How Manifestation Can Differ by Sex

According to the National Institute of Alcohol Abuse and Alcoholism, “Research shows that genes are responsible for about half of the risk for AUD” (alcohol use disorder) (NIAAA). A reader couldn’t be blamed for raising an eyebrow at such a statistic. For those who carry the genetic predisposition, there is a 50% chance of developing the disorder themselves. Though this can be concerning, genetics are not the only risk factor at play. Environmental influences a person is exposed to also contributes to the likelihood of developing an AUD. As you can imagine, having the combined genetic predisposition and the environmental influence of growing up in a household experiencing alcoholism further strengthens this likelihood. As researchers continue to understand inheritability of AUD, new studies suggest that the manifestation of these genetic predispositions may be influenced by a person’s sex.

Researcher, Dr. Carol Prescott, in discussing her findings on sex differences in the genetic risk for alcoholism suggested that, “For men, most of this familiality can be attributed to genetic factors … familiality of alcoholism among women can be attributed to shared environments rather than (or in addition) to genetic factors.” (Prescott 2002). Prescott goes on to present possible reasons for this phenomenon. The first is a gene that is associated with increased activity of the neurotransmitter serotonin in the brain. This gene is associated with a type of alcoholism characterized by aggressivity or antisocial personality. This subtype of alcoholism is mostly found in men and rarely in women (Prescott 2002).

Secondly, men who have genetic vulnerability to AUD tend to engage in externalizing behaviors while women tend to exhibit more internalizing symptoms and insecure attachments. In a study conducted by researchers in 2021, the manifestation of an AUD in adult children of alcoholics (ACOA) was studied and showed differences in the rates between men and women. One explanation proposed by the researchers was that because men are less likely to acknowledge internalized symptoms, they are more likely to use alcohol as a form of self-medication. On the other hand, women are more likely to exhibit higher rates of depression due to this same tendency of internalization. The findings of the study conclude, “It is possible that male and female ACOAs (Adult Children of Alcoholics) could have different clinical manifestation of the same genetic vulnerability.” (Ossola, Paolo, et al. 2021).

When considering ways to help reduce alcohol use disorder in your family, these are important factors to consider. It can be difficult raising a family with a known history of AUD. Understanding more about the genetic and environmental factors of AUD can help inform the decisions you make for yourself and your family. So, what do researchers propose could aid a family with a genetic predisposition? According to researchers in the aforementioned study, childhood history of neglect increases their risk of an AUD. They recommend an early, caring environment for children to learn and grow. Present and nurturing parental relationships can help mitigate a child’s genetic risk of an AUD.

Sources: National Institute of Alcohol Abuse and Alcoholism; Prescott CA. Sex differences in the genetic risk for alcoholism. Alcohol Res Health. 2002;26(4):26473. PMID: 12875036; PMCID: PMC6676693.; Ossola, Paolo, et al. “Alcohol Use Disorders among Adult Children of Alcoholics (ACOAs): Gene-Environment Resilience Factors.” Progress in Neuro-Psychopharmacology and Biological Psychiatry, vol. 108, 2021, p. 110167, https://doi.org/10.1016/j. pnpbp.2020.110167.