Employees of many businesses and government agencies in metropolitan Miami (Dade County, Florida) took five voluntary annual surveys (1989-1993) regarding their attitudes toward and use of drugs. The Workplace Drug Survey data indicated three positive conclusions about employee drug use and attitudes for Dade employees.

1. Reported illicit drug abuse continues to be low compared with national norms.

2. Most employees know that their employer has a policy on alcohol and drug abuse. They also recommend referral of employees with drug or alcohol problems to an Employee Assistance Program (EAP). This demonstrates the effectiveness of the information campaign conducted by the Miami Coalition.

3. These results are increasingly likely to be representative of major Dade County employers, public and private.

But there are some things to be concerned about:

1. Alcohol abuse remains high, even though this is a legal drug.

2. It is likely that employees underreport personal problems with alcohol and other drugs.

3. Employees of other smaller employers can be expected to report higher levels of drug and alcohol abuse, less concern about risks, and less optimism about the availability of help from their employer for an alcohol or drug problem.

4. The reported level of risk associated with drug and alcohol abuse has dropped significantly. This may lead to higher rates of future use.

Introduction.

The past fifteen years have been characterized by popular concern with increased drug abuse as a societal problem. It became a workplace issue because of the relationship between substance abuse and employee productivity, health care costs, and legal liability risks. These concerns led to passage of the Drug-Free Workplace Act (1988), which mandated the adoption of substance abuse policies and Employee Assistance programs by Federal contractors.

In metropolitan Miami (Dade County, Florida), business and civic leaders were concerned about the negative image of Miami as the illegal drug capital of the United States, fueled by lurid news accounts of international drug trafficking by "cocaine cowboys" and by popular television programs like "Miami Vice." In 1988, the Miami Chamber of Commerce sponsored a community-wide effort, led by the Miami Coalition, to (1) assess the impact of drugs on the community, (2) recommend policies and programs to combat substance abuse in schools and the workplace, and (3) evaluate their effectiveness over a five-year period.

The first objective, baseline assessment of the impact of drugs on the workplace, was accomplished through five annual workplace surveys conducted from 1989 through 1993. In these surveys, employees of major public and private employers in metropolitan Miami took voluntary surveys regarding their attitudes toward and use of drugs.¹ The fourteen-page survey was developed by a team of researchers at Florida International University and the University of Miami. It asked employees about their attitudes toward a variety of legal and illegal drugs (including alcohol), their past and current drug use, and their awareness of employers' substance abuse policies and programs. To enable comparison with national norms, it was closely patterned after the instrument developed for the national household survey conducted by the National Institute on Drug Abuse (NIDA).²

The survey was administered by volunteer proctors organized by the Miami Coalition, with the cooperation of employers who contributed their employees' time and made arrangements for them to complete the questionnaires at their work sites. Administration of a detailed, sensitive questionnaire requires that both employers and employees be volunteers. Therefore, the sample of employees used was not random. Nor did the sample comprise the same employees over the five year period. Hence, longitudinal analysis of the results over time is not appropriate. Because the number of employees responding has grown each year³, these results are increasingly likely to be representative of major Dade County employers, public and private.

Literature Review

Controversy Over the Magnitude and Nature of the Drug and Alcohol Problem in the Workplace

Drug and alcohol abuse is a serious public health problem in our society (Arbetter, 1994). The workplace is obviously not immune from the effects of drug and alcohol abuse (Newcomb, 1994). However, the workplace is not representative of the general population, and general population drug use estimates are not valid indicators of employee drug use (Newcomb, 1994). In addition, the literature manifests considerable controversy over the nature and severity of employee drug and alcohol abuse (Reinarman and Levine, 1991; Crow, Villere and Hartman, 1992). The true cost of workplace drug and alcohol abuse is unknown, partly due to the absence of accurate prevalence data (Newcomb, 1994). However, the available information clearly indicates that alcohol is the most abused drug. The National Institute on Alcohol Abuse and Alcoholism estimates alcohol abuse results in a yearly 117 billion-dollar loss in productivity along with 13 billion dollars in employee rehabilitation expenses (Evans, 1994). The National Clearinghouse for Drug and Alcohol Abuse estimates drug abuse costs U.S. employers 7.2 billion dollars per year in productivity losses (Electronic Business, 1993). A large scale longitudinal study of 5,465 postal employees found higher rates of absenteeism and turnover for employees who tested positive for drugs (59.3 percent and 47 percent, respectively) (Norman, Salyards, and Mahoney, 1990).

Given the lack of consensus on the magnitude of the drug use problem, there is considerable disagreement on the appropriate policy responses (Reinarman and Levine, 1991; Crow, Villere and Hartman, 1994; Macdonald, Wells and Fry, 1993). Several authorities have argued that the war on drugs, as applied to the workplace, is out of proportion to its severity. Drug testing is the most prevalent tool in the war on drugs (Romano, 1994). Critics argue that drug testing is a product of a neotemperance movement fed by a moral panic caused by media distortions (Crow, Villere and Hartman, 1994). Drug testing also promotes various political agendas and reflects the manipulation of special interest groups that market and sell drug testing and security services (Reinarman and Levine, 1989; Crow, Villere and Hartman, 1992).

In addition, drug testing is costly, requires elaborate and complex procedures to ensure integrity, violates employee privacy and has not been causally linked to a reduction in drug use (Macdonald, Well and Fry, 1995). In addition, a positive test does not always correlate with a decrement in job performance, an essential criteria for assessing the adverse effects of drugs (Manley and Gibson, 1990). Proponents counter by stating that drug testing is an important tool that symbolizes the employer's (and society's) commitment to the war on drugs (Barnum and Gleason, 1994). Quazi (1993) argues that the most important benefit of drug testing is its deterrent value as evidenced by a five-year decline in positive drug tests. Feinauer and Havlovic (1993) found that a drug testing program did reduce the employee accident and illness rates over a five year period for 12 Wisconsin employers.

There are several other studies that cast doubt on the magnitude and consequences of drug and alcohol use in the workplace. A large survey conducted the by National Institute of Mental Health found that casual drug use does not normally influence work performance (Gillian, 1995). Studies have found that drug use is not a significant factor in most workplace accidents (Normand, Salyards and Mahoney, 1990; Kaestner and Grossman, 1995), and there has been a significant reduction in drug-related accidents since 1989 (Voss, 1994). Proponents of drug testing attribute this reduction to its deterrent effects. However, Pouzar (1994) points out that there is likely to be significant underreporting of drug-related accidents as 20 states deny any compensation claim if drug and alcohol use is present.

Prevalence of Workplace Drug and Alcohol Abuse

Given the extent of the controversy, what does the available data indicate? Newcomb (1994) presents a summary of fifteen studies that assessed drug and alcohol use in the workplace for general population, community and occupational samples. Newcomb (1994) concluded that the most valid surveys indicate that 10 percent or less of employees use drugs or alcohol on the job. Of these 10 percent, only a small minority are chronic users. Therefore, the prevalence of drug abuse is modest to moderate. In terms of gender, males manifest higher rates of drug and alcohol use (Gleason, Veum and Pergamit, 1991; Lehman, Holcom and Simpson, 1990; Newcomb, 1988; Newcomb, 1989) and drug use is highest for young adults (Newcomb, 1988; Newcomb, 1989). Not surprisingly, there is an inverse relationship between drug use and labor supply, but considerable subgroup variation is present (Kaestner, 1994). The reviewed studies are all consistent regarding the rates of drug and alcohol abuse expect for a few occupation specific studies (See Guinn, 1983).

In terms of actual rates of usage, alcohol is the most abused drug followed by marijuana. A large longitudinal sample (n = 16,000) of high school graduates indicated that in 1991, 8 percent of women and 5 percent of men have used alcohol on the job (O'Malley, 1992). Lehman, Holcom and Simpson (1990) studied 1,975 municipal employees and found that 8 percent of the men and 3 percent of the women reported using alcohol on the job. The next most abused drug is marijuana with 5 percent of the men and 1 percent of the women reporting using marijuana while at work (O'Malley, 1992). All other drugs, (amphetamines, barbiturates and cocaine) are used by less than 1 percent of the surveyed employees (O'Malley, 1992).

There have been several occupation specific studies with smaller samples that have uncovered higher rates of drug use. For example, Guinn (1983) found that 80.4 percent of long distance truck drivers use amphetamines to enhance work performance. The motivation is obviously different from other types of abuse as "uppers" are used to enhance job performance and earnings (Newcomb, 1994). Newcomb (1994) concludes that there is little support for viewing drug and alcohol abuse as rampant in the workplace.

Studies that discuss the results of drug testing programs are consistent with surveys of employee drug use. Voss (1994) found that between 2.5 percent and 8.1 percent of employees have tested positive for drugs. Baliga (1994) found that five percent of current employees test positive for drugs and 2.6 percent of candidates tested positive.

Methodological Difficulties in Measuring Drug and Alcohol Use

There are considerable methodological obstacles related to measuring drug and alcohol use. Most risk factors for drug use are unrelated to the job (Newcomb, 1994). The correlations between work and non-work drug use is .63 for alcohol and .50 for cocaine (Newcomb, 1988). There are problems of conceptual ambiguity related to whether drug use on breaks, lunch, or before work is captured in current drug use measures (Newcomb, 1994). Various drugs exhibit different half-lives and can influence employee functioning in variable ways over different periods (Newcomb, 1994). There is also the problem of defining alcohol abuse given that is a legal drug. Is two or three drinks at lunch considered abuse? The physiological effects of an equivalent amount of alcohol vary within and between persons.

There also is the problem related to base rates. Most survey items ask if the employee used a drug at least once during a specific time (Newcomb, 1994). Thus, it is impossible to determine the frequency of drug use on the job. Sporadic or isolated users are included with habitual abusers. Of those employees who reported at least one episode of workplace drug use, only a few employees (3 percent), report drug use on a regular basis (Levy, 1973; Newcomb, 1994). In addition, drug use is likely to be underreported given its social undesirablility. Interestingly, Aquillin (1994) in an experimental design, found that self-administered questionnaires produced the most valid information on employee drug use in comparison to personal and phone interviews. The key factor is convincing the respondent that their answers will be anonymous.

Drug testing is the most common tool for identifying drug abuse. A recent American Management Association survey (Romano, 1994) found that 87 percent of the 794 companies surveyed employed some type of drug testing. There is considerable disagreement over the efficacy and legitimacy of drug testing. Even with the most accurate drug tests, approximately a third of the identified drug users will be false positives (Barnum and Gleason, 1994). In addition, a positive test demonstrates exposure, but not necessarily a decrement in job performance (Cavanaugh and Prasad, 1994).

Alternatives to Drug Testing

The Miami Coalition survey assesses employee attitudes related to the locus of responsibility for drug use and the availability of Employee Assistance Plans (EAP). Is a drug or alcohol problem a medical issue requiring rehabilitation, or is it an ethical issue that entails assigning individual responsibility and punishment? Employee drug testing is one tool that is congruent with a punitive view of drug abuse. Several studies have found that the strongest supporters of drug testing favor a punitive approach toward drug use (Labing, 1992; Bennett, Blum and Roman, 1994). Tepper (1994) found that employees possess more favorable attitudes toward drug testing for safety sensitive positions. Labing (1992) found that there was no relationship between an employee's attitude toward drug testing and EAP use, however.

Several alternatives to drug testing are proposed. Computer tests that measure hand-eye coordination are indicators of employee impairment, which is the critical variable in terms of the effects of drugs on job performance (Crow, Villere and Hartman, 1994; Fenn, 1995). Skills testing is another technique that can detect drug abuse (Comer, 1994). The ultimate solution in the eyes of many authorities is education and changing the norms and values of the workplace (Strong, Peterson and Tellier, 1994). The descriptive literature provides information on a variety of drug and alcohol abuse education programs. The elements of an effective program include cultivating a shared responsibility between labor and management for reducing drug and alcohol abuse (Oliver, 1994), a comprehensive drug education and awareness program (Strong, Peterson and Tellier, 1994), supervisor training on identifying drug use (Quazi, 1993), clear employee policies on drug and alcohol abuse (Quazi, 1993), a fully functioning EAP program (Quazi, 1993), and a focused and limited drug and alcohol testing program (Quazi, 1993).

Employee Assistance Plans

There is a substantial literature on the use of EAPs. Employees are less likely to use an EAP if they lack confidence in the program's confidentiality (Harley, 1991; Hirth, 1994). Confidence in the EAP was the main factor in an employee's intention to use an EAP along with top-management support (Milne, Blum and Roman, 1994). Blum and Roman (1992), in a study of 6,400 employees in 84 work sites, found that women and blacks were over represented in EAP programs. Harley (1991) studied the responses of 415 supervisors from seven organizations and found that employees were eight times more likely to be referred to the EAP after a crisis (accident, illness) than for performance impairment. Therefore, EAPs are used as a crisis management tool.

To develop an effective EAP program, the organization should perform a needs assessment. Berman et al. (1991) recommended that information on the type, severity and prevalence of employee problems be gathered. In addition, an inventory of EAP resources should be conducted along with the identification of barriers to the effectiveness of the EAP. Employees cannot utilize an EAP if they or their supervisors are unaware of its benefits. Frost (1990) offers a framework for assessing employee awareness. Employees should be surveyed on the visibility of the EAP, employee understanding of the services that are available, employee familiarity with the procedures that must be followed to utilize the EAP, and perceptions on the program's confidentiality (Frost, 1990).

Clearly, most employers share a vested interest in rehabilitating employees rather than employing punitive measures. The ADA (Americans with Disabilities Act) prohibits discrimination for in-treatment or rehabilitated drug and alcohol users, and reasonable accommodation may be required. Depending on the type of employee, rehabilitation is cheaper than replacement (Segal, 1992). Hence, the rehabilitative orientation of most EAPs is congruent with employee values.

Findings.

The major findings are presented below. Dade employee data for 1989, 1990, 1991, 1992 and 1993 are drawn from the Miami Coalition Workplace Drug Surveys.⁴ Comparative national drug use figures for are taken from the NIDA household survey (1991).

Alcohol is the drug of choice among Dade employees. Approximately 9 in 10 (range of 88.6% to 95.4%) report using it at some point in their lifetime, compared with 84.7% for the 1991 national population. Usage rates have been constant over the five year period. About two thirds (range of 65.5% to 77.5%) of Dade employees report using it within the past month, compared with 50.9% for the 1991 national population.

Alcohol continues to be the most commonly abused drug, by far. For example, despite widespread public education programs and stiff penalties for drunk driving, approximately a third of the employees reported that they had been in a car with a drinking driver at least once within the last month alone (range of 30.8 to 40%); approximately 1 in 10 (range of 9.2% to 12%) reported that they had been in a car with a driver who had had at least five drinks; and an average of 6.9% (range of 4.9% to 10%); 6.5% reported that they drove a car one or more times after consuming at least five drinks. However, all these figures show a gradual downward trend since 1989.

Tobacco is the second drug of choice among these employees; and its rate of use has exhibited a small decline. About two thirds of the surveyed employees report some lifetime use (compared with 72.7% for the 1991 national sample). The percentage of those reporting that they had used tobacco in the last 30 days declined from 24.9% in 1988 to 20.5% in 1993. This figure is somewhat lower than the national sample norm of 27.0%.

Marijuana is the illicit drug of choice, but recent reported use is quite low while the reported rate of lifetime use has remained relatively constant. Approximately 2 in 5 employees have used marijuana at least once in their lifetime (range of 37.4% to 40.5%). About 1 in 50 report using marijuana in the past month (range of 1.2% to 2.7%). Dade employees continue to report higher lifetime usage than the national population in 1991 (33.4%), but lower usage than the national population estimate for the last month (4.8%).

Tranquilizers continue to be the fourth-ranked lifetime drug of choice among Dade employees, though their reported illegal use appears to be declining. Approximately one in five employees have used tranquilizers at least once without a doctor's prescription (range of 19.8% to 22.3%), while approximately 1 in 50 employees report using tranquilizers in the past month (range of from 0.9% to 3.1%). All these figures are higher than the 1991 national population estimate (5.6% lifetime, 0.4% within the past month).

Past lifetime cocaine has remained stable with approximately 3 in 20 employees reporting its use at least once (range of 14.5% to 14.9%). It is higher than national population estimates for lifetime use in 1991 (11.7%). But recent reported use (in the past 30 days) among Dade employees continues to be lower than the national average for 1991 (0.9%) -- only 1 employee in 1993 (0.1%), 6 employees (0.5%) in 1992, 5 employees (0.4%) in 1991, 3 employees (0.4%) in 1990 and 1 employee (0.2%) in 1989.

Crack cocaine does not appear to be a problem among these samples. Only about 3 employees in 200 (range of 1.3% to 1.9%) report ever having tried crack. In 2 of the 5 years no employees reported using crack within the last month, while for 3 years one employee used crack within the designated time period. These figures are the same as the 1991 population estimate for lifetime use (1.9%), and lower than the 1991 national population estimate for use in the past 30 days (0.2%).

Use of LSD and other hallucinogens has remained relatively low with little change in the rate of usage over the five year period. About 1 in 20 employees have used LSD at least once (range of 3.7% to 6.1%), and reported use during the past month over the entire five year period is negligible -- 5 employees total during the five year survey period. These rates are lower than the 1991 national estimates for lifetime (8.2%) and past month (0.3%) use.

The rates at which respondents reported that it is difficult or easy to obtain illegal drugs has remained constant over the five year period. Approximately two-thirds report that it is easy to obtain marijuana (range of 63% to 66%); about 4 out of 10 report that it would be easy to obtain tranquilizers (range of 53.3% to 60.1%); about half report that it is easy to obtain crack cocaine (range of 48.3% to 52.8%) and regular cocaine (range of 48.7% to 53.2%). There has been a slight but statistically insignificant decline in the perceived ease of obtaining cocaine (52.0% in 1989, 48.7% in 1993) and crack cocaine (52.4% in 1989, 48.3% in 1993).

Most employees consider all drug abuse to be risky (whether the drug is licit or illicit), but there is a disturbing downward trend in the perceived risk of harm. For example: in 1989 47.3% considered having 5 or more drinks once or twice a week a great risk, while in 1993 the rate was 43.3%; 70.2% considered having 5 or more drinks nearly every day a great risk in 1989 compared with 59.7% in 1993; in 1989 65.4% percent considered regular marijuana use to be a great risk, while only 52.2% did so in 1993; and 87.1% considered regular cocaine use a great risk in 1989 compared to 75.5% in 1993. This reduction in the perceived risk of drug and alcohol abuse merits additional study. And employees' actual use of drugs is not necessarily consistent with their perception of risk.

The percentage of employees who report that their employer has a written policy and alcohol abuse has increased over the five year period from 65.8% in 1989 to 83.3% in 1993. This means that the educational campaign conducted by the Miami Coalition and the BAND (Business Against Narcotics and Drugs) is working.

About 7 in 10 employees report that it would not be difficult to get help from their employer with a drug or alcohol problem (66.4% to 71.4%). The level in 1993 is about 5 percent higher than in 1989 (71.4% versus 66.4%).

Most employees (about 19 in 20) feel that employers should first respond to alcohol or drug abuse by helping the employee through an employee assistance program (EAP), rather than by firing the employee. Employees see substance abuse as primarily a medical issue, not a legal or moral one. This figure has increased from 90% to 97% during the five year survey period.

Many employees report that someone in their workplace has a problem with alcohol or drugs, though the rate has dropped since 1990. Approximately 3 in 10 employees report that a co-worker has an alcohol problem (26.7% in 1993, down from 34.0% in 1990), while approximately 1 in 5 report that a co-worker has a problem with some other drug (14.8% in 1993, down from 25.9% in 1990).

A large, relatively constant percentage of employees report that someone in their family has a problem with alcohol or other drugs. Approximately 1 in 10 respondents (9.1% to 13.7% report that a family member has a drug problem, and 1 in 4 (18.7% to 25.9% report that a family member has an alcohol problem.

Few employees report that they themselves have a problem with alcohol or other drugs. The rates of self-reported drug abuse have dropped over the five year period from 1.5% (3 in 200) in 1989 to 0.6% (3 in 500) in 1993. The rates of self-reported alcohol abuse have dropped from 2.9% (3 in 100) in 1989 to 1.8% (2 in 100) in 1993. But given the high rates of reported abuse in employees' workplace and families, and employees' denial, it is likely that employees continue to under-report their drug and alcohol problems.

Conclusions.

The Workplace Drug Survey Data for the five year period indicated three positive conclusions about employee drug use and attitudes for Dade employees:

1. Consistent with other large surveys (Newcomb, 1994), reported illicit drug abuse continues to be low.

2. Most employees know that their employer has a policy on alcohol and drug abuse. Employee knowledge is a key variable in the effectiveness of EAP programs (Frost, 1990). The respondents also recommend referral of employees with drug or alcohol problems to an Employee Assistance Program (EAP). This demonstrates the effectiveness of the information campaign conducted by the Miami Coalition and Business Against Narcotics and Drugs and is consistent with a rehabilitative focus found in other studies (Labing, 1992).

3. Because the number of employees responding has grown each year, these results are increasingly likely to be representative of major Dade County employers, public and private.

But there are some things to be concerned about:

1. Consistent with the results of other studies, alcohol abuse remains high, though this is a legal drug.

2. It is likely that employees underreport personal problems with alcohol and other drugs because of denial or fear of reprisal.

3. These findings apply only to a select sample of employees from major employers. Other employees can be expected to report higher levels of drug and alcohol abuse, less concern about risks, and less optimism about the availability of help from their employer for an alcohol or drug problem. There is considerable occupational variability in drug use, and general samples mask significant deviations (Newcomb, 1994).

4. The reported level of risk associated with drug and alcohol abuse has dropped significantly. This may be a precursor to a relaxed attitude concerning their dangers, and may lead to higher rates of future use.

Recommendations.

Two general types of recommendations follow from these conclusions. With respect to public policy on reducing drug abuse or the use of illegal drugs, they are:

1. Control of demand v. control of supply. The "War on Drugs" has not resulted in a diminished supply of illegal drugs. But the low reported rates of current illegal drug use among these employees indicate that many employees who have used illegal drugs in the past -- especially marijuana and cocaine -- do not use them presently. Although the exposure to drug use is widespread, employees say that their friends are not primarily drug users, except for alcohol. Most employees are quite knowledgeable about the risks of using both legal and illegal drugs. Newspapers, magazines, radio and television are these employees' most important source of drug information. Therefore, it might be more efficacious to control the demand for drugs by shifting more of our limited resources into drug education, job training, and employment programs for at-risk individuals, and away from our current policy focus on demonstrably ineffective investigation, interdiction, and incarceration programs.

2. Abuse of Alcohol v. Illegal Drugs. Despite the media attention given illegal drugs such as crack cocaine, this study reveals that these drugs are not a significant problem for this group of employees. But by focusing on illegal drugs, employers may be neglecting the single most important drug of choice by abusers -- alcohol. And the increased health care costs and legal liability risks for businesses whose employees abuse alcohol are well established (Evans, 1994). It may be time to redirect the focus of Employee Assistance Programs toward alcohol abuse, and away from the current focus on illegal drugs (See Leutzinger and Hunnicutt, 1994). And in any event, employees see substance abuse as primarily a medical issue, not a legal or moral one. They think the employer's first response should be treatment, whether the problem is alcohol or illegal drugs.

The following recommendations for further research also follow from the conclusions reached in this study:

1. What factors correlate with diminished drug use by individual employees? Given that controlling demand for drugs is more efficacious at reducing drug use than is controlling the supply of drugs, what types of education, training, employment, and demographic variables correlate most strongly with diminished employee drug abuse? What particular factors or circumstances lead drug users to cease drug use?

2. How can the validity and reliability of self-reported drug use data be enhanced? Studies of employee drug use and attitudes are generally conducted using self-reported data. But given the high percentage who report behavior indicative of alcohol abuse, it is likely that personal drug or alcohol problems are under-reported. Although self-reporting is still useful in making comparisons among different populations (such as employees of a given organization against population norms), self-reported data need to be combined with more objective measures without risking unacceptable compromises to privacy or anonymity by respondents. How can these objectives be achieved using volunteer respondents and volunteer employers? Additional research is needed in developing more valid measures of the frequency and timing of employee drug use as well.

3. What alternative tools and methods exist for identifying drug use? Drug testing manifests serious deficiencies related to accuracy, cost and violations of privacy (Macdonald, Well and Fry, 1993). Computer testing offers some promise, but is an unproven technology (Crow, Villere and Hartman, 1994). Additional research is needed to develop alternative tools and methods for identifying drug use.

1. The authors wish to thank the Miami Coalition for providing access to the data used in producing this article. Special thanks are due to these persons, among many: Alvah Chapman (Knight-Ridder, Inc., Chair of the Scientific Advisory Committee); Allan Rosenbaum (Dean, School of Public Affairs and Services, Florida International University, and Co-chair of the Scientific Advisory Committee); Ray Surette (Project Manager, Florida International University); and Marilyn Culp (Executive Director, Miami Coalition).

2. National Household Survey on Drug Abuse: Population Estimates 1991 (Washington, D.C.: U.S. Department of Health and Human Services, Public Health Service, Alcohol, Drug Abuse, and Mental Health Administration (ADM 92-1887, 1991).

3. All findings are based on the following sample sizes: 1989 (n=570), 1990 (n=754), 1991 (n=1158), 1992 (n=1165), 1993 (n=1200).

4. Drug Use and Attitude Survey of Selected Employees in Dade County, Florida. Miami, FL: Miami Coalition for a Drug-Free Community, Scientific Advisory Committee, Workplace Survey Subcommittee, 1989, 1990, 1991, 1992, and 1993.

Aquillin, W. S. (1994). Interview mode effects in surveys of drug and alcohol use. Public Opinion Quarterly, 58, 210-240.

Arbetter, L. (1994). The pulse of drug use. Security Management, 38, 12-14.

Baliga , W. (1994). Drug tests uncover few abusers. Journal of Accountancy, 177, 18.

Barnum, D. T., & Gleason, J. M. (1994). The credibility of drug tests: A multi-stage Bayesian analysis. Industrial & Labor Relations Review, 47, 610-621.

Bennett, J., Blum, T. C., & Roman, P. M. (1994). Employee attitudes toward drug testing: Effects of individual characteristics and employment setting. Employee Responsibilities and Rights Journal, 7, 117-128.

Berman, P. S., Sulsky, L., Pargament, K. I., Balzer, W. K., et al. (1991). The role of needs assessment in the design of employee assistance programs: A case study. Employee Assistance Quarterly, 6, 21-35.

Blum, T. C., & Roman, P. M. (1992). A description of clients using employee assistance programs. Special focus: Alcohol and the workplace. Alcohol Health and Research World, 16, 120-128.

Cavanaugh, M. J., & Prasad, P. (1994). Drug testing as symbolic managerial action: In response to 'A Case Against Workplace Drug Testing'. Organization Science, 5, 267- 271.

Comer, D. R. (1994). A case against workplace drug testing. Organization Science, 5, 259- 267.

Crow, S. M., Villere, M. F., & and Hartman, S. J. (1994). Planes, trains, and ships: Drug testing is no substitute for drug supervision: Part II. Supervision, 55, 14-16.

Electronic Business. (1993). Drugs in the workplace: It's worse than you think. Electronic Business, 19, 73.

Evans, D. (1994). Employers face difficult questions in initiatives against alcohol abuse. Occupational Health & Safety, 63, 58-60.

Feinauer, D. M., & Havlovic, S. J. (1993). Drug testing as a strategy to reduce occupational accidents: A longitudinal analysis. Journal of Safety Research, 24, 1-7.

Fenn, D. (1995). An alternative to drug testing? Inc., 17, 112.

Frost, A. K. (1990). Assessing employees' awareness: A first step to utilization. Employee Assistance Quarterly, 6, 45-55.

Gillian, F. (1995). Recreational drug use may not be the biggest threat. Personnel Journal, 74, 21-23.

Gleason, P. M., Veum, J. R., & Pergamit, M. R. (1991). Drug and alcohol use at work: A survey of young workers, Monthly Labor Review, 3-7.

Guinn, B. (1983). Job satisfaction, counterproductive behavior and circumstantial drug use among long-distance truckers. Journal of Psychoactive Drugs, 15, 185-188.

Harley, D. A. (1991). Impaired job performance and worksite trigger incidents: Factors influencing supervisory EAP referrals. Employee Assistance Quarterly, 6, 51-70.

Hirth, R. A. (1994). Workplace drug abuse policy: A comment. Journal of Health Economics, 13, 373-378.

Kaestner, R. (1994). The effect of illicit drug use on the labor supply of young adults. Journal of Human Resources, 29, 125-155.

Kaestner, R., & and Grossman, M. (1995). Wages, workers' compensation benefits and drug use: Indirect evidence of the effect of drugs on the workplace. American Economic Review, 85, 55-60.

Labing, C. E. (1992). Supervisory and nonsupervisory employee attitudes about drug testing. Employee Responsibilities and Rights Journal, 5, 131-141.

Lehman, W. E. K., Holcom, M. L., & Simpson, D. D. (1990). Employee health and performance in the workplace: A survey of municipal employees of a large southwest city. Unpublished manuscript. Institute of Behavioral Research, Texas Christian University.

Leutzinger, J. A., & Hunnicutt, D. M. (1994). Alcohol and employee education (Union Pacific Railroad Program). Business and Health, 12, 76.

Levy, S. I. (1973). A case study of drug-related criminal behavior in business and industry. In J. J. Sher (Ed.) Drug Abuse in industry. Springfield, IL.: Thomas.

Macdonald, S., Wells, S., & Fry, R. (1993). The limitations of drug screening in the workplace. International Labour Review, 132, 95-113.

Manley, S. A., & Gibson, G. S. (1990). Drug-induced impairment: Implications for employers. Psychology of Addictive Behaviors, 4, 97-99.

Milne, S. H., Blum, T. C., & Roman, M. (1994). Factors influencing employees' propensity to use an employee assistance program. Personnel Psychology, 47, 123-145.

Newcomb, M. D. (1988). Drug use in the workplace: Risk factors for disruptive substance use among young adults. Dover, Mass.: Auburn House.

Newcomb, M. D. (1989). Personal and job correlates of drug use in the workplace. Paper presented at the American Psychological Association meeting. New Orleans, Louisiana.

Newcomb, M. D. (1994). Prevalence of alcohol and other drug use on the job: Cause for concern or irrational hysteria? The Journal of Drug Issues, 24, 403-416.

Normand, J., Salyards, S. D., & Mahoney, J. J. (1990). An evaluation of preemployment drug testing. Journal of Applied Psychology, 75, 629-639.

Oliver, B. (1994). Fight drugs with knowledge. Training & Development, 48, 105-109.

O'Malley, P. M. (1992). Report to the National Institute on Medicine Committee on Drug Use in the Workplace

Pouzar, E. (1994). Drug and alcohol abuse present RM challenge. National Underwriter, 98, 13.

Quazi, M. M. (1993). Effective drug-free workplace plan uses worker testing as a deterrent. Occupational Health & Safety, 62, 26-74.

Reinarman, C., & Levine, H. G. (1991). The crack attack: Politics and media in America's latest drug scare. In J. Best (ed.) Images of issues: Typifying contemporary social problems. New York: Aldine De Gruyter.

Romano, C. (1994). More companies test for drugs. Management Review, 83, 8.

Segal, J. A. (1992). Drugs, alcohol, and the ADA. HR Magazine, 37, 73-76.

Strong, M. F., Peterson, R., & Tellier, P. M. (1994). Employment drug testing. Business Quarterly, 58, 12-16.

Tepper, B. J. (1994). Investigation of general and program-specific attitudes toward corporate drug-testing polices. Journal of Applied Psychology, 79, 392-401.

Voss, B. (1994). Good news about downers. Journal of Business Strategy, 15, 9.

National Sample Dade Employees

Lifetime Last Month Lifetime Last Month

1989 95.4% 77.5%

1990 88.6 65.7

1991 84.7% 50.9% 94.3 66.2

1992 92.6 65.5

1993 93.1 65.5

Dade Employees

Yes

1989

In a car with a drinking driver in the past month 40.7%

In a car with a drunk driver (5+ drinks) in the past month 12.1

Drove a car after having 5+ drinks in the past month 9.9

1990

In a car with a drinking driver in the past month 31.8

In a car with a drunk driver (5+ drinks) in the past month 11.3

Drove a car after having 5+ drinks in the past month 6.7

1991

In a car with a drinking driver in the past month 31.9

In a car with a drunk driver (5+ drinks) in the past month 9.4

Drove a car after having 5+ drinks in the past month 5.9

1992

In a car with a drinking driver in the past month 30.8

In a car with a drunk driver (5+ drinks) in the past month 9.9

Drove a car after having 5+ drinks in the past month 6.5

1993

In a car with a drinking driver in the past month 33.6

In a car with a drunk driver (5+ drinks) in the past month 9.2

Drove a car after having 5+ drinks in the past month 4.9

National Sample Dade Employees

Lifetime Last Month Lifetime Last Month

1989 65.0% 24.9%

1990 66.8 23.7

1991 72.7% 27.0% 66.0 20.5

1992 63.0 20.9

1993 62.8 20.5

National Sample Dade Employees

Lifetime Last Month Lifetime Last Month

1989 39.6% 2.3%

1990 37.4 2.7

1991 33.4% 4.8% 40.5 1.2

1992 38.8 2.0

1993 38.6 2.6

National Sample Dade Employees

Lifetime Last Month Lifetime Last Month

1989 22.3% 3.1%

1990 19.8 2.6

1991 5.6% 0.4% 21.1 2.0

1992 21.9 2.6

1993 20.2 0.9

National Sample Dade Employees

Lifetime Last Month Lifetime Last Month

1989 14.6% 0.2%

1990 14.1 0.4

1991 11.7% 0.9% 14.5 0.4

1992 14.8 0.5

1993 14.9 0.1

National Sample Dade Employees

Lifetime Last Month Lifetime Last Month

1989 1.3% 0.0%

1990 1.5 0.1

1991 1.9% 0.2% 1.5 0.1

1992 1.9 0.1

1993 1.5 0.0

National Sample Dade Employees

Lifetime Last Month Lifetime Last Month

1989 4.2% 0.0%

1990 6.1 0.3

1991 8.2% 0.3% 5.9 0.1

1992 6.1 0.1

1993 6.1 0.0

Dade Employees

Difficult Easy

1989

Marijuana 35.0% 65.0%

Tranquilizers 39.9 60.1

Cocaine 48.0 52.0

Crack Cocaine 47.6 52.4

1990

Marijuana 34.7 65.3

Tranquilizers 41.6 58.4

Cocaine 46.8 53.2

Crack Cocaine 47.2 52.8

1991

Marijuana 37.0 63.0

Tranquilizers 43.9 56.1

Cocaine 48.6 51.4

Crack Cocaine 49.3 50.7

1992

Marijuana 34.0 66.0

Tranquilizers 46.7 53.3

Cocaine 50.6 49.4

Crack Cocaine 50.3 49.7

1993

Marijuana 35.6 64.4

Tranquilizers 47.3 52.7

Cocaine 51.3 48.7

Crack Cocaine 51.7 48.3

Dade Employees

None Slight Some Great

1989

1-2 drinks daily 13.1% 30.3% 31.2% 21.4%

5 drinks daily 5.3 6.4 14.3 70.2

5+ drinks 1-2 times 5.7 12.0 30.7 47.3

per week

1990

1-2 drinks daily 12.4 30.1 36.7 18.8

5 drinks daily 9.3 4.3 18.7 65.3

5+ drinks 1-2 times 9.4 11.3 28.5 48.1

per week

1991

1-2 drinks daily 14.0 28.1 30.1 22.1

5 drinks daily 9.7 3.4 16.0 65.3

5+ drinks 1-2 times 8.9 10.5 27.4 46.3

per week

1992

1-2 drinks daily 13.8 26.4 33.5 20.3

5 drinks daily 8.5 4.2 16.9 65.6

5+ drinks 1-2 times 8.1 11.0 26.5 48.3

per week

1993

1-2 drinks daily 16.7 29.8 26.8 19.3

5 drinks daily 11.2 5.8 16.7 59.7

5+ drinks 1-2 times 10.7 10.2 28.3 43.3

per week

Dade Employees

None Slight Some Great

1989

Trying marijuana 15.8% 26.3% 17.1% 33.7%

Using it occasionally 10.1 21.7 23.8 37.6

Using it regularly 7.4 5.3 16.8 65.4

1990

Trying marijuana 19.7 23.7 16.0 30.5

Using it occasionally 14.3 18.9 25.3 32.8

Using it regularly 11.7 4.2 17.0 58.0

1991

Trying marijuana 21.4 23.1 16.2 29.3

Using it occasionally 15.8 21.2 22.8 30.3

Using it regularly 12.5 5.4 16.7 56.8

1992

Trying marijuana 20.6 25.6 15.4 30.1

Using it occasionally 15.5 21.4 24.3 30.7

Using it regularly 12.6 6.2 18.8 54.0

1993

Trying marijuana 22.6 23.2 12.7 31.3

Using it occasionally 17.3 21.5 19.8 30.9

Using it regularly 14.4 7.3 16.3 52.2

Dade Employees

None Slight Some Great

1989

Trying cocaine 10.6% 14.6% 14.4% 56.3%

Using it occasionally 6.6 5.2 14.2 69.9

Using it regularly 6.6 0.4 2.2 87.1

1990

Trying cocaine 12.1 10.7 14.1 54.4

Using it occasionally 10.3 2.4 11.7 67.4

Using it regularly 10.3 0.7 1.8 79.2

1991

Trying cocaine 12.0 10.4 14.4 54.1

Using it occasionally 9.5 3.7 11.9 66.8

Using it regularly 9.5 0.5 2.9 79.8

1992

Trying cocaine 12.4 10.3 13.0 56.6

Using it occasionally 9.8 3.8 13.1 66.2

Using it regularly 10.4 0.4 2.8 79.7

1993

Trying cocaine 14.5 8.7 14.0 53.6

Using it occasionally 12.4 3.3 12.2 63.1

Using it regularly 12.4 0.4 2.9 72.0

"My employer has a written policy on drug and alcohol abuse"

Yes

1989 65.8

1990 69.0

1991 77.8

1992 75.6

1993 83.3

"It Would Not Be Very Difficult to Get Help"

Yes

1989 66.0%

1990 70.0

1991 73.5

1992 70.6

1993 71.4

"Employers should have an Employee Assistance Program (EAP) that would help"

Yes

1989 90.0%

1990 95.0

1991 96.0

1992 97.0

1993 97.0

"Someone in my workplace has a problem with . . ."

Drugs Alcohol

Yes

1989 18.1% 31.0%

1990 25.9 34.0

1991 19.2 31.4

1992 18.4 31.2

1993 14.8 26.7

"Someone in my family has a problem with . . ."

Drugs Alcohol

Yes

1989 9.1% 18.7%

1990 13.7 25.9

1991 12.2 21.0

1992 13.1 21.7

1993 12.0 25.5

"I have a problem with . . ."

Drugs Alcohol

Yes

1989 1.5% 2.9%

1990 0.3 2.3

1991 0.2 1.2

1992 0.6 1.4

1993 0.6 1.8