alcohol and women

Alcohol Medical Scholars Program 2006Alcohol Medical Scholars Program 2006 11

Alcohol and WomenAlcohol and Women

♀♀Nioaka N. Campbell, MD

University of South Carolina School of Medicine


Alcohol Use In WomenAlcohol Use In Women

Significant health concernSignificant health concern– 43% current drinkers43% current drinkers

Alcohol use disorders (AUDs)Alcohol use disorders (AUDs)– 4.5M with abuse4.5M with abuse– 2.5M with dependence2.5M with dependence


Alcohol ResearchAlcohol Research

Most in male subjectsMost in male subjects (14% women)(14% women)

May not consider gender differencesMay not consider gender differences– Body weightBody weight– Body fatBody fat– Alcohol dehydrogenaseAlcohol dehydrogenase


‘‘Drink Like A Man’Drink Like A Man’ Gender gap narrowing: Gender gap narrowing: 1975=23% 2001=12%1975=23% 2001=12%

College women in co-ed dorms adopt College women in co-ed dorms adopt pattern of menpattern of men

Rates are similar age 12-17, 17%Rates are similar age 12-17, 17%


Gender Specific SequelaeGender Specific Sequelae

Mortality rate: Mortality rate: ♀♀= 2x = 2x ♂♂ with AUDs with AUDs

33rdrd leading cause of death, both sexes leading cause of death, both sexes ages 35-55ages 35-55

Other sequelae:Other sequelae:– Liver disease, CNS damage, Breast CALiver disease, CNS damage, Breast CA


Diagnosing AUDs In WomenDiagnosing AUDs In Women

<50% with AUD are identified by <50% with AUD are identified by their MDtheir MD

Yet: Yet: ♀♀ more often frequent their MD more often frequent their MD


This Lecture Will Cover:This Lecture Will Cover: EpidemiologyEpidemiology of use and AUDs of use and AUDs

CourseCourse of alcoholism in women of alcoholism in women

ConsequencesConsequences, gender specific , gender specific

AssessmentAssessment of women with AUDs of women with AUDs

TreatmentTreatment issues in this population issues in this population

EpidemiologyEpidemiology


Race/Ethnicity Comparisons Race/Ethnicity Comparisons

CaucasianCaucasian

– Highest prevalence Highest prevalence

– 55% past month use55% past month use

– 87% lifetime use87% lifetime use

African AmericanAfrican American

– Highest abstainers: Highest abstainers: (46% vs 34% whites)(46% vs 34% whites)




Race/Ethnicity Comparisons Race/Ethnicity Comparisons

HispanicHispanic

– 62% foreign born 62% foreign born abstain abstain



Native AmericanNative American– 65% abstain65% abstain



– Highest ‘heavy drinking’ Highest ‘heavy drinking’ >5 drinks/time, 30%>5 drinks/time, 30%


AbstinenceAbstinence Reported in past year, 2004:Reported in past year, 2004:

– 56% women vs. 43% men56% women vs. 43% men

Lifetime, 1997:Lifetime, 1997:– 22% women vs. 13% men22% women vs. 13% men– ↓↓ with educationwith education– ↓↓ with with ↑ ↑ salariessalaries


Alcohol UseAlcohol Use

WomenWomen MenMenCurrentCurrent 44%44% 57%57%

Age 18-25 Age 18-25 (highest use)(highest use)

76%76% 80%80%

Heavy use: Heavy use: >5 drinks, >1x month>5 drinks, >1x month 9-15%9-15% 21%21%


Defining Alcohol AbuseDefining Alcohol Abuse Clinically significant impairment in Clinically significant impairment in ≥ ≥1 in 12 months:1 in 12 months:

– Failure to fulfill major obligationsFailure to fulfill major obligations

– Physically hazardous conditions Physically hazardous conditions

– Legal problems (DUIs, disorderly cond.)Legal problems (DUIs, disorderly cond.)

– Social/Interpersonal problems Social/Interpersonal problems


Defining Alcohol DependenceDefining Alcohol Dependence Clinically significant impairment in ≥3 in year:Clinically significant impairment in ≥3 in year:

– Withdrawal Withdrawal - Tolerance- Tolerance

– Larger amt./longer period than intended Larger amt./longer period than intended

– Persistent desire/efforts to cut downPersistent desire/efforts to cut down

– Excessive time with or obtaining alcoholExcessive time with or obtaining alcohol

– Activities given up due to alcoholActivities given up due to alcohol

– Continued use despite problems Continued use despite problems


Alcohol Use DisordersAlcohol Use Disorders

WomenWomen MenMenLifetime abuseLifetime abuse 6%6% 13%13%

Lifetime dependenceLifetime dependence 8%8% 20%20%


Drinking Consequences Drinking Consequences

Driving fatalitiesDriving fatalities: 9% : 9% ♀ vs. 18% vs. 18% ♂♂

VictimizationVictimization: : ETOH related rape, assault ETOH related rape, assault

Domestic violenceDomestic violence: victims 2X : victims 2X risk of AUD risk of AUD


Drinking Consequences Drinking Consequences

UnemploymentUnemployment: 48% : 48% ♀♀ vs. 33% vs. 33% ♂♂

Antisocial PDAntisocial PD: 15% : 15% ♂♂ vs. 5% vs. 5% ♀♀

Health consequencesHealth consequences: liver, CNS, hangover: liver, CNS, hangover


Course of AlcoholismCourse of Alcoholism

OverallOverall WomenWomenAge of 1Age of 1stst use use 12-1412-14 1414

Age of 1Age of 1stst intoxication intoxication 14-1814-18 samesameAge of ETOH related Age of ETOH related problemsproblems

18-2518-25 samesame**

Age to seek treatmentAge to seek treatment 4040 samesameAge of death Age of death 55-6055-60 samesame

* ‘Telescoping’


Health Problems and AUDsHealth Problems and AUDs

Axis I D/O: major depression, anxiety, Axis I D/O: major depression, anxiety, eating, suicide(40%♀ with AUD)eating, suicide(40%♀ with AUD)

Comorbidity vs. independent disordersComorbidity vs. independent disorders

Hormonal disruption, changesHormonal disruption, changes Breast Cancer Breast Cancer

– 2% cases attributed to alcohol use2% cases attributed to alcohol use


Fetal Alcohol SyndromeFetal Alcohol Syndrome Varying components:Varying components:

– Facial malformationsFacial malformations

– Pre and post-natal growth retardationPre and post-natal growth retardation

– CNS abnormalitiesCNS abnormalities

– Spontaneous abortionsSpontaneous abortions

– Mild to moderate MRMild to moderate MR


Fetal Alcohol SyndromeFetal Alcohol Syndrome

1% of US population1% of US population

15% pregnant age 14-44 15% pregnant age 14-44 “ “had a drink” had a drink”

$200 M/yr for children with FAS$200 M/yr for children with FAS

Since 1990 guidelines – abstention Since 1990 guidelines – abstention


Assessment of Women with AUDsAssessment of Women with AUDs

Avoid stereotypeAvoid stereotype– Stigma, guiltStigma, guilt– Presentation Presentation

HistoryHistory– Routine screeningRoutine screening– Open vs closed questionsOpen vs closed questions– Non-judgmental attitudes Non-judgmental attitudes – ProblemProblem focused assessment focused assessment


Psychosocial Assessment FactorsPsychosocial Assessment Factors ProtectiveProtective

– Multiple rolesMultiple roles

– MarriedMarried

– Student athletesStudent athletes

RiskRisk– IsolationIsolation

– Early initiationEarly initiation

– Hx of neglect, abuseHx of neglect, abuse

– Other Axis I D/OOther Axis I D/O

– TobaccoTobacco


Genetic FactorsGenetic Factors

50-60% variation of AUD risk50-60% variation of AUD risk

Twin and adoption studiesTwin and adoption studies


Assessment ChallengesAssessment Challenges TimeTime

Objective ToolsObjective Tools– CAGECAGE - MAST- MAST - AUDIT- AUDIT(Gender and Racial differences)(Gender and Racial differences)

PregnancyPregnancy– HBQHBQ -TACE-TACE


TreatmentTreatment 1 in 4 1 in 4 ♀ with AUD receive txwith AUD receive tx

♂♂ with AUD: 2X likely as with AUD: 2X likely as ♀ to receive tx to receive tx

BarriersBarriers– StigmaStigma - Child care- Child care– Legal sanctionLegal sanction - Limited resources- Limited resources


Treatment ProgramsTreatment Programs Some currently provide:Some currently provide:

– Womens’ gp, child care, post partumWomens’ gp, child care, post partum

Womens’ only:Womens’ only:– 2X completion2X completion– Child care optionsChild care options– Minority populationsMinority populations


DHHS Treatment GuidelinesDHHS Treatment Guidelines

Child careChild care Vocational/Legal assistanceVocational/Legal assistance Female intake providerFemale intake provider EmpowerEmpower General medical assessmentGeneral medical assessment Thorough assessmentsThorough assessments


SummarySummary Use/AUDs:Use/AUDs: significant womens’ issues significant womens’ issues

Course:Course: varied, unique varied, unique

Consequences:Consequences: gender specific gender specific

Assessment: Assessment: routine, thoroughroutine, thorough

Treatment:Treatment: comprehensive, individualized comprehensive, individualized


Questions?Questions?

♀♀

alcohol and women

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