Occupational Stress and the Risk of Alcohol Abuse and Dependence

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.