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

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Title: Gender-related differences in structural pathways involving alcohol-related aggressive behaviors, family conflicts, and Cluster B personality disorders in substance use treatment: engagement, discharge, and readmissions.
Authors: Dacosta-Sánchez D; Departamento de Psicología y Antropología, Área de Personalidad, Evaluación y Tratamiento Psicológico, Facultad de Formación del Profesorado, Universidad de Extremadura, Cáceres, España; Research Center on Natural Resources, Health and the Environment, University of Huelva, Huelva, Spain. Electronic address: danields@unex.es., González Ponce BM; Departamento de Psicología y Antropología, Área de Psicología Social, Facultad de Formación del Profesorado, Universidad de Extremadura, Cáceres, España; Research Center on Natural Resources, Health and the Environment, University of Huelva, Huelva, Spain. Electronic address: begonzalezp@unex.es., Mancheño-Velasco C; Department of Clinical and Experimental Psychology, University of Huelva, Huelva, Spain; Research Center on Natural Resources, Health and the Environment, University of Huelva, Huelva, Spain. Electronic address: cinta.mancheno@dpces.uhu.es., Narváez-Camargo M; Department of Clinical and Experimental Psychology, University of Huelva, Huelva, Spain; Research Center on Natural Resources, Health and the Environment, University of Huelva, Huelva, Spain. Electronic address: marta.narvaez@dpces.uhu.es., Lozano ÓM; Department of Clinical and Experimental Psychology, University of Huelva, Huelva, Spain; Research Center on Natural Resources, Health and the Environment, University of Huelva, Huelva, Spain. Electronic address: oscar.lozano@dpsi.uhu.es.
Source: Addictive behaviors [Addict Behav] 2026 Aug; Vol. 179, pp. 108688. Date of Electronic Publication: 2026 Mar 29.
Publication Type: Journal Article
Language: English
Journal Info: Publisher: Elsevier Science Country of Publication: England NLM ID: 7603486 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1873-6327 (Electronic) Linking ISSN: 03064603 NLM ISO Abbreviation: Addict Behav Subsets: MEDLINE
Imprint Name(s): Publication: Oxford : Elsevier Science
Original Publication: Oxford, Elmsford, N. Y., Pergamon Press.
MeSH Terms: Patient Readmission*/statistics & numerical data , Family Conflict*/psychology , Aggression*/psychology , Personality Disorders*/epidemiology , Personality Disorders*/psychology , Alcoholism*/psychology , Alcoholism*/epidemiology , Substance-Related Disorders*/therapy , Substance-Related Disorders*/psychology, Patient Discharge/statistics & numerical data ; Humans ; Female ; Male ; Sex Factors ; Retrospective Studies ; Adult ; Middle Aged
Abstract: Background: Gender-informed addiction care needs evidence on whether alcohol-related aggressive behaviors, family conflict and Cluster B pathology influence treatment differently for men and women.
Objective: To test gender-specific structural pathways associating years of problematic alcohol use, alcohol-related aggressive behaviors, partner conflict, child conflict and Cluster B diagnosis with appointment adherence, retention, therapeutic discharge and readmissions.
Method: Retrospective electronic health record study in Andalusia's public addiction treatment network (N = 4844 entrants, 2015-2021; 25.5% women). Multigroup structural modelling tested within-gender associations and gender differences in pathways to outcomes.
Results: Child conflict was more prevalent in women than men (31.7% vs 15.9%; V = 0.17; p < 0.001) and was associated with higher readmissions in women (β = 0.101; p = 0.001) but not men (β = -0.029; p = 0.126); partner conflict was associated with fewer readmissions in men (β = -0.041; p = 0.019). In men, alcohol-related aggressive behaviors were associated with lower appointment adherence (β = -0.059; p = 0.001). Cluster B diagnosis was associated with lower therapeutic discharge (men: β = -0.063; p = 0.017; women: β = -0.138; p = 0.005) and higher readmissions (men: β = 0.062; women: β = 0.095; both p < 0.001). Retention was associated with higher discharge and fewer readmissions in both genders (all p < 0.001). Meaningful gender-specific structural differences emerged only in the pathway associating child conflict to readmissions.
Discussion and Conclusion: These pathways highlight child conflict as a gender-specific readmission risk marker for women and support family-focused, gender-informed interventions that strengthen adherence and retention.
(Copyright © 2026 The Author(s). Published by Elsevier Ltd.. All rights reserved.)
Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
Contributed Indexing: Keywords: Alcohol-related aggressive behaviors; Appointment adherence; Cluster B personality disorders; Conflict with children; Conflict with partner; Family conflict; Readmissions; Retention; Substance use disorders
Entry Date(s): Date Created: 20260331 Date Completed: 20260714 Latest Revision: 20260714
Update Code: 20260714
DOI: 10.1016/j.addbeh.2026.108688
PMID: 41916201
Database: MEDLINE
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  Data: &lt;searchLink fieldCode=&quot;AU&quot; term=&quot;%22Dacosta-S&#225;nchez+D%22&quot;&gt;Dacosta-S&#225;nchez D&lt;/searchLink&gt;; Departamento de Psicolog&#237;a y Antropolog&#237;a, &#193;rea de Personalidad, Evaluaci&#243;n y Tratamiento Psicol&#243;gico, Facultad de Formaci&#243;n del Profesorado, Universidad de Extremadura, C&#225;ceres, Espa&#241;a; Research Center on Natural Resources, Health and the Environment, University of Huelva, Huelva, Spain. Electronic address: danields@unex.es.&lt;br /&gt;&lt;searchLink fieldCode=&quot;AU&quot; term=&quot;%22Gonz&#225;lez+Ponce+BM%22&quot;&gt;Gonz&#225;lez Ponce BM&lt;/searchLink&gt;; Departamento de Psicolog&#237;a y Antropolog&#237;a, &#193;rea de Psicolog&#237;a Social, Facultad de Formaci&#243;n del Profesorado, Universidad de Extremadura, C&#225;ceres, Espa&#241;a; Research Center on Natural Resources, Health and the Environment, University of Huelva, Huelva, Spain. Electronic address: begonzalezp@unex.es.&lt;br /&gt;&lt;searchLink fieldCode=&quot;AU&quot; term=&quot;%22Manche&#241;o-Velasco+C%22&quot;&gt;Manche&#241;o-Velasco C&lt;/searchLink&gt;; Department of Clinical and Experimental Psychology, University of Huelva, Huelva, Spain; Research Center on Natural Resources, Health and the Environment, University of Huelva, Huelva, Spain. Electronic address: cinta.mancheno@dpces.uhu.es.&lt;br /&gt;&lt;searchLink fieldCode=&quot;AU&quot; term=&quot;%22Narv&#225;ez-Camargo+M%22&quot;&gt;Narv&#225;ez-Camargo M&lt;/searchLink&gt;; Department of Clinical and Experimental Psychology, University of Huelva, Huelva, Spain; Research Center on Natural Resources, Health and the Environment, University of Huelva, Huelva, Spain. Electronic address: marta.narvaez@dpces.uhu.es.&lt;br /&gt;&lt;searchLink fieldCode=&quot;AU&quot; term=&quot;%22Lozano+&#211;M%22&quot;&gt;Lozano &#211;M&lt;/searchLink&gt;; Department of Clinical and Experimental Psychology, University of Huelva, Huelva, Spain; Research Center on Natural Resources, Health and the Environment, University of Huelva, Huelva, Spain. Electronic address: oscar.lozano@dpsi.uhu.es.
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– Name: Abstract
  Label: Abstract
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  Data: Background: Gender-informed addiction care needs evidence on whether alcohol-related aggressive behaviors, family conflict and Cluster B pathology influence treatment differently for men and women.&lt;br /&gt;Objective: To test gender-specific structural pathways associating years of problematic alcohol use, alcohol-related aggressive behaviors, partner conflict, child conflict and Cluster B diagnosis with appointment adherence, retention, therapeutic discharge and readmissions.&lt;br /&gt;Method: Retrospective electronic health record study in Andalusia&#39;s public addiction treatment network (N&#160;=&#160;4844 entrants, 2015-2021; 25.5% women). Multigroup structural modelling tested within-gender associations and gender differences in pathways to outcomes.&lt;br /&gt;Results: Child conflict was more prevalent in women than men (31.7% vs 15.9%; V&#160;=&#160;0.17; p&#160;&amp;lt;&#160;0.001) and was associated with higher readmissions in women (β&#160;=&#160;0.101; p&#160;=&#160;0.001) but not men (β&#160;=&#160;-0.029; p&#160;=&#160;0.126); partner conflict was associated with fewer readmissions in men (β&#160;=&#160;-0.041; p&#160;=&#160;0.019). In men, alcohol-related aggressive behaviors were associated with lower appointment adherence (β&#160;=&#160;-0.059; p&#160;=&#160;0.001). Cluster B diagnosis was associated with lower therapeutic discharge (men: β&#160;=&#160;-0.063; p&#160;=&#160;0.017; women: β&#160;=&#160;-0.138; p&#160;=&#160;0.005) and higher readmissions (men: β&#160;=&#160;0.062; women: β&#160;=&#160;0.095; both p&#160;&amp;lt;&#160;0.001). Retention was associated with higher discharge and fewer readmissions in both genders (all p&#160;&amp;lt;&#160;0.001). Meaningful gender-specific structural differences emerged only in the pathway associating child conflict to readmissions.&lt;br /&gt;Discussion and Conclusion: These pathways highlight child conflict as a gender-specific readmission risk marker for women and support family-focused, gender-informed interventions that strengthen adherence and retention.&lt;br /&gt; (Copyright &#169; 2026 The Author(s). Published by Elsevier Ltd.. All rights reserved.)
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  Data: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
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        Text: English
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        StartPage: 108688
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      – SubjectFull: Patient Discharge statistics & numerical data
        Type: general
      – SubjectFull: Humans
        Type: general
      – SubjectFull: Female
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      – SubjectFull: Male
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      – SubjectFull: Patient Readmission statistics & numerical data
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      – SubjectFull: Family Conflict psychology
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      – SubjectFull: Aggression psychology
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      – SubjectFull: Substance-Related Disorders psychology
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      – TitleFull: Gender-related differences in structural pathways involving alcohol-related aggressive behaviors, family conflicts, and Cluster B personality disorders in substance use treatment: engagement, discharge, and readmissions.
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