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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.

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