Skip to main content
SpringerLink
Log in

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

  • Published:
Current Addiction Reports Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Torchalla I, Nosen E. Sex and gender differences in PTSD and substance use disorder comorbidity; 2019. p. 51–71. https://doi.org/10.4324/9781315442648-4

    Book  Google Scholar 

  2. Bauer EP. Sex differences in fear responses: Neural circuits. Neuropharmacology. 2023;222:109298.

    CAS  PubMed  Google Scholar 

  3. Hilderbrand ER, Lasek AW. Studying Sex Differences in Animal Models of Addiction: An Emphasis on Alcohol-Related Behaviors. ACS Chem Neurosci. 2018;9:1907–16.

    CAS  PubMed  Google Scholar 

  4. Figley CR, Ellis AE, Reuther BT, Gold SN. The study of trauma: a historical overview. In: Gold SN, editor. APA handbook of trauma psychology: foundations in knowledge. American Psychological Association; 2017. p. 1–11. https://doi.org/10.1037/0000019-001.

    Chapter  Google Scholar 

  5. Schudson ZC, Morgenroth T. Non-binary gender/sex identities. Curr Opin Psychol. 2022;48:101499.

    PubMed  Google Scholar 

  6. Flores-Bonilla A, Richardson HN. Sex Differences in the Neurobiology of Alcohol Use Disorder. Alcohol Res. 2020;40:04.

    PubMed  PubMed Central  Google Scholar 

  7. Kimerling R, Allen MC, Duncan LE. Chromosomes to Social Contexts: Sex and Gender Differences in PTSD. Curr Psychiatry Rep. 2018;20:114.

    PubMed  Google Scholar 

  8. Patró-Hernández RM, Nieto Robles Y, Limiñana-Gras RM. The relationship between Gender Norms and Alcohol Consumption: A Systematic Review. Adicciones. 2020;32:145–58.

    PubMed  Google Scholar 

  9. Grant BF, Goldstein RB, Saha TD, Chou SP, Jung J, Zhang H, Pickering RP, Ruan WJ, Smith SM, Huang B, Hasin DS. Epidemiology of DSM-5 Alcohol Use Disorder: Results From the National Epidemiologic Survey on Alcohol and Related Conditions III. JAMA Psychiat. 2015;72:757–66.

    Google Scholar 

  10. Substance Abuse and Mental Health Services Administration. In: 2021 National Survey on drug use and health tables. 2023. https://www.samhsa.gov/data/report/2021-nsduh-detailed-tables.

  11. Goldstein RB, Smith SM, Chou SP, Saha TD, Jung J, Zhang H, Pickering RP, Ruan WJ, Huang B, Grant BF. The epidemiology of DSM-5 posttraumatic stress disorder in the United States: results from the National Epidemiologic Survey on Alcohol and Related Conditions-III. Soc Psychiatry Psychiatr Epidemiol. 2016;51:1137–48.

    PubMed  PubMed Central  Google Scholar 

  12. White AM. Gender Differences in the Epidemiology of Alcohol Use and Related Harms in the United States. Alcohol Res: Curr Rev. 2020;40:1–13.

    Google Scholar 

  13. Slade T, Chapman C, Swift W, Keyes K, Tonks Z, Teesson M. Birth cohort trends in the global epidemiology of alcohol use and alcohol-related harms in men and women: systematic review and metaregression. BMJ Open. 2016;6:e011827.

    PubMed  PubMed Central  Google Scholar 

  14. • Simpson TL, Rise P, Browne KC, Lehavot K, Kaysen D. Clinical presentations, social functioning, and treatment receipt among individuals with comorbid life-time PTSD and alcohol use disorders versus drug use disorders: findings from NESARC-III. Addiction. 2019;114:983–93. Epidemiological findings of co-occurring AUD+PTSD with gender comparisons.

    PubMed  PubMed Central  Google Scholar 

  15. Ralevski E, Olivera-Figueroa LA, Petrakis I. PTSD and comorbid AUD: a review of pharmacological and alternative treatment options. Subst Abuse Rehabil. 2014;5:25–36.

    PubMed  PubMed Central  Google Scholar 

  16. Jacobsen LK, Southwick SM, Kosten TR. Substance use disorders in patients with posttraumatic stress disorder: a review of the literature. Am J Psychiatry. 2001;158:1184–90.

    CAS  PubMed  Google Scholar 

  17. Ouimette P, Read J, Brown PJ. Consistency of retrospective reports of DSM-IV criterion A traumatic stressors among substance use disorder patients. J Trauma Stress. 2005;18:43–51.

    PubMed  Google Scholar 

  18. Stewart SH, Conrod PJ, Samoluk SB, Pihl RO, Dongier M. Posttraumatic Stress Disorder Symptoms and Situation-Specific Drinking in Women Substance Abusers. Alcohol Treat Q. 2000;18:31–47.

    Google Scholar 

  19. Kessler RC, Crum RM, Warner LA, Nelson CB, Schulenberg J, Anthony JC. Lifetime co-occurrence of DSM-III-R alcohol abuse and dependence with other psychiatric disorders in the National Comorbidity Survey. Arch Gen Psychiatry. 1997;54:313–21.

    CAS  PubMed  Google Scholar 

  20. Kessler RC, Sonnega A, Bromet E, Hughes M, Nelson CB. Posttraumatic stress disorder in the National Comorbidity Survey. Arch Gen Psychiatry. 1995;52:1048–60.

    CAS  PubMed  Google Scholar 

  21. Baker DG, Heppner P, Afari N, Nunnink S, Kilmer M, Simmons A, Harder L, Bosse B. Trauma Exposure, Branch of Service, and Physical Injury in Relation to Mental Health Among US Veterans Returning From Iraq and Afghanistan. Military Med. 2009;174:773–8.

    Google Scholar 

  22. Evans-Polce EJ, Kcomt L, Veliz PT, Boyd CJ, Esteban MS. Alcohol, Tobacco, and Comorbid Psychiatric Disorders and Associations With Sexual Identity and Stress-Related Correlates. Am J Psychiatry. 2020;177:1073–81.

    PubMed  PubMed Central  Google Scholar 

  23. Olff M. Sex and gender differences in post-traumatic stress disorder: an update. Eur J Psychotraumatol. 2017;8(sup4):1351204. https://doi.org/10.1080/20008198.2017.1351204.

  24. McLean CP, Asnaani A, Litz BT, Hofmann SG. Gender differences in anxiety disorders: prevalence, course of illness, comorbidity and burden of illness. J Psychiatr Res. 2011;45:1027–35.

    PubMed  PubMed Central  Google Scholar 

  25. Ainamani HE, Elbert T, Olema DK, Hecker T. Gender differences in response to war-related trauma and posttraumatic stress disorder - a study among the Congolese refugees in Uganda. BMC Psychiatry. 2020;20:17.

    PubMed  PubMed Central  Google Scholar 

  26. •• Belfrage A, MjølhusNjå AL, Lunde S, Årstad J, Fodstad EC, Lid TG, Erga AH. Traumatic experiences and PTSD symptoms in substance use disorder: A comparison of recovered versus current users. Nordic Stud Alcohol Drugs. 2023;40:61–75. Examined trajectories of PTSD and SUD by gender and in relation to recovery status among treatment-seeking individuals.

    Google Scholar 

  27. Breslau N. The epidemiology of trauma, PTSD, and other posttrauma disorders. Trauma Violence Abuse. 2009;10:198–210.

    PubMed  Google Scholar 

  28. Tolin DF, Foa EB. Sex differences in trauma and posttraumatic stress disorder: a quantitative review of 25 years of research. Psychol Bull. 2006;132:959–92.

    PubMed  Google Scholar 

  29. Mundy SS, Foss SLW, Poulsen S, Hjorthøj C, Carlsson J. Sex differences in trauma exposure and symptomatology in trauma-affected refugees. Psychiatry Res. 2020;293:113445.

    PubMed  Google Scholar 

  30. Pratchett LC, Pelcovitz MR, Yehuda R. Trauma and violence: are women the weaker sex? Psychiatr Clin North Am. 2010;33:465–74.

    PubMed  Google Scholar 

  31. • Wamser-Nanney R, Cherry KE. Children’s trauma-related symptoms following complex trauma exposure: evidence of gender differences. Child Abuse Negl. 2018;77:188–97. https://doi.org/10.1016/j.chiabu.2018.01.009. Gender differences in complex trauma exposure and subsequent pathology among boys and girls.

  32. Breslau N, Davis GC, Andreski P, Peterson EL, Schultz LR. Sex differences in posttraumatic stress disorder. Arch Gen Psychiatry. 1997;54:1044–8.

    CAS  PubMed  Google Scholar 

  33. • Guina J, Nahhas RW, Kawalec K, Farnsworth S. Are Gender Differences in DSM-5 PTSD Symptomatology Explained by Sexual Trauma? J Interpers Violence. 2019;34:4713–40. Sophisticated analyses examining gender differences in trauma exposure, posttraumatic stress symptoms, and alcohol use to distinguish the impact of gender on posttraumatic stress symptoms and alcohol use.

    PubMed  Google Scholar 

  34. Christiansen DM, Berke ET. Gender- and Sex-Based Contributors to Sex Differences in PTSD. Curr Psychiatry Rep. 2020;22:19.

    PubMed  Google Scholar 

  35. Banducci AN, McCaughey VK, Gradus JL, Street AE. The associations between deployment experiences, PTSD, and alcohol use among male and female veterans. Addict Behav. 2019;98:106032.

    PubMed  Google Scholar 

  36. Street AE, Dardis CM. Using a social construction of gender lens to understand gender differences in posttraumatic stress disorder. Clin Psychol Rev. 2018;66:97–105.

    PubMed  Google Scholar 

  37. •• Valentine SE, Marques L, Wang Y, Ahles EM, De Silva LD, Alegría 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;61:60–8. First comparison of potentially traumatic events and PTSD diagnosis by race and gender.

    PubMed  PubMed Central  Google Scholar 

  38. Brooks Holliday S, Dubowitz T, Haas A, Ghosh-Dastidar B, DeSantis A, Troxel WM. The association between discrimination and PTSD in African Americans: exploring the role of gender. Ethn Health. 2020;25:717–31.

    PubMed  Google Scholar 

  39. Heck AL, Handa RJ. Sex differences in the hypothalamic-pituitary-adrenal axis’ response to stress: an important role for gonadal hormones. Neuropsychopharmacology : official publication of the American College of Neuropsychopharmacology. 2019;44:45–58.

    CAS  PubMed  Google Scholar 

  40. Kornfield SL, Hantsoo L, Epperson CN. What Does Sex Have to Do with It? The Role of Sex as a Biological Variable in the Development of Posttraumatic Stress Disorder. Curr Psychiatry Rep. 2018;20:39.

    PubMed  PubMed Central  Google Scholar 

  41. Rosenhauer AM, Owens B, Glover EM. Using translational models of fear conditioning to uncover sex-linked factors related to PTSD risk. J Psychiatry Brain Sci. 2022;7(5):e220010. https://doi.org/10.20900/jpbs.20220010.

    Article  Google Scholar 

  42. Ramikie TS, Ressler KJ. Mechanisms of Sex Differences in Fear and Posttraumatic Stress Disorder. Biol Psychiatry. 2018;83:876–85.

    PubMed  Google Scholar 

  43. Maria-Rios CE, Morrow JD. Mechanisms of Shared Vulnerability to Post-traumatic Stress Disorder and Substance Use Disorders. Front Behav Neurosci. 2020;14:6.

    CAS  PubMed  PubMed Central  Google Scholar 

  44. • Kezer CA, Simonetto DA, Shah VH. Sex Differences in Alcohol Consumption and Alcohol-Associated Liver Disease. Mayo Clin Proc. 2021;96:1006–16. Review article that details changing alcohol consumption patterns among women, sex differences in alcohol-associated liver disease, and how sex-specific differences in alcohol metabolism may account for sex differences.

    PubMed  Google Scholar 

  45. Klaver M, van Velzen D, de Blok C, Nota N, Wiepjes C, Defreyne J, Schreiner T, Fisher A, Twisk J, Seidell J, T’Sjoen G, den Heijer M, de Mutsert R. Change in Visceral Fat and Total Body Fat and the Effect on Cardiometabolic Risk Factors During Transgender Hormone Therapy. J Clin Endocrinol Metab. 2021;107:e153–64.

    PubMed Central  Google Scholar 

  46. • McHugh RK, Votaw VR, Sugarman DE, Greenfield SF. Sex and gender differences in substance use disorders. Clin Psychol Rev. 2018;66:12–23. Review that examines sex and gender differences in substance use disorder etiology, maintenance, and treatment.

    PubMed  Google Scholar 

  47. • Keyes KM, Jager J, Mal-Sarkar T, Patrick ME, Rutherford C, Hasin D. Is There a Recent Epidemic of Women’s Drinking? A Critical Review of National Studies. Alcohol Clin Exp Res. 2019;43:1344–59. Article that critically reviews U.S. national data on alcohol use and alcohol-related harms by developmental period and birth cohort.

    PubMed  PubMed Central  Google Scholar 

  48. Keyes KM, Hatzenbuehler ML, Grant BF, Hasin DS. Stress and alcohol: epidemiologic evidence. Alcohol Res. 2012;34:391–400.

    CAS  PubMed  PubMed Central  Google Scholar 

  49. Sumra MK, Schillaci MA. Stress and the multiple-role woman: taking a closer look at the “superwoman.” PLoS ONE. 2015;10:e0120952.

    PubMed  PubMed Central  Google Scholar 

  50. Petticrew M, Katikireddi SV, Knai C, Cassidy R, MaaniHessari N, Thomas J, Weishaar H. “Nothing can be done until everything is done”: the use of complexity arguments by food, beverage, alcohol and gambling industries. J Epidemiol Community Health. 2017;71:1078–83.

    PubMed  Google Scholar 

  51. Zemore SE, Karriker-Jaffe KJ, Mulia N. Temporal trends and changing racial/ethnic disparities in alcohol problems: results from the 2000 to 2010 National Alcohol Surveys. J Addict Res Ther. 2013;4 https://doi.org/10.4172/2155-6105.1000160.

  52. Cobb S, Assari S. Psychiatric disorders and alcohol consumption among low-income African Americans: Gender differences. Brain Sci. 2019;9(4):86. https://doi.org/10.3390/brainsci9040086.

    Article  PubMed  PubMed Central  Google Scholar 

  53. • Guinle MIB, Sinha R. The Role of Stress, Trauma, and Negative Affect in Alcohol Misuse and Alcohol Use Disorder in Women. Alcohol Res. 2020;40:05. Article that reviews the biological mechanisms by which stress, trauma, and negative affect contribute to alcohol use, alcohol misuse, and AUD, and how this may differ by sex and gender.

    PubMed  PubMed Central  Google Scholar 

  54. Peltier MR, Verplaetse TL, Mineur YS, Petrakis IL, Cosgrove KP, Picciotto MR, McKee SA. Sex differences in stress-related alcohol use. Neurobiol Stress. 2019;10:100149.

    PubMed  PubMed Central  Google Scholar 

  55. Norman SB, Myers US, Wilkins KC, Goldsmith AA, Hristova V, Huang Z, McCullough KC, Robinson SK. Review of biological mechanisms and pharmacological treatments of comorbid PTSD and substance use disorder. Neuropharmacology. 2012;62:542–51.

    CAS  PubMed  Google Scholar 

  56. •• Hinckley JD, Danielson CK. Elucidating the Neurobiologic etiology of comorbid PTSD and substance use disorders. Brain Sci. 2022;12(9):1166. https://doi.org/10.3390/brainsci12091166. Review of shared neurobiology between co-occcuring SUD and PTSD.

  57. Goode TD, Maren S. Common neurocircuitry mediating drug and fear relapse in preclinical models. Psychopharmacology. 2019;236:415–37.

    CAS  PubMed  Google Scholar 

  58. Steinman MQ, Kirson D, Wolfe SA, Khom S, D’Ambrosio SR, SpierlingBagsic SR, Bajo M, Vlkolinský R, Hoang NK, Singhal A, Sureshchandra S, Oleata CS, Messaoudi I, Zorrilla EP, Roberto M. Importance of sex and trauma context on circulating cytokines and amygdalar GABAergic signaling in a comorbid model of posttraumatic stress and alcohol use disorders. Mol Psychiatry. 2021;26:3093–107.

    CAS  PubMed  Google Scholar 

  59. Radke AK, Held IT, Sneddon EA, Riddle CA, Quinn JJ. Additive influences of acute early life stress and sex on vulnerability for aversion-resistant alcohol drinking. Addict Biol. 2020;25:e12829.

    CAS  PubMed  Google Scholar 

  60. Shaw GA, Bent MAM, Council KR, Pais AC, Amstadter A, Wolstenholme JT, Miles MF, Neigh GN. Chronic repeated predatory stress induces resistance to quinine adulteration of ethanol in male mice. Behav Brain Res. 2020;382:112500.

    CAS  PubMed  PubMed Central  Google Scholar 

  61. Bountress KE, Brick LA, Sheerin C, Grotzinger A, Bustamante D, Hawn SE, Gillespie N, Kirkpatrick RM, Kranzler H, Morey R, Edenberg HJ, Maihofer AX, Disner S, Ashley-Koch A, Peterson R, Lori A, Stein DJ, Kimbrel N, Nievergelt C, Andreassen OA, Luykx J, Javanbakht A, Youssef NA, Amstadter AB. 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.

    PubMed  PubMed Central  Google Scholar 

  62. Sheerin CM, Bountress KE, Meyers JL, de Viteri SSS, Shen H, Maihofer AX, Duncan LE, Amstadter AB. Shared molecular genetic risk of alcohol dependence and posttraumatic stress disorder (PTSD). Psychol Addict Behav. 2020;34:613–9.

    PubMed  PubMed Central  Google Scholar 

  63. Haller M, Chassin L. Risk pathways among traumatic stress, posttraumatic stress disorder symptoms, and alcohol and drug problems: a test of four hypotheses. Psychol Addict Behav. 2014;28:841–51.

    PubMed  PubMed Central  Google Scholar 

  64. Simpson TL, Stappenbeck CA, Luterek JA, Lehavot K, Kaysen DL. Drinking motives moderate daily relationships between PTSD symptoms and alcohol use. J Abnorm Psychol. 2014;123:237–47.

  65. • Peltier MR, Roberts W, Verplaetse TL, Zakiniaeiz Y, Burke C, Moore KE, McKee SA. Sex Differences across Retrospective Transitions in Posttraumatic Stress and Substance Use Disorders. J Dual Diagn. 2022;18:11–20. Article that examines the bidirectional relationship between PTSD and susbtance use disorders by sex in the National Epidemiologic Survey on Alcohol and Related Conditions dataset.

    PubMed  Google Scholar 

  66. McCabe CT, Mohr CD, Hammer LB, Carlson KF. PTSD symptomology and motivated alcohol use among military service members: Testing a conditional indirect effect model of social support. Subst Use Misuse. 2019;54:257–70.

    PubMed  Google Scholar 

  67. Doherty M, Hunt SA. An association between psychological childbirth trauma and hazardous alcohol use. Int J Ment Health Addiction. 2022. https://doi.org/10.1007/s11469-022-00784-3.

  68. Lee CS, González Castro F, Nicholls ME, O’Connor B, Marosi S, Colby SM. Gender differences in drinking behavior among Latino/a heavy drinkers. Int J Drug Policy. 2019;64:79–86.

    PubMed  Google Scholar 

  69. Jordan HR, Madson MB, Nicholson BC, Bravo AJ, Pearson MR. Posttraumatic stress disorder symptoms and problematic alcohol use in college students: The moderating role of alcohol protective behavioral strategies and gender. Psychol Trauma. 2019;11:247–55.

    PubMed  Google Scholar 

  70. Patock-Peckham JA, Belton DA, D’Ardenne K, Tein JY, Bauman DC, Infurna FJ, Sanabria F, Curtis J, Morgan-Lopez AA, McClure SM. Dimensions of childhood trauma and their direct and indirect links to PTSD, impaired control over drinking, and alcohol-related-problems. Addict Behav Rep. 2020;12:100304.

    PubMed  PubMed Central  Google Scholar 

  71. Bremer-Landau JD, Caskie GIL. Gender as Potential Moderator of Associations Among Trauma Exposure, Posttraumatic Stress Disorder Symptoms, and Alcohol Use Disorder Symptoms in Young Adults. J Trauma Stress. 2019;32:586–94.

    PubMed  Google Scholar 

  72. • Hawn SE, Bountress KE, Sheerin CM, Dick DM, Amstadter AB. Trauma-related drinking to cope: A novel approach to the self-medication model. Psychol Addict Behav. 2020;34:465–76. Novel analysis evaluating validity of self-medication model and finding notable gender differences in mechanisms of action.

    PubMed  PubMed Central  Google Scholar 

  73. Khantzian EJ. The self-medication hypothesis of substance use disorders: a reconsideration and recent applications. Harv Rev Psychiatry. 1997;4:231–44.

    CAS  PubMed  Google Scholar 

  74. Flanagan JC, Korte KJ, Killeen TK, Back SE. Concurrent Treatment of Substance Use and PTSD. Curr Psychiatry Rep. 2016;18:70.

    PubMed  PubMed Central  Google Scholar 

  75. Hien DA, Morgan-Lopez AA, Saavedra LM, Ruglass LM, Ye A, Lopez-Castro T, Fitzpatrick S, Killeen TK, Norman SB, Ebrahimi CT, Back SE. Project Harmony: A Meta-Analysis With Individual Patient Data on Behavioral and Pharmacologic Trials for Comorbid Posttraumatic Stress and Alcohol or Other Drug Use Disorders. Am J Psychiatry. 2023;180:155–66.

    PubMed  Google Scholar 

  76. •• Kline AC, Panza KE, Lyons R, Kehle-Forbes SM, Hien DA, Norman SB. Trauma-focused treatment for comorbid post-traumatic stress and substance use disorder. Nature Reviews Psychology. 2022;2:24–39. Review of randomized clinical trials for co-occurring AUD+PTSD.

    Google Scholar 

  77. Hien DA, Fitzpatrick S, Saavedra LM, Ebrahimi CT, Norman SB, Tripp J, Ruglass LM, Lopez-Castro T, Killeen TK, Back SE, Morgan-López AA. What's in a name? A data-driven method to identify optimal psychotherapy classifications to advance treatment research on co-occurring PTSD and substance use disorders. Eur J Psychotraumatol. 2021;13(1):2001191. https://doi.org/10.1080/20008198.2021.2001191.

    Article  PubMed  PubMed Central  Google Scholar 

  78. Agabio R, Pani PP, Preti A, Gessa GL, Franconi F. Efficacy of Medications Approved for the Treatment of Alcohol Dependence and Alcohol Withdrawal Syndrome in Female Patients: A Descriptive Review. Eur Addict Res. 2016;22:1–16.

    PubMed  Google Scholar 

  79. • Verplaetse TL, McKee SA, Petrakis IL. Pharmacotherapy for Co-Occurring Alcohol Use Disorder and Post-Traumatic Stress Disorder: Targeting the Opioidergic, Noradrenergic, Serotonergic, and GABAergic/Glutamatergic Systems. Alcohol Res. 2018;39:193–205. Review of pharmacological interventions for AUD and PTSD.

    PubMed  PubMed Central  Google Scholar 

  80. Canidate SS, Carnaby GD, Cook CL, Cook RL. A Systematic Review of Naltrexone for Attenuating Alcohol Consumption in Women with Alcohol Use Disorders. Alcohol Clin Exp Res. 2017;41:466–72.

    CAS  PubMed  PubMed Central  Google Scholar 

  81. Hien DA, Cohen LR, Miele GM, Litt LC, Capstick C. Promising Treatments for Women With Comorbid PTSD and Substance Use Disorders. Am J Psychiatry. 2004;161:1426–32.

    PubMed  Google Scholar 

  82. Hien DA, Litt L, Cohen LR, Miele GM, Campbell A. Trauma Services for Women in Substance Abuse Treatment: An Integrated Approach. 1st ed. Washington: D.C., American Psychological Association; 2009.

    Google Scholar 

  83. Myers US, Browne KC, Norman SB. Treatment Engagement: Female Survivors of Intimate Partner Violence in Treatment for PTSD and Alcohol Use Disorder. J Dual Diagn. 2015;11:238–47.

    PubMed  PubMed Central  Google Scholar 

  84. Perez-Dandieu B, Tapia G. Treating Trauma in Addiction with EMDR: A Pilot Study. J Psychoactive Drugs. 2014;46:303–9.

    PubMed  Google Scholar 

  85. Simpson TL, Lehavot K, Petrakis IL. 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. Alcoholism: Clin Exp Res. 2017;41:681–702.

    Google Scholar 

  86. Zlotnick C, Johnson J, Najavits LM. Randomized controlled pilot study of cognitive-behavioral therapy in a sample of incarcerated women with substance use disorder and PTSD. Behav Ther. 2009;40:325–36.

    PubMed  Google Scholar 

  87. Greenfield SF, Sugarman DE, Freid CM, Bailey GL, Crisafulli MA, Kaufman JS, Wigderson S, Connery HS, Rodolico J, Morgan-Lopez AA, Fitzmaurice GM. Group therapy for women with substance use disorders: results from the Women’s Recovery Group Study. Drug Alcohol Depend. 2014;142:245–53.

    PubMed  PubMed Central  Google Scholar 

  88. • Berge LI, Gjestad R, Franck J, Javaras KN, Greenfield S, Haver B. Gender specific early treatment for women with alcohol addiction (EWA): Impact on work related outcomes A 25-year registry follow-up of a randomized controlled trial (RCT). Drug Alcohol Depend. 2022;239:109600. Longitudinal findings from a gender-specific treamtent for women with AUD. Results show women who received gender-specific treatment had greater long-term outcomes in economic stability and less missed days of work.

    PubMed  PubMed Central  Google Scholar 

  89. Sugarman DE, Meyer LE, Reilly ME, Greenfield SF. Women's and men's experiences in group therapy for substance use disorders: a qualitative analysis. Am J Addict. 2022;31(1):9–21. https://doi.org/10.1111/ajad.13242.

    Article  PubMed  Google Scholar 

  90. SAMHSA/CSAT treatment improvement protocols. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 1993-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK82999/.

  91. Bornstein K, Longinaker N, Bryant-Genevier M, Terplan M. Sex Differences in Substance Abuse Treatment Adherence in the United States. Addict Disord Treat. 2015;14:131–8.

    Google Scholar 

  92. Johnstone S, Dela Cruz GA, Kalb N, Tyagi SV, Potenza MN, George TP, Castle DJ. A systematic review of gender-responsive and integrated substance use disorder treatment programs for women with co-occurring disorders. Am J Drug Alcohol Abuse. 2023;49:21–42.

    PubMed  Google Scholar 

  93. •• Molina G, Whittaker A. Treatment of post-traumatic stress disorder and substance use disorder in adults with a history of adverse childhood experiences: a systematic review of psychological interventions. Drug and Alcohol Dependence Reports. 2022;2:100028. https://doi.org/10.1016/j.dadr.2022.100028. Systematic review of psychological interventions for co-occurring SUD+PTSD in adults with a history of adverse childhood experiences. Across five studies, authors found significant reductions in PTSD, but not for substance use, and high risk of bias in studies.

    Article  PubMed  PubMed Central  Google Scholar 

  94. Masin-Moyer M, Kim JC, Engstrom M, Solomon P. A Scoping Review of the Trauma Recovery and Empowerment Model (TREM). Trauma Violence Abuse. 2022;23:699–715.

    PubMed  Google Scholar 

  95. 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.

    PubMed  Google Scholar 

  96. Center for Behavioral Health Statistics and Quality. 2015 National Survey on drug use and health: detailed tables. Rockville, MD: Substance Abuse and Mental Health Services Administration; 2016.

    Google Scholar 

  97. Alvanzo AAH, Storr CL, Mojtabai R, Green KM, Pacek LR, La Flair LN, Cullen BA, Crum RM. Gender and race/ethnicity differences for initiation of alcohol-related service use among persons with alcohol dependence. Drug Alcohol Depend. 2014;140:48–55.

    PubMed  PubMed Central  Google Scholar 

  98. • Holzhauer CG, Cucciare M, Epstein EE. Sex and Gender Effects in Recovery From Alcohol Use Disorder. Alcohol Res. 2020;40:03. Review of sex/gender differences in the development, treatment, and recovery from AUD.

    PubMed  PubMed Central  Google Scholar 

  99. Gilbert PA, Pro G, Zemore SE, Mulia N, Brown G. Gender Differences in Use of Alcohol Treatment Services and Reasons for Nonuse in a National Sample. Alcohol Clin Exp Res. 2019;43:722–31.

    PubMed  PubMed Central  Google Scholar 

  100. • McCrady BS, Epstein EE, Fokas KF. Treatment Interventions for Women With Alcohol Use Disorder. Alcohol Res. 2020;40:08. Review of gender differences in AUD treatment entry, retention, and outcomes. Findings highlights barriers for help-seeking among women and encourages treatment programs to include women-specific content or women-only programs.

    PubMed  PubMed Central  Google Scholar 

  101. Sugarman DE, Meyer LE, Reilly ME, Greenfield SF. Feasibility and Acceptability of a Web-Based, Gender-Specific Intervention for Women with Substance Use Disorders. J Womens Health (Larchmt). 2020;29:636–46.

    PubMed  Google Scholar 

  102. Simpson T, Sistad R, Brooks JT, Newberger NG, Livingston NA. Seeking care where they can: A systematic review of global trends in online alcohol treatment utilization among non-veteran and veteran women. Drug Alcohol Depend Rep. 2022;5:100116.

    PubMed  PubMed Central  Google Scholar 

  103. Livingston NA, Simpson T, Lehavot K, Ameral V, Brief DJ, Enggasser J, Litwack S, Helmuth E, Roy M, Rosenbloom D, Keane TM. Differential alcohol treatment response by gender following use of VetChange. Drug Alcohol Depend. 2021;221:108552.

    PubMed  Google Scholar 

  104. Hasin DS, Stinson FS, Ogburn E, Grant BF. 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. Arch Gen Psychiatry. 2007;64(7):830–42. https://doi.org/10.1001/archpsyc.64.7.830.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

This research was supported in part by the National Institute on Drug Abuse K23 DA055209 (PI: Saraiya) and with the Office of Research on Women’s Health and the Medical University of South Carolina U54 DA016511 (MPIs: McRae-Clark & Brady) to Dr. Brown and the National Institute on Alcohol Abuse and Alcoholism R01 AA025853 (MPI: Morgan-Lopez & Hien) and K23 AA027307 (PI: Jarnecke).

Funding

This research was supported in part by the National Institute on Drug Abuse K23 DA055209 (PI: Saraiya) and with the Office of Research on Women’s Health and the Medical University of South Carolina U54 DA016511 (MPIs: McRae-Clark & Brady) to Dr. Brown and the National Institute on Alcohol Abuse and Alcoholism R01 AA025853 (MPI: Morgan-Lopez & Hien) and K23 AA027307 (PI: Jarnecke).

Author information

Authors and Affiliations

  1. Center of Alcohol & Substance Use Studies, Rutgers University-New Brunswick, 607 Allison Road, Piscataway, NJ, 08854, USA

    Tanya C. Saraiya, Alexandria G. Bauer, Lesia M. Ruglass & Denise A. Hien

  2. Department of Psychiatry and Behavioral Sciences, College of Medicine, Medical University of South Carolina, 125 Doughty Street, Suite 300, Charleston, SC, 29425, USA

    Tanya C. Saraiya, Sudie E. Back, Amber M. Jarnecke, Delisa G. Brown & Therese Killeen

  3. Ralph H. Johnson Veterans Affairs Healthcare System, Charleston, SC, USA

    Sudie E. Back

  4. RTI International, Research Triangle Park, NC, USA

    Shannon M. Blakey

  5. Department of Psychology, City College of New York, New York, NY, USA

    Lesia M. Ruglass

Authors
  1. Tanya C. Saraiya
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sudie E. Back
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Amber M. Jarnecke
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Shannon M. Blakey
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Alexandria G. Bauer
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Delisa G. Brown
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Lesia M. Ruglass
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Therese Killeen
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Denise A. Hien
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Tanya C. Saraiya.

Ethics declarations

Conflict of Interest

Drs. Back and Killeen receive royalties from Oxford University Press. All other authors declare they have no financial interests.

Human and Animal Rights and Informed Consent

This is a review paper of published literature. The affiliated research ethics committees have confirmed that no ethical approval is required.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Women and Alcohol

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Saraiya, T.C., Back, S.E., Jarnecke, A.M. et al. Sex and Gender Differences in Co-Occurring Alcohol Use Disorder and PTSD. Curr Addict Rep 10, 617–627 (2023). https://doi.org/10.1007/s40429-023-00511-5

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40429-023-00511-5

Keywords

Search

Navigation