ITALY: EWCO CAR on Use of Alcohol/Drugs at the Workplace

  • Observatory: EurWORK
  • Topic:
  • Health and well-being at work,
  • Working conditions,
  • Published on: 07 May 2012

Mario Giaccone, Daniele Di Nunzio

Disclaimer: This information is made available as a service to the public but has not been edited by the European Foundation for the Improvement of Living and Working Conditions. The content is the responsibility of the authors.

While alcohol and drugs abuse is a very sensitive issue for specific targets, especially students and young people, there is quite a poor attention at workplace. Specific information are limited to some local-level surveys. Further, prevention policies display quite poor link with workplace and trade unions raise several critical issues about the employers’ implementory attitudes.


Block 1: Main sources of information dealing with the issue of alcohol/drug use at the workplace at national level and its relation with working conditions, etc.

1.1 Are there national statistical sources (surveys, administrative registers including company reports as surveys / reports from the Labour Inspectorate, Labour doctors, etc) that provide information on the issue of alcohol/drug use at the workplace in your country? If so, identify them and explain their characteristics and methodology. Please refer both to general population health surveys/sources or general alcohol/drug use surveys/sources as to working conditions or workplace specific surveys/sources

  • Name of the statistical source

  • Scope

  • Goals

  • Methodology

  • Periodicity

The reference source for alcohol consumption is the multi-purpose Istat survey “Aspects of daily life”, carried out every year: figures are summarized in both consolidated and thematic reports. The questionnaire includes a section on alcohol consumption by type of beverage (beer, wine, appetizers, bitters, liqueurs), type of consumption (regular or occasional basis), and quantity consumed (half a liter in the case of wine and beer, 5 drinks for other beverage) in order to highlight binge drinking and risky behaviour.

Similarly, the reference source about drugs consumption is the Epidemiology section of CNR (national research center) which carry out the Annual Report to the Parliament on drug dependencies and regional reports in several regions (Veneto, Abruzzi, Liguria and Sicilia).

1.2. Are there any other sources of information (published after mid-2000s) that may provide valuable information on the issue (i.e. ad-hoc studies, sectoral studies, administrative reports, articles, published case studies, etc). If so, identify and describe them.

Further figures at national level are available from Espad (the European School Survey Project on Alcohol and other Drugs) and EMCDDA (the European Monitoring Center for Drugs and Drug Addiction). At national level, the portal on public health epidemiology Epicentro managed by ISS (Istituto Superiore di Sanità, National Institute of Health), which set up a specific observatory, summarizes the main policies over both alchool and drugs consumption, including the annual report on drugs consumption to the Parliament where there are some information about the employment conditions of the people assisted by the public services for problems related to the use of psychotropic substances.

At local level, Regione Marche in cooperation with Ispesl (now the research branch of Inail, the national insurance against work accidents), and the province of Modena health services carried out surveys on alcohol at worker, respectively in transport and manufacturing. A survey was carried out in Dalmine, a large metalworking company. A survey construction workers’ working conditions, carried out in 2008 by Fondazione Seveso on the behalf of Filca-Cisl of Lumbardy (the federation of construction employees), includes a question on drug abuse at workplace (Negrelli, 2009).

The occupational health services (OHS) in regione Abruzzo carried out an extensive survey on any addictive substances consumption amongst young workers (Manzoli et al., 2007, Manzoli et al., 2009).

Block 2: Information on the extent of the use of alcohol and drugs at the workplace in your country, as well as the type of situations (sectors, occupations, working conditions, etc.) in which this use occurs, its consequences (production process, social relations at work) and the rationale behind it

2.1. Please provide the available data and information on the prevalence of drug/alcohol use at the workplace in your country, if possible differentiating data by:

  • Type of substance

  • Sectors => specific focus on the construction and transport sectors

  • Occupational profiles

  • Other relevant variables

According to the 2010 wave of multi-purpose Istat survey “Aspects of daily life”, the share of the population people consuming alcohol shows a slight decline over time (from 70.4% in 2000 to 67.6% in 2010), especially regular consumption (from 33.5% in 2000 to 27.2% in 2010) although the share of those drinking them while not eating increases from 23.2% in 2000 to 25.8% in 2010. Men drink alcohol more than women and display a slower decline.

Table 1 Alcohol consumption in the general population by gender
% values 2000-2010











Over the past 12 months







Every day














While not eating







Source: Istat, 2011

Along the past decade, Istat reports focus their attention on the nexus between alcohol consumption and road accidents, especially amongst young people and their propensity to go into discotheques. The consolidated reports provide some figures about the occupational status disaggregated by gender but not about their habits at workplace. Employed people not drinking any alcohol are less than the overall population (20.7% with respect to 29.5% in 2006, 22.3% with respect to 31.3% in 2010) with an almost steady gap over time. Both gender employed report a generalized increase in non-drinkers amongst all occupational groups (from 11.4% to 13.4%), especially blue collars (from 13.2% in 2006 to 16% in 2010), except managers and especially self employed women (respectively from 30.3% to 27.3% and from 41.1% to 36.5%).

Table 2 Attitude towards alcohol by occupational status and gender
% values, 2006-2010




Men drinks alcohol while not eating of which less than once a week does not drink any alcohol drinks alcohol while not eating of which less than once a week does not drink any alcohol








managers entrepreneurs etc.







cadres, clerks







workers, apprentices







self employed







overall population







women drinks alcohol while not eating of which less than once a week does not drink any alcohol drinks alcohol while not eating of which less than once a week does not drink any alcohol








managers entrepreneurs, etc.







cadres, clerks







workers, apprentices







self employed







overall population







Total drinks alcohol while not eating of which less than once a week does not drink any alcohol drinks alcohol while not eating of which less than once a week does not drink any alcohol








managers entrepreneurs, etc.







cadres, clerks







workers, apprentices







self employed







overall population







Source: Istat, 2007-2011

Health services in the province of Modena carried out a survey on alcohol at workplace in 2002-2004, followed up by extensive information actions, collecting 1,043 questionnaire out of 5,200 total employees in 21 factories, 79.1% of them blue collars. While 91.7% report being informed that alcohol consumption at workplace is forbidden, 43.4% report having not been informed by their employers and 24% of respondents still drink alcohol at workplace. This notwithstanding, 45% of respondents believe that the incidence of alcohol-related work accidents is "very high" and 42% consider it "high".

According to a campaign of controls on alcohol levels, carried out in 60 construction yards in the province of Teramo (Central Italy) in summer 2006, 9% over 342 workers controlled (10% of the total employment in the sector) consumed alcohol, 19% of which alcohol levels over 0.5 g/l (numero 2006, 28:3 pagg 57-60). Alcohol presence was mainly detected in the afternoon (87% of positive cases), on Monday and Friday (62.5%) and amongst those aged 46-50, by showing a "substantive overlappings" with work accidents' occurrence reported by Inail records (Cocchini et al., 2006). None of the involved workers refused to submit to the test.

According to a survey carried out in a metalworking factory in Tuscany , 60% of respondents consume alcohol, 40.7% believe that in general alcool heatens and 50.9% it makes more disinvolti, although most of them are aware that its consumption at workplace reduces work abilities (81.4%) and increases the risks of work accidents for both the drinkers (80%) and those working with them (61.1.%).

There are no national figures available for working population over drugs consumption. According to the 2009 National Report to the EMCDDA by the Reitox Italian Focal Point, the s were respectively 1.6% of general population (aged 15-64) who stated that they have used heroin at least once in their lifetime, 7% cocaine, and 32% cannabis. Their consumption is on the increase since 2003..

The Annual Report on Drug Addiction in Italy organized by the Anti-drug Policies Department of the Presidency of the Council of Ministers, estimates approximately 2,924,500 consumers in 2010 both occasional addiction and daily use (4.85% of resident population). Further, from the SERT (“Servizio Tossicodipendenze”, Drugs Services) data, addicted individuals needing treatment are 338,425 (8.5/ 1,000 residents aged between 15 and 64 years), mostly for opiates (5.5 / 1,000 residents) and cocaine (3.0 / 1,000 residents). 65% of SERT users are employees (mainly with a casual or fixed work) and 31% is unemployed.

Different researchers try to identify the incidence rate of drug consumption among workers, especially focusing on the compulsory test required by law for specific professions, even if there is not a national survey. According to 3,000 anonymous questionnaires collected nationwide amongst young workers (18-35 years) in 2007, drug consumption is not negligible: 13.5% said they had used cannabis, 4.5% cocaine, 1% opiates, 1.2% acids or other substances(Manzoli, 2007). A research on young workers in Abruzzo (Manzoli, 2009) identifies for the first time significant associations between certain types of use or abuse and professional status: for instance cocaine consumption is associated with professions involved in sales and services; drugs and cannabis with unskilled occupations, stallholder and temporary workers; tobacco consumption with call center operators; overweight and obesity with craft workers and farmers.

The Toxicology Laboratory of Varese has conducted tests on 1447 urine samples of 1369 workers in different professions subject to compulsory drug test between September 2008 and May 2009 (Ferrario et. al., 2009). All workers positive to drug consumption (1.8% of the sample) are employed in transport activities (but we have to consider that the 83.5 of the sample were involved in these activities): 1% used cannabis; 0.5% cocaine; 0.2% opiates, 0.07% methadone. A research in Varese shows that young age and the presence of another positive case in the same company are among factors associated with a positive outcome of the test, (Crespi et al., 2010). Finally, a research on a cohort of 1815 public transport drivers, 9 subjects showed positive for cannabinoids, 2 and 1 positive for cocaine positive for opiates (Riboldi et al., 2009).

2.2. Please provide data and information on the rationale and consequences of drug/alcohol use at work. Focus on construction, transport:

Reasons for consuming alcohol/drugs

  • Use of drugs related to certain working conditions (e.g. alcohol when working in cold / warm environments; stimulants when working at high rhythm, etc…)

  • Accessibility/availability

According to Lombi ( 2010) 6.6% of respondents drink alcohol at workplace “sometimes” or “often”: such a share increase to 14.3% amongst skilled blue collars, 10.7% amongst performing physically demanding tasks. Construction and transport display a share higher than average (respectively 10.1% and 9.3%) but well below commerce and horeca (21.1%). Similar patterns are found for drug consumption, described in terms of a “proximity index”, reported as high for 7.9% of respondents: semi- and low-skilled blue collars (15.9%), nonpermanent workers (18.1%) working in family-managed firms (20.2%) and small businesses (13.3%) report the highest scores. Again, construction and transport display a share higher than average (respectively 10.1% and 9.3%) but well below commerce and horeca (17%).

Consequences of consuming alcohol/drugs

  • working conditions affected by drug use (risk increase, accidents, absenteeism, sick leave…):

  • Accidents and fatalities due to alcohol/drug use

  • Sick leaves attributed to alcohol/drugs, absenteeism

  • Assessment of costs

  • Use of alcohol/drugs negatively affecting other working conditions:

  • Uneven workload distribution…

  • Work organisation

  • working environment (deteriorated social relations at work, higher number of conflicts…)

According to Mariotti, 2004, absenteeism is more than double and occupational accidents are almost four times higher amongst drug addicted employees than non-addicted that the other people, thus reflecting that the intake of these substances alters the reaction times, reduced perception of danger and, more generally, concentration and work performance. This account of the possible effects on third parties: co-workers, users, citizens. Probably the same cannot be said for the occasional consumers outside of working hours, for which the studies conducted to date do not confirm a similar correlation, of course, excluding the case of acute effects from recent consumption.

Many researches demonstrates that there is a relation between drugs consumption and tiring and stressing working conditions, and the increase use of cocaine among workers could be associated to rhythms increasingly frenetic, competitive, success-oriented and profit, representing a “functional support almost imposed from outside factors” (Cipolla C., 2007). A recent research under direction of C. Cipolla give some relevant information about the link between work and drug consumption, with a survey on 1.223 workers (some relevant results are analyzed and presented in Lombi L., 2010) even if all the researches on these issues have many difficulties related to confess bad behaviors punishable by a penal point of view. Among the consequences of alcol and drug consumption, the most common problem seems to be the decrease of concentration at work (30.4%), followed by relationship problems (28.6%), difficulty in maintaining the required productivity (26.5%), health problems (25%), absenteeism at work (20.5%), legal problems (13.5%), accidents (13.1%) and, finally, accidents (11.2%) related to "alcohol and drugs.

According to the Negrelli (2009), 57.8% of respondents in the construction industry in Lumbardy believe it is “false” that there is any drug consumption at workplace, 22.6% share the view it is used in order to cope with personal uncomfort, 5.8% in order to face workload, 4.9% as everybody do so, and 3.1% in order to have more money for fun. There are significant differences amongst the province of Milan and the provinces of Bergamo and Brescia: while in the former “personal uncomfort” item scores 25.6% against (20% and 13.7%), these latter display higher consensus “excessive workload” item (respectively 9.6% and 6.5%) than in Milan (4.7%), with a higher scope for endogenous reasons, thus validating findings from several journalistic inquiries.

Block 3: Identify legislation and agreements at national level concerning alcohol/drugs use at the workplace, specifically

3.1. Please identify and describe the main existing legislation and agreements concerning the prohibition/limitation of alcohol/drug use at work:

  • Is there any legislation or agreement specifically intended to prohibit or limit alcohol/drug use at work? Please describe:

  • Type of legislation / agreement (Government or parliament laws, agreements from social dialogue, from the Governments and social partners, from other organisations, etc.)

  • Contents, stipulations

  • Collectives affected

  • Is there any sectoral legislation or agreement with the same purpose? Please focus on the construction and transport sectors

Law 125/2001 forbids alcohol consumption to those workers performing tasks with at high work accidents' risks: 33 occupations are listed in the 2006 State-Regions agreement, as these latter have the competence on health service, including drivers, teachers and children carers, construction, tasks at height over 2 m, tasks fusion ovens, mining, petrolchemical and wood industries. However, the occupational health and safety unique text (legislative decree 81/2006), while prohibiting alcohol consumption at workplace, allows its limited consumption in canteens while eating. Further, as the Regione Emilia-Romagna guidelines for managing alcohol at workplace point out, legislation is unclear whether such restrictions are explicitly limited to just workplace or employees must get at workplace having not consumed alcohol before (see also for a more extensive discussion Annovi et al, 2006).

Law n.162/90 provides that workers with an established state of addiction, involved in a treatment programs and rehabilitation of health services, if taken indefinitely have the right to preserve the job for as long as the suspension of work performance is due to the implementation of rehabilitation and treatment, however, for a period not exceeding three years.

According to the State-Regions Agreement of October 2007, some specific categories of workers are considered at risk for safety, the safety of his own and others, also in case of sporadic use of drugs and the procedures of medical testing are specified in the State-Regions Agreement of September 2008.

For some specific activities is required a certificate of competency for the performance of hazardous tasks: a) use of toxic gases; b) tasks related to transport activities;c) operational functions of its employees and managers of production, packaging, possession, transportation and sale of explosives.

3.2. Specific focus on legislation / agreements regarding testing practices intended to control the use of alcohol/drugs at work. Please consider questions such us:

  • how are the tests regulated (agreements / legislation or are there guidelines)?

  • what type/forms of tests – testing methods and for what type of substances?

  • who can ask for tests, on who's initiative are tests initiated? for what purpose/reasons?

  • is the consent of the person to be tested needed?

  • is pre-employment testing (before work contract signing) allowed? can tests be included as a clause in work contracts?

  • by whom are the tests undertaken? are tests limited to safety sensitive positions or specific sectors (transport, etc.) or are they overall?

  • when, at what moment can tests be undertaken?

  • What are the necessary established pre-conditions for proceeding for a test?

  • what are the conditions/rules/procedure under which tests can be undertaken? what is the role of the labour doctor and labour inspectorate in testing?

  • To whom will the results be communicated and under what reporting form/

  • who has access to the results of the tests?

  • what can be the consequences of positive results on the work contractual relation?

The so-called "Workers' statute" (law 300/70), att. 5, defends employers to carry out medical inspection on employees' ability to work, which is reserved to public health services or health inspectors of social security institutions, while workplace doctors can carry out visits according to surveillance plans.

According to the Consolidated Act on Health and Safety at Work of 2008 (D. Lgs. 81/08), art. 41, the occupational doctor’s have to evaluate the compatibility between the person and the specific work activity, with 4 typologies of response:

  1. suitability;

  2. partial - temporary or permanent - suitability, with requirements or limitations;

  3. temporary unsuitability;

  4. permanent unsuitability.

The position of social partners and of scientific community on these issues is of extreme caution, since the drug prevention concerns the sphere of personal behavior, even with direct and indirect reflections on living and working, both individually and collective level. Actually, there is an high debate about the procedures and methodologies of evaluation among the social partners and public institutions.

Regions, which are entitled of health services, including OHS, set up their test procedures according to the State-Regions 2006 (on alcohol) and 2008 (on drugs) agreements.

For instance, the Regione Emilia-Romagna guidelines for workplace doctors about alcohol prevention, diagnosis and cure combines laboratory screening with a simplified version of the WHO's Alcohol Use Disorders Identification Test.

Trade Union Confederations express some alarms (in an Unitarian note in 2008 of Cgil, Cisl and Uil, as well as in public debates, e.g. in some conferences in Bologna and in Lombardia, in 2009) concerning:

  1. the risk of individual repression at work;

  2. the lack of prevention activities, especially considering the lack in counseling and support, a poor role for the occupational doctor in the prevention, lack in information and training, lack in the action on work organization;

  3. the lack in the involvement of workers and their representatives;

  4. the lack of a structured company strategy with the involvement of all the actors of the risk assessment system;

  5. the lack of preventive actions and agreements outside the company, e.g. at local or national level;

  6. the risk for the worker to lost his job without a re-integration process.

These arguments support Trade Unions’ fears of abuse in drug-test at workplace, as explained by the Cgil Modena and the metalworkers’ union Fiom-Cgil.

The employers associations consider controls as an useful tool to guarantee the health and safety of all the workers and of clients, also with a positive impact on the competitiveness of the company; on the other side, they ask for a simplification of the procedures related to the investigations, as reported in some public conferences (e.g. in the Confindustria Representative Document at the National Conference on Drugs in 2009).

Describe changes, evolution development of regulation / agreements on testing, drawing the attention to the review in light of the improvement of the testing methods

According to the 2008 State-Regions agreement mentioned above, all workers in those activities listed above (section 3.1) should be subjected to toxicological testing by competent physicians (workplace). The test-positive workers will be temporarily suspended from work and he have to go to the Sert. Sert has the task if the subject is addicted or not. In the case of a diagnosis of addiction as clearly expressed by the team of Sert, the employee will be suspended from work to undergo a specific treatment, as provided by the national labor contracts, after which it will be reinstated in the workplace.

The State-Regions Agreement of 2007 provides three different types of tests:

  1. to identify the absence of drug abuse;

  2. preventive health screening tests with the aim to verify the absence of drugs and psychotropic substances consumption carried out by an occupational doctor, in the moment of recruitment (or for a change of activity) and during the periodical health monitoring on an annual basis (timing can be modified by the occupational doctors) upon notice of at least one day;

  3. investigation of drug dependence diagnosis, carried out by the ASL only if the indication of occupational doctor.

The 2005 National labour contract in logistics and road transports introduces an unpaid leave to those workers working on a permanent basis reporting an alcohol or drug dependency state and starting a rehabilitation program with public health services or qualified organization. employees having a relative needing support for such dependencies can apply for. Such a leave is longer for drug dependents (12 months) than for alcohol dependents (3 months) and can be applied just once. Further, in case of ascertained drug dependency, the employer have to move the employee from the task implying risks to other workers’ health and safety. The 2011 national labour contract logistics and road transports, while confirming such regulations, includes a social partners’ joint commitment in promoting company-level agreement in order to tackle “anomalous absenteeism” as it negatively affects efficiency and firms’ competitiveness.

Block 4: Identify and describe national prevention programmes to combat the use of alcohol/drugs at the workplace, especially those based on agreements and cooperation of the social partners:

  • Organisation(s) responsible for these programmes

  • Drivers and motivations. Objectives

  • Target groups (sectors, specific occupations…)

  • Content and activities developed (campaigns for alcohol/drug free workplaces, information to workers, training, professional counselling and personal assistance, reintegration programmes…)

  • Tools (seminars, brochures, toolkits, guidelines, polls, tests…)

  • Inter-relation with other (health) programmes. Participation of health professionals

  • Are the prevention programmes integrated in the general working conditions/OSH training programmes and management systems?

  • Are the prevention programmes based on joint assessment of the social partners and defined in an agreed policy for the enterprises? Role of work councils and H/S committees.

  • Performance and outcomes of the programmes

  • Changes overtime

  • Assessment of the programmes. Point of view of the social partners.

SERT are the reference structure for prevention actions: they are specialized in the diagnosis, treatment and rehabilitation for people with addiction problems, considering illegal substances (hashish, ecstasy, cocaine, heroin), legal (alcohol, tobacco, drugs) and from behaviors (gambling). SERTs provide listening service, hospitality and advice, addressed to family members, making interventions for addiction; define therapeutic programs and prepare entries in therapeutic communities, dealing with information and prevention.

The 2007 National place on alcohol and health includes workplaces amongst the strategic areas of intervention, having as specific focus work accidents and violence at work, including third parties such customers. It elicits social partners’and local governments’ collaboration in order to promote information, education and secondary prevention by respecting privacy rights.

The most relevant experiences in alcohol prevention are put in place in Emilia-Romagna by setting up guidelines and textbooks (Annovi et al., 2006), in Veneto, where social partners of the province of Verona published a shared brochure to be released to all employees, and in Lumbardy, where the health services of Brescia, in cooperation with the local Associazione Industriali, belonging to Confindustria (the main employers’ association in manufactuing sectors)

National Public Department for Anti-Drug Policies carried out different activities with the aim to contrast the drug addiction, considering the prevention activities especially focused on workers, the most relevant are:

a. DTLR - Monitoring and Evaluation od Drug-Testing, in collaboration with RFI - Rete Ferroviaria Italiana (The public-owned railways infrastructure manager). Project for the creation of a monitoring and evaluation system of Drug Tests on national territory workers with jobs at risk, also with the aim to create a permanent data-base for inter-institutional technical support

b. RELI - Re-employment for drug addicts, supported by the Regione Sardegna. Promotion and realization of a new model (with the collaboration among public and private sectors) of rehabilitation, social and working reintegration for drug addicted persons from the Sert and from the Therapeutic Health Assistance Communities, by the activation of a national network of companies associations and local organizations.

Some training activities are promoted by public health services in collaboration with social partners, with the aim to improve the knowledge of preventive actions and the risk evaluation system (e.g. the course for Workers’ Safety Representatives organized in Milan by trade unions and the local health services).

Commentary by the NC

While there is considerable evidence about the use of alcohol and drugs in daily life, with a specific focus on young people, especially students, and older people in case of alcohol, there is quite a poor evidence about both their use at workplace. Legislative changes display different approaches: while in the case of alcohol use at workplace there are some ambiguities, thus reflecting the strenght of stereotypes about its beneficial effect, especially amongst strenuous jobs, such as construction and metalworking, in the case of drugs these changes display an explictitly “prohibitionist” design, with a quite heavy burden on workplace management. Trade unions in both construction and transport display a wider attention to the issue, while in other sectors more actively cooperate with both health services and NGOs, also displaying some concern about the respect of personal dignity.

Further, according to the 2009 EMCDDA annual report, notwithstanding the Italian Action Plan against drugs includes workplace prevention amongst its objectives and some good practices in some regions, “prevention in the workplace and the related drug addiction services seem the weakest link in regional policies” and as “the subject does not seem to be on the agenda for Regions”, notwithstanding “rare good practices”. In particular, “the risk that the policy of workplace controls deprives small companies of essential staff seems well-established”.


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Mario Giaccone, Daniele Di Nunzio, Ires

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