Alcohol Use Disorders in Primary Care. Do Gender-specific Differences Exist?

Abstract

OBJECTIVE:To describe how alcohol use disorders (AUDs) affect women, focusing on gender-specific implications for primary care physicians (PCPs). A lcohol is the drug of choice among American women.Six million women meet the diagnostic criteria for current abuse or dependence. Until recently, most research, prevention and treatment efforts have been extrapolated from men to women without evidence of whether important and significant gender differences may exist. Within primary care settings, a large proportion of both male and female patients, (approximately 10% to 20%, depending on the severity of the disorder studied), suffer from alcohol use disorders (AUDs). 1±3 Women are more likely than men to seek help for alcohol problems in health care settings, yet are less likely to be identified and diagnosed. 4±6 For many of these women the visit to their primary care provider may be an important opportunity for screening and potential entry into treatment. Research has shown that screening and brief interventions for AUDs in women by primary care providers are effective in reducing future alcohol consumption. 7,8 Given the high prevalence of female patients with AUDs and the fact that currently fewer than half of such cases are properly identified, 5,9 primary care physicians (PCPs) need to take a more active role in identifying such patients.The objective of this paper is to describe how AUDs affect women, the known gender-specific differences in AUDs, and implications for PCPs. Specifically, we will review known differences between men and women suffering from AUDs by epidemiology, genetics, biology, presentation, definition and screening, social context, course and medical consequences, psychiatric comorbidity, victimization and violence, and treatment. Our review of this enormous literature is necessarily selective and we pay greatest attention to those areas of clinical significance to PCPs.

Alcohol Screening Scores and the Risk of New-Onset Gastrointestinal Illness or Related Hospitalization

“…20 This may be especially true for women, who are more vulnerable to the toxic effects of alcohol. 21,22 Indeed our data show that women in the AUDIT-C 0 group (abstainers) were at increased risk for new-onset liver disease. With the exception of abstainers (AUDIT-C 0), women's risk for adverse gastrointestinal outcomes increased only in women in the AUDIT-C 9-12 group.…”

“…This is unexpected given that men had increased risk at lower scores (≥ 5), and women are more vulnerable than men, especially to the hepatotoxic effects of alcohol. 21,22 Several factors may be biasing the results for women in the AUDIT-C 5-8 group to the null. First, even with a sample of over 9,000 women, we had low power to detect rare events (see Table 2).…”

“…Also, women typically underreport drinking levels compared to men due to increased stigma for heavy drinking. 21,23 Thus, some women in the low level drinking group (AUDIT-C 1-4), may in fact have been drinking in the hazardous range. These results need to be understood in light of several additional limitations.…”

Diretrizes da Associação Brasileira de Estudos do Álcool e outras Drogas (ABEAD) para o diagnóstico e tratamento de comorbidades psiquiátricas e dependência de álcool e outras substâncias

“…[20][21][22] Entre as mulheres com AOS, 19% tiveram depressão em algum momento na vida, enquanto que na população geral de mulheres essa prevalência é de 7%. Nos homens com AOS, 78% apresentaram primeiro AOS e depois depressão; entre as mulheres com AOS, 66% apresentaram primeiro a depressão.…”

Comorbidade entre dependência de substâncias psicoativas e transtornos alimentares: perfil e evolução de mulheres em um tratamento específico para dependência química

“…Nesse sentido, conquanto possa ser dito que existe um preconceito social em relação a qualquer dependência de substâncias psicoativas, a mulher é ainda mais estigmatizada que o homem (Blume, 1986;Brienza, Stein, 2002).…”