Injuries on the job: the effects of problem drinking

December 13, 2000

It is well known that heavy drinking as well as alcohol dependence can contribute to a number of injuries through traffic accidents, fires, and falls. What is less known, but often assumed, is that problem drinking is also responsible for a large proportion of workplace injuries. This could be particularly relevant for safety-sensitive fields such as aircraft control, nuclear power, or medicine. A study in the December issue of Alcoholism: Clinical & Experimental Research examines the relationship among heavy drinking, alcohol dependence, and injuries at work.

Numerous studies have demonstrated that alcohol has had a significant role in people's deaths from off-the-job injuries. A notable proportion of individuals - 31 percent of unintentional, non-traffic related injury deaths, 31 percent of homicides, and 22 percent of suicides - were found to be legally intoxicated at the time of their deaths. Furthermore, despite a decrease in the role of alcohol in fatal motor vehicle crashes during the last few years, 30.6 percent of all traffic fatalities are still alcohol-related (in the most recent data available). In contrast, very little is known about the association between problem drinking and workplace injuries. The few studies of blood alcohol in persons who have died from injury at work in the United States have shown that between two and 11 percent of workers were intoxicated at the time of injury.

In this study, researchers analyzed data from the National Longitudinal Survey of Youth (NLSY), which has been sponsored by the U.S. Bureau of Labor Statistics since 1979. The authors were particularly interested in the years 1989 and 1990, when information on both work injury and alcohol was first collected. For those two years, they examined workers ages 23 to 32 who had worked in the six months prior to being interviewed. Respondents were considered "heavy drinkers" if they reported one or more instances of drinking at least five alcoholic drinks in one sitting in the previous month. Respondents were considered "alcohol dependent" according to standard clinical evaluations. All respondents were asked about injuries at work.

"Compared to drinkers who did not report heavy drinking," said Mark Veazie, assistant professor in the College of Public Health at the University of Arizona and lead author of the study, "those who reported heavy drinking were twice as likely to report injury in 1989 and 1990. However, most of this association appeared to be explained by the fact that heavy drinkers worked in more dangerous occupations and held jobs that required a high school education or less. This also appeared to be the case with drinkers who were classified as dependent on alcohol. Initially, they appeared to have a higher risk of injury at work." Further analysis, however, uncovered something unexpected.

"Once education and dangers of the jobs were taken into consideration," agreed Jonathan Howland, professor of social and behavioral sciences, and associate dean for research at the Boston University School of Public Health, "there was no association between job injury and heavy drinking. It would, however, be incorrect to assume on the basis of this one study that there is no association between job injury and heavy drinking."

Both Veazie and Howland cautioned against interpreting these results or using them in isolation from other studies to dismiss the residual effects of heavy drinking on worker performance and injury.

"It appears that the role of alcohol in the problem of work injuries is complex and depends on circumstances that are not yet fully understood," explained Veazie. He cited a 1994 National Health Interview Study which found a "modest" association between self-reported injuries at work and frequency of heavy drinking among workers of all ages. "There are two messages from our study. First, alcohol dependence may not be strongly associated with the occurrence of every day injuries at work, excluding sprains and strains, for the younger, average U.S. worker. Second, other risk factors such as the danger of one's occupation and education required for the job may explain much of the apparent association between heavy drinking and injuries at work among younger workers."

"This is but one of many studies to examine this question," added Howland, "and the results across these studies are not consistent. For example, a number of studies have actually administered enough alcohol to induce intoxication among subjects and then tested their performance the next day using occupational training simulators, such as those used for training aircraft pilots. These studies have shown that performance is impaired the next day, even when all the alcohol has cleared the blood. The performance impairment may or may not result in injury. But it is indicative of the risk of injury. Moreover," he added, "an impaired worker can injure others through poor performance while not injuring him or herself. The Veazie study was not able to determine whether heavy drinking was associated with injury to others."

Howland also noted several ways that heavy drinking could in fact be associated with workplace injury. "First," he said, "there is little doubt that acute exposure to alcohol, even in low doses, is a risk for injury. But, it is also possible that heavy drinking has a residual impairing effect on next-day worker performance, even when blood alcohol is zero. This residual effect can occur even in the absence of hangover symptoms, such as headache, tremors, nausea, etc. The residual effects of heavy drinking have not received a lot of attention from alcohol researchers. There are, however, exceptions and some experimental studies have shown 'hangover effects' for injury. This paper adds to the small but important literature on residual effects of heavy drinking on worker performance and injury."

In summary, said Veazie, "it is still largely unknown how many nonfatal injuries at work are caused by heavy drinking on or off the job. Much more work is also needed to examine the impact of alcohol dependence on occupational injuries."
The co-author of the Alcoholism: Clinical & Experimental Research paper was Gordon S. Smith of the School of Hygiene and Public Health at The Johns Hopkins University. The study was funded by the National Institute on Alcohol Abuse and Alcoholism, the National Institute of Occupational Safety and Health, and the Centers for Disease Control and Prevention.

Alcoholism: Clinical & Experimental Research

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