This page provides guidance for managers on how to approach the problem of drug and alcohol misuse in the workplace.

Substance misuse

Misuse refers to the use of illegal drugs and the misuse, whether deliberate or unintentional, of other drugs, including alcohol and substances such as solvents. Substance misuse can harm the misuser both physically and mentally and, through the misuser’s actions, other people and the environment.

Misuse covers three main areas:

  1. Inappropriate use, where use may aggravate an existing condition or situation, or is done in potentially dangerous or inappropriate circumstances;
  2. Habitual use, where the individual becomes dependent on the effects of the substance to the extent that the desire for these effects becomes a dominant concern, to the detriment of other aspects of their life;
  3. Excessive use, which can lead to physical and mental illness, or antisocial behaviour.

Prescribed medicines

Prescribed or over-the-counter medicines might cause impairment to an individual’s performance at work. Individuals should seek advice from their GP or pharmacist on any medicines they are taking. If appropriate, they should be encouraged to discuss any problems with their occupational health service if they feel this would be helpful, and/or they should inform their line manager of any possible side effects of their medication.

A ‘high functioning addict’

A 'high functioning addict' describes someone who is managing to mask their addiction. The fact that they are functioning 'well', means they are less likely to seek treatment as they may not always recognise that there is a problem. As an employer, it can be difficult to identify these individuals, but some signs to look out for can be found in this PDF.

Criminal activity

The possession of illegal drugs with the intention to deal is illegal and should be reported to the police. Managers will need to be aware of this when drafting their policies. Random testing of staff, as a tool for managing substance misuse, is not appropriate for NHS employers.

Self-referral, treatment and rehabilitation

Staff should be encouraged to seek help through their GP's provision of confidential advice and assistance. In consultation with the employee, their GP will take steps to arrange for counselling, treatment and rehabilitation, with periodic testing if appropriate. Employees at all levels and in all professions should be made aware that they can consult their local occupational health service to discuss any matter associated with drug or alcohol misuse.

Staff can also refer using the Keeping Well website.

The contact details of local organisations that can provide assistance to staff members, who may feel unable to consult their own occupational health service, should be prominently displayed and readily available to all staff. All this information can be found on our drug and alcohol advice/support lines page.

Employers should not automatically invoke disciplinary action for voluntary referrals where the employee successfully undergoes a programme of treatment.

More information can be found in this PDF.

The role of occupational health services

Occupational health may be where the problem is acknowledged first. This may be through self-referral, management referral or when another issue has been raised. If employees acknowledge an alcohol or drug problem, they should be referred to the occupational health service. Non-compliance with the referral and action recommended by the occupational health service might lead to disciplinary action.

On referral to the occupational health service, an assessment should be made of the employee’s fitness for duty. This should be a specialist comprehensive medical assessment. Following assessment, the occupational health service should advise the line manager of the employee’s fitness for work on medical grounds.

However, not all occupational health services will have the appropriate experience and knowledge to enable them to deal with this problem. The occupational health service will normally liaise with the GP, who should arrange treatment, involving specialists in the management of alcohol or drug misuse.

The second role of occupational health is managing the employee’s return to work. Those treating substance misuse are not always aware of the occupational implications and there is a role for occupational physicians in ensuring a suitable and satisfactory return to work. In the majority of cases, the employee should be returning to the same work they were doing before the problem was recognised.


Employees are entitled to representation by a colleague or friend, or by a union or professional organisation representative, at any stage of the management process that has been outlined. Management has the right to the support of the human resources department.

Further support

The best way of dealing with the real or potential effects of drugs and alcohol at work is to make expert advice and help readily available. Employers should make the necessary provision to assist employees to avoid problems and resolve them when they arise.

Keeping Well and occupational health can be contacted for support and advice. Keeping Well BLMK has a dedicated Substance Misuse Practitioner.

Updated on: 20/04/2022