Ten human resources (HR) managers, 5 from private for-profit hospitals (labelled R1 - R5) and 5 from government not-for-profit hospitals (labelled S1-S5) were purposively sampled and interviewed. For private hospitals, we selected those that have operated for at least 10 years in Greater Accra region of Ghana and had not less than 100 employees. The government hospitals had to have been in operation for not less than 5 years as a hospital or polyclinic and had not less than 200 employees. Government hospitals in Ghana generally employ far more employees and professionals per patient load than private hospitals.
Of the ten human resources managers interviewed 7 were males and 3 were females, aged between 30 and 49 years except for one in a private hospital who was more than 60 years. The interviews were conducted in the offices of the participant’s workplace with the help of two research assistants who were acquainted with the content of the study guide. Prior to this, institutional entry was sought from the research departments of the various institutions selected for this study after approval by University of Ghana Business School Ethical Committee. The interview was conducted face-to-face using an interview guide, which included open-ended questions. The structure of the guide helped the researchers to observe the participants and the conversations were also audio-taped after seeking the consent of the participants.
On average, the interview lasted between 45 minutes to an hour. Extensive notes were taken during the interviews, and summaries of each interview were written right after the interview. The names of the research participants were left out to ensure confidentiality and anonymity. At the end of the data collection all the transcripts were coded and transcribed independently by each researcher and cross validated. To ensure content validity, summaries of the transcripts were sent to the participants to ensure that the exact meanings of their perceived attitude had been captured. Subsequently, thematic content analyses was done to generate results and to derive meanings which have been discussed in the following sections.
Analysis and Discussion of Findings
This aspect of the study examines the prevalence of alcohol use disorder (AUD), factors that contribute to AUD at the workplace and employee’s perception of employee assistance program (EAPs). This information set a tone for a good understanding of AUD at the workplace.
A. Prevalence of AUD
Alcohol use disorder is a common condition among the working class and could be in excess of one per every 10 employees as prevalence in the general community was estimated to be 12.7% in the general US community using DSM IV (Grant et al 2017). Relatively, higher percentage than the general population is expected among the working class because AUD is a developmental disorder (Roerecke & Rehm, 2014) beginning in the teens and generally take some 10 years lag behind onset of use to exhibit symptoms (Hingson, Heeren & Winter, 2006) by which time many people would have completed school or training and working. Many persons with AUD also die prematurely (Darvishi, Farhadi, Haghtalab & Poorolajal, 2015; Westman, Wahlbeck, Laursen, Gissler, Nordentoft et al., 2015) hence the majority of persons with the condition will be within the ages of the working class.
Due to the low knowledge of AUD as a medical condition (Maisto, Kirouac & Witkiewitz, 2014) many people tend to see it as a moral problem and will not easily disclose the existence of persons known to them with the condition. Most of the HR managers interviewed (70%) denied knowledge of employees with AUD. Some explained they could not tell while others claim it could not be ascertained even though they work in hospitals where this diagnosis is made.
I have not seen any staff drunk before. I wouldn’t actually know what constitutes it. Because of the nature of the work if anybody even takes alcohol it will be after close of work when everybody is at home, therefore it will be difficult for me to tell. On duty. R1
Now, as I am aware, I don’t know any of my employees with such a disorder. R2
However, the few who admitted that theIR staff had the condition even attempted to explain it away that such employees were either working at a very low level and so did not influence the work or that they were only temporary workers. Others did not really know the difference between regular use of alcohol and the person with AUD and may be oblivious to the fact that such persons can be counterproductive. Another considered AUD to be only when the person is seen to be intoxicated with alcohol during the day, even though the alcohol withdrawal, which can manifest 12 hours after the last drink and last up to 72 hours, possibly from the previous night can become a medical emergency (Roffman, & Stern, 2006). In fact, studies show that persons who regularly drink excess alcohol tend to be more argumentative and prone to injuries at work. (Rehm, 2011)
So far, we know of three and it could be irregular. Irregular in the sense that you don’t see them every day, but most times when you see them, they are drunk. So, it is irregular. R1
Currently, I cannot pick on one, but about 8 years ago we used to have one man at the records who was an alcoholic and it affected his performance. But the people we have now have not shown any great level of that effect on them, on their performance. Probably they may go and booze, but in the morning they will come to work okay. So, when we talk about alcoholics, I do not think we have any. Myself, I drink Whiskey at home, but I come to work normal. I don’t drink to booze. R2
Usually labourers are those seen to be drunk but maybe two to three days. Not all the time. R3
Some employers shared:
Usually before work, but the effects will still be on during working periods. I see them in the afternoons or in the morning working day because I don’t come to work on weekends and night. R1
Not really because they seem to reek of alcohol sometimes but you can’t perceive whether they drank it before coming to work or it was something that they drank yesterday before coming to work because they are casual workers so we don’t really know. R2
This shows how persons with AUD at the workplace are not considered to have serious ill-health like diabetes and hypertension, which require their employers to provide the necessary help to optimize productivity (Sturm, 2002).
B. Factors Influencing Workplace AUD
The study found that the participants attributed factors influencing AUD to be biological, environmental, social and psychological.
i. Biological Factors
Some of the HR managers believed that AUD could be heritable and this is in sync with the disease model of addiction (Bevilacqua & Goldman, 2009). Thus, people are born with a higher propensity to become addicts and the substance they get addicted to is only a symptom of their condition (Spooner & Hetherington, 2004). According to them, this repetitive behaviour picked up from their family line or genes that have been passed on through generations make them more vulnerable to developing alcoholism. One respondent claimed:
I think that some people were born with this urge to drink. When you look at their family there you will realize that most of them drink. This urge tends to increase when they are surrounded by people who drink then it becomes a habit. R1
This supports the results of Reilly, Noronha, Goldman and Koob (2017) who examined genetic studies of alcohol dependence in the context of the addiction cycle. Specifically, the family, twin and adoption studies demonstrate clearly that alcohol dependence and alcohol use disorders are phenotypically complex and heritable which is estimated at approximately 50–60% of the total phenotypic variability. Also the study showed that the vulnerability to alcohol use disorders can be due to multiple genetic or environmental factors or their interaction which gives rise to extensive and daunting heterogeneity.
ii. Environmental Factors
Some participants stated:
One of the factors that influence AUD are the alcohol stores that have been set up almost in every vicinity that people live in. So far as they live close to them they will find joy in drinking. So I think that it is one factor. If these stores were not there, where would they have gone to? R1
In this hospital, probably I would say, my guys have been going to quarters here, so there’s the proximity to the selling point. There’s a place they call Chicago. So, whenever you see them coming from that direction, they’ve gone to take some shots so that’s a major factor. several years ago there was even some just at the car park in front of the hospital, they were selling alcohol there, they were stopped so now they have to walk to quarters to top up occasionally and so that’s one of the factors. R2
The above statements from respondents indicate that people who live closer to alcohol establishments such as alcohol retail stores are prone to participate in alcoholism. Today media outlets have generated attractive adverts that attract the public. Thus people are induced to try drinking and if they enjoy it, they take no account as to whether their tolerance level to alcohol is high or low. This finding finds supports the Ecological System theory which explains how alcohol use disorder results at the workplace due to an interplay between the work environment and the employee’s internal factors. Thereby the kind of constraints and support employees receive from their employers in some way affect their behaviour on and off the job (Gruenewald, Remer, & LaScala, 2014).
iii. Social Factors
With social actors, participants revealed that some people who are prone to alcoholism, are influenced by the numerous functions they attend especially when served with alcoholic drinks at such functions. In order to fit in and be well liked may cause one to participate in activities they normally would have not. If care is not taken, they end up drinking frequently at such events and even start craving for alcohol after every day’s work.
Most of the time when programs are organized like parties or there is a funeral, they give you alcohol to drink you cannot say that you will not take it because of your friends. You have to learn to drink it by force. And if you continue you can become addicted to it. R1
Okay most of the people who work at the morgue and collect the refuse they are the most people seen to reek of alcohol but I can’t really tell if it’s because of those factors that they always drink alcohol. R2
iv. Psychological Factors
Data collected from respondents showed that everyone faces an issue one way or the other. However every person handles issues in their own unique way. As a result people who are usually highly stressed, depressed and with other mental health conditions are more vulnerable to developing alcoholism as alcohol is used by such to suppress their feelings and relief of psychological disorders. Overtime they end up leading to alcohol use disorders. In addition, the study showed that some people may have faced adverse events during childhood which exposed them to the use of alcohol and as they grow they are unable to control their urge leading to alcohol use disorders in adulthood. Some respondents stated:
Well for me I think that some people drink a lot when they are facing a problem. They think that drinking will help them to forget about the issue so they find solace in drinking which can be a serious problem. R1
Some think that when you get boozed you forget the problems you are facing, that’s probably why they are drinking, I don’t think it’s sensible for you to drink and forget problems, you’ll never forget the problem. R2
I think that people who went through difficult situations at a tender age start to develop drinking habits early. Since they drink to overcome their fears. And some of these children they were introduced to drinking by negative people and as they grow you realize that they become glued to alcohol use. R3
According to Keyes, Hatzenbuehler and Hasin (2011) many but not all studies have shown that exposure to adverse events in childhood, such as sexual, emotional, and physical abuse, is a risk factor for developing an AUD in adulthood. The study findings however is consistent with the findings of Meyers et al. (2015) who sampled Israeli adults with a relatively high prevalence of the ADH1B*2 allele (47 percent either heterozygous or homozygous). A history of childhood adversity moderated the influence of ADH1B*2 on alcohol-related phenotypes. In addition, there was a stronger effect of ADH1B*2 on AUD severity and the maximum number of drinks consumed in a day in individuals who had a history of childhood adversity compared with those who did not.
Other studies (Chen, Storr & Anthony, 2010; Jordan & Andersen, 2017; Poudel & Gautam, 2017; Rioux, Castellanos-Ryan & Parent, 2018) have also shown that persons who start drinking at an early age are more likely to develop addiction later in life. What is not clear however is, whether persons born to have addiction start drinking early or early drinking cause damage to the developing brain, particularly to the frontal lobe that develop fully in the mid-20s as opposed to the pleasure centers found in the medial temporal lobe that is developed in the teenage years (Jacobus & Tapert, 2015). This implies that, while young people derive pleasure or euphoria from the abuse of drugs, they are unable to perceive the long term implications and consequences of their acts on their frontal lobe function.
Further, the study sought to find out if alcohol use disorders result in presenteeism, absenteeism or impaired productivity. Responses from interviewees outlined that:
Sure, sure, the number of times they fall sick affect them. Even if they are not sick the level of their strength becomes compromised, when they come to work so definitely it affects productivity. R1
Usually these people fall sick easily and absent themselves from work. So someone have to do their work for them. R2
From statements above, the study disclosed that, usually people with such behaviour tend to fall ill often and absent themselves from work as too much of alcohol destroys the immune system. The results of this study is in line with the results of Buvik et al. (2018) in Carollo (2019) who aimed to map the frequency of alcohol related absence and inefficiency using survey data from a broad sample of employees. They also explored how alcohol use, absenteeism and presenteeism are experienced and handled using data from qualitative reviews. Further analyses revealed that alcohol absence and presenteeism result in economic and practical problems. Since most of the managers mentioned that they had to spend huge sums of money and effort on a single case of an employee who had an alcohol use problems.
In addition, this study also demonstrated that employees prone to alcohol usage demonstrated reduced productivity as the effort one may put into work is impeded. Research evidence suggest that alcohol could impair productivity. According to Andersen, Andersen, Olsen, Grønbæk and Strandberg-Larsen (2012) its impact on the accumulation of human capital through work; the time in life when alcohol leads to ill health and premature death; and its significance in the working age population, relative to other risk factors, results in impaired health and premature death.
C. Attitude of Employers towards Employees with Alcohol Use Disorders
This section intended to find out the diverse form of attitude employers exhibit towards employees with AUD. In line with this, the study sought to know the standards these organizations have put in place to implement policies on AUD. Especially whether they have employee assistance program policies to aid employees. Some respondents asserted:
In our facility, counselling sessions are held in order to educate and advise us against the use of alcohol. S3
We have a code of conduct which is spelled out clearly and every employee of the hospital is aware of. But sometimes they try to address it through counselling and if that fails then they warn and query them and sometimes even dismissal letters are issued to them. R2
No, we don’t have a separate policy for alcohol use disorder, we have a policy code of conduct, full policy it borders on everything and management have been a bit strict on it, ……. verbal warnings and advises, and if you fail to adhere to them, these policies are……… and the punishment thereof given. S2
Responses gathered from participants revealed that these institutions do not have a single set or standalone policy on AUD rather it is embedded in their codes of conduct which is made known to every employee of the organization. Others also made mention of some form of assistance put in place by employers to support employees in the form of counselling programs that help employees cope with stress, mental illness and other related issues. None specifically mentioned Employee Assistance Programme (EAP) that has been shown to help persons particularly with AUD as asserted by Ames and Bennett’s (2011) that some workplace offers many advantages as a setting for preventing alcohol issues among their employees.
Most found the counselling sessions to be very helpful. Others also stressed that their code of conduct included punishments such as dismissal when seen drunk on the work premises during working hours as these can cause damage to the organization. In addition, room is not created to recruit people with alcohol use disorders.
In our institution, as human resource persons we are not allowed to recruit people who have drinking habits or uncontrollably drinking habits as all candidates we aspire to employ go through a physical examination before they are brought on board. We deal with patients not to recruit and treat people we bring on board. However if per chance an employee should exhibit such tendencies after being recruited the severity of the issue will cause the dismissal of the person. R4
The study findings is similar to Negura and Maranda’s (2008) study who sought to examine the social representations underlying managers’ behaviour towards the issue of substance misuse in the company or the hiring process. Seventy managers hiring potential workers for medium-and small sized companies in Montreal and Quebec in Canada were sampled for the study. Data from the managers using a semi-structured interviews indicated that the managers were less likely to employ people who abuse substance of any form, in that the managers were closed minded and ambivalent towards such people.