Gender Differences Emerge in Alcohol Use Disorder Treatment

By Celia Vimont

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 physiological reasons, Dr. Epstein explains. 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. 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.

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.