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Nonfamilial Roles of Alcoholic Women in TreatmentEdith S. Lisansky Gomberg PhD a , Kristine Siefert PhD and MPH b & Iván A. de la Rosa PhD ca Department of Psychiatry , School of Social Work, the University of Michiganb NIMH Center on Poverty, Risk and Mental Health, School of Social Work, the University ofMichiganc School of Public Health, the University of MichiganPublished online: 21 Oct 2008.

To cite this article: Edith S. Lisansky Gomberg PhD , Kristine Siefert PhD and MPH & Iván A. de la Rosa PhD (1999) NonfamilialRoles of Alcoholic Women in Treatment, Women & Health, 29:1, 73-88, DOI: 10.1300/J013v29n01_06

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Nonfamilial Rolesof Alcoholic Women in Treatment

Edith S. Lisansky Gomberg, PhDKristine Siefert, PhD, MPH

Iván A. de la Rosa, PhD

ABSTRACT. This study compared the educational achievement andemployment-related experiences of a sample of 301 alcoholic womenin treatment with 137 non-alcoholic matched controls. Alcoholicwomen were significantly more likely than controls to marry at a youn-ger age and have their first child earlier, had less education, and weremore likely to be employed in blue collar settings than non-alcoholicwomen. Alcoholic women were significantly less likely to be workingoutside the home, and employed alcoholic women were more likely toreport boredom in the workplace than employed non-alcoholic women.The lives of alcoholic women include more than their familial roles.More attention to issues of education, employment, and occupationalstatus on the part of health care providers is needed. [Article copiesavailable for a fee from The Haworth Document Delivery Service:1-800-342-9678. E-mail address: getinfo@haworthpressinc.com]

KEYWORDS. Alcoholism, workplace, women’s health, women’shealth services, age factors, education, case-control studies

Edith S. Lisansky Gomberg is Professor of Psychology, Department of Psychiatryand Adjunct Professor of Social Work, School of Social Work, the University ofMichigan; Kristine Siefert is Professor of Social Work and Associate Director,NIMH Center on Poverty, Risk and Mental Health, School of Social Work, theUniversity of Michigan; and Iván A. de la Rosa is Paul V. Corneley PostdoctoralFellow, School of Public Health, the University of Michigan.

Please address correspondence to Edith S. L. Gomberg, Alcohol Research Center,The University of Michigan, 400 E. Eisenhower Parkway, Suite 2A, Ann Arbor, MI48108-3318.

Women & Health, Vol. 29(1) 1999� 1999 by The Haworth Press, Inc. All rights reserved. 73

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INTRODUCTION

Alcoholism among women is a serious public health problem associatedwith excess mortality, alcoholic liver disease, hypertension, stroke, cancer,and reproductive complications. Nevertheless, women have been underrepre-sented as subjects of research on the biological, sociocultural, and psycholog-ical factors associated with problem drinking. In the research that has beendone, the traditional emphasis has been on the impact of alcohol abuse onwomen’s marital and parenting roles. Compared to male alcohol abusers,women report more marital disruption (Gomberg, 1993). There has been animplicit assumption that heavy drinking disrupts a marriage, although there isevidence that marital difficulties often antecede the drinking. Whatever thesequence, it should be noted that epidemiological data on women’s drinkingsuggest that a marital breakup sometimes leads to improvement in problemdrinking behavior (Klassen, Wilsnack, Harris, and Wilsnack, 1991). Thesame simplistic view has characterized the description of alcoholic women’smaternal role as more destructive of children than paternal alcoholism; butthere is some evidence that the effects of maternal drinking problems are notalways negative (Williams & Klerman, 1984).

Relatively neglected is the aspect of women alcohol abusers’ lives thatdeals with school achievement, occupational status and employment experi-ence. It is not that these aspects of female role are totally ignored, but ratherthat they are stated as part of demographic description and then ignored. AsBlum et al. (1995) have recently noted, most alcoholism research has paidcomparatively little attention to women’s drinking as it relates to work rolesand work performance.

We are presenting data from a study of 301 problem drinking women intreatment and 137 age and social-class matched women who are nonalco-holic. The comparison of marital and parenting role behaviors in bothgroups of women has been reported (Gomberg, 1986; Gomberg, 1993) andthere are further analyses of the findings in terms of depression (Turnbull &Gomberg, 1990) and social supports (Schilit & Gomberg, 1987). The as-sumption underlying the design of the study was that it was appropriate tocompare problem drinking women with other women; this is particularlyrelevant in describing sex role behavior. Since males are socialized differ-ently, the comparison of problem drinking men and women has limitations.Although the presented data were gathered in the 1980s, no recent studies ofproblem drinking women are relevant. Current research on women deem-phasizes histories and is primarily biological or epidemiological. Studies ofwomen’s alcohol use and employment focus on either effects of alcohol onwork performance or on women’s use of employee assistance programs(Blum and Roman, 1997).

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In epidemiological studies, longitudinal surveys of female drinking haveturned up several relationships between alcohol use and female employment:

1. There is a ‘‘special association’’ between women’s drinking and em-ployment in nontraditional occupations (Wilsnack & Wilsnack, 1992);more indication of problem drinking is found not only in studies con-ducted within the United States but in several European countries. Itshould be noted that employment among young women is consideredby some investigators to be a manifestation of ‘‘nontraditional role’’(Parker & Harford, 1992). The ‘‘special association’’ described byWilsnack and Wilsnack (1992), however, is between drinking behav-iors and employment in a non-traditional occupation.

2. Being unmarried, unemployed or part-time employed, summarized as‘‘role deprivation,’’ at time 1 is considered predictive of problem drink-ing at time 2 in epidemiological surveys, particularly for women in theage group 21-34 (Wilsnack & Wilsnack, 1992).

3. Increased consumption of alcoholic beverages by employed men andwomen is associated with ‘‘increased depression symptoms’’ in soberstate (Parker, Parker, Harford, and Farmer, 1987).

Clinical studies have also found relationships between employment andproblem drinking. In a study of the correlates of ‘‘loss of control’’ amongwomen problem drinkers, Fortin and Evans (1983) found that employmentappears to confer protection against loss of control over drinking, and onsetof loss of control is delayed by employment, higher educational level, and thepresence of children in the home.

The alcoholism literature has consistently reported that indices of socialstability, e.g., being married and employed, are predictors of better prognosis(Bromet, Moos, Bliss, and Wuthmann, 1977). This works for women as wellas for men (Bander, Stilwell, Fein, and Bishop, 1983); in a study of 167women alcoholics in treatment, the authors reported that longer periods ofabstinence following treatment were significantly associated with being mar-ried, being self-supporting, and living with others.

Although the investigators cited above report a relationship between em-ployment and less probability of heavy drinking, as well as better functioningand prognosis for employed women problem drinkers, there are contradictoryreports: some argue that there is more problem drinking among women in theworkplace; Johnson (1982) and Celentano and McQueen (1984) reported thatworkplace women drank significantly more than other women; higher alco-hol intake was associated with nonmarried status, higher educational level,and more egalitarian gender role attitudes. A recent study of Finnish workersby Lahelma, Kangas and Manderbacka (1995) agrees that drinking problemsare more frequent for ‘‘employed women.’’ On the other hand, a study from

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Norway (Hammer & Vaglum, 1989) found employment not significantlyrelated to women’s alcohol use ‘‘. . . when controlling for the husband’sconsumption,’’ and reported women’s drinking to be more related to accessi-bility and to life style.

Shore (1985) examined alcohol consumption among women managersand professionals. While she reported a higher percentage of nonabstinentwomen compared to the national average, the drinking was most frequentlylight or moderate. A study of the prevalence of and risk factors for alcoholabuse and depression among male and female managers and professionals(Bromet et al., 1990) reported a higher than expected prevalence rate ofalcohol-related disorders among women, but found no statistically significantor consistent pattern for alcohol abuse/dependence and job status (profes-sional vs. manager), length of employment, average hours worked per day,location, and supervisory responsibility.

A recent report of 6,400 employees in 84 worksites found 238 womenwith primary or secondary alcohol problems; the highest users were in sales,administration, managerial work or professional and technical workers(Blum et al., 1995). Demographically most striking was the ‘‘lack of connec-tion with nuclear families’’ among the women, of whom 41% were divorcedor separated, 27% never married, and 29% married. About half had receivedwarnings at work; their entry routes into EAP’s were similar to those of menexcept that spouses were a far less frequent source of referral for those whowere married than was true for male workers. Gender differences in the studyappeared to be linked to job status, with women in blue-collar jobs holdinglower status and nontraditional positions. Most of the women presented so-cial and personal problems very similar to women alcohol abusers in treat-ment facilities in general. Depression was the most characteristic comorbid-ity. Although there was no evidence of gender-based discrimination in theprocess of EAP utilization, women were less likely to have inadequate insur-ance coverage than men in the study, which limited referral options and mayhave resulted in less appropriate treatment.

Trice and Beyer (1984) studied 480 companies with EAPS and found nogender difference in referrals to the program. Another study (Young, Reich-man, and Levy, 1987) reported a modest association between supervisors’egalitarian attitudes and the likelihood of their referring female employeeswho drink problematically to the EAP.

In summary, two different lines of research have been followed by investi-gators studying the relationship between work and alcohol intake:

Epidemiological research with community samples or samples within theworkplace: Wilsnack and Wilsnack (1992) studied large community samplesand Blum, Roman and Harwood (1995) used large samples of employees inmultiple worksites. Bromet and her colleagues (Bromet et al., 1990) studied a

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large multinational corporation. It is this line of research which has producedinconsistent results, e.g., women in the workplace are more likely to drinkthan women who are not in paid employment or, conversely, housewives aremore likely to drink than women in the workplace. Drinking, as defined inmany of these studies, is not heavy, problematic drinking; it can be infre-quent, occasional, or moderate. But if we look for indicators of heavy orproblematic drinking, many different associations have been made betweenwomen’s problem drinking and paid employment, e.g., stress on the job, roleoverload combining work tasks and domestic responsibilities, lack of controlor autonomy at work with emphasis on the low status of most women’s jobs.This has produced two recent critiques: Wilsnack and Wilsnack (1992) arguefor a more complex, less simplistic view of the relationship between femalepaid employment and alcohol usage, and Brief and Folger (1992) propose anew model emphasizing interaction between ‘‘predispositional factors andthe workplace.’’ It becomes clear, in examining the literature about paidemployment and alcohol consumption that there are many variables to beconsidered, among them: (1) predispositional factors, such as family historyof mental health problems and substance abuse and the worker’s copingmechanisms; (2) job-related factors, such as status of the occupational level,peer drinking, and amount of control exercised in the work; and (3) socialrelationships, including family and community networks.

Clinical research. Whether subjects are samples from a substance abusefacility or from another mental health treatment facility or a clinical sampleof women, those in paid employment and those who are not, the sample isone of women who have demonstrated alcohol problems and have by oneroute or another found their way to a treatment program. The EmployeeAssistance Program clients are a clinical sample, albeit a rather specializedone. Clinical samples of women are almost always compared with malepatients.

We propose several hypotheses which can be tested by comparing twosamples of women: problem drinkers in treatment, and an age-matched groupwith no alcohol problems. The hypotheses:

1. With a larger percentage of reported positive family history among theproblem drinkers and with other indices of early life disruptive familyexperience, women problem drinkers have achieved lower educationallevel than the controls.

2. With less educational achievement, a logical consequence is that theproblem drinking women will demonstrate lower occupational statuswhen compared with the controls.

3. Because of the disruptive effects of the drinking, problem drinkingwomen will be less likely to be employed than the control women.

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4. Because of the drinking, the problem drinking women will report morenegative experience in the workplace.

METHODS

Methods for this study have been previously described in detail (Gomberg,1989; Gomberg, 1986). Briefly, the study sample consisted of 301 womenselected from 21 licensed alcoholism treatment facilities in six counties insoutheastern Michigan. The counties include rural areas, small cities, andlarge metropolitan areas; the treatment sites included hospitals, residentialcenters, and outpatient facilities, i.e., inpatient and outpatient facilities; 203women were drawn from inpatient facilities and 98 from outpatient facilities.The women were asked about their age at the onset of alcohol problems, and,as might be expected, the women in their twenties averaged 19.6 years, thewomen in their thirties’ problems began at average age 28.3, and the fortiesgroup average age at onset was 36.5. They were not asked about the sequenceof events which led to the onset of problem drinking. The best predictors ofearly age at onset turned out to be: age at first intoxication, marijuana usebeginning at age 13, temper tantrums, and ‘‘unhappy while growing up.’’ Thewomen were asked about their previous attempts at treatment and aboutcomorbidities. For approximately two-thirds of the women, the current treat-ment was not their first try. The psychiatric symptomatology most frequentlyrecorded as comorbid were, in order, depression, anxiety states, psychoso-matic symptoms and obsessive thinking.

Only White women were included in this study; the limited data availableon the sociodemographic correlates of alcohol use among Black and Whitewomen indicate that bicultural models are necessary for explaining theirdrinking patterns (Lillie-Blanton, Mackenjie, and Anthony, 1991; Darrow,Russell, Cooper, Mudar, and Frone, 1992; Herd, 1994). Following detoxifica-tion, which typically occurs within one week of admission, women wereasked to participate in a paid, two-hour interview conducted by trained fe-male interviewers. Only 7 percent refused to participate.

A control group of 137 nonalcoholic women was recruited from womenfriends, neighbors or acquaintances identified by the alcoholic women as nothaving alcohol problems. The refusal rate of the nonalcoholic women wasalso 7%. This method resulted in a group closely matched on socioeconomicstatus of family of origin and age. Socioeconomic status of the family oforigin was queried by questions, e.g., ‘‘economic situation of the family waspoor,’’ or ‘‘we had a pretty good income and were able to buy extra thingswhen we wanted them,’’ so that family of origin could be classified as poor,lower middle class, middle class, or upper class. There were small nonsignifi-cant differences in class of family of origin between treatment women and

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control women. Thus, starting from approximately the same economic stationin the family of origin, the eventual differences found between the treatmentand the control women were outcomes of the problems or the relative adequa-cy of their lives. No significant differences were found between the alcoholicand control women on father’s education or occupational status or on moth-ers’ education, employment outside the home, or occupational status. Alco-holic women were more likely to report a positive family history of heavy orproblem drinking; 42.2% of the alcoholic women versus 25.8% of the controlgroup reported that their fathers were heavy or problem drinkers and 12.9%of the alcoholic women versus 5.8% of the control group reported heavy orproblem drinking by their mothers. Screening interviews were used to verifythat the control group was nonalcoholic. The control group was alsocompared with a random sample of women between the ages of 20 and 50from a large national sample to establish that there were no significant differ-ences on items dealing with psychiatric symptomatology (Veroff, Douvan,and Kulka, 1981). The control group resembled the large national sample onthis score.

A standardized interview schedule was developed. Variables were selectedbased on a review of the literature on alcoholism among women. Items weredrawn from the Rutgers Center of Alcohol Studies collection of alcoholismresearch interviews, the NIMH Diagnostic Interview Schedule (DIS), theCenter on Epidemiological Studies Depression Scale (CES-D), and fromrelevant surveys conducted by the Institute for Social Research, University ofMichigan. Detailed sociodemographic data were collected, as were data onthe subjects’ drinking and drug use history, health and reproductive history,work role and employment history, marital and parenting roles, social sup-ports, and life events. The survey instrument was reviewed by a panel offemale providers from several treatment sites and by a panel of recoveredalcoholic women; then field-tested and revised until it could be completed inless than two hours when administered by trained female interviewers.

RESULTS

As expected, the younger alcoholic women began problem drinking at anearlier age than the older women (Table 1). We also found that alcoholicwomen were more likely than nonalcoholic women in the same age groups tomarry at a younger age (19.4 years vs. 20.7, p < .0.05) and have their firstchild earlier (21.0 years vs. 22.6, p < 0.001). Compared to nonalcoholicwomen, the alcoholic women were more likely to have experienced maritaldisruption: only 41.9% of the alcoholic women are currently married,compared with 53.3% of the controls, and 32.9% of the alcoholic women

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TABLE 1. Sociodemographic Characteristics and Employment Status of Clin-ic and Control Women

Age Groups

20-29 30-39 40-49*

Number of SubjectsClinic (301) 99 108 94Control (137) 34 53 50

Mean Age of SubjectsClinic 24.9 35.1 45.1Control 24.0 34.6 45.0

Mean Age at Onset of ProblemDrinking by Clinic Women 19.6 28.3 36.5

(95% CI) (18.9, 20.2) (27.3, 29.3) (35.3, 37.7)

Mean Duration Years of ProblemDrinking by Clinic Women 5.4 6.8 8.6

(95% CI) (4.8, 5.9) (5.9, 7.6) (7.6, 9.6)

Employment Status

WorkingClinic 68.9% 56.5% 39.6%Control 78.1 81.1 71.4

UnemployedClinic 22.2 15.7 17.6Control 9.4 5.7 4.1

HomemakerClinic 8.9 27.8 42.9Control 12.5 13.2 24.5

�2, dfWorking Unemployed Homemaker (P)

TotalClinic 55.2% 18.3% 26.5%Control 76.7 5.8 16.8Difference 21.5 12.4 9.5(95% CI) (12, 31) (7, 18) (1, 17)

20.6, 2(.001)

*Of the 438 subjects, 9 clinic and 2 control respondents were between the age of 50 and56.

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versus 22.2% of the nonalcoholic women report having been separated, di-vorced, or widowed (�2 = 11.6, p < .05).

Table 2 presents the educational achievement of the alcoholic and controlwomen. The difference is striking. Alcoholic women tend to have significant-ly less education compared to their nonalcoholic counterparts. In fact, 64.2%of the control women have at least 13 years of education, while only 43.9% ofthe alcoholic women report this level of schooling.

As is the case with educational achievement, alcoholic women were sig-nificantly less likely than the nonalcoholic controls to be working outside thehome (Table 1). Older alcoholic women are especially likely to be unem-ployed or homemakers compared with the nonalcoholic group: only 39.6%report currently working, compared with 71.4% of the controls. Occupationalcategories also differ between employed alcoholic and nonalcoholic women(Table 2). While control women tend to work more frequently in professionaland managerial positions, significantly more clinic women work in bluecollar settings, e.g., craft operative (19.5% vs. 2.9%) and service labor(19.5% vs. 14.6%).

TABLE 2. Educational Achievement and Occupational Categories* of Clinicand Control Women

Clinic Control

Education+

High school or less, no. (%) 169 (56.1) 49 (35.8)

Some college or more, no. (%) 132 (43.9) 88 (64.2)

Difference, % 20.3(95% CI) (11, 30)

Occupational Categories∧

Professional 24.5% 33.0%Managers 8.8 16.5

Clerical 22.0 27.2Sales 5.7 5.8

Craft Operative 19.5 2.9Service Labor 19.5 14.6

+Chi-square = 15.642, p = 0.0001∧Chi-square = 19.6, p < 0.001*For some analyses, occupational categories were grouped into upper, middle, and lowertiers, i.e. professional and managers, clerical and sales, craft operative and service labor,respectively.

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Asked about nine different difficulties in the workplace (e.g., level ofsatisfaction in work, treatment in an unfriendly way, lost time from work,etc.) there is little difference between the women in treatment and the controlgroup except for reporting boredom at work (Table 3). This is clearly relatedto the lower skilled jobs which represent a larger proportion of employedalcoholic women. When one adds to this the larger proportion of women intreatment listed as housewives or unemployed, the difficulty of these womenin filling time does not seem surprising. Many of them volunteer, ‘‘I have toomuch time and not enough to do.’’ And, although not significant, alcoholicwomen are also more likely to report having to do tasks no one else wantsthan the nonalcoholic group. When asked about drinking while at work, thealcoholic women reported differences depending on job status: 13% of pro-fessional/managerial alcoholic women report drinking at work; 20.5% ofalcoholic women in clerical/sales occupations, and 36.1% of alcoholicwomen in craft/operative occupations. And when the alcoholic women intreatment were asked about warnings in their drinking in the workplace, thedifferences between job status appear again, although the differences are notsignificant: of the professional/managerial group, 20.8% of the women havereceived warnings at work about their drinking, compared with 36.4% of theclerical/sales women and 38.7% of the craft/operative/service/labor group.

To further test the hypotheses that womens’ problem drinking predictsemployment and negative experiences in the workplace, regression analyseswere conducted. Table 4 presents the results of a multiple logistic regressionanalysis of the odds of being employed for all women in the sample. Allvariables were entered simultaneously, and education was entered as a set ofindicator variables with college as the reference category. As expected, afteradjusting for age and education, nonalcoholic women are significantly more

TABLE 3. Negative Experiences at Work for Clinic and Control EmployedWomen

Clinic Control % DifferenceN (%) N (%) (95% CI) P

Experiences

Women who are bored 79 (49.7) 35 (34.0) 15.7 (3.7, 27.7) 0.001

Given tasks no oneelse wants 93 (58.5) 49 (48.5) 10 (�2.4, 22.4) 0.12

Have more thanthey can handle 93 (58.5) 70 (68.0) 9.5 (�2.4, 21.3) 0.12

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TABLE 4. Logistic Regression Analysis: Odds of Being Employeda for Alco-holic and Non-Alcoholic Women (N = 438)

Independent Variable Odds Ratio 95% Confidence Interval

Drinking Statusb 0.57** 0.37-0.87Age 0.98 0.64-1.50Some HS 0.92 0.51-1.63HS grad 0.76 0.50-1.16College+c

Constant 0.01

* p < .05; ** p < .01; *** p < .001aemployed = 1; balcoholic = 1; creference category

likely to work, relative to alcoholic women (p < .01). Table 5 presents thestandardized regression coefficients for the association between drinkingstatus and negative experiences in the workplace. For this analysis, all inde-pendent variables except age are categorical and are modeled as dummy orindicator variables in the regression model. The dependent variables arecoded as 1 = often, 2 = sometimes, 4 = rarely, 5 = never. Among those womenwho do work, alcoholic women are significantly more likely to report boredomat work, after adjusting for age, education, and occupational category (p. < .05).

DISCUSSION

We have raised several questions which may be answered by the clinicaldata presented above. First, the comparative educational achievement of thesample of alcoholic women in treatment and the same age sample of nonalco-holic or control subjects differs significantly. Although no statistically signif-icant differences were found between the two groups of women in earlyfamily socioeconomic background (measures including parents’ educationand occupation and the white collar/blue collar status of the family), thealcoholic women in treatment showed significantly less educational achieve-ment than the control group. This could be linked to the greater incidence ofheavy or problematic drinking in the family of origin of the women in treat-ment. The relatively higher report of positive family history among thewomen diagnosed and treated as alcoholic is consistent with all of the litera-ture on the genetics of alcoholism. Furthermore, whether the sample is alco-holic or nonalcoholic, positive family history does seem linked with lowerededucational achievement: children of alcoholics are more likely to exhibit avariety of school-related problems (Sher, 1991). There is, then, a complex set

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TABLE 5. Standardized Regression Coefficients for the Association BetweenDrinking Status and Negative Experiences in the Workplace (N = 227)

Dependent Variables:Negative Experiences in the Workplacea

Independent VariableTaskb Boredc Overworkedd

Drinking Statuse �.07 �.13* .09Age (year) .14* .30*** .04Education

Some HS �.01 �.15* �.00HS grad �.06 �.07 �.02College+f

Occupational CategoriesProfessionalfCraft operator .06 .00 .07Manager .02 .04 .05Sales .02 .02 �.00Service Labor �.06 �.03 .02

Constant 2.26 1.76 2.03R2 0.04 0.15 0.02

* p < .05; ** p < .01; *** p < .001aResponses are coded: 1 = often; 2 = sometimes; 4 = rarely; 5 = never.bGiven tasks no one else wantscBoredomdFeel I have more than I can handlee0 = nonalcoholic; 1 = alcoholicfReference category

of events: positive family history, which is more likely to produce alcoholproblems in the next generation, is also linked with lower educationalachievement.

Dropping out of school earlier than the nonalcoholic women is one of theways in which the alcoholic women in treatment manifest disadvantage. Theyalso marry at a significantly earlier age and produce a first child at a signifi-cantly earlier age. Even before their heavy drinking commences, there areearly life indications that suggest an increased disadvantage in competition.One may raise issues of capacity for delayed gratification, impulsivity andfuture orientation: this question merits further exploration.

Second, when the alcoholic and nonalcoholic women are compared oncurrent employment status, it is clear that younger women are more likely tobe in the workplace than their older peers. This is true of both groups of

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women. Differences between clinic and control groups emerge most dramati-cally in comparison of homemaker status of women in their 30s and 40s.Among the women in their thirties, 13.2% of the control women and 27.8%(more than double) describe themselves as homemakers. Of the women intheir 40s who self-report as homemakers, not in the workplace, the figuresare 42.9% of clinic women and 24.5% of control women. The question needsto be raised: why are the clinic women in their thirties and forties less likelyto be in the workplace than the matched control group? We do not have ananswer to this question, but several speculations may be offered: the largerproportion of women who are homemakers could be linked to their heavydrinking and reluctance to be publicly visible, to their relative lack of workskills, or to workplace experience in which their alcoholic behaviors havebeen noted. In the sample of alcoholic women in treatment, those women(primarily in their 30s and 40s who are currently married and have children),there is significantly less labor force participation than similarly married/withchildren women in the U.S. general population; the alcoholic women are alsosignificantly more likely than the general population of married/with childrenwomen to be homemakers.

Third, when the clinic and control women are compared on current occu-pational status, the clinic women’s occupational status is significantly belowthat of the control women. It would appear to be a logical consequence oftheir lesser education and the fact that they probably have fewer marketableskills.

Fourth, do the alcoholic women report more negative experience in theworkplace? When the clinic women are compared with the control women onresponse to a question about experiencing boredom at work, half the clinicwomen and a third of the control women report such experience, a statistical-ly significant difference. The relationship between boredom and substanceabuse needs further exploration, as do the implications of the differences indrinking while at work by job status: there is current research on search-for-stimulation as a motivation for drinking, which might be linked to the re-ported boredom.

The fact that there is impairment in work outside the home for womenproblem drinkers does not seem surprising, but it does need to be empiricallydemonstrated. While population-based surveys are needed to confirm thegeneralizability of the findings reported here, it is clear that for the alcoholicwomen in this case-control study, there is a trajectory of problems whichbegins with an early history of more alcohol/drug abuse in the nuclear family.This links to lesser schooling and acquisition of fewer marketable work skillsthan their peers and inevitably, to lower occupational status. The combinationof heavy/problem drinking and lower job status compounds the problems ofthese women. Attention to these issues on the part of Employee Assistance

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Program personnel and other health care providers is essential. One maystart, however, with the recognition that the lives of alcoholic women includemore than their familial roles. It is not only the disruptive effects of thedrinking on spouse, children and relatives that create an overwhelming num-ber of problems for these women, it is also their problems in achievingeducation and in a work-outside-the-home role. Considering the significantproportion of American women now working outside the home, this aspect ofproblem drinking women’s lives must be evaluated further. To what extent dowomen bring predispositional factors to the workplace, and to what extent dopersonal and workplace problems contribute to problematic alcohol use?

Since these data were collected fifteen years ago, the question ariseswhether labor force participation has changed over that decade and ahalf. As early as 1971, the scene was described as follows by Smuts (1971):‘‘ . . . more than 50% of women are in the workplace . . . most women whowork are married and most of these married workers have children . . . ’’ It istrue that the proportion of women working outside the home has increased,but in the decade which passed, there was no sudden shift from the occasionalwoman working outside the home to much larger percentages. Much of thework which created new jobs for women was part-time work.

Another question: has treatment changed? For the last half century, therehas been a mix of pharmacotherapy, counseling and psychotherapy, andmembership in self-help organizations. In the 1980s, cognitive therapies werealso in the treatment mixture. Any major changes in treatment regimes overthe last decade and a half have been largely in pharmacological treatment.

The data indicate quite clearly that the women who become problemdrinkers are disadvantaged in many ways when compared with a matchedgroup of control women: there is more positive family history, more child-hood depression, more family conflict which results in school difficul-ties–which in turn leads to lower occupational achievement. There is noreason to believe that improved treatment of women alcoholics has currentlyproduced a very different picture.

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