Alcohol use disorders linked to decreased ‘work trajectory’
John D. Meyer, MD, MPH, of Icahn-Mount Sinai School of Medicine, New York, and Miriam Mutambudzi, PhD, MPH, of Johns Hopkins School of Medicine, Baltimore, studied the relationship between occupation and AUDs in workers followed up from early adulthood to middle age. The study focused on the “substantive complexity” of work as an indicator of work trajectory - whether individuals were progressing in their careers in terms of factors such as decision latitude and expanded work abilities.
Based on factors such as drinking more than intended or unsuccessful attempts to cut down on drinking, AUDs were initially present in about 15 percent of men and 7.5 percent of women. Lower work trajectory was linked to a higher rate of AUDs - both initially and during follow-up. For both men and women, AUD rates were decreased with higher work trajectory.
But even men though had higher AUD rates, the association between AUD and flat or downward occupational trajectory appeared stronger in women. In contrast, higher education was more strongly associated with lower AUD risk in men.
Together with previous reports, the study suggests that “declining occupational trajectory is a consequence of AUD development,” rather than a predictor.
However, the link between AUDs and occupation appears to be “complex and reinforcing,” Drs Meyer and Mutambudzi write. They add that women’s career paths “may be more readily disrupted” by AUDs, compared to men’s.
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When does drinking become a problem?
For most adults, moderate alcohol use - no more than two drinks a day for men and one for women and older people - is relatively harmless. (A “drink” means 1.5 ounces of spirits, 5 ounces of wine, or 12 ounces of beer, all of which contain 0.5 ounces of alcohol.
Moderate use, however, lies at one end of a range that moves through alcohol abuse to alcohol dependence:
Alcohol abuse is a drinking pattern that results in significant and recurrent adverse consequences. Alcohol abusers may fail to fulfill major school, work, or family obligations. They may have drinking-related legal problems, such as repeated arrests for driving while intoxicated. They may have relationship problems related to their drinking.
People with alcoholism - technically known as alcohol dependence - have lost reliable control of their alcohol use. It doesn’t matter what kind of alcohol someone drinks or even how much: Alcohol-dependent people are often unable to stop drinking once they start. Alcohol dependence is characterized by tolerance (the need to drink more to achieve the same “high”) and withdrawal symptoms if drinking is suddenly stopped. Withdrawal symptoms may include nausea, sweating, restlessness, irritability, tremors, hallucinations and convulsions.
Although severe alcohol problems get the most public attention, even mild to moderate problems cause substantial damage to individuals, their families and the community.
According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), 1 in 12 American adults is an alcohol abuser or alcoholic. And, says NIAAA, young adults aged 18 to 29 are the most likely to have alcohol problems. For example, a government survey revealed that almost 8 percent of young people aged 12 to 17 and almost 41 percent of young adults aged 18 to 25 indulge in binge drinking - downing five or more drinks on the same occasion at least once during the past month.
About the Author
Dr. Meyer may be contacted for interviews at john.meyer (at) mssm.edu
About ACOEM
ACOEM, an international society of 4,500 occupational physicians and other health care professionals, provides leadership to promote optimal health and safety of workers, workplaces, and environments.
Epidemiology of Alcohol Use Disorders
It is necessary to standardize what an alcoholic “drink” is in order to understand the medical consequences of drinking alcohol and to communicate with patients. In the United States, a standard drink has about 14 grams of ethanol, which is what is found in the typical beverage quantities shown on the slide: a 12 oz. bottle or can of beer, a 5 oz. glass of wine, or a standard 1.5 oz. shot of 80-proof spirits, such as gin, vodka, or whiskey.
Other common beverage sizes that contain the same amount of alcohol (14 grams) include one wine cooler, an 8 oz. malt liquor, 3 oz. of a fortified wine like port, or a 1.5 oz. jigger of brandy. These are the “standard” sizes, but others are commonly used. Beer comes in 40 oz. (and larger) bottles, and draft beers are often a pint (16 oz.). Mixed drinks often include several 1.5 oz. shots of alcohol and may be served in very large glasses, thus constituting several drinks. In addition, drink sizes vary in other countries. When assessing patients drinking, it important to clarify the actual quantities consumed rather than assuming a common understanding of what constitutes a drink. It is useful to have a chart to show patients what constitutes a standard drink size.
The National Institute on Alcohol Abuse and Alcoholism (NIAAA) has set recommended maximum daily and weekly amounts of drinking for healthy adult men and women based on epidemiological studies of drinking-related morbidity and mortality that indicate what level of consumption carries increased medical risk.
It should be noted that these limits are for healthy adults. People under the age of 21 and pregnant women are advised to abstain. Medical illnesses exacerbated by alcohol, such as hypertension, diabetes, and hepatitis, or concomitant use of medications that interact with alcohol, may mean that a patient must drink significantly below the NIAAA maximum, or not at all.
About Journal of Occupational and Environmental Medicine
The Journal of Occupational and Environmental Medicine is the official journal of the American College of Occupational and Environmental Medicine. Edited to serve as a guide for physicians, nurses, and researchers, the clinically oriented research articles are an excellent source for new ideas, concepts, techniques, and procedures that can be readily applied in the industrial or commercial employment setting.
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Connie Hughes
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