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Although millions of US workers lack health insurance, the relationship of insurance coverage with substance abuse and access to workplace treatment services remains unexplored. Our analysis shows uninsured workers have higher rates of heavy drinking and illicit drug use than insured workers. Young and part-time workers are, moreover, less likely to have insurance coverage than workers with lower substance abuse risks. Compared to the insured, uninsured workers have less access to employee assistance programs (EAPs) and less drug and alcohol testing by employers. The effectiveness of workplace substance abuse programs and policies designed for insured populations is untested among uninsured workers. Issues include EAP effectiveness with referrals to public treatment and the return on investment for adding coverage of substance abuse treatment. Workers in countries with universal health insurance but inadequate treatment capacity may face similar problems to uninsured workers in the US.Journal of Public Health Policy (2007) 28, 102–117. doi:10.1057/palgrave.jphp.3200105 [ABSTRACT FROM AUTHOR]

Introduction Little is known about the effects of employee assistance programs (EAPs) on occupational injuries. Materials and methods Multivariate regressions probed a unique data set that linked establishment information about workplace anti-drug programs in 1988 with occupational injury rates for 1405 establishments. Results EAPs were associated with a significant reduction in both no-lost-work and lost-work injuries, especially in the manufacturing and transportation, communication and public utilities industries (TCPU). Lost-work injuries were more responsive to specific EAP characteristics, with lower rates associated with EAPs staffed by company employees (most likely onsite). Telephone hotline services were associated with reduced rates of lost-work injuries in manufacturing and TCPU. Drug testing was associated with reductions in the rate of minor injuries with no lost work, but had no significant relationship with lost-work injuries. Practical applications This associational study suggests that EAPs, especially ones that are company-staffed and ones that include telephone hotlines, may prevent workplace injuries. [ABSTRACT FROM AUTHOR]

ABSTRACT. Objective: This study examined how problem drinking and drug use and their related treatment received by workers varied by health insurance coverage and employment characteristics. Method: We used National Survey on Drug Use and Health data on civilian workers ages 18 years and older from the 2002 and 2003 public-use files. Multivariate logistic regressions estimated the relationship between workers' uninsured status and problem use, dependence, and treatment while controlling for worker demographics, education, income, and job characteristics. Results: Controlling for differences in worker and workplace characteristics, uninsured workers were significantly more likely than privately insured workers to be illicit drug users or heavy drinkers. Among dependent workers, the lack of insurance was associated with a reduction in treatment received for problem drinkers (odds ratio = 0.31, p = .13). By contrast, a large, positive-albeit statistically nonsignificant-association between being uninsured and receiving treatment prevailed among uninsured workers using illicit drugs. Workplace substance-use policies were associated with a significant reduction in the odds of treatment received or treatment needed among problem drinkers without insurance coverage. Employee assistance programs were not good predictors of treatment received among uninsured workers. Conclusions: Uninsured workers were more likely to be heavy drinkers or illicit drug users than were workers with health insurance. Health insurance coverage was not significantly associated with treatment received among workers reporting problem use. Uninsured workers may be unable to benefit fully from employee assistance programs' treatment and referral services, whose utility depends on adequate behavioral health coverage for workers. [ABSTRACT FROM AUTHOR]