Workplace Discrimination Experiences of Americans With Alcohol Use Disorders and Americans With Drug Use Disorders: A Comparative Analysis

Abstract

The purpose of this study was to investigate the patterns in allegations of workplace discrimination by individuals with alcohol use disorders (AUDs) relative to those with other drug use disorders (DUD). The goal of the research was to describe the uniqueness of workplace discrimination, both actual and perceived, that has occurred against individuals with AUD when compared to those with DUD through analysis of the U.S. Equal Employment Opportunity Commission (EEOC) Integrated Mission System (IMS) database. An ex post facto, causal comparative quantitative design was used to examine Americans with Disabilities Act Amendments Act (ADAAA) Title I complaints received by the EEOC from individuals with AUD (n = 2,123) from 2009 through 2016 in comparison to ADAAA Title I complaints received from individuals with DUD (n = 1,472) over the same time period. Results revealed statistically significant differences in the patterns of issues alleged by the two groups. The AUD charging parties (individuals who filed the complaints) were, on average, significantly older and involved fewer African Americans than did the DUD comparison group. Individuals with AUD were significantly less likely than the DUD group to achieve merit closures when investigations were completed. This means that the DUD group’s investigations were more often closed as favorable to the charging party. Implications for rehabilitation practice and further research are discussed.

Keywords

alcohol use drug use substance use disorders workplace discrimination vocational rehabilitation

Substance use disorders (SUDs) include alcohol use disorders (AUDs) and drug use disorders (DUDs) and are among the most prevalent and severe health-related conditions in the world (GBD 2016 Alcohol and Drug Use Collaborators, 2018; Schomerus, 2014). The World Health Organization (WHO, 2018) estimates that 283 million people globally experience alcohol-related issues (3.8%), and an additional 275 million people (3.7%) have used illicit drugs in the past year. Since 1990, the number of persons worldwide with SUDs has increased substantially, primarily among men (GBD 2016 Alcohol and Drug Use Collaborators, 2018). Approximately 31 million illicit drug users are reported to have DUDs (United Nations Office on Drugs and Crime [UNODC], 2018; WHO, 2018). Harmful alcohol use alone is estimated to account for 1 in 20 deaths (5.3%) worldwide every year (WHO, 2018). In terms of disability-adjusted life years, alcohol is responsible for 5.1% of the global burden of disease and injury (WHO, 2018). The most recent estimates from the UNODC (2018) are that drug use (other than alcohol) is responsible for about 450,000 deaths globally, with nearly 170,000 of those deaths attributable to overdose. Although cannabis remains by far the most widely used illicit drug worldwide, accounting for nearly 70% of illicit drug use, opioids continue to be the most lethal, responsible for more than three-quarters (76%) of DUD-related deaths (UNODC, 2018).

Currently in the United States, it is estimated that 20.2 million adults meet criteria for SUDs in a 12-month period (Lipari & Van Horn, 2017). Of these adults, 16.3 million (80.7%) have AUDs, and 6.2 million (30.7%) have DUDs. More recent prevalence data indicate that 13.9% of the U.S. adult population meet criteria for an AUD in a 12-month period, with the majority (53.5%) having an AUD and not a co-occurring DUD (Saha et al., 2018). In terms of specific substances used within the DUD category, 3.5 million adult Americans met criteria for cannabis use disorders; 2.4 million met criteria for opioid use disorders; 1.3 million met criteria for stimulant use disorders; 534,000 met criteria for sedative, hypnotic, or anxiolytic use disorders; 191,000 met criteria for hallucinogen-related use disorders; and 57,000 met criteria for inhalant-related use disorders (Lipari & Van Horn, 2017). Saha et al. (2018) reported that of those U.S. adults who met AUD criteria in a 12-month period, 31.5% also met criteria for nicotine use disorder, and 6.1% met criteria for AUD and DUD. Of these groups, severity of AUD was greater in persons who had DUD. The impact of these disorders in the United States is far-reaching across public health, economic, and psychosocial domains. Annually, approximately 88,000 Americans die from alcohol-related causes, making it the third leading cause of preventable death in the United States (National Institute on Alcohol Abuse and Addiction, 2018). Drug overdoses in the United States, driven primarily by opioid use, surpass motor vehicle accidents as the leading cause of unintentional injury deaths (Lockwood, 2018). Drug overdoses have increased across gender, racial/ethnic, and age categories for adults, with estimates indicating that deaths from drug overdoses exceeded 60,000 cases in 2018; more than two-thirds of those deaths were attributable to opioid use (Centers for Disease Control and Prevention [CDC], 2017; Mehta et al., 2017). Every day, more than 115 Americans die from opioid overdoses (CDC, 2017; National Institute on Drug Abuse [NIDA], 2018). Opioid use disorders are now the seventh leading cause of disability-adjusted life years in the United States; AUDs are the 23rd leading cause (The U.S. Burden of Disease Collaborators, 2018).

Substance Use in the Workplace

Businesses in the United States lose billions of dollars each year as a result of substance use due to lost productivity, workplace accidents and injuries, employee absenteeism, low morale, and increased illness (Bush & Lipari, 2015; NIDA, 2018). The prevalence of SUDs is highest among those outside the labor force (i.e., not working or looking for work). However, approximately two-thirds of Americans ages 18 to 64 are employed full-time, a majority of those with SUDs are full-time employees (Larson et al., 2007). Bush and Lipari (2015) reported that nearly 1 in 10 (9.5%) full-time employees met the criteria for SUD in the previous year. When examined by industry, SUD was most common among full-time employees in accommodations and food services (16.9%); followed by construction (14.3%); arts, entertainment, and recreation (12.9%); mining (11.8%); and utilities (11.5%; Bush & Lipari, 2015). Alcohol use was most prevalent in mining (17.5%), construction (16.5%), and accommodations and food services (11.8%). Illicit drug use was most prevalent in accommodations and food services (19.1%); arts, entertainment, and recreation (13.7%); and management (12.1%).

Impact of Drug of Choice on Stigma

Worldwide, SUDs are some of the most highly stigmatizing conditions and, in some studies, more stigmatizing than psychiatric disorders such as schizophrenia (Yang et al., 2017). A number of researchers (e.g., Corrigan et al., 2017; Kulesza et al., 2016) have coined the term addiction stigma, defining it as the practice of endorsing negative stereotypes of persons with SUDs (and those who misuse substances, even if diagnostic criteria are not fulfilled) and displaying prejudice and discrimination toward them. Explanations for addiction stigma include perceptions that persons with SUDs are morally corrupt, social deviants, and/or dangerous. They are regarded with fear and disgust, due in part to the belief that they voluntarily and intentionally engage in problematic substance use. Therefore, they are to be pitied and mistrusted, and their social isolation, coercive and unfair treatment (i.e., discrimination), and punishment (e.g., legal sanctions) are justified.

In their review of 18 studies on public stigma and SUDs, Yang et al. (2017) reported that persons with DUDs can experience greater stigma than those with AUDs. One survey of the U.S. population (Link et al., 1999) found that 90% of respondents were unwilling to have contact with a cocaine-dependent individual, compared to 70% for contact with alcohol dependence. The perception of the general public that an SUD is a behavioral and controllable “choice” rather than a “real” condition where symptoms arise involuntarily contributes to the degree of stigma related to these disorders (Schomerus, 2014). Surveys of population attitudes in the United Kingdom conducted in 1998 and 2003 (see Crisp et al., 2005) revealed that individuals with DUD individuals were viewed as responsible for their “problem” by higher percentages (68% in 1998; 60% in 2003) compared to individuals with AUD (60% in 1998; 54% in 2003). In addition, a review of studies of public perception by Schomerus et al. (2011) revealed that those with DUD were consistently rated as the most “unpredictable and dangerous,” followed by AUD and schizophrenia (which alternated as second and third most violent dependent on the study).

Livingston et al. (2012) suggested three main reasons for the uniqueness of stigma toward individuals with SUDs. First, SUDs are symbolically linked to other stigmatized health conditions such as HIV/AIDS, hepatitis C, other mental health conditions, unsafe behaviors such as impaired driving, and social problems like poverty, unemployment, criminality, and poor education. Second, SUDs are treated as a moral and criminal issue, which is particularly true in the United States regarding illicit substances. Some substances (e.g., heroin) are more highly criminalized and are treated with more punitive measures. Use of illegal substances increases the degree of stigma experienced as opposed to use of legal substances, such as alcohol, especially in the United States (Schomerus, 2014). Livingston et al.’s (2012) third reason for addiction stigma is that persons with SUDs are perceived as capable of controlling their condition.

Employment Legislation

In terms of protections from employment discrimination for those with mental health diagnoses under the Americans with Disabilities Act Amendments Act (ADAAA), which took effect on January 1, 2009, most conditions found in the current edition of the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5; American Psychiatric Association, 2013) are covered as a disability; however, there are certain conditions that are covered with exceptions and some that are excluded altogether. Regarding substance use, Section 104 of the ADAAA excludes all individuals who are actively using illegal substances but still protects those who have gone through or are currently in rehabilitation, as well as those who have been erroneously identified as substance users (ADA National Network, 2019; Cummings et al., 2013; Lowe, 2016; Rubin et al., 2016). In the case of AUDs, a person with an AUD is covered under ADAAA and entitled to consideration of accommodation if that person is qualified to perform the essential functions of the job but is not protected for any use of alcohol that affects job performance or renders the employee not “qualified” (ADA National Network, 2019; Job Accommodation Network [JAN], 2019). For DUDs, active use of illegal substances is always excluded from ADAAA coverage; however, those who are “recovering,” as defined by those not “currently” using substances and receiving treatment, and those who have successfully completed treatment are protected under ADAAA on the basis of their past DUD (ADA National Network, 2019; JAN, 2019; Rubin et al., 2016). The EEOC Technical Assistance Manual on the ADAAA issued the following guidelines on “current” use (JAN, 2019):

(a.) If an individual tests positive on a drug test, he or she will be considered a current drug user, so long as the test is accurate.

(b.) Current drug use is the illegal use of drugs that has occurred recently enough to justify an employer’s reasonable belief that involvement with drugs is an ongoing problem.

(c.) “Current” is not limited to the day of use, or recent weeks or days, but is determined on a case-by-case basis.

In the United States, there are other federal laws and regulations that address substance use in the workplace. Legislation such as the ADAAA (which replaced the 1990 Americans with Disabilities Act [ADA]), falls under the category of laws designed to protect the civil rights of American workers. There is another group of laws designed to target workplace substance use, an example being the Drug-Free Workplace Act of 1988 (Safety Management Clinic, 2008). This act applies to public entities and any private companies or individuals that are federal contractors and grantees, as well as “safety-sensitive industries.” These industries include fields pertaining to public safety and national security including employees in aviation, trucking, railroads, pipelines, and other transportation industries (Safety Management Clinic, 2008).

With these legal considerations, any employer is legally within its rights to create and enforce a drug-free workplace policy. Although it may seem that the spirits of (a) the original ADA and its successor the ADAAA and (b) the Drug-Free Workplace Act are in conflict, the limitations in protections for individuals with a SUD enable these laws to legally coexist. Under the ADAAA, employers are legally prohibited from firing, refusing to hire, or promoting someone due to a history of substance use or if actively enrolled in a drug or alcohol program (Safety Management Clinic, 2008). Employers may not single out employees for drug testing due to an appearance of being under the influence of a substance, and employers may not ask employees about legal prescription drug use as part of a prehiring or prepromotion drug test (ADA National Network, 2019; JAN, 2019; Safety Management Clinic, 2008). Reported ADAAA violations account for nearly one-half of all suits regarding drug-free workplace programs (Safety Management Clinic, 2008).

Work is consistently identified as one of the most critical factors in determining an individual’s overall well-being and quality of life. Obtaining and retaining employment is especially important to individuals with SUD, as it has shown to have a positive impact on quality of life, life satisfaction, overall health, social well-being, and personal acceptance of disability (Dunigan et al., 2014; Gold, 2004; Kerrigan et al., 2004; Roessler & Rumrill, 1998; Sprong et al., 2014). Maintaining employment decreases the chances of relapse for individuals in recovery and can provide vital supports to the recovery process.

While employment is a substantial positive factor in recovery, the inverse is also true. Those unable to access employment opportunities are at a much higher risk of relapsing and using substances again (Kerrigan et al., 2004). Given how crucial employment is in the recovery process, the high unemployment rates for individuals with SUD (estimates ranging from 65% to over 85%) is cause for concern (Kerrigan et al., 2004). Individuals with SUD encounter high rates of stigma and encounter significant barriers, including in the workplace. Individuals with SUDs often reside in areas that have fewer employment and career opportunities and experience poor access to child care (Gold, 2004; Sigurdsson et al., 2012). Due to trends in the American economy that have resulted in exponential increase in reliance of education credentials and skill requirements for both the primary (e.g., professional) and secondary (e.g., semi and unskilled) labor markets, education has become increasingly important. With low levels of education, individuals with SUDs experience difficulty in the modern workforce, relying heavily on part-time and temporary positions without career advancement and health care insurance, and earning wages near the federal minimum (Gold, 2004; Sigurdsson et al., 2012).

Personal factors for individuals with SUD also play a role in the barriers to employment. Individuals with SUD may lack general “soft” skills that are relevant to attaining and maintaining work opportunities. Such soft skills include interviewing skills, on the job behaviors such as punctuality and consistent attendance, appropriate dress, personal grooming, and hygiene (Sigurdsson et al., 2012). Other noted difficulties that may be important for employment stability are communicating clearly and professionally, interpersonal relations with co-workers and supervisors, and empathizing with employer perspective.

Furthermore, personal factors related directly to substance use impairments create additional barriers to the employment process. Medical illness, loss of social and familial support, and illegal activity are factors that could interfere with educational opportunities, job skill acquisition, career development plans, and ultimately employability. In addition, substance-related legal charges create criminal record barriers that can exclude individuals with SUD from specific labor force sectors and types of jobs (Gold, 2004).

Although structural discrimination, personal factors, and disease factors play a role in the high unemployment rates of individuals with SUD, the assumption that poor employment outcomes are strictly a result of these factors is insufficient (Baldwin et al., 2010). An advanced labor market analysis for individuals with SUDs shows that 20% of the employment gap and 30% of the wage gap relative to those without SUD is not explained by functional limitations and other productivity-related variables (Baldwin et al., 2010). Meaning there are still workplace barriers that are preventing this largely underutilized workforce resource, people in recovery, from maximizing their potential. The stress, anxiety, and other affective and psychological consequences of workplace discrimination can also be triggers for relapse, compounding the problem even further (Sigurdsson et al., 2012).

Individuals with SUD may choose to file allegations of workplace discrimination to the Equal Employment Opportunity Commission (EEOC). A review of the workplace discrimination allegations under Title I of the ADA to the EEOC by Leslie and colleagues (2019) revealed that Americans with SUD report disproportionately higher numbers of allegations in the areas of discharge, hiring, and suspension relative to individuals with other disabling conditions. What has yet to be explored in the literature is the extent to which the workplace discrimination experiences of Americans with SUD varies based on the individual’s substance of choice (i.e., alcohol or illicit drugs).

The National EEOC ADA Research Project

The National EEOC ADA Research Project (NEARP) is an exhaustive data-mining effort that relies on the Integrated Mission System (IMS) database used by the EEOC to track investigations of workplace discrimination. NEARP investigators seek to develop disability or industry-specific profiles of employment discrimination, explore the contentious issues involved in workplace discrimination, document the interface of disability with other demographics, evaluate extant theories of stigma, and predict EEOC investigatory outcomes (B. T. McMahon et al., 2005).

As reported by M. C. McMahon and McMahon (2016), the IMS database is used as a management tool to monitor workflow, performance, trends, and outcomes for EEOC field office investigators. The NEARP team was the first to use this database for research purposes under the scrutiny of multiple university Institutional Review Boards (IRBs) and the EEOC Office of Research, Information and Planning. Since its inception, NEARP has obtained data on 834,536 closed allegations spanning from the effective date of the original ADA Title I on July 26, 1992, through December 31, 2016. Allegations of Title I employment discrimination received by the EEOC since January 1, 2009, are adjudicated under the regulations of the ADAAA. This study sought, as part of NEARP, to use the IMS database to examine patterns in the discrimination allegations made by individuals with SUDs, with drug of choice (i.e., AUD or DUD) being used as the independent or grouping variable.

Purpose of the Present Study

The purpose of this study was to increase the body of knowledge regarding the workplace discrimination experiences of individuals with AUDs and DUDs by exploring their allegations filed under Title I of the ADAAA between 2009 and 2016. A thorough investigation of the national EEOC database makes it possible to understand the workplace discrimination experiences of individuals with SUDs, as differentiated by drug of choice. The IMS database enabled the researchers to examine the types of discrimination alleged to have occurred, the characteristics of the individuals experiencing the discrimination (e.g., age, gender, and race/ethnicity), and whether the discrimination was deemed to have legally taken place (merit resolution) or was deemed to be a case of perceived discrimination that did not meet the legal standard (nonmerit resolution).

Research Questions

The primary research question that guided this study was: How do the patterns in allegations of workplace discrimination filed by Americans with AUDs differ from those filed by Americans with DUDs in terms of the types of allegations filed, characteristics of charging parties, and case resolutions or outcomes of the EEOC’s investigatory process?

Three secondary research questions were as follows:

(a) Do patterns in workplace discrimination allegations filed by Americans with AUDs differ from those in allegations filed by Americans with DUDs in terms of the types of discrimination alleged to have occurred?

(b) Do patterns in workplace discrimination allegations filed by Americans with AUDs differ from those in allegations filed by Americans with DUDs in terms of charging party (CP) characteristics?

(c) Do patterns in workplace discrimination allegations filed by Americans with AUDs differ from those in allegations filed by Americans with DUDs in terms of the proportion of merit case resolutions?

Method

An ex post facto, causal comparative quantitative design was implemented. Descriptive and inferential analyses were conducted.

Participants

Researchers used the entire population of ADAAA Title I complaints received by the EEOC from people with AUDs (alcoholism in the EEOC database; n = 2,123) and people with DUDs (drug addiction in the EEOC database; n = 1,472) between 2009 and 2016 (N = 3,595). As this study involved the entire population of ADA Title I allegations filed by the two referent groups, issues of sample selection and assignment do not apply.

Instrument and Variables

Allegation

The primary unit of measure was an allegation of employment discrimination filed by a person with an AUD or a DUD with the EEOC since the effectuation of the ADAAA on January 1, 2009. Each allegation was treated as one distinct data point in the IMS system; if one individual filed more than one allegation with the EEOC under Title I of the ADAAA, each allegation was investigated and adjudicated separately. The number of allegations is greater than the number of charging parties in the IMS database because many charging parties file more than one allegation. In EEOC parlance, allegations are referred to as “Issues.” An Issue describes the nature of the unlawful personnel action alleged by the CP. There are 41 unique Issues that have some level of allegation activity ranging in frequency from 10 to 260,572 in the overall EEOC ADAAA Title I complaint database. It is worth noting that the top 5 Issues on this list account for 76% of all allegation activity.

Characteristics of charging parties

The characteristics of CPs include gender (female/male), race/ethnicity, disability type, and age. Disability type (i.e., AUD or DUD) served as the two-level independent or grouping variable for all nonparametric comparisons in this study.

Resolution

Resolution refers to the final EEOC determination as to whether or not discrimination actually occurred. For the purposes of this study, resolutions were dichotomously classified as merit, favoring the CP (a determination that discrimination did occur) or nonmerit, favoring the respondent employer (a determination that discrimination did not occur).

Procedure

For the current investigation, the researchers secured permission to access the IMS database with proper protections for the CPs (applicants or employees) and Respondents (employers). Only “closed” allegations are captured in the NEARP database. NEARP values the results of the investigations conducted by EEOC personnel, and it uses the EEOC “resolution codes” to classify outcomes as either “merit” (which favor CPs) or “nonmerit” (which favor employers).

Information that served as the basis for this study pertained to the type and number of complaints of employment discrimination under Title I of the ADAAA filed by CPs with SUDs (both AUDs and DUDs) and the manner in which the EEOC resolved those complaints. From approximately 3 million records involving all allegations of employment discrimination, a data set was extracted to include only those variables related to the research questions regarding the comparability of the two disability categories of AUD and DUD. To protect the identity of CPs and Respondents, the extraction process adhered to eight guidelines:

The unit of study was an allegation; it was not an individual CP or an individual respondent. A single CP may bring more than one allegation or may bring the same allegation on more than one occasion (e.g., in 2010 and again in 2015).

Only unique allegations that did not involve recording errors or duplications were included in the study data set.

To maximize confidentiality, all identifying information regarding CPs and Respondents were purged except for age, race/ethnicity, gender, and disability status of CPs.

Study data were strictly limited to allegations brought under Title I of the ADAAA since January 1, 2009. Allegations brought under other federal employment statutes that are not directly related to disability status including the Civil Rights Act, Equal Pay Act, Age Discrimination in Employment Act, and the Family and Medical Leave Act were not considered.

Due to the wide variations in state antidiscrimination statutes based on disability, state charges also were excluded to maintain a consistent definition of both disability and discrimination.

To maintain consistency in definitions and procedures among the study variables, only allegations received, investigated, and closed by the EEOC were included. This required the exclusion of allegations referred by the EEOC to litigation for disposition in civil court, federal or state.

Only allegations that had been closed by the EEOC during the study period, defined as January 1, 2009 (first effective date of ADAAA) through December 31, 2016, were included in the study data set.

Open allegations (still under investigation) were excluded from the study. This exclusion exists to ensure that all allegations in the study data set are “closed” as either merit (reasonable cause for discrimination) or nonmerit (no reasonable cause for discrimination).

Application of these inclusion and exclusion criteria resulted in a data set of 2,333 allegations of employment discrimination pertaining to the target group: CPs with AUDs. The comparison group consisted of CPs with DUDs and included 1,604 allegations.

Statistical Analysis

Data were imported into the Statistical Package for the Social Sciences (SPSS), version 21, for all analyses. Descriptive statistics such as means, standard deviations, frequencies, and percentages were used to determine the distributions of data across the two groups of CPs.

For the categorical dependent variables, nonparametric tests of proportion were used to examine the relationships between AUDs and DUDs allegations in terms of frequencies expected and observed. This test statistic does not require independence of study data (some Charging Parties file more than one allegation), equivalent group sizes, or normality of distribution assumptions. Results of these analyses provided Z scores (distributed generally as χ²) and 99% confidence intervals.

For each categorical dependent variable (i.e., issues, gender, race/ethnicity, and resolution), a Pearson chi-square test was first used to test the homogeneity of proportions across the disability groups. If the Pearson chi-square test indicated the existence of significant proportional differences, standard residuals greater than an absolute value of 2.0 were used to determine the presence of statistically significant differences. For the continuous dependent variable of age, a t test for independent samples was used to compare means between the two groups. For all inferential analyses, alpha level was set conservatively at p < .001.

Results

Findings are presented in both descriptive and inferential terms to illustrate the distribution of scores across the two referent groups. As noted earlier, primarily nonparametric statistics were applied for each research question. Results presented in the following paragraphs correspond to each of the three research questions.

Types of Discrimination

Do patterns in workplace discrimination allegations filed by Americans with AUDs differ from those filed by Americans with DUDs in terms of the types of discrimination alleged to have occurred?

The first analysis explored the specific types of personnel actions in which discrimination was alleged to have occurred. EEOC refers to these as “Issues.” What are these Issues alleged by CPs with AUDs when compared or contrasted to those alleged by CPs with DUDs? Table 1 presents a side by side comparison for both groups. The * symbol denotes statistically significant differences between the two groups in the proportions of allegations by Issue.

Table 1.

Issues Involved in ADA Title I Allegations: 2009–2016.

Charging party issue	AUDs (n = 2,123)		DUDs (n = 1,472)
Charging party issue	%	f	%	f
Discharge	41.6	884	39.1	576
Reasonable accommodation*	13.8	293	9.2	136
Terms/conditions	9.2	196	10.7	158
Harassment	6.3	133	6.9	101
Discipline	5.9	126	4.9	72
Hiring*	4.9	105	10.5	154
Suspension	3.4	72	3.1	45
Constructive discharge	2.2	46	2.4	35
Demotion	1.4	30	1.1	16
Reinstatement	1.2	25	1.2	17

Note. ADA = Americans with Disabilities Act; AUD = alcohol use disorders; DUD = drug use disorders.

p < .001.

As seen in Table 1, during the 2009–2016 retrospective observation period, unlawful discharge was by far the most common Issue filed by persons from both groups: AUDs (41.6%) or DUDs (39.1%), three times more common than the second highest Issue. Reasonable accommodations was the most common issue for AUDs (13.8%), and terms and conditions of employment was second for DUDs (10.7%). With respect to the six most frequent allegations (which include harassment, discipline, and hiring), there was little difference in their rank order or in their overall representation per SUD group: the six most common allegations were 82% of issues filed by persons with AUDs (n = 1,737) and 81% of issues filed by persons with DUDs (n = 1,197).

A chi-square analysis revealed statistically significant differences in the pattern of issues alleged by CPs with AUDs in comparison to the pattern of issues alleged by CPs with DUDs, χ²(37, N = 3,595) = 91.747, p < .001. Specifically, persons in the AUDs group were more likely than those in the DUDs group to allege discrimination related to reasonable accommodation. Persons with AUDs were less likely than those with DUDs to allege discrimination related to hiring.

Characteristics of Charging Parties

Do patterns in workplace discrimination allegations filed by Americans with AUDs differ from those in allegations filed by Americans with DUDs in terms of charging party characteristics?

The second set of analyses concerned the demographic characteristics of ADAAA Title I CPs with AUDs and how they differ demographically from CPs with DUDs. Considered herein are age, gender, and race/ethnicity. The mean age of CPs with AUDs was 45.48 years (SD = 9.196), whereas the mean age for charging parties with DUDs was 41.37 years (SD = 9.952). A t test revealed that CPs with AUDs were significantly older than CPs with DUDs, t (3,157) = 20.984, p < .001.

With regard to gender, CPs with AUDs were 49.3% female and 50.7% male, whereas CPs with DUDs were 50.4% female and 49.6% male. A chi-square analysis revealed no significant proportional differences between the AUD and DUD groups in terms of gender, χ²(1, N = 3,373) = .353, p =.552.

As presented in Table 2, Caucasians were predominant in the AUD group (78.1%) and the DUD group (73.0%). In both groups, African Americans were the second most represented group, followed by Latino/as. A chi-square analysis revealed that the AUD group had proportionally fewer individuals who identified as African American than did the DUD group, χ²(4, N = 3,022) = 23.016, p < .001.

Table 2.

Differences in Charging Party Characteristics.

Characteristics	AUDs		DUDs
	(n = 1,761)		(n = 1,261)
	%	f	%	f
Gender
Female	49.3	980	50.4	698
Male	50.7	1,007	49.6	688
Race/ethnicity
Caucasian	78.1	1,376	73.0	921
African American*	16.8	296	23.2	292
Latino/a	2.7	48	2.1	27
Native American/Alaskan Native	2.0	135	1.1	14
Asian American	0.3	6	0.6	7

Note. AUD = alcohol use disorders; DUD = drug use disorders.

p < .001.

Proportion of Merit Case Resolutions

Do patterns in workplace discrimination allegations filed by Americans with AUDs differ from those in allegations filed by Americans with DUDs in terms of the proportion of merit case resolutions?

The third and final analysis involved the legal outcomes or resolutions of the EEOC investigatory process with respect to allegations brought by CPs with AUDs versus DUDs. For the purposes of comparison, all case resolutions were collapsed into two categories: merit and nonmerit. Merit resolutions include withdrawal with benefits, settlement with benefits and EEOC support, successful conciliation, and conciliation failure. The first two are variations of a settlement. The second two, involving conciliation, refer to an EEOC remedy that was accepted by the Employer (CP successful) or rejected by the Employer (CP failure). In any event, these four types of closures each affirm that some level of discrimination did occur.

Nonmerit resolutions include no cause and administrative closures. No cause findings communicate that insufficient evidence of actual discrimination was discovered. Administrative closures are technicalities which preclude an EEOC decision in that the process was interrupted or terminated. Examples include a CP who becomes unresponsive, or an Employer bankruptcy. Less than one-fifth (18.7%, n = 397) of allegations filed by CPs with AUDs were resolved with merit and 81.3% (n = 1,726) were nonmerit resolutions. For allegations filed by CPs with DUDs, the proportions of merit and nonmerit resolutions were 21.9% (n = 322) and 78.1% (n = 1,150), respectively. A chi-square analysis revealed that CPs with AUDs were significantly less likely than CPs with DUDs to have their allegations result in a merit-based case resolution, χ²(1, N = 3,595) = 5.477, p =.019. It is worth noting that for both groups, these merit proportions are well below the proportions of other impairment groups which hover around 24%.

Discussion

Several of the observed differences between allegations of CPs AUDs versus DUDs on are not surprising, given known differences of these substance types. For example, alcohol dependence was the world’s most prevalent SUD in 2016, approximately five times the prevalence proportion of the most common DUD, cannabis (GBD 2016 Alcohol and Drug Use Collaborators, 2018). More persons consume alcohol than ingest other substances (including tobacco; Substance Abuse and Mental Health Services Administration [SAMHSA], 2019), and problems associated with alcohol use can develop later in life after a longer period of using as compared to illicit drug use. Although the DUD data set used here does not specify specific substance of abuse in the DUD group, research suggests that mortality proportions from illicit drug use are higher and occur at younger ages (i.e., for opioid users) when compared to alcohol use (Finney et al., 2013). This might explain the older age and greater number of CPs allegations in the AUD group.

Types of Discrimination Issues

As previously reported, discharge was by far the most common allegation issue filed whether the CPs were in the AUD group (41.6%) or DUD (39.1%). Furthermore, there were small differences two in the rank order of the seven most common allegations. Looking more closely, however, CPs with statistically significant differences proportions were discovered in the instances of two issues.

The CP allegations filed by AUDs were significantly higher than DUD allegations with respect to the issue of CPs with reasonable accommodations. There was a 4.6% gap between the two groups (13.8% and 9.2%, respectively). It is unlikely that CPs with DUDs are receiving workplace accommodations at higher proportions than those with AUDs, but rather that more CPs with AUDs are open to requesting accommodations from their Employers; if the latter is the case, then it stands to reason that Employers deny accommodation requests from CPs with AUD more often than they deny requests from CPs with DUD. According to the JAN (2020), common workplace accommodations for AUD/DUD include providing the employee a leave of absence to participate in treatment, flexible scheduling to attend appointments or support groups, revised supervisory methods and habit monitoring. If an incumbent worker is in a safety-sensitive position, limitations on safety-sensitive duties may be in order or temporary reassignment. Other accommodations related to SUDs may involve a review of stress tolerance, executive functioning issues, problems with attentiveness or concentration, and those that address secondary health issues or mental health diagnoses.

Conversely, those with AUDs were significantly less likely than those with DUDs to allege discrimination in terms of hiring, with a large 5.6% gap between the two groups (4.9% and 10.5%, respectively). Unlike any other impairment group, ADA allows that during the hiring process, Employers may:

Ask job applicants whether they are currently using drugs illegally or drinking alcohol,

Require employees to undergo a medical examination (one that might reveal a past or current AUD/DUD),

Ask about criminal history or run criminal background checks that might reveal AUD/DUD-related offenses, and

Permit drug testing of applicants for presence of illegal drugs (SAMHSA, 2007).

The combination of alcohol’s legality, lack of presence on some drug tests, and reduced overall stigma could explain the observed differences in hiring discrimination between the two groups. In addition, DUD group CPs are far more likely to have a record of criminality (other than DUI). Practitioners should prepare clients with DUDs for potential employment barriers within the hiring process.

Characteristics of Charging Parties

There were significant differences in the age and ethnic status of allegations derived from CPs with AUDs versus DUDs. CPs from AUDs group were significantly older than those in the DUD group. Generally speaking, proportions of AUD/DUD, especially among those employed, decreased with age over time (Compton et al., 2014). Given the higher proportions of mortality and increased risk of criminal charges at younger ages for DUD, the age difference in the groups is not surprising (Finney et al., 2013).

Regarding ethnicity, those in the AUD group were less likely than the DUD group to identify as African American. This is somewhat surprising, given that data have shown that past year alcohol dependence among African Americans employed full time (7.3%) is over twice as prevalent as past year illicit drug dependence (2.9%; Vasilenko et al., 2017). A closer look at research reveals that AUDs/DUDs for African Americans tend to persist over longer periods of time (Sigurdsson et al., 2012). Possible explanations for this unique feature of AUDs/DUDs in African Americans include lack of resources and access to adequate treatment, greater involvement with more criminalized substances such as crack cocaine and heroin, and more adverse health and social consequences when compared to white individuals (Broman et al., 2008; Cheng & Robinson, 2013; Tran et al., 2010). Furthermore, African Americans are more likely than their White or Latino/a counterparts to encounter both prehire and random drug testing, DUD group (Larson et al., 2007).

Proportion of Case Resolutions With Merit

Americans with AUDs prevail proportionally less often than DUDs when EEOC investigations are closed as resolved. Although somewhat counter-intuitive, this finding may reflect idiosyncratic characteristics of the two referent groups. For example, it may that CPs with DUDs, owing to high levels of stigmatization, are more cautious about filing ADAAA complaints that they do so only when they bring forward a strong basis for their complaints. The reduced stigma associated with AUDs, on the other hand, might free those CPs with AUDs to file allegations more often with a weaker evidentiary basis. Because AUDs are not viewed as negatively by society as DUDs, CPs with AUDs may not be as hesitant to file allegations of questionable legal merit. If so, the result is a higher proportion of nonmerit claims.

It is also possible that Employers are more willing to resolve workplace conflicts internally for CPs with AUDs versus DUDs, before the EEOC is brought in. If this is true, then CPs with DUDs are more reliant on the EEOC for support, which may in turn raise the merit level of their resolutions. Finally, as CPs with AUDs live longer and function more effectively overall than CPs with DUDs (Finney et al., 2013), it could be that Employers expect workers with AUDs to manage their conditions on their own to a greater extent than DUDs. Furthermore, given the wider availability of treatment services for alcohol versus drug abuse, CPs with AUDs who do not accept treatment may be treated more harshly by Employers than CPs with DUDs.

Implications for Rehabilitation and Mental Health Counseling Practice

It is critical for rehabilitation and mental health counselors to serve as advocates for current and potential clients with SUDs, including those with AUDs who may not have a co-occurring DUD. This means familiarizing themselves with state and federal laws enacted to protect persons from employment discrimination, including those with SUDs who may have criminal backgrounds. The Legal Action Center (2020) identifies itself as “the only non-profit law and policy organization in the United States” that has as its sole mission “to fight discrimination against CPs with histories of addiction, HIV/AIDS, or criminal records, and to advocate for sound public policies in these areas.” The Legal Action Center (LAC) offers routine training to the counselors and provides legal services to those who qualify.

We recommend that rehabilitation and mental health counselors use comprehensive assessment inventories to capture and understand the full context of the individual’s substance use. The Addiction Severity Index (ASI; McLellan et al., 1992) is widely used in clinical practice and available in the public domain through Treatment Research Institute (see http://www.tresearch.org/). The ASI is a multidimensional tool identifies SUD-related problems and evaluates functioning in seven areas: medical status, employment/support status, alcohol and drug use, legal status, family and social status, and psychiatric status. ASI provides valuable understanding of the nature and scope of SUDs, including its effect on employment status and treatment from others.

With regard to identifying necessary workplace supports in a proactive manner and hopefully obviating a charge of discrimination, counselors may wish to use the Work Experience Survey (WES; Roessler et al., 2017). WES is a structured interview designed to assess person-in-situation compatibility, specifically employee in job, in relation to barriers to worksite accessibility, performance of essential job functions, job mastery concerns, and job satisfaction. WES concludes with a job accommodation plan drawing on knowledge of the employee, employer, rehabilitation professional, and JAN (2020). This group determines the extent to which they restore a compatible relationship between worker and job. It seeks solutions which both perceive as effective, practical, and affordable. In turn, the CPs with probability of retaining satisfying employment increases. Research has demonstrated that removing barriers to accessibility and understanding essential functions lead to higher levels of job satisfaction. This the reason WES is endorsed as a useful job retention tool (Rumrill et al., 2004) as a job retention tool.

Limitations

Although this study has many strengths including population-level data across the entire ADAAA era, four limitations require acknowledgment. First, most available CP demographic data are nominal in nature, which limits the types of statistical analyses that can be used. Second, there are many demographic characteristics relevant to both employment and AUD/DUD outcomes that were not available in the database including marital status, sexual orientation, socioeconomic status, and urban-rural-suburban residency (Grant et al., 2015, 2016; Larson et al., 2007).

A third limitation is that data on the AUDs and DUDs represented are also limited. Types of substances used for the DUD group, the severity of substance use, the duration of the CP’s addiction, and the preferred method of ingestion for the DUD group were all unavailable. Fourth, and perhaps the most important limitation of this study, was the possibility of overlap between the AUD and DUD groups. For many, AUD and DUD co-occurs, and some of these very allegations definitely were filed by the same CP. Our data set does not capture this. It is also possible that there are CPs who are co-addicted but filed under one auspice but not both.

Conclusion

Findings from this population-level study suggest that employers respond differently to workers with AUDs versus DUDs. The mechanisms that underlie workplace discrimination against Americans with SUDs are determined, at least in part, by the CP’s drug of choice. Specifically, when compared to SUDs allegations, this study revealed that CPs with AUDs were older, less likely to be African American, more likely to involve reasonable accommodations, and less likely to involve hiring. The AUD allegations were also much less likely to be resolved by the EEOC in their favor when compared to the DUD group. These differences suggest that counselors would do well to develop tailored interventions to help CPs with AUDs and DUDs identify, address, and resolve work-related issues that have the potential to undermine their prospects for long-term employment. Results of this study may also help counselors to consult with employers who wish to revisit their policies and practices, especially regarding high-volume personnel actions identified in Table 1. The seven issues listed there represent the opportunity to lower the risk of EEOC charges.

Footnotes

Authors’ Note

These records were examined with permission of the Equal Employment Opportunity Commission (EEOC).

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

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