The epidemiology of alcohol consumption

and dependence across occupations in the United States

Data from a nationwide survey provide prevalence estimates of alcohol use and alcohol dependence among persons in a variety of specific occupations. Further research is needed to define the working conditions of occupations that may be related to alcohol use or misuse.

Alcohol use disorders present serious problems for the interpersonal relationships, health, and productivity of employed men and women. Of the $117 billion estimated as the economic cost of alcoholism and alcohol abuse in the United States in 1983, nearly $71 billion (61 percent) was attributed to lost employment and reduced productivity.

Despite considerable concern about the relationship between alcohol and the workplace, little is known about the drinking practices and alcohol use disorders of the employed. Based on data from surveys with small samples, researchers have identified occupations that appear to increase the risk for alcohol use and abuse. Data from a household survey conducted in San Francisco showed that journalists, postal workers, policemen, sailors, bartenders, housepainters, and restaurant workers had higher rates of heavy drinking and alcohol-related problems than workers in other jobs. Results from a survey conducted in Detroit in 1978 showed that employees with the highest rates of alcohol problems were those in certain blue-collar occupations (including craft workers, laborers, and service workers among men, and machine operators among women). The same survey showed high rates of alcohol problems among employees in certain white-collar occupations (including managers and administrators among women and sales workers among men and women).

Because surveys with representative samples of employed men and women are expensive and time consuming, some researchers have relied on alternative sources of ready information, such as mortality data, to examine relationships between alcohol and occupations. In a review of occupational mortality studies, it was reported that cirrhosis mortality was highest among laborers and unskilled workers, workers in alcohol trades, and workers in occupational subgroups thought to be associated with heavy drinking (for example, writers and journalists). A recent analysis of data from the California Occupational Mortality Study (Harford and Brooks in press) found the highest rates of fatal cirrhosis among workers in blue-collar occupations, such as construction laborers and machinists, and among workers in occupations where alcohol was readily available (specifically, bartenders and waitresses). However, these findings should be interpreted with caution. Mortality data may be unreliable due to errors and inaccuracies in the reported types of occupations and causes of death; furthermore, cirrhosis mortality is not always alcohol related.

Recent access to data collected as part of the National Health Interview Survey (NHIS) has allowed, due to the large size of the survey sample, a closer examination of alcohol consumption and dependence in specific occupations. The NHIS is a nationwide household survey conducted annually by the National Center for Health Statistics. In 1988, a supplemental survey to assess alcohol consumption and dependence, developed by the National Institute on Alcohol Abuse and Alcoholism, was included with the NHIS.

This article provides estimates, based on 1988 NHIS data, of the prevalence of alcohol use and dependence among men and women in a wide variety of blue-collar and white-collar occupations. Possible implications of these findings are discussed, and directions for future research on the occupation-related drinking experiences of employed men and women are suggested.

METHODS AND MEASURES

Alcohol data were obtained in direct interviews of 43,809 respondents, aged 18 years and older, in all 50 States and the District of Columbia . The response rate was 85.5 percent. For prevalence estimates, we used data from the 26,738 respondents who were employed during the 2 weeks preceding their interviews.

Measures of alcohol use included current drinking status and average daily consumption. Current drinking status describes the percentage of respondents in each occupational category who reported consumption of 12 drinks or more during the year preceding their interviews. Average daily consumption describes the mean daily consumption of alcohol among drinkers in each occupational category for the year preceding their interviews, and is expressed in grams of ethanol.

Classification of respondents as alcohol dependent or severely alcohol dependent was based on criteria in the Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised (DSM-III-R; American Psychiatric Association 1987) shown in the sidebar. Respondents were classified as alcohol dependent if they had experienced one or more symptoms for three of the nine criteria during the preceding year. Thus, respondents could be classified as alcohol dependent if they showed symptoms of psychological dependence, or physiological dependence, or impairments in occupational functioning or social relationships and activities.

Classification of respondents as severely alcohol dependent was based upon the DSM-III-R definition for severe dependence: "many symptoms in excess of those required to make the diagnosis, and the symptoms markedly interfere with occupational functioning or with usual social activities and relationships with others". We interpret this definition to mean that persons who are severely alcohol dependent will exhibit symptoms of psychological and physiological dependence in addition to social and occupational impairments. Accordingly, respondents were classified as severely alcohol dependent if they had experienced more than three of the DSM-III-R criteria, including symptoms for at least two of the criteria describing impairments in occupational functioning and social activities and relationships.

In diagnosing alcohol dependence or severe alcohol dependence, DSM-III-R also specifies a duration criterion: some symptoms of dependence must have persisted for at least 1 month or occurred repeatedly over a longer period of time. To satisfy the duration criterion, respondents in our survey must have experienced one or more symptoms for two or more criteria at least twice during the year preceding their interviews. Because withdrawal is defined as a cluster of symptoms, at least two symptoms of withdrawal had to meet the duration criterion for respondents to be classified as alcohol dependent or severely alcohol dependent.

ALCOHOL CONSUMPTION ACROSS OCCUPATIONS

Table 1 shows percentages of current drinkers among employed men and women in various white-collar and blue-collar occupations. Overall, percentages of current drinkers tended to be higher among persons in white-collar occupations than among persons in blue-collar occupations. The highest percentages of current drinkers were found among men and women in managerial and administrative, professional, technical, and sales groups.