Alchohol use effect on women mental health
Health status in the United States has continually improved throughout the last century. However, tremendous disparities in health status exist across various segments of the population. African Americans have higher rates of death, disease, and disability than Caucasians, including higher rates for 13 of the 15 leading causes of death in the U.S.
Results from studies comparing mental health status of African Americans and Caucasians vary. Some researchers found that African Americans have higher levels of psychological distress. However, results from the Epidemiological Catchment Area Study and the National Comorbidity Study found that African Americans have lower or equivalent rates of psychiatric disorder. On the other hand, when gender was examined in the ECA study, African American women had higher rates of anxiety disorders than Caucasian women. The purpose of this manuscript is to compare rural African American and Caucasian women on alcohol and other drug use (AOD), comorbid Axis I psychiatric disorders, and experiences with violence.
Researchers have shown that race is not the primary contributor to health disparities, but socioeconomic status (SES). Compared with Caucasians, African Americans have a median income that is 63% less and are more than twice as likely to be unemployed, three times more likely to be poor, and twice as likely not to have graduated from college. Also contributing to disparities in SES, African American families are more likely to be headed by a single parent, to lack health insurance, and to live in segregated, impoverished housing. More than one-third of all African American women live in poverty, placing them at a tremendous disadvantage. Disparities in health care may exist because people with higher SES status have more resources (money, education, prestige, power, social support and social connections) that can be used to prevent risk and to promote health. Studies of racial differences in health that control for SES often find that racial disparities are reduced and sometimes eliminated. However, importantly, race is often a determinant of SES in that many African Americans face economic discrimination.
Rural women are at particular risk for health disparities. Rural women often live in poverty, are unemployed, lack health insurance, and face environmental and geographic constraints that limit access to what limited health care exists. Lack of personal transportation and unreliable public transportation compounds geographic separation and further limits access to health care for rural women. Many rural areas are characterized by conditions that plague poor, inner-city neighborhoods such as poverty, high crime rates, alcohol and other drug (AOD) use, domestic violence, and few opportunities for entertainment that are not centered around AOD use. In addition to increasing risk for AOD use and relapse after treatment, these conditions are associated with increased risk for stress-related mental disorders such as anxiety disorders and major depression.
Prevalence rates for use of illicit drugs vary across studies and according to time frame (i.e., lifetime, 1 month, 1 year). According to the latest National Household Survey on Drug Abuse, for persons 12 years old or older, more Caucasians use illicit drugs than do African Americans for lifetime use (44.5% vs. 38.6%) and past year use (12.9 vs. 12.2). Past month use of illicit drugs was slightly higher for African Americans (7.4%) than for Caucasians (7.2%). In the age range of 12 to 17, which is the only age range reported by race and gender, more Caucasian women used illicit drugs than African American women for lifetime use (28.5% vs. 27.5%), past year use (21.4% vs. 18.0%), and past month use (10.8% vs. 8.7%).
Similarly, more Caucasians (aged 12 or older) used alcohol than African Americans in three types of alcohol use categories: any use (52.7% vs. 35.1%); binge alcohol use (21.5% vs. 16.8%); and heavy alcohol use (6.4% vs. 4.1%). In the only age range reported by race and gender (12–17 year old), Caucasian women reported higher use than African American women: Any use (19.7% vs. 11.2%) binge alcohol use (11.5% vs. 5.9%); and heavy alcohol use (2.4% vs. .5%) . Earlier studies of alcohol use found that more African American women abstain from alcohol use than do Caucasians (64% vs. 48%).
Although AOD use among African Americans is lower than or equal to that of Caucasians, African Americans disproportionately experience negative health and social consequences of AOD use. African Americans have higher incidences of alcohol related illness such as cirrhosis, cancer, pulmonary disease, malnutrition, and birth defects than do Caucasians. African Americans suffer disproportionately from many AOD related adverse effects: unemployment, substandard housing, homelessness, poor educational outcome, and inadequate health care. However, these same conditions are risk factors for AOD disorders, thus creating a vicious circle. African Americans also are at greater risk of being victims of alcohol or illicit drug-related homicides, being arrested for drunkenness or possession of a controlled substance, and being sent to prison rather than to treatment.
African Americans are at higher risk for toxic effects of cocaine. Cocaine use causes a massive sympathetic nervous system response, and toxicity commonly affects the cardiovascular system including myocardial infarctions, ventricular arrhythmias, and coronary ischemic syndromes. Because hypertension and cardiovascular diseases are common among African Americans, cocaine use exacerbates these health problems. Use of crack cocaine by pregnant women results in problems in pregnancy including fetal injury, death, growth retardation, and neurological impairment.
Rising AOD abuse has created a crisis in the African American community. African American women have been the “pillar of the family” performing vital roles in the family such as primary nurturance, caretaking, and socialization of family members. African American women’s abuse of AOD destroys family relationships, especially that between mother and child, compromising children’s development which is already challenged by poverty and oppression. Moreover, use of AOD, especially cocaine and IV drugs, places women at risk for HIV/AIDS, and African American women in the southeastern United States are the fastest growing segment of those infected with HIV.
Childhood and adult victimization have been linked consistently to AOD disorders in women and may be the source of other health problems. Violence may be a vulnerability factor for substance abuse among women, especially rural women. Findings from the National Violence Against Women Survey indicated that African American women experience more violence that Caucasian women (29.1% vs. 24.8%). Moreover, femicide is the leading cause of premature death among African American women between the ages of 14 and 44.
Reports of health utilization by minorities are often contradictory. According to one report, after adjusting for sociodemographic variables, Caucasians were 1.7 times more likely than African Americans to use outpatient services. Factors hypothesized to contribute to underutilization of services for African Americans were less availability and acceptability of services and difficulty finding facilities within range of available transportation. Factors that specifically influence women in seeking AOD treatment were inability to pay for services, the threat of legal intervention, fear of losing custody of children, and lack of programs for women with children. However, a recent study in South Carolina found that African American women were more likely than Caucasian women to receive inpatient substance abuse services, more community-based day treatment services, and case management services.
In summary, African Americans often have poorer health than do Caucasians. Although some studies are contradictory, many show that African Americans have lower rates of AOD use than Caucasians; however, African Americans often have more severe consequences from AOD use. The questions guiding this study are: Are there differences in African American and Caucasian women in AOD use, Axis I psychiatric disorders, and violence?
Tags: alcohol use, mental health