Addiction and Gender Differences

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Over the past few years NIDA has made a major research commitment to identifying and understanding differences in the ways that women and men-or girls and boys-are first exposed to drugs, in their risks of abuse and addiction, and in the effectiveness of drug treatment. Understanding these differences, and incorporating that understanding into drug abuse prevention and treatment, can reduce the dangers and improve outcomes. NIDA-supported research has shown that gender differences play a role from the very earliest opportunity to use drugs, that women and men tend to abuse different drugs, that the effects of drugs are different for women and men, and that some approaches to treatment are more successful for women than for men.

Are Women Less Likely Than Men to Abuse Drugs?

Men are more likely than women to have opportunities to use drugs, but men and women given an opportunity to use drugs for the first time are equally likely to do so and to progress from initial use to addiction. However, women and men appear to differ in their vulnerability to some drugs. Both are equally likely to become addicted to or dependent on cocaine, heroin, hallucinogens, tobacco, and inhalants. Women are more likely than men to become addicted to or dependent on sedatives and drugs designed to treat anxiety or sleeplessness, and less likely than men to abuse alcohol and marijuana. There are also differences between men and women who seek treatment for drug abuse. Women in treatment programs are less likely than men to have graduated from high school and to be employed and are more likely than men to have other health problems, to have sought previous drug treatment, to have attempted suicide, and to have suffered sexual abuse or other physical abuse.

Are There Gender Differences In the Biological Effects of Drugs?

Animal research and human studies have revealed that males and females may differ in their biological responses to drugs. In studies of animals given the opportunity to self-administer intravenous doses of cocaine or heroin, females began self-administration sooner than males and administered larger amounts of the drugs. Women may be more sensitive than men to the cardiovascular effects of cocaine. In human studies, women and men given equal doses of cocaine experienced the same cardiovascular response despite the fact that blood concentrations of cocaine did not rise as high in women as in men. In studies involving long-term cocaine users, women and men showed similar impairment in tests of concentration, memory, and academic achievement following sustained abstinence, even though women in the study had substantially greater exposure to cocaine. Women cocaine users also were less likely than men to exhibit abnormalities of blood flow in the brain's frontal lobes. These findings suggest a sex-related mechanism that may protect women from some of the damage cocaine inflicts on the brain.

Does Gender Play a Role in Nicotine Addiction?

Women and men are equally likely to become addicted to nicotine, yet women typically smoke cigarettes with lower nicotine content than those smoked by men, smoke fewer cigarettes per day, and inhale less deeply than men. Overall, however, women are less successful than men in quitting smoking and have higher relapse rates after they do quit. Treatment involving nicotine replacement therapy-nicotine gum or patch-works better for men than for women.

What Are Women's Risks for HIV/AIDS?

Research suggests that there are sex-related differences in some fundamental aspects of the HIV/AIDS disease process. For example, an HIV-infected woman with half the amount of virus circulating in the bloodstream as an infected man will progress to a diagnosis of AIDS in about the same time. And, according to the Centers for Disease Control and Prevention, among cases that progress to a diagnosis of AIDS, drug abuse accounts for a greater percentage of cases among women than among men. Nearly half (47 percent) of all women diagnosed with AIDS are injecting drug users (IDUs), whereas among men, IDUs account for 32 percent of AIDS cases. An additional 19 percent of women, compared with 2 percent of men, with AIDS report having sex with users who inject drugs. In all, drug abuse is nearly twice as likely to be directly or indirectly associated with AIDS in women (66 percent) as in men (34 percent).

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