Lawental E, McLellan A T, Grissom G R, Brill P, O'Brien C
Penn-VA Center for Studies of Addiction, Philadelphia, PA 19104, USA.
J Subst Abuse. 1996;8(1):115-28. doi: 10.1016/s0899-3289(96)90127-3.
With the advent of on-site urine testing and other initiatives designed to reduce substance abuse at the workplace, employees who are found to have used alcohol and/or drugs have been coerced into substance abuse treatments under threat of job loss. This widespread practice has produced three questions relative to these practices. First, do these employees have significant substance abuse problems or are they merely "recreational users" who have gotten caught? Second, will these employees participate in standard treatments or will they resist them? Finally, will standard substance abuse treatments provide any benefits to these coerced patients relative to other self-referred patients in treatment? We compared the pretreatment problems, during treatment performance and posttreatment outcomes of 96 employed, insured participants who were coerced into treatment at four private treatment programs due to detection of drug use on the job, to the same measures collected on a comparison group of 161 patients from the same job sites who were self-referred admissions to the same four treatment programs. Results showed that the coerced group had significant substance abuse and other life problems at the start of treatment, but that these problems were generally less severe or chronic than those of the self-referred group. Coerced participants were significantly more likely to remain in treatment (either inpatient or outpatient) than the self-referred participants. Posttreatment follow-up of coerced patients indicated marked improvements in alcohol and drug use, employment, medical, family, and psychiatric problems. These levels of improvement were comparable to those shown by the self-referred patients. We conclude that workplace urine surveillance was successful in detecting employees with significant substance abuse related problems, and that referral to standard treatment was associated with substantial improvements in those problems.
随着现场尿液检测及其他旨在减少工作场所药物滥用的举措的出现，被发现使用酒精和/或毒品的员工受到失业威胁，被迫接受药物滥用治疗。这种普遍做法引发了与这些做法相关的三个问题。第一，这些员工是否存在严重的药物滥用问题，还是仅仅是被抓到的“娱乐性使用者”？第二，这些员工会参与标准治疗还是会抵制？最后，相对于其他自行寻求治疗的患者，标准的药物滥用治疗会给这些被迫接受治疗的患者带来任何益处吗？我们将96名因在工作中被检测出吸毒而在四个私人治疗项目中被迫接受治疗的在职参保参与者的治疗前问题、治疗期间表现和治疗后结果，与从相同工作场所自行转诊至这四个相同治疗项目的161名患者组成的对照组所收集的相同指标进行了比较。结果显示，被迫接受治疗组在治疗开始时存在严重的药物滥用和其他生活问题，但这些问题总体上不如自行转诊组严重或持久。被迫接受治疗的参与者比自行转诊的参与者更有可能坚持治疗（住院或门诊）。对被迫接受治疗患者的治疗后随访表明，他们在酒精和药物使用、就业、医疗、家庭及精神问题方面有显著改善。这些改善程度与自行转诊患者的情况相当。我们得出结论，工作场所尿液监测成功检测出了存在严重药物滥用相关问题的员工，并且转诊至标准治疗与这些问题的大幅改善相关。
