This overlap in neural networks may be important as there is evidence suggesting that women are more likely to drink to avoid negative reinforcers (e.g., negative mood, anxiety), whereas men are more likely to drink for positive reinforcement (e.g., euphoria, social aspects) (for comprehensive reviews see (Logrip et al., 2018; Peltier et al., 2019)). AUD women activate less and AUD men active more in frontal regions in response to fearful stimuli compared to same-sex controls (Padula et al., 2015) and healthy men activate the insula (Lee et al., 2014), an area related to inhibitory control, in response to stress. Thus, it is possible that women may be less able to process negative emotional stimuli compared to men, thereby drinking to regulate negative emotion. Future work in the neuroimaging field should consider examining SG differences in stress-related pathophysiology as it relates to AUD, develop radiotracers to answer fundamental questions about differences in stress-related neurochemistry in women and men with AUD, and how SG-dependent alterations in these neural mechanisms may influence clinical correlates of problem drinking and treatment.
