The effects of stress and coping on daily alcohol use in women

Positive but not negative affect is associated with increased daily drinking likelihood in non-clinical populations: systematic review and meta-analyses

Background: Recent meta-analytical findings indicate that affect regulation plays an important role in alcohol craving, consumption volume, and substance use. However, in view of mixed findings, the affect and drinking likelihood literature remains in need of clarification and consolidation.Objectives: This systematic review with meta-analyses interrogated the results from peer-reviewed studies among non-clinical populations that examined the relationship between daily affective states and intraday likelihood of alcohol consumption.Method: A PRISMA guided search of PsychINFO, PsycARTICLES, Science Direct, Wiley Online Library, PubMed, SCOPUS, and JSTOR databases was conducted. Multilevel meta-analyses yielded 11 eligible negative affect studies (2751 participants, 23 effect sizes) and nine studies on positive affect (2244 participants, 14 effect sizes).Results: The pooled associations between intra-day affect and alcohol consumption likelihood revealed no significant association between negative affective state and drinking likelihood (OR = .90, 95% CI [.73, 1.12]) and that positive affect was associated with increased drinking likelihood (OR = 1.17, 95% CI [1.09, 1.27]). Egger's test, P-curve, fail-safe N, and selection models analyses suggested that the obtained results were unlikely to be the product of publication bias and p-hacking alone.Conclusions: Results converge to suggest that, independent of age, affect measure used, and study design, a significant albeit modest relationship between positive affect and alcohol consumption likelihood exists, which does not appear to be the case for negative affect. In conjunction with other recent meta-analyses, current findings help map out a more nuanced understanding of the affect-alcohol/substance use relationship, with potential implications for interventions.

Self-Assured and Sober: The Relationship Between Maternal Parenting Sense of Competence, Stress, and Alcohol Use

Alcohol misuse is widespread, creating serious health and parenting harms. It is important to explore the motivations behind why people drink and the modifiable factors determining severity of the behavior. While alcohol-related research has historically focused on men, the closing gender gap in alcohol consumption highlights a need for targeted research on women. Parenting stress is a commonly reported motivation for maternal drinking. Likewise, parenting stress is associated with parenting sense of competence. However, there is no research connecting parenting sense of competence with alcohol use directly, nor indirectly via moderation of the alcohol and parenting stress relationship. The current study explored these associations and investigated the potential moderation through a questionnaire completed by a sample of 406 mothers. There were significant correlations between all factors, however, parenting sense of competence was not a significant moderator of the parenting stress and alcohol use relationship. Specifically, as a mother's parenting stress increases, her confidence in the parenting role tends to decline and she is more likely to misuse alcohol. Despite this, variation in parenting sense of competence among women was not significantly correlated with one's likelihood to drink when coping with stress. Further exploration of these relationships is required, with replication of the current study following the COVID-19 pandemic.

Towards an affect intensity regulation hypothesis: Systematic review and meta-analyses of the relationship between affective states and alcohol consumption

While self-medication and positive and negative reinforcement models of alcohol use suggest that there is an association between daily affect and alcohol consumption, findings within the academic literature have been inconsistent. This pre-registered systematic review meta-analytically interrogated the results from studies amongst non-clinical populations that examine the relationship between daily affective states and alcohol consumption volume. PRISMA guided searches of PsychINFO, PsycARTICLES, Science Direct, PubMed, SCOPUS, and JSTOR databases were conducted. When both laboratory and field studies were included, meta-analyses with robust variance estimation yielded 53 eligible studies on negative affect (8355 participants, 127 effect sizes) and 35 studies for positive affect (6384 participants, 50 effect sizes). The significant pooled associations between intra-day affect and alcohol consumption were r = .09, [.03, .14] for negative affect, and r = .17, [.04, .30] for positive affect. A small-to-medium sized effect (d = .275, [.11, .44]) of negative affect on daily alcohol consumption volume was found in laboratory studies (14 studies, 1100 participants). While publication bias was suspected, P-curve analyses suggested that the results were unlikely to be the product of publication bias and p-hacking alone, and selection model analysis revealed no significant differences in results when publication bias was accounted for. For negative affect, using number of drinks as the measure of alcohol consumption was associated with lower effect sizes. For positive affect, the results demonstrated a decline of this observed effect over time. Overall, findings point towards the possibility of developing an affect intensity regulation theory of alcohol use. Conceptualizing the mood-alcohol nexus in terms of affect intensity regulation may afford a more parsimonious explanation of alcohol consumption rather than viewing the behavior as being shaped by either positive or negative affective states.

Thanksgiving Day Alcohol Use: Associations With Expectations and Negative Affect

Thanksgiving is known for celebration, indulgence, and, unfortunately, alcohol-related consequences. No research to date, however, has explored predictors of Thanksgiving drinking that may help to explain the risky behaviors commonly observed over this holiday. We examined whether Thanksgiving Day drinking is related to expectations about the holiday and negative affect, as well as gender differences in these associations. This study is the first to examine Thanksgiving as a high-risk drinking event and to focus exclusively on U.S. non-college adults. Two hundred eight participants recruited via Amazon Mechanical Turk completed online surveys one week before, one day before, and one day after Thanksgiving 2016. Measures included expectations about Thanksgiving, daily anxiety, depressed affect, stress, and alcohol use. Logistic and Poisson regressions were used to predict whether participants drank and how much they drank on Thanksgiving Day, respectively. Choosing to drink on Thanksgiving was associated with higher daily anxiety but not with daily depressed affect or stress. Among men who drank on Thanksgiving, higher daily depressed affect was associated with more consumption, especially for men with positive expectations about Thanksgiving. Among women who drank on Thanksgiving, higher daily depressed affect was associated with more consumption for women with negative expectations about Thanksgiving but less consumption for women with positive expectations. These findings suggest that negative affect experienced during Thanksgiving is relevant to event-specific alcohol use. This study also underscores the importance of research that focuses on specific, high-risk drinking events, and uses samples of non-college U.S. adults.

Adrenocortical sensitivity, moderated by ongoing stress, predicts drinking intensity in alcohol-dependent men

Allostatic load from both environmental stressors and persistent glucocorticoid secretion has been associated with disease severity in alcohol dependence. Heightened relapse risk and/or drinking severity, in particular, may be a reaction to alcohol- and withdrawal-induced changes in physiological stress response systems coupled with ongoing life stress, although their shared contributions upon drinking severity have not been assessed. To investigate the combined contribution of hypothalamic-pituitary-adrenal (HPA) reactivity and environmental stressors (e.g., ongoing life stress) to relapse severity in alcohol-dependent men following treatment, plasma adrenocorticotropin (ACTH) and cortisol were obtained in 4-6 weeks abstinent alcohol-dependent men (n=41) following a psychosocial stressor [the Trier Social Stress Test (TSST)] and two pharmacological provocations [ovine corticotropin releasing factor (oCRH) and cosyntropin]. Following treatment discharge, drinking outcomes (primary outcome: drinks per drinking day (DDD); secondary outcomes: total drinks and drinking days) were assessed weekly and ongoing life stress was assessed biweekly for 24 weeks following treatment discharge. Generalized estimating equation models of drinking severity were fit with basal and stimulated ACTH and cortisol concentrations as predictors and ongoing life stress as the moderator. Greater levels of life stress were independently associated with greater drinking intensity (DDD and total drinks) but not frequency (days drinking). Higher basal cortisol:ACTH or provoked cortisol:ACTH ratios were strongly associated with greater post-treatment DDD in individuals who experienced higher levels of ongoing stress. In conclusion, ongoing life stress is associated with post-treatment drinking intensity in alcohol dependent men; stress also strengthens the relationship between adrenocortical sensitivity and post-treatment drinking. Physiological measures of allostatic load and environmental stressors conjointly increase relapse intensity.

Stress moderates the effect of childhood trauma and adversity on recent drinking in treatment-seeking alcohol-dependent men

OBJECTIVE

This study sought to clarify the relationship between childhood trauma and adversity with later alcohol consumption and the moderating effects of adult psychosocial stress.

METHOD

Seventy-seven recently abstinent alcohol-dependent men attending residential treatment programs were assessed. Childhood trauma/adversity was assessed with the Childhood Trauma Questionnaire (CTQ), drinks per drinking day (DDD) with the Timeline Follow Back, and chronic psychosocial stress with the UCLA Stress Interview. Drinking and stress were retrospectively assessed for 6 months prior to the present treatment episode. Direct associations between childhood trauma/adversity and alcohol consumption and the moderating effects of recent psychosocial stress were assessed. All measures were considered as continuous variables.

RESULTS

Pretreatment drinking severity (DDD) was associated with CTQ Total score (p = .009) and the Emotional Abuse (p < .001) and Physical Abuse (p < .01) subscales. UCLA Total Stress significantly moderated the effects of CTQ Total score on drinking severity (p = .04). Whereas higher CTQ scores were significantly associated with a greater amount of pretreatment drinking in participants with high UCLA stress scores (p = .01), CTQ scores were not associated with the amount of drinking in those with low UCLA stress scores (p = .63).

CONCLUSIONS

Childhood trauma predicts drinking severity in alcohol-dependent men, and this effect is stronger in participants with ongoing stress in adult life. These findings suggest that early childhood trauma/adversity may sensitize stress-response systems.

Co-occurrence and coaction of stress management with other health risk behaviors

This study provides a preliminary investigation of the role of stress management in multiple behavior change. Risk status on stress management and five health behaviors (healthy eating, exercise, alcohol, smoking, and depression management) was assessed before and after a multiple behavior change intervention. Findings suggested a link between stress management and a worse health risk behavior profile at baseline. Results also showed relationships between improved stress management over 6 months and heightened odds of improving on specific behaviors as well as improving one's overall behavioral risk profile. Particularly strong links between stress management and energy balance and other affective behaviors were observed.

A Dutch panel study on the relation between structure of everyday life, daily hassles, and alcohol consumption

Background

A widely held assumption within the general public is that one way in which people cope with their daily hassles is by drinking alcohol. Although the idea of drinking to compensate for daily hassles is intuit, empirical evidence is actually rather scarce. This study aimed to test whether structure of everyday life results in more daily hassles and has a protective effect regarding alcohol consumption (as predicted by classic role theory) or – in case the relation between daily hassles and alcohol consumption is positive (as predicted by tension reduction theories) – daily hassles would decrease the protective effect of having a more structured everyday life.

Methods

A general population panel study (N = 2,440; 47% women; age: M = 52 years, SD = 17), measuring structure of everyday life and daily hassles (T1; 90% response rate) as well as alcohol consumption (T2; 85% response rate).

Results

In line with classic role theory – structure of everyday life was positively associated with daily hassles and had a negative effect on alcohol consumption. Daily hassles was not associated with alcohol consumption.

Conclusions

Daily hassles did not mediate the relationship between structure of everyday life and alcohol consumption.

Stress and the HPA axis: role of glucocorticoids in alcohol dependence

Stress has long been suggested to be an important correlate of uncontrolled drinking and relapse. An important hormonal response system to stress-the hypothalamic-pituitary-adrenal (HPA) axis-may be involved in this process, particularly stress hormones known as glucocorticoids and primarily cortisol. The actions of this hormone system normally are tightly regulated to ensure that the body can respond quickly to stressful events and return to a normal state just as rapidly. The main determinants of HPA axis activity are genetic background, early-life environment, and current life stress. Alterations in HPA axis regulation are associated with problematic alcohol use and dependence; however, the nature of this dysregulation appears to vary with respect to stage of alcohol dependence. Much of this research has focused specifically on the role of cortisol in the risk for, development of, and relapse to chronic alcohol use. These studies found that cortisol can interact with the brain's reward system, which may contribute to alcohol's reinforcing effects. Cortisol also can influence a person's cognitive processes, promoting habit-based learning, which may contribute to habit formation and risk of relapse. Finally, cortisol levels during abstinence may be useful clinical indicators of relapse vulnerability in alcohol-dependent people.

Drinking and stress: an examination of sex and stressor differences using IVR-based daily data

BACKGROUND

Research on the relation of stress to alcohol consumption is inconsistent regarding the direction of effects, and this association has been shown to vary by sex and type of stress. We sought to build upon the stress-drinking literature by examining the direction of the stress-drinking association over time as well as sex and stressor differences using daily data.

METHOD

246 heavy drinking adults (67% men) aged 21-82 reported daily stress levels and alcohol consumption over 180 days using Interactive Voice Response (IVR). Baseline daily hassles were examined as an alternative measure of stress. Generalized estimating equations (GEEs) were conducted to test the stress-drinking association accounting for alcohol dependency at baseline and sex and stressor type as moderators.

RESULTS

IVR daily stress predicted increased alcohol consumption the following day, whereas baseline level of daily hassles did not. Examining the opposite direction of effects, IVR ratings of daily alcohol consumption predicted decreased next-day stress. Stress predicted higher alcohol consumption the next day for men but there was no significant association for women. For both sexes, drinking predicted decreased stress the next day, but this effect was stronger for women.

CONCLUSIONS

This study generally supported the drinking to cope and self-medication hypotheses, with findings that increased stress led to increased drinking. The time-varying relation between stress and alcohol appears to be sex- and measure-specific, however. Therefore, interventions targeted at stress management found to be effective for one sex should not be presumed to be applicable to the other.

Interpersonal problems and negative mood as predictors of within-day time to drinking

Using data collected via handheld electronic diaries (EDs), we examined within-day associations between early-day negative moods and stress and subsequent time to drinking. A sample of 97 (n=48 women) adults recruited to participate in a drinking-reduction intervention study used EDs to record mood and interpersonal problems at randomly selected times during each of 3 reporting intervals and drinking as it occurred each day for 21 days. Using multilevel hazard models, we tested associations between early-day stress/negative mood ratings and time to drinking as well as potential moderating effects of drinking to cope (DTC) motives on these associations. Whereas previous analyses of these data showed no associations between early-day negative moods and number of drinks consumed later in the day, here we found significant associations between negative moods and time to drinking. Associations involving negative moods, DTC, and hazard for drinking varied depending on time of day, and some mood effects were moderated by DTC. These findings suggest that time to drinking may be more sensitive to the effects of acute negative mood states than is drinking quantity.

Coping styles of type I and type II alcohol-dependent men undergoing treatment

The purpose of this study was to investigate the ways by which individuals with alcohol dependence, who were subgrouped into type I and type II according to the typology criteria of von Knorring et al, (J. Study Alcohol. 1987;48:523-527), cope with life events. One hundred male alcohol-dependent individuals participating in a therapeutic program composed the study sample. Of the 100, 61 subjects were categorized as type I and 39 subjects as type II. Coping styles were measured using a self-administered questionnaire that includes 8 subscales of coping styles. The type II subgroup scored significantly lower on the suppression subscale and significantly higher on the replacement, mapping, and substitution subscales as compared with the type I subgroup, of which the latter difference was at a tendency level. As regards the remaining 4 coping style subscales, minimization, help seeking, blame, and reversal, no significant differences were found between the 2 patient subgroups. The differences found may be taken into account in the development of therapeutic programs for the 2 subgroups.

The 8-Year Course of Alcohol Abuse: Gender Differences in Social Context and Coping

BACKGROUND

The aim of this study was to compare women (n=230) and men (n=236) who had alcohol use disorders in terms of social context and coping methods and in terms of changes in these indices associated with participation in professional treatment and Alcoholics Anonymous (AA).

METHODS

Initially untreated problem drinkers were followed up for 8 years.

RESULTS

Women and men did not differ in regard to the type of help received, but women had longer professional treatment. At baseline, women had more stressors and fewer resources from family and relied more on avoidance coping and drinking to cope. During the next 8 years, women, more so than men, increased on approach coping and reduced their use of avoidance coping and drinking to cope. When baseline status was controlled, women had better social resource, coping, and drinking outcomes than men did at 1 year and 8 years. A longer duration of professional treatment during year 1 was associated with improved approach coping among men but not women. A longer duration of AA attendance during year 1 and the full 8 years was associated with more resources from friends, more use of approach coping, and less drinking to cope. In turn, more friends resources and approach coping and less drinking to cope were associated with better drinking outcomes. Decreases in avoidance coping and drinking to cope were more strongly associated with better drinking outcomes among men than among women.

CONCLUSIONS

It may be important to target men for formal services or self-help to increase their use of approach coping in efforts to maintain abstinence. Women's strategies for improving their social context need further explication to be adapted for transfer to male problem drinkers.

Stressful events, personality, and mood disturbance: gender differences in alcoholics and problem drinkers

The present study examined relationships among stressful events, personality characteristics, and affective status in males and females of various alcohol drinking patterns. We examined a total of 154 participants from three distinct alcohol subgroups: alcohol dependent, problem drinker, and light social drinker. These subjects did not meet criteria for any concurrent nonalcohol comorbid psychiatric disorder. The study included an alcohol quantity-frequency interview and self-report questionnaires on stressful life events, depressive symptoms, trait anxiety, and personality characteristics. Results showed female alcoholics reported significantly greater depression, anxiety, and neuroticism compared to their male counterparts (and all other drinking groups). Female problem drinkers reported significantly greater depressive symptoms and health-related stressful events compared to male problem drinkers and the light drinkers. In contrast, male problem drinkers did not show elevations on these dimensions and more closely resembled light drinkers, of whom no gender differences were found. The findings support theories suggesting a "telescoping" of complications, health-related stress, and mood dysfunction in women at a lower threshold level of alcohol consumption compared to their male counterparts.

Alcohol problems among a community sample: longitudinal influences of stress, coping, and gender

This study examined the relationships among stress, coping methods, and alcohol-use associated problems within a longitudinal, community sample of males and females who were followed from adolescence through young adulthood. While fewer females than males were categorized as "dependent users," these females were more debilitated in terms of the number of alcohol-related problems experienced from age 15 through age 25. Measures of both chronic and proximal levels of personal stress and negative coping styles were most helpful in explaining problems with alcohol use. Distal measures of stress and coping, while perhaps serving as mediators or moderators of other important constructs, did not appear to have a direct effect on the outcome measure.

Work stressors, drinking with colleagues after work, and job satisfaction among white-collar workers in Japan

Although previous studies have examined the buffering effects of social support and coping style on the relationship between stress and alcohol consumption, they have typically relied on analysis of variance (ANOVA) or regression analysis. In addition, few studies have examined the potential stress-buffering effects of drinking with coworkers after work on the relationship between job stress and job dissatisfaction. In the present study, using a signal detection analysis, we evaluated the interactions of drinking with coworkers after work and work-stressor variables among Japanese white-collar workers (n = 397) in 1997. The analysis was performed for two groups of subjects divided based on their status in the company. This was necessary because in Japan the obligations to drink socially increase with one's rising status in the company. In both the "staff members and lower-level managers" and "middle-level and higher-level managers' groups, an interaction between work-stressor variables and drinking variables was observed. The findings imply that drinking with coworkers after work ameliorated the sense of job dissatisfaction, but only among those subjects who already had lower levels of work stressors. For subjects with high levels of work stressors, attitudes toward drinking with coworkers were unrelated to job satisfaction levels.

Coping Strategies of Alcoholic Women

Recent efforts have increased research on alcoholic women. Few studies have examined the coping mechanisms characteristic of alcoholic women relative to their nonalcoholic controls. Conforming to DSM-IV criteria for alcohol dependence, 159 alcoholic women stratified by race (black and white) and age (20-29, 30-39, and 40-49 years) were compared to 150 nonalcoholic women from a variety of public and private inpatient and outpatient treatment facilities regarding the types of coping strategies used. Alcoholic women were significantly more likely to favor maladaptive styles of coping, while nonalcoholic women employed significantly more problem-solving and emotion-based coping strategies. Neither race nor age differences significantly influenced the types of coping utilized by these women. The profile of coping strategies utilized by the alcoholic group is consistent with a poor quality of life and compounding of problems.

Stress-coping and temptation-coping as predictors of adolescent substance use

The stress-coping model of addiction posits that stress-coping and temptation-coping skills each make an independent contribution to the likelihood of substance use. Despite the popularity of this model, this proposition has never been examined empirically. The current study tested this proposition using a sample of public high school students (n = 332). Results supported the model, as stress-coping and temptation-coping each accounted for statistically unique and significant variance in teenagers' substance use. In addition, substance-abusing adolescents reported engaging in significantly more avoidance stress-coping and significantly less temptation-coping than demographically-matched nonsubstance-abusing adolescents. Our results replicate and expand previous findings from the stress-coping literature and have implications for future research and intervention efforts in the adolescent substance abuse field.

Stress and substance use among military women and men

This paper examines the relationship between perceived stress (at work, in family or personal life, and from being a woman in the military) and substance use (heavy drinking, illicit drug use, cigarette smoking) among active-duty military women and men. Data were drawn from over 16,000 respondents to the 1995 Department of Defense Survey of Health Related Behaviors Among Military Personnel. Findings indicated substantial substance use and perceived high stress in the armed forces. Further, the relation between substance use and stress varied by gender. Military women reported substantially lower rates of heavy drinking than men, but had similar rates of illicit drug use and cigarette smoking. Both military women and men were more likely to describe their military duties as more stressful than their family or personal lives; for women, the stress associated with being a woman in the military was second to stress at work. Stress at work or in the family was an important predictor of substance use among military men, but not among military women. For military women, stress associated with being a woman in the military was predictive of illicit drug use and cigarette use. These findings suggest that more effective stress management strategies may need to be implemented for military men to reduce the link between stress and heavy alcohol use, illicit drug use, and smoking.

Trauma and addiction experiences of African American women

Substance abuse affects African American women at an increasingly alarming rate. The interaction of substance abuse and traumatic events requires exploration. For many African American women, early life trauma plays a critical role in how and when they fall victim to the ravages of substance abuse. This article about a phenomenological study of 15 African American women uses intense narratives to disclose experiences of incest, rape, abuse, and other horrors that led to drug and alcohol use to extinguish pain. The themes include family history of substance abuse, lack of a caring childhood environment, pain resulting from trauma, and coping and recovery. The womens' stories provide insights for nurses in practice and research related to the psychosocial health of women.

Relationship between posttreatment drinking and alternative responses to high-risk situations proposed during treatment by problem drinkers

Problem drinkers' alternatives to high-risk situations were evaluated and related to treatment outcome. participants were 80 problem drinkers (64% males, 36% females) who completed a brief outpatient Guided Self-Change treatment. Treatment included a homework exercise where clients identified two to three high-risk situations and generated alternative responses for each situation. Based on a coding scheme developed by Moser and Annis (1996), responses were coded as (a) cognitive or behavioral, and (b) active or avoidant. Results indicated that the proportion of cognitive coping responses (e.g., thinking through the consequences) was positively related to posttreatment improvement. This prospective study suggests that intention to use active cognitive coping responses influences the relapse process.