Overview of NIDA Research on Women's Health and Sex/Gender Differences

Introduction

In past research on drug abuse, as well as other fields of public health, research subjects have been almost exclusively male; as a result little data have been available on women. In recent years, however, the National Institute on Drug Abuse (NIDA) has promoted drug abuse research focusing on the study of women and gender differences. Data from laboratory, field and clinical research is beginning to show gender differences in biological factors in drug abuse, the progression and initiation to drug use and abuse, the antecedents and consequences of drug use and abuse, and prevention and treatment. Research on women and gender differences is now supported in all of NIDA's programmatic branches and is grouped into four major program areas: Etiology, Consequences, Prevention, and Treatment and Services.

Etiology

NIDA supports a broad base of animal and preclinical human research as well as field research aimed at investigating gender differences in the nature and extent of drug-using behaviors, gender differences in the pathways and determinants of initiation, progression and maintenance of drug use, and gender differences in the basic behavioral, biological, neurochemical and genetic factors underlying drug dependence and vulnerability.

Included in the etiological research effort are studies on gender differences in psychosocial factors that increase risk for early onset and severity of drug abuse such as stress and coping strategies, self identity and self esteem, sexual identity, social role, and socioeconomic status, as well as family studies that examine intergenerational transmission and genetics of drug abuse from the perspective of gender. Studies also examine gender differences in the co-existence of drug abuse with psychiatric disorders, especially depression, PTSD, anxiety, eating disorders, borderline personality disorder, and antisocial personality. NIDA's research effort on women, violence, trauma and drug abuse includes study of victimization (e.g., childhood and adulthood rape, sexual assault, physical assault, serial assault by know persons, crime victimization), trauma from natural catastrophes and loss as potential factors in the differential etiology of drug abuse in males and females.

Consequences

NIDA supports basic laboratory research, both animal and human, and field research aimed at identifying gender differences in the behavioral and biological effects of abused drugs. Research is also examining the impact of drug use on pregnancy and maternal functioning, as well as effects on pregnancy outcome, the newborn and the behavioral, intellectual and social development of children prenatally exposed. Research on maternal functioning includes examination of maternal psychiatric status and drug use, maternal-infant bonding and interaction, and a wide range of behaviors relating to the ability of drug abusing mothers to provide for the basic safety, physical and emotional needs of their children.

A major research effort is devoted to the study of women and HIV/AIDS, including etiology, pathogenesis, the relationships between drug abuse and associated behaviors and infection with HIV and progression to AIDS, including drug modulation of HIV infectivity and progression to AIDS. Research is addressing gender roles and gender differences relating to the transaction and dynamic aspects of drug-using behaviors, sexual behaviors associated with drug use, partner notification, and needle hygiene and needle exchange. Perinatal issues are addressed through examination of the impact of drug abuse on maternal-infant transmission, the mother's health and the health of the developing fetus.

Prevention

Among NIDA's drug abuse prevention research objectives is the solicitation of research proposals designed to address issues unique and specific to females of all ages with a focus on the development of prevention strategies designed to identify risk and protective factors that may be associated with gender value systems and life experiences, and ethnicity and culture.

Treatment and Services

NIDA supports a broad-based comprehensive drug abuse treatment program that includes pharmacological, psychotherapeutic, behavioral and psychosocial treatment modalities. Studies examine the development of and effectiveness of drug abuse treatment models that address the unique needs of women, including various forms of pharmacotherapy, psychotherapy, behavior therapy, cognitive therapy, skills training, counseling, and other rehabilitative therapies. In addition to treatment for drug abuse, models also address treatment for co-existing psychiatric disorder (e.g., depression, anxiety, PTSD, eating disorders).

Considerable research effort is devoted to addressing treatment and services issues specific to parenting and/or pregnant women. Studies on improvement of treatment outcomes include strategies for treating family/social dysfunction; strategies to improve recruitment, retention, and compliance with treatment; strategies to improve the drug abuse treatment program environment and the delivery of treatment services; investigation of the barriers and the impact of these barriers to entry and engagement in drug abuse treatment for all women but in particular women who are pregnant and those with young children. Studies also investigate the short- and long-term effectiveness of comprehensive drug abuse treatment for women and their young children based in a variety of settings (e.g., hospitals, outpatient clinics, residential facilities, home-based care, etc.).

NIDA has initiated a program of research on models and strategies linking primary care with drug abuse treatment in order to improve the medical treatment for drug users. This program has a strong HIV/AIDS component that seeks to improve outcomes and long-term effectiveness among HIV-infected women and includes studies relating to treatment access, disease detection, AZT treatment for pregnant women and the interaction of illicit drugs and AZT in pregnant women.

For a complete listing of NIDA program announcements on women's health and sex/gender differences, see Program Announcements Encouraging Research on Women's Health and Gender Differences