It is important to note that given the cross-sectional design of the NESARC (Wave 3), it is unclear whether SUD transitions preceded life event stress or vice versa. However, this general pattern of findings is consistent with established literature demonstrating that stress plays an important role in the initiation and maintenance of substance use in both men and women.12,41 Previous reviews hypothesized that women may be more likely than men to use substances to regulate stress and negative affect.42,43 The finding that women with two or more life event stressors were at the greatest odds of having a new onset AUD is in agreement with this hypothesis and other work suggesting that women are more likely than men to attribute their drinking to stress.28 However, the overall pattern of findings suggests few gender differences when considering the impact of life event stress increasing the likelihood of substance use onset and persistence.
