Work Stress and Alcohol Use

Evidence From Research
by National Institute of Health

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A comprehensive review of the entire body of literature on work stressors and alcohol use is beyond the scope of this article2; it does, however, offer a taxonomy consisting of four work-stress models that provides a useful way of organizing recent research. The following sections define each model and summarize representative studies. Although a few studies explicitly tested more than one model, the primary goal of most studies was to test one of the four models.

Among the studies reviewed in this article, two basic research designs are used. The most common research design is the cross-sectional study, in which work stressors and alcohol outcomes are measured at the same time. Although the underlying hypothesis tested in these studies is that work stressors cause alcohol use, cross-sectional studies cannot support conclusions regarding cause and effect. Those studies can only document that work stressors are related to alcohol use. A cross-sectional relation may be attributable to the fact that work stressors cause alcohol use. However, equally plausible is the concept that alcohol use may cause increased levels of work stress or that the relation is spurious, because some other unmeasured variables, such as personality traits, cause some people to choose stressful jobs and to drink heavily. The second research design is the longitudinal study, in which work stressors and alcohol outcomes are measured at two or more different points in time. In the typical longitudinal study, work stressors assessed at baseline are used to predict alcohol use at a later point in time after controlling for initial differences in alcohol use at baseline. Although less common, longitudinal studies offer more convincing evidence that exposure to work stressors causes increases in alcohol use. Unless a study is explicitly labeled as longitudinal, the reader should assume that the studies reviewed below are cross-sectional.

Simple Cause-Effect Model

The first model presented in the figure is the simple cause-effect model of work stress and alcohol use. Research based on this model simply attempts to document an overall relation between various work stressors and different dimensions of alcohol use, usually controlling for basic demographic variables, such as age, gender, income, and occupation. Support for the simple cause-effect model is mixed. For example, Parker and Farmer and Roxburgh reported that low levels of job complexity (jobs that require little thought and independent judgment) are related to impaired control over drinking and elevated daily consumption. Ragland and colleagues found that a measure of work problems was positively related to heavy drinking3 and average weekly consumption; job demands and job control, however, were not related to alcohol use. Using longitudinal data, Crum and colleagues reported that men holding jobs that were high in demands and low in job control were more likely to develop either an alcohol abuse or alcohol dependence disorder than were men in jobs that lacked one or both of these two job stressors. The researchers, however, found no such relation among women. Hemmingsson and Lundberg found that low job control, but not high job demands, was associated with a diagnosis of alcohol abuse or dependence among men. These researchers did not include women in their study.

The studies summarized so far suggest that jobs low in complexity and control and high in demands are related to increased employee alcohol use. Some evidence indicates that these work stressors may be more strongly related to alcohol use among men. Nonetheless, a number of studies assessing similar work stressors have failed to support the simple cause-effect model. Furthermore, even when gender differences are found in the strength of the relation between work stressors and alcohol use, no clear pattern exists across studies.

The inconsistent findings from studies testing the simple cause-effect model are not surprising, because the model has two inherent limitations. First, the model is based on the premise that work stressors are causal antecedents of alcohol use for all, or at least many, employees. Although most adults consume alcohol, it is unlikely that most adults use alcohol to cope with unpleasant work conditions. Many coping behaviors, such as talking to friends or relatives, exercise, leisure activities, and addressing work problems at their source, relieve the resulting negative emotions from work stressors more effectively and have fewer negative side effects than alcohol consumption. It may be more reasonable to assume that only employees who lack certain resources or who have certain vulnerabilities (holding the belief that alcohol use relieves negative emotions or having heavily drinking peers) will use alcohol to cope with work stressors. If this assumption is true, then researchers who do not identify subgroups at risk for stress-induced drinking may have inconsistent and nonsignificant findings.

The second limitation is that even if the simple cause-effect model supports a relation between work stressors and alcohol use, no information is provided about why work stressors cause increased alcohol use. That is, the model makes no attempt to account for intervening variables, such as negative emotions, that would explain how work stressors are related to alcohol use. The underlying assumption of the simple causeeffect model of work stress and alcohol use is that work stressors cause negative emotions, which, in turn, cause alcohol use to relieve those emotions. Nonetheless, this assumption needs to be tested; failing to model intervening variables may render a study less likely to find a work stressor - alcohol relation. These observations have motivated many researchers to move beyond simple models of work stress and alcohol use, as described in the next sections.

About the Author

NIH is the nation's medical research agency - making important medical discoveries that improve health and save lives. The National Institutes of Health (NIH), a part of the U.S. Department of Health and Human Services, is the primary Federal agency for conducting and supporting medical research.