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National Institute on Drug Abuse
Women and Sex/Gender Differences Research
Director's Report to Council
Research Findings Excerpts
May, 1997
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Basic Research |
Gender-Related Differences
A recent article published by NIDA supported researchers demonstrates pronounced gender-related differences in the antinociceptive effects of morphine. These differences appear to reflect markedly enhanced CNS sensitivity to morphine in males compared with females, as opposed to any intrinsic differences in the bioavailability of morphine. Furthermore, these gender-related differences appear to exist at both spinal and supraspinal levels. Their findings also suggested that the acute effects of steroids play little role in the gender-related differences observed; rather, it appears more probable that the organizational effects of steroids, which occur in the late prenatal and early postnatal stages and in large part determine gender-related distinctions in males and females, may be more significant. Although the clinical significance and the underlying mechanisms of these findings are unknown at this point, these results may provide a means to begin examining gender-related differences in abuse liability of psychoactive drugs. Cicero, T.J., Nock, B. and Meyer, E.R. J Pharmacol. Exp. Therap. 279, pp. 767-773, 1996.
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Behavioral Science |
Gender and Vulnerability Factors in Cigarette Abstinence
Dr. David Gilbert from Southern Illinois University is investigating the role of individual differences in physiological and psychological responses to smoking abstinence among females as they relate to individual differences in personality and nicotine dependence and comparing responses of this female sample to a recently collected all-male sample. Large individual differences in response to quitting have been found to correlate with personality, psychopathology, and nicotine dependence. Preliminary data indicate that neuroticism and depressive trait measures predict degree of smoking cessation induced negative affect and depressive state. These findings are consistent with the PI's hypothesis that individuals scoring high in trait depression and neuroticism smoke to self-medicate their temperamental disposition toward negative affect. The data, when complete, will lead to new knowledge that will have implications for how to individualize smoking cessation programs to maximize successful long-term abstinence.
Gender Differences in Psychiatric and Substance Use Comorbidity among Treatment-Seeking Opioid Abusers
Psychiatric and substance use comorbidity was assessed in 716 opioid abusers (47.2% women) seeking methadone maintenance during a 5-year period. Rates of co-occurring mental disorders and personality traits were compared by gender. Although rates of comorbidity were similar in women and men (47% vs 48%), women were less likely than men to have a DSM-III-R personality disorder (28.4% vs 40.5%) or an antisocial personality (15.4% vs 33.9%) but more likely to have a mood disorder (27.5 % vs 11.4%) and 7 times more likely to have a borderline personality (9.5% vs 1.3%). Although all patients had at least one substance use diagnosis beyond opioid dependence, most often cocaine dependence, women were less likely than men to have a life-time cannabis, alcohol, or hallucinogen disorder or a current cannabis (12.1% vs 19.8%) or alcohol dependence (19.5% vs 29.4%). Brooner, R.K., King, V.L., Kidorf, M., Schmidt, C.W., and Bigelow, G.E. Psychiatric and Substance Use Comorbidity Among Treatment-Seeking Opioid Abusers. Arch. Gen. Psychiatry, 54 (1), pp. 71 80, 1997.
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AIDS Research |
Factors that Impact Street Risks Through Sexual Income Generation
Drug addicted women whose economic and social base is the urban street have limited choices for income generation. These limitations often put such women in danger of predation, assault, arrest, and illness. In this context, an important source of income will often become the exchange of sex for drugs or money. Because of the legal, social, interpersonal, and safety risks associated with these exchanges, drug addicted women may not always be able to practice safe sex, raising their chances of contracting or transmitting HIV infection. These complex conditions may pressure women engaged is sexual exchanges for drugs or money to respond in a variety of ways. Street-recruited women drug users participating in NIDA's Cooperative Agreement AIDS research program in Hartford, Connecticut report a range of protective and risk behaviors when exchanging sex for drugs or money. This article discusses some of the ethnic, economic, and drug use differences among women from the street, analyzes how these differences may affect their drug and sexual risk behaviors, and describes the various approaches and significant efforts of many of these women to reduce their HIV risks. Weeks, M. Grier, M., Romero-Daza, N., et al. Streets, Drugs, and the Economy of Sex in the Age of AIDS. Women and Health, 7, In press.
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Epidemiology, Etiology and Prevention Research |
Depression Spectrum Disease
This study used an adoption study design to separate genetic from environmental factors in the etiology of depression spectrum disease, a type of major depression characterized by families in which male relatives are alcoholic and females are depressed. The genetic etiology hypothesis of depression spectrum disease proposes that an alcoholic genetic diathesis predisposes to depression in females but alcoholism, not depression, in males. The study examined 197 adult offspring (95 male and 102 female) of alcoholic biological parents and used logistic regression models to determine the contribution to major depression in male and female adoptees that could be explained by the genetic alcoholic diathesis combined with an environmental factor that was characterized by psychiatrically or behaviorally disturbed adoptive parents. Major depression in females was predicted by an alcoholic diathesis only when combined with the disturbed adoptive parent variable. The same regression model failed to predict depression in males. Other possible environmental confounding factors contributing to an increased chance of depression were found in females: fetal alcohol exposure, age at the time of adoption, and a family with an adopted sibling who had a psychiatric problem. These variables did not diminish the significance of the prediction of depression with the alcohol genetic diathesis and disturbed parent model. Conclusions were that a genetic factor is present for which alcoholism is at least a marker, and which exerts its effect in women as a gene-environment interaction leading to major depression. This finding suggests that an important etiologic factor in depression spectrum disease is gene-environment interaction. The results are important for the substance abuse field because of the lasting effect upon female children of alcoholics and the additional fact that long term follow-up of females with depression spectrum disease find an increase in later life substance abuse. Cadoret, R.J., Winokur, G., Langbehn, D., Troughton, E., Yates, W.R., and Stewart, M.A. Depression Spectrum Disease, I: The Role of Gene-Environment Interaction. American Journal of Psychiatry, 153(7), pp. 892-899, 1996.
Comorbidity and Boundaries of Affective Disorders with Anxiety Disorders and Substance Misuse: Results of an International Task Force
Associations between affective disorders, anxiety disorders and substance use disorders were examined in epidemiological studies conducted in Germany, Switzerland, Puerto Rico, and the mainland U.S. There was a remarkable degree of similarity across studies in the magnitude and type of specific disorders associated with the affective disorders. Comorbidity with affective disorders was greater for the anxiety disorders than for substance misuse. Panic disorder was the subtype of anxiety that was most highly comorbid with depression. Social phobia was the specific phobic type with the strongest association with the affective disorders. The magnitude of associations between substance misuse and affective disorders generally was quite low and less consistent across sites. No major differences were found in the patterns of comorbidity by gender or age group, affective subtype or prevalence period. The onset of anxiety disorders generally preceded that of depression, whereas alcohol misuse was equally likely to pre- or post-date the onset of affective disorders. Finally, comorbidity was associated with an elevation in treatment rates across all sites, confirming Berkson's paradox on an international level. Merikangas, K.R., August, J., Eaton, W., Canino, G., Rubio-Stipec, M., Wacker, H., Wittchen, H.U., Andrade, L., Essau, C., Whitaker, A., Kraemer, H., Robins, L.N., and Kupfer, D.J. British Journal of Psychiatry, 168 (30), pp. 58 67, 1996.
Demographic and Psychosocial Risk for Alcohol Use: Ethnic Differences
NIDA supported researchers examined the influence of demographic variables and social (parents and peers), attitudinal, and intentions variables regarding alcohol use on actual drinking behavior among Asian and white populations. Asian (n=148; 79 female, 69 male) and white (n =132; 72 female, 60 male) college students completed a questionnaire. Confirmatory factor analyses revealed that social and attitudinal factors reflected a common construct of psychosocial vulnerability which, in a structural equation model, was significantly predicted by ethnicity. The white population was exposed to more psychosocial risks to alcohol use compared to the Asian population. Ethnicity, however, did not directly predict either drinking intentions or drinking behavior, after the effects on Psychosocial Vulnerability were considered. These findings suggest that ethnic differences in alcohol use between Asians and whites are mainly due to different levels of exposure to risk factors. Effective prevention programs must consider, not only psychosocial factors, but also certain contextual factors such as sex and ethnicity. Keefe, K., and Newcomb, M.D. Demographic and Psychosocial Risk for Alcohol Use: Ethnic Differences. Journal of Studies on Alcohol, 57, pp. 521-530, 1996
Gender Related Differences in Circumstances Surrounding Initiation and Escalation of Alcohol and Other Substance Use/Abuse
A series of multivariate logistic regression models specifying the effects of gender and other variables on the initiation and escalation of alcohol and other substance use/abuse was estimated. The sample consisted of 6,074 young adults from a general population who participated in a longitudinal study that began in 1971. The original target sample consisted of a random sample of all seventh grade students (N=9,335) in the Houston Independent School District. A follow-up study of these students in the 1980's, when the subjects were in their mid-20's, resulted in the successful interview of 6,074 subjects. After controlling for race, ethnicity, father's education, and a tendency to over-or under endorse statements, the effects of gender on circumstances surrounding initiation/escalation of binge drinking, marijuana use, and use of other illicit drugs were found. The statistical analysis indicated that males tended to show a need to enhance sense of self-importance through use of alcohol and other substances and to report that they feel more important or more powerful for having done it. In addition, males seek social bonding through the use of alcohol or drugs. Females, however, resort to alcohol and other substances because of personal problems such as having a serious argument with a significant other, feeling angry at someone or something, or having troubles too great to bear. Females' use of alcohol or drugs for self-medication was also suggested by their greater tendency to report use proximate to experiences of feeling down emotionally or feeling worthless, and by their reports of feeling less depressed following use. This research asserts that, in multivariate context, gender differentiation is found in the perceptions of the circumstances surrounding the initiation and escalation of substance use/abuse. Liu, X., and Kaplan, H. Gender-Related Differences in Circumstances Surrounding Initiation and Escalation of Alcohol and Other Substance Use/Abuse. Deviant Behavior, 17(1), pp. 71-106, 1996.
Women Convicted of Homicide had Drug Use Histories Similar to Men Convicted of Homicides
In a sample of 589 women convicted of homicide, 70% reported being regular users of drugs and alcohol prior to committing the homicide. The women were also as likely as male convicts to have long criminal histories of violent and non-violent crimes and to have been involved in the crack trade business. Spunt, B., Brownstein, H., Crimmins, S., et al. Drugs and Homicide by Women. Substance Use and Abuse, 31(7), pp. 825-845, 1996.
Female Drug Injectors are Often Peripheral Members of Drug Injection Networks
Female injection drug users (IDUs) reported their usual link to drug injection networks to be by way of their male IDU sex partner. The peripheral or subordinate network positions of women IDUs may explain why they often engage in high risk behaviors. Su, S.S. and Gerstein, D. Understanding Barriers to Positive Behavioral Changes Among Injection Drug Users: A Social Network Approach. Paper presented at the International Sunbelt Social Network Conference, Charleston, SC, 1996.
Differences in Thinking Versus Behavior in Middle and High School Females Concerning Drug Use and Eating Disorders
To evaluate differences as a function of age in middle-school versus high school females in terms of drug use and eating disorders a survey of more than 2,000 young women showed no significant differences across many risk behaviors; use of tobacco, alcohol, cocaine, diet pills, supplements, vitamins, self-induced vomiting or intent to use any of these in the future. However, these females did differ significantly in that the younger females displayed less knowledge of the adverse consequences of these behaviors, they perceived less prevalence of these behaviors among their peers, and expressed less belief in the media. While prevention programs for high school girls may be too late to deter experimentation, the results of this study underscore the need for intervention at an earlier age; at a time when critical knowledge items and attitudes are not yet firmly established. Clarke, G., Goldberg, L, Moe, E., Poole, L., and Witherrite, T. Young Women's Disordered Eating and Drug Use: Do Middle and High School Students Differ? To be presented at the American College of Sports Medicine, Denver, May 1997 and published in Medicine and Science in Sports and Exercise, Vol. 29-S, 1997. High Rates of Drug and Alcohol Use Found Among Women Who Kill Children Researchers in New York City interviewed 42 imprisoned women who were convicted for killing children. The majority of women (67%) reported using drugs and/or alcohol 3 or more days per week for a month. Most commonly used drugs were marijuana (by 26% of the women), alcohol (by 19%), and tranquilizers (by 17%). Sixty percent of the sample also reported coming from homes where drugs/alcohol were used daily. Crimmins, S., Langley, S., Brownstein, H.H., and Spunt, B. Convicted Women Who Have Killed Children. Journal of Interpersonal Violence, 12(1), pp. 49-69, 1997.
Powerlessness, Exploitation, and Degradation of Women in the Inner-City Crack Culture
Ethnographic studies of female crack sellers and commercial sex workers were conducted in New York City. Almost all of the women came from poor, precariously housed families and most had lost support from their families and friends because of their crack use. Single Room Occupancy or "welfare" hotels and shelters were viewed as criminogenic and dangerous. A few of the women "slept rough" or squatted curbside, but usually with a man. The most common alternative living arrangement of these women was with an older man with a dependable income for a period of time. In exchange, women typically provided the men with sex, drugs, domestic services, or companionship. Several women avoided crack houses and shooting galleries by living in so-called "freakhouses" with other women, where they would provide entertainment and sex to men in exchange for crack and other drugs. Although these women of the inner-city crack culture were typically impoverished -- without a regular place to live, sleep, bathe, eat, and store their possessions -- they were rarely homeless and living on the streets. Rather, they tended to find alternative living arrangements which reinforced their powerlessness and reflected their high levels of sexual exploitation and degradation. Maher, L., Dunlap, E., Johnson, B., and Hamid, A. Gender, Power, and Alternative Living Arrangements in the Inner-City Crack Culture. Journal of Research on Crime and Delinquency, 33(2), pp. 181-205, 1996.
Volatile Solvent Use: Patterns by Gender and Ethnicity Among School Attenders and Dropouts
Differences in patterns of volatile solvent use were explored using self report, with specific focus on the relationship to school enrollment status -- dropout, enrolled but academically at-risk, and control. The sample included American Indian, Mexican American and White American youth. Findings indicated that a higher proportion of the dropout cohort have used volatile solvents, used them regularly and with more intensity than the other two groups. There was also an interaction between gender and ethnicity. Bates, S.C., Plemons, B.W., Thurman-Jumper, P., and Beauvais, F. Volatile Solvent Use: Patterns by Gender and Ethnicity Among School Attenders and Dropouts. Drugs and Society 10( ), pp. 59-75, 1997.
Eating Pathology among Women with Alcoholism and/or Anxiety Disorders
Two hundred one non-treatment seeking women with alcoholism, anxiety disorders, alcoholism and anxiety disorders, or neither alcoholism nor anxiety disorders were interviewed to assess core psychopathology associated with eating disorders using the Eating Disorders Examination and DSM-IIIR psychiatric diagnosis. Alcoholic women had significantly higher mean scores on each of the Eating Disorders Examination subscales of Restraint, Overeating, Eating Concern, Shape Concern, and Weight Concern compared with nonalcoholic women. Women with anxiety disorders had significantly elevated scores on subscales of Overeating, Eating Concern, and Weight Concern compared with women without anxiety disorder. Women with both alcoholism and anxiety disorders had higher rates of bulimia nervosa and/or eating disorder NOS compared with women with either disorder alone. Implications of these findings are discussed in the context of the co-morbid association between alcoholism, eating disorders, and anxiety disorders. Sinha, R., Robinson, J., Merikangas, K., Wilson, G. T., Rodin, J., O'Malley, S. Alcohol Clin Exp Res., 20(7), pp. 1184-1191, 1996.
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