At the 2023 Annual Psychiatric Times™ World CME Conference, Dr. Barbara J. Mason, Director of the Pearson Center for Alcohol and Addiction Research and the National Institute on Alcohol Abuse and Alcoholism (NIAAA) P60 Alcohol Research Center of Excellence, delved into the evolving landscape of alcohol misuse, emphasizing its growing relevance in women’s health.
Dr. Mason highlighted the shifting dynamics of alcohol misuse, noting that it was previously considered primarily a disorder affecting men. However, recent epidemiological surveys have revealed a narrowing gender gap in alcohol consumption and its associated harms, making alcohol misuse an increasingly critical concern for women’s well-being.
She began by exploring the parallels and distinctions between men and women regarding alcohol use and its repercussions. Dr. Mason underscored that the gender divide has diminished across various aspects, including the prevalence and frequency of drinking, binge drinking, total alcohol consumption, early-onset drinking, drunk driving, alcohol-induced cirrhosis, emergency department visits, hospitalizations, fatalities, and the prevalence of alcohol use disorder (AUD).
Furthermore, Dr. Mason pointed out that women are less likely than men to seek treatment for AUD. Paradoxically, they are more susceptible to a range of alcohol-related harms even at comparable alcohol intake levels. These harms encompass hangovers, blackouts, liver disease, brain atrophy, cognitive deficits, cardiomyopathy, accelerated AUD progression, and specific cancers.
Among the identified health risks, breast cancer stands out. Dr. Mason cited a study indicating that breast cancer risk increases by 1.04-fold for light drinkers, 1.23-fold for moderate drinkers, and 1.6-fold for heavy drinkers.
Dr. Mason also delved into the potential gender-based disparities in the motivations behind alcohol consumption. She observed that, generally, women are more inclined to drink for negative reinforcement, such as stress reduction and mood improvement. In contrast, men tend to lean toward positive reinforcement, seeking stimulation and enhanced mood through alcohol.
Notably, Dr. Mason acknowledged that these motivations, rooted in neurobiological distinctions, may exhibit some overlap. Some women may predominantly drink for positive reinforcement, while some men may consume alcohol to alleviate negative emotions.
The session also addressed how these gender-based neurobiological differences might influence responses to pharmacotherapy for AUD. Dr. Mason examined recent research on the efficacy and safety of two FDA-approved drugs for AUD: naltrexone and acamprosate.
Notably, studies on naltrexone indicated limited effectiveness in women, warranting further investigation of its efficacy in this demographic. Conversely, recent research on acamprosate demonstrated equivalent efficacy and safety profiles in both men and women.
Dr. Mason underscored the significance of comprehending the gender disparities in alcohol misuse and offered two hypotheses:
1. Women may have a greater motivation to consume alcohol for emotional relief, making them potentially more responsive to pharmacotherapies that restore brain stress system homeostasis (e.g., acamprosate, gabapentin).
2. Alcohol may trigger the reward system to a greater extent in men, resulting in positive reinforcement. This suggests that men may be more responsive to pharmacotherapies that block the reward system (e.g., naltrexone).
The evolving landscape of alcohol misuse underscores the importance of tailored approaches to address its impact on women’s health. Dr. Mason’s insights shed light on the need for further research and targeted interventions in this evolving field.
