Gender differences in substance use disorders

Sex differences in non-reinforced responding for cocaine

Prior studies report no sex differences in cocaine consumption during maintenance of self-administration. We find female rats show poorer lever discrimination during acquisition of self-administration. Now, we test whether female rats show greater non-reinforced or ineffective responding (presses during infusion and time-out periods as well as inactive lever presses) than male rats during maintenance of cocaine self-administration (.0625-1.0 mg/kg/infusion) in Experiment 1. Persistence of responding during extinction when saline-replaced cocaine was also examined. Whether response differences reflect sex differences in movements under a non-drug condition was tested in Experiment 2. Because cocaine may affect lever press rates differentially between sexes, we examined the effects of cocaine (.3-30 mg/kg; IP) on responding for food in Experiment 3. Cocaine consumption does not differ between female and male rats. However, females respond more during infusion and time-out periods and during extinction than males. There is no sex difference in movements and high cocaine doses decrease responding for food more in female vs. male rats. That females engage in more ineffective responding may represent heightened "craving" and cannot be explained by increased movements or cocaine-stimulated increases in lever pressing. In contrast, responding for cocaine in males appears driven by drug delivery.

Patterns of substance involvement and criminal behavior: a gender-based cluster analysis of Pennsylvania arrestees

Recent drug-crime scholarship has underscored the importance of conducting disaggregated research that focuses on the consistencies and variations between subcategories of drug misuse and criminal activity and, further, how these associations may vary across sociodemographic and cultural boundaries. The research presented in this article used cluster analysis to independently classify male and female arrestees based on their arrest charges and substance-specific indicators of initiation, use, dependence, and treatment need. The data come from Pennsylvania's Substance Abuse and Need for Treatment Among Arrestees study conducted as part of the State Treatment Needs Assessment Program. Five groups were identified in both the male and female cluster analyses. The results reveal both important differences and strong similarities in the drug-crime typologies of male and female arrestees. Given these findings, implications are discussed for developing and targeting responsive treatment services that match the particular risks and needs of drug-involved offenders.

Neural correlates of impulse control during stop signal inhibition in cocaine-dependent men

Altered impulse control is associated with substance use disorders, including cocaine dependence. We sought to identify the neural correlates of impulse control in abstinent male patients with cocaine dependence (PCD). Functional magnetic resonance imaging (fMRI) was conducted during a stop signal task that allowed trial-by-trial evaluation of response inhibition. Fifteen male PCD and 15 healthy control (HC) subjects, matched in age and years of education, were compared. Stop signal reaction time (SSRT) was derived on the basis of a horse race model. By comparing PCD and HC co-varied for stop success rate, task-related frustration rating, and post-error slowing, we isolated the neural substrates of response inhibition, independent of attentional monitoring (of the stop signal) and post-response processes including affective responses and error monitoring. Using region of interest analysis, we found no differences between HC and PCD who were matched in stop signal performance in the pre-supplementary motor area (pre-SMA) previously shown to be associated with SSRT. However, compared with HC, PCD demonstrated less activation of the rostral anterior cingulate cortex (rACC), an area thought to be involved in the control of stop signal inhibition. The magnitude of rACC activation also correlated negatively with the total score and the impulse control subscore of the Difficulty in Emotion Regulation Scale in PCD. The current study thus identified the neural correlates of altered impulse control in PCD independent of other cognitive processes that may influence stop signal performance. Relative hypoactivation of the rACC during response inhibition may represent a useful neural marker of difficulties in impulse control in abstinent cocaine-dependent men who are at risk of relapse.

Protracted time-dependent increases in cocaine-seeking behavior during cocaine withdrawal in female relative to male rats

RATIONALE

Female rats display higher sensitivity to cocaine relative to males under a variety of conditions. Time-dependent increases in cocaine-seeking behavior (as measured by nonreinforced operant responses) during cocaine withdrawal have been reported in male, but not female, rats.

OBJECTIVES

The present study determines sex and estrous cycle influences on time-dependent changes in cocaine-seeking behavior.

MATERIALS AND METHODS

Male and female Sprague-Dawley rats were reinforced for "active lever" responses by a cocaine infusion (0.50 mg/kg/infusion, i.v., fixed ratio schedule of reinforcement, FR1) followed by a 20-s time-out when reinforcement was not delivered. Infusions were paired with a light + tone conditioned stimulus. Next, rats underwent cocaine withdrawal for 1, 14, 60, or 180 days before testing cocaine-seeking behavior. Each rat was tested for extinction of operant responding, conditioned-cued reinstatement, and cocaine-primed (10 mg/kg, i.p.) reinstatement.

RESULTS

Both males and females displayed a time-dependent increase in cocaine-seeking behavior (active lever presses) under extinction of operant responding and conditioned-cued reinstatement conditions after 60 days of cocaine withdrawal. Moreover, cocaine-seeking behavior during extinction of operant responding in females, but not males, remained elevated at 180 days of cocaine withdrawal. Furthermore, females tested during estrus exhibited higher cocaine-seeking behavior under both extinction of operant responding and cocaine-primed reinstatement conditions relative to other rats independent of the duration of cocaine withdrawal.

CONCLUSIONS

The effects of reproductive cycle and withdrawal duration on cocaine-seeking behavior are additive and time-dependent increases in cocaine-seeking behavior are more enduring in females than in male rats.

Gender differences in zebrafish responses to cocaine withdrawal

The acute responses to cocaine and its withdrawal contribute to cocaine dependence and potentiate relapse, with gender being one of the genetic factors affecting the outcome. Here we report that in both male and female zebrafish (Danio rerio, AB strain), an initial low-dose cocaine treatment (1.5 muM, immersion) does not acutely change their behavior. The cocaine withdrawal, however, is associated with an anxiety-like state that develops earlier in female zebrafish but is more robust and persistent in males, and can be acutely attenuated by cocaine administration. This is not a result of gender differences in the expression of anxiety-like state, since behavioral responses to an anxiogenic drug, FG-7142, are similar in male and female zebrafish. The basal brain dopamine (DA) levels and the expression of dopamine transporter mRNA (zDAT) show no significant sexual dimorphism. Acute cocaine exposure does not significantly change DA or zDAT. Withdrawal from repeated cocaine administration results in an overall reduction in zDAT, as well as an increase in DA levels. Neither treatment leads to significant gender differences in brain DA or zDAT. The common and gender-specific effects of cocaine on zebrafish, a well-characterized model of vertebrate development and genetics, should help in understanding the mechanisms involved in the anxiety associated with cocaine withdrawal and provide new opportunities in search for therapeutic solutions.

Neurotoxic consequences of chronic alcohol withdrawal: expression profiling reveals importance of gender over withdrawal severity

While women are more vulnerable than men to many of the medical consequences of alcohol abuse, the role of sex in the response to ethanol is controversial. Neuroadaptive responses that result in the hyperexcitability associated with withdrawal from chronic ethanol likely reflect gene expression changes. We have examined both genders for the effects of withdrawal on brain gene expression using mice with divergent withdrawal severity that have been selectively bred from a genetically heterogeneous population. A total of 295 genes were identified as ethanol regulated from each gender of each selected line by microarray analyses. Hierarchical cluster analysis of the arrays revealed that the transcriptional response correlated with sex rather than with the selected withdrawal phenotype. Consistent with this, gene ontology category over-representation analysis identified cell death and DNA/RNA binding as targeted classes of genes in females, while in males, protein degradation, and calcium ion binding pathways were more altered by alcohol. Examination of ethanol-regulated genes and these distinct signaling pathways suggested enhanced neurotoxicity in females. Histopathological analysis of brain damage following ethanol withdrawal confirmed elevated cell death in female but not male mice. The sexually dimorphic response was observed irrespective of withdrawal phenotype. Combined, these results indicate a fundamentally distinct neuroadaptive response in females compared to males during chronic ethanol withdrawal and are consistent with observations that female alcoholics may be more vulnerable than males to ethanol-induced brain damage associated with alcohol abuse.

Substance dependence: Decades apart in a teaching hospital

AIM

The present study was done to understand the changing trends in substance dependence across decades.

SETTINGS AND DESIGN

It is a retrospective study done in Department of Psychiatry in a Teaching Hospital setting. The data of patients who attended the OPD for substance dependence during the months January to December in the years 1985 & 1986, 1995 & 1996 and 2005 & 2006 were collected and analysed.

MATERIALS AND METHODS

A total of 839 new patients with substance dependence identified according to International Classification of Diseases (ICD) (n = 839) was analysed in the present report. Study variables taken into account are alcohol dependence, polysubstance dependence which also includes alcohol, age, sex, age of initiation of substance use, duration of use, and comorbidity.

STATISTICAL ANALYSIS

Z-test, Chi-square test, mean, percentages, standard deviation.

RESULTS

Substance dependence constituted 5.32% in 1985 and 1986, 5.02% in 1995 and 1996, and 4.05% in 2005 and 2006 of the newly registered total psychiatric patients. The variation in incidence figures across the years is statistically not significant (P > 0.05). Among the substance dependents 2% in 1985 & 1986, 1% in 1995 & 1996 and 1% in 2005 & 2006 were females. Majority of the patients were alcohol dependent (87.2% in 1985 and 1986, 89.4% in 1995 and 1996, and 79.6% in 2005 and 2006). Polysubstance dependence showed an increasing trend and it was statistically significant. Comparison of the years 1985 and 1986 with 2005 and 2006 gives Z = 2.4, P < 0.05 (statistically significant). Comparison of the years 1995 and 1996 with 2005 and 2006 gives Z = 3, P < 0.01 (significant statistically). Number of people getting initiated to substance use in early age (viz. 10-19 years) showed an increasing trend. People with positive family history of substance dependence started using substances early in life. (Chi-square value: 164.7, P < 0.0001, significant statistically). In polysubstance dependence comorbidity was more (Z = 4.1, P < 0.001, significant statistically).

CONCLUSIONS

Incidence of substance dependence remained the same across the two decades. But incidence of polysubstance dependence is increasing over the years. People start using substances earlier and are becoming dependent earlier in their lives in the present decade. Polysubstance dependence is correlated with greater comorbidity. Early recognition of comorbidity and its management is essential for better prognosis. Substance dependence is exclusively a male diagnosis in our population.

Acquisition and maintenance of cocaine self-administration in adolescent rats: effects of sex and gonadal hormones

RATIONALE

Previous work has shown that adult female rats are more sensitive than adult male rats to the reinforcing effects of cocaine, an effect that appears to be due, at least in part, to ovarian hormones.

OBJECTIVE

In this study, we examine sex differences in cocaine self-administration during adolescence, a period of marked hormonal change.

MATERIALS AND METHODS

Adolescent male and female Sprague-Dawley rats were trained to self-administer cocaine (0.75 mg/kg per infusion) under a fixed ratio 1 schedule (i.e., each response was reinforced by an infusion of cocaine) beginning on postnatal day 30. After acquisition, responding was assessed under a progressive-ratio schedule until postnatal day 50 with blood sampling occurring before the first five sessions to determine the relationship between gonadal hormones (i.e., estradiol, progesterone, and testosterone) and motivation for cocaine. Estrous cycle phase was monitored throughout the study. Separate groups of adolescent male and female rats were compared on the acquisition of and progressive-ratio responding for sucrose reinforcement.

RESULTS

Females acquired cocaine self-administration more readily than did males, and a greater percentage of females acquired self-administration. Under progressive-ratio testing conditions, adolescent females responded at higher levels than adolescent males to obtain cocaine infusions, and in females, responding was positively associated with levels of estradiol and greatest during estrus. No sex differences were observed for sucrose reinforcement.

CONCLUSION

These findings suggest that sex differences are relevant during adolescence with evidence implicating circulating estradiol level as a factor that contributes to the enhanced sensitivity in females to the reinforcing effects of cocaine.

The effects of novelty-seeking phenotypes and sex differences on acquisition of cocaine self-administration in selectively bred High-Responder and Low-Responder rats

Individual differences in exploratory behavior can predictably influence psychostimulant self-administration behavior. Male rats that exhibit a high degree of locomotor activity in a novel environment (High Responders, HR) will self-administer cocaine more readily than males exhibiting low levels of novelty-induced locomotion (Low Responders, LR). The present experiment investigates the combined influences of the sex of an individual and individual phenotypes in novelty-induced locomotion to predispose animals to acquire cocaine self-administration behavior, in male and female rats selectively bred for the HR-LR phenotypes. We first established that HR females, like their male counterparts, exhibit a dramatically greater locomotor response to novelty and less anxiety-like behavior than do LR females. While locomotor behavior was subtly influenced by estrous stage, with both HR and LR females showing increased activity during metestrus and diestrus compared to proestrus and estrus, the effect did not obscure HR-LR differences. When male and female HR-LR animals were trained to self-administer cocaine (2 h/day, 5 days/wk x 3 wk, 0.2 mg cocaine/kg/infusion), HR males and females acquired cocaine self-administration significantly faster than their LR counterparts. Furthermore, HR females self-administered significantly more cocaine than all other groups. In conclusion, female rats, like males, exhibit HR-LR phenotypes that predict rapidity of acquiring cocaine self-administration. Moreover, HR females self-administer more cocaine than HR males and both LR groups.

Improving the transition from residential to outpatient addiction treatment: gender differences in response to supportive telephone calls

Substance use relapse rates are often high in the first months after discharge from inpatient substance abuse treatment, and patient adherence to aftercare plans is often low. Four residential addiction treatment centers participated in a feasibility study designed to estimate the efficacy of a post-discharge telephone intervention intended to encourage compliance with aftercare. A total of 282 participants (100 women, 182 men) with substance use disorders were included in this secondary analysis. The findings revealed that women were more likely than men to attend aftercare. This "gender effect" persisted after adjustment for a number of potential mediators.

Gender-related differences in individuals seeking treatment for kleptomania

OBJECTIVE

Understanding variations in disease presentation in men and women is clinically important as differences may reflect biological and sociocultural factors and have implications for prevention and treatment strategies. Few empirical investigations have been performed in kleptomania, particularly with respect to gender-related influences.

METHODS

From 2001--2007, 95 adult subjects (n=27 [28.4%] males) with Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition-defined kleptomania were assessed on sociodemographics and clinical characteristics, including symptom severity, comorbidity, and functional impairment, to identify gender-related differences.

RESULTS

Men and women showed substantial symptom severity and functional impairment. Compared with affected men, women with kleptomania were more likely to be married (47.1% vs 25.9%; P=.039), have a later age at shoplifting onset (20.9 vs 14 years of age; P=.001), steal household items (P<.001), hoard stolen items (P=.020), and have an eating disorder (P=.017) and less likely to steal electronic goods (P<.001) and have another impulse-control disorder (P=.018).

CONCLUSION

Kleptomania is similarly associated with significant impairment in women and men. Gender-related differences in clinical features and co-occurring disorders suggest that prevention and treatment strategies incorporate gender considerations.

Psychiatric comorbidity in young cocaine users: induced versus independent disorders

AIMS

To examine the psychiatric status of young cocaine users using a validated instrument for the evaluation of psychiatric comorbidity, emphasizing the distinction between independent and induced psychiatric conditions.

DESIGN

Cross-sectional study.

SETTING

Barcelona, Spain.

PARTICIPANTS

A cohort of 139 young (18-30 years) adult current regular cocaine users.

MEASUREMENTS

The Psychiatric Research Interview for Substance and Mental Disorders (PRISM-IV, which produces diagnoses according to DSM-IV criteria, including Axis II antisocial and borderline personality disorders).

FINDINGS

Nearly 42.5% of the subjects presented psychiatric comorbidity. The most common Axis I diagnoses were mood disorders (26.6%) and anxiety disorders (13%). Increasing age, having ever received treatment for drug use and freebase cocaine use were associated with substance-induced disorders diagnoses relative to primary Axis I disorders.

CONCLUSIONS

This study has shown a relatively high prevalence of psychiatric comorbidity in cocaine users recruited in non-clinical settings. Future studies examining potential differential factors associated with primary versus substance-induced disorders are necessary to optimize the implementation of more suitable approaching programmes for young regular cocaine users.

Gender and non-medical use of prescription opioids: results from a national US survey

AIMS

Gender differences exist regarding alcohol and illicit drug use disorders in the United States. Little is known about the gender-related factors associated with non-medical use of prescription opioids.

DESIGN

Using data from the 2003 National Survey on Drug Use and Health, we examined risk factors for past-year non-medical use of prescription opioids stratified by gender.

SETTING

Non-institutionalized US residences. Participants Civilian, non-institutionalized US citizens aged 12 years and older.

MEASUREMENTS

Self-reported alcohol and drug use, focusing specifically on past-year non-medical use of prescription opioids.

FINDINGS

Among 55 023 respondents, 4.8% reported past-year, non-medical use of prescription opioids. For both women and men, alcohol abuse/dependence and marijuana, hallucinogen, cocaine, non-medical stimulant and sedative/tranquilizer use were associated with past-year non-medical use of prescription opioids. Among women but not men, first use of illicit drugs beginning at 24 years or older [adjusted odds ratios (AOR) 1.90, 95% CI 1.05-3.44], serious mental illness (AOR 1.67, 95% CI 1.29-2.17) and cigarette smoking (AOR 1.33, 95% CI 1.05-1.68) were associated with past-year non-medical use of prescription opioids. Among men but not women, past-year inhalant use (AOR 1.93, 95% CI 1.28-2.92) was associated with the outcome.

CONCLUSIONS

For both women and men, illicit drug use is associated with the non-medical use of prescription opioids. Additionally, certain factors associated with the non-medical use of prescription opioids are notably gender-specific. Clinicians should recognize that patients with a history of illicit substance use or misuse of other prescription medications are at increased risk for non-medical use of prescription opioids, and that gender-specific factors can help to identify individuals at greatest risk.

Female and male rats in late adolescence differ from adults in amphetamine-induced locomotor activity, but not in conditioned place preference for amphetamine

Rodent models display differences in drug-induced behaviour between prepubertal/young adolescents and adults that parallel developmental differences in people; however, little is known as to when the transition to 'adultlike' behaviour occurs. We investigated the differences in locomotor and reward responses to amphetamines in male and female rats in late adolescence and compared them with corresponding adult responses. Long-Evans rats were tested for locomotor activity and conditioned place preference (CPP) for amphetamine (0.25, 0.5 or 1.0 mg/kg), beginning at 45 or 69 days of age. Adolescent female rats moved less to the first injection of amphetamine compared with adult female rats irrespective of dose, whereas adolescent male rats did not differ from adults. Adolescent female rats significantly increased locomotor activity in response to subsequent injections of amphetamine at all three doses, whereas such sensitization was only found at the highest dose for adult female and male rats. No effect of repeated injections at any dose was observed in adolescent male rats. No age differences were observed in CPP, but female rats showed greater CPP during the dioestrous than during the oestrous phase of the cycle. These data suggest that differences in neural systems underlying some behavioural responses to amphetamine continue to mature postpubertally into late adolescence in a sex-specific manner.

Sex differences in drug abuse

Sex differences are present for all of the phases of drug abuse (initiation, escalation of use, addiction, and relapse following abstinence). While there are some differences among specific classes of abused drugs, the general pattern of sex differences is the same for all drugs of abuse. Females begin regularly self-administering licit and illicit drugs of abuse at lower doses than do males, use escalates more rapidly to addiction, and females are at greater risk for relapse following abstinence. In this review, sex differences in drug abuse are discussed for humans and in animal models. The possible neuroendocrine mechanisms mediating these sex differences are discussed.

Polymorphisms TaqI A of the DRD2, BalI of the DRD3, exon III repeat of the DRD4, and 3' UTR VNTR of the DAT: association with childhood ADHD in male African-Caribbean cocaine dependents?

The conflicting results reported by genetic studies with the variants of the genes coding for the dopaminergic system in cocaine addicts could be partially explained by the difficulties to constitute homogenous sample of patients. Childhood attention-deficit/hyperactivity disorder (ADHD), and/or impulsivity are frequently associated with cocaine addiction and could participate in the heterogeneity of the samples in cocaine addicts. Accordingly, it is hypothesized that cocaine addiction would be associated with the variants of the genes coding for the dopamine system in an homogenized sample of cocaine addicts, especially in individuals with childhood ADHD comorbidity, or with a high impulsivity score. The potential association of the variants TaqI A of the DRD2, BalI of the DRD3, exon III repeat of the DRD4, and 3' UTR VNTR of the DAT was examined in African-Caribbean males, smoked-cocaine dependents. All the subjects were assessed with the Diagnostic Interview of Genetic Studies, the Barratt's impulsivity scale, and the Wender Utah rating scale for childhood ADHD. A positive association was found with the DRD2 and DRD4 polymorphisms in the subgroups of patients with childhood ADHD, or with a high impulsivity score, which represented, respectively, 53.3 and 73.0% of the patients. Conversely, no positive association was found for any of the polymorphisms studied when the group of patients was examined as a whole. Therefore, our results suggest that the clinical dimensions of childhood ADHD and of impulsivity could be taken into account to homogenize the samples of patients in cocaine association studies.

Changes in the seasonality of suicides over time in Slovenia, 1971 to 2002. Amplitude is only positively related to suicide rates among females

BACKGROUND

Changes in the suicide rate within one region over time had been hypothesised to correspond to changes in suicide seasonality: a recent investigation from Italy confirmed such an assumption. Data from Slovenia were investigated to further evaluate the links between suicide rates and seasonal amplitude.

METHODS

A total of 14325 male suicides and 4350 female suicides occurring in Slovenia from 1971 to 2002 were investigated with harmonic spectral analysis to extract their monthly seasonal dispersion by eight-year intervals. Changes in rate over time were analysed with a test for trend based on regression analysis.

RESULTS

The suicide rates of both males and females increased over time, with an evident peak in the 1987-1994 period and a decrease thereafter. Seasonality decreased across time in both sexes; however, no change of the peak was observed over time. The amplitude of the major 12-month cycle was slightly positively related to suicide rates, but the correlation was only statistically significant among females (P=0.0053; males: P=0.22).

LIMITATIONS

Data could not be analysed according to age, the method of suicide, or the diagnosis attributable to the deceased, since this information was not available.

CONCLUSION

The study confirmed that the seasonal effect on mortality by suicide is positively related to suicide rates, so much so that changes in suicide rates over time correspond to changes in suicide seasonality, but in Slovenia this effect was only evident among females, further pointing towards differences by sex in the mechanics leading to suicide.

Cannabis reward: biased towards the fairer sex?

In contrast to drugs such as alcohol, amphetamine and cocaine, cannabis use in humans has proven difficult to model in laboratory animals. Recent breakthrough discoveries of intravenous THC self-administration in rhesus monkeys and self-administration of the synthetic cannabinoid agonist WIN 55,212-2 in rats have allowed new studies of the genetic, neural and environmental determinants of cannabis use. In the present issue of BJP, Fattore and colleagues further demonstrate genetic (strain) differences in WIN 55,212-2 self-administration in rats, with Long Evans (LE) and Lister Hooded (LH), but not Sprague-Dawley, rats self-administering this drug. They then show that female LE and LH rats self-administer more WIN 55,212-2 than male rats. Ovariectomy abolished this sex difference, suggesting a permissive role for oestrogen in cannabis reward. This accompanying Commentary reviews recent progress in animal models of cannabis use and highlights the role of genetic, developmental and endocrine factors in driving cannabis use and dependence.

Cannabinoid self-administration in rats: sex differences and the influence of ovarian function

BACKGROUND AND PURPOSE

We recently demonstrated the existence of strain differences in self-administration of the cannabinoid CB1 receptor agonist WIN55,212-2 (WIN) by Long Evans (LE) and Lister Hooded (LH) but not Sprague-Dawley (SD) male rats. This follow-up study is aimed at verifying whether sex and ovarian hormones might also be critical factors in the initiation, retention and extinction of WIN self-administration.

EXPERIMENTAL APPROACH

LE, LH and SD male and female rats, the latter either intact or bilaterally ovariectomized (OVX), were trained to self-administer WIN (12.5 microg kg(-1) per infusion) under a FR1 reinforcement schedule, using lever-pressing.

KEY RESULTS

Data showed that contrary to the findings in SD rats, LE and LH rats developed robust cannabinoid intake, with rates of responding for WIN being constantly higher in intact females than in males (+45 and +42% for LE and LH strains, respectively). In comparison with intact females, OVX females of both strains acquired self-administration at lower rates, displaying slower acquisition, lower drug intake (-42 and -52% for LE and LH, respectively) and longer extinction.

CONCLUSIONS AND IMPLICATIONS

These findings provide the first evidence of significant sex differences in cannabinoid self-administration, females acquiring stable WIN intake at higher rates and more rapidly than males. Moreover, when compared to intact females, a lower percentage of LE and LH OVX rats acquired and maintained stable drug intake, suggesting that ovarian hormones might represent a critical factor in modulating the reinforcing effect of cannabinoids.

The Women's Recovery Group Study: a Stage I trial of women-focused group therapy for substance use disorders versus mixed-gender group drug counseling

The aim of this Stage I Behavioral Development Trial was to develop a manual-based 12-session Women's Recovery Group (WRG) and to pilot test this new treatment in a randomized controlled trial against a mixed-gender Group Drug Counseling (GDC), an effective manual-based treatment for substance use disorders. After initial manual development, two pre-pilot groups of WRG were conducted to determine feasibility and initial acceptability of the treatment among subjects and therapists. In the pilot stage, women were randomized to either WRG or GDC. No significant differences in substance use outcomes were found between WRG and GDC during the 12-week group treatment. However, during the 6-month post-treatment follow-up, WRG members demonstrated a pattern of continued reductions in substance use while GDC women did not. In addition, pilot WRG women with alcohol dependence had significantly greater reductions in average drinks/drinking day than GDC women 6 months post-treatment (p<.03, effect size=0.81). While satisfaction with both groups was high, women were significantly more satisfied with WRG than GDC (p<.009, effect size=1.11). In this study, the newly developed 12-session women-focused WRG was feasible with high satisfaction among participants. It was equally effective as mixed-gender GDC in reducing substance use during the 12-week in-treatment phase, but demonstrated significantly greater improvement in reductions in drug and alcohol use over the post-treatment follow-up phase compared with GDC. A women-focused single-gender group treatment may enhance longer-term clinical outcomes among women with substance use disorders.

Global warming possibly linked to an enhanced risk of suicide: data from Italy, 1974-2003

BACKGROUND

The global increase in surface temperature (known as global warming) was found to impact on mortality through ill health, particularly among the elderly and in summer. This study sets out to explore the impact of global warming on suicide mortality, using data from Italy.

METHODS

Monthly data on suicide mortality and temperature were obtained for a 30-year period (from January 1974 to December 2003), and the relation between them was investigated using the Gaussian low-pass filter, linear correlation analysis and rank analysis.

RESULTS

For males, increasing anomalies in monthly average temperatures associated to a higher monthly suicide mean from May to August and, to a lower extent, in November and December. In January, on the other hand, increasing anomalies in monthly average temperatures appeared to be coupled to a lower number of suicides. For females, the links between temperature and suicides are less consistent than for males, and sometimes have a reverse sign, too.

LIMITATIONS

Data could not be analyzed according to age, since this information was not available across the whole time interval. The use of monthly data, instead of daily data (unavailable), is another major limitation of this study.

CONCLUSIONS

An improvement in the ability of communities to adjust to temperature changes by implementing public health interventions may play an important part in preserving the wellness of the general population, and also in limiting the worst consequences of suicidal behaviour.

A cross-sectional study of personality traits in women previously treated or untreated for alcohol use disorders

BACKGROUND

A better understanding of the relationship between treatment-seeking for alcohol problems and personality traits could give useful insight in factors promoting or hindering treatment for alcohol use disorders (AUD). The aim of this study was to analyze the associations between treatment-seeking for AUD, personality traits, and psychiatric co-morbidity in women. The study was based on pooled cross-sectional data from three population based samples and one clinical sample (n = 1,339). Comparisons were made between treated and untreated women with AUD, and between those with resolved and unresolved AUD.

RESULTS

A stepwise logistic regression model showed that treatment-seeking for AUD was not associated with personality traits. Among women with lifetime AUD (n = 217), those who had been treated (n = 42) had significantly higher scores than untreated women (n = 175) on three personality traits of the Karolinska Scales of Personality (KSP); somatic anxiety, muscular tension, and guilt. Women with resolved AUD, who had received treatment (n = 23) had significantly higher scores on scales measuring somatic anxiety, psychic anxiety, muscular tension, irritability, and guilt than untreated women with resolved AUD. The latter group resembled women without AUD on most personality traits. There were no differences in occurrence of lifetime psychiatric disorders between the treated and the untreated women, whereas treated women with current AUD had increased risk of lifetime anxiety (OR: 3.1, 95% CI: 1.1-8.7).

CONCLUSION

Treatment-seeking was not associated with personality traits in this study. Still, it can be concluded that women with resolved AUD who had received treatment had high scores on the KSP-scales measuring psychic and somatic anxiety, tension, irritability, and feelings of guilt. This suggests that personality assessment might be a useful tool in tailoring individual treatment programs for women with AUD. Future studies need to explore if women who do not seek treatment have special needs which are not met in usual treatment settings.

Plasma progesterone levels and cocaine-seeking in freely cycling female rats across the estrous cycle

Previous studies have reported sex and estrous cycle-dependent differences in the reinstatement of cocaine-seeking triggered by cocaine injections or drug-paired cues. However, the relationship between estradiol or progesterone levels and cocaine-seeking in a reinstatement model of relapse has not been explored. Thus, we examined changes in plasma hormone levels during cocaine-taking and -seeking behaviors in gonadally intact female rats. Rats self-administered cocaine (0.5mg/kg infusion) during daily 2-h sessions, followed by extinction. For reinstatement, cocaine (0, 5, or 10mg/kg, i.p.) was administered 30 min prior to testing. Vaginal smears and blood samples were collected prior to and during chronic cocaine self-administration, extinction, and reinstatement testing. Relative to non-estrous females, females in estrus showed greater responding during self-administration, extinction, and during cocaine-primed reinstatement. The highest progesterone levels were noted at the time of lowest cocaine-seeking (proestrus) and the lowest levels of progesterone occurred at the time of highest cocaine-seeking (estrus). In contrast, plasma estradiol levels did not show any clear pattern with cocaine-seeking. These data from an animal model of relapse supports recent clinical evidence that progesterone reduces subjective craving in cocaine-dependent women. Overall, these results suggest that progesterone administration may be a useful intervention for reducing the incidence of relapse.

Possible contributors to the gender differences in alcohol use and problems

Research on alcohol use and problems has demonstrated a much higher rate of alcohol use disorders (AUDs) among men compared with women. The authors review the most frequently researched biological and psychosocial factors that may play a role in the gender differences in alcohol use and problems. Among the biological factors, women might carry a lower genetic risk for AUDs and tend to suffer more negative biological consequences from drinking as compared with men. Regarding psychosocial factors, men appear to be more likely than women to manifest certain risk factors for alcohol use and problems (e.g., fewer perceived social sanctions for drinking, positive expectancies for alcohol use, personality traits such as impulsivity) and have fewer protective factors. Although these findings have helped to explain some of the gender differences in alcohol use and problems, there are inconsistencies in the literature. Additionally, many studie may not have enough statistical power to detect gender differences. The authors suggest that the biological and social consequences of alcohol abuse for women may be especially potent protective factors against AUDs and discuss the possibility of public health campaigns developed on the basis of this idea.

Psychiatric comorbidity and gender difference among treatment-seeking heroin abusers in Taiwan

The objectives of the present study were to estimate the psychiatric comorbidity of Taiwanese heroin users seeking treatment and to identify the gender differences in psychiatric comorbidity and drug use behavior. Subjects were interviewed using a structured questionnaire on drug use behavior and the Mini International Neuropsychiatric Interview for psychiatric disorders. Of the subjects, 58.5% of the male and 62.5% of the female subjects had at least one non-substance-use axis I psychiatric disorder or antisocial personality disorder. Compared to male subjects, female subjects were younger, were less educated, had higher rates of unemployment and had earlier onset of illicit drug use. Female subjects were 11-fold more likely than male subjects to exhibit suicidal behavior. Among heroin abusers in the present study, female subjects were more widely exposed to unfavorable social factors and had substantially higher incidence of suicidal behavior than male subjects. Drug treatment centers should be aware of these gender differences and pay particular attention to comorbid depressive disorders and suicidal behavior of female heroin abusers.

Adult social behavioral effects of heavy adolescent marijuana use among African Americans

The authors examined the effects of heavy adolescent marijuana use on employment, marriage, and family formation and tested both dropping out of high school and adult marijuana use as potential mediators of these associations among a community sample of African Americans followed longitudinally from age 6 to age 32-33. They used propensity score matching to reduce selection bias when estimating the effects of heavy adolescent marijuana use. Logistic regression results on the sample matched on sex, and early demographic and behavioral variables showed that adolescent marijuana use has adult social behavioral consequences: Use of marijuana 20 times or more during adolescence was associated with being unemployed and unmarried in young adulthood and having children outside of marriage for both males and females. Dropping out of high school and more frequent adult marijuana use seem to be important parts of the pathway from adolescent marijuana use to negative life outcomes.

Gender and stimulus difference in cue-induced responses in abstinent heroin users

BACKGROUND

Environmental stimuli associated with drug taking have been known to elicit drug craving and increase the likelihood of relapse, and sex differences have been observed in the development of drug addiction and relapse to drug taking. Differential cue paradigms (drug-related imagery scripts and drug-related paraphernalia) have been used to investigate cue-induced drug craving. However, there is little research on the possible gender differences in responses to drug cues in heroin-dependent individuals. This study examined whether two different stimuli, drug-related imagery scripts and drug-related paraphernalia, produce similar or different patterns of cue reactivity in heroin-dependent men and women.

METHODS

In the laboratory sessions, 26 male and 23 female heroin-dependent subjects were exposed to script-guided imagery of heroin-related cue situations and to heroin-related paraphernalia (e.g., needles, syringes, spoons, cigarette filters, and aluminum foil). Heroin craving, subjective anxiety, emotion state ratings, and cardiovascular changes were assessed.

RESULTS

Significant increases in heroin craving were seen with drug-imagery scripts or drug paraphernalia but not with neutral-relaxing imagery or neutral-item handling. In addition, drug imagery and paraphernalia produced significant increases in subjective anxiety, negative emotions, systolic and diastolic blood pressure, and heart rate, as well as decreases in positive emotion. Paraphernalia exposure was somewhat more effective than imagery scripts in inducing heroin craving, primarily reflecting a lower response to imagery scripts among men. Most other dependent measures also differed by gender, and each gender difference occurred with imagery scripts only or with paraphernalia only.

CONCLUSIONS

The present results indicate that heroin-imagery scripts and heroin paraphernalia each induce heroin craving and emotional and cardiovascular changes, but that the changes show a complex pattern of gender differences that may need to be taken into account in future laboratory studies.

Huntington disease as a dual diagnosis disorder: data from the National Research Roster for Huntington disease patients and families

Although an extensive literature characterizes a linkage between primary mental illnesses and substance use disorders, a paucity of research exists concerning dual diagnosis phenomena in Huntington disease (HD). Data from the National Research Roster on HD suggest that higher levels of alcohol and cigarette use are associated with greater ratings of psychiatric symptoms and a younger age of HD symptom onset, and that progressive alcohol use after HD symptom onset is linked with worsening psychiatric symptom progression. These findings suggest HD entails dual diagnosis phenomena similar to that identified in patients with primary psychiatric disorders.

Gender differences and pregnant women in a methadone maintenance treatment (MMT) clinic

We prospectively compared gender outcome among 470 MMT patients admitted between June 1993 and Dec 2002. Urine samples were analyzed for drug abuse after one month and after one year. On admission females 131(27.9%) were significantly younger (34.5 +/-7.5 years) than males 339(72.1%) (37.3 +/- 8.3 years) (ANOVA; F = 11, p = 0.001) and had significantly higher cocaine abuse (20% vs. 11.3%) (Fisher's Exact Test, p = 0.02). After one year, groups had: (a) similar retention in treatment (76.3%-females, 72.6%-males), (b) stop in opiate abuse (65%-females, 65.3%-males), (c) a net decrease in cocaine abuse (% positive that became negative minus % negative that became positive) (68.0%-females, 51.6%-males). Females who were admitted to treatment while pregnant (n = 45) were significantly younger (31.5 +/-5.4 years) compared to 86 non-pregnant (36.1 +/- 7.9, ANOVA F = 12.1, p = 0.001). We concluded that compared to males, females started MMT younger and had a higher proportion of cocaine abuse even though females' outcome were similar to males'.

Substance abuse treatment entry, retention, and outcome in women: a review of the literature

This paper reviews the literature examining characteristics associated with treatment outcome in women with substance use disorders. A search of the English language literature from 1975 to 2005 using Medline and PsycInfo databases found 280 relevant articles. Ninety percent of the studies investigating gender differences in substance abuse treatment outcomes were published since 1990, and of those, over 40% were published since the year 2000. Only 11.8% of these studies were randomized clinical trials. A convergence of evidence suggests that women with substance use disorders are less likely, over the lifetime, to enter treatment compared to their male counterparts. Once in treatment, however, gender is not a significant predictor of treatment retention, completion, or outcome. Gender-specific predictors of outcome do exist, however, and individual characteristics and treatment approaches can differentially affect outcomes by gender. While women-only treatment is not necessarily more effective than mixed-gender treatment, some greater effectiveness has been demonstrated by treatments that address problems more common to substance-abusing women or that are designed for specific subgroups of this population. There is a need to develop and test effective treatments for specific subgroups such as older women with substance use disorders, as well as those with co-occurring substance use and psychiatric disorders such as eating disorders. Future research on effectiveness and cost-effectiveness of gender-specific versus standard treatments, as well as identification of the characteristics of women and men who can benefit from mixed-gender versus single-gender treatments, would advance the field.

A 10-year retrospective study of inpatient adolescents with schizophrenia/schizoaffective disorder and substance use

The comorbidity of schizophrenia/schizoaffective disorder and substance use is a major psychiatric concern that is associated with aggressive and suicidal behavior. This study investigated the clinical correlates and characterizes adolescent psychotic inpatients with and without comorbid substance use. We performed a retrospective study of 188 adolescent inpatients who were admitted between the years 1994 and 2004 to the inpatient unit of Geha Mental Health Center and who were diagnosed as suffering from either schizophrenia or schizoaffective disorder. The substance-using psychotic inpatients were found to have more relatives with substance-related disorders, fewer comorbid anxiety disorders, lower scores on the Brief Psychiatric Rating Scale and Hamilton Scale for Depression, higher scores on the Overt Aggression Scale, and they were more suicidal than the nonsubstance using inpatients. Adolescent inpatients with schizophrenia and schizoaffective who use substances possess differential clinical characteristics and particular correlates that justify adopting a specific approach to this high-risk clinical subgroup.

In the ventral tegmental area, cyclic AMP mediates the actions of progesterone at dopamine type 1 receptors for lordosis of rats and hamsters

Progesterone-facilitated lordosis is enhanced by activation of, and inhibited by antagonism of, dopamine type 1 receptors (D1) in the ventral tegmental area (VTA). Given that D1 activation leads to increases in cyclic AMP (cAMP), we hypothesised that, in the VTA, progesterone's actions on lordosis that involve D1 are mediated, in part, by cAMP. In Experiment 1, naturally receptive rats and hamsters were pretested for lordosis, infused with the cAMP analogue 8-bromo-cAMP (200 ng) or vehicle to the VTA, and tested again 30 min later. In Experiments 2 and 3, ovariectomised, oestradiol (10 microg) + progesterone (0 or 100 microg)-primed rats and oestradiol (10 microg) + progesterone (0 or 200 microg)-primed hamsters were pretested for lordosis and infused with 8-bromo-cAMP (200 ng), the adenylyl cyclase inhibitor 2',5'-dideoxyadenosine (12 microM) or vehicle to the VTA. Subjects were tested again 30 min later. In Experiment 4, oestradiol + progesterone-primed rats and hamsters were pretested and infused with the D1 agonist SKF38393 (0 or 100 ng) to the VTA. Thirty minutes later, subjects were tested again and infused with 2',5'-dideoxyadenosine (12 microM) or vehicle. Subjects were tested again 30 min later. VTA infusions of 8-bromo-cAMP enhanced lordosis of naturally receptive or hormone-primed rats and hamsters and 2',5'-dideoxyadenosine decreased lordosis of oestradiol + progesterone-primed rats and hamsters. D1-mediated increases in progesterone-facilitated lordosis were reduced by 2',5'-dideoxyadenosine. These data suggest that progesterone-facilitated lordosis of rats and hamsters may be modulated by D1 and cAMP activity in the VTA.

Learning sobriety together: A randomized clinical trial examining behavioral couples therapy with alcoholic female patients

Married or cohabiting female alcoholic patients (n = 138) and their non-substance-abusing male partners were randomly assigned to 1 of 3 equally intensive interventions: (a) behavioral couples therapy plus individual-based treatment (BCT; n = 46), (b) individual-based treatment only (IBT; n = 46), or (c) psychoeducational attention control treatment (PACT; n = 46). During treatment, participants in BCT showed significantly greater improvement in dyadic adjustment than those in IBT or PACT; drinking frequency was not significantly different among participants in the different conditions. During the 1-year posttreatment follow-up, compared with participants who received IBT or PACT, participants who received BCT reported (a) fewer days of drinking, (b) fewer drinking-related negative consequences, (c) higher dyadic adjustment, and (d) reduced partner violence.

Sex differences in striatal dopamine release in healthy adults

BACKGROUND

Sex differences in addictive disorders have been described. Preclinical studies have implicated the striatal dopamine system in these differences, but human studies have yet to substantiate these findings.

METHODS

Using positron emission tomography (PET) scans with high-specific-activity [11C] raclopride and a reference tissue approach, we compared baseline striatal dopamine binding potential (BP) and dopamine release in men and women following amphetamine and placebo challenges. Subjective drug effects and plasma cortisol and growth hormone responses were also examined.

RESULTS

Although there was no sex difference in baseline BP, men had markedly greater dopamine release than women in the ventral striatum. Secondary analyses indicated that men also had greater dopamine release in three of four additional striatal regions. Paralleling the PET findings, men's ratings of the positive effects of amphetamine were greater than women's. We found no sex difference in neuroendocrine hormone responses.

CONCLUSIONS

We report for the first time a sex difference in dopamine release in humans. The robust dopamine release in men could account for increased vulnerability to stimulant use disorders and methamphetamine toxicity. Our findings indicate that future studies should control for sex and may have implications for the interpretation of sex differences in other illnesses involving the striatum.

Experiences of harm reduction among women with alcohol use problems

This paper explores women's choice of controlled drinking or abstinence goals in harm reduction treatment programs for alcohol use problems. Situated within debates about controlled or abstinence goals for alcohol use, this research project provides a specific focus on women's treatment needs. We explore evidence which reveals that women in treatment for alcohol problems often hold deeply internalized dominant social ideologies on addiction. Results demonstrate that while offered the choice of abstinence or controlled use goals, most women defined themselves as "addicts," adopted a disease metaphor of "addiction," and chose abstinence. The findings here raise questions about whether or not clients receive sufficient education about harm reduction and controlled drinking and make adequately informed choices.

The interplay between interpersonal dynamics, treatment barriers, and larger social forces: an exploratory study of drug-using couples in Hartford, CT

BACKGROUND

The drug treatment field tends to place emphasis on the individual rather than the individual in social context. While there are a growing number of studies indicating that drug-using intimate partners are likely to play an important role in determining treatment options, little attention has been given to the experience and complex treatment needs of illicit drug-using (heroin, cocaine, crack) couples.

METHODS

This exploratory study used in-depth interviews and ethnographic engagement to better understand the relationship between interpersonal dynamics and the treatment experience of ten relatively stable drug-using couples in Hartford, CT. Semi-structured and open-ended qualitative interviews were conducted with each couple and separately with each partner. Whenever possible, the day-to-day realities and contexts of risk were also observed via participant and non-participant observation of these couples in the community. A grounded theory approach was used to inductively code and analyze nearly 40 transcripts of 60-90 minute interviews as well as fieldnotes.

RESULTS

This study builds on a concept of complex interpersonal dynamics among drug users. Interpersonal dynamics of care and collusion were identified: couples cared for each other and colluded to acquire and use drugs. Care and collusion operate at the micro level of the risk environment. Treatment barriers and inadequacies were identified as part of the risk environment at the meso or intermediate level of analysis, and larger social forces such as gender dynamics, poverty and the "War on Drugs" were identified at the macro level. Interpersonal dynamics posed problems for couples when one or both partners were interested in accessing treatment. Structural barriers presented additional obstacles with the denial of admittance of both partners to treatment programs which had a sole focus on the individual and avoided treating couples.

CONCLUSION

Detoxification and treatment facilities need to recognize the complex interplay between interpersonal dynamics which shape the treatment experience of couples, and which are also shaped by larger structural dynamics, including barriers in the treatment system. Improvements to the treatment system in general will go a long way in improving treatment for couples. Couples-specific programming also needs to be developed.

Association study of androgen receptor CAG repeat polymorphism and male violent criminal activity

Androgens exert their effects primarily by stimulating androgen receptors (ARs) and androgen activity has been implicated in antisocial or violent criminal behaviour. Exon 1 of the AR gene contains a highly polymorphic glutamine (CAG) repeat sequence. We tested the hypothesis that shorter AR CAG repeat polymorphisms, which have a greater AR gene expression, are related to violent criminal activity in Chinese males using a sample of 146 extremely violent criminals and 108 normal controls. The results show no association between the AR repeat length and violent convicts, although we found that there are more violent-criminal cases than control cases with the shorter (<17) AR gene trinucleotide repeat polymorphisms (7.5% vs. 1.9%; P=0.047). No correlation was found between the AR CAG repeat length and the first criminal record age in the violent-criminal group. The mean AR repeat length is not significantly different between substance dependence cases and antisocial personality disorder diagnosis in the violent criminals and normal controls. Our findings suggest that the AR CAG repeat polymorphism does not play a major role in the susceptibility of male violent criminal activity.

Symptoms of anxiety and depression in childhood and use of MDMA: prospective, population based study

OBJECTIVE

To investigate whether using ecstasy (3,4-methylenedioxymethamphetamine, MDMA) is preceded by symptoms of behavioural and emotional problems in childhood and early adolescence.

DESIGN

Prospective, longitudinal, population based study

SETTING

The Dutch province of Zuid-Holland.

PARTICIPANTS

A sample of 1580 individuals, followed up across a 14 year period, from childhood into adulthood.

MAIN OUTCOME MEASURES

The first assessment took place in 1983 before MDMA appeared as a recreational drug in the Netherlands and included the child behaviour checklist to obtain standardised parents' reports of their children's behavioural and emotional problems. Use of the drug was assessed with the composite international diagnostic interview 14 years later.

RESULTS

Eight syndrome scales of childhood behaviour were examined. Scores in the deviant range for the scales designated as anxious or depressed in childhood were significantly related to use of MDMA in adolescents and adults, resulting in an increased risk (hazard ratio 2.22, 95% confidence interval 1.20 to 4.11, P = 0.01).

CONCLUSIONS

Individuals with childhood symptoms of anxiety and depression may have an increased tendency to use MDMA in adolescence or young adulthood. Its effects are supposed to include enhanced feelings of bonding with other people, euphoria, or relaxation. Especially individuals with symptoms of anxiety or depression may be susceptible to these positive effects.

Males and females differ in brain activation during cognitive tasks

To examine the effect of gender on regional brain activity, we utilized functional magnetic resonance imaging (fMRI) during a motor task and three cognitive tasks; a word generation task, a spatial attention task, and a working memory task in healthy male (n = 23) and female (n = 10) volunteers. Functional data were examined for group differences both in the number of pixels activated, and the blood-oxygen-level-dependent (BOLD) magnitude during each task. Males had a significantly greater mean activation than females in the working memory task with a greater number of pixels being activated in the right superior parietal gyrus and right inferior occipital gyrus, and a greater BOLD magnitude occurring in the left inferior parietal lobe. However, despite these fMRI changes, there were no significant differences between males and females on cognitive performance of the task. In contrast, in the spatial attention task, men performed better at this task than women, but there were no significant functional differences between the two groups. In the word generation task, there were no external measures of performance, but in the functional measurements, males had a significantly greater mean activation than females, where males had a significantly greater BOLD signal magnitude in the left and right dorsolateral prefrontal cortex, the right inferior parietal lobe, and the cingulate. In neither of the motor tasks (right or left hand) did males and females perform differently. Our fMRI findings during the motor tasks were a greater mean BOLD signal magnitude in males in the right hand motor task, compared to females where males had an increased BOLD signal magnitude in the right inferior parietal gyrus and in the left inferior frontal gyrus. In conclusion, these results demonstrate differential patterns of activation in males and females during a variety of cognitive tasks, even though performance in these tasks may not vary, and also that variability in performance may not be reflected in differences in brain activation. These results suggest that in functional imaging studies in clinical populations it may be sensible to examine each sex independently until this effect is more fully understood.

Consequences of paternal cocaine exposure in mice

The present study examined the potential neuroteratological effects of paternal cocaine (COC) exposure using the novel mouse model of inhalational drug administration. In this model, mice were trained to self-administer COC in multi-hour daily inhalation sessions reminiscent of crack binges. The controls included males pair-fed with COC-inhaling animals as well as ad-lib-fed males. All males were bred with drug-naive females. The newborn pups sired by COC-inhaling males had a reduced biparietal head diameter, suggesting a decreased cerebral volume. When the pups reached adulthood, their sustained visuo-spatial attention and spatial working memory were tested using a 5-arm maze paradigm. During the attention tests, the percentage of correct trials at the shortest stimulus duration employed in the study (0.5 s) was significantly lower for the male offspring of COC-inhaling fathers as compared to the offspring of both pair-fed and ad-lib-fed controls. For the females sired by COC-inhaling fathers, the deficit was observed at light stimulus durations of 0.5 and 0.75 s. Also, during the working memory tests, the male offspring of COC-inhaling fathers required more sessions than the offspring of either pair-fed or ad-lib-fed fathers to reach the selected criterion at retention intervals of 16 min and longer. The impairment of working memory in female offspring of COC-inhaling fathers was even stronger, as the offspring needed more sessions to reach the criterion as compared to their control counterparts, even at retention intervals as short as 4 min. These findings suggest that paternal COC abuse prior to coitus may impact the development of the offspring, particularly if they are females. We further showed that chronic COC exposure in male mice does not result in substantial breakage of spermatozoal DNA, but significantly alters expression of DNA methyltransferases 1 and 3a in the germ cell-rich seminiferous tubules of the testis. Since these enzymes are essential for generating and maintaining parental gene imprinting in germ cells, our observations point to an intriguing possibility that COC may cause paternally induced neuroteratological effects by interfering with gene-imprinting patterns in male gametes.

Gender differences in alcohol and substance use relapse

This review explores gender differences in relapse and characteristics of relapse events in alcohol and substance use. For alcohol, relapse rates were similar across gender. Although negative mood, childhood sexual abuse, alcohol-related self-efficacy, and poorer coping strategies predicted alcohol relapse, gender did not moderate these effects. Gender did moderate the association between marriage and alcohol relapse. For women, marriage and marital stress were risk factors for alcohol relapse; among men, marriage lowered relapse risk. This gender difference in the role of marriage in relapse may be a result of partner differences in problem drinking. Alcoholic women are more likely to be married to heavy drinking partners than are alcoholic men; thus, alcoholic women may be put at risk of relapse by marriage and alcoholic men may be protected by marriage. There are fewer studies documenting gender differences in substance abuse relapse so conclusions are limited and tentative. In contrast to the lack of gender differences in alcohol relapse rates, women appear less likely to experience relapse to substance use, relative to men. Women relapsing to substance use appear to be more sensitive to negative affect and interpersonal problems. Men, in contrast, may be more likely to have positive experiences prior to relapse.

Sex differences in vulnerability to drug self-administration

Recent evidence from both human and animal studies indicates that there are sex differences in all phases of the addiction process, including initiation and acquisition of use, patterns and levels of use, the progression to addiction, and relapse. This brief review summarizes a series of studies on sex differences in drug self-administration in rats on which the Wyeth Young Psychopharmacologist Award was based and relates these findings to human clinical data. Briefly, preclinical findings show that female rats acquire drug self-administration at a faster rate, work harder to obtain drug infusions, "binge" for longer initial periods of time and show a more diurnally dysregulated pattern of self-administration under extended-access conditions, and respond at higher levels under reinstatement testing conditions compared with male rats. Similar results have been reported in humans, suggesting a biological basis of sex differences in vulnerability to drug abuse. A number of biological mechanisms have been explored, and the results show that ovarian hormones play a critical role in modulating the reinforcing effects of drugs of abuse in females. Preclinical studies, in conjunction with human studies, should further inform a sex-specific model for differences in drug abuse, and such a model may be useful for developing prevention and treatment strategies for drug abuse.

Neuroimaging study of sex differences in the neuropathology of cocaine abuse

BACKGROUND

Female and male substance abusers differ in their disease patterns and clinical outcomes. An important question in addiction neuroscience thus concerns the neural substrates underlying these sex differences.

OBJECTIVE

This article aims to examine what is known of the neural mechanisms involved in the sex differences between substance abusers.

METHODS

We reviewed neuroimaging studies that addressed sex differences in cerebral perfusion deficits after chronic cocaine use and in regional brain activation during pharmacologic challenge and cue-induced craving. We also present results from a preliminary study in which cocaine-dependent men and women participated in script-guided imagery of stress- and drug cue-related situations while blood oxygenation level-dependent signals of their brain were acquired in a 1.5T scanner. Spatial pre-processing and statistical analysis of brain images were performed. Regional brain activation was compared between stress and drug cue trials in men versus women.

RESULTS

The results of our study showed greater activation in the left uncus and right claustrum (both, statistical threshold of P = 0.01, uncorrected; extent = 10 voxels) in men (n = 5) during drug cue trials compared with stress trials. No brain regions showed greater activation during stress trials compared with drug cue trials. In contrast, women (n = 6) showed greater activation in the right medial and superior frontal gyri during stress trials compared with drug cue trials at the same statistical threshold. No brain regions showed more activation during drug cue trials than during stress trials.

CONCLUSIONS

The studies reviewed underscore the need to consider sex-related factors in examining the neuropathology of cocaine addiction. Our preliminary results also suggest important sex differences in the effect of stress- and drug cue-associated brain activation in individuals with cocaine use disorder.

Personality, attitudinal and behavioral risk profiles of young female binge drinkers and smokers

PURPOSE

Analyses were conducted to identify personality, attitudinal and behavioral correlates of binge drinking and smoking among adolescent girls and young women, a population whose substance use attitudes and behaviors have received only limited attention in the literature.

METHODS

A nationally representative sample of girls and young women (n = 929) from three age cohorts completed a telephone interview assessing various personality, attitudinal, and behavioral characteristics. Respondents were categorized into four groups based on self-reported binge drinking and smoking (binge drinker/nonsmoker, smoker/non-binge drinker, binge drinker/smoker, or non-binge drinker/nonsmoker) and were assessed on a number of variables, including self-monitoring, depressive symptoms, coping style, religiosity/spirituality, popularity, dieting behavior, and smoking- and alcohol-related expectations. Univariate and multiple regression analyses were conducted to identify characteristics that best describe each of these types of substance users.

RESULTS

Risk profiles varied across the groups. Girls and young women who binge drank but did not smoke were more likely to be high self-monitors, to engage in disordered dieting, and to believe drinking provided an excuse to act with less inhibition. Those who smoked but did not binge drink were more likely to report depressive symptoms. Those who binge drank and smoked were more likely to be popular and to report depressive symptoms. Certain forms of avoidant coping and low religiosity were associated with all three types of substance use.

CONCLUSION

Understanding the risk profiles of girls and young women who engage in specific forms of substance use can facilitate the identification of those at risk and the development of more targeted and effective prevention programs and interventions.

What characterizes substance abusers who commit suicide attempts? Factors related to Axis I disorders and patterns of substance use disorders. A study of treatment-seeking substance abusers in Norway

OBJECTIVE

The frequency of suicide attempts and clinical characteristics of attempters among poly-substance abusers and alcoholics were examined.

METHODS

A consecutive sample (n = 260) of in- and outpatients from two Norwegian counties were assessed by Composite International Diagnostic Interview (Axis I disorders), Millon's Clinical Multiaxial Inventory (Axis II disorders) and the Norwegian National Client Assessment Form. When analysing the association between suicide attempters and the range of predictor variables, logistic regression analysis was conducted.

RESULTS

Almost half (47%) of the sample reported lifetime suicide attempts; significantly more frequently in poly-substance abusers (58%) than alcoholics (38%). A substance use disorder with duration of >or=15 years and an early onset (<18 years of age) were independently associated with being a suicide attempter after controlling for Axis I disorders. In addition, eating disorders, agoraphobia and major depression were strongly and independently associated with being a suicide attempter.

CONCLUSION

Attempts at preventing suicidal behaviour should not ignore the suicide risk among poly-substance abusers. In addition, prevention of suicidal behaviour demands a treatment programme focusing concomitantly on both addictive behaviour and comorbid psychiatric disorders.