NVP Scientific Advisory BoardNVP Scientific Advisory BoardSeptember 2013September 2013

Sara Jo Nixon, Ph.D.Sara Jo Nixon, Ph.D.Professor and co-Vice ChairProfessor and co-Vice Chair

Director, Neurocognitive LaboratoryDirector, Neurocognitive Laboratory

Department of PsychiatryDepartment of Psychiatry

University of FloridaUniversity of Florida

Women and Women and AlcoholAlcohol

Telescoping: A Population ViewTelescoping: A Population View5 Birth Cohorts: 1934-1983 (10 yr intervals: 1 is most recent). Combined data from 2 national surveys

Narrowing gender gapAge at 1st Use (men) Men < WomenCohort 5=19.1 ~ 3 yearsCohort 4=18.4 ~ 2 yearsCohort 3=17.5 ~ 1 yearCohort 2=17.2 ~ .5 yearCohort 1=17.1 ~ .4 year

Keyes et al, 2010 Am J Psychiatry, 2010, 167, 969-976: used ages 18-57

Telescoping to Trouble?Telescoping to Trouble?Survival Curves for Time From Initiation of Alcohol Use to Onset of Dependence Among Lifetime Drinkers Ages 18–57 in Two National

Surveys (N=38,309)a

W/in each cohort: Men demonstrate faster “decline” than do womenKeyes et al., 2010, Am J Psychiatry

Fig. 1. Bars represent number of years (mean±standard error of the mean) elapsed between onset of regular substance use and entry into an index substance abuse treatment by gender and substance dependence diagnosis (*P<0.05). Women experienced fewer pretreatment years of regular use of opioids (P=0.03), cannabis (P=0.01), regular alcohol drinking (P=0.03), and regular alcohol intoxication (P=0.09) than men.

Telescoping in Treatment SeekersTelescoping in Treatment Seekers

Hernandez-Avila et al. (2004)

Where might alcoholic telescoping lie? Where might alcoholic telescoping lie?

 VariableTotal

Males (n=151)

Females (n=114)

M (SD) M (SD) M (SD)

QFI ( avg. ozs of absolute alcohol/day, prior 6 months) (Range: 4.6 – 68.6)

15.62 (17.02) 16.79 (20.76) 14.08 (10.01)

MaxQFI (most ozs/day in 6 months prior) (Range: 6.8 – 78.72)

21.59 (13.84) 23.01 (14.43) 19.67 (12.84)

Age 1st Drink(Range: 1 – 23)

11.79 (4.22) 11.4 (3.69) 12.31 (4.81)

Age 1st Intoxication*(Range: 10 – 33)

14.83 (3.01) 14.38 (2.39) 15.43 (3.61)

Age Regular Use*(Range: 10 – 42)

17.76 (4.95) 17.20 (4.15) 18.55 (5.83)

Age of Self-reported Alcoholism or Problem Drinking(Range: 7 – 52)

20.47 (7.67) 20.71 (8.27) 20.15 (6.79)

1st Drink to Alcoholism or Problem Drinking (yrs) (Range: 0 – 51)

8.96 (7.97) 9.63 (8.41) 8.03 (7.24)

1st Intox to Alcoholism or Problem Drinking (yrs) (Range: 0 – 36)

6.32 (6.84) 7.00 (7.30) 5.32 (6.00)

Reg Use to Alcoholism or Problem Drinking (yrs) (Range: 0 – 36)

3.03 (5.81) 3.51 (6.28) 2.32 (4.98)

* p<0.05

Treatment seekers identified as likely alcoholic by level of drinking only.

Lewis & Nixon,2013. ACER

Drug Types Used:Drug Types Used:

Stimulants Opiates Benzodiazepines &Muscle Relaxants

Regular Drug Use by Gender(High QFI Group Only)

Marijuana Stimulants Opiates Benzos & Muscle

Reg

ular

Use

(%

)

0

20

40

60

80Males Females

Benzodiazepines &Muscle Relaxants

**

*

(p=.001)

(p=.031)(p=.004)

Regular Drug Use by Gender(High QFI Group Only)

Marijuana Stimulants Opiates Benzos & Muscle

Reg

ular

Use

(%

)

0

20

40

60

80Males Females

Benzodiazepines &Muscle Relaxants

**

*

(p=.001)

(p=.031)(p=.004)

MenWomen

Regular Drug Use by Gender(Likely Alcoholics)

Treatment TelescopingTreatment TelescopingAge @• Initial Drink

– M = 11.97 (3.8) Yrs to: 23– F = 13.38 (4.41) Yrs to:

18

• Initial Drunk– M = 15.04 (2.83) Yrs to:

21– F = 16.28 (4.12) Yrs to: 15

• Regular Use– M = 18.18 (3.63) Yrs to:

18– F = 19.82 (6.74) Yrs to: 13

• Problems– M = 21.75 (7. 48) Yrs to:

14– F = 22.71 ( 8.17) Yrs to:

10

1st Treatment Age• Men: 35.1 (10.1)• Women: 31.7 (9.2)

Time to “problems” did not achieve significance; but time between problems and treatment was significantly abbreviated for women.

Lewis & Nixon (2013). ACER

Are the risks really increased for Are the risks really increased for women?women?

• Alcoholic Cirrhosis:• For Men: 80g/day• For Women: 20 g/day(10-12 yr. drinking career)

~ 13g/ standard drink:

These data support concept of a telescoping of women’s alcoholism

Sex, Alcohol & Brain VolumeSex, Alcohol & Brain Volume

Demirakca et al., 2011

Global gray matter (GM) and white matter (WM) volume loss, global cerebrospinal fluid (CSF) increase and regional volume loss in regions of interest, relative to healthy control values (=100%), controlled for sex; orange = healthy controls, dark blue = male alcoholic, light blue = female alcoholic. HC, healthy controls; TIV, total intracranial volume. SEXES = in Brain Structure Change.

Closing ThoughtsClosing Thoughts

• Demonstrable Population Shifts/ Sex Differences in Drinking Behavior

• Probability in Developing Dependence

• Gender/sex Gap in certain milestones

• Yet steeper trajectory for men, when considered at the population level

Closing ThoughtsClosing Thoughts

• Alcohol misuse differentially increases risk for medical consequences among women

• Alcohol-related neurobehavioral changes are observed in treatment-seekers, regardless of sex: Mixed data on telescoping

• Narrowing gender/sex gap on psychosocial variables (e.g., education/ drinking history) must be considered in long-term planning

• Factors of psychiatric comorbidity, familial support must also be considered

AcknowledgementsAcknowledgements

• NIDA R01 DA13677• NIH NCATS UL1 TR000064• UF Psychiatry, Divisions of Addiction Medicine & Addiction Research• Special thanks to the Community & Treatment Volunteers who

participate in these studies

Laboratory Personnel

Robert Prather Layla Lincoln, Jeff Boissoneault, Ph.D.

Lauren Hoffman,Ben Lewis, Ph.D.,

Alfredo Sklar