Despite its limitations, this study provided confirmation at the general population level of the importance of internalizing and externalizing psychopathology in discriminating among alcoholic phenotypes, and it revealed significant gender differences in phenotypes defined by type of disorder. It showed that whereas alcohol dependence and externalizing psychopathology are more common among men than women, their association is greater among women. Bearing in mind the uncertainties imposed by studying lifetime comorbidity, these findings suggest the need to increase alcoholism screening, prevention and intervention among women with externalizing psychopathology, a highly vulnerable group with high rates of alcohol dependence nearly comparable to those of their male counterparts. Despite externalizing psychopathology having the stronger association with alcohol dependence among both men and women, internalizing psychopathology was far more prevalent among lifetime alcoholics. Thus, the emphasis on the externalizing psychopathology in the alcohol literature should not obscure the importance of addressing symptoms of mood and anxiety disorders in alcoholism treatment settings. Finally, among alcoholics with no psychopathology or internalizing psychopathology only, especially women, our data indicate the need for more active screening and referral in various treatment/primary care settings to match the alcohol treatment levels of alcoholics with externalizing psychopathology.
