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The Clinical Course of Alcohol-Related Problems in Alcohol Dependent and Nonalcohol Dependent Drinking Women and Men

Marc A. Schuckit, Jean-Bernard Daeppen, Jayson E. Tipp, Michie Hesselbrock, Kathleen K. Bucholz

Objective: This article examines the differences in the clinical course of alcohol dependence in men and women, interpreting results in light of the gender differences in nonalcoholics and potential findings from the general population. Method: As part of the Collaborative Study on the Genetics of Alcoholism (COGA) protocol, a detailed semistructured interview was administered to 1,085 alcohol dependent women and 2,120 alcohol dependent men, along with 1,936 women and 1,233 men who were drinkers but not alcoholic. Subjects were alcohol dependent probands, controls, and relatives of each. Results: The men's and women's rank orders of alcohol-related life events were similar for alcohol dependent subjects, with a rho (ρ) of .95, a figure that remained constant even when only primary alcoholics were considered. In general, those items for which the two genders evidenced differences in either the mean age of occurrence or the proportion of people who experienced an event were similar to gender differences in drinking among nonalcoholics or the literature on the general population. These included for women a lower maximum number of drinks per day, a 1- to 2-year later onset of several early alcohol-related problems and fewer years between the onset of problems and seeking help. Female alcoholics also showed a lower proportion with legal, job or personal problems related to alcohol. There were also high levels of similarity (ρ = .76, p > .001) for 28 life events related to alcohol for 1,936 women and 1,233 men who were drinkers but not alcohol dependent. Conclusions: Overall, the time course of alcohol-related problems for men and women were more similar than different. While there was evidence of a telescoping of the time between the onset of problems and treatment for women, the gender differences in ages of onset of events were relatively small. These data support the conclusion that, after considering gender differences in drinking in society, there is little evidence that the natural history of alcohol dependence in women is substantially different than in men. (J. Stud. Alcohol 59: 581-590, 1998)