August 9, 2022

Making the Case for Employer-Sponsored Addiction Treatment

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In a hypothetical firm of 10,000 employees, researchers estimated $232,000 of lost wage value annually due to substance use disorder-related absenteeism.

The Bottom Line

There is a substantial cost of unaddressed substance use disorders (SUD) for workplaces. Data shows that, rather than avoid hiring people with addiction, employers should work to invest in specific support for SUDs among their employees — including negotiating for comprehensive insurance coverage and subsidizing wellness programs.


The U.S. continues to be amid several substance use disorder epidemics, which have only spiked in the last three years, in part due to the ongoing COVID-19 pandemic. Drug overdose deaths in the country since 2000 have reached approximately 700,000, and they are up 30% year over year. According to 2020 data, 21.4% (59.277 million) Americans aged 12 and older reported using illegal substances or misused prescription medication within the last year.

People with SUD are not anomalies; they are in the workforce across the U.S. Importantly, employers are the leading provider of health insurance for more than half (55%) of Americans.

Evidence-based treatment and harm-reduction interventions — such as naloxone, fentanyl test strips, needle exchange programs, and more — are supported by evidence as preventing overdose deaths and reduce substance use.

Study Objective

To estimate absenteeism among full-time employees due to SUD.

The Details

Researchers used data from the 2018 National Survey on Drug Use and Health to create its sample of full-time employees. Controlling for available demographic information, they evaluated a connection between absenteeism at work and type of SUD, which did not include alcohol:

  1. Opioid use, including opioids not used as doctor prescribed
  2. Marijuana use
  3. Stimulant use taken in a way not doctor-prescribed
  4. Cocaine use
  5. Methamphetamine use
  6. Polysubstance use

Researchers then divided the sample of full-time employees into three, non-overlapping categories based on their level of substance use: people who report using any or multiple of these substances, people who met the definition of an SUD, and people who reported no substance use or SUD in the last 12 months.

Using a survey, they asked participants to note any absences from work and why. From there, researchers used a model to predict days of missed work for each category of substance use, and then associated the workdays missed to cost to employer.


Among the nationally weighted sample of 114,054,678 full-time employed individuals, 18% reported illegal substance use — including marijuana, though it is legal in some states — and 3% (or approximately 3,421,640 people) met the diagnostic characteristics of SUD.

While marijuana, opioids, and polysubstance use without addiction were “significantly associated with higher absenteeism,” every type of addiction disorder corresponded to more annual missed workdays than the control group, with the highest being polysubstance use disorder.

The findings show a national cost to employers of $10.9 billion for substance use without a disorder and $5.5 billion for SUDs. However, the relative magnitude of cost for people with addiction is higher than those who have reported only use without SUD characteristics. Using a hypothetical firm of 10,000 employees, that means $232,000 of lost wage value every year.

Eliminating people who use substances from the hiring or employment pool would not be beneficial to employers, as that would severely limit the pool of talented candidates, by approximately 20%. This talent pool loss could lead to increased costs for a business to make up for quality of work and productivity loss. Instead, the evidence points to employers having a monetary incentive to prevent and help with treatment for SUDs — via comprehensive health insurance coverage that includes SUD treatment, wellness programs with specific addiction treatment strategies, and lowering barriers to treatment within a work environment.

Pull Quote

“Were employers to place their substantial economic power behind the drive to increase coverage for and access to substance use treatment, they could become a major force for change and a powerful ally in the fight against the SUD epidemic in America.”


Morgan JR, Murphy SM, Assoumou, SA, Linas, BP (2022). “Estimating Absenteeism Related to Nonalcohol Substance Use in a US National Cohort of Full-Time Employees.” Journal of Occupational and Environmental Medicine.

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