The association between stress and drinking: Modifying effects of gender and vulnerability

Aims: To assess the relationship between number and type of past-year stressful experiences and alcohol consumption, with a focus on how gender, poverty, and psychological vulnerability moderate this association. Methods: Data from 26 946 US past-year drinkers 18 years of age and over, interviewed in the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), were used to construct multivariate linear regression models predicting six measures of drinking pattern and volume. Results: There was a consistent positive relationship between number of past-year stressors experienced and all measures of heavy drinking. Frequency of heavy (5+ drinks for men; 4+ drinks for women) drinking increased by 24% with each additional stressor reported by men and by 13% with each additional stressor reported by women. In contrast, the frequency of moderate drinking (< 5 drinks for men; < 4 drinks for women) decreased as stress levels increased. Job-related and legal sources of stress were more strongly associated with alcohol consumption than were social and health-related stress. Men showed a stronger association than women between the number of stressors and the most consumption measures; they also responded more strongly to the presence of any legal and job-related stress. Having an income below the poverty level intensified the effects of job-related stress, but having a mood or anxiety disorder did not affect any of the associations between stress and consumption. Conclusions: Stress does not so much lead individuals to drink more often as to substitute larger quantities of alcohol on the days when they do drink. Treatment and brief interventions aimed at problem drinkers might benefit from addressing the issue of tension alleviation and the development of alternative coping mechanisms.