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Women, girls and alcohol

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The chapter ‘Women, girls and alcohol’ reviews evidence for ‘ convergence’, or women’s drinking catching up with that of men, and ‘telescoping’, or how in women the time from initiating drinking to dependence is shorter than in men. Prescription drug misuse, a growing problem in UK clinical practice, is also discussed. It is the one area of substance misuse where problems are as common in women as they are in men and it is frequently associated with dual diagnoses and chronic pain. Disappointingly, however, there is little on new treatment strategies and nothing at all on benzodiazepine misuse. The chapter dealing with pregnancy emphasises alcohol as the most important and most common teratogenic substance and it also discusses methadone as the treatment of choice in opiate users. The authors specifically state that the UK practice of detoxification from opiates in pregnancy is not supported by the evidence and is associated with high levels of relapse and complications of pregnancy.
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... There are some important gender differences relevant to the selfmedication hypothesis in the context of the COVID-19 pandemic. First, women are more likely than men to experience comorbid emotional (i.e., anxiety, depression, and PTSD) and alcohol use disorders (see Stewart et al., 2009, for a review). Second, some research suggests that women are more vulnerable to experiencing psychological distress from the pandemic (see reviews by Brooks et al., 2020;Taylor, 2019), suggesting women may be more motivated than men to drink to cope with pandemic-related distress. ...
... Further, two of these associationsthe two related to quantity consumedare more pronounced for women than men, consistent with previous literature suggesting that the use of alcohol to cope with distress is more relevant to women's than men's drinking (Kuntsche et al., 2015). In both interactions, at low levels of COVIDrelated psychological distress, men display the usual pattern of drinking more than women (Stewart et al., 2009). However, as distress related to COVID-19 increases, women's drinking "catches up" with or converges with that of the men (see Figures). ...
... However, as distress related to COVID-19 increases, women's drinking "catches up" with or converges with that of the men (see Figures). Gender convergence refers to the observation that women's drinking has been, over recent decades, catching up with men's drinking as women face the stressors that were historically the domain of men (e.g., career stressors) (see Stewart et al., 2009). Our results suggest that exposure to a widespread situational stressor (i.e., COVID-19 psychological reactions) is having a similar effect of leading women to catch up to men in terms of their drinking behavior across several different indices. ...
Article
The 2019 Coronavirus pandemic has brought about significant and unprecedented changes to the modern world, including stay-at-home orders, high rates of unemployment, and more than a hundred thousand deaths across the United States. Derived from the self-medication hypothesis, this research explored how perceived threat and psychological distress related to the COVID-19 pandemic are associated with drinking behavior among an American sample of adults. We also evaluated whether links between COVID-19-related perceived threat and psychological distress with drinking behavior are different for men and women. Participants (N=754; 50% women) completed an online Qualtrics Panels study between April 17th and 23rd, 2020. Results suggested that psychological distress related to the COVID-19 pandemic was consistently related to alcohol use indices, and moderation results indicated this pattern was significant only among women for number of drinks consumed during the recent heaviest drinking occasion and number of drinks consumed on a typical evening. COVID-related distress’ link to frequency of drinking and heavy drinking episodes was not different for men and women. Our results suggest that continued monitoring, particularly among women, should be conducted as this pandemic continues to evolve to identify the long-term public health impacts of drinking to cope with COVID-19 distress.
... When using gender specific cut-off points for hazardous drinking, results showed that, regardless of gender, almost half of the students met the AUDIT-C criteria for "hazardous" drinking. This is consistent with literature showing that the gender gap between men and women is closing (Stewart, Gavric, & Collins, 2009); however, different results may be obtained if gender-neutral cut-off points are used (Narain, 2016). Females were significantly more likely to misperceive same-gender, peer-based drinking norms compared to males. ...
... However, our findings suggest that a Social Norms approach may be more appropriate for women. This is consistent with research showing that women have unique alcohol treatment and prevention needs relative to their male counterparts (Stewart, Gavric, & Collins, 2009). Our results suggest that social norms interventions should be based on gender specific analyses to determine whether they are more effective for women. ...
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The social norms approach to changing excessive drinking behaviour is predicated upon findings that overestimations of peer drinking predict one’s own drinking behaviour. Prior studies have yet to examine whether such social norms effects pertain equally to both genders. First-year students from a Canadian university (N = 1,155; 696 males, 459 females) were assessed for the relationship between misperceived drinking norms and hazardous drinking using the Alcohol Use Disorder Identification Test-Consumption scale (AUDIT-C). A significant positive relationship between the overestimated drinking frequency norm and hazardous drinking was determined for female students, where the odds of hazardous drinking increased by 1.92 (95% CI: 1.32–2.79) when the norm of other female students was overestimated. A non-significant association was found for male students, where the odds of hazardous drinking were unrelated to over-estimation of the drinking norm of other male students. The null association for male students highlights a potential problem when using social norms interventions for alcohol reduction for males in the university context. Implications of these results for the utilization of the social norms approach to alcohol reduction are discussed. © 2018, Canadian Periodical for Community Studies Inc. All rights reserved.
... Regarding gender, the most reliable effect size estimate (RR) found a stronger alcohol use-suicide link for women. While base rates of various alcohol use indices are typically higher for men (Wilsnack & Wilsnack, 2013), heavy alcohol use is associated with greater financial, work, social, and health problems among women than men (Grittner et al., 2012;Stewart et al., 2009). Generally, heavier alcohol use is more problematic for women's health than men's health in areas ranging from physical health to cognitive impairments (Nolen-Hoeksema, 2004). ...
Article
Introduction: Decades of research show an association between alcohol use and death by suicide. However, findings on the temporal link between alcohol use and death by suicide are unclear. In the most comprehensive meta-analysis on the topic to date, we analyzed data from longitudinal studies to determine if alcohol use is a risk for death by suicide. We also explored moderators to uncover conditions where the alcohol use-suicide link is strengthened/weakened. Methods: Our literature search of six databases yielded 33 eligible studies involving 10,253,101 participants (community, psychiatric, and military samples). Results: Alcohol use was associated with a 94% increase in the risk of death by suicide. Specifically, random-effects meta-analysis revealed alcohol use displayed small-to-large significant risk and odds ratios with suicide for quantity of alcohol use and alcohol use diagnosis/alcohol-related problems. Meta-regression generally indicated larger effect sizes for studies with a higher percentage of women, younger age, unadjusted estimates, longer follow-up periods, military samples, and higher frequencies and quantities of alcohol use (relative to drinker/non-drinker status). Conclusion: Our study highlights alcohol use as a substantive risk factor for death by suicide and underscores the importance of monitoring alcohol use among suicidal individuals and screening for suicidality among heavier alcohol users.
... Historically, addictive disorders research has focused primarily on males, since addictive disorders are more prevalent in males than females. 1 Due to this research bias, theory pertaining to the nature, development, and maintenance of addictive disorders has resulted from male-dominated samples (Stewart et al. 2009). Since females have been greatly underrepresented in addictive disorders research, the majority of interventions developed from the literature are potentially less effective for female patients. ...
Article
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Research examining relations between menstrual cycle phase and female addictive behaviors is accumulating. Theories suggest addictive behaviors may increase during specific phases of the menstrual cycle resulting from cyclical fluctuations in hormones and affect. In line with self-medication theory, we predicted that addictive behaviors would increase premenstrually and menstrually, phases marked by elevations in negative affect, relative to the follicular and luteal phases. We also hypothesized, coinciding with reward-sensitivity theory, that addictive behaviors may increase during ovulation, a phase characterized by increased positive affect, compared to the same phases. This systematic review summarizes extant literature examining the menstrual cycle phase-addictive behavior relationship and underlying motivations. Articles pertaining to menstrual cycle phase and addictive behaviors within the PsycINFO, CINAL, and PubMED databases were screened to determine eligibility following PRISMA guidelines (n = 1568). Thirty-four articles examining alcohol use, cannabis use, nicotine use, caffeine use, and gambling behavior across menstrual cycle phase met inclusion criteria. Consistent with self-medication theory, strong evidence indicated that nicotine use increased premenstrually and menstrually. Other factors increasing both nicotine and alcohol use premenstrually and menstrually include having a premenstrual dysphoric disorder diagnosis or having premenstrual syndrome. Motivations for using alcohol and nicotine may too vary by menstrual cycle phase. Results were less consistent or understudied for other addictive behaviors and thus conclusions cannot be drawn. Menstrual cycle phase appears to be a female-specific factor affecting some addictive behaviors, particularly nicotine use, and should be considered when conducting addictive behavior research or clinical interventions for reproductive-aged females with addictive disorders.
... Historically, women have been overlooked in addictions research (Rosenberg, 1993) and attempts to generalize results of research conducted with men have been cautioned against (Green, 2006;Pirisi, 2000;Plant, 2008;Poole & Greaves, 2007;. Compared with men, women experience different adverse effects from alcohol, motivations for drinking, and motivations for treatment (Holmila, 1993;Kosok, 2006;Sanchez-Craig et al., 1991;Stewart et al., 2009). Some research shows women tend to seek treatment more readily and earlier in the course of their alcohol use problem. ...
Article
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The objectives of this study were to profile the landscape of women’s alcohol use programs in Canada. We explored service users’ and providers’ beliefs about alcohol use problems and how this affected treatment choices for alcohol use problems. Data were collected through standardized measures alongside in-depth semi-structured narrative interviews in six women’s alcohol treatment sites in Canada. Findings demonstrated that service users and service providers often supported an abstinence choice and were ambivalent about the viability of controlled or managed use in both abstinence- and harm reduction–based programs. Findings showed that women service users in this study had significant rates of trauma and depression which were associated with their alcohol use; the majority still adopted dominant alcohol addiction discourse which emphasizes the need for abstinence. We offer a number of recommendations to improve the viability of harm reduction for alcohol use in women’s treatment programs.
... Gender differences remained nonsignificant in Finland. As girls are more vulnerable to negative consequences of alcohol use than boys (28,29), prevention methods should particularly focus on reducing alcohol use among girls. ...
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Background: Patterns of alcohol use often start developing during adolescence and are associated with alcohol use and dependence during adulthood. The aims of the study were to describe trends in the prevalence of monthly alcohol use from 2003 to 2015 and to analyze the associations between alcohol use and family-related and school-related factors, risk behavioral factors and perceived alcohol availability in Estonia, Latvia, Lithuania, Finland, and Sweden. Methods: The study used nationally representative data of 15–16-year-old adolescents from the European School Survey Project on Alcohol and Other Drugs (ESPAD). Data from Estonia, Latvia, Lithuania, Finland, and Sweden collected in 2003, 2007, 2011, and 2015 were utilized (n=57,779). The prevalence of monthly alcohol use and light and strong alcohol use was calculated for each study year in all countries. A chi-square test for trend was used to evaluate statistically significant changes in alcohol use over the study period. Logistic regression analysis was performed to analyze the association between alcohol use and different factors. Fully adjusted odds ratios with 95% confidence intervals were calculated. Results: Monthly alcohol use decreased significantly among 15–16-year-old boys and girls in Estonia, Latvia, Lithuania, Finland, and Sweden from 2003 to 2015. In 2015, the prevalence of monthly alcohol use among boys was 36.1% in Estonia, 44.3% in Latvia, 32.4% in Lithuania, 32.3% in Finland, and 22.4% in Sweden, and among girls, it was 39.1%, 45.9%, 35.6%, 31.8%, and 29.1%, respectively. In Estonia, Latvia, Lithuania, and Sweden, girls had higher odds of monthly alcohol use than boys. In all countries, higher odds of monthly alcohol use were observed among adolescents who skipped school, smoked cigarettes, used cannabis, perceived alcohol to be easy to access and had parents who did not know always/often about their child’s whereabouts on Saturday nights. Conclusion: From 2003 to 2015, monthly alcohol use decreased in Estonia as well as in neighboring countries such as Latvia, Lithuania, Finland, and Sweden. The factors related to alcohol use in all five countries were generally similar. Based on the study results, health promotion and alcohol policy interventions could be improved to decrease and prevent alcohol use among adolescents.
Chapter
Prenatal alcohol exposure adversely impacts the developing fetus and leads to negative health outcomes, including the development of fetal alcohol spectrum disorder (FASD). Recent studies indicate that the absolute number of currently drinking women of childbearing age is increasing, which poses a significant harm to maternal and child health. Globally, a significant portion of pregnancies are alcohol-exposed, due to individual and systemic factors, including the COVID-19 pandemic. Accordingly, this chapter outlines the prevalence of alcohol use among women of childbearing age and pregnant women, as well as the prevalence of FASD among the general population and specific sub-populations.KeywordsAlcoholChildbearing-aged womenEpidemiologyFetal alcohol spectrum disorderFetal alcohol syndromePregnancyPrevalence
Chapter
Global trends demonstrate increasing alcohol consumption among women of childbearing age, social acceptability of women’s alcohol use, as well as recent changes in alcohol use patterns due to the COVID-19 pandemic. Increasing levels of consumption may put many pregnancies at higher risk for prenatal alcohol exposure (PAE), which can cause fetal alcohol spectrum disorder (FASD). Therefore, alcohol use screening of women who are or may become pregnant has become more important than ever and should be a public health priority. The current literature review presents the state of the science on various existing alcohol use screening strategies, including the clinical utility of validated alcohol use screening instruments. It also discusses barriers for decreasing alcohol use in pregnancy, such as low uptake of screening during prenatal care, practitioner beliefs and training/time constraints, unplanned pregnancies, delayed access to prenatal care, and stigma associated with substance use in pregnancy as well as recommendations to address these barriers. By implementing consistent alcohol use screening, health-care providers increase opportunities for pregnant women to access counseling, brief interventions, and referral for treatment. Increased use of these strategies would reduce risk of adverse outcomes to women and their children, decrease new cases of FASD and recurrence of FASD in families, and thus would improve maternal and child health.Key wordsAlcoholPregnancyScreeningFetal alcohol spectrum disorderFetal alcohol syndromePreventionChildbearing aged women
Article
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This present study aims to examine the individual and social factors, the predictors and moderators of alcohol consumption during COVID-19 lockdown in Romania. In a community sample of 262 participants, we found gender and age differences on the alcohol consumption during the first two months of the outbreak. In addition, we also found that gender, age, and social influence positively predicted alcohol consumption during the lockdown. The research also explored the moderating role of age and gender in predicting the alcohol consumption during COVID-19 lockdown. The results revealed that only gender moderates the link between social influence and alcohol consumption during the outbreak. These results have practical implications by suggesting the need of designing prevention actions or interventions for this at-risk group.
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Objectives The aims of the study were (1) to describe trends in the prevalence of monthly alcohol use from 2003 to 2015 and (2) to analyse the associations between alcohol use and family-related and school-related factors, risk behaviours and perceived alcohol availability in Estonia compared with Latvia, Lithuania, Finland and Sweden. Methods The study used nationally representative data of 15–16-year-old adolescents from the European School Survey Project on Alcohol and Other Drugs. Data from Estonia, Latvia, Lithuania, Finland and Sweden collected in 2003, 2007, 2011 and 2015 were utilised (n=57 779). The prevalence of monthly alcohol use including light and strong alcohol use was calculated for each study year. A χ ² test for trend was used to evaluate statistically significant changes in alcohol use over the study period. A multilevel logistic regression analysis was used for assessing the association between alcohol use and explanatory factors. Marginal ORs with 95% CIs for each country were calculated. Results Monthly alcohol use decreased significantly among boys and girls in all countries from 2003 to 2015. In 2015, the prevalence of monthly alcohol use among boys was 36.1% in Estonia, 44.3% in Latvia, 32.4% in Lithuania, 32.3% in Finland and 22.4% in Sweden. Among girls, it was 39.1%, 45.9%, 35.6%, 31.8% and 29.1%, respectively. In all countries, higher odds of monthly alcohol use were observed among adolescents who skipped school, smoked cigarettes, used cannabis, perceived alcohol to be easy to access and had parents who did not know always/often about their child’s whereabouts on Saturday nights. Compared with Estonia, associations between alcohol use and explanatory factors were similar in Latvia and Lithuania but different in Finland and Sweden. Conclusion Results of cross-national comparison of alcohol use and explanatory factors could be effectively used to further decrease alcohol use among adolescents.
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