Yale Stress Center, Yale School of Medicine, New Haven, Connecticut.
Alcohol Res. 2020 Aug 20;40(2):05. doi: 10.35946/arcr.v40.2.05. eCollection 2020.
Recent evidence indicates that the United States is facing a public health crisis of alcohol misuse and alcohol use disorder (AUD), which has been fueled in part by dramatic rises in binge and heavy drinking and prevalence of AUD in women. Historically, alcohol misuse and AUD have been more prevalent in men than in women. However, recent evidence on data from the past decade shows increases in AUD prevalence rates that are associated with substantially higher binge and heavy drinking and AUD prevalence in women compared to men. This paper first addresses the key roles of stress, trauma, childhood maltreatment, negative affect, and mood and anxiety disorders; sex differences in the presentation of these psychosocial and psychological factors; and their contributions to alcohol misuse, escalation to binge and heavy drinking, and transition to AUD in women. Also examined are potential central and peripheral biological mechanisms by which stressors and traumatic experiences, as well as chronic stress states-including depression and anxiety-may facilitate differential pathways to alcohol misuse, escalation, and transition to AUD in women. Finally, this paper discusses major gaps in the literature on sex differences in these areas as well as the need for greater research on sex-specific pathways to alcohol misuse and transition to AUD, so as to support a more comprehensive understanding of AUD etiology and for the development of new strategies for prevention and treatment of alcohol misuse and AUD in women.
最近的证据表明，美国正面临着酒精滥用和酒精使用障碍（AUD）的公共卫生危机，部分原因是狂欢和重度饮酒以及女性 AUD 的患病率急剧上升。从历史上看，酒精滥用和 AUD 在男性中比在女性中更为普遍。然而，过去十年的数据显示，AUD 患病率的上升与女性的狂欢和重度饮酒以及 AUD 患病率的显著上升有关，而男性的这一比例则有所上升。本文首先讨论了应激、创伤、儿童期虐待、负性情绪和情绪及焦虑障碍的关键作用；这些心理社会和心理因素在女性中的表现存在性别差异；以及它们对女性酒精滥用、狂欢和重度饮酒的升级以及 AUD 过渡的贡献。本文还探讨了潜在的中枢和外周生物学机制，即压力源和创伤经历，以及慢性应激状态，包括抑郁和焦虑，如何促进女性酒精滥用、升级和过渡到 AUD 的不同途径。最后，本文讨论了这些领域中性别差异文献的主要差距，以及需要更多关于女性特定的酒精滥用和 AUD 过渡途径的研究，以支持对 AUD 病因学的更全面理解，并为预防和治疗女性酒精滥用和 AUD 制定新策略。
