Construction has some of the highest rates of both chronic pain and substance use of any industry. The two are connected more directly than most people realize. Physically demanding work leads to a high rate of injury and long-term pain, and that pain is often managed in ways that create a second, separate problem over time.

Why This Shows Up So Often in Construction

The physical demands of the job are the starting point. Repetitive strain, previous injuries that never fully healed, and the cumulative wear of years of manual labor all contribute to chronic pain rates that are higher in construction than in most other fields. Pain management sometimes involves prescription opioids, and long-term use carries a real risk of dependency, even when it starts as a legitimate response to a real injury.

A few other factors make construction specifically higher risk:

• Injuries are common enough that pain becomes something workers learn to push through rather than address
• Job site culture often discourages taking time off to properly treat an injury
• Inconsistent income and seasonal layoffs can make it harder to access ongoing medical care
• A workforce that skews male and often avoids discussing pain or mental health openly

What This Can Look Like on a Crew

Substance use doesn’t always look the way people expect. It’s often gradual and easy to miss, especially when it starts as a legitimate response to pain. Some patterns worth being aware of:

• A worker who was reliable becomes inconsistent with attendance or performance without a clear explanation
• Noticeable changes in mood, energy, or coordination
• Increasing isolation from coworkers who used to be close
• Financial stress that doesn’t match someone’s known income or circumstances

These signs overlap significantly with the warning signs covered in our post on supporting struggling workers, and for good reason. Substance use, chronic pain, and mental health struggles frequently occur together rather than in isolation.

What Actually Helps

Treat it as a health issue, not a discipline issue, whenever possible. A supervisor’s first response shapes whether a worker is willing to be honest about what’s going on. Approaching the conversation with concern rather than immediate consequences makes it far more likely someone will actually seek help.

Know your company’s resources before you need them. If an Employee Assistance Program exists, know how it works and how confidential it actually is before a situation comes up. If one doesn’t exist, know where to point someone regionally, including SAMHSA’s National Helpline, which is free, confidential, and available 24/7 at 1-800-662-4357.

Build the same peer support structure that works for mental health more broadly. A worker struggling with substance use is often more willing to talk to a trusted coworker first than to a supervisor or HR.

Don’t wait for a crisis to address chronic pain directly. Encouraging a worker to properly treat an injury, rather than pushing through it indefinitely, addresses the root cause before it leads to long-term dependence. That starts with a job-site culture where taking an injury seriously isn’t seen as a weakness.

This Is a Long-Term Pattern, Not a Single Incident

Substance use tied to chronic pain rarely develops overnight, and it rarely resolves overnight either. The goal for a supervisor isn’t solving the problem in a single conversation. It’s making sure a worker knows the door is open, knows where real help exists, and doesn’t feel like admitting a struggle will end their career on the crew.

This post discusses substance use and chronic pain in the construction industry. If you or someone you know is struggling with substance use, SAMHSA’s National Helpline is available 24/7 at 1-800-662-4357.