Occupational Stress and the Risk of Alcohol Abuse and Dependence

Authors

  • Rosa M. Crum,

    Corresponding author
    1. Department of Epidemiology, Johns Hopkins University School of Hygiene and Public Health
    2. Department of Mental Hygiene, Johns Hopkins University School of Hygiene and Public Health
    3. Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
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  • Carles Muntaner,

    1. Laboratory of Socio-environmental Studies, National Institute of Mental Health, Bethesda, Maryland.
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  • William W. Eaton,

    1. Department of Mental Hygiene, Johns Hopkins University School of Hygiene and Public Health
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  • James C. Anthony

    1. Department of Epidemiology, Johns Hopkins University School of Hygiene and Public Health
    2. Department of Mental Hygiene, Johns Hopkins University School of Hygiene and Public Health
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  • This work was supported by a postdoctoral fellowship award from the Mellon Foundation; by a Scientist Development Award for Clinicians from the National Institute on Alcohol Abuse and Alcoholism (AA00168); by research Grants DA04823, DA03992, and DA04392 from the National Institute on Drug Abuse; and by research Grants MH47447 and MH14592 from the National Institute of Mental Health. Data gathering was supported by the ECA Program of the National Institute of Mental Health Division of Biometry and Epidemiology. The Principal Investigators, Co-Investigators, and grant award numbers during data gathering were Jerome K. Myers, Myrna M. Weissman, and Gary L. Tischler at Yale University (MH34224); Morton Kramer, Ernest Gruenberg, and Sam Shapiro at the Johns Hopkins University (MH33870); Lee N. Robins and John E. Helzer at Washington University (MH33883); Dan Blazer and Linda George at Duke University (MH35386); and Marvin Kama, Richard L. Hough, Javier I. Escobar, M. Audrey Burnam, and Dianne Timbers at the University of California-Los Angeles (MH35865). At the National Institute of Mental Health, principal collaborators during data gathering were Darrel A. Regier, Ben Z. Locke, William W. Eaton, and Jack D. Burke, Jr.

Reprint requests: Rosa M. Crum, M.D., M.H.S., Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Health Institutions, 2024 East Monument Street, Suite 2-600, Baltimore, MD 21287.

Abstract

Using prospective data, we examined the relationship between occupational stress and risk for alcohol disorders. Consistent with the Demand/Control model for psychosocial work environments, we hypothesized that individuals working in high-strain occupations (jobs with high demands and low control) would be at increased risk for alcohol abuse-dependence relative to those in low-strain occupations (jobs with low demands and high control). We classified high occupational strain into two categories: (1) jobs with high psychological demands and low control, and (2) those with high physical demands and low control.

A total of 18,571 study subjects were selected in 1980–1984 by taking probability samples of adult household residents at five sites of the Epidemiologic Catchment Area Program. At baseline, participants completed standardized interviews that measured sociode-mographic variables and assessed whether they had met diagnostic criteria for currently or formerly active alcohol abuse-dependence syndromes. The interviews were readministered 1 year later to identify cases among the participants. Subjects were sorted into risk sets by age and residence census tract1 and persons with a previous history of alcohol abuse or dependence, as well as those who were over 64 years or had no history of full-time employment, were excluded. Among the 507 participants included in the risk sets, there were 126 incident cases of alcohol abuse-dependence and 381 age and residence-matched noncases. Relative to low-strain employment, men were found to be 27.5 times more likely to develop alcohol abuse-dependence if they had been employed in a high-strain job classified as having high psychological demands and low control (p= 0.008), and 3.4 times at higher risk for an alcohol disorder if they were employed in high-strain jobs with high physical demands and low control (p= 0.03). No appreciable risk was found for women in any of the high-strain job categories. The results highlight occupational stress as a potential risk factor for alcohol abuse and dependence, and add to the growing body of literature on relationships between psychosocial work environment and disease states. If confirmed in other studies, these findings identify potential sources of preventive strategies for alcohol disorders.

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