The aim of this study was to examine gender differences in alcohol-related symptomatology, other substance use, psychiatric disorders, psychosocial stress, sensation seeking, and a history of substance use and mental health disorders in the family of origin. The sample consisted of 150 women and 150 men who met DSM-III-R lifetime criteria for alcohol dependence. Participants were recruited in equal numbers from treatment settings, correctional centers, and the general community. Participants were interviewed for 2 to 3 hours, over one or two sessions. All interviews were based on structured questions and standardized tests. Multivariate analyses were used to detect patterns of variables associated with gender and the lifetime severity of AUD. The results showed that men had a longer history of severe AUD than women. Women had similar levels of alcohol dependence and medical and psychological consequences of alcohol use, despite 6 fewer years of AUD. More women than men had a history of severe psychosocial stress, severe dependence on other substances, and antecedent mental health problems, especially mood and anxiety disorders. There were differences in family history of alcohol-related problems approximating same-gender aggregation. The severity of a lifetime AUD was predicted by its earlier age at onset and the occurrence of other disorders, especially anxiety, among both men and women. Despite the unique characteristics of this sample, there were some important findings that have implications for the detection and treatment of disorders experienced by people with substance abuse problems. Women, particularly those in correctional and treatment centers, were more vulnerable to a rapid escalation of their substance dependence, which was compounded by pre-existing mental health disorders and severe early life events. This points to a need to increase opportunities for treatment for these clients and, therefore, screening for substance use and mental disorders. Tables, references