New insights on alcohol misuse: a narrative review on how gender shapes modern drinking (2026)

Alcohol use disorder (AUD) remains a significant public health problem in the United States. Understanding gender-related distinctions in the epidemiology of AUD, and alcohol misuse, may aid in reducing drinking disparities. To improve this knowledge, the present narrative provides a brief overview of recent literature on gender differences in hazardous drinking, current AUD criteria, and alcohol-related comorbidities. Converging lines of evidence indicate that women experience unique gender-related risk factors and illness in response to alcohol consumption. Compared to men, women may drink more in response to stress and experience greater withdrawal symptoms with reduced quantities of alcohol. They may also relapse more often in response to distress symptoms such as anxiety or depression. Women who misuse alcohol may also experience unique social stigmas and proceed faster toward heavy drinking compared to their male counterparts. Though alcohol consumption declines with increasing age, our review also notes AUD divergence related to gender within older populations. These female-specific variances may significantly influence the diagnosis of AUD, given that women present distinct physiological, psychological, and social aspects of alcohol misuse. Evaluating problematic drinking through a gender-informed lens may help in developing better AUD diagnosis criteria and reduce health inequalities related to drinking. [Author's abstract]