Harmful alcohol use

Alcohol Research & Health, Wntr, 2003 by Gerhard Gmel, Jurgen Rehm

Alcohol misuse can harm people other than the drinker, and can have negative consequences for society as a whole. It is commonly believed to play a role in decreased worker productivity, increased unintentional injuries, aggression and violence against others, and child and spouse abuse. Research findings support the idea that drinking is involved in or associated with many of these social harms, but do not offer evidence that it causes these effects. Methodological flaws characterize much of the research in this area. Use of better design and statistical methodology is necessary in order to clarify the relationship between drinking and the harmful consequences it is believed to cause. KEY WORDS: AOD (alcohol and other drug) associated consequences; work-related AOD issue; employee absenteeism; labor productivity; job performance; AODR (alcohol and other drug related) injury; aggressive behavior; AODR violence; AODR crime; AODR family problems; spouse abuse

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Alcohol misuse is linked to many harmful consequences for society as a whole and for others in the drinker's environment. Sometimes referred to as the social consequences of alcohol use (Osterberg 1996; Klingemann and Gmel 2001; Rehm 2001), these negative outcomes are reflected in the diagnostic criteria of alcohol abuse given in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) (American Psychiatric Association [APA] 1994). The DSM-IV defines alcohol abuse as alcohol use that results in:

1. Failure to fulfill major role obligations at work, school, or home (e.g., repeated absences or poor work performance, neglect of children or household)

2. Continued drinking even in situations where it is physically hazardous (e.g., driving an automobile or operating machinery)

3. Recurrent alcohol-related legal problems (e.g., arrests for disorderly conduct while drinking)

4. Continued drinking despite persistent or recurrent social or interpersonal problems it may cause (e.g., arguments with spouse, physical fights).

Reflecting these criteria, this article examines a specific negative consequence from each category, discussing research findings on alcohol use and its relation to workplace absenteeism (criterion 1), unintentional injuries (criterion 2), aggression and violence (criterion 3), and spouse abuse (criterion 4).

Some of these consequences might appear to affect only the drinker; for example, unintentional injuries such as falls often involve only the person who has been drinking. Ultimately, however, these events have an impact on society as a whole insofar as they affect economic productivity or require the attention and resources of the criminal justice or health care systems, or of other social institutions. A review of the research on each of these specific harms is followed by an examination of the methodological issues involved in investigating the consequences of alcohol use.

WORKPLACE PRODUCTIVITY

In 1998, alcohol abuse and dependence cost the United States an estimated $97.7 billion, primarily as a result of economic productivity lost because of alcohol-related illness, injury, and crime (Harwood 2000, based on Harwood et al. 1998). (This figure does not include loss of future earnings caused by premature death related to alcohol use.) Whether people are in alcoholism treatment, in jail for alcohol-related crimes, or in the hospital as the result of alcohol-related injuries or violence, their incapacity represents a loss in workplace productivity.

Investigators commonly examine workplace injuries, absenteeism, job performance, and turnover when evaluating the effect of alcohol consumption on productivity. In general, research has found that--although moderate consumption may have a beneficial effect on productivity--alcohol dependence, alcohol abuse, and heavy drinking lower productivity. Mullahy and Sindelar (1998) and Sindelar (1998) provide excellent reviews of these studies.

The following discussion focuses on the relationship between alcohol consumption and absenteeism, followed by remarks on job performance.

Absenteeism

Studies analyzing absenteeism rates of people at all levels of alcohol consumption (1) have yielded mixed results. Some have found no association between absenteeism and drinking. For example, Ames and colleagues (1997) found no significant association between absenteeism and the drinker's usual volume of consumption or frequency of heavy drinking occasions (which they defined as occasions during the past year when a person had 10 or more drinks). Moreover, though drinking at the workplace and hangovers at work were related to other negative consequences, such as workplace injuries, they were not related to absenteeism. Other studies, such as that of Blum and colleagues (1993), showed lower absence rates among heavy drinkers than among light drinkers.

Yet other investigators have found that the relationship between drinking and absenteeism could be described by a U-shaped curve--that is, moderate drinkers were absent from work least frequently, but both heavy drinkers and people who drank little were absent more often. A longitudinal study by Marmot and colleagues (1993) found a U-shaped association, for men, between sickness absence and both the frequency of heavy drinking occasions and the weekly quantity consumed. In other words, drinkers whose frequency and quantity of consumption were moderate were absent less often than either abstainers or heavy drinkers. These results are consistent with a large body of evidence demonstrating the existence of such a U-shaped curve for the association between alcohol consumption and heart disease, as well as overall mortality (National Institute on Alcohol Abuse and Alcoholism [NIAAA] 2000). For women, these researchers found no U-shaped association, although abstainers had higher rates of sickness absences than moderate or heavy drinkers.