Sara Jo Nixon, Ph.D.- Member, RiverMend Health Scientific Advisory Board for Addiction & Psychiatry. Professor and co-Vice Chair , Director, Neurocognitive Laboratory, Department of Psychiatry, University of Florida Dr. Nixon addresses the RiverMend Health Scientific Advisory Board on alcohol and its effect in women and treatment techniques for those seeking help. For more information visit: http://www.rivermendhealth.com/scientific-advisory-board-addiction.html

1. NVP Scientific Advisory BoardNVP Scientific Advisory Board
September 2013September 2013
Sara Jo Nixon, Ph.D.Sara Jo Nixon, Ph.D.
Professor and co-Vice ChairProfessor and co-Vice Chair
Director, Neurocognitive LaboratoryDirector, Neurocognitive Laboratory
Department of PsychiatryDepartment of Psychiatry
University of FloridaUniversity of Florida
Women andWomen and
AlcoholAlcohol

2. Telescoping: A Population ViewTelescoping: A Population View
5 Birth Cohorts: 1934-1983 (10 yr intervals: 1 is most
recent). Combined data from 2 national surveys
Narrowing gender gap
Age at 1st
Use (men) Men < Women
Cohort 5=19.1 ~ 3 years
Cohort 4=18.4 ~ 2 years
Cohort 3=17.5 ~ 1 year
Cohort 2=17.2 ~ .5 year
Cohort 1=17.1 ~ .4 year
Keyes et al, 2010 Am J Psychiatry, 2010, 167, 969-976: used ages 18-57

3. Telescoping to Trouble?Telescoping to Trouble?
Survival Curves for Time From Initiation of Alcohol Use to Onset of
Dependence Among Lifetime Drinkers Ages 18–57 in Two National
Surveys (N=38,309)a
W/in each cohort: Men demonstrate faster “decline” than do women
Keyes et al., 2010, Am J Psychiatry

4. Fig. 1. Bars represent number of years
(mean±standard error of the mean)
elapsed between onset of regular
substance use and entry into an index
substance abuse treatment by gender
and substance dependence diagnosis
(*
P<0.05). Women experienced fewer
pretreatment years of regular use of
opioids (P=0.03), cannabis (P=0.01),
regular alcohol drinking (P=0.03), and
regular alcohol intoxication (P=0.09)
than men.
Telescoping in Treatment SeekersTelescoping in Treatment Seekers
Hernandez-Avila et al. (2004)

5. Where might alcoholic telescoping lie?Where might alcoholic telescoping lie?
Variable
Total
Males
(n=151)
Females
(n=114)
M (SD) M (SD) M (SD)
QFI ( avg. ozs of absolute alcohol/day,
prior 6 months) (Range: 4.6 – 68.6)
15.62 (17.02) 16.79 (20.76) 14.08 (10.01)
MaxQFI (most ozs/day in 6 months
prior) (Range: 6.8 – 78.72)
21.59 (13.84) 23.01 (14.43) 19.67 (12.84)
Age 1st
Drink
(Range: 1 – 23)
11.79 (4.22) 11.4 (3.69) 12.31 (4.81)
Age 1st
Intoxication*
(Range: 10 – 33)
14.83 (3.01) 14.38 (2.39) 15.43 (3.61)
Age Regular Use*
(Range: 10 – 42)
17.76 (4.95) 17.20 (4.15) 18.55 (5.83)
Age of Self-reported
Alcoholism or Problem Drinking
(Range: 7 – 52)
20.47 (7.67) 20.71 (8.27) 20.15 (6.79)
1st
Drink to Alcoholism or Problem
Drinking (yrs) (Range: 0 – 51)
8.96 (7.97) 9.63 (8.41) 8.03 (7.24)
1st
Intox to Alcoholism or Problem
Drinking (yrs) (Range: 0 – 36)
6.32 (6.84) 7.00 (7.30) 5.32 (6.00)
Reg Use to Alcoholism or Problem
Drinking (yrs) (Range: 0 – 36)
3.03 (5.81) 3.51 (6.28) 2.32 (4.98)
* p<0.05
Treatment
seekers
identified as
likely
alcoholic by
level of
drinking
only.
Lewis &
Nixon,2013.
ACER

6. Drug Types Used:Drug Types Used:
Stimulants Opiates Benzodiazepines &
Muscle Relaxants
Men
Women
Regular Drug Use by Gender
(Likely Alcoholics)

7. Treatment TelescopingTreatment Telescoping
Age @
• Initial Drink
– M = 11.97 (3.8) Yrs to: 23
– F = 13.38 (4.41) Yrs to: 18
• Initial Drunk
– M = 15.04 (2.83) Yrs to: 21
– F = 16.28 (4.12) Yrs to: 15
• Regular Use
– M = 18.18 (3.63) Yrs to: 18
– F = 19.82 (6.74) Yrs to: 13
• Problems
– M = 21.75 (7. 48) Yrs to: 14
– F = 22.71 ( 8.17) Yrs to: 10
1st
Treatment Age
• Men: 35.1 (10.1)
• Women: 31.7 (9.2)
Time to “problems” did not
achieve significance; but
time between problems
and treatment was
significantly abbreviated
for women.
Lewis & Nixon (2013). ACER

8. Are the risks really increased forAre the risks really increased for
women?women?
• Alcoholic Cirrhosis:
• For Men:
80g/day
• For Women:
20 g/day
(10-12 yr. drinking career)
~ 13g/ standard drink:
These data support concept of a telescoping of women’s alcoholism

9. Sex, Alcohol & Brain VolumeSex, Alcohol & Brain Volume
Demirakca et al., 2011
Global gray matter (GM)
and white matter (WM)
volume loss, global
cerebrospinal fluid
(CSF) increase and
regional volume loss in
regions of interest,
relative to healthy
control values (=100%),
controlled for sex;
orange = healthy
controls, dark blue =
male alcoholic, light blue
= female alcoholic. HC,
healthy controls; TIV,
total intracranial volume.
SEXES = in Brain
Structure Change.

10. Closing ThoughtsClosing Thoughts
• Demonstrable Population Shifts/ Sex
Differences in Drinking Behavior
• Probability in Developing Dependence
• Gender/sex Gap in certain milestones
• Yet steeper trajectory for men, when
considered at the population level

11. Closing ThoughtsClosing Thoughts
• Alcohol misuse differentially increases risk for
medical consequences among women
• Alcohol-related neurobehavioral changes are
observed in treatment-seekers, regardless of
sex: Mixed data on telescoping
• Narrowing gender/sex gap on psychosocial
variables (e.g., education/ drinking history)
must be considered in long-term planning
• Factors of psychiatric comorbidity, familial
support must also be considered

12. AcknowledgementsAcknowledgements
• NIDA R01 DA13677
• NIH NCATS UL1 TR000064
• UF Psychiatry, Divisions of Addiction Medicine & Addiction Research
• Special thanks to the Community & Treatment Volunteers who
participate in these studies
Laboratory Personnel
Robert Prather Layla Lincoln,
Jeff Boissoneault, Ph.D.
Lauren Hoffman,
Ben Lewis, Ph.D.,
Alfredo Sklar