C A P T A S A

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C A P T A S A Clinical Applications of the
Principles in Treatment of Alcoholism and
Substance Abuse The 8th Annual  CAPTASA
ConferenceJanuary 25 - 26, 2008 Embassy
SuitesLexington, Kentucky
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Gender Differences in Chemical Dependence
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Fact Sheet
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Fact Sheet

• Alcoholism is a problem for both men and women.
• But it is a disease that affects women
  physically, emotionally, and psychologically
  differently than men.
• Women make up one of the fastest growing
  substance-abuse populations in the united states.
• Women with alcohol problems are more at risk of
  heart disease, cancer, liver disorders, loss of
  personal relationships, abusive relationships,
  and suicide.
• Women alcoholics tend to drink to escape feelings
  of loneliness, to become more comfortable with
  their sexuality, and because of depression.

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Fact Sheet

• Studies have shown that 70 percent or more of
  addicted women have been traumatized by verbal or
  physical abuse.
• Substance abuse in women not only has adverse
  affects on their own lives and health but also on
  their children, families, and communities.
• These ties to the family and community are often
  what keeps women from entering treatment.
• Aside from the shame many women alcoholics feel
  for having a drinking problem, often a family is
  oblivious to the problems of its matriarch.
  There's no time for mom, sis, or wife to get
  sick, fall apart, or go into treatment.

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Alcohol Use

• 77.6 of women age 12 and older reported ever
  using alcohol, while 60 reported past year use
  and 45.1 reported using alcohol in the past
  month.
• 82.5 of white women reported ever using alcohol,
  while 65 reported past year use and 49.7
  reported using alcohol in the past month.
• 67.9 of black women reported ever using alcohol,
  while 45.1 reported past year use and 32.3
  reported using alcohol in the past month.
• 60.8 of Hispanic women reported ever using
  alcohol, while 48.4 reported past year use and
  33.6 reported using alcohol in the past month.

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Alcohol Use

• Men and women reported different levels of
  alcohol involvement. 58.7 of men age 12 and
  older reported past month alcohol use compared to
  45.1 of women, while 23.2 of men age 12 and
  older reported binge drinking in the past month
  compared to 8.6 of women
• Among current female drinkers, 7.16 of whites,
  10.22 of blacks, 22.16 of American
  Indians/Alaska native, and 9.03 of Hispanics
  reported alcohol dependence

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The disease is often progressive and fatal.
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What is a Drink?

• A standard drink is
• One 12-ounce beer
• One 5-ounce glass of wine
• 1.5 ounces of 80-proof distilled spirits
• The alcohol content of different types of beer,
  wine and distilled spirits can vary widely.

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Health

• Women absorb and metabolize alcohol differently
  than men.
• Alcohol consumption is associated with a linear
  increase in breast cancer incidence in women over
  the range of consumption reported by most women.
  A pooled analysis of several studies found breast
  cancer risk was significantly elevated by 9 for
  each 10-grams per day increase in alcohol intake
  for intakes up to 60 grams per day.
• 1.5 liters lite beer, .75 liters beer, .4 liters
  wine or.1liter distilled spirits equal 30 grams
  of alcohol.

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Health

• Although the mean lifetime dose of alcohol in
  female alcoholics is only 60 of that in male
  alcoholics, one study noted that cardiomyopathy
  (a degenerative disease of the heart muscle) and
  myopathy (a degenerative disease of skeletal
  muscle) was as common in female alcoholics as in
  males. The study concluded that women are more
  susceptible than men to the toxic effects of
  alcohol on the heart muscle.

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Health

• Brain shrinkage in men and women was found to be
  similar despite significantly shorter periods of
  alcohol exposure or drinking histories in women.
• Women with chronic pancreatitis have shorter
  drinking histories than that of men. Women with
  alcoholic hepatitis and cirrhosis were found to
  have consumed less alcohol per body weight per
  day than men. These findings indicate that women
  are more vulnerable to alcoholic liver disease
  than men.

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Health

• Although alcohol problems are more common in male
  trauma patients, women with alcohol problems are
  just as severely impaired, have at least as many
  adverse consequences of alcohol use, and have
  more evidence of alcohol-related physical and
  psychological harm.

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Suicide

• One study showed that 40 of alcoholic women
  attempted to commit suicide, compared to 8.8 of
  non-alcoholic women.
• Younger women who are alcoholics are nearly twice
  as likely to attempt to commit suicide (50.5)
  than older women who are alcoholics (25.5).
• A study of suicides among females in New Mexico
  found that 65.5 of the decedents had alcohol or
  drugs present in their blood at the time of
  autopsy.

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Use During Pregnancy

• Since 1990 the Dietary Guidelines for Americans
  have stated that women who are pregnant or
  planning to become pregnant should not drink
  alcohol.
• A national survey found that 58.8 of women age
  15-44 drank while pregnant.
• 65.8 of pregnant women in their first trimester
  reported using alcohol, while 56.6 of women in
  their second trimester and 53.9 of women in
  their third trimester reported alcohol use.

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Victimization

• 57 of female victims of intimate violence (i.e.,
  current or former spouses, boyfriends, etc.)
  reported that the offender had been drinking at
  the time of the offense.
• 62 of female victims of alcohol-related violence
  reported experiencing some form of injury.

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Criminal Behavior

• An estimated 4 in 10 women committing violence
  were perceived by the victim as being under the
  influence of alcohol and/or drugs at the time of
  the crime.
• An estimated 25 of women on probation, 29 of
  women in local jails, 29 of women in state
  prisons, and 15 of women in federal prisons had
  been consuming alcohol at the time of the
  offense.

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Drinking and Driving

• Women are less likely than men to be involved in
  fatal alcohol-related crashes. However, from 1977
  to 1997 the number of male drivers involved in
  alcohol-related fatal traffic crashes decreased
  31, while the number of females drivers involved
  in alcohol-related fatal crashes has increased
  12.

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Moderate Drinking

• Moderation is defined as no more than one drink
  per day for women.
• One drink is 12 ounces of regular beer, 5 ounces
  of wine, and 1.5 ounces of 80-proof distilled
  spirits.

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Alcohol and Women
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Alcohol and Women

• Much of our knowledge of alcoholism has been
  gathered from studies conducted with a
  predominance of male subjects.
• Recent studies involving more female subjects
  reveal that drinking differs between men and
  women.

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Alcohol and Women

• Drinking behavior differs with the age, life
  role, and marital status of women.
• In general, a woman's drinking resembles that of
  her husband, siblings, or close friends.
• Whereas younger women (aged 18-34) report higher
  rates of drinking-related problems than do older
  women.
• The incidence of alcohol dependence is greater
  among middle-aged women (aged 35-49).

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Alcohol and Women

• Women who have multiple roles (e.g., married
  women who work outside the home) may have lower
  rates of alcohol problems than women who do not
  have multiple roles . In fact, role deprivation
  (e.g., loss of role as wife, mother, or worker)
  may increase a woman's risk for abusing alcohol.
• Women who have never married or who are divorced
  or separated are more likely to drink heavily and
  experience alcohol-related problems than women
  who are married or widowed. Unmarried women
  living with a partner are more likely still to
  engage in heavy drinking and to develop drinking
  problems.

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Greater Physiological Impairment

• Women become intoxicated after drinking smaller
  quantities of alcohol than are needed to produce
  intoxication in men. Three possible mechanisms
  may explain this response.
• First, women have lower total body water content
  than men of comparable size.
• Second, diminished activity of alcohol
  dehydrogenase (the primary enzyme involved in the
  metabolism of alcohol) in the stomach.
• Third, fluctuations in gonadal hormone levels
  during the menstrual cycle may affect the rate of
  alcohol metabolism, making a woman more
  susceptible to elevated blood alcohol
  concentrations at different points in the cycle.

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Heightened Vulnerability

• Chronic alcohol abuse exacts a greater physical
  toll on women than on men. Female alcoholics have
  death rates 50 to 100 percent higher than those
  of male alcoholics. Further, a greater percentage
  of female alcoholics die from suicides,
  alcohol-related accidents, circulatory disorders,
  and cirrhosis of the liver.
• Increasing evidence suggests that the detrimental
  effects of alcohol on the liver are more severe
  for women than for men.
• Women develop alcoholic liver disease,
  particularly alcoholic cirrhosis and hepatitis,
  after a comparatively shorter period of heavy
  drinking and at a lower level of daily drinking
  than men.
• Proportionately more alcoholic women die from
  cirrhosis than do alcoholic men.

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Heightened Vulnerability

• The exact mechanisms that underlie women's
  heightened vulnerability to alcohol-induced liver
  damage are unclear.
• Drinking also may be associated with an increased
  risk for breast cancer. After reviewing
  epidemiological data on alcohol consumption and
  the incidence of breast cancer, Longnecker and
  colleagues reported that risk increases when a
  woman consumes 1 ounce or more of absolute
  alcohol daily. Increased risk appears to be
  related directly to the effects of alcohol

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Heightened Vulnerability

• According to the journal of the American medical
  Association "alcohol consumption is associated
  with a linear increase in breast cancer incidence
  in women over the range of consumption reported
  by most women. Among women who consume alcohol
  regularly, reducing alcohol consumption is a
  potential means to reduce breast cancer risk."

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Heightened Vulnerability

• Women tend to develop brain "shrinkage" and
  damage to their memory capabilities much faster
  than their male counterparts who drink.
• The researchers found that while male alcoholics,
  sober for three weeks, showed signs of brain
  "shrinkage" compared with healthy men, the
  difference between alcoholic and healthy women
  was much greater.

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Heightened Vulnerability

• Brain damage to females occurs much sooner than
  with men and shows up even in teen-age drinkers.
• Remembering information, solving spatial problems
  like working with maps or puzzles, and doing
  mental arithmetic were less accurate in
  heavy-drinking youth.

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Alcohol Hormones and Women
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Alcohol Hormones and Women

• Hormones control four major areas of body
  function
• Production, utilization, and storage of energy
• Reproduction
• Maintenance of the internal environment (e.g.,
  blood pressure and bone mass)
• And growth and development.

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Alcohol Hormones and Women

• By interfering with hormone actions, alcohol can
• Alter blood sugar levels and exacerbate or cause
  diabetes.
• Impair reproductive functions.
• Interfere with calcium metabolism and bone
  structure, increasing the risk of osteoporosis.
• Conversely, hormones also may affect alcohol
  consumption by influencing alcohol-seeking
  behavior.

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Alcohol Impairs Reproductive Functions

• In women, hormones promote the development of
  secondary sexual characteristics, such as breast
  development and distribution of body hair
  regulate the menstrual cycle and are necessary
  to maintain pregnancy chronic heavy drinking can
  interfere with all these functions.
• Its most severe consequences in both men and
  women include inadequate functioning of the
  testes and ovaries, resulting in hormonal
  deficiencies, sexual dysfunction, and
  infertility.

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Alcohol Impairs Reproductive Functions

• In premenopausal women, chronic heavy drinking
  can contribute to a multitude of reproductive
  disorders. These include cessation of
  menstruation, irregular menstrual cycles,
  menstrual cycles without ovulation, early
  menopause, and increased risk of spontaneous
  abortions
• These dysfunctions can be caused by alcohol's
  interfering directly with the hormonal regulation
  of the reproductive system or indirectly through
  other disorders associated with alcohol abuse,
  such as liver disease, pancreatic disease,
  malnutrition, or fetal abnormalities

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Alcohol Impairs Calcium Metabolism and Bone
Structure

• Calcium exists in two forms in the body. The main
  reservoirs are the bones and teeth, where the
  calcium content determines the strength and the
  stiffness of the bones. The rest of the body's
  calcium is dissolved in the body fluids. Calcium
  is important for many body functions, including
  communication between and within cells. The
  overall calcium levels depend on how much calcium
  is in the diet, how much is absorbed into the
  body, and how much is excreted. Calcium
  absorption, excretion, and distribution between
  bones and body fluids are regulated by several
  hormones, namely parathyroid hormone (PTH)
  Vitamin d-derived hormones And calcitonin, which
  is made by specific cells in the thyroid

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Alcohol Impairs Calcium Metabolism and Bone
Structure

• Acute alcohol consumption can lead to a transient
  PTH deficiency and increased urinary calcium
  excretion, resulting in loss of calcium from the
  body
• Chronic heavy drinking can disturb vitamin D
  metabolism, resulting in inadequate absorption of
  dietary calcium

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Alcohol Impairs Calcium Metabolism and Bone
Structure

• Alcohol is directly toxic to bone-forming cells
  and inhibits their activity
• Chronic heavy drinking can adversely affect bone
  metabolism indirectly, for example by
  contributing to nutritional deficiencies of
  calcium or vitamin D
• Liver disease and altered levels of reproductive
  hormones, both of which can be caused by alcohol,
  also affect bone metabolism

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Osteoporosis

• Calcium deficiency can lead to bone diseases,
  such as osteoporosis.
• Osteoporosis is characterized by a substantial
  loss of bone mass and, consequently, increased
  risk of fractures. It affects 4 million to 6
  million mainly older Americans, especially women
  after menopause.
• In alcoholics, the risk of osteoporosis is
  increased.
• Because many falls are related to alcohol use
  adverse alcohol effects on bone metabolism pose a
  serious health problem.

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Hormones May Influence Alcohol-seeking Behavior

• The effects of alcohol on different hormonal
  pathways may in turn influence alcohol-seeking
  behavior.
• For example, in animals, alcohol-seeking behavior
  appears to be regulated in part through a system
  called the renin-angiotensin system, which
  controls blood pressure and salt concentrations
  in the blood. In rats, activation of this system
  through alcohol consumption caused the animals to
  reduce their alcohol intake. The mechanism and
  relevance of this effect are currently under
  investigation.

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Treatment

• Should It Be Different?

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Treatment Issues For Women

• Researchers have begun to examine whether women
  and men require distinct treatment approaches. It
  has been suggested that women alcoholics may
  encounter different conditions that facilitate or
  discourage their entry into treatment.

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Treatment Issues For Women

• Women represent 25.4 percent of alcoholism
  clients in traditional treatment centers in the
  United States. Although it appears that they
  comprise a small proportion of the treatment
  population (25 percent women compared with 75
  percent men), the proportion of female alcoholics
  to male alcoholics in treatment is similar to the
  proportion of all female alcoholics to male
  alcoholics (30 percent women to 70 percent men).

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Treatment Issues For Women

• In addition, women drinkers pursue avenues other
  than traditional alcoholism programs, such as
  psychiatric services or personal physicians, for
  treatment.
• Women alcoholics may encounter motivators and
  barriers to seeking treatment that differ from
  those encountered by men. Women are more likely
  to seek treatment because of family problems, and
  they often are encouraged by parents or children
  to pursue therapy.
• Men usually are encouraged to pursue therapy by
  their wives.

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Treatment Issues For Women

• Fewer women than men reach treatment through the
  criminal justice system or through employee
  assistance programs
• Lack of child care is one of the most frequently
  reported barriers to treatment for alcoholic
  women
• Studies that have attempted to compare treatment
  outcome between men and women and reported that,
  among those who completed treatment, abstinence
  was slightly higher among women than among men.
  Women had a higher abstinence rate if treated in
  a medically oriented alcoholism facility, whereas
  the abstinence rate was higher for men treated in
  a peer group-oriented facility

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Treatment Issues For Women

• Studies have been done that show men do much
  better in group therapy with women. They have a
  tendency to process their feelings more. Women
  help that. Men do more data processing in groups
  with only other men. With women in the group,
  they open up about feelings. Women, however, do
  much better in groups of only women because it
  allows them to focus on themselves and their own
  healing. The focus is no longer about taking care
  of the men. In addition, women feel safer
  discussing their abuse or even their hormonal
  changes in the presence of only women.

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Treatment Issues For Women

• Treatment outcome was better for women treated in
  a facility with a smaller proportion of female
  clients and better for men in a facility with a
  larger proportion of female clients. This study
  provided preliminary data on gender-specific
  treatment outcome However, the trials were not
  controlled. Although the question of whether
  women should have separate treatment
  opportunities is an important one, the supporting
  evidence still has not been found.

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Greater Risks for Women

• Health problems are not the only risks
• She wakes up groggy with a tremendous hangover,
  then makes a startling discovery. She is not in
  her own room, not in her own bed, and not alone.
• Oh, no! I'm in bed with a man! How did I get
  here? I don't remember. Did we have sex? We must
  have! Did he use protection? Could I be pregnant?
  Could I have a sexually transmitted disease?
• How did this happen? Everybody else was drinking
  and apparently having a good time. She was not
  drinking any more or less than her companion, and
  he seemed to be in control. How did she get so
  out of it?

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Suggested Readings

• Alcohol A Womens Health Issue U.S. Department
  of Health and Human Services NIH, NIAAA NIH
  Publication No. 03-4956
• http//alcoholism.about.com/msubwomen.htm

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Summarizing

• Like men, women have used alcohol throughout
  history. But alcohol does not affect men and
  women in the same ways. Recent research shows
  that women respond to alcohol in many ways
  differently than men. For example

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• Women experience greater impairment than men with
  equivalent doses of alcohol. This includes
  reduced motor coordination, judgment, emotional
  control and reasoning.
• Depending on the point in their menstrual cycles,
  women may get drunk faster and stay drunk longer
  than men. This is because estrogen causes alcohol
  to be more quickly absorbed into the bloodstream,
  but slows down its metabolism from the body.
• Similarly, women who use oral contraceptives
  (birth control pills) experience the
  aforementioned effects of estrogen on alcohol
  absorption and metabolism.
• Alcohol can disrupt or change the menstrual cycle
  and can therefore affect a woman's fertility
  (ability to conceive).

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• Alcohol increases a woman's risk for breast
  cancer.
• Women experience the damaging effects of chronic
  alcohol use more severely and usually more
  rapidly than men.
• Alcohol use during pregnancy puts the unborn
  child at risk of Fetal Alcohol Syndrome or Fetal
  Alcohol Effects-a collection of damaging and
  unalterable consequences that may affect
  physical, emotional, cognitive and social
  functioning.
• Alcohol interferes with several processes of
  aging. For example, alcohol may create more
  extreme changes during menopause alcohol also
  increases risk of osteoporosis because it
  interferes with absorption of calcium, resulting
  in greater loss of bone density.

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Whether or not a woman drinks abusively or is
addicted to alcohol, the impairment alcohol
causes in the context of a single drinking
episode puts her at risk of rape and other acts
of violence. Consider the following
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• More than 60 of STDs and unplanned pregnancy
  among college students result from sexual
  encounters while one or both partners are
  drinking-interfering with adequate sexual
  decision-making and practices of personal
  protection.
• More than 75 of acquaintance rape and 60 of
  stranger rape involve alcohol- either the
  perpetrator and/or the woman are drinking.
• Law enforcement agencies associate the majority
  of domestic violence, including wife battering
  and child abuse, to alcohol.
• Alcohol renders a man less capable of suppressing
  impulses toward violence it makes women less
  able to perceive behavioral cues to potential
  violence and less able to protect themselves from
  violence in progress.

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• Women who are alcoholic frequently have a
  different experience than male alcoholics. For
  example Alcoholism in women is generally
  diagnosed at more advanced stages than it is in
  men, delaying the onset of treatment. This
  probably occurs because women are more discreet
  about their abusive drinking than men and tend to
  be more isolated in their drinking.
• Women are more likely than men to experience
  poly-addiction-they are addicted to more than one
  substance-which complicates treatment.

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• Treatment for women is more often complicated by
  other psychiatric problems such as eating
  disorders or mood disorders (e.g., Depression or
  anxiety).
• Because of employment, economic and family
  factors, women have less access to treatment than
  men. Moreover, there are few treatment programs
  available for women only, which complicates
  treatment for those women with sexual abuse in
  their history.

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HRT, Drinking and Breast Cancer One Drink a Day
Ups Breast Cancer Risk Female Drinking Brain
Damage Dangers Increase for Women Binge
Drinkers Women Get Worse Hangovers Than
Men Females Become Addicted Quicker, Easier Women
Who Drink Heavily More Like to Experience Mental
Illness Young Drug Users at Risk for Sexually
Transmitted Infections Heart Risk Greater for
Women Drinkers Wives of Alcoholics More Likely to
Drink
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