Gender differences in the relationship of internalizing and externalizing psychopathology to alcohol dependence: likelihood, expression and course.

Objective: To determine whether internalizing and externalizing psychopathology were differentially associated with alcohol dependence in men and women.

Methods: Four categories of lifetime psychopathology were examined: neither internalizing nor externalizing (NINE), internalizing only (IO), externalizing only (EO) and both internalizing and externalizing (BIE). Multivariate models assessed gender differences in the adjusted associations of these categories with the odds of lifetime alcohol dependence in a representative sample of 43,093 U.S. adults 18 and older and with clinical course and expression in a subsample of 4781 lifetime alcoholics.

Results: The excess odds of lifetime alcohol dependence associated with IO, EO and BIE were significantly greater for women than men, OR=2.6, 8.8 and 10.7 versus 1.9, 4.0 and 6.5, respectively. Regardless of gender, the ORs were significantly higher for EO than IO and for BIE than EO. Gender differences in the expression and course of alcoholism were most pronounced for the categories of NINE and IO, with men having greater consumption, dependence severity and treatment but less familial alcoholism. Gender variation in the association of psychopathology with the expression and course of alcoholism was most evident in the BIE category, where the associations were stronger for women. Lifetime externalizing psychopathology was associated with an increased likelihood of treatment utilization, especially among women.

Conclusions: Findings highlight the need to increase alcoholism screening, prevention and intervention among women with psychopathology, especially externalizing. The greater numbers of internalizing than externalizing alcoholics emphasize the need to treat symptoms of depression and anxiety in alcohol treatment settings.