Clinical Textbook of Addictive Disorders 3rd ed - R. Frances, S. Miller, A. Mack (Guilford, 2005) WW

446 IV. SPECIAL POPULATIONSCLINICAL FEATURES OF ADDICTIVE DISORDERSIN WOMENTable 20.2 summarizes the more important features that have been described inthe literature as differentiating addictive disorders in women from their occurrencein men. In general, alcoholic women are less likely to report “acting out”behaviors such as breaking the law, problems with the criminal justice system,or feeling “out of control.” Women more commonly report problems withhealth and family, and psychological symptoms such as depression and low selfesteem.Because of the differences in self-identified problems and clinical manifestations,investigators developed several screening tools designed specially toidentify alcoholism in women. These include the T-ACE (Sokol, Martier, &Ager, 1989), TWEAK (Russell, Martier, & Sokol, 1994), SWAG (Spak &Hallstrom, 1996) and Health Questionnaire (Blume & Russell, 1993). Laboratorytesting has also been found helpful in screening for alcoholism in women.In a cohort of 100 early-stage alcoholic women, it was found that a screeningcriterion of either an elevated gamma-glutamyl transferase (GGT) or anincreased mean corpuscular volume (MCV) correctly identified two-thirds ofthe women. The same two laboratory tests were found useful in screening anobstetric population and predicting birth defects (Blume & Zilberman, 2004).Although the clinical presentation of any individual patient depends on acombination of physical, psychological, and social factors, sex differences insymptoms and problems are themselves subject to social and cultural influences.Thus, sex differences may be expected to change over time as society itselfchanges.Mortality rates for alcoholic women are high compared to both the generalpopulation of women and alcoholic men (Klatsky, Armstrong, & Friedman,TABLE 20.2. Features of Addictive Disorders in Women, Compared to Men• Start substance use later (A).• Disease progresses more rapidly (A, C).• Drink significantly less than males (A, C, O).• “Significant other” more likely to be substance abuser (A, C, O).• Higher rates of comorbid psychiatric disorders (A, C).• Higher rates of comorbid prescription drug dependence (A).• More likely to make suicide attempts (A).• More likely to have a history of physical and sexual abuse (A, C, O).• More often date the onset of pathological alcohol/drug use to a specific stressful event(A, C).• More likely to report previous psychiatric treatment (A).• Higher mortality rate (A).Note. See Blume and Zilberman (2004); White, Brady, and Sonne (1996); Lewis, Bucholz, Spitznagel,and Shayka (1996); and Griffin, Weiss, and Mirin (1989). A, reported for alcoholism; C, reported forcocaine; O, reported for other drugs.