Alcohol use disorder in women: Risks and consequences of an adolescent onset and persistent course.

Abstract

Women are more vulnerable to the deleterious effects of both acute and protracted alcohol use than men, but women's lower levels of alcohol consumption and alcohol use disorder (AUD) have resulted in a paucity of investigations on the development of alcohol problems in women. In particular, it is not clear to what extent the cascading effects of key etiological factors that contribute to an especially severe course of AUD in men also underlie the development of AUD in women. To fill this gap, we examined the adolescent risk factors and adult consequences associated with an adolescent onset and persistent course of AUD in a community sample of women (n=636) from ages 17 to 29. Women with AUD exhibited greater psychopathology and psychosocial impairment than those without, with an adolescent onset and persistent course indicative of the greatest severity. Notably, high levels of impairment across all women with AUD reduced the utility of onset and course to differentiate profiles of risk and impairment. In contrast to previous work in men, even women whose AUD symptoms desisted continued to exhibit impairment, suggesting that an adolescent onset of AUD is associated with enduring consequences for women's health and functioning, even after ostensible “recovery.”

Sex differences in behavior and neural development and their role in adolescent vulnerability to substance use

“…After this peak, the likelihood of an individual developing alcohol dependence falls by 13.2% and 14.7% per year for females and males, respectively; similarly, the likelihood of developing alcohol abuse falls by 9.1 and 7.0% for females and males [24]. In addition, adolescent-onset alcohol abuse may have lasting effects on the likelihood that an individual will experience legal troubles, engage in illicit drug use, or display antisocial behavior in adulthood [25,26], though these problems may merely be correlated with, rather than caused by, adolescent-onset alcohol use. Interestingly, there are gender differences in the likelihood that adults will display problems associated with adolescent alcohol use.…”

“…Males that stop abusing alcohol after adolescence resemble men without any history of alcohol abuse [26]. However, females that stop abusing alcohol after adolescence continue to differ from controls in adulthood, particularly with regard to illegal drug use, antisocial behavior and social dysfunction [25]. If adolescent-onset drug use was, in fact, causing these problems, then the especially long-lasting effects in females may contribute to sex differences in the severity of problems associated with drug use.…”

Young women’s alcohol expectancies for sexual risk-taking mediate the link between sexual enhancement motives and condomless sex when drinking

“…Recent data suggest that 70% of U.S. young adults, ages 18–24, drink alcohol, with 39% of young women drinking above recommended daily limits (Chen et al, 2004), including binge drinking (≥4 drinks during a sitting; SAMSHA, 2005). Alcohol misuse differentially impacts young women across multiple domains (e.g., alcohol use disorders progress more quickly in women than men; Foster et al, 2014), and is associated with increased HIV risk-behavior engagement (e.g., sex without a condom; Leigh et al, 2008). Understanding factors that may underlie the association between alcohol use and condomless sex among young women is of considerable public health importance, as incident HIV infections are on the rise among women, with a vast majority (84%) infected via heterosexual contact (CDC, 2014b).…”

Genetic and environmental sources of covariation between early drinking and adult functioning.

“…For more detail about the comparable measures selected for this study, including discussions of their reliability and validity, please see other investigations that have used them with the current sample (Foster, Hicks, Iacono, & McGue, 2014; Hicks, Iacono, & McGue, 2010). Brief descriptions of the measures are given below.…”