The Effects of Alcohol on Anxiety in Problem- and Nonproblem-Drinking Women Cristen C. Eddy, Ph.D. Nonclinical samples of female problem and nonproblem drinkers were compared for their reactions to experimentally manipulated anxiety under alcohol-free and alcohol-dose conditions. The problem drinkers showed more subjective anxiety reduction, were higher in trait anxiety, and experienced more physical and psychosocial life problems.
GROWING body of literature on women A alcohol abusers strongly suggests that these women are characterized by a variety of threatening life problems. Some of these problems include gynecologic and related sexual problems,’s2marital diffic~lties,~ sex role confusion,4.’ a disturbed family background?’ and middleaged identity crisis following children leaving home.’ It is not surprising that a number of indices of psychopathology, including anxiety,’q6 low self-esteem,”-’2and hostility: have been found to be more prevalent in women alcoholics than women nonalcoholics and/or men alcoholics. In keeping with the tensionreduction hypothesis of alcohol use, anxiety and tension are among the most frequently cited attributes of women alcohol abusers. It is commonly believed that women problem drinkers drink to reduce anxiety. In support of this, Mulford’ recently reported that the most common reasons given by a large group of both female and male problem drinkers for their drinking were to “settle my nerves” and to “forget pressures.” Women were significantly more likely than men to drink for these reasons. While anxiety and anxiety reduction as motives for drinking may be typical of female problem drinkers, a question that arises when considering anxiety as a possible etiologic factor in female alcohol abuse is whether alcohol does, in fact, reduce anxiety in problem-drinking women. This investigation focused on this question. Two problems with previous research on psychologic factors related to female problem drinking have been the paucity of controlled experimental studies and the almost exclusive use of clinical samples. In this study, nonclinical samples of problem and nonproblem-drinking women were exposed to anxiety manipulation in
a controlled laboratory setting, both while under the effects of alcohol and while alcohol-free. Recent research contesting the previously well supported hypothesis that alcohol reduces tension indicates that alcohol may even increase subjective anxiety.’&’’ These results have come from studies of male alcoholics drinking over a prolonged period of time in a controlled setting. However, a similar investigation of women by Tracey and NathanI6 showed that four chronic alcoholic women responded with generally increased positive affect when they were allowed to drink alcohol freely in a controlled setting over a 12-day period. This suggests that women alcoholics may be more likely than their male counterparts to experience the tension-reducing effects of alcohol. It was hypothesized in the present study that both problem and nonproblem-drinking women would show a decrease in anxiety after alcohol consumption in a stressful situation. However, drawing on reports of female problem drinkers’ characteristically high anxiety levels, troubled life circumstances, and motive to drink for tension reduction, problem-drinking women were hypothesized to demonstrate more anxiety reduction than nonproblem-drinking women. Problem-drinking women probably experience more anxiety, drink more, and may be more likely to expect and actually find that alcohol has a positive reinforcing effect as an anxiety-reducer. It was further hypothesized that problemdrinking women would show higher levels of trait anxiety and more physical and psychosocial life problems than nonproblem drinkers. From the Department of Psychology. Cornell University. Ithaca, N. Y. Supporled by the Department of Psychology, Cornell University. This article is based on Ph.D. dissertation research done while the author was a graduate student a1 Cornell University. Received for publication August 5. 1978; accepted November 15. 1978. Reprint requests should be addressed to Cristen C. Eddy, Ph.D.. Benjamin Rush Center for Mental Health and Menla1 Retardation. I01 25 VerreeRoad. Philadelphia, Po. 01979 by Grune & Stratton. lnc. 01454008/79/0302-oO03$0l .m/o
Alcoholiun: ClinicalandExperimental Research, Vol. 3,No. 2 (April), 1979
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CRISTEN C. EDDY
108
MATERIALS AND METHODS
Subjects A survey questionnaire method was used to obtain 14 problem- and 14 nonproblemdrinking women to participate in the experiment. Anonymous questionnaires were distributed at two local shopping centers in the city of Ithaca, N.Y. Drinking behavior, medical eligibility, and demographic characteristics of potential subjects were asscssed. Nonstudent women who thought they might be willing to participate in a drinking experiment left their phone numbers on the completed questionnaire. They detached and took with them two “ID tickets” containing identification numbers. A total of 102 women completed the questionnaire. Problem and nonproblem drinkers were categorized based on responses to a problemdrinking behavior scale adapted from Strauss and Bacon” by Naditch.” A quantity-frquency index of the extent of alcohol use was used to eliminate abstinent women and very light drinkers (those who drank one or two drinks in the last year) from the subject pool. Pilot research revealed that very light drinkers were unaccustomed to drinking, and reacted to the experimental situation with unusual anxiety. A medical history index was used to screen subjects who might incur negative health consequences from alcohol intake. The Problem Drinking Behavior Scale contained 18 items reflecting various aspects of problem-drinking behavior, e.g., “Your drinking resulted in a loss of friends.” Subjects indicated how often (“never,” “once or twice,” “from time to time,” “often,” or “very often”) the behavior had occurred in the past year. Responses were scared from 0 (never) to 4 (very often). In order to differentiate problem from nonproblem drinkers, the Problem Drinking Behavior Scale was divided into two parts. The first part included the first eight items, which all began with, “You drank to the point where you . . .” and ended with phrases like “passed out,” “felt unsteady,” etc. The second part, comprised of the final ten items, described more severe drinking problems beyond the immediate, subjective effects of drunkenness, e.g., “Your drinking interfered with your work” or “You feared the long-range consequences of your drinking.” Nonproblem drinkers in this study experienced none of the second set of more severe drinking problems, while problem drinkers were designated a priori as having experienced at least two of these problems. Problem Drinking Behavior Scale scores were obtained by adding individual scale item scares within the first and second parts of the scale. To maximally differentiate prob lem from nonproblem drinkers, problem drinkers also had higher scores on the first part or the “less severe” item series of the Problem Drinking Behavior Scale. Having first chosen subjects who had experienced a t least two or more “severe” drinking problems (items 9 through 18), it was determined that among these, the lowest (“less severe”) item scare was 7. Therefore, nonproblem drinkers could have a scare of 6 or less, and problem drinkers had a scare higher than 6 on the first 8 items of the Problem Drinking Behavior Scale. Moderate problem drinkers who fell in between the criteria for problem and nonproblem drinkers (e.g., experienced only one severe drinking problem) were eliminated. Fourteen problem and 14 nonproblem drinkers, who had been matched as closely as possible on age and education
level, were selected and agreed to participate in the experiment. The size of the drinking groups was limited by the number of eligible problem drinkers. Subjects were briefly informed of the nature of the experiment and told not to eat for 3 hr prior to the experiment and not to drive to the experiment. Table I indicates problem- and nonproblem-drinking groups’ age. education level, extent of alcohol use, and problemdrinking behavior. All subjects were white females (one was of Spanish descent). Seven of the problem-drinking group were married and three had children, while eight of the nonproblem drinkers were married and five had children. A verbal survey revealed that all but one subject, a housewife, were employed or were seeking employment. The two drinking groups did not differ significantly with regard to age (t(l3) 1.97, NS) or education level (t(l3) = 1.89. NS).
-
Procedure Each subject was tested alone and exposed by the experimenter to the following squence of events. ( I ) Introduction to the experiment (30 min): Subjects signed subject consent forms which explained the nature of the experimental procedure; were informed that they would receive $5.00 compensation. and were told of their right to withdraw from the experiment a t any time. Subjects then completed Spielberger’s State-Trait Anxiety Inventory (STAI) A-trait scale and an index of physical and psychosocia1 problems. Subjects practiced a digit span task used to distract them from anxiety measures and to prevent their guessing the purpose of the experiment. Electrodes for heart rate monitoring were attached. Subjects practiced the stress manipulation by making a short, self-recorded speech on a given topic into a cassette tape recorder. (2) Low-stress/no-alcohol condition (7 min): Subjects used a stop watch to make a I-min. self-recorded speech while alone and unobserved in the experimental room. They started talking at their own discretion, on a topic of their choice. Upon indication that subjects were finished with their speech. a decoy digit span test and a STAI A-state scale were immediately administered. (3) High-stress/no-alcohol condition (7 min): Having been moved to a slightly different position in the room, subjects repeated the speech task, except that they were assigned one of two topics (living in a large city versus a small town, or owning a large versus a small car) and were told through an intercom when to start and stop talking. Subjects were observed through a darkened window by two paid female rescarch assistants whom subjects were able to detect visually. Subjects were told the observers had been in the experiment before, had liked the experiment, and had agreed to act as evaluating observers in this experiment. (Had the audience been suspected of condemning subjects’ drinking activities in the experiment. problem drinkers might have demonstrated increased anxiety after drinking. Problem drinkers are more likely to be sensitive and vulnerable to existing social sanctions against female alcohol abuse.) Digit span and STAI A-state scales were again administered immediately following the speech. (4) Alcohol dose (30 min): Subjects had 10 rnin to drink their choice of approximately 19 oz of 100 proof (50%
EFFECTS OF ALCOHOL ON ANXIETY IN WOMEN
109
Table 1. Age, Education, Extent of Drinking. and Problem-Drinking Behavior in Problem and Nonproblem-Drinking Groups Problem Drinkers i n - 14)
Variable
Mean = 25.36
Nonproblem Drinkers
Mean
-
(n-
14)
SD = 5.57 Score range = 20-42
28.00 SD = 4.80 Score range = 20-37
Education
Mean 4.50 SD = 1.09 Score range = 2 (some high school) to 6 (postgraduatestudy)
Mean = 4.93 SD = 1.07 Score range = 3 (high s c h d graduate) to 6 (postgraduate study)
Frequency of alcohol consumption
Mean = 5.50 SD = .52 Score range = 5 (once a week) to 6 (daily or almost daily)
Mean 3.29 SD== 1 . 0 0 Score range = 3 (once a month at most) to 6 (daily or almost daily).
Ouantity of alcohol at a sitting
Mean = 2.00 SD = 1.04 Score range = 1 ( 1 drink) to 4 (more than 4 drinks)
Mean = 1.50 SD = .65 Score range = 1 ( 1 drink) to 3 (3 or 4 drinks)
Problem drinking behavior score: items 1-8
Mean = 14.71 SD = 7.27 Score range = 7-30
Mean = 1.86 SD = 1.51 Score range 0-6
Problem drinking behavior score: items 9- 18
Mean = 5.86
Age
-
SD = 4.77 Score range
-
-
-
2- 19
*Only one nonproblem drinker drank daily. She regularly drank a glass of wine with dinner.
absolute alcohol) vodka. scotch, whiskey, or bourbon. The alcohol dosage was designed to produce a blood alcohol level of 0.05% (0.32 g/kg) 20 min after alcohol consumption, adjusted for bodyweight. A bodyweight and alcohol dose conversion table based on the Widmark f o r m ~ l aand ’ ~ the work of Brown and Cutterm was used. A small pilot study using breathalyzer tests showed that the formula employed to compute values for the alcohol dosage chart was useful for determining the amount of alcohol needed to produce a blood alcohol level of 0.04596 in women of varying weights. ( 5 ) Low-stress/alcohol condition (7 min): The lowstress/no-alcohol condition was repeated, except that subjects spoke on different self-selected topics. (6) High-stress/alcohol condition (7 min): The highstress/no-alcohol condition was repeated except that, of the two possible speech topics, subjects were given that topic on which they did not speak earlier. Speech topics for the alcohol and no-alcohol high-stress conditions were presented in alternating order to each successive subject. (7) Postexperimental session (45 min): The study was explained and subjects informed of their results if they so desired. Refreshments were offered and the effects of alcohol allowed to dissipate. If a subject wished, drinking was discussed. Alcohol community services information was provided to four subjects. During the experiment, both the experimenter and the observers were unaware of how subjects had responded to the drinking behavior survey. Subjects were informed of this before the experiment. The STAI A-state scale, heart rate and speech disturbance were used as indicators of state anxiety in the experiment. Heart rate was measured electronically using a
Harvard Apparatus event recorder. The number of heart beats occurring during the 60 sec of each of 4 experimental
speech tasks was recorded. In order to measure speech disturbance, two independent raters counted the number of repetitions and “Ahs” (and “Ah” variants) that occurred in the first 40 sec of each recorded speech sample; interrater reliability coefficients for the 4 conditions ranged between 0.97 and 1.0. The STAl A-state scale was considered the most valid measure of state anxiety, since there is no clear evidence of the validity of heart rate and speech disturbance as anxiety indicators. The STAl A-trait and A-state scales each consisted of 20 self-description statements, e.g., “I am tense” (A-state scale). People responded to these by indicating the degree to which each described the way they generally felt (A-trait) or the way they were “just feeling” while giving their I-min speech (A-state). Items were scored from 1 to 4, with the highest score indicating the most anxiety. The index of physical and psychosocial problems included the 12 items from Linn and Davis’” Index of Psychosocial Problems in addition to 2 items indicative of physical problems. Subjects responded to this index by indicating whether each of various life problems, e.g.. “have family problems’’ or “get sick often.” was “very,” “somewhat.” “not very,” or “not at all” characteristic of themselves. Responses were scored from 0 (not at all) to 4 (very).
RESULTS
As predicted, problem drinkers had higher levels of t r a i t anxiety (mean = 39.36, SD = 12.09) than did nonproblem drinkers
CRISTEN C. EDDY
110
Table 2. Anatpi8 of Variance: Effects of Drinking Stcrm8, Stresa, and Alcohol on STAI A-State No Aloohd Probbm m a (n = 14)
Alcohd NW-
,
Problem Drinker ( n - 14)
m a r (n = 14)
--
Nonproblem Drinker ( n - 14)
--
Low stress Mean 46.57 SD 12.95
Mean = 40.07 SD 8.84
Mean = 39.14 SD 10.54
Mean 33.19 SD 6.49
High stress Mean 54.14 SD = 14.02
Mean = 42.93 SD = 10.03
Mean = 43.14 SD = 11.90
Mean 5 3 8 . 2 9 10.59 SD
-
-
Sarm
Drinking status StrW Alcohol Drinking status X stress Drinking status X alcohol stress x alcohol Drinking status X stress X alcohol
M
ss
fV&m
s i g n i i
1 1 1 1 1 1 1
1620.32 631.57 1776.04 5.14 141.75 0.67 24.14
7.77 2.55 6 1.39 0.02 4.90 0.02 0.83
0.0074 0.1164 o.oO01
(mean = 33.86, SD = 6.29) t(n = 14) = 18, p < 0.05. (A Wilcoxon signed ranks test for matched pairs was used because there was a significant difference between trait anxiety variances for the two groups [F = 3.70, p < 0.051.) Also, as predicted, problem drinkers reported more physical and psychosocial problems (mean = 18.43, SD = 5.23) than did nonproblem drinkers (mean = 12.07, SD = 4.62) t( 13) = 5.06, p < 0.001. A 2 X 2 X 2 analysis of variance with alcohol, stress, and drinking status (problem versus nonproblem drinker) as independent variables and state anxiety as the dependent variable was used to test the hypotheses that (1) alcohol would reduce anxiety and (2) problem-drinking women would show more anxiety-reducing effects of alcohol than nonproblem-drinking women. Table 2 reveals that an analysis of variance with A-state (STAI) as the dependent variable yielded two significant main effects and one significant interaction. In accord with Spielberger’s theory concerning the proneness of high A-trait individuals to experience more A-states, A-state was significantly higher in the problem than in the nonproblem-drinking group. As hypothesized, A-state was significantly higher in the alcohol-free than in the alcohol condition. Also as predicted, drinking status interacted significantly with alcohol consumption in such a way that problem drinkers showed greater anxiety reduction than did nonproblem drinkers
-
0.03 13
-
when alcohol was consumed. A near-significant effect of stress on A-state suggested that the stress manipulation may have been successful, but not as effective as expected. An analysis of variance with heart rate as the dependent variable yielded one significant main effect for alcohol and no significant interactions (see Table 3). Consistent with the results for A-state, heart rate was higher in the alcohol-free condition than in the alcohol condition. There was an unpredicted, near-significant interaction effect of stress and alcohol consumption on heart rate, such that alcohol reduced heart rate more in the high-stress than in the low-stress condition. This suggests the common-sense interpretation that alcohol is most effective at reducing physiologic tension under more stressful conditions. The hypothesis that problem-drinking women would show more anxiety-reducing effects than nonproblem drinking women was not supported by the heart-rate data. An analysis of variance with speech disturbance as a dependent variable yielded an unexpected significant main effect of stress and an unpredicted significant interaction between alcohol and stress (see Table 4). Contrary to the interpretation given the near-significant interaction of stress and alcohol on heart rate, anxiety (as indicated by speech disturbance) increased from no-alcohol to alcohol-dose conditions under high-stress conditions, but decreased from noalcohol to alcohol-dose conditions under low stress. The hypotheses that alcohol would reduce
EFFECTS
OF ALCOHOC ON ANXIETY IN WOMEN
111
Table 3. Analysis of Variance: Effects of Drinking Status. Streas, and Alcohol on Heart Rate Alcohol
No Alcohol Problem Drinkm (n 14)
Nonproblem Drinka I n - 141
-
Low stress Mean = 96.00 SD = 15.76 High stress Mean 104.21 SD = 17.70
Roblem Drinker In = 141
-
-
Mean = 93.64 SD 12.70
Mean = 90.21 SD = 17.40
Mean = 98.50 SD = 14.12
Mean.- 94.21 SD 22.07
souce
Nonproblem Drinka In-
--
Mean 87.79 SD 8.58
-
dy
1Al
Mean = 88.57 SDE 11.75
ss
f value
456.04 558.04 1744.32 75.57 0.00 120.14 0.04
1.02 1.25 48.73 0.17 0.00 3.36
signifiunea
-
~
Drinking status Stress Alcohol Driwing status X stress Drinking status X alcohol Stress X alcohd Drinking status X stress X alcohd
1 1 1 1 1
1 1
anxiety and that problem-drinking women would experience more anxiety-reducing effects of alcohol than nonproblem-drinking women were not supported by the speech disturbance data. Looking at intercorrelations of the variables, there was one near-significant correlation between A-trait and A-state for the highstress/no-alcohol condition (r' = .30,p < 0.10). The Index of Physical and Psychosocial Problems seems to have been a better indicator of proneness to subjective state anxiety than Atrait. There were three significant or near-significant correlations between A-state and the Index of Physical and Psychosocial Problems (r = .40,
0.2681 o.Ooo1
0.0727
-
0.00
p < 0.05, low-stress/no-alcohol condition; r = .47, p < 0.01, high-stress/no-alcohol condition; r = .27,p < 0.10, low-stress/alcohol condition). Intercorrelating the three state anxiety indicators, A-state, heart rate, and speech disturbance, within each of the four experimental conditions revealed several low-order correlations, only a few of which reached significance. Intercorrelating both high-stress/low-stress differential scores and combined low- and highstress scores within each of the two alcohol conditions was equally unproductive. Aktate, heart rate, and speech disturbance seem to have been only weakly associated with one another.
Table 4. Analysis of Variance: Effects of Drinking Status, Stress, and Alcohol on Speech Disturbance No Alcohol
Alcohd
Problem Drinker (n 14)
Problem Drinka (n 141
Nonproblsm Drinker ( n - 14)
-
NonproMem Drinker ( n - 14)
-
-
~~
-
Low stress Mean 2.43. SD = 2.06 High stress Mean = 3.14 SD = 2.82
--
-
Mean 2.57 SD = 2.38
-
Mean 4.50 SD 2.56
Mean = 2.07 SD 1.77
Mean 3.36 SD 2.90
--
--
Mean * 3.86 SD 2.66
Mean 3.93 SD 2.46 d
ss
fValw
Drinking status Stress Alcohol Drinking status X stress Drinking status X alcohol
1 1 1 1 1
14.29 43.75 0.04
0.2338 0.0399
0.57
1.45 4.44 0.01 0.00 0.23
Stress X alcohol Drinking status X stress X alcohol
1
10.32 0.14
4.23 0.06
0.0448
sarce
1
0.00
.
~
*Scores reflect the number of "Ahs" and repetitions that occurred in the first 40 sec of speech samples.
sign-
-
-
CRISTEN C. EDDY
112
DISCWSSION
A major finding was a two-way interaction effect of drinking status and alcohol on A-state. This clearly supported the hypothesis that problem-drinking women experience more anxietyreducing effects of alcohol than nonproblemdrinking women. An important consideration when interpreting this finding is that problem-drinking women seem to feel more threatened. As hypothesized, problem-drinking women were significantly higher than nonproblem-drinking women on measures of trait anxiety and physical and psychosocial problems. Considering that these two measures were highly correlated, this suggests that problem-drinking women experience more situations which, for them, are more threatening and associated with anxiety. Related to this, Spielberger’s state-trait theory of anxiety was supported in this study by the finding that higher A-trait problem drinkers were more likely to experience state anxiety than lower A-trait nonproblem drinkers. Spielberger’s theory states that high A-trait individuals are more prone to A-states. In addition to the finding that problem drinkers experience more anxiety and life problems, a further analysis of the data revealed problem drinkers also drank more often (t( 13) = 5.32, p < 0.001 ) than nonproblem drinkers. Combined with the finding that problem-drinking women experienced greater anxiety reduction following alcohol consumption than nonproblem-drinking women, this evidence strongly suggests that problem drinkers may be particularly likely to find alcohol useful for coping with stress and anxiety in their lives. Studies of problem and nonproblem-drinking males that examined the effects of experimentally manipulated stress on alcohol consumption have yielded contradictory results. Higgins and Marlatt22 found heavy drinking college males drank more often when exposed to a high-fear condition than a similar group exposed to a low-fear condition. In another study, Higgins and MarlattZ3 manipulated anxiety and found that while nonabstinent alcoholics drank more overall, neither this group nor a group of social drinkers responded to the high-anxiety condition with increased drinking behavior. In yet another
investigation, Allman et aI.l4 observed a small group of chronic alcoholics during a prolonged period of drinking and found that experimental imposition of stress during socialization resulted in increased drinking, while exposure to stress during isolation resulted in decreased drinking. When increased drinking did occur, it was associated with increased anxiety and depression. As pointed out earlier, recent studies have shown that male alcoholics demonstrated increased negative affect during protracted periods of drinking, while a similar study by Tracey and NathanI6 showed that women alcoholics experienced increased positive affect during prolonged drinking. The present investigation adds support to the hypothesis that women may find alcohol a useful anxiety-reducer during periods of stress. Analyzing the data further, a comparison of the amount of postalcohol anxiety reduction experienced by problem and nonproblem drinkers revealed that problem drinkers experienced significantly more A-state reduction than nonproblem drinkers under high-stress conditions (t(13) = 2.64, p < 0.05), but not under low-stress conditions. (A similar comparison for heart rate and speech disturbance yielded no significant results.) The unexpected fact that experimental results with heart rate and speech disturbance often did not parallel findings for A-state suggests several different possibilities. There may be a real lack of correspondence between these variables. However, a more likely possibility may be that subjects’ cognitive expectancies of the effects of alcohol may have affected the three state anxiety indicators differently. Polivy et al.*‘ found in a short-term drinking experiment with male social drinkers that alcohol was a pharmacologic sedative and, overall, reduced subjective anxiety, but cognitive awareness of having consumed alcohol (a manipulated variable) increased subjective tension. i n light of a finding by Smith et al.” that less experience with alcohol results in a more negative alcohol reaction, Polivy et al. pointed out that their relatively inexperienced social drinkers may have had prior negative experiences with alcohol that resulted in increased tension with the knowledge of having consumed alcohol. Or, more important in light of this author’s argument, Polivy et al. suggested their subjects may
EFFECTS OF ALCOHOL ON ANXIETY IN WOMEN
have had less experience learning about alcohol’s reinforcing properties. Thus, while alcohol may reduce physiologic anxiety for most drinkers, only the most experienced drinkers, such as the problem drinkers in the present study, may have learned to expect alcohol-reduced anxiety. This may explain why, in this study, alcohol had a main effect on both A-state and heart rate, but there was an interaction effect of drinking status and alcohol only in the case of A-state. Subjectively measured A-state could easily be influenced by problem and nonproblem drinkers’ different expectations of the effects of alcohol, but heart rate (an objective, physiologic measure) could not. Thus, while alcohol reduced heart rate and A-state, the subjective indicator of anxiety (A-state) may have been further mediated by the different cognitive expectancies of the two drinking groups. The lack of correspondence between speech disturbance data and other data concerning the effects of alcohol on anxiety may be explained by the unhypothesized finding that alcohol increased speech disturbance errors under highstress conditions, but decreased these errors under low-stress conditions. While subjects in this study did not drink enough to reach a “slurred speech” state, it is possible that subjects’ cognitive expectancies of the commonly known detrimental effects of alcohol on speech may have caused an increase in speech disturbance errors in the high-stress, audienceattended speech performance situation. Such expectancies may not have been operating in the more relaxed low-stress condition because speech performance was not evaluated and emphasized. Another interpretation of the speech disturbance data is that the high-stress, audienceattended speech task was more difficult than the low-stress task, i.e., subjects were being observed, they felt they were being evaluated, they were assigned a speech topic, and they started and stopped talking with a forced cue. It may be that alcohol with its sedative effects facilitated the easy task (thus reducing speech disturbance errors), but was detrimental to performance on the more difficult task (thus increasing speech disturbance errors). A limitation of the stress manipulation may have been a lack of counterbalance between the
113
low- and high-stress conditions. The low-stress condition was anticipated to be somewhat stressful because subjects were tape recorded while talking. The low- and high-stress conditions occurred so close together in time (7 min) that it was felt that presenting the high-stress condition first might in some way “overshadow” the lowstress condition, thus adding to any stress already present in that condition. Despite putting the low-stress condition first, results demonstrated that the stress manipulation was only partially successful. There was also a lack of counterbalance between the two alcohol conditions. Stress reduction after alcohol consumption may have been a result of the alcohol dose condition occurring after subjects had the opportunity to become relaxed in the somewhat forbidding setting of a psychophysiologic laboratory. Subjects might also have demonstrated postalcohol stress reduction because the speech tasks became easier after practice (during the no-alcohol condition). The major difficulty with administering alcohol prior to the no-alcohol condition would have been the unpredictable influence of uncontrolled interviewing variables during the long period of time (at least 1 ‘/2 hr) required for the effects of alcohol to dissipate. To compensate for the lack of counterbalanced design, subjects were given ‘/2 hr prior to any stress manipulation to become accustomed to, and relaxed in their situation. At the end of this time, subjects were given a speech task similar to the high-stress task in order to counteract a practice effect during the actual experiment. The trend in the data for the high-stress manipulation to result in increased anxiety in the alcohol condition suggests that a time relaxation effect was not operating enough to dampen out the effects of the stress manipulation. The finding that speech disturbance errors increased in the high-stress condition after alcohol consumption suggests that task difficulty, at least in the high-stress condition, did not decrease after practice in the no-alcohol condition. One clear advantage of this study was the use of a nonclinical, nonstudent sample of female drinkers. Most other investigations of the psychologic effects of alcohol on female alcohol abusers have been studies of women from clinical, alcoholic populations. Most of the present
CRI!3€N C. EDDY
114
sample of problem-drinking women were employed. It is well known that working women are a major target area for alcohol prevention and treatment programs. The drinking problems of this group are important, yet have received little attention. This investigation supports the tension-reduction hypothesis of alcohol use for women. Despite possible limitations of this study, the findings strongly suggest that past studies of
male alcoholics that point to the anxiety-inducing effects of alcohol need to be questioned with regard to the applicability of their results to women. This investigation indicates that drinking women do experience anxiety-reducing effects of alcohol on both subjective and physiologic levels. The anxiety-reducing effects of alcohol or the cognitive expectation of these effects may represent an important factor in the etiology of female alcohol abuse.
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Study. Springfield. 111, Charles C Thomas, 1966 2. Belfer ML, Shader RI. Carroll M,Harmatz JS:Alcoholism in women. Arch Gen Psychiatry 25540-544, 1971 3. Mulford HA. Women and problem drinkers: Sex differences in patients served by Iowa's community alcoholism centers. J Stud Alcohol 38:1624-1639, 1977 4. Parker FB: Sex role adjustment in women alcoholics. J Stud Alcohol 33:647-657,1972 5. Wilsnack S C The needs of the female drinker: Dependency, power or what? in Proceedings of the Sccond Annual Conference of the NIAAA. Rockville, Md, Dept. .of HEW, 1973, pp 65-83 6. Beckman L: Psychosocial aspects of alcoholism in women. Alcoholism 1:177, 1977 (aktr) 7. Rathod NH, Thomson IG: Women alcoholics: A clinical study. J Stud Alcohol 32:45-52, 1971 8. Curlee J: Alcoholism and the 'empty nest.' Bull Menninger Clinic 33:165-171. 1969 9. Hoffman H, Wefring L Sex and age differences in psychiatric symptoms of alcoholics. Psychol Rep 30887889,1972 10. Schuckit M: The alcoholic woman: A literature review. Psychiatry Mcd 3:37-44, 1972 11. Blane H T The Personality of the Alcoholic. New York, Harper & Row, 1968 12. Beckman L Self-esteem of women alcoholics. J Stud Alcohol 39:491-498, 1978 13. Nathan PE, OBrien JS: An experimental analysis of the behavior of alcoholics and nonalcoholics during prolonged experimental drinking: A necessary precursor of behavior therapy? Behav Ther 2455476, 1971
14. Allman LB, Taylor HA, Nathan PE: Group drinking during stress: Effects on drinking behavior, affect. and psychopathology. Am J Psychiatry 129:669478,1972 15. Steffen JJ, Nathan PE, Taylor H A Tension reducing effects of alcohol: Further evidence and some methodological considerations. J Abnorm Psychol 83542-547, 1974 16. Tracey DA, Nathan P E Behavioral analysis of chronic alcoholism in four women. J Consult Clin Psychol 44~832-842,1976 17. Straus R, Bacon S D Drinking in College. New Haven, Yale University Press, 1953 18. Naditch MP: Locus of control and drinking behavior in a sample of men in Army Basic Training. J Consult Clin Psychol 43:96, 1975 19. Wallgren H, Barry H: Actions of Alcohol, vol. 1. New York, Elsevier, 1970 20. Brown RA. Cutter HSG: Alcohol, customary drinking behavior, and pain. J Abnorm Psychol 86179488.1977 21. Linn LS. Davis MS: The use of psychotherapeutic drugs of middle-aged women. J Health Soc Behav 12:331340, 1971 22. Higgins RL, Marlatt GA: Fear of interpersonal evaluation as a determinant of alcohol consumption in male social drinkers. J Abnorm Psychol 84644-651,1975 23. Higgins RL, Marlatt GA: Effects of anxiety arousal on the consumption of alcohol by alcoholics and social drinkers. J Consult Clin Psychol 41:426-433. 1973 24. Polivy J, Schueneman AL, Carlson K:Alcohol tension reduction: Cognitive and physiological effects. J Abnormal Psychol 85:595600,1976 25. Smith BC,Parker ES, Noble EP Alcohol and affect in dyadic social interaction. Psychsom Med 37:25-40, 1975
GROWING body of literature on women A alcohol abusers strongly suggests that these women are characterized by a variety of threatening life problems. Some of these problems include gynecologic and related sexual problems,’s2marital diffic~lties,~ sex role confusion,4.’ a disturbed family background?’ and middleaged identity crisis following children leaving home.’ It is not surprising that a number of indices of psychopathology, including anxiety,’q6 low self-esteem,”-’2and hostility: have been found to be more prevalent in women alcoholics than women nonalcoholics and/or men alcoholics. In keeping with the tensionreduction hypothesis of alcohol use, anxiety and tension are among the most frequently cited attributes of women alcohol abusers. It is commonly believed that women problem drinkers drink to reduce anxiety. In support of this, Mulford’ recently reported that the most common reasons given by a large group of both female and male problem drinkers for their drinking were to “settle my nerves” and to “forget pressures.” Women were significantly more likely than men to drink for these reasons. While anxiety and anxiety reduction as motives for drinking may be typical of female problem drinkers, a question that arises when considering anxiety as a possible etiologic factor in female alcohol abuse is whether alcohol does, in fact, reduce anxiety in problem-drinking women. This investigation focused on this question. Two problems with previous research on psychologic factors related to female problem drinking have been the paucity of controlled experimental studies and the almost exclusive use of clinical samples. In this study, nonclinical samples of problem and nonproblem-drinking women were exposed to anxiety manipulation in
a controlled laboratory setting, both while under the effects of alcohol and while alcohol-free. Recent research contesting the previously well supported hypothesis that alcohol reduces tension indicates that alcohol may even increase subjective anxiety.’&’’ These results have come from studies of male alcoholics drinking over a prolonged period of time in a controlled setting. However, a similar investigation of women by Tracey and NathanI6 showed that four chronic alcoholic women responded with generally increased positive affect when they were allowed to drink alcohol freely in a controlled setting over a 12-day period. This suggests that women alcoholics may be more likely than their male counterparts to experience the tension-reducing effects of alcohol. It was hypothesized in the present study that both problem and nonproblem-drinking women would show a decrease in anxiety after alcohol consumption in a stressful situation. However, drawing on reports of female problem drinkers’ characteristically high anxiety levels, troubled life circumstances, and motive to drink for tension reduction, problem-drinking women were hypothesized to demonstrate more anxiety reduction than nonproblem-drinking women. Problem-drinking women probably experience more anxiety, drink more, and may be more likely to expect and actually find that alcohol has a positive reinforcing effect as an anxiety-reducer. It was further hypothesized that problemdrinking women would show higher levels of trait anxiety and more physical and psychosocial life problems than nonproblem drinkers. From the Department of Psychology. Cornell University. Ithaca, N. Y. Supporled by the Department of Psychology, Cornell University. This article is based on Ph.D. dissertation research done while the author was a graduate student a1 Cornell University. Received for publication August 5. 1978; accepted November 15. 1978. Reprint requests should be addressed to Cristen C. Eddy, Ph.D.. Benjamin Rush Center for Mental Health and Menla1 Retardation. I01 25 VerreeRoad. Philadelphia, Po. 01979 by Grune & Stratton. lnc. 01454008/79/0302-oO03$0l .m/o
Alcoholiun: ClinicalandExperimental Research, Vol. 3,No. 2 (April), 1979
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CRISTEN C. EDDY
108
MATERIALS AND METHODS
Subjects A survey questionnaire method was used to obtain 14 problem- and 14 nonproblemdrinking women to participate in the experiment. Anonymous questionnaires were distributed at two local shopping centers in the city of Ithaca, N.Y. Drinking behavior, medical eligibility, and demographic characteristics of potential subjects were asscssed. Nonstudent women who thought they might be willing to participate in a drinking experiment left their phone numbers on the completed questionnaire. They detached and took with them two “ID tickets” containing identification numbers. A total of 102 women completed the questionnaire. Problem and nonproblem drinkers were categorized based on responses to a problemdrinking behavior scale adapted from Strauss and Bacon” by Naditch.” A quantity-frquency index of the extent of alcohol use was used to eliminate abstinent women and very light drinkers (those who drank one or two drinks in the last year) from the subject pool. Pilot research revealed that very light drinkers were unaccustomed to drinking, and reacted to the experimental situation with unusual anxiety. A medical history index was used to screen subjects who might incur negative health consequences from alcohol intake. The Problem Drinking Behavior Scale contained 18 items reflecting various aspects of problem-drinking behavior, e.g., “Your drinking resulted in a loss of friends.” Subjects indicated how often (“never,” “once or twice,” “from time to time,” “often,” or “very often”) the behavior had occurred in the past year. Responses were scared from 0 (never) to 4 (very often). In order to differentiate problem from nonproblem drinkers, the Problem Drinking Behavior Scale was divided into two parts. The first part included the first eight items, which all began with, “You drank to the point where you . . .” and ended with phrases like “passed out,” “felt unsteady,” etc. The second part, comprised of the final ten items, described more severe drinking problems beyond the immediate, subjective effects of drunkenness, e.g., “Your drinking interfered with your work” or “You feared the long-range consequences of your drinking.” Nonproblem drinkers in this study experienced none of the second set of more severe drinking problems, while problem drinkers were designated a priori as having experienced at least two of these problems. Problem Drinking Behavior Scale scores were obtained by adding individual scale item scares within the first and second parts of the scale. To maximally differentiate prob lem from nonproblem drinkers, problem drinkers also had higher scores on the first part or the “less severe” item series of the Problem Drinking Behavior Scale. Having first chosen subjects who had experienced a t least two or more “severe” drinking problems (items 9 through 18), it was determined that among these, the lowest (“less severe”) item scare was 7. Therefore, nonproblem drinkers could have a scare of 6 or less, and problem drinkers had a scare higher than 6 on the first 8 items of the Problem Drinking Behavior Scale. Moderate problem drinkers who fell in between the criteria for problem and nonproblem drinkers (e.g., experienced only one severe drinking problem) were eliminated. Fourteen problem and 14 nonproblem drinkers, who had been matched as closely as possible on age and education
level, were selected and agreed to participate in the experiment. The size of the drinking groups was limited by the number of eligible problem drinkers. Subjects were briefly informed of the nature of the experiment and told not to eat for 3 hr prior to the experiment and not to drive to the experiment. Table I indicates problem- and nonproblem-drinking groups’ age. education level, extent of alcohol use, and problemdrinking behavior. All subjects were white females (one was of Spanish descent). Seven of the problem-drinking group were married and three had children, while eight of the nonproblem drinkers were married and five had children. A verbal survey revealed that all but one subject, a housewife, were employed or were seeking employment. The two drinking groups did not differ significantly with regard to age (t(l3) 1.97, NS) or education level (t(l3) = 1.89. NS).
-
Procedure Each subject was tested alone and exposed by the experimenter to the following squence of events. ( I ) Introduction to the experiment (30 min): Subjects signed subject consent forms which explained the nature of the experimental procedure; were informed that they would receive $5.00 compensation. and were told of their right to withdraw from the experiment a t any time. Subjects then completed Spielberger’s State-Trait Anxiety Inventory (STAI) A-trait scale and an index of physical and psychosocia1 problems. Subjects practiced a digit span task used to distract them from anxiety measures and to prevent their guessing the purpose of the experiment. Electrodes for heart rate monitoring were attached. Subjects practiced the stress manipulation by making a short, self-recorded speech on a given topic into a cassette tape recorder. (2) Low-stress/no-alcohol condition (7 min): Subjects used a stop watch to make a I-min. self-recorded speech while alone and unobserved in the experimental room. They started talking at their own discretion, on a topic of their choice. Upon indication that subjects were finished with their speech. a decoy digit span test and a STAI A-state scale were immediately administered. (3) High-stress/no-alcohol condition (7 min): Having been moved to a slightly different position in the room, subjects repeated the speech task, except that they were assigned one of two topics (living in a large city versus a small town, or owning a large versus a small car) and were told through an intercom when to start and stop talking. Subjects were observed through a darkened window by two paid female rescarch assistants whom subjects were able to detect visually. Subjects were told the observers had been in the experiment before, had liked the experiment, and had agreed to act as evaluating observers in this experiment. (Had the audience been suspected of condemning subjects’ drinking activities in the experiment. problem drinkers might have demonstrated increased anxiety after drinking. Problem drinkers are more likely to be sensitive and vulnerable to existing social sanctions against female alcohol abuse.) Digit span and STAI A-state scales were again administered immediately following the speech. (4) Alcohol dose (30 min): Subjects had 10 rnin to drink their choice of approximately 19 oz of 100 proof (50%
EFFECTS OF ALCOHOL ON ANXIETY IN WOMEN
109
Table 1. Age, Education, Extent of Drinking. and Problem-Drinking Behavior in Problem and Nonproblem-Drinking Groups Problem Drinkers i n - 14)
Variable
Mean = 25.36
Nonproblem Drinkers
Mean
-
(n-
14)
SD = 5.57 Score range = 20-42
28.00 SD = 4.80 Score range = 20-37
Education
Mean 4.50 SD = 1.09 Score range = 2 (some high school) to 6 (postgraduatestudy)
Mean = 4.93 SD = 1.07 Score range = 3 (high s c h d graduate) to 6 (postgraduate study)
Frequency of alcohol consumption
Mean = 5.50 SD = .52 Score range = 5 (once a week) to 6 (daily or almost daily)
Mean 3.29 SD== 1 . 0 0 Score range = 3 (once a month at most) to 6 (daily or almost daily).
Ouantity of alcohol at a sitting
Mean = 2.00 SD = 1.04 Score range = 1 ( 1 drink) to 4 (more than 4 drinks)
Mean = 1.50 SD = .65 Score range = 1 ( 1 drink) to 3 (3 or 4 drinks)
Problem drinking behavior score: items 1-8
Mean = 14.71 SD = 7.27 Score range = 7-30
Mean = 1.86 SD = 1.51 Score range 0-6
Problem drinking behavior score: items 9- 18
Mean = 5.86
Age
-
SD = 4.77 Score range
-
-
-
2- 19
*Only one nonproblem drinker drank daily. She regularly drank a glass of wine with dinner.
absolute alcohol) vodka. scotch, whiskey, or bourbon. The alcohol dosage was designed to produce a blood alcohol level of 0.05% (0.32 g/kg) 20 min after alcohol consumption, adjusted for bodyweight. A bodyweight and alcohol dose conversion table based on the Widmark f o r m ~ l aand ’ ~ the work of Brown and Cutterm was used. A small pilot study using breathalyzer tests showed that the formula employed to compute values for the alcohol dosage chart was useful for determining the amount of alcohol needed to produce a blood alcohol level of 0.04596 in women of varying weights. ( 5 ) Low-stress/alcohol condition (7 min): The lowstress/no-alcohol condition was repeated, except that subjects spoke on different self-selected topics. (6) High-stress/alcohol condition (7 min): The highstress/no-alcohol condition was repeated except that, of the two possible speech topics, subjects were given that topic on which they did not speak earlier. Speech topics for the alcohol and no-alcohol high-stress conditions were presented in alternating order to each successive subject. (7) Postexperimental session (45 min): The study was explained and subjects informed of their results if they so desired. Refreshments were offered and the effects of alcohol allowed to dissipate. If a subject wished, drinking was discussed. Alcohol community services information was provided to four subjects. During the experiment, both the experimenter and the observers were unaware of how subjects had responded to the drinking behavior survey. Subjects were informed of this before the experiment. The STAI A-state scale, heart rate and speech disturbance were used as indicators of state anxiety in the experiment. Heart rate was measured electronically using a
Harvard Apparatus event recorder. The number of heart beats occurring during the 60 sec of each of 4 experimental
speech tasks was recorded. In order to measure speech disturbance, two independent raters counted the number of repetitions and “Ahs” (and “Ah” variants) that occurred in the first 40 sec of each recorded speech sample; interrater reliability coefficients for the 4 conditions ranged between 0.97 and 1.0. The STAl A-state scale was considered the most valid measure of state anxiety, since there is no clear evidence of the validity of heart rate and speech disturbance as anxiety indicators. The STAl A-trait and A-state scales each consisted of 20 self-description statements, e.g., “I am tense” (A-state scale). People responded to these by indicating the degree to which each described the way they generally felt (A-trait) or the way they were “just feeling” while giving their I-min speech (A-state). Items were scored from 1 to 4, with the highest score indicating the most anxiety. The index of physical and psychosocial problems included the 12 items from Linn and Davis’” Index of Psychosocial Problems in addition to 2 items indicative of physical problems. Subjects responded to this index by indicating whether each of various life problems, e.g.. “have family problems’’ or “get sick often.” was “very,” “somewhat.” “not very,” or “not at all” characteristic of themselves. Responses were scored from 0 (not at all) to 4 (very).
RESULTS
As predicted, problem drinkers had higher levels of t r a i t anxiety (mean = 39.36, SD = 12.09) than did nonproblem drinkers
CRISTEN C. EDDY
110
Table 2. Anatpi8 of Variance: Effects of Drinking Stcrm8, Stresa, and Alcohol on STAI A-State No Aloohd Probbm m a (n = 14)
Alcohd NW-
,
Problem Drinker ( n - 14)
m a r (n = 14)
--
Nonproblem Drinker ( n - 14)
--
Low stress Mean 46.57 SD 12.95
Mean = 40.07 SD 8.84
Mean = 39.14 SD 10.54
Mean 33.19 SD 6.49
High stress Mean 54.14 SD = 14.02
Mean = 42.93 SD = 10.03
Mean = 43.14 SD = 11.90
Mean 5 3 8 . 2 9 10.59 SD
-
-
Sarm
Drinking status StrW Alcohol Drinking status X stress Drinking status X alcohol stress x alcohol Drinking status X stress X alcohol
M
ss
fV&m
s i g n i i
1 1 1 1 1 1 1
1620.32 631.57 1776.04 5.14 141.75 0.67 24.14
7.77 2.55 6 1.39 0.02 4.90 0.02 0.83
0.0074 0.1164 o.oO01
(mean = 33.86, SD = 6.29) t(n = 14) = 18, p < 0.05. (A Wilcoxon signed ranks test for matched pairs was used because there was a significant difference between trait anxiety variances for the two groups [F = 3.70, p < 0.051.) Also, as predicted, problem drinkers reported more physical and psychosocial problems (mean = 18.43, SD = 5.23) than did nonproblem drinkers (mean = 12.07, SD = 4.62) t( 13) = 5.06, p < 0.001. A 2 X 2 X 2 analysis of variance with alcohol, stress, and drinking status (problem versus nonproblem drinker) as independent variables and state anxiety as the dependent variable was used to test the hypotheses that (1) alcohol would reduce anxiety and (2) problem-drinking women would show more anxiety-reducing effects of alcohol than nonproblem-drinking women. Table 2 reveals that an analysis of variance with A-state (STAI) as the dependent variable yielded two significant main effects and one significant interaction. In accord with Spielberger’s theory concerning the proneness of high A-trait individuals to experience more A-states, A-state was significantly higher in the problem than in the nonproblem-drinking group. As hypothesized, A-state was significantly higher in the alcohol-free than in the alcohol condition. Also as predicted, drinking status interacted significantly with alcohol consumption in such a way that problem drinkers showed greater anxiety reduction than did nonproblem drinkers
-
0.03 13
-
when alcohol was consumed. A near-significant effect of stress on A-state suggested that the stress manipulation may have been successful, but not as effective as expected. An analysis of variance with heart rate as the dependent variable yielded one significant main effect for alcohol and no significant interactions (see Table 3). Consistent with the results for A-state, heart rate was higher in the alcohol-free condition than in the alcohol condition. There was an unpredicted, near-significant interaction effect of stress and alcohol consumption on heart rate, such that alcohol reduced heart rate more in the high-stress than in the low-stress condition. This suggests the common-sense interpretation that alcohol is most effective at reducing physiologic tension under more stressful conditions. The hypothesis that problem-drinking women would show more anxiety-reducing effects than nonproblem drinking women was not supported by the heart-rate data. An analysis of variance with speech disturbance as a dependent variable yielded an unexpected significant main effect of stress and an unpredicted significant interaction between alcohol and stress (see Table 4). Contrary to the interpretation given the near-significant interaction of stress and alcohol on heart rate, anxiety (as indicated by speech disturbance) increased from no-alcohol to alcohol-dose conditions under high-stress conditions, but decreased from noalcohol to alcohol-dose conditions under low stress. The hypotheses that alcohol would reduce
EFFECTS
OF ALCOHOC ON ANXIETY IN WOMEN
111
Table 3. Analysis of Variance: Effects of Drinking Status. Streas, and Alcohol on Heart Rate Alcohol
No Alcohol Problem Drinkm (n 14)
Nonproblem Drinka I n - 141
-
Low stress Mean = 96.00 SD = 15.76 High stress Mean 104.21 SD = 17.70
Roblem Drinker In = 141
-
-
Mean = 93.64 SD 12.70
Mean = 90.21 SD = 17.40
Mean = 98.50 SD = 14.12
Mean.- 94.21 SD 22.07
souce
Nonproblem Drinka In-
--
Mean 87.79 SD 8.58
-
dy
1Al
Mean = 88.57 SDE 11.75
ss
f value
456.04 558.04 1744.32 75.57 0.00 120.14 0.04
1.02 1.25 48.73 0.17 0.00 3.36
signifiunea
-
~
Drinking status Stress Alcohol Driwing status X stress Drinking status X alcohol Stress X alcohd Drinking status X stress X alcohd
1 1 1 1 1
1 1
anxiety and that problem-drinking women would experience more anxiety-reducing effects of alcohol than nonproblem-drinking women were not supported by the speech disturbance data. Looking at intercorrelations of the variables, there was one near-significant correlation between A-trait and A-state for the highstress/no-alcohol condition (r' = .30,p < 0.10). The Index of Physical and Psychosocial Problems seems to have been a better indicator of proneness to subjective state anxiety than Atrait. There were three significant or near-significant correlations between A-state and the Index of Physical and Psychosocial Problems (r = .40,
0.2681 o.Ooo1
0.0727
-
0.00
p < 0.05, low-stress/no-alcohol condition; r = .47, p < 0.01, high-stress/no-alcohol condition; r = .27,p < 0.10, low-stress/alcohol condition). Intercorrelating the three state anxiety indicators, A-state, heart rate, and speech disturbance, within each of the four experimental conditions revealed several low-order correlations, only a few of which reached significance. Intercorrelating both high-stress/low-stress differential scores and combined low- and highstress scores within each of the two alcohol conditions was equally unproductive. Aktate, heart rate, and speech disturbance seem to have been only weakly associated with one another.
Table 4. Analysis of Variance: Effects of Drinking Status, Stress, and Alcohol on Speech Disturbance No Alcohol
Alcohd
Problem Drinker (n 14)
Problem Drinka (n 141
Nonproblsm Drinker ( n - 14)
-
NonproMem Drinker ( n - 14)
-
-
~~
-
Low stress Mean 2.43. SD = 2.06 High stress Mean = 3.14 SD = 2.82
--
-
Mean 2.57 SD = 2.38
-
Mean 4.50 SD 2.56
Mean = 2.07 SD 1.77
Mean 3.36 SD 2.90
--
--
Mean * 3.86 SD 2.66
Mean 3.93 SD 2.46 d
ss
fValw
Drinking status Stress Alcohol Drinking status X stress Drinking status X alcohol
1 1 1 1 1
14.29 43.75 0.04
0.2338 0.0399
0.57
1.45 4.44 0.01 0.00 0.23
Stress X alcohol Drinking status X stress X alcohol
1
10.32 0.14
4.23 0.06
0.0448
sarce
1
0.00
.
~
*Scores reflect the number of "Ahs" and repetitions that occurred in the first 40 sec of speech samples.
sign-
-
-
CRISTEN C. EDDY
112
DISCWSSION
A major finding was a two-way interaction effect of drinking status and alcohol on A-state. This clearly supported the hypothesis that problem-drinking women experience more anxietyreducing effects of alcohol than nonproblemdrinking women. An important consideration when interpreting this finding is that problem-drinking women seem to feel more threatened. As hypothesized, problem-drinking women were significantly higher than nonproblem-drinking women on measures of trait anxiety and physical and psychosocial problems. Considering that these two measures were highly correlated, this suggests that problem-drinking women experience more situations which, for them, are more threatening and associated with anxiety. Related to this, Spielberger’s state-trait theory of anxiety was supported in this study by the finding that higher A-trait problem drinkers were more likely to experience state anxiety than lower A-trait nonproblem drinkers. Spielberger’s theory states that high A-trait individuals are more prone to A-states. In addition to the finding that problem drinkers experience more anxiety and life problems, a further analysis of the data revealed problem drinkers also drank more often (t( 13) = 5.32, p < 0.001 ) than nonproblem drinkers. Combined with the finding that problem-drinking women experienced greater anxiety reduction following alcohol consumption than nonproblem-drinking women, this evidence strongly suggests that problem drinkers may be particularly likely to find alcohol useful for coping with stress and anxiety in their lives. Studies of problem and nonproblem-drinking males that examined the effects of experimentally manipulated stress on alcohol consumption have yielded contradictory results. Higgins and Marlatt22 found heavy drinking college males drank more often when exposed to a high-fear condition than a similar group exposed to a low-fear condition. In another study, Higgins and MarlattZ3 manipulated anxiety and found that while nonabstinent alcoholics drank more overall, neither this group nor a group of social drinkers responded to the high-anxiety condition with increased drinking behavior. In yet another
investigation, Allman et aI.l4 observed a small group of chronic alcoholics during a prolonged period of drinking and found that experimental imposition of stress during socialization resulted in increased drinking, while exposure to stress during isolation resulted in decreased drinking. When increased drinking did occur, it was associated with increased anxiety and depression. As pointed out earlier, recent studies have shown that male alcoholics demonstrated increased negative affect during protracted periods of drinking, while a similar study by Tracey and NathanI6 showed that women alcoholics experienced increased positive affect during prolonged drinking. The present investigation adds support to the hypothesis that women may find alcohol a useful anxiety-reducer during periods of stress. Analyzing the data further, a comparison of the amount of postalcohol anxiety reduction experienced by problem and nonproblem drinkers revealed that problem drinkers experienced significantly more A-state reduction than nonproblem drinkers under high-stress conditions (t(13) = 2.64, p < 0.05), but not under low-stress conditions. (A similar comparison for heart rate and speech disturbance yielded no significant results.) The unexpected fact that experimental results with heart rate and speech disturbance often did not parallel findings for A-state suggests several different possibilities. There may be a real lack of correspondence between these variables. However, a more likely possibility may be that subjects’ cognitive expectancies of the effects of alcohol may have affected the three state anxiety indicators differently. Polivy et al.*‘ found in a short-term drinking experiment with male social drinkers that alcohol was a pharmacologic sedative and, overall, reduced subjective anxiety, but cognitive awareness of having consumed alcohol (a manipulated variable) increased subjective tension. i n light of a finding by Smith et al.” that less experience with alcohol results in a more negative alcohol reaction, Polivy et al. pointed out that their relatively inexperienced social drinkers may have had prior negative experiences with alcohol that resulted in increased tension with the knowledge of having consumed alcohol. Or, more important in light of this author’s argument, Polivy et al. suggested their subjects may
EFFECTS OF ALCOHOL ON ANXIETY IN WOMEN
have had less experience learning about alcohol’s reinforcing properties. Thus, while alcohol may reduce physiologic anxiety for most drinkers, only the most experienced drinkers, such as the problem drinkers in the present study, may have learned to expect alcohol-reduced anxiety. This may explain why, in this study, alcohol had a main effect on both A-state and heart rate, but there was an interaction effect of drinking status and alcohol only in the case of A-state. Subjectively measured A-state could easily be influenced by problem and nonproblem drinkers’ different expectations of the effects of alcohol, but heart rate (an objective, physiologic measure) could not. Thus, while alcohol reduced heart rate and A-state, the subjective indicator of anxiety (A-state) may have been further mediated by the different cognitive expectancies of the two drinking groups. The lack of correspondence between speech disturbance data and other data concerning the effects of alcohol on anxiety may be explained by the unhypothesized finding that alcohol increased speech disturbance errors under highstress conditions, but decreased these errors under low-stress conditions. While subjects in this study did not drink enough to reach a “slurred speech” state, it is possible that subjects’ cognitive expectancies of the commonly known detrimental effects of alcohol on speech may have caused an increase in speech disturbance errors in the high-stress, audienceattended speech performance situation. Such expectancies may not have been operating in the more relaxed low-stress condition because speech performance was not evaluated and emphasized. Another interpretation of the speech disturbance data is that the high-stress, audienceattended speech task was more difficult than the low-stress task, i.e., subjects were being observed, they felt they were being evaluated, they were assigned a speech topic, and they started and stopped talking with a forced cue. It may be that alcohol with its sedative effects facilitated the easy task (thus reducing speech disturbance errors), but was detrimental to performance on the more difficult task (thus increasing speech disturbance errors). A limitation of the stress manipulation may have been a lack of counterbalance between the
113
low- and high-stress conditions. The low-stress condition was anticipated to be somewhat stressful because subjects were tape recorded while talking. The low- and high-stress conditions occurred so close together in time (7 min) that it was felt that presenting the high-stress condition first might in some way “overshadow” the lowstress condition, thus adding to any stress already present in that condition. Despite putting the low-stress condition first, results demonstrated that the stress manipulation was only partially successful. There was also a lack of counterbalance between the two alcohol conditions. Stress reduction after alcohol consumption may have been a result of the alcohol dose condition occurring after subjects had the opportunity to become relaxed in the somewhat forbidding setting of a psychophysiologic laboratory. Subjects might also have demonstrated postalcohol stress reduction because the speech tasks became easier after practice (during the no-alcohol condition). The major difficulty with administering alcohol prior to the no-alcohol condition would have been the unpredictable influence of uncontrolled interviewing variables during the long period of time (at least 1 ‘/2 hr) required for the effects of alcohol to dissipate. To compensate for the lack of counterbalanced design, subjects were given ‘/2 hr prior to any stress manipulation to become accustomed to, and relaxed in their situation. At the end of this time, subjects were given a speech task similar to the high-stress task in order to counteract a practice effect during the actual experiment. The trend in the data for the high-stress manipulation to result in increased anxiety in the alcohol condition suggests that a time relaxation effect was not operating enough to dampen out the effects of the stress manipulation. The finding that speech disturbance errors increased in the high-stress condition after alcohol consumption suggests that task difficulty, at least in the high-stress condition, did not decrease after practice in the no-alcohol condition. One clear advantage of this study was the use of a nonclinical, nonstudent sample of female drinkers. Most other investigations of the psychologic effects of alcohol on female alcohol abusers have been studies of women from clinical, alcoholic populations. Most of the present
CRI!3€N C. EDDY
114
sample of problem-drinking women were employed. It is well known that working women are a major target area for alcohol prevention and treatment programs. The drinking problems of this group are important, yet have received little attention. This investigation supports the tension-reduction hypothesis of alcohol use for women. Despite possible limitations of this study, the findings strongly suggest that past studies of
male alcoholics that point to the anxiety-inducing effects of alcohol need to be questioned with regard to the applicability of their results to women. This investigation indicates that drinking women do experience anxiety-reducing effects of alcohol on both subjective and physiologic levels. The anxiety-reducing effects of alcohol or the cognitive expectation of these effects may represent an important factor in the etiology of female alcohol abuse.
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