1 Copyright Alcohol Medical Scholars Program Alcohol-Related Problems in Special Populations: YOUTH and WOMEN Susan F. Tapert, Ph.D. University of California,

1Copyright Alcohol Medical Scholars Program

Alcohol-Related Problems Alcohol-Related Problems in Special Populations:in Special Populations:

YOUTH and WOMENYOUTH and WOMEN

Alcohol-Related Problems Alcohol-Related Problems in Special Populations:in Special Populations:

YOUTH and WOMENYOUTH and WOMEN

Susan F. Tapert, Ph.D.University of California, San DiegoVA San Diego Healthcare System


Alcohol-Related Problems: Alcohol-Related Problems: Special PopulationsSpecial Populations

Alcohol-Related Problems: Alcohol-Related Problems: Special PopulationsSpecial Populations

Epidem-Epidem-iologyiology

Unique Unique FeaturesFeatures

Assess-Assess-mentment

Treat-Treat-mentment

YouthYouth xx xx xx xx

WomenWomen xx xx xx xx


Drinking Rates in YouthDrinking Rates in YouthDrinking Rates in YouthDrinking Rates in Youth

0%

25%

50%

75%

100%

EverDrank

BeenDrunk

>5Drinks

DailyDrinking

12th Graders


Features of Drinking in YouthFeatures of Drinking in YouthFeatures of Drinking in YouthFeatures of Drinking in Youth

PrognosisPrognosis Drink < age 14: Drink < age 14: risk of alcohol dependence risk of alcohol dependence

Typical experimentation sequence:Typical experimentation sequence:

CigarettesCigarettes

or or

AlcoholAlcohol

MarijuanaMarijuana Other drugsOther drugs


Assessing Drinking in YouthAssessing Drinking in YouthAssessing Drinking in YouthAssessing Drinking in Youth

Red flags:Red flags: Change in peersChange in peers Family problemsFamily problems Grades dropGrades drop Mood swingsMood swings

Common consequences:Common consequences: AccidentsAccidents ““3-Ds”: driving, dating, & drug 3-Ds”: driving, dating, & drug

related problemsrelated problems

Uncommon problems:Uncommon problems: Severe withdrawal symptomsSevere withdrawal symptoms Liver problemsLiver problems


Assessing Drinking in YouthAssessing Drinking in YouthAssessing Drinking in YouthAssessing Drinking in Youth

TWEAK:TWEAK: T (tolerance)T (tolerance) “How many drinks can you hold?” “How many drinks can you hold?” W (worried)W (worried) “Have close friends or relatives “Have close friends or relatives

worried or complained about your drinking in the worried or complained about your drinking in the past year?”past year?”

E (eye opener)E (eye opener) “Do you sometimes take a drink “Do you sometimes take a drink in the morning when you first get up?”in the morning when you first get up?”

A (amnesia)A (amnesia) “Has a friend or family member “Has a friend or family member ever told you about things you said or did while ever told you about things you said or did while drinking that you could not remember?”drinking that you could not remember?”

K (cut town)K (cut town) “Do you sometimes feel the need “Do you sometimes feel the need to cut down on your drinking?”to cut down on your drinking?”

2222

11

11

11______3 risky drinking3 risky drinking


Youth: TreatmentYouth: TreatmentYouth: TreatmentYouth: Treatment

FormatsFormats Multi-systemic treatmentsMulti-systemic treatments

Minnesota modelMinnesota model

Therapeutic communitiesTherapeutic communities

Cognitive-behavioralCognitive-behavioral

GroupsGroups

Brief interventionBrief intervention


Youth: TreatmentYouth: TreatmentYouth: TreatmentYouth: Treatment

Pathways to successPathways to success1.1. Traditional routesTraditional routes

2.2. Early individuationEarly individuation

3.3. Family involvementFamily involvement

OutcomeOutcome Treatment helpsTreatment helps

Inpatient = OutpatientInpatient = Outpatient

50-80% relapse in 150-80% relapse in 1stst year after treatment year after treatment


Alcohol Problems in YouthAlcohol Problems in YouthAlcohol Problems in YouthAlcohol Problems in Youth

EpidemiologyEpidemiology

FeaturesFeatures

AssessmentAssessment

TreatmentTreatment


Alcohol Problems in WomenAlcohol Problems in WomenAlcohol Problems in WomenAlcohol Problems in Women


Unique risksUnique risks

DetectionDetection

Treatment issuesTreatment issues


Women: EpidemiologyWomen: EpidemiologyWomen: EpidemiologyWomen: Epidemiology

WomenWomen MenMen

Any alcohol in past yearAny alcohol in past year 62%62% 83%83%

Has met Alcohol Abuse criteria Has met Alcohol Abuse criteria 6%6% 13%13%

Has been Alcohol DependentHas been Alcohol Dependent 8%8% 20%20%


Women & Heavy DrinkingWomen & Heavy DrinkingWomen & Heavy DrinkingWomen & Heavy Drinking

Risk of health problems:Risk of health problems: Alcohol-related liver disease, hepatitis, Alcohol-related liver disease, hepatitis,

infections, anemiainfections, anemia STDs, UTIs, reproductive organ problems, STDs, UTIs, reproductive organ problems,

breast cancerbreast cancer Violence victimization riskViolence victimization risk Neurocognitive effectsNeurocognitive effects


Alcohol & PregnancyAlcohol & PregnancyAlcohol & PregnancyAlcohol & Pregnancy

PrevalencePrevalence 16-35% of pregnant women drink16-35% of pregnant women drink 4% drink frequently or heavily4% drink frequently or heavily

Fetal alcohol syndrome (FAS)Fetal alcohol syndrome (FAS)1.1. Facial dysmorphiaFacial dysmorphia

2.2. Growth deficiencyGrowth deficiency

3.3. CNS deficitsCNS deficits

Fetal alcohol effects (FAE)Fetal alcohol effects (FAE)


Women: DetectionWomen: DetectionWomen: DetectionWomen: Detection

Wide variabilityWide variability

Social risk factors:Social risk factors: Low vocational skills and educationLow vocational skills and education Substance use disordered partnerSubstance use disordered partner Social isolationSocial isolation

Screening tools:Screening tools: TWEAK TWEAK AUDIT-CAUDIT-C


Women: Treatment IssuesWomen: Treatment IssuesWomen: Treatment IssuesWomen: Treatment Issues

BarriersBarriers ExternalExternal

InternalInternal

Optimal treatment for womenOptimal treatment for women Reduce barriersReduce barriers

Combine with obstetrics or other Combine with obstetrics or other healthcarehealthcare

Women-only v. mixed settingWomen-only v. mixed setting


Women & Alcohol ProblemsWomen & Alcohol ProblemsWomen & Alcohol ProblemsWomen & Alcohol Problems


Unique risksUnique risks

DetectionDetection

Treatment issuesTreatment issues


Alcohol-Related Problems in Alcohol-Related Problems in Special PopulationsSpecial Populations

Alcohol-Related Problems in Alcohol-Related Problems in Special PopulationsSpecial Populations

YouthYouth

WomenWomen

Documents

1 Copyright Alcohol Medical Scholars Program Alcohol-Related Problems in Special Populations: YOUTH and WOMEN Susan F. Tapert, Ph.D. University of California,