Gender is a social and cultural construct that shapes human experience, and is one of the most significant social determinants of health [1]. Gendered drinking practices are an example of this. Research across different historical periods and cultural contexts has consistently shown that women are more likely to abstain from alcohol consumption [2, 3], while men generally consume more alcohol [3] and are more likely to engage in heavy episodic drinking than women [4]. Given these differences in consumption, men tend to experience more alcohol-related harms—for example, alcohol-attributable injuries, drink driving and developing alcohol use disorders [3]. In 2016, global disability-adjusted life years (DALY) attributable to alcohol use were far higher for men (6.0%; 95% uncertainty interval 5.4–6.7), compared with women (1.6%; 1.4–2.0), with DALYs lost attributable to alcohol experienced at higher rates in middle age [5, 6]. However, despite drinking less, women's alcohol consumption is subject to greater social sanctions, and is problematised more so than men's [7-10].

While research shows men consume more alcohol and experience more alcohol-related harms, our recent systematic review of over 1200 single-gender studies on alcohol published between 2014 and 2023 showed that researchers have focused their efforts largely on understanding women's drinking [6]. In our review we accepted the definition and terminology related to sex or gender as expressed in the individual study, and identified 44% of single-gender studies in the last decade focused on men, whereas 56% of studies focused on women. Stark disparities were also found in the populations studied. For example, studies on parents were more likely to be on mothers than on fathers, and studies on college students were more likely to be on women than men [6]. There were also glaring methodological differences (i.e., qualitative, quantitative or mixed methods approach), with significantly more qualitative studies on women (12%) than on men (5%).

We also examined the disciplinary focus (by considering authors affiliation, journal, paper's aim and framing), across the following groupings: (i) medicine, focussing on clinical conditions and biological processes; (ii) psychology, including all types of psychology (e.g., clinical, social, cultural etc.) neuroscience and neuroeconomics; (iii) sociology, including anthropology; and (iv) public health, including epidemiology, nutrition, population health and social work [6]. Of the included studies, one in three studies on men were from medical disciplines (nearly 1 in 10 studies on women were from medical disciplines; n = 69), whereas studies on women were more likely to come from social disciplines, such as psychology, public health or sociology.

Not only has alcohol research over the past decade focused on women, but there has been a particular attention to young women's drinking (18- to 24-year-olds). Given that women were notably absent from alcohol research up until the 1970s [4, 11], this research is filling a gap. However, it may do more than just that. While scientists tend to regard research methods as a means of accessing reality, social scientists have suggested that methodological choices (i.e., who we choose to study and how) play an important role in constructing it [12]. We argue that alcohol researchers' current preoccupation with women's drinking, and especially young women's drinking, produces women's alcohol consumption as a more significant problem than men's, despite evidence that this is not the case. The disproportionate focus on women's drinking in turn contributes to the gendered framing of treatment and policy responses. Here we discuss the Australian and Aotearoa New Zealand specific findings of our systematic review that will be of relevance for Drug and Alcohol Review's audience, before considering some pathways for future alcohol research.

1 Australia and Aotearoa New Zealand

In 2016 in Australia, 8.4% of all men's deaths and 8.2% of DALYs lost could be attributed to alcohol. Conversely 2.2% of all deaths and 1.4% of DALYs were attributable to women's alcohol use. Given the difference in rates at which men and women consume alcohol, this is not surprising; 38% of men and 23% of women reported drinking more than five standard drinks on an occasion monthly, and volumetrically, men drink approximately twice as much as women (1.4 drinks per day for men compared with 0.7 for women). Similarly, in Aotearoa New Zealand in 2016, 1.6% of all deaths for women and 8.2% of deaths for men could be attributable to alcohol use [13].

Yet, of the 82 single gender articles published in Australia and Aotearoa New Zealand, 64 (78%) focused on women (see Table 1 for descriptive characteristics of these studies). Here, the number of single gender articles is small but still striking in terms of their gender bias—the only two articles on treatment focused on men, while all five on parents were on mothers, all five on university students were on women, and all four describing single gender interventions focused on women (these included three public health interventions and one medical interventions).

One thing that is abundantly clear is that this focus on women has nothing to do with current efforts to address the gender gap in medical research. Seven of the articles (39%) on men were medically focused while this was only true of two of the articles on women (3%)—articles on men are nearly 20 times as likely to be medical than those on women (odds ratio 0.05, p = 0.001). Conversely, articles on women were nearly seven times more likely to be public health focused (odds ratio 6.68, p = 0.002).

2 Where to Next?

Gender biases, such as those highlighted in the systematic review (e.g., more qualitative studies women, more medical studies on men), facilitate prejudices in how we govern people who consume alcohol (and other drugs), and the strategies developed to reduce alcohol-related problems. For example, lack of attention on men's consumption and the alcohol-related harms men disproportionately experience may divert funding away from prevention efforts, policies or services supporting this group (see also [7]). Similarly, the limited gender specific insights into men's alcohol practices, as evidenced by our findings on disciplinary focus (specifically the limited sociological or public health research on men), may also impact the policy and treatment options available, for example, by failing to consider men's caregiving roles or social stigma and their intersection with drinking. To address this, first critical attention needs to be given to the disciplinary underpinnings of these studies, as well as interrogating who benefits from the research and the framing adopted, who or what is silenced in the process, and what the implications are for the populations we are examining [14].

Second, more research on middle-aged men, who consume the most alcohol and experience the most alcohol-related harms [5, 6, 13], is needed. New qualitative explorations are also needed to deepen our understandings of the contexts and social meanings of men's alcohol consumption and drinking practices. Similarly, given the disproportionate focus on mothers in research on parental alcohol consumption, fathers may be an opportune group to start in reorientating our attention. Australian fathers drink at commensurate rates to other middle-aged men in the Australian population [15], yet may be more open to change [16]. Broadening research to include middle-aged men and fathers can help inform more equitable research agendas and more effective alcohol policies/interventions.

Although our review has limitations, it importantly demonstrated a predominant focus on women in alcohol research that researchers need to keep in mind moving forward. Arguably, research studies captured in our review and pre-2014 have been part of an effort to address the absence of women from alcohol literature which was dominated by a focus on men up until the 1970's. Although our focus was on academic literature, we note that these disparities can be echoed in other spaces. For example, the 2024 the Australasian Professional Society on Alcohol and other Drugs conference themes included a section dedicated to women but no commensurate section for men. Similarly, population level alcohol policies arguably remain gender-blind despite recognition that explicitly identifying whom evidence applies to is necessary to formulate effective policy responses [17]. As such there is also a clear need for policy-relevant research focussed on effective gender-responsive approaches for reducing alcohol-related harms [18]. It is not our intention to single out researchers or research groups, but it is our view that we need to question certain aspects of research culture on alcohol. This includes funding directives that may inadvertently contribute to gaps and inequalities in gendered alcohol research and a lack of gender-responsive treatment options, for example, the recent National Health and Medical Research Council Medical Research Future Fund funding call on alcohol and other drugs focussed on priority populations which included young people and women (with no focus on the group who experiences the most harm; middle-aged men).

Given the ongoing challenges of survey research and economic constraints on robust data collection and research methodologies, each decision we make as researchers precludes studying other issues or groups [19]. In funding and designing future research, it is important to ensure we are not over-researching or over-problematising particular demographics of drinkers, particularly if they are not the group experiencing or causing the most harm from drinking. Prompting such reflexivity can bring our attention to the underlying sociocultural assumptions that guide our research questions and methodological approaches, and enable us to consider the implications for the populations we study. It is our hope that our systematic review and the ongoing dialogue about gender will go some way to helping these reflections.

Author Contributions

Each author certifies that their contribution to this work meets the standards of the International Committee of Medical Journal Editors. All authors contributed to the conceptualisation, data analysis and drafting the manuscript, MC led conceptualisation, data analysis and writing of the manuscript.

Conflicts of Interest

The authors declare no conflicts of interest.