NCETA: Professor Ann Roche, Dr Ken Pidd, Associate Professor Nicole Lee, Dr Petra Bywood, Dr Toby Freeman, Dr Femke Buisman-Piljman, Ms Jane Fischer, Ms Victoria Kostadinov, Ms Victoria Shtangey, Ms Vinita Duraisingam.
National Injury Surveillance Unit, Flinders University: Professor James Harrison, Dr Rachel Newson, Ms Jesia Berry.
University of Sydney: Professor Tim Driscoll.
University of Alaska: Dr Robert Boeckmann.
Charles Darwin University: Dr Mary Morris.
LeeJenn Health Consultants: Ms Jacquie Cameron.
Why did we undertake this research?
There is increasing interest in workers’ wellbeing. The workplace has unique potential as a setting to implement cost-effective public health strategies to address AOD-related harm prevention as well as providing pathways into treatment. However, the workplace has been largely underutilised as an AOD-related harm prevention and intervention setting. In part, this has been due to a lack of research to inform policy and practice. Until relatively recently, little was known about Australian workers’ AOD consumption patterns and associated harm. Such information is needed to quantify risk and develop targeted prevention and intervention strategies.
What did we do?
To address this gap, NCETA has undertaken a broad and comprehensive program of research, over the past decade, on worker wellbeing and AOD use that has informed effective prevention, policy and behavioural change strategies. This work has received national and international acclaim.
Our program of work incorporates secondary data analyses and primary data collection, examination of existing literature, the design and implementation of interventions, RCTs, and research transfer and dissemination strategies to influence policy and practice. Working with a variety of organisations including Beyondblue, VicHealth, Safework SA, TAFEs, unions, employer groups and individual employers, we have:
- Examined workforce AOD consumption patterns and identified workforce groups at risk
- Identified associated factors and related risk of harm
- Undertaken systematic reviews of drug testing and other workplace responses to AOD-related harm
- Developed effective workplace prevention and intervention strategies
- Expanded theoretical and conceptual frameworks relevant to workplace interventions.
Our secondary analyses of National Drug Strategy Household Survey (NDSHS) data examined AOD consumption patterns across industry and occupational groups to assess risk of harms including absenteeism. Examination of the National Hospital Morbidity Database (NHMD) and the National Coroners Information System (NCIS) allowed us to determine the nature and extent of workplace injuries associated with AOD use.
Our primary research has involved quantitative and qualitative methods, largely focused on young workers employed in the construction and hospitality industries. One study examined young building trade apprentices' AOD consumption patterns, the relationship between consumption patterns and workplace AOD policies, and the efficacy of an industry based AOD health and safety awareness program. Similarly, a qualitative study of young commercial cookery trainees was undertaken to identify workplace risk factors for harmful AOD use and poor psychological wellbeing. This study led to the development and implementation of an effective program designed to prevent AOD-related harm and enhance psychological wellbeing.
Currently, NCETA is undertaking an innovative project in partnership with VicHealth that involves several Victorian manufacturing industry workplaces to implement and evaluate an intervention strategy to influence the workplace culture in a way that reduces alcohol-related harm. We also recently commenced a research project funded by Safework SA that involves linking several large datasets to determine the relationship between prescribed opioid use, injury, and return to work among South Australian workers.
What did we find out?
Our reviews of the efficacy of workplace strategies to address AOD-related harm found research in this area to be scarce and limited in scope and quality. For example, evidence concerning workplace drug testing identified relatively few evaluation studies and many of those were of poor quality. Overall the review indicated workplace testing had limited efficacy, especially when used as a stand-alone response.
Our secondary analyses of NDSHS data identified consumption patterns and prevalence that were previously not known. We found employed Australians were significantly more likely to engage in risky AOD use compared to those not in the paid workforce, with significant differences in AOD prevalence rates across workforce groups. These differences remained significant even when controlling for other demographic and individual variables indicating that differences in consumption patterns may be associated with factors in the workplace environment and created an evidence base upon which we could develop tailored interventions. Workforce groups with high AOD prevalence rates included:
- Hospitality industry workers
- Construction industry workers
- Transport industry workers
- Finance industry workers
- Manufacturing industry workers
- Young workers
Analyses of NDSHS data also found that more than 2.6 million work days were lost due to workers’ alcohol use each year at a cost of more than $400M. We identified that although frequent risky drinkers were more likely to take a day off work due to their alcohol use, the much larger proportion of drinkers who drank at risky levels less often, accounted for more than half of all work days lost due to alcohol. Hence interventions were warranted for the majority of low risk drinkers.
NDSHS data also identified the prevalence of AOD use and intoxication during work hours. The types of drugs commonly used at work differed from those most commonly used outside of work hours. Use of painkillers and meth/amphetamine at work was substantially more prevalent than the most prevalent drug used away from work (cannabis). Prevalence rates for alcohol and drug use at work varied significantly across workforce groups with males, young workers, and those employed in hospitality or construction reporting the highest rates of use and intoxication at work. Again this informed our subsequent program and policy advice.
Our research confirmed that young workers employed in the construction and hospitality industries were at high risk of AOD-related harm, and revealed that workplace factors and working conditions played a role in influencing AOD use both at and away from the workplace. For young building workers, both informal workplace norms (co-worker and supervisor AOD-related expectations and behaviours) and formal workplace norms (workplace AOD policy) were particularly important influences on young workers’ AOD consumption patterns. Evaluation of an AOD awareness program, delivered as part of these young workers’ occupational health and safety training, indicated the program was effective in influencing AOD attitudes and behaviours particularly for young workers who reported strong supervisor and co-worker support for their workplace AOD policy.
For young commercial cookery trainees, workplace norms also played a role. However, workplace stress, resulting from working conditions and workplace bullying, was also associated with AOD consumption patterns. Our work with young commercial cookery trainees led to the development of a skills enhancement program, designed with input from trainees and key stakeholders. This brief (3 hour) program aimed to build resilience, enhance workplace communication skills, and raise awareness of alcohol- and cannabis- related harms. A pilot evaluation of this intervention indicated improved levels of psychological distress and AOD-related attitudes and behaviours.
Our research findings led us to develop a cultural model of the relationship between the workplace and AOD use that proposes existing workers’ pre-existing AOD-related attitudes and behaviours, workplace customs and practices, workplace controls, and workplace conditions can individually, or in combination, contribute to a specific workplace culture that can influence the AOD consumption patterns of workers and their significant others.
What does it mean?
Our program of research has allowed us to quantify workplace AOD-related harm in terms of risk to worker safety (i.e., prevalence of AOD intoxication and use at work) and productivity (e.g., prevalence of AOD-related absenteeism). Thus, there is both a social and economic imperative to address AOD-related harm in the workplace. NDSHS data has allowed us to identify workforce groups at high risk of AOD-related harm and develop targeted and cost effective prevention and intervention strategies for these high risk groups. Moreover, NDSHS data and our research with young workers also identified that workplace factors and working conditions are associated with AOD consumption patterns. This highlights that workplaces need to consider these factors and conditions when developing and implementing workplace AOD prevention and intervention strategies and move beyond just focussing on individual behaviour to initiate broader systemic change. In addition, our research concerning the relationship between consumption patterns and absenteeism rates indicated that a ‘whole of workplace’ approach to prevention and intervention strategies needs to be adopted, rather than just focusing on individual ‘problem’ workers.
While we have identified young workers are a high risk group for AOD-related harm, our work also indicated that appropriate strategies may significantly reduce this risk. The key to successful strategies targeting young workers is stakeholder involvement in strategy development and a focus on identified workplace factors that contribute to risk and delivery in an occupational training context. Such an approach may not only reduce immediate risk of AOD-related harm but also have a long term impact on AOD-related behaviours and attitudes.
Furthermore, our cultural model of the relationship between the workplace and AOD use proposes that the same processes that lead to the development of AOD-related norms for harmful use can be used to develop norms that promote low-risk AOD use.