1. 1 Copyright Alcohol Medical Scholars Program Alcohol-Related Problems in Special Populations: YOUTH and WOMEN Susan F. Tapert, Ph.D. University of California, San Diego VA San Diego Healthcare System

2. 2 Copyright Alcohol Medical Scholars Program Alcohol-Related Problems: Special Populations Epidem- iology Unique Features Assess- ment Treat- ment Youthxxxx Womenxxxx

3. 3 Copyright Alcohol Medical Scholars Program Drinking Rates in Youth

4. 4 Copyright Alcohol Medical Scholars Program Features of Drinking in Youth Prognosis  Drink < age 14:  risk of alcohol dependence Typical experimentation sequence: Cigarettes or orAlcohol Marijuana Other drugs

5. 5 Copyright Alcohol Medical Scholars Program Assessing Drinking in Youth Red flags:  Change in peers  Family problems  Grades drop  Mood swings Common consequences:  Accidents  “3-Ds”: driving, dating, & drug related problems Uncommon problems:  Severe withdrawal symptoms  Liver problems

6. 6 Copyright Alcohol Medical Scholars Program Assessing Drinking in Youth TWEAK: ­T (tolerance) “How many drinks can you hold?” ­W (worried) “Have close friends or relatives worried or complained about your drinking in the past year?” ­E (eye opener) “Do you sometimes take a drink in the morning when you first get up?” ­A (amnesia) “Has a friend or family member ever told you about things you said or did while drinking that you could not remember?” ­K (cut town) “Do you sometimes feel the need to cut down on your drinking?” 22 1 1 1 ___ 3 risky drinking

7. 7 Copyright Alcohol Medical Scholars Program Youth: Treatment Formats  Multi-systemic treatments  Minnesota model  Therapeutic communities  Cognitive-behavioral  Groups  Brief intervention

8. 8 Copyright Alcohol Medical Scholars Program Youth: Treatment Pathways to success 1.Traditional routes 2.Early individuation 3.Family involvement Outcome  Treatment helps  Inpatient = Outpatient  50-80% relapse in 1 st year after treatment

9. 9 Copyright Alcohol Medical Scholars Program Alcohol Problems in Youth EpidemiologyFeaturesAssessmentTreatment

10. 10 Copyright Alcohol Medical Scholars Program Alcohol Problems in Women Epidemiology Unique risks Detection Treatment issues

11. 11 Copyright Alcohol Medical Scholars Program Women: Epidemiology WomenMen WomenMen Any alcohol in past year 62%83% Has met Alcohol Abuse criteria 6%13% Has been Alcohol Dependent8%20%

12. 12 Copyright Alcohol Medical Scholars Program Women & Heavy Drinking Risk of health problems:  Alcohol-related liver disease, hepatitis, infections, anemia  STDs, UTIs, reproductive organ problems, breast cancer  Violence victimization risk  Neurocognitive effects

13. 13 Copyright Alcohol Medical Scholars Program Alcohol & Pregnancy Prevalence  16-35% of pregnant women drink  4% drink frequently or heavily Fetal alcohol syndrome (FAS) 1.Facial dysmorphia 2.Growth deficiency 3.CNS deficits Fetal alcohol effects (FAE)

14. 14 Copyright Alcohol Medical Scholars Program Women: Detection Wide variability Social risk factors:  Low vocational skills and education  Substance use disordered partner  Social isolation Screening tools:  TWEAK  AUDIT-C

15. 15 Copyright Alcohol Medical Scholars Program Women: Treatment Issues Barriers  External  Internal Optimal treatment for women  Reduce barriers  Combine with obstetrics or other healthcare  Women-only v. mixed setting

16. 16 Copyright Alcohol Medical Scholars Program Women & Alcohol Problems Epidemiology Unique risks Detection Treatment issues

17. 17 Copyright Alcohol Medical Scholars Program Alcohol-Related Problems in Special Populations YouthWomen