The 14-year course of alcoholism in a community sample: Do men and women differ?

Abstract

Objective-To investigate the course of alcoholism in males and females in a 14-year followup of persons with DSM-III alcoholism compared to very heavy drinkers and unaffected controls in a community sample.Methods-Case-control study based on data from the 1997 Health Services Use and Cost study, a 14-year followup survey of 442 individuals who participated in 2 waves of the 1981-1983 St. Louis Epidemiologic Catchment Area study. Cases met criteria for DSM-III alcohol abuse (AA) or dependence (AD) at both waves of the ECA: "Two-times Alcohol Use Disorder Positives (ECA 2t-AUDPs)." Two comparison groups were frequency matched to 2t-AUDPs: 1) ECA Very Heavy Drinkers/One-time Alcohol Use Disorder Positives (ECA VHD/1t-AUDPs) and 2) ECA Alcoholunaffecteds. Lifetime and past year alcohol use disorders, patterns of drinking and recovery among males and females are reported.Results-84.6% of 2t-AUDPs again met lifetime DSM-III criteria at 14-year followup. At followup, only 9.3% male 2t-AUDPs and 20.7% female 2t-AUDPs met past year DSM-IV AUD criteria. Past year drinking patterns, however, revealed higher rates of DSM-IV AA or AD, problemor risk drinking among 2t-AUDPs (61.7%) compared to both ECA VHD/1t-AUDPs (41.2%) and ECA Alcohol-unaffecteds (22.1%).Conclusions-In a community sample, the rate of past year DSM-IV alcohol dependence was lower among male 2t-AUDPs than females, though both groups showed past year rates substantially lower than lifetime rates. However, less than half of ECA 2t-AUDPs exhibited low-risk or abstinent alcohol use behaviors, indicating that while remission from diagnosis is common, clinical relevance persists.

Exposure to fentanyl-contaminated heroin and overdose risk among illicit opioid users in Rhode Island: A mixed methods study

“…Heroin users in Rhode Island are encountering illicitly made fentanyl and fentanyl analogs produced in clandestine labs, not the medical-grade drug (Mercado-Crespo et al, 2014). There is some evidence that chronic users of illicit or diverted opioids may prefer the physical effects of fentanyl to those of pure heroin (Comer, Sullivan, Whittington, Vosburg, & Kowalczyk, 2008; Greenwald, 2008), and may seek it out (Macmadu et al, 2017); however, with no drug quality information available to opioid consumers and a high local prevalence of fentanyl-related overdose, perceived desirability of fentanyl in Rhode Island currently appears low.…”

Emergence of sex differences in the development of substance use and abuse during adolescence

“…Age of onset of drinking alcohol and perhaps other drug use has shifted earlier in recent years in women but not men (Grucza, Norberg, Bucholz, & Bierut, 2008). Even among women who started later, some studies show that they accelerate drinking more rapidly than men (Bohman, Cloninger, Sigvardsson, & von Knorring, 1987; Cloninger, Sigvardsson, & Bohman, 1988; Gilligan, Reich, & Cloninger, 1987; Lovallo, Yechiam, Sorocco, Vincent, & Collins, 2006; Piazza et al, 1989; Randall et al, 1999; Schuckit et al, 1998; Schuckit et al, 2001; Tarter et al, 1999) and may show more persistence once they are diagnosed (Edens, Glowinski, Grazier, & Bucholz, 2008). …”

Racial Disparities in Substance Abuse Treatment and the Ecological Fallacy

“…Consensus among primary treatment staff regarding treatment activities is an aspect of organizational culture that has been shown to affect client engagement in treatment through its influence on the consistency of staff responses to clients, which, in turn, affects clients’ expectations for the program and engagement in treatment (Melnick et al, 2006). Consensus among clients about the goals and objectives of substance abuse treatment programs is believed to be related to staff consensus and has been shown to influence 1-year treatment outcomes (Melnick et al, 2008). Treatment climate reflects the supportiveness of the treatment program and has been associated with better treatment outcomes (Moos, 1997; Moos, Finney, Ouimette, & Suchinsky, 1999; Moos & Moos, 2003).…”

“…Treatment activities were drawn from three residential treatment modalities: therapeutic communities, cognitive behavioral therapy, and 12-step programs (Lipton, Pearson, & Wexler, 1999). Consensus uses variance as a measure of agreement and is measured as within-group variability based on a ratio score, following Melnick, Wexler, and Cleland (2008), in which the actual standard deviation is divided by the theoretical maximum standard deviation and then subtracted from 1 to indicate consensus rather than variability. Consensus about treatment implementation was measured using three scales of 15-point Likert item scale ranging from 0 (“not at all important in our program”) to 3 (“extremely important in our program”).…”