Transcript Percentage of Middle & High School Principals, Teachers

Alcohol-Related Problems
in Special Populations:
YOUTH and WOMEN
Susan F. Tapert, Ph.D.
University of California, San Diego
VA San Diego Healthcare System
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Alcohol-Related Problems:
Special Populations
Epidem- Unique Assess- Treatiology Features ment
ment
Youth
x
x
x
x
Women
x
x
x
x
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Drinking Rates in Youth
12th Graders
100%
75%
50%
25%
0%
Ever
Drank
Been
Drunk
>5
Drinks
Daily
Drinking
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Features of Drinking in Youth
Prognosis
 Drink < age 14:  risk of alcohol dependence
Typical experimentation sequence:
Cigarettes
or
Alcohol
Marijuana
Other drugs
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Assessing Drinking in Youth
Red flags:




Change in peers
Family problems
Grades drop
Mood swings
Common consequences:
 Accidents
 “3-Ds”: driving, dating, & drug
related problems
Uncommon problems:
 Severe withdrawal symptoms
 Liver problems
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Assessing Drinking in Youth
TWEAK:
2 - T (tolerance) “How many drinks can you hold?”
2 - W (worried) “Have close friends or relatives
worried or complained about your drinking in the
past year?”
1 - E (eye opener) “Do you sometimes take a drink
in the morning when you first get up?”
1 - A (amnesia) “Has a friend or family member
ever told you about things you said or did while
drinking that you could not remember?”
1 - K (cut town) “Do you sometimes feel the need
___ to cut down on your drinking?”
3 risky drinking
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Youth: Treatment
Formats
 Multi-systemic treatments
 Minnesota model
 Therapeutic communities
 Cognitive-behavioral
 Groups
 Brief intervention
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Youth: Treatment
Pathways to success
1. Traditional routes
2. Early individuation
3. Family involvement
Outcome

Treatment helps

Inpatient = Outpatient

50-80% relapse in 1st year after treatment
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Alcohol Problems in Youth
Epidemiology
Features
Assessment
Treatment
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Alcohol Problems in Women
Epidemiology
Unique risks
Detection
Treatment issues
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Women: Epidemiology
Women Men
Any alcohol in past year
62%
83%
Has met Alcohol Abuse criteria
6% 13%
Has been Alcohol Dependent
8% 20%
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Women & Heavy Drinking
Risk of health problems:
 Alcohol-related liver disease, hepatitis,
infections, anemia
 STDs, UTIs, reproductive organ problems,
breast cancer
 Violence victimization risk
 Neurocognitive effects
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Alcohol & Pregnancy
Prevalence

16-35% of pregnant women drink

4% drink frequently or heavily
Fetal alcohol syndrome (FAS)
1. Facial dysmorphia
2. Growth deficiency
3. CNS deficits
Fetal alcohol effects (FAE)
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Women: Detection
Wide variability
Social risk factors:
 Low vocational skills and education
 Substance use disordered partner
 Social isolation
Screening tools:
 TWEAK
 AUDIT-C
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Women: Treatment Issues
Barriers
 External
 Internal
Optimal treatment for women
 Reduce barriers
 Combine with obstetrics or other
healthcare
 Women-only v. mixed setting
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Women & Alcohol Problems
Epidemiology
Unique risks
Detection
Treatment issues
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Alcohol-Related Problems in
Special Populations
Youth
Women
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