Drug Abuse

 

THE INTERNATIONAL JOURNAL OF DRUG POLICY, VOL 7, NO 3,1996

DOES FEMINISM DRIVE WOMEN TO DRINK?

CONFLICTING THEMES

Marguerite Babcock, CAC, Unit Director, Center for Substance Abuse, McKeesport, PA, USA

'Convergence', subscribed to by several scholars, is the claimed phenomenon that women are beginning to catch up with men in druglalcohol use. Some research shows increased drug and alcohol use by women. The 'convergence hypothesis' argues that this is an actual increase, and proponents also often argue that convergence is fuelled by the pressures of feminism on women. An examination of relevant studiesshows that research has usually ignored the greater under-reporting of druglalcohol use in women compared with men, and that 'convergence' may be only apparent as this avoidance recedes. The notion that women have used AugsIalcohol less than men in the past is not solidly substantiated. Rather, relaxing sex roles now may be allowing women to be more open about their use, and gradual utilization of improved research is showing more accurately the actual level ofuse in women.

INTRODUCTION

Several authors comment on the continuing madequacy of addictions research for women (Bepko, 1986; Brett et al., 1995; Copeland and Hall, 1992; Cyr and Moulton, 1993; el-Guebaly, 1995; Harrison, 1991; Jarvis, 1992; Lammers and Schippers, 1991; Turnbull and Gomberg, 1991; Vanicelli and Nash, 1984; Waterson and Ettorre, 1989). As is true in other health concerns (Holloway, 1994; Holloway and Yam, 1992; Science News, 1990, 1994), research on addictions still uses predominantly male subjects (John, 1987; Mendelson et al., 1991; Murray, 1989; National Institute on Alcohol Abuse and Alcoholism, 1990; Ross, 1989; Svikis et al., 1994). Wilsnack et al. (1987) wrote that 'publications and funded research on women and alcohol have increased markedly'(p. 86). However, the increase in competent research on women and addictions has a distance to go before it can even be termed sufficient. Harrison (1989) commented that'Gender is a key variable to be taken into account in attempts to understand any behavior' (p. 655). Turnbull and Gomberg (1991) observed that'There isanunstated assumption that the consequences of alcohol consumption can be considered without taking gender into account' (p. 29). Brett et al. ( 1995) noted that 'Most frequently, criticisms of bias in addictions research have centered on assumptions and practices that consider male experience as normative'(p. 24).

Conflicting themes

Marsh (1982) comments that 'the way we perceive a social problem is very much influenced by the social and cultural context' (p. 154). The context of inadequate research on women and addictions has produced the co-existence of several common themes on women and drug/alcohol use, themes that exist in the literature are often oddly isolated from each other, creating unresolved contradictions. This paper focuses on the issue of prevalence of wcmen's drug/alcohol use compared with that of men. The relevant, at times conflicting, themes are the following:

There is extra stigma for addicted women

Several authors report that compared with men, there is extra stigma for addicted women (et-Guebaly, 1995; O'Connor et al., 1994). This extends even to treatment. Weisner and Schmidt ( 1992) noted that'the social stigma attached to drinking by women may operate as a social sanction that inhibits female problem drinkers from seeking care' (p. 1872). The stigma may also affect women who use any drugs and alcohol at all (Blume, 1988; George et al., 1988; Richardson and Campbell, 1982; Robbins, 1989). The notion of recreational drug/alcohol use does not fit into the stereotype of a proper'lady.'The only common exception is for'medicinal' use by women (Gomberg, 1982; Marsh et al,, 1982; Suffer and Brotman, 1976; Verbrugge, 1982)'

There is more under-reporting for women's than for men's drug/alcohol use

Some research shows that women, whether addicted or not, are more distrustful than men about revealing information to professionals (Fleming et al., 1989). This premise can certainly be applied to research on the stigmatized issue of substance use (Hilton, 1984, Turnbull and Gomberg, 1991). Several authors assert that indeed there is more under-reporting of drug/alcohol use in women than in men due to this greater stigma for women (Celentano et al., 1980; Cyr and Moulton, 1993; Fillmore, 1987; Hurley, 1991; Lammers and Schippers, 1991; Morrow-Tlucak et al., 1989; Rosenbaum and Murphy, 1990). Robbins (1989) wrote that:

Thus, a woman may take greater pains to conceal her substance use ... To the extent that she has internalized society's disapproval of female drunkenness and drug use, however, she will be unable to mitigate the psychological consequences (p. 119).

This under-reporting applies not only to women's self-report, but also to significant others' reporting about them. Roy et al. (1994) as well as Schuckit et al. (1995) wrote about the misclassification by family members trying to identify alcoholic relatives. Smith et al. ( 1994) indicated that this especially applies to the identification of female relatives as alcoholics. This under-reporting about (not just by) addicted women is also perpetuated by physicians (Cyr and Moulton, 1995; Dawson et al., 1992; Moore et al., 1989).

Despite Fillmore's (1984) optimism, there is still little recognition that compared with men, women and their significant others report even less about women's drug/alcohol consumption than is reality, due to the special stigma on women for such behaviour.

Addiction (as well as non problematic drug alcohol use) is less common among women than men

Although there is some awareness of this minimising for women, routinely we read, even in academic articles, that problematic as well as non-problematic drug and alcohol use is usually less common in women than in men in terms of volume and frequency (Bucholz, 1992, Cyr and Moulton, 1994; Engs and Hanson, 1990; Fillmore, 1984; Hamlett et al., 1989Johnson, 1982; Robbins, 1989; Suffer and Brotman: 1976; Weissman et al., 1980). Engs and Hanson (1990) claimed that lesser use of alcohol by women than by men is an international phenomenon. The idea of lesser use by women is so pervasive that it is even promoted by some authors otherwise insightful about issues of women and substance abuse. However, these authors ignore how the under-reporting issue for women raises serious questions about the alleged lesser use by women. Heath (1991) gives a contrasting cross-cultural view:

Women have been drinking as long as men have throughout history, and they drink about as often as men in many cultures; in a few instances, they even seem to drink more (p. 17 5).

Ross (1989) reported from her study of patients being treated for alcoholism that:

While men have significantly more alcohol problems than women, as measured by the DIS and the MAST, these differences disappear when the length of alcohol abuse history, antisocial personality disorder and employment status are controlled for (p. 8 10).

Several authors indulge in other guesses about the reasons for the gender discrepancy in reported rates of drug/alcohol use, whilst avoiding the issue of possible under- reporting. Engs and Hanson (1990), for example, explained the discrepancy is based in actual sex role behavioun'thc traditional belief that the use and abuse of alcohol was a male prerogative' (p. 38). Midanik and Room (1992) stated that'social differentiations predict who drinks frequentl~ or heavily'(p. 186). Chan et at. (1994) simplydeclared that 'These gender differences are probably a furictionof [actual] underlying prevalence' (p. 700).

Women may be catching up with men in their rate of alcohol and drug use (the 'convergence hypothesis')

This hypothesis argues that women are now using more like men (Fillmore, 1984; Mercer and Khavari, 1990; Ross, 1989). It continues in prominence in addictions literature, although it is not accepted by all addiction scholars (Robbins, 1989; Shore, 1994). Wi1snack et al. (1994), comparingtheir 1981-1991 NIA,6~,A study on trends in women's drinking to other similar studies, concluded that there was no gender convergence in drinking during the 1970s and 1980s. Robbins (1989), analysing data from the 1985 National Household SurveyonDrugAbuse (NIDAandNIAAA), agreedthat convergence has not happened.

Nevertheless, several authors writing specifically on women's issues in addictions agree that convergence is actually happening (Bucholz, 1992; Hamlett et al., 1989, Suffet and Brotman, 1976). Mercer and Khavari (1990), reporting from their 1977-1985 study of college students, wrote that'the data suggested that convergence was not a trend, but had in fact occurred' (p. 461). They ascribe authors' conflicting opinions on convergence to methodological differences. Robins et al. (1988), looking at data from the 1980-1988 Epidemiological Catchment Area (ECA) study (NIMH), and Reich et al. (1988) all concluded that convergence did happen. However, these authors ignore the issue of extra under-reporting for women, and the possibility that it may be lessening as sex roles have become more relaxed, followed by less stigma on women's drug/alcohol use (Hoar, 1983). Thar is, these authors see the convergence as real, and not as an artefact of reporting.

This 'convergence' is caused by changing sex roles for women

Current speculation in addictions often proposes not only that convergence is real, but also that it is fuelled by changing sex roles for women. Robbins (1989) wrote: 'Several studies suggest that women in less traditional roles are at increased risk for substance use'(p. 120). Harrison (1989) noted 'the hypothesis that shifts in behavioral norms around drinking and drug use, along with changing roles and expectations for women in American society, may have profoundly altered the chemical dependency profile of women entering treatment'(p. 656). Hoar (1983) and Heath (199 1) summarised the argument concerning alcohot: that either the stress of changing sex roles is causing heavierdrinking in women (convergence), or that the relaxing of sex roles is allowing more women to be open about their drinking (without increase in use). Wilsnack et al. 0 994) posed the question of'whether the higher rates of alcohol problems found in some studies [of women] are a result of increased recognition of alcohol problems and a greater willingness to report them, or whether the prevalence of these disorders is actually increasing [for women]' (p. 179).

One variant of 'convergence' is the notion that at least younger women are now beginning to catch up with men in their use (Cyr and Moulton, 1993; Suffer and Brotman, 1976, Wilsnack et al., 1994). Wilsnack and Wilsnack (1979), analysing the 1975 NIAAA national survey of drinking, reported that even then, adolescent girls were beginning to catch up with adolescent boys in amount of alcohol use. Bucholz (1992), citing data from the ECA study and the 1988 National Health Interview Survey (N IAAA and the National Center for Health Statistics), wrote:

That the lowest male-to-female ratios [for prevalence of alcoholism] were observed among the younger age groups and suggests that alcoholism rates of women may be catching tip to those of men (p. 203).

Harrison and Belille (1987) admitted that this may just be a function of reporting: 'Older wornen may be more likely than younger women to deny or minimize the occurrence of behaviors or experie rices considered deviant' (p. 5 7 7). They then disputed this by drawing on data about frequency of reports of sexual abuse/problems by women and men (aquestionable comparison). They embrace the notion that the increase of substance use among younger women is real:'... although research is certainly needed to clarify the nature of the apparent increase in problems reported by younger women, it cannot be dismissed tooreadily as merely an increase in reporting'(p. 578). However, it would certainly stand to reason that youngerwomen, having been raised in the contemporary culture of relaxed sex role restrictions, would be less inhibited than their elders about admitting to their own alcohol/drug use. Interestingly, Osterling andBerglund (1994) found a'convergence'in alcohol problems in their female and male Swedish subjects, who were 60 years old or older. They, at least, are riot so convinced that this is an actuality, noting that the convergence'maybe partly explained by emancipatorytrends in [Swedish] elderly women, who have possibly become more freely able to drinle and also to acknowledge problem drinking by accepting referral to an alcohol treatment agency' (p. 1320).

Another variant on the convergence theme is that it is not necessarily just younger women who now are using addictive substances more, but specifically women moving into non-traditional jobs (Forth-Finegan, 1991; Wilsnack et al., 1994). Bucholz (1992) wrote that:

Changes in alcoholism prevalence among women may be related to increasingly relaxed social attitudes toward female drinkers (perhaps permitting greater exposure to alcohol); in addition, as women enter traditionally male-dominated occupations, patterns of drinking and related problems may increasingly resemble those of men (p. 205).

In reference to women's alleged drinking more in non-traditional jobs, Wilsnack et al. (1994) assumed that this was a real trend, and offered several explanations for this other than exploring the underreported issue. They mentioned:

peer influences (i.e. women's imitation of the male drinking model), more drinking opportunities in non-traditional employment settings, stress related to a minority status in male-dommated occupations, or the use of drinking as a symbolic expression of power and gender equality (p. 177).

LaRosa (1990) similarly reported that executivelevel women are more likely to drink at all levels than other employed women of otherwise similar demographics. Johnson ( 1982) presented data from NIAAA research of 1974, which showed that employed married women have significantly higher rates of problem drinking than single working women or housewives. She interpreted this to mean that 'a traditional female rote is often incongruous with a work role regardless of her job level' (p. 114), with this exacerbated by a woman's trying to combine marriage and work.

Again, however, it is debatable as to whether women in non-traditional work are actually using drugs/alcohol more or just feel more liberated to report it.

FEMINISM AND DEVIANCE

Forth-Finegan's (1991) literature review shows that the allegation that convergence is due to feminism has been a common theme in addictions literature: 'women who act out-of- (traditional) role are, as a result of feminism, drinking more heavily and are poorly-socialized females' (p. 30). The popularity of sex-role research in addictions peaked in the 1970s, but the speculations about the effects of sex roles on drinking and drug use continues. Parker (1972) wrote of his study's assumption that conflict within the personality or between the self and social role will generate tension and anxiety that may lead to excessive drinking (p. 647). Suffet and Brotman (1976) wrote that:

to the extent that women gain social equality with men and subscribe to greater personal lifestyle freedom, they may be expected to show a higher rate of illicit drug use (p. 20).

EI-Guebaly (1995) expressed virtually the same sentiment two decades later:

... culture concomitantly has also been more protective of women in as much as women experienced less pressure from peers to drink and had less [sic] opportunities to do so. As the lives of men and women run a more parallel course, this protection is reduced and both drinking pressures and opportunities for women have increased (p. 74).

However, Hamlett et al. (1989) questioned the impact of sex roles on women's dnig/alcohol use patterns. From their analysis of the Framingham Study, they report that frequency of alcohol intake is associated with a range of psychosocial. and demographic variables, noti List sex roles. Harrison (1989) and Morrissey (1986) both wrote that the idea that worrien'schanging sex roles have changed their actual drug/alcohol use has not been supported in research. Women who are responsive to feminism may simply feel less restricted by traditional 'femininity' (which includes the notion of greater disapproval for women's than for men's substance use), and so may be more willing to report their drug/alcohol use than are other women. They are not necessarily using more than'traditional' women; they are just more willing to talk about it.

The notion that new sex role pressilres are causing women to actually catch up in level of substance use (convergence) is certainly part of what Faludi (199 1) refered to as the'backlash'against feminism. An alternative, plausible interpretation is that feminism, instead, allows women to more openly ask for help if their drug/alcohol use is problematic. Wilsnack (1976) also noted that through the reduction of gender stereotypes, feminism may indeed decrease stress in women and so decrease their rate of alcoholism.

SUMMARY OF THEMES

The accuracy of our data for comparative levels of female and male substance use is questionable. Women may have been using substances just as much as men all along (or more so). Heath (1991) indicated that, cross -cut tura Ily, it has not always been found that women drink less than men. Gossop et at. (1994) noted that the usual reported ratio of drug users in Britain is 3:1 male:femate, but they found in their sample of cocaine smokers and sniffers that the number of female and male users was about equal. The author of this paper argues that if some research does find an apparent increase in women's substance use, the increase is not real but probably instead the result of employing more sensitive research tools for identifying use in women. Also,with the loosening of gender role limits, more women are now admitting their previously stigmatised use.

It should be noted that the position presented in this paper is almost the reverse image of that presented by Fillmore in 1984. She argued that for alcoholism, indeed it is less common in women than in men, but that it has been exaggerated in women from time to time due to the extra stigma on their drinking: 'It is possible that the exaggerated claims of deviant drinking among women actually reflect a societal reaction to any drinking among women' (p. 22). Fillmore devoted a sectionof her paper to disputing the allegation of under-reporting of alcoholism in women. However, she asserted that research efforts to use behavioural indicators specifically sensitive for women's drinking (which are used infrequently, in any case) have adequately addressed possible under- reporting. Yet she (and most other researchers) ignore several other aspects of research that are also necessary to counteract the censoring effect of extra stigma on women's drug/alcohol use. For example, Davis and Morse (1987), Dawson and Grant (1993) and Robbins (1989) found that the nature of questions in research tools resulted in gender differences in the reporting of alcohol-related problems. Wilsnack et al. (1984/85) recommended that there should be 'continued attention to gender differences in the design, analysis, and reporting of drinking practice surveys' (p. 12).

Much more intensive investigation needs to begin on such questions as: how research tools compare in validity by gender; how the cut-off points for significant addictions findings in scoring research tools need to be adjusted by gender; how behavioural markers of addictions differ by gender; and how biological markers of drug/alcohol use differ by gender.

CONCLUSION

Mechanic (1976) wrote, 'It seems clear that many investigators confound perceptions with reporting' (p. 38). More drug/alcohol using women are now beginning to show up in research. The'convergence hypothesis' portrays this apparent increase as actual increase, and one common argument is that women are drinking/using other drugs more now because of the impact of feminism on women.

However, poor research on addicted wornen, which has often ignored the issue of extra, stigmabased under-reporting for females, has fed for decades on the notion that women use drugs/atcohol less than do men. It has become a circular situation: Ind ifference to studying women leads to ignoring of underreporting of drug/alcohol use in women, which leads to the notion that there are fewer using women than men, which leads to indifference to studying women's drug/alcohol use. However, a more careful look at the research that has been done on women indicates that women)s increase in use is probably only apparent. Instead, more using/addicted women are being found, due to gradual adoption of better research tools for women and/or due to the relaxing of sex roles, which allows more women to admit to their use,

A full discussion of how feminism is in fact impacting women's alcohol and other drug use needs to be the subject of another paper. It certainly can be argued that feminism has a greater potential of helping women out of their addictions rather than further hurting them. Instead of assuming that changing sex roles only add stress to women's experience, it can be interpreted that feminism allows women to more openly ask for help for their addictions.

This article is intended to provoke a much closer examination of the author's allegations that women's drug/alcohol use and addiction have usually been under-detected due to poor research on women, and that 'convergence' has been misinterpreted as being 'real'. We need an accurate exploration of the impact of sex roles on actual drug/alcohol use, as well as the above-mentioned improvements on research on women and addictions. After several years of such study, we can then begin to discuss much less prejudicially the similarities and differences for drug/alcohot use by women and men.

Marguerite Babcock, R.D. 1, Box 138, Acme PA 15610, USA

REFERENCES

Bepko CS (1986). Alcoholism as oppression: The dilemma of the woman in the alcoholic system. Family Therapy Collections 16: 64- 7 7.

Blume SB (1988). Alcohol/Drug Dependent Women: New Insights into Their Special Problems, Treatment and Recovery. Minneapolis: Johnson Institute.

Brett PJ, Graham K, Smythe C (1995). An analysis of specialty journals on alcohol, drugs and addictive behaviors for sex hias in research methods and reporting. Journal of Studies on Alcohol 56: 24-34.

Bucholz KK (1992). Alcohol abuse and dependence from a psychiatric epiderniologic perspective. Alcohol Health & Research World 16(3): 197-208.

Celentano DD, McQueen DV,Chee E(l 980). Substanceabuse bywomen: Areviewof theepiderniologic I i terature. journal of Chronic Diseases 33: 383-94.

ChanAWK, PristachEA,WeltejW(1994). Detection of alcoholism in three populations by the Brief-MAST. Alcoholism: Clinical and Experimental Research 18:695-701.

Copeland J, Hall W (1992). A comparison of women seeking drug and alcohol treatment in a specialist women's and two traditional mixed-sex treatment services. British journal of Addiction 87: 1293-302.

Cyr MG, Moulton AW (1993). The physician's role in prevention, detection, and treatment of alcohol abuse in women. Psychiatric Annals 23:454-62.

Davis LJ, Morse RM (1987). Age and sex differences in the responses of alcoholics to the self-administered alcoholism screening test. Journal of Clinical Psychology 43: 423-30.

Dawson DA, Grant BF (1993). Gender effects in diagnosing alcohol abuse and dependence. Journal ofClinical Psychology 49:298-307.

Dawson NV, Dadheech G, Speroff T, Smith RL, Schubert DSP ( 1992). The effect of patient gender on the prevalence and recognition of alcoholism in a general medicine inpatient service.-Iournal of General Internal Medicine 7: 38-45.

el-Guebaly N (1995). Alcohol and polysubstance abuse among women. Canadianjournal of Psychiatry 40: 73-9.

Engs RC, Ha nson DJ (1990). Gender differences in drinking patterns and problems among college students: A review of the literature. Journal of Alcohol and Drug Education 35: 36-47.

Faludi, S. (1991). Backlash: The Undeclared War Against American Women. New York: Crown.

Fillmore KM (I 984).'When angels fall': Women's drinking as cultural preoccupation and as reality. In Wilsnack SC, Beckman LJ (Eds) Alcohol Problems in Women: Antecedents, Consequences, and Intervention. New York: The Guilford Press. pp. 7-36.

Fillmore KM (1987). Women's drinking across the adult life course as compared to men's. British Journal of Addiction 82: 801-11.

Fleming MF, Bruno M, Barry K, Fost N (1989). Informed consent, deception and the use of disguised alcohol questionnaires. Americanjournal of Drug and Alcohol Abuse 15: 309-19.

Forth - Finega n J L ( 199 1 ). S ugar a nd spice and everyth i ng n ice: Gender socialization and women's addiction: A literature review. In: BepkoC(Ed.) Feminism andAddiction. New York: The Haworth Press, Inc. pp. 19-48.

George WH, Gournic SJ, McAfee MP (1988). Perceptions of Mendelson JH, Weiss R, Griffin M, Mirin SM, Teoh SK, Mello
post-drinking female sexuality: Effects of gender, beverage
choice, and drink payment. Journal of Applied Social Psychol
ogy 18: 1295-317.

Gomberg ESL (1982). Historical and political perspective: Women and drug use. Journal of Social Issues 38: 9-23.

Gossop M, Griffiths P, Powis B, Strang J G 994). Cocaine: Patterns of use, route of administration, and severity of dependence. Britishjournalof Psychiatry 164:660-4.

Hamlett K, Eaker ED, Stokes J (1989). Psychosocial correlates of alcohol intake among women aged 45 to 64 years: The Framingham Study. Journal of Behavioral Medicine 12: 525-42.

HarrisonM (1991). Drugaddic tion in pregnancy: The interfact of science, emotion, and social policy. Journal of Substancc Abuse Treatment 8: 261-8.

Harrison PA (1989). Women in treatment: Changing over time. The International Journal of the Addictions 24: 655-73.

HarrisonPA, Belille CA (1987). Women in treatment: Beyond the stereotype. Journal of Studies on Alcohol 48: 5 74-78.

Heath D13 (1991), Women and alcohol: Cross-cultural perspectives. Journal of Substance Abuse 3: 175-85.

Hilton ME (1984). Drinking patterns and drinking problems in 1984: Results from a general population survey. Alcoholim.: Clinical and Experimental Research 11: 167-7 5.

Hoar CH (1983). Women alcoholics-are they difl~erent from other women? The International journal of the AcMictions 18: 251-70.

Holloway M (1994). Trends in women's health: A global view. Scientific American 2 7 1 (2): 7 6-83.

Hol loway M, Y a to P ( 199 2). R efl ec ting diffe rences: He a I th care begins to address needs of women and minorities. Scientijic American 266(3):13,16-18.

Hurley DL (1991). Women, alcohol and incest: An analytkal review. Journal of Studies on Alcohol 5 2: 253-68.

Jarvis TJ (1992). Implications of gender for alcohl treatment research: A quantitative and qualitative review. BritislijournalofAddiction 87:1249-61.

John U (1987). Alcohol -dependent men and women in detoxification: Some comparisons. Alcoholism: Clinicaland Experimental Research It: 15 5-7,

Johnson P13 (1982). Sex differences, women's roles and alcohol use: Preliminary national data. Journal of Social Issues 38: 93-116.

Lammers SMM, Schippers GM (1991). Sex as a variable: critical look at the place of female drinkers in recent alcohol quences of alcohol and drug abuse.journalof HealthandSocial research in the Netherlands. Contemporary Drug Problems Behaviour 30~ 117-30. 18:75-97.

LaRosa JH ( 1990). Executive women and health: Perceptions and practices. American journal of Public Health 80: 1450-54.

Marsh JC (1982). Public issues and private problems: Women -and drug use. Journal of Social Issues 38:153-65.

Marsh JC, Colten ME, Tucker MB (1982). Women's use of drugs and alcohol: New perspectives. Journal of Social Issues 38:1-8.

Mechanic D (1976). Sex, illness behavior, and the useofhealth services. Journal of HumanStress 2(4): 29-40.
NK, Lex BW (1991). Some special considerations for treatment of drug abuse and dependence in women. In PickensRW,LeukefeldCG, SchusterCR(Eds) ImprovingDrugAbuse Treatment, N IDAResearch Monograph 106.Rockville, MD: US Department of Health and Human Services. pp313-27.

Mercer PW, Khavari KA (1990). Are women drinking more like men? An empirical examination of the convergence hypothesis. Alcoholism: Clinical and Experimental Research 14:461-6.

MidanikLT,RoomR (1992). The epidemiology ofalcohol consumption. Alcohol Health & Research World 16:183-90.

Moore RD, Bone LR, Geller G, Mamon JA, Stokes EJ, Levine DM (1989). Prevalence, detection, and treatment of alcoholism in hospitalized patients. Journal of the American Medicine Association 261:40,3-7.

Morrissey M (1986). Contradictions inhering in liberal feminist ideology: Promotion and control of women's drinking. Contemporary DrugProblems Spring 13:65-88.

Morrow-Tlucak M, Ernhart CB, Sokol RJ, Martier S, Ager J (1989). Underreporting of alcohol use in pregnancy: Retationship to alcohol problem history. Alcoholism: Clinical and Experimental Research 13: 399-40 1.

MurrayjB(1989). Psychologists and alcoholic women. Psychological Reports 64:627-44.

National Institute on Alcohol Abuse and Alcoholism (1990, October). Alcohol and women. Alcohol Alert, (190) PH290.

O'ConnorLE, BerryJW, Inaba D, WeissJ, Morrison A (1994). Shame, guilt, and depression in men and women in recovery from addiction. Journal of Substance Abuse Treatment 11: 503-10.

Osterling A, Berglund M (1994). Elderly first time admitted alcoholics: A descriptive study on gender differences in a clinical population. Alcoholism: Clinical and Experimental Research 18:1317-21.

Parker F13 (1972). Sex-role adjustment in women alcoholics. Quarterly Journal of Studies on Alcoholism 33: 647-57.

Reich T, Cloninger CR, Van Eerdewegh P, Rice JP, Mullaney) ( 1988). Secular trends in the familial transmission of alcoholism. Alcoholism: Clinical and Experimental Research 12: 458-64.

Richardson D,CampbellJ (1982). Alcohol and rape: The effect of alcohol on attributions of blame for rape. Personality and Social Psychology 8:468-76.

Robins LN, HelzerJE, Przybeck TR, Regier DA (1988). Alcohol disorders in the community: A report from the Epidemiological Catchment Area. In Rose RM, Barrett J (Eds) Alcoholism: Origins and Outcome. New York: Raven Press.

Rosenbaum M, Murphy S (1990). Women and Addiction: Process, Treatment, and Outcome. N I DA Research Monograph 98, Rockville, MD: US Department of Health and Human Services. pp. 120-27.

Ross HE (1989). Alcohol and drug abuse in treated alcoholics: A comparison of menand women, Alcoholism: Clinical and Experimental Research 13: 810-16.

Roy MA, Walsh D, Prescott CA, Kendler KS (1994). Biases in the diagnosis of alcoholism by the family history method. Alcoholism: Clinical and Experimental Research 18: 845-5 1.

Schuckit MA, Klein JL, Twitchell GR (1995). The misclassification of family history status in studies of children of al(-oholics.Journal of Studies onAlcohol 56:47-50.

ScienceNews (1990). NIHaddresses women's ills. 138(12): 180.

Science News (1994). Women and clinical research. 14502): 190,

Shore ER (1994). Outcomes of a primary prevention project For business and professional women.Journal of Studies on Alcohol 55: 6 5 7-9.

Smith EM, Przybeck TR, Bradford SE, Gogineni A, Spitznagel EL (1994). Adult offspringof alcoholic women asfamily history informants. Alcoholism: Clinical and Experimem,al Research 18: 13 54-60.

Suffer F, Brotman R (1976). Female drug use: Some obser,. ations. InternationalJournal of the Addictions 11: 19-33.

Svikis DS, Velez ML, Pickens RW (1994). Genetic aspects of alcohol use and alcoholism in women. Alcohol Health & Research World 18(3): 192-6.

Turnbull JE, Gomberg ESL (1991). The structure of drinkingrelated consequences in alcoholic women. Alcoholism: Clinical and Experimental Research 15: 29-38.

Vanicelli M, Nash L (1984). Effect of sex bias on women's studies in alcoholism. Alcoholism: Clinical and Experimental Research 8: 334-6.

Verbrugge LM (1982). Sex d ifferences in legal drug use.Jourral of Social Issues 38: 59-76.

Watersonj,EttorreB(1989). Providing services for women wit difficulties with alcohol or other drugs: The current UK situ ation as seen by women practitioners, researchers and policy makers in the field. DrugandAlcohol Dependence 24: 119-25 ,

Weisner C, Schmidt L (1992). Gender disparities in treatment for alcohol problems. Journal of the American Medical Association 268: 1872-76.

Weissman MM, Myers JK, Harding PS (1980). Prevalenceand psychiatric heterogeneity of alcoholism in a United States urban community. Journal of Studies onAlcohol4l: 672-81.

WilsnackRW, WilsnackSC, KlassenAD (1987). Antecedents and consequences of drinking and drinking problems in women: Patternsfroma US national survey. --- - I -, Rivers PC (Eds) Nebraska Symposium on Motivation, 1986' Lincoln and London: University of Nebraska Press. pp. 85-158.

Wilsnack SC (1976, Sept. 23.) The Impact of Sex Roles on Drinking Patterns of Women and Girls. Po - the Continuing Education Seminar of the National Institute on Alcohol Abuse and Alcoholism, Rockville, MD.

Wilsnack SC, Wilsnack RW (1979). Sex roles and adolescent drinking. In Blane HT, Chafetz ME (Eds) Youth, Alcohol, and Social Policy. New York and London: Plenum Press.

WilsnackSC,WilsnackRW,Hiller-SturmhofeIS(1994). Epi-, demiology of women's drinking and problem drinking. Alcohol Health& Research World 18(3):173-81.

Wilsnack SC, Wilsnack RW, Klassen AD (1984/85, Winter). Drinking and drinking problems among women in a US National Survey. Alcohol Health and Research World 9: 3-13.