British Journal of Addiction (1992) 87, 1205-1206
Letter to the Editor The editor welcomes all letters whether they are short case reports, preliminary reports of research, discussion or comments on papers published in the journal. Authors should follow the same guidelines given for the preparation and submission of articles on the inside back cover of each ittue.
Female Chinese problem drinkers SIR—I read with interest the article by Watson, Kershaw & Davies.' The study showed that 15.2-18.6% of female patients in a general hospital ward were detected as newly identified problem drinker by a structured interview while the blood test (GGT and MCV) were of limited value. Shum, Leung & Yeung^ did a survey of alcoholism in a general hospital in Hong Kong using the MAST. They found that among the 1001 Chinese patients surveyed, 133 were detected alcoholics while 34 were suspected alcoholics, making a detection rate of 16.7%. When computed separately for each sex, 6.32% of the female patients screened were having drinking problems while the corresponding figure for the male patients was 23%. The relative low rate of alcohol problem in the Chinese female patients compared to the western counterpart may be due to different screening methodology. However, the administration of MAST as a screening device has been quoted as more accurate than clinical judgement and laboratory test in detecting unsuspected alcoholics.' Indeed, the large difference seen here is more likely due to cultural or ethnic factors instead. Schmidt, Klee and Ames'' reviewed that abstention rate was higher in black and hispanic women when compared to white women. Moreover, hispanic women tend not to report alcohol related problems and tend not to seek formal treatment. This seems to be the case in Chinese women as well. As part of our research into the drinking patterns among Chinese who are dependent on alcohol, the 475 patients who received an alcohol related diagnosis at the Department of Psychiatry, University of Hong Kong between the period of 1979 to 1990
were traced for re-assessment and if necessary, given appropriate treatment. Sixty of them are female—8 with alcohol dependence (AD), 1 delirium tremens (DT), 1 simple withdrawal state (WS), 2 alcoholic hallucinosis (AH), 46 non-dependent alcohol abuse (drunkenness) and 2 unclassified. This is in contrast to the 415 male patients—175 AD, 49 DT, 48 WS, 19 AH, 44 drunkenness, and 6 unclassified, and other diagnoses not found among the female group like Korsakoff-Wernicke Syndrome, alcoholic dementia, alcoholic psychosis and alcoholic jealousy. Forty-six out of the 175 males dependent on alcohol turned up while none of the 8 females did. The only one whom we managed to contact over the phone claimed that her husband believed what she really needed was to exercise more self control, have less self-pity and spend more time and energy on her children. The tracing of the female patients with other diagnoses was equally unsuccessful. From our registry data, it is clear that some Chinese women do drink and to an extent that leads to alcohol-related hospital admission. Moreover, it appears that they are unforthcoming in seeking specialist help and probably tend to see their drinking problem, like their American or British counterparts, through a moral, psychological, marital or familial perspective rather than a medical one, as pointed out by Oppenheimer.' Our data, though echoing the findings of male predominance in various diagnostic groups, highlight the exceptional over-representation of females in the non-dependent alcohol abuse diagnostic group in a general hospital setting. As this sub-population consists of females still at an early stage in their problematic drinking, it does argue for more active screening and
1205
1206
Letter to the Editor hospital ward, British Journal of Addiction, 86, pp. 889-894.
intervention for female problem drinkers at the general hospital setting. This certainly will give clearer answers to the phenomenon of the relative rarity of alcohol misusers in Chinese females.
SHUM, P. S., LEtWG, S. C. & YEUNG, S. (1983) A
preliminary survey of alcoholism in hospital patients using the MAST. Proceedings of the Second Pan Pacific Congress on Drugs and Alcohol, Hong Kong, pp. 173-178.
MICHAEL T . H . WONG
Alcohol &• Substance Misuse Clinic, Department of Psychiatry, University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong. References 1.
WATSON, H . E., KERSHAW, P. W. & DAVIES, J. B.
(1991) Alcohol problems among women in a general
WILSON, K . C . M . , WHITEOAK, R., DEWEY, M . E . &
WATSON, J. P. (1988) Problem drinking in a military endoscopy clinic, British Journal of Addiction, 83, pp. 1063-1065. 4.
SCHMIDT, C , KLEE, L . & AMES, G . (1990) Review
and analysis of literature on indicators of women's drinking problems, British Journal of Addiction, 85, pp. 179-192. OPPENHEIMER, E. (1991) Alcohol and drug misuse among women—an overview, British Journal of Psychiatry, 158 (Suppl. 10), pp. 36-44.
Letter to the Editor The editor welcomes all letters whether they are short case reports, preliminary reports of research, discussion or comments on papers published in the journal. Authors should follow the same guidelines given for the preparation and submission of articles on the inside back cover of each ittue.
Female Chinese problem drinkers SIR—I read with interest the article by Watson, Kershaw & Davies.' The study showed that 15.2-18.6% of female patients in a general hospital ward were detected as newly identified problem drinker by a structured interview while the blood test (GGT and MCV) were of limited value. Shum, Leung & Yeung^ did a survey of alcoholism in a general hospital in Hong Kong using the MAST. They found that among the 1001 Chinese patients surveyed, 133 were detected alcoholics while 34 were suspected alcoholics, making a detection rate of 16.7%. When computed separately for each sex, 6.32% of the female patients screened were having drinking problems while the corresponding figure for the male patients was 23%. The relative low rate of alcohol problem in the Chinese female patients compared to the western counterpart may be due to different screening methodology. However, the administration of MAST as a screening device has been quoted as more accurate than clinical judgement and laboratory test in detecting unsuspected alcoholics.' Indeed, the large difference seen here is more likely due to cultural or ethnic factors instead. Schmidt, Klee and Ames'' reviewed that abstention rate was higher in black and hispanic women when compared to white women. Moreover, hispanic women tend not to report alcohol related problems and tend not to seek formal treatment. This seems to be the case in Chinese women as well. As part of our research into the drinking patterns among Chinese who are dependent on alcohol, the 475 patients who received an alcohol related diagnosis at the Department of Psychiatry, University of Hong Kong between the period of 1979 to 1990
were traced for re-assessment and if necessary, given appropriate treatment. Sixty of them are female—8 with alcohol dependence (AD), 1 delirium tremens (DT), 1 simple withdrawal state (WS), 2 alcoholic hallucinosis (AH), 46 non-dependent alcohol abuse (drunkenness) and 2 unclassified. This is in contrast to the 415 male patients—175 AD, 49 DT, 48 WS, 19 AH, 44 drunkenness, and 6 unclassified, and other diagnoses not found among the female group like Korsakoff-Wernicke Syndrome, alcoholic dementia, alcoholic psychosis and alcoholic jealousy. Forty-six out of the 175 males dependent on alcohol turned up while none of the 8 females did. The only one whom we managed to contact over the phone claimed that her husband believed what she really needed was to exercise more self control, have less self-pity and spend more time and energy on her children. The tracing of the female patients with other diagnoses was equally unsuccessful. From our registry data, it is clear that some Chinese women do drink and to an extent that leads to alcohol-related hospital admission. Moreover, it appears that they are unforthcoming in seeking specialist help and probably tend to see their drinking problem, like their American or British counterparts, through a moral, psychological, marital or familial perspective rather than a medical one, as pointed out by Oppenheimer.' Our data, though echoing the findings of male predominance in various diagnostic groups, highlight the exceptional over-representation of females in the non-dependent alcohol abuse diagnostic group in a general hospital setting. As this sub-population consists of females still at an early stage in their problematic drinking, it does argue for more active screening and
1205
1206
Letter to the Editor hospital ward, British Journal of Addiction, 86, pp. 889-894.
intervention for female problem drinkers at the general hospital setting. This certainly will give clearer answers to the phenomenon of the relative rarity of alcohol misusers in Chinese females.
SHUM, P. S., LEtWG, S. C. & YEUNG, S. (1983) A
preliminary survey of alcoholism in hospital patients using the MAST. Proceedings of the Second Pan Pacific Congress on Drugs and Alcohol, Hong Kong, pp. 173-178.
MICHAEL T . H . WONG
Alcohol &• Substance Misuse Clinic, Department of Psychiatry, University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong. References 1.
WATSON, H . E., KERSHAW, P. W. & DAVIES, J. B.
(1991) Alcohol problems among women in a general
WILSON, K . C . M . , WHITEOAK, R., DEWEY, M . E . &
WATSON, J. P. (1988) Problem drinking in a military endoscopy clinic, British Journal of Addiction, 83, pp. 1063-1065. 4.
SCHMIDT, C , KLEE, L . & AMES, G . (1990) Review
and analysis of literature on indicators of women's drinking problems, British Journal of Addiction, 85, pp. 179-192. OPPENHEIMER, E. (1991) Alcohol and drug misuse among women—an overview, British Journal of Psychiatry, 158 (Suppl. 10), pp. 36-44.
