The Gender Risk–Severity Paradox for Alcohol Use Disorder From Adolescence Through Young Adulthood

Abstract

A large proportion of the public health costs of alcohol use disorder (AUD) can be accounted for by a small percentage of severe cases with a chronic course starting in adolescence and persisting into adulthood. However, chronicity may be a less effective marker of AUD severity in women than men due to a gender risk–severity paradox, wherein comparable levels of risk exposure yield more co-occurring problems for women than men with AUD. To model this paradox, we compared trajectories of alcohol and drug use problems, depression symptoms, and antisocial behavior from ages 17 to 29 in men and women with a persistent, desistent, or no history of AUD. Problems followed a quadratic trajectory (i.e., increases followed by decreases), with gender and AUD chronicity moderating age-related change. Specifically, persistent and desistent courses differentiated the severity of problems more effectively in men while chronicity had less utility for differentiating AUD severity in women.

Keywords

alcohol use disorder gender adolescent problems emerging adulthood development

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References

Acker

(1986a). Neuropsychological deficits in alcoholics: The relative contributions of gender and drinking history. Addiction, 81, 395–403. doi:10.1111/j.1360-0443.1986.tb00346.x

Arnett

J. J.

(2000). Emerging adulthood: A theory of development from the late teens through the twenties. American Psychologist, 55, 469–480. doi:10.1037//0003-066X.55.5.469

Babor

Hofmann

Delboca

Hesselbrock

Meyer

Dolinksky

Rounsaville

(1992). Types of alcoholoics. 1. Evidence for an empirically derived typology base on indicators of vulnerability and severity. Archives of General Psychiatry, 49, 599–608.

Beckman

L. J.

Amaro

(1986). Personal and social difficulties faced by women and men entering alcoholism treatment. Journal of Studies on Alcohol, 47, 135–145. doi:10.15288/jsa.1986.47.135

Chassin

Flora

King

(2004). Trajectories of alcohol and drug use and dependence from adolescence to adulthood: The effect of familial alcoholism and personality. Journal of Abnormal Psychology, 113, 483–498.

Chen

Kandel

D. B.

(1995). The natural history of drug use from adolescence to the mid-thirties in a general population sample. American Journal of Public Health, 85, 41–47. doi:10.2105/AJPH.85.1.41

Clark

D. B.

(2004). The natural history of adolescent alcohol use disorders. Addiction, 99, 5–22.

Clark

D. B.

Kirisci

Tarter

R. E.

(1998). Adolescent versus adult onset and the development of substance use disorders in males. Drug and Alcohol Dependence, 49, 115–121. doi:10.1016/S0376-8716(97)00154-3

Cloninger

C. R.

(1987). Neurogenetic adaptive mechanisms in alcoholism. Science, 236, 410–416.

10.

Cottler

Robins

Helzer

(1989). The reliability of the CIDI-SAM: A comprehensive substance abuse interview. Addiction, 84, 801–814. doi:10.1111/j.1360-0443.1989.tb03060.x

11.

Cranford

J. A.

Nolen-hoeksema

Zucker

R. A.

(2011). Alcohol involvement as a function of co-occurring alcohol use disorders and major depressive episode: Evidence from the National Epidemiologic Survey on alcohol and related conditions. Drug and Alcohol Dependence, 117, 145–151. doi:10.1016/j.drugalcdep.2011.01.011

12.

Culverhouse

Bucholz

K. K.

Crowe

R. R.

Hesselbrock

Nurnberger

J. I.

Porjesz

… Bierut

L. J.

(2005). Long-term stability of alcohol and other substance dependence diagnoses and habitual smoking: An evaluation after 5 years. Archives of General Psychiatry, 62, 753–760. doi:10.1001/archpsyc.62.7.753

13.

Dickey

Azeni

(1996). Persons with dual diagnoses of substance abuse and major mental illness: their excess costs of psychiatric care. American Journal of Public Health, 86(7), 973–977. http://doi.org/10.2105/AJPH.86.7.973

14.

Elkins

I. J.

King

S. M.

McGue

Iacono

W. G.

(2006). Personality traits and the development of nicotine, alcohol, and illicit drug disorders: Prospective links from adolescence to young adulthood. Journal of Abnormal Psychology, 115, 26–39. doi:10.1037/0021-843X.115.1.26

15.

Elkins

I. J.

McGue

Iacono

W. G.

(2007). Prospective effects of attention-deficit/hyperactivity disorder, conduct disorder, and sex on adolescent substance use and abuse. Archives of General Psychiatry, 64, 1145–1152. doi:10.1001/archpsyc.64.10.1145

16.

Elkins

I. J.

McGue

Malone

Iacono

W. G.

(2004). The effect of parental alcohol and drug disorders on adolescent personality. The American Journal of Psychiatry, 161, 670–676.

17.

Erol

Karpyak

V. M

. (2015). Sex and gender-related differences in alcohol use and its consequences: Contemporary knowledge and future research considerations. Drug and Alcohol Dependence. doi:10.1016/j.drugalcdep.2015.08.023

18.

Foster

K. T.

Hicks

B. M.

Iacono

McGue

(2014). Alcohol use disorder in women: Risks and consequences of an adolescent onset and persistent course. Psychology of Addictive Behaviors, 28. doi:10.1037/a0035488

19.

Foster

K. T.

Hicks

Iacono

McGue

(2015). Gender differences in the structure of risk for alcohol use disorder in adolescence and young adulthood. Psychological Medicine, 1–12. doi:10.1017/S0033291715001014

20.

Gomberg

(1981). Women, sex roles, and alcohol problems. Professional Psychology. doi:10.1037/0735-7028.12.1.146

21.

Gomberg

(1988). Alcoholic women in treatment: The question of stigma and age. Alcohol and Alcoholism, 23, 507–514. doi:10.1093/oxfordjournals.alcalc.a044852

22.

Granic

Hollenstein

(2017). Dynamic systems methods for models of developmental psychopathology. Development and Psychopathology, 15, 641–669. doi:10.1017.S0954579403000324

23.

Granic

Patterson

G. R.

(2006). Toward a comprehensive model of antisocial development: A dynamic systems approach. Psychological Review, 113, 101–131. doi:10.1037/0033-295X.113.1.101

24.

Grant

(2006). Women and drugs: A feminist perspective. In DeKeseredy

W. S.

Perry

(Eds.), Advancing critical criminology: Theory and application (pp. 179–198).

25.

Grant

B. F.

Goldstein

R. B.

Saha

T. D.

Chou

S. P.

Jung

Zhang

… Hasin

D. S.

(2015). Epidemiology of DSM-5 alcohol use disorder: Results from the National Epidemiologic Survey on alcohol and related conditions III. JAMA Psychiatry, 72, 757–766. doi:10.1001/jamapsychiatry.2015.0584

26.

Grant

LaBrie

J. W.

Hummer

J. F.

Lac

(2012). How drunk am I? Misperceiving one’s level of intoxication in the college drinking environment. Psychology of Addictive Behaviors: Journal of the Society of Psychologists in Addictive Behaviors, 26, 51–58. doi:10.1037/a0023942

27.

Greenfield

S. F.

(2002). Women and alcohol use disorders. Harvard Review of Psychiatry, 10, 76–85. doi:10.1080/10673220216212

28.

Hankin

B. L.

Abramson

L. Y.

(2001). Development of gender differences in depression: An elaborated cognitive vulnerability–transactional stress theory. Psychological Bulletin, 127, 773–796. doi:10.1037/0033-2909.127.6.773

29.

Hawkins

J. D.

Catalano

R. F.

Miller

J. Y.

(1992). Risk and protective factors for alcohol and other drug problems in adolescence and early adulthood: Implications for substance abuse prevention. Psychological Bulletin, 112, 64–105. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/1529040

30.

Hicks

B. M.

Iacono

W. G.

Mcgue

(2010). Consequences of an adolescent onset and persistent course of alcohol dependence in men: Adolescent risk factors and adult outcomes. Alcoholism: Clinical & Experimental Research, 34, 819–833. doi:10.1111/j.1530-0277.2010.01154.x

31.

Hicks

B. M.

Schalet

B. D.

Malone

S. M.

Iacono

W. G.

McGue

(2011). Psychometric and genetic architecture of substance use disorder and behavioral disinhibition measures for gene association studies. Behavior Genetics, 41(4), 459–75. http://doi.org/10.1007/s10519-010-9417-2

32.

Hollingshead

(1957). Two Factor Index of Social Position. New Haven, CT: Yale University Department of Sociology.

33.

Hommer

Momenan

Kaiser

Rawlings

(2001). Evidence for a gender-related effect of alcoholism on brain volumes. The American Journal of Psychiatry, 158, 198–204.

34.

Hox

J. J.

(2010). Multilevel analysis: Techniques and applications (2nd ed.). New York: Routledge

35.

Huselid

R. F.

Cooper

M. L.

(1992). Gender roles as mediators of sex differences in adolescent alcohol use and abuse. Journal of Health and Social Behavior, 33, 348. doi:10.2307/2137313

36.

Iacono

W. G.

Carlson

S. R.

Taylor

Elkins

I. J.

McGue

(1999). Behavioral disinhibition and the development of substance-use disorders: Findings from the Minnesota Twin Family Study. Development and Psychopathology, 11, 869–900.

37.

Iacono

W. G.

Malone

McGue

(2008). Behavioral disinhibition and the development of early-onset addiction: Common and specific influences. Annual Review of Clinical Psychology, 4, 325–348. doi:10.1146/annurev.clinpsy.4.022007.141157

38.

Johnston

L. D.

O'Malley

P. M.

Miech

R. A.

Bachman

J. G.

Schulenberg

J. E.

(2015). Monitoring the Future national survey results on drug use, 1975-2014: Overview, key findings on adolescent drug use. Ann Arbor: Institute for Social Research, The University of Michigan.

39.

Johnstone

Leino

Ager

Ferrer

Fillmore

(1996). Determinants of life-course variation in the frequency of alcohol consumption: Meta-analysis of studies from the collaborative alcohol-related longitudinal project. Journal of Studies on Alcohol, 57, 494–506.

40.

Kendler

K. S.

Prescott

C. A.

Myers

Neale

M. C.

(2003). The structure of genetic and environmental risk factors for common psychiatric and substance use disorders in men and women. Archives of General Psychiatry, 60, 929–937. doi:10.1001/archpsyc.60.9.929

41.

Keyes

K. M.

Grant

B. F.

Hasin

D. S.

(2008). Evidence for a closing gender gap in alcohol use, abuse, and dependence in the United States population. Drug and Alcohol Dependence, 93, 21–29. doi:10.1016/j.drugalcdep.2007.08.017

42.

Krueger

R. F.

Hicks

B. M.

Patrick

C. J.

Carlson

S. R.

Iacono

W. G.

McGue

(2002). Etiologic connections among substance dependence, antisocial behavior and personality: Modeling the externalizing spectrum. Journal of Abnormal Psychology, 111, 411–424. doi:10.1037//0021-843X.111.3.411

43.

Leggio

Kenna

G. A.

Fenton

Bonenfant

Swift

R. M.

(2009). Typologies of alcohol dependence. From Jellinek to genetics and beyond. Neuropsychology Review, 19, 115–129. doi:10.1007/s11065-008-9080-z

44.

Littlefield

A. K.

Winograd

R. P.

(2013). Maturing Out. In Principles of Addiction (pp. 363–370). Elsevier. http://doi.org/10.1016/B978-0-12-398336-7.00038-3

45.

Mann

Ackermann

Croissant

Mundle

Nakovics

Diehl

(2005). Neuroimaging of gender differences in alcohol dependence: Are women more vulnerable? Alcoholism: Clinical & Experimental Research, 29, 896–901. doi:10.1097/01.ALC.0000164376.69978.6B

46.

Moffitt

T. E.

Caspi

(2001). Childhood predictors differentiate life-course persistent and adolescence-limited antisocial pathways among males and females. Development and Psychopathology, 13, 355–375.

47.

Moss

H. B.

Chen

C. M.

(2007). Subtypes of alcohol dependence in a nationally representative sample. Drug and Alcohol Dependence, 91, 149–158. doi:10.1016/j.drugalcdep.2007.05.016

48.

Niaura

R. S.

Nathan

P. E.

Frankenstein

Shapiro

A. P.

Brick

(1987). Gender differences in acute psychomotor, cognitive, and pharmacokinetic response to alcohol. Addictive Behaviors, 12, 345–356.

49.

Nolen-Hoeksema

(2004). Gender differences in risk factors and consequences for alcohol use and problems. Clinical Psychology Review, 24, 981–1010. doi:10.1016/j.cpr.2004.08.003

50.

Nurmi

J.-E.

(1993). Adolescent development in an age-graded context: The role of personal beliefs, goals, and strategies in the tackling of developmental tasks and standards. International Journal of Behavioral Development, 16, 169–189. doi:10.1177/016502549301600205

51.

Patterson

G. R.

Yoerger

(1997). A developmental model for late-onset delinquency. In Osgood

D. W.

(Ed.), Motivation and delinquency (pp. 119–177). Lincoln: University of Nebraska Press.

52.

Plomin

DeFries

J. C.

Loehlin

J. C.

(1977). Genotype-environment interaction and correlation in the analysis of human behavior. Psychological Bulletin, 84, 309–322.

53.

Raudenbush

S. W.

Bryk

A. S.

(2002). Hierarchical linear models: Applications and data analysis methods. Angeles, CA: Sage.

54.

Rehm

Mathers

Popova

Thavorncharoensap

Teerawattananon

Patra

(2009). Global burden of disease and injury and economic cost attributable to alcohol use and alcohol-use disorders. Lancet, 373, 2223–2233. doi:10.1016/S0140-6736(09)60746-7

55.

Robins

Wing

Wittchen

Helzer

Babor

Burke

… Towle

(1988). The composite international diagnostic interview—An epidemiologic instrument suitable for use in conjunction with different diagnostic systems and in different cultures. Archives of General Psychiatry, 45, 1069–1077.

56.

Rutledge

Sher

(2001). Heavy drinking from the freshman year into early young adulthood: The roles of stress, tension-reduction drinking motives, gender and personality. Journal of Studies on Alcohol, 62, 457–466.

57.

Scarr

McCartney

(1983). How people make their own environments: A theory of genotype (leading to) environment effects. Child Development, 54, 424–435. doi:10.2307/1129703

58.

Schulenberg

Maggs

J. L.

(2002). A developmental perspective on alcohol use and heavy drinking during adolescence and the transition to young adulthood. Journal of Studies on Alcohol and Drugs, 14, 54–70. Retrieved from http://www.jsad.com.proxy.lib.umich.edu/doi/pdf/10.15288/jsas.2002.s14.54

59.

Schulenberg

O’Malley

P. M.

Bachman

J. G.

Johnston

L. D.

(2000). “Spread your wings and fly”: The course of well-being and substance use during the transition to young adulthood. In Crockett

L. J.

Silbereisen

R. K.

(Eds.), Negotiating adolescence in times of social change (pp. 224–255). New York, NY: Cambridge University Press.

60.

Sherrod

L. R.

Haggerty

R. J.

Featherman

D. L.

(1993). Introduction: Late adolescence and the transition to adulthood. Journal of Research on Adolescence, 217–226. doi:10.1111/1532-7795.ep11301463

61.

Stockwell

McLeod

Stevens

Phillips

Webb

Jelinek

(2002). Alcohol consumption, setting, gender and activity as predictors of injury: A population-based case-control study. Journal of Studies on Alcohol, 63, 372–379.

62.

Wilsnack

S. C.

Wilsnack

R. W.

Kantor

L. W.

(2013). Focus on: Women and the costs of alcohol use. Alcohol Research: Current Reviews, 35, 219–228. doi:10.1016/j.drugalcdep.2014.12.016

63.

Windle

Scheidt

D. M.

(2004). Alcoholic subtypes: Are two sufficient? Addiction, 99, 1508–1519. doi:10.1111/j.1360-0443.2004.00878.x

64.

World Health Organization. Dept. of Substance. (2004). Global status report on alcohol. Retrieved from http://www.who.int/iris/handle/10665/42971

65.

Zucker

R. A.

(1994). Pathways to alcohol problems and alcoholism: A developmental account of the evidence for multiple alcoholisms and for contextual contributions to risk. In Zucker

R. A.

Boyd

G. M.

Howard

(Eds.), The developmental of alcohol problems: Exploring the biopsychosocial matrix of risk (pp. 255–289). NIAAA Research Monograph 26. Department of Health and Human Services.