Stress and drinking context in college first offenders.

Abstract

Social-cognitive theory has provided a framework within which to examine the complex interactions of stress, alcohol expectancies, drinking problems and drinking context. The current study of 505 college students who drink examines the relationships among self-reported stress, drinking related problems (socio-emotional and community-related), and gender with three distinct drinking contexts, (convivial, intimate and negative coping). Results support the direct relationship between stress and excessive drinking across all three contexts, but also show that stress and self-reported social-emotional drinking problems interact to predict drinking to cope with negative emotions. Men with greater self-reported stress also appear more likely to drink to cope with negative emotions. Recommendations for secondary prevention efforts based on context-related drinking styles are suggested.

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Over the past two decades, a broad social-cognitive framework for understanding the complexities of youthful drinking has begun to emerge (Abrams and Niaura, 1987; Burke and Stephens, 1999). Much of the emphasis has been on linking motivations for drinking, alcohol expectancies of drinking effects, stress and related factors and social-contextual variables as determinants of problem drinking. Other descriptive research has catalogued, with some consistency, an array of potentially serious problems related to excessive drinking in college students (Wechsler, Lee, Kuo, and Lee, 2000; Wechsler, Davenport, Dowdall, Moeykens, and Costillow, 1994; O'Hare, 1990a). These problems include negative psychological (e.g. depression, suicide, anxiety), interpersonal (e.g., fights, unplanned sex) and community (e.g. driving under the influence) problems. The rates of alcohol abuse among university students is of particular concern since college age drinkers generally consume even greater amounts than their non-college cohorts (Gfoerer, Greenblatt, and Wright, 1997), and youthful drinking patterns may have prognostic value for future alcohol dependence (Bennett, McCrady, Johnson and Pandina, 1999; Schuckit, 1998). These data collectively suggest a potentially important role for targeted prevention efforts.

Among the many factors considered within social-cognitive theory, three areas have received considerable attention in the past 20 years: stress and related factors (e.g., social anxiety, negative emotions), alcohol expectancies (e.g., belief that alcohol will relieve tension, increase social pleasure), and the social context of drinking (where, with whom, and under what circumstances one drinks). Although some research has attempted to address these factors in a discrete manner, a growing body of literature has come to focus on the interactional nature of psycho-physiological, cognitive and contextual aspects of youthful drinking. The following study is one such attempt to advance the knowledge of related to youthful drinking by examining the linkages among stress, problem drinking and various drinking contexts.

Stress and college drinking

In recent years there has been a growing literature on stress and youthful drinking. Stress symptoms appear to be a common complaint in college emergency services (Meilman, Shipp, Hacker and Kraus-Zeilmann, 1993), and evidence suggests that stress may be particularly common in college freshman (Sher, Wood and Gotham, 1996). Others have associated distressful events with depression, poorer general health and general well-being in college students (Damush, Hays and DiMatteo, 1997). Emotional distress also appears to be related to drug and alcohol abuse (Arthur, 1998). O'Hare and Sherrer (2000) surveyed a large sample of undergraduate first offenders (i.e., those caught drinking illegally on campus, a previous cohort of the current investigation), and demonstrated that substance abuse and psychosocial stress co-occurred significantly in this group, and women with moderate stress levels showed disproportionately greater involvement with substance abuse than men. In a 7-year longitudinal study that controlled for family history of alcoholism, Rutledge and Sher (2001) demonstrated that in years 2, 3, and 4, drinking to reduce tension was a stronger predictor of heavy drinking for men than for women, but (in the seventh year) stress was positively associated with heavy drinking only for males who had stronger tension reduction drinking motives. The results suggest developmental gender differences in the relationship between stress and using alcohol to alleviate it. In a panel study of successive college graduating classes, Perkins (1999) examined the relationship between stress-motivated drinking as a predictor of problem drinking, and demonstrated that, although stress-related reasons for drinking are common for both men and women in all age groups (college and post-graduate), the prevalence of drinking to cope with stress seems to increase substantially after college. Stewart, Zvolensky & Eifert (2001) showed that undergraduates with high anxiety sensitivity (vs. low anxiety subjects) were likely to drink excessively, and this relationship appeared to be stronger for men than women.

Few studies have specifically examined co-occurring mental health and substance abuse problems in college samples using clinical screening instruments. One such study examined one hundred and ten college students who sought university mental health counseling services. Ross and Tisdall (1994), using the CAGE questionnaire (i.e., cut down, annoyed, guilty, eye opener) and a DSM-based screening instrument, demonstrated a significant relationship between drinking and mild psychiatric symptoms including anxiety and panic. Droz and Syckle (1996) also employed DSM criteria with college students mandated for counseling, and demonstrated a substantial relationship between alcohol abuse and stress symptoms. Overall, there appears to be a consistent link (with some variation by gender) between stress symptoms and the extent of alcohol use and related problems among college students.

Linking stress and social drinking contexts

The relationship between stress symptoms and drinking is especially important for young people since most of their drinking appears to be associated with positive convivial experiences (Carey, 1995; O'Hare, 1997a). Although direct linkages between stress-related constructs and alcohol abuse have gained considerable support as reflected in these studies, there is little reason to accept an invariant "drinking-tension reduction" relationship across social drinking situations. Alcohol expectancy research has conceptually bridged stress-related drinking research and context-related research by focusing on a range of expected effects of drinking that occur in both positive social circumstances (e.g., increased social pleasure, increased assertiveness), as well as those which are related to coping with tension and other negative emotions (e.g., anxiety, anger, depression) (Brown, 1985; Brown, Christensen & Goldman, 1987; Goldman, Greenbaum & Darkes, 1997; Evans and Dunn, 1995; Cooper, Russell & George, 1988, O'Hare, 1998a). Expectancies have also shown discriminative validity with social drinking contexts, particularly when drinking in intimate encounters (MacLatchey-Gaudet and Stewart, 2001; O'Hare, 1998a). Drinkers expect both positive and negative effects from using alcohol, and these expectancies appear to be related to stress symptoms including social anxiety (Wilson and Abrams, 1977; O'Hare, 1990b; Burke and Stephens, 1999). Although expectancy research provides some understanding of link between positive and negative beliefs in the effects of alcohol and related consequences, expectancies are only implicitly related to specific social drinking contexts, and usually refer to "having a few drinks." What is not clear is whether those who report generally higher levels of stress are more likely to drink excessively in positive social situations (i.e., convivial or intimate) vs when coping with negative emotions. More research is needed to directly link stress, and the cognitive and social dimensions of drinking excessively in different social circumstances.

Purpose of the current study

The current study is an effort to further examine the interrelationships among stress, drinking problems and different contexts of drinking by taking a slightly different approach than prior research. First, it is understood that students may express more stress symptoms for a variety of reasons, some related to excessive drinking (i.e., physiological "rebound"), stress related to negative social consequences that result from drinking (e.g., arrested), or stress related to other causes (e.g., studying, social conflicts, finances). The ambiguous source of stress may cause researchers to confound general stress symptoms with stress related to the consequences of drinking. To control somewhat for confounding general stress symptoms with drinking related problems that may cause stress (social-emotional and community) the current study measures these constructs separately, and employs regression models to control for their relative explanatory value as predictors of excessive drinking in three different circumstances, Secondly, the current study employs the Drinking Context Scale which combines elements of positive and negative expectancies, but applies them to specific situations where respondents are likely to drink excessively rather than reflect on the effects of having had a "few drinks," an approach more common with expectancy research.

Given that stress has been associated with excessive drinking in both positive social circumstances as well as when coping with negative emotions, the following hypotheses are suggested: 1) those students who report more overall current stress in their lives are more likely to drink excessively across a range of social drinking contexts, both positive (convivial and intimate) as well as negative (when coping with negative emotions), even when controlling for self-reported drinking problems; 2) both stress and stress-related (socio-emotional) drinking problems will have an additive effect in predicting those students who drink excessively when coping with negative emotions; 3) given the mixed evidence regarding the role of stress and drinking in men and women, a gender by stress interaction will be examined to determine its predictive value for social drinking contexts.

Sample and procedure

Five hundred and five undergraduate students (n=505; age (M=18.7, SD=1.29); at the University of Rhode Island responded to an anonymous questionnaire consecutively between September, 1997 and December, 1998 as part of an adjudication process of having been cited by campus authorities (campus police or residence hall assistants) for violating university rules concerning under-age drinking or the use of illicit drugs. Study participants are described as follows (in frequencies, percents): gender (female (186, 36.8%)/male (319, 63.2%); year in school (freshman (389, 77.0%), sophomore (89, 17.6%), junior (22, 4.4%), senior (4, .8%). Residence status included: (living on campus (482, 95.4%), living off campus/independent (14, 2.8%), living off campus/with parents (4,. 8%), other (5, 1%). Eighty-seven (17.2%) were members of a fraternity or sorority. The majority (471, 93.3%) were white with Native Americans, Asian/Pacific Islanders, Black, Latinos and "others" distributed over the remaining sample (6.7%). Family income was identified as poor (7, 1.4%), lower middle class (34, 6.7%), middle class (254, 50.3%), upper middle class (185, 36.6%) and wealthy (18, 3.6%) with seven respondents (1.4%) not reporting. Four hundred and four respondents (80%) were cited for alcohol violations, and one hundred and one (20%) for marijuana infractions. All respondents in this sample consumed alcohol within the past year.

When reporting to the Office of Student Life to pay a required fine, students completed the anonymous questionnaire to provide an "accurate picture of the range of experiences [relevant to substance use] among the students referred to us." Instructions to the respondent were generally self-explanatory, but office staff consisting of the project director (MSW), other trained counselors and graduate students in related fields were available to answer questions. Anonymity was assured by not requesting names or other unique identifiers on the questionnaire. After completing the questionnaire, students were invited to return for further consultation if they had any concerns about their own substance use. The instrument and procedures for administering it were approved by the university human subjects review committee.

Instrument

The Drinking Context Scale

The nine-item Drinking Context Scale (O'Hare, 2001), developed with a previous cohort (O'Hare, 1997a), measures three separate drinking contexts: convivial drinking, intimate drinking and negative coping. Respondents are asked to rate each item ["extremely high" (5), "high" (4), "moderate" (3), "low" (2), "extremely low" (1)] following this question: "Based on your personal experience, how would you rate the chances that you might find yourself drinking excessively in the following circumstances?" Items include: convivial (When I'm celebrating something important to me, When I'm at a party, When I'm at a concert), intimate (When I'm on a date, Before having sex, When I'm with my lover), and negative coping (When I'm lonely or homesick, When I'm feeling sad, depressed or discouraged, When I'm angry with myself or someone else). The DCS has shown good factorial validity, good internal consistency (Cronbach's alpha's for subscales of the 22-item version, respectively: .93, .85, .87), and evidence of concurrent validity with a modified Mast, a QF index (O'Hare, 1997a), and alcohol expectancies (O'Hare, 1998a). Confirmatory factor analysis recently supported a nine-item version of DCS (O'Hare, 2001) (three items for each subscale) with excellent fit indices (all in the .90's) and Chronbach alphas in the low to mid-80's despite having fewer than half the items of the original. This version is used in the current analysis.

SSPI-R (stress subscale)

Stress is a broad construct that typically includes symptoms of anxiety and depression as well as other behavioral indicators (e.g., trouble sleeping, angry outburst). A subscale of the South Shore Problem Inventory-Revised (SSPI-R) (O'Hare, 1995) is a self-reported indicator of stress related to psychological, physiological and social factors, and will be used in this study as a brief measure of psychosocial stress. The original fifteen items were reduced (to eliminate several excessively skewed items) to nine including: 1) depression, helplessness, hopelessness; 2) anxiety, fears, phobias, stress, tension; 3) anger, hostility, belligerence toward others; 4) conflicts with other people; 5) loneliness; 6) impulsive, don't think about consequences; 7) shyness, unassertive with other people; 8) trouble sleeping; 9) difficulty concentrating/organizing thoughts. Respondents rated these items on a severity scales (5 "severe"....3 "moderate"....1 "mild/no problem") after they were prompted in the written instructions to "score all of the following problem areas as they are currently affecting you." Given that the original SSPI-R was developed with outpatient mental health clients, it was assumed that this subscale would be suitable for a "non-clinical" population, but scores would be expected to fall in the mild to moderate range. The SSPI-R, in particular the psychophysiological stress subscale, has been shown in two separate outpatient studies to have good factorial validity (replicated factor structure), good concurrent validity (correlated well with alcohol consumption measures), and good internal consistency rating in two studies (.79 and .89) (O'Hare, 1993; 1995).

The College Alcohol Problem Scale

The College Alcohol Problem Scale (CAPS) was developed and replicated with previous cohorts of the current sample (O'Hare, 1997b; O'Hare, 1998b). The initial item pool was based on an array of instruments used in prominent college drinking studies conducted over the past twenty years (O'Hare, 1990a; Wechsler, et al., 1994). Factor analysis with two samples replicated the same ten of twenty items. Six constitute a socio-emotional factor (1) feeling sad, blue, depressed; 2) nervous, irritability; 3) family problems related to your drinking; 4) badly affected a relationship; 5) hurt another person emotionally/physically; 6) caused you to feel bad about yourself), and four-item factor representing problems associated with acute affects and community problems; (1) nausea, vomiting, feeling tired/hungover; 2) spent too much money on alcohol or drugs; 3) drove under the influence; 4) problems with law/school administration and/or illegal activities associated with drugs). Chronbach alphas in both samples were comparable (socio-emotional .88, .89; community .79, .76), and the CAPS demonstrated good concurrent validity with the quantity-frequency index, a version of the MAST, and peak drinking index from the AUDIT (O'Hare, 1997b; O'Hare, 1998b).

The statistical strategy employed includes the following: a review of univariate data on major factors, a correlation matrix of major variables in the study, the three linear regression models examining the overall and relative predictive power of stress, drinking problems (socio-emotional and community), gender and their respective interactions with three drinking contexts (convivial, intimate and negative coping) as the dependent variables.

Results

Major univariate measures

Means and standard deviations for the main factors (N=505) are as follows: SSPI-R (stress) (M=13.94, SD=5.08), CAPS (socio-emotional) (M=7.57, SD=2.89), CAPS (community) (M=6.71, SD=2.84), DCS (convivial) (M=9.23, SD=3.42), DCS (intimate) (M=5.42,SD=2.42),and DCS (negative coping) (M=4.30, SD=2.09).

Correlation of major factors

A correlation matrix can be examined in Table 1.

Logistic regression 

To examine the independent and collective predictive value of stress, drinking problems, gender and their interactions with three different drinking contexts, three regression models were analyzed employing the three DCS subscales as dependent variables on the stress subscale of the SSPI-R, two CAPS subscales, gender and all respective interactions as independent variables. All models were developed by entering the independent variables in the same sequence: first step (stress), second step (CAPS), third step (CAPS by stress interactions), fourth step (gender), and fifth step (gender by CAPS and gender by stress interactions). The three final models were all significant: convivial drinking (F (df,9/495)=25.60, p<.001), (R squared=.32, adjusted R squared=.31); intimate drinking (F (df,9/495)=20.57, p<.001), (R squared =.27, adjusted R squared=.26); and, negative coping (F(df,9/495)=37.79, p<.001), (R squared =.41, adjusted R squared =.40). Results of final models for each dependent variable can be reviewed in Table 2.

Discussion

Stress is a significant independent predictor of excessive drinking in convivial and intimate drinking circumstances, but not when drinking to cope with negative emotions.

However, the additive interaction effect of stress and self-reported socio-emotional drinking problems did significantly predict drinking excessively when coping with negative emotions. Men who reported greater stress are more likely in this sample to drink to cope with negative emotions. Thus, the hypotheses of this study are generally supported.

However, unexpected results include the finding that stress interacts with community problems to predict excessive drinking in both convivial and intimate drinking contexts. Perhaps, in retrospect, this finding should have been anticipated since those more likely to drink in convivial (public) circumstances (e.g., "partying") are more likely, it seems to incur drinking problems related to consequences in the community. On the other hand, the interaction of stress and community problems resulting from drinking also predicted excessive drinking during intimate encounters (with lover, before sex, on a date). One can speculate that those who are under more stress and whose drinking is more likely to result in community disturbances may also be more likely to engage in excessive drinking in intimate situations as well. Evidence suggests that problem drinking often reflects a more general risk-taking behavioral repertoire for some young people (Leigh, 1999). Socio-emotional problems, which include interpersonal problems that the respondent ascribes to drinking (e.g., badly affected relationship," hurt another person emotionally/physically") were also associated with excessive drinking in intimate situations. Those with higher reports of stress may be more likely to drink excessively when engaging in intimate encounters which may cause more stress-related drinking. Evidence has strongly supported a correlational relationship between drinking and potentially serious problems related to sexual encounters such as contracting sexually transmitted diseases and increasing the chances of sexual assault (O'Leary, Goodhart, Sweet, Jemmott, Boccher-Lattimore, 1992; Abbey, McCauslan and Ross, 1998; O'Hare, 1999).

Overall the direct relationship between stress and excessive drinking in both positive social circumstances as well as when coping with negative emotions is supported here and reflects similar findings in the literature. However, these data reflect clear differences in the relationship between stress and different drinking contexts. Stress as an independent variable dropped out of the equation as a predictor of drinking to cope with negative emotions, but interacted significantly with socio-emotional problems that the respondent attributed to their own drinking. Students who drink to "have fun" may be drinking as a way of "blowing off steam," that is, to relieve stress. Although this may be a relatively common and benign motive, the consequences are potentially severe. These risks include driving under the influence, engaging in drinking games with medical consequences, falling out of windows, fighting with resulting injuries, vandalism and other criminal acts. On the other hand, drinking excessively to cope with negative emotions may result in somewhat different problems such as serious depression or other related psychological difficulties that, in circular fashion, may precipitate more drinking. Although drinking excessively in these different circumstances (convivial vs. negative coping) may be engaged in by the same student, these two drinking styles are only moderately correlated in this sample. This finding suggests that these respondents, overall, tend to favor drinking excessively in one situation or the other.

The current finding that men with higher stress scores are more likely to drink excessively to cope with negative emotions reflects the results of other studies regarding stress-related drinking in college students (Rutledge and Sher, 2001; Stewart et al. 2001). Although women may be more vulnerable to the effects of stress-related drinking (Gomberg, 1994), gender-related cultural drinking norms transmitted through social-cognitive processes (e.g., role modeling) may support heavy drinking by men as a more acceptable way of coping with stress, tension and other negative emotions, whereas, women are more discouraged to do so (Rutledge and Sher, 2001). In some respects, the image of men drinking excessively to cope with life's stressors is still less stigmatizing than the same behavior is for women (Lex, 1994). However, the relationship among gender, stress and drinking is complex and is likely to be mediated by a wide array of genetic, psychological and social learning factors.

Implications for prevention and limitations of this study

Given the limited measurable benefits of primary prevention efforts with college drinking overall (Wechsler et al. 2000; Werch, Pappas, Castellon-Vogel, 1996), there has been an increase in research on targeting identified "at risk" students with more direct problem-focused interventions. Some cognitive-behavioral strategies appear promising for reducing some of the more distressing psychological, interpersonal and community problems associated with youthful drinking (Kivlahan, Marlatt, Fromme, Coppel and Williams, 1990). These efforts include expectancy challenge, which helps the student to behaviorally disconfirm erroneous beliefs about drinking (Darkes & Goldman, 1993), brief, motivational enhancement methods to facilitate the student's evaluation of the pro's and con's of their own drinking accompanied by a fact-based examination of college population drinking norms (Bosari and Carey, 2000). In any case, college health, counseling and adjudication personnel may want to take a heterogenous view of problem-drinking students when conducting assessment and planning interventions. This data suggest that drinking-related problems should be examined in light of different drinking contexts, and stress symptoms should be seen as both potential precipitants and consequences of alcohol abuse. Differentiating public consequences of problem drinking from serious psychological difficulties may lead to more effective interventions than one-size-fits-all approaches. However, more context-specific evaluation of such interventions and policies is needed. A more differentiated assessment can lead to more finely-tuned interventions that emphasize psychotherapeutic or disciplinary measures, or a combination of both. The accumulating data suggest that practitioner's assessment should consider the reciprocal interactions among stress, expectancies, social context of drinking, type of drinking problem and gender differences. Finally, these data are based on adjudicated college students (i.e., those under-aged students who were cited by university authorities for using alcohol), not a random sample of college undergraduates. Therefore, one should be cautious in generalizing these findings to all undergraduates.

Table 1: Pearson correlation matrix of major factors (N=505)

                  Stress      CAPS           CAPS
                              (socio-emo)    (comm.)

CAPS              .51 **        (1)
(soc-emo)
CAPS              .49 **        .59 **
(Comm.)
DCS (conviv.)     .26 **        .30 **       .53 **
DCS               .32 **        .40 **       .48 **
(Intimate)
DCS (neg.         .45 **        .59 **       .47 **
coping)

                 DCS          DCS
                 (conviv.)    (intimate)

CAPS
(soc-emo)
CAPS
(Comm.)
DCS (conviv.)
DCS               .54 **
(Intimate)
DCS (neg.         .39 **        .48 **
coping)

(1) ** = p<.01

Table 2: Linear regression models (N=505) with three DCS subscales
as dependent variables:

final models with significant remaining variables.

Dependent variable: Convivial Drinking

                                      Std.
Variables                       B    Error   Beta     T      Signif.(p)

Constant                      .68    1.34              .506      .603
Stress                        .25     .09     .37     2.95       .003
CAPS (comm.)                 1.28     .17    1.06     7.42       .001
Stress x CAPS (comm.)        -.039    .01    -.86    -4.38       .001

Dependent variable: Intimate drinking

                                      Std.
Variables                      B     Error   Beta      T     Signif.(p)

Constant                     -1.13    .98            -1.16      .248
Stress                         .21    .06     .44     3.38      .001
CAPS (Socio-emo)               .33    .15     .39     2.17      .031
CAPS (comm.)                   .48    .13     .56     3.79      .001
Stress x CAPS (comm.)         -.01    .01    -.40    -1.99      .048

Dependent variable: negative coping

                                      Std.
Variables                      B     Error    Beta      T    Signif.(p)

Constant                     -.18     .76             -.24      .810
CAPS (Socio-emo)              .55     .12     .76     4.65      .001
Stress x CAPS (Socio-emo)    -.01     .01    -.53    -2.47      .014
Stress x gender               .07     .04     .27     2.00      .046

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THOMAS O'HARE, PH.D. (1)

Boston College 

Graduate School of Social Work

(1) Please direct all correspondence to Tom O'Hare, Boston College, McGuinn Hall, Room 202, Chestnut Hill, MA 02167-3807 or email to O'[e-mail].