Diana Chapman Walsh

A Randomized Trial of Treatment Options for Alcohol-Abusing Workers

BACKGROUND Employee-assistance programs sponsored by companies or labor unions identify workers who abuse alcohol and refer them for care, often to inpatient rehabilitation programs. Yet the effectiveness of inpatient treatment, as compared with a variety of less intensive alternatives, has repeatedly been called into question. In this study, anchored in the work site, we compared the effectiveness of mandatory in-hospital treatment with that of required attendance at the meetings of a self-help group and a choice of treatment options. METHODS We randomly assigned a series of 227 workers newly identified as abusing alcohol to one of three rehabilitation regimens: compulsory inpatient treatment, compulsory attendance at Alcoholics Anonymous (AA) meetings, and a choice of options. Inpatient backup was provided if needed. The groups were compared in terms of 12 job-performance variables and 12 measures of drinking and drug use during a two-year follow-up period. RESULTS All three groups improved, and no significant differences were found among the groups in job-related outcome variables. On seven measures of drinking and drug use, however, we found significant differences at several follow-up assessments. The hospital group fared best and that assigned to AA the least well; those allowed to choose a program had intermediate outcomes. Additional inpatient treatment was required significantly more often (P less than 0.0001) by the AA group (63 percent) and the choice group (38 percent) than by subjects assigned to initial treatment in the hospital (23 percent). The differences among the groups were especially pronounced for workers who had used cocaine within six months before study entry. The estimated costs of inpatient treatment for the AA and choice groups averaged only 10 percent less than the costs for the hospital group because of their higher rates of additional treatment. CONCLUSIONS Even for employed problem drinkers who are not abusing drugs and who have no serious medical problems, an initial referral to AA alone or a choice of programs, although less costly than inpatient care, involves more risk than compulsory inpatient treatment and should be accompanied by close monitoring for signs of incipient relapse.

Health Promotion versus Health Protection? Employees' Perceptions and Concerns

The “second public health revolution” targets factors in the environment, together with lifestyle, to prevent illness and untimely death. Yet the growth of the “wellness movement” has driven a wedge between public health advocates who argue for environmental solutions and those whose major focus is individual behavior. This tension is nowhere more evident than in the workplace, where the new wellness professionals are at odds with specialists in occupational health and industrial hygiene.This paper reports findings from a cross-sectional survey of a sizeable sample of workers at six New England facilities of a very large American manufacturing firm, assessing their perceptions of risk in the two domains: environmental exposures and lifestyle risks. Multiple regression analyses reveal that both job risks and life risks are associated with a variety of potentially costly and disruptive health problems, even after controlling for demographic and occupational factors. This analysis suggests that wellness programs in the workplace will be more effective if they integrate environmental protection with efforts to reduce lifestyle risk.

Researching and preventing alcohol problems at work: toward an integrative model

Purpose of Proposal. A consolidated framework is proposed to highlight modifiable factors in work organizations that may contribute to alcohol-related problems. This research model serves to organize existing knowledge, highlight pathways for new research initiatives, and offer insights into the design of primary and secondary preventive strategies. Contributing Influences. Current research on problem drinking in the workplace either locates problems in individual drinkers or looks to the social environment to understand how drinking problems unfold. There is a clear need for a more complete theoretical model which incorporates social, cultural, organizational, and personal factors. Proposal Summary. This article elaborates on a model for examining problem drinking at work which integrates policy, normative, and psychosocial influences. It emphasizes the structures within which health-related decisions and actions are contained and constrained. The focus here on the connections between alcohol use and work builds on the premise that health is socially produced.

Toward a sociology of worksite health promotion: A few reactions and reflections

This collection of papers fairly represents the range and depth of current sociological thinking on health promotion at the worksite. In so doing, it invites scholarly attention to a field that is embryonic and in many ways still struggling to formulate workable answers to a cascade of pressing questions about what works best, and why, and at what price, borne by whom (whether wittingly or not). Sociological analysis of health promotion has been relatively rare. As Conrad observes in his introduction to this special issue, the literature on worksite health promotion programs has been concentrated mostly in health education, occupational health, and public health journals. Also, it has been bifurcated. By far the larger branch has been decidedly utilitarian, looking for practical insights into how best to organize programs the value of which is taken mostly for granted. The smaller, more critical branch has sounded alarms about social control, hidden agendas, and harmful and/or unintended consequences. The first group of writings has tended to adopt a positivist tone and to be basically atheoretical; the second has been more frankly polemical, but often short on valid or compelling data. The present collection begins to bridge the gap between the two branches and to adumbrate what sociology can bring to the study of health promotion on the job. More than answers, the worksite health promotion field urgently needs a more self-conscious approach to the posing of answerable-and fundamental--questions. This question posing is what the authors of these eight new papers are struggling to do, with varying degrees of success because the field is so new. Nevertheless there is much we can learn from these papers: from what they say or neglect to say and from difficulties they encounter. Rather than try to canvass all the terrain they collectively cover, I will dwell on the two issues they raise that seem to me most salient. They are intertwined and can be thought of as issues of meanings and questions of motives.

Payer, provider, consumer : industry confronts health care costs

1. Introduction: Industry Confronts Health Care Costs.- 2. Industry as Payer: Employee Health Benefits.- Assuming a Broader Role.- An Expanding Benefit Package.- Some Causes and Effects of Rising Costs.- Approaches to Cost Containment.- 3. Industry as Provider: Health Programs Sponsored by Employers or Unions.- Early History.- Occupational Medicine Takes Shape.- The Occupational Safety and Health Act.- Industrial Medical Programs.- Creating Alternative Delivery Systems-A Role for Industry.- 4. Industry as Consumer: Health Planning and Consumer Health Information.- Community Health Planning.- Industry Involvement in Health Planning.- Individual Decisions about Health and Health Care.- 5. Summing Up.- 6. Issues for the Future.- Appendix: Conference Participants Quoted.- Notes.- Annotated Bibliography.

Divided loyalties in medicine: The ambivalence of occupational medical practice

This paper develops two divergent views of occupational medicine. The first holds that the field has a major contribution to make in the prevention of disease and the stabilization of health care costs. The second sees in it all the worst characteristics of contemporary medical practice. Consideration of the special difficulties of occupational physicians raises fundamental questions about the divided loyalties and moral conflicts that will increasingly beset the general practice of medicine as bureaucratic forms and controls continue to proliferate.

Women, work, and health : challenges to corporate policy

I. Context and Current Issues.- 1. Genesis and Highlights of a Conference.- 2. Overview: The Health of Working Women.- II. Physical Conditioning, Strength, and Stamina.- 3. The State of the Art of Strength Testing.- 4. Moving Women into Outside Craft Jobs.- III. Social Conditioning and the Culture of the Corporation.- 5. Changing Roles and Mental Health in Women.- 6. Employee Health Services for Women Workers.- 7. Special Needs of Women in Health Examinations.- 8. Sex Discrimination in Group Pensions.- IV. Reproductive Potential and Possible Occupational Hazards.- 9. A Legal Perspective on Workplace Reproductive Hazards.- 10. The Biology of Toxic Effects on Reproductive Outcomes.- 11. Evaluation and Control of Embryofetotoxic Substances.- 12. Fetotoxicity and Fertile Female Employees.- 13. The Control of Hazardous Exposures in the Workplace.- V. Pregnancy and Maternity Leave.- 14. A Legal Perspective on Pregnancy Leave and Benefits.- 15. Non-Medical Issues Presented by the Pregnant Worker.- VI. Issues for the Future.- 16. Challenges to Corporate Policy.- Appendix: Conference Participants.

Periodic medical review: assessing the quality and appropriateness of care in skilled-nursing facilities.

Mandated by Congress in 1969,1 Periodic Medical Review (PMR) is a state-run program of external peer review of the care rendered Medicaid-supported patients in skilled-nursing facilities (SNF). In ...

Comprehensive health care and motor-vehicle safety.

Motor-vehicle accidents in Massachusetts last year claimed on the order of 31,000 years of potential life1 (Table 1), second for that dubious distinction only to ischemic heart disease. Accidents i...

Graduated sanctions to enforce nursing-home standards.

The nursing-home industry in the United States is, on paper, the most closely regulated sector of the health-care system. Owing in part to the dependency of many patients1 and their inability to ex...