Gender differences in response to alcohol use disorder treatment. A systematic review

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.
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.