1. Alcohol Medical Scholars Program 2006 1 Alcohol and Women ♀ Nioaka N. Campbell, MD University of South Carolina School of Medicine

2. Alcohol Medical Scholars Program 2006 2 Alcohol Use In Women  Significant health concern –43% current drinkers  Alcohol use disorders (AUDs) –4.5M with abuse –2.5M with dependence

3. Alcohol Medical Scholars Program 2006 3 Alcohol Research  Most in male subjects (14% women) (14% women)  May not consider gender differences –Body weight –Body fat –Alcohol dehydrogenase

4. Alcohol Medical Scholars Program 2006 4 ‘Drink Like A Man’  Gender gap narrowing: 1975=23% 2001=12% 1975=23% 2001=12%  College women in co-ed dorms adopt pattern of men  Rates are similar age 12-17, 17%

5. Alcohol Medical Scholars Program 2006 5 Gender Specific Sequelae  Mortality rate: ♀= 2x ♂ with AUDs  3 rd leading cause of death, both sexes ages 35-55  Other sequelae: –Liver disease, CNS damage, Breast CA

6. Alcohol Medical Scholars Program 2006 6 Diagnosing AUDs In Women  <50% with AUD are identified by their MD  Yet: ♀ more often frequent their MD

7. Alcohol Medical Scholars Program 2006 7 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

8. Epidemiology

9. Alcohol Medical Scholars Program 2006 9 Race/Ethnicity Comparisons  Caucasian –Highest prevalence –55% past month use –87% lifetime use  African American –Highest abstainers: (46% vs 34% whites) –37% past month use –73% lifetime use

10. Alcohol Medical Scholars Program 2006 10 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%

11. Alcohol Medical Scholars Program 2006 11 Abstinence  Reported in past year, 2004: –56% women vs. 43% men  Lifetime, 1997: –22% women vs. 13% men –↓ with education –↓ with ↑ salaries

12. Alcohol Medical Scholars Program 2006 12 Alcohol Use WomenMen Current44%57% Age 18-25 (highest use) 76%80% Heavy use: >5 drinks, >1x month 9-15%21%

13. Alcohol Medical Scholars Program 2006 13 Defining Alcohol Abuse  Clinically significant impairment in ≥1 in 12 months: ≥1 in 12 months: –Failure to fulfill major obligations –Physically hazardous conditions –Legal problems (DUIs, disorderly cond.) –Social/Interpersonal problems

14. Alcohol Medical Scholars Program 2006 14 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

15. Alcohol Medical Scholars Program 2006 15 Alcohol Use Disorders WomenMen Lifetime abuse 6%13% Lifetime dependence 8%20%

16. Alcohol Medical Scholars Program 2006 16 Drinking Consequences  Driving fatalities: 9% vs. 18% ♂  Driving fatalities: 9% ♀ vs. 18% ♂  Victimization:  ETOH related rape, assault  Domestic violence: victims 2X  risk of AUD

17. Alcohol Medical Scholars Program 2006 17 Drinking Consequences  Unemployment: 48% ♀ vs. 33% ♂  Antisocial PD: 15% ♂ vs. 5% ♀  Health consequences: liver, CNS, hangover

18. Alcohol Medical Scholars Program 2006 18 Course of Alcoholism OverallWomen Age of 1 st use 12-1414 Age of 1 st intoxication 14-18same Age of ETOH related problems 18-25same* Age to seek treatment 40same Age of death 55-60same * ‘Telescoping’

19. Alcohol Medical Scholars Program 2006 19 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

20. Alcohol Medical Scholars Program 2006 20 Fetal Alcohol Syndrome  Varying components: –Facial malformations –Pre and post-natal growth retardation –CNS abnormalities –Spontaneous abortions –Mild to moderate MR

21. Alcohol Medical Scholars Program 2006 21 Fetal Alcohol Syndrome  1% of US population  15% pregnant age 14-44 “had a drink” “had a drink”  $200 M/yr for children with FAS  Since 1990 guidelines – abstention

22. Alcohol Medical Scholars Program 2006 22 Assessment of Women with AUDs  Avoid stereotype –Stigma, guilt –Presentation  History –Routine screening –Open vs closed questions –Non-judgmental attitudes –Problem focused assessment

23. Alcohol Medical Scholars Program 2006 23 Psychosocial Assessment Factors  Protective –Multiple roles –Married –Student athletes  Risk –Isolation –Early initiation –Hx of neglect, abuse –Other Axis I D/O –Tobacco

24. Alcohol Medical Scholars Program 2006 24 Genetic Factors  50-60% variation of AUD risk  Twin and adoption studies

25. Alcohol Medical Scholars Program 2006 25 Assessment Challenges  Time  Objective Tools –CAGE- MAST- AUDIT (Gender and Racial differences)  Pregnancy –HBQ-TACE

26. Alcohol Medical Scholars Program 2006 26 Treatment  1 in 4 with AUD receive tx  1 in 4 ♀ with AUD receive tx  ♂ with AUD: 2X likely as to receive tx  ♂ with AUD: 2X likely as ♀ to receive tx  Barriers –Stigma- Child care –Legal sanction- Limited resources

27. Alcohol Medical Scholars Program 2006 27 Treatment Programs  Some currently provide: –Womens’ gp, child care, post partum  Womens’ only: –2X completion –Child care options –Minority populations

28. Alcohol Medical Scholars Program 2006 28 DHHS Treatment Guidelines  Child care  Vocational/Legal assistance  Female intake provider  Empower  General medical assessment  Thorough assessments

29. Alcohol Medical Scholars Program 2006 29 Summary  Use/AUDs: significant womens’ issues  Course: varied, unique  Consequences: gender specific  Assessment: routine, thorough  Treatment: comprehensive, individualized

30. Alcohol Medical Scholars Program 2006 30 Questions? ♀