Gender a Key Consideration in Substance Abuse Treatment

Women with substance use disorders (SUDs) do not have the same risk factors, comorbidities, disease course, and treatment response as male patients, and addiction psychiatrists should be mindful of the gender differences. This was the message conveyed by experts at a symposium at APA's 2010 annual meeting in New Orleans in May.

The symposium was part of a track supported by the National Institute on Drug Abuse (NIDA) at the meeting.

Women are traditionally considered to have a much lower prevalence of SUDs than men, but the epidemiology is changing. In 2004, 7.7 million women in the United States were estimated to have alcohol or substance use disorders, according to Kathleen Brady, M.D., a professor of psychiatry and associate dean for clinical research at the Medical University of South Carolina. Alcohol dependence is two to three times more common in men, but the gender gap is smaller for illicit drug dependence at 5.6 percent for women versus 9.2 percent for men. “When it comes to prescription drug misuse or abuse, men and women are about equal,” Brady said.

Among the gender differences are the risk factors for substance abuse. Having a significant other with heavy drinking or drug use problems and having a history of childhood abuse or family violence are very strongly associated with an increased likelihood of substance abuse in women, much more so than in men, according to Brady. The role of childhood trauma appears to be a key risk factor in many women with SUDs.

In addition, Brady cited an abundance of data demonstrating some gender differences in comorbidities: Women with SUDs are more likely to have depressive and anxiety disorders, while men with SUDs are more likely to have attention-deficit/hyperactivity disorder and concurrent alcohol use.

In terms of disease trajectory, telescoping refers to the phenomenon that women appear to progress faster than men from first alcohol and substance use to abuse and to dependence and treatment seeking, Brady said. “In alcohol dependence, we know there are physiological bases that may be underpinning some of the telescoping [effects],” she said. For example, alcohol on average has higher circulating blood levels in women than in men because women tend to be smaller in size, have a lower proportion of body water, and less alcohol dehydrogenase activity. Thus, women are more likely to become intoxicated than men on the same amount of drinking.