Study discovers a key gender difference in how people react to stress and alcohol

The holiday season is in full swing, and for many, getting into the holiday spirit means consuming plenty of spirits. In fact, if you drink more alcohol these days, you’re in good company. Between the pandemic and alcohol’s starring role in many social settings, you may be imbibing more regardless of whether you’re staying home or spreading holiday cheer (and hopefully not Covid-19).

Booze ads tend to show glam drinkers having a good time, but alcohol can also be a tempting salve during the least glamorous, most stressful times. You have a hard day at work — so you crack a beer. Who doesn’t have that friend who insists they will have one drink to calm the nerves — and then suddenly it’s 11 p.m., they’re five drinks deep, and they want tequila shots?

This kind of binge drinking can lead some down a path toward alcohol use disorder, a condition characterized by uncontrolled drinking and preoccupation with alcohol. But who ends up with the condition is down to a complex mix of factors, including genetics, environmental factors, and occupational stress. Part of the problem in teasing out these risk factors is the research into alcohol use tends to be split along gender lines — most of it is in men.

“Most alcohol self-administration work was only conducted on men and most of these studies are pretty small,” Julie Patock-Peckham tells Inverse. Patock-Peckham is an assistant research professor in the Department of Psychology at Arizona State University who studies alcohol use disorders. The lack of gender diversity means there is a lack of good data on what tips people to problem drinking. But she and her team are trying to change that.

This week, her team published a study in the journal Psychology of Addictive Behaviors specifically looking at differences in who men and women use alcohol when they are under stress. Her findings suggest a key difference in how men and women consume alcohol — at least under certain conditions.

“We study impaired control over drinking which is intending to limit to one or two alcoholic beverages per social event, but some individuals can stop after one or two drinks and some can not,” Patock-Peckham says.

“Some individuals just keep drinking once they have some alcohol in their system. To me, impaired control over drinking is at the crux of addiction.”

What they did — The study took place in a lab dressed up to look like a bar. They had bar stools, a bartender, and allowed the participants — 105 men and 105 women — to intermingle.

Some participants’ first drink contained roughly three times the amount of alcohol you would typically find in a drink. Others didn’t get any alcohol, though the rim of their glass was doused with a negligible amount of booze — a trick designed to make these participants unsure if they were drinking alcohol or not.

“A lot of the research in this area is limited to two-drink taste test studies which really does not model impaired control over alcohol well. Very few existing studies manipulating stress as a causal mechanism have studied this large of a group of women in a social drinking context prior to our study,” Patock-Peckham says.

Stress test — Participants were then separated into two different groups:

• One group underwent a Trier Social Stress Test— a test that’s been shown to reliably induce higher distress than control populations.

In this case, participants were asked to complete a two-part test: The first part of the test required the participants to prepare for a speech about what they did and didn’t like about themselves. The second part of the test included an arithmetic task during which “the participant had to verbally count backward from 1,022 in increments of 13 for 5 min. Any error resulted in the participant being asked to start over from 1,022.”

Participants were videotaped during both the speech and math tasks.

• The other (control) group also had to complete tasks, but they were fairly easy and didn’t induce stress.

After that, all participants were allowed to drink however much they wanted (up to a certain BAC limit) for 90 minutes. Participants were encouraged to moderate their drinking to only one alcoholic drink per hour, buttressed by financial incentives (participants who stuck to one alcoholic drink per hour would get more money at the end than those who didn’t).

But importantly, participants were not specifically instructed not to drink.

What they found — As you might expect, all the participants who were exposed to the stressful situation consumed more booze than the control group.

Men whose first drink contained alcohol and who then experienced stress drank more than men who received the alcohol-free drink.

Women who experienced stress drank heavily regardless of if their first drink contained alcohol or not.

The researchers were surprised that there was such a stark gender divide among the participants who didn’t receive alcohol for their first drink.

“Theoretically, we expected both men and women to need the stress and the prime dose to achieve the highest blood alcohol concentrations. Ladies just needed the stress,” Patock-Peckham says.

This held true despite the financial incentives, she adds.

“Stress made people violate these instructions.”

What it means for the future — Patock-Peckham is well aware that more research needs to be done to get better and more consistent drivers of alcohol use disorder.

“There are so many personality and situational contexts that need to be studied. Our study is just the first of its kind and it needs to be replicated,” she says.

“I would like to study this with neuroimaging of the brain and to have trauma histories on people to push this science farther,” she adds.

“The important take-home message is that it is not ‘ok’ to apply models of alcohol addiction designed from studies of just cisgender men to cisgender women,” she says.

“Sex and gender differences really do matter and we need more money to continue to figure out the mechanisms as to why we found this in the first place.”

Objective: The Self-Medication Hypothesis (SMH) theorizes that alcohol is used to alleviate negative states. We assessed whether an acute social stressor (Trier Social Stress Test, TSST), a priming dose of alcohol, and participant sex impacted 90-min ad libitum drinking. We expected exposure to stress to be associated with increased consumption, and this effect to be stronger following an alcohol priming dose; we also explored whether participant sex moderated these effects. Method: Using a 2×2 experimental design, we randomized groups of two to three drinkers to stress (TSST vs. no TSST) and priming beverage (alcohol vs. placebo) conditions. All participants subsequently completed the 90-min ad libitum drinking period and were instructed not to exceed more than one alcoholic beverage per hour for optimal performance to model behavioral impaired control. We examined (a) number of drinks ordered, (b) violations of the drink limit, (c) change in breath alcohol concentration (BAC), and (d) peak BAC. Results: Analyses showed that exposure to stress was associated with heavier ad libitum drinking. This effect was qualified by a three-way interaction; women who received a stressor and no prime dose (placebo) reached higher BACs, whereas men who received a stressor and a prime reached higher BACs. Conclusions: The hypothesized interaction between an alcohol priming dose and social stress was only evident among men, whereas women drank more under social stress in the absence of a priming dose. Findings suggest the importance of exploring sex differences in future studies of the SMH.