Ruth Fox Course Planned to Offer Latest Research Findings on Effects of Addiction in Women

Margaret A. E. Jarvis, M.D., FASAM

Margaret A. E. Jarvis, M.D., FASAM

In planning a useful and thought-provoking 2012 Ruth Fox Course for Physicians, course directors sought to focus on how women are uniquely affected by addictive diseases and invited women to be course speakers, with one exception. The result was a symposium with the theme “Improving the Health of Women” that brought new research and insights to the forefront.

“Our speakers included a number of ASAM members who are quite successful, who have served this organization, or served at the national level in various government agencies,” says Margaret A. E. Jarvis, M.D., FASAM, Co-Director of the Ruth Fox Course for Physicians.

“There are gender differences in how this disease manifests and how to treat it,” Dr. Jarvis says. “Over the last three to four years, we’ve done a lot of thinking about how to do things so that the Ruth Fox Course is useful. This is one aspect of addiction disease and treatment that needs to be addressed.”

Dr. Jarvis notes that the progress of researching the gender difference in addiction manifestation and treatment is analogous to that of women and heart disease.

“It seems to run a decade behind, and we saw that in the area of heart disease and women,” she says. “There are nuances in treatment based on gender that we need to incorporate into practice.”

The speakers at this year’s Ruth Fox Course highlighted recent research that is focused on women and addiction.

“We always have Stanley Gitlow, M.D., begin this course, because he remembers Ruth Fox so well and shares his insights and memories of her exceptional work and commitment to this,” Dr. Jarvis says.

Research on women and addiction, such as that presented at the Ruth Fox Course, is relatively new.

“We looked at doing things differently in research involving women,” Dr. Jarvis says. “Historically, research in this area has ignored the fact that there are women with addictions, and we’re ignorant regarding how best to treat them.”

For example, that recent research shows that women may be more genetically vulnerable to addictions than men, and these new findings have the potential to change the way people with addictions are treated, she says.

“It’s still very new,” Dr. Jarvis says. “We have to begin to incorporate these nuances into practice.”

More ASAM members can now access the information presented during the Ruth Fox Course, thanks to the uploading of the course to the ASAM e-Live Learning Center.

“A perennial quandary for those at this meeting has been that the Ruth Fox Course and the Pain & Addiction Course are opposite each other, and there’s so much information to absorb,” she says. “But this year, I’d encourage everyone to take advantage of the ASAM e-Live Learning Center and get access to all the information that’s available.”

The Ruth Fox Course for Physicians will be available through the e-Live Learning Center at the end of May. Find the e-Live Learning Center at the ASAM website, under the “Education” tab.

Ruth Fox Identifies Telescoping as a Challenge in Dealing with Addiction Problems Among Women

Andrea Barthwell, M.D., FASAM

Andrea Barthwell, M.D., FASAM

Telescoping occurs much more frequently in women than men and therefore places them at increased risk for substance use disorders. So concludes one of the many speakers for Thursday’s Ruth Fox Course for Physicians, Andrea Barthwell, M.D., FASAM, who was interviewed before the ASAM Annual Medical Science Conference.

Dedicated to the Founding President of ASAM, speakers of this year’s Ruth Fox Course for Physicians focused on “Improving the Health of Women” by providing new directions and concepts in clinical practice, as well as updates on research and practical applications and a review of important and timely issues in addiction medicine.

Penelope P. Ziegler, M.D., FASAM

Penelope P. Ziegler, M.D., FASAM

For her presentation, “Substance Use and Women’s Health,” Dr. Barthwell presented her work from the last 30 years with women and summarized a recent publication of the same title. The former Deputy Director for Demand Reduction at the Office of National Drug Control Policy under President George W. Bush, Dr. Barthwell defined telescoping as the rapid progression toward alcoholism and drug dependence and an earlier onset of consequences by using the same, or similar, quantity of the substance compared to patients who do not experience this phenomenon. Telescoping and alcohol-related, alcohol-caused diseases in women are unique or occur at rates greater than in men. Dr. Barthwell advocates different approaches to assessment for alcohol, tobacco, and other drug use in women.

Penelope P. Ziegler, M.D., FASAM”With educational objectives aimed at changing a physician’s behavior, we intend to help ASAM practitioners identify and intervene in women’s substance abuse much earlier so that women experience fewer consequences in the future,” she says. “We hope to change how ASAM physicians interview and approach women in their practices in order to improve women’s health through earlier intervention and women-sensitive treatment.”

As an example of the difference between men and women, the American Cancer Society reveals a sobering fact about women and tobacco use.

“While women start smoking later in life than men, they experience health consequences earlier,” Dr. Barthwell says. “When dealing with a woman, we teach physicians to modify their screening techniques.”

Dr. Barthwell says the same is true for alcohol abuse. “Women need intervention earlier because liver disease develops at a lower cirrhotic threshold and earlier than in men,” she says. “With regard to alcohol, clear physiological differences exist between women and men because the critical enzyme in women, alcohol dehydrogenase, is less effective in breaking down alcohol than the one in a man’s stomach and small intestine. If a woman drinks the same amount as a man, her organs are bathed in a higher volume of alcohol at similar consumption rates, and the clearance of alcohol is delayed due to differences in the volume of distribution in women when compared to men.”

In another pre-Med-Sci Conference interview, Martha Wunsch, M.D., FAAP, FASAM, of Blacksburg, Va., discusses her presentation, “Addiction and Adolescent Girls,” noting that addiction often begins with use of tobacco, cannabis, and alcohol in the pediatric age group.

“Girls are catching up with boys in use and abuse of drugs, particularly in mid-adolescence,” she says. “We are familiar with some factors that are protective, as well as those that place a young girl at increased risk for abuse.”

Dr. Wunsch says that it is important to increase physicians’ familiarity, and comfort level, with teens and substance use disorders.

“There are very few pediatricians who focus on addiction medicine, and so the addiction medicine specialist must be prepared to provide care to the adolescent,” she says. “Teens in general are greatly underserved. I will present skills that are helpful when working with this patient population. I hope to attract more physicians to focus their talents here.”

Still another pre-conference interview gleaned insights from Penelope P. Ziegler, M.D., FASAM, Medical Director of the Virginia Health Practitioners’ Monitoring Program , on “Addiction in Women Physicians.” She makes the point that not only are women different from men across the board when it comes to addiction, but women physicians also differ from their male counterparts.

“The fact of the matter is that there is very little information available with regard to addicted women in medicine,” she says. “If you take a look at various sources, very few women are being included in these monitoring studies. While the numbers of addicted women are similar to men, it is a mystery why there are so few women in these peer-assistance programs.”

She says that it would be easy to assume that fewer women get addicted than men, but data show that is not the case.

“It is possible the system is enabling women to go undetected and fewer are reported to monitoring programs because people are less comfortable with reporting women,” she says. “It is less likely for a woman to be suspected of abuse, often because women are more private in their drug abuse, and they may be more clever in the ways they go about avoiding detection.”