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Occup Environ Med. 2004 March; 61(3): 219–224.
PMCID: PMC1740737

The psychosocial work environment and alcohol dependence: a prospective study


Aims: To examine whether a stressful psychosocial work environment predicts alcohol dependence.

Methods: Alcohol dependence of participants in the Whitehall II occupational cohort of London based civil servants (1985–88) was measured in 1991–93 using the CAGE questionnaire. The psychosocial work environment was measured by self report questions on the job demand-support-control model and on the model of effort-reward imbalance. Potential mediators including physical illness and poor mental health (GHQ) were measured at follow up in 1989.

Results: Effort-reward imbalance at work was associated with alcohol dependence in men after adjustment for employment grade and other baseline factors related to alcohol dependence. Although effort-reward imbalance predicted future longstanding illness, poor mental health and negative aspects of close relationships, the association between effort-reward imbalance and alcohol dependence in men was only partially mediated through these health and social support measures. In women, low decision latitude was related to alcohol dependence to some extent, but alcohol dependence among women was more prevalent in higher occupational grades. Men with high job demands or with low work social supports had a slightly reduced risk of alcohol dependence. No association was found between objectively assessed demands, job control, and alcohol dependence in either men or women.

Conclusion: A stressful psychosocial work environment in terms of effort-reward imbalance was found to be a risk factor for alcohol dependence in men. In view of the public health importance of alcohol dependence in working populations these findings call for more emphasis on psychosocial factors in occupational health research and prevention.

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Selected References

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  • Cooper ML, Russell M, Frone MR. Work stress and alcohol effects: a test of stress-induced drinking. J Health Soc Behav. 1990 Sep;31(3):260–276. [PubMed]
  • Mensch BS, Kandel DB. Do job conditions influence the use of drugs? J Health Soc Behav. 1988 Jun;29(2):169–184. [PubMed]
  • Siegrist J. Adverse health effects of high-effort/low-reward conditions. J Occup Health Psychol. 1996 Jan;1(1):27–41. [PubMed]
  • Marmot MG, Smith GD, Stansfeld S, Patel C, North F, Head J, White I, Brunner E, Feeney A. Health inequalities among British civil servants: the Whitehall II study. Lancet. 1991 Jun 8;337(8754):1387–1393. [PubMed]
  • Stansfeld SA, Fuhrer R, Shipley MJ. Types of social support as predictors of psychiatric morbidity in a cohort of British Civil Servants (Whitehall II Study). Psychol Med. 1998 Jul;28(4):881–892. [PubMed]
  • Bosma H, Marmot MG, Hemingway H, Nicholson AC, Brunner E, Stansfeld SA. Low job control and risk of coronary heart disease in Whitehall II (prospective cohort) study. BMJ. 1997 Feb 22;314(7080):558–565. [PMC free article] [PubMed]
  • Bosma H, Peter R, Siegrist J, Marmot M. Two alternative job stress models and the risk of coronary heart disease. Am J Public Health. 1998 Jan;88(1):68–74. [PubMed]
  • North FM, Syme SL, Feeney A, Shipley M, Marmot M. Psychosocial work environment and sickness absence among British civil servants: the Whitehall II study. Am J Public Health. 1996 Mar;86(3):332–340. [PubMed]
  • Ewing JA. Detecting alcoholism. The CAGE questionnaire. JAMA. 1984 Oct 12;252(14):1905–1907. [PubMed]
  • Smart RG, Adlaf EM, Knoke D. Use of the CAGE scale in a population survey of drinking. J Stud Alcohol. 1991 Nov;52(6):593–596. [PubMed]
  • Mayfield D, McLeod G, Hall P. The CAGE questionnaire: validation of a new alcoholism screening instrument. Am J Psychiatry. 1974 Oct;131(10):1121–1123. [PubMed]
  • Bernadt MW, Mumford J, Taylor C, Smith B, Murray RM. Comparison of questionnaire and laboratory tests in the detection of excessive drinking and alcoholism. Lancet. 1982 Feb 6;1(8267):325–328. [PubMed]
  • van Loon AJ, Tijhuis M, Surtees PG, Ormel J. Lifestyle risk factors for cancer: the relationship with psychosocial work environment. Int J Epidemiol. 2000 Oct;29(5):785–792. [PubMed]
  • Niedhammer I, Goldberg M, Leclerc A, David S, Bugel I, Landre MF. Psychosocial work environment and cardiovascular risk factors in an occupational cohort in France. J Epidemiol Community Health. 1998 Feb;52(2):93–100. [PMC free article] [PubMed]
  • Siegrist J. Place, social exchange and health: proposed sociological framework. Soc Sci Med. 2000 Nov;51(9):1283–1293. [PubMed]
  • Peter R, Siegrist J, Hallqvist J, Reuterwall C, Theorell T. Psychosocial work environment and myocardial infarction: improving risk estimation by combining two complementary job stress models in the SHEEP Study. J Epidemiol Community Health. 2002 Apr;56(4):294–300. [PMC free article] [PubMed]
  • Stansfeld SA, Fuhrer R, Shipley MJ, Marmot MG. Work characteristics predict psychiatric disorder: prospective results from the Whitehall II Study. Occup Environ Med. 1999 May;56(5):302–307. [PMC free article] [PubMed]
  • Bisson J, Nadeau L, Demers A. The validity of the CAGE scale to screen for heavy drinking and drinking problems in a general population survey. Addiction. 1999 May;94(5):715–722. [PubMed]
  • Pileire B, Bredent-Bangou J, Valentino M. Comparison of questionnaire and biochemical markers to detect alcohol abuse in a West Indian population. Alcohol Alcohol. 1991;26(3):353–359. [PubMed]
  • Stansfeld SA, Bosma H, Hemingway H, Marmot MG. Psychosocial work characteristics and social support as predictors of SF-36 health functioning: the Whitehall II study. Psychosom Med. 1998 May-Jun;60(3):247–255. [PubMed]

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