Gender differences in substance use disorders

The efficacy of moderate‐intensity exercise as an aid for smoking cessation in women: A randomized controlled trial

Evidence suggests that vigorous-intensity exercise interventions may be effective for smoking cessation among women; however, few studies have examined the efficacy of a moderate-intensity exercise program. The present study examined the efficacy of moderate-intensity exercise for smoking cessation among female smokers. Healthy, sedentary female smokers (N = 217) were randomly assigned to an 8-week cognitive-behavioral smoking cessation program plus moderate-intensity exercise (CBT+EX) or to the same cessation program plus equal contact (CBT). A subsample received nicotine replacement therapy. Results indicated that the CBT+EX and CBT groups were equally likely to attain smoking cessation at the end of treatment, as measured by cotinine-verified 7-day point-prevalence abstinence (20.2% for CBT+EX vs. 18.5% for CBT). The CBT+EX group was more likely to report smoking cessation, as measured by 7-day point prevalence at the 3-month follow-up (11.9% vs. 4.6%, p<.05), compared with the CBT group. No group differences were found at 12 months by either 7-day point prevalence (7.3% for CBT+EX vs. 8.3% for CBT) or continuous abstinence (0.9% for CBT+EX vs. 0.9% for CBT). Additionally, among participants in the CBT+EX group, those with higher adherence to the exercise prescription were significantly more likely to achieve smoking cessation at the end of treatment than were participants reporting lower adherence to exercise. Our findings indicate that the empirical support for moderate-intensity exercise as an adjunctive treatment to CBT for smoking cessation may be limited. Perhaps future studies could compare moderate- vs. vigorous-intensity physical activity to test their relative efficacy.

Coming home from jail: the social and health consequences of community reentry for women, male adolescents, and their families and communities

Each year, more than 10 million people enter US jails, most returning home within a few weeks. Because jails concentrate people with infectious and chronic diseases, substance abuse, and mental health problems, and reentry policies often exacerbate these problems, the experiences of people leaving jail may contribute to health inequities in the low-income communities to which they return. Our study of the experiences in the year after release of 491 adolescent males and 476 adult women returning home from New York City jails shows that both populations have low employment rates and incomes and high rearrest rates. Few received services in jail. However, overall drug use and illegal activity declined significantly in the year after release. Postrelease employment and health insurance were associated with lower rearrest rates and drug use. Public policies on employment, drug treatment, housing, and health care often blocked successful reentry into society from jail, suggesting the need for new policies that support successful reentry into society.

Potentiation of cocaine-primed reinstatement of drug seeking in female rats during estrus

RATIONALE

Gender differences exist in the patterns of drug taking in cocaine addiction, suggesting that the propensity to relapse varies between men and women. Previous reports have shown sex differences in both cocaine-primed and conditioned-cued reinstatement of cocaine-seeking behavior, including recent evidence that the estrous cycle influences the level of conditioned-cued reinstatement. However, the influence of the estrous cycle on cocaine-primed reinstatement has not been examined.

OBJECTIVE

Accordingly, we assessed the influence of sex and estrous cycle status on cocaine-primed reinstatement of drug-seeking behavior in Sprague-Dawley rats.

METHODS

Intact male and female rats were trained to lever press to self-administer intravenous cocaine (0.5 mg/kg every infusion; fixed ratio 1, 20-s time-out following each infusion), followed by prolonged extinction training, and subsequently tested for the ability of a cocaine-priming injection (0, 5, or 10 mg/kg i.p.) to reinstate extinguished cocaine seeking (i.e., nonreinforced lever responding).

RESULTS

Despite no differences in cocaine intake between male and female rats, females responded more on the cocaine-paired lever during self-administration and extinction relative to males. Subsequently, both males and females exhibited a dose-dependent cocaine-primed reinstatement of extinguished drug-seeking behavior. Moreover, females in estrus exhibited significantly higher reinstatement than either males or non-estrus females, following a high-dose (10 mg/kg) cocaine prime.

CONCLUSIONS

Estrus females display heightened sensitivity to the motivational and/or stimulant effects of cocaine, suggesting that hormonal state modulates drug craving and propensity for drug relapse in cocaine addicts.

Effect of short- vs. long-term estrogen on reinstatement of cocaine-seeking behavior in female rats

Estrogen effects on cocaine-induced reinstatement of lever responding were examined in sham-operated, vehicle-treated (SH+VEH), ovariectomized (OVX+VEH), and OVX female Wistar rats with estrogen replacement (OVX+EB). The effect of long- (64+/-1.56 days) and short-term (9 days) EB treatment on reinstatement of cocaine-seeking behavior was compared in Experiment 1 and 2, respectively, in order to compare the effect of EB when it was present during the development vs. expression of reinstatement of cocaine-seeking behavior. Rats were trained to self-administer 0.4 mg/kg/inf cocaine. After the acquisition criteria were met, rats continued to respond for cocaine for 2 h/day for a 14-day maintenance period. Cocaine was then replaced with saline and the 21-day extinction period commenced. Subsequently, rats were tested for reinstatement of lever responding on the previously drug-paired lever after alternating daily injections of saline or cocaine. In both experiments, there were no differences between groups in self-administration behavior during training, maintenance, or extinction. In Experiment 1, SH+VEH and chronically treated OVX+EB rats had greater cocaine-induced reinstatement than OVX+VEH rats. In Experiment 2, short-term treated OVX+EB rats also showed enhanced cocaine-induced reinstatement compared to OVX+VEH rats. The results indicate that EB-mediated enhancement of cocaine-induced reinstatement is dependent on EB presence during the expression of reinstatement but not during the formation of stimulus-reward associations during the development of cocaine-reinforced behavior.

Sex differences in the escalation of oral phencyclidine (PCP) self-administration under FR and PR schedules in rhesus monkeys

RATIONALE

Studies with male rats indicate that long access (LgA) vs short access (ShA) to i.v. cocaine and heroin self-administration leads to an escalation of drug intake and a subsequent upward shift of the dose-response function.

OBJECTIVE

The purpose of this experiment was to extend these results to male and female rhesus monkeys and oral phencyclidine (PCP) self-administration under fixed-ratio (FR) and progressive-ratio (PR) schedules.

METHODS

Adult rhesus monkeys (seven females and nine males) orally self-administered PCP (0.25 mg/ml) and water under concurrent FR 16 FR 16 schedules during daily ShA 3-h sessions. Since females weighed less than males, each liquid delivery (0.6 ml) represented a higher unit dose mg/kg for females than males, but drug concentration mg/ml remained constant. Concurrent PR PR schedules were then used to obtain a concentration-response function (0.125, 0.25, 0.5, and 1.0 mg/ml). Next, PCP and water were available during LgA 6-h sessions under concurrent FR 16 FR 16 schedules for 21 days. The monkeys were then retested under the concurrent FR 16 FR 16 and PR PR conditions during ShA sessions.

RESULTS

Under the initial ShA concurrent FR 16 FR 16 schedules, females and males did not differ on PCP deliveries or intake (mg/kg); however, during LgA, males and females had more PCP deliveries compared with ShA. During LgA, males exceeded females in PCP deliveries, but females were higher than males in mg/kg PCP intake. Also, PCP (but not water) deliveries and mg/kg PCP intake significantly increased from the first 3 days to the last 3 days of the 21-day LgA period in both males and females. The subsequent ShA FR 16 FR 16 performance did not differ by sex, but it was significantly elevated above the first ShA period in both sexes. The concentration-response function for PCP break point under the PR PR schedules and PCP intake (mg/kg) were significantly shifted upward during the second (vs first) ShA period, and females' mg/kg intake significantly exceeded males'.

CONCLUSIONS

Male and female rhesus monkeys both showed escalation of PCP self-administration during LgA to PCP and during ShA that occurred after (vs before) LgA. Both showed vertical upward shifts in the concentration x intake (mg/kg) function under the PR schedule, and females exceeded males on this measure. These findings with PCP and monkeys are consistent with vertical upward shifts of cocaine dose-response functions in previous escalation studies in male rats and reports of sex differences (F>M) during several other phases of drug abuse.

Helplessness in the tail suspension test is associated with an increase in ethanol intake and its rewarding effect in female mice

BACKGROUND

Depression is frequently observed in drug abusers. However, depression may be a primary factor of predisposition to drug abuse or a consequence of drug abuse. The aim of this study was to analyze the influence of a preexisting depressive-like state/helplessness on subsequent alcohol responsiveness in mice.

METHODS

Male and female CD1 mice were selected according to their immobility time in the tail suspension test, and only mice with "high immobility" and "low immobility" time were retained. Using a two-bottle free-choice paradigm, these mice were given continuous access to tap water or solutions of ethanol (3-20% v/v), quinine (12.5-50 mg/liter), or sucrose (1-4% w/v). In female mice, rewarding and aversive effects of ethanol (1.5 and 3 g/kg, intraperitoneally) were also investigated using the conditioned place preference and the conditioned taste aversion paradigms.

RESULTS

Female mice were more immobile and drank more ethanol than male mice. No striking sex difference was observed in quinine consumption. Sucrose intake was higher in female than in male mice, whatever the solution concentration. At the 4% concentrated solution, a sucrose-induced increase in daily fluid intake was observed only in female mice. Female mice with high immobility time (HI) consumed more ethanol at the highest concentration than female mice with low immobility time (LI), whereas no difference was observed between HI and LI male mice. Moreover, whereas LI female mice failed to express place conditioning induced by the 3-g/kg dose of ethanol, HI female mice were strongly responsive to the rewarding effect of this high ethanol dose. Ethanol dose-dependently induced a conditioned taste aversion with a similar magnitude in both LI and HI female mice.

CONCLUSIONS

The findings indicate that female CD1 mice tend to drink greater amounts of ethanol or sucrose solutions than male CD1 mice, suggesting that female mice may be a better model of excessive alcohol intake. Furthermore, no relationship was found between immobility scores and ethanol consumption in male mice. On the contrary, within female mice, HI mice consumed higher amounts of ethanol than LI mice probably because they experienced greater rewarding effects of ethanol. The present results support the hypothesis that depressive-like responses may predispose to ethanol abuse in female mice.

Gender differences in stress reactivity among cocaine-dependent individuals

RATIONALE

Recent investigations suggest that stress reactivity may play an important role in the relationship between stress and substance use. Important gender differences, such as reasons for using substances, have been well documented, and it is likely that men and women also differ in their stress response.

OBJECTIVES

In this study, gender differences in stress reactivity to two laboratory stress manipulations were examined among 18 men and 21 women with current cocaine dependence.

METHODS

Participants completed a psychological stress task, the Mental Arithmetic Task (MAT), and a physical stress task, the Cold Pressor Task (CPT). Subjective stress responses (i.e., feelings of stress, anxiety, nervousness, pain, mood), physiological stress responses (i.e., heart rate, skin conductance), and cocaine craving were assessed.

RESULTS

In response to both the MAT and the CPT, significant increases in subjective and physiological stress were observed among participants. Women, however, demonstrated greater subjective reactivity, as evidenced by significantly higher ratings of stress, nervousness, and pain as compared to men. Women also immersed their hand in the cold water bath for a significantly shorter period of time as compared to men.

CONCLUSIONS

The current findings are among the first to report on gender differences in stress reactivity among cocaine-dependent individuals. The findings suggest that the mechanisms linking stress and substance use may be gender-specific, and that stress reactivity may play a different role for women than for men. Future research and implications for clinical interventions are discussed.

Long-lasting, sex- and age-specific effects of social stressors on corticosterone responses to restraint and on locomotor responses to psychostimulants in rats

Many neural systems are undergoing marked development over adolescence, which may heighten an animal's vulnerability to stressors. One consequence may be altered sensitivity to drugs of abuse. We previously reported that social stressors in adolescence increased behavioral sensitization to nicotine in adulthood in female, but not male, rats. Here we examined whether social stressors in adolescence alter the functioning of the hypothalamic-pituitary-adrenal (HPA) axis by examining corticosterone release in response to restraint in adulthood. To further assess effects of social stressors on behavioral sensitivity to psychostimulants, we examined locomotor activity in response to nicotine and to amphetamine. In a second set of experiments, we investigated whether the same procedure of social stressors administered in adulthood produces effects similar to that observed when administered in adolescence. Rats underwent daily 1 h isolation followed by pairing with a new cage mate on either postnatal days 33-48 (pubertal stress: PS) or days 65-80 (adult stress: AS). Three weeks later rats tested for either: (a) corticosterone levels were measured in response to restraint, or (b) locomotor sensitization to nicotine (0.25 mg/kg; 5 days) followed by an amphetamine challenge (0.5 mg/kg) 24 h later. Effects of social stressors were evident only in females. PS females had increased locomotor activity to amphetamine compared to controls, and AS females had increased corticosterone release compared to controls. No effect of the social stressors was found in males at either age except for reduced weight gain during the stress procedure. Thus, females are more susceptible to the enduring effects of these moderate social stressors than are males. However, in terms of behavioral sensitivity to drugs of abuse, females may be more susceptible to stressors during adolescence than adulthood, although the reverse appears to be true for HPA function.

Influence of sex and estrous cyclicity on conditioned cue-induced reinstatement of cocaine-seeking behavior in rats

RATIONALE

Sex differences have been reported in physiological and behavioral responses to cocaine, but it is unclear whether sex differences exist in conditioned-cued relapse to cocaine seeking after prolonged abstinence. Furthermore, the role of estrous cyclicity in conditioned-cued relapse has not been investigated.

OBJECTIVE

We assessed the influence of sex and estrous cyclicity on conditioned-cued reinstatement of drug-seeking behavior in Sprague-Dawley rats.

METHODS

Rats were trained to self-administer intravenous cocaine (unconditioned stimulus, US; 0.25, 0.4, 0.5, 0.6, or 1.0 mg/kg per infusion) paired with light+tone conditioned stimuli (CSs) and were subsequently tested for the ability of the CSs to reinstate extinguished cocaine seeking (i.e., nonreinforced lever responding).

RESULTS

Females exhibited more responding on the cocaine-paired lever during self-administration and extinction than males. Subsequently, males exhibited equally robust conditioned-cued reinstatement of extinguished drug-seeking behavior independent of cocaine training dose. Males and females trained on 0.4-0.6 mg/kg cocaine reinstated to a similar extent. However, females trained on the lowest dose (0.25 mg/kg) exhibited less reinstatement than males, and the source of this effect was the absence of reinstatement in estrous females. In addition, independent of estrous state, females trained on the highest dose (1.0 mg/kg) exhibited less reinstatement than males.

CONCLUSIONS

While males and females are equally responsive to cocaine-paired CSs when the conditions for CS-US association are optimal, females appear to attribute less motivational significance to the CS when it presumably acquires weaker motivational salience because of (a) a low cocaine dose or (b) weaker CS-US contiguity due to the prolonged effects of a high cocaine dose.

The 8-Year Course of Alcohol Abuse: Gender Differences in Social Context and Coping

BACKGROUND

The aim of this study was to compare women (n=230) and men (n=236) who had alcohol use disorders in terms of social context and coping methods and in terms of changes in these indices associated with participation in professional treatment and Alcoholics Anonymous (AA).

METHODS

Initially untreated problem drinkers were followed up for 8 years.

RESULTS

Women and men did not differ in regard to the type of help received, but women had longer professional treatment. At baseline, women had more stressors and fewer resources from family and relied more on avoidance coping and drinking to cope. During the next 8 years, women, more so than men, increased on approach coping and reduced their use of avoidance coping and drinking to cope. When baseline status was controlled, women had better social resource, coping, and drinking outcomes than men did at 1 year and 8 years. A longer duration of professional treatment during year 1 was associated with improved approach coping among men but not women. A longer duration of AA attendance during year 1 and the full 8 years was associated with more resources from friends, more use of approach coping, and less drinking to cope. In turn, more friends resources and approach coping and less drinking to cope were associated with better drinking outcomes. Decreases in avoidance coping and drinking to cope were more strongly associated with better drinking outcomes among men than among women.

CONCLUSIONS

It may be important to target men for formal services or self-help to increase their use of approach coping in efforts to maintain abstinence. Women's strategies for improving their social context need further explication to be adapted for transfer to male problem drinkers.

Gender differences in risk factors and consequences for alcohol use and problems

Women drink less alcohol and have fewer alcohol-related problems than men. Women appear to be less likely than men to manifest certain risk factors for alcohol use and problems and are more likely to have certain protective factors against these problems: women perceive greater social sanctions for drinking; women are less likely to have characteristics associated with excessive drinking including aggressiveness, drinking to reduce distress, behavioral undercontrol, sensation-seeking and antisociality; and women are more likely to have desirable feminine traits (e.g., nurturance) protective against excessive drinking. In addition, consequences of heavy alcohol use, or alcohol use disorders, appear to be more negative for women than men, at least in some domains: women suffer alcohol-related physical illnesses at lower levels of exposure to alcohol than men, and some studies suggest women suffer more cognitive and motor impairment due to alcohol than men; women may be more likely than men to suffer physical harm and sexual assault when they are using alcohol; heavy alcohol use in women is associated with a range of reproductive problems. Implications of these findings for future research and public health education campaigns are discussed.

Sex differences in brain activation during stress imagery in abstinent cocaine users: a functional magnetic resonance imaging study

BACKGROUND

Because stress mediates drug seeking and relapse, and sex differences have been observed in stress and in the development of cocaine addiction, in this study we used functional neuroimaging to examine the effect of sex on stress responses in abstinent cocaine users.

METHODS

In a functional magnetic resonance imaging session, 17 male and 10 female cocaine-dependent subjects participated in script-guided imagery of neutral or stress situations. Subjects rated imagery vividness, anxiety, and cocaine craving for each trial. Brain activation during the stress and neutral imagery periods relative to their own baseline was examined in individual subjects. Sex contrast was obtained in second-level group analysis.

RESULTS

Female subjects demonstrated more activation, compared with male subjects, in left middle frontal, anterior cingulate, and inferior frontal cortices and insula, and right cingulate cortex during stress imagery. Region of interest analysis showed that the change of activity in left anterior cingulate and right posterior cingulate cortices both correlated inversely with the change of craving rating during stress imagery.

CONCLUSIONS

The greater left frontolimbic activity in women suggests that women might use more verbal coping strategies than do men while experiencing stress. The results also suggest a distinct role of the cingulate cortices in modulating stress-induced cocaine craving.

Neonatal isolation stress potentiates cocaine seeking behavior in adult male and female rats

Little is known with regard to how sex and stress might interact as vulnerability factors in cocaine abuse. In this study, we compared the effects of neonatal isolation stress on cocaine self-administration under extended access conditions and on subsequent responding in a cue-induced reinstatement paradigm in adult male and female rats. Pups from each litter were subjected to either neonatal isolation (1 h/day) or brief daily handling from postnatal day 2 through 12. Adults rats were then trained to self-administer cocaine, and once they acquired lever responding for cocaine under a fixed ratio 1 schedule, they were given 24-h access to intravenous cocaine infusions (1.5 mg/kg) that were available in discrete trials (4, 10 min trials/h) for 7 consecutive days. At 10 days after the last discrete trial session, responding was assessed during six to eight 1-h extinction sessions that were followed by a 1-h cue-induced reinstatement session. Results revealed that females took more cocaine than did males over the 7-day discrete trial self-administration period and tended to respond at higher levels during the initial extinction sessions. Although intake did not differ between handled control rats and isolated rats under extended access conditions, stress effects were observed under subsequent extinction and cue-induced reinstatement testing conditions with isolated rats responding at higher levels during both phases. Notably, stress seemed to obscure sex differences in extinction responding such both isolated males and females responded at high levels. These findings demonstrate robust and enduring effects of neonatal isolation stress on cocaine seeking behavior in adult male and female rats.

Alcohol and tobacco use patterns among heterosexually and homosexually experienced California women

BACKGROUND

Mounting evidence suggests that lesbians and bisexual women may be at especially elevated risk for the harmful health effects of alcohol and tobacco use.

METHODS

We report findings from the California Women's Health Survey (1998-2000), a large, annual statewide health surveillance survey of California women that in 1998 began to include questions assessing same-gender sexual behavior.

RESULTS

Overall, homosexually experienced women are more likely than exclusively heterosexually experienced women to currently smoke and to evidence higher levels of alcohol consumption, both in frequency and quantity. Focusing on age cohorts, the greatest sexual orientation disparity in alcohol use patterns appears clustered among women in the 26-35-year-old group. We also find that recently bisexually active women report higher and riskier alcohol use than women who are exclusively heterosexually active. By contrast, among homosexually experienced women, those who are recently exclusively homosexually active do not show consistent evidence of at-risk patterns of alcohol consumption.

DISCUSSION

Findings underscore the importance of considering within-group differences among homosexually experienced women in risk for tobacco and dysfunctional alcohol use.

Gender effects following repeated administration of cocaine and alcohol in humans

RATIONALE

Use of cocaine, alcohol, and the two drugs simultaneously is common and the risk of morbidity and mortality associated with these drugs is widely reported. This double-blind, placebo-controlled, randomized study examined gender differences in response to administration of these drugs alone and in combination.

METHODS

Current users of cocaine and alcohol (n = 17) who met diagnostic criteria (DSM-IV) for cocaine dependence and alcohol abuse or dependence (not physiologically dependent on alcohol) and who were not seeking treatment for substance use disorders gave voluntary, written, informed consent to participate in three drug administration sessions:1) four doses of intranasal cocaine (1 mg/kg every 30 min) with oral alcohol (1 g/kg following the initial cocaine dose and a second drink at +60 min (120 mg/kg) calculated to maintain a plasma alcohol concentration of approximately 100 mg/dL; 2)four doses of cocaine and alcohol placebo; 3) cocaine placebo and alcohol. Pharmacokinetics were obtained by serial blood sampling, physiological measurements (heart rate and blood pressure) were obtained with automated equipment, and subjective effects were assessed using visual analog scales over 480 min.

RESULTS

Responses to cocaine, alcohol, and cocaine-alcohol were equivalent by gender for most measurements. Women had higher heart rates following alcohol administration (p = .02). Women consistently reported higher ratings for "Feel Good:' a measure of overall mental/physical well-being, for all study conditions, reaching statistical significance for cocaine (p = .05) and approaching significance for alcohol administration (p = .1).

CONCLUSION

Women showed equivalent responses to drug administration with the exception of perception of well-being, which was significantly increased for women. These findings may have implications for differential risk for acute and chronic toxicity in women.

Differential effects of chronic ethanol administration and withdrawal on gamma-aminobutyric acid type A and NMDA receptor subunit proteins in male and female rat brain

BACKGROUND

Investigations have shown that chronic ethanol exposure results in selective alterations in levels of gamma-aminobutyric acid (GABA)A and NMDA receptor subunits. We previously reported significant sex differences in these chronic ethanol-induced adaptations. Because we have more recently found important sex differences in timing for the development of and recovery from ethanol dependence, we wanted to ascertain whether there were associations between overt expression of withdrawal and neuroadaptations at the level of GABAA and NMDA receptors.

METHODS

Western blot analysis was used to assay protein levels for several GABAA and NMDA receptor subunits in rat cerebral cortex and hippocampus by using subunit-selective antibodies. Rats were fed 6% ethanol in a liquid diet with pair-fed controls. Feeding, harvesting of tissue, and Western blot experiments were all conducted while maintaining the paired design. Tissue was harvested after 3 days of ethanol exposure, 9 days of ethanol exposure, or 3 days of ethanol withdrawal after 14 days of liquid diet administration.

RESULTS

We again found sex-, subunit-, and brain region-selective effects of ethanol administration and withdrawal for GABAA and NMDA receptors. There was a strong association between increased GABAA receptor alpha4 subunit levels and previously determined withdrawal-induced changes in seizure susceptibility, highlighted by the sex differences in ethanol exposure length required to cause withdrawal signs. In addition, results obtained after 9 days of ethanol administration were in general agreement with previous findings after 14 days of ethanol administration.

CONCLUSIONS

These data further support the suggestion that alterations in subunit assembly of GABAA and NMDA receptors may have some mechanistic role in neuroadaptations underlying ethanol dependence and withdrawal. Furthermore, significant sex differences in these adaptations suggest that multiple types of adaptations may be elicited, depending on innate differences in the actions/effects of ethanol.

Prevalence of non-medical drug use and dependence among homosexually active men and women in the US population

AIMS

The aim of this study was to compare patterns of drug use and dependence between homosexually experienced and exclusively heterosexually experienced individuals.

DESIGN

We used a cross-sectional national household interview survey conducted in the United States.

SETTING

Secondary data analysis of the 1996 National Household Survey on Drug Abuse was employed.

PARTICIPANTS

Participants were sexually active individuals, aged 18 years and older, who reported the genders of their sexual partners in the past 12 months; included 174 homosexually experienced (98 men, 96 women) and 9714 exclusively heterosexually experienced (3922 men, 5792 women) respondents.

MEASUREMENTS

Life-time, past 30 days and daily use of nine classes of drugs. Symptoms of dysfunctional use and dependence.

FINDINGS

There were consistent patterns of elevated drug use in homosexually experienced individuals for life-time drug use, but these were greatly attenuated for recent use. Homosexually experienced men were more likely to report use of marijuana, cocaine and heroin, and homosexually experienced women more likely to report use of marijuana and analgesics than individuals reporting only opposite-sex partners. Both homosexually active men and women were more likely than exclusively heterosexually active respondents to report at least one symptom indicating dysfunctional drug use across all drug classes, and to meet criteria for marijuana dependence syndrome. The only difference between homosexually experienced men and women was that men were more likely to report any daily drug use.

CONCLUSIONS

These data are consistent with surveys suggesting that there is a moderate elevation of drug, particularly marijuana, use and dependence in gay and bisexual men and women when compared to heterosexual men and women.

Sex and estrogen influence drug abuse

Evidence is accumulating that the etiology, epidemiology, consequences and mechanisms that underlie drug abuse are different in males and females. In this review, we present examples of sex differences in all phases of drug abuse, including acquisition, steady-state maintenance, escalation, dysregulation, withdrawal, relapse and treatment. Most reported findings are based on laboratory research in animals, but there are corroborating reports from human clinical and epidemiological studies. In all phases of drug abuse, females seem to be more sensitive to the rewarding effects of drugs than males, and estrogen is a major factor that underlies these sex differences.

Does pregnancy affect outcome of methadone maintenance treatment?

Studies of pregnant women receiving methadone maintenance have tended to focus on teratogenic, prenatal, and neonatal issues. We are not aware of any controlled studies comparing pregnant to non-pregnant heroin-addicted women in methadone treatment. This article presents findings from a study examining treatment outcome between pregnant and non-pregnant participants in a metropolitan methadone-maintenance program. Participants were 51 pregnant women and 51 non-pregnant women enrolled in a methadone maintenance program between 1994 and 2003. Groups were compared on demographic characteristics, psychiatric comorbidity, urinalysis results and retention rates. Groups were comparable in terms of most demographic characteristics and severity of addiction at intake. Groups did not differ significantly in terms of urinalysis results or retention rates. While most women reduced their drug use, a majority of both groups continued to use illicit drugs at least occasionally. Psychiatric comorbidity was significantly different with the non-pregnant group being more psychiatrically disordered. Clinical implications are discussed.

Relationship between alcohol use disorders and suicidality in a psychiatric population: in-patient prevalence study

BACKGROUND

Alcohol misuse is a risk factor in suicide and parasuicide.

AIMS

To measure the prevalence of alcohol use disorders in a cohort of psychiatric admissions using the Alcohol Use Disorders Identification Test (AUDIT), and the relationship between the AUDIT score and suicidality.

METHOD

Consecutive psychiatric admissions were interviewed with a lifestyle survey that included the AUDIT, and admission case notes were reviewed.

RESULTS

Out of 200 subjects, 48.5% scored 8 or more (indicating hazardous or harmful alcohol use) and 22.5% scored 16 or more (indicating significant alcohol dependence) on the AUDIT. There were no significant gender differences. Alcohol misuse was strongly associated with suicidality.

CONCLUSIONS

The AUDIT questionnaire should be incorporated into psychiatric assessments when risk of self-harm is being evaluated. Further research is warranted to examine the impact of interventions for alcohol use disorders in psychiatric settings on self-harm and suicidal ideation.

Sex differences in the behavioral effects of 24-h/day access to cocaine under a discrete trial procedure

Although more men than women are addicted to cocaine, it has been suggested that women may have an accelerated transition to addiction, and that once addicted they may be more vulnerable to relapse. Here we investigate the effects of extended access to cocaine under a 24-h/day discrete trial procedure on patterns of intake and subsequent motivation to use cocaine as assessed by responding under a progressive-ratio schedule in male and female rats. Rats were initially trained to self-administer cocaine (1.5 mg/kg/infusion) under a fixed-ratio 1 schedule until acquisition occurred, and then responding was assessed under a progressive schedule for three sessions. Subsequently, rats had 24-h access to intravenous cocaine infusions (1.5 mg/kg) that were available in discrete trials (4, 10 min trials/h) for 7 consecutive days. At 10 days after the last discrete trial session, responding was reassessed under a progressive-ratio schedule for three additional sessions to investigate changes in motivation to obtain cocaine. Prior to cocaine self-administration under the 24-h access discrete trial procedure, males and females did not differ on cocaine self-administration under the fixed-ratio or progressive-ratio schedules. However, sex differences emerged under the 24-h access discrete trial procedure with females self-administering higher levels of cocaine, for longer initial periods of time, and showing a greater disruption in the diurnal control over intake than did males. Additionally, following a 10-day forced abstinence period, females responded at higher levels under the progressive-ratio schedule to obtain cocaine infusions than did males. These findings suggest that extended access to cocaine under the discrete trial cocaine self-administration procedure produces sex-dependent patterns of intake and sex-specific changes in motivation to obtain cocaine as measured by progressive-ratio responding.

Psychiatric comorbidity and gender differences of persons incarcerated for methamphetamine abuse in Taiwan

Methamphetamine (MAP) abuse has been common in Taiwan for the past decade. The purpose of the present study was to investigate MAP abuse in Taiwan, with specific attention to psychiatric comorbidity and gender differences. A total of 325 MAP abuse subjects (180 male, 145 female) from a detention center in Taipei were assessed with the Diagnostic Interview for Genetic Studies. The following were studied: drug use behavior, treatment-seeking behavior, lifetime prevalence of mood disorders, MAP psychosis, alcohol use disorders, pathological gambling and antisocial personality. The MAP-abuse subjects in Taiwan had high psychiatric morbidity and low access to mental health services. There also exist certain differences in the prevalence of psychiatric illnesses and treatment-seeking behavior between male and female subjects. Compared with their male counterparts, more female subjects reported experience of mental disturbance and experience of psychiatric treatment. The female subjects more commonly reported suicidal behaviors than the male subjects.

You, me...and drugs--a love triangle: important considerations when both members of a couple are abusing substances

Concordant couples can be defined as couples in which both partners have issues with "substance abuse." Studies demonstrate that couples display similar patterns of "substance abuse" that cannot be explained by sociodemographic factors alone. Unfortunately, few studies have focused on the unique relationship dynamics and needs of concordant couples. "Substance abuse" by a client's partner can profoundly affect their recovery and treatment. It is therefore important to understand how clients are influenced by their partners' use. This article attempts to define the needs and issues of concordant couples within a broader psychosocial context. In addition, an overview on the concordant couple literature is provided, along with a discussion of effective treatment and potential barriers to treatment.

Gender similarities and differences: the prevalence and course of alcohol- and other substance-related disorders

Changes in women's social role over the past years likely influenced the gender gap in substance use and substance-related disorders, with potentially significant prevention and treatment implications. The authors reviewed the literature about gender differences in prevalence estimates and course of substance-related disorders. Male-to-female ratios of prevalence estimates of substance use are narrowing in different countries. The initiation of substance use is progressively taking place at younger ages, the trend being more dramatic among women as compared to men. Women's accelerated progression to dependence (so-called "telescoping effect") is a robust finding among alcohol-dependent individuals, although the effect seems to be weaker among younger individuals. As for other drugs, the literature is weaker and further research is needed. It is concluded that women's earlier age of initiation of substance use, faster progression to dependence and under-representation in addiction treatments should be addressed in future health care planning.

Psychosocial treatments for women with substance use disorders

Research on psychosocial treatments for women generally has consisted of quasi-experimental studies, with few randomized controlled trials that specifically test the effectiveness of treatment for women. Review of the available research literature suggests the following: (1) women, compared with men, evidence poorer prognostic characteristics; (2) women generally do not differ significantly from men on treatment utilization or outcome, with the possible exception of employment outcomes, which have been found to be poorer for women; and (3) women may benefit significantly from enhanced treatment services. This article also discusses guidelines for treatment providers and researchers.

The impact of an outpatient program for women with substance use-related disorders on retention

Meeting the needs of women manifesting substance-use disorders is a goal in developing treatment programs for this population. As retention in treatment is positively related to treatment outcome, the length of stay in outpatient treatment of alcohol- and other drug-dependent women in Brazil was compared between two programs. Data were analyzed from 181 women entering a Mixed-Gender Program from 1986 to 1996 and from 80 women entering a Women-Only Program from 1997 to 1998. A greater 3-month retention rate was observed in the Women-Only as opposed to the Mixed-Gender Program. Moreover, the impact was more significant among the alcohol-dependent women. This finding suggests that the heterogeneity of women with substance-use disorders has to be taken into account when developing appropriate treatment strategies.

Discriminating drug-dependent women from alcoholic women and drug-dependent men

The authors compared 99 drug-dependent women to 162 alcoholic women and 66 drug-dependent men entering an outpatient treatment program. They were assessed by a semistructured interview for demography, progression of dependence prior to entering treatment, prior suicidal behavior, and baseline functioning in different areas (alcohol/drug use, occupation, family relationships, and leisure activities). Discriminant analysis techniques were good at predicting group membership for all groups, with an overall correct classification of 69%; though at a lesser degree for the group of drug-dependent women (55%). Among those drug-dependent women misclassified, two-thirds were reclassified into the drug-dependent men group and the remaining third into the alcoholic women group. Taken together, these findings suggest that the drug-dependent women are a distinct group of substance users, who show more heterogeneous characteristics, as well as sharing more features with the drug-dependent men. This should be taken into account when devising treatment strategies for this specific population.

Substance use problems and associated psychiatric symptoms among adolescents in primary care

OBJECTIVE

Substance use disorders (SUDs) are associated with other mental disorders in adolescence, but it is unclear whether less severe substance use problems (SUPs) also increase risk. Because youths with SUPs are most likely to present first to their site of primary care, it is important to establish the presence and patterns of psychiatric comorbidity among adolescent primary care patients with subdiagnostic use of alcohol or other drugs. The objective of this study was to determine the association between level of substance use and psychiatric symptoms among adolescents in a primary care setting.

METHODS

Patients who were aged 14 to 18 years and receiving routine care at a hospital-based adolescent clinic were eligible. Participants completed the Problem Oriented Screening Instrument for Teenagers Substance Use/Abuse scale, which is designed to detect social and legal problems associated with alcohol and other drugs, and the Adolescent Diagnostic Interview, which evaluates for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition diagnoses of substance abuse/dependence and 8 types of psychiatric symptoms. We examined gender-specific associations of no/nonproblematic substance use (NSU), SUP, and SUD with psychiatric symptom presence (any symptoms within each type), score (symptom scores summed across all types), and number of types (number of different symptom types endorsed).

RESULTS

Of 538 adolescents (68% female; mean +/- standard deviation age: 16.6 +/- 1.4 years), 66% were classified with NSU, 18% with SUP, and 16% with SUD, and 80% reported having at least 1 type of psychiatric symptom in the previous 12 months. Symptoms of anxiety were most common (60% of both boys and girls), followed by symptoms of depression among girls (51%) and symptoms of attention-deficit disorder (ADD) among boys (47%). Compared with those with NSU, youths with SUP and those with SUD were more likely to report symptom presence for several types of psychiatric symptoms. Girls with SUP or SUD had increased odds of reporting symptoms of mania, ADD, and conduct disorder; girls with SUD were at increased risk for symptoms of depression, eating disorders, and hallucinations or delusions. Boys with SUP had increased odds of ADD symptoms, whereas boys with SUD had increased odds of reporting hallucinations or delusions. Boys with SUP or SUD had increased odds of reporting symptoms of conduct disorder. Youths with SUP and SUD also had higher psychiatric symptom scores and reported a wider range of psychiatric symptom types (number of types) compared with youths with NSU.

CONCLUSIONS

Like those with SUD, adolescents with subdiagnostic SUP were at increased risk for experiencing a greater number of psychiatric symptoms and a wider range of psychiatric symptom types than youths with NSU. Specifically, adolescents with SUP are at increased risk for symptoms of mood (girls) and disruptive behavior disorders (girls and boys). These findings suggest the clinical importance of SUP and support the concept of a continuum between subthreshold and diagnostic substance use among adolescents in primary care. Identification of youths with SUP may allow for intervention before either the substance use or any associated psychiatric problems progress to more severe levels.

Gender differences in prevalence, risk, and clinical correlates of alcoholism comorbidity in bipolar disorder

OBJECTIVE

The prevalence of lifetime alcohol abuse and/or dependence (alcoholism) in patients with bipolar disorder has been reported to be higher than in all other axis I psychiatric diagnoses. This study examined gender-specific relationships between alcoholism and bipolar illness, which have previously received little systematic study.

METHOD

The prevalence of lifetime alcoholism in 267 outpatients enrolled in the Stanley Foundation Bipolar Network was evaluated by using the Structured Clinical Interview for DSM-IV. Alcoholism and its relationship to retrospectively assessed measures of the course of bipolar illness were evaluated by patient-rated and clinician-administered questionnaires.

RESULTS

As in the general population, more men (49%, 57 of 116) than women with bipolar disorder (29%, 44 of 151) met the criteria for lifetime alcoholism. However, the risk of having alcoholism was greater for women with bipolar disorder (odds ratio=7.35) than for men with bipolar disorder (odds ratio=2.77), compared with the general population. Alcoholism was associated with a history of polysubstance use in women with bipolar disorder and with a family history of alcoholism in men with bipolar disorder.

CONCLUSIONS

This study suggests that there are gender differences in the prevalence, risk, and clinical correlates of alcoholism in bipolar illness. Although this study is limited by the retrospective assessment of illness variables, the magnitude of these gender-specific differences is substantial and warrants further prospective study.

Effects of negative and positive mood phrases on priming of alcohol words in young drinkers with high and low anxiety sensitivity

This study investigated whether potential emotional cues for drinking activate alcohol concepts in young drinkers. Participants were 84 university freshmen with high or low levels of anxiety sensitivity (AS). A verbal priming task measured activation (i.e., priming) of alcohol concepts (e.g., beer) by positive and negative mood phrases. Time to read alcohol target words was the dependent measure. Negative mood phrases consistently primed alcohol targets; positive mood phrases did not. Degree of negative mood priming did not differ as a function of gender or AS. Reported tendency to drink in bad moods predicted negative mood priming in women, whereas men showed negative mood priming irrespective of their reported drinking tendency. A general association between negative mood priming and severity of alcohol problems also emerged.

Gender differences in treatment-seeking Brazilian drug-dependent individuals

The authors compared 66 women and 66 men entering an outpatient treatment for drug dependence, focussing on demographics, progression of dependence, and other associated clinical features. Most of the subjects were dependent on cocaine (75%). Women, as compared with men, had a higher level of education, were more likely to have migrated from other places to the city of Sao Paulo, to report past suicide attempts, and to have first-degree relatives with alcohol problems. There were no gender differences regarding the total time of drug use, baseline severity of dependence, and rates of concurrent psychiatric comorbidity. Clinicians working with drug-dependent women should note the high rates of suicidal behavior in this population, and should explore, besides psychiatric status, risk factors such as impulsive temperament traits. It should also be noted that higher rates of alcohol problems in women's family background pose challenges for the development of effective preventive and treatment strategies.

Primary and secondary substance misusers: do they differ in substance-induced and substance-independent mental disorders?

AIMS

This study evaluated the primary/secondary distinction among substance misusers according to comorbid mental disorders.

METHODS

A consecutive sample (n = 287) of DSM-IV substance dependents from public treatment facilities in two counties in Norway were assessed by the Composite International Diagnostic Interview. According to the debut of the first independent mental disorder, patients were divided into primary substance use disorder (SUD) (17%), secondary SUD (76%) and SUD in the same year as the first mental disorder (7%).

RESULTS

A lifetime substance-independent mental disorder was found in 90%. Forty-two per cent had a combination of substance-independent and substance-induced mental disorders. Five per cent had substance-induced mental disorders only. Primary SUD patients comprised less women, and a lower number of substance-independent mental disorders. Secondary SUD patients had more major depression, phobic disorders and obsessive-compulsive disorder. There were no differences between primary SUD and secondary SUD regarding the number of substance-induced disorders or the pattern of substance misuse.

CONCLUSIONS

Clinical differences between primary and secondary SUD were small and do not support the distinction.

Pathological gambling in women: a review

Pathological gambling was only recently recognized as a psychiatric disorder (DSM-III, APA, 1980). Most studies of pathological gambling include only male subjects. Despite the paucity of information, it is likely that at least one-third of pathological gamblers are women. The objective of this article is to review clinical and epidemiological characteristics of female gamblers as compared to their male counterparts. MEDLINE and PsycINFO were searched for investigational studies and reviews of the past 10 years on clinical (sociodemographic, course and progression, psychiatric comorbidities, genetics, and personality) and epidemiological aspects of female gamblers. Other relevant articles were also selected from reference lists. It is concluded that the current literature indicates some common characteristics in female and male gamblers, but it also indicates the possibility that each gender may carry etiopathogenic differences that when better understood should lead to improved treatment and prevention strategies.

Changing patterns of "drug abuse" in the United States: connecting findings from macro- and microepidemiologic studies

Trend analyses of the U.S. monitoring data systems (the National Household Survey on Drug Abuse and the Monitoring the Future Study) and of the country's surveillance program, the Community Epidemiology Work Group (CEWG), indicate that several new "drug abuse" patterns have emerged over the past several years. For adolescents, drug use rates are converging for females and males, the mean age at which youngsters initiate drug use has declined, and more young adolescents are reporting using drugs. Furthermore, emergent new drug use patterns are being observed by the CEWG. The use of drugs such as Rohypnol, the injecting of crack-cocaine, and the spread of methamphetamines by new traffickers challenge our existing knowledge and understanding of drug use and its prevention. The National Institute on Drug Abuse has funded several large longitudinal studies that follow selected children and adolescents into their twenties, and some into their thirties. This research has been a rich source of information on the determinants of initiating and continuing drug abuse. Yet the findings from the surveys have not been well explored by the longitudinal studies, nor have the findings from the longitudinal studies been used in the surveys to better understand the observed changing trends in drug use patterns. This paper addresses six issues that have been observed from the findings from analyses of data from the surveys or macroepidemiologic studies. Information from the sub-population or micro-epidemiologic studies are reviewed for possible hypotheses to explain each issue. Suggestions for further research and implications for prevention also are presented.

Sex differences in the effects of baclofen on the acquisition of intravenous cocaine self-administration in rats

Baclofen, a GABA(B) agonist, decreases both the maintenance and reinstatement of i.v. cocaine-reinforced responding in rats. In the present experiment the effects of baclofen were extended to a comparison of male and female rats during the acquisition of i.v. cocaine self-administration. Four groups of rats were trained to self-administer i.v. cocaine (0.2 mg/kg) under a fixed-ratio 1 (FR 1) schedule using an autoshaping procedure. The criterion for acquisition was a 5-day period during which a mean of 100 cocaine infusions were administered. Rats were given 30 days to reach this criterion. Male and female groups (n=10-13) were pretreated with i.p. injections of baclofen (2.5 mg/kg) or vehicle 30-min prior to the sessions. A subset of rats (N=5) that did not acquire cocaine self-administration continued to be exposed to the acquisition procedure after baclofen treatment ended. Pretreatment with baclofen decreased both the rate of acquisition of cocaine self-administration and the percentage of rats meeting the acquisition criterion to a greater extent in females than in males. Female rats that did not meet the acquisition criterion with baclofen treatment, acquired within a few days after treatment ended. The findings confirm previous reports of enhanced acquisition of cocaine self-administration in females versus males, and they indicate that baclofen suppressed the acquisition of cocaine self-administration significantly more in females than in males.

A profile of neuropsychological deficits in alcoholic women

Neuropsychological deficits, most notable in executive, visuospatial, and functions of gait and balance, are detectable in alcoholic men even after a month of sobriety. Less well established are the severity and profile of persisting deficits in alcoholic women. The authors used an extensive test battery to examine cognitive and motor functions in 43 alcoholic women who were sober, on average, for 3.6 months. Functions most severely affected in alcoholic women involved visuospatial and verbal and nonverbal working memory processes as well as gait and balance. Areas of relative sparing were executive functions, declarative memory, and upper-limb strength and speed. The authors found that lifetime alcohol consumption was related to impairment severity on Block Design (Wechsler Adult Intelligence Scale-Revised, D. Wechsler, 1981) and verbal and nonverbal working memory, suggesting a dose effect of alcohol abuse. The alcohol-related deficits in working memory, visuospatial, and balance implicate disruption of prefrontal, superior parietal, and cerebellar brain systems.

Antisocial behavioral syndromes and return to drug use following residential relapse prevention/health education treatment

This study compared residential addiction treatment clients meeting full DSM-III-R criteria for antisocial personality disorder (ASPD) with those reporting syndromal levels of antisocial behavior only in adulthood (AABS) on time to and severity of first posttreatment drug use. Antisocial syndrome and selected other mental disorders were assessed using the Diagnostic Interview Schedule, Revised for DSM-III-R, and validity of self-reported posttreatment drug behavior was measured against results of hair analysis. Among subjects followed within 180 days after treatment exit, individuals with ASPD were at modestly increased risk of a first lapse episode compared to those with AABS. However, the two groups did not differ in severity of lapse. Participants with ASPD demonstrated poorer agreement between self-reported posttreatment drug behavior and hair data. These results add to the evidence suggesting that the DSM requirement for childhood onset in ASPD may be clinically important among substance abusers in identifying a severely antisocial and chronically addicted group at elevated risk for early posttreatment recidivism. Our findings support the importance of careful classification of antisocial syndromes among substance abusers and the identification of characteristics of these syndromes that underlie clients' risks for posttreatment return to drug use to provide optimally individualized treatment planning.

Meperidine addiction or treatment frustration?

There have been few studies of the psychiatric characteristics of analgesics addiction. The physician's perceptions that patients were addicted to analgesics might be partially attributable to frustration with poor response to treatment. In this retrospective study, we evaluated the medical records of 20 subjects (15 male and 5 female) who were perceived as having addiction to meperidine by general physicians. The most common medical diagnosis among these patients was chronic pancreatitis (7/20). Among them, five had a past history of suicide attempt and three had self-injury behavior during the index admission. The fact that subjects were perceived as being addicted might be attributable to a vicious cycle of the following factors: 1) chronic intractable pain; 2) poor staff-patient relationship; 3) lower pain threshold or tolerance due to anxiety or depression; 4) patients with a history or tendency of substance abuse; 5) placebo use and inadequate analgesics regimen. The findings of this study suggest that the importance of the following diagnostic and treatment procedures in these patients: 1) suicide risk should be evaluated; 2) comorbid psychiatric diseases should be treated; 3) factors that cause a vicious cycle in pain control should be identified; 4) misconceptions of opiate analgesics among medical staff should be discussed; 5) poor staff-patient relationship should be managed aggressively; and 6) "addiction" is a critical diagnosis that should be avoided if possible.