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SCOTT JAGOW: The percentage of workers testing positive for drugs is the lowest it’s been in nearly two decades. Sounds great. But the tests don’t detect a lot prescription drugs, and those are the most abused after marijuana. Plus, there’s alcohol, which still causes a lot of lost productivity. Ashley Milne-Tyte now on the burdens of addiction in the workplace.

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ASHLEY MILNE-TYTE: Dominick is an attorney in a town outside Manhattan. He’s also a recovering alcoholic and drug addict. For years his job involved a lot of socializing. For him, that meant a lot of drinking. By the early 1990s, it seemed he did virtually all his business in a local bar.

DOMINICK:“I hired people in the bar. I ended up taking employees who I had trouble with to talk to them out of the firm and in the bar, so it became almost as a second office.”

Finally his boss confronted him. Local judges had seen Dominick staggering about at lunchtime; the boss was worried about the firm’s reputation. Dominick went into rehab.

Eric Goplerud directs a Georgetown University Medical Center program that works on getting more alcoholics into treatment. These days, he says, most health care insurers study doctors’ billing records to identify those with addiction problems and provide outreach. But it’s slow going.

ERIC GOPLERUD:“They currently are only identifying about two people per thousand with an alcohol problem and getting them started in treatment.”

He says the reality is about 80 out of a thousand people are alcoholics. But if you never see a doctor, health care plans can’t help you. Or maybe you are the doctor.

KAREN MIOTTO: “We always joke that MD stands for massive denial.”

Psychiatrist Karen Miotto of UCLA works mainly with medical professionals with addictions. She says usually it’s the person’s co-workers who realize something’s wrong, but saying anything is another matter.

She remembers a case where a senior physician was hooked on prescription drugs.

MIOTTO:“Only one individual came forward because the other people felt that there would be retaliation, or you know what if the person did something drastic in response to being found out.”

Carrying the addicted person’s workload also causes resentment among colleagues.

Dominick says in his case, his staff saved his life. Five years after quitting drinking, he got into cocaine. By this time he had his own law firm. He became rude and nasty, unable to function, running out of meetings to get a fix.

DOMINICK:“As a result of all of this — threats by staff, who had taken up the slack as well as left me — I went gung-ho back into the program.”

Meaning rehab. Karen Miotto of UCLA says she wishes more people would get up the gumption to confront a suspected addiction problem at work. After all she says, in some jobs, whether it’s construction or medicine, other people’s lives may depend on it.

In New York, I’m Ashley Milne-Tyte for Marketplace.