Gender differences in risk factors and consequences for alcohol use and problems
Introduction
A robust finding in the mental health literature is that women drink less alcohol than men and have fewer alcohol-related problems than men (SAMHSA, 2002). In this paper, the epidemiology of gender differences in alcohol consumption and alcohol-related problems is reviewed. Then, the literature on the predictors and consequences of women's and men's alcohol consumption and alcohol-related problems is summarized. This literature is vast; the major themes in this literature are highlighted, and empirical articles that have examined gender differences are reviewed.1 This review suggests that predictors of heavy drinking and alcohol use disorders are more similar than different in women and men, but women may be less likely than men to carry certain of these risk factors. Gender differences in the consequences of drinking alcohol are large and consistent. Specifically, women appear to suffer serious negative consequences of alcohol consumption earlier and to a greater degree than men. The proximal consequences (e.g., negative effects on cognitive and motor functioning at low doses of alcohol) may discourage most women from excessive alcohol intake, and the distal consequences (e.g., poor reproductive health) may have created selection pressures against heavy alcohol consumption in women, resulting in lower rates of alcohol use disorders or alcohol-related problems in women compared to men.
Section snippets
Definitions
Alcohol use disorders are the alcohol-related psychiatric disorders recognized by the DSM-IV-TR (APA, 2000) and its predecessors. These include alcohol abuse, which involves persistent drinking behavior in the face of repeated social, interpersonal, and occupational problems that are due to excessive alcohol consumption. Alcohol dependence includes these psychosocial problems, but can also involve physiological dependence on alcohol, such as tolerance and withdrawal symptoms. This is the
Epidemiology of the gender difference in alcohol use and disorders
Women consistently drink less than men and have more alcohol-related problems than men. Nationwide data show that, at all ages and among Blacks, and Hispanics, and non-Hispanic Whites, men are more likely than women to drink four or more drinks in one sitting (Jackson, William, & Gomberg, 1998). Large age differences are also apparent, with the greatest consumption occurring in the young adult years for both men and women, and in all three racial/ethnic groups.
Gender differences are found for
Risk factors for women's and men's alcohol consumption and problems
A number of biological, psychological, and social risk factors for heavy alcohol consumption and alcohol-related problems and disorders have been studied. The focus here will be on those risk factors for which at least some studies have examined gender differences in the prevalence of the risk factor or in its association to alcohol use and problems. Table 1 summarizes the evidence regarding each of the factors.
Gender differences in the consequences of drinking alcohol
Women appear to suffer more negative consequences in a number of domains than men from drinking a given amount of alcohol, as is summarized in Table 2.
Conclusions
Women may drink less than men and may be less likely to develop alcohol-related problems because they are less likely to carry several risk factors for these behaviors or these risk factors are less potent for women than for men. Specifically, a genetic predisposition to alcoholism may have a weaker effect among women than among men, although studies are not completely consistent. The few existing studies of alcohol sensitivity suggest that women are less likely than men to manifest low alcohol
Acknowledgement
Support for the writing of this review was provided by NIAAA grant R01 AA007065. The author thanks Robert Zucker for his helpful comments on previous drafts of this paper.
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