title: Substance abuse and the uninsured worker in the United States.
abstract: 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.
authors.affiliation: Pacific Institute for Research and Evaluation, Calverton, MD 20705, USA. Miller@pire.org
authors.forename: Deborah M
authors.initials: DM
authors.lastname: Galvin
authors.forename: Ted R
authors.initials: TR
authors.lastname: Miller
authors.forename: Rebecca S
authors.initials: RS
authors.lastname: Spicer
authors.forename: Geetha M
authors.initials: GM
authors.lastname: Waehrer
mesh_terms: D000041:Absenteeism; D000293:Adolescent; D000328:Adult; D000437:Alcoholism / Q000191:economics* / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D017057:Medically Uninsured / Q000706:statistics & numerical data*; D008875:Middle Aged; D009786:Occupational Health Services / Q000191:economics* / Q000706:statistics & numerical data; D019966:Substance-Related Disorders / Q000191:economics* / Q000453:epidemiology; D014481:United States / Q000453:epidemiology