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Misconceptions About Women And Alcohol
Misconceptions About Women And Alcohol
Misconceptions About Women And Alcohol
Misconceptions About Women And Alcohol
Misconceptions About Women And Alcohol
Misconceptions About Women And Alcohol
Misconceptions About Women And Alcohol
Misconceptions About Women And Alcohol
Misconceptions About Women And Alcohol
Misconceptions About Women And Alcohol
Misconceptions About Women And Alcohol
Misconceptions About Women And Alcohol
Misconceptions About Women And Alcohol
Misconceptions About Women And Alcohol
Misconceptions About Women And Alcohol
Misconceptions About Women And Alcohol
Misconceptions About Women And Alcohol
Misconceptions About Women And Alcohol
Misconceptions About Women And Alcohol
Misconceptions About Women And Alcohol
Misconceptions About Women And Alcohol
Misconceptions About Women And Alcohol
Misconceptions About Women And Alcohol
Misconceptions About Women And Alcohol
Misconceptions About Women And Alcohol
Misconceptions About Women And Alcohol
Misconceptions About Women And Alcohol
Misconceptions About Women And Alcohol
Misconceptions About Women And Alcohol
Misconceptions About Women And Alcohol
Misconceptions About Women And Alcohol
Misconceptions About Women And Alcohol
Misconceptions About Women And Alcohol
Misconceptions About Women And Alcohol
Misconceptions About Women And Alcohol
Misconceptions About Women And Alcohol
Misconceptions About Women And Alcohol
Misconceptions About Women And Alcohol
Misconceptions About Women And Alcohol
Misconceptions About Women And Alcohol
Misconceptions About Women And Alcohol
Misconceptions About Women And Alcohol
Misconceptions About Women And Alcohol
Misconceptions About Women And Alcohol
Misconceptions About Women And Alcohol
Misconceptions About Women And Alcohol
Misconceptions About Women And Alcohol
Misconceptions About Women And Alcohol
Misconceptions About Women And Alcohol
Misconceptions About Women And Alcohol
Misconceptions About Women And Alcohol
Misconceptions About Women And Alcohol
Misconceptions About Women And Alcohol
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Misconceptions About Women And Alcohol

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The Presentation for The Neuroscience and Addiction Conference 2009, presented by M. Kotz, DO.

The Presentation for The Neuroscience and Addiction Conference 2009, presented by M. Kotz, DO.

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    • 1. Misconceptions About Women and Alcohol M. Kotz, DO Associate Professor Case Western Reserve University
    • 2. Key Points
      • Limited literature; current research shows significant gender differences
      • Unique physiological, psychiatric, social impact
      • Physiological distinction: rate of metabolism and the effect of given dose of alcohol on total blood level
      • More severe medical consequences with accelerated disease progression
      • Different cultural and social expectations
      • Mediates vulnerability and treatment access
    • 3. Introduction
      • Sparse information
      • First attempt to separately examine alcoholism in women was in 1978 by NIAAA
      • Prior research
        • Focused on males
        • Extrapolated to women
        • Assumed gender differences not significant
      • Last three decades have shown drastic misconceptions
      • Biopsychosocial aspects dramatically different
      • Vast evidence: more acute and chronic problems
      • Sex bias continues leading to misunderstanding
    • 4. Prevalence
      • SAMSHA: More males drink than females
      • Except 12-17 age group, 17.4 to 17.9 current use
      • Increased number of women drinking
      • Convergence: men to women about 2:1
      • NSDUH: Gender gap closed youngest age group
    • 5. Risk for Developing AUD
      • Start drinking before age 15: 40% higher risk
      • 39% fourteen year old girls report drinking in past month
      • Alarming: 21% had five or more, single occasion
    • 6. Prevalence UK
      • International surveys: Young people among heaviest drinkers in the world
      • European School Survey: Age 15-16
        • Sixth for frequent drinking, third for drunkeness, second for binge drinking and for “being drunk before age 13”
          • McArdle, Arch Dis Child, April 2008
    • 7. UK Undergraduate Female Drinkers
      • Since 1995: significant increase female binge drinking , has been noted in accident and emergency dept reports
        • Simpson, International Journal of Drug Policy, 2007
      • 40% exceed ‘sensible’ weekly intake of 14 units
      • Student binge drinking high - three times normal population
      • Female students drinking like male colleagues
      • UK initiatives for sensible drinking failing
      • Binge drinking within this age group viewed as normal
        • Gill, Alcohol and Alcoholism 2001
    • 8. Special Risk Factors
      • Alcohol Use Disorders: use, abuse, dependence
      • Telescoping: Piazza et al, short interval from initiation to treatment
      • Accelerated course: briefer periods between regular drinking and loss of control
      • Shortened course: less time for intervention
      • Genetic vulnerability: Kendler et al, 50%-60%
    • 9. Physiological Differences
      • Metabolism: Higher BAC /unit of alcohol
      • Frezza,1990,lower levels of alcohol dehydrogenase in gastric mucosa
      • Less first-pass metabolism
      • Higher alcohol absorption
      • Higher BAC
    • 10. Body Composition Differences
      • Quantity ingested versus BAC explained by
      • Women lower proportion of water, higher proportion of fat
      • Distributed over smaller volume
      • Older women: higher BAC, “goes to head more quickly”
    • 11. Gender Matters
      • One drink for a man = two for a woman
      • Women get high faster and stay high longer than men, matching them drink for drink
    • 12. Pharmacologic Differences
      • Oral contraceptives:
        • Decreased ethanol elimination rate
        • Consistent across all three phases of menstrual cycle
        • Higher alcohol level
        • Harder to predict ….variable BAC
        • Jones and Jones, Alcoholism: Clinical and Experimental Research, 2008
    • 13. Socio-cultural Factors
      • Female historical and current stereotypes: “party girl, promiscuous, slut, lush, bad mother”
      • Men: “macho, boys will be boys”
      • Main psychological difference: severe stigma
      • Conflicts with society’s view of femininity and roles as wife and mother
      • Women internalize this stigma: feel guilt, shame, self-loathing and despair
    • 14. Socio-cultural Factors
      • Stigma and threat of severe consequences lead women and families to profound denial
      • Losing custody, criminal charges
      • Paternalism
      • Social contagion factor: assume drinking patterns like partner
      • Men leave alcoholic wives, wives stay with alcoholic men
    • 15. Victimization: Sexual Assault
      • Study of 24,000 college women showed correlation to rape and acute intoxication J. Study of Alcohol 2004
      • One in twenty women reported rape, nearly 75% victims reported intoxication at the time
      • Adolescent girls use alcohol more than 5 times a month, five times likelier to be sexually active
      • One third less likely to use condoms
    • 16. Societal Stereotyping
      • A woman drinking is sexually available
      • Double standard even with assault:
      • Blume: “Society considers a rapist less responsible, whereas a female victim who is intoxicated is blamed for the assault”
      • Dichotomy of madonna and fallen woman
    • 17. Gender Gap Closing
      • 1978 family analysis: protective factors, deterrents, less social pressure, fewer gender specific situations, different drinking practices
      • Gradual changes in social norms
      • More women in work force, professions, sports
      • Vocational drinking incentives
      • Feminist movement and equal rights: drinking with power, “drink like a guy, will be like a guy”
      • “ Going toe-to-toe with men is a feminist act”
      • Drinking uneasy relationship to women’s freedoms
    • 18. Drinking Patterns Changed
      • Starting age 14: over one third have drank in past month
      • More alarming: one in five had binged, five or more drinks per episode
      • Young women in twenties and early thirties more likely to drink - public place
      • Middle age and older women: ‘behind closed doors’, solitary drinking, even more stigma
      • Women have come out of the closet
    • 19. Marketing and Media Efforts
      • Liquor Companies mid-’70s : targeted women
      • Fashion magazines: splashy ads of women sipping themselves into various states of rapture
      • Jim Bean ad: “Get in touch with your masculine side”
      • TV “Sex and the City”: tossing down candy-colored cocktails at a bar
      • Seductive role models: glamorous fantasies
      • Girls today four times more likely than their mothers to begin drinking by age 16
      • NO LONGER A MAN’S DISEASE
    • 20. Evaluation
      • Needs to be earlier due to telescoping
      • Seek help as a consequence of health or family problems
      • Seen in primary care physician offices and mental health settings, not alcohol services
      • Women less likely to be diagnosed, under-represented in treatment
    • 21. Delayed Identification
      • Patient denial - more stigma “a lady doesn’t get drunk”
      • Physician denial: “she’s too much of a lady to be drunk”
      • Probability of missed diagnosis: “pt better educated, higher socio-economic status, privately insured and female”
      • Family denial: “not my mother”
      • Boss denial: women may get away with more
      • Police denial: don’t cite
      • Fewer legal and occupational consequences
      • Less organized referral programs: EAP’s, drunk driving schools
    • 22. No Gender Sensitive Tools
      • AUDIT
      • TWEAK
      • “ Do you sometimes drink alcohol beverages? If you do, please continue.”
      • T Tolerance: How man drinks does it take before you begin to feel the first effects of the alcohol? (record number of drinks)
      • 2 pts for three or more
      • W Have close friends or relatives worried or complained about your drinking in the past year?
      • 2 pts for yes
      • E Do you sometimes take a drink in the morning when you first get up?
      • 1 pt for yes for EAK
      • A Amnesia: Are there times when you drink and afterwards you can’t remember what you said or did?
      • K Cut-down: Do you sometimes feel the need to cut down on your drinking?
    • 23. Medical Considerations/Consequences
      • Same health problems: drink less, shorter period of time
      • Alcoholic liver disease: more women die from cirrhosis, alcoholic hepatitis
      • Estrogen augments alcohol’s toxicity
      • Higher at any level of consumption: relative risk 7-13 drinks vs14-27
      • Osteoporosis, cardiovascular and neurological disorders, enhanced brain damage
      • Greater toxic effects: brain mass decreased, less exposure, imaging studies grey matter smaller
      • If drinking, 75% more likely to smoke; smokers are 86% more likely to drink, greatly compounds osteoporosis risk
      • High estrogen phases and elevated levels of acetaldehyde implicated in pathogenesis
    • 24. Special Teen Risks
      • Prefrontal cortex: still maturing, substantial changes
      • Functions to assess situations, make sound decisions
      • Increased risk for poor decisions
      • Amygdala: emotional reactions, response to stress
      • Increased risk-taking behaviors
      • Hippocampus: learning and memory
      • Decreased volume, decreased learning
    • 25. Sexual and Reproductive Functioning
      • Increased risk/association: breast ca, PMS
      • Sexual arousal: dissociation between greater arousal perceived and decreased physiological/orgasmic response
      • Sobriety enhances sexual function
      • Teratogenic effects: FAS, mental retardation, spontaneous abortion
      • Infertility
      • Interferes with puberty
    • 26. Psychiatric Comorbidities
      • Mood disorders: strong association with depression: relative risk 2.6 higher for heavy drinking
      • Bipolar: odds ratio 7.35 for women compared to 2.77
      • Anxiety disorders: higher prevalence
      • High rate of sexual and physical abuse
      • PTSD greater severity and re-victimized
      • High cross addiction to prescription meds
      • Alcoholic women attempt suicide 4 times more
      • Female alcoholics death rates 50-100 times that of males
    • 27. Treatment
      • Most efficacious way: no consensus
      • Special issues/barriers: child care, transportation, custody concerns,stigmatization and loss of relationships, less access to treatment
      • Treat co-morbid conditions: physical and psychiatric
      • Addressing sexual abuse improves treatment success
      • Same facility: both sexes benefited equally
      • Female only: 2 yr follow-up: better outcomes, but had more services
      • Like morbidity, mortality greater: Lindberg et at, females five times higher expected rate as compared to 3 times for men
      • Most successful treatment starts with early, accurate diagnosis
    • 28. 12 Step Programs: AA
      • 34% Women
      • Interpret powerlessness: culturally empowered man versus sexually abused woman
      • Treatment goal: learning to take control rather than give it up
      • Women for Sobriety
      • AA women only groups
    • 29. Relapse Prevention
      • Women relapse due to negative affect and interpersonal problems, men positive feelings
      • Education about effects and risks
      • Sexual compulsivity, shopping, eating disorders
      • Familial relationships, especially with children
      • Safety issues/ family involvement
      • Vocational rehab
      • Mayo study: “the more depressed, the greater craving for alcohol”
    • 30. Prevention
      • Address misconceptions:
      • “ It won’t happen to me”
      • “ I am too young to have a problem”
      • “ I need to go out with my colleagues after work and drink, it’s part of my job”
      • “ I take medication for my depression, but drink on the week-ends, it’s no big deal”
      • “ I drink less than my boyfriend, so I can’t have a problem”
      • “ I can drink more than my boyfriend, so I can’t have a problem”
      • “ If I have a problem, everybody has a problem””
      • “ I only drink wine or beer”
    • 31. Education
      • Definition of “a drink”
      • One 12-oz bottle of beer or wine cooler
      • One five -oz glass of wine
      • 1.5 oz of 80-proof distilled spirits (hard liquor)
    • 32. Assess Risk Factors
      • Can’t change genetic liability
      • Can change “environment”
      • Decrease risk factors: safe exposure for maximum drinking limit
      • No more than 3 drinks in a day and
      • No more than 7 drinks in a week
    • 33. Conclusion
      • As prevalence converges, address women’s unique need
      • Prevention is critical
      • Education about special risks
      • Earlier interventions
      • Increase access
      • Address stigma
    • 34.
      • What’s a Standard Drink?
      • In the U.S., a standard drink is any drink that contains about 14 grams of pure alcohol (about 0.6 fluid ounces or 1.2 tablespoons) .
    • 35.  
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    • 44. B
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    • 49. NN
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    • 51.  
    • 52. Typical US Patterns of Adult Drinking
      • Never exceed daily or weekly limits
        • 2/3 have < 12 drinks/yr
        • 1% have AUD
      • Exceed only the daily limit
        • 20% have AUD
      • Exceed both daily and weekly limits
        • ~50% have AUD
      72% 16% 10%
    • 53. Conclusions
      • Women are at special risk for alcohol-related problems
      • They are also at special risk for going undiagnosed
      • Knowledge is an essential remedy for both issues
      • Unwarranted shame and stigma are the enemies of diagnosis and recovery
      • When treated, outcomes for women patients are often excellent

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