Gender differences in treatment-seeking Brazilian drug-dependent individuals

Cocaine Use May Moderate the Associations of HIV and Female Sex with Neurocognitive Impairment in a Predominantly African American Population Disproportionately Impacted by HIV and Substance Use

HIV-associated neurocognitive disorders (HAND) remain a major challenge for people with HIV in the antiretroviral therapy era. Cocaine use may trigger/exacerbate HAND among African American (AA) adults, especially women. Between 2018 and 2019, 922 adults, predominantly AAs, with/without HIV and with/without cocaine use in Baltimore, Maryland, were enrolled in a study investigating the association of HIV and cocaine use with neurocognitive impairment (NCI). Neurocognitive performance was assessed with the NIH Toolbox Cognition Battery (NIHTB-CB). NCI was considered to be present if the fully adjusted standard score for at least two cognitive domains was 1.0 standard deviation below the mean. Although the overall analysis showed HIV and female sex were associated with NCI, the associations were dependent on cocaine use. Neither HIV [adj prevalence ratio (PR): 1.12, confidence interval (95% CI): 0.77-1.64] nor female sex (adj PR: 1.07, 95% CI: 0.71-1.61) was associated with NCI among cocaine nonusers, while both HIV (adj PR: 1.39, 95% CI: 1.06-1.81) and female sex (adj PR: 1.53, 95% CI: 1.18-1.98) were associated with NCI in cocaine users. HIV was associated with two NIHTB-CB measures overall. In addition, HIV was associated with a lower dimensional change card sort score (an executive function measure) in cocaine users and not in nonusers. Cognitive performance was poorer in female than in male cocaine users. The adverse effect of HIV on cognitive performance predominantly affected cocaine users. However, cocaine use may moderate the impact of HIV and female sex on cognitive performance, highlighting the importance of reducing cocaine use in NCI prevention among the AA population.

White matter deficits in cocaine use disorder: convergent evidence from in vivo diffusion tensor imaging and ex vivo proteomic analysis

White matter (WM) abnormalities in patients with cocaine use disorder (CUD) have been studied; however, the reported effects on the human brain are heterogenous and most results have been obtained from male participants. In addition, biological data supporting the imaging findings and revealing possible mechanisms underlying the neurotoxic effects of chronic cocaine use (CU) on WM are largely restricted to animal studies. To evaluate the neurotoxic effects of CU in the WM, we performed an in vivo diffusion tensor imaging assessment of male and female cocaine users (n = 75) and healthy controls (HC) (n = 58). Moreover, we performed an ex vivo large-scale proteomic analysis using liquid chromatography-tandem mass spectrometry in postmortem brains of patients with CUD (n = 8) and HC (n = 12). Compared with the HC, the CUD group showed significant reductions in global fractional anisotropy (FA) (p < 0.001), and an increase in global mean (MD) and radial diffusion (RD) (both p < 0.001). The results revealed that FA, RD, and MD alterations in the CUD group were widespread along the major WM tracts, after analysis using the tract-based special statistics approach. Global FA was negatively associated with years of CU (p = 0.0421) and female sex (p < 0.001), but not with years of alcohol or nicotine use. Concerning the fibers connecting the left to the right prefrontal cortex, Brodmann area 9 (BA9), the CUD group presented lower FA (p = 0.006) and higher RD (p < 0.001) values compared with the HC group. A negative association between the duration of CU in life and FA values in this tract was also observed (p = 0.019). Proteomics analyses in BA9 found 11 proteins differentially expressed between cocaine users and controls. Among these, were proteins related to myelination and neuroinflammation. In summary, we demonstrate convergent evidence from in vivo diffusion tensor imaging and ex vivo proteomics analysis of WM disruption in CUD.

Effects of prior cocaine self-administration on cognitive performance in female cynomolgus monkeys

Cocaine use has been associated with cognitive impairments that may contribute to poor treatment outcomes. However, the degree to which these deficits extend into periods of abstinence has not been completely elucidated. This study tested whether prior experience self-administering cocaine affected acquisition of two cognitive tasks in 16 adult female cynomolgus monkeys. Seven monkeys had previously self-administered cocaine but had not had access to cocaine for 2 months at the start of this study. After monkeys were trained to respond on a touchscreen, associative learning and behavioral flexibility were assessed using a stimulus discrimination (SD) and reversal (SDR) task from the CANTAB battery. Performance on this task was monitored over the subsequent 3 months. Additionally, working memory was assessed with a delayed match-to-sample (DMS) task. Cocaine-naïve monkeys required fewer total trials and made fewer errors and omissions before acquiring the SD and SDR tasks compared with monkeys who had previously self-administered cocaine; two monkeys in the latter group did not acquire the task. However, this cognitive impairment dissipated over several months of exposure to the task. The number of sessions for touch training and delays required to establish a performance-based curve on the DMS task did not differ between groups. Results suggest that cocaine exposure can impair the ability to learn a novel task requiring behavioral inhibition and flexibility, even after an extended period of abstinence. However, this deficit did not extend to maintenance of the task or to acquisition of a working memory task.

Fatores desencadeantes do uso de drogas de abuso em mulheres

O objetivo deste estudo foi identificar e discutir fatores desencadeantes do uso de drogas em mulheres. Estudo qualitativo de caráter descritivo com 12 mulheres provenientes de três municípios do Paraná, notificadas a um centro de assistência toxicológica nos anos 2008 a 2010. Os dados foram coletados da ficha de Ocorrência Toxicológica dos prontuários, e do roteiro para entrevista semiestruturado aplicado durante visita domiciliar e analisados por conteúdo temático. A maioria era da raça/cor parda, estava entre 17 e 33 anos e convivia em união estável. Os fatores desencadeantes do uso de drogas estavam relacionados às características individuais das mulheres e aspectos socioculturais. Destacaram-se a faixa etária precoce, baixa escolaridade, baixa inserção no mercado de trabalho, conflitos intrafamiliares e o uso e tráfico de drogas pelos companheiros e parentes. Verificaram-se vínculo afetivo fraco, com dinâmica familiar inadequada. Amigos, familiares e companheiros favoreceram o comportamento aditivo.

Prevalência do uso de drogas de abuso por gestantes

OBJETIVO: Determinar a prevalência do uso de drogas de abuso por gestantes. MÉTODO: Estudo transversal que incluiu 394 gestantes usuárias de serviço de atenção primária. A variável dependente foi o uso de drogas de abuso durante a gestação e as variáveis independentes foram: socioeconômicas e obstétricas. RESULTADOS: A prevalência do uso de drogas ilícitas entre gestantes foi de 18,28%. A regressão logística multivariada indicou como variáveis significativas: anos de estudo, participação em grupo de gestante e orientação de profissional de saúde quanto ao risco de usar drogas de abuso durante a gestação. CONCLUSÃO: Os resultados indicam a predominância de gestantes jovens, pardas, com baixa escolaridade e renda de até três salários mínimos e que faz uso de drogas de abuso, sendo que a mais utilizada o cigarro, seguido do álcool. As drogas ilícitas utilizadas foram a cocaína e seu derivado o crack e a maconha.

Impact of Sex and Gonadal Hormones on Cocaine and Food Reinforcement Paradigms

Men and women express sexually dimorphic patterns of cocaine abuse, such that women progress faster from initially trying cocaine to becoming dependent upon the drug and display a greater incidence of relapse. Sex differences in response to cocaine are also seen in the laboratory in both humans and animal models. In this review, animal models of cocaine abuse that have reported sex differences in appetitive reinforcement are discussed. In both human and animal studies, sex differences in the subjective and behavioral effects of cocaine are often related to the female reproductive cycle and ovarian hormones. As a comparison, food reinforcement studies have shown the opposite profile of sex differences and the impact of sex steroids on food intake and response rate. In contrast, limited attention has been given to "choice" models in rodents of either sex, however, our recent studies have indicated a role of sex and estrogen in cocaine choice over food with intact females, and OVX females treated with estrogen, choosing cocaine significantly more than males. Interestingly, estrous cycle phase does not seem to impact cocaine choice as it does response rate in single-reinforcer studies, suggesting that genomic rather than neurosteroid effects of estrogen modulate sex differences in this model. Future studies should more fully explore the impact of sex hormones on concurrent reinforcement and discrete choice models of addiction.

Discriminating drug-dependent women from alcoholic women and drug-dependent men

The authors compared 99 drug-dependent women to 162 alcoholic women and 66 drug-dependent men entering an outpatient treatment program. They were assessed by a semistructured interview for demography, progression of dependence prior to entering treatment, prior suicidal behavior, and baseline functioning in different areas (alcohol/drug use, occupation, family relationships, and leisure activities). Discriminant analysis techniques were good at predicting group membership for all groups, with an overall correct classification of 69%; though at a lesser degree for the group of drug-dependent women (55%). Among those drug-dependent women misclassified, two-thirds were reclassified into the drug-dependent men group and the remaining third into the alcoholic women group. Taken together, these findings suggest that the drug-dependent women are a distinct group of substance users, who show more heterogeneous characteristics, as well as sharing more features with the drug-dependent men. This should be taken into account when devising treatment strategies for this specific population.