Treatment underutilization is particularly notable among adult women with alcohol use disorder (Alvanzo et al., 2014; Cohen, Feinn, Arias, & Kranzler, 2007; Khan, Okuda, et al., 2013). Additionally, men are more likely to receive specialized SUD treatment (e.g., self-help groups, specialized outpatient treatment, etc.), whereas women with SUDs are more likely to seek treatment at mental health treatment settings (Edlund, Booth, & Han, 2012). Results of our 2007 review of gender and SUD treatment entry, retention and outcome (Greenfield, Brooks, et al., 2007) suggested that women, in general, were less likely to seek treatment for SUDs relative to men but the majority of studies also found that women and men did not differ with respect to treatment retention or outcomes. Nonetheless, a number of key prognostic variables–such as co-occurring psychiatric disorders–disproportionately affect women, and such subgroups may benefit from targeted interventions (e.g., treatment of PTSD and SUDs concurrently; Hien et al., 2009a). Below, we provide a brief update on the research on gender differences in the treatment of SUDs published over the past 10 years.

Nonetheless, a wide array of differences have been identified that suggest that sexual dimorphisms–including, but not exclusively related to gonadal hormones–can impact the acute effects of substances, their long-term consequences, and the treatment of SUDs. Below, we highlight several consistent findings in the literature on sex and gender differences in SUDs. The NSDUH report provides nationally representative data on the self-reported use of tobacco, alcohol, and illicit drugs; substance use disorders; mental health conditions; suicidal thoughts and behaviors; and substance use and mental health treatment among the civilian, noninstitutionalized population aged 12 or older in the United States. The NSDUH estimates allow researchers, clinicians, policymakers, and the general public to better understand and improve the nation’s behavioral health. Addressing the nation’s mental health crisis and drug overdose epidemic is a top priority of the Biden-Harris Administration and a core pillar of the Administration’s Unity Agenda. The Substance Abuse and Mental Health Services Administration (SAMHSA) is the agency within the U.S.

Sex differences in the metabolism of other substances have not been consistently demonstrated. However, there is some evidence that females metabolize nicotine more rapidly than males (Benowitz, Lessov-Schlaggar, Swan, & Jacob, 2006; Berlin, Gasior, & Moolchan, 2007) and exhibit higher peak plasma levels of cocaine (Lukas et al., 1996), which signs of being roofied may be modulated by ovarian hormones. Substantial heterogeneity within sexes in metabolic processes, as well as the contribution of multiple metabolic pathways to the clearance of substances may obscure sex differences in drug metabolism (DeVane, 2009). Nonetheless, findings to date suggest that the metabolism of substances (and, accordingly their effects) cannot be assumed to be consistent for males and females. However, the available literature suggests that men and women do not substantively differ with respect to SUD outcomes across substances, with the exception of smoking cessation.

Drug Regulation & Scheduling

1. For example, contingency management (Tappin et al., 2015) and cognitive-behavioral therapy have demonstrated efficacy for smoking cessation in pregnant women (Lee et al., 2015).
2. If you or someone you love is struggling with substance misuse, American Addiction Centers can help.
3. The report highlights that despite some reduction in the alcohol-related death rates since 2010, the overall number of deaths due to alcohol consumption remains unacceptably high and amounts to 2.6 million in 2019, with the highest numbers in the European Region and the African region.
4. Striatal dopamine release–which is reflective of activation of the brain reward pathways–is higher in men relative to women in response to stimulants (Munro et al., 2006), alcohol (Urban et al., 2010), and nicotine (Cosgrove et al., 2014).

Although findings are somewhat mixed regarding gender differences in the legal consequences of substance use, a number of studies indicate greater legal problems in men (Sonne, Back, Diaz Zuniga, Randall, & Brady, 2003; Westermeyer & Boedicker, 2000). Drug abuse and misuse of prescription drugs is generally more prevalent in males than in females. NIDA data breaks down its research report according to illegal drugs, prescription drugs, and other substances. The report highlights the urgent need to accelerate actions globally towards achieving Sustainable Development Goal (SDG)  target 3.5 by 2030 by reducing alcohol and drug consumption and improving access to quality treatment for substance use disorders.

Sex and Gender Differences in Substance Use Disorders

Significant improvements have been made in the inclusion of females in studies of SUDs; however, significant gaps in research remain (Wetherington, 2007). Filling these research gaps requires not only inclusion of both sexes, but also analytic plans that test specific gender-related questions with sufficient statistical power. For example, a review of structural neuroimaging studies in SUDs found that although the representation of women increased in research over time, almost three-quarters of the studies reviewed did not evaluate sex differences at all (Lind et al., 2017). Accordingly, studies should include evaluation of both main and interaction effects of gender and sex as standard reporting practice. The U.S. Preventive Services Task Force recommends that tobacco use should be assessed in all pregnant women, with behavioral interventions identified as the first line of care (Siu, 2015). For example, contingency management (Tappin et al., 2015) and cognitive-behavioral therapy have demonstrated efficacy for smoking cessation in pregnant women (Lee et al., 2015).

According to federal data from 2014, 40 percent of deaths by suicide involved alcohol intoxication, 30 percent involved opioids, and 21 percent involved marijuana. Treatment-seeking and entry is limited among pregnant women with SUDs, with only 8.7% receiving specialized treatment (Terplan, McNamara, & Chisolm, 2012). Despite the efficacy of medications such as buprenorphine and methadone in preventing relapse, treatment attrition, and neonatal abstinence syndrome (H. E. Jones et al., 2010; Klaman et al., 2017), a minority games for substance abuse groups of pregnant women with opioid dependence gain access to such treatment (Martin, Longinaker, & Terplan, 2015; K. Smith & Lipari, 2013). Women with children also face unique barriers to SUD treatment due to limited availability of childcare in SUD treatment settings (i.e., 6.8% provide childcare services) (SAMHSA, 2017). Most of the 145 countries that reported data did not have a specific budget line or data on governmental expenditures for treatment of substance use disorders. Although mutual help and peer support groups are useful resources for people with substance use disorders, almost half of responding countries reported that they do not offer such support groups for substance use disorders.

What Are Some Signs of Drug or Alcohol Abuse Among Men?

Among adults, prescription drugs are among the only substance class for which past-month prevalence of misuse is similar in adults of both genders (2.2% of women vs. 2.7% of men). Men are more likely than women to use almost all types of illicit drugs,13 and illicit drug use is more likely to result in emergency department visits or overdose deaths for men than for women. “Illicit” refers to use of illegal drugs, including marijuana (according to federal law) and misuse of prescription drugs. For most age groups, men have higher rates of use or dependence on illicit drugs and alcohol than do women.14 However, women are just as likely as men to develop a substance use disorder.15 In addition, women may be more susceptible to craving16–19 and relapse,20,21 which are key phases of the addiction cycle.

NIDA had no further role in study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the paper for publication. Aftercare is individualized to help patients remain sober, and it can include outpatient treatment, private therapy, 12-step meetings, and/or sober living options. Sober living and long-term residential treatment provide structure and monitoring, and teach men how to be accountable for their actions as they slowly learn how to readjust to society while sober.

The front page of DrugAbuseStatistics.org features the most noteworthy drug abuse data, including overdose deaths, demographics, mental health, drug abuse treatment programs, and the cost of the War on Drugs. Structural neuroimaging studies suggest that there may be sex-specific neural consequences of substance use. For example, both females and males with cocaine use disorder exhibited lower gray matter volume relative to controls; but the regions exhibiting these volumetric differences varied (Rando, Tuit, Hannestad, Guarnaccia, & Sinha, 2013). Moreover, females may stages of alcoholic recovery be more susceptible to the negative effects of chronic cocaine (Ide et al., 2014) and alcohol use (Mann et al., 2005) on brain volume; however, not all studies have reported these differences (Demirakca et al., 2011) and causality cannot be established in these cross-sectional designs. Nearly half (45.6 percent) of adults with an SUD also have a mental illness, such as depression. Additionally, rates of suicide are almost four times greater for men than for women, although substances are commonly found in both males and females who complete suicide.