Cora Lee Wetherington, Ph.D. Women & Gender Research Coordinator National Institute on Drug Abuse Women Across the Life Span Conference July 12-13, 2004.

Cora Lee Wetherington, Ph.D. Women & Gender Research Coordinator National Institute on Drug Abuse Women Across the Life Span Conference July 12-13, 2004 Baltimore Marriott Inner Harbor

Gender Differences in Drug Abuse u Gender Differences: The Numbers u Gender Differences: Animal Models u Gender Differences: Menstrual Cycle u Gender Differences: Predictors & Progression u Gender Differences: Treatment

Gender Differences: The Numbers Population prevalence data u Drug use: greater for males than females u Drug dependence: greater for males than females u 9.2% Males u 5.6% Females (1994 Natl Comorbidity Survey) Are females less vulnerable to drug abuse than males?

Gender Differences: The Numbers Calculate use prevalence only among individuals with opportunity to use individuals with opportunity to use Van Etten et al. (1999) Study drugs: Marijuana, Cocaine, Heroin, Hallucinogens Data Source: 1993 NHSDA Findings: Opportunity to use: greater for males than for females. Among individuals with opportunity to use : males and females are equally likely to initiate use.

Opportunity to Use Drugs 0 10 20 30 40 50 60 70 MarijuanaCocaineHallucinogensHeroin Percent Male Female

Percent Use Given an Opportunity

Gender Differences: The Numbers Calculate Dependence Only among Users: Males and females = likely to become dependent on cocaine tobacco heroin inhalants hallucinogens analgesics Anthony et al. (1994) (Data Source: National Comorbidity Survey)

Gender Differences: The Numbers Calculate Dependence Only among Users: Males more likely than females to become dependent on marijuana alcohol Anthony et al. (1994) Data Source: National Comorbidity Survey

Gender Differences: The Numbers Calculate Dependence Only among Users: Females more likely than males to become dependent on anxiolytics or sedatives or hypnotics Anthony et al. (1994) (Data Source: National Comorbidity Survey)

Gender Differences: The Numbers Do prevalence data, adjusted for opportunity, suggest that females are less vulnerable to drugs than males ? No. If females are offered drugs, they are as likely as males to use them: marijuana, cocaine, heroin, hallucinogens. No. If females use drugs, they are as likely as males to become dependent; exceptions in both directions. Caveat: Females are less likely to receive drug offers.

Gender Differences: The Numbers All Age Groups vs. Adolescents Adolescents

Gender Differences: The Numbers Monitoring the Future Survey 1975 - Present 1975 - Present Annual prevalence of illicit drug use other than marijuana 12 th graders: > for boys than girls (exceptions: 1975 & 1981 girls > boys) 10 th graders: > for girls than boys (since 1991) 8 th graders: > for girls than boys (since 1991)

Gender Differences: The Numbers Dependence Among Adolescents Users: (Aged 12-17) Alcohol: males = females Marijuana: males = females Nicotine: males = females Cocaine : females > males 17.4% vs. 4.7% Kandel et al. (1997 ) Data Source: 1991, 1992, 1993 NHSDA

Gender Differences: The Numbers Patterns of Drug Use

Gender Differences: The Numbers CAVEAT: Usage data are from treatment samples. Perhaps female heavy users are more likely than male heavy users to present for treatment.

Gender Differences: The Numbers DATOS Intake Data (n=10,010, 96 programs, 11 cities, 4 modalities) Women, compared to men, were less likely to have graduated from high school almost half as likely to be employed more likely to report prior drug treatment depression, suicidal attempts & thoughts being troubled over current emotional/psychological problems health problems weekly or daily illegal activity (but < likely to be CJ involved) more likely to report physical, sexual abuse or both in year prior to treatment occurring more than a year prior to treatment Wechsberg et al. (1998)

Gender Differences: The Numbers Myth: Females are less vulnerable to drugs than males 1. If given the opportunity, females are as likely as males to use drugs to become dependent 2. Adolescent females, compared to males, in 8 th and 10 th grades are more likely to use any illicit drugs other than marijuana are more likely to become dependent on cocaine

Gender Differences: The Numbers Myth: Males are more vulnerable than females 3. Use patterns suggest that women are more likely to use daily cocaine, heroin, barbiturates use more times per week cocaine & heroin use more grams per week cocaine 4. Women presenting for treatment have poorer levels of functioning. Does this reflect a greater vulnerability to the impact of drugs on women? (i.e., consequence) Are women with poorer levels of functioning more vulnerable to drugs than men with poorer levels of functioning? (i.e., etiologic)

Gender Differences: Animal Models Do data from animal behavioral models suggest that males are more vulnerable to drugs than females?

Gender Differences: Animal Models Behavioral Models: 1.Amount of Drug Self-Administered 2.Reinforcing Effectiveness 3.Speed of Acquisition of Self-Administration 4.Prevalence of Self-Administration 5.Relapse: Reinstatement following Extinction

Gender Differences: Animal Models 1. Amount of Drug Self-Administered Females, compared to males, self-administer more alcohol Hill, 1978; Lancaster & Spiegel, 1992 caffeine Heppner et al., 1986 cocaine Morse et al., 1993; Matthews et al., 1999; Lynch & Carroll,1999 fentanyl Klein et al., 1997 heroin Carroll et al., 2001 morphine Alexander et al, 1978; Hill, 1978; Cicero et al, 2000 nicotineDonny et al., 2000

Gender Differences: Animal Models 2. Reinforcing Effectiveness Females reach higher progressive ratio breakpoint for cocaine (Roberts et al., 1989) nicotine (Donny et al., 2000) Females have shorter latency for first nicotine infusion of the session (Donny et al., 2000)

Gender Differences: Animal Models Progressive ratio breakpoint (BP) (Roberts et al., 1989) Males: 48.2 Females: 264.1 Females during estrus: approx. 400 Estrus BP > metestrous/diestrous or proestrus BP

Gender Differences: Animal Models 3. Speed of Acquisition of Self-Administration Females acquire self-administration faster than males cocaine approx 1/2 the # sessions ( Lynch & Carroll, 1999) heroin approx 2/3 the # sessions (Lynch & Carroll, 1999) nicotine at lowest dose only (Donny et al., 2000)

Gender Differences: Animal Models 4. Prevalence of Self-Administration (SA) Similar percentage of female rats acquire heroin SA: 90.0% females vs. 91.7% males (Lynch & Carroll, 1999) More female rats acquire cocaine SA: 70% females vs. 30% males (Lynch & Carroll, 1999) More female Rhesus monkeys acquire PCP SA: 100% females vs. 36.4% males (Carroll et al., 2000)

Gender Differences: Animal Models 5. Relapse: Reinstatement following Extinction of Cocaine SA Females, compared to males, exhibit greater reinstatement of extinguished responding relapse with a lower priming dose Lynch & Carroll (2000)

Gender Differences: Animal Models Behavioral Models: 1.Amount of Drug Self-Administered 2.Reinforcing Effectiveness 3.Speed of Acquisition of Self-Administration 4.Prevalence of Self-Administration 5.Relapse: Reinstatement following Extinction

Hormonal Changes During the Menstrual Cycle Hormonal Changes During the Menstrual Cycle

Gender Differences: Menstrual Cycle Pharmacokinetics (Humans) : Cocaine u Pharmacokinetics of i.v. 0.2 and 0.4 mg/kg cocaine: peak plasma levels time to reach peak plasma level (Tmax) elimination half life AUC u No differences among males, females (luteal), females (follicular) Exception: Tmax for 0.4 mg/kg Females follicular phase: 4.0 min luteal phase: 6.7 min Males: 8.0 min Mendelson et al. (1999)

Gender Differences: Menstrual Cycle ORAL d-AMPHETAMINE Subjective effects > follicular than luteal: > feeling of high > euphoria (ARCI MBG) > energy & intellectual efficiency (ARCI BG) > liking the drug > wanting the drug Justice & de Wit (1999)

Gender Differences: Menstrual Cycle SMOKED COCAINE Repeated doses smoked cocaine (0, 6, 12.5 or 25 mg) In follicular phase (v. luteal phase) Higher ratings of high Higher ratings of good drug effect Evans et al. (2002)

Gender Differences: Menstrual Cycle NICOTINE CESSATION STUDY Quitters in the late luteal phase, vs follicular phase: more withdrawal symptoms more depressive symptomatology Implications for timing of initiation of cessation Perkins (2000)

Gender Differences: Menstrual Cycle CUE-INDUCED NICOTINE CRAVING Follicular phase females reported significantly less craving than luteal phase females males Franklin et al. (2004)

On a scale of 1 to 10, how much do you desire a cigarette at this moment? CRAVING SCORECRAVING SCORE F L Early F Late L p

Cora Lee Wetherington, Ph.D. Women & Gender Research Coordinator National Institute on Drug Abuse Women Across the Life Span Conference July 12-13, 2004.

Documents

females males

numbers u gender differences

opportunity slide

females marijuana

females cocaine

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females u drug dependence

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