Gender and psychiatric comorbidity: impact on clinical presentation of alcohol dependence

We examined differences in clinical presentation for outpatient alcohol treatment in: 1) males and females, considering comorbidity; and 2) three comorbid groups, considering gender. Drinking indices and emotional, physical, and sexual abuse reports were compared in 127 male and 69 female alcohol-dependent patients who have a current (36.2%) or lifetime (20.4%) psychiatric disorder or who never had a psychiatric disorder (43.4%). Females reported more emotional and physical abuse than males. Females reported drinking smaller volumes of alcohol but on more days than males. All with current comorbidity, irrespective of gender, reported more days of heavy drinking than other groups. When evaluating drinking status, gender and comorbidity should be considered.     

Progression through early drinking milestones in an adolescent treatment sample

Aims Research using nationally representative and community samples demonstrates a robust association between early onset of drinking and increased likelihood of numerous adverse outcomes. However, little is known about the subsequent drinking that occurs early in the drinking career. The present study dissects the transition from any alcohol use to treatment entry by taking a fine‐grained approach to examining the attainment and progression of drinking events in a sample of adolescents in substance use treatment. Design/Setting Data were taken from the Drug Abuse Treatment Outcome Study for Adolescents (DATOS‐A), a multi‐site, community‐based study of adolescents entering treatment. Participants Respondents included 3331 youth aged 12–18 years (mean = 15.75) admitted to treatment in 1993–95 (74% male, 52% white, 24% African American, 20% Hispanic). Measurements Age of attainment was obtained for five drinking‐related milestones, including first drink of alcohol, first time drunk, first monthly drinking, first drank five or more drinks/day on a weekly basis and first drank five or more drinks/day on a daily basis. Findings Most milestones were attained at a very early age, and average progression through adjacent drinking events was relatively swift, Movement through early drinking milestones was accelerated in girls and white youth. Youth who reported their first drink at an early age (age 10 or younger) showed slower progression, suggesting the existence of distinct processes underlying early use and drinking transitions within an individual. Conclusions This study provides data relevant to understanding drinking progression/natural history in a large clinical sample, especially for differences by gender and ethnicity. The findings have implications for the identification of intermediate stages that might benefit from selected intervention programs.     

Comorbid psychiatric disorders predict and influence treatment outcome in female alcoholics

Drinking patterns, psychiatric comorbidity and personality disorders (PD) at intake and at a 2-year follow-up were studied in 120 female alcoholics early in their treatment career. At follow-up, the women had improved their drinking patterns, but their mental health still differed significantly from women of the general population. Psychiatric comorbidity at intake correlated with a significantly worse drinking and mental health outcome. Subjects with high scores on phobias more frequently dropped out of treatment and thereby had a worse drinking outcome. Subjects with depression at follow-up also had a poorer drinking outcome, as well as subjects with schizoid PD. When tested by multivariate analyses, only depression at follow-up contributed significantly to the increased explained variance in drinking outcome when controlling for drinking pattern and treatment duration.     

Predictors of Mortality in Alcoholic Women: A 20-Year Follow-Up Study

Very little is known about the factors that predict mortality in female alcoholics. This study investigates these predictors in 103 female alcoholics who were psychiatrically hospitalized between 1967 and 1968 and followed for over 20 years. The findings showed that age, benders, and/or delirium tremens, comorbidity, and 3-year posttreatment drinking status were associated with time to death. That older alcoholics and those with pathological drinking within 3 years after treatment had a significantly shorter time to death was not surprising. However, the association of benders with mortality indicated that women may be very sensitive to short periods of high concentrations of alcohol. Comorbidity also had an intriguing effect in that women with a history of depression were more likely to survive. The predictors of mortality in these female alcoholics differed from those of the male alcoholics in this sample. These differences will be discussed in future publications.     

Morbidity after long-term remission for acromegaly: persisting joint-related complaints cause reduced quality of life

Active acromegaly is associated with significant comorbidity and reduced quality of life. However, the prevalence of comorbidity after long-term remission is not established. Therefore, we assessed the presence of comorbidity in 118 patients in long-term remission after surgery, radiotherapy, and/or somatostatin analog treatment according to strict biochemical criteria of serum GH and IGF-I concentrations and evaluated the impact of comorbidity on quality of life. The mean duration of remission was 12.0 +/- 7.4 yr, and mean actual IGF-I sd scores were 0.6 +/- 1.7. Self-reported joint problems occurred in 77% of patients, hypertension in 37%, a history of myocardial infarction in 9%, and diabetes mellitus in 11%. The presence of joint problems was not related to GH and IGF-I levels, active disease duration, or age. Joint complaints had significant negative impact on quality of life. Patients with a history of myocardial infarction had reduced scores for general health, depression, and fatigue, and diabetes mellitus was associated with reduced scores for anxiety and sleep. In conclusion, acromegalic patients had a high prevalence of joint-related comorbidity and hypertension despite long-term control of GH excess. Especially, joint complaints contributed to a reduced perceived quality of life in these patients.     

Ten-year patterns of alcohol consumption and drinking problems among older women and men

AIMS: This study focused on changes in 10-year patterns of alcohol consumption among older women and men, late-life and life history predictors of drinking problems, and gender differences in these predictors. DESIGN, SETTING, PARTICIPANTS: A sample of late-middle-aged community residents (N = 1291) who had consumed alcohol in the past year or shortly before was surveyed at baseline and 1 year, 4 years and 10 years later. MEASUREMENTS: At each contact point, participants completed an inventory that assessed their alcohol consumption, drinking problems and health-related and life context factors. Participants also provided information about their life history of drinking. RESULTS: Over the 10 years, the proportion of individuals who consumed alcohol declined. Among individuals who continued to drink, women and men showed comparable declines in alcohol consumption, minor concomitants of alcohol consumption and drinking problems. In addition to the amount of alcohol consumption, smoking, friends' approval of drinking and avoidance coping consistently predicted late-life drinking problems. With respect to life history factors, heavy drinking, drinking problems and increased drinking in response to life events were related to a higher likelihood of late-life drinking problems; obtaining help from family members and friends and, among men, participation in Alcoholics Anonymous, were related to a lower likelihood of problems. CONCLUSION: Older women and men show comparable declines in alcohol consumption and drinking problems. Specific late-life social context and coping variables, and life history indices, are risk factors for late-life drinking problems among both women and men.     

Variations in drinking patterns in the rural South: joint effects of race, gender, and rural residence

OBJECTIVES: To understand the relative contribution of gender, race (African-American vs. Caucasian), and rural residence on variations in drinking patterns, including past year abstinence, at-risk drinking, and recent drinking quantity and frequency for drinkers only. METHODS: A brief health survey was administered by telephone to a probability sample of 11,529 residents of six southern states, over-sampling rural inhabitants. RESULTS: Drinking patterns varied by gender, race, and rural residence in bivariate analysis. Gender effects were independent of rural residence, but race effects on abstinence and at-risk drinking were found only in urban residents and race differences in drinking quantity only in rural residents. Multivariate analysis, controlling for age and education, found gender and rural residence to be the strongest predictors, as well as being an African-American female. CONCLUSIONS: Female gender, African-American race, and rural residence appear protective for at-risk drinking but rural residence dominates racial differences.     

Age‐Related Changes in Drinking Patterns From Mid‐ to Older Age: Results From the Wisconsin Longitudinal Study

Background: Drinking has generally been shown to decline with age in older adults. However, results vary depending on the measure of alcohol consumption used and the study population. The goals of this study were to (i) describe changes in drinking in a current cohort of older adults using a variety of measures of drinking and (ii) examine a number of different possible predictors of change. Methods: This is a longitudinal study of a community‐based sample surveyed at 2 time points, ages 53 and 64 years. We estimated a series of logistic regressions to predict change and stability in drinking categories of nondrinking, moderate drinking, and heavy drinking. Linear regressions were used to predict change in past‐month drinking days, past‐month average drinks per drinking day, and past‐month total drinks. Results: From age 53 to 64, average drinks per drinking day and heavy drinking decreased. Frequency of drinking increased for men and women, and total drinks per month increased for men. The most consistent predictors of drinking changes were gender, health, and education. Other factors predicted drinking change but were not consistent across drinking measures including: adolescent IQ, income, lifetime history of alcohol‐related problems, religious service attendance, depression, debt, and changes in employment. Conclusions: Heavy drinking decreases with age, but we may see more frequent moderate drinking with current and upcoming cohorts of older adults. Components of quantity and frequency of drinking change differently. Composite measures of total alcohol consumption may not be adequate for describing relevant changes in drinking over time. A number of factors predicted patterns of change in drinking and warrant further exploration.     

Gender differences in intimate partner violence on substance abuse, sexual risks, and depression among a sample of South Africans in Cape Town, South Africa.

Because men account for nearly half of the HIV cases in South Africa, it is critical to understand the contexts in which they live and the behaviors in which they engage. The purpose of this study was to describe and examine gender differences in intimate partner violence on substance abuse, sexual risks, and depression among a sample of South Africans in Cape Town. We found that recent exposure to intimate partner violence among men was associated with all forms of drug use, whereas women who were recently abused were more likely to suffer from depression and problem drinking. We also found high levels of problem drinking among both men (58%) and women (42%). Men were more likely to use drugs. Exposure to community violence increased sexual risk behaviors among men. Overall, these gender differences have important implications for alcohol and drug prevention strategies as they relate to HIV transmission risk.     

Variations in Drinking Patterns in the Rural South: Joint Effects of Race,Gender, and Rural Residence

Objectives: To understand the relative contribution of gender, race (African-American vs. Caucasian), and rural residence on variations in drinking patterns, including past year abstinence, at-risk drinking, and recent drinking quantity and frequency for drinkers only. Methods: A brief health survey was administered by telephone to a probability sample of 11,529 residents of six southern states, over-sampling rural inhabitants. Results: Drinking patterns varied by gender, race, and rural residence in bivariate analysis. Gender effects were independent of rural residence, but race effects on abstinence and at-risk drinking were found only in urban residents and race differences in drinking quantity only in rural residents. Multivariate analysis, controlling for age and education, found gender and rural residence to be the strongest predictors, as well as being an African-American female. Conclusions: Female gender, African-American race, and rural residence appear protective for at-risk drinking but rural residence dominates racial differences.     

The Influence of Sociodemographic Characteristics on Familial Alcohol Problems: Data from a Community Sample

The moderating influence of race (black versus white), age, sex, and socioeconomic status on the relationship between alcohol abuse/dependence in offspring and a family history of alcoholism/problem drinking was investigated in a representative general population sample (N = 1659). Significant family history by race by age and family history by race by sex interactions were observed when predicting lifetime risk of alcohol abuse/dependence in offspring. Socioeconomic status did not moderate the effect of familial alcoholism/problem drinking on offspring alcohol abuse/dependence. Relative odds ratios indicated that the risk of alcohol abuse/dependence associated with a positive family history increased with increasing age among whites; whereas, it decreased with increasing age among blacks. Among whites, the relative odds ratio for the effect of family history was higher for females than for males; however, among blacks it was higher for males than females. Although these findings need to be replicated in other populations, they suggest that it is important to take race, age, and sex into consideration when investigating familial alcohol problems.     

RESEARCH REPORT Sample selection bias in the emergency room: an examination of the role of alcohol in injury

Abstract Aims. Injury location, injury cause and patient drinking patterns were used to predict blood alcohol content (BAC) and self-reported drinking before injury using emergency room (ER) data. Design. Models estimating both BAC and self-reported drinking among emergency room injury patients were used; the ER sample was also compared to an injured sample from the general population. Setting. Data were from three of six communities participating in the project "Preventing Alcohol Trauma: a community trial". Participants. ER data were collected from nine hospitals on Friday and Saturday nights between 6 p.m. and 2 a.m. on alternate weekends from June 1992 to December 1995. Telephone survey data were collected between April 1992 and March 1996. Measurements. Drinking measures included drinking frequency, drinks per occasion, and variance. Other measures involved injury time, location, and type; drinking before and after injury; and age, race, gender, education, marital status and household income. Model estimation corrected both for selection bias and censoring of the dependent measure. Findings. The results indicate: (1) ER populations tended to be female, less well educated, non-white, poor and younger; (2) there were significant selection bias effects in the ER sample; (3) assaults were more likely to involve drinking than other injury types; (4) drinking patterns were significant non-linear predictors of alcohol involvement; and (5) selfreported drinking before injury was both a sensitive and specific indicator of measured BAC. Conclusions. Assaults uniquely involve the use of alcohol and selection bias may threaten ER study validity.     

Gender Differences in Comorbidly Depressed Alcohol-Dependent Outpatients

Clinical profiles of alcohol-dependent male and female outpatients were evaluated at treatment entry to compare the level of clinical severity in alcoholics with a coexistent comorbid depressive disorder to alcoholics who have never been depressed. Due to a higher proportion of females than males in the depressed alcoholic population, selected patient groups were oversampled to create a study group with equivalent number of males and females with and without comorbid depression. Clinical severity was assessed by examining both the extent of alcohol problems, and depressive symptomatology at treatment entry with respect to gender differences (unrelated to depression), effects of comorbid depression (unrelated to gender), and effects from the interaction of gender and depression. There were 93 DSM-III-R alcohol-dependent outpatients (SO males, 43 females), half of whom had a current or lifetime DSM-III-R depressive disorder. The amount of drinking in the 90 days before treatment entry, the degree of alcohol severity, and the number of lifetime drinking-related consequences were collected in the first week after detoxification. Diagnoses of lifetime and current depression were determined via the Structured Clinical Interview for DSM-III-R, and depressive symptoms were evaluated with rating scales 1 week after detoxification. In most cases, a depressive disorder was diagnosed only if sometime in the patient's history depressive symptoms had either predated problem drinking or been present during a 6-month abstinent period. Results: depressed males had a more severe clinical profile with respect to their alcoholism (i.e., more drinking, drinking-related problems, and alcohol severity than depressed females and never-depressed males). Surprisingly, females who had never been depressed (also no family history of depression) reported drinking the same quantities of alcohol in the 90 days before treatment and had comparable alcohol severity and number of consequences as males who had never been depressed. Depressed females, however, were more severely depressed (i.e., reported more intensive depressive symptoms than depressed male alcoholics). Thus, determining the type and extent of clinical severity at treatment entry in comorbidly depressed alcoholics depends on the gender of the patient. The significant interaction between gender and the presence of comorbid depression that was found in this study may have important implications for predicting success in treatment.     

Correlates of Injury Among ED Visits: Effects of Alcohol,Risk Perception,Impulsivity, and Sensation Seeking Behaviors

This cross-sectional study used a random sample of 412 Emergency Department (ED) patients to test the following hypothesizes: 1) injury would be positively associated with problem drinking and recent drinking; 2) impulsivity and sensation seeking would be positively associated with injury, while risk perception would be negatively associated with injury. Results show recent drinking is associated with 2-fold increase in the odds of injury [OR and 95%; CI = 2.34 (1.07–5.10)] while problem drinking and personality factors were unrelated to injury. Other significant predictors were gender and age. Findings suggest a need for alcohol screening for patients who check themselves into the ED due to injury.     

Correlates of injury among ED visits: effects of alcohol, risk perception, impulsivity, and sensation seeking behaviors

This cross-sectional study used a random sample of 412 Emergency Department (ED) patients to test the following hypothesizes: 1) injury would be positively associated with problem drinking and recent drinking; 2) impulsivity and sensation seeking would be positively associated with injury, while risk perception would be negatively associated with injury. Results show recent drinking is associated with 2-fold increase in the odds of injury [OR and 95%; CI = 2.34 (1.07-5.10)] while problem drinking and personality factors were unrelated to injury. Other significant predictors were gender and age. Findings suggest a need for alcohol screening for patients who check themselves into the ED due to injury.     

Alcohol consumption in high school adolescents: frequency of use and dimensional structure of associated problems

The goal of this paper is in present data regarding the occurrence of alcohol consumption and the relative prevalences and the factorial structure of DSM-IV symptoms of alcohol abuse/dependence in a sample of 1507 older (14–18 years) community adolescents. Participants were diagnostically assessed at two time points, approximately 1 year apart. Three-quarters of the sample had tried alcohol. Boys in general had greater usual frequency and quantity of alcohol consumption than girls and began drinking at an earlier age; girls with a diagnosis of alcohol abuse/dependence had a significantly earlier mean age of alcohol disorder onset and were more likely to have a relapse of alcohol disorder. However, gender differences in symptom prevalence were non-significant. Seventeen per cent of the sample had at least one alcohol abuse/dependence symptom. The most frequent symptoms included reduced activities because of alcohol use, consumed more than intended, and tolerance. Eight of the 11 symptoms made a unique contribution to the prediction of diagnosis in a multiple logistic regression analysis. Components analysis supported the general division of symptoms into the categories of abuse and dependence.     

Characteristics of Pathological Gamblers with a Problem Gambling Parent

This analysis compares the characteristics of adult pathological gamblers with and without a problem gambling parent. A sample of 517 individuals with current DSM‐TV pathological gambling was categorized based on presence of a parental problem gambler. Groups were compared on clinical characteristics, gambling severity, gambling‐related problems, and psychiatric comorbidity. Although the groups were similar on most measures, pathological gamblers with at least one problem gambling parent were more likely to have a father with an alcohol abuse/dependence problem; have financial and legal problems; and report daily nicotine use. Females with a problem gambling parent had significantly earlier onset of gambling behavior, were significantly more likely to have a father with an alcohol use disorder, and were significantly more likely to have financial problems secondary to gambling than females without a problem gambling parent. Males with a problem gambling parent were significantly more likely to have a father with an alcohol use disorder and have legal problems secondary to gambling compared to males without a problem gambling parent. Treatment approaches may need to be tailored for specific problems secondary to gambling and gender issues based on the history of having a problem gambling parent.     

Alcoholism,antisocial behavior and family history*

Previous investigations in selected and clinical samples have demonstrated a close association between alcoholism and both antisocial behavior and a family history of problem drinking. This study uses the National Institute of Mental Health (NIMH) Epidemiological Catchment Area (EGA) data to assess this relationship in the general population in St. Louis, Missouri (U.S.A.). The results showed that serious antisocial behavior (both conduct disorder and antisocial personality disorder), gender, and a family history of problem drinking were all significantly associated with alcoholism (DSM-III alcohol abuse or dependence). Having either conduct disorder, antisocial personality, or a first-degree relative (parent, sibling, or child) with problem drinking increased the probability of alcoholism; being male also increased its probability. Antisocial behavior and gender interacted in that antisocial behavior was a more potent risk factor for women than for men. However, despite their close association with alcoholism, having either antisocial personality or a positive family history of problem drinking identified only 49% of male alcoholics and 14% of female alcoholics. Thus, these two important predictors of alcoholism would be somewhat inefficient screeners for primary prevention. More investigation is needed to understand the development of alcoholism in those without these major risk factors and the lack of alcoholism in those with them.     

Late‐Life Alcohol Consumption and 20‐Year Mortality

Background: Growing epidemiological evidence indicates that moderate alcohol consumption is associated with reduced total mortality among middle‐aged and older adults. However, the salutary effect of moderate drinking may be overestimated owing to confounding factors. Abstainers may include former problem drinkers with existing health problems and may be atypical compared to drinkers in terms of sociodemographic and social‐behavioral factors. The purpose of this study was to examine the association between alcohol consumption and all‐cause mortality over 20 years among 1,824 older adults, controlling for a wide range of potential confounding factors associated with abstention. Methods: The sample at baseline included 1,824 individuals between the ages of 55 and 65. The database at baseline included information on daily alcohol consumption, sociodemographic factors, former problem drinking status, health factors, and social‐behavioral factors. Abstention was defined as abstaining from alcohol at baseline. Death across a 20‐year follow‐up period was confirmed primarily by death certificate. Results: Controlling only for age and gender, compared to moderate drinkers, abstainers had a more than 2 times increased mortality risk, heavy drinkers had 70% increased risk, and light drinkers had 23% increased risk. A model controlling for former problem drinking status, existing health problems, and key sociodemographic and social‐behavioral factors, as well as for age and gender, substantially reduced the mortality effect for abstainers compared to moderate drinkers. However, even after adjusting for all covariates, abstainers and heavy drinkers continued to show increased mortality risks of 51 and 45%, respectively, compared to moderate drinkers. Conclusions: Findings are consistent with an interpretation that the survival effect for moderate drinking compared to abstention among older adults reflects 2 processes. First, the effect of confounding factors associated with alcohol abstention is considerable. However, even after taking account of traditional and nontraditional covariates, moderate alcohol consumption continued to show a beneficial effect in predicting mortality risk.     

Childhood Abuse History and Substance Use Among Men and Women Receiving Detoxification Services

According to data collected from women and adolescents, a strong link exists between childhood abuse history and substance abuse. Using a sample of 274 women and 556 men receiving detoxification services, we explored whether the same pattern emerged across genders and types of abuse. Results revealed 20% of men and more than 50% of women reported childhood physical or sexual abuse. Sexual or physical abuse had negative sequelae, regardless of gender. Individuals with abuse history reported earlier age of onset of drinking, more problems associated with use of alcohol/drugs, more severe psychopathology, and more lifetime arrests, arrests related to substance use, and arrests related to mental health. Prevention and proactive intervention activities are crucial to prevent negative sequelae of childhood victimization.