ALCOHOLISM MAY TAKE HARDER TOLL ON WOMEN.

Byline: Daily News Wire Services

Alcoholism in women may cause more health problems and require different approaches than in men, according to a Miami researcher whose groundbreaking work on treating depression and alcoholism together is published in today's Journal of the American Medical Association.

"For this to be so understudied among women is a serious problem," said Barbara Mason, a University of Miami psychologist who spoke Tuesday at an AMA gathering of alcoholism experts.

The number of women with alcohol problems is closing in on that of men, with apparently more severe health and social consequences, Mason said. Although the ratio of male problem drinkers to female has been estimated at 3 to 1, recent surveys suggest that for those under age 30, the ratio is 2 to 1.

Researchers are finding that women develop liver disease and deteriorate mentally from alcohol more quickly than men, and heavy-drinking women may risk decreased fertility, Mason said. But if an alcoholic woman conceives, the fetus is at risk: Alcohol is the leading cause of preventable retardation.

In women, there also is a stronger link between depression and problem drinking, although it is not clear which comes first. Mason has new evidence that both must be treated if a woman is to overcome her drinking.

In her study, Mason found that depressed alcoholics were able to remain abstinent longer if they received medication for their depression.

"For some people, depression comes first. For others, drinking comes first. But by the time a person has full-blown depression, it doesn't matter what came first," Mason said. "Once you have diagnosed alcoholism and diagnosed depression, you really have to treat both. Not treating one will compromise recovery for the other."

In addition to the Mason study, a number of other findings on alcohol were announced Tuesday at an AMA media briefing in New York. Among them:

Despite the claims of some problem drinkers, a major study shows that trying to return to controlled drinking doesn't work for alcoholics.

In fact, men who try controlled drinking usually relapse, while those who manage to stay sober for five years rarely do, according to the study, which tracked more than 700 college-educated and less-educated male drinkers for nearly 50 years.

Men who stay sober for only two years - the length of follow-up in most studies - face a 40 percent risk of relapse, the study found. And while less-educated men are more likely than college graduates to become alcoholics, they are twice as likely to achieve lasting sobriety.

The study, led by Dr. George H. Vaillant, director of psychiatric research at Brigham and Women's Hospital in Boston, is being published this week in the Archives of General Psychiatry.

Men who need more alcohol than others to "get a buzz" are at greater risk of alcohol dependence.

In fact, a mild response to alcohol at age 20 is a strong predictor of alcohol abuse or dependence nearly 10 years later, according to a study of more than 450 men by Dr. Marc A. Schuckit, professor of psychiatry at the University of California at San Diego School of Medicine, published in the latest Archives of General Psychiatry.

But contrary to widespread belief, the researchers also found that many of the alcoholic men functioned well in life, which contradicts the view that alcoholism is inevitably an attempt to "self-medicate" for depression, anxiety or psychosis.

A 12-week, placebo-controlled trial of the drug naltrexone (Trexan) showed that the drug, which combats cravings for alcohol, helps prevent drinking relapses, according to a study by Stephanie S. O'Malley, a psychiatric researcher at Yale University School of Medicine.

Only about one-third of the patients receiving naltrexone, a drug approved in early 1995, resumed heavy drinking at the end of a six-month follow-up period, O'Malley said, compared to two-thirds of those on placebo. All 80 patients in the study received some form of psychotherapy, too, but those taught "coping skills" to address drinking appeared to fare better.

Some benefits of naltrexone seem to continue after patients stop taking the drug.

Though other studies have trumpeted the health benefits of a drink or two a day, alcohol abuse remains a widely underdiagnosed problem, said Dr. David Lewis, professor of medicine and community health at Brown University.

Alcohol contributes to the deaths of more than 100,000 Americans a year and costs millions in lost productivity and medical care, studies show. In fact, alcohol kills five times as many people as all illicit drugs combined and ranks second only to tobacco in drug-related deaths.

Primary care physicians should screen patients for potential drinking problems, added Lewis, noting that as many as one in five patients may have a problem.

And what works to combat a drinking problem?

One of the most tried-and-true methods is participation in Alcoholics Anonymous, said Vaillant of Brigham and Women's Hospital.

"Willpower and motivation do not get you sober" but AA can, especially four key components of the famous 12-step program, he said.

AA works in part, he said, by supplying a substitute dependency for alcohol. Instead of taking a drink, for instance, recovering alcoholics can go to a meeting.

AA also works by supplying an framework for recovery.