AbstractIn response to the need for research that incorporates multiple aspects of theory into a testable framework, this study attempted to replicate and extend the results of Cooper, Russell, Skinner, Frone, and Mudar (1992). A modified stressor vulnerability model of stress-related drinking was tested in a homogeneous sample of 65 male and female undergraduate student drinkers. Total weekly consumption ofalcohol was used as the criterion measure, whereas family history of alcoholism (Adapted SMAST: Sher & Descutner, 1986), alcohol outcome expectancies/valences (CEOA: Fromme, Stroot, & Kaplan, 1993), perceived stress (PSS: Cohen, Kamarck, & Mermelstein, 1983), and coping dispositions (COPE: Carver, Scheier, & Weintraub, 1989) were used as the predictor variables. The proposed modified model postulates that expectancies play a proximal mediating role in stress-related drinking, whereas gender, family history of alcoholism, and coping all play a distal moderating role. Hierarchical multiple regression procedures were then performed to evaluate the model. The results failed to support the hypothesized model.
Specifically, expectancies emerged as a distal rather than proximal predictor of stress-related drinking, and family history of alcoholism did not moderate stress-related drinking. In contrast, gender and coping styles emerged as the most powerful predictors in the model. Despite the shortcomings of the proposed model, the present results offer an alternative interpretation as to what constitutes the stressor vulnerability model of stress-related drinking.IntroductionStress as a Causal Factor in Drinking One of the common stereotypes about the effects of alcohol involves the drug’s capacity to act as astress antagonist.
Conger (1956) has proposed a theory, known as the tension reduction hypothesis (TRH) of drinking, to support this notion. Essentially the theory holds that alcohol’s sedative action on the central nervous system serves to reduce tension, and because tension reduction is reinforcing, people drinkto escape it (Marlatt & Rohsenow, 1980). Strong evidence to support the validity of the theory comesfrom epidemiological findings which indicate that the prevalence of anxiety disorders in alcoholics rangesfrom 16 to 37%, compared to a rate of only 4-5% in the general population (Welte, 1985).Notwithstanding, there seems to be a subset of people for whom the predictions of the TRH do nothold. For instance, in a study conducted by Conway, Vickers, Ward, and Rahe (1981) it was found that theconsumption of alcohol among Navy officers during periods of high job demands was actually lower than theconsumption during low-demand periods. In addition, other studies (i.
e., Mayfield, 1968; Mendlson, Ladou,& Soloman, 1964) have shown that some drinkers actually consider alcohol as a tension generator ratherthan a tension reducer.Overall, when taking into account these conflicting findings, it seems prudent to find some middleground. The solution to this problem than is a modified version of the TRH, specifying the conditions underwhich stress will lead to an increase in drinking.Moderating and Mediating Factors in Stress Induced DrinkingIn addition to stress, several other variables have been shown to be crucial in determining an individual’sdrinking behavior.
These variables include gender of drinker (gender), coping behavior of drinker (coping),and alcohol outcome expectancies of drinker (expectancies). In the following discussion, the importance ofeach of these variables to drinking will be considered first, followed by an evaluation of these as potentialmoderators or mediators of stress in drinking. 1Differential Gender Drinking BehaviorIt has been repeatedly demonstrated that significant differences exist between the drinking patterns ofmen and women (Hilton, 1988). In a comprehensive survey of US drinking habits conducted by the USNational Center for Health Statistics in 1988, significant gender differences were found in three areas aspointed out by Dawson and Archer (1992). The first significant difference pertained to the number of maleand female current drinkers.
Roughly 64% of all men were current drinkers in comparison to 41% of allwomen. The second and third significant differences concerned the quantity of alcohol consumed. Menwere more likely to (a) consume alcohol on a daily basis and (b) be classified as heavy drinkers.
Men’s dailyaverage of ethanol intake (17.5 grams per day) was almost twice as high as women’s (8.9 grams per day).Even when an adjustment for body weight was made (females require less ethanol than males to achieve asimilar increase in blood alcohol level), men’s consumption was still 53% greater than women’s. Withregards to drinking classification, males were classified substantially more often than females as heavydrinkers (i.e. the number of males who drank five or more drinks a day was 88% greater than thecorresponding number of females).
Furthermore, as the classification measures became stricter so did thedisparity between male and female heavy drinkers increase (i.e., the ratio of male to female heavy drinkersincreased by a factor of 3 as the definition of heavy drinker was changed from five drinks or more a day tonine drinks or more a day).Gender as a Moderating Factor of StressTo understand why men and women drink differently requires an understanding of the prevailingsocialization practices (Dohrenwend & Dohrenwend, 1976; Horwitz & White, 1987). According to thissociological view, “women have been socialized to internalize distress, whereas men have been socialized toexternalize distress” (Cooper, Russell, Skinner, Frone, & Mudar, 1992; P. 140). Therefore, women tend tocope with stress by utilizing personal (internal) devices such as emotion, rather than impersonal (external)devices such as alcohol, which are used more often by men. In addition, men and women also holddifferential expectations about the effects of drinking.
Several studies (i.e. Abrams & Wilson, 1979; Sutker,Allain, Brantly, & Randall, 1982; Wilson & Abrams, 1977) have shown that “although pharmacologicaleffects appear to be similarly stress reducing for both sexes, the belief that alcohol has been consumed mayactually increase distress among women” (Cooper et al. , 1992; P.
140). Therefore, it seems plausible thatfemales actually expect to experience some form of distress from drinking as opposed to males’ expectationto experience tension reduction from drinking (Rohsenow, 1983).Differential Coping Styles in DrinkingConsiderable evidence has been accumulated in support of the notion that certain methods of coping aremore likely to be associated with problem drinking than others (Moos, Finney, & Chan, 1981). This hasled to the development of social learning theory which postulates that abusive drinkers differ from relativelyhealthy drinkers in (a) their capacity to effectively cope with stressors and (b) in their beliefs about drinking(Abrams & Niaura, 1987).In general, two types of coping responses have been shown to predominate in most situations (Folkman& Lazarus, 1980). The first type, problem-focused coping (also known as approach coping), is directed ateither solving the presenting problem or altering the source of the stress (Carver, Scheier, & Weintraub1989).
The second type, emotion-focused coping (also known as avoidance coping ), attempts to reduce theunpleasant emotional feelings which accompany the stressor (Carver et al. , 1989). Even though peopleusually use both methods in response to a given stressor, the former type will tend to predominate whenpeople feel that the situation is changeable, whereas the latter type will tend to predominate when peopleappraise the situation as unchangeable (Folkman & Lazarus, 1980).People who predominantly resort to avoidance coping have been shown to display pathological drinkingbehavior much more than those who utilize approach coping (Cooper, Russell, & George, 1988; Cooper etal. , 1992). Those who typically resort to avoidance coping (a group which consists of up to 25% of alldrinkers), report that they do so in order to regulate negative emotions (Cahalan, Cisin, & Crossley, 1969;Mullford & Miller, 1963; Polich & Orvis, 1979). The strongest evidence to support this contentioncomes from studies which have investigated post-treatment relapse in alcoholics. In three such studies(Marlatt, & Gordon, 1979; Moos et al.
, 1981; Moos, Finney, & Gamble, 1982), it was found thatindividuals were more likely to relapse in situations which elicited unpleasant emotional states.Coping as a Moderating Factor of StressThe key to understanding the differential impact of avoidance and approach coping on drinking lies inthe availability of an effective coping response to a given stressor (Cooper et al. , 1992). By definition,people who utilize approach coping mechanisms to deal with their stress, engage in concrete problemsolving which serves to actively reduce the amount of stress. By contrast, people who rely on avoidancecoping may manage to reduce their distress, but they tend to do so by distracting themselves from the stress.Therefore, it is not surprising that drinking should appeal more to those who predominately use avoidancecoping, because the consumption of alcohol serves as a substitute action which can distract from the stress.
When viewed from a social learning perspective (Abrams & Niaura, 1987), it can be seen that “alcohol useserves as a general coping mechanism invoked when other presumably more effective coping responses areunavailable” (Cooper et al. , 1992; P. 140). Evidence to support this idea comes from studies (i.
e., Higgins& Marlatt, 1975; Hull & young 1983; Marlatt, Kosturn, & Lang, 1975) which have investigated drinking inresponse to negative affects, when no coping alternative was present. For instance, Marlatt et al. (1975)have shown that drinkers who were provoked and were unable to retaliate drank significantly more at asubsequent taste rating task than drinkers who had the option to retaliate (Cooper et al. , 1988).
Differential Expectancies About DrinkingAlcohol outcome expectancies (AOE) can be thought of as the beliefs people hold about the effects ofdrinking (Goldman, Brown, & Christiansen, 1987). These expectancies first develop in childhood as indirectlearning experiences (e.g., media, family modeling, peer influence ) and, as a result of increased directexperiences with the pharmacological effects of alcohol, become more refined (Christiansen, Goldman, &Inn, 1982; Christiansen & Goldman, 1983; Christiansen, Goldman, & Brown 1985; and Miller, Smith, &Goldman, 1990).The expectancies that people hold about alcohol have been shown to predict alcohol consumption in avariety of settings (Goldman, Brown, & Christiansen 1987). Brown, Goldman, Inn, and Anderson (1980)have shown that light drinkers typically hold global expectancies about alcohol (i.
e. alcohol affects multiplefactors), whereas heavy drinkers typically hold more specific expectancies, such as alcohol’s ability toincrease sexual and aggressive behavior. Furthermore, Brown (1985a) has shown that people who hold theexpectancy that alcohol enhances social experience are less likely to be problem drinkers than people whodrink with the expectancy of tension reduction. It is important to note, however, that AOE may “vary withlearning context, personal characteristics of the drinker, amount of alcohol consumed, and other addictionrisk factors” (Brown, 1993; P. 58).Expectancies as a Mediating Factor of StressAlthough it is well established that AOE differentially predict drinking behavior (Brown, 1993), very littleis known about how they exert their effects. To date, most of the research suggests that AOE (genderspecific) directly predict alcohol consumption and, as such, are thought to play a mediational role (Brown,1993).
Intuitively, it makes sense that people who hold the expectancy that alcohol can alleviate their stressshould drink more than people who do not hold this expectancy. However, little research has beenconducted thus far to support this contention. Prior to Cooper et al. (1992), only one study (McKirnan &Peterson, 1988) investigated the role of expectancies in stress-induced drinking. The study tested a stress-vulnerability model among homosexual men, who show culturally specific stressors and vulnerability (i.e.,homophobic discrimination). It was found that tension reduction expectancies significantly predicteddrinking among individuals who experienced “negative affectivity” stress (i.
e., low self-esteem).Althoughthe Mckirnan and Peterson (1988) study found that expectancies exacerbated stress, the utility of thefindings is limited because of the use of a non-representative sample of gay males, and non-standardmeasures of stress (Cooper et al.
, 1992).The Synthesis of Gender, Coping & Expectancies in Stress-Related DrinkingAs was discussed previously, gender, coping, and expectancies are thought to play a significant role instress-related drinking. Nevertheless, the bulk of literature in this area has typically investigated thesefactors in isolation from each other (at best, only two of these factors have been combined simultaneously).
Since stress-related drinking , however, is such a complex phenomenon (recall that the tension reductionhypothesis of drinking does not apply universally) it is necessary to integrate these factors in order to gain acomplete, holistic picture.The only study which has combined all three factors simultaneously was the landmark study of Cooper etal. (1992). The study tested an interactional model of stress-related drinking which postulated that“exposure to environmental stressors is most strongly related to alcohol use and abuse among vulnerableindividuals”, such that, “Vulnerable individuals are more likely to be male, to hold strong positiveexpectancies for alcohol’s effects, and to have limited adaptive coping responses” (Cooper et al. , 1992; P.141).
The results supported a stressor vulnerability model of drinking. As expected, it was found that menwere more likely to drink than women by virtue of their gender role socialization. More importantly,however, it was also found that, for problem drinking to occur in men, a second vulnerability factor mustoften be present. In particular, men who either held strong positive expectancies or relied on avoidant formsof coping were more likely to be problem drinkers than men who did not possess these attributes. (Cooperet al. , 1992). With respect to expectancies, it was shown again that both men and women who held strongpositive AOE, drank significantly more then men and women who did not.
Much more important, however,was the finding that “expectancies appeared to function as stressor vulnerability factor among men but notamong women” (Cooper et al. , 1992; P. 148).Finally, with regards to coping, it was confirmed that coping styles play an important role in problemdrinking.
However, significant interactions with gender and expectancies were also indicated. Men whorelied on avoidant forms of coping were more likely than women to be vulnerable to stress induced drinking.Similarly, stressors were much more likely to elicit problem drinking among individuals who were both highin avoidance coping and positive AOE, than amongst individuals who were only high in avoidance coping.(Cooper et al.
, 1992).Purpose of the present studyThe purpose of the present study is to extend and modify the work of Cooper et al. (1992) in an attemptto clarify the role of stress in alcohol consumption, with respect to the interactional stressor vulnerabilitymodel of drinking. Specifically, the Cooper et al. (1992) study was limited to the investigation of gender,coping, and expectancies in stress-related drinking. Given that Family history of alcoholism (FH) has beenshown to play a significant role in drinking (i.e., Cotton, 1979; Goodwin, 1988; Hill, Nord, & Blow 1992;Ohannessian & Hesselbrock, 1993), it is appealing to investigate the role of FH as an additional vulnerabilityfactor as suggested by Cooper et al.
(1992). Moreover, the Cooper et al. (1992) study conceptualizesgender, coping, and expectancies as moderators of stress-related drinking. Given that expectancies directlypredict alcohol consumption (as discussed previously), a modified interactional model is proposed such thatgender, coping, and family history play an indirect moderational role in predicting stress-related drinking;whereas expectancies play a direct mediational role as conceptualized by Figure 1 below. Figure 1.
Proposed Modified Stressor Vulnerability Model of Drinking GenderSTRESSExpectanciesDRINKING Coping Family History MethodSubjectsAll subjects in this study were undergraduate psychology students from a large Canadian university. Theinitial sample consisted of 84 volunteers. For the purpose of this study, only those subjects who drank atleast once a weak were included. A total of 65 out of 84 subjects (77.4%), aged 19 years and over,successfully met this criterion. The sample consisted of a roughly equal number of 31males (47.7%) and 34females (52.
3%), who were predominantly Caucasian (64.6%). More than three-quarters (75.4%) of thesubjects were in their first year of studies, and were mostly employed part-time (60.
0%). Nearly three-quarters (72.3%) of those who were employed received an annual income smaller than $ 10,000. The meanage at which subjects first consumed alcohol was 14.
7, whereas the mean age at which they began to drinkregularly was 17.9. Subjects total weekly consumption of alcohol averaged 11.1 drinks.MeasuresMeasures used in the present study were embedded in a general assessment battery that was a part of alarger research project. For the purpose of the present study, the following measures, administered in a fixedorder, were employed to assess the variables of interest.
Weekly Alcohol Consumption. Subjects were given a chart which contained the days of the week. Foreach day they were instructed to indicate the number of standard alcoholic drinks and the amount of time itwould take to consume these drinks in a typical week. A standard alcohol drink was defined as either aregular size can/bottle of beer, 1.5 ounce shot of liquor, or a 5 ounce glass of wine. Subjects who drank lessthan once a month were instructed to skip this section. The total number of drinks in one week was summedand used as the dependent variable.Adapted Short Michigan Alcoholism Screening Test (Adapted SMAST).
The adapted SMAST (Sher &Descutner, 1986) is a 13 item self-report questionnaire designed to measure family history of alcoholism.Specifically, the questionnaire assesses the extent of an individual’s mother’s and father’s alcohol abuse.Assessment is based on a two point scale consisting of 0=no and 1=yes. For the purpose of the presentstudy only 10 items were used, and the mother/father answer categories were extended to biological mother/father and step or adoptive mother/father.Comprehensive Effects of Alcohol (CEOA).
The CEOA (Fromme, Stroot, & Kaplan, 1993) is a 38 itemself-report questionnaire designed to assess alcohol outcome expectancies and their subjective valence. It iscomposed of seven expectancy scales, four positive (sociability, tension-reduction, liquid-courage, andsexuality) and three negative (cognitive-behavioral impairment, risk and aggression, and self perception).Expectancy assessment is based on a four point scale from 1=disagree to 4=agree. The valence of theseexpectancies is assessed on a five point scale from 1=bad to 5=good. Both items and instructions werecarefully worded to ensure that the elicited expectancies were neither dose-specific, nor situation specific.
Perceived Stress Scale (PSS). The PSS (Cohen, Kamarck, & Mermelstein, 1983) is a 14 item self-reportquestionnaire designed to assess the degree to which situations in one’s life are appraised as stressful. Anequal number of 7 positive and 7 negative statements make up the questionnaire. Assessment is based on afive point scale from 0=never to 4=very often.
Scores are obtained by reversing the scores on the sevenpositive items (i.e., 0=4, 1=3, 2=2, etc.
), and then summing across all 14 items.COPE. The COPE (Carver et al., 1989) is a 53 item self-report questionnaire designed to assessindividual coping dispositions. The questionnaire is comprised of 14 scales which are categorized into threecoping styles: Problem-Focused Coping (Active coping, Planning, Suppression of competing activities,Seeking social support for instrumental reasons, and Restraint coping), Emotion-Focused Coping(Acceptance, Seeking social support for emotional reasons, Positive reinterpretation, Turning to religion,and Focus on and venting of emotion), and Less than Useful Coping (Denial, Behavioral Disengagement,and Mental Disengagement). For the purpose of the present study the Alcohol-drug disengagement scalewas excluded from these categories, and was treated as a separate category called Drinking to Cope.Assessment is based on a four point scale from1=I usually don’t do this at all to 4=I usually do this a lot.Both items and instructions were worded such that dispositional , rather than situational, styles of copingwere assessed.
ProcedureAll participants were recruited from undergraduate psychology courses at York University. Thequestionnaire was administered in a classroom setting. Participants completed the questionnaire in agroup format of mixed sex ranging in size from 10 to 30 individuals. Informed consent was obtainedfrom all participants, and a phone number was provided in case any concerns arose. The completequestionnaire required approximately 40 minutes to administer. Respondents were compensated for theirtime by being entered in a lottery with a 1 in 50 chance of winning $ 50.00.
ResultsCorrelational AnalysesTable 1 presents zero-order correlations, computed for all relevant study variables. Conceptuallyvariables may be grouped into one of five categories: weekly drinking (variable 1), perceived stress(variable 2), family history of alcoholism (variable 3), coping variables (Variables 4-7), and expectancyvariables (variables 8-21). Examining the pattern of correlations between these variables suggests severalconclusions.First, family history of alcoholism was neither significantly correlated with perceived stress nor withweekly drinking, suggesting that family history of alcoholism is not important in stress-induced drinking.Second, several coping variables were significantly correlated with either weekly drinking and/orperceived stress. Specifically, drinking to cope was significantly positively correlated with both weeklydrinking (r = .420) and perceived stress (r = .
310), less useful coping was significantly positively correlated(r = .674) with stress, and problem focused coping was significantly negatively correlated (r = -.327) withweekly drinking.
These findings suggest that coping variables play an important role in stress-relateddrinking.Finally, only one expectancy variable, the valence expectancy for cognitive and behavioral impairment,was significantly correlated (r = .340) with weekly drinking, but not with perceived stress. However, severalexpectancy variables were significantly positively correlated (.357 < r < .517) with drinking to cope. Thesefindings suggest that expectancies are more likely be a distal, rather than a proximal predictor of stress-related drinking.
Estimating the ModelHierarchical multiple regression analyses were employed to test the model depicted in Figure 1. Table 2contains summary statistics for the stepwise regression used to identify the predictor variables of weeklydrinking. As can be seen from Table 2, gender emerged as the most important predictor variable accountingfor over 28% of the variance. The coping variables of drinking to cope and problem-focused drinking werealso significant, and accounted for an additional 12% and 8% of the variance, respectively. Further multipleregression analyses were used to determine which variables predicted drinking to cope, and problem-focusedcoping, respectively.
Table 3 shows that the expectancy for risk accounted for over 26% of the variance inpredicting drinking to cope, with the expectancy for tension and perceived stress accounting for anadditional 16%. Table 4 shows that emotion-focused coping accounted for over 34% of the variance inpredicting problem-focused drinking, with the expectancy valence for self perception accounting for anadditional 8%. Figure 2 summarizes the direct effects estimated in the foregoing series of multipleregression analyses.Table 1.Zero-Order Correlations Among Relevant Study Variables______________________________________________________________________________________Measure 1234567891. Weekly Drinking—-.143-.
072-.327* -.232 -.206 .420**.016.2402.
Perceived Stress— .001.198.138.674** .310* -.069 -.0743.
Family History of Alcoholism —-.186-.111 -.002-.211-.003 -.
1284. Problem-Focused Coping—.491** .170-.044-.132 -.
1125. Emotion-Focused Coping —.166.062.111.
1076. Less Useful Coping—.223-.073-.0177. Drinking to Cope—.234 .
412**Alcohol Expectancy Outcomes8. Sociability—.2629. Tension Reduction –10. Liquid Courage11. Sexuality12. Cognitive & Behavioral Impairment13. Risk & Aggression14.
Self PerceptionAlcohol Expectancy Valence15. Sociability16. Tension Reduction17. Liquid Courage18. Sexuality19. Cognitive & Behavioral Impairment20. Risk & Aggression21. Self Perception* p < .
01; ** p < .001Table 1. (Continued) Zero-Order Correlations Among Relevant Study Variables______________________________________________________________________________________ Measure10 11 12 13 14 15 16 17 181. Weekly Drinking.116-.008-.
1942. Perceived Stress-.041-.069.133.213.
039.044.196 .058 -.0383. Family History of Alcoholism -.052.018-.
0074. Problem-Focused Coping.035.
012.175.141.218 -.097-.075.052 -.
0355. Emotion-Focused Coping.044.
295*.218.154.151 -.230 -.084-.053 -.0556.
Less Useful Coping-.178-.006.238.
066.059.016.096-.025.0727. Drinking to Cope.
371* .225-.017 .517** -.009 .066.357*.115.
178Alcohol Expectancy Outcomes8. Sociability .697** .488** -.120 .433** -.
160 .569** .469** .174.2899. Tension Reduction .
233.263 .041.180.006 .202.282.
132.22210. Liquid Courage —.509**.032 .622** .
046 .433** .436** .381* .24511. Sexuality—.260 .522** .
14912. Cognitive & Behavioral Impairment —.221.354* -.227 -.241-.171 -.06113.
Risk & Aggression— .236 .158.
304*.106 -.00114. Self Perception—-.335* -.175-.
089 -.247Alcohol Expectancy Valence15. Sociability— .510** .499**.
490**16. Tension Reduction —.412**.409**17. Liquid Courage — .
541**18. Sexuality—19. Cognitive & Behavioral Impairment20. Risk & Aggression21. Self Perception* p < .01; ** p < .001Table 1.
(Continued) Zero-Order Correlations Among Relevant Study Variables______________________________________________________________________________________Measure 1920211. Weekly Drinking .340* .026.1972. Perceived Stress-.164.065 -.
1393. Family History of Alcoholism -.229.045.0094. Problem-Focused Coping -.
289 -.053 -.357*5.
Emotion-focused Coping -.122 -.123 -.
1356. Less Useful Coping-.262 -.
054 -.3227. Drinking to Cope .119.166-.054Alcohol Expectancy Outcomes8. Sociability .141.
170.1359. Tension Reduction.196.166.
01510. Liquid Courage.123.278.13811. Sexuality -.
271 -.152 -.16012. Cognitive & Behavioral Impairment -.
396**-.217-.09713. Risk & Aggression-.038 -.
019-.13814. Self Perception-.363*-.274-.
220Alcohol Expectancy Valence15. Sociability .249 .
482** .11316. Tension Reduction.150 .227-.13117. Liquid Courage.375*.
717** .21918. Sexuality.162 .515** .18119. Cognitive & Behavioral Impairment—.544**.539**20. Risk & Aggression—.517**21. Self Perception –* p < .01; ** p