Gender differences in alcohol-cue-induced craving and heart-rate variability in hazardous drinkers

Alcohol use disorder (AUD) has risen more rapidly in women than men in recent decades. While previous studies identified gender differences in AUD, the mechanisms remain unclear. This study examined gender differences in alcohol cue-induced craving and heart rate variability (HRV) in 114 people who engage in heavy drinking (61 women) using an alcohol-cue reactivity task. We predicts that men will show stronger cue-induced reward cravings, women will have more intense relief cravings. Additionally, it is expected that the relationship between cue-induced craving and HRV will differ by gender: reward craving in men will correspond with increased HRV, whereas relief craving in women will correlate with decreased HRV. The alcohol cue-reactivity task began with a 75-second relaxation exercise, followed by 30-second presentations of alcohol-related pictures and imagery, and a 120-second session of handling an alcohol beverage. Craving was assessed before and after using the desire for alcohol questionnaire (DAQ), and HRV was continuously recorded via electrocardiograph throughout the task. Repeated measures ANOVAs showed significant increases in both relief (p < .05) and reward craving (p < .001) after the alcohol cue-reactivity task, with no gender differences. Exploratory analysis found that HRV decreased in response to alcohol cues for both genders, with men showing a significantly greater decline during the picture phase (p < .05). Additionally, those with higher relief craving had lower HRV during the imagery phase compared to the picture phase, regardless of gender (p = .20). The current study suggests that gender differences in alcohol cue reactivity are more pronounced in HRV than in subjective responses.