Alcohol and Women

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Alcohol and Women
Nioaka N. Campbell, MD University of South
Carolina School of Medicine

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Alcohol Use In Women

• Significant health concern
• 43 current drinkers
• Alcohol use disorders (AUDs)
• 4.5M with abuse
• 2.5M with dependence

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Alcohol Research

• Most in male subjects
• (14 women)
• May not consider gender differences
• Body weight
• Body fat
• Alcohol dehydrogenase

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Drink Like A Man

• Gender gap narrowing
• 197523 200112
• College women in co-ed dorms adopt pattern of men
• Rates are similar age 12-17, 17

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Gender Specific Sequelae

• Mortality rate ? 2x ? with AUDs
• 3rd leading cause of death, both sexes ages 35-55
• Other sequelae
• Liver disease, CNS damage, Breast CA

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Diagnosing AUDs In Women

• lt50 with AUD are identified by their MD
• Yet ? more often frequent their MD

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This Lecture Will Cover

• Epidemiology of use and AUDs
• Course of alcoholism in women
• Consequences, gender specific
• Assessment of women with AUDs
• Treatment issues in this population

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Epidemiology
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Race/Ethnicity Comparisons

• African American
• Highest abstainers (46 vs 34 whites)
• 37 past month use
• 73 lifetime use

• Caucasian
• Highest prevalence
• 55 past month use
• 87 lifetime use

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Race/Ethnicity Comparisons

• Native American
• 65 abstain
• 36 past month use
• 81 lifetime use
• Highest heavy drinking gt5 drinks/time, 30

• Hispanic
• 62 foreign born abstain
• 40 past month use
• 73 lifetime use

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Abstinence

• Reported in past year, 2004
• 56 women vs. 43 men
• Lifetime, 1997
• 22 women vs. 13 men
• ? with education
• ? with ? salaries

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Alcohol Use
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Defining Alcohol Abuse

• Clinically significant impairment in
• 1 in 12 months
• Failure to fulfill major obligations
• Physically hazardous conditions
• Legal problems (DUIs, disorderly cond.)
• Social/Interpersonal problems

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Defining Alcohol Dependence

• Clinically significant impairment in 3 in year
• Withdrawal - Tolerance
• Larger amt./longer period than intended
• Persistent desire/efforts to cut down
• Excessive time with or obtaining alcohol
• Activities given up due to alcohol
• Continued use despite problems

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Alcohol Use Disorders
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Drinking Consequences

• Driving fatalities 9 ? vs. 18 ?
• Victimization ? ETOH related rape, assault
• Domestic violence victims 2X ? risk of AUD

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Drinking Consequences

• Unemployment 48 ? vs. 33 ?
• Antisocial PD 15 ? vs. 5 ?
• Health consequences liver, CNS, hangover

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Course of Alcoholism
Telescoping
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Health Problems and AUDs

• Axis I D/O major depression, anxiety, eating,
  suicide(40? with AUD)
• Comorbidity vs. independent disorders
• Hormonal disruption, changes
• Breast Cancer
• 2 cases attributed to alcohol use

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Fetal Alcohol Syndrome

• Varying components
• Facial malformations
• Pre and post-natal growth retardation
• CNS abnormalities
• Spontaneous abortions
• Mild to moderate MR

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Fetal Alcohol Syndrome

• 1 of US population
• 15 pregnant age 14-44
• had a drink
• 200 M/yr for children with FAS
• Since 1990 guidelines abstention

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Assessment of Women with AUDs

• Avoid stereotype
• Stigma, guilt
• Presentation
• History
• Routine screening
• Open vs closed questions
• Non-judgmental attitudes
• Problem focused assessment

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Psychosocial Assessment Factors

• Protective
• Multiple roles
• Married
• Student athletes

• Risk
• Isolation
• Early initiation
• Hx of neglect, abuse
• Other Axis I D/O
• Tobacco

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Genetic Factors

• 50-60 variation of AUD risk
• Twin and adoption studies

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Assessment Challenges

• Time
• Objective Tools
• CAGE - MAST - AUDIT
• (Gender and Racial differences)
• Pregnancy
• HBQ -TACE

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Treatment

• 1 in 4 ? with AUD receive tx
• ? with AUD 2X likely as ? to receive tx
• Barriers
• Stigma - Child care
• Legal sanction - Limited resources

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Treatment Programs

• Some currently provide
• Womens gp, child care, post partum
• Womens only
• 2X completion
• Child care options
• Minority populations

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DHHS Treatment Guidelines

• Child care
• Vocational/Legal assistance
• Female intake provider
• Empower
• General medical assessment
• Thorough assessments

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Summary

• Use/AUDs significant womens issues
• Course varied, unique
• Consequences gender specific
• Assessment routine, thorough
• Treatment comprehensive, individualized

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Questions?

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