1. CHAPTER 5: Alcohol Use in Women

2. Introduction Alcohol use in women has important physical and psychological effects on women’s health. Recent large nationally representative population samples have greatly increased our understanding of women’s alcohol use. Yet, it is important to continue to investigate women’s drinking across the lifespan.

3. Introduction Majority of women who meet criteria for an alcohol use disorder do not perceive a need for treatment. – Reason for very low utilization of alcohol intervention programs However, when engaged in treatment, women’s treatment completion and success rates equal or exceed men’s rates.

4. Definitions of Alcohol Use According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), a “drink” refers to: – a 12-ounce regular beer, – a 5-ounce serving of wine, or – 1.5 ounces of 80-proof distilled spirits

5. Patterns of Alcohol Use and Alcohol Problems in Women Almost 60% of adult women report drinking in the past year. Women are more likely to abstain from alcohol use. Women are less likely to drink at moderate or heavy levels. Women’s alcohol use fluctuates across the lifespan.

6. Patterns of Alcohol Use and Alcohol Problems in Women “Risky” drinking is defined as four or more drinks per day for women. Overall rate of risky drinking for women is 14.2%. – Almost 30% of women ages 18–24 reported at least one episode of risky drinking.

7. Patterns of Alcohol Use and Alcohol Problems in Women Alcohol use disorder (DSM-IV-TR) – Continued use of alcohol despite distress or impairment in several areas, including role impairment, legal problems, hazardous use, or social and interpersonal problems – Includes physiological tolerance, withdrawal symptoms, and a desire or unsuccessful efforts to cut down on use 4.9% of women meet criteria for an alcohol use disorder

8. Health and Social Consequences of Women’s Drinking Potential Health Consequences: – Cirrhosis of the liver – Cardiovascular disease – Alcohol-related cardiomyopathy – Epilepsy – Cognitive impairment – Nerve damage – Type 2 diabetes mellitus – Reproductive health problems – Cancer

9. Health and Social Consequences of Women’s Drinking Potential Psychosocial Consequences: – Increased risk for sexual assault/IPV – Car accidents due to DUI/DWI – Comorbidities with mood, anxiety, and personality disorders

10. Risk Factors for Women’s Problem Drinking Women’s problem drinking is associated with: – Younger age – White or American Indian race/ethnicity – Family history of alcohol problems – Their partners’ heavy drinking – Child and adult victimization – Certain comorbid disorders

11. Assessment, Intervention, and Prevention of Alcohol Problems Identification of women’s problem drinking occurs: – Through self-assessment – By significant others/family/friends – At the workplace – By the legal system – By healthcare professionals

12. Assessment, Intervention, and Prevention of Alcohol Problems Screening in healthcare settings is the most effective way to assess women’s alcohol use problems. – NIAAA recommends screening along a continuum. – “How many times in the past year have you had four or more drinks per day?” – For patients who report one or more times, assess frequency, quantity, and maximum number of drinks on one occasion.

13. Assessment, Intervention, and Prevention of Alcohol Problems Evidence-based Interventions: – Brief interventions – Motivational interviewing – Cognitive-behavioral interventions – Alcoholics Anonymous and other support groups – COMBINE study

14. Assessment, Intervention, and Prevention of Alcohol Problems Targets for prevention: – Increase alcohol prices to lower youth consumption. – Restrict number of alcohol outlets. – Strengthen enforcement and laws. – Reduce and control alcohol advertising. – Increase screening and assessment in healthcare settings.

15. Conclusions and Future Directions Women under 25 remain a high-risk group for alcohol use problems. Once engaged in treatment, women are generally successful. More training is needed for healthcare professionals on comprehensive assessment of and interventions for women.