• The Most Dangerous Aspect Of Multiple Depressant Use Is The __ Factor. Mean
• The Most Dangerous Aspect Of Multiple Depressant Use Is The Factor

OverviewBased on human and animal studies, women are more sensitive to the consumption andlong-term effects of alcohol and drugs than men. From absorption to metabolicprocesses, women display more difficulty in physically managing the consequences ofuse.

In general, with higher levels of alcohol and drugs in the system for longerperiods of time, women are also more susceptible to alcohol- and drug-relateddiseases and organ damage.This chapter provides an overview of the physiological impact of alcohol and drugs onwomen, with particular emphasis on the significant physiological differences andconsequences of substance use in women. It begins with a general exploration of howgender differences affect the way alcohol and drugs are metabolized in the body andthen highlights several biopsychosocial and cultural factors that can influencehealth issues associated with drugs and alcohol. The chapter goes on to explore thephysiological effects of alcohol, drugs (both licit and illicit), and tobacco on thefemale body.

A summary of key research on the impact of these substances when takenduring pregnancy follows, and the chapter closes with a review of the effect thatsubstance abuse has on women’s HIV/AIDS status. Counselors can use the informationpresented in this chapter to educate their female clients about the negative effectssubstances can have on their physical health. A sample patient lecture is includedthat highlights the physiological effects of heavy alcohol use. Physiological Effects and Consequences of Substance Abuse in WomenAlcohol and drugs can take a heavy toll on the human body. The same generalstatements can be made for both men and women about their long-term effects—forexample, both genders incur liver problems resulting from alcohol abuse, respiratoryimpairment and lung cancer as a consequence of smoking, HIV/AIDS and hepatitis frominjection drug use, and memory difficulties associated with the use of marijuana.Yet women have different physical responses to substances and greater susceptibilityto health-related issues. Women differ from men in the severity of the problems thatdevelop from use of alcohol and drugs and in the amount of time between initial useand the development of physiological problems (; ).

For example, a consequence ofexcessive alcohol use is liver damage (such as cirrhosis) that often begins earlierin women consuming less alcohol over a shorter period of time. By and large, womenwho have substance use disorders have poorer quality of life than men onhealth-related issues.In addition, women who abuse substances have physiological consequences, healthissues, and medical needs related to gynecology. Specifically, drugs andalcohol affect women’s menstrual cycles, causing increased cramping and heavier orlighter periods. Women sometimes use illicit drugs and alcohol as medication forcramping, body aches, and other discomforts associated with menstruation. On theother hand, women who use heroin and methadone can experience amenorrhea (absence ofmenstrual periods; ), leading them to believe that they are unable to conceive andmisreading early signs of pregnancy as withdrawal symptoms. Subsequently, they areunaware that they are pregnant. Women’s substance use also poses risks to fetusesand nursing infants.

Limitations of Current Research on Gender Differences in MetabolismIn general, research on the unique physiological effects of alcohol and drugs inwomen is limited and sometimes inconclusive. Although the differences in the waywomen and men metabolize alcohol have been studied in some depth, research ondifferences in metabolism of illicit drugs is limited. For many years, much ofthe research on metabolism of substances either used male subjects exclusivelyor did not report on gender differences. Historically, women were omitted due tothe potential risk of pregnancy and the possibility that hormonal changes acrossthe menstrual cycle would wreak havoc on the drugs’ effects and subsequentresults.Available research is typically based on small sample sizes and has not beenreplicated. Race and ethnic background can affect metabolism and thepsychological effects of alcohol and illicit drugs, as can thepsychopharmaceuticals sometimes used in treatment , but their effects have notbeen studied.

Similar to men, few women abuse only one substance. Polysubstanceuse complicates the ability to study and understand the physiological effects ofspecific drugs on women, while increasing the risk associated with synergisticeffects when substances are combined. Significant gaps in knowledge existregarding physiological effects across the continuum of a woman’s life. Ethnicity and CultureThe level of acculturation and cultural roles and expectations play a significantrole in substance use patterns among women of color. The prevalence ofsubstance abuse among ethnic women typically coincides with higher levels ofacculturation in the United States, thus leading to greater health issues.Literature suggests that women from ethnically diverse backgrounds who havesubstance use disorders possess greater risks for developing certain conditionsand disorders, such as hypertension, high blood pressure, and HIV/AIDS (Centersfor Disease Control CDC 2000 a, b;; ). These health disparities arisefrom many sources, including difficulty in accessing affordable health care,delays in seeking treatment, limited socioeconomic resources, racism, anddiscrimination (;; ).

In addition,mistrust of health care providers is a significant barrier to receivingappropriate screening, preventive care, timely interventions, and adequatetreatment. More recent studies have explored the role of gender in perceiveddiscrimination and health, and some studies have noted differences in the typeof stressors, reactions, and health consequences between men and women (; ). Forexample, the Black Women’s Health Study found that perceived experiences ofracism were associated with an increased incidence of breast cancer. Sexual OrientationLesbian/bisexual women exhibit more prevalent use of alcohol, marijuana,prescription drugs, and tobacco than heterosexual women, and they are likely toconsume alcohol more frequently and in greater amounts (;, ). Based on the Substance Abuse and MentalHealth Services Administration’s (SAMHSA’s) 1996 National Household Survey onDrug Abuse, researchers compared patterns of use between homosexual andheterosexual women and found that lesbians have greater alcohol-relatedmorbidity. Likewise, they are less likely to have health insurance and touse preventive screenings, including mammograms and pelvic examinations.

Withless utilization of routine screenings, lesbians and bisexual women may not beafforded the benefit of early detection across disorders, including substanceuse disorders, breast cancer, and cardiovascular disease. Socioeconomic Status and HomelessnessOverall, lower socioeconomic status is associated with higher mortality rates andgreater risks for cervical cancer, coronary heart disease, HIV/ AIDS, and otherhealth conditions and medical disorders.

More than ethnicity,socioeconomic status heavily influences the health risks associated withsubstance abuse. Research suggests that when the socioeconomic conditions ofethnically diverse populations are similar to those of the White population,consequences of substance use appear comparable. Among women, alcoholand drug-related morbidity and mortality are disproportionately higher inindividuals of lower socioeconomic status, which is associated with insufficienthealthcare services, difficulties in accessing treatment, lack of appropriatenutrition, and inadequate prenatal care. Subsequently, impoverished women whoabuse substances often experience greater health consequences and poorer healthoutcomes.Similarly, homelessness is associated with higher mortality rates for alllife-threatening disorders, including greater risks for infectious diseases.With greater high-risk sexual behaviors and repeated exposure to overcrowdedshelters, homeless women who use injection drugs are more likely to be infectedwith HIV/AIDS and other infectious diseases, including airborne infections suchas tuberculosis, thereby leading to greater health consequences (for review, see). Developmental Issues and AgingAlthough little is known regarding the effect of alcohol and drugs on developmentacross the lifespan, there is some evidence in alcohol-related research thatthere are different vulnerabilities at different ages for women.

Even thoughdevelopmental research on alcohol is not easily transferred to other drugs ofabuse, it can give us a glimpse of the potential physiological issues associatedwith age and aging. For example, adolescent women are more likely than theirmale counterparts to experience cognitive impairment despite less alcoholconsumption. Women of child-bearing age are more likely to experienceinfertility with heavier drinking. Postmenopausal women are more likely toexhibit significant hormonal changes with heavy consumption of alcohol, leadingto potentially higher risks for breast cancer, osteoporosis, and coronary heartdisease. Older women are more sensitive to alcohol and display adecrease in tolerance and alcohol metabolism. While research has been more devoted toexamining gender differences, limited data are available for other substancesand less is known regarding the effect of these substances on development andaging. Co-Occurring Disorders: A Bidirectional InfluenceAccording to SAMHSA’s National Survey on Drug Use and Health (NSDUH) report, women with co-occurring mental and substance use disorders arelikely to experience serious physical health problems.

Co-occurring disordershave a bidirectional relationship and often a synergistic effect on one another.As much as substance abuse can increase the risk of, exacerbate, or causemedical conditions, medical disorders can also increase substance abuse as ameans of self-medicating symptoms or mental distress associated with thedisorder. Similar to men, women who have mental disorders can have moredifficulty adhering to health-related treatment recommendations, such astreatment attendance, diet restrictions, or medication compliance. Gender Differences in Metabolism and EffectsAlcohol is a leading cause of mortality and disability worldwide.

According tothe World Health Organization, alcohol is one of the five most significant riskfactors for diseases, with more than 60 percent of alcohol-related diseasesbeing chronic conditions, including cancer, cirrhosis of the liver, diabetes,and cardiovascular disease.Alcohol’s effects on women have been studied more than those of illicit drugs.Compared with men, women become more cognitively impaired by alcohol and aremore susceptible to alcohol-related organ damage. Women develop damage at lowerlevels of consumption over a shorter period of time (for review, see ).

When men andwomen of the same weight consume equal amounts of alcohol, women have higherblood alcohol concentrations. Women have proportionately more body fat and alower volume of body water compared with men of similar weight. Liver and Other Organ DamageFemales are more likely than their male counterparts to experience greater organdamage as a result of consuming similar amounts of alcohol. Compared with men,women develop alcohol-induced liver disease over a shorter period of time andafter consuming less alcohol. Women are more likely than men to developalcoholic hepatitis and to die from cirrhosis.

One researcher has theorized thatwomen’s faster alcohol elimination rate can endanger the liver by subjecting itto high, though transient, levels of acetaldehyde, a toxic byproduct of alcoholmetabolism. This exposure may explain the higher liver cirrhosis rates amongwomen (e.g., ). Cardiac-Related ConditionsAccording to current studies, women who drink exhibit a greater propensity todevelop alcohol-induced cardiac damage. While light consumption (less than onedrink per day) can serve as a protective factor for women who have a risk forcoronary artery disease, studies suggest that protection is not evident foryounger women, women who drink heavily, and women without risk factorsassociated with heart disease. Women who are dependent on alcohol or consumeheavier amounts are more likely to die prematurely from cardiac-relatedconditions (;; ).Heavy consumption (more than four drinks per day) is associated with increasedblood pressure in both women and men.

A majorepidemiological study found that women between ages 30 and 64 who consumed 15–21units of alcohol per week had an increased risk of hypertension compared withthose who drank 14 or fewer units; those who drank 1–7 units per week had anoverall decrease in 10-year risk of cardiovascular disease compared with thosewho drank more. The female heart appears to experience a functional decline ata lower level of lifetime exposure to alcohol than does the male heart.

Reproductive ConsequencesResearch into the adverse impact of alcohol consumption on fertility is growing.While numerous studies have shown a consistent relationship between heavydrinking and infertility (; ), additional studies examining moderate consumption are moreinconsistent. Nevertheless, findings suggest a need to educate and screen womenfor alcohol use while they are seeking infertility treatment. Inaddition, heavy drinking is associated with painful and/or irregularmenstruation.

The reproductive consequences associatedwith alcohol use disorders range from increased risk for miscarriage to impairedfetal growth and development.There are considerable variations among women in their capacity to consume andmetabolize alcohol. Early literature suggests that variations in alcoholmetabolism among women may be linked to the different phases of the menstrualcycle, but more recent reviews suggest that there are no consistent effects ofthe menstrual cycle on the subjective experience of alcohol intake or alcoholmetabolism. Studies reviewed by found thatsignificant hormonal changes are reported in postmenopausal women who consumealcohol. Women taking hormone replacement therapy (HRT), now referred to asmenopausal hormone therapy, and consuming 14 or more standard drinks weekly hadsignificantly higher estradiol levels. These high levels are associated with agreater risk of breast cancer and coronary heart disease.

Breast and Other CancersNumerous studies have documented associations and suggested causal relationshipsbetween alcohol consumption and breast cancer risk (;; ). A review of data from morethan 50 epidemiological studies from around the world revealed that for eachdrink of alcohol consumed daily, women increased their risk of breast cancer by7 percent.

Postmenopausal women have an increased risk of breast canceras well if they currently drink alcohol (; ). OsteoporosisAccording to, evidence suggests “decreased boneformation and abnormal vitamin D metabolism may predispose alcohol-dependentpremenopausal women to osteoporosis” (p. Heavy alcohol use clearly hasbeen shown to harm bones and to increase the risk of osteoporosis by decreasingbone density. These effects are especially striking in young women, whose bonesare developing, but chronic alcohol use in adulthood also harms bones.

In addition,animal studies suggest that the damaging effects of early chronic alcoholexposure are not overcome even when alcohol use ceases. Tobacco use also may increasethe risk of osteoporosis and fractures; people who drink are 75 percent morelikely to smoke, and people who smoke are 86 percent more likely to drink.Women in menopause who enter treatment need bone densityassessment, nutritional guidelines, and medication consultations. Clinical Activity: Sample Client-Educating Lecture Outline forCounselors Physiological Effects of AlcoholThis 60-minute lecture provides a general outline highlighting thephysiological effects of moderate-to-heavy alcohol use. Refer to thisTIP chapter for additional information to support your lecture. Toincrease participation, first ask women in the group to identify medicalproblems they believe to be related to their alcohol use.

The format ofthis lecture can also be used with illicit and prescription drugs. Manyconditions do occur in men, but it is important to emphasize theenhanced risk and the earlier appearance of these diseases andconditions among women. The list of physiological consequencesidentifies the most common disorders; it is not intended as acomprehensive review. Gender Differences in Metabolism and EffectsResearch supports the concept of an accelerated progression to treatmententry among women dependent on opioids, cannabis, or alcohol, and suggests theexistence of a gender-based vulnerability to the adverse consequences of thesedisorders. No gender difference was noted for age at onset of regular use, butthe women had used opioids, cannabis, and alcohol for fewer years beforeentering treatment. The severity of drug and alcohol dependence did not differby gender, but women reported more severe psychiatric, medical, and employmentcomplications than did men.

In one substance abuse treatment study focused onurban outpatient clinics, women had more symptoms than men across substances.They reported more cardiovascular, mood, nose and throat, neurological, skin,and gastrointestinal symptoms than did men. In addition, there is evidence thatwomen who use injection drugs are more susceptible to medical disorders andconditions. Similarly, women who use cocaine, heroin, or injection drugshave a heightened risk of developing herpes, pulmonary tuberculosis, and/orrecurrent pneumonia.To date, little is known regarding the consequences of specific drug use amongwomen.

Complicated by polysubstance use, studies are often unable to obtainadequate sample sizes of women who abuse only one drug. The following sectionhighlights specific physiological effects of licit and illicit drugs that areunique to women. This is not a general primer on drugs, but rather a compendiumof known physiological effects that are gender-specific. Cocaine, Amphetamine, and MethamphetamineHormonal changes across the menstrual cycle have the greatest effect onstimulant drugs, particularly cocaine and amphetamine. Literature highlightsa consistent and greater mood-altering effect of stimulant use during thefollicular phase of the cycle (for review, see ), and thefluctuations in progesterone levels may account, in part, for this sexdifference (;).

More specifically, investigated whether cocaine effectsvary as a function of menstrual cycle phase; they found that heart rate andratings such as “good drug effect” were increased more during the follicularphase than the luteal phase. Conversely, injection drugs and/or crackcocaine appear to produce changes in the menstrual cycle, including thedevelopment of amenorrhea, degree of blood flow, and the intensity of cramps. Overall, women who use cocaine report more positivesubjective drug effects, including greater euphoria and desire to use, whilephysiological responses to the drug did not change.Methamphetamine use has an array of possible adverse effects (for review, see), but data regarding specific gender differences are limited.Psychoactive effects of methylenedioxy- methamphetamine (ecstasy) have beenfound to be more intense in women than in men; women report experiencing ahigher degree of perceptual changes, thought disturbances, and fear of theloss of control of their bodies.

Acute adverse effects, such as jawclenching, dry mouth, and lack or loss of appetite, are more common amongwomen. Heroin and Other OpioidsResearch is lacking that would allow definitive conclusions about gendersimilarities or differences in the following effects of heroin use: scarredand collapsed veins, bacterial infections of blood vessels and heart valves,abscesses, cellulitis, and liver or kidney disease.Research suggests that there are no menstrual cycle differences in women’ssubjective experience or physiological reaction to opioids , butwomen using heroin or methadone do experience menstrual abnormalities,particularly amenorrhea or an irregular menstrual cycle (;; ). It cantake up to a year for regular menstrual cycles to resume after drug use isstopped.

Deficits in sexual desire and performance are also consequences ofheroin use. These symptoms probably are related to the lower levels ofluteinizing hormone, estradiol, and progesterone found in these women. Amenorrheaand other symptoms often make women believe they are permanently sterile, afear that can be lessened with education. TIP 43 Medication-AssistedTreatment for Opioid Addiction in Opioid Treatment Programs provides more information. Prescription and Over-the-Counter MedicationsWomen are significantly more likely to use and abuse prescriptionmedications, including anxiolytics (antianxiety medications) and narcoticanalgesics (pain medications), than are men.

Little research isavailable, however, on the gender differences and differential physiologicaleffects of abuse of prescription medications. Moreover, research into theinfluence of hormonal changes across the menstrual cycle on subjective,behavioral, and physiological effects is limited to benzodi-azepines, andfindings are minimal (; ).Over-the-counter (OTC) medications include cold remedies, antihistamines,sleep aids, and other legally obtained nonprescription medications. It isnot uncommon for individuals with eating disorders, particularly thosediagnosed with bulimia nervosa, to abuse laxatives, diuretics, emetics, anddiet pills. Misuse of these medications can result in serious medicalcomplications for those with eating disorders, who primarily are women. Complicationscan involve the gastrointestinal, neuromuscular, and cardiac systems and canbe lethal. Many prescription and OTC medications interact negatively withalcohol and drugs.

Gender Differences and OTC DrugsAcross studies, prevalence rates comparing the use and misuse of OTC medicationsamong men and women vary according to age and race/ethnicity. For individuals 65years of age and older, women are more likely to use OTC drugs (Halon et al.2001).

NSDUH evaluated the misuse of OTC cough and cold medications amongpersons aged 12 to 25 and found that women aged 12 to 17 were more likely than men tohave misused OTC cough and cold medications in the past year, while men between18 and 25 years of age were more likely to have misused these medications.Whites and Hispanics had higher rates of misuse than African Americans. Similarto men, women who had ever misused OTC cough and cold medications also hadlifetime use of marijuana and inhalants. In evaluating prescription and OTC drugtreatment admissions, women represented a larger proportion of prescription andOTC medication admissions (46 percent) than treatment admissions for allsubstances (30 percent; ).“Every woman is different. No amount of drinking is 100 percent safe, 100percent of the time, for every individual woman” (National Institute onAlcohol Abuse and Alcoholism NIAAA 2003). Effects of Alcohol, Drugs, and Tobacco Use on Pregnancy and BirthOutcomesThe use of alcohol, drugs, and tobacco can affect a pregnant woman in a variety ofways. Substance use can result in obstetric complications, miscarriage, orsignificant problems for the fetus. It is difficult to tease out individual effectsof licit and illicit substances on fetal and infant development because women whoabuse these substances typically abuse more than one, and the substance abuse can beaccompanied by psychological distress, victimization, and poverty.

A detaileddiscussion of alcohol- and drug-related problems in infants and children is beyondthe scope of this TIP except insofar as these problems create additional demands andstressors for women as well as guilt and shame about the use of alcohol, drugs,and/or tobacco during pregnancy. This section highlights specific effects of alcoholand drugs during the course of pregnancy. Alcohol Use and Birth OutcomesAbove all other drugs, alcohol is the most common teratogen (any agent thatinterrupts development or causes malformation in an embryo or fetus) inpregnancy. Inutero, alcohol use is associated with an increased risk of spontaneous abortionand increased rates of prematurity and abruptio placentae (premature separationof the placenta from the uterus).

A study found that women who consumed five ormore drinks per week were three times as likely to deliver a stillborn babycompared with those who had fewer than one drink per week.Maternal alcohol use during pregnancy contributes to a wide range of effects onexposed offspring, known as fetal alcohol spectrum disorders (FASDs), and themost serious consequence is fetal alcohol syndrome (FAS). FAS is characterizedby abnormal facial features, growth deficiencies, and central nervous systemproblems. Symptoms can include hyperactivity and attention problems,learning and memory deficits, and problems with social and emotionaldevelopment. Infants who show only some of these features were previouslyidentified as having fetal alcohol effects (FAE).

Since 1996, the term FAE hasbeen replaced by alcohol-related birth defects (ARBD), partial fetal alcoholsyndrome (pFAS), and alcohol-related neurodevelopmental disorder (ARND; ).Children with ARBD have problems with major and sensory organs, as well asstructural abnormalities; children with ARND have central nervous systemabnormalities.Despite alcohol-related birth defects being completely preventable, FASDs arethe most common nonhereditary causes of mental retardation.Another risk factor associated with alcohol exposure in utero is the potential ofsubstance use disorders. Found an association of early-onset of alcohol disorders amongchildren exposed to alcohol prenatally; this association was more pronouncedwith early pregnancy exposure. While little is known about the prevalence ofFASD among individuals with substance use disorders, this co-occurring conditionis likely to further challenge recovery effects. For guidelines in identifyingand referring persons with FAS, see.Women who drink during breastfeeding pass alcohol on to the baby. Althoughnumerous studies of laboratory animals have demonstrated a variety of adverseoutcomes in breastfed offspring during periods when their mothers are consumingalcohol, human data are limited. A review of empirical literature on women whodrink while breastfeeding provides evidence that maternal alcohol consumptiondoes not promote lactation and may affect infant sleep patterns. (for review,see )The SAMHSA FASD’s Center for Excellence Web site provides information andresources about FASD and related information on legislation, treatment andtraining curricula, and community awareness.

Cocaine Use and Birth OutcomesAccording to reviews of several studies conducted during the late 1980s and early1990s, there are a variety of adverse effects of cocaine use during pregnancy(;).Studies reported that cocaine-exposed infants had smaller head circumference;lower birth weight and length; irritability; poor interactive abilities; and anincreased incidence of stillbirth, prematurity, and sudden infant death syndrome(SIDS; ).Other studies dispute many previously reported severe effects of prenatalexposure of cocaine on the offspring. Of theliterature found that the most consistent effects were small size andless-than-optimal motor performance. Found no evidence of the previouslyreported devastating effects of prenatal cocaine exposure. Followed a cohort ofcocaine-exposed infants from birth to age 6; although they found lower weightand head circumference, they found no difference in developmental scores betweencocaine-exposed and non–cocaine-exposed infants.

However, other evidencesuggests that children exposed to cocaine during the first trimester weresmaller on all growth parameters at 7 and 10 years of age compared with childrenwho were not exposed to cocaine. This longitudinal analysis indicated thatthe disparity in growth between both groups did not converge over time. Pregnant women using opioids should enter methadone maintenancetreatment, which protects the fetus from repeated episodes ofwithdrawal, eliminates the risks of infection from needles, andcreates a mandatory link to prenatal care.An extensive review by of all studies published in English from 1984 to2000 (N = 74) that met rigorous methodological criteria (N = 36) concluded thatmany apparent adverse outcomes of cocaine use during pregnancy “can be explained by other factors, including prenatal exposure to tobacco, marijuana, oralcohol and the quality of the child’s environment” (p. Other studies(;;; ) have supported this conclusion. Reportedthat the quality of the caregiving environment was the strongest independentpredictor of cognitive outcomes among children exposed to cocaine.Nonetheless, the effects of cocaine on the fetus may be dose and timingdependent, and significant cocaine use during pregnancy, with or without otherdrug use, is associated with negative consequences for the offspring and themother.

Birth weight, length, and head circumference of infants withhigh exposure to cocaine differed from those with low or no exposure.Heavily cocaine-exposed infants were found to have more jitteriness andattention problems than infants with light or no exposure to cocaine and lowerauditory comprehension than unexposed infants. Evidence suggests thatsubtle deficits exist in cognitive and attentional processes in cocaine-exposedpreschool and 6-year-old children (; ). In addition, infants exposed to cocaine duringpregnancy had more infections, including hepatitis and HIV/AIDS exposure. Much isstill unknown about the effects of prenatal cocaine exposure. However, cocaineuse by a pregnant woman should be viewed as an indication of multiple medicaland social risk factors (; ); her ability to access prenatal care, gain supportiveand effective case management services, and obtain substance abuse treatment canmake all the difference in outcome. Opioid Use and Birth OutcomesOpioid use in pregnant women presents a difficult situation because of the manymedical complications of opioid use, such as infections passed to the fetus bythe use of contaminated needles. Obstetric complications in pregnant women whouse opioids often are compounded by lack of prenatal care.

Complications includespontaneous abortion, premature labor and delivery, premature rupture ofmembranes, preeclampsia (high blood pressure during pregnancy), abruptioplacentae, and intrauterine death. The fetus is at risk for morbidity andmortality because of episodes of maternal withdrawal. Marijuana Use and Birth OutcomesThe limited research on the effects of prenatal exposure to marijuana showssomewhat inconsistent results.Longitudinal studies by found marijuana to be associated with reducedlength at birth, but it did not affect weight or head circumference. Found thatexposed fetuses had significantly reduced body weight and length, even when thedata were adjusted to account for maternal alcohol consumption and smoking.Children prenatally exposed to marijuana functioned above average on the BayleyScale of Infant Development (BSID) at 9 months, but third-trimester marijuanause was associated with decreased BSID mental scores. Followup assessment ofthese children at age 10 found that prenatal marijuana exposure was associatedwith higher levels of behavior problems. In a review ofexisting data, reported that although global IQ is unaffected by prenatalmarijuana exposure, aspects of executive function appear to be negativelyassociated with prenatal exposure in children beyond the toddler stage. Amphetamine and Methamphetamine Use and Birth OutcomesExposure to amphetamines in utero has been associated with both short- andlong-term effects, including abnormal fetal growth, withdrawal symptoms afterbirth, and impaired neurological development in infancy and childhood.

Bothanimal and human studies have shown that fetal exposure to amphetaminesincreases the risk of reduced fetal growth, cardiac anomalies, and cleft lip andpalate. Unfortunately, knowledge of the effects of methamphetamine duringpregnancy is limited. While there is evidence of increased rates of prematuredelivery, placental abruption, reduced fetal growth, and heart abnormalities,studies are confounded by other issues, including polysubstance abuse amongparticipants and methodological issues in the research design. In one study,which took into account several confounding variables, findings suggest thatmethamphetamine exposure in utero is associated with decreased growth (includinglower birth weight) and smaller gestational age for exposed neonates. Tobacco Use and Birth OutcomesWomen who smoke tobacco increase their chances of ectopic pregnancy (developmentof a fetus outside the uterus), spontaneous abortion, premature rupture ofmembranes, abruptio placentae, placenta previa, preeclampsia, and pretermdelivery. Infants born to women who smoke are more likely to have lower birthweights and have an increased risk of SIDS (; ). Children of parents who smoke heavily can beaffected adversely in their auditory, language, and cognitive performance;hyperactivity and attention deficit disorders are also common, according to theliterature.

Studies have also drawn an association between maternal smokingduring pregnancy and disruptive behavior earlier in development (;; ). Effects of Alcohol and Illicit Drugs on HIV/AIDS StatusPeople who inject drugs have a high prevalence of co-infection with tuberculosis,hepatitis, and HIV (;). Evidencesuggests that women who inject drugs often incur added risk by injecting after men,who often procure the drugs and injection equipment. HCV and WomenThe hepatitis C virus (HCV) is the primary cause of cirrhosis and liver cancer inUnited States. An estimated 4.1 million people in the United States are infectedwith HCV. Of these, 80 to 85 percent will develop chronic hepatitis C, but therate is lower for women.

In 2006, the rate of HCV in women was 0.25 cases per100,000.HCV can remain silent for many years; most people infected with chronic hepatitisC thus may not be aware that they are infected because they are not chronicallyill. For some, the only sign of an infection is found in blood testresults. A positive result can occur when the liver enzyme ALT is abnormallyhigh. Women’s ALT levels are naturally lower than men’s, yet the cutoff numberfor abnormal liver tests is the same for both sexes.

The Most Dangerous Aspect Of Multiple Depressant Use Is The __ Factor. Mean

This can result in womenbeing misdiagnosed as having a normal ALT level. If a woman’s liver enzymes areon the high side of normal or she has any risk factors for HCV, testing isrecommended for HCV.Approximately 250,000 women are infected with HCV due to blood they receivedafter a cesarean section prior to 1992. Since 1992, screening andregulations on U.S.

Blood supplies ensure that the recipient is free from risksof contracting any blood-borne illness. Currently, risk factors for contractingHCV are generally the same for men and women, yet women are at higher risk ofcontracting HCV from sexual contact with an HCV-positive partner, and women aremore likely to be initiated into drug use or share equipment for injection drugswith a sexual partner. Below is a list of risk factors for acquiring HCV:. Perinatal or vertical transmission (5 percent in children of mothers withHCV monoinfection; 18.7 percent rate in mothers with HIV/HCVco-infection; ).Almost one out of four newly diagnosed cases of HIV in the United States is awoman, and approximately 20 percent of these newly diagnosed women with HIV areco-infected with HCV. Among pregnant and nonpregnant women, HCV and HIVco-infection is significantly associated with injection drug use. Therate of HIV/HCV co-infection may be as high as 50 to 90 percent for those whocontracted HIV through injection drug use.

HIV co-infection with HCV appears toraise the risk of mother-to-child transmission to 18.7 percent. The risk fortransmission from a woman with HCV monoinfection to her infant is 5.4 percent.

The Most Dangerous Aspect Of Multiple Depressant Use Is The Factor

Prevention and interventionPrevention strategies are gender neutral and include screening blood, plasma,organ, tissue, and sperm donors; effective infection control practices;identification, testing, and counseling of at-risk persons; and medicalmanagement of infected persons.Although this is by no means an overview of the disease or its treatmentprocess, a review of interventions can prove beneficial when working withclients who are infected with HCV. Gender-specific guidelines forintervention are minimal.Early medical intervention is helpful even though people infected with HCVinfection often experience mild symptoms and subsequently do not seektreatment. Not everyone with hepatitis C needs medical treatment. Treatmentis determined by HCV genotype, viral load, liver enzyme levels, and extentof liver damage. There are many elements to consider when undergoingtreatment for chronic hepatitis C virus. Women are slightly more likely torespond favorably to HCV treatment; however, there are gender-specificissues that factor into the decision to start treatment.

Women have less hemoglobin (a component of red blood cells thatcarries oxygen to the cells) than men. Menstruating women have evenlower hemoglobin levels because of monthly blood loss, which cansometimes cause anemia. HCV-positive women undergoing treatmentshould talk to their medical advisor about ribavirin (one of thetreatment medications for HCV) and its connection to hemolyticanemia—a type of anemia that causes red blood cells to burst beforethe body has a chance to use them. Women, especially menstruatingwomen, are vulnerable to this kind of anemia and need to bemonitored with regular blood tests during treatment.In general, women are two times more likely than men to have depression.Depression is a common side effect of HCV treatment medications. Someproviders recommend starting an antidepressant prior to starting treatmentfor HCV.Women are less likely to need HCV treatment because they tend to have lesssevere liver damage due to the virus. Approximately 3 to 20percent of clients with chronic HCV will develop cirrhosis over a 20- to30-year period.

Alcoholic beverage consumption accelerates HCV-associatedfibrosis and cirrhosis. A study by reveals that heavyalcohol use affects females more strongly than males, resulting in a highermortality rate. This difference may be due to the more detrimental effect ofalcohol on the progression of liver injury among women than among men with asimilar level of alcohol use. Current guidelines strongly recommend thatHCV patients be vaccinated for hepatitis A and B if they have not yet beenexposed to these viruses, as these would radically worsen their liverdisease.Some ways addiction counselors can contribute to treatment are (for review,see ):. Providing moral support and hope to clients of obtaining the bestpossible results by maintaining treatment.Accessing screening and care on behalf of addicted clients with HCV can takepersistence.

Although the HCV antibody screening test is relativelyinexpensive, the HCV viral test is not, but most county medical clinics andhospitals will provide it. Substance abuse treatment providers are moreapt to spot the signs of depression or mania in those patients on medicaltherapy for HCV. Early detection and stabilization of any psychiatric sideeffect should not interrupt the progression of treatment. People with asubstance use disorder can participate successfully in HCV therapy. For moreinformation, see the planned TIP Viral Hepatitis and Substance UseDisorders (CSAT in development j).

It's best to avoid combining antidepressants and alcohol. It may worsen your symptoms, and it can be dangerous. If you mix antidepressants and alcohol:. You may feel more depressed or anxious. Drinking can counteract the benefits of your antidepressant medication, making your symptoms more difficult to treat. Alcohol may seem to improve your mood in the short term, but its overall effect increases symptoms of depression and anxiety.

Side effects may be worse if you also take another medication. Many medications can cause problems when taken with alcohol — including anti-anxiety medications, sleep medications and prescription pain medications.

Side effects may worsen if you drink alcohol and take one of these drugs along with an antidepressant. You may be at risk of a dangerous reaction if you take MAOIs. When combined with certain types of alcoholic beverages and foods, antidepressants called monoamine oxidase inhibitors (MAOIs) can cause a dangerous spike in blood pressure. If you take an MAOI, be sure you know what's safe to eat and drink, and which alcoholic beverages are likely to cause a reaction. Your thinking and alertness may be impaired.

The combination of antidepressants and alcohol will affect your judgment, coordination, motor skills and reaction time more than alcohol alone. Some combinations may make you sleepy.

This can impair your ability to drive or do other tasks that require focus and attention. You may become sedated or feel drowsy. A few antidepressants cause sedation and drowsiness, and so does alcohol. When taken together, the combined effect can be intensified.

Don't stop taking an antidepressant or other medication just so that you can drink. Most antidepressants require taking a consistent, daily dose to maintain a constant level in your system and work as intended. Stopping and starting your medications can make your depression worse.While it's generally best not to drink at all if you're depressed, ask your doctor. If you have depression:. You may be at risk of alcohol abuse.

People with depression are at increased risk of substance abuse and addiction. If you have trouble controlling your alcohol use, you may need treatment for alcohol dependence before your depression improves. You may have trouble sleeping. Some people who are depressed have trouble sleeping. Using alcohol to help you sleep may let you fall asleep quickly, but you tend to wake up more in the middle of the night.If you're concerned about your alcohol use, you may benefit from substance abuse counseling and treatment programs that can help you overcome your misuse of alcohol.

Joining a support group or a 12-step program such as Alcoholics Anonymous may help.If you're at low risk of addiction to alcohol, it may be OK to have an occasional drink, depending on your particular situation, but talk with your doctor.Also, tell your doctor about any other health conditions you might have and any other medications you take, including over-the-counter medications or supplements. Keeping your doctor informed is important because:. Some liquid medications, such as cough syrups, can contain alcohol. As you age, your body processes medication differently and levels of medication in your body may need to be adjusted. Adding a new medication may change the level of another medication in your body and how it reacts to alcohol. Can I drink alcohol if I'm taking antidepressants? Accessed May 2, 2017.

Frequently asked questions: Can I drink alcohol while taking antidepressants? National Alliance on Mental Illness. Accessed May 2, 2017. Back SE, et al. Treatment of co-occurring substance use disorder and anxiety-related disorders in adults. Accessed May 2, 2017. Dual diagnosis and recovery.

Depression and Bipolar Support Alliance. Accessed May 2, 2017. Bonnet MH, et al. Treatment of insomnia in adults. Accessed May 9, 2017. Hall-Flavin DK (expert opinion).

Mayo Clinic, Rochester, Minn. May 12, 2017.