| by Stephen O. Griffin , Adrienne Keller , Alan Cohn Employee drug testing has been around for more than 30 years. The practice was embraced by private employers early on and is now widespread, particularly among larger companies. The development of drug testing programs in the public sector, however, has been slower and more deliberate due to constitutional law constraints, and perhaps also to a more democratic, convoluted decision-making process. Intensity of interest in drug testing has long subsided with respect to the literature; there are, nevertheless, compelling reasons to revisit this issue. Much of the past literature focuses on drug testing in the private sector, and where public-sector issues were broached (primarily from the legal/constitutional perspective), many have not been resolved. Moreover, many issues confronted by public policymakers have not been identified or adequately discussed. Also, most treatment in the literature has been academic and explicit, whereas analysis in this article is more anecdotal and implicit. Increasingly, policymakers are finding value in qualitative analysis of this type of data, as such analysis fills in gaps and guides utilization of the more explicit data. This is especially true of policymakers in the public sector who are keenly aware that decision making in this arena is often a politically- or socially-sensitive process, and that the hard data alone is insufficient to assist them. Four years ago, the University of Virginia undertook the labyrinthine task of developing a policy providing for the drug screening of prospective employees and current employees in safety-sensitive positions at the university and its medical center. This article identifies the primary issues encountered by university policymakers and examines the means whereby they were addressed, all from the point of view of key players in the process. Background and Rationale Drug testing is not new. The U.S. Department of Defense began testing military personnel returning from Viet Nam during the 1960s and early 1970s. With a heightened awareness of drug abuse problems and development of more reliable technology in the 1980s, drug testing increased significantly, with many private companies implementing employee and applicant drug screening. President Reagan's 1986 executive order promoting the establishment of a drug-free federal workplace and the enactment of the Anti-Drug Abuse Act spurred unprecedented growth in drug testing in both the public and private sectors.[1] Drug and alcohol testing for employees in safety-sensitive positions in the railroad, airline, mass transit, motor carrier, and pipeline industries was mandated by the Omnibus Employee Testing Act of 1991. The act was implemented in 1994. President Clinton expanded the federal program in 1995 to include various white-collar government employees.[2] Today, workplace drug testing is prevalent. The American Management Association reported in 1996 that 81 percent of all major corporations employed some type of drug testing, up from 21.5 percent in 1987--a fourfold increase.[3] The nation's largest employer, the federal government, mandates drug testing for employees in safety-sensitive positions. Many states have promulgated regulations that either permit or provide incentives for drug testing within the state government and/or for contractors doing business with the state. Of the 11 states of the Eastern Seaboard for which statistics were available, all but one had regulations which either permitted or encouraged drug testing.[4] The rampant growth of drug testing programs was due in part to the perception that both licit and illicit drug abuse were pervasive in American society and therefore, by extension, in the American workforce. This perception was not unfounded. The U.S. Department of Health and Human Services (DHHS) Administration's National Household Survey on Drug Abuse, published in 1991, showed that "in any particular year about 7 percent of U.S. workers use an illicit drug, and that approximately two-thirds of all illicit drug users are employed full time."[5] The National Household Survey on Drug Abuse published in 1998 by DHHS found that 73 percent of all current drug users 18 and older were employed in 1997. The 1996 survey had revealed that more than 14 percent of American workers reported heavy drinking. There is also compelling evidence that employee substance abuse comes with a cost, both for industry and society as a whole. "Alcohol and drug abuse is estimated to cost the nation $160 billion per year in lost productivity, health care costs, and crime."[6] The Firestone Tire and Rubber Company documented (in 1983) that among abusing employees, absenteeism ran twice as high, worker compensation requests five times as high, and wage garnishments seven times as high. They demonstrated that drug and alcohol abusers have three to four times as many accidents on the job and four to six times as many accidents off the job.[7,8] A U.S. Post Office longitudinal study showed that employees who had tested positive for illicit drugs prior to being hired had an absenteeism rate 53.9 percent higher than employees who had tested negative after 1.3 years of employment, and a 47 percent higher rate of voluntary turnover.[9] The cost of substance abuse in terms of human suffering is immeasurable; the economic costs are enormous: The National Institutes of Health (NIH) reported that alcohol and drug abuse cost the U.S. economy $246 billion in 1992.[10] Given the perceived prevalence of substance abuse in the workplace and its negative impact on worker health and productivity, policymakers in industry and government have become increasingly receptive to the idea that employee drug testing can be instrumental in mitigating this impact. Notwithstanding the paucity of rigorous research on the efficacy of drug testing, some documentation has been supportive of its benefits. In the U.S. Post Office study mentioned above: "An economic utility analysis indicated that the total savings (due to lower involuntary turnover and absenteeism) obtained by screening out job applicants who test positive for drug use was approximately $52,750,000 for one cohort of new employees."[11] Federal Aviation Agency data demonstrate a reduction in positive test results--sby 13 percent from 1992 to 1993. "Many corporations have stated that urine drug testing, as a component of a substance abuse policy, results in significant savings, e.g., from decreased absenteeism and turnover."[12] However encouraging these preliminary assessments appear, the jury is still out on whether drug testing is beneficial from the financial viewpoint. But, as Peat points out, financial effectiveness is not the only rationale for employee drug testing. Humanitarian concerns, moralism, safety concerns, regulatory requirements, and public image considerations also contribute to the rationale for developing and implementing a drug testing policy. Implementation With respect to implementing drug testing within a university setting, the literature is silent. And, although implementation of drug testing in both government and industry stretches back over many years, few attempts have been made to rigorously analyze the organization or effectiveness of such implementation. "From the research perspective, there remain huge gaps in our knowledge about the effectiveness of testing programs as a deterrent or as a tool in the early identification of addicts."[13] The authors of this statement go on to describe drug testing as a widely adopted "public health" intervention lacking a broad science base. This is important because policymakers need to take into account both the effectiveness and costs of various policy alternatives. The effectiveness of a drug testing program relates to its objectives. MacDonald and Wells identified three major objectives for drug screening: 1) reduce workplace accidents; 2) reduce performance problems (e.g., absenteeism and turnover); and 3) reduce drug use in society as a whole.[14] In citing and analyzing the literature, they note that, while some companies report dramatic reductions in absenteeism, disciplinary actions, and accidents since implementing a drug testing program, many of these studies have been criticized for failing to account for the influence of other variables. As an indicator of reduced drug use in society as a whole, some employers cite the reduction in the percentage of the employees who test positive over subsequent years of screening. Such studies fail to account for the fact that drug users are less likely to apply to employers with a drug screening policy, or that they have improved their ability to defeat the test. They conclude that: "Too few empirical studies on the effectiveness of drug screening programs exist at this time to prove that programs are effective in reducing drug use among employees, accidents and performance problems in the workplace, or drug problems in society as a whole." In the absence of conclusive information regarding effectiveness, it may be useful for policymakers to be aware of the characteristics of drug testing programs that have been widely implemented. Murphy and Thornton listed 56 policies and practices that characterize drug testing programs. They then surveyed 177 organizations (with a 40.6 percent response rate) to determine the frequency with which each characteristic was included in actual testing programs. Those characteristics present in the majority of the organizations included: 1) testing all applicants and refusing to hire those who fail; 2) testing "for cause"; 3) using drug tests to discourage use on the job, screen out abusers, and protect the health and safety of workers; 4) circulating written descriptions of programs to employees and designating some person or department responsible for the program; 5) training supervisors to recognize impairment; 6) taking steps to minimize false positives and notifying incumbents and applicants of test results; and 7) some form of ongoing evaluation of the testing program.[15] Because most program descriptors and effectiveness studies have targeted private industry, public policymakers are left to extract whatever elements they feel are appropriate to guide their own policymaking decisions. But if they are seeking conclusive findings to support advocacy of a specific policy component, they are likely to be disappointed. Advantages and Disadvantages of Drug Testing Policymakers could consider the advantages and disadvantages of drug testing, both as a general proposition and with respect to the various types of drug testing (i.e., pre-employment, random, for cause, etc.). In general, the perceived advantages of drug testing for employers are that it: 1) discourages drug abusing applicants; 2) detects and leads to either "weeding out" or rehabilitating drug abusing workers; 3) detects drug abuse among current workers; 4) reduces accidents and injuries and increases job performance (often defined as a decrease in absenteeism, turnover, conflict with co-workers, etc.); 5) reduces the employer's risks for lawsuits; 6) ensures public safety; 7) enhances the employer's public image and promotes public trust; 8) leads to a decrease in the costs of medical insurance premiums; and 9) decreases drug abuse in society. Disadvantages of drug testing are that it: 1) is expensive to implement; 2) can result in a loss of skilled employees and lead to increased training costs; 3) decreases the applicant pool; 4) decreases morale among current employees; 5) spurs resistance from employee advocates (e.g.; unions, employee councils, etc.); 6) leads to legal challenges; 7) results in an initial increase in medical insurance utilization and replacement costs for rehabilitating employees; 8) generates false positives, fails to account for positives being due to factors other than drug abuse, and cannot assure that positive test results relate to impaired performance; and 9) raises ethical concerns. These general notions about the relative merits of drug testing provide the context for considering specific testing strategies. Most strategies will employ one testing methodology, urinalysis, as it is by far the most frequently used methodology by employers.[16] Choice of drug testing strategy will depend upon its advantages and disadvantages as they relate to an employer's identified objective. Pre-employment testing is the most frequently implemented drug testing strategy among employers.[17] Court decisions have mostly favored employers when legal challenges have been mounted-- the court reasoning that applicants have less interest in the job than current employees (who have more to lose), and that they have less expectation of privacy, because a physical exam including urinalysis is routine for most new hires. Still, the employer is on firmer legal footing if the job being applied for is considered as "safety sensitive," meaning that the failure to perform at a certain standard could endanger the public or other employees. Pre-employment drug screening is less contentious from the point of view of employee advocacy groups, because current employees are not subject to the policy. Another important advantage for the employer is that, by having a pre-employment screening policy in place, you discourage drug abusers from applying in the first place. This is especially important if other employers who share your applicant pool have a drug testing policy, because you can then avoid attracting the applicants they rejected due to positive drug test results. Such a policy is also good for the employer's public image in that it sends the message that drug abuse is not tolerated within the organization. The obvious disadvantage of the pre-employment testing strategy is that, with foreknowledge of the policy, an applicant can simply discontinue drug use until they are hired, whereupon they can resume. Pre-employment drug testing may pose a disadvantage to recruitment of quality employees. One study showed that college students preferred companies without drug testing policies.[18] However, a more recent replication of that study found that to no longer be the case.[19] For-cause drug testing is usually triggered by suspicion based either upon employee behavior or documented poor employee work performance. Legally, employers are held to a standard of "reasonable suspicion." This is a lesser standard than "probable cause." Nevertheless, the suspicion cannot be based upon vague or whimsical grounds. "There must be articulable grounds for directing the test--objective facts that would lead a reasonable person to conclude that the individual is using drugs or is impaired by drug use."[20] Employers have benefited by the court's willingness to lower the probable cause standard under certain defined circumstances, allowing "for cause" drug testing to withstand challenges based on Fourth Amendment protection against unreasonable searches.[21] One advantage of testing based on behavioral observation is that, in order to trigger a test, evidence must normally be sufficient to survive a legal challenge.[22] The disadvantage is that supervisors must be trained to recognize behavioral signs of abuse, which may not be related to work problems. "Misdiagnosis" and employee abuse could result. A benefit of basing testing on work performance criteria is that courts require a lower standard for suspicion; a major disadvantage is that diminished job performance could be due to factors other than drug abuse. One could argue also that employees should be dealt with on the basis of poor performance without regard to cause. The advantage to testing, however, is that, with early detection, highly trained employees can be rehabilitated and retained. Also, federal law and some state laws preclude the dismissal of employees whose drug addiction constitutes a handicapping condition.[23] Another major shortcoming of "for cause" testing in general is that it fails to detect abusers who perform better on drugs, but who may be more severely addicted than their fellow employees who are detected.[24] Notwithstanding arguments against it, "for cause" drug testing meets with less resistance and fewer legal challenges from employers[25] and enjoys wide public support.[26] Post-accident drug testing, as the name implies, would require drug screens of all employees who are involved in workplace accidents. Among the advantages of such testing is that it doesn't discriminate, and courts are supportive of the employer's right and responsibility to investigate all accidents in order to insure a safe working environment.[27, 28] Some states deny workers' compensation benefits to injured employees, if the injury is due to alcohol or illicit drug impairment.[29] A significant disadvantage to post-accident testing is that, even with a confirmed positive test, employers may not be able to demonstrate that the accident was the result of the drug impairment. Another potential drawback is that some accidents may go unreported. Periodic drug testing is not very controversial in that it usually means that the urine is taken at a regularly scheduled (usually annual) physical examination, so that courts are less sympathetic to legal action based on privacy because of the routine nature of the act. Employees and their advocates are less resistant because of the generous advanced notice given. For this same reason, however, the test is less likely to be useful, either for detection or deterrence. Return-to-work testing is usually unannounced testing provided for by an agreement between employee and employer (subsequent to an employee's rehabilitation or treatment for substance abuse) as a condition for the employee's reinstatement. This sort of testing has been around for years and engenders little conflict. Advantage accrues to both parties, as the employee regains his or her job and the employer retains a valuable worker. Random drug testing is clearly the most controversial and contentious form. With this type of testing, employees are randomly assigned to be screened at a given time, usually without notice. Such testing stands on unstable legal turf because it is not based on any suspicion whatever--reasonable or otherwise. It has been cited as a significant morale deflator in the workplace. Additionally, it is perceived as discouraging qualified applicants due to its unpopularity. Critics of the strategy also complain that random testing is more likely to identify the infrequent or "recreational" user rather than the serious abuser. However, one analysis, based on probability theory, projected that random testing identified 40 percent of daily users, 8 percent of monthly users, and only 1 percent of annual users (at a 50 percent testing rate). The authors conclude that: "Random drug tests in the workplace are effective in identifying near-daily users of illicit drugs, but are less effective in identifying infrequent users."[30] This would suggest that random testing does deter serious abusers. Sujak, Villanova, and Daly found that random testing did not significantly affect intention to apply for a job. The randomly assigned students in this study were shown to hold negative attitudes about drugs as well as low self-reported frequencies of use which "might mean that those participants felt that a random testing program would pose no particular threat to them because they did not use drugs themselves."[31] Also, if drug screenings are truly random, with everyone having an equal chance of being tested, the risk of discriminatory testing or stigmatization is quite low. Courts have sustained random drug testing in the public domain for safety-sensitive positions and for government-mandated testing by private employers where employees are engaged in jobs with public safety responsibilities.[32] Although it may be difficult to decide whether to establish a drug testing policy and to determine the most useful strategy based on the advantages and disadvantages, the real challenge for policymakers is to make these decisions relative to the dynamics of their own particular institution. Participant Perspectives The impetus for institutional change is stimulated by both external and internal forces.[33] The validity of this maxim was certainly affirmed by policymakers at the University of Virginia, as they recounted the process of establishing a drug testing policy from the perspective of their own participation. They reveal that the maintenance of momentum toward final policy enactment posed a significant challenge; the process from conception to enactment took more than four years. In the words of the vice president and provost of the health system: "You can surmise that we have not rushed into this." The following is a summary of the process from the perspective of some of the key participants: Vice President of the University and Provost of the Health System As all participants interviewed for this paper have acknowledged, Dr. Robert Cantrell, provost of the health system, was the force behind the drug testing policy initiative. The provost defined the problem succinctly with regard to the health system: "Most hospitals, and all hospitals within a 50-mile radius, have drug testing policies. Most include pre-employment testing, and all have for cause testing. UVA has requirements for bus drivers and athletes to undergo drug testing; it seemed appropriate for the health system faculty and staff who are in safety-sensitive positions to include direct contact with patients to fall into the same category." Dr. Cantrell's frustration with the slowness of the process echoed that of the other participants. He was impatient with the many legal reviews and rewrites. He observed that civil libertarians were concerned that "we were trampling on people's rights." His question continued to be: "What about the right of patients to have a drug-free health care professional providing their care?" He stated that pre-employment and for-cause testing is legally defensible and offers legal protection for the university. He expressed the hope that an effective pre-employment testing program would preclude the need to perform for-cause testing. Dr. Cantrell added that they decided not to perform random drug testing because: "we do not have a serious drug use problem; it would have a negative impact on employee morale ('no trust'); and most available research does not substantiate the effectiveness of random testing." The provost's opinion of the final version of the drug testing policy is that it fills the need of the university. Associate Vice President of Human Resources for the Health System The associate vice president for human resources for the health system, Mr. Ronald Bouchard, stated the concerns that provided impetus for developing a policy: 1) the need to protect patients in the health system by assuring a drug-free workplace for health care professionals, and 2) to avoid hiring into the health system those applicants who are abusing substances, some of whom may have failed pre-employment drug tests elsewhere. He recalled that the concept of a drug testing policy was basically initiated by the health system and that the academic division was less enthusiastic. Targeting safety-sensitive positions allowed them to develop a policy that was "university wide." Few academic division employees would be subject to testing--only police, fire and emergency personnel, etc. They were able to exclude academic researchers because of the small number who actually worked with dangerous materials. Upper-echelon stakeholders, such as the university president, agreed in principle with developing the policy, without the need for presenting a great deal of documentation early on. Mr. Bouchard described the policy taskforce as cohesive. A crucial early decision concerned whether or not to include alcohol as part of the drug testing policy. The chair of psychiatric medicine, the director of FEAP (Faculty and Employee Assistance Program), and the provost were adamant that it be included. And, it was. All acknowledged that its inclusion would make the policy more difficult to "sell," but the committee decided that it was important enough to justify an all-or-none approach." Mr. Bouchard confirmed that the legal department was involved from the beginning. Numerous issues needed to be resolved. For example, funding the program would be difficult, because the state's constitution does not allow deficit budgeting. Of course, both state and federal constitutions protect citizens against illegal searches. He described the process of seemingly endless legal reviews to be the most frustrating aspect of the policymaking task. "Finally, you just have to withdraw emotionally." He said that he understood general counsel's concern, however. "They did not want to be the first out of the chute on this. And yet, because of the university's unique circumstances, from the legal perspective, they were moving into uncharted territory." Director of Employee Relations The director of employee relations, Mr. William Vining, recalled that the committee that eventually became instrumental in formulating a drug testing policy began as a taskforce established to provide managers and supervisors with a framework for resolving problems with employees suspected of substance abuse. The vice president and provost of the health system had already expressed his concern about the absence of a drug testing policy at the university. As this process evolved, it became clear that a drug testing policy should be considered. They became aware that other organizations were testing for drugs, many in their own community. Mr. Vining said that they wondered if they were attracting most of the abusers because they didn't test. They also wanted to reassure the public. But, they pondered whether or not they had a problem with drugs sufficient to warrant the expense of drug testing. The university's experience with the mandatory Department of Transportation drug testing had produced a very low number of positive test results. "We questioned the cost-benefit of such a program." They concluded, however, that the potential legal liability ensuing from an accident involving an impaired worker, while impossible to account for in cost-benefit terms, nevertheless poses an unacceptable financial risk. It may be difficult to defend against such a lawsuit if you are the only organization in the region without a drug testing policy. Mr. Vining specified some of the difficult issues encountered by the taskforce committee as they explored policy options. As a state entity, they must demonstrate that there is a valid reason to test, such as the need to protect the public or to provide a safe work environment. An interesting issue arose regarding medical faculty who are tenured. How do directives regarding positive test results interface with provisions for protection under tenure? Clinical department chairs had to be convinced. Ultimately, the medical school and hospital agreed to the plan finally adopted. Other difficulties related to organizational changes. The Board of Visitors, who approve university policy, had given preliminary approval to the committee's proposals. But then the composition of the board changed, and there arose, at around the same time, some high-profile legal action wherein negligence was alleged on the part of university personnel. These events resulted in increased scrutiny and vigilance by the board with regard to legality. There was also a change in general counsel. Mr. Vining noted that this was like starting over. All background and justification had to be repeated. The proposal had to be completely rewritten. "Any resemblance to the original document was completely coincidental." Director of Occupational Health Occupational health was able to provide valuable assistance to the policymaking task. The director, Betty Joe Coyner, stated that they had been doing drug testing for years. They had been doing random screenings pursuant to return-to-work agreements as well as pre-hire, random, for-cause, and post-accident testing in implementation of the federally mandated testing of transportation employees at the university. Her knowledge of procedure and protocol helped the committee work through problems related to chain of custody of samples, cutoff levels for positive readings, etc. "We had to establish procedures to deal with people who said they had 13 poppy-seed bagels for breakfast or who said they were exposed to secondhand marijuana smoke." Also discussed was the need for increased funding for personnel to implement some elements of the policy. Another important issue focused on the determination of which positions should be labeled "safety-sensitive." Resistance from certain professional or occupational groups could be anticipated (e.g., physicians who are teaching faculty). However, it was decided that new medical faculty would be subject to pre-employment testing as part of a credentialing process. For-cause testing would apply to everyone. Ms. Coyner expressed the opinion that pre-employment testing is really an IQ test; it can easily be defeated with a little foresight. Nevertheless, it sends an important message to prospective applicants and is good public relations. She, too, had to become resigned to the "on again, off again" nature of the process. "I will not order the cups until the policy is approved." Director of the Employee Assistance Program Mr. Alan Cohn, director of the faculty and employee assistance program (FEAP), encountered an ethical concern from the outset and confronted it head on. The Faculty and Employee Assistance Program provides assessment and referral, case management, and training services for all employees at the university. Traditionally, EAPs have opposed drug testing because its impact seems inconsistent with the ethical principle of client self-determination. Additionally, the EAP's involvement in drug testing policy development may be perceived by employees as "collusion with management" to a degree that might undermine trust in confidentiality. Mr. Cohn reasoned, however, that these concerns were counterbalanced by other considerations pertinent to FEAP's overall mission. Without a clearly defined drug testing policy with a provision requiring manager/supervisor training, managers and supervisors are unsure of how to respond to an alcohol-or drug-impaired employee. Consequently, they either fail to take reasonable steps to detect substance abuse among employees, or they ignore it when they do detect it. This can leave a severely ill or impaired employee without help and endanger other employees and/or the public. Preventing this from occurring is a valid EAP concern, consistent with promoting a health and wellness paradigm in the work environment as well as providing for early detection and treatment of substance abuse. A policy could deter supervisors from enabling negative behavior or addiction. Also, a referral to FEAP pursuant to such a policy would be more focused, and testing results could assist in identifying the need for treatment as well as its intensity. Mr. Cohn stressed the need to form partnerships with other university stakeholders, such as human Resources and the health system, as a prerequisite for developing a consensus on the need for drug testing. This meant demonstrating the need, on a case-by-case basis, with managers and supervisors being encouraged to report every incident involving suspected substance abuse to human resources. Documentation of trends and patterns was reported to the provost. All were in agreement that, "Without a drug testing policy, our statements about providing a drug-free workplace were just statements." A committee was formed, consisting of the vice president and provost of the health system, human resource representatives from both the health system and academic divisions of the university, the chair of the department of psychiatric medicine, the FEAP director, and others. Meetings were attended by general counsel of the university, who provided legal guidance. Some compromises came early on. Random drug testing was removed from the table at the outset, as the issue was considered to be too contentious. There was disparity in support for drug testing, with the health system division of the university being much more supportive than the academic division. A "political" decision was made to target only employees in safety-sensitive positions--a decision more acceptable to the academic division, where such positions were few in number. Mr. Cohn recalled some of the frustrations as policy development proceeded over time. About a year and a half into the process, a personnel shift occurred in general counsel, requiring a total re-evaluation of policy components. Work ground to a halt. Things were then in a holding pattern for awhile, until the committees work was re-energized by the determination and commitment of the provost of the health system. Policymaking then got back into high gear. Another lull occurred when the policy was undergoing a rewrite, and a JCAHO (Joint Committee on the Accreditation of Hospital Organizations) evaluation was in progress in the health system. Finally, a draft policy was completed. It underwent numerous legal reviews and required approval by the state's personnel department, the attorney general's office, and the university's board of visitors. The proactive stance taken by the FEAP with respect to policy development, in Mr. Cohn's assessment, offered an opportunity to prevent the inappropriate use of the FEAP for drug testing, while promoting the inclusion of provisions valued by FEAP such as an emphasis on rehabilitation. The Board of Visitors of the University of Virginia approved the drug testing policy on October 16, 1999. Discussion Drug testing was a hotly debated issue in the late 1980s. In 1987, George Lundberg, editor of the Journal of the American Medical Association, labeled drug testing programs "chemical McCarthyism."[34] The celebrated attorney, F. Lee Bailey, in an article about drug testing published that same year, wrote: "No democracy can ever afford to relax its vigil for erosions of individual rights that, although initiated in some superficially worthy cause, point in the direction of the police states we so totally oppose."[35] Also in that year, Abbie Hoffman wrote, with Jonathan Silvers, a book entitled, Steal this Urine Test: Fighting Drug Hysteria in America.[36] As the title suggests, this book vehemently criticizes drug testing. Ronald Reagan's "drug-free workplace" directives and Nancy Reagan's "just say no" campaign served to raise the hackles of civil libertarians and others who were concerned about the unwarranted intrusion of "Big Brother." Developing a drug testing policy in a public university in that climate was sure to invite intense scrutiny and incite inflamed rhetoric. A reasoned deliberation of the relative merits of any drug testing policy--even one for employees whose impairment could harm the public, with screening strategies designed to be nondiscriminatory and constitutionally defensible, and in the context of a sound policy stressing rehabilitation rather than punishment--would have posed a real challenge. But that was then. Now, a decade later, the issue of drug testing, while still able to elicit strong opinions and intense negotiation, has a much higher flashpoint than in the past. For example, the Charlottesville, Virginia, daily newspaper, The Daily Progress, in its coverage of the October 16, 1999 Board of Visitors meeting, made no mention of its approval of a drug testing policy for the University of Virginia. It was, perhaps, this restrained atmosphere that contributed to the successful cultivation of stakeholders by policymakers at the university. In a more tumultuous environment, it may have been necessary to conduct informational "public hearings" with employee groups and others in order to broaden support for the initiative, as the California State Board of Personnel was obliged to do in evolving a drug testing policy for state employees.[37] But foresight and skillful compromise also played a significant role at UVA, especially in obtaining "buy-in" from clinical faculty and from the academic division, whose initial response apparently ranged from apathetic to oppositional. A policy that focuses on solving real, well-documented problems in the workplace is much more likely to engender support than one fabricated from the unsubstantiated, and often politically incendiary, edicts offered up by power brokers or fueled by media hype. Such a policy also has more credibility and may serve to diffuse a lot of potential opposition. All policymakers interviewed were generally in favor of drug testing for safety-sensitive positions from the outset. They were also consistent in eschewing random testing. These preferences, however, were predicated on differing concerns and the policymaking task approached from differing perspectives. For example, the objection to random testing was ethically troubling to some participants while others rejected it strictly as a practical consideration. Observations gleaned from these interviews can provide the reader with insight into how issues get identified, value weighted, and addressed within a public institution, where issues proliferate from various competing interests and where the significance of these issues for policymakers and constituents varies over time. While compromise may be the key to consensus building, it may not always be wise to remove all contentious issues from the table without thoroughly examining their efficacy. Random drug testing is a case in point. Some evidence suggests that random drug testing is effective in identifying frequent users and in providing a deterrent. Moreover, health care professionals are at a higher risk for diversion of controlled substances and may be able to perform their duties in a superior manner while using the drug (whereas interruption of their supply may lead to rapid onset of impairment). They are not likely, therefore, to be detected in a timely manner by "for cause" drug testing. Also, the courts have been supportive of random testing in circumstances where impaired workers pose an imminent threat to public safety. Properly administered, random testing is the least likely to lead to employee abuse and discrimination. Interestingly, federally mandated testing already in place at the University of Virginia means that, while bus drivers are subject to random testing, surgeons are not. This does not mean, however, that random drug testing is desirable for UVA or for any organization; its negative impacts often outweigh its advantages. This may well be the case at the university's medical center, where recent implementation of procedures with improved technology provide for more accurate tracking of controlled medications, thereby reducing the risk of diversion. However, an in-depth study of all issues--their merits in the abstract and their implementation in other settings--should be undertaken before deciding to abandon them. John L. Daly has pointed out that the focus of drug testing policy transforms over time, moving from a primary focus on detection to a focus on rehabilitation, and, ultimately, to a focus on employee educational awareness or primary prevention.[38] While he acknowledges that these three elements are often employed simultaneously in many settings, Daly suggests that, with maturity, a policy will place increasing emphasis on employee education. The University of Virginia policy specifies EAP responsibility for consultation with, and training of, managers and supervisors, but no formal requirement for ongoing employee education is incorporated. This omission is mitigated to the extent that such education may be provided for in other personnel policies within the system, or is a formally or informally assumed practice of the EAP. However, it might serve the causes of continuity and emphasis if a drug testing policy contains, in addition to the detection and rehabilitation language, an employee educational awareness provision. The stated intent of a drug testing policy may be crucial to dispelling the perceived injustice of such a policy. Cropanzano and Konovksy argue that, "Employees are often more tolerant of controversial assessment techniques to the extent that these procedures do not result in particularly negative outcomes."[39] The intent of the UVA policy is clearly stated in the first paragraph: "It is the intent and goal of this policy to provide a supportive process for intervention and rehabilitation while also protecting the learning and working environment."[40] As the University of Virginia experience bears out, policymakers can expect to be stymied by the legal process. With an issue as complex and jurisprudentially diverse as drug testing, comprehensive legal reviews seem inevitable. This is especially true in the public sector. Nevertheless, it might be possible to infuse the legal review team with a greater sense of expediency. The following suggestions serve to advance the cause of efficiency: 1) Anticipate issues most likely to be contentious. UVA did this by involving general counsel in their deliberations from the beginning. 2) Maintain frequent communication with the legal team between meetings. This may require persistence on the part of an identified taskforce member, but it serves to remind the legal department of the expectation of timeliness. (This is the old "squeaky wheel gets the oil" strategy.) 3) Cultivate and request assistance from powerful stakeholders who have a desire to see progress on the issue as well as sufficient leverage to influence the legal department. All policy should be proactive in furthering the mission and goals of the organization. When the potential exists for persons or groups within the organization to be negatively affected by policy, policymakers must find the proper balance between accommodating those concerns and advancing the overall mission. In the end, if that mission is worthy and enjoys broad support, sound policy is likely to evolve. The authors of an article about alcohol and drug testing policy at an Australian university, in recognizing that education is a primary means by which persons achieve independence, economic advancement, and personal growth, concluded that: "These expectations and values, if they are to be upheld, require on the part of the University more than is required of any employer in the area of occupational health, safety and welfare. This level of expectation requires that the University be a role model in the provision of a safe and healthy environment in which students can reach their highest potential."[41] | |
Stephen O. Griffin
University of Virginia
Department of Psychiatric Medicine
P.O. Box 800623
Charlottesville, VA 22908
Phone: (804) 982-1863
| | Stephen O. Griffin is a Research Assistant in the Department of Psychiatric Medicine at the University of Virginia. He received a BA in Psychology from Augusta College and a MSW from West Virginia University. He has worked as a Mental Health Clinician, Psychotherapist, and Substance Abuse Counselor. He participated in the writing of the Sexual Assault Prevention Plan for the Virginia Department of Health. | |
Adrienne Keller
University of Virginia
Department of Psychiatric Medicine
P.O. Box 800623 I
Charlottesville, VA 22908
| | Adrienne Keller is an Associate Professor of Psychiatric Medicine and Health Evaluation Sciences at the University of Virginia, and Research Director of the Under Fives Study Center. She received a BA in History from the University of Colorado and a Ph.D. in Medical Sciences from the University of Calgary. An Epidemiologist, she has served as Principal Investigator or Research Director on numerous funded research projects, studying Attachment Disorder, Substance Abuse, Sexual Assault Prevention, and Cardiovascular Disease Prevention. She is has authored over forty publications, including books, chapters, and journals. | |
Alan Cohn
Faculty and Employee Assistance Program
# 223-31, Medical Center
University of Virginia Health Sciences Center
Charlottesville, VA 22908
| | Alan Cohn is currently the Director of the Faculty and Employee Assistance Program at the University of Virginia. He received a BA in Psychology from Adelphi University, and an MSW from the University of Michigan. He has served as a clinician and director of services in various clinical settings, both civilian and military, and was a professor in the Social Work: Department at the University of Southern Colorado. He is a Board Certified Diplomat Employee Assistance Professional and is licensed by a number of human service: professional organizations. Notes [1.] MacDonald, S., and Wells, S., 1994. "The Impact and Effectiveness of Drug Testing Programs in the Workplace," in: Research Advances in Alcohol and Drug Problems, vol. 2, S. MacDonald, and P. Roman, eds., p. 122, Plenum Press, New York and London. [2.] Gerson, B. and Subramaniam, S., 1998. "Drug Testing as Part of the War on Drugs," Clinics in Laboratory Medicine, 18: 785. [3.] Devon, D. "Drug Testing of Health Care Workers: Toward a Coherent Hospital Policy," American Journal of Law and Medicine, 23: 399. [4.] U.S. Department of Labor, 1999, Working Partners: Substance Abuse Information Database (web site). [5.] DuPont, R.L., Griffin, DW., Siskin, B.R., Shiraki, S., and Katze, E., 1995. "Random Drug Tests at Work: The Problem of Identifying Frequent and Infrequent Users of Illicit Drugs," Journal of Addictive Diseases, 14: 2. [6.] Osterloh, J.D., and Becker, C.C., 1990. "Chemical Dependency and Drug Testing in the Workplace," Journal of Psychoactive Drugs, 22:407. [7.] Reynolds,J.L., McGovern, P.M., Kochevar, L., Olson, D., and Hibbs, B.F., 1991. "Minnesota Workplace Testing: Analysis of Policy and Procedures," AAOHN Journal, 39: 523. [8.] Masi, D., and O'Brien, M., 1985. "Dealing with Drug Abuse in the Workplace," Business and Health, 3: 29-32. [9.] Normand, J., Salyards, S.D., and Mahoney, J.J., 1990. "An Evaluation of Pre-Employment Drug Testing," Journal of Applied Psychology, 75: 629-39. [10.] National Institute of Drug Abuse, 1992. "The Economic Costs of Drug Abuse in the United States" (web site). [11.] Bereman, N.A., Lengnick-Hall, M.L., and Jones, R.F., 1994. "The Effect of Job Impact, Job Interdependence, and Employee Characteristics on the Acceptability of a Drug Testing Policy," Employee Responsibilities and Rights Journal, 7: 104. [12.] Peat, M.A., 1995. "Financial Viability of Screening for Drugs of Abuse," Clinical Chemistry, 41: 805. [13.] Gust, S.W., Brenner, E.H., and Schuster, C.R., 1996. "Drug Testing in the Workplace: Legal, Technical, and Scientific Issues," NIDA Resource Monograph, 162: 40. [14.] MacDonald, S., and Wells, S., 1994. "The Impact and Effectiveness of Drug Testing programs in the Workplace," in: Research Advances in Alcohol and Drug Problems, vol. 2, S.MacDonald, and P. Roman, eds., pp. 129-139, Plenum Press, New York and London. [15.] Murphy, K.R., and Thornton, G.C., 1992. "Characteristics of Employee Drug Testing Policies," Journal of Business and Psychology, 6: 300-306. [16.] Devon, D., "Drug Testing of Health Care Workers: Toward a Coherent Hospital Policy," American Journal of Law and Medicine, 23: 402. [17.] Devon, D., "Drug Testing of Health Care Workers: Toward a Coherent Hospital Policy," American Journal of Law and Medicine, 23: 402. [18.] Crant, J.M., and Bateman, T.S., 1990. "An Experimental Test of the Impact of Drug-Testing Programs on Potential Job Applicants' Attitudes and Intentions," Journal of Applied Psychology, 75: 127-131. [19.] Mastrangelo, P.M., 1997. "Do College Students Still Prefer Companies Without Employment Drug Testing?" Journal of Business and Psychology, 11: 336. [20.] Devon, D., "Drug Testing of Health Care Workers: Toward a Coherent Hospital Policy," American Journal of Law and Medicine, 23: 403. [21.] Lieberwitz, R.L., 1994. "Constitutional and Statutory Treatment of Drug Testing in the United States," in: Research Advances in Alcohol and drug Problems, vol. 2, S. MacDonald, and P. Roman, eds., pp. 185-203, Plenum Press, New York and London. [22.] MacDonald, S., and Wells, S., 1994. "The Impact and Effectiveness of Drug Testing Programs in the Workplace," in: Research Advances in Alcohol and Drug Problems, vol. 2, S. MacDonald, and P. Roman, eds., p. 122, Plenum Press, New York and London. [23.] Segal, J.A., 1989. "How Reasonable is Your Suspicion?" Personnel Administrator, 34: 104. [24.] Winick, C., 1993. "Social Behavior, Public Policy, and Non-Harmful Drug Use," in: Confronting Drug Policy: Illicit Drugs in a Free Society, R. Bayer, and G. Oppenheimer, eds., pp. 136-159, Cambridge University Press, Cambridge(UK) and New York. [25.] Brooks, J.P., and Dempsey, J., 1992. "Health Care Organization Drug Testing," The Health Care Supervisor, 11: 4. [26.] Latessa, E.J., Travis, L.F., and Cullen, F.T., 1988. "Public Support for Mandatory Drug-Alcohol Testing in the Workplace," Crime & Delinquency, 34: 379-90. [27.] MacDonald, S., and Wells, S., 1994. "The Impact and Effectiveness of Drug Testing Programs in the Workplace," in: Research Advances in Alcohol and Drug Problems, vol. 2, S.MacDonald, and P. Roman, eds., p. 125, Plenum Press, New York and London. [28.] Decresce, R.P., Lifshitz, M.S., Ambre, J., Mazura, A.C., Tilson, J.E., and Cochran, K.M., 1989, Drug Testing in the Workplace, p. 183, ASCP Press (American Society of Clinical Pathologists), Chicago. [29.] U.S. Department of Labor, 1999, Working Partners: Substance Abuse Information Database (web site). [30.] DuPont, R.L., Griffin, DW., Siskin, B.R., Shiraki, S., and Katze, E., 1995. "Random Drug Tests at Work: The Problem of Identifying Frequent and Infrequent Users of Illicit Drugs," Journal of Addictive Diseases, 14: 2. [31.] Sujak, D.A., Villanova, P., and Daly, J.P., 1995. "The Effects of Drug Testing Program Characteristics on Applicant's Attitudes Toward Potential Employment," The Journal of Psychology, 129: 413. [32.] Devon, D., "Drug Testing of Health Care Workers: Toward a Coherent Hospital Policy," American Journal of Law and Medicine, 23: 404-405. [33.] Daly, J.L., 1993. "Substance Abuse Policy Adaptation in Florida Municipal Government," Public Personnel Management, 22: 202. [34.] Holdon, C., 1987. "Doctors Square off on Employee Drug Testing [News]," Science, 238: 744. [35.] Bailey, F.L., 1987. "Legal Factors Surrounding Drug Testing in the Workplace," Pharmacotherapy, 7: 60. [36.] Hoffman, A., and Silvers, J., 1987, Steal this Urine Test: Fighting Drug Hysteria in America, Penguin Books, New York. [37.] Atwood, J.F., 1992. "Applicant Drug Testing: An Intriguing Odyssey," Public Personnel Management, 21: 120. [38.] Daly, J.L., 1993. "Substance Abuse Policy Adaptation in Florida Municipal Government," Public Personnel Management, 22: 205-207. [39.] Cropanzano, R., and Konovsky, M.A., 1995. "Resolving the Justice Dilemma by Improving the Outcomes: The Case of Employee Drug Screening," Journal of Business and Psychology, 10: 221. [40.] University of Virginia Policy and Procedures. [41.] Blaze-Temple, D., Howat, P., Barney, J., Saunders, B., and Saxon, S., 1989. "Legislative and Humanitarian Impetus for Development of Alcohol and Other Drug Policy at an Australian University," Community Health Studies, 23: 465. |
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