Alcohol Use Disorder in Women

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Women have lower rates of alcohol abuse and dependency than their male counterparts, 1.5% overall and 1.5% in older adult women (Mouton and Espino, 1999) (Box 49-7). Women generally enter treatment later than men and have more psychiatric symptoms. Women seem to develop many pathologic effects of alcohol more rapidly than men (Blume and Zilberman, 2005), including fatty liver, hypertension, anemia, malnutrition, GI hemorrhage, and peptic ulcer requiring surgery (Zweben, 2009). For women, five to seven drinks daily is sufficient to cause significant disease progression.

Box 49-7 Women Alcoholics

Lower rates of abuse than men. More hidden drinking than men. TWEAK screening better than CAGE.

Less alcohol consumption than men may cause significant disease progression.

Treatment in all-women program is preferred.

Nonmedical use of prescription drugs in general and opioids in particular has been identified as a significant problem since the late 1990s. Women also have higher associated rates with first use of illicit drugs after age 24, serious mental illness, and cigarette smoking (Tetrault et al., 2008). Comorbid conditions for women include drug addiction, sexual abuse, intimate partner violence, borderline personality disorder, eating disorders, mood disorders and anxiety disorders, and HIV infection. Women who drink alcohol may be more sensitive to the behavioral effects of concomitant cocaine use (Zweben, 2009).

Family physicians generally detect alcohol use disorders in women later than in male alcoholics. Screening tests (e.g., CAGE) have less sensitivity in women and need to be interpreted differently, usually with lower cutoff points. This difference may result from the lower volume of alcohol consumed and the social stigmatization of these women (Bradley et al., 1998). Screening tests such as the TWEAK have performed better than the CAGE in women. It is important for physicians to educate women about their greater risk, even highly educated patients (Green et al., 2007). Incarcerated women often begin using drugs and alcohol at very young ages and frequently require significant educational and job-training support to make successful transitions to recovery (Zweben, 2009). Women may have better treatment outcomes if referred to all-women programs or programs specializing in women's addictions (Hodgkins et al., 1997).

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