A

Absenteeism, 7, 130, 134-144, 169, 220-222

and employee assistance programs, 249-250, 253

and wellness programs, 244, 245

Abuse of drugs

definition, 2, 21

progression to, 3, 31-32, 36, 43

Accidents, 7, 11, 129, 144-152, 169, 216, 237

alcohol-related, 19, 129, 148, 149, 150-151, 159

testing after, 75, 78, 114, 285, 288

transportation, 7, 144, 145-149, 158-159, 169

Accuracy of testing procedures, 7-8, 179, 192-195, 207-208

personality profiles, 10, 209-210

urinalysis, 8, 10, 207, 210

Adulteration of specimens, 182-183, 195

After-care, 261-263

Age-related differences, 5, 6, 35, 58, 99, 123

Alcoholics Anonymous (AA), 256, 257

Alcohol use, 2, 5, 15, 19, 31, 34, 37, 42, 56, 57, 90, 95-97, 99, 131

and accidents, 19, 129, 148, 149, 150-151, 159

deaths, 15, 18n

and early intervention, 260-261

and employee assistance programs, 255-256, 257

and employment status, 5, 58, 61, 94, 98, 99

heavy drinking, 4, 5, 32, 41-42, 52-53, 56, 66, 67, 98, 99, 163

and job satisfaction, 154-155

by military personnel, 66, 67, 69-70

performance effects, 6, 69-70, 73, 112-113, 123, 157, 163-164

and polydrug use, 3, 36, 43

residual effects, 113, 114-115

social attitudes toward, 15-16, 41, 42

testing for, 51, 75, 81, 149, 191, 215-216

and wellness programs, 242-243

Americans With Disabilities Act (ADA), 191, 299

Amotivational syndrome, 112

Amphetamines, 19, 20, 42-43, 75, 118, 148, 184, 194, 215

Applicant testing, 8, 9, 10, 11, 12, 52, 75, 77, 208-209, 216, 218 -224, 227-228, 235, 286, 296, 300

consequences of positive results, 12, 236

personality profiles, 202-203

and self-selection, 233, 235

Arrestee studies, 72-73

Attitudes of employees, 33, 38, 39-40, 157-158

toward testing, 12, 158, 233-235, 236

Automobile accidents, 148

Aviation accidents, 149

B

Behavioral effects, see Performance and productivity effects

Benchmark measures

behavioral effects, 6, 122, 123

usage rates, 5, 100

Blood testing, 183

Breath testing, 183, 191

C

Caffeine, 2, 19n, 22

Case-referent studies, 272

Causes and risk factors, 3-4, 29-34, 119-120, 273

individual traits, 3-4, 29, 30, 37-39, 43

initiation, 3, 31, 32, 43

and intervention effectiveness, 3

progressive severity, 3, 31-32, 43

role of workplace, 3-4, 37-40, 41, 43

Certification

of laboratories, 8, 50, 51, 179, 180, 188, 207, 285

of test result reviewers, 13, 264

Cigarettes, see Smoking and tobacco use

Clinical diagnostic criteria, 22

Clinical Laboratory Improvement Act (CLIA), 190

Cocaine, 15, 19, 31, 36, 37, 41, 61, 72, 75, 80, 94, 96, 116, 184, 215

performance effects, 6, 123, 164-165

Collective bargaining, 294

College of American Pathologists, 180

Combinations of drugs, see Polydrug use

Community factors, 29, 30

Comparability and differences among studies, 5, 35, 89-98, 99-100, 272

Conrail-Amtrak train crash (Maryland), 16, 129

Consensus Report on Employee Drug Testing, 1989, 8, 180-181, 207

Constitutional issues, 286-296, 299

Construction workers, 4, 61, 79-80, 98

Constructive confrontation, 246, 252, 253-254, 257, 259

Costs of drug use, 16, 17-18

employer-provided health care, 18, 244-245, 250, 255-257

field studies, 7, 160-166, 169

illegal drugs, 18, 160-161

testing, 24n, 231-232

Counseling, 243-244.

see also Employee assistance programs (EAPs)

Coworker relations, 37, 38, 157-158

Crack cocaine, 15, 31, 32

Crime-related costs, of illegal drug use, 18, 161

Cross-sectional studies, 272

Cultural factors, 29-30

Customs Service, 289-291

D

Deaths, 15, 18

accidental, 148, 150

Deaths from substance abuse, 15, 18

Decongestants, 194

Definitions

of ''drug," 1-2, 18, 19-21

for epidemiological issues, 273

of use, abuse, and dependence, 2, 18, 21-22

of work force, 2, 18-19, 22

Demographics, see Age-related differences;

Ethnic groups;

Individual traits;

Sex-related differences

Department of Defense (DoD), 8, 178, 179, 186, 207

usage surveys, 42-43, 49, 50, 52-53, 65-71

Department of Justice, 291-292

Department of Transportation (DOT), 180, 285-286

Dependence on drugs, 2, 3, 21-22, 43, 114

Deterrence, testing effects, 11, 149, 151-152, 177, 180, 226-227, 235-236, 299n

Deviant behavior, 7, 32, 33, 39, 130-133, 169

Diagnostic and Statistical Manual (DSM-III-R), 22n

Dismissals, for positive results, 12, 236, 293, 295

Dosages, 6, 116-117, 123

Drug Abuse Scale (DAS), 196-197

Drug Abuse Warning Network (DAWN), 71-72

Drug Evaluation and Classification Program (DEC), 203-206

Drug Free Workplace Act (DFWA), 285, 294

Drug recognition experts (DREs), 204-206

Drug Use Forecasting (DUF) system, 72-73

E

Early intervention, 259-261

Educational status and problems, 29, 30, 33, 67

Emergency room visits, as epidemiological data source, 4, 71-72, 98

EMIT, 179, 185

Empirical studies, see Field studies

Employee assistance programs (EAPs), 12-13, 206-207, 246-257, 263-264, 285

supervisor training, 205, 246, 251-254

Employment status and patterns

studies of, 4-5, 58-65, 99, 165-166

turnover, 152-154, 220-221

Ephedrine, 194

Epidemiological studies, 4-5, 49-52, 98-100

as basis for test battery additions, 9, 208

biochemical testing, 49, 50-51, 73-81

large-scale surveys, 49, 52-73

limitations, 50-52, 89, 273-275

methodology, 272-275

national panel surveys, 4, 99

organization-specific, 49, 81-89

Ethical issues, 299-300

Ethnic groups, 5, 35, 38, 58, 61, 67, 99

Etiology, see Causes and risk factors

Executive Order 12564, 19, 178, 179, 215, 285

Experience with drugs, 6, 31, 33, 123

Experimental studies, 13-14, 273, 275-278, 283

External validity, 115, 278

Exxon Valdez oil spill, 16, 129

F

False negatives, 194-195

False positives, 9, 185, 192, 193-194, 195, 208-209, 298

personality profiling, 197-199, 202-203

Family relationships, 18, 29, 30, 33, 248-249

Federal contractors, 179, 285

Federal employees, 19, 179, 247, 285

Federal Railroad Administration (FRA), 288-289

Field studies, 7, 129, 133-160, 169

absenteeism, 7, 134-144, 169

accidents, 7, 144-152, 169

cost-of-drug use, 7, 160-166, 169

experimental, 13-14, 273, 276-278, 283

interpretation of, 161-162, 166-168

job satisfaction, 154-155

limitations of, 130-133, 159-160, 166-168

research base development, 7, 169

turnover, 152-154

Firings, see Dismissals, for positive results

Fluorescence polarization immunoassay (FPIA), 185

Follow-up, 75, 261-263

employee assistance programs (EAPs), 12, 254-255, 257, 261-263, 285

Fourtune 500 corporations, 247

Fourth Amendment issues, 286-294

G

Gas chromatography (GC), 179, 184, 185-186

Gender, see Sex-related differences

Genetic factors, 29, 31

H

Hair testing, 9, 177, 183-184, 208, 299

Hangover effects, 2, 6, 22, 113, 123, 124

Hard-core and heavy users, 5, 37, 99

alcohol, 4, 5, 32, 41-42, 52-53, 56, 66, 67, 98, 99, 163

Health care costs, 17, 161

for employers, 18, 244-245, 250, 255-257

Health maintenance organizations, 255

Health promotion and wellness programs, 241-246

Heroin, 15, 19, 178

High performance liquid chromatography (HPLC), 186-187

High School Senior surveys (HSS), 42-43, 49, 52, 53-56, 95-96, 235

Hospital employees, 85, 90

Hospitalization, 255-257

Housing authority employees, 86, 135

I

Illegal drug use, 4, 16, 19, 31-32, 53, 56-57, 71-73, 75, 80-81,94, 95-96, 98, 135

deaths, 15, 18, 161

and employment status, 4, 5, 58, 61, 73, 94, 99

hard-core users, 4, 71-72, 73, 98

by military personnel, 67, 70-71

and polydrug use, 3, 43

societal costs, 18, 160-161

Immunoassays, 179, 185

Income level, 61, 163-164

Indirect assessment of drug use, 178, 195-207

Individual traits, 3-4, 29, 30, 37-39, 43

Initiation to drug use, 3, 31, 32, 43

Integrity testing, 10, 196-199, 209

Interaction effects, 4, 33, 43

International Classification of Diseases (ICD-10), 22n

Interpersonal factors, see Family relationships;

Peer relationships

Intervention programs, national, 4.

See also Workplace intervention programs

J

Job satisfaction, 37, 38, 154-155

Justification for testing, 12, 233-234, 236, 237, 289-291, 292-293

of rarely used drugs, 9, 191-192, 208

L

Laboratory studies, 6, 107-115, 121-124

limitations, 107-108, 111, 115, 118-121

methodology, 115-118, 278

Laboratory testing, see Testing procedures and results

Law enforcement agencies, 290-291, 292, 293

Legal issues, 284-299

Limitations of studies

laboratory-based, 107-108, 111, 115, 118-121

observational, 130-133, 159-160, 166-168

self-reports, 50, 89, 130, 177, 281-282

Longitudinal studies, 274, 275, 280

deterrent effects of testing, 11, 236

of usage, 4, 32-33, 100

LSD, 20

justification for testing of, 9, 159

M

Managed care, 246

"Mandatory Guidelines for Federal Workplace Testing Programs,"; 19, 179, 215, 285

Mandatory testing, 19, 179, 284-286, 287-294, 298

Manufacturing, 61, 88, 90

Marijuana, 19, 31, 36, 37, 38, 42, 61, 75, 80, 94, 95, 96-97, 215, 293

accidents involving, 114, 129, 148, 149, 150

passive inhalation, 193-194

performance effects, 6, 112, 117-118, 121, 123, 164, 219-220

residual effects, 114

and urine tests, 51, 114, 149, 184

Marital status, 38, 39, 67

Mass spectrometry, 179, 185-186

Measurement artifacts, 273-274, 277

Measurement errors, 281-282

Metabolites of drugs, 6, 123, 193

Methamphetamines, 19, 20, 184, 194, 215

Military personnel, 4, 98, 178

Navy recruit testing, 86-87, 152-153, 219

usage surveys, 42-43, 49, 50, 52-53, 65-71

Minority groups, see Ethnic groups

Morphine, 19, 194

Municipal governments

employees, 85-86, 94, 134-135

laws, 297

N

National Household Surveys on Drug Abuse (NHSDA), 4, 49-50, 52, 56 -65, 79-80, 99

National Institute on Drug Abuse (NIDA), 8, 9, 74, 179, 207, 208

testing standards, 7-8, 9, 179-180, 184, 186, 186-190, 207, 208

National Laboratory Certification Programs, 8, 179, 189-190, 207

National Treasury Employees Union v. Von Raab, 287, 288-291

Navy, 178

recruit testing, 86-87, 152-153, 219

Nuclear Regulatory Commission, 180, 186

O

Observational studies, see Field studies

Occupational alcoholism programs (OAPs), 206

Occupational differences in use, 5, 35, 40-43, 61-65, 90, 94, 99

Omnibus Transportation Employee Testing Act (OTETA), 215-216, 285286, 294

On-Site Drug Testing Study, 8, 207

On-site testing facilities, 8, 185, 190-191, 207

Opiates, 19, 75, 113, 184, 215

in poppy seeds, 194

Over-the-counter drugs, 6, 20, 124, 191

residual effects, 6, 123

test result reporting, 10, 191, 209

P

Paper-and-pencil tests, 10, 196-197, 209, 210

Peer relationships, 29, 30, 32, 33, 37, 38, 155, 157-158

Performance and productivity effects, 16-18, 95, 219-226

laboratory studies, 6, 107-123

legal medications, 6, 20, 124, 191

of testing, 11-12, 227-231, 236

see also Field studies

Performance testing methods, 10, 195, 203-207, 209-210, 299

Periodic medical testing, 75, 77-78

Personality testing and profiling, 10, 52, 195, 196-203, 209-210, 282

Phencyclidine, 19, 75, 184, 215

Physiological effects, 2

Policies, see Public policies;

Testing programs and policies

Polydrug use, 3, 36-37, 43, 115-116

performance effects, 6, 123

Poppy seeds, 193, 194

Positive results

consequences of, 12, 236, 293-294

and treatment referral, 13, 263-264

Postal employees, 81, 85, 134, 152, 219-224

Practical importance, of study results, 278-279

Prescription drugs, 6, 20, 124, 191

residual effects, 6, 123

test result reporting, 10, 191, 209

Prevalence, 35-36, 98, 273

as basis for test battery additions, 9, 208

and employment status, 5, 98, 99

see also Epidemiological studies

Prevention programs, 3, 43, 241-246

Prison testing, 185

Privacy issues, 9-10, 191-192, 209, 234, 285, 286-299

Private-sector drug testing, 286, 294-295, 298-299

Probable cause, 286-287

Productivity, see Performance and productivity effects

Professional occupations, 4, 61, 65, 98, 234

Prohibition, 15

Prospective panel studies, 272-273

Protective factors, 33-34

Psychological testing, see Personality testing and profiling

Public policies, 16, 19, 216-217, 231, 284-286

savings assessments, 7, 161-162, 169

Q

Quality control, testing procedures, 8-9, 75n, 187-190, 207-208

Quality of research, 11, 23, 159-160, 236

and policy decisions, 7, 278-279

Quasi-experimental studies, 275-276

R

Racial and ethnic groups, see Ethnic groups

Radio immunoassay (RIA), 185

Railroad accidents, 16, 129

testing after, 148-149, 288-289

Randomized field studies, 13-14, 273, 276-278, 283

Random testing, 75, 77, 78, 81, 88-89, 216, 226-227, 291-292, 293

Reagan and Bush administration policies, 16, 19, 178, 179, 215, 216 -217, 285

Reasonableness standard, 287, 290, 291-292, 295, 296

Referral for treatment, 13, 246, 252-254, 257, 258-261, 263-264

Regional variation, 58, 79

among treatment programs, 273

Regulatory requirements

for employee assistance programs, 247-248

mandatory testing, 19, 179, 284-286, 287-294, 298

testing procedures, 8-9, 186-191, 207-208

Relapse, 261-263

Residual effects, 2, 6, 22, 34, 113-115, 123, 124

Retail employees, 94

Reverse causation, 4, 43, 273, 274, 276

Risk factors, see Causes and risk factors

S

Safety-sensitive positions

justification of drug testing, 12, 233-234, 237, 289-291, 292-293

and legal medications, 6, 123, 124

mandatory testing, 285-286, 297

Saliva testing, 9, 183, 208

Samples and sampling methods, usage studies, 5, 51-52, 100

see also under Testing procedures and results;

Urine testing;

and other specific testing methods

Sedatives

performance effects, 6, 113, 118, 121, 123

testing of, 9, 191, 208

Self-esteem, 38, 39, 274

Self-referral, for treatment, 242, 245, 246, 253, 258-259

Self-report studies

Self-report surveys, 4, 5, 35, 74, 98, 99-100

large-scale surveys, 49, 52-73

limitations, 50, 89, 130, 177, 281-282

Self-selection, by job applicants, 233, 235

Sex-related differences, 5, 35, 37, 38, 42-43, 58, 61, 90, 95, 99, 165

Skinner v. Railway Labor Executive's Association, 287, 288-291, 293

Smoking and tobacco use,2,4,19n, 22, 53, 56, 57, 98, 99

among military personnel, 66, 67, 70

among teens, 4, 31, 98

deaths, 15, 18n

and polydrug use, 3, 36, 43

and wellness programs, 243-244

Social attitudes and norms, 15-16, 32, 33, 43

Specimens for testing, see under Testing procedures and results;

Urine testing;

and other specific testing methods

Spuriousness, of causal relationships, 273, 277, 280-281

Standards and guidelines

diagnostic criteria, 22n

employee assistance programs, 246, 257

for test result review, 13, 264

State laws, 180, 296-298

Statistical modeling, 274, 275, 280-282

Statistical significance, 278-279

Stimulants, 6, 111-112, 115, 116, 121, 123, 148

Stress, work-related, 4, 37, 43, 130

Studies

comparability and differences among, 5, 35, 89-98, 99-100, 272

design issues, 228-231, 271-283

see also Epidemiological studies;

Field studies;

Laboratory studies

Supervisor intervention

constructive confrontation, 246, 252, 253-254, 257, 259

employee assistance programs, 205, 246, 251-254

Supplemental Appropriations Act of 1987, 285

T

Tampering with specimens, 182-183, 195

Temperance movements, 15-16

Temporal sequence, 280-281

Testing procedures and results, 24n, 178-195

accuracy and reliability, 7-8, 179, 192-195, 207-208, 281

costs, 24n, 231-232

as epidemiological data source, 49, 50-51, 73-81

false positives, 9, 185, 192, 193-194, 195, 208-209, 298

GC/MS technology, 9, 179, 184, 185-186, 209

interpretation of, 13, 180, 192-195, 264

laboratory certification, 8, 50, 51, 179, 180, 188, 207, 285

limitations of, 130, 177-178

nonurine specimens, 8, 9, 183-184, 208

on-site facilities, 8, 185, 190-191, 207

privacy issues, 9-10, 209, 285

quality control, 8-9, 75n, 187-190, 207-208

regulation and standards, 8-9, 74, 75-77, 179-181, 185, 186-191, 207 -208

selection of drugs for analysis, 9, 191-192, 208

specimen collection, 9, 181-184, 208

see also Performance testing methods; Urine testing

Testing programs and policies, 11, 12, 177-178, 216-218, 236, 284299

applicant testing, 8, 9, 10, 11, 12, 52, 75, 77, 208-209, 216, 218 -224, 227-228, 235, 286, 296, 300

attitudes and morale impacts, 12, 158, 233-235, 236

deterrent effects, 11, 149, 151-152, 177, 180, 226-227, 235-236, 299n

ethical issues, 299-300

evaluation, 11, 228-232, 236

for-cause, 75, 88, 216, 224-226

mandatory, 19, 179, 284-286, 287-294, 298

productivity effects, 11-12, 227-231, 236

random, 75, 77, 78, 81, 88-89, 216, 226-227, 291-292, 293

Theft, 155, 156

Therapeutic drugs, see Over-the-counter drugs;

Prescription drugs

Thin-layer chromatography (TLC), 179, 186-187

Timing of consumption, 6, 123

Tobacco, see Smoking and tobacco use

Tranquilizers, 43

Transportation industry, 4, 61, 65, 98, 112, 191, 247

accidents, 7, 144, 145-149, 158-159, 169

mandatory testing, 285-286, 292-293, 298

Treatment, assessment of, 273.

See also Employee assistance programs (EAPs)

Truck drivers, 19, 94-95, 116, 145, 148

Turnover, 152-154, 220-221

U

Unemployment, 4, 5, 58, 61, 98, 99

Unionized industries, 294-295

Urine testing, 4, 8, 9, 10, 50-51, 98, 180, 181, 208

accuracy, 8, 10, 207, 210

limitations and contraindications, 80, 177, 191, 193-195, 281

privacy issues, 234, 288, 293, 299

specimen collection, 9, 181-183, 208, 285, 293

U.S. Government, see Federal employees;

Public policies;

names of specific agencies

U.S.S. Nimitz accident, 129

Utility employees, 87-88

V

Validity of studies, 177, 281-282, 282,

see also Limitations of studies

Vandalism, 155

Vicks inhaler, 194

Vignettes, 200

Violence, 18

W

"War on drugs," 34; 15, 16, 216-217

Wellness programs, 241-246

Wholesale trae workers, 4, 61, 98

Withdrawal effects, 6, 19n, 21, 31, 113-114, 123, 124

Work force, definition, 2

Workplace intervention programs, 3, 5, 99,

see also Employee assistance programs (EAPs);

Health promotion and wellness programs;

Testing programs and policies

Worldwide Surveys of Substance Abuse and Health Behaviors Among Military Personnel (MWS), 42-43, 49, 50, 52-53, 65-71

Y

Young adults, 4, 53, 57, 94, 98, 135

Youth, 29-31, 131

smoking, 4, 31, 98