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Alcohol Use and Job Strain

Effort-Reward Imbalance

“The concept of effort-reward imbalance (ERI) was developed by Johannes Siegrist to study lack of reciprocity (low rewards relative to high effort) and its association over a sustained period of time with the development of stress-related disorders. The ERI model also encompasses the idea of having an “over-commitment” to work, meaning that some people may be more likely to expend a large amount of effort for low reward because of an “intrinsic” or personal over-commitment to their job.

In a review of longitudinal epidemiological studies, Siegrist found that “people who experience failed reciprocity at work are twice as likely to suffer from incident cardiovascular disease, depression, or alcohol dependence compared to those who are not exposed” [29, p. 1033]. 

Finnish factory workers with effort-reward imbalance were heavier than those without effort-reward imbalance in one study [70]. Another study showed that Finnish public employees with effort-reward imbalance were more likely to have several risk factors for heart disease: overweight, smoking, heavy alcohol use, and lack of exercise [125]. Male British civil servants with effort-reward imbalance had an increased risk of developing Type 2 diabetes, although this pattern was not seen among female civil servants [126]. Finally, several studies have shown that workers with effort-reward imbalance had higher levels of cholesterol [102, 127, 128].

Long Work Hours

Overtime work was associated with unhealthy weight gain in two studies, increased alcohol use in two of three studies, and increased smoking in one of two studies, but it was not related to exercise or drug abuse [43]. One [129] of two [129, 130] Japanese studies found a relationship between work hours and adult onset (Type 2) diabetes.

Job Strain

In a preliminary analysis of data from men in the New York City Work Site BP Study, job strain was 54% more common among men with masked hypertension (at entry into the study) and more than five times more common (at the 3-year follow-up measurement period), taking into account other risk factors for high blood pressure such as age, race, weight, education, smoking, and alcohol use.

Direct Costs

According to the Institute for Health and Productivity Studies, the top physical health conditions financially affecting large U.S. employers through direct costs were chronic maintenance of angina pectoris, essential hypertension, diabetes mellitus, mechanical low back pain, acute myocardial infarction, chronic obstructive pulmonary disease, back disorders other than low back, traumatic spine and spinal cord, sinusitis, and diseases of the ear, nose, throat, or mastoid processes [4]. Six of these 10 conditions have been associated with psychosocial stressors in past studies (see chapters 6 and 7). The top mental health conditions were: bipolar disorders; depression; neurotic, personality, and non-psychotic disorders; alcoholism; anxiety disorders; acute phase schizophrenia, and psychoses. Of these conditions, anxiety disorders, depression, and alcoholism have been shown to have some roots in workplace stressors.


Taken from: Schnall PL, Dobson M, Rosskam E, Editors Unhealthy Work: Causes, Consequences, Cures. Baywood Publishing, 2009.

97. Schnall, P. L., J. E. Schwartz, P. A. Landsbergis, K. Warren, and T. G. Pickering, Relation between Job Strain, Alcohol, and Ambulatory Blood Pressure, Hypertension, 19, pp. 488-494, 1992.

11. Hasin, D. S., R. D. Goodwin, F. S. Stinson, and B. F. Grant, Epidemiology of Major Depressive Disorder: Results from the National Epidemiological Survey on Alcoholism and Related Conditions, Archives of General Psychiatry, 62:10, pp. 1097-1106, 2005.

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