Gender Differences in the Psychosocial Determinants Underlying the Onset and Maintenance of Alcohol Use Disorder

Abstract

A large number of different mechanisms have been linked to Alcohol Use Disorder (AUD), including psychosocial, neurocognitive, affective, and neurobiological factors. Gender has been shown to impact the presentation and progression of AUD; yet, little work has been done to parse the different mechanisms underlying AUD within the lens of gender differences. A review of the literature on adolescence revealed that psychosocial factors, in particular lack of family social support and interactions with peers, drive the onset of alcohol use more strongly in girls relative to boys. However, research done on gender differences in disease progression in adults remains limited. Our gender-specific analysis of the mechanisms underlying AUD in adults revealed that lack of social support was causally linked to negative affect, mental health symptoms, and AUD symptom severity in women, but not men. These novel results suggest that psychosocial factors may play a gender-specific role not only in the onset of use in adolescence, but also in the maintenance of addiction in adults. If confirmed, this suggests the need for investigating gender-specific recovery trajectories. In this perspective piece, we review the literature regarding gender differences in the onset and maintenance of AUD and present original data that support unique risk factors in women.

Explainable machine learning analysis reveals sex and gender differences in the phenotypic and neurobiological markers of Cannabis Use Disorder

“…Spechler and colleagues (2019) found that individual level factors such as sensation/novelty seeking were predictive of cannabis use onset in boys, whereas factors that are more closely linked to the environment, such as verbal IQ, sexual relationships and parent personality, were predictive in girls 10 . These findings also fit with our recent review and empirical data demonstrating a much greater importance of social support as a protective factor preventing the escalation of alcohol use in adolescence and maintenance of alcohol misuse in adulthood particularly in girls and women, as compared to boys and men 101 . We are only aware of one previous study on sex/gender differences in CUD in adults 102 .…”

Gender Differences in Alcohol Use: a Nationwide Study in a Multiethnic Population

“…In this study, recovery was a subjective report indicating the age they last experienced AUDrelated symptoms. As females did not seek help for their AUD, formal treatments such as pharmacotherapy and psychotherapy were not reasons for their symptom alleviation and recovery (Holzhauer et al, 2020;Maxwell et al, 2022;Tucker et al, 2020). Pregnancy and motherhood and the responsibilities associated with it could explain the earlier age of recovery in females in this study, but not completely (Nolen-Hoeksema, 2004;Nolen-Hoeksema & Hilt, 2006).…”

“…Tucker et al (2020) reported that approximately 70% of individuals with AUD and maladaptive drinking patterns experience natural recovery, where they see an improvement without formal interventions. In another study, Maxwell et al (2022) reported that social support for women, but not in men, plays a greater role in regulating alcohol use. They found that increased social support helped build a barrier against negative affect, mental health symptoms, and poor self-regulation which alleviates AUD severity (Maxwell et al, 2022).…”

“…In another study, Maxwell et al (2022) reported that social support for women, but not in men, plays a greater role in regulating alcohol use. They found that increased social support helped build a barrier against negative affect, mental health symptoms, and poor self-regulation which alleviates AUD severity (Maxwell et al, 2022). A strong family unit and collectivist culture could be a possible explanation for an earlier age of recovery for females in Singapore.…”

Sex-specific association between alcohol consumption and liver cirrhosis: An updated systematic review and meta-analysis

“…One study reported that men have a higher rate of accessing healthcare prior to being diagnosed with alcohol-related LC than women, but they are less likely to receive interventions or referrals than women (57). Nevertheless, women report having less social support for treatment engagement when dealing with alcohol use disorders (58). To formulate effective and accessible prevention and treatment options, these factors should be taken into account.…”