The Gender Risk–Severity Paradox for Alcohol Use Disorder From Adolescence Through Young Adulthood

Katherine T. Foster, Brian M. Hicks, C. Emily Durbin, William G. Iacono, Matt McGue

Research output: Contribution to journalArticlepeer-review

17 Scopus citations


A large proportion of the public health costs of alcohol use disorder (AUD) can be accounted for by a small percentage of severe cases with a chronic course starting in adolescence and persisting into adulthood. However, chronicity may be a less effective marker of AUD severity in women than men due to a gender risk–severity paradox, wherein comparable levels of risk exposure yield more co-occurring problems for women than men with AUD. To model this paradox, we compared trajectories of alcohol and drug use problems, depression symptoms, and antisocial behavior from ages 17 to 29 in men and women with a persistent, desistent, or no history of AUD. Problems followed a quadratic trajectory (i.e., increases followed by decreases), with gender and AUD chronicity moderating age-related change. Specifically, persistent and desistent courses differentiated the severity of problems more effectively in men while chronicity had less utility for differentiating AUD severity in women.

Original languageEnglish (US)
Pages (from-to)375-386
Number of pages12
JournalEmerging Adulthood
Issue number6
StatePublished - Dec 1 2018

Bibliographical note

Funding Information:
The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This research was supported by United States Public Health Service grants F31 AA023121 (Foster) and R01 AA009367 (McGue) from the National Institute on Alcohol Abuse and Alcoholism and R37 DA005147 (Iacono) and R01 DA034606 (Hicks) from the National Institute on Drug Abuse.

Publisher Copyright:
© 2017 Society for the Study of Emerging Adulthood and SAGE Publishing.


  • adolescent problems
  • alcohol use disorder
  • development
  • emerging adulthood
  • gender


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