Explaining unexpected gender differences in hostility among persons seeking treatment for substance use disorders.

OBJECTIVE: Gender differences in depression and anxiety are found among patients seeking treatment for substance use disorders, but few data exist on differences in hostility. As part of a larger study describing substance abuse treatment seekers, analyses investigated whether women would be more depressed and anxious than men, but less hostile. METHOD: Data were collected at baseline from 336 outpatients (62% men) at an addiction treatment agency. Most of the outpatients (81%) had DSM-IV chart diagnoses of alcohol dependence or abuse. RESULTS: On the depression, anxiety and hostility subscales of the Brief Symptom Inventory, women had significantly higher scores than did men. When scores were converted to gender-keyed T scores standardized on a normal sample, differences in depression and anxiety were no longer significant. However, differences in hostility remained. A regression analysis indicated that hostility scores were explained not by gender, but by greater severity of adverse consequences from substance use, insomnia, lack of social support, and being married. A childhood history of physical or sexual abuse, although more common in women than men, did not explain gender differences in hostility after controlling for other variables. CONCLUSIONS: The women in this study did not appear to be more anxious and depressed than did the men after controlling for gendered population norms. However, the women were more hostile than the men. Women's greater hostility was explained not by gender per se, but by personal and social factors that were differentially distributed across genders. Treatment implications are reviewed.

Stability in the drinking habits of older problem-drinkers recruited from nontreatment settings.

Few prospective studies have examined older problem-drinkers not currently in treatment to determine the stability in alcohol problems over time. Seventy-eight currently drinking, older adults meeting a diagnosis of alcohol abuse or dependence were recruited via advertising to complete a health interview; 48 were reinterviewed approximately 3 years later. Participants were categorized based on alcohol consumption (risk) and alcohol-related diagnostic symptoms (problem) at baseline and follow-up. At follow-up, few older adults (11.4%) were resolved using both risk and problem criteria. Alcohol risk/problem groups were not significantly stable between baseline and follow-up. Health problems was the most common reason for changing drinking habits. Average and maximum consumption at baseline and follow-up were significant markers of follow-up risk group and follow-up alcohol-related consequences, respectively, with maximum consumption being more robust. The course of alcohol problems among older adults fluctuates over time, and heavy drinking appears to be the best indicator of problem continuation.

Nonfamilial roles of alcoholic women in treatment.

This study compared the educational achievement and employment-related experiences of a sample of 301 alcoholic women in treatment with 137 non-alcoholic matched controls. Alcoholic women were significantly more likely than controls to marry at a younger age and have their first child earlier, had less education, and were more likely to be employed in blue collar settings than non-alcoholic women. Alcoholic women were significantly less likely to be working outside the home, and employed alcoholic women were more likely to report boredom in the workplace than employed non-alcoholic women. The lives of alcoholic women include more than their familial roles. More attention to issues of education, employment, and occupational status on the part of health care providers is needed.

Dieting severity and gastrointestinal symptoms in college women.

Young women report symptoms associated with irritable bowel syndrome (IBS), such as pain, bloating, and changes in bowel movements, more often than young men. Young women with eating disorders also report these gastrointestinal symptoms frequently. We hypothesized that if dieting behaviors were associated with these symptoms, the prevalence and frequency of the symptoms would be positively related to dieting severity in young women. We interviewed 301 1st-year college women representing the continuum of dieting severity. We found that severity of dieting was positively related to frequency of abdominal pain, bloating, diarrhea, and constipation, and that the women who reported 3 or more symptoms regularly scored higher on a scale for dieting severity. Although this study did not examine the relationship between dieting severity and clinical IBS, the findings suggested that dieting is associated with gastrointestinal symptoms in young women.

Older adult controlled drinkers and abstainers.

Little is known about the lifetime course of alcohol problems, especially during late adulthood. Many individuals with a history of alcohol problems achieve remission of their symptoms through abstinence or controlled drinking. This study examined 135 older adults with a prior history of alcohol diagnoses who were symptom free for at least the past year. Two groups were identified based on their alcohol consumption within the past year: abstinent individuals (n = 92) and controlled drinkers (n = 43). The groups did not differ in age, racial composition, education, income, or years since their last alcohol-related symptom, but they did differ in gender composition, indices of alcoholism severity, history of formal and informal treatment, as well as lifetime alcohol consumption patterns. Abstinent individuals had more severe alcohol problems, consumed higher amounts of alcohol on drinking days, had more years of heavy alcohol consumption, and were more likely to have attended alcohol treatment and Alcoholics Anonymous (AA). The controlled drinkers had a longer history of moderate social drinking, and their current consumption habits appeared to be similar to symptom-free older adult drinkers. The results suggest that gender, alcoholism severity, history of formal and informal treatment, and past consumption patterns are associated with whether older adults with histories of alcoholism attain successful outcomes through abstinence or controlled drinking.

Older women and alcohol. Use and abuse.

Although estimates of elderly problem drinkers and alcohol-related health problems among the elderly are approximate, there does appear to be a decline in the number of drinkers and the number of heavy drinkers. As with all age groups, there are fewer women who drink than men and fewer women problem drinkers. Moderate social drinking varies with health and income. Among older women, there may well be more problematic use of prescribed psychoactive drugs than alcohol. In the few studies of older problem drinkers available, there are gender differences: Older men are more likely to be married, divorced, or separated, but older women problem drinkers show a hgh rate of widowhood; onset is more recent for older women than for older men; older women are more problematic users of prescribed psychoactive drugs; and the prevailing comorbidity among older women alcohol abusers is probably depressive disorder.

Determinants of early alcohol and drug use among young women in alcoholism treatment.

Substance abuse experimentation may be one of several types of problem behaviors. Data from 99 Caucasian women interviewed in alcoholism treatment (19-29 years old) were used to test a developmental model of substance experimentation. Respondents were classified into three groups based on their use prior to age 15: nonusers, users of alcohol only, and users of alcohol and other drugs. Family history of alcoholism was not related to childhood anxiety and impulse control problems. Childhood anxiety and impulse control problems predicted adolescent emotional and impulse control problems but did not differentiate early experimenters. Whereas adolescent emotional problems were not related to early experimentation, early drug and alcohol users were significantly more likely to have engaged in other impulsive behaviors (e.g., running away from home, trouble with school authorities) than were nonusers or users of alcohol only. Alcoholism prevention programs, therefore, would do well to target youth who exhibit acting-out behaviors as a high-risk group for early alcohol and drug use.

Alcohol, women and the expression of aggression.

The need for agreed upon definitions of terms like aggression, anger and violence is emphasized as well as the need to encompass a broader range of human aggressive behaviors in research than has been customary. Gender differences and female-as-aggressor and as object of aggression are reviewed. Some of the work on effects of alcohol on aggressive response and male and female studies are also reviewed. Some suggestions for future development of alcohol/aggression studies are made.

Women and alcohol: use and abuse.

National surveys of the quantity/frequency of drinking, conducted over the last half century, show that the percentage of nonabstaining women has remained at about 60%. Although male/female differences in drinking are smaller than they were a generation ago, this appears to relate primarily to drinking by young adults. Study of social attitudes toward male and female intoxication has consistently indicated more disapproval of female intoxication. Alcoholism in women has a complex etiology that includes biological factors, positive family history, difficulties in impulse control, depression, and drinking by significant others in the social environment. Male/female differences in patterns and consequences of alcoholic behavior are summarized, as are differences among alcoholic women with earlier or later onset.

Recent developments in alcoholism:gender issues.

Study of women and alcohol may involve a female/male comparison or comparison among subgroups of women. Epidemiological study over the last decades has not supported the hypothesis of convergence of male and female drinking rates, but changes in women's drinking patterns have occurred. Problem drinking and alcohol abuse in men and women are compared: genetics, vulnerability to liver damage, age at onset, spouse's drinking, use of other drugs. A critical issue is the public/private nature of drinking and the consequences which follow from that. Major antecedents to female problem drinking appear to be difficulties in impulse control, depression, and the earlier appearance of other diagnostic syndromes such as eating disorders or phobia. The consequences of problem drinking and alcoholism--interpersonal, legal, occupational, and medical--are discussed. In spite of the increase in gender-related research reports, women remain "the second sex" in theory development and diagnostic definitions.

The structure of drinking-related consequences in alcoholic women.

This study examines the structure of drinking-related consequences in women in treatment facilities by describing indices that were constructed by submitting 69 measures to factor analysis. Two hundred fifty-four (254) alcoholic women responded to self-report interview items that measured the consequences that the respondent perceived to follow or result from her drinking. The items were submitted to a series of exploratory principal component analyses. Nine factors, social withdrawal, sexuality, early effects, maternal role, accidents, symptoms, work, illness, and relationship conflict, emerged in the rotated solution, with the majority of coefficient alphas in the 0.6 to 0.8 range. Internal reliabilities for the indices remained sufficiently high across age subgroups in the sample.

The structure of depression in alcoholic women.

This study examines depression that is manifest at the time of an alcoholic woman's admission to treatment by describing indices of depression that were constructed by submitting interview items to factor analysis. Alcoholic women (N = 301) and nonalcoholic women (N = 137), who served as controls, responded to 48 depression items taken from several interview schedules, including the Diagnostic Interview Schedule, the Center for Epidemiological Studies Depression Scale and the Personal Attributes Questionnaire. These 48 items were submitted to exploratory principal components analysis. Four factors, Current Mood, Low Self-Esteem, Negative Perceptions of Childhood and Somatic Symptoms emerged in the rotated solution, with coefficient alphas ranging from .83 to .92. Internal reliabilities for the depression indices remained sufficiently high across age and sample subgroups, suggesting that the structure of alcohol-induced depression in women does not differ from depression in nonalcoholic control women.

Suicide risk among women with alcohol problems.

The current study compares 301 alcoholic women, ages 20 to 50, interviewed in 21 treatment facilities, and a control group of nonalcoholic women matched for age and socioeconomic status of family of origin. A significantly higher percentage of alcoholic women (40.0% vs 8.8%) reported having made suicide attempts, a difference of 31.2 percentage points (95% CI = 23.9, 38.5). Age comparisons within the alcoholic sample show the percentage of younger alcoholic women attempting suicide to be twice as great as the percentage of the alcoholic women suicide attempters in their forties. Such age differences were not found among the nonalcoholic control group. The findings suggest that youthfulness and alcohol/drug abuse are the critical combination for high risk. Awareness of the suicide attempt risk potential is necessary both for emergency room personnel and for substance abuse facility workers.

Alcoholic women in treatment: early histories and early problem behaviors.

When data from interviews with 301 alcoholic women, drawn from 21 treatment facilities, are compared with interview responses of 137 age-matched nonalcoholic control women, differences in report of early life experience appear. The two groups of women do not differ significantly in report of painful early life events, but they do differ significantly in reports of response to these events and their affective reactions during their early years. Clinic and Control women also differ significantly in report of impulsive childhood and adolescent behaviors. Comparison of Clinic women of different ages with nonalcoholic age peers suggest that childhood and adolescent impulse control problems are more likely to be associated with earlier onset of alcoholism. Present data are based on retrospection and self-report. Assuming that alcoholic women introduce no more memory distortions than nonalcoholic women in evoking early life memories, the consistent finding is that early life emotional/behavioral problems are reported to a significantly greater extent by women who will later become alcoholic than by those who will not.

Impact of depressive symptomatology on alcohol problems in women.

The association between the amount of depression manifest at time of an alcoholic woman's admission to treatment, the course of alcoholism and its consequences, and early psychosocial vulnerabilities was examined in a sample of women in treatment for alcoholism (n = 301). Two indices of depression, one reflecting low self-esteem and the other current mood were constructed by factor analysis of interview items measuring depression (drawn from Center for Epidemiological Studies Depression scale, Diagnostic Interview Scale, and Personal Attributes Questionnaire). Both depression indices were associated with earlier age of onset and earlier loss of control. Binge drinking was associated with current mood, while daily/weekend drinking was associated with low self-esteem. Both measures were associated with the consequences of alcoholism. An examination of alcoholic women's background revealed that there are some influences in the early family environment that are associated with increased levels of depression in alcoholic women.

Alcoholic women in treatment: the question of stigma and age.

Both alcoholic women in treatment and a matched group of non-alcoholic women feel that social attitudes are more negative towards female intoxication and problem drinking than towards male intoxication and their drinking problems. Alcoholic women report significantly more negative attitudes, both social and personal, than do the non-alcoholic control women. The older group of alcoholic women are consistently harsher than the younger in their judgments, both of social attitudes and in expression of their own opinions. The less negative attitude of younger women alcoholics may reflect more liberal attitudes of younger persons but there is a curious juxtaposition in that younger alcoholic women report more family and social rejection than do older alcoholic women. There is dissonance in younger alcoholic women's report of less negative attitudes and more experienced rejection and stigmatization. Perhaps more rejecting social attitudes towards younger alcoholic women are related to their greater likelihood of public rather than private drinking. When the total sample (438 women, alcoholic and non-alcoholic) is compared in terms of positive family history versus negative family history, those with positive histories are more likely to agree with disapproving statements about women's problem drinking. Significantly more women with positive histories believe that social attitudes are more disapproving of women alcoholics then men, and they believe, to a significantly greater extent than those without such histories, that the effects of maternal alcoholism are worse than those of paternal alcoholism.

Social support structures of women in treatment for alcoholism.

The authors in this article explore the weak social support structures of alcoholic women to identify those critical elements that might be usefully attended to in treatment. Data were derived from a comparison between survey questionnaires from 301 alcohol-dependent women and 136 nonalcohol-dependent women. Results showed that alcoholic women reported less social support than their nonalcoholic peers as children and adolescents. Alcoholic women reported less current support than controls; were more likely to be separated or divorced; and described their existing relationships as less happy and less supportive. Additionally, the current study reports that the linking of social support to various aspects of psychological adaptation offers a theoretical base for developing broad-based preventive and treatment interventions.