Psychosocial and psychopathology differences in hospitalized male and female cocaine abusers: A retrospective chart review

doi:10.1016/0306-4603(91)90056-N

Addictive Behaviors

Volume 16, Issue 6, 1991, Pages 489-496

https://doi.org/10.1016/0306-4603(91)90056-N Get rights and content

Abstract

While considerable amounts of psychological and pharmacological data have been collected on male substance abusers in public treatment facilities, relatively little information is available about the psychosocial characteristics of men in private treatment settings and of women presenting for substance abuse treatment. The present study reviewed the records of 100 male and female cocaine abusers admitted to a private substance abuse treatment program between 1987 and 1989. Patterns of cocaine use and levels of impairment were found to be similar for men and women, with male cocaine abusers more likely to abuse additional substances. Male cocaine abusers were employed more frequently than women and held higher status jobs despite equivalent levels of education. Female cocaine abusers were more likely to be diagnosed with concurrent psychiatric disorders and were more likely to report family histories of substance abuse. Both groups produced elevations on MMPI scales indicating depression, anxiety, paranoid features, and acting-out tendencies. These data suggest that while male and female cocaine abusers show similarities on some measures, there are significant gender differences that may have implications for both research and treatment.

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2016, Forensic Science International
Citation Excerpt :
Women with cocaine and heroin addiction seem less likely than men to develop a comorbidity to alcohol [5]. Studies on heroin and cocaine abusers have indicated that since the late 1980s, women have tended to take drugs for a shorter duration and enter treatment at earlier ages relative to men [13–15]. The term “telescoping” has been introduced to indicate “an accelerated progression from initiation of substance use to the onset of dependence and first admission to treatment” [5,16,17].
Gender differences in substance use/abuse have been the focus of research in the last 15 years. Initiation, use patterns, acceleration of disease course, and help-seeking patterns are known to be influenced by gender differences with regard to biological, psychological, cultural and socioeconomic factors. This paper presents a systematic review of published data on gender differences in the use/abuse of psychoactive and psychotic drugs, focusing on the importance of a multidisciplinary approach.
The basis for this paper was obtained by Medline searches using the search terms “human” and “gender”, combined with individual drug names or “drugs of abuse”. The reference lists of these papers were further checked for other relevant studies.
The gender difference in drug abuse is more evident in adults than in adolescents (13–19 years): adult men are 2–3 times more likely than women to develop drug abuse/dependence disorders and approximately 4 times as likely to have an alcohol use disorder. Such prevalence rates have not been observed in adolescents.
Differences between men and women involve: (i) the biological response to the drug, (ii) the progression to drug dependence, and (iii) the comorbid psychiatric diagnoses, which may be due to both sociocultural factors and innate biological differences. A crucial role played by ovarian hormones (oestrogens and progesterone) has been documented in both human and animal model studies.
Epidemiological data on how particular psychobiological and physiological characteristics in females influence vulnerability to both drug addiction and toxicological consequences of drugs are still in their infancy. Significant gaps remain in our knowledge, which are primarily attributable to the lack of empirical data that only a systematic and multidisciplinary approach to the topic can generate. The introduction of gender into forensic toxicological evaluations may help elucidate the relationship between the body's absorption of abused drugs (alone or in combination) and the onset of intoxications, both lethal and none.
Mental and Physical Health Needs of Lesbian, Gay, and Bisexual Clients in Substance Abuse Treatment
2015, Journal of Substance Abuse Treatment
Lesbian, gay, and bisexual (LGB) orientation predicts greater substance use, treatment utilization, and poorer mental and physical health, but health needs of LGB individuals in substance abuse treatment remain largely unknown. The purpose of this study was to identify differences in mental and physical health needs of LGB individuals in substance abuse treatment.
Substance abuse treatment admissions data from the County of San Francisco were used in this investigation of differences in mental and physical health problems and service utilization between LGB (n = 1,441) and heterosexual individuals (n = 11,770).
LGB individuals were more likely to have mental health diagnoses (_adjORs ranging from 1.86 to 4.00) and current mental health prescription medications (_adjORs from 1.79 to 4.99) than heterosexual counterparts. Gay and bisexual men and bisexual women but not lesbian women, were more likely to be receiving mental health treatment. Gay men and bisexual women were more likely than heterosexual counterparts to report physical health problems. Gay and bisexual men and bisexual women but not lesbian women were more likely to be receiving health care. There were no differences between LGB individuals and heterosexual counterparts in the number of emergency room visits or hospital overnight stays.
This study found that LGB individuals entering substance abuse treatment have greater mental and physical health needs than heterosexual counterparts. Implications for healthcare integration, research, and practice are discussed.
An examination of psychiatric comorbidities as a function of gender and substance type within an inpatient substance use treatment program
2011, Drug and Alcohol Dependence
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These rates are comparable to those of Compton et al. (2000b), where 18% of African American women and 10% of African American men in treatment for SUDs met criteria for MDD, but are lower than those of Stecker et al. (2007), where 50% of women and 34% of men in the VA system with SUDs met criteria for MDD. Interestingly, among patients with cocaine dependence or cannabis dependence, rates of mood disorders did not differ by gender, which is similar to patterns observed by other researchers who have not found elevated rates of mood disorders among female as compared to male substance users for specific substance types (Brady et al., 1993; Denier et al., 1992). Among individuals with cannabis dependence, alcohol dependence, and opioid dependence, males and females were not significantly different in their likelihood of being diagnosed with ASPD, while among individuals with cocaine dependence, males were more likely to be diagnosed with ASPD than females.
There are elevated rates of comorbid psychiatric disorders among individuals with substance dependence; however, little research examines these rates within inpatient settings, particularly in relation to gender and type of substance. The current study aimed to fill this gap.
465 patients (71.4% male) were recruited from an inpatient substance use treatment facility from 2006 to 2009. These patients were interviewed and diagnosed using the Structure Clinical Interview for DSM-IV and the Diagnostic Interview for Personality Disorders.
60.6% of patients with substance dependence had a current comorbid psychiatric disorder, and more than 30% had at least two psychiatric disorders. The most common current Axis I diagnosis was major depressive disorder (25.8%), followed by PTSD (14%). Comparable rates were found for Antisocial and Borderline Personality Disorders. Females were significantly more likely to meet diagnostic criteria for a psychiatric disorder than were males (73.7% versus 55.4%). When examining comorbidities across different substance dependences, the highest rates of comorbid psychiatric disorders were found among individuals with alcohol dependence (76.8%) and cannabis dependence (76%), although rates were above 60% for cocaine and opioid dependence. Rates of psychiatric diagnoses were significantly lower (27%) among patients who did not meet diagnostic criteria for substance dependence.
There are particularly elevated rates of psychiatric disorders among individuals with substance dependence in inpatient treatment. These rates differ as a function of substance dependence type and gender, making these factors important to consider when researching and treating this type of population.
Using a latent variable approach to inform gender and racial/ethnic differences in cocaine dependence: A National Drug Abuse Treatment Clinical Trials Network study
2010, Journal of Substance Abuse Treatment
Citation Excerpt :
Another study on marijuana dependence among clinical patients also found greater odds of having it among women as compared with men (Wu, Pan et al., 2009). Taken together, this and other studies suggest that treatment-seeking cocaine-using women may be disproportionately more severe in their substance use patterns and related problems than treatment-seeking men (Denier et al., 1991; Hernandez-Avila et al., 2004; Weiss et al., 1997; Wu, Blazer et al., 2009). Lastly, amphetamine dependence in this study was associated with decreased odds of cocaine dependence, suggesting that dependence on both cocaine and amphetamines is infrequent.
This study applies a latent variable approach to examine gender and racial/ethnic differences in cocaine dependence, to determine the presence of differential item functioning (DIF) or item-response bias to diagnostic questions of cocaine dependence, and to explore the effects of DIF on the predictor analysis of cocaine dependence. The analysis sample included 682 cocaine users enrolled in two national multisite studies of the National Drug Abuse Treatment Clinical Trials Network (CTN). Participants were recruited from 14 community-based substance abuse treatment programs associated with the CTN, including 6 methadone and 8 outpatient nonmethadone programs. Factor and multiple indicators–multiple causes (MIMIC) procedures evaluated the latent continuum of cocaine dependence and its correlates. MIMIC analysis showed that men exhibited lower odds of cocaine dependence than women (regression coefficient, β = −0.34), controlling for the effects of DIF, years of cocaine use, addiction treatment history, comorbid drug dependence diagnoses, and treatment setting. There were no racial/ethnic differences in cocaine dependence; however, DIF by race/ethnicity was noted. Within the context of multiple community-based addiction treatment settings, women were more likely than men to exhibit cocaine dependence. Addiction treatment research needs to further evaluate gender-related differences in drug dependence in treatment entry and to investigate how these differences may affect study participation, retention, and treatment response to better serve this population.
Substance abuse treatment entry, retention, and outcome in women: A review of the literature
2007, Drug and Alcohol Dependence
Citation Excerpt :
Lower educational attainment can lead to less-frequent employment (Green et al., 2002; Hser et al., 2003; Loneck et al., 1997; Wechsberg, 1998; Wong et al., 2002) and other economic barriers experienced by women enrolled in entitlement programs (Hammett et al., 1998; Klein and Zahnd, 1997; Montoya and Atkinson, 2002; Rosen et al., 2004). Higher rates in females than males of certain co-occurring psychiatric disorders such as mood, eating, anxiety, and post-traumatic stress disorders may make it difficult to obtain appropriate treatment for both disorders (Brady et al., 1998; Brady and Randall, 1999; Denier et al., 1991; Fornari et al., 1994; Grella, 1996, 1997; Merikangas et al., 1998; Najavits et al., 1997; Nelson-Zlupko et al., 1995; Sonne et al., 2003). Such multiple disorders also may increase the likelihood that women will perceive their problem as specific to the psychiatric disorder and seek treatment in mental health rather than substance abuse settings (Schober and Annis, 1996; Weisner and Schmidt, 1992).
This paper reviews the literature examining characteristics associated with treatment outcome in women with substance use disorders. A search of the English language literature from 1975 to 2005 using Medline and PsycInfo databases found 280 relevant articles. Ninety percent of the studies investigating gender differences in substance abuse treatment outcomes were published since 1990, and of those, over 40% were published since the year 2000. Only 11.8% of these studies were randomized clinical trials. A convergence of evidence suggests that women with substance use disorders are less likely, over the lifetime, to enter treatment compared to their male counterparts. Once in treatment, however, gender is not a significant predictor of treatment retention, completion, or outcome. Gender-specific predictors of outcome do exist, however, and individual characteristics and treatment approaches can differentially affect outcomes by gender. While women-only treatment is not necessarily more effective than mixed-gender treatment, some greater effectiveness has been demonstrated by treatments that address problems more common to substance-abusing women or that are designed for specific subgroups of this population. There is a need to develop and test effective treatments for specific subgroups such as older women with substance use disorders, as well as those with co-occurring substance use and psychiatric disorders such as eating disorders. Future research on effectiveness and cost-effectiveness of gender-specific versus standard treatments, as well as identification of the characteristics of women and men who can benefit from mixed-gender versus single-gender treatments, would advance the field.
Gender differences in cue exposure reactivity and 9-month outcome
2004, Journal of Substance Abuse Treatment
Gender differences have been shown to be related to the course of cocaine dependence and treatment. While previous research has shown cue exposure procedures to be somewhat effective at reducing reactivity of substance dependent individuals to drug related stimuli, the few studies that have examined gender differences in craving and cue-reactivity have yielded equivocal results. We have recently demonstrated that an active cue-exposure procedure that featured cocaine-dependent individuals receiving immediate feedback about their level of physiological arousal following videotaped exposure to cocaine-related stimuli was capable of positively influencing in-treatment (helplessness, abstinence efficacy) as well as 9-month followup outcome (i.e., urinalysis) indices (Sterling, R., Gottheil, E., Murphy, J., & Weinstein, S. (2001). Cue exposure and abstinence efficacy. College on Problems of Drug Dependence, Phoenix, AZ, June 17, 2001). The purpose of the present study was to determine whether differential in-treatment or 9-month followup outcomes were obtained for male and female study participants. Subjects in this study were 81 individuals (47 male/34 female) who met DSM-IV criteria for cocaine dependence and who had consented to be randomly assigned to either the active cue-exposure or control conditions. Participants were compared along a myriad of pre-treatment, in-treatment, and 9-month followup measures. Other than males reporting more recent employment, there was no obvious systematic pattern of differences on pre-treatment indices. No gender differences in treatment retention were observed. With respect to 9-month followup, no gender differences on measures of addiction severity, psychological functioning, or urinalyses were noted. However males were more “cue-reactive” and more successful at establishing control over their reactivity to the cocaine stimuli. Additional research is needed to determine whether these differences in reactivity can be more clearly defined and utilized positively in a treatment setting.

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^☆: This research was conducted while the first author was a postdoctoral research fellow (NIAAA AA07474) at the Medical University of South Carolina.

^∗: The authors wish to thank John McGill, CEO, Fenwick Hall Hospital, for his cooperation and support of this research project.

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Psychosocial and psychopathology differences in hospitalized male and female cocaine abusers: A retrospective chart review☆

Abstract

Psychiatric Clinics of North America

Psychiatric Clinics of North America

Psychological functioning of cocaine free-basers derived from objective personality tests

Journal of Clinical Psychology

Are special treatment facilities for female alcoholics needed?

Alcoholism: Clinical and Experimental Research

Phoenix House: Psychopathological signs among male and female drug-free residents

Addictive Diseases

Personality sex differences of narcotics addicts and treatment implications

The International Journal of the Addictions

Women's drinking across the adult life course as compared to men's

British Journal of Addiction

Cocaine and other stimulants: Actions, abuse, and treatment

New England Journal of Medicine

A comparison of male and female cocaine abusers

Archives of General Psychiatry

A clinical profile of 136 cocaine abusers

Personality disorders classification and symptoms in cocaine and opioid addicts

Journal of Consulting and Clinical Psychology