In 1912, physician Alice Hamilton co-founded the field of occupational medicine as a scientific discipline in the US at Harvard Medical School by documenting toxic exposures in factories and making workplace health risks visible. Her approach was radical for the time: observe, measure, act. Hamilton's perspective on the interconnections between work organization, health, and behavior laid the foundation for a modern prevention culture—addressing questions that high performers grapple with today: How do we create work environments that enhance performance without slipping into risky coping strategies like alcohol? The connection between Hamilton's work and a drug-free, mentally resilient work culture is more direct than many might think.

A drug-free work culture is not a moral project but a principle of performance. It reduces errors, enhances cognitive clarity, and fosters psychological safety. Central concepts include Eustresspositive, challenging stress experienced as manageable and psychological stressorsburdensome demands or conditions that produce discomfort and may precede clinical symptoms. While eustress catalyzes growth, uncontrollable stressors increase the risk of maladaptive strategies—such as alcohol use in the workplace. Equally important are decision latitudethe degree of autonomy in how and when tasks are completed and social supportperceived help, backing, and belonging within the team. Both have been shown to be resources that buffer stress, enhance self-efficacy, and make risky behavior less likely. Stigma is a risk factor in itself: addiction stigmaderogatory attitudes and prejudices towards addiction decreases help-seeking and worsens outcomes—a hidden productivity killer in performance-oriented cultures.

Alcohol consumption during work hours diminishes work performance and increases the risk of accidents—especially under conditions such as shift work, long working hours, or tolerant team norms. A review shows that certain organizational structures and social standards can promote consumption, while the data on physical workload is scant ^[1]. Psychological stressors are systematically associated with discomfort that precedes clinical symptoms; changes to these stressors are therefore preventively effective ^[2]. Stigma acts as a barrier: between 22% and 40% of individuals with addiction disorders cite stigma as a significant reason for not seeking help—implications for health and safety in the workplace ^[3]. For high performers, this means: uncontrolled stress combined with a high tolerance for alcohol in the team undermines focus, decision quality, and long-term performance.

A line of research in occupational psychology shows that eustress is supported by perceived competence: repeatedly mastering challenging tasks builds resources for future stressors. Empirically, psychological stressors are linked to precursors of clinical symptomatology; interventions that enhance decision latitude and social support demonstrate preventive effects—especially when stressors cannot be modified in the short term ^[2]. A systematic review on alcohol consumption in the workplace identifies work organization (shift models, long working hours) and organizational norms as risk factors. The findings are relevant to practice: not only individual vulnerability matters, but also modifiable conditions. The authors emphasize the value of occupational health prevention at both the organizational and individual case levels ^[1]. Additionally, a large review on addiction stigma shows that familiarity with addiction often correlates with lower public stigma and that stigma related to substance use disorders is more pronounced than for behavioral addictions. Crucially for practice: a significant proportion of affected individuals cite stigma as a barrier to seeking help; evidence-based countermeasures are still underdeveloped, presenting clear opportunities for targeted programs ^[3].

- Programmatically introduce eustress instead of distress: Set demanding, well-defined goals with autonomy in implementation. Consciously increase decision latitude in teams—such as through flexible time slots and self-organized sprints. This builds coping resources and acts preventively against harmful stress reactions ^[2].
- Systematically build social support: Mentoring pairs, regular peer check-ins, and psychological counseling reduce psychological stressors. Social backing protects against maladaptive coping—including alcohol ^[2].
- Establish a clear no-alcohol-at-work policy and change social norms: Replace alcohol at team events with high-quality alternatives; communicate the policy positively as a performance standard. Tolerant norms foster consumption—clear standards reduce risk and accidents ^[1].
- Use stigma-free communication: Employ person-first language (“employee with a substance use problem” instead of “addict”), emphasize treatment as a normalized health service, and enable anonymous access to help. Lower stigma increases help-seeking and safety ^[3].
- Implement an integrated health promotion approach with psychological support: Combine stressor reduction, empowerment of autonomy, and low-threshold counseling. Even when stressors cannot be modified in the short term, decision latitude and social support serve as preventive levers ^[2].
- Actively monitor risk constellations: In shift systems and during long working hours, regularly screen for strain, sleep, and team norms. Adjust work organization (e.g., predictable rotations) to break patterns that favor alcohol ^[1].

The next evolutionary stage of workplace culture combines performance orientation with mental sustainability: clear standards, high autonomy, strong social networks. In the coming years, more precise anti-stigma interventions and organizational preventive components are anticipated—from adaptive shift designs to evidence-based support pathways that make seeking help a habit.