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

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.