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. Author manuscript; available in PMC: 2022 May 1.
Published in final edited form as: Addict Behav. 2021 Jan 6;116:106815. doi: 10.1016/j.addbeh.2020.106815

Gender and past year serious psychological distress are associated with past year AUD: Time-varying results from the National Survey on Drug Use and Health (NSDUH; 2008–2017)

Terril L Verplaetse 1, MacKenzie R Peltier 1, Walter Roberts 1, Brian Pittman 1, Sherry A McKee 1
PMCID: PMC7887085  NIHMSID: NIHMS1660230  PMID: 33450666

Abstract

Background:

Rates of alcohol use disorder (AUD) have increased in women in the last decade. Women may be more likely to engage in alcohol use to regulate stress and negative affect compared to men. Findings from our group found that life event stress was more strongly associated with new AUD in women vs. men. Our aim was to extend these findings to psychological distress, a potentially related construct to stress, using a second nationally representative dataset.

Methods:

Using data from the National Survey on Drug Use and Health (NSDUH; 2008–2017, total n=562,072), we examined time-varying associations between gender and past year serious psychological distress (SPD; Kessler-6 distress scale: scores >13 yes, <13 no) with past year vs. absent DSM-IV AUD.

Results:

A significant (p<0.0001) gender by SPD interaction for past year vs. absent AUD demonstrated that past year SPD was associated with increased odds of past year AUD in men (OR=3.33, 95% CI=3.15, 3.52) and even greater odds of past year AUD in women (OR=4.39, 95% CI=4.14, 4.66). The gender by SPD by time interaction was not significant (p=0.06).

Conclusions:

Results highlight that while men with past year SPD were 3 times more likely to have a past year AUD, women with past year SPD were nearly 4.5 times more likely to have a past year AUD. Psychological distress is clearly an important factor in AUD in both men and women, but results suggest that other factors may be driving the increase in rates of AUD in women.

Keywords: sex, gender, distress, alcohol, alcohol use disorder

Introduction

Over the last decade, rates of alcohol use disorder (AUD) have increased by 84% in women relative to a 35% increase in men (Grant et al., 2017). The prevalence of alcohol use, including drinking volume and frequency, has also increased more so in women than in men in the past ten years (Grant et al., 2017, Grucza et al., 2018, Dawson et al., 2015). Further, a recent meta-analysis of six national surveys found substantial increases in alcohol consumption and binge drinking over the past 16 years, a finding driven solely by women (Grucza et al., 2018). This is concerning given that women have worse alcohol-related health consequences compared to men, such as alcohol-related liver injury, cardiovascular conditions, and cancer (Agabio et al., 2017, National Institute of Alcohol Abuse and Alcoholism, 2017, Rehm et al., 2010, Patra et al., 2010, Chen et al., 2011), and other sex-dependent health risks, including menstrual irregularity and complications during pregnancy (Andersen et al., 2012, Martel et al., 2017, Emmanuel et al., 2003).

Stress is a primary mechanism associated with the initiation and maintenance of alcohol use (Koob and Volkow, 2016, Koob, 2009, Peltier et al., 2019), and women may be more likely to consume alcohol to manage stress and negative affect compared to men (Peltier et al., 2019). In a recent epidemiologic study conducted by our group using data from the U.S. National Epidemiologic Survey on Alcohol and Related Conditions (NESARC; Wave 3, 2012–2013), women with two or more past year stressful life events (e.g., fired or laid off, separation or divorce, bankruptcy, serious trouble with the police or the law, death of a family member or close friend, homelessness) were 4 times more likely to have a new Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5) AUD compared to those with zero or one stressful life event (Verplaetse et al., 2018). In this study, men with two or more past year stressful life events were 2.5 more likely to have a new AUD compared to those with zero or one stressful life event (Verplaetse et al., 2018). Thus, life event stress was strongly associated with the transition from absent to new DSM-5 AUD diagnoses in both men and women, but the association was particularly robust in women.

Serious psychological distress (SPD) is considered a subjective stress response to an environmental stressor or challenge (e.g., life event stress; Harkness and Monroe, 2016). As such, individuals with greater life event stress are more likely to have higher stress responses (Harkness and Monroe, 2016; McEwen, 2006). Research indicates that women are more likely to have serious psychological distress than men among adults in the United States (Myer et al., 2008, Pratt et al., 2007, Weissman et al., 2015). There is elevated risk for alcohol use and binge drinking among those who experience moderate to severe psychological distress (Prochaska et al., 2012; Woo et al., 2017). Further, data from the National Health Interview Survey (NHIS) suggest that women with SPD are at an increased likelihood for heavy alcohol use compared to women without SPD (Tsai et al., 2009). Similarly, binge/heavy drinking is related to psychological distress in older women, but not in older men (Choi et al., 2011). Thus, examining the interaction between gender and psychological distress, a potentially related construct to stress (e.g., life event stress), on rates of AUD, as opposed to heavy alcohol use, may be an important next step in understanding mechanisms underlying problematic drinking in women and men.

Given that rates of AUD have increased in women in the last decade and that women who consume alcohol more heavily report heightened levels of stress and distress (Peltier et al., 2019), the aim of this study was to extend our previous findings and examine the impact of gender and psychological distress on the presence of past year AUD across 10 years of data from the National Survey on Drug Use and Health (NSDUH; 2008–2017). For the first time, we examined time-varying (e.g., across survey years) effects of gender and past year SPD (Kessler-6 distress scale) on past year Diagnostic and Statistical Manual of Mental Disorders Fourth Edition (DSM-IV) AUD vs. absent AUD across ten years of the NSDUH to determine if psychological distress may be related to the increases in drinking in women in the last years. We hypothesized that individuals who experienced past year SPD would be more likely to have AUD vs. absent AUD in the past year, and that this effect would be stronger for women compared to men. Given that rates of AUD have increased in women over the past ten years and life event stress is associated with greater odds of new AUD in women compared to men, psychological distress may also be a factor related to increases in drinking in women across time. Thus, we hypothesized that women with past year SPD would be increasingly more likely to have a past year AUD across the ten years of the NSDUH compared to men. It should be noted that causal relationships between serious psychological distress and past year AUD cannot be addressed in the present investigation.

Materials and Methods

Data source.

For the present investigation, data were drawn from the 2008–2017 NSDUH dataset. The NSDUH has been administered by the Substance Abuse and Mental Health Services Administration (SAMHSA), an agency in the U.S. Department of Health and Human Services, since 1971, and includes repeated cross-sectional data on alcohol, tobacco, and drug use, mental health and other health-related issues of approximately 70,000 U.S. civilian, non-institutionalized population aged 12 and older each year. The 2008–2017 interviews were conducted using computer-assisted interviewing methodology in all 50 states and the District of Columbia. Households were selected at random. After completing the interview, each person received $30 in cash. Measures used in the present investigation were identical across the 2008–2017 survey years. Complete methodology used in the NSDUH is detailed elsewhere (Substance Abuse and Mental Health Services Administration, 2014).

Gender.

The NSDUH interviewers recorded each respondent’s gender as either male or female. Interviewers then confirmed that they entered the correct gender. Beginning with the 2002 survey, missing values for the gender question were no longer permitted. In the 2017 survey, 48% of respondents were male and 52% of respondents were female. Because the NSDUH interviewer recorded respondent’s gender, we use gender, not sex, throughout the manuscript. Respondents were not asked their gender and non-binary options were not available.

Psychological Distress.

The NSDUH used the Kessler-6 distress scale to assess past year (12 months) serious psychological distress (Kessler et al., 2002). The Kessler-6 included non-specific psychological distress questions on how frequently each respondent experienced symptoms of psychological distress. For example, “How often did you feel nervous?”, “How often did you feel hopeless”, “How often did you feel restless or fidgety?”, “How often did you feel so sad or depressed that nothing could cheer you up?”, and “How often did you feel that everything was an effort?”. Respondents could answer with the following 5-point Likert scale: all the time, most of the time, some of the time, a little of the time, or none of the time. The Kessler-6 items were only asked to respondents 18 years of age or older. The NSDUH categorized scores less than 13 as “no” to past year SPD. Scores greater than 13 were categorized as “yes” to past year SPD. This categorization is consistent with other research using the Kessler-6 to examine SPD (Lawrence and Williams, 2016, Weinberger et al., 2019, Weissman et al., 2015, 2018). The Kessler-6 has been validated as a measure of mental distress and mental distress across gender in prior work (Drapeau et al., 2010; Furukawa et al., 2003; Kessler et al., 2002; Prochaska et al., 2012). Due to the addition of the past month Kessler-6 items in 2008, it was determined that past year SPD measured after 2008 was not comparable with years prior to 2008. Thus, we limited our analysis of past year SPD to the ten-year span of 2008–2017.

Alcohol use disorder.

The NSDUH used the DSM-IV to assess for the presence of past year (12 months) alcohol abuse and alcohol dependence. If respondents were categorized as “yes” to past year alcohol abuse or “yes” to past year alcohol dependence, then they were categorized as “yes” to past year AUD. Respondents that were categorized as “no” to both past year alcohol abuse and alcohol dependence were categorized as “no” to past year AUD.

Statistical analysis.

Data were analyzed using PROC SURVEYLOGISTIC in SAS, version 9.4 (SAS v9.4, SAS Institute Inc., Cary, NC). This procedure allowed for incorporating the stratification, clustering (i.e., primary sampling unit [PSU]), and unequal weighting of the sampling design. Binary logistic regression analysis was used to examine associations between gender and past year serious psychological distress with past year AUD (vs. absent past year AUD). Relationships between gender and serious psychological distress were assessed in terms of odds ratios and were considered significant at p ≤ 0.05. The effects of each variable of interest on any given outcome were interpreted relative to our chosen reference outcome (i.e., male, no past year serious psychological distress). Two-way interactions between gender and SPD for past year AUD (vs. absent past year AUD) and three-way interactions between gender, SPD, and year (i.e., survey year of the NSDUH, 2008–2017) for past year AUD (vs. absent past year AUD) were performed to investigate associations with the presence of past year DSM-IV AUD diagnoses.

Results

Sample characteristics by gender are summarized in Table 1 (total n=562,072). All chi-square analyses to examine sample characteristics were significant (p<0.0001). Rates of past year SPD were higher in women compared to men (17.6% vs. 11.3%, respectively). Men had higher rates of past year DSM-IV AUD compared to women (9.7% vs. 6.4%, respectively). In this sample, 4.3% of individuals (5.5% of men vs. 3.3% of women) were diagnosed with alcohol abuse and 3.6% of individuals (4.2% of men vs. 3.1% of women) were diagnosed with alcohol dependence.

Table 1.

Sample characteristics by gender (NSDUH, 2008–2017).

Total n=562,072 Male Female X2 P
Age (%) 1170.04 <0.0001
12–20 years old 42.6 38.3
21 years old 3.7 3.7
22–23 years old 7.3 7.5
24–25 years old 7.2 7.7
26–29 years old 5.5 5.8
30–34 years old 6.2 6.8
35–49 years old 15.6 16.9
50–64 years old 7.3 8.0
>65 years old 4.7 5.3
Race (%) 168.16 <0.0001
Non-Hispanic White 60.9 59.9
Non-Hispanic Black 12.2 13.3
Non-Hispanic Native American 1.5 1.5
Non-Hispanic Native Hawaiian/Pacific Islander 0.5 0.5
Non-Hispanic Asian 4.0 4.0
Non-Hispanic Other 3.5 3.6
Hispanic 17.2 17.3
Marital Status (%) 4388.45 <0.0001
Married 29.4 32.0
Widowed 1.1 3.1
Divorced or Separated 3.1 5.0
Never Been Married 62.9 55.4
Income (%) 1501.84 <0.0001
Less than $20,000 20.0 23.7
$20,000 – $49,999 32.3 32.7
$50,000 – $74,999 16.5 15.9
$75,000 or more 31.3 27.7
Education (%) 2721.39 <0.0001
12 to 17 year olds 30.9 27.3
Less than high school 11.6 9.9
High school graduate 22.2 21.0
Some college 19.7 23.7
College graduate 15.6 182.0
Past year SPD (%) 3181.40 <0.0001
Yes 11.3 17.6
No 88.7 82.4
Past Year AUD (%) 2094.11 <0.0001
Yes 9.7 6.4
No 90.3 93.6
Year* (%) 42.11 <0.0001
2008 9.8 9.8
2009 9.8 9.8
2010 10.2 10.2
2011 10.5 10.2
2012 9.9 9.8
2013 9.8 9.8
2014 9.8 9.9
2015 9.9 10.4
2016 10.1 10.1
2017 10.1 10.0
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Note: alcohol use disorder, AUD; serious psychological distress, SPD.

*

Each year had ~55,000–70,000 respondents.

Past year AUD vs. absent past year AUD.

A significant two-way interaction (p<0.0001) between gender and past year serious psychological distress demonstrated that women with past year serious psychological distress had increased odds of having past year AUD compared to women without past year serious psychological distress (OR=4.39, 95% CI=4.14, 4.66; Cohen’s d=0.82; see Figure 1). Men with past year serious psychological distress had increased odds of having past year AUD compared to men without past year serious psychological distress (OR=3.33, 95% CI=3.15, 3.52; Cohen’s d=0.66; see Figure 1).

Figure 1.

Figure 1.

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Associations between gender and past year serious psychological distress (SPD) with past year alcohol use disorder (AUD) vs. absent AUD. Data are presented in terms of odds ratios and 95% confidence intervals (CI) estimating risk of past year AUD by gender by past year SPD averaged over year. A significant (p<0.0001) gender by SPD interaction for past year vs. absent AUD demonstrated that past year SPD was associated with increased odds of past year AUD in men (OR=3.33, 95% CI=3.15, 3.52) and even greater odds of past year AUD in women (OR=4.39, 95% CI=4.14, 4.66).

When examining time-varying effects of the association between gender and past year serious psychological distress with past year AUD, the three-way interaction between gender, past year serious psychological distress, and year was not significant (p=0.06). The trend-level effect demonstrated that overall women with past year serious psychological distress had increased odds of having a past year AUD compared to men with past year serious psychological distress over the ten years of the NSDUH (see Figure 2). Post-hoc analyses indicated that this effect was most notable for years 2008–2011, 2014, and 2017 (p=0.0004–0.05). To further explore this trend-level interaction, we examined rates of past year SPD by year for men and women. Results indicate that while women had higher rates of past year SPD compared to men from 2008–2017, these rates remained relatively steady across time (see Figure 3).

Figure 2.

Figure 2.

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Associations between gender, past year serious psychological distress (SPD), and time (in years) with past year alcohol use disorder (AUD) vs. absent AUD over the past 10 years of the NSDUH. Data are presented in terms of odds ratios and 95% confidence intervals (CIs) estimating risk of past year AUD by gender by past year SPD across ten years of the NSDUH (2008–2017). A non-significant, trend-level only (p=0.06) finding demonstrated that women with past year SPD were more likely to have a past year AUD across the past ten years of the NSDUH (2008–2017) compared to men. Results were most notable for years 2010, 2014, and 2017.

Figure 3.

Figure 3.

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Rates of past year serious psychological distress (SPD) by year for men and women across ten years of the NSDUH. While women had higher rates of past year SPD compared to men from 2008–2017, these rates remained relatively steady across time.

Discussion

Epidemiologic findings from our group using the NESARC demonstrate that while life event stress was robustly associated with the transition from absent to new onset AUD in both men and women, the association was particularly robust in women (Verplaetse et al., 2018). Women with past year life event stress were 4 times more likely to have a new onset AUD, whereas men with past year life event stress were 2.5 times more likely to have a new onset AUD (Verplaetse et al., 2018). The aim of the present investigation was to extend these findings in another nationally representative dataset to newly examine time trends over the past ten years to understand the increase in rates of AUD in women over the same period of time (Grant et al., 2017). Indeed, results from the present investigation are highly consistent with our findings from the NESARC (Verplaetse et al., 2018). Using the NSDUH, findings identify that past year serious psychological distress is strongly associated with the presence of past year AUD in both men and women, with medium to large effects, respectively. Again, results demonstrate that this association was particularly strong in women. Women with past year serious psychological distress were over 4 times more likely to have a past year AUD, whereas men with past year serious psychological distress were 3 times more likely to have a past year AUD. It should be noted that the difference in odds ratios between women and men, while significant, represents a relatively small effect (Cohen’s d=0.03).

A non-significant, trend-level only (p=0.06) finding demonstrated that women with past year SPD were more likely to have a past year AUD across the past ten years of the NSDUH (2008–2017) compared to men. Results were most notable for years 2010, 2014, and 2017. We hypothesized that women with past year SPD would have increasing odds of past year AUD over the ten years of the NSDUH. However, we did not find a linear increase in the likelihood of women with past year SPD having increased odds of past year AUD compared to men. Further, exploratory data examining rates of past year SPD by year for men and women indicate that while women had higher rates of past year SPD compared to men from 2008–2017, these rates remained relatively steady across time. Serious psychological distress is clearly an important factor in AUD, but results suggest that other factors may be driving the increase in rates of AUD in women. Regarding the notable results for years 2010, 2014, and 2017, it is possible there could be some cohort effect from the particular cross-sectional sample in those years. Alternatively, there could be factors, such as increased life event stress, not captured by the NSDUH that occurred during these years. Future work should further investigate mechanisms underlying instances of increased rates of AUD in particular years in the last decade.

It is established that stress, negative mood, and negative affect are mechanisms underlying problematic alcohol use (Peltier et al., 2019). Results from two nationally representative epidemiologic datasets add to this literature by identifying robust associations between gender, stressors (e.g., life event stress) or stress responses (e.g., SPD), and the onset or maintenance of AUD (Verplaetse et al., 2018). Preclinical and human laboratory studies also consistently identify stress as a precipitant of relapse in self-administration paradigms of addictive behaviors (e.g., alcohol, nicotine, food) (McKee et al., 2015, Bertholomey et al., 2013, Bertholomey et al., 2016, Becker and Koob, 2016, Peltier et al., 2019, Fox et al., 2007, McKee et al., 2011), with research demonstrating that females may be more susceptible to stress-induced craving and drinking behavior than males. Future work should consider the role of stress in novel sex-appropriate pharmacotherapeutic treatment strategies for high-risk drinking and AUD (Koob and Mason, 2016, Peltier et al., 2019).

It should be noted that this study examined stress responses as opposed to stress exposures. The NSDUH assessed stress using the Kessler-6 distress scale, which identifies non-specific psychological distress. However, we cannot determine if past year serious psychological distress was specific to certain life event stressors (i.e., financial, interpersonal, legal) in this dataset. Nonetheless, other research suggests that certain environmental stressors may be related to psychological distress. For example, individuals reporting greater debt stress, lower socioeconomic status, or poor social support systems had increased odds of moderate to severe psychological distress (Hamilton et al., 2019, Myer et al., 2008). Thus, life event stress and serious psychological distress, while different constructs, may be related. This is especially important given the similar results from our group using the NESARC (Verplaetse et al., 2018) and the current study using the NSDUH.

Limitations.

This study is not without limitations. First, study findings were limited to data collected in the U.S. and may not generalize to findings from other countries. While results from the present investigation are highly consistent with other national datasets, future work should examine these relationships in international datasets. Second, the NSDUH is a cross-sectional study; thus, causal relationships between serious psychological distress and past year AUD cannot be addressed in the present investigation. It is possible that individuals with AUD were more likely to develop psychological distress or worsening psychological distress or vice versa. Third, the NSDUH used DSM-IV criteria to identify AUD so findings may not extend to datasets using DSM-5 (e.g., NESARC, Wave 3); although, our findings are consistent with data from the NESARC, Wave 3 survey. Finally, the NSDUH assessed stress using the Kessler-6 distress scale, which identifies non-specific psychological distress, and also may be a marker for depressive and anxiety disorders (Lawrence et al., 2011, Smith et al., 2015); thus, we cannot determine if past year serious psychological distress was specific to certain life event stressors (i.e., financial, interpersonal, legal) or to specific types of mental illness.

Conclusions.

Results identify that psychological distress is a critical factor associated with AUD for both men and women, with stronger associations in women, using ten years of survey data from the National Survey on Drug Use and Health. However, the increased prevalence of AUD in women in the last decade (Grant et al., 2017) may not be due solely to serious psychological distress per se, but some other factor(s) (e.g., stress exposure). Findings extend work by our group using other national cohort data and by examining a potentially related construct to stress, psychological distress, in relation to problematic alcohol use. Results highlight the importance of targeting the brain stress systems as a potential treatment intervention for AUD.

  • Rates of AUD have increased to a greater degree in women vs. men in the last decade.

  • Psychological distress may be related to problematic drinking by gender.

  • Women with psychological distress were over 4 times more likely to have an AUD.

  • Men with psychological distress were 3 times more likely to have an AUD.

  • Psychological distress is an important factor in AUD, particularly in women.

Funding

This work was supported by the National Institutes of Health grants K01AA025670 (TLV), K23AA026890 (WR), P01AA027473 (SAM), and U54AA027989 (SAM).

Footnotes

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Declaration of Conflicting Interests

All authors declare that they have no conflicts of interest.

References

  1. Agabio R, Pisanu C, Luigi Gessa G, Franconi F (2017). Sex differences in alcohol use disorder. Current medicinal chemistry 24, 2661–2670. [DOI] [PubMed] [Google Scholar]
  2. Andersen A-MN, Andersen PK, Olsen J, Grønbæk M, Strandberg-Larsen K (2012). Moderate alcohol intake during pregnancy and risk of fetal death. International journal of epidemiology 41, 405–413. [DOI] [PubMed] [Google Scholar]
  3. Becker JB, Koob GF (2016). Sex differences in animal models: focus on addiction. Pharmacological reviews 68, 242–263. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Bertholomey M, Nagarajan V, Torregrossa MM (2016). Sex differences in reinstatement of alcohol seeking in response to cues and yohimbine in rats with and without a history of adolescent corticosterone exposure. Psychopharmacology 233, 2277–2287. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Bertholomey ML, Verplaetse TL, Czachowski CL (2013). Alterations in ethanol seeking and self-administration following yohimbine in selectively bred alcohol-preferring (P) and high alcohol drinking (HAD-2) rats. Behavioural brain research 238, 252–258. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Chen WY, Rosner B, Hankinson SE, Colditz GA, Willett WC (2011). Moderate alcohol consumption during adult life, drinking patterns, and breast cancer risk. Jama 306, 1884–1890. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Choi NG, DiNitto D (2011). Psychological distress, binge/heavy drinking, and gender differences among older adults. The American Journal on Addictions 20, 420–428. [DOI] [PubMed] [Google Scholar]
  8. Dawson DA, Goldstein RB, Saha TD, Grant BF (2015). Changes in alcohol consumption: United States, 2001–2002 to 2012–2013. Drug and alcohol dependence 148, 56–61. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Drapeau A, Beaulieu-Prevost D, Marchand A, Boyer R, Preville M, Kairouz S (2010). A life-course and time perspective on the construct validity of psychological distress in women and men. Measurement invariance of the K6 across gender. BMC Medical Research Methodology 10, 68. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Emmanuel M, Wezeman F, Emanuele N (2003). Alcohol’s Effects on Female Reproductive Function. Alcohol Res Health. 26(4), 274–81. [PMC free article] [PubMed] [Google Scholar]
  11. Fox HC, Bergquist KL, Hong KI, Sinha R (2007). Stress-induced and alcohol cue-induced craving in recently abstinent alcohol-dependent individuals. Alcoholism: Clinical and Experimental Research 31, 395–403. [DOI] [PubMed] [Google Scholar]
  12. Furukawa TA, Kessler RC, Slade T, Andrews G (2003). The performance of the K6 and K10 screening scales for psychological distress in the Australian national survey of mental health and well-being. Psychol Med 33, 357–362. [DOI] [PubMed] [Google Scholar]
  13. Grant BF, Chou SP, Saha TD, Pickering RP, Kerridge BT, Ruan WJ, Huang B, Jung J, Zhang H, Fan A (2017). Prevalence of 12-month alcohol use, high-risk drinking, and DSM-IV alcohol use disorder in the United States, 2001–2002 to 2012–2013: results from the National Epidemiologic Survey on Alcohol and Related Conditions. JAMA psychiatry 74, 911–923. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Grucza RA, Sher KJ, Kerr WC, Krauss MJ, Lui CK, McDowell YE, Hartz S, Virdi G, Bierut LJ (2018). Trends in adult alcohol use and binge drinking in the early 21st-century United States: a meta-analysis of 6 National Survey Series. Alcoholism: clinical and experimental research 42, 1939–1950. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Hamilton HA, Wickens CM, Ialomiteanu AR, Mann RE (2019). Debt stress, psychological distress and overall health among adults in Ontario. J Psychiatr Res. 111, 89–95. [DOI] [PubMed] [Google Scholar]
  16. Harkness KL, Monroe SM (2016). The assessment and measurement of adult life stress: Basic premises, operational principles, and design requirements. Journal of Abnormal Psychology 125(5), 727. [DOI] [PubMed] [Google Scholar]
  17. Kessler RC, Andrews G, Colpe LJ, Hiripi E, Mroczek DK, Normand S-LT, Walter EE, Zaslavsky AM (2002). Short screening scales to monitor population prevalences and trends in non-specific psychological distress. Psychological Medicine 32(6), 959–976. [DOI] [PubMed] [Google Scholar]
  18. Koob GF (2009). Brain stress systems in the amygdala and addiction. Brain research 1293, 61–75. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Koob GF, Mason BJ (2016). Existing and future drugs for the treatment of the dark side of addiction. Annual review of pharmacology and toxicology 56, 299–322. [DOI] [PubMed] [Google Scholar]
  20. Koob GF, Volkow ND (2016). Neurobiology of addiction: a neurocircuitry analysis. The Lancet Psychiatry 3, 760–773. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Lawrence D, William JM (2016). Trends in smoking rates by level of psychological distress - Time series analysis of US National Health Interview Survey Data 1997–2014. 18(6), 1463–1470. [DOI] [PubMed] [Google Scholar]
  22. Lawrence D, Mitrou F, Zubrick SR (2011). Non-specific psychological distress, smoking status and smoking cessation: United States National Health Interview Survey 2005. BMC public health 11, 256. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Martel MM, Eisenlohr-Moul T, Roberts B (2017). Interactive effects of ovarian steroid hormones on alcohol use and binge drinking across the menstrual cycle. Journal of Abnormal Psychology 126, 1104–1113. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. McEwen BS (2006). Protective and damaging effects of stress mediators: Central role of the brain. Dialogues in Clinical Neuroscience 8, 367–381. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. McKee SA, Potenza MN, Kober H, Sofuoglu M, Arnsten AF, Picciotto MR, Weinberger AH, Ashare R, Sinha R (2015). A translational investigation targeting stress-reactivity and prefrontal cognitive control with guanfacine for smoking cessation. Journal of psychopharmacology 29, 300–311. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. McKee SA, Sinha R, Weinberger AH, Sofuoglu M, Harrison EL, Lavery M, Wanzer J (2011). Stress decreases the ability to resist smoking and potentiates smoking intensity and reward. Journal of psychopharmacology 25, 490–502. [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. Myer L, Stein DJ, Grimsrud A, Seedat S, Williams DR (2008). Social determinants of psychological distress in a nationally-representative sample of South African adults. Soc Sci Med. 66(8), 1828–1840. [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. NIAAA. (2017). Women and Alcohol. https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/women-and-alcohol
  29. Patra J, Taylor B, Irving H, Roerecke M, Baliunas D, Mohapatra S, Rehm J (2010). Alcohol consumption and the risk of morbidity and mortality for different stroke types-a systematic review and meta-analysis. BMC Public Health 10, 258. [DOI] [PMC free article] [PubMed] [Google Scholar]
  30. Peltier MR, Verplaetse TL, Mineur YS, Petrakis IL, Cosgrove KP, Picciotto MR, McKee SA (2019). Sex differences in stress-related alcohol use. Neurobiology of stress. 2019 Feb 8; 10:100149. [DOI] [PMC free article] [PubMed] [Google Scholar]
  31. Pratt LA, Dey AN, Cohen AJ (2007). Characteristics of adults with serious psychological distress as measured by the K6 scale: Unites States, 2001–04. Adv. Data, 382, 1–18. [PubMed] [Google Scholar]
  32. Prochaska JJ, Sung HY, Max W, Shi Y, Ong M (2012). Validity study of K6 scale as a measure of moderate mental distress based on mental health treatment need and utilization. Int. J. Methods Psychiatry Res 21, 88–97. [DOI] [PMC free article] [PubMed] [Google Scholar]
  33. Rehm J, Taylor B, Mohapatra S, Irving H, Baliunas D, Patra J, Roerecke M (2010). Alcohol as a risk factor for liver cirrhosis: A systematic review and meta-analysis. Drug and alcohol review 29, 437–445. [DOI] [PubMed] [Google Scholar]
  34. SAMHSA. (2014). Results from the 2013 National Survey on Drug Use and Health: Summary of National Findings, Rockville, MD: https://www.samhsa.gov/data/sites/default/files/NSDUHresultsPDFWHTML2013/Web/NSDUHresults2013.pdf [Google Scholar]
  35. Smith PH, Saddleson ML, Homish GG, McKee SA, Kozlowski LT, Giovino GA (2015). The relationship between childhood physical and emotional abuse and smoking cessation among US women and men. Psychology of Addictive Behaviors 29, 338. [DOI] [PMC free article] [PubMed] [Google Scholar]
  36. Tsai J, Floyd RL, O’Connor MJ, Velasquez MM (2009). Alcohol use and serious psychological distress among women of childbearing age. Addict Behav. 34(2), 146–153. [DOI] [PubMed] [Google Scholar]
  37. Verplaetse TL, Moore KE, Pittman BP, Roberts W, Oberleitner LM, Smith PH, Cosgrove KP, McKee SA (2018). Intersection of stress and gender in association with transitions in past year DSM-5 substance use disorder diagnoses in the United States. Chronic Stress. 2018 Jan-Dec;2. [DOI] [PMC free article] [PubMed] [Google Scholar]
  38. Weinberger AH, Pacek LR, Sheffer CE, Budney AJ, Lee J, Goodwin RD (2019). Serious psychological distress and daily cannabis use, 2008–2016: Potential implications for mental health? Drug and Alcohol Dependence. 197(1), 134–140. [DOI] [PMC free article] [PubMed] [Google Scholar]
  39. Weissman JF, Pratt LA, Miller EA, Parker JD (2015). Serious psychological distress among adults: United States, 2009–2013. NCHS Data Brief. 203, 1–8. [PubMed] [Google Scholar]
  40. Weissman J, Russel D, Jay M, Malaspina D (2018). Racial, ethnic, and gender disparities in health care access and use among U.S. adults with serious psychological distress. Psychiatry Serv. 69, 517–522. [DOI] [PubMed] [Google Scholar]
  41. Woo B, Wang K, Tran T, (2017). Racial and ethnic differences in associations between psychological distress and the presence of binge drinking: Results from the California health interview survey. Addictive Behaviors 65, 1–6. [DOI] [PubMed] [Google Scholar]

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