Gender-related issues in the diagnosis and classification of alcohol use disorders among Mexican patients seeking specialized services

Abstract

Objective: The objective of the study was to examine the role of gender in the endorsement of symptoms included in both the International Classification of Diseases-10(th) Edition and the Diagnostic and Statistical Manual of Mental Disorders-4(th) Edition. Methods: Six hundred patients treated for alcohol-related problems in outpatient services in Mexico were evaluated with the Substance Abuse Module of the Composite International Diagnostic Interview. Results: Confirmatory factor analyses using the International Classification of Diseases-10(th) Edition and Diagnostic and Statistical Manual of Mental Disorders-4(th) Edition criteria produced two factors that included a combination of abuse/harmful alcohol use and dependence symptoms, which explained 40% and 49.2% of the total variance, respectively. In the abuse/harmful use groups of patients, symptoms and social consequences differed according to gender: withdrawal syndrome, lack of control and legal problems were more frequent in men, while women exhibited higher rates of attempts to give up alcohol and difficulties to accomplish daily activities. Specific gender-related factors differentiated abuse/harmful use from dependence, such as loss of control and time spent to drink in the case of men and desire to drink among women, according to the Diagnostic and Statistical Manual of Mental Disorders-4(th) Edition dependence criteria; and presence of physical symptoms in men and family/social problems, craving, anti futile effort to stop drinking in women, according to the International Classification of Diseases-10(th) Edition dependence criteria. Conclusion: Future classification systems of substance abuse disorders should take into account differences between genders in order to help closing the treatment gap for women.