measures for alcohol and substance misuse7-10,15

The effectiveness of alcohol and substance misuse programs depends on the intensity of program effort and the use of multiple interventions. A rule of thumb is that the more programs implemented together as a package or campaign, the more successful the interventions will be.

Baseline
Process
  • Periodic repeats of baseline measures
Outcome
  • Assess changes in the percentage of employees who report excess alcohol consumption or substance misuse
  • Determine changes in levels of diagnostic and treatment procedures related to alcohol and substance misuse from health care and pharmaceutical claims data
  • Assess changes in employee knowledge, attitudes, and beliefs about alcohol and substance misuse
    • Measure changes in employee knowledge of alcohol and substance misuse health risks and threats
    • Assess changes in employee awareness of existing workplace alcohol and substance misuse programs, policies, and benefits

Top of Page

Organizational change measures for alcohol and substance misuse7-10

Employees with alcohol and substance misuse problems require ongoing support from employers. New programs can be added over time and evaluated periodically for their effectiveness. For best results, recognition of the benefits of diagnosis and treatment of misuse and co-occurring problems should become an inherent part of organizational change and corporate culture.

Measuring organization change is an assessment of company-initiated programs and policies that affect most employees regardless of their health status (e.g., establishing Employee Assistance Programs). These efforts need to be integrated for greatest effectiveness and will require time for full implementation. Regular measures of employee attitudes and program development are key in determining whether new programs are effective or require further adaptation to prevent continuing investment in ineffective efforts.

Baseline

  • Determine workplace barriers to employee’s knowledge and use of education, diagnosis, and treatment programs for alcohol and substance misuse
    • In particular, the stigma related to substance misuse may be a strong barrier
  • Assess current workplace supported alcohol and substance misuse programs
    • List current alcohol and substance misuse options for employees through worksite and identify number of employees (i.e., participation) using each option. Examples:
      • Number of alcohol and substance misuse programs (e.g., education seminars and EAP services) and participation in these programs
      • Availability of educational materials on alcohol and substance misuse
      • Number of workplace communications/media campaigns regarding alcohol and substance misuse
      • Number of alcohol and substance misuse related policies
      • Number of partnerships with community resources such as local alcohol and substance misuse treatment programs or Alcoholics Anonymous
    • Determine costs of current company alcohol and substance misuse programs such as:
      • Staffing, equipment, and space
      • Employee time to participate in programs during work hours (e.g., education)
      • Costs of EAP services
    • Conduct survey of employee satisfaction with current workplace supported alcohol and substance misuse programs
Process
  • Reassess barriers to employee’s knowledge and use of education, diagnosis, and treatment programs for alcohol and substance misuse
  • Document steps taken and progress toward implementing each intervention selected
    • List numeric goals in each form of intervention within a designated time period (e.g., 12 months from startup):
      • Employee reach (e.g., number of educational pamphlets distributed)
      • Employee participation. These data should be collected anonymously
    • Describe timeline for implementation of each planned program (e.g., length of time and timing of tasks to develop, initiate, and conduct a mass campaign)
    • Create a baseline budget for new interventions including classes, instructors, classroom space, materials, etc
    • Identify opportunities for new partnerships with community groups who provide programs related to alcohol and substance misuse, such as Alcoholics Anonymous, Al-Anon, or public mental health services
  • Reassess employee satisfaction regarding workplace supported alcohol and substance misuse programs such as EAP
Outcome
  • Measure reductions in the number and type of employee barriers to knowledge and use of education, diagnosis, and treatment programs for alcohol and substance misuse
  • Assess changes in workplace supported alcohol and substance misuse programs including progress in achieving goals and in implementation of each intervention (e.g., length of time and timing of tasks to develop, initiate, and conduct a mass campaign)
    • Measure changes in the number of alcohol and substance misuse options for employees through the worksite and changes in employee participation using each option before and after the alcohol and substance misuse program or campaign. Examples:
      • Number of new programs developed and offered to employees and participation in these programs
      • Number of new educational materials developed and made available to employees
      • Number of new workplace communications/media campaigns, such as posters, brochures, and information on EAP services
      • Number of new workplace policies developed and implemented compared to baseline and adherence to the policy (i.e., determining the number of employees who have violated a worksite drug-free policy)
      • Number of new partnerships with community groups who provide programs related to alcohol and substance misuse, such as Alcoholics Anonymous, Al-Anon, or public mental health services
    • Assess changes in program costs from baseline
      • Increases in staffing or equipment needs due to new program offerings
      • Changes in employee participation time during work hours (e.g., education)
      • Changes in costs of EAP services
    • Assess changes in survey responses for employee satisfaction following program implementation of a workplace supported alcohol and substance misuse program and compare to baseline

Depending on goal success, evaluate the need to adjust workplace programs.

Tools and Resources

Alcohol and Substance Misuse Baseline Measures

The assessment tools described in the assessment module include specific questions related to alcohol and substance misuse.

  Health-related Programs

  • Q11; Q12; Q13; Q20e,f; Q21g; Q22; Q23; Q24a,b,d,e,h,i,j,k; Q26; Q27; Optional Questions A, B, C, J, L, M, N, OO

  Health-related Policies

  • Q28a

  Health Benefits

  • Q29; Q31; Q32; Q36; Optional Questions T, U, V, Z

  Environmental Support

  • Q39; Q40; Q41; Optional Questions CC, JJ, LL, NN

Additional Tools

  • The Substance Abuse and Mental Health Services Administration's (SAMHSA) Drug Free Workplace Kit: Assess Your Workplace website provides employers with information on completing a drug-free workplace needs assessment to determine whether alcohol and other drugs are affecting the workplace
  • The Substance Abuse and Mental Health Services Administration’s (SAMHSA) Communities That Care includes surveys, training for community activities, assessment and other tools to enhance community capacity to prevent alcohol and substance misuse and related problem behaviors
  • Health Risk Appraisals at the Worksite: Basics for HRA Decision Making [PDF - 2.3MB] is a guide developed by the National Business Coalition on Health in collaboration with the Centers for Disease Control and Prevention (CDC) in the selection and use of health risk appraisals in the workplace available for employers
  • The CDC Healthy Communities Program developed the Community Health Assessment aNd Group Evaluation (CHANGE) assessment tool to provide communities with a picture of the policy, systems, and environmental change strategies currently in place throughout the community, where gaps exists and facilitate action planning for making improvements. The CHANGE tool address five community sectors including worksites and health indicators related to physical activity, nutrition, tobacco use, chronic disease management, and leadership
  • Ensuring Solutions to Alcohol Problems is a project of George Washington University. Its website includes an alcohol cost calculator for employers to estimate the cost of alcohol misuse in their companies

Top of Page

 

Contact Us:
  • Division of Population Health/Workplace Health Promotion
    Centers for Disease Control and Prevention
    4770 Buford Highway, Northeast, Mailstop K-45
    Atlanta, GA 30341
  • 800-CDC-INFO
    (800-232-4636)
    TTY: (888) 232-6348
  • Contact CDC-INFO
USA.gov: The U.S. Government's Official Web PortalDepartment of Health and Human Services
Centers for Disease Control and Prevention   1600 Clifton Rd. Atlanta, GA 30333, USA
800-CDC-INFO (800-232-4636) TTY: (888) 232-6348 - Contact CDC–INFO
A-Z Index
  1. A
  2. B
  3. C
  4. D
  5. E
  6. F
  7. G
  8. H
  9. I
  10. J
  11. K
  12. L
  13. M
  14. N
  15. O
  16. P
  17. Q
  18. R
  19. S
  20. T
  21. U
  22. V
  23. W
  24. X
  25. Y
  26. Z
  27. #