Health Train Express: In Treating Alcohol Use Disorder, Gender Matters

Sunday, October 11, 2020

In Treating Alcohol Use Disorder, Gender Matters | by Phillip Levin

These days, talking about the differences between men and women can be perilous. The subject is a polarizing one and for a good reason.

One has to wonder, what can be gained of acknowledging our differences?

However, there is one area where such discussion may have great utility: medicine.

There are biological differences between the sexes, and when it comes to medicine, these such differences may be too important to ignore.

Take, for example, Alcohol Use Disorder. Researchers at the Boston University School of Medicine published a study recently that indicates significant differences exist in the neuropathology of Alcohol Use Disorder in men and women.

In the study, researchers found that brain activity in regions associated with the processing of memories, emotion, and socialization are more significantly reduced in men diagnosed with alcoholism than men who are not alcoholics. Meanwhile, researchers found increased brain activity in women alcoholics compared to women who are not alcoholics.

Admittedly, such findings come with the potential to provide power to those who want to endorse gender stereotypes. But equally so, findings like this present an opportunity to better understand an affliction that causes real harm and suffering to anyone hurt by this substance use disorder — a cause that is important to many, independent of gender.

Previous research had indicated that there may be abnormalities in how the brains of alcoholics process “aversive stimuli” associated with “negative feelings, such as fear, pain, and stress,” according to the neuroscientists responsible for the study. This differential response could be implicated in the likelihood of developing Alcoholic Use Disorder as well as the relapse of recovering alcoholics.

These researchers were willing to ask an important but perhaps controversial question: what’s the difference between men and women?

In an effort to better understand how alcoholism affects the brains of men and women, researchers used functional magnetic resonance imaging (fMRI) to monitor the brain’s response to emotional stimuli. Alcoholic and non-alcoholic men were compared separately, while alcoholic and non-alcoholic women were also compared.

In both cases, the neuroscientists showed study participants variety of images expected to invoke a particular type of emotion. Specifically, images with salience related to erotic, fixation, neutral, happy, aversive, gruesome feelings were used. The researchers then measured the activity of different brain regions to determine if men and women’s brains were affected differently by Alcoholic Use Disorder.

The study’s findings suggest they are.

The researchers found diminished brain activity in alcoholic men in response to having seen emotional and neutral images. In particular, the reduced brain activity occurred in the inferior parietal gyrus, anterior cingulate gyrus, and postcentral gyrus. The experiment revealed that there was significantly lower activation of brain regions, such frontal, parietal, and temporal regions,in alcoholic men across the different types of emotional stimuli. According to the researchers, this may indicate “deficits” in “maintaining positive and negative emotions.”

In alcoholic men, the inferior parietal cortex also showed a diminished response. This brain region processes the “perception of emotions in facial stimuli.” Most of the images shown to the subjects contained faces, according to the researchers, so this reduced response “may represent an impairment in processing emotional facial expressions” for men with Alcohol Use Disorder. Additionally, the limbic and subcortical structures of men with the disorder responded similarly to both erotic and neutral pictures. This is surprising, given that these brain regions in non-alcoholic men typically respond differently to such types of images.

Interestingly, the researchers found that the brain activity of women was increased in different areas than in men, including the superior frontal and supramarginal cortex. Meanwhile, in alcoholic women, the superior frontal cortexhad an increased response to happy stimuli and supramarginal gyrus an increased response to aversive stimuli. This, according to the scientists, may suggest “possible compensation for deficiency in maintaining positive and negative emotions.” The difference in the limbic and subcortical response of alcoholic women’s brains to erotic and neutral pictures was increased, indicating an increased emotional response in women with Alcohol Use Disorder.

From a scientific standpoint, such differences are interesting. However, it is necessary that findings like these are delivered with a careful awareness about the implications and repercussions of such ideas should they be misconstrued or wrongly characterized by those with malicious intent for society.

One must actively circumvent the wrong ideas here. Medical discoveries about the differences between the sexes are not statements about the value of either sex. This is a discovery about a disease and information about how to proceed with future medical interventions.

The important thing here is not that men and women with Alcohol Use Disorder are different. Rather, it’s that treatment plans can be improved, perhaps, by understanding the details of the pathology, including the effect of sex differences.

If knowledge of biological differences between men and women can lead to better treatment plans, should we not acknowledge and employ such information in developing treatments?

It seems that such distinctions might, at the very least, be beneficial in developing treatment plans to help the more than 100-million people worldwide who are suspected of struggling with Alcohol Use Disorder.