Transcript Alcohol and Women - Alcohol Medical Scholars Program

Alcohol and Women
Nioaka N. Campbell, MD
University of South Carolina School of Medicine
Alcohol Medical Scholars Program 2006
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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:
1975=23% 2001=12%
 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
 <50%
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
Race/Ethnicity Comparisons

Caucasian
– Highest prevalence
– 55% past month use
– 87% lifetime use
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
African American
– Highest abstainers:
(46% vs 34% whites)
– 37% past month use
– 73% lifetime use
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Race/Ethnicity Comparisons

Hispanic
– 62% foreign born
abstain
– 40% past month use
– 73% lifetime use

Native American
– 65% abstain
– 36% past month use
– 81% lifetime use
– Highest ‘heavy drinking’
>5 drinks/time, 30%
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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
Women
Men
Current
44%
57%
Age 18-25
76%
80%
9-15%
21%
(highest use)
Heavy use:
>5 drinks, >1x month
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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
Women
Men
Lifetime abuse
6%
13%
Lifetime dependence
8%
20%
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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
Overall
Women
Age of 1st use
12-14
14
Age of 1st intoxication
14-18
same
Age of ETOH related
problems
18-25
same
*
40
same
55-60
same
Age to seek treatment
Age of death
* ‘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

Risk

Protective
– Isolation
– Multiple roles
– Early initiation
– Married
– Hx of neglect, abuse
– Student athletes
– 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
– Legal sanction
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- Child care
- 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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