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Research Questions

  1. Do the efficacy and/or safety of first-line treatments for alcohol use disorder differ according to gender?
  2. Do gender differences vary by pharmacological versus psychosocial treatment?
  3. Do gender differences vary by duration and intensity of treatment?
  4. Do gender differences vary by treatment setting?

Given the documented gender differences in characteristics of alcohol use disorder, men and women might also respond differently to some treatments for this disorder. If so, this would be important for physicians to consider when selecting treatment. The purpose of this systematic review was to synthesize the evidence for gender differences in effects of treatments for the disorder. RAND researchers culled 13,771 citations, contacted authors, and reviewed 1,434 publications as full text. Of the 1,434 publications reviewed, only 24 original studies published in 63 publications and four systematic reviews met inclusion criteria. Studies reported efficacy or safety results for men and women separately or presented analyses of gender differences. The review used innovative analytic methods to assess gender differences in treatment effects by analyzing the differences in outcome between active and control treatments in studies with US adults undergoing evidence-based treatments. Although individual studies demonstrated gender differences in treatment effects, researchers did not identify systematic differences across studies. Most notably, despite an extensive search and thorough screening procedure, very few studies were found to report on treatment effects according to gender, hindering all analyses. The review showed a profound lack of information on the presence and absence of gender differences. Those studies that met inclusion criteria tended to be smaller and/or did not enroll comparable numbers of men and women; tended to assess a wide variety of outcomes, making cross-study comparisons difficult; and tended to have relatively high risk of bias.

Key Findings

Gender differences are an understudied area in alcohol use disorder

  • Despite a large evidence base for effects of alcohol use disorder treatment, very few published studies report on the presence or absence of gender differences in efficacy or safety.
  • In this project, the researchers developed an innovative method to analyze gender differences in responses to alcohol use disorder treatment.
  • Of the few available studies, most included only a small number of women, hindering analyses.
  • In the few available studies, researchers found no evidence of systematic gender differences in the treatment effects across studies.
  • Given the paucity of data, it was difficult to assess whether effects vary by pharmacological versus psychological treatment, by duration and intensity of treatment, or by treatment setting.

Recommendations

  • Researchers should increase their focus on women in studies of alcohol use disorder to strengthen the evidence base.
  • Before undertaking new studies, this field would benefit from reanalyzing existing studies with a focus on potential gender differences in response to treatment.
  • More analyses are needed to assess gender differences. Researchers should routinely review any potential effects of gender, given the differences in characteristics between men and women regarding alcohol use disorder.

Table of Contents

  • Chapter One

    Introduction

  • Chapter Two

    Methods

  • Chapter Three

    Results

  • Chapter Four

    Discussion

  • Appendix A

    Search Strategies

  • Appendix B

    Evidence Tables and Study Overview

  • Appendix C

    Critical Appraisal

  • Appendix D

    Publications Not Meeting Inclusion Criteria with Reasons for Exclusion

This research was sponsored by the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury, now part of the Psychological Health Center of Excellence, and conducted within the Forces and Resources Policy Center of the RAND National Defense Research Institute, a federally funded research and development center sponsored by the Office of the Secretary of Defense, the Joint Staff, the Unified Combatant Commands, the Navy, the Marine Corps, the defense agencies, and the defense Intelligence Community.

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