Gender Issues in the Identification and Management of AUD

AUD is more likely to be under-detected in women than men. As such, greater attention to routine and opportunistic screening of women is important. Where an AUD has been identified, gender should be considered when both screening for and treating AUD. Key gender-related issues when screening for and managing alcohol-related problems are:

1. Screening both women and men for domestic violence (victim and/or perpetrator);
2. Screening for alcohol-related violence in men;
3. Screening for and managing alcohol-related problems for parents and caregivers of children;
4. Screening of and advice for about contraception for women; and
5. Gender-specific treatment programs.

Unsolicited disclosure of domestic violence is uncommon. Evidence from a Cochrane review found screening in healthcare settings does increase identification, but there is insufficient evidence that it improves outcomes, including referrals. Where screening is undertaken, the use of a screening tool is more effective, although no specific tool has been identified as superior for women with AUD. All domestic violence screening should be provided with contextual and environmental factors in mind and be trauma informed. The Royal Australian College of General Practitioners provide recommendations on how to ask questions about intimate partner violence in the general practice setting. Some Australian states and territories mandate domestic violence screening in certain public hospital settings; in New South Wales it includes drug and alcohol services (Box 13.2). 

Men are more likely to be the perpetrators, rather than victims, of domestic violence. Specific tools compatible to the clinical context, such as the Revised Conflict Tactics Scale, have been developed and trialled in substance treatment settings, but have not yet been widely adopted and their overall effectiveness has not been established. There are no data on the impact of such screening. Implementation of screening in men cannot be firmly recommended at this point. 

Within the usual clinical setting, referral to social work or specific community government and non-government services may be necessary to ascertain the safety and need for child protection or police involvement.