Typologies of alcohol dependent cocaine-using women enrolled in a community-based HIV intervention

Background/Significance: Alcohol dependence with comorbid cocaine use is a significant public health problem for women in the United States. However, not much is known about alcohol dependent women as a group or how alcohol dependent women may characteristically differ from each other. Research has suggested that alcohol dependent women are heterogeneous: they may differ with regard to how they become dependent, how quickly they become dependent, (e.g., Ridenour et al., 2004), and when in their lifetimes they begin drinking regularly (e.g., Babor et al., 1992). Research on types or classifications of alcoholics have mainly focused on men, or have examined men and women together in inpatient alcohol treatment centers.

Alcohol dependence alone and cocaine use alone are risk factors for sexually transmitted infections including HIV (Jessup, 1997). Together, alcohol dependence and cocaine use increase that risk. Women's vulnerability to alcohol and drug problems stem from factors such as being sexually or physically abused in childhood, having had conduct problems, being depressed, and having a family history of alcohol and drug problems. Women with alcohol dependence who use cocaine tend to have many sex partners and are likely to use condoms inconsistently, increasing their risk of contracting infections including HIV. Women may also trade sex for alcohol and drugs, increasing that risk.

Methods: A subsample of women from two similar community-based HIV intervention programs in a Midwestern metropolitan area were analyzed. Women were eligible for inclusion if they had a history of drinking and/or using drugs, and were currently not in treatment for alcohol or drug problems. This is the first known study to investigate types of alcohol dependent women in a non-treatment, community-based setting. It is also the first study to examine how different types of alcohol dependent women respond to a community-based HIV intervention program targeted at decreasing risky behaviors and increasing education about substance use and abuse and risky sexual practices.

Results: 324 women who met lifetime DSM-IV criteria for alcohol dependence and had ever used cocaine in their lifetimes were analyzed into four typologies based on onset of regular drinking and length of time to dependence. Results show significant differences among typologies with regard to experience of childhood abuse; conduct disorder; depression diagnosis; and suicidal ideation. Current analyses show that women who start drinking regularly at a later age (after age 18) and take a while to become dependent (more than 6 years) look significantly different than women who start drinking regularly before age 18, and from those who become dependent quickly.

Conclusion/Implications: Understanding differences among alcohol dependent women is a crucial step in planning effective treatment protocols. Knowing the different ways alcohol dependence may present itself in women as well as factors which may predict alcohol dependence can help prevent women who misuse alcohol from becoming dependent. Public health implications include education and awareness programs for women as well as for health and mental health practitioners.