TAILIEUCHUNG - Neurologic Disease in Women - part 10

432 NEUROLOGIC DISEASE IN WOMEN insomnia, and anxiety. Less than half of these cases are correctly identified as alcohol-related. Women are also more likely to be admitted to non–alcohol-specific treatment, such as general psychiatric units rather than conventional alcohol treatment services (81) and are more likely to drop out of treatment (85). Because female alcoholics often have low self-esteem and feelings of shame and embarrassment, they may balk at confrontational techniques and require more supportive and skill-building approaches. The very serious consequences of alcoholism for women’s health make it crucial for physicians to screen for alcohol abuse, to educate female patients on. | 432 NEUROLOGIC DISEASE IN WOMEN insomnia and anxiety. Less than half of these cases are correctly identified as alcohol-related. Women are also more likely to be admitted to non-alcohol-specific treatment such as general psychiatric units rather than conventional alcohol treatment services 81 and are more likely to drop out of treatment 85 . Because female alcoholics often have low self-esteem and feelings of shame and embarrassment they may balk at confrontational techniques and require more supportive and skill-building approaches. The very serious consequences of alcoholism for women s health make it crucial for physicians to screen for alcohol abuse to educate female patients on the risks of drinking what are often seen as moderate amounts of alcohol for men and to refer patients to specialized substance abuse treatment when appropriate. Women of childbearing age should be made aware of the consequences of alcohol abuse as they relate to fertility as well as to fetal and maternal health. Although direct questions about the amounts of alcohol consumed tend to be unreliable screening for alcohol abuse should not be limited to an assessment of laboratory values suggestive of alcoholism such as anemia increased red blood cell mean corpuscular volume or elevated liver function tests and triglycerides. The question Have you ever had a drinking problem and the four-item CAGE questionnaire Table 86 provide an easy two-minute screen for an alcohol use problem. Since the sensitivity of the CAGE is lower for women than for men a cut off for a positive response of one affirmative response has been suggested. Faced with the diagnosis of alcohol abuse initial denial and rationalization are common. Support education and discussion of the physical psychologic and social costs of drinking on repeat visits will help a patient commit to treatment. Patient fears that they may lose their partner or custody of their children if they enter treatment and child care issues are .

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