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Substance Use, Symptom, and Employment Outcomes of Persons With a Workplace Mandate for Chemical Dependency Treatment

Dr. Weisner is affiliated with the Department of Psychiatry, University of California, San Francisco, 401 Parnassus Ave., Box F-0984, San Francisco, CA 94143 (e-mail: constance.weisner{at}kp.org). She is also with the Division of Research, Kaiser Permanente Medical Care Program, Oakland, California, where Ms. Lu, Ms. Hinman, and Ms. Chi are affiliated. Dr. Monahan and Mr. Bonnie are with the School of Law, University of Virginia, Charlottesville. Dr. Moore is with Kaiser Permanente Chemical Dependency Recovery Program, Sacramento, California. Dr. Appelbaum is with the Department of Psychiatry, Columbia University, and the New York State Psychiatric Institute, New York City.

OBJECTIVE: This study examined the role of workplace mandates to chemical dependency treatment in treatment adherence, alcohol and drug abstinence, severity of employment problems, and severity of psychiatric problems. METHODS: The sample included 448 employed members of a private, nonprofit U.S. managed care health plan who entered chemical dependency treatment with a workplace mandate (N=75) or without one (N=373); 405 of these individuals were followed up at one year (N=70 and N=335, respectively), and 362 participated in a five-year follow up (N=60 and N=302, respectively). Propensity scores predicting receipt of a workplace mandate were calculated. Logistic regression and ordinary least-squares regression were used to predict length of stay in chemical dependency treatment, alcohol and drug abstinence, and psychiatric and employment problem severity at one and five years. RESULTS: Overall, participants with a workplace mandate had one- and five-year outcomes similar to those without such a mandate. Having a workplace mandate also predicted longer treatment stays and improvement in employment problems. When other factors related to outcomes were controlled for, having a workplace mandate predicted abstinence at one year, with length of stay as a mediating variable. CONCLUSIONS: Workplace mandates can be an effective mechanism for improving work performance and other outcomes. Study participants who had a workplace mandate were more likely than those who did not have a workplace mandate to be abstinent at follow-up, and they did as well in treatment, both short and long term. Pressure from the workplace likely gets people to treatment earlier and provides incentives for treatment adherence.

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