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Under the Influence? Drugs and the American Work Force
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Under the Influence? Drugs and the American Work Force
A
Absenteeism, 7, 130, 134-144, 169, 220-222
and employee assistance programs, 249-250, 253
and wellness programs, 244, 245
Abuse of drugs
definition, 2, 21
progression to, 3, 31-32, 36, 43
Accidents, 7, 11, 129, 144-152, 169, 216, 237
alcohol-related, 19, 129, 148, 149, 150-151, 159
testing after, 75, 78, 114, 285, 288
transportation, 7, 144, 145-149, 158-159, 169
Accuracy of testing procedures, 7-8, 179, 192-195, 207-208
personality profiles, 10, 209-210
urinalysis, 8, 10, 207, 210
Adulteration of specimens, 182-183, 195
After-care, 261-263
Age-related differences, 5, 6, 35, 58, 99, 123
Alcoholics Anonymous (AA), 256, 257
Alcohol use, 2, 5, 15, 19, 31, 34, 37, 42, 56, 57, 90, 95-97, 99, 131
and accidents, 19, 129, 148, 149, 150-151, 159
deaths, 15, 18n
and early intervention, 260-261
and employee assistance programs, 255-256, 257
and employment status, 5, 58, 61, 94, 98, 99
heavy drinking, 4, 5, 32, 41-42, 52-53, 56, 66, 67, 98, 99, 163
and job satisfaction, 154-155
by military personnel, 66, 67, 69-70
performance effects, 6, 69-70, 73, 112-113, 123, 157, 163-164
and polydrug use, 3, 36, 43
residual effects, 113, 114-115
social attitudes toward, 15-16, 41, 42
testing for, 51, 75, 81, 149, 191, 215-216
and wellness programs, 242-243
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Americans With Disabilities Act (ADA), 191, 299
Amotivational syndrome, 112
Amphetamines, 19, 20, 42-43, 75, 118, 148, 184, 194, 215
Applicant testing, 8, 9, 10, 11, 12, 52, 75, 77, 208-209, 216, 218 -224, 227-228, 235, 286, 296, 300
consequences of positive results, 12, 236
personality profiles, 202-203
and self-selection, 233, 235
Arrestee studies, 72-73
Attitudes of employees, 33, 38, 39-40, 157-158
toward testing, 12, 158, 233-235, 236
Automobile accidents, 148
Aviation accidents, 149
B
Behavioral effects, see Performance and productivity effects
Benchmark measures
behavioral effects, 6, 122, 123
usage rates, 5, 100
Blood testing, 183
Breath testing, 183, 191
C
Caffeine, 2, 19n, 22
Case-referent studies, 272
Causes and risk factors, 3-4, 29-34, 119-120, 273
individual traits, 3-4, 29, 30, 37-39, 43
initiation, 3, 31, 32, 43
and intervention effectiveness, 3
progressive severity, 3, 31-32, 43
role of workplace, 3-4, 37-40, 41, 43
Certification
of laboratories, 8, 50, 51, 179, 180, 188, 207, 285
of test result reviewers, 13, 264
Cigarettes, see Smoking and tobacco use
Clinical diagnostic criteria, 22
Clinical Laboratory Improvement Act (CLIA), 190
Cocaine, 15, 19, 31, 36, 37, 41, 61, 72, 75, 80, 94, 96, 116, 184, 215
performance effects, 6, 123, 164-165
Collective bargaining, 294
College of American Pathologists, 180
Combinations of drugs, see Polydrug use
Community factors, 29, 30
Comparability and differences among studies, 5, 35, 89-98, 99-100, 272
Conrail-Amtrak train crash (Maryland), 16, 129
Consensus Report on Employee Drug Testing, 1989, 8, 180-181, 207
Constitutional issues, 286-296, 299
Construction workers, 4, 61, 79-80, 98
Constructive confrontation, 246, 252, 253-254, 257, 259
Costs of drug use, 16, 17-18
employer-provided health care, 18, 244-245, 250, 255-257
field studies, 7, 160-166, 169
illegal drugs, 18, 160-161
testing, 24n, 231-232
Counseling, 243-244.
see also Employee assistance programs (EAPs)
Coworker relations, 37, 38, 157-158
Crack cocaine, 15, 31, 32
Crime-related costs, of illegal drug use, 18, 161
Cross-sectional studies, 272
Cultural factors, 29-30
Customs Service, 289-291
D
Deaths, 15, 18
accidental, 148, 150
Deaths from substance abuse, 15, 18
Decongestants, 194
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Under the Influence? Drugs and the American Work Force
Definitions
of ''drug," 1-2, 18, 19-21
for epidemiological issues, 273
of use, abuse, and dependence, 2, 18, 21-22
of work force, 2, 18-19, 22
Demographics, see Age-related differences;
Ethnic groups;
Individual traits;
Sex-related differences
Department of Defense (DoD), 8, 178, 179, 186, 207
usage surveys, 42-43, 49, 50, 52-53, 65-71
Department of Justice, 291-292
Department of Transportation (DOT), 180, 285-286
Dependence on drugs, 2, 3, 21-22, 43, 114
Deterrence, testing effects, 11, 149, 151-152, 177, 180, 226-227, 235-236, 299n
Deviant behavior, 7, 32, 33, 39, 130-133, 169
Diagnostic and Statistical Manual (DSM-III-R), 22n
Dismissals, for positive results, 12, 236, 293, 295
Dosages, 6, 116-117, 123
Drug Abuse Scale (DAS), 196-197
Drug Abuse Warning Network (DAWN), 71-72
Drug Evaluation and Classification Program (DEC), 203-206
Drug Free Workplace Act (DFWA), 285, 294
Drug recognition experts (DREs), 204-206
Drug Use Forecasting (DUF) system, 72-73
E
Early intervention, 259-261
Educational status and problems, 29, 30, 33, 67
Emergency room visits, as epidemiological data source, 4, 71-72, 98
EMIT, 179, 185
Empirical studies, see Field studies
Employee assistance programs (EAPs), 12-13, 206-207, 246-257, 263-264, 285
supervisor training, 205, 246, 251-254
Employment status and patterns
studies of, 4-5, 58-65, 99, 165-166
turnover, 152-154, 220-221
Ephedrine, 194
Epidemiological studies, 4-5, 49-52, 98-100
as basis for test battery additions, 9, 208
biochemical testing, 49, 50-51, 73-81
large-scale surveys, 49, 52-73
limitations, 50-52, 89, 273-275
methodology, 272-275
national panel surveys, 4, 99
organization-specific, 49, 81-89
Ethical issues, 299-300
Ethnic groups, 5, 35, 38, 58, 61, 67, 99
Etiology, see Causes and risk factors
Executive Order 12564, 19, 178, 179, 215, 285
Experience with drugs, 6, 31, 33, 123
Experimental studies, 13-14, 273, 275-278, 283
External validity, 115, 278
Exxon Valdez oil spill, 16, 129
F
False negatives, 194-195
False positives, 9, 185, 192, 193-194, 195, 208-209, 298
personality profiling, 197-199, 202-203
Family relationships, 18, 29, 30, 33, 248-249
Federal contractors, 179, 285
Federal employees, 19, 179, 247, 285
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Federal Railroad Administration (FRA), 288-289
Field studies, 7, 129, 133-160, 169
absenteeism, 7, 134-144, 169
accidents, 7, 144-152, 169
cost-of-drug use, 7, 160-166, 169
experimental, 13-14, 273, 276-278, 283
interpretation of, 161-162, 166-168
job satisfaction, 154-155
limitations of, 130-133, 159-160, 166-168
research base development, 7, 169
turnover, 152-154
Firings, see Dismissals, for positive results
Fluorescence polarization immunoassay (FPIA), 185
Follow-up, 75, 261-263
employee assistance programs (EAPs), 12, 254-255, 257, 261-263, 285
Fourtune 500 corporations, 247
Fourth Amendment issues, 286-294
G
Gas chromatography (GC), 179, 184, 185-186
Gender, see Sex-related differences
Genetic factors, 29, 31
H
Hair testing, 9, 177, 183-184, 208, 299
Hangover effects, 2, 6, 22, 113, 123, 124
Hard-core and heavy users, 5, 37, 99
alcohol, 4, 5, 32, 41-42, 52-53, 56, 66, 67, 98, 99, 163
Health care costs, 17, 161
for employers, 18, 244-245, 250, 255-257
Health maintenance organizations, 255
Health promotion and wellness programs, 241-246
Heroin, 15, 19, 178
High performance liquid chromatography (HPLC), 186-187
High School Senior surveys (HSS), 42-43, 49, 52, 53-56, 95-96, 235
Hospital employees, 85, 90
Hospitalization, 255-257
Housing authority employees, 86, 135
I
Illegal drug use, 4, 16, 19, 31-32, 53, 56-57, 71-73, 75, 80-81,94, 95-96, 98, 135
deaths, 15, 18, 161
and employment status, 4, 5, 58, 61, 73, 94, 99
hard-core users, 4, 71-72, 73, 98
by military personnel, 67, 70-71
and polydrug use, 3, 43
societal costs, 18, 160-161
Immunoassays, 179, 185
Income level, 61, 163-164
Indirect assessment of drug use, 178, 195-207
Individual traits, 3-4, 29, 30, 37-39, 43
Initiation to drug use, 3, 31, 32, 43
Integrity testing, 10, 196-199, 209
Interaction effects, 4, 33, 43
International Classification of Diseases (ICD-10), 22n
Interpersonal factors, see Family relationships;
Peer relationships
Intervention programs, national, 4.
See also Workplace intervention programs
J
Job satisfaction, 37, 38, 154-155
Justification for testing, 12, 233-234, 236, 237, 289-291, 292-293
of rarely used drugs, 9, 191-192, 208
L
Laboratory studies, 6, 107-115, 121-124
limitations, 107-108, 111, 115, 118-121
methodology, 115-118, 278
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Laboratory testing, see Testing procedures and results
Law enforcement agencies, 290-291, 292, 293
Legal issues, 284-299
Limitations of studies
laboratory-based, 107-108, 111, 115, 118-121
observational, 130-133, 159-160, 166-168
self-reports, 50, 89, 130, 177, 281-282
Longitudinal studies, 274, 275, 280
deterrent effects of testing, 11, 236
of usage, 4, 32-33, 100
LSD, 20
justification for testing of, 9, 159
M
Managed care, 246
"Mandatory Guidelines for Federal Workplace Testing Programs,"; 19, 179, 215, 285
Mandatory testing, 19, 179, 284-286, 287-294, 298
Manufacturing, 61, 88, 90
Marijuana, 19, 31, 36, 37, 38, 42, 61, 75, 80, 94, 95, 96-97, 215, 293
accidents involving, 114, 129, 148, 149, 150
passive inhalation, 193-194
performance effects, 6, 112, 117-118, 121, 123, 164, 219-220
residual effects, 114
and urine tests, 51, 114, 149, 184
Marital status, 38, 39, 67
Mass spectrometry, 179, 185-186
Measurement artifacts, 273-274, 277
Measurement errors, 281-282
Metabolites of drugs, 6, 123, 193
Methamphetamines, 19, 20, 184, 194, 215
Military personnel, 4, 98, 178
Navy recruit testing, 86-87, 152-153, 219
usage surveys, 42-43, 49, 50, 52-53, 65-71
Minority groups, see Ethnic groups
Morphine, 19, 194
Municipal governments
employees, 85-86, 94, 134-135
laws, 297
N
National Household Surveys on Drug Abuse (NHSDA), 4, 49-50, 52, 56 -65, 79-80, 99
National Institute on Drug Abuse (NIDA), 8, 9, 74, 179, 207, 208
testing standards, 7-8, 9, 179-180, 184, 186, 186-190, 207, 208
National Laboratory Certification Programs, 8, 179, 189-190, 207
National Treasury Employees Union v. Von Raab, 287, 288-291
Navy, 178
recruit testing, 86-87, 152-153, 219
Nuclear Regulatory Commission, 180, 186
O
Observational studies, see Field studies
Occupational alcoholism programs (OAPs), 206
Occupational differences in use, 5, 35, 40-43, 61-65, 90, 94, 99
Omnibus Transportation Employee Testing Act (OTETA), 215-216, 285286, 294
On-Site Drug Testing Study, 8, 207
On-site testing facilities, 8, 185, 190-191, 207
Opiates, 19, 75, 113, 184, 215
in poppy seeds, 194
Over-the-counter drugs, 6, 20, 124, 191
residual effects, 6, 123
test result reporting, 10, 191, 209
P
Paper-and-pencil tests, 10, 196-197, 209, 210
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Peer relationships, 29, 30, 32, 33, 37, 38, 155, 157-158
Performance and productivity effects, 16-18, 95, 219-226
laboratory studies, 6, 107-123
legal medications, 6, 20, 124, 191
of testing, 11-12, 227-231, 236
see also Field studies
Performance testing methods, 10, 195, 203-207, 209-210, 299
Periodic medical testing, 75, 77-78
Personality testing and profiling, 10, 52, 195, 196-203, 209-210, 282
Phencyclidine, 19, 75, 184, 215
Physiological effects, 2
Policies, see Public policies;
Testing programs and policies
Polydrug use, 3, 36-37, 43, 115-116
performance effects, 6, 123
Poppy seeds, 193, 194
Positive results
consequences of, 12, 236, 293-294
and treatment referral, 13, 263-264
Postal employees, 81, 85, 134, 152, 219-224
Practical importance, of study results, 278-279
Prescription drugs, 6, 20, 124, 191
residual effects, 6, 123
test result reporting, 10, 191, 209
Prevalence, 35-36, 98, 273
as basis for test battery additions, 9, 208
and employment status, 5, 98, 99
see also Epidemiological studies
Prevention programs, 3, 43, 241-246
Prison testing, 185
Privacy issues, 9-10, 191-192, 209, 234, 285, 286-299
Private-sector drug testing, 286, 294-295, 298-299
Probable cause, 286-287
Productivity, see Performance and productivity effects
Professional occupations, 4, 61, 65, 98, 234
Prohibition, 15
Prospective panel studies, 272-273
Protective factors, 33-34
Psychological testing, see Personality testing and profiling
Public policies, 16, 19, 216-217, 231, 284-286
savings assessments, 7, 161-162, 169
Q
Quality control, testing procedures, 8-9, 75n, 187-190, 207-208
Quality of research, 11, 23, 159-160, 236
and policy decisions, 7, 278-279
Quasi-experimental studies, 275-276
R
Racial and ethnic groups, see Ethnic groups
Radio immunoassay (RIA), 185
Railroad accidents, 16, 129
testing after, 148-149, 288-289
Randomized field studies, 13-14, 273, 276-278, 283
Random testing, 75, 77, 78, 81, 88-89, 216, 226-227, 291-292, 293
Reagan and Bush administration policies, 16, 19, 178, 179, 215, 216 -217, 285
Reasonableness standard, 287, 290, 291-292, 295, 296
Referral for treatment, 13, 246, 252-254, 257, 258-261, 263-264
Regional variation, 58, 79
among treatment programs, 273
Regulatory requirements
for employee assistance programs, 247-248
mandatory testing, 19, 179, 284-286, 287-294, 298
testing procedures, 8-9, 186-191, 207-208
Relapse, 261-263
Residual effects, 2, 6, 22, 34, 113-115, 123, 124
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Retail employees, 94
Reverse causation, 4, 43, 273, 274, 276
Risk factors, see Causes and risk factors
S
Safety-sensitive positions
justification of drug testing, 12, 233-234, 237, 289-291, 292-293
and legal medications, 6, 123, 124
mandatory testing, 285-286, 297
Saliva testing, 9, 183, 208
Samples and sampling methods, usage studies, 5, 51-52, 100
see also under Testing procedures and results;
Urine testing;
and other specific testing methods
Sedatives
performance effects, 6, 113, 118, 121, 123
testing of, 9, 191, 208
Self-esteem, 38, 39, 274
Self-referral, for treatment, 242, 245, 246, 253, 258-259
Self-report studies
Self-report surveys, 4, 5, 35, 74, 98, 99-100
large-scale surveys, 49, 52-73
limitations, 50, 89, 130, 177, 281-282
Self-selection, by job applicants, 233, 235
Sex-related differences, 5, 35, 37, 38, 42-43, 58, 61, 90, 95, 99, 165
Skinner v. Railway Labor Executive's Association, 287, 288-291, 293
Smoking and tobacco use, 2, 4, 19n, 22, 53, 56, 57, 98, 99
among military personnel, 66, 67, 70
among teens, 4, 31, 98
deaths, 15, 18n
and polydrug use, 3, 36, 43
and wellness programs, 243-244
Social attitudes and norms, 15-16, 32, 33, 43
Specimens for testing, see under Testing procedures and results;
Urine testing;
and other specific testing methods
Spuriousness, of causal relationships, 273, 277, 280-281
Standards and guidelines
diagnostic criteria, 22n
employee assistance programs, 246, 257
for test result review, 13, 264
State laws, 180, 296-298
Statistical modeling, 274, 275, 280-282
Statistical significance, 278-279
Stimulants, 6, 111-112, 115, 116, 121, 123, 148
Stress, work-related, 4, 37, 43, 130
Studies
comparability and differences among, 5, 35, 89-98, 99-100, 272
design issues, 228-231, 271-283
see also Epidemiological studies;
Field studies;
Laboratory studies
Supervisor intervention
constructive confrontation, 246, 252, 253-254, 257, 259
employee assistance programs, 205, 246, 251-254
Supplemental Appropriations Act of 1987, 285
T
Tampering with specimens, 182-183, 195
Temperance movements, 15-16
Temporal sequence, 280-281
Testing procedures and results, 24n, 178-195
accuracy and reliability, 7-8, 179, 192-195, 207-208, 281
costs, 24n, 231-232
as epidemiological data source, 49, 50-51, 73-81
false positives, 9, 185, 192, 193-194, 195, 208-209, 298
GC/MS technology, 9, 179, 184, 185-186, 209
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interpretation of, 13, 180, 192-195, 264
laboratory certification, 8, 50, 51, 179, 180, 188, 207, 285
limitations of, 130, 177-178
nonurine specimens, 8, 9, 183-184, 208
on-site facilities, 8, 185, 190-191, 207
privacy issues, 9-10, 209, 285
quality control, 8-9, 75n, 187-190, 207-208
regulation and standards, 8-9, 74, 75-77, 179-181, 185, 186-191, 207 -208
selection of drugs for analysis, 9, 191-192, 208
specimen collection, 9, 181-184, 208
see also Performance testing methods; Urine testing
Testing programs and policies, 11, 12, 177-178, 216-218, 236, 284299
applicant testing, 8, 9, 10, 11, 12, 52, 75, 77, 208-209, 216, 218 -224, 227-228, 235, 286, 296, 300
attitudes and morale impacts, 12, 158, 233-235, 236
deterrent effects, 11, 149, 151-152, 177, 180, 226-227, 235-236, 299n
ethical issues, 299-300
evaluation, 11, 228-232, 236
for-cause, 75, 88, 216, 224-226
mandatory, 19, 179, 284-286, 287-294, 298
productivity effects, 11-12, 227-231, 236
random, 75, 77, 78, 81, 88-89, 216, 226-227, 291-292, 293
Theft, 155, 156
Therapeutic drugs, see Over-the-counter drugs;
Prescription drugs
Thin-layer chromatography (TLC), 179, 186-187
Timing of consumption, 6, 123
Tobacco, see Smoking and tobacco use
Tranquilizers, 43
Transportation industry, 4, 61, 65, 98, 112, 191, 247
accidents, 7, 144, 145-149, 158-159, 169
mandatory testing, 285-286, 292-293, 298
Treatment, assessment of, 273.
See also Employee assistance programs (EAPs)
Truck drivers, 19, 94-95, 116, 145, 148
Turnover, 152-154, 220-221
U
Unemployment, 4, 5, 58, 61, 98, 99
Unionized industries, 294-295
Urine testing, 4, 8, 9, 10, 50-51, 98, 180, 181, 208
accuracy, 8, 10, 207, 210
limitations and contraindications, 80, 177, 191, 193-195, 281
privacy issues, 234, 288, 293, 299
specimen collection, 9, 181-183, 208, 285, 293
U.S. Government, see Federal employees;
Public policies;
names of specific agencies
U.S.S. Nimitz accident, 129
Utility employees, 87-88
V
Validity of studies, 177, 281-282, 282,
see also Limitations of studies
Vandalism, 155
Vicks inhaler, 194
Vignettes, 200
Violence, 18
W
"War on drugs," 34; 15, 16, 216-217
Wellness programs, 241-246
Wholesale trae workers, 4, 61, 98
Withdrawal effects, 6, 19n, 21, 31, 113-114, 123, 124
Work force, definition, 2
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Workplace intervention programs, 3, 5, 99,
see also Employee assistance programs (EAPs);
Health promotion and wellness programs;
Testing programs and policies
Worldwide Surveys of Substance Abuse and Health Behaviors Among Military Personnel (MWS), 42-43, 49, 50, 52-53, 65-71
Y
Young adults, 4, 53, 57, 94, 98, 135
Youth, 29-31, 131
smoking, 4, 31, 98
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