Social class and substance use disorders: the value of social class as distinct from socioeconomic status. 1998

T Wohlfarth, and W van den Brink
Department of Social Psychology, Free University Amsterdam, The Netherlands.

The relationship between social class and substance use disorders (SUDs) is explored and compared to the relationship between SES and SUDs. Social class and SES are two different conceptualizations of socioeconomic inequality (SEI) which emanate from two different theoretical orientations in sociology. SES is commonly used in epidemiological research and is usually measured in terms of education, income or occupational prestige. Social class is less known and less used. Here, following the work of Wright et al. (Wright, E. O., Hachen, D. and Costello, C. et al. (1982) The American class structure. American Sociological Review 47, 709-726) it is measured in terms of four types of control people have in their work place: ownership, control over budget decisions, control over other workers, and control over one's own work. Data are derived from an epidemiological survey, conducted in Israel, using a two stage sampling procedure for the identification of cases. In the first stage 4914 respondents were screened with the Psychiatric Epidemiological Research Interview (PERI). In the second stage (n = 2741), those who screened positive (and a sample of the negatives) were diagnosed by psychiatrists using a structured interview that yielded diagnoses according to the Research Diagnostic Criteria (RDC). The results indicate that those who are advantaged in terms of ownership, i.e. self-employed, have higher rates of SUDs compared to employees. Furthermore, it appears that most disorders have an onset subsequent to entry into the current job, indicating that ownership plays a causal role in the onset of SUDs rather than the other way around. These results are contrasted with those of a previous report from the same study by Dohrenwend et al. (Dohrenwend, B. P., Levav, I. and Shrout, P. E. et al. (1992) Socioeconomic status and psychiatric disorders: the causation selection issue. Science 255, 946-952) which showed just the opposite association between SES and SUDs, i.e. those who are advantaged in terms of SES have lower rates of SUDs. As an explanation of these apparently conflicting results, the possibility is entertained that social class and SES represent independent causal pathways to the onset of SUDs with social class mainly related to primary SUDs and SES mainly to secondary SUDs.

UI MeSH Term Description Entries
D007557 Israel A country in the Middle East, bordering the Mediterranean Sea, between Egypt and Lebanon. The capital is Jerusalem.
D008297 Male Males
D005260 Female Females
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000328 Adult A person having attained full growth or maturity. Adults are of 19 through 44 years of age. For a person between 19 and 24 years of age, YOUNG ADULT is available. Adults
D000437 Alcoholism A primary, chronic disease with genetic, psychosocial, and environmental factors influencing its development and manifestations. The disease is often progressive and fatal. It is characterized by impaired control over drinking, preoccupation with the drug alcohol, use of alcohol despite adverse consequences, and distortions in thinking, most notably denial. Each of these symptoms may be continuous or periodic. (Morse & Flavin for the Joint Commission of the National Council on Alcoholism and Drug Dependence and the American Society of Addiction Medicine to Study the Definition and Criteria for the Diagnosis of Alcoholism: in JAMA 1992;268:1012-4) Alcohol Abuse,Alcoholic Intoxication, Chronic,Ethanol Abuse,Alcohol Addiction,Alcohol Dependence,Alcohol Use Disorder,Abuse, Alcohol,Abuse, Ethanol,Addiction, Alcohol,Alcohol Use Disorders,Chronic Alcoholic Intoxication,Dependence, Alcohol,Intoxication, Chronic Alcoholic,Use Disorders, Alcohol
D012923 Social Class A stratum of people with similar position and prestige; includes social stratification. Social class is measured by criteria such as education, occupation, and income. Caste,Social Gradients,Socioeconomic Level,Socioeconomic Status,Middle Class Population,Castes,Class, Social,Gradient, Social,Level, Socioeconomic,Middle Class Populations,Population, Middle Class,Social Classes,Social Gradient,Socioeconomic Levels,Status, Socioeconomic
D012959 Socioeconomic Factors Social and economic factors that characterize the individual or group within the social structure. Economic and Social Factors,Social Inequalities,Social Inequality,Social and Economic Factors,Socioeconomic Characteristics,Factors, Socioeconomic,High-Income Population,Land Tenure,Standard of Living,Characteristic, Socioeconomic,Factor, Socioeconomic,High Income Population,High-Income Populations,Inequality, Social,Living Standard,Living Standards,Population, High-Income,Socioeconomic Characteristic,Socioeconomic Factor,Tenure, Land
D015986 Confounding Factors, Epidemiologic Factors that can cause or prevent the outcome of interest but are not intermediate variables of the factor(s) under investigation. Confounding Factor, Epidemiologic,Confounding Factors, Epidemiological,Confounding Factors, Epidemiology,Confounding Variables,Confounding Variables, Epidemiologic,Confounding Variables, Epidemiological,Confounding Factor, Epidemiological,Confounding Factor, Epidemiology,Confounding Variable,Confounding Variable, Epidemiologic,Confounding Variable, Epidemiological,Epidemiologic Confounding Factor,Epidemiologic Confounding Factors,Epidemiologic Confounding Variable,Epidemiologic Confounding Variables,Epidemiological Confounding Factor,Epidemiological Confounding Factors,Epidemiological Confounding Variable,Epidemiological Confounding Variables,Epidemiology Confounding Factor,Epidemiology Confounding Factors,Variable, Confounding,Variable, Epidemiologic Confounding,Variable, Epidemiological Confounding,Variables, Confounding,Variables, Epidemiologic Confounding,Variables, Epidemiological Confounding
D015987 Effect Modifier, Epidemiologic Factors that modify the effect of the putative causal factor(s) under study. Halo Effect,Hawthorne Effect,Interviewer Effect,Conditional Variables,Effect Modifiers, Epidemiologic,Epidemiologic Effect Modifier,Epidemiologic Effect Modifiers,Moderator Variables,Modifiers, Epidemiologic Effect,Conditional Variable,Effect, Halo,Effect, Hawthorne,Effect, Interviewer,Effects, Halo,Effects, Interviewer,Halo Effects,Interviewer Effects,Moderator Variable,Modifier, Epidemiologic Effect,Variable, Conditional,Variable, Moderator,Variables, Conditional,Variables, Moderator

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