Flying below the Radar: Psychoactive Drug Use among Young Male Construction Workers in Sydney, Australia.

Background: Globally, there is growing concern regarding workers' illicit drug use and its implications for health and workplace safety. Young workers in male-dominated industries, such as construction, may be more susceptible to illicit drug use, risky drinking and its associated harms.Purpose/objectives: To investigate drug use and perceptions of risk among male construction workers, drawing comparisons between workers under 25 years with older age groups.Methods: Workers in Sydney, Australia (N = 511) completed a survey measuring past year illicit drug and alcohol use, psychological distress and perceptions of drug-related risks to health and safety. Prevalence in the total sample was compared with national estimates, and differences between younger and older survey respondents were examined using logistic regression models.Results: Survey respondents' cocaine, meth/amphetamine and cannabis use was significantly higher than estimates of male employees nationally (OR = 6.60, 3.58, 1.61, respectively). Young workers ≤24 were more likely to frequently use illicit drugs, drink heavily, and report psychological distress than those aged 35+. Workers ≤24 were least likely to perceive that drug use posed high risks to health or safety when compared with 25-34 and 35+ age groups.Conclusions/importance: The findings highlight the high prevalence of illicit drug use amongst young construction workers, representing threats to workplace safety even if used outside work hours. Greater emphasis on potential adverse effects of alcohol and drug use and closer examination of contributory workplace factors are required. These findings have practical implications to inform occupational health and safety programs and interventions in high-risk workplaces.

Exploring the relationship between psychological distress and likelihood of help seeking in construction workers: The role of talking to workmates and knowing how to get help.

BACKGROUND: Mental health problems are prevalent in male-dominated industries such as construction, where suicide rates are higher than the population average and help seeking is typically low. OBJECTIVE: To examine psychological distress in Australian construction workers and its relationship with help seeking via two hypothesised mediators: confidence in knowing how to get help and confidence in talking to workmates about mental health issues. METHODS: Workers (N = 511) completed a survey that assessed psychological distress, likelihood of help seeking, and confidence in knowing how to get help and talking to workmates. Bootstrapped multiple mediation analysis was performed using the PROCESS macro for SPSS. RESULTS: Psychological distress was higher than national estimates and most prevalent in men aged 25-44. Controlling for age and ability to recognise personal signs of mental health problems, psychological distress negatively predicted likelihood of help seeking. This relationship was partially mediated by knowing how to get help and confidence in talking to workmates. CONCLUSIONS: Results highlight the need to redress and mitigate mental health problems among high-risk groups of male workers. It provides useful guidance on multilevel workplace strategies to reduce stigma, enhance confidence and comfort in the process of seeking help and support in construction and other male-dominated industries.

Construction workers' alcohol use, knowledge, perceptions of risk and workplace norms.

INTRODUCTION AND AIMS: Globally, there is growing concern regarding workers' alcohol use and its implications for health, wellbeing and workplace safety. Male-dominated industries are more susceptible to risky alcohol consumption and its associated harms. This paper investigated the patterns, prevalence and predictors of risky drinking among construction workers. DESIGN AND METHODS: Male construction workers (n = 511) completed a survey measuring alcohol-related measures including Alcohol Use Disorders Identification Test - Concise (AUDIT-C), which was compared with population data. Hierarchical multiple regression examined alcohol-related knowledge, perception of risk to workplace safety, psychological distress, job stress, general health, quality of life and workplace alcohol culture variables as predictors of risky drinking. RESULTS: Prevalence of risky drinking was higher than the national average, particularly for younger (<25 years) and mid-aged (45-54 years) workers. One in six construction workers reported workmates being visibly affected by alcohol in the workplace. Key predictors of risky drinking were perception of alcohol-related risks to workplace safety, general health, alcohol knowledge and descriptive norms regarding workmates' alcohol use. DISCUSSION AND CONCLUSIONS: These findings provide useful insights into the patterns and predictors of risky drinking in construction and can inform future preventive programs and interventions in high-risk workplaces. In addition to tailoring programs to both young and mid-aged workers, this work highlights the importance of implementing strategies to increase awareness of risks to workplace safety; and the adoption of norms that inhibit the social acceptability of risky drinking behaviour in the wider workplace.

Tobacco Cost of Illness Studies: A Systematic Review.

INTRODUCTION: To identify studies reporting costs arising from tobacco use and detail their (1) economic approaches, (2) health outcomes, and (3) other cost areas included. METHODS: We searched PubMed, Scopus, Cochrane Library, EconLit, and Google Scholar for studies published between 2008 and April 2018 in English. Eligible articles reported tobacco-related costs and included all tobacco-using populations (multinational, national, subpopulations, and involuntary smokers). All economic approaches that resulted in monetary outcomes were included. We reported USD or converted local currencies to USD. Two health economists extracted and two researchers independently reviewed the data. RESULTS: From 4083 articles, we reviewed 361 abstracts and examined 79 full-texts, with 63 (1.6%) deemed eligible. There were three multinational, thirty-four national, twenty-one subpopulation or condition(s)-specific analyses, and five evaluating involuntary smoking. The diverse approaches and outcomes precluded integrating costs, but these were substantial in all studies. For instance, about USD 1436 billion in global health expenditures and productivity losses in 2012 and USD 9 billion in lost productivity in China, Brazil, and South Africa in 2012. At the national level, costs ranged from USD 4665 in annual per respondent health expenses (Germany 2006-2008) to USD 289-332.5 billion in medical expenses (United States 1964-2014). CONCLUSIONS: Despite wide variations in the methods used, the identified costs of tobacco are substantial. Studies on tobacco cost-of-illness use diverse methods and hence produce data that are not readily comparable across populations, time, and studies, precluding a consistent evidence-base for action and measurement of progress. Recommendations are made to improve comparability. IMPLICATIONS: In addition to the health and financial costs to individual smokers, smoking imposes costs on the broader community. Production of comparable estimates of the societal cost of tobacco use is impaired by a plethora of economic models and inconsistently included costs and conditions. These inconsistencies also cause difficulties in comparing relative impacts caused by differing factors. The review systematically documents the post-2007 literature on tobacco cost-of-illness estimations and details conditions and costs included. We hope this will encourage replication of models across settings to provide more consistent data, able to be integrated across populations, over time, and across risk factors.

Quantifying the societal cost of methamphetamine use to Australia.

Globally, there are increasing concerns about the harms associated with methamphetamine use. This paper i) reports on the results of a cost-of-illness (CoI) study that quantified the social costs associated with methamphetamine use in Australia and, ii) drawing on examples from this study, critically examines the general applicability of CoI studies for the alcohol and other drug field. A prevalence approach was used to estimate costs in 2013/2014, the most recent year for which reasonably comprehensive data were available. The value selected for a statistical life-year in our central estimate was AUD 281,798. Other costs were estimated from diverse sources. Total cost was estimated at AUD 5023.8 million in 2013/14 (range, AUD 2502.3 to AUD 7016.8 million). The greatest cost areas were crime including costs related to policing, courts, corrections and victims of crime (AUD 3244.5 million); followed by premature death (AUD 781.8 million); and, workplace costs (AUD 289.4 million). The social costs of methamphetamine use in Australia in 2013/14 are high, and the identification of crime and premature mortality as the largest cost areas is similar to USA findings and represents important areas for prevention and cost remediation. However, caution is required in interpreting the findings of any CoI study, as there is uncertainty associated with estimates owing to data limitations. Moreover, CoI estimates on their own do not identify which, if any, of the costs are avoidable (with drug substitution being a particular problem) nor do they shed light on the effectiveness of any potential interventions. We also recognise that data limitations prevent some costs from being estimated at all.

Workplace alcohol harm reduction intervention in Australia: Cluster non-randomised controlled trial.

INTRODUCTION AND AIMS: The workplace holds substantial potential as an alcohol harm reduction and prevention setting. Few studies have rigorously examined strategies to reduce workplace alcohol-related harm. Hence, an in-situ 3 year trial of a comprehensive alcohol harm reduction intervention in Australian manufacturing workplaces was undertaken. DESIGN AND METHODS: Informed by a gap analysis, a multi-site trial was undertaken. Three manufacturing industry companies, located at four separate worksites, with a minimum of 100 employees were recruited through a local industry network. Based on worksite location, two worksites were allocated to the intervention group and two to the comparison group. The pre-specified primary outcome measure, risky drinking (Alcohol Use Disorders Identification Test, AUDIT-C) and other self-report measures were collected pre-intervention (T1), 12 months (T2) and 24 months post-intervention (T3). RESULTS: No significant intervention effect was observed for the primary outcome measure, risky drinking. Significant intervention effects were observed for increased awareness of alcohol policy and employee assistance. At T3, the odds of intervention group participants being aware of the workplace policy and aware of employee assistance were 48.9% (95% confidence interval 29.3-88.9%) and 79.7% (11.5%, 91.8%), respectively, greater than comparison group participants. DISCUSSION AND CONCLUSIONS: Comprehensive tailored workplace interventions can be effective in improving workplace alcohol policy awareness. This is one of few workplace alcohol trials undertaken to-date and the findings make an important contribution to the limited evidence base for workplace alcohol harm prevention initiatives.

Men, Work, and Mental Health: A Systematic Review of Depression in Male-dominated Industries and Occupations.

Among men, depression is often unrecognised and untreated. Men employed in male-dominated industries and occupations may be particularly vulnerable. However, efforts to develop tailored workplace interventions are hampered by lack of prevalence data. A systematic review of studies reporting prevalence rates for depression in male dominated workforce groups was undertaken. Studies were included if they were published between 1990 - June 2012 in English, examined adult workers in male-dominated industries or occupations (> 70% male workforce), and used clinically relevant indicators of depression. Twenty studies met these criteria. Prevalence of depression ranged from 0.0% to 28.0%. Five studies reported significantly lower prevalence rates for mental disorders among male-dominated workforce groups than comparison populations, while six reported significantly higher rates. Eight studies additionally found significantly higher levels of depression in male-dominated groups than comparable national data. Overall, the majority of studies found higher levels of depression among workers in male-dominated workforce groups. There is a need to address the mental health of workers in male-dominated groups. The workplace provides an important but often overlooked setting to develop tailored strategies for vulnerable groups.

Alcohol- and drug-related absenteeism: a costly problem.

OBJECTIVE: Absenteeism related to alcohol and other drug (AOD) use can place a substantial burden on businesses and society. This study estimated the cost of AOD-related absenteeism in Australia using a nationally representative dataset. METHODS: A secondary analysis of the 2013 National Drug Strategy Household Survey (n=12,196) was undertaken. Two measures of AOD-related absenteeism were used: participants' self-reported absence due to AOD use (M1); and the mean difference in absence due to any illness/injury for AOD users compared to abstainers (M2). Both figures were multiplied by $267.70 (average day's wage in 2013 plus 20% on-costs) to estimate associated costs. RESULTS: M1 resulted in an estimation of 2.5 million days lost annually due to AOD use, at a cost of more than $680 million. M2 resulted in an estimation of almost 11.5 million days lost, at a cost of $3 billion. CONCLUSIONS: AOD-related absenteeism represents a significant and preventable impost upon Australian businesses. IMPLICATIONS: Workplaces should implement evidence-based interventions to promote healthy employee behaviour and reduce AOD-related absenteeism.

Do workplace policies work? An examination of the relationship between alcohol and other drug policies and workers' substance use.

BACKGROUND: There is growing interest in workplace policies as a strategy to prevent or manage alcohol and other drug (AOD) problems. This study is the first to explore the prevalence and impact of AOD policies in Australian workplaces using a nationally representative dataset. METHODS: A secondary analysis of the 2010 National Drug Strategy Household Survey was conducted (n=13,590). Descriptive analyses explored the prevalence of AOD policies. Multinomial and logistic regression assessed the relationship between policies and health behaviours. RESULTS: Workplace AOD policies were associated with reduced employee substance use. Having any AOD policy in place was associated with significantly decreased odds of high risk drinking (OR: 0.61). In terms of specific policy types, policies on 'use' and 'use plus assistance' were associated with significantly decreased odds of high risk drinking (OR: 0.64 and 0.43, respectively). 'Comprehensive' policies were associated with significantly decreased odds of drug use (OR: 0.72). AOD policies were not significantly related to absence due to AOD use, attending work under the influence, or usually consuming AOD at work. CONCLUSION: These findings provide empirical support for the value and efficacy of policies to reduce alcohol and drug problems. While basic policies on 'use' were associated with a reduction in high risk drinking, more comprehensive policies were required to impact drug use. Notably, alcohol/drug testing in isolation does not appear to be related to reduced employee substance use. Scope exists for Australian workplaces to implement effective AOD policies. This could result in considerable benefits for both individuals and workplaces.

Addressing inequities in alcohol consumption and related harms.

Social determinants, or the conditions in which individuals are born, grow, live, work and age, can result in inequities in health and well-being. However, to-date little research has examined alcohol use and alcohol-related problems from an inequities and social determinants perspective. This study reviewed the evidence base regarding inequities in alcohol consumption and alcohol-related health outcomes in Australia and identified promising approaches for promoting health equity. Fair Foundations: the VicHealth framework for health equity was used as an organizing schema. The review found that social determinants can strongly influence inequities in alcohol consumption and related harms. In general, lower socioeconomic groups experience more harm than wealthier groups with the same level of alcohol consumption. While Australia has implemented numerous alcohol-related interventions and policies, most do not explicitly aim to reduce inequities, and some may inadvertently exacerbate existing inequities. Interventions with the greatest potential to decrease inequities in alcohol consumption and alcohol-related harms include town planning, zoning and licensing to prevent disproportionate clustering of outlets in disadvantaged areas; interventions targeting licensed venues; and interventions targeting vulnerable populations. Interventions that may worsen inequities include national guidelines, technological interventions and public drinking bans. There is a need for further research into the best methods for reducing inequities in alcohol consumption and related harms.

How effective is drug testing as a workplace safety strategy? A systematic review of the evidence.

The growing prevalence of workplace drug testing and the narrow scope of previous reviews of the evidence base necessitate a comprehensive review of research concerning the efficacy of drug testing as a workplace strategy. A systematic qualitative review of relevant research published between January 1990 and January 2013 was undertaken. Inclusion criteria were studies that evaluated the effectiveness of drug testing in deterring employee drug use or reducing workplace accident or injury rates. Methodological adequacy was assessed using a published assessment tool specifically designed to assess the quality of intervention studies. A total of 23 studies were reviewed and assessed, six of which reported on the effectiveness of testing in reducing employee drug use and 17 which reported on occupational accident or injury rates. No studies involved randomised control trials. Only one study was assessed as demonstrating strong methodological rigour. That study found random alcohol testing reduced fatal accidents in the transport industry. The majority of studies reviewed contained methodological weaknesses including; inappropriate study design, limited sample representativeness, the use of ecological data to evaluate individual behaviour change and failure to adequately control for potentially confounding variables. This latter finding is consistent with previous reviews and indicates the evidence base for the effectiveness of testing in improving workplace safety is at best tenuous. Better dissemination of the current evidence in relation to workplace drug testing is required to support evidence-informed policy and practice. There is also a pressing need for more methodologically rigorous research to evaluate the efficacy and utility of drug testing.

What factors need to be addressed to support dental hygienists to assist their patients to quit smoking?

INTRODUCTION: Dental hygienists are well placed to assist their patients to quit smoking. Smoking affects oral health and dental treatments, and hygienists report greater time with patients than dentists with more focus on prevention. However, there has been little research into the extent to which hygienists assist patients to quit smoking and strategies to support them in this role. METHODS: A 2-stage survey of Australian dental hygienists was conducted. The first survey measured potential predictors of asking patients about smoking and assisting patients to quit smoking using the Theory of Planned Behavior as a framework. The second survey measured these behaviors in the past week. Structural equation modeling was used to examine predictors of the two behaviors. RESULTS: A total of 362 hygienists returned the first questionnaire. Intentions to ask and assist patients were high. The 273 hygienists who returned the second questionnaire assisted an estimated total of 1,394 patients to quit smoking in 1 week. Predictors within the Theory of Planned Behavior framework explained significant variance in asking (11%) and assisting (29%) behaviors, with self-efficacy the most critical predictor in both cases (ß = .27 and .32, respectively). CONCLUSIONS: Dental hygienists may be a viable and willing avenue for addressing smoking. Hygienists may be best supported in this role through increasing skills and confidence around asking sensitively about smoking, building rapport, and assisting patients to quit smoking. Incorporation of smoking status into general history taking and adoption of organizational policies on assisting patients to quit smoking could also be encouraged.

Minimum qualifications in the alcohol and other drugs field: employers' views.

INTRODUCTION AND AIMS: To examine employers' opinions of minimum qualifications and perceptions of vocational education and training (VET) and determine the extent to which the VET sector addressed current workforce development needs in the alcohol and other drugs (AOD) field. DESIGN AND METHODS: An online survey of 186 AOD treatment agency managers across Australia was conducted to determine levels of satisfaction with and attitudes toward AOD VET qualifications as a minimum qualification. Descriptive analyses were undertaken. RESULTS: Most managers were supportive of a minimum qualification strategy and deemed VET AOD qualifications sufficient as a minimum level qualification. However, over half indicated that the minimum qualification should be higher than certificate IV level. One in four managers were dissatisfied with VET provided by technical and further education colleges. When seeking to employ AOD specialist workers, most managers preferred those with university level qualifications rather than VET qualifications. DISCUSSION AND CONCLUSIONS: VET has potential to meet the increasingly complex needs of AOD work by providing ongoing certificate and diploma level training and qualifications at the vocational graduate level. However, the relatively high levels of dissatisfaction with the VET sector, and concern regarding the ability of certificate IV level training to meet the needs of the AOD workforce, warrant attention. Improved linkages and relationships between the AOD field and the VET sector could increase the quality of training provided and may assist in addressing the AOD workforce development needs.

Hazardous alcohol use interventions with emergency patients: Self-reported practices of nurses, and predictors of behaviour.

OBJECTIVES: The present study examined Australian ED nurses' practices in asking patients about alcohol and assisting them to manage their alcohol consumption. It also investigated strategies to support ED nurses in these interventions. METHODS: A two-stage survey was administered to ED nurses. The first questionnaire measured theoretical and organizational predictors of behaviour, and underlying beliefs, and the subsequent questionnaire explored rates of asking and assisting patients. RESULTS: A total of 125 nurses returned the first questionnaire. Participants held generally positive attitudes, perceived norms, feelings of legitimacy and perceived ability to ask about and intervene for alcohol, but lower role adequacy. The 71 ED nurses who completed the second questionnaire had intervened with almost 500 patients concerning alcohol in the previous week. Participants asked approximately one in four patients about alcohol (median = 26.3% of patients, 1095/4279 total patients asked). The Theory of Planned Behaviour did not predict rates of asking or assisting patients. Several strategies were identified that might increase rates: identify environmental factors that prevent nurses acting on their intentions to ask and intervene, raise confidence and skills, make asking about alcohol part of routine assessment, make supports such as drug and alcohol units or nurses available, and implement organizational policies on alcohol. CONCLUSIONS: Nurses appear positively disposed to engage with patients in regard to alcohol. However, greater support is needed to achieve the considerable significant public health benefits from this engagement. The findings point to several practical strategies that could be pursued to provide this support.

Intoxicated workers: findings from a national Australian survey.

AIMS: To identify prevalence of alcohol and drug use and intoxication at work. PARTICIPANTS: A total of 9,828 Australian workers ≥14 years old. SETTING: Australia 2007. MEASUREMENTS: Work-place alcohol use and drug use, intoxication at work, industry and occupation of employment. DESIGN: Secondary analysis of a large nationally representative survey involving descriptive and weighted multivariate logistic regressions. FINDINGS: Differential patterns were identified by drug type, worker characteristics and occupational setting, controlling for demographic variables. Nearly 9% of workers surveyed (8.7%) usually drank alcohol at work and 0.9% usually used drugs at work. Attending work under the influence of alcohol was more prevalent (5.6%) than attending work under the influence of drugs (2.0%), and significantly more likely among young, male, never married workers with no dependent children. Hospitality industry workers were 3.5 times more likely than other workers to drink alcohol and two to three times more likely to use drugs at work or attend work under the influence of alcohol or drugs. Other high-risk industries and occupations included construction, financial services, tradespersons and unskilled workers. CONCLUSION: More than one in 20 Australian workers admit to having worked under the influence of alcohol and almost one in 50 report attending work under the influence of psychoactive drugs. The rates are higher for some industries, such as the hospitality industry, than others.

Achieving professional practice change: from training to workforce development.

ISSUES: The traditional approach to increasing the capacity of health and human service professionals to deliver alcohol, tobacco and other drug interventions has been to build relevant knowledge, skills and attitudes through the provision of education and training. However, as a stand alone strategy, education and training is likely to have limited impact. APPROACH: This paper examines not only the features and characteristics of successful training programs and approaches, but also the wider array of systems and structural factors that might act as impediments to the implementation of new knowledge, skills and clinical behaviours. KEY FINDINGS: There is a constellation of factors that extend beyond traditional notions of 'training' that fall under the rubric of 'workforce development'. IMPLICATIONS AND CONCLUSIONS: A workforce development approach requires three levels of action-system-wide, capacity building and professional development to ensure effective responses.

Drug testing in Australian schools: policy implications and considerations of punitive, deterrence and/or prevention measures.

BACKGROUND: There have been increasing national and international calls for the introduction of drug testing as a policy measure to address harmful drug use. Such strategies have been applied in workplaces, sporting arenas, prisons and more latterly school settings. They are predicated on a belief in their efficacy in reducing drug-related harm, a need to 'send the right' message to potential users and to reassure the community at large that 'something is being done.' Rigorous examination is required of purported benefits of drug testing in schools. METHODS: A comprehensive examination was made of testing efficacy and accuracy. Australian legal and ethical issues, encompassing duty of care, rights of the child and privacy determinations, were juxtaposed with that of the United States of America. RESULTS: Evidence examined indicates no compelling case for the application of drug testing and that caution should be applied when considering drug testing as a drug detection and prevention strategy in the school setting. CONCLUSION: While this review did not support school drug testing, there are alternative evidence-based strategies that schools can implement to prevent drug-related problems among student populations.

Workers' drinking patterns: the impact on absenteeism in the Australian work-place.

AIMS: To examine the relationship between Australian workers' patterns of alcohol consumption and absenteeism. DESIGN: A secondary analysis of the 2001 National Drug Strategy Household Survey data. SETTING: Australia 2001. PARTICIPANTS: A total of 13 582 workers aged >or=14 years. MEASUREMENTS: Alcohol consumption levels associated with National Health and Medical Research Council (NHMRC) guidelines for short- and long-term harm were identified and compared with self-reported measures of absenteeism due to alcohol use and due to any illness/injury. FINDINGS: More than 40% of the Australian work-force consumed alcohol at risky or high-risk levels at least occasionally. High-risk drinkers were up to 22 times more likely to be absent from work due to their alcohol use compared to low-risk drinkers. Short-term high-risk drinkers were also significantly more likely to be absent from work due to any illness or injury than employed low-risk drinkers. Young employees and males were more likely to report alcohol-related absenteeism compared to older workers and females. CONCLUSIONS: The relationship between workers' alcohol consumption patterns and absenteeism is more substantial than previously recognized or documented. Alcohol-related absenteeism is not restricted to small numbers of chronic heavy drinkers, but also involves the much larger number of risky non-dependent drinkers who drink less frequently at risky levels. To improve workers' health and wellbeing and enhance productivity and economic prosperity, appropriate education, prevention and policy strategies are warranted and necessitate revision of previously narrow approaches undertaken with work-place programmes.

Methamphetamine use among Australian workers and its implications for prevention.

INTRODUCTION AND AIMS: Little attention has been directed to the use of methamphetamine among Australian workers. To address this, a study was conducted that examined drug consumption patterns of the Australian work-force. DESIGN AND METHOD: A secondary analysis of the 2004 National Drug Strategy Household Survey (NDSHS) data was undertaken that focused on methamphetamine use among those in paid employment. RESULTS: Methamphetamine use in the past 12 months was reported by 4.0% of workers compared to 2.2% of respondents not in the paid work-force. A larger proportion of male (4.8%) than female workers (3.0%) used methamphetamine. The highest prevalence occurred among 18-29-year-old workers (11.2%; males: 12.6%; females: 9.4%), and among workers in hospitality (9.5%), construction (5.4%) and transport (5.4%) industries and among tradespeople (6.5%). Significantly more methamphetamine users reported absenteeism compared to users of other illicit drugs and non-drug users. Among respondents reporting methamphetamine use, 13.4% reported absenteeism due to illicit drug use, while 56.8% reported absenteeism due to any illness or injury. Significantly more methamphetamine users (32.9%) reported going to work under the influence than users of other illicit drugs. Compared to users of other illicit drugs, methamphetamine users were also significantly more likely to drive a car, operate heavy machinery or abuse someone while under the influence. DISCUSSION AND CONCLUSIONS: The specific details of the profile of workers using methamphetamine and the impact it has on work performance allows for the development of targeted interventions and tailored prevention strategies previously not possible.