Sex and Gender Differences in Co-Occurring Alcohol Use Disorder and PTSD

Overview

Journal Curr Addict Rep

Date 2024 Jul 19

PMID 39026610

Authors

Tanya C Saraiya

Sudie E Back

Amber M Jarnecke

Shannon M Blakey

Alexandria G Bauer

Delisa G Brown

Lesia M Ruglass

Therese Killeen

Denise A Hien

Affiliations

Soon will be listed here.

Abstract

Purpose Of Review: Research demonstrates a strong association between alcohol use disorder (AUD) and posttraumatic stress disorder (PTSD). However, less is known about sex- and gender-based differences among individuals with AUD + PTSD. This narrative review examines recent literature in this area and aims to be a reference for future research endeavors.

Recent Findings: Extant literature shows that intertwining biological systems increase females' risk of developing PTSD and experiencing more adverse effects from AUD compared to males. Sex-based physiological differences further interact with gendered sociocultural environments to influence the risk of AUD + PTSD. Emerging research suggests potential gender-specific pathways between PTSD, coping, and AUD which may inform prevention and treatment. However, barriers to care are often gender-specific and tailored approaches are needed to improve reach and uptake.

Summary: Additional research is needed to examine intersectional and contextual factors that synergistically influence sex/gender differences in AUD + PTSD, particularly beyond cisgender identities, and mechanisms of action.

References

Agterberg S, Schubert N, Overington L, Corace K . Treatment barriers among individuals with co-occurring substance use and mental health problems: Examining gender differences. J Subst Abuse Treat. 2020; 112:29-35. DOI: 10.1016/j.jsat.2020.01.005. View

Kessler R, Crum R, Warner L, Nelson C, Schulenberg J, Anthony J . Lifetime co-occurrence of DSM-III-R alcohol abuse and dependence with other psychiatric disorders in the National Comorbidity Survey. Arch Gen Psychiatry. 1997; 54(4):313-21. DOI: 10.1001/archpsyc.1997.01830160031005. View

Kessler R, Sonnega A, Bromet E, Hughes M, Nelson C . Posttraumatic stress disorder in the National Comorbidity Survey. Arch Gen Psychiatry. 1995; 52(12):1048-60. DOI: 10.1001/archpsyc.1995.03950240066012. View

Simpson T, Lehavot K, Petrakis I . No Wrong Doors: Findings from a Critical Review of Behavioral Randomized Clinical Trials for Individuals with Co-Occurring Alcohol/Drug Problems and Posttraumatic Stress Disorder. Alcohol Clin Exp Res. 2017; 41(4):681-702. DOI: 10.1111/acer.13325. View

McCrady B, Epstein E, Fokas K . Treatment Interventions for Women With Alcohol Use Disorder. Alcohol Res. 2020; 40(2):08. PMC: 7384374. DOI: 10.35946/arcr.v40.2.08. View

Shaw G, Bent M, Council K, Pais A, Amstadter A, Wolstenholme J . Chronic repeated predatory stress induces resistance to quinine adulteration of ethanol in male mice. Behav Brain Res. 2020; 382:112500. PMC: 7035990. DOI: 10.1016/j.bbr.2020.112500. View

Flores-Bonilla A, Richardson H . Sex Differences in the Neurobiology of Alcohol Use Disorder. Alcohol Res. 2020; 40(2):04. PMC: 7532022. DOI: 10.35946/arcr.v40.2.04. View

Bountress K, Brick L, Sheerin C, Grotzinger A, Bustamante D, Hawn S . Alcohol use and alcohol use disorder differ in their genetic relationships with PTSD: A genomic structural equation modelling approach. Drug Alcohol Depend. 2022; 234:109430. PMC: 9018560. DOI: 10.1016/j.drugalcdep.2022.109430. View

Evans-Polce R, Kcomt L, Veliz P, Boyd C, McCabe S . Alcohol, Tobacco, and Comorbid Psychiatric Disorders and Associations With Sexual Identity and Stress-Related Correlates. Am J Psychiatry. 2020; 177(11):1073-1081. PMC: 7606786. DOI: 10.1176/appi.ajp.2020.20010005. View

10.

Keyes K, Jager J, Mal-Sarkar T, Patrick M, Rutherford C, Hasin D . Is There a Recent Epidemic of Women's Drinking? A Critical Review of National Studies. Alcohol Clin Exp Res. 2019; 43(7):1344-1359. PMC: 6602861. DOI: 10.1111/acer.14082. View

11.

Valentine S, Marques L, Wang Y, Ahles E, De Silva L, Alegria M . Gender differences in exposure to potentially traumatic events and diagnosis of posttraumatic stress disorder (PTSD) by racial and ethnic group. Gen Hosp Psychiatry. 2019; 61:60-68. PMC: 6870874. DOI: 10.1016/j.genhosppsych.2019.10.008. View

12.

Sugarman D, Meyer L, Reilly M, Greenfield S . Women's and men's experiences in group therapy for substance use disorders: A qualitative analysis. Am J Addict. 2021; 31(1):9-21. PMC: 8799487. DOI: 10.1111/ajad.13242. View

13.

Greenfield S, Sugarman D, Freid C, Bailey G, Crisafulli M, Kaufman J . Group therapy for women with substance use disorders: results from the Women's Recovery Group Study. Drug Alcohol Depend. 2014; 142:245-53. PMC: 4150678. DOI: 10.1016/j.drugalcdep.2014.06.035. View

14.

Peltier M, Roberts W, Verplaetse T, Zakiniaeiz Y, Burke C, Moore K . Sex Differences across Retrospective Transitions in Posttraumatic Stress and Substance Use Disorders. J Dual Diagn. 2021; 18(1):11-20. PMC: 9086923. DOI: 10.1080/15504263.2021.2016027. View

15.

Ralevski E, Olivera-Figueroa L, Petrakis I . PTSD and comorbid AUD: a review of pharmacological and alternative treatment options. Subst Abuse Rehabil. 2014; 5:25-36. PMC: 3953034. DOI: 10.2147/SAR.S37399. View

16.

Johnstone S, Dela Cruz G, Kalb N, Tyagi S, Potenza M, George T . A systematic review of gender-responsive and integrated substance use disorder treatment programs for women with co-occurring disorders. Am J Drug Alcohol Abuse. 2022; 49(1):21-42. DOI: 10.1080/00952990.2022.2130348. View

17.

Pratchett L, Pelcovitz M, Yehuda R . Trauma and violence: are women the weaker sex?. Psychiatr Clin North Am. 2010; 33(2):465-74. DOI: 10.1016/j.psc.2010.01.010. View

18.

Heck A, Handa R . Sex differences in the hypothalamic-pituitary-adrenal axis' response to stress: an important role for gonadal hormones. Neuropsychopharmacology. 2018; 44(1):45-58. PMC: 6235871. DOI: 10.1038/s41386-018-0167-9. View

19.

Zlotnick C, Johnson J, Najavits L . Randomized controlled pilot study of cognitive-behavioral therapy in a sample of incarcerated women with substance use disorder and PTSD. Behav Ther. 2009; 40(4):325-36. PMC: 3031094. DOI: 10.1016/j.beth.2008.09.004. View

20.

Perez-Dandieu B, Tapia G . Treating Trauma in Addiction with EMDR: A Pilot Study. J Psychoactive Drugs. 2014; 46(4):303-9. DOI: 10.1080/02791072.2014.921744. View