Abstract
Background
The CohRTA multicenter study aims to characterize patients undergoing a first treatment for alcohol use disorder (AUD). The objective is to analyze sex-specific differences in the comorbidity of AUD when starting the first treatment for the disorder.
Methods
A multicenter study was carried out between 2014 and 2021 in 6 public centers in Spain. Sociodemographic characteristics were collected, variables related to alcohol consumption, medical comorbidity according to Cumulative Illness Rating Scale-Substance Abuse (CIRS-SA), antecedent of psychiatric comorbidity, general blood test and screening for drugs in urine. Logistic regression models were used to establish associations.
Results
A total of 896 patients (634 M, 262 W) were included. Median age at admission was 48 years [IQR:41–56 years]. Men reported beginning regular alcohol consumption at an earlier age and drank more alcohol. The most frequent medical comorbidities were hepatic, respiratory, vascular and neurological. The median number of affected systems was three, with no differences between men and women. However, depressive disorder was more frequent in women. In the multivariate analysis, women were up to 4 times more likely to have a major depressive disorder, elevated ESR and elevated total cholesterol than men. Men started alcohol consumption earlier, had a higher body mass index (BMI), a higher probability of using cocaine and a higher frequency of GGT and bilirubin alteration than women.
Conclusion
Differences by sex were found among individuals beginning first treatment for AUD. These differences must be taken into account when designing specific therapeutic strategies for men and women.
Similar content being viewed by others
Avoid common mistakes on your manuscript.
Alcohol use disorder (AUD) is a disease characterized by the problematic use of alcohol. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the disorder is diagnosed when two or more criteria are presented out of eleven that are evaluated, including the amount of alcohol ingested and the appearance of withdrawal symptoms when discontinuing consumption. AUD is considered severe if six or more diagnostic criteria are detected (APA, 2013).
The prevalence of AUD in the Western world is high, affecting 12% of the European adult population. In 2016, alcohol consumption was responsible for 3% and 8% of mortality in women and men, respectively (WHO, 2018).
The prevalence of alcohol consumption and amount has historically been higher in men than in women (Slade et al., 2016). However, these differences have been narrowing in recent years (Slade et al., 2016; White, 2020). The frequency and amount of consumption is increasing among women, while in men, these patterns remain stable (Grucza et al., 2018). In adolescents, the pattern of binge drinking has declined more rapidly in men than in women, causing sex differences to narrow and even reverse (Johnston et al., 2016).
In the older population, an increase in the prevalence of alcohol consumption and in the binge drinking pattern is described, especially among women (Han et al., 2017). However, men over 50 years of age show a higher prevalence of consumption and standard drink units per day, although with geographic variations among the 21 countries analyzed (Calvo et al., 2020).
There are sex-specific differences in the risk factors for develo** AUD, as well as in the medical and psychiatric comorbidity of individuals who are dependent or abuse alcohol (Erol & Karpyak, 2015). For example, in women, anxiety disorder, childhood trauma and disturbances in mood or emotions (internalizing symptoms) have been described as risk factors (Guinle & Sinha, 2020; McHugh & Weiss, 2019). In men, develo** AUD has been linked to novelty seeking, conduct disorder, parental loss and low self-esteem (Kendler et al., 2015).
In relation to the medical comorbidities associated with AUD, a greater vulnerability to the neurotoxic effects of ethanol, liver disease, cardiovascular disease, breast cancer, infertility and early menopause has been reported (Nolen-Hoeksema, 2004). Psychiatric comorbidities such as major depression, dysthymia and anxiety disorders occur more frequently in women, while in men, antisocial personality disorder is more frequent (Boykoff et al., 2010; Kendler et al., 2015; McHugh & Weiss, 2019; Nolen-Hoeksema, 2004). In addition, depressive symptoms seem to be associated with relapses in alcohol consumption, mainly in women (Schutte et al., 1997).
The increase in the frequency and quantity of alcohol consumption among women could be reflected in the increasing morbidity and mortality of this population. In this sense, an increase in the number of visits to the emergency room and in alcohol-related mortality has been described (White et al., 2018, 2020).
It has been suggested that sex differences should be considered in the design of specific therapeutic interventions for AUD (Greenfield et al., 2007). However, a sufficient number of patients is needed to establish differential aspects of the disorder and the severity of medical and psychiatric complications (Agabio et al., 2017).
The CohRTA multicenter study has as its main objective to characterize AUD in men and women in Spain as they begin their first treatment for the disorder (Sanvisens et al., 2021). We aimed to analyze sex differences in the context of sociodemographic, clinical and disease burden aspects to better understand different treatment interventions in this population.
Material and Methods
Participants and Methods
From January 2014 to March 2021, 896 patients who began their first treatment for AUD in six public centers of the Spanish health system affiliated with the CohRTA study were enrolled. The centers were Hospital Son Espases (Palma de Mallorca), Hospital Clinic (Barcelona), Hospital del Mar (Barcelona), Hospital 12 de Octubre (Madrid), Hospital Universitari Germans Trias i Pujol (Badalona) and Hospital Universitari de Bellvitge (Hospitalet de Llobregat).
The study was approved by the Clinical Research Ethics Committee (CEIC) of the coordinating center (Hospital Universitari Germans Trias i Pujol) and by the CEIC of each participating center. The patients signed an informed consent form that included the transfer of clinical data and biological samples. The methods used in this study have complied with the ethical standards for medical research, the principles of good clinical practice established by the Declaration of Helsinki, and Organic Law 3/2018 on Data Protection and Guarantee of Digital Rights (LOPD-GDR) and Law 14/2007 on Biomedical Research.
The diagnosis of AUD was made according to DSM-5 criteria (APA, 2013), and the patients followed the same clinical protocol in all participating centers. The CohRTA multicenter study has a database with 1) sociodemographic variables (i.e., age, sex, employment status, educational level, marital status); 2) alcohol consumption questionnaire: age at first alcohol exposure, age of onset of regular alcohol consumption (i.e. weekly drinking), duration of regular alcohol consumption (i.e. elapsed time between age of onset of regular alcohol consumption, and age at admission to treatment), amount of alcohol consumption (last 30 days) in Standard Drinks per day (SD/day), and number of alcohol intoxications (lifetime); 3) use of other substances (i.e., cocaine); 4) Cumulative Illness Rating Scale-Substance Abuse (CIRS-SA), which assesses the involvement of organs and systems and the severity of comorbidity; 5) psychiatric comorbidity; and 6) laboratory parameters with hemogram, biochemistry, viral serologies and screening for drugs of abuse in urine when entering the study.
The CIRS-SA scale is validated in the Spanish population (Castillo et al., 2004; Rivas et al., 2013) and analyzes comorbidities in the following organs/systems: (i) heart; (ii) vascular and hematopoietic; (iii) respiratory; (iv) eyes, ears, nose; (v) throat and larynx; (vi) gastrointestinal tract; (vii) liver, including hepatitis B and C viruses; (viii) renal; (ix) genitourinary; (x) musculoskeletal; (xi) neurological; (xii) endocrinology, breast and infectious diseases; and (xiii) HIV infection. Each category receives a score between 0 and 4 according to the severity of the illness, with 0 being the absence of comorbidity and 4 being a very severe manifestation. In addition, CIR-SA generates three indicators: (a) total score (range from 0 to 54), (b) number of organs or systems affected (range from 0 to 13) and (c) severity index (total score divided by the number of organs or systems affected).
Antecedent of psychiatric comorbidity might be established following a review of the medical records to obtain diagnoses from specialists in Psychiatry: major depression, psychosis, attention and hyperactivity disorder, posttraumatic stress disorder, generalized anxiety disorder, panic disorder, social phobia and mania.
Upon entry into the study, blood samples were obtained for hematological parameters (i.e., hemogram), liver function (i.e., aspartate aminotransferase (AST), alanine aminotransferase (ALT), gamma-glutamyl transferase (GGT) and acute phase reactants, such as erythrocyte sedimentation rate (ESR). Serologies were performed to detect antibodies against HIV, HCV and HBV. In addition, a urine drug screen was carried out.
Statistical analysis
Categorical variables are expressed as relative frequencies, and continuous variables are expressed as the median and interquartile range (IQR). Sex differences in categorical variables were determined using Fisher's exact test or the chi-square test. Mann‒Whitney U test was applied as a nonparametric test for continuous variables.
A logistic regression model was used to analyze sex differences, with men being the reference category. For the regression model, some variables with various categories were dichotomized (i.e., oropharynx and larynx). The multivariate analysis included those variables that were statistically significant in the univariate analysis; specifically, laboratory parameters were included in the model when statistically significant globally and pathologically. Results with a p value < 0.05 were considered statistically significant. Statistical analyses were performed with IBM SPSS Statistics version 22 (IBM, Armonk, NY, USA).
Results
A total of 896 patients (634 men) were included in the study. The age at the first treatment (median [IQR]: 48 years [41–56]) was similar in men and women. However, statistically significant differences (p < 0.001) were observed in work and family situations: women were more dedicated to household chores (5.9% vs. 0.2%), they had a lower prevalence of disability (13% vs. 19.7%) and they were divorced more frequently (36.8% vs. 30.6%), while men tended to be single (36.8% vs. 24%).
Regarding educational level, 21% of the men and 13% of the women had a primary school education; 56% of both genders had secondary education, and women had a higher frequency of university studies than men (25.3% vs. 16.3%, respectively) (p = 0.002).
Alcohol consumption
Table 1 shows the characteristics of alcohol consumption. Men started drinking, on average, one year earlier than women (median [IQR]: 15 [13–17] years vs. 16 [14–18] years; p = 0.002) and tended to consume alcohol regularly from an earlier age (median [IQR]: 20 [17–26] years vs. 26 [20–37] years; p < 0.001). In addition, men consumed a greater amount of alcohol than women (median [IQR]: 15 [10–24] SU/day vs. 12 [8–20] SU/day; p < 0.001).
In addition, a family history of AUD was more frequent among women (p = 0.004), and in relation to the consumption of other substances, men showed a higher prevalence of cocaine use than women (p = 0.003).
Medical comorbidity
Table 2 shows the sex differences in baseline medical comorbidities. Overall, the most frequent organ or system involvement was the liver (73%), followed by respiratory (55%) and vascular (52%) systems. Compared with women, men showed a higher prevalence of severe or very severe medical comorbidities in most organs or systems, although statistically significant differences were observed only in oropharynx and larynx (p < 0.05). In addition, the severity index score of the CIRS-SA scale was higher for men (p < 0.05).
Psychiatric comorbidity
Table 3 shows the prevalence of psychiatric comorbidities. The most frequent disorders were major depression (MDD) (24.0%), generalized anxiety (6.1%) and psychotic disorder (2.5%). The prevalence of MDD was significantly higher in women than in men (46.7% vs. 22.0%, p < 0.001).
Anthropometric and blood parameters
The BMI and general laboratory parameters are described in Table 4. Men had a higher BMI than women (25.6 vs. 24.0 kg/m2, p < 0.001). Men also showed a higher median leukocyte count and hemoglobin level than women (p = 0.018 and p < 0.001, respectively), while women showed a higher frequency of mean corpuscular volume (MCV) > 95 fl (p < 0.001), and ESR > 20 mm (p = 0.001) than men.
In relation to biochemistry markers, women showed higher total cholesterol levels (p < 0.001). However, men had higher concentrations of triglycerides (p = 0.001), basal glucose (p < 0.001), creatinine (p < 0.001), AST (p = 0.027), and ALT (p = 0.004), as well as higher prevalence of albumin < 35 g/L (p = 0.007), total bilirubin > 1.2 mg/dL (p = 0.003), and GGT > 55 U/L (p < 0.001).
Sex-specific associations
Multivariate analysis (described in Table 5) showed that the diagnosis of MDD was four times more likely in women than men (OR = 4,29, 95% CI: 2,57–7,16), as was elevated ESR levels (> 20 mm) (OR = 2,55, 95% CI: 1,54–4,22) and total cholesterol (> 200 mg/dL) (OR = 1,61, 95% CI: 0.99–2.58).
Age of onset of alcohol consumption (OR = 0.94, 95% CI = 0.90–0.99), BMI > 25 kg/m2 (OR = 0.56, 95% CI: 0.35–0.89), cocaine use (OR = 0.11, 95% CI = 0.03–0.46), elevated levels of total bilirubin (> 1.2 mg/dL) (OR = 0.47, 95% CI = 0.24–0.94) and GGT > 55 U/L (OR = 0.54, 95% CI = 0.33–0.88) were more likely in men than in women.
Discussion
The results of this study show sex differences when starting the first treatment for AUD. Men and women begin their first treatment at a similar age, although women report fewer years of regular alcohol consumption. Although women would be less likely to seek treatment for AUD (Agabio et al., 2017), these results indicate that when they do it for the first time, they have been exposed to excessive alcohol consumption for fewer years.
If women show less time of excessive alcohol use, the expected comorbidity could be less than that of men. However, in our results the expected comorbidity is similar for both sexes in most organs or systems; previous studies show a greater vulnerability of women to the harmful effects of alcohol after fewer years of excessive alcohol use in comparison with men (Mumenthaler et al., 1999; Randall et al., 1999).
The global medical comorbidity according to CIRS-SA is mild or moderate for both men and women; however, a high prevalence of hepatic, respiratory, vascular and neurological affectation is shown at the beginning of treatment, which suggests the need for treatment as secondary prevention to the progression of the comorbidity. The literature includes liver diseases as the most frequent complication and the first cause of death in these patients (Timko et al., 2006). Further, preclinical and clinical studies show that women are more susceptible to liver damage caused by alcohol (Alharshawi et al., 2021; Fulham & Mandrekar, 2016).
Our results also show sex differences in laboratory parameters. Specifically, elevated levels of ESR and total cholesterol are more prevalent in women with AUD. The ESR rate is a marker of systemic inflammation that tends to be more frequently altered in women and to increase with age (Alende-Castro et al., 2019; Ernst et al., 2010). Although we have not found any studies that show sex differences in total cholesterol levels associated with AUD, there is evidence that chronic alcohol consumption alters the synthesis of hepatic cholesterol (Charlet & Heinz, 2017; Rosoff et al., 2020).
On the other hand, this study shows that men are more likely to have elevated levels of GGT and total bilirubin. GGT, in addition to being an indicator of alcohol consumption, is a marker associated with diabetes mellitus, metabolic syndrome, arteriosclerosis and cardiovascular diseases (Hernández-Rubio et al., 2022; Lu et al., 2020; Ndrepepa et al., 2018). According to our results, the literature shows differences between the sexes in the study of GGT as a biomarker of hepatic steatosis with high GGT activity as a predictor of an increase in mortality among men (Haring et al., 2009).
It is noteworthy that when starting the first treatment for AUD, men are more likely to be overweight/obese than women. In contrast, a study published in 2011 showed that women were almost five times more likely to be obese grade II (BMI > 30 kg/m2) than men (Sanvisens et al., 2011). It is possible that differences in study design and patient selection may have influenced the findings. In any case, BMI has been poorly described in patients requesting treatment for AUD and suggests the need to analyze the impact of alcohol consumption on overweight and obesity.
Another interesting piece of information from the results of this study is that almost 70% of the women had a family history of AUD, which was more frequent than in men. There is literature that relates a family history of alcohol dependence with an increased risk of develo** an AUD, as well as develo** depressive and anxiety disorders (Hill et al., 2001; Sjoerds et al., 2013).
Men in our study showed a higher prevalence of cocaine use than women. Epidemiological studies have described that substance use disorders are between 3 and 5 times more common in men than in women, although the sex difference in the consumption of alcohol, cannabis and cocaine has been narrowing in recent years (Hecksher & Hesse, 2009).
With regard to psychiatric comorbidity, MDD was the most prevalent diagnosis in patients with AUD, being more frequent in women. This result is consistent with previous studies suggesting that emotional states have a gender-specific impact, based on the evidence of high rates of depressive comorbidity and anxiety disorders among patients in treatment for AUD, especially women (Hasin et al., 2007). There are studies that indicate that women experience complex negative emotional states and psychological stress (Brady & Sinha, 2005; Fox & Sinha, 2009), while men show more substance-induced depression (Karpyak et al., 2016).
Finally, this study has several limitations that should be mentioned. First, it is a cross-sectional design that prevents conclusions about the causality of the findings. The lack of information in relation to specific hormonal situations of women (e.g., menopause, treatment with oral contraceptives) could have caused an overestimation of the frequency of certain alterations. However, the main strength of this study is that, to our knowledge, it is the largest patient cohort on the topic in which sex differences were analyzed comprehensively.
In conclusion, the present findings support the differences between the sexes as a result of the study of the clinical variables collected for the treatment of AUD. The main differences between men and women with AUD are that men present high dysregulation in liver markers (GGT and total bilirubin) and higher risk consumption patterns, while women present high prevalence of psychiatric comorbidity, inflammatory markers (ESR) and elevated cholesterol. These results provide valuable clinical information to establish improvements in therapeutic and preventive measures based on sex in a population especially vulnerable to chronicity, such as patients with AUD.
References
Agabio, R., Pisanu, C., Gessa, G. L., & Franconi, F. (2017). Sex Differences in Alcohol Use Disorder. Current Medicinal Chemistry, 24(24), 2661–2670. https://doi.org/10.2174/0929867323666161202092908
Alende-Castro, V., Alonso-Sampedro, M., Vazquez-Temprano, N., Tuñez, C., Rey, D., García-Iglesias, C., . . . Gonzalez-Quintela, A. (2019). Factors influencing erythrocyte sedimentation rate in adults: New evidence for an old test. Medicine (Baltimore), 98(34), e16816. https://doi.org/10.1097/md.0000000000016816
Alharshawi, K., Fey, H., Vogle, A., Klenk, T., Kim, M., & Aloman, C. (2021). Sex specific effect of alcohol on hepatic plasmacytoid dendritic cells. Int Immunopharmacol, 90, 107166. https://doi.org/10.1016/j.intimp.2020.107166
Boykoff, N., Schneekloth, T. D., Hall-Flavin, D., Loukianova, L., Karpyak, V. M., Stevens, S. R., . . . Frye, M. A. (2010). Gender differences in the relationship between depressive symptoms and cravings in alcoholism. Am J Addict, 19(4), 352–356. https://doi.org/10.1111/j.1521-0391.2010.00057.x
Brady, K. T., & Sinha, R. (2005). Co-occurring mental and substance use disorders: The neurobiological effects of chronic stress. American Journal of Psychiatry, 162(8), 1483–1493. https://doi.org/10.1176/appi.ajp.162.8.1483
Calvo, E., Medina, J. T., Ornstein, K. A., Staudinger, U. M., Fried, L. P., & Keyes, K. M. (2020). Cross-country and historical variation in alcohol consumption among older men and women: Leveraging recently harmonized survey data in 21 countries. Drug Alcohol Depend, 215, 108219. https://doi.org/10.1016/j.drugalcdep.2020.108219
Castillo, C., Bulbena, A., Serras, E., Torrens, M., López-Colomés, J. L., Martínez, M. A., & Politinska, B. (2004). Medical assessment in drug addicts: Reliability and validity of the Cumulative Illness Rating Scale (Substance Abuse version). European Addiction Research, 10(3), 112–117. https://doi.org/10.1159/000077699
Charlet, K., & Heinz, A. (2017). Harm reduction-a systematic review on effects of alcohol reduction on physical and mental symptoms. Addiction Biology, 22(5), 1119–1159. https://doi.org/10.1111/adb.12414
Compton, W. M., Auriacombe, M., Borges, G. L. G, Bucholz, K. K., Budney, A. J., Grant, B. F., . . . O’Brien, C. P. (2013). Substance-Related and Addictive Disorders. In S. K. Schultz & E. A. Kuhl (Eds.), Diagnostic and statistical manual of mental disorders (5th ed., pp. 490–497). American Psychiatric Association Publishing. https://doi.org/10.1176/appi.books.9780890425596
Ernst, A. A., Weiss, S. J., Tracy, L. A., & Weiss, N. R. (2010). Usefulness of CRP and ESR in predicting septic joints. Southern Medical Journal, 103(6), 522–526. https://doi.org/10.1097/SMJ.0b013e3181ddd246
Erol, A., & 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, 156, 1–13. https://doi.org/10.1016/j.drugalcdep.2015.08.023
Fox, H. C., & Sinha, R. (2009). Sex differences in drug-related stress-system changes: Implications for treatment in substance-abusing women. Harvard Review of Psychiatry, 17(2), 103–119. https://doi.org/10.1080/10673220902899680
Fulham, M. A., & Mandrekar, P. (2016). Sexual Dimorphism in Alcohol Induced Adipose Inflammation Relates to Liver Injury. PLoS One, 11(10), e0164225. https://doi.org/10.1371/journal.pone.0164225
Global status report on alcohol and health 2018. Geneva: World Health Organization; 2018. Licence: CC BY-NC-SA 3.0 IGO
Greenfield, S. F., Brooks, A. J., Gordon, S. M., Green, C. A., Kropp, F., McHugh, R. K., . . . Miele, G. M. (2007). Substance abuse treatment entry, retention, and outcome in women: a review of the literature. Drug Alcohol Depend, 86(1), 1–21. https://doi.org/10.1016/j.drugalcdep.2006.05.012
Grucza, R. A., Sher, K. J., Kerr, W. C., Krauss, M. J., Lui, C. K., McDowell, Y. E., . . . Bierut, L. J. (2018). Trends in Adult Alcohol Use and Binge Drinking in the Early 21st-Century United States: A Meta-Analysis of 6 National Survey Series. Alcohol Clin Exp Res, 42(10), 1939–1950. https://doi.org/10.1111/acer.13859
Guinle, M. I. B., & Sinha, R. (2020). The Role of Stress, Trauma, and Negative Affect in Alcohol Misuse and Alcohol Use Disorder in Women. Alcohol Res, 40(2), 05. https://doi.org/10.35946/arcr.v40.2.05
Han, B. H., Moore, A. A., Sherman, S., Keyes, K. M., & Palamar, J. J. (2017). Demographic trends of binge alcohol use and alcohol use disorders among older adults in the United States, 2005–2014. Drug and Alcohol Dependence, 170, 198–207. https://doi.org/10.1016/j.drugalcdep.2016.11.003
Haring, R., Wallaschofski, H., Nauck, M., Dörr, M., Baumeister, S. E., & Völzke, H. (2009). Ultrasonographic hepatic steatosis increases prediction of mortality risk from elevated serum gamma-glutamyl transpeptidase levels. Hepatology, 50(5), 1403–1411. https://doi.org/10.1002/hep.23135
Hasin, D. S., Stinson, F. S., Ogburn, E., & Grant, B. F. (2007). Prevalence, correlates, disability, and comorbidity of DSM-IV alcohol abuse and dependence in the United States: Results from the National Epidemiologic Survey on Alcohol and Related Conditions. Archives of General Psychiatry, 64(7), 830–842. https://doi.org/10.1001/archpsyc.64.7.830
Hecksher, D., & Hesse, M. (2009). Women and substance use disorders. Mens Sana Monogr, 7(1), 50–62. https://doi.org/10.4103/0973-1229.42585
Hernández-Rubio, A., Sanvisens, A., Bolao, F., Cachón-Suárez, I., Garcia-Martín, C., Short, A., . . . Muga, R. (2022). Prevalence and associations of metabolic syndrome in patients with alcohol use disorder. Sci Rep, 12(1), 2625. https://doi.org/10.1038/s41598-022-06010-3
Hill, S. Y., De Bellis, M. D., Keshavan, M. S., Lowers, L., Shen, S., Hall, J., & Pitts, T. (2001). Right amygdala volume in adolescent and young adult offspring from families at high risk for develo** alcoholism. Biological Psychiatry, 49(11), 894–905. https://doi.org/10.1016/s0006-3223(01)01088-5
Johnston, L. D., Miech, R. A., O’Malley, P. M., Bachman, J. G., Schulenberg, J. E., & Patrick, M. E. (2019). Demographic subgroup trends among adolescents in the use of various licit and illicit drugs, 1975–2018 (Monitoring the Future Occasional Paper No. 92). Ann Arbor, MI: Institute for Social Research, The University of Michigan. https://monitoringthefuture.org/wp-content/uploads/2021/02/mtf-occ92.pdf
Karpyak, V. M., Biernacka, J. M., Geske, J. R., Abulseoud, O. A., Brunner, M. D., Chauhan, M., . . . Mrazek, D. A. (2016). Gender-specific effects of comorbid depression and anxiety on the propensity to drink in negative emotional states. Addiction, 111(8), 1366–1375. https://doi.org/10.1111/add.13386
Kendler, K. S., Edwards, A. C., & Gardner, C. O. (2015). Sex differences in the pathways to symptoms of alcohol use disorder: A study of opposite-sex twin pairs. Alcoholism, Clinical and Experimental Research, 39(6), 998–1007. https://doi.org/10.1111/acer.12694
Lu, G. H., Gong, S. G., Li, C., Zhao, Q. H., Jiang, R., Luo, C. J., . . . Zhang, R. (2020). Prognostic Value of Gamma-Glutamyltransferase in Male Patients With Idiopathic Pulmonary Arterial Hypertension. Front Cardiovasc Med, 7, 580908. https://doi.org/10.3389/fcvm.2020.580908
McHugh, R. K., & Weiss, R. D. (2019). Alcohol Use Disorder and Depressive Disorders. Alcohol Res, 40(1). https://doi.org/10.35946/arcr.v40.1.01
Mumenthaler, M. S., Taylor, J. L., O’Hara, R., & Yesavage, J. A. (1999). Gender differences in moderate drinking effects. Alcohol Research & Health, 23(1), 55–64.
Ndrepepa, G., Colleran, R., & Kastrati, A. (2018). Gamma-glutamyl transferase and the risk of atherosclerosis and coronary heart disease. Clinica Chimica Acta, 476, 130–138. https://doi.org/10.1016/j.cca.2017.11.026
Nolen-Hoeksema, S. (2004). Gender differences in risk factors and consequences for alcohol use and problems. Clinical Psychology Review, 24(8), 981–1010. https://doi.org/10.1016/j.cpr.2004.08.003
Randall, C. L., Roberts, J. S., Del Boca, F. K., Carroll, K. M., Connors, G. J., & Mattson, M. E. (1999). Telesco** of landmark events associated with drinking: a gender comparison. J Stud Alcohol, 60(2), 252–260. https://doi.org/10.15288/jsa.1999.60.252
Rivas, I., Sanvisens, A., Bolao, F., Fuster, D., Tor, J., Pujol, R., . . . Muga, R. (2013). Impact of medical comorbidity and risk of death in 680 patients with alcohol use disorders. Alcohol Clin Exp Res, 37 Suppl 1, E221–227. https://doi.org/10.1111/j.1530-0277.2012.01861.x
Rosoff, D. B., Charlet, K., Jung, J., Lee, J., Muench, C., Luo, A., . . . Lohoff, F. W. (2020). Lipid profile dysregulation predicts alcohol withdrawal symptom severity in individuals with alcohol use disorder. Alcohol, 86, 93–101. https://doi.org/10.1016/j.alcohol.2020.02.164
Sanvisens, A., Rivas, I., Bolao, F., Tor, J., Rosón, B., Rey-Joly, C., & Muga, R. (2011). Gender and liver, nutritional and metabolic alterations of severe alcoholism: A study of 480 patients. Medicina Clínica (barcelona), 137(2), 49–54. https://doi.org/10.1016/j.medcli.2010.11.030. Géneroyalteracioneshepáticas,nutricionalesymetabólicasdelalcoholismograve:estudiode480pacientes.
Sanvisens, A., Zuluaga, P., Short, A., Rubio, G., Gual, A., Torrens, M., . . . Muga, R. (2021). Sex-specific Associations of Alcohol Withdrawal in Patients Admitted for the Treatment of Alcohol Use Disorder. J Addict Med, 15(1), 68–73. https://doi.org/10.1097/adm.0000000000000704
Schutte, K. K., Hearst, J., & Moos, R. H. (1997). Gender differences in the relations between depressive symptoms and drinking behavior among problem drinkers: A three-wave study. Journal of Consulting and Clinical Psychology, 65(3), 392–404. https://doi.org/10.1037//0022-006x.65.3.392
Sjoerds, Z., van Tol, M. J., van den Brink, W., van der Wee, N. J., Aleman, A., Beekman, A. T., . . . Veltman, D. J. (2013). Family history of alcohol dependence modulates functional neurophysiology in mood/anxiety disorders. Psychol Med, 43(7), 1487–1497. https://doi.org/10.1017/s003329171200222x
Slade, T., Chapman, C., Swift, W., Keyes, K., Tonks, Z., & Teesson, M. (2016). Birth cohort trends in the global epidemiology of alcohol use and alcohol-related harms in men and women: systematic review and metaregression. BMJ Open, 6(10), e011827. https://doi.org/10.1136/bmjopen-2016-011827
Timko, C., Debenedetti, A., Moos, B. S., & Moos, R. H. (2006). Predictors of 16-year mortality among individuals initiating help-seeking for an alcoholic use disorder. Alcoholism, Clinical and Experimental Research, 30(10), 1711–1720. https://doi.org/10.1111/j.1530-0277.2006.00206.x
White, A. M. (2020). Gender Differences in the Epidemiology of Alcohol Use and Related Harms in the United States. Alcohol Res, 40(2), 01. https://doi.org/10.35946/arcr.v40.2.01
White, A. M., Castle, I. P., Hingson, R. W., & Powell, P. A. (2020). Using Death Certificates to Explore Changes in Alcohol-Related Mortality in the United States, 1999 to 2017. Alcoholism, Clinical and Experimental Research, 44(1), 178–187. https://doi.org/10.1111/acer.14239
White, A. M., Slater, M. E., Ng, G., Hingson, R., & Breslow, R. (2018). Trends in Alcohol-Related Emergency Department Visits in the United States: Results from the Nationwide Emergency Department Sample, 2006 to 2014. Alcoholism, Clinical and Experimental Research, 42(2), 352–359. https://doi.org/10.1111/acer.13559
Funding
Open Access Funding provided by Universitat Autonoma de Barcelona.
Author information
Authors and Affiliations
Consortia
Corresponding author
Ethics declarations
Informed Consent
Yes.
Human Rights
Yes.
Conflict of Interest
None.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Appendix
Appendix
CohRTA Study. Spanish Network on Addictive Disorders, Alcohol Program.
Coordinating Center: Department of Internal Medicine. Hospital Universitari Germans Trias i Pujol, Badalona, Spain.
CohRTA centers and researchers as of February 1, 2022: Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol/IGTP, Badalona, Spain: Arantza Sanvisens, Paola Zuluaga, Daniel Fuster, Anna Hernández-Rubio, Magí Farré, Esther Papasseit, Clara Pérez-Mañá, Lourdes Poyatos, Nuria García-Marchena, Enric Abellí-Deulofeu, Robert Muga. Department of Psychiatry, Alcohol Unit, Hospital Universitari Son Espases/IdISPa, Palma de Mallorca, Spain: Catalina Moranta, Rafael Blanes. Department of Psychiatry, Hospital Universitario 12 de Octubre, i + 12, Madrid, Spain: Gabriel Rubio, Ana Sion. Department of Psychiatry, Hospital Clínic de Barcelona/IDIBAPS, Barcelona, Spain: Laia Miquel, Lluisa Ortega, Pol Bruguera, Elsa Caballeria, Ana Messeguer. Department of Neuropsychiatry and Addictions, Parc de Salut Mar/IMIM, Barcelona, Spain: Marta Torrens, Francina Fonseca, Joan Ignasi Mestre-Pinto, María Alías, Fernando Dinamarca. Department of Internal Medicine, Hospital Universitari de Bellvitge/IDIBELL, L’Hospitalet de Llobregat, Spain: Ferran Bolao. Biomedical Research Institut/IBIMA, Málaga, Spain: Fernando Rodríguez-Fonseca, Francisco Javier Pavón-Morón. Department of Internal Medicine, Hospital Universitario de Salamanca/IBSAL, Salamanca, Spain: Miguel Marcos. Department of Internal Medicine, Hospital Universitario de Canarias/HUGCDN, Santa Cruz de Tenerife, Spain: Candelaria Martín, Onán Pérez-Hernández.
CohRTA Biobank: Department of Neurosciences, Miguel Hernández University, San Juan de Alicante, Spain: Jorge Manzanares, Francisco Navarrete, Ani Gasparyan.
Rights and permissions
Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
About this article
Cite this article
García-Marchena, N., Sanvisens, A., Abellí-Deulofeu, E. et al. Sex differences in the comorbidity of patients seeking a first treatment for Alcohol Use Disorder. Int J Ment Health Addiction (2023). https://doi.org/10.1007/s11469-023-01112-z
Accepted:
Published:
DOI: https://doi.org/10.1007/s11469-023-01112-z