Addictive Behaviors, Vol. 16, pp. 315-327, Printed in the USA. All rights reserved.

1991 Copyright

0306-4603/91 $3.00 + .OO o 1991 Pergamon Press plc

GENDER DIF’FERENCES IN USING ALCOHOL TO COPE WITH DEPRESSION BERTRAND

D. BERGER and VINCENT University

of Wisconsin,

J. ADESSO

Milwaukee

Abstract - To examine gender differences in alcohol consumption as a function of mood and expectancies, 32 nondepressed and 32 moderately depressed male and female social drinkers were compared during a 15minute taste-rating session. Results indicated that depressed subjects tended to consume more alcohol than nondepressed subjects and men consumed more alcohol than women. Depressed men drank more and drank more per sip than all other subjects. Three depressed men consumed more than all other subjects. Depression and anxiety decreased over time for all subjects. However, a Sex X Depression X Time interaction showed that only depressed men and nondepressed women were substantially less depressed after drinking. The nondepressed women, compared to the depressed men, consumed less alcohol and reported a greater increase in positive mood. Men expected more global positive effects from drinking than women, suggesting the tension reduction hypothesis (TRH) is mediated by gender-specific expectancies. INTRODUCTION

Alcohol consumption has frequently been associated with both depressed mood and anxiety although the majority of research has investigated the connection between anxiety and alcohol use (Adesso, 1985; Cappell & Greely, 1987). Little work has investigated the connection between depression and alcohol use even though, clinically and anecdotally, it is claimed that alcoholics and social drinkers report drinking to relieve depression, to “get a lift,” or to alleviate a negative mood (e.g., Freed, 1978; Russell & Mehrabian, 1975; Williams, 1966). The traditional theoretical explanation used to connect mood and alcohol consumption is the tension reduction hypothesis (TRH; Conger, 1956), which suggests that (a) alcohol reduces tension and other negative affect and (b) alcohol is consumed for its tension-reducing effects. Thus, the TRH assumes that negative moods like depression motivate drinking. Research investigating both tenets of the TRH has produced inconsistent results (Adesso, 1985). Furthermore, the TRH does not specify gender differences. The present study represents an attempt to delineate some of the factors that mediate the applicability of the TRH with depression, particularly gender-related factors. It has been shown that depression is related to both gender and alcohol consumption (Richman & Flaherty, 1986). Surveys suggest that men consume more alcohol than women (e.g., Cahalan, Cissin, & Crossley, 1969; Hingson, Scotch, Barret, Goldman, & Mangione, 1981) and that women are about twice as likely as men to become depressed (e.g., Weissman & Klerman, 1977). Several authors (e.g., Egeland & Hostetter, 1983; Pihl, Murdoch, Lapp, & Marinier, 1986; Vredenburg, Krames, & Flett, 1986) have speculated that sex differences in depression are partially mediated by alcohol consumption in that men may mask depression with alcohol consumption but women do not. However, in this form this proposition is difficult to test experimentally because it provides no way to distinguish between men who are not depressed and those who effectively mask their deThese data were used in partial fulfillment of the requirements of the M.S. degree of the first author under the supervision of the second author. The authors would like to express their appreciation to Professors Robyn Ridley-Johnson. Michael T. Hynan, Susan Lima, and an anonymous reviewer for helpful comments on earlier drafts of this manuscript. We’would also like to thank the assistants of the Alcohol Studies Center at the University of Wisconsin-Milwaukee for helping with data collection. Requests for reprints should be sent to Vincent J. Adesso, Department of Psychology, University of Wisconsin-Milwaukee, Milwaukee, WI 53201. 315

316

BERTRAND

D. BERGER and VINCENT

J. ADESSO

pression with drinking (Freed, 1978; Hayman, 1974). An alternative formulation of this notion, which may provide gender specificity to the TRH, is that men are more likely than women to cope with depression by drinking (Timmer, Veroff, & Cohen, 1985). Vredenburg et al. (1986) and Pihl et al. (1986) have suggested that women cope with depression by confiding in friends, by taking psychotropic medication, or by seeking professional help while men cope by ignoring the problem, taking drugs, or drinking. This may be because women expect less positive consequences from drinking than men do (Adesso, 1985; Goldman, Brown, & Christiansen, 1987). Investigations of the correlations among alcohol consumption, gender, and depression have produced conflicting results (e.g., Brennan, Walfish, & AuBuchon, 1986; Corrigan, 1985; Ratliff & Burkhart, 1984; Richman & Flaherty, 1986). Only three experimental studies have examined the connections between depression and alcohol consumption but none considered gender effects. Two used only male subjects (Pihl, Segal, & Yankofsky, 1980; Pihl & Yankofsky, 1979), and one used only female subjects (Noel & Lisman, 1980). In all three studies an attempt was made to induce depression by means of an experimental manipulation prior to alcohol consumption. Although the effectiveness of the depression-induction manipulation was questioned by the authors of all three studies, the results provided some support for the notion that depression may lead to increased alcohol consumption. The mediating role of gender or gender-specific expectancies have not been examined. The present study was designed to examine the links among depression, gender, and alcohol consumption. Rather than attempting to induce depression, mildly to moderately depressed men and women were selected from a college population with the Beck Depression Inventory (BDI; Beck, 1967; Beck, Rush, Shaw, & Emery, 1979; Beck, Ward, Mendelson, Mock, & Erbaugh, 1961) and compared to nondepressed subjects on a tasterating task. The BDI was used as it has been shown to differentiate depression from generalized anxiety (Steer, Beck, Riskind, & Brown, 1986). All subjects were moderate to heavy social drinkers. Transient mood changes were assessed with the Multiple Affect Adjective Checklist (MAACL; Zuckerman & Lubin, 1969). The MAACL was selected because its scales include adjectives relevant to both positive and negative aspects of depression, anxiety, and hostility. In this way variations in mood could be examined over the course of the study without concern for possible floor effects among the nondepressed subjects. The Alcohol Expectancy Questionnaire (AEQ; Brown, 1985; Brown, Christiansen, & Goldman, 1987) was used to assess expectations about the effects of alcohol consumption. The following hypotheses were tested: (a) as predicted by the TRH, depressed subjects would report a greater decrease in depression (on the MAACL) as a result of drinking and consume more alcohol than nondepressed subjects; (b) men would drink more alcohol than women; and, (c) as predicted by the coping hypothesis, depressed men would not only consume more alcohol but also evidence a greater decrease in depression (on the MAACL) after drinking than depressed women and nondepressed men and women. Such results would suggest that men consume alcohol to cope with depression. Finally, the role of expectancies, as measured by the AEQ, in mediating these gender-related differences was examined. METHOD

Subjects From a pool of introductory psychology students who completed screening questionnaires as part of a test packet administered in class, 32 male and 32 female volunteer subjects (mean age = 23.44; SD = 3.85; range = 20-40) were selected based upon

Gender differences

in alcohol use

317

Table 1. Means and standard deviations on Beck Depression Inventory (BDI) and Cahalan Quantity Frequency Variability (CQFV) overall drinking scale Groups” Nondepressed

BDI score

Depressed

Men

Women

Men

Women

SD

1.37 1.26

.81 1.05

12.87 2.99

16.06 6.35

M SD

6.37 2.55

6.62 2.87

5.00 2.50

6.06 2.59

M

CQN overall drinking =n = 16.

their BDI scores and drinking practices. All subjects were classified as heavy or moderate drinkers according to the initial administration of the Cahalan Quantity-Frequency-Variability drinking practices questionnaire (CQFV; Cahalan, Cissin, & Crossley, 1969). Thirty-two (16 men and 16 women) subjects were selected into each of the depression conditions based on the initial BDI. A score of 3 or lower on the BDI was the range for the nondepressed group and a score of 10 or higher (range = 10-32) on the BDI was the cutoff score for the mildly depressed group. According to Bumberry, Oliver, and McClure (1978), Beck’s original system for categorizing individuals’ depression levels based on their BDI scores was as follows: 0 to 9 = not depressed; 10 to 15 = mildly depressed; 16 to 23 = moderately depressed; and 24 to 63 = severely depressed (Beck et al., 1961). A more stringent criterion (3 or lower) than that used by Beck was employed for the nondepressed group to assure greater mood differences between nondepressed and depressed groups. The cutoff score of 10 or higher used to select the mildly depressed group has been used as a cutoff by other researchers (e.g., Zimmerman, 1986). Subjects completed the BDI again just prior to participation due to the transient nature of depression as measured by the BDI in college students (Sacco, 1981). Seventeen subjects who did not score within the specified ranges at the time of the experiment were replaced with qualified subjects. The means and standard deviations of the groups’ scores on the BDI and CQFV overall drinking scale are presented in Table 1. Individuals with histories or symptoms of any physical or mental condition that might be aggravated by alcohol consumption (e.g., pregnancy, medication) were excluded. Subjects were asked not to drink any alcoholic beverages for 24 hours and not to eat or drink any beverage other than water for 4 hours prior to their participation. Assistants Male and female undergraduates served as both experimenters and assistants. Female experimenters tested female subjects; male experimenters tested male subjects. All were blind to the subject’s condition and the experimental hypotheses. Reliability of ratings Taste-rating sessions were videotaped to permit assessment of the reliability of sip counts. Three independent ratings of the number of sips taken were completed: the first by the original assistant, the second by a separate assistant, and the third by an assistant

31X

BERTRAND

D. BERGER

and VINCENT

J. ADESSO

unfamiliar with the study. The reliability between sets of ratings was greater than ~$64) = .98. The third set of ratings was used in data analyses to ensure absence of bias. Paper-m&pencil measures Subjects were administered the Revised Shipley Institute of Living Scale (Zachary, 1986) to check group comparability in intellectual ability. Two forms of the MAACL (Zuckerman & Lubin, 1969) were used to assess mood (depression, anxiety, and hostility) changes due to drinking. The AEQ (Brown, Christiansen & Goldman, 1987) was used to measure alcohol-related expectancies. The AEQ has six subscales: 1. 2. 3. 4. 5. 6.

Global, positive changes; Enhanced sexual performance and experience; Physical and social pleasure; Increased social assertiveness; Relaxation and tension reduction; and Arousal and power.

Filler tasks were also used to space subject participation and to occupy the subject during detoxification. Finally, all subjects completed a post-experimental questionnaire that served as a manipulation check, and asked for an evaluation of the experimenter, the assistant, and aspects of the experiment. Apparutus and tnuteriuls The experiment was conducted in a bar-like setting. The subject was seated at the bar so he or she was clearly observable through a hidden video camera used to tape the tasterating session. All paper-and-pencil tests were administered in a debriefing room so that the barroom setting did not affect responding. Subjects rated the sensory quality of three brands of malt liquor (Old English 500, Schlitz Malt Liquor, and Colt 45) on 120 adjectives typed on 3- by 5-inch cards. The liquor cans were covered to disguise their labels. In another room, an Omicron Intoxilyzer (an automated breathalyzer) was used to measure blood alcohol concentration (BAC) from breath samples and a Sears’ model 6450 doctor’s scale was used to weigh the subject. Procedure Subjects were contacted by telephone a few days in advance of participation, screened for contraindications, and scheduled. All subjects were run on weekday afternoons. Informed consent was obtained from participants when they arrived. The subject was asked to surrender his or her car keys (according to University regulations). A baseline intoxilyzer reading was taken to ensure the absence of residual alcohol. A subject would have been dismissed if residual alcohol were present. No subject was dismissed for this reason. The subject was then weighed, The subject was next taken to another room and given a packet of forms: the CQFV, BDI, AEQ, MAACL (form l), and fillers. The experimenter then left the room. When these forms were completed, the experimenter escorted the subject to the bar where the malt liquors, sip rating form, adjective cards, and glasses were in place in front of the subject’s seat. The first set of cans was opened and poured in the presence of the subject. A second set of unopened cans was on the bar should the subject desire more of any beverage. After subjects were instructed to drink as much of each beverage as they needed to rate it on the various adjectives, the experimenter left the bar without indicating the rating task’s length.

Gender differences

Table 2. Means and standard deviations

Nondepressed Men Women

measures for sex as a function of

Total no. of sips

Amount per sip (ml)

BAC-2b

SD

543.50 296.40 329.56 157.63

31.69 14.66 30.87 14.25

18.81 10.82 11.73 5.64

,036 ,027 ,023 ,019

M SD M SD

430.57 210.57 252.87 137.94

34.44 21.85 24.56 10.65

16.06 13.20 10.73 4.53

.03 1 .025 ,019 ,019

M

SD Women

of consumption depression

319

Amount consumed (ml)

Groups” Depressed Men

in alcohol use

M

% = 16. ‘BAC-2: Blood Alcohol Concentration

taken directly after drinking.

An assistant observed the subject through the video camera and counted the number of sips per minute. The task lasted 15 minutes, after which time the experimenter reentered the room and stopped the subject. The subject was given crackers and water to aid absorption of excess alcohol in the mouth. The second intoxilyzer reading was taken by the assistant and the Revised Shipley Institute of Living Scale, MAACL (form 2), and filler tasks were administered. While the subject was detoxifying and prior to debriefing, the subject was asked to answer the postexperimental questionnaire. The third BAC reading was taken after debriefing. When the subject’s BAC was below .05 mg%, the subject received experimental credit and was released. If the subject was from the depression group, she or he was given a handout that described mood states and listed free mental health services available to students. RESULTS

All data were analyzed using the statistical software package by SPSS/PC + version 3.0 (SPSS, 1988). Comparability of groups was assessed with two-way (Sex X Depression) analyses of variance (ANOVAs) on overall drinking score from CQFV, age, weight, and Shipley scores. The groups did not differ on overall drinking, Shipley scores, or age. Heterogeneity of variance on the weight variable was controlled with the following transformation: the square root of x + 1 plus the square root of x, where x is weight (Freeman & Tukey, 1950). Men (M = 171.31, SD = 28.2) were significantly heavier than women (M = 137.60, SD = 26.6), F(l,60) = 31.07, p < .OOOl. However, Pearson correlation coefficients indicated that weight was not significantly correlated with consumption, ~(64) = .23, so weight was not covaried. Responses to the post-experimental questionnaire, on an 11-point scale (0 = no to 10 = yes), indicated subjects tended to feel there was more to the experiment than met the eye (M = 7.23, SD = 2.63). As no subject was able to describe the study’s hypotheses in any way, no subject was dropped for this reason. Manipulation

checks

To ensure group differences administration of the MAACL

in depression, the groups were compared on the initial depression, anxiety, and hostility scales. Depressed sub-

320

BERTRAND

D. BERGER

and VINCENT

J. ADESSO

Table 3. Means and standard deviations of the Multiple Affect Adjective Checklist (MAACL) scales of depression (-D) and anxiety (-A) before (ADM 1) and after (ADM 2) drinking for sex as a function of depression MAACL-D Groups” Depressed Men Women Nondepressed Men Women

MAACL-A

ADM 1

ADM 2

ADM 1

ADM 2

M SD

18.06 4.25 16.37 7.38

15.5 4.91 15.25 6.58

9.43 2.94 8.69 4.15

8.00 2.88 7.12 3.42

M SD M SD

12.00 5.37 12.81 5.29

11.06 5.55 9.75 5.31

6.69 3.86 5.00 2.94

5.43 3.16 4.56 2.97

M SD

% = 16

jects were expected to report more depression than nondepressed subjects. A 2 X 2 (Sex X Depression) multivariate analysis of variance (MANOVA) yielded a multivariate main effect for depression, Hottelings T = .24, approximate F(3, 58) = 4.65, p = .006. Univariate tests uncovered significant effects on the depression, F(1,60) = 11.22, p = .OOl , and anxiety scales, F( 1,60) = 13.39, p = .OOl , with depressed subjects scoring higher on depression (M = 17.21, SD = 5.41) and anxiety (M = 9.05, SD = 3.07) than the nondepressed subjects (depression, M = 12.40, SD = 5.60; anxiety, M = 5.84, SD = 3.5 1). There were no significant effects for hostility or any interactions. Consumption measures Depressed subjects were expected to drink more than nondepressed subjects, and men were expected to drink more than women. Depressed men were expected to drink more than all other subjects. Three 2 X 2 (Sex X Depression) ANOVAs were computed using milliliters of malt liquor consumed, number of sips, and average milliliters per sip as the dependent measures. Average milliliters per sip were computed by dividing the amount consumed by the total number of sips. The means and standard deviations for these variables are presented in Table 2. The data for the analysis of the total milliliters of malt liquor consumed were transformed to the square root to make the groups’ variances homogeneous. The analysis revealed a significant main effect for sex, F( 1,60) = 14.06, p < .OOl, with men consuming more malt liquor than women. The depression main effect approached significance, F(1,60) = 3.47, p = ,068, with depressed subjects tending to consume more than nondepressed subjects. There was no interaction. An a priori contrast revealed that depressed men drank significantly more than the average of the nondepressed men, nondepressed women, and depressed women, t(60) = 3.26, p = .002. An a posteriori Tukey pairwise analysis revealed depressed men to be significantly different from both depressed and nondepressed female groups (p < .05). The Tukey analysis also revealed 2 homogeneous subsets of groups: both female groups and the nondepressed male group made up one subset and nondepressed and depressed male groups made up the other subset (SPSS, 1988). This again suggests that the depressed men were significantly different from the average of the nondepressed men, nondepressed women, and depressed women; however,

Gender differences

321

in alcohol use

0

-

l

A-A

al 0

20

::

18

A-A

19

s

17

$

16

:

15

0

Depressed

l

Depressed Women Nondepressed Men Nondepressed

Men

Women

14 13 12 11 10 9

a 7 Before

Drinking

Fig. 1. Mean scores of groups before and after drinking list (MAACL) depression scale.

After

Drinking

on the Multiple Affect Adjective

Check-

it also suggests that the nondepressed men were not significantly different from the female groups or the depressed men. After controlling for heterogeneity of variance by taking the square root of the data, the analysis of the average milliliters consumed per sip revealed a main effect for sex, F( 1,60) = 7.17, p = .Ol , with men consuming more per sip than women. Additionally, an a priori contrast revealed depressed men drank more per sip than did the average of the nondepressed men, nondepressed women, and depressed women, t(60) = 2.23, p = .029. There were no significant a posteriori effects. The analysis of the number of sips yielded no effects. The number of sips taken in each of the 5-minute blocks of the taste-rating task was computed and analyzed with a 2 X 2 X 3 (Sex X Depression X Time) repeated measures ANOVA. The only significant effect was a main effect for time, F(2,120) = 142.07, p < .OOl, indicating that sipping decreased over time. Two 2 X 2 (Sex X Depression) ANOVAs were computed using the BAC data obtained just after drinking and just before debriefing as dependent measures. The means and standard deviations for these data are also placed in Table 2. The only significant effect obtained was a main effect for sex on the BAC data obtained just after drinking, F(1,60) = 4.93, p = .03. Men had a higher BAC just after drinking than women. Only three subjects opened additional cans of malt liquor. All three were males from the depressed group. The responses of these three men were compared to the remaining depressed male subjects, using four one-way ANOVAS, on overall drinking measured by the CQFV, BDI scores, and MAACL depression scores (form 1 and form 2). No differences were found on overall drinking measured by the CQFV, BDI scores, or form 1 of the MAACL depression scale. A marginally significant effect was found on form 2 of the MAACL depression scale, F(1,14) = 4.38, p = .055, with depressed male subjects who opened additional cans reporting lower depression (M = 10.67, SD = 7.64) than the remaining depressed men (M = 16.61, SD = 3.64). A similar analysis of these three

BERTRAND

322

D. BERGER

and VINCENT J. ADESSO

A ~

A

Nondepressed

Women

0 Before

Drinking

Fig. 2. Mean number of positive (MAACL) depression scale endorsed

After

Drinking

adjectives from the Multiple Affect by groups before and after drinking.

Adjective

Checklist

using an one-way MANOVA with all six scales of the AEQ used as dependent sures revealed no significant differences.

men

mea-

Mood measures

MAACL scores on the depression, anxiety, and hostility scales before and after consuming alcohol were used to measure mood changes. The means and standard deviations of the three scales of the MAACL are located in Table 3. Mood changes from before to after drinking were analyzed with a repeated measures 2 X 2 X 2 (Sex X Depression X Time) MANOVA using the three scales of the MAACL as dependent measures. The between-subject multivariate effect resulted in a multivariate main effect between depression groups, Hotellings T = .0155, approximate F(3,58) = 5.9, p = .OOl. Univariate analyses indicated that depressed subjects scored higher on the combined depression (form 1 and form 2), F(1,60) = 13.23, p = .OOl, and anxiety scales (form 1 and form 2), F(1,60) = 19.27, p < .OOl, than nondepressed subjects. There was also a multivariate repeated measures main effect for time across the two administrations of the MAACL .47, approximate F(3,58) = 9.05, (before and after drinking), Hotellings T = p < .0005. Univariate analyses revealed significant repeated measures effects on the depression, F(1,62) = 16.92, p < .OOOl, and anxiety scales, F(1,62) = 13.16, p = .OOl, suggesting decreases in both anxiety and depression as a result of time. No significant effects were revealed on the hostility scale. A significant multivariate three-way interaction (Sex X Depression x Time) was obtained, Hotellings T = .17, approximate F(3,58) = 3.34, p = ,025. Univariate analyses of this interaction revealed that the depression scale of the MAACL was the primary dependent variable contributing to the multivariate effect, Standardized Beta = 1.051, F(1,60) = 3.74, p = .058. Simple interaction effect analyses, using the Bonferonni Inequality method (Hays, 1981) to control for Type I error, revealed that depressed men, F(1,60) = 7.75, p < .05, and nonde-

Gender differences

323

in alcohol use

Table 4. Means and standard deviations of the positive and negative adjectives from the Multiple Affect Adjective Checklist (MAACL) depression scale before (ADM 1) and after (ADM 2) drinking for sex as a function of depression Negative adjectives

Positive adjectives ADM2

ADMl

SD

4.44 2.94 6.43 4.94

6.31 4.24 6.81 4.94

2.50 2.90 2.81 3.56

1.81 2.83 2.06 2.62

M SD M SD

8.56 5.09 7.56 5.43

9.44 5.24 10.31 5.17

0.56 1.55 0.37 0.62

0.50 1.21 0.06 0.25

ADM 1

Groups” Depressed Men

M

SD Women Nondepressed Men Women

M

ADM 2

%I = 16.

pressed women reported a decrease in depression after drinking, F( 1,60) = 11.07, p < .05. Figure 1 illustrates the interaction. To clarify this interaction, responses to the 20 positive (e.g., glad, strong) and 20 negative adjectives (e.g., awful, blue) used to score the Depression scale of the MAACL were compared using two 2 x 2 x 2 (Sex x Depression x Time) repeated measures ANOVAs. Means and standard deviations are located in Table 4. For the positive adjectives, the results indicated a between subjects main effect for depression, F(1, 60) = 6.77, p = .012, with nondepressed subjects scoring higher than depressed subjects. Additionally, the results indicated a Sex X Depression X Time interaction, F (1,60) = 4.95, p = .03. After controlling for Type I error using the Bonferonni Inequality method, simple interaction contrast effects indicated that only nondepressed women significantly increased their endorsement of positive items after drinking, F(1,60) = 13.15, p < .05. Figure 2 illustrates the interaction. There was also a main effect for time, F(1,60) = 15.00, p < .OOl, which indicated an increase in all subjects’ endorsement of positive items after drinking. Analysis of negative mood items violated the homogeneity of variance assumption of ANOVA due to floor effects in the nondepressed subjects even after transformations of the data. The only significant within-subjects effect was for time, F(1,60) = 5.16, p = .027, which would not be affected by violations of the homogeneity assumption. This effect suggested that subjects decreased in their endorsement of negative items after drinking. There were no significant interactions. A 2 X 2 (Sex X Depression) MANOVA was computed on the MAACL scores obtained after drinking (form 2) to determine whether the depressed subjects continued to differ in mood from the nondepressed subjects. A multivariate main effect for depression was obtained, Hotellings T = .31, approximate F(3,58) = 5.95, p = .OOl. Univariate analyses indicated that after drinking depressed subjects continued to report higher levels of depression, F(1,60) = 12.49, p = .OOl, and anxiety, F(1,60) = 10.21, p = .002, than nondepressed subjects. No effects were found for the hostility scale. Using several 2 x 2 (Sex X Depression) ANOVAs on the post-experimental questionnaire, depressed subjects (M = 3.33, SD = 2.01) reported experiencing a more improved mood compared to nondepressed subjects (M = 1.78, SD = 1.95) after drinking, F(1,60) = 11.61, p = .OOl. Additionally, depressed subjects (M = 3.69, SD = 2.45)

324

BERTRAND

D. BERGER and VINCENT

reported feeling more intoxicated than nondepressed after drinking, F(1,60) = 8.19, p = .006. Expectancy

J. ADESSO

subjects

(M = 2.19,

SD =

1.62)

measure

Responses to the six subscales of the AEQ were analyzed with a 2 X 2 (Sex X Depression) MANOVA. Two nondepressed males, one depressed male, and one depressed female did not fully complete the AEQ, so the data of 56 subjects were analyzed. A multivariate main effect was found for sex, Hotellings T = .27, approximate F(3,54) = 2.30, p = .048. Univariate analyses indicated that the effect was due to the AEQ subscale measuring global, positive changes, F(3,54) = 5.00, p = .029. Males (M = 9.22, SD = 5.25) expected greater global, positive changes than females (M = 6.56; SD = 3.98). There were no other main effects or interactions. DISCUSSION

Depressed subjects tended to drink more and saw themselves as more intoxicated and more improved in mood than nondepressed subjects. Thus, there was some support for the TRH prediction that depression motivates drinking. Had more deeply depressed subjects been used, it is possible that the finding regarding consumption would have been stronger. Further support for the TRH was found in subjects’ report of subjective mood change as a result of drinking. All subjects reported a decrease in anxiety and depression after drinking. However, group differences were maintained, with depressed subjects sustaining higher levels of depression and anxiety than nondepressed subjects. The failure to find an interaction among depression, consumption, and gender may suggest that the TRH applies equally across sexes. However, the predicted finding that men consumed more than women may indicate that further specificity in the TRH is needed to account for gender differences in the connection between consumption and depression. It is possible that some men may effectively mask depression with alcohol consumption and, as a result, do not score highly enough on measures of depression such as the BDI to be labeled depressed. Some of these men may have been included in the group of nondepressed men. The findings that the changes in depression reported by these subjects were often paralleled by changes in anxiety as measured by the MAACL raises the question of whether it is possible to separate depression and anxiety. The BDI was selected for use in the present study precisely because it has been shown to be capable of separating the two moods (e.g., Steer et al., 1986). However, the present findings and other recent research (e.g., Dobson, 1985; Watson & Kendall, 1989) suggest this may not be easy to accomplish. In fact, these findings raise the question of what role depression has played in past TRH research that has looked only at anxiety. Future TRH research needs to clarify the relations between these moods. The coping hypothesis, that men drink alcohol to cope with depression, was intended to illuminate potential gender differences and received both direct and indirect support. The direct support was that depressed men drank more and drank more per sip than the average of the nondepressed men, nondepressed women, and depressed women. However, a posteriori analysis of the amount consumed per sip did not find any specific pairs of groups to be different obscuring the finding. The a posterior? analysis of the amount consumed suggests that depressed men drank more than both depressed and nondepressed women. However, the amount consumed by the nondepressed men was intermediate to that of the women and the depressed men. This finding suggests that men are more likely

Gender differences

in alcohol use

325

to consume alcohol than women and that depression may exacerbate the likelihood of men drinking. The first bit of indirect support came from the observation that the only subjects to open additional cans of malt liquor were three depressed men. Given that all subjects were heavy to moderately heavy drinkers, this may suggest the existence of subgroups of depressed men, some of whom use alcohol to cope with depression and some who use other coping strategies. Further analyses of the data of these three subjects revealed them to be equivalent to the remaining depressed men on BDI, initial mood, and overall consumption scores. However, these subjects did perceive a marginally greater decrease in post-drinking depression compared to the remaining depressed men (p = .055). This may simply be the result of their greater alcohol consumption. Alternatively, these subjects may have expected greater mood change and reinforcement from alcohol, and therefore increased their alcohol use in the face of negative affect. However, these three men did not differ from the other depressed men in their responses to the AEQ. Unfortunately, the small number of subjects involved limits the possibility of testing this notion adequately but does suggest the potential utility of the coping hypothesis. A second finding that lends some support to the coping hypothesis is derived from the three-way interaction on the Depression scale of the MAACL. Depressed men reported reduced depression on the MAACL after drinking, an effect not found in depressed women or nondepressed men. This finding is complicated by the fact that nondepressed women also experienced decreased depression after drinking. However, it appears that the mood change experienced by the nondepressed women was qualitatively different from that experienced by the depressed men. The nondepressed women endorsed more positive mood adjectives than depressed men. Finally, it was the nondepressed women who drank the least. The results of research on alcohol-related expectancies indicate that women expect a less positive emotional outcome from drinking (Adesso, 1985; Goldman et al., 1987). The results of the present study are in agreement with these findings in two ways. Women expected less global, positive changes from drinking, and the women who drank the least (the nondepressed women) reported the most positive emotional state after drinking. This evidence, that women who drank the least reported more positive emotional states, may indicate a dosage effect. Women may expect positive emotional effects at a lower dosage than men. These findings suggest that an interaction among gender, depression, and alcohol consumption does exist and is mediated by gender-specific expectancies. The results of this study provide some support for the TRH and the consumption of alcohol as a coping strategy for depressed men. They also suggest an explanation for the use of other coping strategies by women: Women do not expect alcohol to produce the positive emotional changes that men do. Future research should consider developing greater specificity in the predictions of the TRH, particularly with regard to gender, expectancies, and the overlap of depression and anxiety. The use of larger number of more depressed men who specifically indicate alcohol use as a general coping strategy might help to elucidate the connections among mood, gender, alcohol consumption, and beliefs suggested by the present data.

REFERENCES Adesso, V.J. (1985). Cognitive factors in alcohol and drug use. In M. Galizio & S.A. Maisto (Eds.), Dererminanrs ofsubstance abuse (pp. 179-208). New York: Plenum.

326

BERTRAND

D. BERGER and VINCENT J. ADESSO

Beck. A.T. (1967). Depression: Clinical, experimental, and theoretical aspects. New York: Harper & Row. Beck. A.T.. Ward, C.H., Mend&on. M.. Mock, J.. & Erbaugh, J. (1961). An inventory for measuring depression. Archives of General Psychiatry, 4, 561-571. Beck. A.T.. Rush, A.J., Shaw. B.F., & Emery, G. (1979). Cognitive therapy depression.New York: Guilford. Brennan, A.F. Walfish, S.. & AuBuchon, P. (1986). Alcohol use and abuse in college students. 1. A review of individual and personality correlates. The International Journal of the Addictions, 21, 449474. Brown, S.A. (1985). Expectancies versus background in the prediction of college drinking patterns. Journal of Consulting and Clinical Psvchologv, 53. 123-130. Brown, S.A.. Christiansen. B.A. & Goldman, M.S. (1987). The Alcohol Expectancy Questionnaire: An instrument for the assessment of adolescent and adult alcohol expectancies. Journal of Studies on Alcohol. 48. 383391. Bumberty. W., Oliver, J.M.. & McClure, J.N. (1978). Validation of the Beck Depression Inventory in a university population using psychiatric estimates as the criterion. Journal of Consulting and Clinical Psychology. 46, 150-155. Cahalan. D., Cissin, I., & Crossley, H. (1969). American drinking practices. New Brunswick, NJ: Rutgers Center of Alcohol Studies. Cappell, D., & Greely, S. (1987). Alcohol and tension reduction: An update on research and theory. In H.T. Blane & K.E. Leonard (Eds.). Psychological theories ofdrinkingand alcoholism. (pp. 15-54). New York: Guilford. Conger. J.J. (1956). Reinforcement theorv and the dynamics of alcoholism. Quarterl! Journd of Studies on LAlcoho/. 17, 296-305. Corrigan. E.M. (1985). Gender differences in alcohol and other drug use. Addictive Behaviors. 10. 313-317. Dob&. K.S. (1985). Relationship between anxiety and depression.-Clinical Psychology Review,, 5, 305-324. Egeland, J.A., & Hostetter. A.M. (1983). Amish study I: Affective disorders among the Amish, 197&1980. American Journal of Psychratry. 140, 56-61. Freed, E.X. (1978). Alcohol and mood: An updated review. The International Journal of the Addictions, 13, 173-200. Freeman. M.F., & Tukey. J.W. (1950). Transformations related to the angular and the square root. Annals of MathemoticA und Statistics, 21, 607-61 1. Goldman, M.S., Brown, S.A., & Christiansen, B.A. (1987). Expectancy theory: Thinking about drinking. In H.T. Blane & K.E. Leonard (Eds.). Psyhological theories qf drinking and alcoholism (pp. 181-226). New York: Gmlford. Hayman, M. (1974). The relationship of depression to alcoholism. In S. Lesse (Ed.), Mrrsked depression (pp. 318-338). New York: Jason Aronson. Hays, W. L. (1981). Statistics (3rd ed.). New York: CBS College Publishing. Hingson, R.. Scotch. N.. Barrett. J.. Goldman, E.. & Mangione, T. (1981). Life satisfaction and drinking practices in the Boston metropolitan area. Journal of Studies on Alcohol. 41, 24-37. Noel, N.E. & Lisman. S.A. (1980). Alcohol consumption by college women following exposure to unsolvable problems: Learned helplessness or stress induced drinking? Behavior Research & Therapy. 18, 429440. Pihl, R.O.. Murdoch, D.. Lapp, J.E. & Marinier, R. (1986). Psychotrope and alcohol use by women: One or two populations. Journml qf Clinical Psychology, 42, 991-999. Pihl, R.O.. Segal, Z.. & Yankofsky, L. (1980). The effect of alcohol and placebo on affective reactions of social drinkers to a procedure designed to induce depressive affect anxiety and hostility. Journal of Clinical Psyhology, 36, 337-342. Phil. R.O. & Yankofsky, L. (1979). Alcohol consumption in male social drinkers as a function of situationally induced depressive affect and anxiety. Psyhopharmacology. 65, 251-257. Ratliff, D.G. & Burkhart. B.R. (1984). Sex differences in motivations for and effects of drinking among coilege students. Journal of Studies on Alcohol, 45, 2632. Richman. J.A., & Flaherty, J.A. (1986). Sex differences in drinking among medical students: Patterns and psychosocial correlates. Journal of Studies on Alcohol. 47, 283-289. Russell, J.A. & Mehrabian. A. (1975). The mediating role of emotions in alcohol use. Journal of Studies on Alcohol, 36, 150X-1536. Sacco, W.P. (1981). Invalid use of the Beck Depression Inventory to identify depressed college-student subjects: A methodological comment. Cognitive Therapy and Research. 5, 143-147. SPSS Inc. (1988). SPSS/PC+ V2.0 Base h4anual. Chicago: Author. Steer, R.A., Beck, A.T., Riskind. J.H.. 8; Brown, G. (1986). Differentiation of depressive disorders from generalized anxiety by the Beck Depression Inventory. Journal of Clinical Psychology, 42, 475-478. Timmer. S.G.. Veroff, J.. & Colten. M.E. (1985). Life stress. helplessness, and the use of alcohol and drugs to cope: An analysis of national survey data. In S. Shiffman & T.A. Wills, (Eds.). Coping and substance use (pp. 171-197). San Diego: Academic Press. Vredenhurg. K., Krames. L., & Flett, G.L. (1986). Sex differences in the clinical expression of depression. Se* Roles. 14, 37-49. Watson. D.. & Kendall. P.C. (1989). Understanding anxiety and depression: Their relation to negative and positive affective states. In P.C. Kendall & D. Watson, (Eda.), Anxiey and Depression: Distinctive and orerLcrppin,y .fecrrures (pp. 3-26). San Diego: Academic Press.

of

Gender differences

in alcohol use

327

Weissman, M.M., & Klerman, G.L. (1977). Sex differences and the epidemiology of depression. Archives of General Psychiatry, 34, 98-l 11. Williams, A.F. (1966). Social drinking, anxiety and depression. Journal of Personality and Social Psychology, 26, 586-594. Zachary, R.A. (1986). Manual for the revised Shipley Institute of Living Scale. Los Angeles: Western Psychological Services. Zimmerman, M. (1986). The stability of the revised Beck Depression Inventory in college students: Relationship with life events. Cognitive Therapy and Research, 10,3743. Zuckerman, M., & Lubin, B. (1969). Manual for the Multiple A#ect Adjective Check List. San Diego: Educational and Industrial Testing Service.