Journalo[ Studieson Alcohol,Vol. 39, No. 5, 1978

Stress, Escapism andPatternsof Alcohol andDrugUse' S. W. Sadava,R. Thistleand R. Forsyth øSVMMXX•y. Stress-related misuse o[ alcoholor drugsappears to be impulsive and ma•lre[lectconflict, learned helplessness or anattemptto reduce cognitive dissonance.

havepersistently linked escape, avoidance and relief(2, to alB EI-IAVIORISTS (e.g., 1)and psychodynami theorists 3)

coholanddrugproblems. Termsin the literatureconverge around "escapism": for example, "tension relief"(1, 4), "personal effectsfunctions" (5, 6), "assuagement" drinking(7), "ataraxic" motivation (8) and"psychological dependence" (9, 10). Indeed, Sanford (2) feelscompelled to warnagainst the assumption that anytemporary "escapist" drinkingis maladaptive andirreversible. The problemis that a consistent patternof escapist drinkingresuits in an exclusive focus on alcohol as an end in itself. The

presentstudyreportsdata on drinkingand drug use in relation

to stress andescapis•n, andchallenges assumptions aboutescapist drinking. Two recent reviews (4, 11) reveal a fascinatinginconsistency.

Environmental or intrapsychic stressmay be followedby heavier drinking,particularly amongproblemdrinkerswhoexpectalcohol to providefeelingsof reliefor the abilityto forgettheir problems. Yet, a seriesof experiments hasfailedto provideconsistent physiological, behavioralandexperiential evidenceof the relief of tensionin drinkers.This paradoxdeserves criticalattention. • Supportedby a grantfrom the Researchon Drug AbuseProgram,Non-Medical Use of Drugs Directorate, Dept. of National Health & Welfare, and by a Leave Fellowship,Canada Council. An earlier draft was written while Dr. Sadavawas a visitingscholarat the Wright Institute,Berkeley,CA. Discussions with Nevitt Sanford and Robert Ekblad were most helpful, as were the efforts of Eileen Brown, SusanDafoe, Robert Armstrong,Calvin Brown, Gerry Furlong and Helga Lange. a Brock University,St. Catharines,Ontario L25 3A1, Canada. Receivedfor I•ublication:3 March 1977. Revision: 6 September1977. 725

726

S. W. SADAVA•R. THISTLEAND R. FORSYTH

The hypothesis that alcoholmisuseresultsfrom drinkingfor the relief of tensionis basedon t;vo assumptions: that peopledrink to

relievetensionandthat alcoholprovidesthat relief.Escapist drinking is thus learned, intentional behavior. The drinker wishes to

escapefrom an externalsituationor internalstate,is willing and able to drink, expectsrelief, and attributesmoodchangesto alcohol. Becomingintoxicatedmay Icad to a pleasantemotional change, to oblivionor to socialdefinitionasan irresponsible "drunk." A drinker'sescapistintent cannotbe assumedfrom observedeffects,even if one can assumethat the drinkerintrospects about alcoholand statesof mind (9).

Similarly,the intentor experience of a drinkercannotbe determineddirectlyfrom observed changes in drinkingaccompanied by

stress. In samples of patientsandnormalsubjects, drinkingand drugproblems havebeenrelatedto stressful life events(12, 13) andto job-related stress(14-16). In experimental situations, stress mayelicitincreased drinking.However,the unpleasant emotional stateis not necessarily relieved,and may even be intensified(4, 11, 17-20). One well-designed study(21) foundthat alcoholics,

whendrinking, become physiologically lessaroused but subjectively lesscomfortable. Whiledrinkingmayreducethe anxietyof personsunder stress,the awarenessof drinking may increaseanxiety.

Heavydrinkers maybe ambivalent or uncomfortable aboutdrinking-a source of tension notrelieved by moderate doses of alcohol. While drinkersmayrelatetheirdrinkingto stressandescapism, theroleof the personal meanings of drinking, in relationto ex-

perienced stress, hasnotbeendirectly investigated. Onestudy(22) hasreported correlations betwccn problem drinking andpersonal dissatisfaction (low expcctancics, alienation)in Italian Americans

butnotin Italians.Apartfrompharmacology, drinking in response to dissatisfaction or stressmustbe mediatedby the culturalor personalmeanings of drinking.In Italy, drinkingdoesnot meanrelief from tension.Of course,as drinkingintensifies,the drinker will find morereasons for drinking.The hypothesis that drinking

is motivated by escapism wouldsuggest thatstress-related drinking is associated with escapist or copingfunctions. In thepresent study, stress isrepresented by aspects of thejob andby majorchanges in life.TheHolmes andRaheprocedure, usingnormarive weightings forspecific events, hasbeendiscussed

STRESS• ESCAPISlkI AND ALCOHOL

AND

DRUG USE

727

elsewhere (23, 24).aIn thepresentstudy,indicesof the perception of changes in life represent an interaction of externaleventsandthe adaptivecapacitiesof the individual. The escapist hypothesis wouldpredictthat (1) misuseof alcohol and drugsshouldincreasewith increasinglevelsof stressand

with increasingly positiveand decreasingly negativefunctions for use, (2) stressshouldbe relatedspecifically to copingfunctions and (3) maximum usepatternsshouldoccurwhenstress andcoping functions combine. METHOD

Subjects.Of the 370 adultsrecruited,all were fully employed,238 as teachers,67 as factoryworkersand 65 as nurses.Approximatelyequal numbersof men (49%) and women (51%) were studied.The average

ageof the subjects xvas36, the rangebeing20 to 62. Most of the subjects(707•)xveresingle,227•beingmarriedand87•separated or divorced. Somepostsecondary education wasreportedby 59• of the sample. Procedure.Data were collectedby meansof a 38-pagequestionnaire 'L containing itemsthat had beendevelopedand validatedin earlierresearch. Withina larger,multivariate design, measures of job stress, lifechange,alcoholuseand functions of alcoholusewereincluded. FromCaplanet al. (25), 27 itemswerecombined into a cumulative measure with a Cronbach alpharatioof .65.The itemsassess perceived work load,variabilityin hoursand work load,complexity, boredom, roleconflictandambiguity, inequityin pay,underutilization of abilities and socialsupportfrom others.

The measureof life-change stresswas basedon research validating

theapproach (23, 24)/ For eachof sixareas(health,heterosexual relationships, family,work,money andlifestyle), theindividual wasasked to reportsignificant changes occurring withinthepastyear.Thesubject wasaskedto ratethechanges alongthreedimensions: extentof change

("nochange" to "verygreatchange"); affect(feelingaboutthese changes, ranging from"verybad"to "verygood"); andimpact of these changes on "life as a whole."Changes alongeachdimension were cumulatedacrossthe six areasof life. As theseare cumulativeindices, internal reliability coefficientsare not appropriate.

3CI-IIRIBOGA, D. A.Lifeevents weighting system; a comparative analysis. Presented

at the84thannualconvention of theAmerican Psychological Association, NewYork, 3-7 September 1976.

* Available fromtheRalphG. Connor Alcohol Research Reference Files(CARRF), Centerof AlcoholStudies, RutgersUniversity, New Brunswick, NJ 08903.The mea-

sures, theirstructures andproperties havebeendescribed by SAr)AVA, S. W. and FoRsYT•4, R. A social psychology of non-medical drugusein working samples. St. Catharines, Ont.;BrockUniversity, Depart2nent of Psychology; 1976.

728

s.w. SADAVA, 1t. THISTLEAND1t. FOltSYTH

Measuresof positive and negative functionsof use have been extensivelyvalidated (5, 22, 26, 27). Four subscales(having Cronbach alphas of .74 to .91) were uscd for functionsof alcohol and drugs. Instrumentalfunctionsincluded the use of alcohol for pleasure,social conviviality,dietary customs,confo•Tnity,insomniaor iust "something to do" and the use of drugs for esthetics,self-understanding or feelingsof closeness with others;copingfunctionsincludedthe use of alcoholand drugsfor copingwith socialor personalanxiety,self-dissatisfaction,worry or other emotionalproblems;ideologicalfunctions included the avoidance of alcohol as inconsistentwith one's values, self-

image or good taste and the avoidanceof drugs as inconsistentwith conventional values; fear functions included the avoidance of alcohol

and drugsbecauseof possibleeffectson health,possiblelegal problems and possibleloss of control. The measuresof alcoholuse were basedon earlier work (5, 9, 10, 22,

28). A 10-pointscaleassessed the averageamountof alcoholconsumed on any occasion, and a quantity-frequency (Q-F) index measuredthe quantityof beer,wine and distilledspiritsdrunkmultipliedby the number of occasionson which they were drunk. The 3-item intoxication

index measuredthe monthlyfrequencyof feeling "pretty high," "unsteadyon yourfeet"and "lostcontrolof yourself." A gradedseriesof symptomsof intoxicationavoidedtermssuchas "drunk"in an attempt to overcome likely social-desirability bias.Five itemspertainedto selfdefinedproblemsin drinking,identityas a problemdrinker,and helpseekingbehaviorrelated to suchproblems.Fifteen items,in a 4-point Likert format,concerned adverseconsequences of drinkingin areassuch as work,relationships with family and friends,health,legal problems and emotionalstability. Earlier work on the multidimensional measurementof drug use (28)

yieldedmeasures of self-reported frequency of cannabis useduringthe previous 3-month period;timeelapsed sincethefirstuseof illicitdrugs; adverse consequences in areassuchaswork,relationships, health,legal problems andemotional stability of illicitdruguse;therangeof polydrug use.A 3-pointLikert formatdifferentiated betweenone or two experimentations andmorefrequentuse;two itemspertainedto the useof "overthe counter"medicinesin combination with alcoholand marihuana; and three items assessed the simultaneous use of alcohol and other

psychoactive substances (illicit drugs,cannabis and over-the-counter medicines ).

Alcoholism, ProblemDrinkingandthe Sample

Thenormal rangeof alcohol anddrugusewasfoundin thissample. Theaverage subiect drankon 12.6___ 16.1(sD)occasions permonth. Theq?Fscores covered a rangeof 286,theaverage being63.7___ 67.8. In thepreceding 3 months, 21• hadabstained fromalcohol. Druguse wasconsiderably lessfrequent,22• havingusedmarihuana an average of 3.3 times.

STHESS,ESCAPISM AND ALCOHOL AND DRUG USE

729

While thisis not a sampleof diagnosed alcoholics, recentreliablesurveydata(9, 10) showsurprisingly frequentdrinkingproblems in normal populations. The data on the presentsampleshowsimilartrends.The distribution of scores(15 of 17) on the scaleof self-perceived drinking problems coveredalmostthe entirerange,the meanbeing4.2 ñ 2.4. The majorityof drinkersreportedat leastone adverseconsequence of drinkingduringthe preceding3 months.More important,16%said that at leastone adverseconsequence occurred"often."The mostfrequent of theseconsequences were feelingsof guilt over drinking,hangovers and lossof controlover drinking.Thus, while the sampleincludes abstainers and many drinkerswho do not have problems,the evidence of substantiallevelsof problemdrinkingis compelling. The averagescorefor iob stresswas 43.3 +__9.2 in a range of 0-108. Within this sampleare many heavy drinkersand problemdrinkersand somewith drug problems.A few of the subiectsmay display symptoms consistentwith the diagnosticcriteria of early-stagealcoholism. However,extrapolations to the spectrumof "alcoholismic" patternsmust be cautious.

StatisticalAnalysis The interrelations of perceivedstressand personalfunctionsof alcohol or drug use and behaviorare exploredwith multiple measuresof alcohol and drug use. First, correlationsbetween the two setsof predictorsand the criteriaof behaviorare presented.Then, the correlationsbetween stressand personalfunctionsof alcoholor drug useare presented. Finally, multiple regressionanalysesexplorethe combinedprediction of stress and functions. RESULTS

Correlations opStressand Functionswith Behavior.Pearsoncor-

relations (Table1) showrelationships betweenbehaviorandfunctionsof alcohol use.The 38 (of a possible 48) statistically reliable correlations suggestthat increasing useof alcoholtendsto be ac-

companied by morepositive functions of useand,morestrongly, by fewernegativefunctions of use.In general,thesedata suggest that, as drinkingor drug useincreases, all positivefunctionsof use tend to increaseand all negativefunctionstend to decrease.

Relationships between stress andbehavior areconsiderably weaker. Of the 36 correlations, 17 are at leastmarginallyreliable,all

in theanticipated direction. At leasti measure of stress correlated with eachof the criteria of drinkingbehavior.

Correlations of Stress with Functions. Of the32 correlations presentedin Table 2, the 18 reliable correlationsform a consistent

730

S. W. SADAVA,R. THISTLE AND R. FORSYTH

STRESS• ESCAPISM AND ALCOHOLAND DRUGUSE

731

TalLy, 2.-Pearson Correlationsof Stressand Functions JoB LIFE-CHANgE

Affect

STRESS

Impact

S:rRv.SS

Extent

Functions o)• alcohol use Instrumental

.05 --.09* .13t .11•

Coping Ideological Fear

.195 .185 --.11' .06

.165 .05 --.13• --.09*

--.02 .01 --.09*

.225 .19:[: M .07 .10'

.18:[: .14'{' .04 • .09•-

.01 .02 -- .12' --. 15-{'

M.07

Functions drug use

Instrumental Coping Ideological Fear P < .05.

•' P < .01.

.06 .03 .03 .03 :I:P < .001.

pattern.High stresstendsto be accompanied by morefunctions for use and fewer functionsfor abstinence.Significantly,the re-

liablecorrelations arenotprimarilywith copingfunctions; in fact, a somewhat higherproportion are with negativefunctions. CombinedPredictions of UsePatterns.Table 3 presentsstep-wise

multipleregression analyses of Stress andFunctions on Drinking behavior.Stresswas entered first. In 6 of 12 analyses,significant

increments in prediction werefoundwith combinations of Stress andFunctions. All loadings arein anticipated directions. Ideological (negative)functions occurred mostfrequently.In all but one

case,bothpositive andnegative functions enteredreliably. Similarpatterns areevident in drug-use analyses (Table4). In fourof sixanalyses, bothpositiveandnegativefunctions enterreliablyandaccount for similarovcr-alllevelsof variance. In both

analyses, different patterns of predictors areevident withdifferent criteria.In all cases, the directions of loadings are consistent with prior expectations. DIscussioN

Limitationsin thesedata mustbe recognized. While the pattern

ofrelationships isconsistent, thevariance in drinking anddruguse which isexplained bythese fewvariables is,notsurprisingly, modest.Thesample-relatively intact,"normal" individuals-is by no means representative of allworkers; extrapolations to alcoholics in

732

s.w. SADAVA,R. THISTLEAND R. FORSYTH

TABLE3.-Multiple RegressionAnalysesof Stressand Functions on Drinking Behavior• Correlation

Predictor c

F

Job stress

4.3*

]ob Stressb .39

Intoxication

.49

Functions:

instrumental ideological coping

Alcohol/drugmix

.23

Job stress

36.55 14.6j: 5.8* 5.1'

.20 --.16 .16

.11

Functions:

Life-change Stress b Q-F index

.44

instrumental ideological

10.2;• 5.4'

.18 --. 13

Life-changeaffect

4.3*

--.76

Functions:

instrumental

51.2j:

.24

ideological

16.65

--.25

6.7•'

.17

5.4*

--.93

coping Intoxication

.39

Life-changeaffect Functions:

instrumental

36.15

.21

ideological

13.75

--.16

coping

Adverseconsequences

.43

Life-change extent affect

4.2*

.14

9.9p 8.6'•

.25 --.12

56.8:•

.35

16.6•

.23

Functions:

coping

Alcohol/drugmix

.30

Life-changeextent Functions:

ideological

8.0•

--.18

instrumental

6.5P

.16

a Hierarchical entry: stress measures were entered until F (to enter) was below the .05 level; then functions

were

entered.

b Only criteria with significant entries from both sets of predictors were included. c Only reliable predictors are listed. * P < .05.

•' P < .01.

:l:P < .001.

treatmentarehazardous. Also,effectsof stressovertime andchanges

in drinkingpatternswerenot investigated in the presentstudy. Two general observations can be made about these findings.

Stresstendsto be accompanied by moreproblem-prone patterns of alcoholand drug use,althoughthere is no evidencethat stress-

relateddrinkingor druguseis accompanied by a specific increase in thecopingfunctions of alcohol or druguse.Indeed,understress,

STRESS,ESCAPISM AND ALCOHOL AND DRUG USE

733

TABLE4.-Multiple Regression Analysesof Stressand Functions on Criteria of Drug Uses Correlation

Predictor*

F

B

Job stress

6.0•

.68

53.0•

-- .37

12.3•

.13

43.0•

-- .26

5.2*

.75

Job stresd'

Frequency of cannabisuse

.37

Function:

fear Adverse consequences

.37

Job stress Function:

fear Rangeof polydruguse

.37

Job stress Functions:

fear instrumental Alcohol/drug mix

.39

Job stress

24.4:i: 24.9• 5.1'

-- .32 .20 .86

Functions

Life-changestress b Frequencyof cannabisuse

.39

instrumental fear

39.1:1: 17.4•

.25 --.21

Life-change affect

3.8*

--.18

57.8•

--.39

Function:

fear Time

as user

.45

Life-changeextent

7.2'•

.21

fear instrumental

65.41• 9.0•

-- .32 .28

Life-changeextent

11.3.•

.13

23.1•

.20

16.6.•

.19

31.0.• 22.1:•

.20 --.24

Functions:

Medicine/drug mix

.30

Function:

coping Alcohol/drug mix

.42

Life-change extent Functions:

instrumental fear

a Hierarchical entry: stressmeasureswere entered until F (to enter) was below the .05 level; then functions

were entered.

b Only criteria with significant entries from both actaof predictors were included. c Only reliable predictors are listed. * P • .05.

•- P • .Ol.

• P • .ool.

theimportance of thefunctions of abstinence or controldecreases considerably. The data are not consistentwith the learned, intentional es-

capist model. Whilethese datacannot provide directempirical supportfor alternative explanations, several canbe suggested.

734

s. •v. SADAVA, R. THISTLEANDR. FORSYTH

Onepossible explanation wouldbe in ternisof postdecision cognitive dissonance: as drinkingor drug useintensifies, the drinker

findsmorereasons to justifyuseandfewerreasons to justifyabstinence. Perhaps thedrinkermustavoidadmitting anescape from responsibility which is too divergentfrom "Calvinistasceticism" (10). However, evidence reviewed earlier demonstrateda con-

tinued,evenintensified,emotionaldiscomfort aboutdrinking.At-

temptsto reducecognitive dissonance aboutdrinkingappearto be strikinglyunsuccessful.

The concurrent increases in positivefunctionand decreases in negativefunctionmayrepresent a stress-induced reductionin conflict. Sanford(2) suggests that the escapist drinkerlosesalternatives to alcohol so that alcohol serves more functions. The reduced

controlrepresented by changesin negativefunctionmay facilitate the short-cut expression of impulses throughdrinking.Stressmay act throughan increasedintoleranceof ambivalenceand increas-

inglyrigid thinking,phenomena reportedin the literature. Finally,learnedhelplessness maybe considered a representation of depression. Seligman's model(29) describes a generalized absenceof purposive behavior.Cliniciansfrequentlyencounter alcoholicswho, after a periodof abstinence, react to stresswith a binge.Recallingtheir emotionalstateduringstress,thesealcoholics

useexpressions suchas"I didn'tgivea damnaboutanything." Their decision to drinktendsto be highlyimpulsive and not motivated by a "need"or "drive"to drink.The alcoholic maysimplysubstitute "Whynot?"for "Why?"That is,he mayno longerseeanypurpose in abstinence or control.Thusdrinkingmay representa lossof purposeratherthanintentionalescapism. Depression hasbeenreportedin manydiagnosed alcoholics (e.g., 30-33). Of course, depression maybe precipitated by or intensified by the devastating and cumulative physiological and socialconsequences of the abuseof a depressant suchas alcohol.However, if repeated misuse of alcoholfailsto providereliefit alsofailsto providean escape. The significant reduction in negativefunctions mayrepresent a "Whynot?"reaction, a lossof purposive behavior

in response to stress. Thus,alcoholmaybe misused because the drinkerfeelshelpless in responding to stress and helpless in controlling his drinking.

If cognitivedissonance or conflict-reduction modelspredictin-

creased problems, theneducation andtherapymustreinforce the

STRESS• ESCAPISM AND ALCOHOL AND DRUG USE

735

conflictthroughproblem-solving, the realisticunderstanding of theconsequences of misuse, andtheprovision of alternatives to alcohol ordrugs. However, if a sense of purpose isreplaced by helplessness, thenthe functions of drinkingare no longerrelevant.In thatcase,the restoration of a sense of personal efficacyseems to beparamount. Of course, moreempirical evidence mustcomefirst.

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Stress, escapism and patterns of alcohol and drug use.

Journalo[ Studieson Alcohol,Vol. 39, No. 5, 1978 Stress, Escapism andPatternsof Alcohol andDrugUse' S. W. Sadava,R. Thistleand R. Forsyth øSVMMXX•y...
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