Elsevier

Clinical Psychology Review

Volume 24, Issue 8, December 2004, Pages 981-1010
Clinical Psychology Review

Gender differences in risk factors and consequences for alcohol use and problems

https://doi.org/10.1016/j.cpr.2004.08.003Get rights and content

Abstract

Women drink less alcohol and have fewer alcohol-related problems than men. Women appear to be less likely than men to manifest certain risk factors for alcohol use and problems and are more likely to have certain protective factors against these problems: women perceive greater social sanctions for drinking; women are less likely to have characteristics associated with excessive drinking including aggressiveness, drinking to reduce distress, behavioral undercontrol, sensation-seeking and antisociality; and women are more likely to have desirable feminine traits (e.g., nurturance) protective against excessive drinking. In addition, consequences of heavy alcohol use, or alcohol use disorders, appear to be more negative for women than men, at least in some domains: women suffer alcohol-related physical illnesses at lower levels of exposure to alcohol than men, and some studies suggest women suffer more cognitive and motor impairment due to alcohol than men; women may be more likely than men to suffer physical harm and sexual assault when they are using alcohol; heavy alcohol use in women is associated with a range of reproductive problems. Implications of these findings for future research and public health education campaigns are discussed.

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.

References (250)

  • H. Amaro et al.

    Violence during pregnancy and substance use

    American Journal of Public Health

    (1990)
  • American Psychiatric Association

    Diagnostic and statistical manual

    (2000)
  • A. Ammendola et al.

    Gender and peripheral neuropathy in chornic alcoholism: A clinical-electroneurographic study

    Alcohol and Alcoholism

    (2000)
  • J.E. Anderson et al.

    High-risk sexual behavior in the general population: Results from a national survey, 1988–1990

    Sexually Transmitted Diseases

    (1992)
  • C.S. Aneshensel et al.

    Depression, alcohol use, and smoking over one year: A four-wave longitudinal causal model

    Journal of Abnormal Psychology

    (1983)
  • S. Armeli et al.

    Stress and alcohol use: A daily process examination of the stressor-vulnerability model

    Journal of Personality and Social Psychology

    (2000)
  • R.C. Bailly et al.

    Gender differences in drinking motivations and outcomes

    Journal of Psychology

    (1991)
  • A.R. Baldwin et al.

    To drink or not to drink: The differential role of alcohol expectancies and drinking refusal self-efficacy in quantity and frequency of alcohol consumption

    Cognitive Therapy and Research

    (1993)
  • B.D. Bartholow et al.

    Moderation of the expectancy-alcohol use relation by private self-consciousness: Data from a longitudinal study

    Personality and Social Psychology Bulletin

    (2000)
  • L.J. Beckman

    Self-esteem of women alcoholics

    Journal of Studies on Alcohol

    (1978)
  • L.J. Beckman

    Treatment needs of women with alcohol problems

    Alcohol Health and Research World

    (1994)
  • H. Bergman

    Brain dysfunction related to alcoholism: Some results form the KARTAD Project

  • L.J. Bierut et al.

    Familial transmission of substance dependence: Alcohol, marijuana, cocaine, and habitual smoking: A report from the collaborative study on the genetics of alcoholism

    Archives of General Psychiatry

    (1998)
  • A. Biglan et al.

    Social and behavioral factors associated with high-risk sexual behavior among adolescents

    Journal of Behavioral Medicine

    (1990)
  • S.B. Blume

    Sexuality and stigma: The alcoholic woman

    Alcohol Health and Research World: Special Issue: Alcohol and Sexuality

    (1991)
  • S.B. Blume et al.

    Alcohol and substance abuse in obstetrics and gynecology practice

  • S.A. Brown et al.

    Expectations of reinforcement from alcohol: Their domain and relation to drinking patterns

    Journal of Consulting and Clinical Psychology

    (1980)
  • C.M. Bulik et al.

    Features of childhood sexual abuse and the development of psychiatric and substance use disorders

    British Journal of Psychiatry

    (2001)
  • R.J. Cadoret et al.

    Adoption study demonstrating two genetic pathways to drug abuse

    Archives of General Psychiatry

    (1995)
  • R. Caetano

    Drinking and alcohol-related problems among minority women

    Alcohol Health and Research World: Special Focus: Women and Alcohol

    (1994)
  • C.B. Caldwell et al.

    Sex differences in the risk for alcoholism: A twin study

    Behavior Genetics

    (1991)
  • A. Caspi et al.

    Personality differences predict health-risk behaviors in adulthood: Evidence from a longitudinal study

    Journal of Personality and Social Psychology

    (1997)
  • A. Caspi et al.

    Behavioural observations at age 3 predict adult psychiatric disorders: Longitudinal evidence from a birth cohort

    Archives of General Psychiatry

    (1996)
  • B.D. Caudill et al.

    Alcohol and self-disclosure: Analyses of interpersonal behavior in male and female social drinkers

    Journal of Studies on Alcohol

    (1987)
  • L. Chassin et al.

    Binge drinking trajectories from adolescence to emerging adulthood in a high-risk sample: Predictors and substance abuse outcomes

    Journal of Consulting and Clinical Psychology

    (2002)
  • L.A. Chassin et al.

    Self-image and social-image factors in adolescent alcohol use

    Journal of Studies on Alcohol

    (1985)
  • S. Chomak et al.

    Relationship between sex-role behaviors and alcohol consumption in undergraduate men and women

    Journal of Studies on Alcohol

    (1987)
  • C.A. Clifford et al.

    A genetic and environmental analysis of a twin family study of alcohol use, anxiety, and depression

    Genetic Epidemiology

    (1984)
  • C.R. Cloninger et al.

    Inheritance of alcohol abuse: Cross-fostering analysis of adopted men

    Archives of General Psychiatry

    (1981)
  • C.R. Cloninger et al.

    Psychopathology in adopted-out children of alcoholics: The Stockholm Adoption Study

  • C.R. Cloninger et al.

    Childhood personality predicts alcohol abuse in young adults

    Alcoholism: Clinical and Experimental Research

    (1988)
  • C.D. Coles et al.

    Behavioral development in children prenatally exposed to drugs and alcohol

    International Journal of the Addictions

    (1993)
  • C.D. Coles et al.

    Early identification of risk for effects of prenatal alcohol exposure

    Journal of Studies on Alcohol

    (2000)
  • M.L. Cooper

    Alcohol and increased behavioral risk for AIDS

    Alcohol Health and Research World

    (1992)
  • M.L. Cooper et al.

    Drinking to regulate positive and negative emotions: A motivational model of alcohol use

    Journal of Personality and Social Psychology

    (1995)
  • M.L. Cooper et al.

    Drinking and sexual experience on first dates among adolescents

    Journal of Abnormal Psychology

    (1997)
  • M.L. Cooper et al.

    Gender, stress, coping, and alcohol use

  • M.L. Cooper et al.

    Substance use and sexual risk-taking among black adolescents and white adolescents

    Health Psychology

    (1994)
  • M.L. Cooper et al.

    Work stress and alcohol effects: A test of stress-induced drinking

    Journal of Health and Social Behavior

    (1990)
  • M.L. Cooper et al.

    Stress and alcohol use: Moderating effects of gender, coping, and alcohol expectancies

    Journal of Abnormal Psychology

    (1992)
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