Author Archives: edmontonfetalalcoholnetwork

BBC: Why alcohol affects women more than men

OOEC6SBKLVEDNKIPQMHWPMWZQQIt used to be that men were the outsized alcohol drinkers in Western society – perhaps best depicted in popular culture by Don Draper’s Mad Men cronies, who swilled from office stashes of brown liquor, knocked back three-martini lunches and imbibed Old Fashioneds in an after-work pub culture where few women dared tread.

But epidemiologists have noted that the rise of marketing alcohol to women and the changing of gender roles have gradually shifted the booze imbalance. Overall, men are still almost twice as likely as women to binge drink. But that isn’t true for younger people, specifically. In fact, women born between 1991 and 2000 now drink just as much as their male counterparts – and their drinking rates could eventually surpass them.

Women’s bodies are affected differently by alcohol than men’s bodies – for reasons that go beyond mere size

Women are increasingly suffering from the ill effects of alcohol, too. National data show that the cirrhosis death rate shot up by 57% among women aged 45-64 from 2000-2015 in the US, compared to 21% among men. And it rose 18% in women aged 25-44, despite decreasing by 10% among their male peers. Adult women’s visits to hospital emergency departments for overdosing on alcohol also are rising sharply. And risky drinking patterns are escalating among women in particular.

But the problem isn’t just that women are drinking more. Researchers are finding that women’s bodies are affected differently by alcohol than men’s bodies – for reasons that go beyond mere size.

Scientists have discovered that women produce smaller quantities of an enzyme called alcohol dehydrogenase (ADH), which is released in the liver and breaks down alcohol in the body.

Meanwhile, fat retains alcohol, while water helps disperse it. So thanks to their naturally higher levels of body fat and lower levels of body water, women experience an even more dramatic physiological response to alcohol.

“That vulnerability is why we see increases in medical problems in women with alcohol-use disorders, compared to men,” says Dawn Sugarman, a psychology professor at Harvard Medical School and addiction psychologist at McLean Hospital in Belmont, Massachusetts. (Find out more about how different bodies react to alcohol differently in our recent story Why do only some people get blackout drunk?)

Women who drink excessively also tend to develop addiction and other medical issues more quickly than men. It’s a phenomenon called ‘telescoping’: women with alcohol struggles tend to start drinking later in life than men, but it takes them much less time to develop alcohol addiction. Women are also faster to experience liver disease and damage to their hearts and nerves.

Many of these gender-based differences in alcohol’s effects on the body weren’t discovered until recent decades. The earliest study on gender-based differences in ADH, for example, was published in 1990.

In fact, almost all clinical studies on alcohol were done entirely on men until the 1990s. This was partly because scientists were encouraged to eliminate as many variables as possible that might influence an experiment’s results – one of which was gender. And because alcoholism was assumed to be a mostly male problem, no-one wondered what not studying women and alcoholism might miss.

That changed when government institutions like the US National Institutes of Health mandated that women and minorities had to be included as clinical research subjects, and critical gender gaps in medical research began to be addressed.

Scientists just assumed, well, you could study men and it could apply to women – Sharon Wilsnack

“People just didn’t think about women,” says Sharon Wilsnack, a psychiatry and behavioural science professor at the University of North Dakota’s School of Medicine and Health Sciences. “To the extent that they did, they just assumed, well, you could study men and it could apply to women.”

For her PhD at Harvard University in the early 1970s, Wilsnack wrote her graduate dissertation about women and alcohol; her literature review then yielded only seven studies at Harvard’s Widener Library. With her husband, a sociologist, Wilsnack went on to lead the first long-term national study on women’s drinking habits. Among their many findings was the discovery that women who abuse alcohol often have been sexually abused as children, a gender difference that has since been deemed as crucial in helping women with addiction.

Gender-based alcohol research since then has turned up a variety of other sex-specific results.

Click to read full article by Marisa Taylor 

Retrieved from


Research: Addressing the public health concerns of Fetal Alcohol Spectrum Disorder, Impact of stigma and health literacy

Stigma concept.



Fetal alcohol spectrum disorders (FASD) are a group of developmental disabilities that may result from the mother’s consumption of alcohol during pregnancy. The present study examined the effects of health literacy and stigma on the public health agenda for preventing FASD.


Three hundred and forty-one participants were sampled to ascertain levels of endorsement of the public health priorities of FASD, and FASD health literacy. Stigma towards women who consume alcohol during pregnancy, and towards biological mothers of children with FASD were operationalized using ratings of difference and disdain.


Public stigma towards women who consume alcohol during pregnancy was greater than stigma towards biological mothers of children with FASD. Research participants with higher FASD literacy were more likely to endorse the prevention priorities of FASD, but also more likely to endorse greater stigma towards biological mothers of children with FASD. Interestingly, those who endorsed greater stigma supported the public health priorities of FASD more strongly. Female research participants more strongly supported the prevention priorities of FASD than male participants. Male participants were more likely to endorse stigma than female participants.


Stigma experienced by biological mothers of children with FASD generalizes to women who consume alcohol while pregnant. Some results were contrary to expectations: stigma was positively associated with health literacy and endorsement of prevention priorities of FASD. Reasons for these findings are speculated and should be tested in future research.

(Health literacy is defined as the ability of an individual to access, understand, and use health-related information and services to make appropriate health decisions.)

Retrieved from

New Resources for Collaborative Conversations on Substance Use with Girls and Women

Two new resources are available for health and social service providers to assist them in providing brief intervention on substance use with women and girls. Both were introduced in a June 4th Webinar on the Dialogue to Action on Discussing Alcohol with Women project. The research and consultation arising from this project promote a broader use of brief intervention, in the form of conversations about the health effects of substances and women’s relationship to substance use, not only case finding for problematic use. This is particularly relevant in the context of alcohol use in pregnancy, where any drinking, not only harmful substance and addiction is of concern.

During 13 regional meetings across professions and practice approaches, a common theme emerged:

In general, clinical guidelines recommend that screening be conducted with all women, and that service providers should continue to provide additional information or conduct brief interventions with only the small percentage of women who “screen positive.” This was seen as focusing on women’s behaviour in a way that might be perceived as judgmental or stigmatizing (e.g., “Yes, you are at risk because of _____”) and limiting opportunities to discuss issues connected to women’s substance use (e.g., mental wellness, gender-based violence) with all women. –excerpt from “Doorways to Conversation”

Service providers emphasized that brief interventions were valued as an opportunity to develop open and ongoing dialogue about substance use and interconnected health concerns, whereas screening tools tended to use close-ended questions (e.g., yes/no, # of drinks) and be focussed narrowly on substance use, in ways not necessarily suited to their setting. Doorways to Conversation: Brief Intervention on Substance Use with Girls and Women offers adaptations that providers from a variety of professions and practices can use to begin or enhance their conversations with girls and women. In this way curiosity and learning about the effects of substances can be increased in helpful, non-stigmatizing ways.

50 Brief Intervention Ideas for Dialogue, Skill Building, and Empowerment is an excerpt from the previous resource and serves as a quick reference for providers. The 50 ideas are grouped together according to service type and illustrate how brief interventions can become a natural part of good overall care in a variety of settings: primary care, preconception care, prenatal care, sexual health, anti-violence services, and with various groups: girls and young women, and women and their partners.

With funding from the Public Health Agency of Canada and FASD National Strategic Project Fund, project goals were to reduce stigma, support engagement in further care and treatment, and improve the overall health and well-being of girls and women. Project evidence summaries and resource lists provided a baseline for discussions on current practices of providers, opportunities to expand brief intervention across roles and profession, and ways to align with child protection practice/policies and perinatal data gathering.

See earlier posts on these topics:



Research: Substance Use in Pregnant Women Using the Emergency Department: Undertested And Overlooked?


C. Leigh Moyer, BA, Sean Johnson, BS, Marilyn G. Klug, PhD, and Larry Burd, PhD

West J Emerg Med. 2018 May; 19(3): 579–584.
Published online 2018 Apr 5. doi:  10.5811/westjem.2018.1.35630


The objective was to determine if pregnant women visiting the emergency department (ED) are tested for substance use as frequently as non-pregnant women.


We captured all ED visits over a six-year period (2010–2016) from a single community hospital and identified women of childbearing age, defined for our study as 11–50 years old. We collected demographic data including age in years, ethnicity, body mass index, marital status, disposition, last encounter department, method of arrival, and day of week. An independent binary variable was created based on whether the woman was tested for alcohol or drugs (amphetamines, barbiturates, benzodiazepines, cannabis, cocaine, opioids) during her visit. We then compared rates of testing for substance use by pregnancy status.


We identified 61,222 ED visits by women of childbearing age (range 11–50, mean 30.5, standard deviation 9.6) over a six-year period from 2010–2016. Of the 57,360 non-pregnant women, 4.14% were tested compared to 1.04% of the 3,862 pregnant women tested with a relative risk of 0.25 (p<0.001, 95% confidence interval [CI] [0.183–0.341]). The most highly tested chief complaints for all women – psychiatric or substance use concerns – showed pregnant women were still 37% and 54% less likely to be tested, respectively (risk ratio [RR] 0.46, 95% CI [0.19–1.13]; RR 0.63, 95% CI [0.41–0.96]). Beyond pregnancy status, we found no significant interaction between patient demographics and substance use testing.


Pregnant women presenting to the ED were 75% less likely to be tested for drug or alcohol use than non-pregnant women. Our study showed only pregnancy status as a statistically significant variable in drug- and alcohol-screening rates when pregnant and non-pregnant patient chief complaints and demographics were compared. Increased attention to the screening of pregnant women for substance use may be necessary to provide adequate care and intervention to this population.

To access research please visit

Mothers’ Mental Health Toolkit: A Resource For The Community

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A mother’s mental health is critical to the physical, mental, and emotional wellbeing of herself and her children. The adjustment to mothering is always a big step in a woman’s personal development. Significant mental and emotional problems are one of the most common complications of childbirth, affecting at least two in ten women.

This toolkit was developed as a public resource for community service providers and families for education, advocacy, and treatment support for mothers with mental health problems. The materials are drawn from general medical and clinical knowledge and the particular experience of the principal developers, together with a wide variety of information in the broad public realm. Included are original descriptions and writing from the author/developers. Where possible effort was made to provide specific acknowledgement of other original sources. As well, we have included general lists of references and resources, print and web-based.  

Click to download full toolkit: mmh-toolkit


The Globe and Mail: What Canada’s doctors are concerned about with marijuana legalization



As Justin Trudeau’s Liberal government tables its long-awaited marijuana legislation, Canada’s doctors have a message about pot: Just because it will eventually be legal, doesn’t mean it’s safe.

The Canadian Medical Association, the Canadian Psychiatric Association, the Canadian Paediatric Society and other organizations representing front-line health-care providers have been busy broadcasting their concerns about the ill effects of cannabis, especially for chronic smokers under the age of 25.

“We’re saying, ‘please keep the public-health focus front of mind as this legislation is unrolled,’ ” said Gail Beck, the clinical director of youth psychiatry at The Royal, a psychiatric hospital in Ottawa. “Lots of people think this is harmless.”


Explainer: Legal marijuana is coming but what does it mean for you?

The medical profession in this country has long had misgivings about medicinal marijuana – namely, that there is not enough solid evidence of pot’s efficacy in treating chronic pain and other ailments to warrant a doctor’s endorsement. But with the advent of legal recreational marijuana, doctors have a different set of worries.



One top-of-mind concern: The potential for addiction to marijuana, especially among teens and young adults. “We know that 1 in 7 teenagers who start using cannabis will develop cannabis-use disorder, which is significant,” said Christina Grant, a professor of pediatrics at McMaster University in Hamilton.

Cannabis use crosses over into disorder territory when it begins to cause dysfunction in users’ day-to-day lives, derailing their commitment to school or work and sowing conflict in their families, said Dr. Grant, the lead author of the Canadian Paediatric Society’s position statement on marijuana, released last fall.

Mental illness

Cannabis has also been linked to certain mental illnesses. The drug’s relationship to depression and anxiety is still up in the air; the science has not established a causal relationship between the two. In other words, it’s not clear if people smoke pot because they are depressed and anxious or are depressed and anxious because they smoke pot.

There is stronger evidence that heavy use of cannabis can lead to psychosis, especially among people who have a family history of mental illness, Dr. Beck said. However, the vast majority of the research involved people who use cannabis daily. The scientific literature is virtually silent on the mental-health effects of smoking pot now and then.

“We don’t know the lower limit that’s safe,” Dr. Grant cautioned. “There’s no evidence to say, yeah, use it once, use it twice and nothing will happen.”

Please click to read full article

Webinar Series, REGISTER- Health Promotion for Girls: Gender-Transformative Approaches

Date & Time: Monday June 18Time: 1:00pm ETD / 10:00AM PDT

(11:00am MDT/ 12:00pm CDT/ 2:00 pm ADT/ and 2:30 NDT)


The Presenters

Nancy Poole, Director, Centre of Excellence for Women’s Health
Marbella Carlos, Project Officer, Girls Action Foundation

This webinar will be the first of two webinars on our collaborative work to define, develop curriculum, pilot, and evaluate gender-transformative approaches to health promotion within girls’ programming. This first webinar will focus on promising practices in, and examples of, gender transformative girls’ programming. In the second webinar (to be held in the fall) we will share a new guide on this approach which has been piloted in six communities in Nova Scotia, BC, Ontario and Quebec.

We welcome all individuals and groups who are interested in girls’ group programming and girls health and wellness overall.

To register, please click

The Girls Action Foundation

At Girls Action we are committed to building a movement of active, engaged individuals and organizations across Canada. The Girls Action Foundation’s approach is based on 5 overarching principles: 1. popular education, 2. integrated feminist analysis, 3. gender specific spaces, 4. critical asset based, and 5. social action and change.

With the Centre of Excellence for Women’s Health, we have partnered on several projects about integrating health promotion approaches within girls’ empowerment group programming that is grounded in these five principles.

This webinar has been made possible by financial contribution from the Public Health Agency of Canada.  The views expressed within will not necessarily represent the view of PHAC.

For more information about this webinar contact Marbella Carlos:

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