Alcohol & Substance Misuse

Once assessment and planning have been completed, including analysis of the collected data, the next step is implementing the strategies and interventions that will comprise the workplace health program. The intervention descriptions above provide the public health evidence base for each intervention, details on interventions for alcohol and substance misuse, and links to examples and resources.

Before implementing any interventions, the evaluation plan should also be developed. Potential baseline, process, health outcome, and organizational change measures for these programs are listed under evaluation of alcohol and substance misuse programs.

Alcohol misuse

The National Institute on Alcohol Abuse and Alcoholism uses the following definitions of alcohol misuse:

  • Alcohol misuse describes alcohol consumption that puts individuals at increased risk for adverse health and social consequences. It is defined as excess daily consumption (more than 4 drinks per day for men or more than 3 drinks per day for women), or excess total consumption (more than 14 drinks per week for men or more than 7 drinks per week for women), or both1

The Centers for Disease Control and Prevention (CDC) Alcohol Team uses the following definitions of alcohol misuse:

  • Alcohol misuse
    • For women, more than 1 drink per day on average
    • For men, more than 2 drinks per day on average
  • Binge drinking
    • For women, 4 or more drinks during a single occasion
    • For men, 5 or more drinks during a single occasion
  • Excessive drinking includes heavy drinking, binge drinking or both
  • Alcohol misuse is a pattern of drinking that results in harm to one’s health, interpersonal relationships or ability to work
  • Alcohol dependence, also known as alcohol addiction and alcoholism, is a chronic disease and is associated with experiencing withdrawal symptoms, loss of control, or alcohol tolerance

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”2
  • There are approximately 79,000 deaths attributable to excessive alcohol use each year in the United States3

Alcohol misuse is a risk factor for a number of adverse health outcomes including:

  • Unintentional injuries (e.g., motor vehicle accidents, falls)
  • Violence (e.g., homicide, suicide)
  • Liver disease
  • Diseases of the central nervous system (e.g., stroke, dementia)
  • Heart disease including coronary artery disease, atrial fibrillation (i.e., abnormal heart rhythm), high blood pressure, and congestive heart failure
  • Various cancers (e.g., breast, colorectal, and liver)
  • Risky sexual behaviors and adverse pregnancy outcomes

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 alcohol consumption or frequent binges. Nondependent drinkers who misuse alcohol account for the majority of alcohol-related disability and death in the general population.4

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 costs5
  • 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 work6

The United States Preventive Services Task Force recommends screening and behavioral counseling interventions to reduce alcohol misuse by adults, including pregnant women, in primary care settings.

Other substance misuse

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.7



1.  National Institute on Alcohol Abuse and Alcoholism. Helping patients who drink too much: a clinician’s guide, updated 2005 edition. Rockville: National Institutes of Health; 2005 [cited 2008 Dec 5]. Available from: [PDF – 473K]

2.  National Institute on Alcohol Abuse and Alcoholism. New advances in alcoholism treatment. Alcohol Alert [serial on the internet]. 2000 Oct [cited 2008 Dec 5]; 49: [about 5p.]. Available from:

3.  Centers for Disease Control and Prevention. Alcohol-Related Disease Impact (ARDI). Atlanta, GA: CDC; 2008 [updated 2008 Aug 6; cited 2008 Dec 5]

4.  Campbell KP, Lanza A, Dixon R, Chattopadhyay S, Molinari N, Finch RA, editors. A Purchaser’s Guide to Clinical Preventive Services: Moving Science into Coverage. Washington, DC: National Business Group on Health; 2006. Available from:

5.  Harwood H. Updating estimates of economic costs of alcohol abuse in the United States: estimates, update methods, and data. Rockville (MD): National Institute on Alcohol Abuse and Alcoholism; 2000. NIH Publication No. 98-4327. Available from:

6.  Frone MR. Prevalence and distribution of alcohol use in the workplace: a U.S. national survey. J Stud Alcohol 2006;67:147-56.

7.  Substance Abuse and Mental Health Services Administration. Integrated health promotion/wellness and substance abuse prevention in the workplace [monograph on the internet]. Rockville (MD): Substance Abuse and Mental Health Services Administration; [cited 2008 Dec 5]. Available from: