journal
of Substance
Abuse,
Gender
4,235-245
(1992)
Differences
in Depression and Anxiety Among Alcoholics Lois A. Benishek Kathleen J. Bieschke Bertram E. Stiiffelmayr Brian E. Mavis Keith A. Humphreys Michigan
State University
Recent research suggests that psychopathology, in particular depression and anxiety, differentially affects the substance abuse treatment response of men and women. This study explores the relationship between global psychopathology, depression, anxiety, and alcoholism treatment outcome. These variables were assessed in a sample of 507 (373 men; 134 women) substance abuse clients at intake and at a 6-month follow-up. With the exception of alcohol dependence, there were significant differences in the levels of alcohol problems, depression, anxiety, and global psychopathology for men and women at both intake and follow-up. For the whole sample and for men, initial levels of alcohol problems and alcohol dependence were the best predictors of alcohol problems at follow-up. For women, the initial levels of alcohol dependence and a global measure of psychological functioning were predictive of outcome at follow-up. These findings are compared with past research, and suggestions for further investigation are proposed.
Although it is well documented that depression and anxiety are associated with alcohol abuse (Schuckit & Monteiro, 1988; Weiss & Rosenberg, 1985), the details and implications of the relationships are unclear, particularly in the area of gender differences. Much of what is known about psychopathology and alcoholism is derived from studies of men (e.g., Penick, Powell, Liskow, Jackson, 8c Nickel, 1988; Schuckit, 1985). Only recently have large-scale studies of psychopathology and gender differences among substance-abusing populations been published (e.g., Ross, Glaser, dc Stiasny, 1988; Turnbull & Comberg, 1988). Several recent studies of treated alcoholics (Hesselbrock, Meyer, 8c Keener, 1985; Ross et al., 1988; Rounsaville, Dolinsky, Babor, & Meyer, 1987) suggest that concomitant psychopathology, as established by either diagnosis or symptomatology, has different treatment outcome implications for male and female alcoholics. Estimates of depression among alcoholics in treatment vary from approx-
Correspondence Building 1, Room
and requests for reprints 125, Weber State University,
should be sent to Lois Benishek. Ogdon. UT 84408-1402.
Counseling
Center,
235
236
LA.
Benishek,
K.J. Bieschke,
B.E. Stiiffelmayr,
B.E. Mavis,
and K.A. Humphreys
imately 25% (Nakamura, Overall, Hollister, & Radcliffe, 1983) to 66% (Pottenger et al., 1978). Alcohol-abusing women are as much as four times more likely than men to report depressive symptoms (Hesselbrock et al., 1985; Jaffe & Ciraulo, 1986). Research findings on the relationship between alcohol problems and depression are inconsistent. Some research indicates that women alcoholics who suffer from depressive problems have comparatively good posttreatment outcomes on alcohol-related measures in comparison to women without depressive problems (Rounsaville et al., 1987; Schuckit & Winokur, 1972). In contrast, some studies of male and female alcoholics demonstrate that depressive symptoms at intake are associated with increased drinking problems (Pottenger et al., 1978). Rounsaville et al. (1987) found that, for men, alcohol problems in combination with depression were associated with poorer drinking-related outcomes, whereas alcohol problems without depression were associated with better outcomes. The discrepant findings of these studies suggest a different relationship between depression and alcoholism for men and women. Reported prevalence rates of anxiety range from about 10% to 33% among alcoholics (Vaglum, Vaglum, 8c Larsen, 1987; Weiss 8c Rosenberg, 1985), which is significantly higher than among their nonalcoholic counterparts (Ross et al., 1988; Weiss & Rosenberg, 1985). Female alcoholics report more anxiety than male alcoholics (Ross et al., 1988). There is some evidence that anxiety combined with depression is positively associated with alcoholism in women (Hurlen, Vaglum, Vaglum, Larsen, & Storaas, 1984; Vaglum et al., 1987). Of particular interest are the findings of Hurlen et al. (1984). They presented preliminary evidence that among depressed women, high levels of anxiety are associated with high levels of alcohol consumption. In a subsequent study (Vaglum et al., 1987), the authors hypothesized that differences in drinking levels of nonalcoholic depressed women could be explained by the effect of anxiety. Specifically, they proposed that anxiety counterinfluences the consumption-reducing effects of depressed mood. Global psychopathology (i.e., the presence of a variety of psychological difficulties) has been used as a prognostic indicator in alcoholism research. Studies indicate that high levels of psychopathology are associated with more alcohol and life-functioning problems (McLellan, Luborsky, Woody, O’Brien, & Druley, 1983; Stiiffelmayr, Benishek, Humphreys, Lee, & Mavis, 1989). Rounsaville et al. (1987) also found that a global rating of psychopathology was a strong predictor of outcome for both men and women. These studies demonstrate that the combination of higher levels of global psychopathology with a substance abuse problem is associated with poorer treatment outcomes. In conclusion, clinicians and researchers adhere to an assumption that psychopathology, specifically depression and anxiety, has different implications for the treatment outcomes of male and female alcoholics. However, the limited empirical evidence neither consistently supports nor contradicts this speculation and merits further exploration. This study is intended to provide information on gender differences and psychopathology in an alcohol treatment population. Specifically, this study ex-
Gender Differences
237
amines whether men and women differ in their levels of alcohol problems, alcohol dependence, global psychopathology, depression, and anxiety at intake and 6-month follow-up. Also, the usefulness of global psychopathology, anxiety, depression, and the interaction between anxiety and depression as predictors of drinking problems at outcome for men and women is assessed. . METHOD Subjects This study was based on data obtained from an ongoing, state-funded substance abuse treatment outcome evaluation study in Michigan. Subjects included 507 clients (373 men; 134 women) receiving treatment at over 30 state-funded substance abuse treatment programs who were assessed when entering treatment and then again 6 months later. The treatment programs provided outpatient, inpatient, or residential services. Excluded from this study were clients (a) requesting primary treatment for a nonalcohol and/or drug-related psychiatric disorder, or (b) who were under 18 years of age. This sample of 507 clients represents approximately 67% of the clients assessed at intake. The additional 33% were considered “lost to follow-up” because they were deceased (2%), refused to continue to participate (6%), or could not be located within a reasonable time of their 6-month follow-up date (25%). Analysis of variance (ANOVA) revealed no significant differences between clients who were “lost to follow-up” and those interviewed 6 months after entering treatment on any of the following variables: global psychopathology, depression, anxiety, age, race, gender, or the type of treatment entered. The demographic characteristics of the study sample at intake are presented in Table 1. Design and Procedure Clients were approached at their respective treatment programs by trained interviewers and asked to participate in the study. Every effort was made to approach clients in a chronological order until a predetermined number agreed to participate. The majority of the client assessments were completed within 10 days of their entering treatment. Clients receiving detoxification were not assessed until after detoxification was completed. A battery of measures was administered to each participant at both intake and 6 months later. Participants were paid $10.00 for completing the intake assessment and $20.00 for the follow-up contact. Whenever possible, assessors interviewed the same clients at both intake and at 6-month follow-up. Assessors were not aware of the research hypotheses or the clients’ scores on the self-report questionnaires. The assessment battery was not completed if there was any indication that the client was under the influence of alcohol and/or drugs. No corroborative information was collected. Client assessors were trained to administer the Addiction Severity Index (ASI) and the self-report questionnaires. The quality of the data was monitored
LA.
238
Bble
1.
Demographic
Benishek,
K.J. Bieschke,
Characteristics
Race White Black Other Educational Level Less than High School High Schoo1lG.E.D. Some College or College Graduate School
8.E. StiMelmayr,
Men,
n = 373;
women,
and K.A. Humphreys
at Intake
Degree
Age 18-29 30-44 t 45 Program Type Outpatient Inpatient/Residential Primary Drug of Choice Alcohol Drug Alcohol and Drug Note.
8.E. Mavis,
Men (96)
Women (96)
63 33 4
57 43 0
30 46 21 3
21 47 30 2
47 45 8
46 42 12
41 59
46 54
48 I1 41
31 25 44
n = 134.
primarily through two ongoing activities. First, interrater agreement was evaluated on a monthly basis. Second, the reliability of the data was monitored on a bimonthly basis by having interviewers observe and score videotaped ASI interviews. Measures
Three instruments were used to assess client symptomutology in this study. The Brief Symptom Inventory (BSI) is a multidimensional self-report measure of psychological functioning (Derogatis & Melisaratos, 1983). The 53 BSI items are answered using a 5-point scale from not distressed at all (0) to extremely distressed (4) with regard to the client’s functioning in the past 7 days. The Global Symptom Index (GSI) and the depression and anxiety subscales were used in this study. The AS1 is a structured interview that assesses seven life-problem areas common to substance abusers (McLellan et al., 1985). The degree of alcohol and psychological problems as established using the composite scores from each of their respective sections. The composite scores were specifically developed to reflect change over time and are based on objective data representing client behavior in the past 30 days. A higher composite score indicates greater levels of patient problems. Alcohol dependence information was collected using the 25-item Alcohol Dependence Scale (ADS; Skinner & Horn, 1984). ADS scores range from 0 to 47 with higher scores indicating the presence of a larger number of alcohol dependence symptoms.
Gender
Differences
239
Data Analysis Intercorrelations were calculated to determine the relationship among the BSI subscales, the ASI composite scores for the psychological and alcohol sections, and the ADS scores for men and women at intake and follow-up. A univariate repeated-measures ANOVA was completed to identify gender differences and change over time on each variable of interest. Two sets of regression analyses were completed. Sample sizes differ among these analyses due to the use of pairwise deletion of missing data. The first set of regression analyses investigated the predictive strength of global psychopathology on subsequent alcohol problems for men, women, and the whole sample. The independent variables were entered into the regression equation in the following order: intake levels of alcohol problems, alcohol dependence, and psychological problems. The second set of regression analyses investigated the predictive relationship between depression and anxiety on subsequent alcohol problems for each sample. The independent variables were entered into the regression equation in the following order: intake levels of alcohol problems, alcohol dependence, anxiety, depression, and the interaction between anxiety and depression. RESULTS Table 2 contains the correlation matrix for the BSI subscales and the GSI, the AS1 composite scores, and the ADS at intake and 6-month follow-up for men and women. Values for men can be found in the lower triangular portion of the correlation matrix, whereas values for women can be found in the upper triTable 2. Intercorrelation Values for Men; Upper
GSI, GSI, AS1 AS1 Dep, Dep, Anx, Anx, AS1 AS1 ADS, ADS,
Psy, Psy,
Ale, Ale,
Matrix Triangular
by Gender (Lower Triangular Matrix Matrix Contains Values for Women)
Contains
GSI,
GSI,
AS1 Psy,
AS1 Psy,
Dep,
Dep,
Anx,
Arm,
ASI Ale,
AS1 Ale,
ADS,
ADS,
.27 .32 .18 .48 .21 .51 .28 .21 .16 .17 .37
.48 .35 .63 .41 .88 .47 .90 .16 .37 .29 .55
.47 .33 .33 .52 .35 .52 .32 .32 .17 .39 .45
.48 .66 .41 .23 .59 .25 .61 .17 .38 .32 .56
.85 .38 .42 .36 .37 .75 .39 .37 .21 .39 .37
.43 .91 .31 .64 .42 .38 .79 .I5 .40 .26 .51
.90 .44 .45 .45 .75 .36 .48 .39 .23 .45 .42
.46 .94 33 .64 .35 .79 .45 .18 .35 .31 .55
.44 .17 .33 .19 .46 .13 .48 .25 .36 .39 .45
.32 .49 .28 .46 .34 .45 .34 .52 .45 .32 .56
.51 .26 .58 .46 .54 .23 .55 .29 .58 .46 .56
.30 .48 .52 .72 .28 .42 .34 .51 .52 .72 .62 -
Note. GSI, = GSI at intake; GSI, = GSI at follow-up; AS1 Psy, = AS1 psychological composite score at intake; AS1 Psy, = AS1 psychological composite score at follow-up; Dep, = Depression at intake; Dep, = Depression at follow-up; Anx, = Anxiety at intake; Anx, = Anxiety at follow-up; AS1 Ale, = AS1 alcohol composite score at intake; AS1 Ale, = AS1 alcohol composite score at follow-up; ADS, = score at intake; ADS, = score at follow-up. All values are significant at .Ol level.
LA.
240
Table 3.
ANOVAS
Benishek,
K.J. Bieschke,
for Differences
B.E. Stiiffelmayr,
By Gender
at Intake Men (df
ASI Psychological Composite Scores Intake*** Follow-up*** BSI Global Psychopathology Scores Intake* Follow-up** BSI Depression Scores Intake*** Follow-up** BSI Anxiety Scores Intake*** Follow-up** ASI Alcohol Composite Scores Intake* Follow-up* Alcohol Dependence Scale Scores Intake Follow-up No&. Standard *p < .05. **p
deviations are indicated < .Ol. ***p < .OOl.
= 365)
B.E. Mavis,
and K.A. Humphreys
and Follow-up Women (df = 133)
0.27 0.15
(0.21) (0.17)
0.35 0.21
(0.22) (0.21)
0.97 0.5 1
(1.27) (0.52)
1.18 0.72
(0.83) (0.79)
1.14 0.59
(0.98) (0.70)
1.50 0.86
(1.04) (0.98)
0.92 0.50
(0.86) (0.64)
1.31 0.72
(1.05) (0.88)
0.35 0.19
(0.27) (0.19)
0.30 0.14
(0.28) (0.17)
14.31 7.66
(10.29) ( 9.31)
13.24 7.07
(11.33) (10.25)
in parentheses.
angular portion. All the scales were significantly correlated at both time points (p < .Ol). The correlations ranged in magnitude from .16 to .90. The correlations between the initial levels of anxiety and depression with the GSI were approximately double in magnitude for women. No such differences were found in the relationship between anxiety and depression with the ASI measure of global psychopathology or in the relationship between anxiety and alcohol dependence. The results of a univariate repeated-measures ANOVA indicated significant differences by gender,F(l, 461 = 6.328,~ zs .012, and by time, F(l, 461) = 136.706, p I .OO1. At both intake and follow-up, women reported significantly less severe alcohol problems and more psychopathology than men (p c .05), though there were no significant differences between men and women on their levels of alcohol dependence. From intake to follow-up, decreases were seen in all variables studied for both men and women (see Table 3). Regression analyses based on global indicators of psychopathology were conducted to predict alcohol problems at follow-up for the whole sample of clients, and for the male and female samples. Results from these analyses are found in Table 4. Intake levels of alcohol problems and alcohol dependence were significant predictors for the whole sample of clients and the male sample. The regression models accounted for 18% and 16% of the explained variance for each of these groups, respectively (p < .OOl). Neither of the two measures of global psychopathology were predictive of treatment outcome.
Gender
Differences
Table 4. Multiple Global Predictors
241
Regressions Predicting of Psychopathology
Alcohol
Problems
at Follow-up
Using
Adjusted t
Source
I3
Full Sample (n = 408) Alcohol Problems Alcohol Dependence ASI Psychological Problems GSI Psychological Problems
.24 .22 .05 .06
4.62*** 4.25*** 0.93 1.27
Male Sample (n = 303) Alcohol Problems Alcohol Dependence AS1 Psychological Problems GSI Psychological Problems
.26 .18 .03 .07
4.37*** 3.05** 0.48 1.20
Female Sample (n = 105) Alcohol Problems Alcohol Dependence AS1 Psychological Problems GSI Psychological Problems
.I0 .36 .I9 .05
0.91 3.22** 1.98* 0.43
*p < .05.
**p
of Substance
Abuse,
Gender
4,235-245
(1992)
Differences
in Depression and Anxiety Among Alcoholics Lois A. Benishek Kathleen J. Bieschke Bertram E. Stiiffelmayr Brian E. Mavis Keith A. Humphreys Michigan
State University
Recent research suggests that psychopathology, in particular depression and anxiety, differentially affects the substance abuse treatment response of men and women. This study explores the relationship between global psychopathology, depression, anxiety, and alcoholism treatment outcome. These variables were assessed in a sample of 507 (373 men; 134 women) substance abuse clients at intake and at a 6-month follow-up. With the exception of alcohol dependence, there were significant differences in the levels of alcohol problems, depression, anxiety, and global psychopathology for men and women at both intake and follow-up. For the whole sample and for men, initial levels of alcohol problems and alcohol dependence were the best predictors of alcohol problems at follow-up. For women, the initial levels of alcohol dependence and a global measure of psychological functioning were predictive of outcome at follow-up. These findings are compared with past research, and suggestions for further investigation are proposed.
Although it is well documented that depression and anxiety are associated with alcohol abuse (Schuckit & Monteiro, 1988; Weiss & Rosenberg, 1985), the details and implications of the relationships are unclear, particularly in the area of gender differences. Much of what is known about psychopathology and alcoholism is derived from studies of men (e.g., Penick, Powell, Liskow, Jackson, 8c Nickel, 1988; Schuckit, 1985). Only recently have large-scale studies of psychopathology and gender differences among substance-abusing populations been published (e.g., Ross, Glaser, dc Stiasny, 1988; Turnbull & Comberg, 1988). Several recent studies of treated alcoholics (Hesselbrock, Meyer, 8c Keener, 1985; Ross et al., 1988; Rounsaville, Dolinsky, Babor, & Meyer, 1987) suggest that concomitant psychopathology, as established by either diagnosis or symptomatology, has different treatment outcome implications for male and female alcoholics. Estimates of depression among alcoholics in treatment vary from approx-
Correspondence Building 1, Room
and requests for reprints 125, Weber State University,
should be sent to Lois Benishek. Ogdon. UT 84408-1402.
Counseling
Center,
235
236
LA.
Benishek,
K.J. Bieschke,
B.E. Stiiffelmayr,
B.E. Mavis,
and K.A. Humphreys
imately 25% (Nakamura, Overall, Hollister, & Radcliffe, 1983) to 66% (Pottenger et al., 1978). Alcohol-abusing women are as much as four times more likely than men to report depressive symptoms (Hesselbrock et al., 1985; Jaffe & Ciraulo, 1986). Research findings on the relationship between alcohol problems and depression are inconsistent. Some research indicates that women alcoholics who suffer from depressive problems have comparatively good posttreatment outcomes on alcohol-related measures in comparison to women without depressive problems (Rounsaville et al., 1987; Schuckit & Winokur, 1972). In contrast, some studies of male and female alcoholics demonstrate that depressive symptoms at intake are associated with increased drinking problems (Pottenger et al., 1978). Rounsaville et al. (1987) found that, for men, alcohol problems in combination with depression were associated with poorer drinking-related outcomes, whereas alcohol problems without depression were associated with better outcomes. The discrepant findings of these studies suggest a different relationship between depression and alcoholism for men and women. Reported prevalence rates of anxiety range from about 10% to 33% among alcoholics (Vaglum, Vaglum, 8c Larsen, 1987; Weiss 8c Rosenberg, 1985), which is significantly higher than among their nonalcoholic counterparts (Ross et al., 1988; Weiss & Rosenberg, 1985). Female alcoholics report more anxiety than male alcoholics (Ross et al., 1988). There is some evidence that anxiety combined with depression is positively associated with alcoholism in women (Hurlen, Vaglum, Vaglum, Larsen, & Storaas, 1984; Vaglum et al., 1987). Of particular interest are the findings of Hurlen et al. (1984). They presented preliminary evidence that among depressed women, high levels of anxiety are associated with high levels of alcohol consumption. In a subsequent study (Vaglum et al., 1987), the authors hypothesized that differences in drinking levels of nonalcoholic depressed women could be explained by the effect of anxiety. Specifically, they proposed that anxiety counterinfluences the consumption-reducing effects of depressed mood. Global psychopathology (i.e., the presence of a variety of psychological difficulties) has been used as a prognostic indicator in alcoholism research. Studies indicate that high levels of psychopathology are associated with more alcohol and life-functioning problems (McLellan, Luborsky, Woody, O’Brien, & Druley, 1983; Stiiffelmayr, Benishek, Humphreys, Lee, & Mavis, 1989). Rounsaville et al. (1987) also found that a global rating of psychopathology was a strong predictor of outcome for both men and women. These studies demonstrate that the combination of higher levels of global psychopathology with a substance abuse problem is associated with poorer treatment outcomes. In conclusion, clinicians and researchers adhere to an assumption that psychopathology, specifically depression and anxiety, has different implications for the treatment outcomes of male and female alcoholics. However, the limited empirical evidence neither consistently supports nor contradicts this speculation and merits further exploration. This study is intended to provide information on gender differences and psychopathology in an alcohol treatment population. Specifically, this study ex-
Gender Differences
237
amines whether men and women differ in their levels of alcohol problems, alcohol dependence, global psychopathology, depression, and anxiety at intake and 6-month follow-up. Also, the usefulness of global psychopathology, anxiety, depression, and the interaction between anxiety and depression as predictors of drinking problems at outcome for men and women is assessed. . METHOD Subjects This study was based on data obtained from an ongoing, state-funded substance abuse treatment outcome evaluation study in Michigan. Subjects included 507 clients (373 men; 134 women) receiving treatment at over 30 state-funded substance abuse treatment programs who were assessed when entering treatment and then again 6 months later. The treatment programs provided outpatient, inpatient, or residential services. Excluded from this study were clients (a) requesting primary treatment for a nonalcohol and/or drug-related psychiatric disorder, or (b) who were under 18 years of age. This sample of 507 clients represents approximately 67% of the clients assessed at intake. The additional 33% were considered “lost to follow-up” because they were deceased (2%), refused to continue to participate (6%), or could not be located within a reasonable time of their 6-month follow-up date (25%). Analysis of variance (ANOVA) revealed no significant differences between clients who were “lost to follow-up” and those interviewed 6 months after entering treatment on any of the following variables: global psychopathology, depression, anxiety, age, race, gender, or the type of treatment entered. The demographic characteristics of the study sample at intake are presented in Table 1. Design and Procedure Clients were approached at their respective treatment programs by trained interviewers and asked to participate in the study. Every effort was made to approach clients in a chronological order until a predetermined number agreed to participate. The majority of the client assessments were completed within 10 days of their entering treatment. Clients receiving detoxification were not assessed until after detoxification was completed. A battery of measures was administered to each participant at both intake and 6 months later. Participants were paid $10.00 for completing the intake assessment and $20.00 for the follow-up contact. Whenever possible, assessors interviewed the same clients at both intake and at 6-month follow-up. Assessors were not aware of the research hypotheses or the clients’ scores on the self-report questionnaires. The assessment battery was not completed if there was any indication that the client was under the influence of alcohol and/or drugs. No corroborative information was collected. Client assessors were trained to administer the Addiction Severity Index (ASI) and the self-report questionnaires. The quality of the data was monitored
LA.
238
Bble
1.
Demographic
Benishek,
K.J. Bieschke,
Characteristics
Race White Black Other Educational Level Less than High School High Schoo1lG.E.D. Some College or College Graduate School
8.E. StiMelmayr,
Men,
n = 373;
women,
and K.A. Humphreys
at Intake
Degree
Age 18-29 30-44 t 45 Program Type Outpatient Inpatient/Residential Primary Drug of Choice Alcohol Drug Alcohol and Drug Note.
8.E. Mavis,
Men (96)
Women (96)
63 33 4
57 43 0
30 46 21 3
21 47 30 2
47 45 8
46 42 12
41 59
46 54
48 I1 41
31 25 44
n = 134.
primarily through two ongoing activities. First, interrater agreement was evaluated on a monthly basis. Second, the reliability of the data was monitored on a bimonthly basis by having interviewers observe and score videotaped ASI interviews. Measures
Three instruments were used to assess client symptomutology in this study. The Brief Symptom Inventory (BSI) is a multidimensional self-report measure of psychological functioning (Derogatis & Melisaratos, 1983). The 53 BSI items are answered using a 5-point scale from not distressed at all (0) to extremely distressed (4) with regard to the client’s functioning in the past 7 days. The Global Symptom Index (GSI) and the depression and anxiety subscales were used in this study. The AS1 is a structured interview that assesses seven life-problem areas common to substance abusers (McLellan et al., 1985). The degree of alcohol and psychological problems as established using the composite scores from each of their respective sections. The composite scores were specifically developed to reflect change over time and are based on objective data representing client behavior in the past 30 days. A higher composite score indicates greater levels of patient problems. Alcohol dependence information was collected using the 25-item Alcohol Dependence Scale (ADS; Skinner & Horn, 1984). ADS scores range from 0 to 47 with higher scores indicating the presence of a larger number of alcohol dependence symptoms.
Gender
Differences
239
Data Analysis Intercorrelations were calculated to determine the relationship among the BSI subscales, the ASI composite scores for the psychological and alcohol sections, and the ADS scores for men and women at intake and follow-up. A univariate repeated-measures ANOVA was completed to identify gender differences and change over time on each variable of interest. Two sets of regression analyses were completed. Sample sizes differ among these analyses due to the use of pairwise deletion of missing data. The first set of regression analyses investigated the predictive strength of global psychopathology on subsequent alcohol problems for men, women, and the whole sample. The independent variables were entered into the regression equation in the following order: intake levels of alcohol problems, alcohol dependence, and psychological problems. The second set of regression analyses investigated the predictive relationship between depression and anxiety on subsequent alcohol problems for each sample. The independent variables were entered into the regression equation in the following order: intake levels of alcohol problems, alcohol dependence, anxiety, depression, and the interaction between anxiety and depression. RESULTS Table 2 contains the correlation matrix for the BSI subscales and the GSI, the AS1 composite scores, and the ADS at intake and 6-month follow-up for men and women. Values for men can be found in the lower triangular portion of the correlation matrix, whereas values for women can be found in the upper triTable 2. Intercorrelation Values for Men; Upper
GSI, GSI, AS1 AS1 Dep, Dep, Anx, Anx, AS1 AS1 ADS, ADS,
Psy, Psy,
Ale, Ale,
Matrix Triangular
by Gender (Lower Triangular Matrix Matrix Contains Values for Women)
Contains
GSI,
GSI,
AS1 Psy,
AS1 Psy,
Dep,
Dep,
Anx,
Arm,
ASI Ale,
AS1 Ale,
ADS,
ADS,
.27 .32 .18 .48 .21 .51 .28 .21 .16 .17 .37
.48 .35 .63 .41 .88 .47 .90 .16 .37 .29 .55
.47 .33 .33 .52 .35 .52 .32 .32 .17 .39 .45
.48 .66 .41 .23 .59 .25 .61 .17 .38 .32 .56
.85 .38 .42 .36 .37 .75 .39 .37 .21 .39 .37
.43 .91 .31 .64 .42 .38 .79 .I5 .40 .26 .51
.90 .44 .45 .45 .75 .36 .48 .39 .23 .45 .42
.46 .94 33 .64 .35 .79 .45 .18 .35 .31 .55
.44 .17 .33 .19 .46 .13 .48 .25 .36 .39 .45
.32 .49 .28 .46 .34 .45 .34 .52 .45 .32 .56
.51 .26 .58 .46 .54 .23 .55 .29 .58 .46 .56
.30 .48 .52 .72 .28 .42 .34 .51 .52 .72 .62 -
Note. GSI, = GSI at intake; GSI, = GSI at follow-up; AS1 Psy, = AS1 psychological composite score at intake; AS1 Psy, = AS1 psychological composite score at follow-up; Dep, = Depression at intake; Dep, = Depression at follow-up; Anx, = Anxiety at intake; Anx, = Anxiety at follow-up; AS1 Ale, = AS1 alcohol composite score at intake; AS1 Ale, = AS1 alcohol composite score at follow-up; ADS, = score at intake; ADS, = score at follow-up. All values are significant at .Ol level.
LA.
240
Table 3.
ANOVAS
Benishek,
K.J. Bieschke,
for Differences
B.E. Stiiffelmayr,
By Gender
at Intake Men (df
ASI Psychological Composite Scores Intake*** Follow-up*** BSI Global Psychopathology Scores Intake* Follow-up** BSI Depression Scores Intake*** Follow-up** BSI Anxiety Scores Intake*** Follow-up** ASI Alcohol Composite Scores Intake* Follow-up* Alcohol Dependence Scale Scores Intake Follow-up No&. Standard *p < .05. **p
deviations are indicated < .Ol. ***p < .OOl.
= 365)
B.E. Mavis,
and K.A. Humphreys
and Follow-up Women (df = 133)
0.27 0.15
(0.21) (0.17)
0.35 0.21
(0.22) (0.21)
0.97 0.5 1
(1.27) (0.52)
1.18 0.72
(0.83) (0.79)
1.14 0.59
(0.98) (0.70)
1.50 0.86
(1.04) (0.98)
0.92 0.50
(0.86) (0.64)
1.31 0.72
(1.05) (0.88)
0.35 0.19
(0.27) (0.19)
0.30 0.14
(0.28) (0.17)
14.31 7.66
(10.29) ( 9.31)
13.24 7.07
(11.33) (10.25)
in parentheses.
angular portion. All the scales were significantly correlated at both time points (p < .Ol). The correlations ranged in magnitude from .16 to .90. The correlations between the initial levels of anxiety and depression with the GSI were approximately double in magnitude for women. No such differences were found in the relationship between anxiety and depression with the ASI measure of global psychopathology or in the relationship between anxiety and alcohol dependence. The results of a univariate repeated-measures ANOVA indicated significant differences by gender,F(l, 461 = 6.328,~ zs .012, and by time, F(l, 461) = 136.706, p I .OO1. At both intake and follow-up, women reported significantly less severe alcohol problems and more psychopathology than men (p c .05), though there were no significant differences between men and women on their levels of alcohol dependence. From intake to follow-up, decreases were seen in all variables studied for both men and women (see Table 3). Regression analyses based on global indicators of psychopathology were conducted to predict alcohol problems at follow-up for the whole sample of clients, and for the male and female samples. Results from these analyses are found in Table 4. Intake levels of alcohol problems and alcohol dependence were significant predictors for the whole sample of clients and the male sample. The regression models accounted for 18% and 16% of the explained variance for each of these groups, respectively (p < .OOl). Neither of the two measures of global psychopathology were predictive of treatment outcome.
Gender
Differences
Table 4. Multiple Global Predictors
241
Regressions Predicting of Psychopathology
Alcohol
Problems
at Follow-up
Using
Adjusted t
Source
I3
Full Sample (n = 408) Alcohol Problems Alcohol Dependence ASI Psychological Problems GSI Psychological Problems
.24 .22 .05 .06
4.62*** 4.25*** 0.93 1.27
Male Sample (n = 303) Alcohol Problems Alcohol Dependence AS1 Psychological Problems GSI Psychological Problems
.26 .18 .03 .07
4.37*** 3.05** 0.48 1.20
Female Sample (n = 105) Alcohol Problems Alcohol Dependence AS1 Psychological Problems GSI Psychological Problems
.I0 .36 .I9 .05
0.91 3.22** 1.98* 0.43
*p < .05.
**p
