Coerced treatment for substance abuse problems detected through workplace urine surveillance: is it effective?

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.