Sex-related structural differences in alcohol-related aggressive behaviors, family conflicts and Cluster B personality disorders in substance use treatment: engagement, discharge and readmissions

Aims: We estimated whether sex-related structural differences in alcohol-related aggressive behaviors, family conflicts and Cluster B personality disorders were associated with treatment engagement and outcomes among patients with substance use disorders. We estimated (i) sex differences in years of problematic alcohol use and prevalence of alcohol-related aggressive behaviors, conflict with partner and conflict with children at treatment entry; (ii) sex differences in treatment processes and outcomes by years of problematic alcohol use and across groups defined by alcohol-related aggressive behaviors, family conflicts and Cluster B diagnosis; (iii) associations among years of problematic alcohol use, family conflicts, alcohol-related aggressive behaviors and Cluster B diagnosis within each sex; and (iv) sex differences in structural pathways linking these factors to appointment adherence, retention, therapeutic discharge and readmissions. Design: Retrospective multicentric observational study using electronic health records. Setting: Public addiction treatment network, Andalusia, Spain. Participants: 4,844 treatment entrants between 3 January 2015 and 15 September 2021 (25.5% women). Measurements: Predictors were years of problematic alcohol use, conflict with partner, conflict with children, alcohol-related aggressive behaviors and Cluster B personality disorder diagnosis. Outcomes were appointment adherence (proportion of scheduled appointments attended), retention (time in treatment), therapeutic discharge and number of readmissions. Findings: Conflict with children was more prevalent in women (31.7%) than men (15.9%) (V = 0.17; p < .001). Conflict with children was associated with higher readmissions in women (β = 0.101, p = .001) but not men (β = −0.029, p = .126), whereas partner conflict was associated with fewer readmissions in men (β = −0.041; p = .019). In men, alcohol-related aggressive behaviors were associated with lower appointment adherence (β = −0.059; p = .001). Cluster B diagnosis was associated with lower therapeutic discharge (men: β = −0.063; p = .017; women: β = −0.138; p = .005) and higher readmissions (men: β = 0.062; women: β = 0.095; both p < .001). Retention was associated with higher therapeutic discharge and fewer readmissions in both men and women (all p < .001). Sex differences in structural pathways were confined to the association between conflict with children and readmissions Conclusions: In Andalusia, Spain, conflict with children was associated with higher readmissions among women but not men, whereas partner conflict was associated with fewer readmissions among men. Alcohol-related aggressive behaviors were associated with lower appointment adherence among men, and Cluster B personality disorders were associated with lower therapeutic discharge and higher readmissions in both men and women.