Substance use in the construction industry has become a significant threat to the health and safety of the workforce. Many construction workers struggle with alcohol disorder, illicit drug use, or prescription drug misuse at rates well above national averages. Opioid prescriptions tied to work-related injuries often lead some workers down a path toward long-term dependence. This issue doesn’t just affect individuals—it undermines productivity, safety, and family well-being. Recognizing substance use in the construction industry is essential so that firms, trade unions, and workers can address what too many treat as “just part of the job.”
Quick look
- About 1 in 5 construction workers struggles with substance use, with alcohol and opioid misuse far above national averages.
- Physically demanding work, injuries, long hours, job insecurity, and cultural stigma all fuel higher risk.
- Substance use is linked to more accidents, higher insurance costs, reduced productivity, and devastating personal consequences.
- Solutions include clear workplace policies, supervisor training, access to counseling and rehab, non-opioid pain management, and open conversations about mental health.
- Using support programs early, prioritizing safe practices, and speaking up about stress or pain can protect health and safety.
How big is the substance use problem in construction?
Research shows construction workers suffer from high rates of substance use disorders (SUD), alcohol misuse, and illicit drug use. Data from the U.S. National Survey on Drug Use and Health, cited in reports by American Addiction Centers, indicates that about 15% of all construction workers have a substance use disorder, compared to about 8.6% of U.S. adults overall.
Alcohol use disorder affects about 12% of construction workers, significantly higher than the general population rate of 7.5%. Illicit drug use in the past month is also sitting around 11.6% among construction workers. Prescription opioid misuse and opioid use disorder also show elevated numbers: 1.3% of workers report pain-medication/opioid use disorder, nearly double the national averages.
About 25.3% of construction workers with work-related injuries used prescribed opioids at some point, more than double the rate (8.9%) among non-injured counterparts. These numbers place construction among the most vulnerable industries for substance misuse. The patterns are not isolated incidents but reflect systemic pressures across the trade: physical injury, prescription practices, workplace culture, and stress.
Why construction is particularly vulnerable
Several conditions in construction combine to raise the risk of substance misuse.
Physical toll and injury leading to pain management
Heavy lifting, repetitive motion, falls from heights, and equipment accidents are common in trades. Musculoskeletal disorders (MSDs) affect a large share of workers. When injured, many workers receive pain medicines, including opioids. In one study, among those with MSDs, opioid prescriptions were ~3 times higher than among workers without MSDs.
Long hours, fatigue, and stress
Construction often demands early starts, long shifts, and overtime. Fatigue reduces the ability to cope with pain or mental strain. When workers are exhausted, they may use alcohol, sedatives, or prescription drugs to “knock off” injuries or stress.
Culture: tough image, stigma, peer norms
Many crews expect workers to work through pain. Asking for help may be seen as a weakness. Alcohol may be normalized after work; drug misuse is sometimes tolerated or overlooked. Stigma discourages treatment and even discussing problems.
Job instability and remote or seasonal work
Many workers are employed intermittently, travel between sites, or work in remote locations. Between projects, there may be layoffs, loss of insurance or benefits, and income gaps. Remote sites may limit access to medical care or support resources.
Prescription practices & access
Doctors may prescribe opioids quickly after injury; supply duration, dose, or guidelines may not always follow best practices. Work comp claims often result in prescriptions. In small firms, oversight of pain management may be weak.
Mental health & psychological distress
Many workers suffer from depression, anxiety, sleep problems, or post-traumatic stress (after serious injury or witnessing danger). Mental distress can feed substance use. Data shows that moderate to severe psychological distress is common among male construction workers.
The impact of substance use on job sites
Photo courtesy of Shutterstock.
Safety consequences
Impaired reaction times, slower judgment, and clouded attention increase the risk of falls, mishandling tools, and accidents involving machinery. A worker under the influence or in withdrawal poses a risk to themselves and coworkers. Fatalities are higher, particularly with opioid overdose among injured workers.
Business costs
Absenteeism and presenteeism rise: workers miss hours or perform poorly when on the job. Insurance premiums rise when claims include substance misuse. Turnover increases when workers leave or are fired. Productivity suffers when delays accumulate, skills are lost, and retraining is needed.
Human side: health, overdoses, family & community
Overdoses happen on- and off-site. Chronic pain and addiction lead to deteriorated health: liver damage, mental illness, and physical deterioration. Families suffer: financial instability, emotional stress, and breakdown in relationships. Communities bear a higher burden of medical and social services.
What employers and workers can do to drive change
Substance use in construction is preventable and manageable when firms and workers take proactive steps. These measures focus on early intervention, education, and creating a culture where asking for help is acceptable.
For firms
- Create clear written policies on impairment, drug/alcohol use, and prescription obligations: Firms should establish detailed policies outlining acceptable and prohibited behaviors regarding drugs, alcohol, and prescription medications. Policies must clearly define impairment, outline steps for reporting concerns, and specify consequences for violations. Fair enforcement builds trust, while written procedures help reduce confusion and legal liability. Policies should also address accommodations for workers in recovery, including timelines for reintegration.
- Train supervisors and crew leads to recognize warning signs: Supervisors and team leads are the first line of observation on worksites. Training should teach them to identify behavioral changes such as frequent absenteeism, mood swings, unexplained injuries, or declining work quality. Recognizing early warning signs enables supervisors to intervene before problems escalate, thereby helping to prevent accidents, costly claims, and long-term health issues for workers.
- Offer confidential counseling and support: Employers should provide access to Employee Assistance Programs (EAPs) and ensure that workers are aware these services are confidential. Facilitating access to counseling and rehabilitation services helps employees address issues before they get worse. Firms can partner with local clinics, treatment centers, or telehealth providers to make support accessible, especially for workers on remote sites or in smaller crews.
- Implement wellness programs that focus on injury prevention and healthier recovery: Wellness programs don’t just improve morale—they can keep injuries from snowballing into bigger problems. Chronic pain is one of the strongest links to substance use in construction, and tackling it head-on makes a difference. Simple steps, such as offering subsidized physical therapy, teaching ergonomic lifting techniques, and conducting injury prevention workshops, provide crews with practical tools to protect themselves on the job.
- Review prescribing practices with medical providers: Employers can collaborate with medical providers and insurance carriers to promote safe prescribing for work-related injuries. This includes encouraging the use of the lowest effective dose, prescribing short courses, and scheduling regular follow-ups. Tracking prescriptions for workers on long-term pain medication ensures early identification of potential misuse and allows for timely intervention.
For workers
- Seek medical advice early and explore non-opioid pain relief: Workers should speak with healthcare providers at the first sign of injury or chronic pain. Exploring non-opioid treatments—physical therapy, targeted exercise, topical medications, and ice or heat therapy—can prevent dependency on opioids and reduce the risk of long-term substance misuse.
- Use Employee Assistance Programs and occupational health resources: Utilizing EAPs, mental health hotlines, or occupational health clinics enables workers to access confidential support without fear of stigma. Early engagement can prevent problems from escalating into serious health or safety risks.
- Participate in safety measures to prevent injuries: Proper lifting techniques, ergonomic practices, the use of protective equipment, and taking regular rest breaks all help reduce the risk of injury. Workers who proactively follow safety measures can minimize the need for pain medications and reduce the stress that sometimes drives alcohol or drug use.
- Talk with peers, supervisors, or friends about mental distress: Breaking the culture of silence is critical. Sharing struggles with trusted colleagues, supervisors, or friends can help create a support network that reduces feelings of isolation. By modeling vulnerability and seeking help, workers contribute to a safer and more supportive work environment while also protecting their health.
Substance use in the construction industry is a silent crisis because many assume it’s “just part of the job.” These numbers show it’s hurting lives, safety, families, and profits. We need action now—firm policies, better medical care, trust, and support.
If you want more stories, data, or tips on keeping workplaces safe and healthy, join our newsletter to get updates on these issues and more from the construction world.
