Episodes of intimate partner violence are associated with alcohol consumption. To explore this relationship further, researchers interviewed a random sample of heterosexual couples at baseline and 5 years later. They assessed alcohol use and related problems, and the incidence (new cases) and recurrence (cases at both follow-up and baseline) of male-to-female partner violence and female-to-male partner violence. Analyses included 1136 couples who were cohabitating and/or married at both baseline and follow-up. Partner violence was defined as a range of violent behaviors, such as slapping, kicking, forcing sex, and threatening with a gun or knife.

• At follow-up, the incidence of both female-to-male and male-to-female partner violence was only 6 percent. However, recurrence was more common (female-to-male violence 44 percent, male-to-female violence 39 percent).
• In unadjusted analyses, incidence and/or recurrence of partner violence was significantly associated with greater mean consumption by male perpetrators; heavy drinking (at least 5 drinks on an occasion in the past year) by male and female perpetrators; and/or alcohol problems among male and female perpetrators.
• Among these alcohol indicators, only mean consumption (among both female perpetrators and male victims) remained significantly associated with new or recurrent cases of female-to-male partner violence when analyses were adjusted for potential confounders.

Comments by Joseph Conigliaro, MD, MPH: Female-to-male partner violence was as common as male-to-female partner violence in this population-based sample, whereas male perpetration of partner violence is often the norm in clinical samples. Nevertheless, heavy episodic drinking, alcohol problems, and higher average alcohol consumption should be considered risk factors for partner violence and addressed in prevention efforts.

Reference: Caetano R, McGrath C, Ramisetty-Mikler S, et al. Drinking, alcohol problems and the five-year recurrence and incidence of male to female and female to male partner violence. Alcohol Clin Exp Res. 2005;29(1):98-106.

Reprinted with permission from “Alcohol and Health: Current Evidence”.

Healing the Trauma of Domestic Violence: A Workbook for Women (New Harbinger Self-Help Workbook) by Edward S., Ph.D. Kubany, Mari A. McCaig, Janet R. Laconsay Read more about this title…

Bipolar Patients with Comorbid Substance Use Disorders; Diagnostic and Treatment Considerations:

Comorbidity of bipolar disorder (BD) and alcoholism and substance use disorders (SUDs) represents a serious public health problem and a major challenge to treatment systems.

Bipolar disorder is among the top causes of disabilities worldwide, and reportedly the fourth leading mental illness as a source of disease burden in established market economies. Large epidemiologic surveys in the United States have consistently confirmed a high association between bipolar disorder and SUDs. The Epidemiological Catchments Area Study reported bipolar I and bipolar II disorders as having the highest association with SUDs when compared with any other major psychiatric disorder.

The prevalence of lifetime alcohol abuse or dependence in persons with bipolar I disorder and bipolar II disorders were found to be 46%, and 39.2% respectively.

Similarly, the National Comorbidity Survey reported respondents with mania to be 8 to 9 times more likely to have an additional lifetime disorder of drug or alcohol dependence compared with the general population. The most recent and largest epidemiologic survey of more than 42,000 respondents in the United States, the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), reported that mania and hypomania were associated with very high rates of SUDs. Those with mania were 6 times more likely to have alcohol dependence and 14 times more likely to have drug dependence over the past 12 months.

Research from; Psychiatric Annals, Volume 38 · Number 11, NOVEMBER 2008

Alcoholism Is Not Just A “Man’s Disease” Anymore

A new examination of data on similarly aged groups, compared across decades, has found substantial increases in drinking and alcohol dependence among women.

Increases were particularly notable among white and Hispanic women – beginning with those born in the United States after World War II.

Cross-sectional studies, which collect information at a single point in time, generally find that young Americans report having more lifetime alcohol problems than older Americans, despite having had less time to develop these problems.  But these studies are hampered by the fact that people of different ages may remember or report problems to different degrees.  A new examination of data, collected on similarly aged groups one decade apart, has found substantial increases in drinking and alcohol dependence among women – particularly white and Hispanic women – beginning with those born in the United States after World War II.

Results are published in the May issue of Alcoholism: Clinical & Experimental Research.

“By looking at two different cross-sectional surveys that asked the same questions in the same manner, but were conducted 10 years apart, we were able to compare, for example, 30 – 40 year olds in 2001 with 30 – 40 year olds in 1991,” explained Richard A. Grucza, an epidemiologist at Washington University School of Medicine and the study’s corresponding author.  “Essentially, this allowed us to correct for the effects of age on reporting.  When we did this, we found that the tendency for young people to have higher levels of lifetime alcohol dependence clearly remained for women, although it disappeared for men.”

Furthermore, added Shelly F. Greenfield, associate clinical director of the Alcohol and Drug Abuse Treatment Program at McLean Hospital, prevalence surveys are inclusive.  “Epidemiologic surveys document the prevalence of an illness such as alcohol dependence in the entire population rather than just one segment of the population, such as those seeking treatment,” she said.  “This allows us to track trends in illnesses – including whether certain people are more vulnerable for a particular disease, at what age they manifest symptoms, and how quickly the illness progresses.”

For this study, researchers examined two large, national surveys: the National Longitudinal Alcohol Epidemiologic Survey (NLAES), conducted in 1991 and 1992; and the National Epidemiological Survey on Alcohol and Related Conditions (NESARC), conducted in 2001 and 2002.  They compared lifetime prevalence rates from the same age groups and demographics, while simultaneously controlling for age-related factors.

“We found that for women born after World War II, there are lower levels of abstaining from alcohol, and higher levels of alcohol dependence, even when looking only at women who drank,” said Grucza.  “However, we didn’t see any significant tendency for more recently born men to have lower levels of abstention, or higher levels of alcohol dependence.”  He added that these results shed more light on a “closing gender-gap in alcoholism,” showing that it is probably due to higher levels of problems among women, while men have been more or less steady in their levels of dependence. 

Greenfield concurred.  “This is an excellent study that adds important information to the accumulating evidence that the gender gap between women and men in the prevalence of alcohol dependence is narrowing,” she said.  “One possible explanation is that between 1934 and 1964, the social acceptability of women’s drinking increased.  As it was more socially acceptable for women to drink, a greater number of them became drinkers.  Because women have a heightened vulnerability to the effects of alcohol – that is, greater blood alcohol levels at similar ‘doses’ of alcohol – we may therefore see a concomitant rise in alcohol dependence among those who ever drank.”

Grucza drew an analogy between women’s drinking habits and culture and immigration.  “Clearly there were many changes in the cultural environment for women born in the 40s, 50s and 60s compared to women born earlier,” he said.  “Women entered the work force, were more likely to go to college, were less hampered by gender stereotypes, and had more purchasing power.  They were freer to engage in a range of behaviors that were culturally or practically off-limits, and these behaviors probably would have included excessive drinking and alcohol problems.”

He noted that U.S. immigrants from cultures with conservative values vis-à-vis drinking tend to adhere to their own cultural norms, while their children are likely to adopt U.S. norms, which are comparatively lax regarding alcohol.

“We can think of U.S. culture as having been traditionally dominated by white men,” added Grucza.  “As women have ‘immigrated’ into this culture, they have become ‘acculturated’ with regard to alcohol use.  But Black women – who still have the lowest rates of drinking among the demographic groups we looked at – have a second barrier between them and the dominant U.S. culture, namely, their race, that may be keeping them from adopting the standards of the dominant culture with respect to alcohol use.”

Greenfield suggested that specially designed prevention programs that target female drinkers might help to lower drinking rates, and also delay the age of drinking initiation, which could help prevent later alcohol problems.  “It would also be helpful to educate women about the gender differences in metabolism of alcohol, and the associated heightened female vulnerability to alcohol’s adverse health consequences at lower doses than men,” she said.

Grucza agreed that interventions for women need further investigation.  “Whenever we see change in a disorder in the population, there is an opportunity to take a closer look at which risk factors for the disorder might be changing at the same time,” he said.  “The classic example of this would be the rise in lung cancer in the late 20th century, a time in which sales of commercially produced cigarettes also skyrocketed.  In this case, we obviously wouldn’t want to change the progress made by women over the last 50 – 60 years, but we can look at specific changes in their drinking behavior and start to speculate about what interventions might work.”

Richard A. Grucza, Kathleen K. Bucholz, John P. Rice, Laura J. Bierut. (May 2008). Secular trends in the lifetime prevalence of alcohol dependence in the United States: a re-evaluation.  Alcoholism: Clinical and Experimental Research (ACER). 32(5): 763–770.

See also;

• 12-Step Treatment More Effective than Alternative
• AA Offers Recovery Not Religion
• Brief-TSF ASSESSMENT
• Subscribe to Twelve Step Facilitation by e-Mail

Counseling The Alcoholic Woman by Joseph F. Perez Read more about this title…

The Process of Reconnecting: Recovery from the Perspective of Addicted Women

This study examined women’s experiences with addiction to drugs and/or alcohol and their process of recovery. The techniques of in-depth interviews and participant observations were employed to elicit the perspectives of the women. The study consisted of 12 participants, 6 who were currently involved in a 90-day community-based drug and alcohol treatment program and 6 who had more than five years of recovery.

Grounded theory method guided data collection and analysis. The women in this study described experiences of connectedness and disconnectedness throughout their lives, their addiction, and their recovery. The researcher constructed a substantive theory and model to explain this process of connectedness and disconnectedness.

The findings support that making connections and establishing healthy relationships play a significant role for women in achieving sobriety and maintaining recovery.

Research; The Process of Reconnecting: Recovery from the Perspective of Addicted Women. Carolynn Masters & Dorothy S. Carlson. Journal of Addictions Nursing, Volume 17, Issue 4 December 2006 , pages 205 – 210

Coping Strategies of Female Victims of Child Abuse in Treatment for Substance Abuse Relapse: Their Advice to Other Women and Healthcare Professionals,

Abstract

This study was a part of a larger qualitative descriptive study designed to explore chronic sorrow as a relapse trigger among female victims of child abuse who were currently enrolled in substance abuse treatment for relapse.

The purpose of this study was to identify coping strategies and other factors these women perceived as helpful to their recovery. A purposive sample of twelve women participated in interviews using a semistructured interview schedule.

The advice the participants offered to women in similar situations reflected interpersonal, cognitive and action-focused positive coping strategies.

They encouraged clinicians in primary care facilities to approach persons suspected of substance abuse in a nonjudgmental manner. Healthcare professionals should be more assertive in recommending resources for substance abuse treatment.

Research; Cheryl Slaughter Smith. Coping Strategies of Female Victims of Child Abuse in Treatment for Substance Abuse Relapse: Their Advice to Other Women and Healthcare Professionals, Journal of Addictions Nursing, Volume 18, Issue 2 April 2007 , pages 75 – 80

Australian Broadcasting Commission, Online, AM, 11 January 2007, journalist Anne Barker

TONY EASTLEY: It’s proven that women who drink in pregnancy risk causing life-long health problems for their unborn children.

What isn’t so well known is that there’s growing evidence that foetal alcohol disorders, as they’re known, are a major cause of crime.

A Canadian lawyer is in Darwin this week talking to judges and barristers about the impact of foetal alcohol.

Anne Barker reports.

ANNE BARKER: It’s common knowledge that women who drink when they’re pregnant can cause permanent and serious brain damage to the unborn child.

But only now is a growing body of research revealing the scale of foetal alcohol disorders in the western world.

One man who has witnessed the consequences of alcohol induced delinquency over 20 years is Canadian barrister David Boulding.

DAVID BOULDING: Alcohol acts like nail polish remover on your nails. It dissolves brain cells. And when the brain cells are not there, the brain is missing brain function.

So you get kids who are impulsive, suggestive, no abstract thinking, memory problems, learning problems, attention problems.

ANNE BARKER: David Boulding believes one to two per cent of the population has some form of life-long disability caused even before they were born. And contrary to popular belief, he says they’re more likely to come from an affluent background.

DAVID BOULDING: Rich, white stockbrokers have wives who drink while they are pregnant.

The University of California just did a huge multi-year study and they found out that women that drink the most while they are pregnant are white, with four years of university education, earning 400 per cent above the poverty line.

ANNE BARKER: Wealthy or not, youngsters with foetal alcohol disorders, whether it’s learning problems or memory loss appear to account for a staggering proportion of delinquents.

In the only study of its kind in one Canadian province, one quarter of young offenders were found to have some form of permanent foetal alcohol syndrome.

David Boulding says there’s a clear connection to crime.

DAVID BOULDING: They really are missing that little voice. That superior, frontal lobe conscience part of the brain that knows right and wrong.

But also they are alone. They don’t have friends, they’ll do anything to please people. They will confess to murder, they’ll hold the gun, they’ll drive the get away car.

ANNE BARKER: David Boulding is in the Northern Territory this week as a guest of the Aboriginal justice agency NAAJA, which represents Indigenous offenders in court.

One NAAJA lawyer Stewart O’Connell says despite the clear impact of alcohol on crime in the NT, the prevalence of foetal alcohol syndrome is virtually unknown.

STEWART O’CONNELL: We are locking Aboriginal people up in jail at a greater rate than ever before. The sentences are getting longer, and it’s not working.

And we have to ask the question – why is it not working? And one of the reasons may be because of things such as foetal alcohol syndrome.

ANNE BARKER: And David Boulding says while nothing can ever reverse foetal alcohol disorders, a recognition of the problem would lead to more effective solutions than jail.

He says it’s already working in Canada.

DAVID BOULDING: Every probation officer, every judge, every lawyer has got stories where somebody took and interest in somebody and made sure, okay he’s not going to hang out with those guys any more, he’s not going to go there any more. I’m going to get him some kind of job maybe, even if it’s volunteer work, he’s going to have new friends.

And guess what? The crime stops.

TONY EASTLEY: Canadian barrister David Boulding talking to Anne Barker in Darwin.

Link to story: http://www.abc.net.au/cgi-bin/common/printfriendly.pl?http://www.abc.net.au/am/content/2007/s2136186.htm

Postural sway among abstinent alcoholics can be improved up to a point

Excessive sway during quiet standing is a common and significant consequence of chronic alcoholism, even after prolonged sobriety, and can lead to fall-related injury and even death.

A new study of residual postural instability in alcohol-abstinent men and women shows that alcoholics improve with prolonged sobriety, but the improvement may not fully erase the problem of instability.

Results will be published in the March 2010 issue of Alcoholism: Clinical & Experimental Research and are currently available at Early View.

“Caricatures depict acutely intoxicated individuals with a stumbling, weaving, wobbly gait,” said Edith V. Sullivan, professor in the department of psychiatry and behavioural sciences at Stanford University School of Medicine and corresponding author for the study. “With sobriety, gait and balance become stable. However, even with prolonged sobriety, people with long-term chronic alcohol dependence can have difficulty in standing upright. Their balance can be marked by sway that exceeds what most of us experience while standing still in one place, especially with feet together and hands down by one’s side, that is, without use of natural stabilizing factors.”

Sullivan said that quantifying the sway can be accomplished by using a force plate to record the sway path in fractions of an inch over fractions of seconds during quiet standing. This provides “sway path tracking” as well as measurement of body tremor, which are micro-movements often reflective of central nervous system damage that can be found both in Parkinson’s disease and alcoholism.

Researchers used a “force platform” to measure postural sway – with and without stabilizing conditions from touch, vision and stance – in 34 alcoholic men, 15 alcoholic women, 22 control men, and 29 control women. They then analyzed “biomechanical control mechanisms” that indicate skeletomuscular control over balance, which – under normal circumstances – means the muscles, joints, and skeletal structure are working synergistically, in a give-and-take manner.

“Results show the sway paths of alcoholics are longer and cover a wider area than those of controls for a given time,” said Sullivan. “However, it is important to note that the standing stability of sober alcoholics can be improved by using stabilizing factors. These factors can include simple aids like turning a light on in a dark room, touching a banister while walking down a flight of stairs, or walking or standing with feet apart rather than with ankles close together.”

Sullivan added that the disproportionately greater sway in the anterior-posterior (front-to-back) direction than the medial-lateral (side-to-side) direction that they found is associated with chronic alcoholism as well as pathology of the anterior superior vermis of the cerebellum.

“This part of the brain is often disturbed in alcoholism, and lesions there, whether or not a result of alcoholism, can cause impairment in gait and balance,” she said. “It is interesting to note that while alcoholic men and women can quell their imbalance with stabilizing factors, alcoholic women do not necessarily improve to control levels.” Until more is known about improving this deficit, Sullivan suggested that people who are at risk utilized simple strategies to stabilize balance and to avert falls.

Women and the Twelve Steps of Alcoholics Anonymous: A Gendered Narrative

This paper examines how women “work” the twelve steps of Alcoholics Anonymous (AA) from a gendered perspective.

Feminist critics of AA have

• challenged the language of AA’s Twelve Steps,
• the spiritual nature of the steps, and
• the male-dominated culture of the Twelve-Step program.

This paper offers insight into how women in AA approach, interpret, and utilize the Twelve Steps to recover from alcoholism.

Through survey and narrative data, findings suggests

• that women working AA’s Twelve Steps become empowered and
• change for the better in spite of the male-dominated culture and language of the Twelve Steps and
• regardless of the difficulty they may have encountered in completing these steps.

In particular, the first three steps-the “surrender steps”-

• encourage women to let go of their alcoholic obsession and
• begin a spiritual path of recovery.

Steps Four through Nine require

• women to “clean house” and
• get rid of old self-destructive ways so that they may develop a new and stronger sense of self.

Finally, on completing Steps Ten through Twelve, women

• experience a spiritual awakening and
• then, in turn, “pass on” what they have learned from the Twelve Steps to other women in the program.

Woven throughout these women’s experiences is

• an acknowledgment of gender and
• the role it plays in how they work the Twelve Steps.

In the end, these women express a sense of personal empowerment that is particular to a gender-specific orientation to the Twelve Steps of AA.

Research; Jolene M. Sanders, Women and the Twelve Steps of Alcoholics Anonymous: A Gendered Narrative. Alcoholism Treatment Quarterly, Volume: 24 Issue: 3, 2006

Al-anon, Adult Children of Alcoholics, Gambler Anonymous, Narcotics Anonymous,

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Predictors of changes in alcohol-related self-efficacy over 16 years

Self-efficacy is a robust predictor of short- and long-term remission after alcohol treatment. This study examined the predictors of self-efficacy in the year after treatment and 15 years later.

A sample of 420 individuals with alcohol use disorders was assessed five times over the course of 16 years.

Predictors of self-efficacy at 1 year included

• improvement from baseline to 1 year in heavy drinking,
• alcohol-related problems,
• depression,
• impulsivity,
• avoidance coping,
• social support from friends, and
• longer duration of participation in mutual-help Alcoholics Anonymous (AA).

Female gender, more education, less change in substance use problems, and impulsivity during the first year predicted improvement in self-efficacy over 16 years.

Clinicians should focus on

• keeping patients engaged in self-help of AA,
• addressing depressive symptoms,
• improving patient’s coping, and
• enhancing social support

during the first year and reduce the risk of relapse by monitoring individuals whose alcohol problems and impulsivity improve unusually quickly.

Research; Predictors of changes in alcohol-related self-efficacy over 16 years. John McKellar Ph.D, Mark Ilgen Ph.D., Bernice S. Moos B.A. and Rudolf Moos Ph.D. J Subst Abuse Treat. 2007 Nov 23.

See also;

• AA and Treatment Work Better Together
• Brief-TSF can assist patients cease alcohol consumption.
• AA Offers Recovery Not Religion

Drug and Alcohol Abuse: A Clinical Guide to Diagnosis and Treatment by Marc A. Schuckit Read more about this title…

Tolerance Equals More Consumption for Older Problem Drinkers

Adults over age 60 who have alcohol problems tend to drink more than their younger counterparts, probably because they have developed greater tolerance for alcohol, according to researchers at Ohio State University.

Science Daily reported that a study found that alcohol-dependent individuals over age 60 consumed an average of more than 40 drinks per week, compared to 25-35 among younger people with similar levels of dependence.

Researchers said that older drinkers developed tolerance for alcohol, meaning they had to drink more to get the same effects.

The older drinkers also reported more monthly binge-drinking episodes.

“A combination of high levels of drinking and the physiological effects of aging are particularly problematic for older adults,” noted researcher Linda Ginzer.

Younger Americans were still more likely to have drinking problems than older Americans, however.

Researchers found that binge drinking was more common among Americans classified as alcohol abusers than among those who were heavy drinkers but not seen as problem drinkers.

“That suggests binge drinking may be a better measure of problem drinking than just the total amount of drinks someone has per week,” Ginzer said.

The findings, drawn on findings from the National Epidemiologic Survey on Alcohol and Related Conditions, were unveiled at a recent meeting of the Gerontological Society of America. From; Join Together Online.

• See also;
• Brief-TSF is designed to address these issues.
• Alcohol & Medication Interactions
• Physical effects of alcohol on women