Investigating sex and gender differences in alcohol cue-reactivity: implications for treatment strategies?
Background Alcohol use disorder (AUD) is one of the most prevalent psychiatric disorders worldwide and is characterized by high relapse rates. While the prevalence of AUD is 2-3 times higher in men than in women, this gap is quickly closing. Recent studies suggest that women are particularly prone to stress-related craving and relapse, whereas men are more prone to alcohol cue-induced craving and relapse. The current study aimed to investigate sex and gender differences in the relationship between physiological (heart rate variability: HRV) and subjective (relief and reward craving) alcohol cue-reactivity and prospective drinking in individuals with an AUD receiving cognitive behavioral treatment (CBT).
Methods All participants underwent an alcohol cue-exposure (ACE) session in the two weeks preceding the start of CBT. ACE started with a relaxation exercise (90 sec), followed by exposure to alcohol-related videos (180 sec), and ended with a relaxation exercise. Relief and reward craving were measured before and after ACE using the Desire for Alcohol Questionnaire. Heart rate variability (HRV) was measured continuously during ACE. Subsequently, participants completed daily surveys on their smartphones for 16 weeks to assess alcohol intake. We tested for i) sex differences in alcohol cue-induced changes in HRV, relief craving, and reward craving and ii) the relationship between alcohol cue-reactivity and the number of drinking days in the 16 weeks following-up.
Results Data collection is currently ongoing. In this preliminary analysis, n=70 participants were included (24% women), of which n=59 completed the 16-week follow-up period. Participants reported drinking alcohol on 19,8% of the days. ACE reduced HRV significantly in both men and women (p<0.001), but no significant sex/gender differences were found. Similarly, ACE significantly increased reward craving (p=0.049) but not relief craving, and no sex/gender differences were found. ACE-induced reductions in HRV were trend-significantly related to the number of drinking days in the 16 weeks follow up (p=0.11), and while this relationship seemed to be most prominent in men, this effect was not significant. The relationship between ACE-induced relief craving and number of heavy drinking days was trend-significantly moderated by sex/gender (p=0.09): an increase in ACE-induced relief craving was related to a higher number of drinking days at follow-up in women, but not in men. Additionally, reward craving, irrespective of ACE, was trend-significantly positively associated with number of heavy drinking days in both men and women (p=0.09).
Conclusion These results suggest that relief craving in response to ACE might be more predictive of relapse in women than in men. While speculative, these findings support the existence of sex and gender differences in the mechanisms underlying AUD, which could pave the way for the development of sex and gender-specific treatment strategies.
