>but it seems almost childlike that the paper doesn't address the obvious confounding variable:
I thought that's the reason why they used "Evidence from Labor Market Shocks"? The idea is that when "Labor Market Shocks" (ie. mass layoffs) happen, the people who lose their jobs are somewhat random, so there isn't the confounding variable of low performers/sick people.
It's not about "low performers / sick people," it's unemployment itself (especially sudden layoffs) making people more susceptible to substance abuse, regardless of their health when they're unemployed.
I'm not sure that completely addresses the GP's point, because "mass layoffs" are still somewhat selective. You're more likely to lay off the people that you think aren't worth their pay, which would include those who are already suffering cognitive decline, those who are drinking enough that it's affecting their job performance, and so on.