Women might be slipping through the cracks with early drinking problem diagnosis

Men are more likely than women to experience many of the problems commonly associated with nondependent drinking, according to a new study.

But the authors suggest women are prone to different alcohol-related problems that are less likely to be diagnosed.

Penny Nichol, co-author and quantitative psychologist, said the current study is distinguished by how specifically it measures alcohol problems: “We're not comparing just any man and any woman; we're comparing men and women with similar levels of problems.”

Balancing such comparisons allowed the University of Minnesota researchers to explore an underlying question: Are the criteria for alcohol abuse and dependence as accurate for women as for men, Nichols said it's possible that studies “aren't looking at the correct symptoms” for women.

Participants comprised 1,348 men and 1,402 women enrolled in the Minnesota Twin Family Study, all parents of twin children. The study appears in the May issue of the journal Alcoholism: Clinical and Experimental Research .

The authors looked at 105 symptoms associated with alcohol consumption, collected from inventories ranging from screening surveys to clinical assessments. The study sample was made up predominantly of white, middle-aged, married parents, so results may not apply to the general population.

Only about a third of the symptoms were sex-specific, but the male-oriented symptoms, such as binge drinking and violent behavior, were those that tend to predominate in sets of criteria used to detect problems with alcohol.

The finding raises the question of whether a separate, female-oriented measure is needed to effectively identify incipient alcohol disorders in women.

For instance, feelings of guilt about alcohol consumption and depression were among the symptoms more often reported by women participants. Yet neither is included among the criteria in the latest version of the Diagnostic and Statistical Manual of Mental Disorders, which is used by U.S. psychologists and psychiatrists to diagnose alcohol dependence.

Suzanne Thomas, Ph.D., director of the shared scientific resource core at the Charleston Alcohol Research Center of the Medical University of South Carolina, praised the study's design and statistical approach. “With the dependence criteria, I was encouraged to see that only one … was gender-specific,” she said. “The part where we should be more discouraged tends to be in pre-disease screening,” added Thomas, who was not associated with the ACER study.

The study results are also significant, Thomas said, because women tend to progress more quickly than men from alcohol abuse to alcohol dependence. Coupled with the possibility that women are being underidentified at the screening level, clinicians may find that they are only adequately identifying women's problems once they've reached the dependence, or brain disease, level. “Women might be slipping through the cracks,” Thomas said.

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