Alcohol, tobacco and cannabis use are associated with job loss at follow-up: Findings from the CONSTANCES cohort

Abstract

BackgroundSubstance use is more prevalent among unemployed subjects compared to employed ones. However, quantifying the risk subsequent of job loss at short-term according to substance use remains underexplored as well as examining if this association persist across various sociodemographic and occupational positions previously linked to job loss. We examined this issue prospectively for alcohol, tobacco, cannabis use and their combination, among a large population-based sample of men and women, while taking into account age, gender, overall health status and depressive symptoms.MethodsFrom the French population-based CONSTANCES cohort, 18,879 working participants were included between 2012 and 2016. At baseline, alcohol use disorder risk according to the Alcohol Use Disorders Identification Test (mild, dangerous, problematic or dependence), tobacco (non-smoker, former smoker, 1–9, 10–19, >19 cigarettes/day) and cannabis use (never, not in past year, less than once a month, once a month or more) were assessed. Employment status at one-year (working versus not working) was the dependent variable. Logistic regressions provided Odds Ratios(OR(95%CI)) of job loss at one-year, adjusting for age, gender, self-reported health and depressive state (measured with the Center of Epidemiologic Studies Depression scale). Stratified analyses were performed for education, occupational grade, household income, job stress (measured with the Effort-Reward Imbalance), type of job contract, type of work time and history of unemployment. In sensitivity analyses, employment status over a three-year follow-up was used as dependent variable.ResultsAlcohol, tobacco and cannabis use were associated with job loss, from the second to the highest category: 1.46(95%CI:1.23–1.73) to 1.92(95%CI:1.34–2.75), 1.26(95%CI:1.09–1.46) to 1.78(95%CI:1.26–2.54) and 1.45(95%CI:1.27–1.66) to 2.68(95%CI:2.10–3.42), respectively, and with dose-dependent relationships (all p for trend <0.001). When introduced simultaneously, associations remained significant for the three substances without any between-substance interactions. Associations remained significant across almost all stratifications and over a three-year follow-up as well as after adjustment for all the sociodemographic and occupational factors.ConclusionsAlcohol, tobacco and cannabis use were independently associated with job loss at short-term, with dose-dependent relationships. This knowledge will help refining information and prevention strategies. Importantly, even moderate levels of alcohol, tobacco or cannabis use are associated with job loss at short-term and all sociodemographic and occupational positions are potentially concerned.

Screening and care for alcohol use disorder in France: expectations, barriers and levers using a mixed-methods approach

“…For some of the study population, the unexpected association between unemployment and seeking care for AUD might be attributable to job loss or difficulties finding a job due to alcohol consumption. This contrasts however with previous studies which found a positive association between job loss, unemployment and AUD [49,50], especially among people with a higher education level [51].…”

Effect of alcohol use disorders and alcohol intake on the risk of subsequent depressive symptoms: a systematic review and meta‐analysis of cohort studies

“…The added AUD characteristics beyond alcohol intake might contribute to the association observed between AUD and the risk of depressive symptoms. It has been suggested that AUD could lead to a decline in life circumstances, such as health impairment, mental breakdown, job loss, family disruption and illegal conduct , which might further lead to the development of depressive symptoms. Other possible explanations include the genetic theory that AUD presence increases the risk of depression by regulating neurotransmission function .…”

Associations between adolescent cannabis use and young-adult functioning in three longitudinal twin studies

“…Concerns regarding adolescent cannabis use are supported by three streams of research. First, large-scale observational studies have shown that adolescent use is associated with many negative outcomes, including mental health problems (8)(9)(10)(11), misuse of alcohol and other drugs (8,11,12), cognitive impairment (13)(14)(15)(16), reduced socioeconomic attainment (11,17), and unemployment (18,19). Most studies find these associations become increasingly likely the earlier cannabis use is initiated.…”