PERREIRA AND SLOAN
Life Events and Alcohol Consumption among Mature
Adults: A Longitudinal Analysis*
KRISTA M. PERREIRA, PH.D.,† AND FRANK A. SLOAN, PH.D.†
Cecil G. Sheps Center for Health Services Research, University of North Carolina, CB 7590, 725 Airport Road, Chapel Hill,
North Carolina 27599-7590
ABSTRACT. Objective: Four waves of the Health and Retirement Study
were used to examine changes in alcohol consumption co-occurring and
following stress associated with major health, family and employment
events. Method: The final sample consisted of 7,731 (3,907 male) indi-
viduals between the ages of 51 and 61 at baseline. We used multino-
mial logit analysis to study associations between important life events
and changes in alcohol consumption over a 6-year study period. Inter-
actions between stressful life events, gender and problem drinking were
also evaluated. Results: Most persons (68%) did not change their use
of alcohol over the entire 6 years. Hospitalization and onset of a chronic
condition were associated with decreased drinking levels. Retirement
was associated with increased drinking. Widowhood was associated with
L IFE EVENTS both affect drinking and are affected by
it. Stressful life events may affect patterns of alcohol
use, abuse and dependence for several reasons. First, people
may drink to relieve stress brought about by changing life
circumstances (Moos et al., 1998; Welte, 1998). Second,
life events may result in changes in social affiliations that
promote or inhibit alcohol use (Alexander and Duff, 1988;
Christopherson et al., 1984; Stall, 1986a,b; Zucker, 1998).
Last, stressful life events, especially those directly related
to health, may lead people to re-evaluate their lifestyles
and change their health behaviors accordingly.
Among younger adults, changes in patterns of consump-
tion have been related to such stressful life events as mar-
riage (Miller-Tutzauer et al., 1991), divorce (Horwitz and
Davies, 1991; Horwitz et al., 1996; Magura and Shapiro,
1988), death of relatives (Umberson and Chen, 1994), de-
parture of children from home (Borland, 1982), job loss
(Atkinson et al., 1990; Catalano et al., 1993; Ettner et al.,
1997) and presence of stress (Welte, 1985; Wills, 1985). In
Received: May 24, 2000. Revision: February 1, 2001.
*This research was funded by National Institute on Alcohol Abuse and
Alcoholism grant R01 AA12162-01. Additional support for Dr. Perreira was
provided by the National Research Service Award Post-Doctoral Traineeship
from the Agency for Health Research and Quality sponsored by the Cecil G.
Sheps Center for Health Services Research, University of North Carolina at
Chapel Hill (grant T32Hs00032).
†Frank A. Sloan is with the Center for Health Policy, Law and Manage-
ment, Duke University, Durham, NC. Correspondence may be sent to Krista
M. Perreira at the above address or via email to: perreira@mail.schsr.unc.edu.
501
501
increased drinking but only for a short time. Getting married or divorced
was associated with both increases and decreases in drinking, with a
complex lag structure. A history of problem drinking influenced the as-
sociation between certain life events (e.g., divorce and retirement) and
changes in drinking. Gender modified the association between losing a
spouse and changes in drinking. Conclusions: Even after controlling for
problem drinking history, social support and coping skills, changes in
drinking behavior were related to several life events occurring over a 6-
year period for a national cohort of individuals in late middle-age. The
magnitude of these relationships, however, varied by gender and prob-
lem drinking history. (J. Stud. Alcohol 62: 501-508, 2001)
older adults, heavy drinking has been positively associated
with a prior history of drinking problems, family history of
alcohol abuse, male gender, stress, suburban residence and
smoking. It has been negatively associated with socioeco-
nomic status, rural residence and an active/health-oriented
lifestyle (Mirand and Welte, 1996; Welte, 1998; Welte and
Mirand, 1994). In clinical studies, stressful life events have
been one of the most significant risk factors in late-onset
problem drinking (Brown and Chiang, 1983-84; Finlayson
et al., 1988; Hubbard et al., 1979; Rosin and Glatt, 1971).
Results of analyses of general population surveys have been
less conclusive (Welte, 1998).
Research linking life events to alcohol consumption, the
topic of our study, has been limited in several respects.
First, and most important, with very few exceptions (e.g.,
Brennan et al., 1999; Glass et al., 1995), previous studies
have been cross-sectional, making it difficult to discern the
timing of life events versus levels of alcohol consumption.
Second, many of the cross-sectional databases have derived
from clinic populations, raising issues of representativeness
and generalizability. Third, when longitudinal data have been
available, with one exception (Brennan et al., 1999), the
data have been limited to two waves. Fourth, when a panel
has been available, information on drinking history at
baseline has been limited. Fifth, many previous studies have
used an index of life events or stressors to assess impacts
on alcohol consumption. Although such indexes have the
advantage of simplicity and ease of interpretation of find-
ings, they do not allow for heterogeneity in life events,
502 JOURNAL OF STUDIES ON ALCOHOL / JULY 2001
especially in regard to their potential link to alcohol use.
Such events as onset of a chronic disease may be nega-
tively associated with alcohol use. By contrast, there may
be a positive association for other events (e.g., a divorce).
In our analysis of relationships between life events and
alcohol consumption, we used four waves, spanning 1992
through 1998, of the Health and Retirement Study (HRS;
University of Michigan, 1999) to examine associations be-
tween alcohol consumption and (1) adverse health events
(e.g, hospitalization or diagnosis of a chronic condition),
(2) family events (e.g., divorce or death of a spouse) and
(3) employment changes (e.g., job loss or retirement). With
the HRS panel data, we could determine whether the life
event or the change in drinking occurred first. Since the
HRS provided a drinking history, we could identify prob-
lem drinkers at baseline, allowing us to ascertain whether
those who had a history of heavy use of alcohol responded
differently following acute life events that occurred over
the 6-year period.
Method
Data
The National Institute of Aging sponsored the HRS to
provide social science researchers with the longitudinal data
essential for understanding the dynamics of aging. The
database is unique in the extent to which it contains infor-
mation on health, wealth, employment and family struc-
ture—key factors in the dynamics of aging—all in the same
survey.
The study sample for the HRS consisted of individuals
aged 51-61 in 1992 and, if married, their spouses. Partici-
pants in the HRS were interviewed every 2 years from 1992.
By Wave 4 (1998), the original respondents were between
57 and 67 years of age. Baseline interviews were conducted
in respondents’ homes, with subsequent interviews by tele-
phone. A response rate of approximately 80% was obtained
in each year (University of Michigan, 1999). At baseline,
12,652 persons (7,608 households) were sampled, with
oversampling for Mexican Americans, African Americans
and residents of Florida (Juster and Suzman, 1995).
In our analysis, we excluded spouses younger than age
51 (n = 1,595), respondents 51+ who died (n = 734) or
were lost to follow-up (n = 2,106) after Wave 1, and those
with missing data (n = 486). The resulting data set (N =
7,731) was composed of the 3,824 women and 3,907 men
who participated in all four waves. Heavy drinkers, non-
white men without a high school education and the unin-
sured were more likely to be lost to follow-up. Smokers
and those with an acute medical condition during 1992-98
(e.g., heart attack or stroke) were less likely to be lost.
Among those not lost, problem and very heavy (5+ drinks/
day) drinkers, smokers, those in poor health, nonwhite and
older men, and persons who were not employed were more
likely to die. The majority of our analysis sample was white
(82%), married (79%), employed (64%), had children (91%),
had at least a high school education (73%) and had some
religious affiliation (95%). Mean income and age were
$46,000 and 57 years. Demographic characteristics of men
and women were similar; however, women tended to have
less education, were more often married and less often in
the workforce.
Variable definitions
Drinking behavior. Using drinking behavior questions
in each of the four waves, we categorized respondents as
current drinkers or nondrinkers and, among drinkers, by
drinks per day (<1, 1-2, 3-4, 5+). In Waves 1 and 2, re-
spondents were asked: (1) Do you ever drink any alcoholic
beverage such as beer, wine or liquor? and (2) In general,
do you have less than one drink per day, 1-2 drinks per
day, 3-4 drinks per day or 5 or more drinks per day? Using
these two questions, drinking was coded as a categorical
variable from 0 to 4, with Category 4 being 5+ drinks per
day. In Waves 3 and 4, respondents were asked: (1) Do
you ever drink any alcoholic beverage such as beer, wine
or liquor? (2) In the last 3 months, on average, how many
days per week have you had any alcohol to drink? and (3)
In the last 3 months, on the days you drink, about how
many drinks do you have? From these questions, we calcu-
lated mean drinks per day among the drinkers in Waves 3
(1996) and 4 (1998). Based on this average, we coded drink-
ing as a categorical variable from 0 to 4 to match coding
for Waves 1 and 2. The HRS did not define the term “drink.”
In each wave, it was self-defined by respondents.
These changes in questionnaire design may have intro-
duced measurement error into our measurement of drink-
ing status and threatened consistency of results over time.
However, analysis of correlations in drinking measures
across waves indicated that the measures were stable and
unaffected by changes in questionnaire design. Drinking at
Waves 1 and 2 was highly correlated (ρ = 0.73, p < .0001)
as was drinking at Waves 2 and 3 (ρ = 0.73, p < .0001)
and Waves 3 and 4 (ρ = 0.74, p < .0001).
Using data from Wave 1, we also identified “problem
drinkers.” The Wave-1 questionnaire included the CAGE
instrument for clinical assessment of alcohol disorders
(Steinbauer et al., 1998). The acronym CAGE represents
four aspects of drinking: Have you ever felt you should
Cut down on your drinking? Have people Annoyed you by
criticizing your drinking? Have you ever felt bad or Guilty
about your drinking? Have you ever had a drink first thing
in the morning (Eye-opener) to steady your nerves or to
get rid of a hangover? Item responses on the CAGE are
scored 0 or 1, with a higher score indicating presence of an
alcohol problem. We defined “problem drinkers” as those
 PERREIRA AND SLOAN
with a score of 2+ on the CAGE scale, a score considered
clinically significant. The CAGE does not provide a DSM-
III-R diagnosis of alcohol abuse or dependence (Grant et
al., 1991), but it has been validated as an excellent clinical
screening tool (Buchsbaum et al., 1991; Chan et al., 1994;
Girela et al., 1994; Mayfield et al., 1974; McIntosh et al.,
1994). Because the CAGE scale identifies only persons who
have “ever” had any problems, it was asked just once, at
entry to the HRS.
At baseline, 62% of respondents (69% of men, 54% of
women) were current drinkers. Only 5% reported consum-
ing 3+ drinks daily; most of these (84%) were men. At the
first interview, 14% were self-reported problem drinkers,
but many problem drinkers (39%) reported at baseline that
they had quit drinking. The mean value of the CAGE scale
was 0.47 (range: 0-4).
Logit analysis indicated that those who reported that they
had a drinking problem at Wave 1 were significantly more
likely to be male, older and black. They tended to drink
more, be less educated and have more chronic medical con-
ditions at Wave 1. Current employment and marital status
were not related to problem drinking; however, persons who
had ever been divorced or widowed by the time of the first
interview were more likely to be problem drinkers. Fre-
quency of church attendance was significantly and nega-
tively related to problem drinking. Heavy stress and poor
coping skills (see below) were positively associated with
problem drinking.
Life events. We identified three types of major life events
commonly associated with acute stress, all defined for the
2 years before each wave. Health events were any one of
the following: (1) hospital stay of 3+ days, (2) heart attack,
(3) stroke and (4) a newly diagnosed chronic condition (con-
gestive heart failure, high blood pressure, diabetes, cancer,
lung disease or arthritis) or a psychological disorder.
Employment events were (1) a new job, (2) becoming un-
employed or (3) disabled, (4) retiring, (5) becoming a home-
maker and (6) going on leave or experiencing some other
change in employment status. Family events were getting
married, divorced or experiencing the death of a spouse.
Chronic stressors. We measured chronic stress at baseline
by first identifying those who had ever been divorced, wid-
owed or diagnosed with a chronic disease (Brennan et al.,
1999). Second, we used a quality-of-life scale included in
the HRS (similar to Jennison, 1992). The scale measured
the degree to which respondents were very satisfied (=1) to
very dissatisfied (=5) with the person’s house, community,
financial situation, friendships, family life, marriage, job
situation and life in general. For regression analyses, per-
sons were categorized into quartiles based on their total
score (4 = high stress quartile).
Social support and coping skills at baseline. Social sup-
port was measured by frequency of church attendance (0 =
never, 4 = more than once weekly); presence of friends or
503
relatives within a respondents’ community (0,1); and fre-
quency of visits with neighbors (0 = never/hardly ever, 4 =
daily/almost daily). We measured coping skills using re-
spondents’ self-reported satisfaction with the way they
handle problems that arise in life (1 = very satisfied, 5 =
very dissatisfied).
Sociodemographics. We controlled for the following
baseline socioeconomic characteristics: annual household
income; years of education; race/ethnicity (black, white, His-
panic or other); religious affiliation (1 = any affiliation);
age; gender; marital status (single, currently married, di-
vorced or widowed); and employment status (employed,
disabled, retired, homemaker or other). To create mutually
exclusive employment categories, individuals indicating
more than one employment status (6% at baseline) were
assigned first to employment, then disability, then retire-
ment, and so on. Last, we controlled for self-reported health
status at baseline (1 = excellent, 5 = poor).
Statistical analysis
Using multinomial logit analysis, we evaluated effects
of family, employment and health events on changes in
drinking status over the 6-year follow-up period in two
ways. First, because of the relatively small number of life
events occurring at each wave, we assessed changes in
drinking over the entire 6-year follow-up period as a func-
tion of life events occurring in any of the previous waves.
This allowed us to identify more persons with each signifi-
cant life event over Waves 1-4 and test whether associa-
tions between events and drinking were cumulative. This
analysis revealed the mean association between changes in
family, employment, and health and alcohol consumption
over 6 years. By construction, the mean was weighted by
the proportion of events reported at each wave.
Second, to test whether associations between events and
drinking became weaker (stronger) as time following events
lapsed, we modeled changes in drinking behavior between
Waves 3 and 4 as a function of life events occurring within
the past 2 years (between Waves 3 and 4), those occurring
2 to 4 years ago (between Waves 2 and 3), and 4 to 6 years
ago (between Waves 1 and 2). Some events may have an
immediate link to drinking, but, for others, the relationship
is delayed. Also, some events resulting in an initial increase
(decrease) in drinking may be followed by a decrease (in-
crease) in drinking as respondents return to previous drink-
ing levels over time. Analyses of changes in drinking
between Waves 1 and 2 and 2 and 3 yielded similar results
and are not shown.
The dependent variable consisted of three mutually ex-
clusive alternatives—increased, decreased and no change
in alcohol consumption. No change in drinking was the
omitted reference group. In both regressions, we controlled
for problem drinking status and other characteristics mea-
504 JOURNAL OF STUDIES ON ALCOHOL / JULY 2001

sured at baseline. With this specification, we allowed for TABLE 2. Multinomial logit analysis: Associations between life events
the possibility that some people respond to stressful life experienced since Wave 1 and change in drinking between Waves 1 and 4
(N = 7,731)
events through self-medication, using alcohol. Others may
respond to the same event as a wake-up call or warning Increased Decreased
sign and decrease their drinking. Robust standard errors OR 95% CI OR 95% CI
were calculated in all regressions to account for inclusion Problem-drinking history 1.5 1.2-2.0† 1.5 1.2-1.8†
of persons from the same household in the sample. Family events within 6 yrs
Got married 1.3 0.6-3.0 1.2 0.7-2.0
Got divorced 1.8 1.2-2.7† 1.0 0.7-1.3
Results Became widowed 1.1 0.6-1.8 0.9 0.7-1.3
Employment events within 6 yrs
Became employed 0.9 0.7-1.2 1.1 0.9-1.3
Life events Became disabled 0.9 0.6-1.3 1.1 0.9-1.4
Retired 1.6 1.3-2.1† 1.1 1.0-1.3
Nearly half of the sample experienced some major life Became unemployed 1.3 0.8-2.0 1.2 0.9-1.6
Became homemaker 1.2 0.9-1.7 1.0 0.8-1.3
event in any given wave (see No event, Table 1). Almost Other 1.2 0.8-1.7 1.2 0.9-1.4
80% had experienced at least one major life event over the Health events within 6 yrs
four waves. From Waves 1 to 4, diagnoses with a chronic Was hospitalized 1.1 0.8-1.4 1.2 1.0-1.4*
Had heart attack 0.8 0.5-1.3 0.8 0.6-1.0
condition (43%), retirement (34%) and hospitalization (29%) Had stroke 0.9 0.5-1.7 1.1 0.8-1.5
were the three most commonly experienced life changes or New chronic condition 1.1 0.9-1.5 1.2 1.0-1.4*
events. Marriage (2%), stroke (3%) and unemployment (4%) Number of events 0.9 0.8-1.0 1.0 0.9-1.1
were least common. Notes: All regressions controlled for sociodemographic characteristics (age,
gender, race, income, self-reported health and religiosity) and chronic stres-
Changes in alcohol consumption over time sors (i.e., any chronic health condition, ever divorced and ever married) at
baseline. We also controlled for social support, general stress and self-rated
coping skills at baseline. The model included several interactions between
Most respondents (68%) did not change daily alcohol problem drinking and life events, and gender and life events. These inter-
consumption levels between Waves 1 and 4 (Table 1). More actions are shown in Table 4. Comparison group is no change in alcohol
consumption. Coefficient was significant at the *p < .05 or †p < .01 level.
decreased consumption (23%) than increased it (9%). Within
each 2-year interview interval (first three columns), most
respondents reported no change, with more reporting de- With odds ratios of 1.5 for both increased and decreased
creases than increases in alcohol consumption. drinking, respondents with a problem-drinking history were
just as likely to increase as to decrease consumption be-
tween Waves 1 and 4 (Table 2). Getting divorced and retir-
ing were associated with increased drinking between these
TABLE 1. Life events by wave, in percent (N = 7,731)
waves, whereas being hospitalized or being diagnosed with
Wave Wave Wave Wave a new chronic condition were associated with decreased
1-2 2-3 3-4 1-4
alcohol consumption.
Change in drinking
None 75.4 75.2 76.9 67.9
These relationships were modified somewhat by respon-
Increased 9.0 9.7 10.1 8.7 dents’ problem-drinking history and by gender (Table 3).
Decreased 15.5 15.1 12.9 23.3
No event 54.2 57.2 48.2 20.8
Family event TABLE 3. Multinomial logit analysis: Interactions between problem drink-
None 96.6 97.5 93.8 89.8 ing, gender and life events and change in drinking between Waves 1 and
Got married 0.5 1.0 0.5 2.1 4 (N = 7,731)
Got divorced 1.4 0.8 2.4 4.5
Increased Decreased
Became widowed 1.5 0.7 3.2 5.4
Employment event OR 95% CI OR 95% CI
None 75.4 76.5 69.0 47.1
Became employed 4.3 4.0 5.1 13.1 Problem drinker
Became disabled 3.2 3.3 3.1 9.3 Became divorced 1.4 0.6-3.3 2.2 1.1-4.1*
Retired 9.2 10.7 14.9 33.7 Retired 1.1 0.7-1.7 0.7 0.5-1.0*
Became unemployed 1.7 1.3 0.8 3.8 Male
Became homemaker 3.3 2.2 4.6 11.2 Got married 0.2 0.0-1.2 1.3 0.6-2.9
Other 3.0 2.0 2.5 7.7 Became widowed 2.3 1.1-4.8† 1.2 0.7-2.0
Health event Problem drinker, male
None 73.0 74.1 72.3 43.5 Got married 0.6 0.0-7.5 0.2 0.0-0.6†
Was hospitalized 11.4 13.2 14.9 28.5
Had heart attack 1.0 1.5 1.7 4.2 Notes: Main effects of life events for this model are shown in Table 4.
Had stroke 0.9 0.8 1.1 2.8 Interactions were included using backwards elimination for each model.
New chronic condition 18.9 15.7 15.9 42.8 Only interactions significant at the .10 level in the model predicting either
Mean number of events 0.7 0.6 0.8 2.1 increased drinking or decreased drinking were retained. Coefficient was
significant at the *p < .05 or †p < .01 level.
 PERREIRA AND SLOAN 505

TABLE 4. Multinomial logit analysis: Associations between life events ized and/or acquired a new chronic condition tended to de-
occurring after Wave 1 and change in drinking between Waves 3 and 4 crease alcohol consumption.
(N = 7,731)
Three different patterns are apparent. First, for hospital-
Increased Decreased izations, drinking decreases around the time of the event
OR 95% CI OR 95% CI and rebounds subsequently. There was an increase in con-
Problem drinking history 1.3 1.0-1.6* 1.1 0.9-1.4 sumption between Waves 3 and 4 after a hospitalization
Family events that occurred between Waves 2 and 3. It is plausible that
Got married
Waves 3-4 0.4 0.1-1.5 0.6 0.2-1.8 this change occurred because, after a short-term dip imme-
Waves 2-3 2.2 1.0-4.6* 2.5 1.3-4.9† diately following the hospital stay, individuals returned to
Waves 1-2 1.3 0.5-3.5 0.4 0.1-1.5 about the same consumption levels as before. The statisti-
Got divorced
Waves 3-4 0.8 0.5-1.5 1.1 0.7-1.7 cally significant increase in drinking between Waves 3 and
Waves 2-3 2.4 1.1-5.3* 2.2 1.0-4.7* 4 following a newly occurring chronic condition in Waves
Waves 1-2 2.1 1.1-4.0* 1.4 0.8-2.5 1 to 2 can also be explained on this basis.
Became widowed
Waves 3-4 1.9 1.2-3.0† 1.2 0.8-1.9 Second, for retirement, a different pattern emerges—a
Waves 2-3 1.9 0.8-4.6 1.4 0.6-3.1 general upward shift in drinking associated with the life
Waves 1-2 1.1 0.5-2.4 0.8 0.4-1.5 event. Not only did drinking increase in the same 2-year
Employment events
Retired period that the retirement occurred, but drinking also in-
Waves 3-4 1.6 1.2-2.1† 1.2 0.9-1.5 creased between Waves 3 and 4 for retirement occurring
Waves 2-3 1.8 1.3-2.4† 1.2 0.9-1.5 earlier. The statistically significant odds ratio for retirement
Waves 1-2 1.8 1.3-2.5† 1.4 1.0-1.8*
Health events between Waves 1 and 2 implies that retirement was associ-
Was hospitalized ated with changes in drinking patterns more than 4 years
Waves 3-4 1.0 0.7-1.4 1.6 1.2-2.0† hence. For widowhood, there was a short-term spike in
Waves 2-3 1.4 1.0-1.9* 0.9 0.7-1.2
Waves 1-2 1.3 0.9-1.8 1.1 0.8-1.4 drinking, with no association between drinking change from
New chronic condition 1996-98 1.2 0.9-1.7 1.4 1.1-1.9† Wave 3 to 4 and loss of spouse occurring in earlier periods.
Waves 2-3 1.4 1.0-1.9 1.2 1.0-1.6 Third, for marriages and divorces, there was no change
Waves 1-2 1.5 1.1-2.0* 1.3 1.0-1.7*
in drinking around the time of these events. Changes in
Notes: All regressions controlled for sociodemographic characteristics (age, alcohol consumption levels in both directions followed pas-
gender, race, income, self-reported health and religiosity) and chronic stres- sage of time after getting married or divorced.
sors (i.e., any chronic health condition, ever divorced and ever married) at
baseline. We also controlled for social support, general stress and self-rated
coping skills. Comparison group is no change in alcohol consumption. Discussion
We show only the time path effects of life events that had significant
main or interactive effects in the analyses of changes between Waves 1
and 4. Other events were controlled for in the analysis but not presented. Our analysis, based on a national sample, reaffirmed the
Coefficient was significant at the *p < .05 or †p < .01 level. relatively high prevalence of drinking and heavy drinking
among Americans in late middle-age. Prevalence rates we
reported fall within the range of previous cross-sectional
For problem drinkers, those who got divorced between studies (Adams et al., 1990; Mirand and Welte, 1996; Sulsky
Waves 1 and 4 were more likely to decrease their alcohol et al., 1990). For most persons, alcohol consumption did
consumption during this period. Men who became widowed not change over this phase of the life cycle, but when there
were more likely to increase their alcohol consumption. was a change, decreases greatly outnumbered consumption
Also, alcohol consumption decreased on average for men increases. Despite the overall persistence of drinking pat-
with no problem-drinking history who were newly married terns established in early life for many, stressful life events
but was more likely to remain unchanged for men with a were associated with changes in alcohol use. The almost
problem-drinking history who married. two decades prior to age 65 were years of frequent disrup-
Next, we examined relationships between life events and tions due to employment and health changes.
changes in alcohol consumption between Waves 3 and 4 Over the 6-year time span, we found that newly occur-
(Table 4). The events could occur concurrently with (for ring health conditions were generally associated with
life events occurring between Waves 3 and 4), or prior to, reduced levels of alcohol use; however, these reductions
the observed change in alcohol consumption (for life events lasted for only one wave. Mechanisms underlying these
occurring between Waves 1 and 2, 2 and 3). Only two relationships could not be identified with information from
concurrent life event-alcohol consumption changes were sta- our survey. Likely reasons include reduced social interac-
tistically significant at conventional levels. Persons who re- tions (which may also lead to increased drinking) and ad-
tired between Waves 3 and 4 tended to increase alcohol verse side effects of medications used to treat these new
consumption during this period. Those who were hospital- conditions.
506 JOURNAL OF STUDIES ON ALCOHOL / JULY 2001
Onset of retirement was associated with increased drink-
ing. This pattern of increased drinking seems to persist and
even increase for many retirees years after the retirement
date. Also, those who had drinking problems at Wave 1
were less likely to decrease drinking after retirement. It is
plausible that such trends are related to increased time for
consumption and, in some cases, to increased social isolation.
Loss of spouse was associated with increased drinking
during the 2-year period in which this event occurred,
but this relationship did not exist over a longer period,
suggesting that the increase in drinking was a temporary
phenomenon
Patterns for divorces and marriages were the most com-
plex. Both types of events were associated with changes in
drinking levels, but in both directions. Also, the changes
did not occur immediately after these life events but, rather,
with a lag. Among problem drinkers of both genders, be-
coming divorced was associated with decreased drinking
levels. Among men, marriage was associated with decreased
drinking but only if there were no problem-drinking history.
The Health and Retirement Study documented changes
within a 2-year time span, but did not provide new infor-
mation on the mechanisms underlying these changes. Also,
a history of problem drinking was documented at baseline,
but not when this problem drinking occurred. For non-
problem drinkers, the loss (gain) of social supports may
promote increased (decreased) drinking. For at least some
problem drinkers, these changes may sometimes signal the
need to seek treatment for alcohol abuse/dependence. For
others, lifestyle changes like retirement may result in de-
pression, an increased desire to drink, more time to drink,
or changing social affiliation to that which encourages al-
cohol use. Probing the mechanisms underlying all of these
life changes is a very important extension of this study.
These findings cast doubt on previous research showing
little or no relationship between stressful life events and
alcohol consumption (Brennan and Moos, 1990; Huffine et
al., 1989; Romelsjo et al., 1991; Welte and Mirand, 1995).
These earlier analyses were often hindered by a lack of
longitudinal data or, when the data were longitudinal, small
clinic samples reduced their generalizability. The few popu-
lation-based longitudinal studies conducted to date have
found that health-related stressors were related to lower al-
cohol consumption, whereas nonhealth-related stressors were
related to higher consumption or there was no relationship
(Brennan and Moos, 1996; Brennan et al., 1994; Glass et
al., 1995; Moos et al., 1998). Drinking history, social sup-
port and coping mechanisms modified these relationships.
Our study confirms these results.
In our analysis, we relied on self-reports of alcohol use.
Self-reports may understate actual levels of alcohol use (Gra-
ham, 1986; Ivis et al., 1997). However, even if respondents
to the HRS underreported alcohol use, the relative rankings,
as seen from comparisons of self-reported histories of prob-
lem drinking and current levels of daily alcohol use at
baseline, and between the CAGE score and levels of alco-
hol use, showed a consistent pattern. Also, many results
were plausible. In this context, data from other sources (e.g.,
medical records, collateral reports or diary studies) are by
no means the gold standard (Babor et al., 2000; Redman et
al., 1987; Samo et al., 1989; Tucker et al., 1989). The reli-
ance on respondents’ own definition of the term “drink”
may have introduced additional variation among individu-
als in our measure of alcohol consumption. The possible
consequence of such measurement error is randomly dis-
tributed and, if nonrandom, is not correlated with the de-
pendent variable.
Although the analysis accounted for many potential cor-
relates of drinking, we did not account for other health
behaviors (e.g., smoking and exercise). These behaviors may
influence and be influenced by alcohol consumption (Alex-
ander and Duff, 1988; Breslau et al., 1996; Mirand and
Welte, 1996). We excluded other potentially significant risk
factors and stressful life events—death of child, parent, or
close friend; entry into a nursing home; and crime victim-
ization—extremely rare events in the HRS population.
Last, we focused our analysis on changes in alcohol con-
sumption co-occurring or following life events. Increased
consumption may also precede such events as divorce, job
loss and deterioration of health status. Many such events
preceded individuals’ entry into the HRS.
Many previous studies linking life events to alcohol use
have called for panel data. Although having a panel in our
study for a 6-year period is a major step forward, having
longer panels will even be more useful. Assembling such
data should be a high priority.
Acknowledgments
The authors would like to thank Lynn Van Scoyoc for her excellent
assistance in compiling the data from the HRS, and they would also like
to thank Snehal Patel for providing research support.
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