Sex, marital status, and psychological distress in later life: a comparative analysis

Some investigators maintain that while married men experience less distress than married women, the opposite may be true for those who are not married. In this instance, women are thought to report fewer symptoms of distress than men. The purpose of this study is to examine the relationships among gender, marital status, psychological distress and alcohol use in five culturally-diverse groups of older adults: U.S. whites, U.S. blacks, Japanese, Taiwanese and elderly people in the People's Republic of China. We find little evidence of the pattern described above. Instead, the data suggest that being single is equally detrimental for older men and women regardless of the cultural setting.     

Five-year alcohol and drug treatment outcomes of older adults versus middle-aged and younger adults in a managed care program

AIMS: This study compared 5-year treatment outcomes of older adults to those of middle-aged and younger adults in a large managed care chemical dependency program. We examined age group differences in individual, treatment and extra-treatment factors, which may influence long-term outcome. DESIGN: Seventy-seven per cent of original study participants completed a telephone interview 5 years after out-patient chemical dependency treatment at Kaiser Permanente. This sample (N = 925) included 65 patients aged 55-77, 296 patients aged 40-54 and 564 patients aged 18-39 (age at baseline). MEASUREMENTS: Measures at follow-up included alcohol and drug use, Addiction Severity Index (ASI), Alcoholics Anonymous Affiliation Scale, social resource and self-reported health questions. Mortality data were obtained from contact with family members of patients as well as automated health plan records. FINDINGS: Older adults were less likely to be drug-dependent at baseline than younger and middle-aged adults, and had longer retention in treatment than younger adults. At 5 years, older adults were less likely than younger adults to have close family or friends who encouraged alcohol or drug use. Fifty-two per cent of older adults reported total abstinence from alcohol and drugs in the previous 30 days versus 40% of younger adults. Older women had higher 30-day abstinence than older men or younger women. Among participants dependent only on alcohol, there were no significant age differences in 30-day abstinence. In logistic regression analysis, age group was not significant. Variables associated with greater age that independently predicted 30-day abstinence in the logistic regression model included longer retention in treatment and having no close family or friends who encouraged alcohol or drug use at 5 years; female gender was also significant. CONCLUSIONS: Results indicate that older adults have favorable long-term outcome following treatment relative to younger adults, but these differences may be accounted for by variables associated with age such as type of substance dependence, treatment retention, social networks and gender. Age differences in these characteristics inform intervention strategies to support long-term recovery of older adults and provide direction for investigation of how age affects outcome.     

Cohort effects on gender differences in alcohol dependence

Aims The present study investigated the presence of cohort effects on gender differences in the course, severity and symptomatology of DSM‐III‐R alcohol dependence in a community‐based sample. Design A comparison of substance‐related variables among men and women divided into two groups based on the median birth year of the sample was conducted. Participants Participants were 468 men and 132 women with life‐time alcohol dependence, the vast majority of whom were born between 1941 and 1960. Measurements Substance use and DSM‐III‐R substance use disorders were assessed by a structured interview administered in person. Findings Individuals born after 1951 had higher rates of alcohol dependence. Among individuals with alcohol dependence, those born after 1951 had an earlier onset and longer duration of alcohol‐related problems. Significant interactions indicated that these effects were stronger for women than men. Conclusions Risk for alcohol dependence appears to be rising in younger generations, and particularly for younger women, making them an important target group for prevention and treatment programs.     

Factors affecting the initiation of substance abuse treatment in managed care

Aims. A long-standing concern of clinicians in addiction treatment is that a large number of individuals who are admitted to treatment do not return to actually begin the program. We identified characteristics that predict treatment initiation. Design. In-person structured interviews were conducted with consecutive admissions to a large outpatient program (N = 1204), and the health plan's automated registration data were used to determine treatment attendance. We compared those who returned to begin treatment with those who did not. Setting. The study was conducted at the Chemical Dependency program of a large group model health maintenance organization (HMO). Participants. Study subjects were individuals age 18 or over admitted to the program. Measurement. Study variables included DSM-IV alcohol and drug dependence and abuse, Addiction Severity Index problem severity, motivation and treatment entry measures. Findings. Those who were drug-dependent were less likely to begin treatment than those dependent only on alcohol. Measures of motivation, such as work-place pressures and the patient's perception of the importance of alcohol treatment, predicted starting treatment for individuals who were alcohol-dependent only or alcohol- and drug-dependent. Among patients who were dependent only on alcohol, women were more likely than men to start treatment, and for those who were drug-dependent, being employed and having higher drug severity scores predicted starting treatment. Conclusions. Screening at intake may identify those at risk of not returning after admission to start treatment. Clinicians may consider making additional efforts during the intake process to engage individuals who are unemployed and have drug (as opposed to alcohol) disorders and less motivation.     

Patterns of drinking in the UK Armed Forces

AIMS: To examine patterns of drinking in the UK Armed Forces, how they vary according to gender and other demographics, and to make comparisons with the general population. DESIGN: Large cross-sectional postal questionnaire study (response rate 60%). SETTING: United Kingdom. PARTICIPANTS: A random representative sample of the regular UK Armed Forces who were in service in March 2003 (n = 8686; 7937 men, 749 women). Comparisons were made with the general population of Great Britain. MEASUREMENTS: Alcohol consumption was assessed using the Alcohol Use Disorders Identification Test (AUDIT). FINDINGS: Sixty-seven per cent of men and 49% of women in the UK Armed Forces had an AUDIT score of 8+ (defined as hazardous drinking), compared to 38% of men and 16% of women in the general population. In both sexes, for all ages, the military have a higher prevalence of hazardous drinking. Binge drinking was associated with being younger, being in the Army, being single, being a smoker and being white. Among military men, heavy drinking (AUDIT score 16+) was associated with holding a lower rank, being younger, being single, being in the Naval Service or Army, being deployed to Iraq, not having children, being a smoker, having a combat role and having a parent with a drink or drug problem. CONCLUSIONS: Excessive alcohol consumption is more common in the UK Armed Forces than in the general population. There are certain socio-demographic characteristics associated with heavy drinking within the military; for example, young age, being single and being a smoker, which may allow the targeting of preventive interventions.     

Predictors of substance abuse treatment retention among women and men in an HMO

BACKGROUND: Although prior research has examined predictors of treatment retention in public alcohol and drug treatment programs, little is known about factors that influence treatment retention in an insured outpatient population. Because there is growing evidence that the factors which influence treatment retention may differ by gender, we identify sex-specific predictors. METHODS: We recruited all eligible intakes to a health maintenance organization's outpatient alcohol and drug treatment program during a 2-year period and obtained a sample of 317 women and 599 men. The programs, day hospital and traditional outpatient modalities, were abstinence based. We separated our sample by sex and used least squares and logistic regression to identify independent predictors of length of stay and program completion, respectively. RESULTS: One general pattern of predictors of increased retention was shared by women and men in this alcohol and drug treatment program--fewer and less severe drug problems. However, most predictors were sex-specific. Among women, retention was predicted by having higher incomes, belonging to ethnic categories other than African American, being unemployed, being married, and having lower levels of psychiatric severity. Among men, predictors of higher retention included being older, receiving employer suggestions to enter treatment, and having abstinence goals. CONCLUSIONS: These findings highlight the importance of examining aspects of the course of treatment separately by sex. They also suggest treatment factors that may enhance retention among insured populations, including employer referrals, psychiatric services, and drug-related services.     

DSM-IV alcohol disorders in a general population sample of adolescents and young adults

Aims/Design. As part of the Early Developmental Stages of Psychopathology (EDSP) study, results from the baseline cross-sectional assessment of DSM-IV alcohol disorders are presented for a sample of 14-24-yearolds resident in Munich, Germany ( N = 3021; 71% response rate). Findings. Life-time prevalence of DSM-IV alcohol abuse (men: 15.1%; women: 4.5%) was found to be considerably more prevalent than dependence (men: 10.0%; women: 2.5%) with few cases among respondents younger than 16 years of age; 12-month prevalence of abuse was 8.4% among men and 2.7% among women and of dependence was 7.3% among men and 2.2% among women. Results show that peak incidence of alcohol disorders occurs at 16-17 years of age and that early initiation into alcohol use is associated with an increasing odds of disorder onset, especially for dependence among women. Exploratory analysis of retrospectively assessed diagnostic stability show: a temporal progression to abuse and then dependence, that nearly half of past abuse diagnoses are in remission, abuse remission is more common than progression to dependence, and dependence is highly persistent, especially among women. Conclusions . Alcohol disorders are frequent in adolescents and young adults being characterized by transient abuse and less prevalent but persistent dependence syndromes. The relatively high prevalence of dependence diagnoses in this young population with few years of alcohol use is discussed with regard to the clinical validity of DSM-IV criteria in adolescents and young adults.     

Birth cohort differences in features of antisocial alcoholism among men and women

BACKGROUND: This study examines the relations between birth cohort, gender, and family history of alcohol problems on alcohol dependence, and on the endorsement of alcohol abuse/dependence symptoms related to antisocial behavior. METHODS: Men (n = 1,365) and women (n = 625) were recruited from the community, hospitals, and other treatment sites and were given a structured diagnostic interview. Data were analyzed by using logistic regression. RESULTS: Age of first regular alcohol use was lower in more recent birth cohorts for both men and women, with those born in the most recent cohort reporting earliest regular use. The decline across cohort was more dramatic in women than in men. For those participants with a diagnosis of alcohol dependence, being born in a more recent cohort was associated with increased risk of dependence onset before age 25. Among those participants with onset of alcohol dependence before age 25 (n(men) = 400; n(women) = 51), being born in a more recent cohort was associated with increased risk of fights while drinking, police involvement, and drunk driving trouble as well as with increased risk for a diagnosis of abuse or dependence on another drug. CONCLUSIONS: These results suggest that the prevalence of antisocial alcoholism may be increasing for both men and women. These data exemplify how societal change may affect expression of underlying vulnerability for traits thought to be genetically influenced.     

Benzodiazepine use and anxiolytic abuse and dependence in treated alcoholics

The prevalence and correlates of benzodiazepine use and anxiolytic abuse and dependence are examined in a sample of 427 patients in Toronto, Canada, who met lifetime DSM-III criteria for alcohol abuse or dependence. The patients were evaluated with the NIMH-DIS and other standard psychiatric and substance abuse rating scales. Forty per cent were recent users of benzodiazepines and 20% had abused or been dependent upon anxiolytics, including benzodiazepines, during their lifetime. Patients with antisocial personality disorder (ASPD) were at higher risk for an anxiolytic disorder as were women and the unemployed. Recent users of benzodiazepines showed more current psychological distress, depressive symptomatology and more severe substance abuse problems than other patients and were more likely to have a lifetime DSM-III anxiety disorder. Patients with anxiolytic disorders, even if ASPD was controlled for, showed more psychiatric impairment and drug abuse problems than the remaining patients. Of those with a positive urine screen, 46% did not report using benzodiazepines in the previous week. Nineteen per cent of the patients who did not report benzodiazepine use in the previous week had a positive urine screen and were more likely to be found in the detoxification unit.     

Alcohol and Drug Abuse in Treated Alcoholics: A Comparison of Men and Women

A survey of 229 male patients and 198 female patients who met lifetime DSM-III criteria for alcohol abuse or dependence was carried out in Toronto, Canada. The patients were evaluated with the National Institute of Mental Health Diagnostic Interview Schedule and other substance abuse rating scales. The prevalence of individual alcohol and drug symptoms, the patterns of abuse, and the prevalence of drug disorders were compared in the two sexes. The study patients were younger than previous treatment samples and were more likely to have other drug disorders. While the overall prevalence of drug disorders was similar in male and female alcoholics, women were more likely to abuse sedatives and minor tranquilizers while men were more prone to the abuse of cannabis and tobacco. Men continue to be more likely to have social and occupational problems resulting from alcohol abuse, to start abusing alcohol earlier in their lives, to have been abusing for longer, and to report higher quantity and frequency of alcohol consumption. With one or two exceptions, the sexes do not differ on other indicators of pathologic use, withdrawal or tolerance, medical sequelae or treatment history. While men have significantly more alcohol problems than women, as measured by the DIS and the MAST, these differences disappear when length of alcohol abuse history, antisocial personality disorder and employment status are controlled for. Similarly, when these variables are controlled for, women exhibit more symptoms of alcohol dependence as measured by the ADS. Women alcoholics come into treatment earlier in their alcoholic careers.     

Substance Use and High-Risk Sex Among People with HIV: A Comparison Across Exposure Groups

Substance use is associated with increased risk for HIV transmission by HIV-positive people to uninfected partners through sexual contact. The largest risk groups for infection, men who have sex with men (MSM) and injecting drug users (IDUs), have high rates of substance use, but little is known about their substance use post-HIV diagnosis. We compared the prevalence of substance use between these two groups and a third group, heterosexual men and women, and tested for differential association between substance use and sexual behaviors across exposure groups in a national sample of patients in treatment for HIV. Substance use was most prevalent among MSM. Substance use and current dependence were associated with being sexually active among MSM but not IDUs; marijuana, alcohol, and hard drug use were most strongly associated with being sexually active among MSM. Whereas substance use predicted high-risk sex, there were few differences among exposure groups in these associations.     

The epidemiology of alcohol use in Australian women: findings from a national survey of women''s drinking

This is the first study of alcohol use, alcohol problems and alcohol dependence in a general population sample of Australian women using a standardized screening instrument developed by the World Health Organization, the Alcohol Use Disorders Identification Test (AUDIT). Sixty-six percent of a sample of 6000 women randomly selected from the electoral rolls responded to the questionnaire. The majority of women (87%) had drunk alcohol at some time in their lives, while 82% had consumed alcohol within the past 12 months. Of the women who currently drank alcohol, 34% were classified as hazardous drinkers, 4% as harmful drinkers and 1% as dependent according to AUDIT definitions. Using a cut-off score of 8 for the AUDIT, 8% of women were classified as currently having a drinking pattern of hazardous or harmful alcohol consumption. These women were more likely to be younger (17-44 years), single, or living in a de facto relationship. The results of this survey provide important data which can be used as a bench-mark to measure changes in women's drinking behaviour and drinking related problems.     

The epidemiology of drinking among women of child-bearing age

OBJECTIVES: 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). METHODS: Subjects are part of a national multistage random sample from the 2002 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). RESULTS: 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 US dollars) are at a higher risk for heavier drinking. CONCLUSIONS: 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.     

Psychological distress, binge/heavy drinking, and gender differences among older adults

Previous studies provide conflicting information on the relationship between drinking and mental health problems in older men and women. This paper addresses the relationship of binge/heavy drinking to psychological distress in community-dwelling older men and women. The study sample consisted of subjects aged 50 and older (n = 2,462 men and 2,863 women) who participated in the 2008 National Survey on Drug Use and Health. Men and women who drank and drank heavily were compared, and ordinary least squares regression analysis was used to examine the association between drinking and psychological distress after demographic factors and health status were controlled for. Binge/heavy drinking was found to be related to psychological distress in older women, but not in older men. Though findings on the relationship between heavy drinking and psychological distress in men and women are not consistent across studies, older men and women should be assessed for both conditions in clinical settings.     

Effects of gender and level of parental involvement among parents in drug treatment

Most studies of parents in drug treatment have focused exclusively on mothers, and few studies have examined the effects of parents' level of involvement with their children on the parents' drug use and psychological functioning, either before or after treatment. This study examined mothers and fathers (n = 331) who were parents of children under the age of 18; participants were sampled from 19 drug treatment programs across four types of treatment modalities in Los Angeles County. A majority of each group (57% of 214 mothers and 51% of 117 fathers) were classified as being highly involved with their children. At the baseline assessment, higher parental involvement was related to lower levels of addiction severity, psychological severity, and symptoms of psychological distress, and to higher levels of self-esteem and perception of parenting skills. In general, fathers had higher levels of alcohol and drug-use severity than did mothers, but fathers who were more involved with their children showed lower levels of addiction severity than fathers who were less involved. Parental involvement at baseline was unrelated to drug use at the 12-month follow-up, although parents who were less involved with their children reported experiencing more stressors. Given the association of parental involvement with lower levels of addiction severity and psychological distress at baseline, treatment protocols should build upon the positive relationships of parents with their children, and seek to improve those of less-involved parents.     

Extension of a Typology of Alcohol Dependence Based on Relative Genetic and Environmental Loading

Mild, severe, and dyssocial subtypes of alcohol dependence, previously identified among Caucasian men from the Epidemiologic Catchment Area study, were also identified among Caucasian men and women with DSM-IV alcohol dependence from the National Longitudinal Alcohol Epidemiologic Survey (n= 2,703; 1,746 respectively). These subtypes were not identified among African American and Hispanic American men or women with DSM-IV alcohol dependence. Among Caucasians with alcohol dependence, the subtypes were characterized by differential loading on three dimensions: genetic, general environmental, and dyssocial environmental symptom scales developed in a prior twin study. The mild subtype (60% of men and 66% of women) was distinguished by low mean scores on all three scales; the dyssocial subtype (24% of men and 20% of women) by low mean genetic and general environmental scores but high mean dyssocial environmental scores; and the severe subtype (16% of men and 14% of women) by high scores on the genetic and general environmental scales. These subtypes also showed the expected distinctions in clinical characteristics. The severe subtype showed greater comorbid drug dependence and major depression, more treatment seeking, and a higher prevalence of parental alcoholism. The severe subtype also showed significantly greater genetic influence adjusted for overall severity of alcohol dependence (genetic ratio). Only the severe subtype showed a pattern of scale scores and clinical characteristics suggestive of substantial genetic influence. The present study indicates a robustness of the typology originally developed among DSM-III alcohol-dependent Caucasian men by empirical extension of the subtypes to a different sample of Caucasian men and, separately, Caucasian women. The use of this typology may aid in distinguishing between Caucasian alcohol-dependent individuals on the basis of relative genetic influence, enabling genetic, behavioral, and epidemiological investigations to reduce genetic or environmental “noise” and better focus on specific aspects of alcohol dependence.     

Gender moderates the influence of psychosocial factors and drug use on HAART adherence in the context of HIV and childhood sexual abuse

This study aimed to examine gender moderation within a stress and coping model of HIV medication adherence in adults with a history of childhood sexual abuse (CSA). Sequelae of CSA, including negative coping, psychological distress, and drug use, interfere with adherence to highly active antiretroviral treatment (HAART). These obstacles to adherence are likely moderated by gender. Gender may particularly influence the mediational effect of drug use on adherence. Participants included 206 adults living with HIV/AIDS and CSA. Categorical/continuous variable methodology in a structural equation modeling framework was used to test a multigroup model with women and men. Gender significantly moderated several effects in the model. For women, the effect of psychological distress on HAART adherence was mediated by drug use and the effect of drug use on viral load was mediated by HAART adherence. Among men, drug use did not significantly impact adherence. Since gender appears to moderate the effect of drug use on medication adherence, it is particularly important to address drug use within the context of HIV disease management in women with a history of CSA. Further, interventions to increase HAART adherence should take trauma history, gender, and drug abuse into account when assessing efficacy.     

EEG low-voltage alpha and alpha power in African American young adults: relation to family history of alcoholism

BACKGROUND: Several studies support an association between having a low-voltage EEG and alcohol dependence; however, it is not clear whether this measure represents a risk marker or is a result of years of heavy drinking. The present study's aims were to investigate the prevalence of low-voltage alpha EEG variants in African American young adults who have not yet developed alcohol dependence and to test for associations between low-voltage alpha (LVA) EEG, alpha power, and a family history of alcohol dependence. METHODS: Clinical ratings and spectral characteristics of the EEG, collected using bipolar recordings, were investigated in 81 African American young adult men and women (18-25 years old) who had no personal history of alcohol dependence. Information on psychiatric diagnoses, personality features, personal drinking and drug use history, and family history (FH) of alcoholism was obtained. RESULTS: Thirty-two percent (n = 26) of the participants had an LVA EEG variant, and an additional 22% (n = 18) had borderline LVA. The presence of an LVA variant was not associated with drinking status, a family history of alcoholism, or a personal history of anxiety disorders but was associated with significantly higher extroversion scores. Participants who had an FH of alcoholism had significantly higher spectral power in the slow alpha frequencies (7.5-9 Hz). FH was not associated with any significant differences in any other EEG frequency band. CONCLUSIONS: These findings suggest that considerable ethic variation may exist in the prevalence of LVA EEG variants. In addition, like findings in other populations of non-African descent, having an FH of alcohol dependence may be associated with significantly higher voltage in the alpha frequency ranges.     

Psychopathoiogy and alcohol consumption among treatment-seeking alcoholics: a prospective study

The association between psychopathology and alcohol consumption was studied in a nation-wide representative sample of inpatient alcoholics (n = 245) who were examined at intake and 15 months later. As regards baseline observations men and women with antisocial personality disorder or cognitive impairment had consumed more alcohol in the month prior to admission than those not so affected. In contrast, men with panic disorder drank less compared with those not so affected. The prognosis for men consuming more than the median amount of alcohol was worse than that of women. However, after controlling for psychiatric distress and alcohol consumption at baseline, the prognosis of women was worse. Women but not men who had stopped drinking had a higher degree of psychiatric distress at follow-up compared with those still drinking at a low level. Regarding the prognostic significance of psychiatric disorders at baseline, among men panic disorder predicted continued drinking. Psychiatric distress and alcohol consumption at baseline interacted in the prediction of alcohol consumption at follow-up. The study highlights the importance of a thorough assessment of psychopathology and course of drinking when evaluating the outcome of alcoholism treatment.     

Work-site variation in managerial drinking

The association between psychopathology and alcohol consumption was studied in a nation-wide representative sample of inpatient alcoholics (n = 245) who were examined at intake and 15 months later. As regards baseline observations men and women with antisocial personality disorder or cognitive impairment had consumed more alcohol in the month prior to admission than those not so affected. In contrast, men with panic disorder drank less compared with those not so affected. The prognosis for men consuming more than the median amount of alcohol was worse than that of women. However, after controlling for psychiatric distress and alcohol consumption at baseline, the prognosis of women was worse. Women but not men who had stopped drinking had a higher degree of psychiatric distress at follow-up compared with those still drinking at a low level. Regarding the prognostic significance of psychiatric disorders at baseline, among men panic disorder predicted continued drinking. Psychiatric distress and alcohol consumption at baseline interacted in the prediction of alcohol consumption at follow-up. The study highlights the importance of a thorough assessment of psychopathology and course of drinking when evaluating the outcome of alcoholism treatment.