522 Women’s Health Psychology
of these women between the ages of 18 and 29 years
(B. Grant, Hartford, Dawson, Chou, & Pickering, 1994).
Lifetime prevalence rates for DSM-IValcohol use disorders
(i.e., abuse and/or dependence) are 25.54% for males and
11.36% for females (B. Grant & Harford, 1995). Rates of dis-
orders decrease with age, and African American women have
lower rates across all age groups relative to non-African
American women. Although fewer women than men abuse
alcohol, mortality rates for women who abuse alcohol are
higher than among women in the general population and
higher than those of men who abuse alcohol (Green“eld,
1996). Risk factors for alcohol dependence vary over a
woman•s lifespan and include, but are not limited to, family
history of substance abuse, dysfunctional and unstable family
environment, peer pressure, divorce, and retirement (see
Stoffelmayr, Wadland, & Guthrie, 2000). Alcohol use itself is
a risk factor for a variety of health problems such as alcohol-
related organ damage, adverse birth outcomes, and physical
trauma related to motor vehicle accidents, as well as for so-
cial problems such as unprotected sex resulting in STD/HIV
infection and unplanned pregnancies.
Studies have demonstrated that there are gender differ-
ences in alcohol use responses. For example, alcohol con-
sumption leads to higher blood alcohol levels in women than
in men. Therefore, given the same amount of alcohol, women
become more intoxicated than men (El-Guebaly, 1995).
Also, women tend to abuse alcohol later in life than men, but
women deteriorate more rapidly and develop alcohol-related
symptoms faster than men. This phenomenon, known as •tele-
scoping,Ž is often associated with the development of liver,
cardiovascular, and gastrointestinal diseases (Lex, 1992).
Furthermore, women who are heavy drinkers are more sus-
ceptible to depression (four times more than men who are
heavy drinkers), menstrual problems, infertility, and early
menopause (see Stoffelmayr et al., 2000). Women•s drinking
patterns can be in”uenced by their social relationships. For ex-
ample, married women who abuse substances are more likely
to have a spouse that abuses a substance than are married
men who abuse substances (T. Brown, Kokin, Seraganian, &
Shields, 1995). Research efforts should continue to explore
gender differences in etiology (particularly related to psy-
chosocial factors), risk factors, treatment outcomes, and pre-
vention programs. Speci“c issues to be examined include use
of alcohol as a coping strategy and the role of alcohol in stress
management, depression, and domestic violence, for example.
Issues Relevant to Treatment of Mental Disorders
Although women are more likely to suffer from depressive,
anxiety, and eating disorders, most do not seek treatment.
Women seek treatment for mental disorders more often
than men (Zerbe, 1999), but only one-third to one-fourth of
women with depression actually seek professional help or
treatment (Kessler, 2000). Women are also unlikely to pur-
sue treatment for a substance abuse disorder (Mondanaro,
1989). When women do seek help, it is usually from their pri-
mary care physicians rather than from a mental health spe-
cialist (Glied, 1997; Narrow, Regier, Rae, Manderscheid, &
Locke, 1993). Primary care physicians typically provide phar-
macological treatment for affective disorders (e.g., antidepres-
sants). Therefore, for the interdisciplinary intervention needed
to treat such mental disorders, it is important for clinical health
psychologists to have a presence in primary care settings„
either as a referral source for adjunctive psychotherapy or as
part of a multidisciplinary treatment team in the primary care
setting itself. Treatment outcomes are likely to be enhanced
when the various treatment team members (e.g., physicians,
mental health care providers) communicate and coordinate
their efforts. Moreover, interdisciplinary treatment that incor-
porates a biopsychosocial approach can facilitate adherence to
antidepressant medication protocols, improve satisfaction
with care, and help offset medical costs (Katon, 1995).
Although women commonly receive psychotropic med-
ications, research has not investigated the interaction be-
tween such medications and a woman•s menstrual cycle even
though menstrual cycle, pregnancy, and the postpartum pe-
riod can in”uence the course of mood and anxiety disorders
(Leibenluft, 1999). Moreover, drug and treatment trials were
researched primarily on men. This has left many questions of
how medications interact with female hormones. As a result,
the American Medical Association (1991) notes that research
on the use of antidepressants originally was conducted on
men and cautions that antidepressants may work differently
for women than men, citing the fact that effectiveness of
some antidepressants can vary over the course of a woman•s
menstrual cycle. It has also been noted that women experi-
ence more adverse side effects when taking antidepressants.
Speci“cally, women are less likely to tolerate the side effects
of weight gain or drowsiness and often stop treatment when
these side effects occur (Kessler, 2000). Medical research
should continue to investigate the interaction of psychotropic
medications with the menstrual cycle, pregnancy, and lacta-
tion, as well as identify side effects speci“c to women so that
such treatment barriers can be addressed.HEALTH CAREWomen are major consumers of the health care industry in a
variety of ways. According to Smith Barney Research (1997),