Managing Drug and Alcohol Misuse at Work

In the workplace, substance misuse is a challenging issue. As part of our Well at Work blog series, Cognate Health physician Dr Rozali Athanasaki discusses drug and alcohol misuse and what to know about workplace testing.


Employees under the influence of alcohol or drugs pose a risk to their own safety and their colleagues. Drugs and alcohol misuse also increases absenteeism, decreases work productivity and damages company reputation. 

Many large companies are adopting workplace drug and alcohol testing. This is particularly relevant in industries where the safety risk is high such as transportation, heavy manufacturing and the defence sector. In the US and Canada, mandatory drug and alcohol testing is required of all inter-state truckers, commercial driver’s license holders and other transportation drivers.

In Ireland, there’s no statutory obligation to carry out pre-employment alcohol and drug testing. The Safety, Health and Welfare at Work Act 2005 obliges employers to ensure the safety, health and welfare at work of his/her employees. While it does not enforce employers to test for drugs and alcohol, if the contract of employment provides for such testing during employment, employees must comply.


It’s estimated work related alcohol misuse costs the UK economy up to £6.4 billon and contributes to the loss of 17 million working days annually.

Liver damage is likely if a man consumes 21 units weekly and if a woman consumes 14 units per week. To put that into context, a ‘unit’ of alcohol is a half pint of beer; 100ml of wine; or a 25ml measure of spirits.

Likely effects of Alcohol on a normal adult (source: Simpson’s Forensic Medicine)


Drugs can be taken by injection (intravenous, subcutaneous, or rarely intramuscular), sniffing into the nose, inhalation; orally, and very rarely through vaginal or rectal route.

Some key terms around drug abuse include “tolerance”, when the dose does not produce the ‘standard’ effects; “dependence”, which is the inability of the user to give up the habit, and “withdrawal symptoms”, when drugs are withdrawn and severe symptoms like fear and anxiety and tremors and cramps can happen.


In an occupational health environment, drug and alcohol testing is conducted because:

  1. Part of the pre-employment health assessment
  2. Random drug and alcohol testing
  3. To assess an employee in the context of an unusual event. (eg work accident, behavioral change).

Drug substances most commonly are assessed by urine sampling. For alcohol detection, a breathalyser and/or blood testing is recommended.

Before Sampling

It’s important the donor presents an acceptable form of photographic identification (passport or driving license).

The collector explains the collection procedures and ensures the donor has filled out and signed the consent form. The donor is informed the temperature of the specimen is critical, and that it needs to be brought to the collector as soon as possible after urination. If it’s longer than four minutes, the specimen may be out of range and a repeat procedure may be required.

The collector verifies the restroom is clear of other samples and the water in the cistern is coloured so the specimen cannot be contaminated. It’s important to also check, if possible, that the donor is not bringing other items into the restroom.

Sampling Procedure

The collector gives to the donor, or allows the donor, to select the collection kit. Either the collector or the donor — with both present — unwraps the kit. The collector requests the donor to write their full name and date on the container and for the donor to provide a specimen in an allocated restroom.

After Sampling

The collector checks the temperature of the specimen as soon as the donor hands it over — an acceptable range is 32°-38°C/ 90°-100°F. The collector also checks there’s a sufficient amount of urine (minimum 45 mL) and there’s no unusual color, presence of foreign material, or other signs of tampering.

The collector analyses the specimen in accordance with kit supplier instructions. If the specimen is positive, they prepare it to be sent to a lab for further investigation using the chain of custody procedure.

During her specialist training in the Laboratory of Forensic Medicine and Toxicology at the University of Thessaloniki, Greece, Dr Athanasaki performed drug testing as part of post-mortem examinations, clinical examinations of drug addicts, and workplace drug testing. She followed analytical techniques in forensic toxicology as immunoassays, thin layer chromatography (TLC), gas chromatography (GC), and metal analyses- atomic absorption spectrophotometry (AAS).  

Dr Athanasaki has served as an accredited doping officer for the Hellenic National Council for Combating Doping (WADA Code Signatory) and her role involved collection of samples in athletes abiding with WADA procedures.  Dr Athanasaki  works for Cognate Health since 2015 and has a special interest in workplace drug testing.  

For more on how Cognate Health can assist with your occupational health needs, such as substance and drugs testing please contact our customer relationship team, led by Denis Weir at


Key Legislation in Ireland

  • John Hobson, Julia Smedley, Fitness for Work, The medical aspects, Sixth edition
  • Richard Shepherd, Simpson’s Forensic Medicine, 12th edition
  • Joseph Ladou, Robert Harrison, Current diagnosis & treatment, Occupational & Environmental Medicine, 5th edition
  • Stuart H James, Jon J. Norby, Forensic Science, An introduction to scientific and investigative techniques
  • Julia Smedley, Finlay Dick, Steven Sadhra, Oxford handbook of occupational health, 2nd edition

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