The moderate levels of early risk factors found in the two gender-related subtypes, together with the parallels to conventional gender roles, suggest that the development and expression of alcohol problems in the two groups depend on sociocultural factors (e.g., differing social expectations for women and men or differential approval of drinking by men versus women) rather than an inherited predisposition. This observation suggests an etiology for women in the internalizing group. Despite the current acceptability of a wider range of roles for women in American society, assertiveness among women is still discouraged. Thus, females might be expected to internalize problems and to self-medicate with alcohol to a greater degree than males; higher levels of negative affect and guilt as a result of drinking may set the stage for an alcohol consumption pattern that could result in alcoholism for the internalizing subtype. Similarly, the greater acceptability of aggressiveness and alcohol use among males may contribute to the pattern observed in the externalizing subtype.
