Understanding Alcohol Misuse in Women

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CONFERENCE REPORTER

“Alcohol misuse in women is becoming an increasingly important topic because it used to be thought of as recently as 50 years ago as a men’s disorder. But epidemiological surveys have shown that gender gaps and alcohol consumption and alcohol-related harms are narrowing for women and men—such that alcohol is growing women’s health issue.”

Barbara J. Mason, PhD, discussed alcohol misuse in women at the 2023 Annual Psychiatric Times™ World CME Conference. Mason is director of the Pearson Center for Alcohol and Addiction Research and director of the National Institute on Alcohol Abuse and Alcoholism (NIAAA) P60 Alcohol Research Center of Excellence.

Mason began by emphasizing the similarities and differences between men and women when it comes to alcohol use and alcohol-related harms. She noted that the gap between men and women has narrowed in terms of prevalence and frequency of drinking, binge drinking, total amount of alcohol consumed, early-onset drinking, drunk driving, alcohol-induced cirrhosis, related emergency department visits, related hospitalizations, related deaths, and prevalence of alcohol use disorder (AUD).

Mason also stated that women are less likely than men to receive treatment for AUD and are more likely than men to experience a variety of alcohol-related harms at comparable doses, including hangovers, blackouts, liver disease, brain atrophy, cognitive deficits, cardiomyopathy, faster progression of AUD, and certain cancers.

One such cancer is breast cancer: One study Mason cited found that light drinkers have a 1.04-fold higher risk, moderate drinkers have a 1.23-fold higher risk, and heavy drinkers have a 1.6-fold higher risk of developing breast cancer.

Mason also explored some possible differences in motivation for drinking between men and women. She stated that, generally, women are more likely to drink for negative reinforcement (eg, to dampen stress and negative affect), whereas men are more likely to drink for positive reinforcement (eg, for stimulation, to enhance mood).

Although this reflects sex differences in the neurobiological underpinnings of drinking behavior, Mason also noted that there is some overlap between these populations: Some women may drink largely for positive reinforcement, while some men may drink largely for negative reinforcement.

Mason also noted that the sex differences in neurobiology that drive the motivation(s) to drink alcohol may influence responses to AUD pharmacotherapy. She discussed some recent research on AUD treatment with 2 drugs approved for this indication by the US Food and Drug Administration (FDA): naltrexone and acamprosate.

In several studies on naltrexone, the drug did not show efficacy in women, suggesting that further study of the drug’s efficacy in women is warranted. In recent research on acamprosate, however, the drug showed equivalent efficacy and safety in men and women.

Mason emphasized the importance of better understanding the differences between men and women when it comes to alcohol misuse. She posed 2 hypotheses currently under consideration:

1. Women might be more motivated to consume alcohol to relieve emotional discomfort and, therefore, may be more responsive to pharmacotherapies that restore homeostasis in brain stress systems (eg, acamprosate, gabapentin).
2. Alcohol appears to activate the reward system to a greater extent in men than it does in women, which leads to positive reinforcement. This suggests that men may be more responsive to pharmacotherapies that block the reward system (eg, naltrexone).

Mason concluded by posing the following questions that should be explored in future research:

• What is driving the escalation of alcohol use in women?
• What causes the differences in health effects in women compared to men?
• How and why do women and men differ in their relationships with alcohol?
• How can AUD prevention and treatment strategies be modified to more effectively address women’s issues?

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