The Effects of Substance Use on Workplace Injuries

Substance Use and Misuse and Occupational Injuries: Empirical 
Evidence
In 1993 and 1994, two reviews synthesized the empirical literature that aimed to investigate 
the relationship between substance use and misuse and occupational injuries. In the first of 
these, Stallones and Kraus (1993) conclude that there was not enough evidence to establish a 
causal relationship between alcohol use and workplace injuries. A year later, the Institute of 
Medicine (IOM) released its own review of drugs and the American workforce (Normand, 
Lempert, and O’Brien, 1994). In the IOM report, the Committee on Drug Use in the Work-
place conducted a wider review of the impact of alcohol and other drug use on a range of 
occupational outcomes, including absenteeism, turnover, job satisfaction, and accidents. With 
respect to occupational injuries, the committee concludes that, while there was evidence that 
substance use negatively affected job behaviors and occupational outcomes, including injury, 
substance use’s influence on these injuries was small. More importantly, however, the IOM 
study highlights the lack of rigorous analytic approaches in most studies, which limited their 
ability to say anything definitive about the relationship. For example, although many research-
ers had hypothesized that deviance proneness could be an important omitted factor causing 
spurious correlation between substance use and workplace injuries in the absence of a causal 
effect, many studies lacked controls for personality traits and other risk-taking dispositions in 
multivariate models. In addition, both reviews note that very few studies employed a control 
group, which limited their ability to estimate differential risk between substance-using and 
nonusing groups. 
In the current study, we review selected studies that have been conducted since the previ-
ous review (i.e., 1993–1994), though we highlight findings from earlier studies where relevant. 
Studies conducted since 1994 were located using PubMed® and Google Scholar™ searches using 
the terms “occupational injuries” and “workplace injuries” in conjunction with “substance 
use,” “alcohol,” and “drug”; additional studies were identified using cited-reference searches. 
Studies were selected that provided empirical evidence linking any measure of substance-using 
behaviors with any measure of occupational injury. While many follow the same methodol-
ogy of the previous studies mentioned in the earlier reviews, some have advanced the research 
field by using multivariate analysis to control for other related behaviors (e.g., Hoffman and 
Larison, 1999), a control group for comparison (e.g., Lapham, McMillan, and Gregory, 2003), 
or alternative identification strategies (e.g., Kaestner and Grossman, 1998) in their attempts to 
parse out the causal effect of substance abuse on occupational injuries. 
We identified a total of 33 studies. Studies varied widely with respect to methods of 
measuring substance use and injuries, using both subjective (e.g., survey responses) and objec-
tive (e.g., diagnostic tests, hospital-chart reviews) measures. We discuss the results from these 

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6 The Effects of Substance Use on Workplace Injuries
studies, presented in categories defined generally by the measurement strategy that each study 
employed.