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Alcohol and Women

Alcohol and Women. Nioaka N. Campbell, MD University of South Carolina School of Medicine. ♀. Alcohol Use In Women. Significant health concern 43% current drinkers Alcohol use disorders (AUDs) 4.5M with abuse 2.5M with dependence. Alcohol Research. Most in male subjects (14% women)

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Alcohol and Women

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

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

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

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

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

  8. Epidemiology

  9. 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 Race/Ethnicity Comparisons Alcohol Medical Scholars Program 2006

  10. 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% Race/Ethnicity Comparisons 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 Alcohol Medical Scholars Program 2006

  12. Alcohol Use Alcohol Medical Scholars Program 2006

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

  15. Alcohol Use Disorders Alcohol Medical Scholars Program 2006

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

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

  18. Course of Alcoholism * ‘Telescoping’ 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 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 Alcohol Medical Scholars Program 2006

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

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

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

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

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

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

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

  30. Questions? ♀ Alcohol Medical Scholars Program 2006

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