Mental Health, Alcohol Use, and Substance Use Resources for Workers and Employers

The workplace is an important setting to address mental health conditions, excessive alcohol use, and other substance use disorders among workers. In 2021, more than half of U.S. adults who reported a mental illness in the last year were employed. National U.S. data show that 70% of all adults with a substance use disorder (including alcohol or illicit drug use disorders) are employed. Alarmingly, rates of suicide, drug overdose deaths, and deaths from conditions fully caused by alcohol use¹ have been climbing over the last two decades. Rates of overdose and binge drinking², along with rates of suicide, are more common in some occupations, such as those in construction, mining, and the oil and gas industries. The National Institute for Occupational Safety and Health is working to address these issues in the context of work and the workplace.

Mental Health, Substance Use, and Work

Many safety and health issues straddle both work and non-work spheres. Mental health conditions and substance use can impact workers both on the job and away from work, as well as the worker’s co-workers, staff, family, and community. The Total Worker Health^®* perspective views the worker as a whole person and considers whole health impacts. Work and the workplace contribute to worker safety, health, and well-being, and therefore can be modified to improve those outcomes. This blog explores mental health conditions and substance use from a Total Worker Health perspective to consider that health challenges outside of work can combine with workplace exposures to affect worker safety and health. For example, stressors outside of work can combine with stressors in the workplace to affect mental health or substance use. In this situation, changes in mental health or substance use can affect a worker’s job and can affect how challenges in the workplace impact a worker’s safety and health.

Mental health conditions, substance use, and excessive alcohol use can affect various aspects of work:

• Job and workplace safety and health
• Job performance
• Work engagement
• Coworker communications
• Productivity at work
• Worker well-being
• Physical capability and daily functioning

Family and community relationships and other personal issues are non-work issues that can affect worker safety and health along with workplace variables.

Job-related factors, such as job strain (a combination of low job control and high job demands), long work hours (> 40 hours per week), and workplace violence can negatively affect mental health conditions. Work-related factors can also affect substance use. Stress, experienced on or off the job, and burnout may also impact mental health conditions and substance use.

Many people with substance use disorders (SUDs) can experience mental health disorders. Multiple national population surveys have found that about half of those who experience a mental illness during their lives will also experience a SUD and vice versa:

• NIMH » Substance Use and Co-Occurring Mental Disorders
• The Connection Between Substance Use Disorders and Mental Illness

Stigma can affect workers who are experiencing mental health conditions or substance use, making them worse. The effects of stigma can include reduced hope, lower self-esteem, difficulties with social relationships, reduced likelihood of staying with treatments, and more problems at work. Addressing stigma is an important part of helping workers with mental health conditions or substance use.

The 988 Suicide & Crisis Lifeline (formerly known as the National Suicide Prevention Lifeline) offers 24/7 call, text, and chat access to trained crisis counselors who can help people experiencing a suicidal, substance use, and/or mental health crisis, or any other kind of emotional distress. People can also dial 988 if they are worried about a loved one who may need crisis support. Veterans can press “1” after dialing 988 to connect directly to the Veterans Crisis Lifeline.

Read more here about how the workplace can serve as a suicide education, prevention, and intervention site.

Substance Use Disorders

Substance use disorders are treatable, chronic diseases that can affect anyone – regardless of race, gender, income level, or social class, and can be experienced by a worker at any organizational level. Substance use disorders can apply to the following classes of drugs: alcohol; cannabis; hallucinogens; inhalants; opioids; sedatives, hypnotics, or anxiolytics; stimulants; tobacco (nicotine); and other (or unknown) substances. Of these, alcohol is the most widely obtainable and prevalent compared to other substances. (see more on alcohol use below).

Workplace Resources

Substance use and mental health conditions can broadly affect workplaces, including effects on coworkers and staff as well as workers’ families and communities. As the lines between work and non-work environments have blurred for many in the wake of the COVID-19 pandemic, it is more important than ever to use a coordinated approach to meet the needs of employers and workers. NIOSH applies Total Worker Health® principles and strategies to advance worker well-being. This involves integrating protecting workers from work-related safety and health hazards while promoting injury and illness prevention efforts.

Workplaces represent a critical point of contact for people who are struggling with or recovering from a mental health condition or substance use disorder. A recovery-supportive workplace strives to create a work environment that actively prevents substance use and mental stress, reduces stigma, and encourages treatment and long-term recovery.

The new Recovery-Ready Workplace Resource Hub, hosted by the Department of Labor, provides information, guidance, tools, best practices, and other resources to support public and private sector employers in addressing substance use disorders in the workforce. These resources also help employers support workers who are in recovery and hire people who are in or seeking recovery. The Hub also provides links to treatment locations and other tools and resources. The Hub is an effort spearheaded by the White House’s Office of National Drug Control Policy and Domestic Policy Council in collaboration with various government agencies, including NIOSH.

Alcohol

Alcohol is the most commonly used substance in the U.S. and excessive alcohol use can impact occupational safety and health. Factors related to the community environment, such as the availability and accessibility of alcohol, and workplace factors can affect a person’s alcohol use. For some occupations, there may be certain regulations, laws, or other rules regarding alcohol, such as time of use in relation to performing work duties.

Here we present some basic information to help workers and employers make informed decisions about alcohol use and its impacts on health and safety in the workplace.

Too much alcohol is harmful to one’s health. Excessive alcohol use includes binge drinking, heavy drinking, any alcohol use by people under the age 21 minimum legal drinking age, and any alcohol use by pregnant women. Alcohol can affect nearly every organ system in the body. Excessive alcohol use increases the risk for short-term health problems, such as injuries, violence, and sexual risk behaviors. It also increases the risk for chronic disease, such as high blood pressure, certain types of cancer, learning and memory problems, and alcohol use disorder. However, diseases caused by alcohol misuse can be prevented by reducing or stopping use.

If adults of legal drinking age (age 21 and older) choose to drink alcohol, this can possibly have effects on overall health and on daily life, including non-work and work activities. According to the Dietary Guidelines for Americans, 2020-2025, published by the United States Department of Agriculture (USDA) and Department of Health and Human Services (DHHS), adults of legal drinking age can choose not to drink or to drink in moderation by limiting intake to 2 drinks or less in a day for men or 1 drink or less in a day for women on days when alcohol is consumed. This refers to a standard drink,** which may differ from the amount of alcohol in an alcoholic beverage bottle, glass, or other container.

People might reduce or stop drinking for a variety of reasons. These may include to avoid hangovers, sleep better, reduce one’s risk for long-term health problems, or improve the health and safety of others at home or work. Adults can check their alcohol use and plan ways to reduce their drinking to improve their health and well-being by using CDC’s alcohol use tool. For individuals who have concerns about a potential alcohol use disorder, the National Institute for Alcohol Abuse and Alcoholism’s treatment navigator may be helpful.

What Steps Are Your Workplace Taking?

Preventing, addressing, and providing support for alcohol use, substance use disorders, and mental health conditions are critical to developing and sustaining overall worker well-being. What steps are your workplace taking? Let us know in the comment section below.

Learn more about the Five Essentials for Workplace Mental Health & Well-Being in the Surgeon General’s report: Workplace Mental Health & Well-Being. 

Jamie C. Osborne, MPH, CHES®, is a contractor with Advanced Technologies and Laboratories (ATL) International, Inc. serving as a Public Health Analyst with the NIOSH Office of the Director.

Sudha P. Pandalai, MD, PhD, MS, is a Research Physician (public health) in the Risk Evaluation Branch, Division of Science Integration, at NIOSH.  

* Total Worker Health® is a registered trademark of the US Department of Health and Human Services.

** In the United States, a standard drink is equivalent to:

• 12-ounces of beer (5% alcohol content).
• 8-ounces of malt liquor (7% alcohol content).
• 5-ounces of wine (12% alcohol content).
• 1.5-ounces of 80-proof (40% alcohol content) distilled spirits or liquor (e.g., gin, rum, vodka, whiskey.

References

1. Karaye IM, Maleki N, Hassan N, Yunusa I. Trends in Alcohol-Related Deaths by Sex in the US, 1999-2020. JAMA Netw Open.2023;6(7):e2326346. doi:10.1001/jamanetworkopen.2023.26346
2. Shockey TM, Esser MB. Binge Drinking by Occupation Groups among Currently Employed U.S. Adults in 32 States, 2013-2016. Subst Use Misuse. 2020;55(12):1968-1979. doi: 10.1080/10826084.2020.1784947. Epub 2020 Jul 3. PMID: 32619144; PMCID: PMC8725193.