NVP Scientific Advisory BoardNVP Scientific Advisory BoardSeptember 2013September 2013
Sara Jo Nixon, Ph.D.Sara Jo Nixon, Ph.D.Professor and co-Vice ChairProfessor and co-Vice Chair
Director, Neurocognitive LaboratoryDirector, Neurocognitive Laboratory
Department of PsychiatryDepartment of Psychiatry
University of FloridaUniversity of Florida
Women and Women and AlcoholAlcohol
Telescoping: A Population ViewTelescoping: A Population View5 Birth Cohorts: 1934-1983 (10 yr intervals: 1 is most recent). Combined data from 2 national surveys
Narrowing gender gapAge at 1st Use (men) Men < WomenCohort 5=19.1 ~ 3 yearsCohort 4=18.4 ~ 2 yearsCohort 3=17.5 ~ 1 yearCohort 2=17.2 ~ .5 yearCohort 1=17.1 ~ .4 year
Keyes et al, 2010 Am J Psychiatry, 2010, 167, 969-976: used ages 18-57
Telescoping to Trouble?Telescoping to Trouble?Survival Curves for Time From Initiation of Alcohol Use to Onset of Dependence Among Lifetime Drinkers Ages 18–57 in Two National
Surveys (N=38,309)a
W/in each cohort: Men demonstrate faster “decline” than do womenKeyes et al., 2010, Am J Psychiatry
Fig. 1. Bars represent number of years (mean±standard error of the mean) elapsed between onset of regular substance use and entry into an index substance abuse treatment by gender and substance dependence diagnosis (*P<0.05). Women experienced fewer pretreatment years of regular use of opioids (P=0.03), cannabis (P=0.01), regular alcohol drinking (P=0.03), and regular alcohol intoxication (P=0.09) than men.
Telescoping in Treatment SeekersTelescoping in Treatment Seekers
Hernandez-Avila et al. (2004)
Where might alcoholic telescoping lie? Where might alcoholic telescoping lie?
VariableTotal
Males (n=151)
Females (n=114)
M (SD) M (SD) M (SD)
QFI ( avg. ozs of absolute alcohol/day, prior 6 months) (Range: 4.6 – 68.6)
15.62 (17.02) 16.79 (20.76) 14.08 (10.01)
MaxQFI (most ozs/day in 6 months prior) (Range: 6.8 – 78.72)
21.59 (13.84) 23.01 (14.43) 19.67 (12.84)
Age 1st Drink(Range: 1 – 23)
11.79 (4.22) 11.4 (3.69) 12.31 (4.81)
Age 1st Intoxication*(Range: 10 – 33)
14.83 (3.01) 14.38 (2.39) 15.43 (3.61)
Age Regular Use*(Range: 10 – 42)
17.76 (4.95) 17.20 (4.15) 18.55 (5.83)
Age of Self-reported Alcoholism or Problem Drinking(Range: 7 – 52)
20.47 (7.67) 20.71 (8.27) 20.15 (6.79)
1st Drink to Alcoholism or Problem Drinking (yrs) (Range: 0 – 51)
8.96 (7.97) 9.63 (8.41) 8.03 (7.24)
1st Intox to Alcoholism or Problem Drinking (yrs) (Range: 0 – 36)
6.32 (6.84) 7.00 (7.30) 5.32 (6.00)
Reg Use to Alcoholism or Problem Drinking (yrs) (Range: 0 – 36)
3.03 (5.81) 3.51 (6.28) 2.32 (4.98)
* p<0.05
Treatment seekers identified as likely alcoholic by level of drinking only.
Lewis & Nixon,2013. ACER
Drug Types Used:Drug Types Used:
Stimulants Opiates Benzodiazepines &Muscle Relaxants
Regular Drug Use by Gender(High QFI Group Only)
Marijuana Stimulants Opiates Benzos & Muscle
Reg
ular
Use
(%
)
0
20
40
60
80Males Females
Benzodiazepines &Muscle Relaxants
**
*
(p=.001)
(p=.031)(p=.004)
Regular Drug Use by Gender(High QFI Group Only)
Marijuana Stimulants Opiates Benzos & Muscle
Reg
ular
Use
(%
)
0
20
40
60
80Males Females
Benzodiazepines &Muscle Relaxants
**
*
(p=.001)
(p=.031)(p=.004)
MenWomen
Regular Drug Use by Gender(Likely Alcoholics)
Treatment TelescopingTreatment TelescopingAge @• Initial Drink
– M = 11.97 (3.8) Yrs to: 23– F = 13.38 (4.41) Yrs to:
18
• Initial Drunk– M = 15.04 (2.83) Yrs to:
21– F = 16.28 (4.12) Yrs to: 15
• Regular Use– M = 18.18 (3.63) Yrs to:
18– F = 19.82 (6.74) Yrs to: 13
• Problems– M = 21.75 (7. 48) Yrs to:
14– F = 22.71 ( 8.17) Yrs to:
10
1st Treatment Age• Men: 35.1 (10.1)• Women: 31.7 (9.2)
Time to “problems” did not achieve significance; but time between problems and treatment was significantly abbreviated for women.
Lewis & Nixon (2013). ACER
Are the risks really increased for Are the risks really increased for women?women?
• Alcoholic Cirrhosis:• For Men: 80g/day• For Women: 20 g/day(10-12 yr. drinking career)
~ 13g/ standard drink:
These data support concept of a telescoping of women’s alcoholism
Sex, Alcohol & Brain VolumeSex, Alcohol & Brain Volume
Demirakca et al., 2011
Global gray matter (GM) and white matter (WM) volume loss, global cerebrospinal fluid (CSF) increase and regional volume loss in regions of interest, relative to healthy control values (=100%), controlled for sex; orange = healthy controls, dark blue = male alcoholic, light blue = female alcoholic. HC, healthy controls; TIV, total intracranial volume. SEXES = in Brain Structure Change.
Closing ThoughtsClosing Thoughts
• Demonstrable Population Shifts/ Sex Differences in Drinking Behavior
• Probability in Developing Dependence
• Gender/sex Gap in certain milestones
• Yet steeper trajectory for men, when considered at the population level
Closing ThoughtsClosing Thoughts
• Alcohol misuse differentially increases risk for medical consequences among women
• Alcohol-related neurobehavioral changes are observed in treatment-seekers, regardless of sex: Mixed data on telescoping
• Narrowing gender/sex gap on psychosocial variables (e.g., education/ drinking history) must be considered in long-term planning
• Factors of psychiatric comorbidity, familial support must also be considered
AcknowledgementsAcknowledgements
• NIDA R01 DA13677• NIH NCATS UL1 TR000064• UF Psychiatry, Divisions of Addiction Medicine & Addiction Research• Special thanks to the Community & Treatment Volunteers who
participate in these studies
Laboratory Personnel
Robert Prather Layla Lincoln, Jeff Boissoneault, Ph.D.
Lauren Hoffman,Ben Lewis, Ph.D.,
Alfredo Sklar
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