17 million working days are taken off sick due to excessive drinking. We explore approaches to encourage responsible attitudes to drinking outside of working hours - creating a win-win for businessess and employees. .
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Supporting alcohol harm reduction in the workplace
1. Supporting individuals to monitor and
reduce their alcohol intake
Don Shenker
Alcohol Health Network
Recovery Festival
2nd July, 2015
2. Overview
‘What works’ to reduce alcohol harm at
work
Prevention vs. Treatment -
Recognising signs of problem drinking
‘Identification and Brief Advice’ – what
the research tells us
Findings from AHN and UCL /
Middlesex study
Copyright: Alcohol Health Network
3. Alcohol Health Network
Our objective: Early intervention and
prevention of alcohol misuse
• Encourage alcohol self-awareness
and identification
• Provide alcohol awareness
campaigns and advice
• Signpost heavy drinkers to local
services
Collaboration with UCL’s E-Health Unit
and Camden and Islington NHS Trust
Copyright: Alcohol Health Network
4. Awareness of alcohol units – Health Survey
England
Good news - heard of daily drinking -
75%
Not so good: 35% of men / 47% of
women don’t know recommended
guidelines
“Those who attempted to define the
recommendations were more likely to
be wrong than right”
People can underestimate their alcohol
intake by around 40 to 60% (UCL,
2014)
Copyright: Alcohol Health Network
5. Proportion of drinking patterns – England
Copyright: Alcohol Health Network
4% Dependent
5% High Risk
17% Increasing Risk
62% Low Risk
12% Abstain
1.6m people
7.1m people
6. Normalised workplace culture?
• Alcohol is the most widely used substance
among working adults
• Almost 80% of risky drinkers are employed
• One UK study found that:
⁻ 1/3 employees admitted having been to work
with a hangover
⁻ 15% reported having been drunk at work
⁻ 1 in 10 reported hangovers at work once a month; 1 in
20 once per week
Copyright: Alcohol Health Network 6
7. ‘Social’ drinking - a problem at work?
• Time off work due to hangovers
or feeling unwell in the morning
• Poor sleep affects performance
at work
• Long term poor health or
mental health problems
• Concealed from colleagues or
tolerated and this causes stress
and tension for the whole team
Copyright: Alcohol Health Network
8. Impact of heavy drinking on
the workplace
• Heavy drinking is associated with
multiple negative workplace outcomes:
⁻ Increased presenteeism;
⁻ Higher rates of absenteeism;
⁻ Accidents;
⁻ Reduced academic performance;
⁻ Increased risk of unemployment;
⁻ Premature mortality.
• Heavy drinking Reduced productivity tangible
costs to both employee AND employer
Copyright: Alcohol Health Network
9. Why ask employees questions about their
drinking?
• Majority of heavy drinkers are of
working age and in work
• Majority of individuals poorly
informed of health risks
• NICE: Questions lead to behaviour
change
• Duty of care
Copyright: Alcohol Health Network
10. Alcohol Use Disorders Identification Test (AUDIT)
NICE : Identification and Brief Advice (IBA) one of most cost effective
measures to identify, prevent and reduce risky drinking
Use of AUDIT alcohol screening to identify problem drinking in GP / A&E /
Hospital settings now well established
Review of 32 controlled trials: 1 in 8 problem drinkers reduced drinking to
lower-risk levels (Moyer 2002)
Project Treat in US – use of IBA in GP settings – found cost savings at 12 /
48 month in terms of alcohol related hospital / A&E costs (Fleming 2002)
Copyright Alcohol Health Network
12. International evidence for impact of IBA
at work
Hermansson 2010 – Scandinavian transport company - 20% of employees drank
excessively
• Following IBA at 12m follow up 28% reduced excessive drinking
• Baseline 51% scored >8 on AUDIT - 23% at 12m follow up
Saitz et al 2006 - US web-based study of 4,000 students – 33% of women and 15%
of men drinking at increased risk reduced their drinking to low risk one month later.
Doumas 2007 found e-based IBA and personalised feedback reduced heavy drinking
by 30% among young workers compared to assessment-only
Quanbeck et al 2010 developed a US cost benefit model - Benefit to cost ratio of 4.4
– 1 for spend on IBA delivery in workplace
Copyright: Alcohol Health Network
13. Identification and Brief Advice approaches – in
the workplace
Reactive approach – Occupational Health / EAP
Proactive approach - Encourage employees to use AUDIT tool
privately - to measure own drinking rates
Online
Induction
Market stall / Health Days
Training managers
Signposting – services and self-help resources
Copyright: Alcohol Health Network
14. AHN Online IBA Studies
Middlesex University 2013 - Evaluation of the Better Drinking Habits
Online Tool
University College London /
Newcastle University 2013 - Feasibility study
of electronic screening and brief intervention
for alcohol misuse in workplace settings
• Online alcohol / health assessment tool - Promoted via intranet / posters
• Confidential risk-based feedback on drinking and health measures
• Baseline measure and follow up 3-m later
Copyright: Alcohol Health Network
16. AHN Online Awareness Study findings
Middlesex University 2014
• 17% completion rate
• Statistically significant reduction in
drinking
• 38% respondents reduced
consumption
• 68% found feedback useful
University College London 2014
• < 35% completion rate
• 7% reduction in proportion of staff
drinking at Increasing or High Risk
levels
Copyright: Alcohol Health Network
17. Learning from workplace alcohol
awareness prevention approaches
Majority of employees using tool value this approach
Anonymity very important
Approach appeals to increased/high risk drinkers
Staff want to understand more about health risks for different levels
Alcohol focus attracts larger proportions of heavy drinkers
compared to health focus
Copyright: Alcohol Health Network
18. Recommendations for companies and
organisations
Review Policy – encourage staff to come
forward and seek support
Alcohol awareness programmes should
encourage self-identification
Pro-actively make workplaces “alcohol
aware” – change the culture
Ensure prominent signposting to support
services
Act as “champions” to engage other
companies and organisations
Copyright: Alcohol Health Network
19. References / Further Reading
Doumas DM, Hannah E. Preventing high-risk drinking in youth in the workplace: a web-based normative feedback program. Journal of
substance abuse treatment. 2008;34(3):263-71. Epub 2007/06/30.
Fleming M.F, Mundt M.P, French M.T, Manwell L.B, Stauffacher E.A, Barry K.L. (2002) Brief physician advice for problem drinkers: long-term
efficacy and benefit-cost analysis. Alcohol Clin Exp Res. 26(1), 36-43.36
Hermansson U, Helander A, Brandt L, Huss A, Ronnberg S. (2010) Screening and brief intervention for risky alcohol consumption in the
workplace: results of a 1 year randomised controlled study. Alcohol and alcoholism. 45 (3) 252-257
Khadjesari Z, Murray E, Hewitt C, Hartley S, Godfrey C. Can stand-alone computer-based interventions reduce alcohol consumption? A
systematic review. Addiction (Abingdon, England). 2011;106(2):267-82. Epub 2010/11/19
Middlesex University / NHS North Central London / Alcohol Academy / IHWUK (2011) Alcohol and the workplace? The importance of
early intervention and workplace policies in reducing the health and business impact of alcohol misuse
Moyer, A., Finney, J., Swearingen, C. and Vergun, P. (2002) Brief Interventions for alcohol problems: a meta-analytic review of controlled
investigations in treatment -seeking and non-treatment seeking populations, Addiction, 97, 279-292.
NICE Public Health Guidelines 24 (2010) Alcohol Use Disorders – Preventing the development of hazardous and harmful drinking, NICE
Quanbeck A, Lang K, Enami K and Brown R. (2010). A Cost-Benefit Analysis of Wisconsin’s Screening, Brief Intervention, and Referral
to Treatment Program: Adding the Employer’s Perspective. Wisconsin Medical Journal ; 109(1): 9–14
Roche AM, Pidd K, Berry JG et al. (2008). Workers’ drinking patterns: the impact on absenteeism in the Australian work-place. Addiction,
103:738–748.
Seymour L. (2010) Common mental health problems at work. What we now know about successful interventions. A progress review.
BOHRF/Sainsburys centre for mental health
Wallace P, Murray E, McCambridge J, Khadjesari Z, White IR, et al. (2011) On-line Randomized Controlled Trial of an Internet Based
Psychologically Enhanced Intervention for People with Hazardous Alcohol Consumption. PLoS ONE 6(3): e14740.
doi:10.1371/journal.pone.0014740
Watson H, Godfrey C, et al (2009) Reducing Alcohol-related Harm In The Workplace - A Feasibility Study Of Screening And Brief
Interventions For Hazardous Drinkers Alcohol Research UK
Copyright: Alcohol Health Network
20. Thank you – please contact us!
Alcohol Health Network
donshenker@alcoholhealthnetwork.org.uk
www.alcoholhealthnetwork.org.uk
4th Floor, 17-23 Willow House, London
SW1P 1JH
Tel. 020 3151 2420
Copyright: Alcohol Health Network 20
Editor's Notes
Lessons leant from international studies - ‘what works’ to reduce alcohol harm at work and the impact if its not addressed
Prevention vs. Treatment – why alcohol harm prevention is better than cure and how to achieve it
Recognising signs of problem drinking behaviour – what systems to use
IBA – what the research tells us about this approach
Findings from AHN and UCL collaborative study of ‘online alcohol awareness’ across 6 organisations
AHN is a new social enterprise that aims to prevent alcohol related harm in the workplace
Our objective: Early intervention and prevention of alcohol misuse
Encourage alcohol self-awareness and identification
Provide alcohol awareness campaigns and advice
Signpost heavy drinkers to local services
Collaboration with UCL’s E-Health Unit and Camden and Islington NHS Trust
Good news - percentage of people who had heard of daily drinking limits increased from 54% in 1997 to 75% in 2009
Only a third of men and half of women know the correct alcohol guidelines for their gender
The majority of heavy drinkers are unaware of the maximum recommended units
25% of drinkers drink 5 or more drinks in one sitting
Health Survey for England 2007
Ibid
APHO (2007) Indications of Public Health in the English Regions – Alcohol (Chapter 8)
The impact of drinking leads to time off work due to hangovers or feeling unwell in the morning
Drinking leads to poor sleep and this affects performance at work
Drinking leads to long term poor health or mental health problems
Drinking behaviour is concealed from colleagues or tolerated and this causes stress and tension for the whole team
Off-duty drinking has an impact on absenteeism and presenteeism
Majority of heavy drinkers are of working age and in work
The act of asking evidence-based questions leads to behaviour change on drinking rates (NICE, 2010)
Employers have duty of care to ensure employees drinking at higher rates are aware of this and know how to get help
Proactive approach - Encourage employees to use AUDIT tool to measure drinking rates and provide confidential personalised feedback on drinking levels and risk score
Anonymity very important for self-assessment
Approach appears to appeal most to increased/high risk drinkers – higher proportions than national average
Staff appear to use alcohol assessment tools more than once to understand more about health risks for different levels
An alcohol focused approach appeals to larger proportions of heavy drinkers than a general health focus
Adopt a comprehensive, written, alcohol workplace policy – for long-term impact
Implement health-related alcohol programmes, as comprehensively as resources allow – including as part of a wider health and well-being agenda
Pro-actively make their workplaces “alcohol free”
Review working practices and management styles that can cause stress and perpetuate or worsen heavy drinking
Where they have experience of alcohol policies and interventions, consider acting as “champions” to engage other companies and organisations