Substance Abuse in Women

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Epidemiology

Gender differences in rates of substance abuse have been consistently observed in the general population and treatment-seeking samples, with men exhibiting significantly higher rates of substance use, abuse, and dependence.1, 2, 3 However, recent epidemiologic surveys suggest that this gap between men and women has narrowed in recent decades.3, 4 For example, surveys in the early 1980s estimated the male/female ratio of alcohol-use disorders as 5:1,5 in contrast to more recent surveys that

Neuroactive Gonadal Steroid Hormones

Ovarian steroid hormones (eg, estrogen, progesterone), metabolites of progesterone, and negative allosteric modulators of the γ-aminobutyric acid A (GABA-A) receptor, such as dehydroepiandrostenedione (DHEA), may influence the behavioral effects of drugs.12, 13 In human studies, the follicular phase of the menstrual cycle, in which estradiol levels are high and progesterone low, is associated with the greatest responsivity to stimulants.14 A study investigating response to cocaine

Mood and Anxiety Disorders

Lifetime rates of mood and anxiety disorders are significantly higher among women than men, with and without substance-use disorders.22 A recent study by Goldstein23 using the wave 1 NESARC (n = 24,575) found that the 12-month prevalence rates of mood and anxiety disorders among women with substance-use disorders were 29.7% and 26.2%, respectively. The most common mood disorder was major depressive disorder (15.4%) and the most common anxiety disorder was specific phobia (15.6%).

Given this high

Alcohol

Although men consume and misuse alcohol at significantly higher rates than women, this gender gap has decreased over time3 and has been well documented in several large epidemiological studies. For example, the 2001 to 2002 NESARC, which sampled more than 42,000 individuals, found that sex differences in rates of alcohol use and abuse or dependence were smallest for younger cohorts (with cohorts ranging from 1913–1932 to 1968–1984).3 In a similar vein, examination of changes in the age of

Treatment outcome for women with substance-use disorders

Data from the TEDS, which captures data on national treatment admission rates, report that the overall proportion of men to women within the treatment system has remained fairly constant from 1995 to 2005 at 2:1.107 A recent review of the literature between 1975 and 2005 concluded that women are less likely to enter substance abuse treatment than men.46 However, once women enter treatment, gender itself is not a predictor of treatment retention, completion, or outcome.46 Several gender-specific

Conclusions and future directions

Gender differences in substance-use disorders and treatment outcomes for women with substance-use disorders have been a focus of research in the last 15 years. The initiation, use patterns, acceleration of disease course, and help-seeking patterns are affected by gender differences in biologic, psychological, cultural, and socioeconomic factors. Important gender-specific factors also predict women's substance abuse treatment entry, retention, and outcomes. Understanding the basic biological

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    The authors would like to acknowledge support from grant K24DA019855 (SFG), K23DA021228 (SEB) and K24 DA00435 (KTB) from the NIH/NIDA, and P50 DA016511 (KTB) from NIAMS/ORWH.

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