Learn Strategies to Identify Opioid and Other Drug Use Problems at Work

Not sure what to look for? This section provides strategies to identify potential substance use problems at your organization.

Contact Information

Phone: 1-877-SAMHSA-7


Email: dwp@samhsa.hhs.gov

  • Strategy 1: Reduce Stigma

    Promote a Workplace Environment Based on Trust, Respect, and Support.

    Stigma is a negative perception associated with a circumstance, quality, or person. Substance use disorders are highly stigmatized.

    Employees will only come forward with a substance use problem if they feel safe and supported and know that their privacy will be protected. Employees should know they can seek help without fear of judgment or punishment.

    Employers Can Take the Following Actions to Reduce Substance Misuse Stigma in the Workplace:

    • 1 Educate

      Counter inaccurate stereotypes or myths about substance use disorders by replacing them with factual information.[4] Build this content into workplace discussions and messages about overall wellness. If you decide to host voluntary educational training sessions or provide substance use materials, allow for confidential participation or access. Any educational trainings or materials should also be available and promoted to all staff to ensure that no individuals or groups appear to be singled out.

    • 2 Revise Policies

      Offer health benefits that provide comprehensive coverage for substance use disorders as the default option for all staff, not as a service that employees must opt into or select separately.

    • 3 Increase Prevention Efforts

      Consider participating in a prescription drug take-back event[13]—with the cooperation of local law enforcement and community groups—alongside similar events (for example, battery/electronics recycling, document shredding, and food pantry donations). Publicize these events to increase visibility and participation.

    • 4 Connect to Resources

      Feature substance use resources alongside other staff resources. Identify and create relationships with a range of community service providers who treat various aspects of substance use disorders, including prevention, treatment, and recovery.

    • 5 Promote Support Groups

      Provide a way for staff at all levels to connect and share stories about their own or their family members’ struggles or bring in outside speakers to share their stories with staff.

  • Strategy 2: Assist Employees

    Provide Confidential Tools Employees Can Use to Determine if They Have a Substance Use Problem or Are at Risk of Developing a Problem.

    Screening can help prevent substance misuse, identify those at risk, discover a potential problem, or point to a need for further evaluation and treatment. Early identification of substance misuse may reduce treatment time and prevent costly safety risks, prevent reduced productivity, and other problems.

    What Are Screening Tools?

    Screening tools are short questionnaires that employees can use on their own to recognize substance use problems that could interfere with their health and safety at home and at work. Employees do not share this information with anyone else unless they choose to. Employers can easily place these tools in existing wellness materials.

    How Accurate Are Screening Tools?

    Screening tools are developed based on their ability to correctly identify people with and without a substance use problem. No screening tool is 100% accurate, but they can be useful predictors of who is at risk for substance use problems. Just remember that only a qualified health professional can confirm a diagnosis.

    What if an Employee Identifies a Potential Problem?

    If an employee screens positive for a potential problem, it’s important that they seek professional support. Employers can provide information to all employees about what confidential support they offer, such as an Employee Assistance Program or contact lists of local health care providers.

    Employers can also make all employees aware of the free SAMHSA National Helpline (1-800-662-HELP [4357]). This is a confidential, free, 24-hour-a-day, 365-day-a-year, information service, in English and Spanish, for individuals and family members facing mental health or substance use disorders. This service provides referrals to local treatment facilities, support groups, and community-based organizations. Callers can also order free publications and other information.

    Example Screening Tools

    • The 4-item CAGE-AID

      The 4-item CAGE-AID [Download CAGE-AID]

      • Have you ever felt you ought to cut down on your drinking or drug use?*
      • Have people annoyed you by criticizing your drinking or drug use?
      • Have you ever felt bad or guilty about your drinking or drug use?
      • Have you ever had a drink or used drugs first thing in the morning to steady your nerves or to get rid of a hangover?

      Scoring: Regard one or more positive answers as a positive screen.

      *When thinking about drug use, include illegal drug use and prescription drugs used other than prescribed.

    • Rx Misuse Fact Sheet

      Screening for Rx Misuse Fact Sheet

      [Download Factsheet]

  • Strategy 3: Provide Training

    Train Supervisors and Managers to Recognize Potential Problem Use.

    Employers or supervisors often do not act until an employee has an accident, is reported by coworkers, or fails a drug test. Finding the right balance between being proactive and respecting employees’ privacy and legal rights is possible.

    What Can Employers Ask?

    The Americans with Disabilities Act applies to all employees and restricts what employers can ask about drug use. [Go To Resource]

    Employers can ask employees:

    • Health-related questions if they have learned that an employee’s job functions will be impaired due to prescribed drug use or there will be a direct threat to safety.
    • To take a medical examination.

    Learn more about what employers can ask before, during, and after hiring employees. [Download Factsheet]

    What Can't Employers Ask?

    Employers cannot ask their employees about their prescribed drug use unless the side effects of the drugs directly affect their job function. [Go To Resource]

    What Should Employers Look For?

    The following are some of the behavioral characteristics that may occur with substance use. These characteristics do not always indicate a substance use problem, but they may warrant further investigation. Supervisors and managers can be trained to spot these and other warning signs:

    • Increased absenteeism, including unexplained absences or vague excuses for needing time off
    • Frequent breaks and disappearances from the work site
    • Failure to keep appointments or meet deadlines
    • Work performance that alternates between periods of high and low productivity
    • Increase in accidents on and off the job
    • Lack of attention or focus
    • Unusual carelessness
    • Confusion or difficulty concentrating or recalling details and instructions
    • Increases in the effort and time required for ordinary tasks
    • Problems getting along with coworkers
    • Not taking responsibility for errors or oversights
    • Progressive deterioration in personal appearance and hygiene
    • Increasing personal and professional isolation
    • Signs of morning-after hangovers
    • Physical signs such as drowsiness, hyperactivity, dilated pupils, or slurred speech

    What if This Is a Potential Problem?

    If a supervisor or coworker suspects an employee’s substance use may be a safety concern or is affecting their ability to perform their job functions, they should notify human resources or management.

    Other reasons may exist for the observed symptoms, so having a performance discussion with employees may allow them the opportunity to share this information. Employees may report that they are dealing with family issues or a new health condition and are adjusting to new medications. In these circumstances, an employer can start discussions about reasonable accommodations or available medical/personal leave options.

    An employer should proceed with normal actions to address an employee who is underperforming or displaying inappropriate behavior in the workplace if that employee denies any substance use issues.



    Employee health-related information is protected by law. Therefore, an employer must adhere to strict confidentiality regulations. An employee’s prescribed drug use history can be shared with the employee’s supervisor if there are work-related restrictions resulting from the use.

  • Strategy 4: Consider a Drug-Testing Program

    Carefully Weigh Your Options for Drug Testing in the Workplace.

    Drug testing may deter employees from coming to work when they are unfit for duty. The first consideration regarding drug testing is to determine whether it is required for some or all employees.

    There are many reasons [Go To Resource] an employer may decide to have a drug-testing program, including:

    • To comply with federal regulations [Go To Resource]
    • To comply with customer or contract requirements
    • To comply with insurance carrier requirements
    • To reinforce the organization’s “no drug use” position
    • To identify employees with substance use disorders and refer them for assistance
    • To establish grounds for discipline or firing
    • To improve safety
    • To deter recreational drug use that could lead to addiction
    • To reduce the costs of alcohol and other drug misuse in the workplace

    If you are considering adopting a drug-free workplace policy or drug-free workplace program, you may have many questions and concerns, such as:

    • Is this something that will enhance the health and productivity of employees?
    • Will it be expensive?
    • How will employees react to it?
    • Will some employees feel safer?
    • How do I provide drug testing in a lawful manner?


    Legal Requirements

    For important information about legal requirements that can affect workplace drug testing and policies, access SAMHSA resources
    [Go To Resource]