Women and Addiction: The Importance of Gender Issues in Substance Abuse Research

The association between psychopathology and substance use: adolescent and young adult substance users in inpatient treatment in Cape Town, South Africa

INTRODUCTION

Evidence suggests that comorbid psychopathology can negatively affect treatment outcomes in substance users. In South Africa, limited information exists regarding the prevalence, nature and role of psychiatric comorbidity in substance users. This study examined psychiatric comorbidity and its association with specific substance use, and young adult substance users in treatment for substance use.

METHODS

Male and female inpatient substance users (n=95; ages 17-30 years) were sampled consecutively in order of admission from three clinics in Cape Town. An interview schedule was administered to elicit patients' sociodemographic and substance use history details. The computer-assisted Diagnostic Interview Schedule DSM IV (C-DIS IV) was administered to screen patients for current psychiatric disorders.

RESULTS

The sample was largely male, Coloured, Muslim and single. Cannabis (51.6%) and crystal methamphetamine (17.9%) were the most common first substances of use. Heroin (53.7%) and crystal methamphetamine (33.7%) were the most common substances for which treatment was sought (primary substances). The most common comorbid psychopathologies were anti-social personality disorder (ASPD 87.4%) and conduct disorder (CD 67.4%). Regression analyses showed a marginally significant association between specific phobia and first use of cannabis, but indicated no statistically significant associations between psychopathology and substance use.

CONCLUSION

The results demonstrated a high proportion of previously unidentified comorbid psychopathology in inpatient substance users. Further research is needed to investigate psychiatric comorbidity in inpatient substance users.

Prevalence of cocaine use in Brazil: data from the II Brazilian national alcohol and drugs survey (BNADS)

OBJECTIVE

To determine the current prevalence rates of cocaine use and dependence in a representative sample of the Brazilian population, and to investigate possible associations with sociodemographic factors.

METHOD

The Second Brazilian Alcohol and Drugs Survey (II BNADS) interviewed 4607 individuals aged 14 years and older from the Brazilian household population including an over sample of 1157 adolescents (14 to 18 years old).The survey gathered information on alcohol, tobacco and illegal substances use as well as on risk factors for abuse and dependence. The Severity of Dependence Scale was used to evaluate cocaine dependence rates among users.

RESULTS

Last year consumption of crack-cocaine was 2.2% in the overall population excluding the elderly group.Lifetime and last year prevalence rate of snorted cocaine was 3.9% and 1.7%, respectively. Smoked cocaine use in Brazil was estimated in 1.5% for lifetime and 0.8% for last year use. Cocaine addiction was identified in 41.4%between users in the prior year.

CONCLUSIONS

The prevalence rates of snorted and smoked cocaine in Brazil suggests that the country is amongst the nations with greatest annual consumption rates becoming one of the biggest consumer markets of cocaine worldwide. Prevention and treatment policies should take this into consideration and strengthen the focus on cocaine use in the country.

RECIPROCAL RESPONSIBILITY AND SOCIAL SUPPORT AMONG WOMEN IN SUBSTANCE USE RECOVERY

This study sought to identify individual- and house-level predictors of women's employment, education, and retention in self-run recovery homes. Data from a national study of 292 women in Oxford House, an international organization of recovery homes grounded on self-help/mutual aid and 12-step principles were analyzed. Results indicated that the house's Reciprocal Responsibility predicted number of days of paid work. Individual and house variables did not predict participation in education. The presence of recovery home members in personal social networks was statistically significant in predicting retention in the recovery home. Lastly, results indicated that number of days of paid work were not predictive of likelihood of substance use in the next 12 months. The findings of this study indicate that the ability to develop social networks and Reciprocal Responsibility in recovery homes can contribute to positive outcomes for women.

Trauma-informed treatment decreases posttraumatic stress disorder among women offenders

Traumatic experiences among women offenders can impact their psychological well-being and patterns of substance use and offending. However, rigorous research in this area for women offenders with a history of trauma is sparse. This study combined data from 2 previous studies of women offenders in order to provide greater statistical power in examining the psychological trends found in the individual studies. Specifically, women in gender-responsive treatment (GRT; n = 135) were compared to women in non-GRT (n = 142) in regard to their change in posttraumatic stress disorder (PTSD) and related symptomatology from baseline to follow-up. The pooled sample of women were predominantly White (58%) or Hispanic (22%), and many had never been married (47%); their mean age was 36 years (SD = 8.9), and, on average, they had 12 years (SD = 1.8) of education. Methamphetamine was their primary drug (71%). Moreover, 55% of the women reported histories of sexual abuse and 37% physical abuse. Finally, 31% had a diagnosis of PTSD. Using generalized estimation equations, we detected significant Group × Time interactions in PTSD (odds ratio [OR] = 0.17) and some related symptomatology (reexperiencing: OR = 0.42; and avoidance: OR = 0.24). Given the aggregate impact of trauma in the lives of women offenders, these women, their families, and their communities could benefit from research on how trauma influences their lives and on services that mitigate the negative impact of such histories.

A home for body and soul: substance using women in recovery

BACKGROUND

We report on an in-depth qualitative study of 28 active and former substance addicted women of low or marginal income on the core components of a harm reduction-based addiction recovery program. These women volunteered to be interviewed about their perceptions of their therapeutic needs in their transition from substance addiction to recovery.

METHOD

Data were gathered about women's experiences and essential needs in addiction recovery, what helped and what hindered their past efforts in recovery, and their views of what would constitute an effective woman-centred recovery program. The research was based upon the experience and knowledge of the women in interaction with their communities and with recovery programs. The study was informed by harm reduction practice principles that emphasize the importance of individual experience in knowledge construction, reduction of harm, low threshold access, and the development of a hierarchy of needs in regard to addiction recovery.

RESULTS

Three core needs were identified by study participants: normalization and structure, biopsychosocial-spiritual safety, and social connection. What hindered recovery efforts as identified by participants was an inner urban location, prescriptive recovery, invidious treatment, lack of safety, distress-derived distraction, problem-focused treatment, coercive elements of mutual support groups, and social marginalization. What helped included connection in counselling and therapy, multidisciplinary service provision, spirituality focus, opportunities for learning and work, and a safe and flexible structure. Core components of an effective recovery program identified by women themselves stand in contrast to the views of service providers and policymakers, particularly in regard to the need for a rural location for residential programs, low threshold access, multidisciplinary service provision of conventional and complementary modalities and therapies for integrated healing, long-term multi-phase recovery, and variety and choice of programming.

CONCLUSION

A key barrier to the addiction recovery of women is the present framework of addiction treatment, as well as current drug laws, policies and service delivery systems. The expectation of women is that harm reduction-based recovery services will facilitate safe, supportive transitioning from the point of the decision to access services, through independent living with community integration.

Comparação do uso de drogas entre universitários brasileiros, norte-americanos e jovens da população geral brasileira

OBJETIVO: Comparar o uso de drogas entre os universitários e a população geral brasileira, assim como com os universitários norte-americanos, identificando possíveis diferenças de uso pela interferência da cultura. MÉTODOS: Para comparar o uso de drogas na vida entre as populações de interesse, foram utilizados os dados públicos de levantamentos estatísticos brasileiros realizados com universitários e a população geral, assim como levantamento estatístico norte-americano, por meio da comparação de intervalos de confiança (IC 95%). RESULTADOS: O uso de drogas na vida é mais frequente entre os estudantes norte-americanos, que relatam usar mais tabaco, tranquilizantes, maconha, ecstasy, alucinógenos, cocaína, crack e heroína que os universitários brasileiros. Em contrapartida, os universitários brasileiros relatam usar quase duas vezes mais inalantes do que os universitários norte-americanos. Esse padrão se repete ao se analisarem as diferenças intragênero. A isso se soma que os universitários brasileiros parecem envolver-se com mais frequência no uso de bebidas alcoólicas, maconha, tranquilizantes, inalantes, alucinógenos e anfetamínicos que seus pares da população geral brasileira. CONCLUSÕES: Conhecer as particularidades do uso de drogas entre os universitários é de suma importância para a detecção precoce desse consumo. Investimentos nesse segmento e diferenças de sexo devem ser contempladas nas políticas preventivas, assim como na elaboração de estratégias para a redução e o controle desse consumo, como programas de triagem e intervenção breve, uma vez que possuem a melhor relação custo-benefício.

The role of gender in the association between child maltreatment and substance use behavior: a systematic review of longitudinal research from 1995 to 2011

This systematic review analyzes the role of gender in the association between childhood maltreatment and substance use outcomes, among longitudinal papers published between 1995 and 2011. Ten papers examined gender as a moderating variable. Results on gender differences were mixed. When studies that found no gender effects were compared with studies that did identify gender effects, differences in measurement, sample composition, and developmental timing of outcomes were identified. This review also examines how gender effects are assessed. Implications and limitations of these findings are discussed. Areas for future research are identified.

Psychosocial Functioning Among Inmates in Prison-Based Drug Treatment: Results from Project BRITE

OBJECTIVE

To assess the impact of a positive behavioral reinforcement intervention on psychosocial functioning of inmates over the course of treatment and on post-treatment self-reported measures of treatment participation, progress, and satisfaction.

METHOD

Male (n = 187) and female (n = 143) inmates participating in 12-week prison-based Intensive Outpatient (IOP) drug treatment were randomly assigned to receive standard treatment (ST) or standard treatment plus positive behavioral reinforcement (BR) for engaging in targeted activities and behaviors. Participants were assessed for psychosocial functioning at baseline and at the conclusion of treatment (post-treatment). Self-reported measures of treatment participation, treatment progress, and treatment satisfaction were also captured at post-treatment.

RESULTS

The intervention affected female and male subjects differently and not always in a way that favored BR subjects, as compared to the ST subjects, most notably on measures of depression and criminal thinking.

CONCLUSIONS

Possible explanations for the results include differences in the male and female custody environments combined with the procedures that study participants had to follow to earn and/or receive positive reinforcement at the two study sites, as well as baseline differences between the genders and a possible floor effect among females on measures of criminality. Limitations of the study included the inability to make study participants blind to the study conditions and the possible over-branding of the study, which may have influenced the results.

Barriers to receiving substance abuse treatment among rural pregnant women in Kentucky

Research presenting outcomes for women who enter substance abuse treatment during pregnancy consistently shows benefits. While treatment has nearly universal benefits, there are many barriers to seeking substance abuse treatment for pregnant women. The purpose of this study is to explore barriers for rural pregnant women seeking substance abuse treatment. There were three eligibility criteria for study participation: (1) aged 18 and older, (2) pregnant, and (3) undergoing short-term inpatient detoxification at the University of Kentucky Chandler Medical Center. Eighty-five rural women (N = 85) were included in the analysis. Substance use history and previous treatment were assessed with measures adapted from the Addiction Severity Index. Treatment barriers were measured with three qualitative questions and were coded into four overarching categories: availability, accessibility, affordability, and acceptability barriers. This sample had an extensive substance use history. Almost all participants had used alcohol (98%), marijuana (98%), illicit opiates (99%), and cigarettes (97%). On average, participants reported about two barriers to receiving treatment (Mean = 1.8; SD = 1.3), with over 80% of the sample reporting having experienced any barrier to treatment. The majority experienced acceptability (51%) and accessibility (49%) barriers. Twenty-six percent (26%) of the sample reported availability barriers. A smaller percentage of participants reported affordability barriers (13%). Rural pregnant women seeking substance abuse treatment face many obstacles to receiving needed treatment. More studies on barriers to substance abuse treatment among rural pregnant women are needed. Identifying these barriers can help in improving treatment access and services.

GENDER-RESPONSIVE DRUG COURT TREATMENT: A Randomized Controlled Trial

This pilot study compared outcomes for 94 women offenders in San Diego County, California, who participated in four drug court programs. Women were randomized to gender-responsive (GR) programs using Helping Women Recover and Beyond Trauma or standard mixed-gender treatment. Data were collected at program entry, during treatment, and approximately 22 months after treatment entry. Bivariate and multivariate analyses were conducted. Results showed that GR participants had better in-treatment performance, more positive perceptions related to their treatment experience, and trends indicating reductions in posttraumatic stress disorder (PTSD) symptomology. Both groups improved in their self-reported psychological well-being and reported reductions in drug use (p < .06) and arrest (a diagnosis of PTSD was the primary predictor of reductions in rearrest, p < .04). Findings show some beneficial effects of adding treatment components oriented toward women's needs. Significant questions remain, particularly around PTSD and whether it should be targeted to improve substance use outcomes for women.

Sex differences in the cumulative incidence of substance use by birth cohort

BACKGROUND

Men present higher overall rates of substance use and abuse than women; yet, evidence suggests that an increase of substance use by the younger cohorts of women in recent decades is narrowing this gap in western societies. Moreover, younger cohorts may also be reporting earlier initiation of substance use, representing an increased risk for developing substance-related problems. With this study we intend to identify changes in the patterns of substance use of men and women in Spain for public health policy, planning and intervention.

METHODS

Sex differences in the cumulative incidence of alcohol, tobacco, cannabis and cocaine were examined by birth cohort using a combined sample of individuals aged 15-64 years from eight editions of the Spanish National Survey on Drugs (1995-2009).

RESULTS

Initiation of substance use in Spain is progressively taking place at younger ages, particularly among women. The gender-gap of life-time occurrence of substance use is narrowing (cannabis and cocaine) almost closing (alcohol) and even reversing (tobacco) in the youngest cohort.

CONCLUSION

These results reflect the particular evolution and trends of Spanish society regarding substance use. Women's increased use of substances and the earlier age of initiation of substance use by both sexes present particular challenges for prevention and treatment of future substance-related problems. The trends registered for legal and illegal substances would require re-evaluation of existing prevention policies.

The Cedar Project: sexual vulnerabilities among Aboriginal young people involved in illegal drug use in two Canadian cities

OBJECTIVES

Very few studies in Canada address the sexual health of young Aboriginal people who use drugs; the focus in established literature has been on parenteral risks. This study sought to identify the risk factors associated with inconsistent condom use in a cohort of young Aboriginal people who live in British Columbia and use drugs.

METHODS

This analysis includes baseline questionnaire data from October 2003 to April 2005. Multivariable modeling stratified by gender identified independent demographic, traumatic, sex and drug use risk factors associated with inconsistent condom use.

RESULTS

Of the 292 women and 313 men at baseline, prevalence of inconsistent condom use during insertive sex was 59% and 46%, respectively. In multivariable logistic regression, after adjusting for age and location, inconsistent condom use among women was significantly associated with ever being enrolled in a drug/alcohol treatment program (AOR: 1.95, 95% CI: 1.06-3.60), and ever being sexually abused (AOR: 1.80, 95% CI: 1.01-3.20). Among men, inconsistent condom use was significantly associated with having more than 20 lifetime sex partners (AOR: 2.06, 95% CI: 1.24-3.44).

CONCLUSION

Our study demonstrates high rates of inconsistent condom use among young Aboriginal people who use drugs, highlighting their vulnerability to contracting sexually transmitted infections. Culturally tailored sexual health interventions must be made a priority and need to incorporate the reality of gendered differences in the context of multigenerational trauma, including non-consensual sex.

Examining barriers to and motivations for substance abuse treatment among pregnant women: does urban-rural residence matter?

Barriers to entering and motivations for substance abuse treatment were examined among rural and urban pregnant women. All pregnant women entering inpatient detoxification at the University of Kentucky Medical Center were approached about participating in a study on health and well-being. One hundred fourteen (N = 114) pregnant women voluntarily participated. Treatment barriers and motivators were measured with open-ended questions. The Treatment Attitude Profile quantitatively measured motivation. Both groups reported approximately two treatment barriers. Top treatment motivators were pregnancy (65.8%), needing help (23.7%), family (18.4%), and being tired of the lifestyle (16.7%). Overall, Treatment Attitude Profile scores were fairly high (Mean = 74.3, SD = 10.7), representing motivation for treatment. Multivariate analyses revealed a significant negative relationship between treatment motivation and gestational age (β = -0.233; p = 0.012), and a positive relationship between treatment motivation and reporting an acceptability barrier (e.g., denial, stigma) (β = 0.202; p = 0.024). Few between group differences existed in barriers and treatment motivation. Individuals residing in rural areas have unique beliefs, social ties, attitudes, and financial hardships. Research about the role of these factors in treatment access and motivation could be used to minimize treatment barriers.

The association between online gaming, social phobia, and depression: an internet survey

BACKGROUND

Online gaming technology has developed rapidly within the past decade, and its related problems have received increasing attention. However, there are few studies on the psychiatric symptoms associated with excessive use of online games. The aim of this study is to investigate the characteristics of online gamers, and the association between online gaming hours, social phobia, and depression using an internet survey.

METHODS

An online questionnaire was designed and posted on a popular online game websites, inviting the online gamers to participate the survey. The content of the questionnaire included demographic data, profiles of internet usage and online gaming, and self-rating scales of Depression and Somatic Symptoms Scale (DSSS), Social Phobia Inventory (SPIN), and Chen Internet Addiction Scale (CIAS).

RESULTS

A total of 722 online gamers with a mean age of 21.8 ± 4.9 years completed the online survey within one month. 601 (83.2%) participants were male, and 121 (16.8%) were female. The mean weekly online gaming time was 28.2 ± 19.7 hours, which positively associated with history of online gaming (r = 0.245, p < 0.001), total DSSS (r = 0.210, p < 0.001), SPIN (r = 0.150, p < 0.001), and CIAS (r = 0.290, p < 0.001) scores. The female players had a shorter history of online gaming (6.0 ± 3.1 vs. 7.2 ± 3.6 years, p = 0.001) and shorter weekly online gaming hours (23.2 ± 17.0 vs. 29.2 ± 20.2 hours, p = 0.002), but had higher DSSS (13.0 ± 9.3 vs. 10.9 ± 9.7, p = 0.032) and SPIN (22.8 ± 14.3 vs. 19.6 ± 13.5, p = 0.019) scores than the male players. The linear regression model showed that higher DSSS scores were associated with female gender, higher SPIN scores, higher CIAS scores, and longer weekly online gaming hours, with controlling for age and years of education.

CONCLUSION

The online gamers with longer weekly gaming hours tended to have a longer history of online gaming, and more severe depressive, social phobic, and internet addiction symptoms. Female online gamers had fewer weekly online gaming hours and a shorter previous online gaming history, but tended to have more severe somatic, pain, and social phobic symptoms. The predictors for depression were higher social phobic symptom, higher internet addiction symptoms, longer online gaming hours, and female gender.

Neurocognitive performance in drug-dependent males and females with posttraumatic stress disorder symptoms

Sex differences in neurobiological mechanisms of substance dependence are well documented but studies of sex differences in associated neurocognitive deficits have produced inconsistent results. Posttraumatic stress disorder (PTSD) is comorbid with substance dependence and frequently affects neurocognition. Thus, we investigated the effects of sex and PTSD symptoms on sustained attention and inhibition abilities among 126 female and 297 male substance-dependent individuals (SDIs) using the Immediate Memory Test (IMT). Females with significant PTSD (PTSD+) symptoms demonstrated significantly impaired IMT performance relative to other participants. These results represent progress in efforts to delineate sex-specific risk factors for neurocognitive deficits among SDIs.

Are the symptoms of cannabis use disorder best accounted for by dimensional, categorical, or factor mixture models? A comparison of male and female young adults

Despite the consensus that criteria for cannabis abuse and dependence and symptoms of withdrawal are best explained by a single latent liability, it remains unknown whether alternative models provide a better explanation of these criteria. A series of latent factor, latent class, and hybrid factor mixture models were fitted to data from 872 recent cannabis users from the Minnesota Twin Family Study who completed Diagnostic and Statistical Manual of Mental Disorders (3rd ed., revised, and 4th ed.) diagnostic criteria for cannabis abuse, dependence, and symptoms of withdrawal. Despite theoretical appeal, results did not support latent class or factor mixture modeling. Instead, symptoms of abuse, dependence, and withdrawal were better summarized by a single latent factor Cannabis Use Disorder (CUD) for male and female young adults. An almost 2-fold sex difference in item endorsement was best explained by a single mean difference on the CUD factor, indicating that young men have a greater latent liability toward expressing CUD.

Mindful awareness in body-oriented therapy as an adjunct to women's substance use disorder treatment: a pilot feasibility study

This study examined mindful awareness in body-oriented therapy (MABT) feasibility as a novel adjunct to women's substance use disorder (SUD) treatment. As an individual therapy, MABT combines manual and mind-body approaches to develop interoception and self-care tools for emotion regulation. A 2-group randomized controlled trial repeated-measures design was used, comparing MABT to treatment as usual (TAU) on relapse to substance use and related health outcomes. Sixty-one women were screened for eligibility, and 46 enrolled. Participants randomized to MABT received 8 weekly MABT sessions. Results showed moderate to large effects, including significantly fewer days on substance use, the primary outcome, for MABT compared with TAU at posttest. Secondary outcomes showed improved eating disorder symptoms, depression, anxiety, dissociation, perceived stress, physical symptom frequency, and bodily dissociation for MABT compared with TAU at the 9-month follow-up. In conclusion, it is feasible to implement MABT in women's SUD treatment, and results suggest that MABT is worthy of further efficacy testing.

Acute plant poisoning: analysis of clinical features and circumstances of exposure

INTRODUCTION

Human contact with potentially toxic plants, which may occur through abuse or by accident or attempted suicide, is frequent and sometimes results in clinically significant toxicity.

OBJECTIVE

The aim of the present study was to identify which plants may lead to severe poisoning, and to define the clinical relevance of plant toxicity for humans in Switzerland.

METHODS

We analyzed 42,193 cases of human plant exposure and 255 acute moderate, severe, and lethal poisonings, which were reported to the Swiss Toxicological Information Centre between January 1995 and December 2009.

RESULTS

Plant contact was rarely responsible for serious poisonings. Lethal intoxications were extremely rare and were caused by plants with cardiotoxic (Taxus baccata) or mitosis-inhibiting (Colchicum autumnale) properties.

CONCLUSIONS

Most often, plant contact was accidental and patients remained asymptomatic or developed mild symptoms, which fully resolved within a short time.

Outcomes following Prison and Jail-Based Treatment among Women Residing in Metro and Non-Metro Communities following Release

This study uses data from the Criminal Justice Kentucky Treatment Outcome Study (CJKTOS) to describe treatment outcomes following prison and jail-based treatment among women residing in metro and non-metro areas following release. The study takes an exploratory look at potential differences in sustained abstinence, community treatment utilization, and recidivism by geographic location (metro/non-metro) and treatment program (jail or prison). Baseline data was collected from women as they entered two prison and two jail-based treatment programs, and follow-up data was collected 12 months post-release in the community. Bivariate group differences were noted with a higher percentage of metro women who participated in prison-based treatment relapsing to cocaine use during the follow-up period compared to non-metro women. In multivariate models, females who participated in jail-based treatment and prison-based treatment fared similarly on study outcomes. There was, however a main effect of residence status in that women living in non-metro areas during the follow-up period were less likely to utilize community-based aftercare treatment and less likely to be re-incarcerated during the follow-up period than women living in metro areas. Findings are discussed with regard to future research and practice implications for women offenders transitioning to geographically different communities following release.

The effects of oral micronized progesterone on smoked cocaine self-administration in women

There are currently no FDA-approved pharmacotherapies for cocaine abuse. Converging preclinical and clinical evidence indicates that progesterone may have potential as a treatment for cocaine-abusing women, who represent a growing portion of cocaine users. We have previously shown that oral progesterone reduced the positive subjective effects of cocaine in female cocaine users during the follicular phase of the menstrual cycle, when endogenous progesterone levels were low. To extend these findings, the present study assessed the effects of oral progesterone (150 mg BID) administered during the follicular phase on smoked cocaine self-administration in women relative to the normal follicular and luteal phases. Healthy, non-treatment seeking female cocaine smokers (N=10) underwent three 4-day inpatient stays, during: 1) a normal follicular phase; 2) a normal luteal phase; and 3) a follicular phase when oral progesterone was administered. During each stay, participants completed 4 self-administration sessions in which they first smoked a "sample" dose of cocaine (0, 12, 25 or 50 mg) and then had 5 opportunities at 14-minute intervals to self-administer that dose at a cost of $5 per dose. Expected cocaine dose effects on self-administration, subjective effects, and cardiovascular effects were observed. However, there was no effect of oral progesterone administration or menstrual cycle phase on cocaine self-administration. Thus, oral progesterone was not effective in reducing cocaine use in women under the current conditions. However, based on previous literature, further research assessing the role of oral progesterone for the treatment of cocaine dependence in women is warranted.

A randomized controlled trial of fluoxetine in the treatment of cocaine dependence among methadone-maintained patients

BACKGROUND

Cocaine abuse and dependence continue to be widespread. Currently, there are no pharmacotherapies shown to be effective in the treatment of cocaine dependence.

METHODS

A 33-week outpatient clinical trial of fluoxetine (60 mg/day, po) for cocaine dependence that incorporated abstinence-contingent voucher incentives was conducted. Participants (N = 145) were both cocaine and opioid dependent and treated with methadone. A stratified randomization procedure assigned subjects to one of four conditions: fluoxetine plus voucher incentives (FV), placebo plus voucher incentives (PV), fluoxetine without vouchers (F), and placebo without vouchers (P). Dosing of fluoxetine/placebo was double blind. Primary outcomes were treatment retention and cocaine use based on thrice-weekly urine testing.

RESULTS

The PV group had the longest treatment retention (M = 165 days) and lowest probability of cocaine use. The adjusted predicted probabilities of cocaine use were 65% in the P group, 60% in the F group, 56% in the FV group, and 31% in the PV group.

CONCLUSIONS

Fluoxetine was not efficacious in reducing cocaine use in patients dually dependent on cocaine and opioids.

Gender issues in the pharmacotherapy of opioid-addicted women: buprenorphine

Gender, a biological determinant of mental health and illness, plays a critical role in determining patients' susceptibility, exposure to mental health risks, and related outcomes. Regarding sex differences in the epidemiology of opioid dependence, one third of the patients are women of childbearing age. Women have an earlier age of initiation of substance use and a more rapid progression to drug involvement and dependence than men. Generally few studies exist which focus on the special needs of women in opioid maintenance therapy. The aim of this paper is to provide an overview of treatment options for opioid-dependent women, with a special focus on buprenorphine, and to look at recent findings related to other factors that should be taken into consideration in optimizing the treatment of opioid-dependent women. Issues addressed include the role of gender in the choice of medication assisted treatment, sex differences in pharmacodynamics and pharmacokinetics of buprenorphine drug interactions, cardiac interactions, induction of buprenorphine in pregnant patients, the neonatal abstinence syndrome and breastfeeding. This paper aims to heighten the awareness for the need to take gender into consideration when making treatment decisions in an effort to optimize services and enhance the quality of life of women suffering from substance abuse.