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...on Women

www.ProjectCork.org

Spring 2003

Does the treatment of attention-deficit/hyperactivity disorder with stimulants contribute to drug use/abuse? A 13-year prospective study.

Barkley RA; Fischer M; Smallish L; Fletcher K. Pediatrics 111(1): 97-109, 2003. (74 refs.)
Objective. To examine the impact of stimulant treatment during childhood and high school on risk for substance use, dependence, and abuse by young adulthood. Methods. A total of 147 clinic-referred hyperactive children were followed approximately 13 years into adulthood (mean: 21 years old; range: 19-25). At adolescent (age 15) and adult follow-up, probands were interviewed about their use of various substances and duration of stimulant treatment. Results. Duration of stimulant treatment was not significantly associated with frequency of any form of drug use by young adulthood. Stimulant-treated children had no greater risk of ever trying drugs by adolescence or any significantly greater frequency of drug use by young adulthood. Stimulant treatment in high school also did not influence drug use in adulthood except for greater use of cocaine. This difference was no longer significant after controlling for severity of attention-deficit/hyperactivity disorder and conduct disorder in childhood, adolescence, and adulthood. Stimulant treatment in either childhood or high school was not associated with any greater risk for any formal Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised drug dependence or abuse disorders by adulthood. Treatment with stimulants did not increase the risk of ever having tried most illegal substances by adulthood except for cocaine. Subsequent analyses showed that this elevated risk was primarily mediated by severity of conduct disorder by young adulthood and not by stimulant treatment in childhood. Conclusion. This study concurs with 11 previous studies in finding no compelling evidence that stimulant treatment of children with attention-deficit/hyperactivity disorder leads to an increased risk for substance experimentation, use, dependence, or abuse by adulthood.

Towards best practices in the treatment of women with addictive disorders.

Zilberman ML; Tavares H; Blume SB; El-Guebaly N. Addictive Disorders & Their Treatment 1(2): 39-46, 2002. (85 refs.)
Data on gender differences and gender-specific effects of substance use in women are reviewed to assist health professionals in making treatment decisions in clinical practice. Sections of the article address gender differences relevant to treatment, including differences in barriers to detection; course of illness; psychiatric comorbidity; craving; parental, family, and developmental issues; sex-specific effects of substances; and self-help approaches. The article includes a discussion of what is known well and what remains to be learned, and concludes with a set of best-practices guidelines for treating women with substance-related disorders.

Coverage of tobacco dependence treatments for pregnant women and for children and their parents.

Ibrahim JK; Schauffler HH; Barker DC; Orleans CT. American Journal of Public Health 92(12): 1940-1942, 2002. (13 refs.)
The 2000 Public Health Service (PHS) clinical practice guideline Treating Tobacco Use and Dependence recommends health insurance payment for services demonstrated to be effective in helping smokers to quit, thereby reducing the barrier of cost.8 Non-medication counseling interventions, including individual face-to-face, group, and telephone counseling, are recommended as the first line of treatment for pregnant smokers at the initial prenatal visit and throughout pregnancy, given the uncertain risks and benefits of pharmacotherapy for maternal and fetal health outcomes. For adolescents, the PHS guideline recommends assessing tobacco use and offering cessation counseling 8 that increases quit rates above naturally occurring levels.9 The guideline also recommends that pediatricians "offer smoking cessation advice and interventions to parents to limit children's exposure to secondhand smoke."8 Medicaid requires states to cover specific preventive services, including prenatal care and Early and Periodic Screening, Detection, and Treatment (EPSDT) services for youths younger than 21 years.10 Coverage for additional preventive services, such as treatments for tobacco use and dependence, is optional and decided by each state. The purpose of this research was to determine the extent to which guideline-based tobacco dependence treatments are covered by state Medicaid programs for pregnant women, and under EPSDT for children and their parents who smoke. It is concluded that adding coverage for effective tobacco dependence treatments to the federally mandated Medicaid benefits package for pregnant women and for children and parents under EPSDT would eliminate the disparities in coverage across the states and make a significant difference in the health of low-income pregnant women and their children, 2 of our most vulnerable populations.

Faster absorption of ethanol and higher peak concentration in women after gastric bypass surgery.

Klockhoff H; Naslund I; Jones AW. British Journal of Clinical Pharmacology 54(6): 587-591, 2002. (30 refs.)
Aims To investigate the absorption, distribution and elimination of ethanol in women with abnormal gut as a result of gastric bypass surgery. Patients who undergo gastric bypass for morbid obesity complain of increased sensitivity to the effects of alcohol after the operation. Methods Twelve healthy women operated for morbid obesity at least 3 years earlier were recruited. Twelve other women closely matched in terms of age and body mass index (BMI) served as the control group. After an overnight fast each subject drank 95% v/v ethanol (0.30 g kg(-1) body weight) as a bolus dose. The ethanol was diluted with orange juice to 20% v/v and finished in 5 min. Specimens of venous blood were taken from an indwelling catheter before drinking started and every 10 min for up to 3.5 h post-dosing. The blood alcohol concentration (BAC) was determined by headspace gas chromatography. Results The maximum blood-ethanol concentration (C (max) ) was 0.741 +/- 0.211 g l(-1) (+/- s.d.) in the operated group compared with 0.577 +/- 0.112 g l(-1) in the controls (mean difference 0.164 g l(- 1) , 95% confidence interval (CI) 0.021, 0.307). The median time to peak (t (max) ) was 10 min in the bypass patients compared with 30 min in controls (median difference -15 min (95% CI -10, -20 min). At 10 and 20 min post-dosing the BAC was higher in the bypass patients (P < 0.05) but not at 30 min and all later times (P > 0.05). Other pharmacokinetic parameters of ethanol were not significantly different between the two groups of women (P > 0.05). Conclusions The higher sensitivity to ethanol after gastric bypass surgery probably reflects the more rapid absorption of ethanol leading to higher C-max and earlier t(max) . The marked reduction in body weight after the operation might also be a factor to consider if the same absolute quantity of ethanol is consumed.

Scars, harm and pain: About being injected among drug using Latina women.

Epele ME. Journal of Ethnicity in Substance Abuse 1(1): 47-69, 2002. (50 refs.)
The practice of being injected by others is one social vector that promotes a higher vulnerability to HIV among injector drug-using (IDU) women. This paper suggests that this practice can be interpreted as a strategy used by these women to avoid the bodily damage caused by muscle injection, and thus to reduce its political and economic consequences. Abscesses and scars that are more frequent with muscle injection lead to further subordination within the hierarchies of their social networks, and deteriorate the women's precarious strategies of income production. Although being injected by another increases the probability of HIV infection, it simultaneously prevents the visible physical damage that subjects these women to greater vulnerability. In the street ideology of this network, the moral devaluation arising from the bodily damage implies a moral anatomy that reproduces in this setting the politics of self care that dominate in mainstream society. This local practice was studied through interviews of Latina IDU women and ethnographic immersion into a social network of drug consumption in the Mission District of San Francisco, CA.

Alcohol consumption and incidence of benign breast disease.

Byrne C; Webb PM; Jacobs TW; Peiro G; Schnitt SJ; Connolly JL et al. Cancer Epidemiology, Biomarkers & Prevention 11(11): 1369-1374, 2002. (22 refs.)
We evaluated whether moderate alcohol consumption is associated with increased risk of developing benign breast disease (BBD), a potential "precursor" or marker for breast cancer development. This study evaluated associations between reported alcohol consumption and BBD diagnosis among 75,826 women in the Nurses' Health Study II. Between 1989 and 1997, 16,035 women reported a first diagnosis of BBD (317/10,000 person-years), of which 2,999 diagnoses were confirmed by tissue biopsy (59/10,000 person-years). Of the pathology specimens reviewed, 532 were nonproliferative benign breast conditions, and 932 were proliferative conditions. Person-time models provided estimates of the rate ratio (RR) and 95% confidence interval (CI). Reported recent adult consumption of alcohol was not associated with increased BBD incidence. Compared with women who did not drink alcohol, the age- and body mass index (BMI)-adjusted RRs for any reported BBD were 0.98 (95% CI, 0.95-1.02) for those who consumed <5 g/day, 0.93 (95% CI, 0.89-0.98) for those who consumed 5-14.9 g/day, and 0.90 (95% CI, 0.83-0.98) for those who consumed; greater than or equal to15 g/day. The adjusted RRs for biopsy confirmed BBD and any proliferative benign condition were similar. However, reported alcohol consumption of 2:15 g/day between ages 18 and 22 years was associated with higher rates of biopsy-confirmed BBD (age- and body mass index-adjusted RR = 1.14; 95% CI, 1.00-1.30), nonproliferative BBD (RR = 1.46; 95% CI, 1.09-1.96), and any proliferative BBD (RR = 1.33; 95% CI, 1.05-1.69), but not atypical hyperplasia. In this study, recent alcohol consumption was associated with slightly lower rates of reported BBD. However, greater alcohol consumption earlier in life (ages 18-22 years) was associated with higher proliferative BBD rates, suggesting that timing of exposure may be relevant to disease incidence.

Survey of physicians knowledge regarding awareness of maternal alcohol use and the diagnosis of FAS.

Nevin AC; Christopher P; Nulman I; Koren G; Einarson A. BMC Family Practice 3(1): 2-6, 2002. (13 refs.)
Alcohol is the most widely used drug in the world that is a human teratogen whose use among women of childbearing age has been steadily increasing. It is also probable that Fetal Alcohol Syndrome is under-diagnosed by physicians. The objectives of this study were twofold: (1) to evaluate the experience, knowledge and confidence of family physicians with respect to the diagnosis of FAS; and (2) to evaluate physicians' awareness of maternal drinking patterns. A multiple choice anonymous questionnaire was sent to a randomly selected group of family physicians in the Metropolitan Toronto (Canada) area. Overall, 6/75 (8 percent) of family physicians reported that they had actually diagnosed a child with FAS; 17.9 percent had suspicions but did not make a diagnosis and 12.7 percent reported making a referral to confirm the diagnosis. Physician rated confidence in the ability to diagnose FAS was low, with 49 percent feeling they had very little confidence. Seventy-five percent reported counselling pregnant women and 60.8 percent reported counselling childbearing women in general on the use of alcohol. When asked what screening test they used to detect the use of alcohol, 75 percent described frequency/quantity. Not a single respondent identified using the currently accepted screening method for alcohol use (TWEAK) which is recommended by The Centre for Addiction and Mental Health. It is concluded that family physicians do not feel confident about diagnosing FAS.

Treatment needs of female offenders: A review. (review).

Sorbello L; Eccleston L; Ward T; Jones R. Australian Psychologist 37(3): 198-205, 2002. (55 refs.)
The number of women involved in the criminal justice system is growing, yet few programs and services are geared specifically towards their needs. Moreover, even with gender-specific programming, a risk management model (Andrews & Bonta, 1998) has dominated rehabilitation policy, where criminogenic needs or harm avoidance have been the primary focus. Development of a theoretical approach that embraces gender-specific treatment and addresses the realities of women's lives is critical. This paper posits that the enhancement model (Ward & Stewart, in press) provides such a framework to guide the construction of rehabilitation programs for female offenders. This model moves away from focusing on criminogenic needs, and instead emphasizes enhancing offender capabilities to assist women in living balanced and fulfilling lives. A review of female- specific treatment needs encompassed within the enhancement model is therefore outlined, including issues of physical and sexual abuse, mental health, children and families, vocation, life skills and substance abuse. The integration of these needs into a holistic rehabilitation framework conceptually based on the enhancement model is then proposed. We argue that this framework is fundamental to reducing female recidivism, and improving women's wellbeing and overall quality of life.

Use of postmenopausal hormones, alcohol, and risk for invasive breast cancer.

Chen WY; Colditz GA; Rosner B; Hankinson SE; Hunter DJ; Manson JE; Stampfer MJ; Willett WC; Speizer FE. Annals of Internal Medicine 137(10): 798-804, 2002. (28 refs.)
Background: Physiologic evidence suggests that use of alcohol increases the risk for breast cancer through a hormonal mechanism, but the relationship among breast cancer, alcohol, and postmenopausal hormones (PMH) remains unclear. Objective: To examine the relation between concurrent use of alcohol and PMH and invasive breast cancer. Design: Prospective cohort study Setting: Nurses' Health Study. Participants: 44187 postmenopausal women. Measurements: Self-reported data on PMH use and breast cancer obtained from biennial questionnaires completed from 1980 to 1994 and average alcohol consumption in 1980, 1984, 1986, and 1990. Results: 1722 women developed invasive breast cancer. Risk for breast cancer was elevated in women who currently used PMH for 5 or more years and did not drink alcohol (relative risk, 1.32 [95% CI, 1.05 to 1.66]) and those who never used PMH but drank 20 or more g (1.5 to 2 drinks) of alcohol daily (relative risk, 1.28 [Cl, 0.97 to 1.69]). Current users of PMH for 5 or more years who consumed 20 or more g of alcohol daily had a relative risk for breast cancer nearly twice (1.99 [Cl, 1.42 to 2.79]) that of non-drinking nonusers of PMH. A hypothetical postmenopausal woman whose lifetime risk for breast cancer is 4% could increase her risk to 8% with 5 or more years of current PMH use and consumption of more than one alcoholic drink daily. Conclusions: Both alcohol consumption and PMH use were associated with an increased incidence of breast cancer. Women who are currently taking PMH may want to consider the added risks of regular alcohol consumption.

Benefit-cost analysis of addiction treatment in Arkansas: Specialty and standard residential programs for pregnant and parenting women.

French MT; McCollister KE; Cacciola J; Durell J; Stephens RL. Substance Abuse 23(1): 31-51, 2002. (62 refs.)
A benefit-cost analysis of specialty residential treatment (Specialty) and standard residential treatment (Standard) was conducted on a sample of pregnant and parenting substance abusers from Arkansas. Economic benefits were derived from client self-reported information at treatment entry and at 6-month postdischarge with the use of an augmented version of the Addiction Severity Index (ASI). The average cost of treatment in Specialty programs was 8,035 dollars versus 1,467 dollars for Standard residential treatment. Average net benefits (benefit-cost ratios) were estimated to be 17,144 dollars (3.1) for Speciality and 8,090 dollars (6.5) for Standard. The main policy implication of this research is that investment in Specialty residential treatment for pregnant and parenting substance-abusing women appears to be economically justified, but future evaluations should analyze larger and more comparable samples to improve power and precision in the benefit-cost statistics.

Crack babies and the Constitution: Ruminations about addicted pregnant women after Ferguson v. City of Charleston.

Marrus E. Villanova Law Review 47: 299-336, 2002. (235 legal refs.)
Summary: "The courts have sought to coerce crack addicted pregnant women into treatment by threatening and actually imposing imprisonment if they did not enter and stay in a drug abuse treatment program. ... In Ferguson v. City of Charleston, a six-to-three decision, the United States Supreme Court invalidated a policy in which a state hospital transmitted positive drug test results of pregnant women to the police for criminal prosecution if the women did not enroll in or remain in a substance abuse treatment program. ... In a surprising constriction of the special needs line of cases, the Ferguson majority noted the "pervasive involvement" of the police and lack of special medical treatment for drug abusing pregnant women and their fetuses once they were identified. ... Nonetheless, abortion rights advocates see the current trend of imprisoning addicted pregnant women to force cessation of drug use as a way of undermining women's privacy right. ... " There is evidence that crack addicted pregnant women are less likely to seek medical help early in their pregnancy, and therefore, neither criminal prosecution nor civil commitment is likely to help prevent damage to the fetus, as this is more likely to occur early on in the pregnancy. ...

Evaluation of a women-only service for substance misusers.

Osorio R; McCusker M; Salazar C. Journal of Substance Use 7(1): 41-49, 2002. (17 refs.)
This study evaluated the procedures and effectiveness of a women-only service (WS) within a substance misuse service in the United Kingdom. Questionnaire data were gathered from 208 attendees divided into two groups: those who had attended more than three sessions and those who had attended two or fewer sessions. Questions were designed to assess whether service aims had been achieved and satisfaction of the attendees with the program. A special assessment instrument was used to evaluate objective changes in health and social status. Most of the women were referred to the WS internally from the subs-tance misuse service rather than from the community. More alcohol users were represented than drug users. The WS did not affect the male-female ratio within the substance misuse service. Results indicate that participants attained improved health and social status, and were satisfied with the program. Regular users of the service also attained both perceived and objective improvements in addition to user satisfaction. It is concluded that a gender-specific treatment program undertaken as an integral part of a substance misuse service can be effective.