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Recent changes in the labor market tied to the flexible organization of work are creating performance and excellence norms that can be hard to resist. In this context, psychoactive substance uses in regard to work are changing; they are now sometimes a means for workers to maintain exceptional performance, or a way to face the suffering tied to the impossibility of achieving such performance levels. This article is mainly based on a doctoral thesis that studied Quebec unions’ initiatives toward preventing mental health problems in the workplace. It has a dual objective. First, the article aims to demonstrate the ties between work organizations and the rise in problematic consumption of psychoactive substances (such as drugs or alcohol) in the workforce. These problems can be understood as the result of a defensive strategy, as defined by the psychodynamic of work, deployed in order to face the imperatives of a hyperflexible work organization. Second, the article describes the Quebec union initiative of peer assistance programs in order to discuss the role of peers in the prevention of workplace mental health problems, including substance abuse and misuse.