Of the 46 million Americans who struggle with at least one substance-use disorder, most—some 60% of those over the age of 12—have a job, according to the National Survey on Drug Use and Health. That’s an uncomfortable and largely unacknowledged reality in American business, where talking about addiction to alcohol or drugs has traditionally been taboo.
Even though substance-use disorder is a protected status under the Americans With Disabilities Act (so long as an individual is not currently engaged in the illegal use of drugs) studies show that many avoid acknowledging it for fear of getting fired or being judged harshly at work, and the stigma can even be a barrier to those seeking treatment.
Substance-use disorder—a brain disease as defined by the American medical and scientific communities—affects one in 11 American workers. These numbers in themselves buck the stereotype that “addicts” are derelict and nonfunctioning, and make it clear that addiction is an issue in every industry, affecting individuals at all levels of seniority.
Put another way: Whether you know it or not, you likely work for or with, or manage people who have a substance-use disorder. As Dr. Rahul Gupta, director of the White House Office of National Drug Control Policy, explained it to an audience at the Brookings Institution in April: “If you think that you do not have anyone in recovery or with substance-use [issues] in your business, you’re either too small, or you’re mistaken.”
An analysis of National Survey on Drug Use and Health data from 2012 to 2018, conducted by the National Safety Council and NORC at the University of Chicago, found that construction and mining employ the most individuals struggling with substance-use disorder (SUD)—an estimated 19% of workers in those industries. Service occupations, such as those in the food and hospitality industries, had the second highest proportion of workers with SUD—15.6%. For these and other SUD rates by occupation group, see below:
View this interactive chart on Fortune.com
As I reported in a recent Fortune feature, substance-use disorder doesn’t just affect employees themselves and their families; businesses lose enormous sums every year as a result of the issue in the form of higher health care costs, absenteeism, and presenteeism (when employees are at work, but not fully productive).
Using the National Safety Council’s Substance-Use Employer Cost Calculator, which provides estimates based on a workplace’s location, size, and industry, I did some rough calculations and found that at a company with the size and profile of Amazon, the annual costs could be as high as $1.1 billion. The NSC calculator predicts a loss of $1.3 billion for Walmart and $128 million for Apple. A 2022 report from Fors Marsh found that the issue results in 500 million lost workdays and $740 billion in total costs nationally each year.
Some businesses and policymakers are working to better accommodate these workers—to help them get treatment, sustain recovery, and be productive—in “recovery-friendly workplaces.” The movement has the backing of the Biden administration, which sees changing how companies deal with substance-use disorder in their workforces as a key part of efforts to address the overdose and opioid crises and encourage more people to get help. (Currently, just 8% of those who need it do.)
Having a “get well” job—that provides a supportive, low-stress, substance-free environment where one can openly talk about SUD and seek help when necessary—can make a huge difference for individuals in recovery such as Catherine Forbes, a 36-year-old stitcher at Genfoot America, a boot manufacturer in New Hampshire. After many years in the throes of heroin addiction, Forbes is now four years sober and has twice been named employee of the month. “My ambition has skyrocketed,” she told me. “I went from not wanting to be at work and not knowing what to do being at work, to wanting to be there.”
Several workers, including Forbes, told me about having been derailed in their previous attempts to overcome addiction, in part owing to unsupportive work environments. This is particularly difficult in the restaurant industry, where alcohol flows freely and substance use is common among colleagues: 16.9% of food service workers reported a substance use disorder, according to SAMHSA data from 2008 and 2012.
“Depression, loneliness, addiction, and worse are rampant,” says John Anthony, VP of operations for Spaghetti on the Wall, a Las Vegas restaurant group. “The [industry’s] promotion of the unhealthy ‘pirate’ lifestyle is romantic with its youthful exuberance, but it’s not sustainable nor healthy.”
It was that culture that Anthony and his business partner, chef Brian Howard, set out to change when the company opened its first restaurant, Sparrow + Wolf, in 2017. Industry veterans, they’d grown unsettled by its work-all-night, drink-until-morning culture and by the number of friends and associates they’d lost to addiction and mental health struggles over the years. Howard comes from “a family of addiction," he says: He lost his mother to drugs at an early age, and battled addiction himself earlier in his career.
As part of that effort, they eliminated the standard practice of shift drinks—staff drinks after working a shift—in favor of family picnics and service days, and strictly forbade drinking or other substance use on the job. To offer healthy alternatives, they’ve trained team members on breathing techniques, goal setting, and meditation.
Anthony and Howard speak openly about addiction and wellness issues in the industry, Anthony tells Fortune. “We have had many candid conversations with team members, and although not every one of them turned out the way we had wished, it was never for lack of care or attempt.”
The company, which has been designated as one of Nevada’s “Recovery-Friendly Workplaces,” has hired people in recovery from drug and alcohol addiction, which they say has had myriad benefits: It helped keep Sparrow + Wolf staffed during the pandemic, brought in extra cash—$1,000 per month per employee in recovery (for the first two months) through a state incentive program—and most of all, says Anthony, introduced them to some of the restaurant’s most hardworking and dedicated employees.
“We could not be more proud of these relationships,” he told Fortune. “We celebrate them every day.”
