In U.S., alcohol use disorder linked to 232 million missed workdays annually

Heavy alcohol use is associated with missing work, but the scope of that relationship has not been well understood. Now, based on survey data from more than 110,000 U.S. adults with full-time jobs, researchers at Washington University School of Medicine in St. Louis have quantified the extent of the problem.

Among U.S. adults working full time, an estimated 9% — almost 11 million full-time workers — met the diagnostic criteria for alcohol use disorder, a medical condition characterized by an impaired ability to stop or control alcohol use despite adverse consequences in one’s social life, work life or health.

The findings are published online March 17 in the journal JAMA Network Open.

Analyzing the survey data, the researchers found that people with severe alcohol use disorder reported missing 32 days of work each year because of illness, injury or simply skipping work, more than double the number of workdays missed by individuals without alcohol use disorder. In all, workers with alcohol use disorder missed more than 232 million work days annually.

“Alcohol use disorder is a major problem in the United States and a big problem in many workplaces, where it contributes to a significant number of workdays missed,” said senior investigator Laura J. Bierut, MD, the Alumni Endowed Professor of Psychiatry. “The problem likely has worsened during the pandemic, and we need to try to do more to ensure that people can get the help they need to deal with alcohol use disorder. The new data also point to an economic incentive for employers and policymakers to address the issue.”

Bierut and her colleagues analyzed data gathered from 2015 through 2019 via the National Survey on Drug Use and Health. The survey is administered every year by the Substance Abuse and Mental Health Services Administration, which asks individuals over age 12 about their use of alcohol and other drugs over the previous 12 months.

Alcohol use disorder is diagnosed using a series of questions — such as whether an individual tried to stop drinking but couldn’t, spent a great deal of time sick from drinking, or continued to drink even after having a memory blackout.

Those surveyed who did not meet criteria for alcohol use disorder missed about 13 days of work annually, but individuals with mild alcohol use disorder missed an average of almost 18 days. Meanwhile, those with moderate alcohol use disorder missed nearly 24 days, and those with severe alcohol use disorder reported missing 32 days of work each year.

“Often, people who miss that much work lose their jobs,” said Bierut, who also directs the Washington University Health & Behavior Research Center. “But our hope is that the workplace might be a point of contact where intervention can occur. You’re there eight hours a day, and when an employer begins seeing these difficulties, perhaps instead of firing a person, they could take action to assist with that individual’s recovery.”

The researchers found that although people with alcohol use disorder represented about 9.3% of the full-time workforce, those with drinking problems accounted for 14.1% of total workplace absences.

Alcohol use disorder was more common among men, younger people, those who identified as white or Hispanic and those with lower incomes. The analysis included only full-time workers.

With more people working remotely during the pandemic, problems with excessive absence may be harder for employers to spot. The pandemic changed many things about how people work, and it also changed alcohol consumption patterns. For example, in the early days of the pandemic, from March through September 2020, alcohol sales increased by 20% compared with the same period in 2019. Further, the latest data indicate that sales have remained at about that level ever since.

“We specifically chose to stop our data analysis the year before the pandemic began so that we could be more confident in our findings,” said first author Ian C. Parsley, MD, a psychiatry resident. “Having more people working at home could change the associations we saw before the pandemic began. The amount of alcohol consumed since people have been working from home more has really just gone through the roof. That’s not something that’s just going to resolve itself, even as we slowly come out of this pandemic.”

Bierut said it’s likely that the loss of the routine of going to a job has contributed to problems.

“Work has the benefit of giving us structure: You get up in the morning, get dressed, go to work,” she explained. “But many people lost their jobs during the pandemic while others worked at home and lost that structure. We’ve lost our guardrails for certain types of behaviors, so if anything, I think it’s likely alcohol use disorder is having a greater impact on the population and on the workforce than it did in 2019. And as our findings show, it was having a big impact in 2019.”

Parsley IC, Dale AM, Fisher SL, Mintz CM, Hartz SM, Evanoff BA, Bierut LJ. Workplace absenteeism associated with alcohol use disorder from the National Survey on Drug Use and Health 2015-2019. JAMA Network Open, March 17, 2022.

This work is supported by the National Institute on Drug Abuse, the National Institute of Mental Health, and the National Institute on Alcohol Abuse and Alcoholism of the National Institutes of Health (NIH). Grant number K12 DA041449, R34 DA050044-01, R25 MH112473 and U10 AA008401. Additional funding comes from a Substance Abuse and Mental Health Services Administration grant H79TI082566.

Washington University School of Medicine’s 1,700 faculty physicians also are the medical staff of Barnes-Jewish and St. Louis Children’s hospitals. The School of Medicine is a leader in medical research, teaching and patient care, and currently is No. 4 in research funding from the National Institutes of Health (NIH). Through its affiliations with Barnes-Jewish and St. Louis Children’s hospitals, the School of Medicine is linked to BJC HealthCare.