The stigma of addiction in the workplace

August 2018
AOD-related stigma is often present in a variety of settings and contexts, including the workplace. It is, however, not always recognised or even well understood. Despite this, AOD-related stigma at work is ubiquitous, disproportionate, and profoundly harmful on many levels. Its effects range from overt discrimination in hiring practices to marginalisation and exclusion from full participation in work life, and it represents a significant threat to wellbeing.

NCETA sought to comprehensively review the evidence on AOD stigma in the workplace by examining:

  1. How AOD-related stigma is defined and understood
  2. How AOD stigma manifests at work
  3. Strategies for reducing AOD stigma at work
  4. Non-stigmatising workplace AOD policies.


AOD use is a highly stigmatised behaviour in society and is often seen as a moral deficit or failing rather than as a health issue [1, 2]. The reasons for this are varied but include:

  • Voluntary engagement by the person using AOD in illegal or criminal activities
  • A belief that AOD use contributes to violence, unsafe behaviours, illness, social problems and inability to work
  • A combination of hedonism (in the pursuit of pleasure) and perceived selfishness [2, 3].

Stigma may be perceived (e.g., real or imagined fear of discrimination), enacted (e.g., actual experiences of discrimination), and /or internalised (e.g., negative thoughts/feelings due to identifying with a stigmatised group) [4]. It may also operate on a subconscious level, influencing perception, memory, emotions and behaviour [5, 6].

The degree of stigmatisation that a person using drugs or alcohol experiences may vary depending on: their personal characteristics (including whether they are members of any other stigmatised groups), the type of substance used, and the frequency, method, context, and consequences of use. For example, illicit drug use is more likely to be stigmatised than alcohol use [4].

AOD use in the workplace and stigma

AOD use in the workplace is prevalent in many countries and is often associated with risks to productivity and safety. However, in contrast to popularly held beliefs, most people who use drugs and/or alcohol do so infrequently, do not experience significant problems and are not addicted.

Despite this, employees who use AOD may be subject to stigmatisation that can manifest in a number of different ways, including:

  • Discrimination in hiring and promotional decisions
  • Refraining from seeking work as a result of internalised stigmatising attitudes (“self-stigma”)
  • Exclusion/marginalisation from professional and social interactions.

The extent to which workers who use AOD experience stigma in the workplace is shaped by a number of wider cultural and social influences, including:

  • Perceptions of AOD use in that country/region/population (which in turn are shaped by the media, government legislation, social norms, etc.)
  • The healthcare system (particularly in the US where employment and healthcare are inextricably linked)
  • Workplace culture and values.

Most workplace responses to employee AOD use are underpinned by a formal policy. The way in which these policies are developed and implemented can influence the level of AOD use but also the extent of AOD-related stigmatization [7, 8].

At times the AOD policies implemented in workplaces may facilitate and promote stigmatisation, particularly if they are focused on protecting a workplace from productivity losses and safety risks via punitive measures rather than adopting a “whole-of-workplace” approach [9].

A whole-of-workplace approach recognises AOD use as a wider workforce wellbeing issue that can affect any employee, rather than a problem that resides within a minority of individual employees [10, 11]. Focusing on all employees within a health and wellbeing framework is not only likely to be more effective, it is also more likely to minimise stigmatisation.

Strategies to reduce AOD-related stigma at work

The workplace is an ideal setting in which to implement anti-stigma initiatives. There are a number of practical strategies that workplaces can use to prevent and reduce AOD-related stigma. Examples of these strategies include:

  • Educating employers and employees about AOD, discrimination, and how to appropriately and sensitively work with people who use AOD (this should not be a stand-alone initiative but rather undertaken in conjunction with systemic organisational strategies) [4].
  • Developing and implementing policies and supports that:
    • formalise the organisation’s commitment to diversity and tolerance
    • clearly state that discussions about a staff member’s AOD use (and related matters e.g. treatment) are to be kept strictly confidential
    • ensure robust procedures are in place for lodging complaints about discrimination (and that any such complaints are handled appropriately)
    • promote the use of factual rather than emotive/discriminatory language in conversation and personnel files [4].
  • Making the same provisions for staff with AOD-related problems as for staff with health conditions or challenging personal circumstances (e.g. flexible work arrangements, reasonable adjustment of duties) [4].
  • Wider societal strategies which focus on changing public perceptions of people who use AOD are also likely to have flow-on effects for workplaces [12].

There is also a need to better support people who experience AOD-related problems when they are attempting to find employment. People receiving treatment for AOD problems should therefore be offered access to education, training and employment services as part of their discharge planning [1].

Implementing dedicated strategies for reducing AOD-related stigma at work will not only benefit individuals but also their families, colleagues and the broader community.

The findings from NCETA’s study on AOD-related stigma in the workplace will be reported in full in the chapter The Stigma of Addiction in the Workplace to be published in The Stigma of Addiction: An Essential Guide, edited by Jonathon and Joseph Avery and published by Springer.

  1. Room, R., Rehm, J., Trotter, R.T., et al. (2001). Cross-cultural views on stigma, valuation, parity and societal values towards disability. In: Ustun, T.B., Chatterji, S., Bickenbach, J.E., Trotter, R.T., Room, R., Rehm, J., et al., editors. Disability and culture: Universalism and diversity. Seattle: Hogrefe & Huber; p. 247-91.  

  2. Livingston, J.D., Milne, T., Fang, M.L., Amari, E. (2012). The effectiveness of interventions for reducing stigma related to substance use disorders: a systematic review. Addiction; 107(1):39-50. 

  3. Room, R. (2005). Stigma, social inequality and alcohol and drug use. Drug and Alcohol Review; 24(2):143-55. 

  4. Queensland Mental Health Commission (2018). Changing attitudes, changing lives: Options to reduce stigma and discrimination for people experiencing problematic alcohol and other drug use. Brisbane: Queensland Mental Health Commission. 

  5. Kapur, N. (2015). Unconscious bias harms patients and staff. British Medical Journal, 351. 

  6. Alcohol and Drug Foundation (2017). Stigma and vulnerability to AOD. Available from:

  7. Pidd, K., Kostadinov, V., Roche, A.M. (2016). Do workplace policies work? An examination of the relationship between AOD policies and workers' substance use. International Journal of Drug Policy; 28:48-54. 

  8. Pidd, K., Roche, A.M. (2013). Workplace alcohol and other drug programs: What is good practice? Australian Drug Foundation. 

  9. Foster, W.H., Vaughan, R.D. (2005). Absenteeism and business costs: Does substance abuse matter? Journal of Substance Abuse Treatment; 28(1):27-33. 

  10. Pidd, K., Roche, A.M. (2008). Changing workplace cultures: An integrated model for the prevention and treatment of alcohol-related problems. In: Moore D, Dietze P, editors. Drugs and Public Health. Melbourne, Australia: Oxford; p. 49-59. 

  11. Pidd, K., Roche, A.M., Cameron, J., Lee, N., Jenner, L., Duraisingam, V. (2018). Workplace alcohol harm reduction intervention in Australia: Cluster non-randomised controlled trial. Drug and Alcohol Review; 37(4):502-13. 

  12. Krupa, T., Kirsh, B., Cockburn, L., Gewurtz, R. (2009). Understanding the stigma of mental illness in employment. Work; 33(4):413-25.