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Gender Differences Emerge in Alcohol Use Disorder Treatment

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A growing body of research is showing that when it comes to treatments for alcohol use disorders, women’s needs are different from men’s. Scientists who recently presented studies at the Research Society on Alcoholism are exploring gender differences in alcohol treatment and moving beyond a one-size-fits-all strategy.

“Women have different barriers to treatment than men,” says Elizabeth Epstein, PhD, Research Professor in the Clinical Division of the Center of Alcohol Studies at Rutgers University in New Brunswick, NJ. “They are less likely to seek alcohol treatment in a dedicated alcohol facility, and more likely to seek treatment with a general practitioner or psychiatrist for depression or fatigue.” However, many of these doctors don’t routinely screen for an alcohol or drug use problem, she explains.

“We know that 85 percent of people who have alcohol problems in their lifetime don’t seek treatment for it, so we are focusing most of our treatment research resources on the 15 percent who do,” according to Dr. Epstein. “We need to look beyond that, to who is struggling without treatment.” More training in alcohol use disorders is needed for emergency department physicians, obstetrician/gynecologists and family practitioners, she states. “We need to develop interventions that allow doctors to screen for alcohol use problems, since we know that women are not likely to come in and say they drink too much.”

Alcohol tends to affect women more than men for several reasons. Dr. Epstein explains, “A woman who weighs the same as a man and consumes the same amount of alcohol over the same length of time is likely to have a higher blood alcohol level. Women have less body water than men, leading to a higher blood alcohol concentration, and they also have less lean muscle mass and fewer enzymes in the stomach that break down alcohol. That means more ethanol is going into the bloodstream and directly to organs like the heart, brain and liver, and doing damage.”

She notes that women develop a host of alcohol-related health problems more quickly than men, even though they tend to start drinking later. “Older womens’ bodies are not processing anything as well as younger women, including alcohol,” she says. “And we are seeing younger women’s drinking patterns catching up with men’s, which is not a good thing. That means that as this generation progresses, we’ll see more and more older women with alcohol problems.”

Success With Individual Therapy

Dr. Epstein is leading the Rutgers Women’s Treatment Project at the Center of Alcohol Studies. This five-year clinical research study, funded by the National Institute of Alcohol Abuse and Alcoholism, is testing the effectiveness of therapies for women with drinking problems.

She and her colleague, Dr. Barbara McCrady, looked at marital therapy combined with alcohol therapy for women, testing it against individual alcohol therapy for women. “The women in both groups did very well, reducing their drinking days from an average of about 70 percent before the study, to 20-30 percent while in and after treatment,” states Dr. Epstein. The coupled treatment conferred a slight advantage in terms of maintaining the gains in the year following treatment. That study required women to be in a committed relationship or marriage to a male to be eligible. Many women didn’t want to sign up, because their spouse had to be involved.

Both doctors then offered a choice of either individual therapy or couples therapy in a two-armed clinical research study to treat alcohol use disorders. For that study, women had to be in a committed relationship, but did not need to bring their partner in if they chose individual therapy. Most women in that study chose individual therapy. Women who chose individual therapy were randomly assigned to regular cognitive behavioral therapy (CBT) or female-specific CBT. In CBT, emphasis is placed on the importance of breaking the drinking habit and learning coping skills.

The female-specific treatment also emphasized womens’ rights to care for themselves, and helped them feel more self-confident and less sensitive to what other people thought about them. The treatment provided assertiveness training and helped women address how to deal with a partner who drinks heavily, and with anxiety and depression. Women learned about anger management and how to make connections with sober people who treat them well and don’t abuse them.

While women in both groups showed improvement in their drinking, Dr. Epstein and her colleagues found that women who chose individual therapy were more likely to stick with therapy than those who chose couples therapy.

Currently Dr. Epstein is investigating the effectiveness of female-specific-CBT treatment delivered in women-only groups. She explains, “We want to be able to develop treatments for a broad range of women, which could be integrated into community-based therapy.”

Trauma and Substance Abuse Linked

Many women with substance abuse disorders also suffer from post-traumatic stress syndrome (PTSD), resulting from interpersonal violence, says Denise Hien, PhD, ABPP, who presented data at the meeting about promising treatments for women who suffer from PTSD and substance use disorders. “They drink in response to trauma,” says Dr. Hien, Professor at the City University of New York, and Adjunct Senior Research Scientist at Columbia University College of Physicians and Surgeons in New York.

Dr. Hien compared a type of CBT called “Seeking Safety” for substance abuse and PTSD with a relapse prevention treatment. “Seeking Safety” is a short-term treatment for both trauma and substance abuse in women. Both disorders are treated at the same time by the same clinician. Secondary analyses indicate that trauma therapy may be most effective for women who are also receiving some type of self-help, such as being part of a 12-step group. “If a person is not affiliated with a self-help group, she may actually get worse from trauma therapy alone,” Dr. Hien says.

Last year, she published a study in the American Journal of Psychiatry that found if you treat the PTSD symptoms first, in women who suffer from both substance abuse and PTSD, it led to a reduction in substance abuse. The study found little evidence that treating substance abuse first improved PTSD symptoms. Currently, patients who suffer from both disorders often are not treated for PTSD until they receive addiction treatment and stop using drugs and alcohol. This sequence is based on the assumption that addressing trauma could worsen a person’s substance abuse.

Dr. Hien is also conducting a clinical trial that is examining whether adding the antidepressant sertraline HCI (Zoloft) to trauma therapy benefits women with PTSD and alcohol misuse or alcohol use disorders.

7 Responses to this article

  1. Avatar of patricia Corbett
    patricia Corbett / July 26, 2011 at 9:29 am

    I am wondering why the women had to be in a committed relationship or married to a man in order to be a part of the couples treatment paradigm?

  2. Avatar of Mark Young
    Mark Young / July 25, 2011 at 12:01 pm

    Devote as much as is spent on alcohol marketing and promotion to treatment, be it gender-specific or traditional, then watch the problem shrink from 85% who never get treatment to something miniscule. When society decides this is a problem worth addressing with resources, that is when things will change.

  3. Richard / July 22, 2011 at 4:06 pm

    If the monies spent on this research had only been applied to providing treatment for women addicted to alcohol…

  4. Jim Sharp / July 20, 2011 at 8:40 pm

    I concur with the other comments that these findings are not breaking new ground. Based on “ancient” research and responding to the pleas of clients and women staff, the Van Dyke Addiction Treatment Center (Willard, NY) developed two totally separate, gender-specific treatment programs that were initiated in 1986 and continue to this day. Once the women clients were provided a safe setting and encouragement, their treatment “took off”, exploring issues of abuse, trauma, etc., that were never safe to address in a mixed setting. Interestingly, there were beneficial effects for the men’s program now that they could drop the posturing and preening that went on when the women were around. Now that it is well established that gender-separate is optimal, I would like to see more research on the best treatment methods for each gender.

  5. Avatar of Penny Mary Hauser
    Penny Mary Hauser / July 20, 2011 at 2:34 pm

    I continue to be amazed, amused and concerned that researchers continue to spend money on “new” research and claim as a new finding that women’s treatment for addiction needs to be different from men’s. Many, many studies have proven this before. My book “Broken by addiction, Blessed by God-a woman’s path to sustained recovery” identifies gender specific issues, treatment perspectives, and recovery issues based in our gender uniqueness. Women grow and heal in relationship-with themselves, with other women and with their spiritual core. Good news but not new news! Penny Mary Hauser

  6. maryellen Doyle / July 20, 2011 at 12:33 pm

    Celia Vimont: Articles in this group’s publication interest me, but your article grabbed. I’ve been sober and clean in four states, but none have compared to the male-dominated aura that clouds treatment success. I was a counselor in a treatment center in New Mexico, and couldn’t believe what occurred (the women left sicker than when they came in). I have a burning desire to start a female-only facility in Albuquerque
    where the need is too great to describe. Could Rutgers help?

    Maryellen Doyle

  7. Avatar of Rosa Neal
    Rosa Neal / July 20, 2011 at 11:36 am

    Are your kidding? This may be a reaffirmation of data as old as 1980, but it certainly is not new! Why do you think that treament programs for women, and later treament programs for women and children were developed. It has long ben noted that women with addiction problems respond differenlty to treatment than men.

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