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
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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
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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
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‘‘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%
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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
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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
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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
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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)
– 37% past month use37% past month use
– 73% lifetime use73% lifetime use
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Race/Ethnicity Comparisons Race/Ethnicity Comparisons
HispanicHispanic
– 62% foreign born 62% foreign born abstain abstain
– 40% past month use40% past month use
– 73% lifetime use73% lifetime use
Native AmericanNative American– 65% abstain65% abstain
– 36% past month use36% past month use
– 81% lifetime use81% lifetime use
– Highest ‘heavy drinking’ Highest ‘heavy drinking’ >5 drinks/time, 30%>5 drinks/time, 30%
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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
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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%
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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
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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
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Alcohol Use DisordersAlcohol Use Disorders
WomenWomen MenMenLifetime abuseLifetime abuse 6%6% 13%13%
Lifetime dependenceLifetime dependence 8%8% 20%20%
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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
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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
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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’
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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
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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
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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
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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
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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
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Genetic FactorsGenetic Factors
50-60% variation of AUD risk50-60% variation of AUD risk
Twin and adoption studiesTwin and adoption studies
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Assessment ChallengesAssessment Challenges TimeTime
Objective ToolsObjective Tools– CAGECAGE - MAST- MAST - AUDIT- AUDIT(Gender and Racial differences)(Gender and Racial differences)
PregnancyPregnancy– HBQHBQ -TACE-TACE
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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
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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
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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
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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
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Questions?Questions?
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