The University Record, April 2, 2001

Women more adversely affected by alcoholism than men, says study

By Colleen Newvine
News and Information Services

The daily lives of alcoholic women are more adversely affected by alcoholism than are the lives of their male counterparts, according to a study Kyle L. Grazier, associate professor of health management and policy, presented last month.

Alcoholic women report greater problems with physical and social functioning, more bodily pain, and poorer physical and mental health than do men with the condition, according to data Grazier and co-author Kathleen Bucholz of Washington University analyzed in a three-year, $2 million study funded by the National Institute of Alcohol Abuse and Alcoholism.

Grazier and Bucholz tracked more than 700 people initially interviewed as part of a larger National Institutes of Health study conducted 20 years ago in five American cities.

In their study, Grazier and Bucholz located three groups of respondents from the St. Louis sample: those diagnosed in the original study as stably alcoholic, borderline alcoholic and unaffected by alcohol. They conducted interviews and reviewed all medical records for care received over a two-year period. Grazier notes that their approach is unique, because most researchers examine alcoholics in treatment centers. Grazier and Bucholz looked at individuals in the community who may or may not have received treatment.

“We don’t know very much about people in the general community,” Grazier says. There have been no other community-based longitudinal studies that have followed individuals for almost 20 years to examine the long-term health services effects of alcohol use and abuse.

Women who were labeled stable alcoholics showed greater effects on their daily lives, including simple activities such as walking and shopping, than men in that group. Grazier and Bucholz are exploring reasons for the disparity. Those causes carry implications for the way physicians treat women and ways community-based programs educate people about the health risks of alcohol.

Grazier presented the study at the First World Congress on Women and Mental Health March 27–31 in Berlin. Investigators from around the world focused on the relationships among psychiatry, psychosomatics, neurosciences, obstetrics and gynecology.

In addition, Grazier presented a second study at the Congress—a $300,000, three-year National Institute for Mental Health-funded study on the effects of managed mental health care on women. She looked at what are known as “carve-out” programs, in which a separate administrative structure manages mental health and substance abuse services apart from other medical care.

Grazier gained access to the records of 45,000 employees at a large West Coast company, one of the first to implement a carve-out program, and looked for changes in costs and health care use over the six years of the program.

In looking at the records, Grazier saw that carve-outs had a greater effect on women than men. For example, women made fewer visits to care givers, and when they did receive care, they more frequently used alternative providers such as social workers, which are less expensive to insurers.

She notes that carve-out programs appear to increase access to and utilization of entry-level services among both men and women.

“However, the managed care arrangement significantly reduced access to higher-intensity service use to a greater extent for women than for men. Women with mental health needs were almost twice as likely as men to have health services curtailed beyond the minimal level,” Grazier wrote in her study overview.

Grazier said she can’t draw conclusions about the quality of care received by women but said the study does raise the question.