Primary care: detection of women with alcohol use disorders

There are several limitations to our knowledge of alcohol abuse and women. First, the efficacy for women of traditional alcohol screening instruments is unclear since most have been tested and normalized on male populations. The T-ACE and the TWEAK have been tested primarily in specialized populations, limiting their generalizability. Second, the efficacy of brief intervention among women who are moderate to heavy drinkers is also unclear. Reasons for this gap in our knowledge include exclusion of women from research studies, inadequate sample sizes of female subjects, limiting generalizability, and conflicting results from the studies focusing on women and brief interventions in the general medical setting. The barriers to early identification of problem drinking in women and subsequent intervention in the primary care setting may have application to psychiatric practice as well. Women with alcohol dependence are more likely to be seen in other mental health facilities than in alcohol treatment centers. Because of the high rate of comorbidity of alcohol use disorders among individuals with other mental disorders, a careful review of alcohol consumption should be part of every psychiatric evaluation. Psychiatrists therefore might play an important role in early identification of women problem drinkers and be able to intervene, educate, and work collaboratively with primary care providers to reduce the morbidity and mortality of alcohol-abusing women.