Alcohol Craving in Women, Not Men, More Likely to Be Linked to Depression

Marlene Busko

May 06, 2008

May 6, 2008 (Washington, DC) — Depressive symptoms in women, but not men, correlated with alcohol craving in an early retrospective study of over 300 patients who were self-referred for an alcohol addiction treatment program at the Mayo Clinic.

The study was presented in a poster at the American Psychiatric Association 161st Annual Meeting.

On admission to the treatment program, compared with the men, women also had higher depressive-symptom and alcohol-craving scores. This was true for subjects with a clinical diagnosis of alcohol dependence alone as well as those with a dual diagnosis, which was defined as alcohol dependence plus depression, bipolar disorder, or anxiety disorder.

"It appears that the women are drinking to relieve anxiety and to relieve depression, whereas the men might be drinking just to feel good, for a positive feeling," lead study author Nelli Boykoff, from the University of California, San Francisco, California, told Medscape Psychiatry.

"What we were really struck by was that when women came into the 28-day program, their depressive symptoms and cravings for alcohol were significantly higher than those of the men, and that correlation [between depression and alcohol craving] was robust," said study coauthor Mark A. Frye, MD, from the Mayo Clinic in Rochester, Minnesota.

"To our knowledge, this is one of the first studies to show that indeed women and men differ in their clinical correlates of alcoholism, and there may be some very relevant ways to target treatment based on some of these correlational data," he added.

Depressed Women Drinkers

The investigators performed a retrospective analysis of clinical data from 364 patients (135 women and 229 men) who participated in the Intensive Addiction Program, a 28-day residential treatment program, in the Mayo Clinic. Depressive symptoms were measured by the Beck Depression Inventory (BDI), and alcohol cravings were measured by the Pennsylvania Alcohol Craving Scale (PACS).

On average, the patients were aged 47.9 years and had started drinking when they were 19.7 years old. Women were drinking almost as heavily as the men — on average, as many as 10.8 drinks/day vs the men's 13.8 drinks/day. About half of the patients (53%) were daily drinkers, and 75% met the National Institute on Alcohol Abuse and Alcoholism (NIAAA) definition of hazardous user (more than 5 drinks/day for a man or more than 4 drinks/day for a woman). There were 92 subjects with alcohol-only addiction and 139 subjects with alcoholism along with depression, bipolar disorder, or anxiety disorder.

On admission to the treatment program, compared with the men, the women had significantly higher depression (= < .001) and alcohol craving (P = .001) scores.

Women, but not men, had a marked correlation between their depression and craving scores. This correlation was found in women who had only alcohol dependence (r = .78; < 0.0001) and as well as in those who had both alcohol dependence and an additional Axis 1 nondrug diagnosis (r = .36; P = 0.01).

Possible Explanation: Relief Craving vs Reward Craving

Craving for alcohol is a central component of alcohol dependence and has been shown to be linked with relapse, which makes successful control of craving a key element of alcoholism treatment strategies, the group writes.

They note that craving can be divided into subtypes with different possible mechanisms — relief craving (involving glutamate), reward craving (involving dopamine, opiate), and obsessive craving (involving serotonin). Some preliminary work has suggested that naltrexone and acamprosate may be more effective for reward craving and relief craving, respectively, they observe.

"Depression seems so strongly correlated with alcohol craving in women that we definitely need to take a look at it [and at relief craving] in further studies and see whether it will affect outcome and treatment," Ms. Boykoff concluded.

Dr. Frye is a consultant for Janssen-Cilag, AstraZeneca Pharmaceuticals, Abbott Laboratories, Bristol-Myers Squibb, GlaxoSmithKline, and Otsuka Pharmaceuticals. Ms. Boycoff did not provide any financial disclosure.

American Psychiatric Association 161st Annual Meeting: New Research Young Investigators' Poster Session 1. Poster NR1-013. May 3-8, 2008.

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