The relationship between educational attainment and alcohol use is ‘bidirectional,’ for example, alcohol use may hinder educational attainment; whereas education may serve as a protective factor against the development of alcohol-use disorders. A study in the August issue of Alcoholism: Clinical & Experimental Research has found that educational attainment may also be able to predict drinking outcomes following alcohol treatment.
"People have been interested in the association between educational attainment and alcohol disorders because education is a modifiable factor," said Shelly F. Greenfield, assistant professor of psychiatry at Harvard Medical School, and medical director of the alcohol and drug abuse ambulatory treatment program at McLean Hospital. "Education is something you might have influence over. Although previous studies have looked at this association, none to our knowledge have looked at the influence of educational attainment on the outcome of inpatient alcohol treatment."
For this study, researchers consecutively recruited between 1993 and 1996 101 individuals (60 males, 41 females) who were hospitalized for alcohol dependence, and monitored their progress for one year following discharge. Each study participant was interviewed during their hospital stay, and at monthly intervals following discharge. Study authors examined the relationship between the inpatients’ educational attainment prior to treatment and their post-discharge drinking outcomes, including time to relapse.
Results indicate than an individual’s years of education are able to significantly predict alcohol-treatment outcomes.
"Lower levels of educational attainment among patients in alcohol treatment before they entered treatment predicted a poorer outcome in the year following discharge from treatment," said Greenfield. "In particular, lower educational attainment predicted a shorter time until they took their first drink following discharge from inpatient alcohol treatment; it also predicted a shorter time to relapse. Specifically, if someone had high school or less, and they entered this treatment program and received the same treatment as the others, upon discharge they would likely have their first drink and relapse almost three times more quickly than the others. Significantly, this finding was the same for men and women."
Greenfield added that one of the more important components of this study was the "robust" nature of the association found between educational attainment and treatment outcomes.
"We controlled for a lot of other variables, characteristics that we thought might have made a difference in our findings. Things like gender, marital status, income levels, other psychiatric illnesses they might have had, severity of the drinking problem, age of onset of the drinking problem, family history, and parental income levels. However, despite searching for factors that might affect our results, educational attainment still stood out."
Greenfield said the results raise the question of why this may be. "Part of it might be the type of treatment that people receive for alcohol dependence," she said.
"Our study used what is fairly typical of alcohol treatment in the United States, which consists mainly of talking therapies, group therapies, and some individual treatment," she said. "It is possible that this particular form of treatment may be less successful in people who have lower levels of education, which may in turn reflect different styles of learning. The verbal form of therapy that is most often used in treatment may too closely resemble a school-like format that may be less successful for these individuals."
Greenfield suggested that future research address issues related to better "matching" patients to various kinds of treatment. "Our results should make people question how individuals with different levels of educational attainment ‘mesh’ with the treatment program that they’re in. The bottom line is trying to make treatment optimal for people who are trying to help themselves with an alcohol problem."
Funding for this Addiction Science Made Easy project is provided by the Addiction Technology Transfer Center National Office, under the cooperative agreement from the Center for Substance Abuse Treatment of SAMHSA.
Articles were written based on the following published research:
Greenfield, S.F., Sugarman, D.E., Muenz, L.R., Patterson, M.D., He, D.Y., Weiss, R.D. (August 2003). The relationship between educational attainment and relapse among alcohol-dependent men and women: A prospective study. Alcoholism: Clinical & Experimental Research, 27(8), 1278 - 1286.
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