Loosening the Grip: a handbook of Alcohol Information 9th



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Women

Acierno R, Resnick HS, Flood A, Holmes M. An acute post-rape intervention to prevent substance use and abuse. Addictive Behaviors 28(9): 1701–1715, 2003. (35 refs.)


The trauma of rape is routinely associated with extreme acute distress. Such peri-event anxiety increases risk of developing psychopathology and substance use or abuse post-rape, with the degree of initial distress positively predicting future problems. Unfortunately, the nature of post-rape forensic evidence collection procedures may exacerbate initial distress, thereby potentiating post-rape negative emotional sequelae. Consequently, substance use may increase in an effort to ameliorate this distress. To address this, a two-part video intervention was developed for use in acute post-rape time frames to (a) minimize anxiety during forensic rape examinations, thereby reducing risk of future emotional problems, and (b) prevent increased post-rape substance use and abuse. Pilot study data with 124 rape victims indicated that the low-cost, easily administered intervention was effective in reducing risk of marijuana abuse at 6 weeks. Nonstatistically significant trends also were evident for reduced marijuana use. Trends were also noted in favor of the intervention in the subgroup of women who were actively using substances pre-rape (among pre-rape alcohol users, 28% viewers vs. 43% nonviewers met criteria for post-rape alcohol abuse; among pre-rape marijuana users, the rates of post-marijuana use were 17% vs. 43%). Copyright 2003, Elsevier Science

Anstey KJ, Jorm AF, Reglade-Meslin C, Maller J, Kumar R, von Sanden C, et al. Weekly alcohol consumption, brain atrophy, and white matter hyperintensities in a community-based sample aged 60 to 64 years. Psychosomatic Medicine 68(5): 778–785, 2006. (46 refs.)


Objective: The objective of this study was to determine the association between weekly alcohol consumption and brain atrophy in adults aged 60 to 64 years. Methods: Brain magnetic resonance imaging scans from 385 adults recruited through a community survey were analyzed. Automated segmentation and manual tracing methods were used to obtain brain subvolumes and automated methods were used to obtain quantification and localization of white matter hyperintensities. Visual measures of cortical atrophy were obtained as were data on health and lifestyle factors. Alcohol consumption was assessed with the Alcohol Use Disorders Identification Test. Results: In men, weekly alcohol consumption had a positive linear association with ventricular volume and gray matter and a negative linear association with white matter. In women, weekly alcohol consumption had a nonlinear relationship with cerebrospinal fluid and white matter. Alcohol consumption was not associated with white matter hyperintensities, corpus callosum size, hippocampal or amygdala volumes in analyses adjusting for confounding variables. Conclusion: An association between alcohol consumption and brain atrophy is evident at the population level. In women, detrimental effects of alcohol on the brain appear to occur at lower levels of consumption. It remains possible that low levels of alcohol consumption have neuroprotective benefits but is clear that high levels of consumption are detrimental. Copyright 2006, Lippincott, Williams & Wilkins

Ashley OS, Marsden ME, Brady TM. Effectiveness of substance abuse treatment programming for women: A review. American Journal of Drug and Alcohol Abuse 29(1): 19–53, 2003. (102 refs.)


This is a review of the literature on the extent and effectiveness of substance abuse treatment programming for women and provides an overview of what is known about the components of successful treatment programs for women. 38 studies of the effect on treatment outcomes of substance abuse treatment programming for women are reviewed. Seven were randomized, controlled trials, and 31 were nonrandomized studies. In the review, 6 components of substance abuse treatment programming for women were examined: child care, prenatal care, women-only programs, supplemental services and workshops that address women-focused topics, mental health programming, and comprehensive programming. The studies found positive associations between these 6 components and treatment completion, length of stay, decreased use of substances, reduced mental health symptoms, improved birth outcomes, employment, self-reported health status, and HIV risk reduction. Findings suggest that to improve the future health and well-being of women and their children, there is a continued need for well-designed studies of substance abuse treatment programming for women. Copyright 2003, Marcel Dekker Inc.

Blume S, Frausto T, Guschwan M, Silverman S, Trautman R, Virzi O, et al. Position statement on the care of pregnant and newly delivered women addicts. American Journal of Psychiatry 158(7): 1180, 2001. (0 refs.)


The position statement reprinted here was adopted by the American Psychiatric Association Assembly and Board of Trustees in Mach 2001. It states that "substance abuse and dependence are psychiatric disorders that often affect women of child bearing age, putting them and their offspring at risk for multiple problems. There has been a trend toward prosecuting and jailing pregnant and/or postpartum addicts or, alternatively, subjecting them to civil commitment. Such policies are likely to deter these women from seeking both prenatal care and addiction treatment. The most effective way to prevent harm to both mothers and infants to make available accessible, culturally appropriate prevention and treatment services designed specifically for adolescent girls and women." The rationale is described and four specific actions outlined: i.e,: opposition to criminal prosecution or; assuring adequate prenatal care without regard for ability to pay or fear of punitive consequences; directing of social resources to prevention and care not punitive actions; and opposition to commitment laws that are applied only to pregnant women in ways that do not apply to men. Copyright 2001, American Psychiatric Association

Burgdorf K, Chen X, Walker T, Porowski Al, Herrell JM. The prevalence and prognostic significance of sexual abuse in substance abuse treatment of women. Addictive Disorders and Their Treatment 3(1): 1–13, 2004. (41 refs.)


This paper presents findings from a longitudinal study of 3482 women who received long-term (6- to 12-month) residential substance abuse treatment in 41 federally funded treatment programs for pregnant and parenting women and their children. Consistent with previous studies, we found the prevalence of sexual abuse histories to be very high in this population (48-64%, depending on the definition), and we found many associations between sexual abuse and indicators of other maltreatment and of psychologic dysfunction -- depression, anxiety, suicide attempts, prior mental health treatment episodes, etc. However, contrary to some speculation in the literature, we did not find sexual abuse associated with any reduction in treatment retention, completion, or post-treatment abstinence from drug or alcohol use. Sexually abused clients had generally positive treatment outcomes, on a par with those seen for non-abused clients. Copyright 2004, Lippincott Williams & Wilkins

Caetano R, Ramisetty-Mikler S, Floyd LR, McGrath C. The epidemiology of drinking among women of child-bearing age. Alcoholism: Clinical and Experimental Research 30(6): 1023–1030, 2006. (52 refs.)


To estimate the prevalence of drinking, binge drinking (4 or more drinks), and alcohol abuse and dependence and to identify predictors of heavier drinking among women of child-bearing age (18-44 years). Subjects are part of a national multistage random sample from the 2002 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Binge drinking, abuse, and dependence are higher in younger (< 30 years) pregnant and nonpregnant women. Among pregnant women, binge drinking is highest among Whites; alcohol abuse and dependence rates are relatively low and similar in all racial/ethnic groups. Among nonpregnant women, Whites and mixed race women have the highest rates of binge drinking. Alcohol abuse and dependence are highest among Native Hawaiian/Pacific Islanders, followed by Native American/Alaska Native women. Women who are White, younger (21-29 years), single, or cohabiting and with a higher income (>$40,000) are at a higher risk for heavier drinking. Drinking and heavier drinking remain at high levels among women of child-bearing age. Prevention efforts must be comprehensive and should target pregnant women who are drinking and those who could become pregnant and are drinking at high-risk levels. Copyright 2006, Research Society on Alcoholism

Champion HLO, Foley KL, DuRant RH, Hensberry R, Altman D, Wolfson M. Adolescent sexual victimization, use of alcohol and other substances, and other health risk behaviors. Journal of Adolescent Health 35(4): 321–328, 2004. (55 refs.)


Purpose: To examine the relationship between substance use, other health risk behaviors, and sexual victimization among adolescent females. Methods: A cross-sectional telephone survey of 16-20-year-olds, including 647 female "ever drinkers" (1999) and 1236 female "never drinkers" and "ever drinkers" (2000) from 17 states, was conducted as part of the National Evaluation of the Enforcing Underage Drinking Laws Program. The survey assessed underage alcohol use, sexual victimization, and other risky behaviors. Logistic regression modeling was used to measure the association among sexual victimization, substance use, and other risk behaviors. Results: In 1999, 8.2% and in 2000, 7.1% of the participants reported having experienced actual or attempted sex against their will. Logistic regression analyses revealed that binge drinking in the past 2 weeks (1999), age at first drink (2000), sex without birth control (1999 and 2000), marijuana use in the past 30 days (1999 and 2000), and ever having been in a fight (2000) were associated with sexual victimization. Conclusions: Indicators of substance abuse and other health risk behaviors were strongly associated with sexual victimization among adolescent females. Implications for the direction of causal relationships are discussed. Copyright 2004, Society for Adolescent Medicine

Conners CA, Grant A, Crone CC, Whiteside-Mansell L. Substance abuse treatment for mothers: Treatment outcomes and the impact of length of stay. Journal of Substance Abuse Treatment 31(4): 447–456, 2006. (45 refs.)


This article examines the treatment outcomes of 305 women enrolled in a comprehensive, residential substance abuse treatment program for pregnant and parenting women and their children. The women were assessed at intake and three times in the year after discharge. Analyses focused on change in client functioning over time, and investigating the impact of length of stay in treatment on client outcomes. Comparisons of clients' functioning before and after treatment suggest significant improvements in a number of domains, including substance use, employment, legal involvement, mental health, parenting attitudes, and risky behaviors. For most outcome domains, results suggest that longer treatment stays are associated with more positive outcomes. Copyright 2006, Elsevier Science

Ebrahim SH, Gfroerer J. Pregnancy-related substance use in the United States during 1996–1998. Obstetrics and Gynecology 101(2): 374–379, 2003. (24 refs.)


OBJECTIVE: To provide a baseline estimate of the national prevalence of pregnancy-related illicit drug use and abstinence rates. METHODS: We analyzed data collected between 1996 and 1998 from the National Household Survey on Drug Abuse, a nationally representative sample survey of 22,303 noninstitutionalized women aged 18-44 years, of whom 1249 were pregnant. RESULTS: During 1996-1998, 6.4% of nonpregnant women of childbearing age and 2.8% of pregnant women reported that they used illicit drugs. Of the women who used drugs, the relative proportion of women who abstained from illicit drugs after recognition of pregnancy increased from 28% during the first trimester of pregnancy to 93% by the third trimester. However, because of postpregnancy relapse, the net pregnancy-related reduction in illicit drug use at postpartum was only 24%. Marijuana accounted for three-fourths of illicit drug use, and cocaine accounted for one-tenth of illicit drug use. Of those who used illicit drugs, over half of pregnant and two- thirds of nonpregnant women also used cigarettes and alcohol. Among the sociodemographic subgroups, pregnant and nonpregnant women who were young (18-30 years) or unmarried, and pregnant women with less than high school education had the highest rates of illicit drug use. CONCLUSION: The continued burden of illicit drug use during pregnancy calls for policy efforts to enable primary care providers to identify and refer women who use substances to treatment and support services. Prevention of uptake of illicit drug use should be an integral part of public health programs for young women. Copyright 2003, American College of Obstetricians and Gynecologists.

Gram IT, Braaten T, Terry PD, Sasco AJ, Adami HO, Lund E. Breast cancer risk among women who start smoking as teenagers. Cancer Epidemiology, Biomarkers & Prevention 14(1): 61–66, 2005. (37 refs.)


Objective: To examine the effect of smoking on breast cancer risk in a large population-based cohort of women, many of whom started smoking as teenagers. Methods: We followed 102,098 women, ages 30 to 50 years, completing a mailed questionnaire at recruitment to the Norwegian-Swedish Cohort Study in 1991/1992, through December 2000. We used Cox proportional hazard regression models to estimate relative risk (RR) of breast cancer associated with different measures of smoking initiation, duration, and intensity adjusting for confounding variables. We conducted analyses on the entire study population, among women who had smoked for at least 20 years, among nondrinkers, and separately for each country. Results: Altogether, 1,240 women were diagnosed with incident, invasive breast cancer. Compared with never smokers, women who smoked for at least 20 years and who smoked 10 cigarettes or more daily had a RR of 1.34 (95% CI, 1.06-1.70). Likewise, those who initiated smoking prior to their first birth (1.27, 1.00-1.62), before menarche (1.39, 1.03-1.87), or before age 15 (1.48, 1.03-2.13) had an increased risk. In contrast, women who had smoked for at least 20 years, but started after their first birth, did not experience an increased breast cancer risk. The increased RR associated with smoking was observed among nondrinkers of alcohol, women with and without a family history of breast cancer, premenopausal and postmenopausal women, and in both countries. Conclusion: Our results support the notion that women who start smoking as teenagers and continue to smoke for at least 20 years may increase their breast cancer risk. Copyright 2005, American Association of Cancer Research

Gutierres SE, Van Puymbroeck C. Childhood and adult violence in the lives of women who misuse substances (review). Aggression and Violent Behavior 11(5): 497–513, 2006. (117 refs.)


A review of the literature found that women substance misusers, more often than men, have been found to have high rates of violent victimization as children and as adults. These victims of childhood sexual and physical abuse exhibit negative psychological outcomes of low self-esteem, depression, and anxiety, and they may turn to substance use as a way to cope with these painful psychological consequences. Once women begin to use substances, their experience in the drug world, coupled with their vulnerable psychological state from childhood trauma puts them at risk for continued victimization from domestic violence, and from sexual assault. The experience of adult victimization reinforces negative feelings of low self-worth, depression and helplessness for these women which in turn leads to continued misuse and dependence on substances. Clinical implications for treatment of women with substance misuse problems are presented, and suggestions for future research are discussed. Copyright 2006, Elsevier Science

Haas AL, Peters RH. Development of substance abuse problems among drug-involved offenders: Evidence for the telescoping effect. Journal of Substance Abuse 12(3): 241–253, 2000. (35 refs.)


Purpose: The present study was designed to evaluate gender differences in the development of substance abuse disorders among drug-involved offenders and to determine whether women in this population exhibit a telescoping effect (i.e., acceleration in the progression from substance use to substance abuse), which has been observed in other settings. Method: Participants consisted of 160 polysubstance-abusing individuals (118 men, 42 women) who were admitted to two Florida drug court programs. Data were obtained from the Addiction Severity Index, intake interviews, and archival court records. Results: Female and male offenders differed significantly in the developmental trajectory of their addiction. Women offenders initiated alcohol and marijuana use significantly later in life than their male cohorts but began using cocaine earlier in the course of their addiction. Women also reported more problems related to cocaine use and significantly more prior treatment episodes. Women were found to have a shorter latency from first use of cocaine to cocaine abuse. Findings are consistent with those of previous studies examining gender differences among individuals referred for substance abuse treatment. Future directions for research and implications for treatment planning are discussed. Copyright 2000, Ablex Publishing Corp.

Hommer DW, Momenan R, Kaiser E, Rawlings RR. Evidence for a gender-related effect of alcoholism on brain volumes. American Journal of Psychiatry 158(2): 198–204, 2001. (29 refs.)

Hser YI, Niv N. Pregnant women in women-only and mixed-gender substance abuse treatment programs: A comparison of client characteristics and program services. Journal of Behavioral Health Services & Research 33(4): 431–442, 2006. (31 refs.)
This study compared characteristics of pregnant women treated in women-only (WO) and mixed-gender (MG) substance abuse treatment programs and compared services provided by these two types of programs. Participants were 407 pregnant women who were admitted to 7 WO programs and 29 MG programs in 13 counties across California during 2000-2002. Pregnant women treated in WO programs demonstrated greater severity in drug use, legal problems, and psychiatric problems than those treated in the MG programs. They were also less likely to be employed and more likely to be homeless. Women-only programs were more likely to offer child care, children's psychological services, and HIV testing. The greater problem severity of pregnant women treated in WO programs suggests that these specialized services are filling an important gap in addiction services, although further expansion is warranted in psychiatric, legal, and employment services. (Copyright 2006, Springer)

Kaskutas LA, Graves K. Pre-pregnancy drinking: How drink size affects risk assessment. Addiction 96(8): 1199–1209, 2001. (26 refs.)


Aims. We considered the role of drink size in determining average daily consumption among groups at risk for Fetal Alcohol Syndrome. Design. In-person hour-long interviews gathered cross-sectional retrospective data about drinking before an index pregnancy. Setting. Subjects were recruited at public clinics in Los Angeles and the San Francisco Bay area. To reach those not necessarily seeking prenatal care, community outreach in the same urban areas was undertaken. Participants: Three hundred and twenty-one pregnant women were interviewed: 102 Native Americans, 185 African Americans, and 34 Caucasians. Measurements. Volume of drinking prior to pregnancy was assessed using the graduated frequency series, which asks respondents to specify their drinking in terms of standard drinks. Using vessel models and photographs, respondent-defined drink sizes were then determined, and volume was recalculated accordingly. Findings: For most beverages, the difference in milliliters between self-selected drink size and a standard size drink was significant, with the mean self-selected drink sizes ranging from 49% above the standard size (for beer) to 307% above the standard size (for spirits). For women whose pre-pregnancy average daily volume (ADV) was at the risk level of greater than or equal to1 standard drink per day, ADV increased from four to almost 10 standard drinks per day when self-defined drink sizes were instead considered. Similarly, for women having three or more standard drinks a day, their daily dose of ethanol increased from 57 g to 153 g of ethanol per day. Conclusions. If risk levels have been based on underestimates that assume women with alcohol-affected infants had standard drink sizes, then true risk levels may be higher than previously thought. Related, risk drinkers presenting at prenatal clinics may be missed if screening protocols do not ask about drink size. Copyright 2001, Society for the Study of Addiction to Alcohol and Other Drugs

Manwell LB, Fleming MF, Mundt MP, Stauffacher EA, Barry KL. Treatment of problem alcohol use in women of childbearing age: Results of a brief intervention trial. Alcoholism: Clinical and Experimental Research 24(10): 1517–1524, 2000. (38 refs.)


Background: Studies suggest that 14% of women age 18 to 40 drink alcohol above recommended limits. Of special concern is the increasing use of alcohol by women during pregnancy. This article reports 48 month follow-up data from a subanalysis of a trial for early alcohol treatment (Project TrEAT) focused on women of childbearing age. Methods: Project TrEAT was conducted in the offices of 64 primary care, community-based physicians from 10 Wisconsin counties. Of 5979 female patients ages 18 to 40 who were screened for problem drinking, 205 were randomized into an experimental group (n = 103) or control group (n = 102). The intervention consisted of two 15 min, physician- delivered counseling visits that included advice, education, and contracting by using a scripted workbook. A total of 174 subjects (85%) completed the 48 month follow-up procedures. Results: No significant differences were found between the experimental and control groups at baseline for alcohol use, age, socioeconomic status, smoking, depression or anxiety, conduct disorder, lifetime drug use, or health care utilization. The trial found a significant treatment effect in reducing both 7 day alcohol use (p = 0.0039) and binge drinking episodes (p = 0.0021) over the 48 month follow-up period. Women in the experimental group who became pregnant during the follow-up period had the most dramatic decreases in alcohol use. A logistic regression model based on a 20% or greater reduction in drinking found an odds ratio of 1.93 (confidence interval 1.07-3.46) in the sample exposed to physician intervention. Age, smoking, depression, conduct disorder, antisocial personality disorder, and illicit drug use did not reduce drinking significantly. No significant differences were found in health care utilization and health status between groups. Conclusions: This trial provides the first direct evidence that brief intervention is associated with sustained reductions in alcohol consumption by women of childbearing age. The results have enormous implications for the U.S. health care system. Copyright 2000, Research Society on Alcoholism

Porowski AW, Burgdorg K, Herrell JM. Effectiveness and sustainability of residential substance abuse treatment programs for pregnant and parenting women. Evaluation and Program Planning 27(2): 191–198, 2004. (16 refs.)


This paper summarizes outcome findings from an evaluation of residential treatment projects funded by the Center for Substance Abuse Treatment (CSAT), in the Substance Abuse and Mental Health Services Administration, under its Residential Women and Children and Pregnant and Postpartum Women demonstration programs. It first examines client-level treatment outcomes as indicated by pre-post changes in drug and alcohol use, criminal involvement, economic well-being, parenting success, and other important outcome dimensions. Post-treatment status was assessed through interviews administered 6 months after discharge to a sample of approximately 1200 former clients from 32 treatment sites. The paper also examines projects' success in obtaining continuation funding after the initial 5-year CSAT grant ended. Project sustainability provides another major indicator of the perceived value and effectiveness of the treatment program's services. Key findings were that a majority of former clients (61%) reported being completely drug- and alcohol-free throughout the follow-up period, large pre-post improvements were noted in other important areas of client and family functioning, and most of the projects begun with CSAT seed-money support (92%) were able to continue operations after the grant support ended. (Copyright 2004, Elsevier Science)

Redgrave GW, Swartz KL, Romanoski AJ. Alcohol misuse by women (review). International Review of Psychiatry 15(3): 256–268, 2003. (146 refs.)


Alcohol misuse among women is an important and growing problem. There is epidemiological and metabolic evidence that risk factors for and consequences of alcohol misuse are significantly different for women than for men. Understanding these differences is imperative if effective preventative and treatment interventions are to be undertaken. This article reviews the epidemiology of alcohol misuse by women, effects of alcohol misuse on women, fetuses, and relationships, and assessment and treatment strategies. We then suggest directions for future research in this field. (Copyright 2003, Carfax Publishing)

Saules KK, Pomerleau CS, Snedecor SM, Mehringer AM, Shadle MB, Kurth C, et al. Relationship of onset of cigarette smoking during college to alcohol use, dieting concerns, and depressed mood: Results from the Young Women’s Health Survey. Addictive Behaviors 29(5): 893–899, 2004. (15 refs.)


To investigate the issue of smoking initiation during college, we administered a survey of women's health behavior to college women during freshman orientation, at the end of their freshman year and again during their senior year. Never smokers (NS; n=374), early-onset smokers (EOS; n=52), and late-onset smokers (LOS; n=64) were compared on dieting concerns, mood problems, alcohol-related problems, and frequency of binge drinking episodes. By the senior year of college, 55% (64/116) of those who had smoked in the past month had started smoking during college, although they were more likely than never smokers to have experimented with cigarettes prior to college. Escalating depression during the first year of college, dieting concerns, and alcohol-related problems were significant risk factors for smoking initiation during college, while binge drinking appeared to covary with cigarette smoking. Results suggest that prevention efforts should target nonsmokers with high dieting concerns and escalating depression early in college, while intervention efforts may need to target not only smoking but also problematic alcohol use among smoking college women. (Copyright 2004, Elsevier Science Ltd)

Simoni-Wastila L, Ritter G, Strickler G. Gender and other factors associated with the nonmedical use of abusable prescription drugs. Substance Use & Misuse 39(1): 1–23, 2004. (47 refs.)


Although there is extensive research on gender differences in the use of alcohol and illicit substances, few studies have examined gender differences in nonmedical prescription drug use. Using data from the 1991 National Household Survey on Drug Abuse (NHSDA), based on a sample of 3185 persons, logistic regression analysis is employed to determine how gender and other factors affect the likelihood of past-year nonmedical prescription drug use. Analysis revealed that women are significantly more likely than men to use any prescription drug, and that this gender difference is primarily driven by women's increased risk for narcotic analgesic and minor tranquilizer nonmedical use. Other factors, such as race, age, health status, and other substance use, also are significant predictors of nonmedical use. Findings from this study will enable researchers, policy makers, and providers to have a greater understanding of nonmedical drug use patterns and support greater gender sensitivity in the prevention, education, and treatment of nonmedical prescription drug use. (Copyright 2004, Marcel Dekker, Inc)

Sorocco KH, Ferrell SW. Alcohol use among older adults. Journal of General Psychology 133(4): 453–467, 2006. (46 refs.)


Alcohol use problems among older adults have been called the "invisible epidemic." As the population of older adults continues to grow, there is an increased need to reexamine alcohol use in this population. The authors provide an overview on alcohol use in the over-60 age group. The main areas of focus included research on the prevalence of drinking in that population, as well as comments on the best practices in assessment and psychological treatment. Several screening assessments have been recommended for use with older adults, such as the CAGE questionnaire, Michigan Alcohol Screening Test-Geriatric version, Alcohol-Related Problems Survey, and the Alcohol Use Disorders Identification Test. The authors note age-appropriate psychological treatment interventions that include brief interventions, family interventions, motivational counseling, and cognitive behavioral therapies. Barriers to assessment and treatment are also discussed. Copyright 2006, Heldref Publishing

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