Neuroimaging of Gender Differences in Alcohol Dependence: Are Women More Vulnerable?

Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health, University of Heidelberg, Mannheim, Germany.
Alcoholism Clinical and Experimental Research (Impact Factor: 3.21). 06/2005; 29(5):896-901. DOI: 10.1097/01.ALC.0000164376.69978.6B
Source: PubMed


Alcoholic brain damage has been demonstrated in numerous studies using neuropathology and brain imaging techniques. However, gender differences were addressed only in a few studies. Recent research has shown that development, course, and consequences of alcohol dependence may differ between female and male patients. Our investigation was built upon earlier research where we hypothesized that women develop alcoholic brain damage more readily than men do. To further compare the impact of alcohol dependence between men and women, we examined brain atrophy in female and male alcoholics by means of computed tomography (CT).
The study group consisted of a total of 158 subjects (76 women: 42 patients, 34 healthy controls; 82 age-matched men: 34 patients, 48 healthy controls). All patients had a DSM-IV and ICD-10 diagnosis of alcohol dependence. CT with digital volumetry was performed twice in patients (at the beginning and end of the 6-week inpatient treatment program) and once in controls.
Patients of both genders had consumed alcohol very heavily. Although the average alcohol consumption in the year before the study was significantly lower in female alcoholics, this gender difference disappeared when controlled for weight. However, women had a significantly shorter duration of alcohol dependence. Despite this fact, both genders developed brain atrophy to a comparable extent. Brain atrophy was reversible in part after 6 weeks of treatment; it did not reach the level in the control groups.
Gender-specific differences in the onset of alcohol dependence were confirmed. This is in line with the telescoping effect, where a later onset and a more rapid development of dependence in women were described. Under the assumption of a gradual development of consequential organ damage, brain atrophy seems to develop faster in women. As shown in other organs (i.e., heart, muscle, liver), this may confirm a higher vulnerability to alcohol among women.

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    • "Asimismo, las personas con PD presentan mayores problemas biopsicosociales en comparación con los que no la tienen, por lo que reportan mayor uso de servicios de urgencias y hospitalización (Martín-Santos et al., 2006), más riesgo de contagio de enfermedades de trasmisión sexual como VIH, hepatitis B y C (Carey, Carey, Maisto, Gordon, & Vanable , 2001), altas tasas de suicidio, recaída y abandono de tratamiento (Gomberg, 1989; Szerman et al., 2013). Debido a diversas diferencias biológicas por género, se sabe que las mujeres desarrollan mayor severidad de los TCS con menos años de consumo en comparación con los hombres (Hernández-Ávila, Rounsanville, & Kranzler, 2004; Piazza, Vrbka, Yeager, 1989; Johnson, Richter, Kleber, McLellan, & Carise, 2005), situación que se asocia con el desarrollo de otros problemas de salud mental y física (Antai-Ontog, 2006; Mann et al., 2005). De ahí que diversos estudios reporten que las mujeres con TCS presentan altas prevalencias de problemas médicos , como es el caso de cáncer de mama y de otros tipos (Bagnardi, Blangiardo, La Vecchia, & Corrao, 2001; Key et al., 2006; Tiemersma et al., 2003), osteoporosis en mujeres premenopáusicas (Sampson, 2002), neuropatía periférica, deterioro cognitivo (Flannery et al., 2007; Sohrabji , 2002), cirrosis hepática y enfermedades "
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    ABSTRACT: Introduction: women with substance use disorders (SUD) are more likely to endorse dual disorders (DD) in comparison to men with the same condition, defining DD as the co-occurrence of SUD with other psychiatric disorders (OPD). This relationship causes negative consequences in the severity of the symptomatology and treatment of both conditions. Objective: to analyze the clinical characteristics and treatment history of women with DD. Method: psychiatric interview of women receiving treatment in two residential treatment centers. Disorders and their characteristics were compared in relation to previous treatments, GEE was used to determine the differences in medical prescriptions over time. Results: data from 100 women was analyzed, 30 of them reported not having received any previous treatments, and less than 20% reported important medical illness. Women with borderline personality disorder had approximately a third of the odds of reporting previous treatments (OR= .33; IC 95% .13-.84). Significant differences were found in antidepressant (17.6% vs 41.8%; p<.05), mood stabilizers (12.1% vs 32.7%; p<.05), antipsychotics (15.4% vs 48.0%; p<.05), others (4.4% vs 29.6%; p<.05) over time. Discussion and conclusions: this study represents an approximation based on the clinical evaluation of women with SUD and OPD, where the change in medical prescription over time might be related to the pharmacological treatment needs, which are not adequately treated.
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    • "Although not all studies agree (Hommer, 2003), women appear more vulnerable than men to the widespread damaging effects of alcohol on the brain, including volumetric loss in frontolimbic regions that subserve affective processing despite, on average, having fewer years of drinking and consuming less alcohol in their lifetimes (Mann et al., 1992; Medina et al., 2008). On par, both men and women with AD demonstrate atrophy following years of chronic drinking, however, atrophy appears to develop faster in women, suggesting an increased vulnerability (Mann et al., 2005). However, Pfefferbaum and colleagues (2010) did not find a gender vulnerability to the effects of alcohol when examining white matter bundles, nor were there gender differences in gray or white matter volumes in recently detoxified individuals with AD (Demirakca et al., 2011). "
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    ABSTRACT: Background Alcohol dependence (AD) has global effects on brain structure and function, including frontolimbic regions regulating affective processing. Preliminary evidence suggests alcohol blunts limbic response to negative affective stimuli and increases activation to positive affective stimuli. Subtle gender differences are also evident during affective processing.Methods Fourteen abstinent AD individuals (8 F, 6 M) and 14 healthy controls (9 F, 5 M), ages 23 to 60, were included in this facial affective processing functional magnetic resonance imaging pilot study. Whole-brain linear regression analyses were performed, and follow-up analyses examined whether AD status significantly predicted depressive symptoms and/or coping.ResultsFearful Condition—The AD group demonstrated reduced activation in the right medial frontal gyrus, compared with controls. Gender moderated the effects of AD in bilateral inferior frontal gyri. Happy Condition—AD individuals had increased activation in the right thalamus. Gender moderated the effects of AD in the left caudate, right middle frontal gyrus, left paracentral lobule, and right lingual gyrus. Interactive AD and gender effects for fearful and happy faces were such that AD men activated more than control men, but AD women activated less than control women. Enhanced coping was associated with greater activation in right medial frontal gyrus during fearful condition in AD individuals.Conclusions Abnormal affective processing in AD may be a marker of alcoholism risk or a consequence of chronic alcoholism. Subtle gender differences were observed, and gender moderated the effects of AD on neural substrates of affective processing. AD individuals with enhanced coping had brain activation patterns more similar to controls. Results help elucidate the effects of alcohol, gender, and their interaction on affective processing.
    Alcoholism Clinical and Experimental Research 02/2015; 39(2). DOI:10.1111/acer.12626 · 3.21 Impact Factor
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    • "Gender telescoping has been observed among users of nicotine (Oncken et al., 2004), cannabis (Hernandez-Avila et al., 2004), cocaine (Haas and Peters, 2000), and both heroin and prescription opioids (Sartor et al., 2014) as well as non-treatment seeking prescription opioid users (Back et al., 2011a). Findings are equivocal among alcoholdependent populations: some studies replicated the Piazza et al. (1989) findings of gender telescoping (Bravo et al., 2013; Diehl et al., 2007; Johnson et al., 2005; Mann et al., 2005; Piazza et al., 1989; Randall et al., 1999) whereas others did not (Alvanzo et al., 2011; "
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    ABSTRACT: Background: Addiction research literature suggests some demographic groups exhibit a later age of substance use initiation, more rapid escalation to dependence, and worse substance use-related outcomes. This 'telescoping' effect has been observed more often in females but has not yet been examined in not-in-treatment heroin users or racial subgroups. Methods: Not-in-treatment, intensive heroin-using adults screened for laboratory-based research studies (N=554; range 18-55 yr; mean age: 42.5 yr; 60.5% African American [AA]; 70.2% male) were included in this secondary analysis. A comprehensive drug history questionnaire assessed heroin-use characteristics and lifetime adverse consequences. We examined telescoping effects by racial and gender groups: Caucasian males and females; AA males and females. Results: Caucasian males initiated heroin use significantly later than AA males but this difference was not observed for age at intensive heroin use (≥3 times weekly). Caucasian males reported significantly more lifetime heroin use-related consequences, were more likely to inject heroin, and reported more-frequent past-month heroin use, but did not differ from AA males in lifetime heroin quit attempts or prior heroin treatment. Females, compared to males, reported later onset of initial and intensive use, but there was no gender-telescoping effect from initial to intensive heroin-use. Conclusions: In this not-in-treatment sample, Caucasian males exhibited more rapid heroin-use progression and adverse consequences than AA males, i.e., within-gender, racial-group telescoping. Despite later-onset heroin use among females, there was no evidence of gender-related telescoping. Given the resurgence of heroin use, differential heroin-use trajectories across demographic groups may be helpful in planning interventions.
    Drug and Alcohol Dependence 01/2015; 148. DOI:10.1016/j.drugalcdep.2015.01.010 · 3.42 Impact Factor
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