Substance-Use Problems: Are Uninsured Workers at Greater Risk?

Abstract

This study examined how problem drinking and drug use and their related treatment received by workers varied by health insurance coverage and employment characteristics. We used National Survey on Drug Use and Health data on civilian workers ages 18 years and older from the 2002 and 2003 public-use files. Multivariate logistic regressions estimated the relationship between workers' uninsured status and problem use, dependence, and treatment while controlling for worker demographics, education, income, and job characteristics. Controlling for differences in worker and workplace characteristics, uninsured workers were significantly more likely than privately insured workers to be illicit drug users or heavy drinkers. Among dependent workers, the lack of insurance was associated with a reduction in treatment received for problem drinkers (odds ratio = 0.31, p = .13). By contrast, a large, positive-albeit statistically nonsignificant-association between being uninsured and receiving treatment prevailed among uninsured workers using illicit drugs. Workplace substance-use policies were associated with a significant reduction in the odds of treatment received or treatment needed among problem drinkers without insurance coverage. Employee assistance programs were not good predictors of treatment received among uninsured workers. Uninsured workers were more likely to be heavy drinkers or illicit drug users than were workers with health insurance. Health insurance coverage was not significantly associated with treatment received among workers reporting problem use. Uninsured workers may be unable to benefit fully from employee assistance programs' treatment and referral services, whose utility depends on adequate behavioral health coverage for workers.