Articles on alcohol dependence and effect on work

Acta Biomed 2023; Vol. 94, N. 2: ISSN: 0392-4203 | eISSN: 2531-6745 © Mattioli 1885
247
IMPACT OF ALCOHOL DEPENDENCE ON VOCATION: A PROSPECTIVE CROSS
SECTIONAL STUDY.
Dr Sangita Chaurasia
Assistant Professor, Dept of Forensic Medicine and Toxicology, Gandhi Medical College
Bhopal, MP, India, Madhya Pradesh Medical University, Jabalpur, India
Dr Shrikant Sonraya
Resident, Dept of Community Medicine, Gandhi Medical College, Bhopal, MP, India
Madhya Pradesh Medical University/ Jabalpur, India
Dr Santosh Kumar Mishra
Assistant Professor, Dept of Orthopaedics, Gandhi Medical College Bhopal, MP, India
Madhya Pradesh Medical University, Jabalpur, India
Dr J.P. Agrawal
Professor, Dept of Psychiatry, Gandhi Medical College Bhopal, MP, India
Madhya Pradesh Medical University, Jabalpur, India
Dr Anshuli Trivedi (Corresponding author)
Associate Professor, Department of Community Medicine, Gandhi Medical College Bhopal,
Madhya Pradesh India, Madhya Pradesh Medical University, Jabalpur, India
dranshulitrivedi@yahoo.com
Abstract-
Background - Alcoholism results from interplay between psychological, social, and
environmental factors. Continued and excessive consumption of alcohol can lead dependence and
withdrawal syndrome when its consumption is ceased or reduced. It has a substantial impact on
vocation and income. In severe cases alcohol dependence negatively affects the quality of life. The
present study aimed to assess the impact of alcohol dependence on vocation.
Methods: A descriptive, cross sectional study was conducted at Department of Psychiatry, Gandhi
Medical College, Bhopal, using non random opportunity sampling to select newly diagnosed
patients with symptoms of alcohol dependence. The WHO-Alcohol Use Disorders Identification
Test (WHO-AUDIT) was used as screening tool, to assess the risk of alcohol dependence. Multiple
logistic regressions was used to study the co-relationship of alcohol dependence with various
aspects of vocation.
Result: The study included 213 patients, of whom 21.1% had high and 62% had very high AUDIT
scores. There was a statistically significant association between very high AUDIT scores and a

248 Acta Biomed 2023; Vol. 94, N. 2: ISSN: 0392-4203 | eISSN: 2531-6745
decrease in work efficiency (P=0.022) and impaired concentration ability (P=0.001).This resulted
in absenteeism from work (P=0.007) and monetary loss (P=0.001).
Conclusion: Alcohol has an adverse effect on vocation as it reduces workplace performance and
productivity. The patients have significant absences from work which can trigger bad behavior at
the workplace and cause significant monetary losses.
Key words: Alcohol dependence, Non random sampling, WHO- AUDIT score, Multiple logistic
regression.
Introduction: Alcohol is a psychotropic substance that can lead to dependence and its abuse has
serious social and economic repercussions as well as high burden of illness. It causes 3 million
deaths annually, accounting 5.3% of all deaths. Overall, 5.1% of the global burden of disease and
injury is caused by alcohol. (1)
Alcohol consumption is associated with a high risk of developing
various psychiatric and behavioral disorders, including about 200 diseases, trauma and other health
conditions. A significant proportion of the health burden and socioeconomic losses arises from
unintentional and intentional injuries, caused due to road traffic accidents, intentional injuries and
self harm. It is observed that fatal injuries are relatively more common in younger age group. It
causes untimely deaths and disabilities, especially in individuals aged 20–39 years accounting
13.5% of total deaths in this age group. A causal association has been established between the
hazards of alcohol consumption and the incidence of infectious diseases such as tuberculosis and
HIV/AIDS. (1)
Impact of alcohol consumption on acute and chronic health effects is determined by the pattern of
its consumption, total volume of alcohol consumed and episodes of heavy drinking. As per the
WHO, there are differences in levels and patterns of alcohol consumption and alcohol-related
mortality and morbidity amongst males and females. The proportion of alcohol-associated deaths
among men is almost 7.7% of all global deaths, compared to 2.6 % of all deaths among women. It
was found that in 2016, total per capita alcohol consumption among male and female drinkers
worldwide was on an average 19.4 litres of pure alcohol for males and 7.0 litres for females. (2)
Vocation is an important part of life, not only a means of earning a livelihood but also shapes
dimensions of life. It gives meaning to one's existence and defines one's role in society. A person
satisfied with their vocation, lives a contended life. It is observed that excessive alcohol
consumption interferes with performance at the workplace by its potentially addictive action. It
interferes with cognitive functions, alters the ability to analyze costs and benefits, and affects
physical coordination and balance. Also present and/or past alcohol misuse can hinder workers
abilities to perform their jobs by producing physical impairments. (3)
It poses a huge financial loss
due to workplace absence, variable health complications and accidents at work leading to decrease
in net productivity. When an employee is struggling with alcohol abuse, it affects not only the
individual but also personnel around him/her, superior staff, co-workers and entire work team. It

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Acta Biomed 2023; Vol. 94, N. 2: ISSN: 0392-4203 | eISSN: 2531-6745
increases the wages of performing staff, as other co-workers cover for non performing alcoholic
workers and there is loss of trained and experienced employee. In serious cases when an employee
is no longer employable and is forced to quit due to incompetency, adds further expenses for
compensation and increase employers liabilities.
NFHS-5 data stated that among men aged 15–49 who drink alcohol, 15% drink almost every day,
43% drink about once a week, and 42% drink less than once a week. (4)
This study identifies the
pattern of alcohol consumption in alcohol dependent patients and its impact on vocation.
Material and Methods:
The present cross sectional, descriptive study was conducted at department of Psychiatry, after
due authorization from the Institutional Ethics Committee (IEC) (IEC Protocol-56/IEC/2021 Date-
23/07/21) of Gandhi Medical College Bhopal from January 2022 to December 2022. Newly
diagnosed patients with alcohol dependence fulfilling the seven criteria of DSM-IV (5)
were
included in the study. A pattern of alcohol use that is not healthy and causes clinically substantial
impairment or distress, as shown by three or more of the seven criteria below, occurring at any
time within the last 12 months:
1. Tolerance – including
A. Requirement for significantly higher alcohol dosages, to produce the intended drunkenness or
desired effect.
B. Significantly reduced the effect, after continued usage of the same dosage of alcohol.
2. Withdrawal – including
A. Typical alcohol withdrawal syndrome (see DSM-IV for further information)
B. Alcohol consumption is done to lessen or prevent withdrawal symptoms.
3. Alcohol is frequently used in greater quantities or for longer periods of time than anticipated.
4. There is a steadfast desire a rare fruitless attempt to reduce or regulate alcohol consumption.
5. Activities required to obtain desirable effects of alcohol, consume alcohol, or recuperate from
its effects take up a significant amount of time.
6. Because of alcohol usage, significant social, professional, or recreational activities are
discontinued or scaled back.

7. Continued alcohol use despite knowledge of a physical or psychological issue that is likely to
have been triggered by or made worse by the alcohol (for example, continued drinking despite
knowledge that alcohol use aggravated an ulcer).
However, this study excluded patients who had previously been treated for alcohol dependence or
substance abuse. Also, severely ill, nonresponsive psychiatric patients were excluded.
Newly diagnosed patients seeking treatment at the Department of Psychiatry at Gandhi Medical
College, Bhopal, were selected by using non random opportunity sampling method. Due written
informed consent obtained; and interviewed by using a predesigned, pretested, semi-structured
questionnaire.
The Alcohol Use Disorder Identification Test (WHO-AUDIT) is a 10-item questionnaire, that is
used as a screening tool to assess alcohol consumption, alcohol-related problems, and drinking
behaviours.(6)
Patients with a WHO AUDIT score of > 8–14 were considered to have a moderate
risk of Alcohol dependence. Patients with scores of 15–19 and >20 were considered to have a high
or very high risk of alcohol dependence respectively. The sample size used was calculated on the
basis of prevalence of current alcohol consumption in Madhya Pradesh as 17.1% (NFHS-5) at a
95 % confidence interval, 5 % allowable error. (7)
Data was compiled in MS Excel 2021, and
analyzed by using Epi Info 7.0 software. Descriptive statistics were used for data interpretation.
Multiple logistic regression was used to study the co-relationship of alcohol dependence with
various aspects of vocation.
Results:
Total, 213 patients participated in the study; the mean age of the patients was 38.7 + (9.2) years.
Out of which 99% (211/213) were male, 41.8% of patients were salaried, 39.9% were self-
employed and 18.3% were unemployed. Almost 62% of patients had a very high risk AUDIT score
(Table 1).
48.4% consumed alcohol daily, with daily binge drinking in 30.1% of patients. 53.5% of patients
had history of alcohol consumption for 1 to 10 years. No effect of alcohol on vocation was seen in
11.06% of employed or salaried patients (Table 2). Most of the patients reported impairment of
work efficiency (p=0.022) and decreased concentration ability (p= 0.001), especially in patients
with very high AUDIT scores.
Discussion:
Alcohol is a psychoactive substance and it is observed that excessive alcohol consumption
interferes with performance at the workplace. By its potentially addictive action it interferes with
cognitive functions and affects physical coordination and balance. (3)
It poses a huge financial loss

251
due to workplace absence, variable health complications and accidents at work, leading to decrease
in net productivity.
Present study was conducted on the patients reported in psychiatric department of Gandhi Medical
College, Bhopal, recently diagnosed as alcohol dependent. Total 213 Patients were selected, within
the age group of 20-65 years, with a mean age of 38.7 ± 9.24 years, 99% were male. This is
comparable to study of Dr. Gopal Das CM (8)
in 2018; reported, 94% were males with mean age of
39.08 + 7.66 years. This could be due to males reported most frequently to the hospital for the
treatment of alcohol dependence as compared to females.
Present study showed 18.3% of patients were unemployed, or barred from employment due to
consequences resulting from alcohol addiction. PopoviciI and Michael T. French, observed that
loss of employment leads to a corresponding increase in average daily alcohol consumption,
increased binge drinking episodes resulting in alcohol abuse/dependence. (9)
In the current study, it was found that 53.5% of patients were consuming alcohol for >1 year and
16.9% were consuming alcohol for >20 years and became alcohol dependent. A vast percentage
of patients, i.e., 48.4%, consuming alcohol for >5 days per week; 68.5% consumed >750 ml per
week. Also, 30.1% of patients had episodes of daily binge drinking. (Table 1) Binge drinking is
defined as alcohol consumption pattern of more than five drinks per occasion for men and more
than four drinks per occasion for women on a weekly basis. (10)
Similar to the findings of International Alliance for Responsible Drinking Report of five Indian
states in July 2018, (11)
Present study also found that 19.1% patients consumed foreign liquor,
30% consumed country liquor, and 47% consumed both Indian made foreign liquor and Country
liquor (Table 1).
Based on the AUDIT score and severity of alcohol dependence, almost 62% of patients had very
high alcohol dependence, and 16.9% had had moderate risk of alcohol dependence (Table 1). The
findings were similar to those of V. Vijay Ramanan and Suresh Kumar Singh (12)
reported AUDIT
score of 41.2% of study participants had a moderate risk of alcohol dependence, 29.3% of
participants had a high risk, and 30.45% of participants had a low risk of alcohol dependence.
It was observed that there was a decrease in physical efficiency and concentration capacity among
alcoholic dependent patients in both salaried and self employed patients (Table 2). Patients with
higher AUDIT scores had statistically significant declines in physical efficiency (P= 0.022) and
concentration capacity (P=0.001) (Table-3). This is similar to the study observed by S. Jones, S
Casswell, J F Zhang in Auckland, where a 25% reduction in work efficiency was observed among
heavy alcohol consuming workers. (13)

The current study showed impaired memory (P=0.252) in 29.9% of employed salaried patients,
and 36% of employed and 37.64% of self employed patients confessed for drinking alcohol during
duty or working hours. Almost 25.8% of employed patients reported bad behavior with co-workers
due to alcohol inebriation. A study conducted in European population in 2017, reported that
alcohol use is an issue of concern in the workplace as it can lead to an increase in accidents due to
altered attention, causing injuries, leading to absenteeism from work, and inappropriate behavior
by reducing a worker’s physical and psychological integrity, and significantly affecting the health
and safety of co-workers, leading to mechanical accidents due to reckless attitude. (14)
Present study reported, 43.5% of self- employed patients who were absenting themselves from
work on a regular basis, i.e.,> once a week, there was a significantly (P=0.007) higher incidence
of absenteeism in patients with higher AUDIT scores. Similarly seen in Auckland study, where
3.7% of participants reported alcohol-related absences and 12% reported reduced efficiency days;
also observed deterioration of personal and work relationships, resulting in a loss of productivity.
It can have a negative impact on work environments and employee performance. (14)
It was observed that patents with high and very high AUDIT scores have more workplace
problems, resulting in lower performance, job loss and monetary losses (P = 0.354).
A similar observation was drawn by Mangione et al. that moderately heavy and heavy drinkers
reported more problems at work place than very light, light, or moderate drinkers. (15)
There was
no significant association between alcohol dependence and the loss of dexterity in patients;
contrary to findings by Kish and Cheyney in 1969, used a general aptitude battery on alcoholics
and found serious impairments of motor coordination, finger dexterity, and manual dexterity. (16)
Also, alcohol dependence resulted in significant monetary losses but an insignificant loss in
employment. However, 12.4% of employed and 15.35% of self employed patients did not observe
any significant ill effects of alcohol dependence on their vocation.
Conclusion:
The study emphasises the importance of the adverse effects of alcohol intoxication at the
workplace. An alcohol addiction and intoxication at work should be perceived as a red flag and
considered as workplace misconduct. A repeated offender should be confronted, and his or her
alcohol dependence should be taken seriously. Person addicted with alcohol can be counselled
under confidential Employee Assistance Programmes that addresses alcohol related issues and
provide counselling, periodic assessment and transfer of employees with alcohol dependence. (17)
Such programmes are provided in the U.S. by the U.S. Office of Personnel Management,
addressing the adverse effects of alcohol on productivity, escalating health care costs, increased
traffic accidents, and personal tragedies. Such programmes foster better awareness among
supervisors, managers, and human resource personnel of the issues surrounding alcoholism and
alcohol abuse.

253
Alcohol causes significant deterioration in work efficiency and reduces concentration ability. It
causes absenteeism from work, which causes monetary losses.
It is expected that the high alcohol dependence of employees causes disruption of activities at
workplace. An alcohol dependent individual is perceived as a liability by no- or mild-alcoholics.
Their addiction can result in monetary losses for employees and may pave the way for their
unemployment. In severe cases, the employee must be confronted to ensure that it is his/her
ultimate responsibility, for own rehabilitation, recovery and performance. Also measures like
Employee Assistance Programme can rehabilitate alcohol dependent worker in cordial manner
hence preventing loss of a qualified workers, due to alcohol abuse. As the menace of alcohol is
increasing in India, this study will to understand the interplay of various consequences of alcohol
dependence and to manage them without losing an employee.
Limitation: This study was performed during the COVID-19 Pandemic hence, variations in the
consumption pattern of alcohol during and after lockdown cannot be compared. As most of the
patients had significant variations in employment conditions and availability of alcohol during and
after lockdown.
Acknowledgment: Personnel at Dept of Psychiatry, Gandhi Medical College, Bhopal, Madhya
Pradesh, India
Funding-None
Statement of conflict of Interest-No Conflict
Author’s Contribution-
1) Dr Sangita Chaurasia - Revising the article critically for important intellectual content and Final
approval of version of article to be published.
2) Dr Srikant Sonraya- Acquisition of data, data -analysis and interpretation.
3) Dr Santosh Kumar Mishra - Drafting the article
4) Dr J. P. Agrawal - Drafting the article
5) Dr Anshuli Trivedi - Conception and design of study. Final approval of version of article to be
published.
References-
1) Hammer JHPM, Spiker DA. Global Status Report on Alcohol and Health, Global Status
Report on Alcohol. World Health Organization. (2018). Available online
at: http://www.who.int/substance_abuse/publications/global_alcohol_report/msbgsruprofiles.
pdf (Accessed February 1, 2020).

2) Alcohol.WHO.Key facts. https://www.who.int/news-room/fact-sheets/detail/alcohol.
(Accessed April 24, 2023).
3) French MT, Maclean JC, Sindelar JL, Fang H. The morning after: alcohol misuse and
employment problems. Appl Econ. 2011;43(21):2705-2720. doi:
10.1080/00036840903357421. PMID: 22162875; PMCID: PMC3234116.
4) Office of the Surgeon General (US); National Institute on Alcohol Abuse and Alcoholism
(US); Substance Abuse and Mental Health Services Administration (US). The Surgeon
General's Call to Action To Prevent and Reduce Underage Drinking. Rockville (MD): Office
of the Surgeon General (US); 2007. Appendix B: DSM-IV-TR Diagnostic Criteria for Alcohol
Abuse and Dependence. Available from: https://www.ncbi.nlm.nih.gov/books/NBK44358/.
5) American Psychiatric Association. 1994. Diagnostic and Statistical Manual of Mental
Disorders (4th ed.) (DSM-IV). Washington, D.C.: APA.
http://www.alcoholcostcalculator.org/business/about/dsm.html.Retrived on 20/12/21.
6) AUDIT-WHO
http://pubs.niaaa.nih.gov/publications/Practitioner/pocketguide/pocket_guide2.htm
RETRIEVED ON 30.4.23.
7) National Family Health survey -2019-21.Key
Indicators.http://rchiips.org/nfhs/factsheet_NFHS-5.shtml. (Accessed April 24, 2023).
8) Chikkerahally GDMD. Assessment of quality of life in patients with
alcohol dependence syndrome. Open Jour of Psych & Allied Scie.2019;10(1):57.
doi:10.5958/2394-2061.2019.00014.4.
9) Popovici I, French MT. Does Unemployment Lead to Greater Alcohol Consumption? IndRelat
(Berkeley). 2013 Apr;52(2):444-466. doi: 10.1111/irel.12019. Epub 2013 Mar 18. PMID:
23543880; PMCID: PMC3609661.
10) White AM, Tapert S, Shukla SD. Binge Drinking. Alcohol Res. 2018;39(1):1-3. PMID:
30557141; PMCID: PMC6104965.
11) Unrecorded alcohol in India. iard.org/getattachment/fdd90791-41cb-4bd3-98f0-
555fbf9818f8/unrecorded-alcohol-in-india.pdf.retrived on 20/07/23.
12) Ramanan VV, Singh SK. A study on alcohol use and its related health and social problems in
rural Puducherry, India. J Family Med Prim Care. 2016 Oct-Dec;5(4):804-808. doi: 10.4103/2249-
4863.201175. PMID: 28348995; PMCID: PMC5353818.
13) Jones S, Casswell S, Zhang JF. The economic costs of alcohol-related absenteeism and reduced
productivity among the working population of New Zealand. Addiction. 1995 Nov;90(11):1455-
61. doi: 10.1046/j.1360-0443.1995.901114553.x. PMID: 8528030.
14) Borrelli I, Santoro PE, Gualano MR, Perrotta A, Daniele A, Amantea C, Moscato U. Alcohol
Consumption in the Workplace: A Comparison between European Union Countries' Policies. Int
J Environ Res Public Health. 2022 Dec 17;19(24):16964. doi: 10.3390/ijerph192416964. PMID:
36554848; PMCID: PMC9779578.

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15)Mangione, Thomas & Howland, Jonathan & Amick, B & Cote, Jennifer & Lee, M & Bell,
Nicole & Levine, S. (1999). Employee drinking practices and work performance. Journal of studies
on alcohol. 60. 261-70. 10.15288/jsa.1999.60.261.
16)A. E. MAY, BA, ABPS and others, Intropunitiveness and Finger Dexterity in
Alcoholics, Alcohol and Alcoholism, Volume 11, Issue 1, 1976, Pages 21–
23, https://doi.org/10.1093/oxfordjournals.alcalc.a043996
17) Alcoholism In The Workplace: A Handbook for Supervisors.US office of Personnel
management.https://www.opm.gov/policy-data-oversight/worklife/reference-
materials/alcoholism-in-the-workplace-a-handbook-for-supervisors. Retrieved on 29/07/2023.
Tables :
Table-1-Frequency Distribution of study participants based on the practices and pattern of
alcohol consumption.
N %
Type of alcohol consumed Indian made Foreign Liquor 42 19.7
Country 64 30
Both 102 47.9
Home-made 5 2.3
Duration (in years) 1-10 114 53.5
11-20 63 29.6
>20 36 16.9
Frequency of alcohol consumed
(Days/week)
1-2 16 7.5
3-5 94 44.1
>5days 103 48.4
Amount of alcohol consumed
/week
1 bottle( 750ml) 34 16
1-2 bottle( 751-1500ml) 131 61.5
>2 bottle (>1500ml) 48 22.5
Episodes of Binge drinking Never 30 13.7
Monthly 68 31.9
Weekly 55 25.8
Daily 64 30.1
AUDIT score and risk of
alcohol dependence
8-14 (Moderate) 36 16.9
15-19( High) 45 21.1
20-40(Very high) 132 62

Table-2 - Frequency Distribution of study participants based on vocational
effects of alcoholism.
Impact on work Salaried
N
% Self-employed
N
%
Decrease physical efficiency 43 48.3 30 35.2
Decrease concentration ability 43 48.3 36 42.2
Impaired memory 13 14.6 13 15.3
Loss of dexterity 12 13.5 7 8.2
Absenteeism 38 42.7 37 43.5
Loss of job 29 32.6 18 21.2
Bad behaviour at work place 23 25.8 15 14.96
Poor performance at work 21 24.7 22 24.7
Drinking during duty hours 30 36 32 37.64
No effect 11 12.4 13 15.35
Table-3 - Distribution of patients on the basis of AUDIT score of alcohol dependence and its
effect on vocation (multiple responses received)-
Moderate
(N)
High (N) Very
high(N)
OR (CI-95%) P value
Decrease work
efficiency
12 15 46 1.31 (1.15-1.48) 0.022
Decrease
concentration
ability
13 17 49 4.24 (3.72-4.49) 0.001
Impaired
memory
4 5 14 2.76 (0.65-3.01) 0.252
Loss of
dexterity
3 4 12 2.078 (1.32-2.19) 0.354
Absenteeism 13 16 46 2.656 (1.42-1.98) 0.007
Loss of job 33 10 29 2.078 (0.625-2.25) 0.354
Unable to cope
up with stress
23 14 137 3.809 (1.15-3.9) 0.35
Monetary loss 18 15 0 2.65 (1.97-3.35) 0.001

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