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Abstract
The current article provides a brief summary of biopsychosocial gender differences in alcohol use disorder (AUD), then reviews existing literature on gender differences in treatment access, retention, outcomes, and longer-term recovery. Among psychotherapies for AUD, there is support for the efficacy of providing female-specific treatment, and for female-only treatment settings but only when female-specific treatment is included. However, despite mandates from the National Institutes of Health to do so, there is little work thus far that directly compares genders on outcomes of specific psychotherapies or pharmacotherapies for AUD. Although existing research has mixed findings on sex and gender differences in overall outcomes, there are more consistent findings suggesting different mechanisms of behavior change among men and women in AUD treatment and long-term recovery. Thus, more work is needed that attends to gender and sex differences, including planning studies that are structured to examine not only gender-differentiated outcomes in treatment response, but equally important, differences in treatment access and attendance as well as differences in mechanisms of change in drinking behavior.
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Affiliation(s)
- Cathryn Glanton Holzhauer
- Department of Psychiatry, University of Massachusetts Medical School, Worcester, Massachusetts.,Division of Research and Education, VA Central Western Massachusetts, Leeds, Massachusetts
| | - Michael Cucciare
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, Arkansas.,VA South Central Mental Illness Research, Education, and Clinical Center and Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock, Arkansas
| | - Elizabeth E Epstein
- Department of Psychiatry, University of Massachusetts Medical School, Worcester, Massachusetts
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2
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Muñoz RE, Tonigan JS. Alcoholics Anonymous-Related Benefit for Urban Native Americans: Does Urban Native American Gender Moderate AA Engagement and Outcomes? ALCOHOLISM TREATMENT QUARTERLY 2017; 35:34-45. [PMID: 29255338 DOI: 10.1080/07347324.2016.1256715] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Alcoholics Anonymous (AA) is one of the most commonly accessed resources for individuals seeking to reduce their drinking. How urban Native Americans fare in AA is only beginning to be investigated in spite of circumstantial evidence suggesting that a majority of treatment-seeking urban Native Americans will receive 12-step treatment. Even less is known about Native American gender differences with regard to AA-related benefit. The current study addressed this gap by investigating urban Native American gender differences in AA attendance rates and outcomes. To this end, as part of two larger NIH-funded studies we recruited 63 Native American men and women and followed them for 9 months in this naturalistic study (n= 35 males, n = 28 females). Urban Native Americans significantly reduced their drinking over the study period, and AA attendance explained, in part, increased abstinence of study participants. No significant differences in AA attendance and drinking outcomes were observed between Native American men and women; however, descriptively men reported greater reductions in hazardous drinking relative to women. Clinical implications and future directions are discussed.
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Affiliation(s)
- Rosa E Muñoz
- University of New Mexico, Center on Alcoholism, Substance Abuse and Addictions, Albuquerque, NM
| | - J Scott Tonigan
- University of New Mexico, Center on Alcoholism, Substance Abuse and Addictions, Albuquerque, NM
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3
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Gruszczyńska E, Kaczmarek M, Chodkiewicz J. Hitting rock bottom? Resource loss as a predictor of alcoholism treatment completion. Nord J Psychiatry 2016; 70:351-7. [PMID: 26813301 DOI: 10.3109/08039488.2015.1123293] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background Efforts to better understand the phenomenon of the 'bottom', the beginning of the process of turning away from alcohol, are important for both theoretical and practical goals. The conservation of resources theory by Hobfoll may represent a suitable framework to base these attempts around. Aim The aim of the study was to examine the role of resource loss in completing alcoholism treatment on the basis of Hobfoll's conservation of resources theory. Methods The study included 86 patients undergoing inpatient alcoholism treatment. An assessment of resource loss and gain during the previous year, as well as of the decisional balance regarding the pros and cons of drinking alcohol, took place at the beginning of therapy. Results The results of hierarchical binary logistic regression confirmed that resource loss was the only significant predictor of therapy completion, after adjustment for decisional balance, demographics and basic clinical data. Additionally, gender moderated the relationship between resource gain and therapy completion: while an increase in gain was related to a decreased chance of completing therapy in men, the opposite effect was noted in women. Conclusions Resource loss has more influence than decisional balance in predicting therapy completion, which can be translated into clinically valid recommendations based on gender differences.
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Affiliation(s)
- Ewa Gruszczyńska
- a Department of Health Psychology , Institute of Clinical Psychology, University of Social Sciences and Humanities , Warsaw , Poland
| | - Małgorzata Kaczmarek
- b Department of Health Psychology , Institute of Psychology, University of Łódź , Poland
| | - Jan Chodkiewicz
- c Department of Health Psychology , Institute of Psychology, University of Łódź , Poland
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Parkman TJ, Lloyd C, Splisbury K. Self-Help Groups for Alcohol Dependency: A Scoping Review. ACTA ACUST UNITED AC 2015. [DOI: 10.1080/1556035x.2015.1034824] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Kelly JF, Hoeppner BB. Does Alcoholics Anonymous work differently for men and women? A moderated multiple-mediation analysis in a large clinical sample. Drug Alcohol Depend 2013; 130:186-93. [PMID: 23206376 PMCID: PMC3596430 DOI: 10.1016/j.drugalcdep.2012.11.005] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2012] [Revised: 10/23/2012] [Accepted: 11/04/2012] [Indexed: 11/25/2022]
Abstract
BACKGROUND Alcoholics Anonymous (AA) began as a male organization, but about one third is now female. Studies have found that women participate at least as much as men and benefit equally from AA, but it is unclear whether women benefit from AA in the same or different ways as men. This study tested whether gender moderated the mechanisms through which AA aids recovery. METHODS A cohort study of alcohol dependent adults (N=1726; 24% female; Project MATCH) was assessed on AA attendance during treatment; with mediators at 9 months; outcomes (Percent Days Abstinent [PDA] and Drinks per Drinking Day [DDD]) at 15 months. Multiple mediator models tested whether purported mechanisms (i.e., self-efficacy, depression, social networks, spirituality/religiosity) explained AA's effects differently for men and women controlling for baseline values, mediators, treatment, and other confounders. RESULTS For PDA, the proportion of AA's effect accounted for by the mediators was similar for men (53%) and women (49%). Both men and women were found to benefit from changes in social factors but these mechanisms were more important among men. For DDD, the mediators accounted for 70% of the effect of AA for men and 41% for women. Again, men benefitted mostly from social changes. Independent of AA's effects, negative affect self-efficacy was shown to have a strong relationship to outcome for women but not men. CONCLUSIONS The recovery benefits derived from AA differ in nature and magnitude between men and women and may reflect differing needs based on recovery challenges related to gender-based social roles and drinking contexts.
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Affiliation(s)
- John F Kelly
- Center for Addiction Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, United States.
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Ullman SE, Najdowski CJ, Adams EB. Women, Alcoholics Anonymous, and Related Mutual Aid Groups: Review and Recommendations for Research. ALCOHOLISM TREATMENT QUARTERLY 2012. [DOI: 10.1080/07347324.2012.718969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Witbrodt J, Romelsjö A. Treatment seeking and subsequent 1-year drinking outcomes among treatment clients in Sweden and the U.S.A.: a cross-cultural comparison. Addict Behav 2012; 37:1122-31. [PMID: 22673154 PMCID: PMC3395428 DOI: 10.1016/j.addbeh.2012.05.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2011] [Revised: 05/15/2012] [Accepted: 05/16/2012] [Indexed: 10/28/2022]
Abstract
Cross-cultural comparisons provide a method for distinguishing unique aspects as well as shared aspects of different cultures. Theoretically framed by a health-services conceptual model, we examine the extent that culture-specific versus common characteristics are associated with treatment seeking and drinking outcome. Swedish (n=997) and U.S. (n=501) alcohol-dependent individuals were interviewed at baseline and 1-year (n=635 and n=384 respectively). Both studies gathered comparable background, help-seeking, and drinking data. Regression models tested predictors of 1-year follow-up drinking defined as abstinence or moderate drinking versus heavy drinking. Swedish individuals were older and had social networks comprised mostly of substance abusers compared to U.S. individuals who reported higher problem severity and greater drug involvement. Whereas U.S. individuals reported greater prior mutual-help attendance, Swedish individuals reported greater prior treatment involvement. Better 1-year drinking outcomes were reported by women, younger age groups and those with an abstinence goal in both samples. Cultural and institutional differences were apparent. For example, with Swedish individuals having a mostly non-using network predicted better outcomes, whereas lower problem severity was a predictor for U.S. individuals.
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Affiliation(s)
- Jane Witbrodt
- Alcohol Research Group, 6475 Christie Avenue, Suite 400, Emeryville, CA 94608, USA.
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Curzio O, Tilli A, Mezzasalma L, Scalese M, Fortunato L, Potente R, Guidoni G, Molinaro S. Characteristics of alcoholics attending 'clubs of alcoholics in treatment' in Italy: a national survey. Alcohol Alcohol 2012; 47:317-21. [PMID: 22366119 DOI: 10.1093/alcalc/ags018] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIMS To provide an overview of alcoholics attending a socio-ecological treatment programme [Clubs of Alcoholics in Treatment (CATs)] and to identify factors associated with abstinence and self-perceived improvement in lifestyle. METHODS A national sample of 7522 subjects (76% males and 24% females, mean age 53.2 ± 11.3 years ± SD) attending CATs was evaluated using a self-administered questionnaire completed at a weekly meeting in 2006. RESULTS Of participants, >70% reported no alcohol use in the last year and around 90% indicated no use in the previous month, whereas 4% of them declared no alcohol use before club attendance. Abstinence and lifestyle improvement were related positively to the number of years of club attendance but negatively to the presence of other problems in addition to the alcohol-related one. Moreover, being older or female was associated with more likely achievement of abstinence as well as with the perception of a better lifestyle. Finally, attending the club with one or more family members was associated with achievement of better lifestyle. CONCLUSION These data provide an overview of alcoholics attending the CAT programme and are a first step toward developing a surveillance system. In addition, on the basis of this preliminary picture further research (notably longitudinal studies) can be planned considering this method and its effectiveness.
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Affiliation(s)
- Olivia Curzio
- Institute of Clinical Physiology, Italian National Research Council, Pisa, Italy
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Jenkins COE, Tonigan JS. Attachment avoidance and anxiety as predictors of 12-step group engagement. J Stud Alcohol Drugs 2012; 72:854-63. [PMID: 21906512 DOI: 10.15288/jsad.2011.72.854] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Twelve-step mutual help groups such as Alcoholics Anonymous (AA) rely heavily on social interactions and support to reduce drinking, but little is known about how individual differences in social behavior tendencies, such as adult attachment, affect 12-step group engagement and resulting benefits. This prospective study investigated relationships between the anxiety and avoidance dimensions of adult attachment and subsequent 12-step meeting attendance, program behaviors, sponsorship, and alcohol use. METHOD Early 12-step group affiliates (N = 253) were recruited from community-based AA and from outpatient treatment. Participants completed baseline interviews that included the Relationship Questionnaire, measures of motivation and professional treatment, and measures of 12-step meeting attendance, practices, and sponsorship. Follow-up interviews were conducted at 3, 6, 9, 12, 18, and 24 months. RESULTS At baseline, participants reported elevated attachment anxiety relative to a college population. Lagged analyses demonstrated that, as predicted, high attachment avoidance was related to lower rates of 12-step meeting attendance, practice of behaviors prescribed by 12-step organizations, and lower probability of acquiring a sponsor. Attachment anxiety did not predict any of these aspects of subsequent 12-step group engagement. Contrary to predictions, baseline attachment avoidance did not moderate the relationship between early sponsorship and alcohol use. CONCLUSIONS Findings support the hypothesis that social demands of behaviors prescribed by 12-step groups may deter high-avoidance individuals from fully engaging in them. Perhaps because of instability in attachment avoidance in this population, however, baseline attachment avoidance did not predict drinking outcomes or moderate sponsor benefits.
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Affiliation(s)
- Christopher O E Jenkins
- Department of Psychology, University of New Mexico, Albuquerque, New Mexico 87131-0001, USA.
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Witbrodt J, Delucchi K. Do women differ from men on Alcoholics Anonymous participation and abstinence? A multi-wave analysis of treatment seekers. Alcohol Clin Exp Res 2011; 35:2231-41. [PMID: 21689121 PMCID: PMC3179825 DOI: 10.1111/j.1530-0277.2011.01573.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Given the widespread use of Alcoholics Anonymous (AA) and other similar groups in the United States and the increasing membership of women, this study compares women with men on their meeting attendance and AA-prescribed behaviors, factors associated with that AA participation, and tests how these relate to women's and men's abstinence across time. METHODS All consecutive new admissions (age ≥ 18) from county-wide public and private treatment programs representing the larger population of treatment seekers were approached to be in the study at treatment entry. Those consenting at baseline (n = 926) were sought for follow-up interviews 1, 3, 5, and 7 years later. Generalized linear models were used to test whether various help-seeking factors were associated with AA participation differentially by gender and, controlling for AA and other confounders, whether women differ from men on abstinence. RESULTS At each follow-up interview, women and men attended AA at similar rates and similarly practiced specific AA behaviors, and they were alike on most factors associated with AA participation and abstention across time including abstinence goal, drink volume, negative consequences, prior treatment, and encouragement to reduce drinking. Relative to men, women with higher drug severity were less likely to participate in AA. Although higher AA participation was a predictor of abstinence for both genders, men were less likely to be abstinent across time. Men were also more likely to reduce their AA participation across time. CONCLUSIONS These findings add to an emerging literature on how women compare with men on factors related to AA participation and subsequent drinking outcomes across time. Findings have clinical implications for service providers referring clients to such groups.
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Affiliation(s)
- Jane Witbrodt
- Alcohol Research Group, 6465 Christie Avenue, Suite 400, Emeryville, CA 94608, , 510-597-3440 (telephone), 510-985-6459 (fax)
| | - Kevin Delucchi
- University of California, San Francisco, San Francisco, CA,
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Witbrodt J, Delucchi K. Do women differ from men on Alcoholics Anonymous participation and abstinence? A multi-wave analysis of treatment seekers. Alcohol Clin Exp Res 2011. [PMID: 21689121 DOI: 10.1111/j.1530-0277.2011.01573.x.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Given the widespread use of Alcoholics Anonymous (AA) and other similar groups in the United States and the increasing membership of women, this study compares women with men on their meeting attendance and AA-prescribed behaviors, factors associated with that AA participation, and tests how these relate to women's and men's abstinence across time. METHODS All consecutive new admissions (age ≥ 18) from county-wide public and private treatment programs representing the larger population of treatment seekers were approached to be in the study at treatment entry. Those consenting at baseline (n = 926) were sought for follow-up interviews 1, 3, 5, and 7 years later. Generalized linear models were used to test whether various help-seeking factors were associated with AA participation differentially by gender and, controlling for AA and other confounders, whether women differ from men on abstinence. RESULTS At each follow-up interview, women and men attended AA at similar rates and similarly practiced specific AA behaviors, and they were alike on most factors associated with AA participation and abstention across time including abstinence goal, drink volume, negative consequences, prior treatment, and encouragement to reduce drinking. Relative to men, women with higher drug severity were less likely to participate in AA. Although higher AA participation was a predictor of abstinence for both genders, men were less likely to be abstinent across time. Men were also more likely to reduce their AA participation across time. CONCLUSIONS These findings add to an emerging literature on how women compare with men on factors related to AA participation and subsequent drinking outcomes across time. Findings have clinical implications for service providers referring clients to such groups.
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Affiliation(s)
- Jane Witbrodt
- Alcohol Research Group, Emeryville, California 94608, USA.
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Schonbrun YC, Strong DR, Anderson BJ, Caviness CM, Brown RA, Stein MD. Alcoholics Anonymous and hazardously drinking women returning to the community after incarceration: predictors of attendance and outcome. Alcohol Clin Exp Res 2010; 35:532-9. [PMID: 21158877 DOI: 10.1111/j.1530-0277.2010.01370.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND The number of women incarcerated within the United States has risen dramatically in recent decades, and high rates of alcohol problems are evident among this population. Although little is known about the patterns of help utilization and efficacy for alcohol problems, preliminary evidence suggests that Alcoholics Anonymous (AA) is a widely available resource for this population. METHODS Data were collected as part of a study evaluating the effect of a brief intervention to reduce alcohol use among hazardously drinking (i.e., score of 8 or above on the Alcohol Use Disorders Identification Test or 4 or more drinks at a time on at least 3 days in prior 3 months) incarcerated women. The current study characterized demographic, clinical, and previous AA attendance variables associated with AA attendance in the 6 months following incarceration. Associations between frequency of AA attendance and drinking outcomes following incarceration were also evaluated. RESULTS Among the 224 participants who provided data about AA attendance, 54% reported some AA attendance during the follow-up assessment period. AA attendance in the year prior to study entry (OR = 4.02; 95% CI: 3.32 to 4.71) and greater baseline consequences of alcohol use (OR = 2.09; 95% CI: 1.73 to 2.44) were associated with increased odds of higher frequency of AA attendance following incarceration. Weekly or greater AA attendance was associated with reductions in negative drinking consequences (B = -0.45; p < 0.01) and frequency of drinking days (B = -0.28; p < 0.01) following incarceration. CONCLUSIONS Findings from this study suggest that AA is frequently utilized by hazardously drinking women following incarceration. Alcohol outcomes may be enhanced by AA attendance at a weekly or greater frequency is associated with better alcohol outcomes relative to lower levels of AA attendance. Evaluation of clinical guidelines for prescribing AA attendance for incarcerated women remains a task for future research.
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Affiliation(s)
- Yael Chatav Schonbrun
- Butler Hospital, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.
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