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Chapter 39. Women and Addiction

Kathleen T. Brady, M.D., Ph.D.; Sudie E. Back, Ph.D.
DOI: 10.1176/appi.books.9781585623440.355951

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Until the early 1990s, much of the research in substance abuse was focused on males or mixed-gender samples without significant attention to gender differences. In 1994, the National Institutes of Health published guidelines concerning the inclusion of women and minorities as subjects in clinical research (National Institutes of Health 1994). Since that time, the number of published research reports examining various aspects of substance use disorders in women and gender differences in substance use disorders has increased tremendously. There is now greater recognition that important biological and psychosocial differences between men and women influence the prevalence, presentation, comorbidity, and treatment of substance use disorders. This increase in awareness of gender-specific issues is also seen in the clinical sector, with approximately 40% of substance abuse treatment facilities now providing special programs or groups for women (Substance Abuse and Mental Health Services Administration 2006a). This chapter provides an overview of the current knowledge base concerning substance use disorders in women. Specifically, the epidemiology, neurobiology, psychiatric comorbidity, course of illness, and treatment of substance use disorders in women is reviewed.

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Table Reference Number
TABLE 39–1. Lifetime prevalence of substance use disorders among men and women
Table Reference Number

The overall prevalence rates of drug and alcohol use disorders are higher among men than among women. However, for prescription drugs and nicotine, prevalence rates of women closely approach those of men.

One of the most consistent findings in studies focused on gender differences in substance use disorders is the increased vulnerability of women to the adverse medical and psychosocial consequences of substance use. This has been coined the "telescoping" of substance use disorders in women.

Women become intoxicated after drinking smaller amounts of alcohol and achieve higher blood-alcohol concentration after drinking equivalent amounts of alcohol as compared with men. This is primarily because women have less total body water than do men of comparable size and a lower concentration of gastric alcohol dehydrogenase, which metabolizes alcohol.

Patterns of comorbid psychiatric disorders found in men and women with addiction parallel those found in the general population. Epidemiological and treatment studies show that, regardless of substance use disorder status, women evidence higher rates of anxiety, depression, eating disorders, and borderline personality disorder, whereas men evidence higher rates of antisocial personality disorder.

Among substance users, gender differences in the temporal onset of comorbid psychiatric conditions have been observed. Women more often than men have a primary mental health disorder (e.g., depression) that precedes the onset of their substance use disorder. This suggests differences in the etiological relationship of substance use and comorbid psychiatric conditions among men and women.

Women are less likely than men are to enter substance abuse treatment. Possible reasons for lower rates include sociocultural factors (e.g., stigma, lack of partner/family support to enter treatment), socioeconomic factors (e.g., child care), pregnancy, and fears concerning incarceration and child custody issues.

Although fewer women enter substance abuse treatment, treatment outcomes for women appear comparable with those for men. Few consistent gender differences have been observed in outcomes, retention rates, or relapse rates.

It is unclear whether women-focused or gender-specific treatments are more effective than standard substance abuse treatments. Programs that allow women to be accompanied by their children may result in higher rates of retention, which is important in predicting treatment outcome. Programs that pay special attention to psychiatric comorbidity, family and parenting issues, victimization, and gender-specific barriers to treatment are likely to be more successful.

Maternal substance use during pregnancy remains a significant problem. Self-report measures, such as the Alcohol Use Disorders Identification Test or the CAGE Questionnaire, are useful for screening in primary health care and obstetric clinics. Psychosocial and pharmacological interventions may be helpful in reducing substance use and associated issues (e.g., depression, posttraumatic stress disorder, criminal behavior) among pregnant and postpartum substance-dependent women.

References

American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision. Washington, DC, American Psychiatric Association, 2000
 
Annas GJ: Testing poor pregnant women for cocaine: physicians as police investigators. N Engl J Med 344:1729–1732, 2001
[PubMed]
 
Arria AM, Derauf C, LaGasse LL, et al: Methamphetamine and other substance use during pregnancy: preliminary estimates from the Infant Development, Environment, and Lifestyle (IDEAL) study. Matern Child Health J 10:293–302, 2006
[PubMed]
 
Ashley OS, Marsden ME, Brady TM: Effectiveness of substance abuse treatment programming for women: a review. Am J Drug Alcohol Abuse 29:19–53, 2003
[PubMed]
 
Benowitz NL: Gender differences in the pharmacology of nicotine addiction. Paper presented at the College on Problems of Drug Dependence, Nashville, TN, June 1997
 
Brady KT, Randall CL: Gender differences in substance use disorders. Psychiatr Clin North Am 22: 241–252, 1999
[PubMed]
 
Brady KT, Grice DE, Dustan L, et al: Gender differences in substance use disorders. Am J Psychiatry 150:1707–1711, 1993
[PubMed]
 
Brady TM, Ashley OS (eds): Women in Substance Abuse Treatment: Results From the Alcohol and Drug Services Study (ADSS) (DHHS Publication No. SMA 04-3968, Analytic Series A-26). Rockville, MD, Substance Abuse and Mental Health Services Administration, Office of Applied Studies, 2005. Available at http://www.oas.samhsa.gov/womenTX/womenTX.pdf. Accessed November 26, 2006.
 
Campbell UC, Morgan AD, Carroll ME: Sex differences in the effects of baclofen on the acquisition of intravenous cocaine self-administration in rats. Drug Alcohol Depend 66:61–69, 2002
[PubMed]
 
Canterbury RJ: Alcohol and other substance abuse, in Women's Mental Health: A Comprehensive Textbook. Edited by Kornstein SG, Clayton AH. New York, Guilford, 2002, pp 222–243
 
Caprara DL, Nash K, Greenbaum R, et al: Novel approaches to the diagnosis of fetal alcohol spectrum disorder. Neurosci Biobehav Rev 31:254–260, 2007
[PubMed]
 
Carroll ME, Campbell UC, Heideman P: Ketoconazole suppresses food restriction-induced increases in heroin self-administration in rats: sex differences. Exp Clin Psychopharmacol 9:307–316, 2001
[PubMed]
 
Chang G, McNamara TK, Orav EJ, et al: Brief intervention for prenatal alcohol use: the role of drinking selection. J Subst Abuse Treat 31:419–424, 2006
[PubMed]
 
Chang L, Ernst T, Strickland T, et al: Gender effects on persistent cerebral metabolite changes in the frontal lobes of abstinent cocaine users. Am J Psychiatry 156:716–722, 1999
[PubMed]
 
Chatham LR, Hiller ML, Rowan-Szal GA, et al: Gender differences at admission and follow-up in a sample of methadone maintenance clients. Subst Use Misuse 34:1137–1165, 1999
[PubMed]
 
Cicero TJ, Ennis T, Ogden J, et al: Gender differences in the reinforcing properties of morphine. Pharmacol Biochem Behav 65:91–96, 2000
[PubMed]
 
Cicero TJ, Aylward SC, Meyer ER: Gender differences in the intravenous self-administration of mu opiate agonists. Pharmacol Biochem Behav 74:541–554, 2003
[PubMed]
 
Claus RE, Orwin RG, Kissin W, et al: Does gender-specific substance abuse treatment for women promote continuity of care? J Subst Abuse Treat 32:27–39, 2007
[PubMed]
 
Cohen LS, Altshuler LL, Nonacs R, et al: Relapse of major depression during pregnancy in women who maintain or discontinue antidepressant treatment. JAMA 295:499–507, 2006
[PubMed]
 
Conners NA, Grant A, Crone CC, et al: Substance abuse treatment for mothers: treatment outcomes and the impact of length of stay. J Subst Abuse Treat 31:447–456, 2006
[PubMed]
 
Conway KP, Compton W, Stinson FS, et al: 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 67:247–257, 2006
[PubMed]
 
Copeland J, Hall W, Didcott P, et al: A comparison of a specialist women's alcohol and other drug treatment service with two traditional mixed-sex services: client characteristics and treatment outcome. Drug Alcohol Depend 32:81–92, 1993
[PubMed]
 
Cornelius JR, Salloum IM, Haskett RF, et al: Fluoxetine versus placebo in depressed alcoholics: a 1-year follow-up study. Addict Behav 25:307–310, 2000
[PubMed]
 
Cornelius JR, Bukstein OG, Birmaher B, et al: Fluoxetine in adolescents with major depression and an alcohol use disorder: an open–label trial. Addict Behav 26:735–739, 2001
[PubMed]
 
Cornelius JR, Clark DB, Bukstein OG, et al: Fluoxetine in adolescents with comorbid major depression and an alcohol use disorder: a 3-year follow-up study. Addict Behav 30:807–814, 2005
[PubMed]
 
Dahlgren L, Willander A: Are special treatment facilities for female alcoholics needed? A controlled 2-year follow-up study from a specialized female unit (EWA) versus a mixed male/female treatment facility. Alcohol Clin Exp Res 13:499–504, 1989
[PubMed]
 
Dawson DA, Grant BF, Stinson FS, et al: Recovery from DSM-IV alcohol dependence: United States, 2001–2002. Addiction 100:281–292, 2005
[PubMed]
 
Edwards EM, Werler MM: Alcohol consumption and time to recognition of pregnancy. Matern Child Health J 10:467–472, 2006
[PubMed]
 
Evans SM, Foltin RW: Exogenous progesterone attenuates the subjective effects of smoked cocaine in women, but not in men. Neuropsychopharmacology 31:659–674, 2006
[PubMed]
 
Fitzsimons HE, Tuten M, Vaidya V, et al: Mood disorders affect drug treatment success of drug-dependent pregnant women. J Subst Abuse Treat 32:19–25, 2007
[PubMed]
 
Frezza M, di Padova C, Pozzato G, et al: High blood alcohol levels in women: the role of decreased gastric alcohol dehydrogenase activity and first-pass metabolism. N Engl J Med 322: 95–99, 1990
[PubMed]
 
Fuchs CS, Stampfer MJ, Colditz GA, et al: Alcohol consumption and mortality among women. N Engl J Med 332:1245–1250, 1995
[PubMed]
 
Gentilello LM, Rivara FP, Donovan DM, et al: Alcohol problems in women admitted to a level I trauma center: a gender comparison. J Trauma 48:108–114, 2000
[PubMed]
 
Gilman SE, Abraham HD: A longitudinal study of the order of onset of alcohol dependence and major depression. Drug Alcohol Depend 63:277–286, 2001
[PubMed]
 
Grant BF, Harford TC: Comorbidity between DSM-IV alcohol use disorders and major depression: results of a national survey. Drug Alcohol Depend 39:197–206, 1995
[PubMed]
 
Grant BF, Dawson DA, Stinson FS, et al: The 12-month prevalence and trends in DSM-IV alcohol abuse and dependence: United States, 1991–1992 and 2001–2002. Drug Alcohol Depend 74:223–234, 2004a
 
Grant BF, Hasin DS, Chou P, et al: Nicotine dependence and psychiatric disorders in the United States. Arch Gen Psychiatry 61:1107–1115, 2004b
 
Greenfield SF, Brooks AJ, Gordon SM, et al: Substance abuse treatment entry, retention, and outcome in women: a review of the literature. Drug Alcohol Depend 86:1–21, 2007
[PubMed]
 
Harris LH: The status of pregnant women and fetuses in US criminal law. JAMA 289:1697–1699, 2003
[PubMed]
 
Henskens R, Mulder CL, Garretsen H: Gender differences in problems and needs among chronic, high-risk crack abusers: results of a randomized controlled trial. J Subst Abuse Treat 10:128–140, 2005
 
Hernandez-Avila CA, Rounsaville BJ, Kranzler HR: Opioid-, cannabis-, and alcohol-dependent women show more rapid progression to substance abuse treatment. Drug Alcohol Depend 74:265–272, 2004
[PubMed]
 
Hogle JM, Curtin JJ: Sex differences in negative affective response during nicotine withdrawal. Psychophysiology 43:344–356, 2006
[PubMed]
 
Hommer D, Momenan R, Rawlings R, et al: Decreased corpus callosum size among alcoholic women. Arch Neurol 53:359–363, 1996
[PubMed]
 
Hser YI, Joshi V, Maglione M, et al: Effects of program and patient characteristics on retention of drug treatment patients. Eval Program Plann 24:331–341, 2001
 
Hser YI, Evans E, Huang YC: Treatment outcomes among women and men methamphetamine abusers in California. J Subst Abuse Treat 28:77–85, 2005
[PubMed]
 
Hughes PH, Coletti SD, Neri RL, et al: Retaining cocaine-abusing women in a therapeutic community: the effects of a child live-in program. Am J Public Health 85:1149–1152, 1995
[PubMed]
 
Johnson EO, Schultz L: Forward telescoping bias in reported age of onset: an example from cigarette smoking. Int J Methods Psychiatr Res 14:119–129, 2005
[PubMed]
 
Jones H: Drug addiction during pregnancy: advances in maternal treatment and understanding child outcomes. Curr Dir Psychol Sci 15:126–130, 2006
 
Kaufman MJ, Levin JM, Maas LC, et al: Cocaine-induced cerebral vasoconstriction differs as a function of sex and menstrual cycle phase. Biol Psychiatry 49:774–781, 2001
[PubMed]
 
Kendler KS, Bulik CM, Silberg J, et al: Childhood sexual abuse and adult psychiatric and substance use disorders in women: an epidemiological and cotwin control analysis. Arch Gen Psychiatry 57:953–959, 2000
[PubMed]
 
Kessler RC: Impact of substance abuse on the diagnosis, course, and treatment of mood disorders: the epidemiology of dual diagnosis. Biol Psychiatry 56:730–737, 2004
[PubMed]
 
Kessler RC, McGonagle KA, Zhao S, et al: Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States: results from the National Comorbidity Survey. Arch Gen Psychiatry 51:8–19, 1994
[PubMed]
 
Kessler RC, Nelson CB, McGonagle KA, et al: The epidemiology of co-occurring addictive and mental disorders: implications for prevention and service utilization. Am J Orthopsychiatry 66:17–31, 1996
[PubMed]
 
Kilpatrick DG, Resnick HS, Saunders BE, et al: Victimization, posttraumatic stress disorder, and substance use and abuse among women, in Drug Addiction Research and the Health of Women (NIH Publ No. 98–4290). Edited by Wetherington CL, Roman AB. Rockville, MD, U.S. Department of Health and Human Services, 1998, pp 285–307
 
Kilts CD, Gross RE, Ely TD, et al: The neural correlates of cue-induced craving in cocaine-dependent women. Am J Psychiatry 161:233–241, 2004
[PubMed]
 
Kornstein SG, Schatzberg AF, Thase ME, et al: Gender differences in treatment response to sertraline versus imipramine in chronic depression. Am J Psychiatry 157:1445–1452, 2000
[PubMed]
 
Kosten TA, Gawin FH, Kosten TR, et al: Gender differences in cocaine use and treatment response. J Subst Abuse Treat 10:63–66, 1993
[PubMed]
 
Kosten TR, Kosten TA, McDougle CJ, et al: Gender differences in response to intranasal cocaine administration to humans. Biol Psychiatry 39:147–148, 1996
[PubMed]
 
Levin JM, Holman BL, Mendelson JH, et al: Gender differences in cerebral perfusion in cocaine abuse: technetium-99m-HMPAO SPECT study of drug-abusing women. J Nucl Med 35:1902–1909, 1994
[PubMed]
 
Li CS, Kosten TR, Sinha R: Sex differences in brain activation during stress imagery in abstinent cocaine users: a functional magnetic resonance imaging study. Biol Psychiatry 57:487–494, 2005
[PubMed]
 
Lynch WJ, Roth ME, Carroll ME: Biological basis of sex differences in drug abuse: preclinical and clinical studies. Psychopharmacology 164:121–137, 2002
[PubMed]
 
Mancinelli R, Benetti R, Ceccanti M: Woman, alcohol, and environment. Emerging risks for health. Neurosci Biobehav Rev 31:246–253, 2007
[PubMed]
 
Mangrum LF, Spence RT, Steinley-Bumgarner MD: Gender differences in substance-abuse treatment clients with co-occurring psychiatric and substance-use disorders. Brief Treat Crisis Interv 6:255–267, 2006
 
Mann K, Ackermann K, Croissant B, et al: Neuroimaging of gender differences in alcohol dependence: are women more vulnerable? Alcohol Clin Exp Res 29:896–901, 2005
[PubMed]
 
Manning MA, Hoyme HE: Fetal alcohol spectrum disorders: a practical clinical approach to diagnosis. Neurosci Biobehav Rev 31:230–238, 2007
[PubMed]
 
Marshall AW, Kingstone D, Boss M, et al: Ethanol elimination in males and females: relationship to menstrual cycle and body composition. Hepatology 3:701–706, 1983
[PubMed]
 
McGee R, Williams S: Predictors of persistent smoking and quitting among women smokers. Addict Behav 31:1711–1715, 2006
[PubMed]
 
McKay JR, Rutherford MJ, Cacciola JS, et al: Gender differences in the relapse experiences of cocaine patients. J Nerv Ment Dis 184:616–622, 1996
[PubMed]
 
Minkoff H, Paltrow L: Melissa Rowland and the rights of pregnant women. Obstet Gynecol 105:1148, 2005
 
Moos RH, Moos BS, Timko C: Gender, treatment and self-help in remission from alcohol use disorders. Clin Med Res 4:163–174, 2006
[PubMed]
 
Moylan PL, Jones HE, Haug NA, et al: Clinical and psychosocial characteristics of substance-dependent pregnant women with and without PTSD. Addict Behav 26:469–474, 2001
[PubMed]
 
National Institutes of Health: NIH Guidelines on the Inclusion of Women and Minorities as Subjects in Clinical Research. Bethesda, MD, National Institutes of Health, 1994. Available at http://grants.nih.gov/grants/guide/notice-files/not94-100.html. Accessed March 7, 2007.
 
Niv N, Hser Y: Women-only and mixed-gender drug abuse treatment programs: service needs, utilization and outcomes. Drug Alcohol Depend 87:194–201, 2007
[PubMed]
 
Oncken C, Cooney J, Feinn R, et al: Transdermal nicotine for smoking cessation in postmenopausal women. Addict Behav 32:296–309, 2007
[PubMed]
 
Ondersma SJ, Chase SK, Svikis DS, et al: Computer-based brief motivational intervention for perinatal drug use. J Subst Abuse Treat 28:305–312, 2005
[PubMed]
 
Perkins KA, Donny E, Caggiula AR: Sex differences in nicotine effects and self-administration: review of human and animal evidence. Nicotine Tob Res 1:301–315, 1999
[PubMed]
 
Perkins KA, Gerlach D, Broge M, et al: Greater sensitivity to subjective effects of nicotine in nonsmokers high in sensation seeking. Exp Clin Psychopharmacol 8:462–471, 2000
[PubMed]
 
Perrotti LI, Russo SJ, Fletcher H, et al: Ovarian hormones modulate cocaine-induced locomotor and stereotypic activity. Ann NY Acad Sci 937:202–216, 2001
[PubMed]
 
Pettinati HM, Dundon W, Lipkin C: Gender differences in response to sertraline pharmacotherapy in type A alcohol dependence. Am J Addict 13:236–247, 2004
[PubMed]
 
Piazza NJ, Vrbka JL, Yeager RD: Telescoping of alcoholism in women alcoholics. Int J Addict 24:19–28, 1989
[PubMed]
 
Project MATCH Research Group: Matching alcoholism treatments to client heterogeneity: Project MATCH posttreatment drinking outcomes. J Stud Alcohol 58:7–29, 1997
 
Randall CL, Roberts JS, Del Boca FK, et al: Telescoping of landmark events associated with drinking: a gender comparison. J Stud Alcohol 60:252–260, 1999
[PubMed]
 
Regier DA, Farmer ME, Rae DS, et al: Comorbidity of mental disorders with alcohol and other drug abuse: results from the Epidemiologic Catchment Area (ECA) study. JAMA 264:2511–2518, 1990
[PubMed]
 
Robbins SJ, Ehrman RN, Childress AR, et al: Comparing levels of cocaine cue reactivity in male and female outpatients. Drug Alcohol Depend 53:223–230, 1999
[PubMed]
 
Roth ME, Carroll ME: Sex differences in the acquisition of IV methamphetamine self-administration and subsequent maintenance under a progressive ratio schedule in rats. Psychopharmacology (Berl) 172:443–449, 2004
[PubMed]
 
Russo SJ, Festa ED, Gazi SJ, et al: Gonadal hormones differentially modulate cocaine-induced place preference in male and female rats. Neuroscience 120:523–533, 2003
[PubMed]
 
Sinha R, Rounsaville BJ: Sex differences in depressed substance abusers. J Clin Psychiatry 63:616–627, 2002
[PubMed]
 
Sofuoglu M, Dudish-Poulsen S, Nelson D, et al: Sex and menstrual cycle differences in the subjective effects from smoked cocaine in humans. Exp Clin Psychopharmacol 7:274–283, 1999
[PubMed]
 
Sofuoglu M, Mitchell E, Kosten T: Effects of progesterone treatment on cocaine responses in male and female cocaine users. Pharmacol Biochem Behav 78:699–705, 2004
[PubMed]
 
Stewart J: Pathways to relapse: the neurobiology of drug- and stress-induced relapse to drug-taking. J Psychiatry Neurosci 25:125–136, 2000
[PubMed]
 
Substance Abuse and Mental Health Services Administration: Facilities offering special programs or groups for women: 2005. The DASIS Report, Issue 35, 2006a. Available at http://www.oas.samhsa.gov/2k6/womenTx/womenTX.htm. Accessed March 7, 2007.
 
Substance Abuse and Mental Health Services Administration: National Survey on Drug Use and Health. Rockville, MD, Substance Abuse and Mental Health Services Administration, 2006b. Available at http://www.oas.samhsa.gov/nsduh.htm. Accessed March 7, 2007.
 
Szuster RR, Rich LL, Chung A, et al: Treatment retention in women's residential chemical dependency treatment: the effect of admission with children. Subst Use Misuse 31:1001–1013, 1996
[PubMed]
 
Tuten M, Jones HE, Tran G, et al: Partner violence impacts the psychosocial and psychiatric status of pregnant, drug-dependent women. Addict Behav 29:1029–1034, 2004
[PubMed]
 
Velez ML, Montoya ID, Jansson LM, et al: Exposure to violence among substance-dependent pregnant women and their children. J Subst Abuse Treat 30:31–38, 2006
[PubMed]
 
Weisner C, Schmidt L: Gender disparities in treatment for alcohol problems. JAMA 268:1872–1876, 1992
[PubMed]
 
Wilcox C, Brizendine L: For women only: hormones may prevent addiction relapse. Curr Psychiatry 5:39–45, 2006
 
Wurst FM, Wiesbeck GA, Metzger JW, et al: On sensitivity, specificity, and the influence of various parameters on ethyl glucuronide levels in urine: results from the WHO/ISBRA study. Alcohol Clin Exp Res 28:1220–1228, 2004
[PubMed]
 
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There are significant differences in the rates of substance use disorders between the genders. Which of the following is more common in adolescent females than males?
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When compared with male substance abusers entering treatment, female substance abusers have less of which of the following?
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Which is true regarding the physiological metabolism in women as compared with men?
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