Alcohol misuse by women

A longitudinal analysis on determinants of problem drinking among Korean women: focusing on a gender perspective

Background

In recent years, female drinking has been on the rise worldwide, and this trend can be observed in Korea as well. Accordingly, this study aimed to examine the heterogeneous longitudinal changes in drinking patterns among Korean women, while also exploring the determinants of these changes. In particular, the study identified the gender perspective-related determinants of the classified patterns of problem drinking.

Methods

Data on 4615 adult women who participated in the Korea Welfare Panel Study (KOWEPS) for 3 years (2018–2020) were analyzed longitudinally using SPSS Statistics 22.0 and M-plus 7.0. The changes in female drinking patterns were analyzed using latent class growth analysis. Subsequently, multinomial logistic regression analysis was performed to identify the predictive factors affecting the changes in drinking patterns.

Results

Latent class analysis yielded three classes: “low problem drinking/decreased,” “moderate problem drinking/maintained,” and “high problem drinking/increased.” Of the participants, 80.4% were in the first class, 14.5% in the second, and 5.1% in the third. After controlling for sociodemographic and psychosocial factors, we found: i) domestic violence, work–family balance stress, and gender role perception were not statistically significant for the “moderate problem drinking/maintained” class; lower levels of depression (odds ratio; OR = .750, p < .05) and higher levels of satisfaction with social relationships (OR = 1.257, p < .05) increased the probability of belonging to the “moderate problem drinking/maintained” group compared to the low problem drinking/decreased class; ii) in the “high problem drinking/increased” class, relative to the low problem drinking/decreased class, experience of domestic violence (OR = 1.857, p < .05), work–family balance stress (OR = 1.309, p < .05), and gender role perception (OR = .705, p < .05) were significant predictors of drinking behavior.

Conclusions

Problem drinking in Korean women demonstrated heterogeneous patterns of change, with gender-specific factors being the main predictors of this change. Therefore, this study developed a strategy for reducing the harmful effects of female drinking, which considers the characteristics of the changes in women’s drinking patterns as well as factors from the gender perspective.

Sex and gender-related differences in alcohol use and its consequences: Contemporary knowledge and future research considerations

AIMS

To review the contemporary evidence reflecting male/female differences in alcohol use and its consequences along with the biological (sex-related) and psycho-socio-cultural (gender-related) factors associated with those differences.

METHODS

MEDLINE, PubMed, Web of Science, SCOPUS, PsycINFO, and CINAHL databases were searched for relevant publications, which were subsequently screened for the presence/absence of pre-specified criteria for high quality evidence.

RESULTS

Compared to men, more women are lifetime abstainers, drink less, and are less likely to engage in problem drinking, develop alcohol-related disorders or alcohol withdrawal symptoms. However, women drinking excessively develop more medical problems. Biological (sex-related) factors, including differences in alcohol pharmacokinetics as well as its effect on brain function and the levels of sex hormones may contribute to some of those differences. In addition, differences in alcohol effects on behavior may also be driven by psycho-socio-cultural (gender-related) factors. This is evident by variation in the magnitude of differences in alcohol use between countries, decreasing difference in the rates of alcohol consumption in recent generations and other findings. Evidence indicates that both sex and gender-related factors are interacting with alcohol use in complex manner, which differentially impacts the risk for development of the behavioral or medical problems and alcohol use disorders in men and women.

CONCLUSIONS

Discovery of the mechanisms underlying biological (sex-related) as well as psycho-socio-cultural (gender-related) differences in alcohol use and related disorders is needed for development of personalized recommendations for prevention and treatment of alcohol use disorders and related problems in men and women.

Age-based differences in treatment outcome among alcohol-dependent women

The literature suggests that women are at higher risk for negative consequences from alcohol use than men and that these risks are compounded by age. The current study investigated how alcohol-dependent women from different age groups might differ in terms of baseline functioning and treatment response. The sample consisted of 181 participants drawn from two randomized clinical trials of cognitive-behavioral treatments for alcohol-dependent women. Demographic and psychopathology data were obtained at baseline using the SCID (Structured Clinical Interview for DSM disorders) I for Axis I disorders and the SCID II or Personality Disorders Questionnaire for Axis II disorders. Social networks data were collected using the Important People and Activities Interview. Drinking data were collected at baseline and follow-up using the Timeline Follow Back Interview. ANOVAs revealed that older women had better psychosocial functioning in terms of being better educated and reporting fewer Axis I disorders. Also, older women had more supportive social networks in terms of more people, a smaller percentage of heavy drinkers, and a nondrinking spouse. Older women reported a less severe lifetime substance use history with a later age of first drink, later onset of alcohol use disorders, fewer lifetime abuse/dependence items, and less drug use. However, they reported drinking more frequently and more heavily over the 90 days prior to treatment. Finally, older women were more compliant with treatment and responded better by reducing drinking frequency and percentage of heavy drinking days. Suggestions to enhance treatment efficacy for younger women are made as well as suggestions for future research.

Long-term behavioral changes in response to early developmental exposure to ethanol in zebrafish

BACKGROUND

Zebrafish is becoming an important research tool for the analysis of brain function and behavior. It has been proposed to model human alcoholism as well as fetal alcohol syndrome. Previous studies investigating the consequences of exposure to ethanol during early development of zebrafish employed robust dosing regimens (high ethanol concentration and long exposure) that may model a rare situation in the human clinic. These studies found major structural abnormalities developing in the exposed fish.

METHODS

Here we hope to avoid such gross changes and administer only low doses of ethanol (0.00, 0.25, 0.50, 0.75, 1.00 vol/vol %) at 24-hour postfertilization and for only a short period of time (for 2 hours). We analyze the behavior of exposed fish at adult stage using computerized stimulus presentation and automated videotracking response quantification.

RESULTS

Despite the short ethanol exposure period and the modest concentrations, significant behavioral alterations were found: fish exposed to higher doses of ethanol swam at an increased distance from a computer-animated zebrafish shoal while their activity levels did not change.

CONCLUSIONS

Although the interpretation of and the mechanisms underlying this finding will require further investigation, the results suggest that zebrafish will be an appropriate model organism for the analysis of the effects of moderate to mild prenatal ethanol exposure.

Women's Early Recovery: Managing the Dilemma of Substance Abuse and Intimate Partner Relationships

Numerous studies have shown that women's patterns of substance use are strongly impacted by social relationships. Using a hermeneutic phenomenological method, this study examined the interplay between intimate partner relationships and substance abuse recovery through in-depth interviews with 17 women in a treatment program. Six essential themes about the dilemmas posed by recovery and relationships emerged from analysis: (a) experiencing themselves as damaged goods; (b) paying the price for both recovery and relationship choices made; (c) trading parts of self for relationships and drugs; (d) waking from the nightmare and realizing the impact of abuse; (e) hoping, but not always quite believing, in the possibility of recovery; (f) asking themselves “who's in charge of my life?” This study expands on previous findings by examining critical similarities in the dynamics of interpersonal relationships and recovery for women and the meanings they assign to each.

Women, aging, and alcohol use disorders

The increase in prevalence rates of alcohol use disorders in younger versus older cohorts of female drinkers is many times higher than the corresponding increase in prevalence rates for male drinkers. Thus, the number and impact of older female drinkers is expected to increase over the next 20 years as the disparity between men's and women's drinking rates decrease. Due to differences in metabolism of alcohol, women of all ages compared to men are at higher risk for negative physical, medical, social, and psychological consequences associated with at-risk and higher levels of alcohol consumption. Aging women face new sets of antecedents related to challenges in the middle and older adult phases of life, such as menopause, retirement, "empty nest," limited mobility, and illness. As women age, they are subject to an even greater physiological susceptibility to alcohol's effect, as well as to a risk of synergistic effects of alcohol in combination with prescription drugs. On the other hand, there is mixed research indicating that older women may benefit from the buffering effect of low levels of alcohol on hormonal declines associated with menopause, perhaps serving as a protective factor against Coronary Heart Disease and osteoporosis. However, with heavier drinking, these benefits are either reversed or eclipsed. In addition, any alcohol consumption increases the risk for breast cancer in older women. The possible beneficial effects of alcohol must be weighed with the fact that the research does not typically establish causality, that low-risk drinking equates to one standard drink per day, that there is a risk of progression towards alcohol dependence, and that there are alternate methods to gain the same benefits without the associated risks. Older women also experience unique barriers to detection of and treatment for alcohol problems. Current treatment options specifically for older women are limited, though researchers are beginning to address differential treatment response of older women, as well as development of elder women-specific treatment approaches. Treatment options include self-help/mutual peer support, which provides ancillary advantages, brief interventions in primary care settings, which have been demonstrated to be effective in reducing drinking levels, and cognitive behavioral techniques, which have been demonstrated to be useful; but more studies and larger samples are needed. Elder-specific treatments need to be appropriate in terms of content, to address the challenges associated with life stage, such as the loss of the parental role and widowhood, and in terms of process, such as delivery in a respectful therapeutic style and at a slower pace. Future directions in research should address the lack of assessment instruments, the risks of simultaneous use of alcohol and prescription medications, and the under-representation of older women in randomized trials of alcohol treatments.

Acute and chronic effects of some dietary bioactive compounds on folic acid uptake and on the expression of folic acid transporters by the human trophoblast cell line BeWo

Folic acid (FA) is a vitamin that acts as a coenzyme in the biosynthesis of purine and pyrimidine precursors of nucleic acids, which are critically important during pregnancy. Our group has previously shown that both reduced folate carrier (RFC1) and folate receptor alpha (FRalpha) seem to be involved in the uptake of [3H]folic acid ([3H]FA) by a human trophoblast cell line (BeWo) and by human primary cultured cytotrophoblasts. Our aim was to study the interaction between FA and some nutrients/bioactive substances. For this, we tested the acute and chronic effects of some dietary compounds on [3H]FA apical uptake and on the expression of both RFC1 and FRalpha mRNA in BeWo cells. Our results show that [3H]FA uptake was significantly reduced by acute exposure to epicatechin, isoxanthohumol (1-400 microM) or theophylline (0.1-100 microM); isoxanthohumol seemed to act as a competitive inhibitor, whereas epicatechin and theophylline caused an increase in both Km and Vmax. On the other hand, [3H]FA uptake was significantly increased by chronic exposure to xanthohumol, quercetin or isoxanthohumol (0.1-10 microM), and this increase does not seem to result from changes in the level of RFC1 or FRalpha gene expression. Moreover, [3H]FA uptake was significantly reduced by chronic exposure to ethanol (0.01%). This reduction seems to be, at least in part, due to a reduction in FRalpha expression. These results are compatible with an association between a deficient FA supply to the placenta/fetus and ethanol toxicity in pregnancy.

Naltrexone and cognitive behavioral coping skills therapy for the treatment of alcohol drinking and eating disorder features in alcohol-dependent women: a randomized controlled trial

BACKGROUND

Despite important gender differences in drinking patterns, physiological effects of alcohol, and co-occurring psychiatric conditions, relatively little is known about the efficacy of naltrexone for the treatment of alcohol dependence in women. This study investigated the safety and efficacy of naltrexone in combination with Cognitive Behavioral Coping Skills Therapy (CBCST) in a sample of alcohol-dependent women, some with comorbid eating pathology.

METHODS

One hundred three women meeting DSM-IV criteria for alcohol dependence (29 with comorbid eating disturbances) were randomized to receive either naltrexone 50 mg or placebo for 12 weeks in addition to weekly group CBCST. Subjects were enrolled between October 1995 and December 2000 at an outpatient research clinic.

RESULTS

No significant differences were observed on the primary outcomes of time to first drinking day, time to first day of heavy drinking, or the percentage of participants who continued to meet the criteria for alcohol dependence. Secondary analyses revealed that naltrexone significantly delayed the time to the second (chi2=5.37, p=0.02) and third (chi2=4.35, p=0.04) drinking days among subjects who did not maintain abstinence from alcohol. Among those with eating disturbances, symptoms of eating pathology improved during treatment, but the effects did not differ according to medication condition.

CONCLUSION

When used in conjunction with CBCST, naltrexone did not significantly improve drinking outcomes in the overall sample of alcohol-dependent women. However, naltrexone may be of benefit to women who are unable to maintain total abstinence from alcohol. For women with concurrent eating pathology, participation in treatment for alcoholism may be associated with improvements in eating pathology.

Stigma towards people with mental illness in developing countries in Asia

BACKGROUND

There is a wide range of literature on stigmatization and discrimination of people with mental illness. Most studies, however, derive from Western countries. This review aims at summarizing results from developing countries in Asia published between 1996-2006.

METHOD

Medline search focusing on English-speaking literature.

RESULTS

Comparable to Western countries, there is a widespread tendency to stigmatize and discriminate people with mental illness in Asia. People with mental illness are considered as dangerous and aggressive which in turn increases the social distance. The role of supernatural, religious and magical approaches to mental illness is prevailing. The pathway to care is often shaped by scepticism towards mental health services and the treatments offered. Stigma experienced from family members is pervasive. Moreover, social disapproval and devaluation of families with mentally ill individuals are an important concern. This holds true particularly with regards to marriage, marital separation and divorce. Psychic symptoms, unlike somatic symptoms, are construed as socially disadvantageous. Thus, somatisation of psychiatric disorders is widespread in Asia. The most urgent problem of mental health care in Asia is the lack of personal and financial resources. Thus, mental health professionals are mostly located in urban areas. This increases the barriers to seek help and contributes to the stigmatization of the mentally ill. The attitude of mental health professionals towards people with mental illness is often stigmatizing.

CONCLUSION

This review revealed that the stigmatization of people with mental illness is widespread in Asia. The features of stigmatization-beliefs about causes of and attitudes towards mental illness, consequences for help-seeking-have more commonalities than differences to Western countries.