Drug and Alcohol Dependence, 10 (1982) 223 - 233 223 FEMALE REFERRAL TO EMPLOYEES ASSISTANCE PROGRAMS: THE IMPACT OF SPECIALIZED INTERVENTION MARY H. CAHILL, BEVERLY J. VOLICER and EVELYN NEUBURGER The Planners Studio, 375 Elliot Street, Newton Upper Falls, Massachusetts 02164 (U.S.A.) (Received July 14, 1982) Summary A model intervention to address the needs of female employees with drinking problems was undertaken in several federal agencies participating in an employee assistance program. Supervisors and employees provided information through questionnaires, obtained at the time of the intervention and subsequently, on response to the intervention and later behavior. Further, detailed information was collected on clients entering the employee assis- tance program. Results indicated a positive increase in knowledge about alco- holism and a willingness to use the program. The intervention resulted in an increase in female referrals and a decrease in the proportion of female clients with prior disciplinary action. There was no significant increase in female alcohol-related referrals. There was a high incidence of alcohol problems among family members and possibly peers of women who attended the inter- vention programs. Introduction Research about the effectiveness of employee assistance programs ( EAPs) in identification and treatment of female employees, in general, and female alcoholics in particular, is in its infancy. Traditionally, employee assistance programs have been structured on a male model, designed and administered by men for a male clientele. However, since the proportion of women in the labor force has dramatically increased in the past decade, the effectiveness of these programs in reaching employed female alcoholics is now being challenged. According to occupational program practitioners, female alcoholic workers have not utilized existing company program, for help with their problems. Moreover, little attention has been paid to the strategies of identification and referral of female employees to company programs, or to the possible differences in approach which might be needed for men vs. women. Existing models for referral of problem drinkers to occupational pro- grams show supervisors as being in ideal positions to initiate this process by 0376-8716/82/0000-0000/$02.75 @ Elsevier Sequoia/Printed in The Netherlands
Transcript
Drug and Alcohol Dependence, 10 (1982) 223 - 233 223
FEMALE REFERRAL TO EMPLOYEES ASSISTANCE PROGRAMS: THE IMPACT OF SPECIALIZED INTERVENTION
MARY H. CAHILL, BEVERLY J. VOLICER and EVELYN NEUBURGER
The Planners Studio, 375 Elliot Street, Newton Upper Falls, Massachusetts 02164 (U.S.A.)
(Received July 14, 1982)
Summary
A model intervention to address the needs of female employees with drinking problems was undertaken in several federal agencies participating in an employee assistance program. Supervisors and employees provided information through questionnaires, obtained at the time of the intervention and subsequently, on response to the intervention and later behavior. Further, detailed information was collected on clients entering the employee assis- tance program. Results indicated a positive increase in knowledge about alco- holism and a willingness to use the program. The intervention resulted in an increase in female referrals and a decrease in the proportion of female clients with prior disciplinary action. There was no significant increase in female alcohol-related referrals. There was a high incidence of alcohol problems among family members and possibly peers of women who attended the inter- vention programs.
Introduction
Research about the effectiveness of employee assistance programs ( EAPs) in identification and treatment of female employees, in general, and female alcoholics in particular, is in its infancy. Traditionally, employee assistance programs have been structured on a male model, designed and administered by men for a male clientele. However, since the proportion of women in the labor force has dramatically increased in the past decade, the effectiveness of these programs in reaching employed female alcoholics is now being challenged. According to occupational program practitioners, female alcoholic workers have not utilized existing company program, for help with their problems. Moreover, little attention has been paid to the strategies of identification and referral of female employees to company programs, or to the possible differences in approach which might be needed for men vs. women.
Existing models for referral of problem drinkers to occupational pro- grams show supervisors as being in ideal positions to initiate this process by
0376-8716/82/0000-0000/$02.75 @ Elsevier Sequoia/Printed in The Netherlands
224
monitoring job behaviors of employees, and documenting changes in quality and quantity of performance [ 1 - 31. Recently, some researchers have sug- gested that these job-based criteria are not sensitive enough to allow super- visors to identify employees in the early stages of problem drinking [4]. Further, since these models are based on job criteria developed for the male alcoholic, they may be inappropriate for the female alcoholic. Several labor and management studies have suggested that traditional sex role stereotyping may cause supervisors to evaluate female and male employees differently [ 5, 61. Pryor and Mondy [ 7 ] in a survey of attitudes of workers, found that managers generally expected less of their female subordinates in regard to productivity. In the light of these possible differences in expectations for men and women, it may be that female alcoholics are able to get by with less than satisfactory job performance and therefore are not being referred to EAPs. If women do not fit the prescribed patterns for EAP referrals, then their supervisors may need to engage in more conducive management styles to facilitate referral.
Female employees, on the other hand, may need different motivations to seek help from the company programs than their male counterparts. Al- though self and family referral have been ongoing sources of clients to EAPs in the past, the emphasis on outreach at many programs has been directed to- ward male employees. Little attention has been paid to the issues of whether female problem drinkers could be attracted to EAP orientation programs directed to them at the worksite or whether this type of training would affect help-seeking behavior among participants, either for their own alcohol problems or those of family members. The apparent need for special atten- tion to these issues surrounding female alcoholism in the workplace led to congressional legislation that directed the National Institute of Alcohol Abuse and Alcoholism (NIAAA) to support efforts to assess and meet those needs. On September 1, 1978, the Occupational Branch of NIAAA contracted with The Planners Studio (PS) to conduct a demonstration project for women in the field of occupational alcoholism.
As part of that project, a needs assessment was conducted in 1979 in four sites with operating EAPs or alcoholism programs, including both public and private organizations at several locations in the Northeast. This assess- ment included a survey of the male and female employed populations in sev- eral work settings; interviews with management personnel including super- visors, company employee assistance program counselors and human resource managers; monitoring of EAP clients; investigation of existing treatment resources; and investigation of organizational policy and procedures for oper- ation and human resource management. The Planners Studio project interim report [8] includes the results of this first phase of the study. The findings are also summarized in subsequent publications [ 9 - 1 l] .
A model intervention to address the needs of female employees with drinking problems was designed in 1980 and took place from October 1980 through June 1981. It had been anticipated at the outset of the study that all four sites would participate in the intervention program. Due to various
225
problems which arose during the course of the study, the sites in the private sector withdrew prior to the implementation of the intervention, and there- fore the intervention was carried out only in the public site consisting of federal agencies. The results of the intervention program on both supervisors and employees, and the EAP itself are included in the final project report [ 121. The present paper discusses the evaluation of the project and implica- tions for future efforts of this kind.
Methods
The study s&e was a group of 12 independent and autonomous agencies located in a major metropolitan area. From 1980 to 1982, the 12 agencies employed 3210 males and 2338 females (total employment of 5548). The range of women’s skills varied; however, they fell into categories of clerical, secretarial, technical, supervisory and administrative workers. All 12 of the agencies contracted with a consortium employee assistance program based in the metropolitan area. The EAP offered a full range of diagnostic and referral services to employees and their families in response to personal prob- lems (i.e., alcoholism, drugs, marital, legal, financial, emotional) which might affect job performance.
A survey of employees conducted at the site in 1979 resulted in esti- mates of the frequency of problem drinking of 12% among females and 22% among males. Analysis of data from clients entering the EAP program indi- cated that fewer than 1% of the female problem drinkers and only 1.3% of the male problem drinkers had entered the EAP for help with their alcohol problems. Analysis of correlates of problem drinking indicated that the female problem drinkers could not be considered a well-defined subgroup in demographic or socioeconomic terms. The most definitive findings indicated a higher-than-expected incidence of problem drinking among females at low government service (GS) levels, and an excess of problem drinking among those females with problem drinking relatives. Interviews with supervisors did not indicate a moralistic or rejecting attitude toward alcoholics which would be interfering with supervisor confrontation and referral of problem drinkers. Supervisors did tend to handle job performance problems them- selves, for both male and female employees, rather than making referrals to the EAP, and reported some problems in confrontation of female employees.
The intervention, based on an interactive model, consisted of two train- ing components-supervisor training and employee orientation. The training package design was based on the assumption that if supervisors were trained first to carry out their role early in the job review process and if female em- ployees were then made aware of the alcohol problem and their right to use the services of the EAP, both would be more apt to use the EAP in their res- pective ways. The supervisor training component provided practice (skill- building) in the areas of analyzing and documenting deteriorating job perfor- mance as well as techniques in confronting female employees (conflict man-
226
agement). This component also included informational material on female alcoholism and agency EAP procedures. The training component was divided into three modules, each of three hours. Case examples and group exercises focused on female employees with job deterioration problems at an early stage.
The employee orientation was designed to provide information about female alcoholism, employee survey results, and effects of alcoholism on families and co-workers and on job performance. The goals of the training were both to give information and encourage use of the EAP by female em- ployees. The orientation session consisted of one session of two hours divided into the two subject areas of female alcoholism at the worksite and recogni- tion of the helping services of the EAP. The sessions included group exercises and media presentations.
The experimental intervention took place in six of the twelve agencies during a nine month period. The six remaining agencies served as a compari- son group. Supervisors with large numbers of female employees were selected for training to maximize the number of female employees whose supervisors were exposed to the training program. Employees who attended the orienta- tion sessions were self selected or were nominated by their supervisors. Re- lease time was given for all attendance. Data from both supervisors and em- ployees were obtained at the time of the intervention and subsequently, to provide information on response to the program and later behavior. Further, detailed information was collected on clients entering the EAP from Septem- ber 1978 through January 1982, providing for baseline data as well as evalua- tion of intervention effects.
Supervisor Testing A set of statements was designed and administered as a pre- and post-
test to measure changes in supervisors’ knowledge on the five factors address- ed by the training program. These included: facts about alcoholism in gen- eral; the problem of alcoholism among female employees at the agencies studied; problems among supervisors in confrontation and referral of female employees at the agencies studied; appropriate steps in documentation of job performance problems; and appropriate procedures for confrontation and referral of employees with job performance problems. The post-test form also included questions on demographic and occupational characteristics and supervisors’ perceptions of whether they had benefited from the training effort. Self-administered questionnaires were distributed to participants three months subsequent to the training sessions, in order to determine whether they had made an effort to document work performance or confront any female employees as a result of participation in training.
Orientation Questionnaire Self-administered questionnaires were given to employees who partici-
pated in the orientation program at the end of the sessions, filled out and returned at the same time. The following information was obtained: descrip-
tive information about the participants; reasons for attending the orientation sessions; evaluation of changes in knowledge or attitudes about alcoholism in women or the EAP which resulted from participation; and estimates of prob- lem drinking and family history of problem drinking.
To allow for an evaluation of the degree of underreporting of problems with use of alcohol by the orientation participants, a special procedure called the randomized response technique (RRT) was used. The RRT required the use of two different questionnaire forms and included six items from the Short Michigan Alcoholism Screening Test (SMAST) to allow for estimation of the proportion of participants who could be considered alcoholic or pos- sibly alcoholic. The RRT is a procedure for obtaining information about sen- sitive behavior while generating anonymity to respondents. The choice of SMAST items was based on the criteria of choosing questions to which an unidentified problem drinker, especially a female, might be expected to give an alcohol-indicating response [ 12, 131.
Self-administered follow-up questionnaires about the behavior of the participants after training was also collected six months later, to determine any effects of the intervention which were not reflected in employee refer- rals to the EAP. Participants were questioned about any efforts they might have made to seek help for alcohol problems outside of the work place, either for themselves or for family members or friends, as well as other help- seeking behavior subsequent to the orientation session.
Client Evaluation Client interviews provided data, taken at intake, on age, sex, date of
intake, agency of employment, reason for referral (alcohol problems, etc.), and type of referral (self/supervisor), for all clients seen during the three years of this study, including those from experimental, and comparison agen- cies. Additional information was collected on job characteristics and prob- lems, quantity and frequency of alcohol use, and treatment recommenda- tions. These data were intended to provide for a detailed description of char- acteristics of clients coming into the EAP, and for a comparison of changes in client population characteristics over time in the experimental vs. the comparison groups.
Results
Of the total of 252 supervisors who participated in the training program, 180 (71.4%) attended both sessions where pre- and post-tests were distrib- uted, completed both tests, and provided the requested demographic and occupational data. Table 1 shows the demographic and occupational charac- teristics of those tested. Questions included in the test provided for measure- ment of changes in knowledge along the five factors addressed by the training program. Between the pre- and post-tests, there were significant increases in scores on all five subscales. As Table 2 indicates there was more change, with
228
TABLE 1
Demographic and occupational characteristics of supervisors completing pre and post test questionnaires (N = 180) and supervisors interviewed in 1979 phase I of study (N = 63)
Variable Supervisors completing pre and post tests (N = 180)
.u + SE
Supervisors interviewed in 1979 phase I study (N = 63)
X f SE
Age
GS Level
Years worked for government*
Years worked as a supervisor
No. of employees supervised
No. of female employees supervised
45.2 f 0.75 45.2 + 1.3
11.2 * 0.21 12.5 * 0.3
18.3 + 0.65 13.9 rf: 1.2
7.1 + 0.51 7.1 * 0.7
19.4 f 2.96 19.1 + 3.1
9.3 * 1.54 9.9 k 0.53
Sex distribution 74.7% Male 71.4% Male
*p < 0.05, by f-test.
TABLE 2
Stepwise multiple regression results for demographic and occupational variables as predic- tors of change, controlling for pretest scores (N = 16 1)
Regression Significant predictors (in order entered) dependent variable and direction of relationship*
Alcoholism in general Alcoholism in female
employees Supervisors’ problems Documentation Confrontation Total
Pretesti (-), Age (-), GS (+), Supyears (-) Pretest* (-), Age (-), GS (+), Supfem (-)
*For each regression procedure, the appropriate pretest was constrained to enter first. Subsequent variables were selected according to their partial correlations with change scores. The procedure was terminated when R2 could no longer be increased significantly by adding a new variable.
pretest scores taken into account, among younger than older supervisors, those with high GS vs. low GS levels, and those who supervised few female employees compared with those who supervised many female employees. Response to the training program was generally positive, with the majority of supervisors claiming they had gained in knowledge about alcoholism and willingness to use the EAP.
229
On follow-up questionnaires distributed to the supervisor training parti- cipants three months subsequent to the training sessions, the majority of res- pondents claimed to have no job performance problems or none severe enough to warrant confrontation, for either male or female employees. The proportion of supervisors reporting job performance problems in male em- ployees was higher than the corresponding proportion for female employees, Of those who had such problems in female employees, 75% (12 of 16) were in the process of taking action. For males, the corresponding figure was 88%, (22 of 25). Those reporting problems supervised more employees than those reporting no problems, both for males and females. Among those reporting female job performance problems, male supervisors were more likely to take action than female supervisors. Close to half of the respondents indicated they would recommend more emphasis in the training program on documen- tation of job performance problems and on confrontation skills.
A total of 464 employees from the experimental group agencies partici- pated in the orientation sessions. Though the sessions were intended primar- ily for female employees, in some cases males participated. Of the total of 464 participants, 378 (81.5%) were females and 86 (18.5%) were males. Table 3 shows that demographic and occupational characteristics of partici- pants classified by sex and type of response were similar to the previous sur- vey respondents, except for fewer years of government service. The reported alcoholism or possible alcoholism among the participants was higher than that reported by the previous survey respondents, and the participants were also more likely to report problem drinking in family members.
The RRT results indicated significant underreporting of problems with alcohol by direct response. By direct response, 21.9% of the orientation par- ticipants gave responses classifying them as either alcoholics or possible alco- holics. The corresponding figure estimated by the RRT was 34.3%. The degree of underreporting was also found to be differential by several respon- dent characteristics which are discussed in the final report and in a subse- quent paper [ 12, 141. There was a greater degree of underreporting for older than younger respondents, lower than higher GS levels, those with fewer
TABLE 3
Demographic and occupational characteristics of participating employees, by type of res- ponse and sex
RRT Females significantly older and worked for government longer than DR Females
230
compared to more years of government service, and for never married com- pared to other respondents. There was also more underreporting among those who claimed they were told they had to attend vs. others and among those who claimed they were not curious about the topic of alcoholism vs. others. These results indicated there was a tendency for problem drinkers to be sent to the orientation sessions by their supervisors, but to deny having any inter- est in the topic of alcoholism.
On follow-up questionnaires distributed six months subsequent to the orientation sessions, participants were asked to provide information about their drinking problems and problems among their family and friends and to indicate specific kinds of help-seeking behavior taken for themselves or others. For female participants who reported drinking problems in the past six months, 83.3% (5 of 6) claimed to have taken some action (males admit- ted to no current problems). About half of those females reporting current problems among family and friends claimed to have taken action, compared with about three fourths of the males. Various kinds of help-seeking behav- ior were reported, including confrontation, consultation with doctor, thera- pist or minister, and contact with programs designed to help alcoholics. A stepwise multiple regression analysis was used to select predictors of help- seeking behavior. Results clearly indicated that help-seeking behavior was more likely to be taken by those with high education and no family history of drinking in grandparents, compared to other individuals. The association between low GS level (and presumably low education) and problem drinking suggested by the RRT results and the known association between family drinking and ‘respondent’ drinking would make these findings consistent with the hypothesis that help seekers were less likely to be individuals with alcohol problems themselves, compared to those who were not help seekers.
A total of 320 clients were seen by the EAP program during the three years of the study. When the numbers of referrals from the experimental agencies were compared with those from comparison and other agencies, a significant increase was found in referrals of females from the experimental agencies only. This increase was for all types of referrals taken together, and was not due to an increase in alcohol-related referrals. There was no shift in the proportion of supervisor (vs. self) referrals over time. There was a decrease in the proportion of female clients from the experimental agencies with prior disciplinary action taken, which did not occur in the other agencies. Among all EAP cases determined to be alcohol related, those with presenting alcohol problems (as stated on initial contact with the EAP) were more likely to be referred for alcohol-related treatment than those who entered the EAP with different presenting problems.
Discussion
The results of this study made clear that there is a multiplicity of fac- tors involved in efforts to reach employed female alcoholics at the workplace
231
through employee assistance programs. It was assumed at the outset of this study that the supervisor-training component would be supplemental to prior organizational training on identification and documentation of job perfor- mance problems, and that the main thrust of the intervention would be to change the focus to female employees. However, most of the supervisors lacked any experience in attempting to measure job performance in behav- ioral terms, and the need for practice of this ability took on greater emphasis during the training sessions than was allowed for in time. Later, the majority of supervisors who participated in the training and responded to follow-up questions on subsequent efforts to confront and refer female employees for job performance problems, claimed to have no female employees with job performance problems at all. It is possible that few job performance prob- lems existed among female employees in the population studied or that the traditional sex role stereotyping still shaped most supervisors attitudes toward women. It is more probable, however, as suggested by management literature, that the organization’s performance evaluation system was not well enough developed to enable supervisors to measure performance problems in docu- mentable terms. This contention is supported by the fact that more than 40% of the training participants who responded to the follow-up survey requested additional training in documentation of job performance problems as well as confrontation.
The supervisor training concentrated on early stage intervention, and this focus was reinforced by the use of case examples and group exercises which encouraged supervisors to identify and act on problems at the earliest time possible. The analysis of EAP referrals indicated a decrease in the pro- portion with prior disciplinary action among female referrals from the exper- imental agencies following the intervention. It should be noted that the effect of the focus on early intervention might have been a decrease in supervisor referrals to the EAP of employees with alcohol problems. The result of an early stage (prior to disciplinary action) confrontation with a problem drinker might be that the employee would attempt to self-correct, rather than accept referral to the EAP. Data collection efforts which allow for evaluation of the outcome of a confrontation which does not result in EAP referral are neces- sary to more fully determine the effect of a supervisor-training program, since such cases would not appear in the EAP client data [ 151.
For all types of problems taken together, the intervention resulted in an increase in referral of females from the experimental agencies to the EAP. There were no measured changes with respect to alcohol related referrals to the EAP which could be attributed to the experimental intervention. While the focus of the females orientation sessions was on identification of alco- holism through behavioral problems, it is possible that more educational emphasis on alcoholism as a disease with associated risk factors and on spe- cific types of treatment available would encourage additional self-referral for alcohol problems. However, the fact that there was a tendency for problem drinkers to be sent to the orientation by their supervisors, but to deny having any interest in the topic of alcoholism suggests still another obstacle. Hingson
232
found that only a small fraction of people with drinking problems, male or female, seek professional or organizational help [ 161. This study seems to support that contention. Perhaps the stigma associated with female alcohol- ism is still strong enough that most female alcoholics will not use a company program under any circumstances. If so, it is essential that employee orienta- tion includes information on alternative sources of help outside of the com- pany setting.
The emphasis in supervisor training on early stage intervention and the focus of the employee orientation on getting female problem drinkers to accept assistance as early as possible was based on the notion that early inter- vention is associated with improved prognosis. A result of these efforts might have been that clients appeared at the EAP in an early stage, with problems difficult to identify as alcohol related. Since the study did indicate some problems in getting individuals with alcohol problems referred for treatment for alcoholism, EAP counselors themselves may need training to increase their awareness of signs of early stage drinking problems,
Further, it was clear that there was a high incidence of alcohol problems among family members and possibly among peers of those who attended the employee orientation sessions. The findings suggest that those who were help seekers for alcohol problems in family members and friends were less likely to be individuals with alcohol problems themselves, compared to those who were not help seekers. Many employees reported on the follow-up that they had confronted family members and peers and were seeking help outside the EAP. This suggests that future educational efforts for the general employee populations should include confrontation strategies for employees and more information on specific resources for help both inside and outside the EAP
[171* Several areas of possible research were not within the scope of this pro-
ject, but would be interesting and important topics that might be studied in the future. The issue of how alcoholism affects job performance and how early in the course of development of alcoholism job performance can be affected needs further study, particularly since a supervisor’s responsibility for confrontation is based on evaluation of job performance. Further, the effect of the alcoholic employee’s behavior at work on co-workers has not been systematically studied, nor has the effect of family alcoholism on a worker’s ability to carry out his/her job. For employees who have been diag- nosed as alcoholics and treated, the roles of supervisors and co-workers on successful reentry into the workforce need to be studied. Research in any of these areas will increase understanding of the factors involved in alcoholism in the workplace and will reshape future efforts to deal with the problem.
Acknowledgement
The work upon which this publication is based was performed in whole under Contract No. ADM 281-78-0012 between the Planners Studio and the
233
National Institute on Alcohol Abuse and Alcoholism, Alcohol, Drug Abuse, and Mental Health Administration, Department of Health and Human Ser- vices.
References
1 A. M. Trite and P. M. Roman, Spirits and Demons at Worh: Alcohol and Other Drugs on the Job, Ithaca, Cornell University, New York, 1972, p. 152.
2 M. Heyman, Referral to alcoholism in industry: coercion, confrontation and choice. J. Stud. Alcohol, 37 (1976) 900 - 907.
3 N. R. Kurtz and B. Goggins, Managing the alcoholic employee: towards a model for supervisory inte.+vention. Industrial Management, 21 (1979) 15 - 21.
4 B. Goggins and N. Kurtz, Factors inhibiting supervisory referrals to occupational alco- holism intervention programs. J. Stud. Alcohol, 41 (1980) 1196 - 1199.
5 E. G. Schwartz, The Sex Barrier in Business. Georgia State University Press, Atlanta, GA, 1971.
6 B. Rosen and T. H. Jerdee, Sex stereotyping in the executive suite. Harvard Bus. Reu., 52 (1980) 45 - 58.
7 M. G. Pryor and R. W. Mondy, How men and women view their jobs - and what this means to the supervisor. Supervisory Management, 23 (1978) 17 - 24.
8 M. H. Cahill, B. J. Volicer, J. Smith and J. Benson, Women’s Occupational Alcoholism Demonstration Project, Phase I, Interim Report, NIAAA, The Planners Studio, New- ton, MA, 1980.
9 M. H. Cahill and B. J. Volicer, Male and female differences in severity of problems with alcohol at the workplace. Drug Alcohol Depend., 8 (1981) 143 - 156.
10 M. H. Cahill, B. J. Volicer and J. L. Smith, Strategies for reaching the female problem drinker at the worksite. Labor-Management Alcoholism J., II (1981) 13 - 24.
11 B. J. Volicer, M. H. Cahill and J. L. Smith, Sex differences in correlates of problem drinking among employed males and females. Drug Alcohol Depend., 8 (1981) 175 - 187.
12 M. H. Cahill, B. J. Volicer, E. Neuburger and G. Arntz, Evaluation of a Women’s Oc- cupational Alcoholism Demonstration Project, NIAAA, The Planners Studio, Newton, MA, 1982.
13 B. J. Volicer, M. H. Cahill and E. Neuburger, The LSMAST: an even shorter version of the SMAST (submitted for publication).
14 B. J. Volicer, M. H. Cahill, E. Neuburger and G. Arntz, Randomized response esti- mates of problem use of alcohol among employed females (submitted for publication).
15 M. H. Cahill, B. J. Volicer and E. Neuburger, Training effects on supervisory referral of female workers to occupational alcoholism programs (submitted for publication).
16 R. Hingson, N. Scotch, N. Day and A. Culbert, Recognizing and seeking help for drinking problems. J. Stud. Alcohol, 41 (1980) 1102. 1117.
17 M. H. Cahill, B. J. Volicer and E. Neuburger, Help-seeking behavior for alcohol prob- lems among female workers (submitted for publication).
