Women with alcohol problems seeking treatment : underlying individual and psychosocial characteristics

Sammanfattning: The consequences of hazardous or harmful alcohol use are both physiological and psychosocial and seem to occur earlier in the use of alcohol for women as compared to men. Seeking treatment for alcohol problems means crossing a threshold; this is especially the case for women who perceive that having an alcohol problem is not compatible with female gender expectations. In the present thesis the complete data sets of 134 women, consecutively seeking treatment during 2001-2005 at a Swedish clinic specialized in women with alcohol problems, were studied. Almost all women fulfilled the criteria of a DSM-IV diagnosis of alcohol dependence. The main aims were to explore the women s underlying individual and psychosocial characteristics within a Swedish context, and to examine factors influencing treatment outcomes. In study I we performed a qualitative analysis of data from case journals in order to examine the cultural meanings associated with women with alcohol problems and their seeking treatment for these problems. The findings stressed that cultural factors are of importance for understanding this population, for example they perceived a negative Swedish cultural identity status in relation to their problem drinking. In study II we investigated moods and expectancies before a typical drinking occasion in relation to perceived relations to parents. The findings indicated that the women had expectations of a mood change when drinking and primarily negative feelings, which they wanted to change by drinking. Their perceived relation to parents was positive for only 12% of the women and it was found that a perceived negative relation to mother significantly influenced the amount of drinking in the direction of increased drinking at the end of treatment. In study III factors related to treatment approaches and outcomes for two different samples of problem-drinking women, Swedish and North American, were contrasted. The findings indicated that having the opportunity to receive any type of alcohol treatment is utterly important for reducing harmful drinking to a non-risky level. Study IV investigated whether personality and perceived health characteristics could be of importance for treatment planning. Two clusters were identified. Women in Cluster 1 perceived themselves as having severe psychological health problems, and rated different aspects of their personality deviant from mean norm scores. In Cluster 2 the women perceived better psychological health and had a personality profile within mean norm scores. The women in the clusters differed in treatment utilization: with Cluster 1 having a significantly higher treatment visit rate than those in Cluster 2. Both clusters significantly decreased their drinking; yet there were no differences between the clusters related to decreased alcohol consumption at the end of treatment. In conclusion, the present women with alcohol problems seeking treatment had severe alcohol problems, though they were relatively well-functioning socially. Taken as a group, these women were found to be heterogenic in terms of personality dimensions and perceived self-rated psychological health. Most of them were brought up with one or both parents having alcohol problems and had a relation to their parents influencing their own drinking and treatment outcome, in a negative way. However, availing themselves of treatment helped the women as a group to reduce their drinking.