Sex and Gender Differences in Substance Use Disorders

Overview

Journal Clin Psychol Rev

Specialty Psychology

Date 2017 Nov 28

PMID 29174306

Citations 309

Authors

R Kathryn McHugh

Victoria R Votaw

Dawn E Sugarman

Shelly F Greenfield

Affiliations

Soon will be listed here.

Abstract

The gender gap in substance use disorders (SUDs), characterized by greater prevalence in men, is narrowing, highlighting the importance of understanding sex and gender differences in SUD etiology and maintenance. In this critical review, we provide an overview of sex/gender differences in the biology, epidemiology and treatment of SUDs. Biological sex differences are evident across an array of systems, including brain structure and function, endocrine function, and metabolic function. Gender (i.e., environmentally and socioculturally defined roles for men and women) also contributes to the initiation and course of substance use and SUDs. Adverse medical, psychiatric, and functional consequences associated with SUDs are often more severe in women. However, men and women do not substantively differ with respect to SUD treatment outcomes. Although several trends are beginning to emerge in the literature, findings on sex and gender differences in SUDs are complicated by the interacting contributions of biological and environmental factors. Future research is needed to further elucidate sex and gender differences, especially focusing on hormonal factors in SUD course and treatment outcomes; research translating findings between animal and human models; and gender differences in understudied populations, such as those with co-occurring psychiatric disorders and gender-specific populations, such as pregnant women.

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References

Benowitz N, Lessov-Schlaggar C, Swan G, Jacob 3rd P . Female sex and oral contraceptive use accelerate nicotine metabolism. Clin Pharmacol Ther. 2006; 79(5):480-8. DOI: 10.1016/j.clpt.2006.01.008. View

Otiniano Verissimo A, Grella C . Influence of gender and race/ethnicity on perceived barriers to help-seeking for alcohol or drug problems. J Subst Abuse Treat. 2017; 75:54-61. PMC: 5329903. DOI: 10.1016/j.jsat.2016.12.013. View

Carliner H, Mauro P, Brown Q, Shmulewitz D, Rahim-Juwel R, Sarvet A . The widening gender gap in marijuana use prevalence in the U.S. during a period of economic change, 2002-2014. Drug Alcohol Depend. 2016; 170:51-58. PMC: 5321672. DOI: 10.1016/j.drugalcdep.2016.10.042. View

McKee S, Smith P, Kaufman M, Mazure C, Weinberger A . Sex Differences in Varenicline Efficacy for Smoking Cessation: A Meta-Analysis. Nicotine Tob Res. 2015; 18(5):1002-11. PMC: 5942618. DOI: 10.1093/ntr/ntv207. View

Hernandez-Avila C, Rounsaville B, Kranzler H . Opioid-, cannabis- and alcohol-dependent women show more rapid progression to substance abuse treatment. Drug Alcohol Depend. 2004; 74(3):265-72. DOI: 10.1016/j.drugalcdep.2004.02.001. View

Khan S, Secades-Villa R, Okuda M, Wang S, Perez-Fuentes G, Kerridge B . Gender differences in cannabis use disorders: results from the National Epidemiologic Survey of Alcohol and Related Conditions. Drug Alcohol Depend. 2012; 130(1-3):101-8. PMC: 3586748. DOI: 10.1016/j.drugalcdep.2012.10.015. View

Tappin D, Bauld L, Purves D, Boyd K, Sinclair L, MacAskill S . Financial incentives for smoking cessation in pregnancy: randomised controlled trial. BMJ. 2015; 350:h134. DOI: 10.1136/bmj.h134. View

Ward K, Vander Weg M, Sell M, Scarinci I, Read M . Characteristics and correlates of quitting among black and white low-income pregnant smokers. Am J Health Behav. 2006; 30(6):651-62. DOI: 10.5555/ajhb.2006.30.6.651. View

Potenza M, Hong K, Lacadie C, Fulbright R, Tuit K, Sinha R . Neural correlates of stress-induced and cue-induced drug craving: influences of sex and cocaine dependence. Am J Psychiatry. 2012; 169(4):406-14. PMC: 3690485. DOI: 10.1176/appi.ajp.2011.11020289. View

10.

Kerridge B, Saha T, Chou S, Zhang H, Jung J, Ruan W . Gender and nonmedical prescription opioid use and DSM-5 nonmedical prescription opioid use disorder: Results from the National Epidemiologic Survey on Alcohol and Related Conditions - III. Drug Alcohol Depend. 2015; 156:47-56. PMC: 4633313. DOI: 10.1016/j.drugalcdep.2015.08.026. View

11.

Chartoff E, McHugh R . Translational Studies of Sex Differences in Sensitivity to Opioid Addiction. Neuropsychopharmacology. 2015; 41(1):383-4. PMC: 4677149. DOI: 10.1038/npp.2015.272. View

12.

Caris L, Wagner F, Rios-Bedoya C, Anthony J . Opportunities to use drugs and stages of drug involvement outside the United States: Evidence from the Republic of Chile. Drug Alcohol Depend. 2009; 102(1-3):30-4. PMC: 4922899. DOI: 10.1016/j.drugalcdep.2008.12.004. View

13.

Ondersma S, Svikis D, Thacker L, Beatty J, Lockhart N . Computer-delivered screening and brief intervention (e-SBI) for postpartum drug use: a randomized trial. J Subst Abuse Treat. 2013; 46(1):52-9. PMC: 3818299. DOI: 10.1016/j.jsat.2013.07.013. View

14.

Niv N, Hser Y . Women-only and mixed-gender drug abuse treatment programs: service needs, utilization and outcomes. Drug Alcohol Depend. 2006; 87(2-3):194-201. DOI: 10.1016/j.drugalcdep.2006.08.017. View

15.

Prendergast M, Messina N, Hall E, Warda U . The relative effectiveness of women-only and mixed-gender treatment for substance-abusing women. J Subst Abuse Treat. 2011; 40(4):336-48. PMC: 3081899. DOI: 10.1016/j.jsat.2010.12.001. View

16.

Conway K, Compton W, Stinson F, Grant B . Lifetime comorbidity of DSM-IV mood and anxiety disorders and specific drug use disorders: results from the National Epidemiologic Survey on Alcohol and Related Conditions. J Clin Psychiatry. 2006; 67(2):247-57. DOI: 10.4088/jcp.v67n0211. View

17.

Lehavot K, Stappenbeck C, Luterek J, Kaysen D, Simpson T . Gender differences in relationships among PTSD severity, drinking motives, and alcohol use in a comorbid alcohol dependence and PTSD sample. Psychol Addict Behav. 2013; 28(1):42-52. PMC: 3769473. DOI: 10.1037/a0032266. View

18.

Vega W, Aguilar-Gaxiola S, Andrade L, Bijl R, Borges G, Caraveo-Anduaga J . Prevalence and age of onset for drug use in seven international sites: results from the international consortium of psychiatric epidemiology. Drug Alcohol Depend. 2002; 68(3):285-97. DOI: 10.1016/s0376-8716(02)00224-7. View

19.

King A, Cao D, Zhang L, OMalley S . Naltrexone reduction of long-term smoking cessation weight gain in women but not men: a randomized controlled trial. Biol Psychiatry. 2012; 73(9):924-30. PMC: 3629005. DOI: 10.1016/j.biopsych.2012.09.025. View

20.

Messina N, Grella C, Cartier J, Torres S . A randomized experimental study of gender-responsive substance abuse treatment for women in prison. J Subst Abuse Treat. 2009; 38(2):97-107. PMC: 2815183. DOI: 10.1016/j.jsat.2009.09.004. View