The Effects of Substance Use on Workplace Injuries

Critique of Objective Measures of Injury
These studies make an effort to avoid the pitfalls of using self-reported injuries, but there are 
limitations to these approaches as well. Studies that use workers’ compensation claims are ret-
rospective, so it is difficult to ascertain the amount of alcohol or drugs in someone’s system at 
the time of injury or during the period around the injury date. Additionally, administrative 
records on workers’ injuries may be biased because employees may fear socioeconomic disin-
centives for making an injury aware to their employers; employers, on the other hand, may 
file incomplete reports out of fear of increased regulatory or financial burdens (Dembe, 2001; 
Rosenman et al., 2006). The major limitation to studies that use ED visits to measure injuries 
is that only about one-third of all occupational injuries and illnesses result in a visit to the ED, 
so it yields an undercount of injuries and is likely to only capture the most severe and omit 
those that do not require professional treatment (CDC, 2001). Similarly, only the most severe 
injuries will be captured using objective measures and such studies are therefore not generaliz-
able to the full spectrum of injuries experienced in the workplace. In addition, the identifica-
tion of work-related cases is dependent on the injured or ill worker reporting that the injury 
was work-related and that this be noted in the patient’s medical chart.

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12 The Effects of Substance Use on Workplace Injuries
Objective Measures of Substance Use
The five studies presented in Table 3.3 are those that have used objective measures of both sub-
stance use and injuries. Ohsfeldt and Morrisey (1997) used state-level variation in beer taxes 
across states over a 10-year period, which the authors use as a proxy for alcohol abuse and has 
been used previously in studies relating alcohol use to other outcomes. The other four papers