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Risk Factors for Problem Drinking in Women:Findings from a 20-Year Longitudinal StudySharon C. Wilsnack, Ph.D.Department of Clinical NeuroscienceUniversity of North Dakota School of Medicine & Health SciencesSymposium on Sex, Gender, and Drug AbuseUniversity of Michigan Substance Abuse Research Center & Institute for Research on Women and GenderOctober 16, 2008

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National Study of Health and Life Experiences of Women(NSHLEW)Sharon C. Wilsnack, Ph. D. Richard W. Wilsnack, Ph. D.Principal InvestigatorsArlinda F. Kristjanson, Ph. D. Nancy D. Vogeltanz-Holm, Ph. D. Project Director Research Psychologist Perry Benson, M. A. Chunzi Peng, Ph.D.Database Manager/Program Analyst Research Associate Qing Li, M.D., Dr.P.H.Postdoctoral Fellow University of North Dakota School of Medicine & Health SciencesGrand Forks, North DakotaSupported by Research Grant AA004610 from the National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health

1981 survey sample
1981 Survey Sample
  • National probability sample stratified to interview all women reporting consumption > 4 drinks/week (moderate to heavy drinkers), and 25% of women reporting less drinking
  • 4,032 households screened for potential respondents
  • Ninety-minute structured interviews with:

- 500 moderate to heavy drinking women

(89% of those eligible)

- 378 light drinking or abstaining women

(83% of those eligible)

- 386 men representing all drinking levels

(66% of those eligible)

1986 survey sample
1986 Survey Sample
  • Follow-up interviews with:

a. PROBLEM DRINKERS

b. NON PROBLEM DRINKERS

  • 91% of respondents located successfully
  • Follow-up interviews completed with

- 143 problem drinkers (94% completion rate)

- 157 nonproblem drinkers (93% completion rate

1991 followup national sample
1991 Followup National Sample
  • 75-minute structured face-to-face interviews with

- 696 women first interviewed in 1981 (ages 31+ in 1991; 85% completion rate)

- 403 younger women new to the study (ages 21-30 in 1991; stratified to include

all moderate-to-heavy drinkers; 91% completion rate)

1996 survey sample
1996 Survey Sample
  • 15-year follow-up of women initially interviewed in 1981
  • 5-year follow-up of women age 21-30 added to sample in 1991
  • Personal interviews with 711 women age 21-49 in 1991 (87% completion rate)
  • Personal interviews with 369 spouses or partners (76% completion rate)
2001 survey sample
2001 SURVEY SAMPLE

75-minute CAPI interviews with. . .

• 785 women first interviewed in 1981 or 1991 (age

31 and older) (88% completion rate)

• 341 women new to the study (age 21-30) (79% completion rate)

nshlew interview questionnaire
NSHLEW INTERVIEW QUESTIONNAIRE
  • Detailed questions about drinking behavior, drinking contexts and expectancies, and adverse consequences of drinking
  • Questions about hypothetical antecedents and consequences of alcohol consumption, including demographic characteristics, family history and socialization, personality traits and values, social roles, close interpersonal relationships, stressful life events, depression, sexual experience, reproductive disorders, drug use, and antisocial behavior
prevalence of any heavy episodic drinking among 12 month drinkers 1981 2001
Prevalence of Any Heavy Episodic Drinking Among 12-Month Drinkers, 1981 - 2001

Source: Wilsnack et al., 2006.

some risk factors for women s drinking
SOME RISK FACTORS FOR WOMEN’S DRINKING
  • Family history of alcohol problems
some risk factors for women s drinking15
SOME RISK FACTORS FOR WOMEN’S DRINKING
  • Family history of alcohol problems
  • Age: Younger women
employment and women s drinking
EMPLOYMENT AND WOMEN’S DRINKING
  • Role overload vs. role deprivation
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Percentages of Women Drinkers Age 21-34 Reporting Problem Consequences and Alcohol Dependence Symptoms in Preceding 12 Months, by Marital and Work Roles

One or more problem consequences Tau C=.117, p<.05

One or more alcohol dependence symptoms Tau C=.252, p<.001

Percent

n=301

Source: Wilsnack & Cheloha, 1987.

relationship risk factors for women s drinking20
RELATIONSHIP RISK FACTORS FOR WOMEN’S DRINKING
  • Marital/relationship status

- Cohabiting women

relationship risk factors for women s drinking21
RELATIONSHIP RISK FACTORS FOR WOMEN’S DRINKING
  • Marital/relationship status

- Cohabiting women

- Divorce: Risk or benefit?

slide23
Remission of Alcohol Dependence Symptoms as Related to Divorce or Separation over Five Years, Among Time 1 Problem Drinking Women

Time 2 Dependence Symptoms (% 1+)

42%

30%

β= -.24, (p<.05)

Source: Wilsnack et al., 1991. See also Walitzer & Dearing, 2006.

relationship risk factors for women s drinking24
RELATIONSHIP RISK FACTORS FOR WOMEN’S DRINKING
  • Marital/relationship status

- Cohabiting women

- Divorce: Risk or benefit?

  • Drinking partnerships

- Heavy-drinking partner

relationship risk factors for women s drinking26
RELATIONSHIP RISK FACTORS FOR WOMEN’S DRINKING
  • Marital/relationship status

- Cohabiting women

- Divorce: Risk or benefit?

  • Drinking partnerships

- Heavy-drinking partner

- Drinking discrepancies

relationship risk factors for women s drinking27
RELATIONSHIP RISK FACTORS FOR WOMEN’S DRINKING
  • Marital/relationship status

- Cohabiting women

- Divorce: Risk or benefit?

  • Drinking partnerships

- Heavy-drinking partner

- Drinking discrepancies

  • Intimate partner violence
physical partner aggression events by past 12 month heavy episodic drinking u s women
Physical Partner Aggression Events by Past-12-Month Heavy Episodic Drinking: U.S. Women

N=1103

Source: Wilsnack et al., in press. See also Caetano et al., 2005; Drapkin et al., 2005.

sexual experience and women s drinking
SEXUAL EXPERIENCE AND WOMEN’S DRINKING
  • Sexuality-related alcohol expectancies
perceived effects of drinking on sexual inhibition
Perceived Effects of Drinking on Sexual Inhibition

How true is it that when you drink you feel less inhibited about sex?

n : 166 256 107

Source: Wilsnack, Plaud et al., 1997. See also Bogren et al., 2007.

perceived effects of drinking on sexual pleasure
Perceived Effects of Drinking on Sexual Pleasure

How true is it that when you drink, sexual activity is more pleasurable for you?

n : 164 254 105

Source: Wilsnack, Plaud et al., 1997. See also Schacht et al., 2007.

sexual experience and women s drinking33
SEXUAL EXPERIENCE AND WOMEN’S DRINKING
  • Sexuality-related alcohol expectancies
  • Sexual dysfunction
sexual experience and women s drinking34
SEXUAL EXPERIENCE AND WOMEN’S DRINKING
  • Sexuality-related alcohol expectancies
  • Sexual dysfunction
  • Childhood sexual abuse
nshlew questions on childhood sexual abuse
NSHLEW QUESTIONS ON CHILDHOOD SEXUAL ABUSE
  • Exposure of the respondent’s genitals
  • Exhibitionism by the perpetrator
  • Touching/fondling
  • Sexual kissing
  • Oral-genital activity (as initiator and recipient)
  • Anal intercourse
  • Vaginal intercourse
wyatt definition of childhood sexual abuse
WYATT DEFINITION OF CHILDHOOD SEXUAL ABUSE

Intra-familial

- Respondent was age 17 or younger

- Sexual experience was unwanted, or involved family

member 5+ years older

Extra-familial

- Respondent was age 17 or younger and sexual experience was unwanted, OR

- If respondent was under age 13, involved another person

5+ years older

- Voluntary experiences occurring between ages 13 and 17

with partners 5+ years older are not considered abuse

Source: Wyatt, 1985.

abused vs non abused women reporting alcohol use and heavier consumption
Abused vs. Non-Abused Women (%) Reporting Alcohol Use and Heavier Consumption

Alcohol Use

Heavy EpisodicDrinking

Intoxication

43.6

30.4

27.4

19.1

15.9

10.6

Adjusted Odds Ratio = 1.79 (p<.01)

Adjusted Odds Ratio = 1.58 (n.s.)

Adjusted Odds Ratio = 1.65 (p<.05)

Odds ratios adjusted for age, ethnicity, and parental education.

CSA=Childhood sexual abuse

Source: Wilsnack, Vogeltanz et al., 1997; Wilsnack et al., 2004.

abused vs non abused women reporting adverse drinking consequences
Abused vs. Non-Abused Women (%) Reporting Adverse Drinking Consequences

Alcohol Dependence Symptoms

ProblemConsequences

Problem Drinking Index

Adjusted Odds Ratio = 2.52(p<.001)

Adjusted Odds Ratio = 2.39(p<.01)

Adjusted Odds Ratio = 3.04(p<.001)

Odds ratios adjusted for age, ethnicity, and parental educations.

Source: Wilsnack, Vogeltanz et al., 1997. See also Hughes et al., 2007; Sartor et al., 2007.

slide39

Effects of Less Severe and More Severe CSA on Women's

Depression and Hazardous Drinking over 20 Years

HazardousDrinking T2

Childhood Sexual Abuse (more severe)

HazardousDrinking T3

DepressionT3

Source: S. Wilsnack et al., 2007. See also Schacht et al., 2007.

risk factor findings suggest importance of relational issues in treatment of women
Risk factor findings suggest importance of relational issues in treatment of women
  • Partner’s drinking
  • Marital/relationship distress
  • Intimate partner violence
  • Sexual adjustment/satisfaction
central importance of childhood sexual victimization suggests attention to
Central importance of childhood sexual victimization suggests attention to . . .
  • Treatment of major sequelae of CSA (including shame/self-blame, anxiety, depression, impaired relationships, avoidant coping strategies)
  • Early intervention with CSA victims
  • Community-based prevention of CSA and other child maltreatment
thank you

THANK YOU

Sharon C. Wilsnack (swilsnac@medicine.nodak.edu)

Department of Clinical Neuroscience

University of North Dakota

School of Medicine & Health Sciences

P.O. Box 9037

Grand Forks, ND 58202-9037