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Work Stress, Coping, and

Substance Use Among

Female Nurses

R. Lorraine Collins, Ph.D.; Gernot Gollnisch, Ph.D.; and

Elizabeth T. Morsheimer, Ed.M.

INTRODUCTION

As women enter the work force, they are exposed to new or additional sources of stress, which may result in substance use. This chapter

presents results from a National Institute on Drug Abuse (NIDA)-funded

research project on work stress, coping, and substance use among a

regional sample of female nurses. It includes a summary of data on the

prevalence of substance use among these nurses and a test of models of

the relationships among personality, work stress, coping, and substance

use in a subsample of female nurses. Findings from this research will

enhance understanding of the complex issues involved in women’s use

of a variety of substances.

WORK STRESS AND SUBSTANCE USE

Although theoretical and commonsense notions suggest a link

between work stress and substance use among women, empirical support

for such a relationship is not consistent (Wilsnack and Wilsnack 1992).

Some studies have reported support for such a link (e.g., Parker and

Farmer 1988, pp. 113-130; Sadava et al. 1978; Timmer et al. 1985,

pp. 171-198). For example, Timmer and colleagues (1985, pp.171-198)

reported that women, particularly young women, were more likely to

use alcohol to cope with work-related stress than were men. Sadava

and colleagues (1978) reported that all their measures of drug use were

significantly related to job stress. Other studies have reported no support

for substance use as a direct response to work stress but have found

limited support for the notion that individuals who use less effective

coping strategies are more likely to use substances as a function of work

stress (Cooper et al. 1990; Harris and Fennell 1988; Steffy and Laker

1991). These studies suggest that job stress, particularly when combined
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with ineffective coping strategies, can increase the potential for substance use.

COPING AND SUBSTANCE USE

Coping involves efforts to master, reduce, or tolerate the demands

that are created by stress. Use of a particular coping strategy may be the

result of several factors, including more enduring dispositional characteristics such as personality. Most coping strategies are grouped as either

adaptive responses that solve or remove the source of stress or maladaptive

responses that provide temporary escape or avoidance from the stressor

(Lazarus and Folkman 1984; Roth and Cohen 1986; Suls and Fletcher

1985).

Substance use is typically seen as an example of a short-term

coping strategy that provides temporary relief from distress but leaves

the original source of the distress unchanged; thus, it is maladaptive

(Folkman and Lazarus 1980; Timmer et al. 1985, pp. 171-198; Wills

and Shiffman 1985, pp. 3-24). To the extent that women have been

socialized to use fewer adaptive coping strategies, some women more

readily may turn to substance use to alleviate difficulties temporarily

(Beckman and Bardsley 1981; Timmer et al. 1985, pp. 171-198; Wills

1990, pp. 215-250). Thus, women who experience high levels of stress

may use substances as a function of either their stress or their socialization to use coping strategies that provide only temporary relief.

NEUROTICISM AND THE RELATIONSHIPS

AMONG STRESS, COPING, AND SUBSTANCE USE

Given the inconsistencies regarding the relationships among stress,

coping, and substance use, the authors sought a variable common to

these constructs that might further illuminate their interrelationships.

The decision was made to explore the role of personality, particularly

neuroticism, because neuroticism has been independently linked to stress

and coping and may be predictive of substance use. If neuroticism helps

explain the links among stress, coping, and substance use, it may help

reconcile some of the inconsistencies in the literature as well as represent another variable that places some women at risk for substance use

and abuse.
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The five-factor model of personality is currently accepted as a viable

explanation of normal adult personality functioning (Costa and McCrae

1985). One of these factors, neuroticism, is said to be related to stress

and to coping (Bolger 1990; Bolger and Schilling 1991; McCrae 1990;

McCrae and Costa 1986; Parkes 1986) and also may be related to

substance use (Cox 1987, pp. 55-89; Earleywine et al. 1990; Martin

and Sher 1994). Neuroticism involves negative states such as anxiety,

depression, hostility, self-consciousness, impulsiveness, and vulnerability

(Costa and McCrae 1985). It has been linked to the propensity to

perceive events as stressful; highly neurotic subjects report more exposure

to stress and greater emotional reactivity to daily stressors (Bolger and

Schilling 1991).

One possible explanation for differences in the reaction to stress is

that highly neurotic individuals use fewer adaptive coping strategies,

thereby exacerbating stressful encounters. Persons high in neuroticism

generally use maladaptive coping strategies such as hostility, escape, and

wishful thinking. That is, they attempt to lessen emotional distress by

changing the meaning of the situation or escaping from the stressor,

but typically, they are not effective in removing the source of stress.

The authors’ research began with the notion that the links among

stress, coping, and substance use might be related to neuroticism, a

dispositional characteristic that is independently related to stress and

coping. The key question was whether work stress and coping contribute

to substance use among nurses or whether personality, particularly

neuroticism, affects the relationships among stress, coping, and substance

use. These relationships were tested using structural equation modeling,

with alcohol use as the dependent variable.

The authors focused on female nurses because nursing is a predominantly female occupation (95.7 percent) (American Nurses Association

1994), and empirical and anecdotal reports suggest that nursing is a

highly stressful occupation. Sources of stress include low pay, low status,

advanced technology, patient care, high administrative demands, and

lack of supervisory support (Haack 1987, 1988; Moos and Schaefer 1987;

Numerof and Abrams 1984; Naegle 1988). These work-related stressors,

as well as access to a variety of medications, may place nurses at high

risk for substance use or abuse (Bissell and Haberman 1984; Hutchinson

1986; Sullivan 1987; Trinkoff and Storr 1994). However, some studies

have reported rates of substance use among nurses comparable with the
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general population of working women (Haack and Harford 1985,

pp. 201-226; Plant et al. 1991; Trinkoff et al. 1991). Although nursing

has some features that make it unique (e.g., patient care, rotating shifts),

nursing provides an adequate context for beginning to examine the

relationships among the variables of interest.

SURVEY METHOD

Sample

The sample consisted of 1,951 female nurses who resided and

worked in the 8 counties of western New York. They were identified

based on lists of professional nurses collected by the New York State

Department of Education, Division of Professional Licensing Services.

Survey booklets were mailed to the homes of a random sample of

4,000 licensed nurses (registered nurses and licensed practical nurses).

After mailing the survey and 2 reminder cards, the authors received

2,400 responses (a response rate of 60 percent), of which 1,951 contained

usable data. Each participant received $30 as compensation. Descriptive

information for the entire sample is provided in table 1.

Data on the prevalence of substance use are presented on the complete sample of 1,951 nurses. Also tested were models of the relationships among neuroticism, stress, coping, and substance use (specifically

alcohol consumption) on a subsample of 637 nurses who worked in

patient care workplaces and were current drinkers (women who reported

having consumed alcohol during the past month). This subsample had

demographic characteristics similar to the larger sample; the mean age

was 34.6 years (standard deviation [SD]=8.6).

Measures

Assessment of Substance Use. Nurses’ substance use was assessed

for lifetime and the past month. Four categories of substances were

included in the survey: (1) licit substances (e.g., alcohol, caffeine,

tobacco), (2) illicit substances (e.g., marijuana, cocaine/crack, opiates),

(3) prescription drugs (e.g., barbiturates, tranquilizers), and (4) over-thecounter (OTC) drugs (e.g., pain medications, sleeping pills, antiobesity

drugs). Lifetime use was categorized into “never used” and “used.” Pastmonth substance use was measured dichotomously (yes/no).
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TABLE 1. Demographic characteristics of sample of female nurses

(n=1,951)

Variable N Percent

Age

18-24 187 9.6

25-34 661 33.9

35-44 747 38.3

45-54 253 13.0

55 80 4.1

Marital status

Married 1,209 62.0

Separated/divorced/widowed 284 14.5

Never married 306 15.7

Children

Yes 1,422 72.9

No 528 27.1

Ethnicity

European-American 1,817 93.1

African-American 76 3.9

Hispanic-American 10 0.5

Asian-American 3 0.2

Other 34 1.7

Highest degree in nursing

Diploma 793 40.6

Associate degree 655 33.6

Bachelor’s degree 418 21.4

Master’s degree 64 3.3

Doctoral degree 0 0

Type of nurse

Licensed practical nurse 587 30.1

Registered nurse 1,363 69.9

Work setting

Urban 986 50.5

Suburban 537 27.5

Rural 375 19.2

Workplace

Hospital 1,149 58.9

Private medical office 102 5.2

Nursing home 280 14.4

Community/public health agency 147 7.5

University/research facility 25 1.3

Other 244 12.5

Typical shift

Days 1,116 57.2

Evenings 357 18.3

Nights 344 17.6

Rotation 128 6.6

Work schedule

Full time 1,254 64.3

Part time 682 35.0
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TABLE 1. (continued)

Variable N Percent

Tasks (at least 50 percent of time)

Direct patient care 1,405 72.0

Administrative 127 6.5

Supervision 164 8.4

Teaching/research 90 4.6

Other 164 8.4

Salary

<$10,000 192 9.8

$10,001-$20,000 676 34.6

$20,001-$30,000 735 37.7

$30,001-$40,000 292 15.0

>$40,000 46 2.4

Specialty

Medical/surgical 390 20.0

Geriatrics 290 14.9

Pediatrics/obstetrics-gynecology/nursery 265 13.6

Critical/intensive care 157 8.0

Community/school/home care 150 7.7

Psychiatric/mental health 103 5.3

OR/ER/anesthesia/recovery 88 4.5

Cardiology 69 3.5

Oncology 59 3.0

Administration/education 48 2.5

Orthopedics 33 1.7

Rehabilitation 31 1.6

Neurology 16 0.8

Miscellaneous 119 6.1

NOTE: Because of missing data, not all variables add up to 100 percent.

KEY: OR=operating room, ER=emergency room

Neuroticism Scale of the NEO Personality Inventory. The Neuroticism Scale of the NEO Personality Inventory (Costa and McCrae

1985) consists of six facets: anxiety, hostility, depression, self-consciousness, impulsiveness, and vulnerability. Subjects rate their level of

agreement with each item (e.g., “I often feel tense or jittery”; “I am

seldom sad or depressed”) on a 5-point Likert scale (0=strongly disagree,

4=strongly agree), and ratings are summed across the 8 items of each

facet. The facets are summed to form a score for neuroticism. The scale

possesses good internal consistency (Cronbach alpha=0.85 for this

sample) and test-retest reliability.

Nursing Stress Inventory. The Nursing Stress Inventory (NSI)

(Numerof and Abrams 1984) contains 46 items designed to assess

nursing-related stress. Subjects rate each item based on its frequency
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of occurrence during the past month (1=not at all, 5=all the time) and

degree of stress (1=no stress, 5=high stress). The NSI includes six

factors: organizational environment, work demands, emotional aspects

of patient care, death-related issues, lack of procedural/administrative

support, and supervisor’s role. Item scores are calculated by multiplying

ratings of frequency of occurrence by degree of stress. The authors’ factor

analysis of the six NSI scales yielded a single higher order factor named

“work stress” (alpha=0.85).

The COPE. The COPE (Carver et al. 1989) is a multidimensional

coping inventory designed to measure approaches to handling stress.

Subjects rate the degree to which they typically use each of 60 ways of

responding to stress (e.g., “I try to get advice from someone about what

to do”) on a 4-point scale (1=“I usually don’t do this at all,” 4=“I usually

do this a lot”). The items form 15 factors (e.g., active coping, acceptance), each of which contains 4 items. Factors exhibit good to moderate reliability (mean alpha=0.71) (Carver et al. 1989) and test-retest

reliability. Scale scores are calculated by summing across ratings. The

dispositional version of the COPE was administered. The factor analysis

of the COPE subscales yielded three factors: competent coping (CC)

(strategies that typically resolve or remove stress), social-emotional

coping (SEC) (provides social support and emotional release), and

disengagement coping (DC) (provides temporary escape/avoidance

from stress).

Alcohol-Related Variables. Alcohol use is represented by three different

variables. (1) Drinking to cope with work (DCW) asks respondents to

rate a single item (“Were you more likely to drink if you have had a

rough day at work?”) on a 10-point scale (1=not likely, 10=very likely).

The mean score was 2.16 (SD=2.02), indicating that for the most part,

subjects did not rate themselves as likely to drink to cope with work

stress. (2) Typical drinking (TD) represents the number of drinks

consumed in a typical month (zero to 10 or more drinks per day). The

mean number of drinks per month was 17.19 (SD=14.20). (3) Effects

of intoxication (EI) represent experiences of acute negative effects of

drinking, such as feeling flushed and tipsy, during the past month. Each

EI item was rated on a 6-point scale (1=never, 6=always), and ratings

were summed to derive a total score (alpha=0.65). The mean rating for

experiencing acute effects was 4.61 (SD=1.83), indicating that these

effects were experienced with relatively low frequency.
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Based on previous research, the authors expected that all three

alcohol-related variables would be positively related to each other and

that drinking to cope would be the alcohol variable most likely to be

associated with work stress.

RESULTS

The results are presented in two sections. First, an overview of the

prevalence of substance use for the entire sample of 1,951 nurses is presented to provide a context for model testing. Second, the testing results

of a series of hierarchically nested models of the relationships among

neuroticism, stress, coping, and substance use are described. These models

were tested on a subsample of 637 nurses who self-reported consuming

alcohol during the past month.

Prevalence of Substance Use

Lifetime and past-month prevalence for four categories of substances

(licit, illicit, prescription, and OTC) were assessed. Results are presented

in table 2.

Use of Licit Substances. The highest rate of lifetime use of licit substances was for alcohol (94.9 percent), followed by caffeine (93.9 percent)

and tobacco (55.8 percent). Nurses’ use of licit substances during the past

month was significantly lower than their lifetime use. Although caffeine

use stayed relatively high (88.1 percent), there were significant drops in

past-month use of alcohol (66.2 percent) and tobacco (26.6 percent).

Use of Illicit Substances. Marijuana was the most widely used illicit

drug (37.3 percent) over the lifetime. Rates for the use of other illicit

substances ranged from 16.0 percent (opiates) to 3.4 percent (hallucinogens). The authors were not able to distinguish between prescribed and

non-prescribed use of opiates. Even so, lifetime opiate use in this sample

is notable. Rates of past-month use were significantly lower than lifetime

use. They ranged from a high of 2.1 percent (opiates) to zero percent

(hallucinogens).

Use of Prescription Drugs. Nurses exhibited high levels of lifetime use

of the three classes of prescription drugs included in the survey. Almost

20 percent of nurses had used tranquilizers, and about 12 percent had

used barbiturates and amphetamines during their lifetime. Rates of use

during the past month were much lower than lifetime, ranging from about
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TABLE 2. Respondents’ substance use (n=1,951) and general

population estimates (percent)

Respondents General Population

Lifetime Past Lifetime Past

Substance Use Month Use Month

Licit

Alcohol 94.9 66.2 88.5 (86.1-90.6)* 54.7 (50.9-58.5)*

Caffeine 93.9 88.1 — — — —

Tobacco 55.8 26.6 70.2 (67.2-73.0)* 28.5 (25.3-31.9)*

Illicit

Marijuana 37.3 1.3 32.6 (29.5-35.7)* 4.1 (3.2-5.2)*

Opiates 16.0 2.1 — — — —

Cocaine 4.7 0.3 10.0 (8.6-11.5)* 0.6 (0.5-0.8)*

Hallucinogens 3.4 0.0 7.3 (6.7-7.9)* 0.1 (0.1-0.2)*

Prescription†

Tranquilizers 19.7 2.1

Barbiturates 12.5 1.0

Amphetamines 12.2 0.2

Over-the-counter

medications

Analgesics n/a 80.3

Allergy n/a 28.9

Antacids n/a 23.6

Cough/cold n/a 11.3

Laxatives n/a 8.1

Sleeping pills n/a 2.0

Stimulants n/a 1.2

Antiobesity n/a 1.1

*95-percent confidence interval

†Sometimes used illegally

NOTE: General population estimates are not available for prescription and over-thecounter medications.

KEY: n/a=not applicable

2 percent for tranquilizers to 0.2 percent for amphetamines. The format

of the survey did not allow investigators to distinguish between prescribed and nonprescribed use.

Use of Over-the-Counter Medications. Because most people use many

OTC medications during their lifetimes, only past-month use of these

drugs was assessed. In this sample of nurses, the prevalence of OTC

medication use was particularly high for analgesics (80.3 percent).

There was a significant drop in the next most frequently used class of

drugs, allergy medications (28.9 percent), which was followed by gradual
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declines to low rates of use of stimulants (1.2 percent) and antiobesity

drugs (1.1 percent).

Comparison of Substance Use Among Nurses

and the General Population of Women

Comparison of substance use rates of this sample of nurses with those

of women in the general population provides a context for considering

these findings concerning substance use among nurses. Where possible,

rates of substance use among this sample of nurses were compared with

prevalence estimates from the National Household Survey on Drug Abuse

data on women ages 18 to 64 years who resided in the mid-Atlantic (New

Jersey, New York, Pennsylvania) region of the United States (personal

communication, health official, Office of Applied Studies, Substance

Abuse and Mental Health Services Administration, March 1994).

Alcohol use was reported with high frequency by both nurses and

the general population of women. However, the sample of nurses had

slightly higher rates of lifetime use of alcohol (94.9 percent) than did

the general population of women (88.5 percent). Nurses also reported

slightly higher rates of marijuana use (37.3 percent compared with

32.6 percent). Conversely, nurses reported much lower lifetime rates

of tobacco, cocaine, and hallucinogen use than those estimated for the

general population of women.

The pattern for substance use in the past month was slightly different

from that for lifetime use. In comparison with the general population

of women, nurses reported higher rates of alcohol use, similar rates of

tobacco use, and lower rates of marijuana and cocaine use.

Although some differences existed in the rates of substance use,

nurses and the general population of adult women reported comparable

rates for licit substances. However, nurses reported using less marijuana

and cocaine than their counterparts in the general population.

Tests of Models of the Relationships Among Neuroticism,

Work Stress, Coping, and Substance Use

Previous research results as well as the authors’ prevalence data

suggest that alcohol is the most commonly used of the addictive

substances. Thus, models of substance use were tested that focused

on three alcohol-related variables: (1) DCW, (2) TD, and (3) EI.
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Based on the research literature, the authors generated a base model

in which work stress has an indirect effect on alcohol use. This relationship is mediated by coping. The investigators predicted that because

coping occurs in response to stress, work stress and coping are positively

related, regardless of the type of coping. Adaptive forms of coping would

be negatively related to alcohol-related outcomes, whereas maladaptive

forms of coping would be positively related to alcohol-related outcomes.

In the base model (figure 1), neuroticism is part of the measurement

model, but it is not linked to any other model components.

Relationships Among Variables in the Models

Means, SDs, and the correlation matrix for the variables included

in the model are presented in table 3. Neuroticism was significantly

correlated with all variables, except TD. All such relationships were

positive, with the exception of a moderately strong negative correlation

FIGURE 1. Base model of relationships among neuroticism,

work stress, coping, and substance use

Chi-squared (367, n=637)=1,368.21, p<0.001; normed fit index=0.81; nonnormed fit

index=0.84; comparative fit index=0.85

*p<0.05

†p<0.01

‡p<0.001

NOTE: Standardized parameter estimates and significance levels of paths are

presented.

KEY: A=anxiety; H=hostility; D=depression; S=self-consciousness; I=impulsiveness;

V=vulnerability; N=neuroticism; WS=work stress; CC=competent coping;

SEC=social-emotional coping; DC=disengagement coping; DCW=drinking to

cope with work stress; TD=typical drinking; EI=effects of intoxication. Circles

represent latent constructs; squares represent single-item manifest variables.
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TABLE 3. Descriptive statistics and correlations among model

variables (n=637)

Standard

Variable Mean Deviation 1 2 3 4 5 6 7

Neuroticism 78.77 22.37

Work stress 37.91 15.12 0.21*

Competent

coping (CC) 67.34 9.34 –0.32* –0.04

Social-emotional

coping (SEC) 34.37 6.12 0.13* 0.07 0.36*

Disengagement

coping (DC) 20.11 4.31 0.43* 0.17* –0.08* 0.10*

Typical drinking (TD) 17.19 14.20 0.07 0.05 –0.06 –0.03 0.11*

Drinking to cope

with work (DCW) 2.16 2.02 0.20* 0.23* –0.07 0.10* 0.13* 0.29*

Effects of

intoxication (EI) 4.61 1.83 0.17* 0.12* –0.12* 0.12* 0.16* 0.29* 0.23*

*p<0.05, two-tailed

between neuroticism and CC. Although neuroticism was related to

DCW and EI, it was not related to TD. This suggests that neuroticism

was related to the more maladaptive aspects of drinking (DCW and EI)

but not to TD, which was likely to occur as a function of a variety of

social and cultural factors. Work stress was positively related to three

variables: DCW, DC, and EI. Again, data indicate that stress and a

variety of maladaptive responses were associated. Although all three

coping variables were significantly related, the relationships were

relatively small, except for that between CC and SEC, r(636)=0.36.

As expected, the three alcohol-related variables exhibited low, but

significant, correlations with each other.

Tests of Hierarchically Nested Models

The models were tested using maximum likelihood estimation

procedures in the EQS structural equations modeling program (Bentler

1989). Given the large sample size, the chi-squared test is a less accurate

reflection of model fit. The NNFI (nonnormed fit index) and the CFI

(comparative fit index) are goodness-of-fit indexes less influenced by

sample size and, thus, are a more accurate reflection of model fit when

the sample size is large (Bentler and Bonett 1980).
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Estimation of the base model resulted in a significant chi-squared

test, chi squared (367, n=637)=1,368.21, p<0.001, indicating a poor

model fit. However, this was expected, given the many subjects in the

study. Additional fit indexes suggested a reasonable fit of the model to

the observed covariance matrix (normed fit index [NFI]=0.81,

NNFI=0.84, CFI=0.85).

To further refine the model, the authors hypothesized that the

indirect effects of neuroticism on alcohol use were mediated through its

direct effects on work stress and its direct and indirect effects on coping.

That is, neuroticism was predicted to be positively related to work stress

and to the use of maladaptive coping strategies but negatively related to

the use of adaptive coping strategies that remove or lessen stress. Work

stress and coping, in turn, affected alcohol use. The next steps moved

through a series of hierarchically nested models involving the addition

of direct and indirect paths. Paths were introduced from neuroticism

to the other model components (first work stress, coping, then alcohol

use), while maintaining the previously introduced paths. In this way,

the unique contribution of each new set of paths could be evaluated.

The final model (figure 2) incorporated theoretically derived modifications to improve the fit as well as the constraint of nonsignificant paths

to zero. As expected, the large sample size produced a significant chisquared test, chi squared (361, n=637)=1,118.04, p<0.001, for the final

model. However, the fit indexes that are less influenced by sample size

suggested a reasonable fit of the model to the observed covariance

matrix (NFI=0.84, NNFI=0.87, CFI=0.89).

In the final model, both neuroticism and work stress had direct

effects on DCW, but the indirect effect of neuroticism on DCW

as mediated by work stress was not significant. The strongest relationships in the final model were those between neuroticism and DC and

CC. Interestingly, none of the coping factors predicted DCW after

neuroticism was included in the model. Thus, the final model provided

support for the notion that with neuroticism accounted for, coping

has no relationship to alcohol use.
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FIGURE 2. Final model in which nonsignificant paths are

constrained to zero

Chi-squared (361, n=637)=1,118.04, p<0.001; normed fit index=0.84; nonnormed fit

index=0.87; comparative fit index=0.89

*p<0.01

†p<0.001

NOTE: Standardized parameter estimates and significance levels of paths are

presented.

KEY: N=neuroticism; WS=work stress; CC=competent coping; SEC=social-emotional

coping; DC=disengagement coping; e=error; DCW=drinking to cope with work

stress; TD=typical drinking; EI=effects of intoxication

RELATIONSHIP OF FINDINGS TO NURSES’

SUBSTANCE USE

Prevalence of Substance Use

Findings for use of licit and illicit substances are consistent with

other studies of nurses (Haack and Harford 1985, pp. 201-226; Plant et

al. 1991; Trinkoff et al. 1991), which have reported levels of substance

use similar to those of women in the general population.

Nurses’ lifetime and past-month rates of prescription drug use were

high but comparable with those reported for a sample of male and female

physicians (Hughes et al. 1992). This consistency across two studies of

health care professionals suggests that these professionals may be at

particular risk for use and abuse of psychoactive substances. Both nurses

and physicians have access to prescription medications, including

controlled substances, which may contribute to attitudes that facilitate
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use (Naegle 1988; Trinkoff and Storr 1994). Future prevention efforts

for health care professionals should focus on access and attitudes regarding the use of prescription medications.

Role of Neuroticism in Substance Use

Models of the relationships among neuroticism, stress, coping,

and substance use clearly indicate that adding neuroticism to the stresscoping-alcohol connection lessens the role of coping as a contributor to

alcohol use. Results suggest that neuroticism accounted for the relationships between stress and coping as well as between coping and alcohol

use. The final model (figure 2) suggests that there may be two different

routes by which neuroticism affects alcohol-related outcomes: (1) a

direct route involving use of alcohol to cope and (2) an indirect route

mediated by work stress. The former route is consistent with notions

that negative affect contributes to use of substances to cope (Pandina

et al. 1992, pp. 179-209). The latter suggests that as the propensity to

experience negative affect and other neurotic symptoms increases, so

does the perception and experience of work stress (compare Bolger and

Schilling 1991). Thus, for women prone to anxiety or negative affect,

the demands of work (in this case patient care and administrative tasks

related to nursing) may enhance the likelihood of drinking in an attempt to cope with stress.

Neuroticism predicted DC and CC, neither of which predicted

alcohol use. The strong positive relationship between neuroticism and

DC is particularly noteworthy because this is an all-female sample.

Research indicates that anxiety disorders and depression are relatively

common among women (McGrath et al. 1990) and women tend to use

coping strategies that are less effective (Stone et al. 1985, pp. 199-220;

Vingerhoets and Van Heck 1990; Weidner and Collins 1993, pp. 241-

265). However, this characterization of women’s coping styles must be

considered in the context of complex issues concerning the controllability and duration of the stressor, which are beyond the purview of the

study described in this chapter.

LIMITATIONS AND CONCLUSIONS

This research contains limitations regarding the sample and the

model testing that affect the generalizability of the findings. With
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regard to the sample, nursing has certain unique characteristics, and the

sample was homogeneous in gender and occupation. Thus, the results

should not be generalized beyond female nurses. Another limitation

involves the use of structural equation modeling with cross-sectional

data, which inherently does not allow for testing of causal relationships.

Longitudinal data would provide a better basis for evaluating assumptions

of the study regarding the directions of the proposed relationships.

Even with these limitations, the findings indicate that this regional

sample of nurses exhibited rates of legal and illegal substance use that

were comparable with those of the general population of women. In

addition, nurses who were highly neurotic were likely to experience

greater work stress, which in turn could contribute to substance use.

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ACKNOWLEDGMENTS

This research was supported by NIDA Grant DA-05892 to Dr.

Collins. The New York State Department of Education, Division of

Professional Licensing Services, provided data tapes from which the

sample of nurses was drawn. The Substance Abuse and Mental Health

Services Administration (SAMHSA), Office of Applied Studies, provided data from the National Household Survey on Drug Abuse.

AUTHORS

R. Lorraine Collins, Ph.D.

Senior Research Scientist

(716) 887-2523 (Tel)

(716) 887-2252 (Fax)

collins@ria.org (E-mail)

Gernot Gollnisch, Ph.D.

Research Scientist II

(716) 887-2554 (Tel)

(716) 887-2252 (Fax)

gollnisc@ria.org (E-mail)

Elizabeth T. Morsheimer, Ed.M.

Project Coordinator

(716) 887-2251 (Tel)

(716) 887-2252 (Fax)

morsheim@ria.org (E-mail)

Research Institute on Addictions

1021 Main Street

Buffalo, NY 14203