'Workers' drinking and its impact on health, performance and productivity'. Professor Ann M Roche Di

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'Workers' drinking and its impact on health,
performance and productivity'.Professor Ann M
RocheDirectorNational Centre for Education and
Training on AddictionPresentation to the
Flinders University Department of General
PracticeWednesday 19 July 2006
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This presentation will address.

• General perceptions of alcohol
• Problem domains
• Drinking Guidelines
• (short vs long term risk levels)
• New study data
• Patterns and prevalence (age, gender
  occupation/industry)
• Absenteeism, attending work under the influence
• Psychological distress

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Breaking the silence on alcohol beyond the
Charlie Chaplin syndrome
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In wine there is health Pliny the Elder,
AD 23
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. in the late 1800s Dr William Osler
described alcohol as... the most valuable
medicinal agent and the milk of old age
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Alcohol is the anesthesia by
which we endure the operation of life.George
Bernard Shaw (1856 - 1950)
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An alcoholic is someone you dont like
who drinks as much as you do. Dylan Thomas
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Alcohol

• Our most popular drug
• over 80 of population drinks, and 90 of the
  Australian workforce drinks.
• Until now, relatively little
• detailed information about
• workers patterns of drinking

Alcohol
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INTOXICATION
REGULAR USE
DEPENDENCE
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Alcohol Dependence
DEPENDENCE
It has been estimated that alcohol dependence
is more common than dependence on all other drugs
combined, and over 17 times as common as opioid
dependence.
Hall et al. (1998)
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IntoxicationAccidents and injuryHangoverInterp
ersonal Violence O/Dose
INTOXICATION
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Australias Drinking Guidelines

• Australias drinking guidelines were developed by
  the NHMRC.
• See www.nhmrc.gov.au

Alcohol
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Harms Associated with Risky Patterns of Alcohol
Use
Long term harms (chronic)
Short term harms (acute) Assaults,
violence, aggressive behaviours Motor vehicle
accidents Pedestrian accidents Accidents and
injury (eg falls, burns) Hangovers, nausea,
vomiting Blackouts, memory
loss

• Hypertension, stroke
• Cardiomyopathy
• Peripheral neuropathy
• Impotence
• Cirrhosis and hepatic or bowel carcinomas
• Cancer of lips, mouth, throat and oesophagus
• Cancer of breast
• Foetal alcohol syndrome

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Different Types of Problems From Different
Patterns of Alcohol Use
Short term harms (eg
intoxication effects) Harms occur at slightly
higher levels of consumption in the short term
gt 6 drinks - Men gt 4 drinks - Women
Long term harms (cumulative
effects)

• Harms commence at
• lower levels of consumption, over long
  periods of time
• gt 4 drinks - Men
• gt 2 drinks - Women

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Low-Risk Drinking Levels Standard Drinks
Risky Drinking Levels Standard Drinks
High-Risk Drinking Levels Standard Drinks
MEN
WOMEN
WOMEN
MEN
WOMEN
MEN
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LONG TERM HARM LEVELS
6
5
4
4
2
Average 2/day
Average 4/day
3-4/day
5-6/day
5/day
7/day
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Low-Risk Standard Drinks
Risky Standard Drinks
High-Risk Standard Drinks
WOMEN
MEN
WOMEN
MEN
WOMEN
MEN
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SHORT TERM HARM LEVELS
7
7
7
6
6
6
6
5
4
4
4
4
CHRONIC HARM
2
Average 2/day
Average 4/day
5-6/day
5/day
7/day
3-4/day
On any one day, no more than 3 days/week
On any one day
On any one day
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Pattern of Drinking Matters

• Is not just how much, but when, where, how
  often and with whom you drink that also has an
  impact on risk.
• Short term vs long term harms.
• Level of risk low risk, risky and high risk.
• 3. Frequency Daily/weekly, monthly, yearly.

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Standard Drink Measures
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Drug Alcohol Interactions

• Opioid analgesics (flu medication),
  antihistamines (some)
• Sedatitves and anxiolytics
• e.g. benzodiazepines (valium)
• Antipsychotics, antidepressants
• Diabetes medication

• Central nervous system depression
• Confusion, depressed respiration
• Decreased metabolism, toxicity CNS depression
• Facial flushing, headache

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Complimentary copies available
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Workplace Drug Alcohol Use Information
Data Series

• 1. Workers Patterns of Alcohol Consumption
• 2. Workers Alcohol Use and Absenteeism
• 3. Responding to Alcohol and Other Drug Issues in
  the Workplace
• 4. Drug Testing as a response to Alcohol and
  Other Drug Issues in the Workplace
• 5. Illicit Drugs in the Australian Workforce
  Prevalence and Patterns of Use

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National Drug Strategy Household Survey (NDSHS)

• Conducted every 3 years
• 2001 and 2004 surveys
• Multi-stage stratified sample design
• A representative national sample,
• weighted to correspond to whole population
• 2001 total survey population 26,744
• 51 in paid workforce

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NDSHS Data

• Identifies
• 1. Patterns of alcohol use in the Australian
  workforce by
• Gender
• Age groups
• Occupations
• Industries
• 2. Specific workplace outcomes (safety
  productivity)
• Working under the influence of alcohol
• Absenteeism due to alcohol use
• Absenteeism due to any illness/injury
• Psychological distress

What does this cost ?
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Unique Data Set

• Conservative Data
• Underestimates of actual levels of drinking.
• Self-report data recall bias (forget,
  underestimate and inaccurate about standard
  drinks)
• Sampling bias
• Robust Data
• Self attribution of alcohol as the reason
• for days off work

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Proportion of abstainers aged 14 years and over,
by employment status and gender
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Proportion of abstainers aged 14 years and over,
by age group and gender, Australia 2001
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Who are the risky drinkers?

• Varies by
• Age
• Gender
• Occupation
• Industry
• Geographical location

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Proportion of the workforce aged 14 years and
over drinking at risk of harm in the long-term
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Proportion of the workforce drinking at risky
and high risk levels for harm in the short-term
43 of workers drink at risky levels (at least
sometimes)
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Workers Risky Drinking

• 8 drink weekly at risky or high risk levels
• (9.6 males 7.3 females)
• Nearly 1 in 10 of all male workers
• Approximately 1 in 6 of male workers
• aged 14-30 years of age
• More than 1 in 4 females aged 14-19
• drink at risky or high risk levels weekly.

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• Contrary to traditional approaches
• focusing on dependent drinkers,
• recent research highlights the need to
• also focus on risky non-dependent drinkers.

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Counter-intuitive Findings

• Those who drink at risky levels only occasionally
  are at greater risk of incurring an injury !
• Occasional risky drinking is inversely related
  to risk of injury.

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Low Risk vs Risky Drinking

• 61 of alcohol is consumed at a level that
  places the drinkers health and safety at risk.

Low risk consumption
Risky consumption
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.as much as 90 of the mistakes of thinking are
mistakes of perception.deBono, 1999278-9
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Proportion of workforce aged 14 years and over
drinking weekly at levels for harm in the
short-term, by age, Australia, 2001
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Proportion of the workforce aged 14 years and
over drinking at levels for harm in the
short-term, by age and gender, Australia, 2001
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Proportion of the workforce aged 14 years and
over drinking at levels for harm in the
long-term, by age and gender, Australia, 2001
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Age and Gender

• The younger the worker the more likely they are
  to drink at risky levels.
• True for males and females.
• Very young females (aged 14-19) had the largest
  proportion of weekly high risk drinkers of any
  group of workers.
• DUTY OF CARE !
• Female managers and supervisors riskier drinkers
  than male counterparts.

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Proportion of the workforce aged 14 years and
over drinking at levels for harm in the short-
and long-term, by industry classification,
Australia, 2001
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A LARGE PROPROTION OF HOSPITALITY INDUSTRY
WORKERS ARE YOUNG (OFTEN THEIR FIRST JOB
WAITERS/BAR TENDERS), HIGH PROPORTION OF
FEMALES.
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Proportion of the workforce aged 14 years and
over drinking at levels for harm in the short-
and long-term, by occupational classification,
Australia, 2001
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Attending Work Under the Influence

• 7 of workers reported attending work under the
  influence
• (9 males vs 3 females)
• Most prevalent among younger workers
• (13 of 14-19 year olds)
• Risky drinkers 6 times more likely to attend work
  under the influence, compared to low risk drinkers

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Put in Fear, Verbally or Physically Abused

• 1 in 5 workers reported being put in fear, or
  verbally or physically abused by someone affected
  by alcohol or drugs.
• ¾s of these episodes involved alcohol.
• Perpetrators not usually co-workers, but
  customers, clients or others encountered in the
  work environment.
• Particularly common in health sector (services
  industry) and hospitality industry.

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Geographical Differences

• State difference
• (NT and Tas. higher proportion of workers are
  risky drinkers)
• Regional differences
• (more non-city workers are risky drinkers than
  workers in capital cities)

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Self assessment of drinkingAttitude by
short-term risk category for employed recent
drinkers
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Why does it matter?

• Risky drinking gt Absenteeism
• Risky drinkers, compared to low risk drinkers,
  have a higher proportion of days off work that
  are alcohol-related.
• Drinkers also have more days off work for any
  illness/injury than abstainers !!!

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Berocca Effect
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Self-reported alcohol-related absenteeism and
illness/injury absenteeism
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• Risky/high risk drinkers were
• 19 times more likely to
• miss work because of their alcohol use.
• 26 times more likely for high risk drinkers

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Preventable

• Approximately 10
• of all absenteeism in Australia workplaces
• is alcohol-related
• and therefore preventable.

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Which Drinkers ?

• Low risk drinkers and
• infrequent short-term risky drinkers accounted
  for
• over 50 of
• alcohol-related absenteeism

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of workers reporting days off due to alcohol
use, by age group and gender
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Work days missed due to alcohol use
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Industry and occupation classification by work
days missed due to any illness/injury
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Economic Cost of Alcohol-related Absenteeism

• National Drug Strategy Household Survey data
  (2001), all self-reported alcohol-related
  absenteeism in past 3 months X 4
• Equates to 2,685,000 (2.7 million) days off work
  due to alcohol alone
• Using the then average wage rate
• 437 million

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• 437 million cost of alcohol-related
  absenteeism in 2001
• 12 times greater cost
• than estimated by
• Collins and Lapsley (est. 35 million)

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Costs of Absenteeism

• Productivity loss
• Extra workload for remaining workers
• Morale and service suffers
• Financial costs
• Payment of overtime
• Cost of paying the absent workers wage/salary or
  benefits while not producing
• Employment of replacement staff
• Lower profit margins
• Administrative costs
• Time required to secure replacement, reassign
  tasks, and manage absenteeism

Engleman (2001)
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Psychological Distress

• Risky and high risk drinkers are more likely than
  low risk drinkers or abstainers to experience
  high or very high levels of psychological
  distress.

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Proportion of survey population experiencing
moderate, high and very high levels of
psychological distress by drinking status,
Australia 2004
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Death from Overwork

• Karoshi (death from overwork) has reached
  Australia.
• Workplace deaths due to heart attacks and strokes
  have increased by 30 between 2000-02
• Work stress is a main factor of 21 of suicides
• Mental stress caused 21 fatalities in 2000-01
  (NOHSC,2002)

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Stressors in the Workplace

• Changing trends at work
• Working conditions
• Job characteristics
• Organisational factors

Drawing by Simon Kneebone
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Working Hours

• Australia now has the 2nd longest average working
  hours for full-time employees in the OECD and the
  largest proportion of people working gt 50 hours a
  week (i.e. 1 in 4 people) (ACTU, 2003)
• Over 50 of Australians work more than 40 hours
  per week (ABS, 2002)
• The number of Australians working 50 hrs or more
  a week has doubled in the past 20 years to more
  than 1.7 million (ABS, 2003)

Source ABS Labour Force Survey
Proportion of full-time workers working more than
50 hours per week
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10 Summary Points

• High levels of risky drinking among workers
• Most prevalent among young, males but
• Very young females drinking at high risk levels
• Hospitality industry and trade persons
• Non-city workers and more remote states have
  higher prevalence of risky drinking
• Drinkers absenteeism costs
• Preventable !
• Duty of care issues especially re school-to-work
  transition and psychological distress
• Workplace culture a shaper of drinking
  behaviour
• Comprehensive strategies needed

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