Gender disparities in opioid treatment progress in methadone versus counseling

BACKGROUND

In the United States, the high dropout rate (75%) in opioid use disorder (OUD) treatment among women and racial/ethnic minorities calls for understanding factors that contribute to making progress in treatment. Whereas counseling and medication for OUD (MOUD, e.g. methadone, buprenorphine, naltrexone) is considered the gold standard of care in substance use disorder (SUD) treatment, many individuals with OUD receive either counseling or methadone-only services. This study evaluates gender disparities in treatment plan progress in methadone- compared to counseling-based programs in one of the largest SUD treatment systems in the United States.

METHODS

Multi-year and multi-level (treatment program and client-level) data were analyzed using the Integrated Substance Abuse Treatment to Eliminate Disparities (iSATed) dataset collected in Los Angeles County, California. The sample consisted of 4 waves: 2011 (66 SUD programs, 1035 clients), 2013 (77 SUD programs, 3686 clients), 2015 (75 SUD programs, 4626 clients), and 2017 (69 SUD programs, 4106 clients). We conducted two multi-level negative binomial regressions, one per each outcome (1) making progress towards completing treatment plan, and (2) completing treatment plan. We included outpatient clients discharged on each of the years of the study (over 95% of all clients) and accounted for demographics, wave, homelessness and prior treatment episodes, as well as clients clustered within programs.

RESULTS

We detected gender differences in two treatment outcomes (progress and completion) considering two outpatient program service types (MOUD-methadone vs. counseling). Clients who received methadone vs. counseling had lower odds of completing their treatment plan (OR = 0.366; 95% CI = 0.163, 0.821). Female clients receiving methadone had lower odds of both making progress (OR = 0.668; 95% CI = 0.481, 0.929) and completing their treatment plan (OR = 0.666; 95% CI = 0.485, 0.916) compared to male clients and receiving counseling. Latina clients had lower odds of completing their treatment plan (OR = 0.617; 95% CI = 0.408, 0.934) compared with non-Latina clients.

CONCLUSIONS

Clients receiving methadone, the most common and highly effective MOUD in reducing opioid use, were less likely to make progress towards or complete their treatment plan than those receiving counseling. Women, and in particular those identified as Latinas, were least likely to benefit from methadone-based programs. These findings have implications for health policy and program design that consider the need for comprehensive and culturally responsive services in methadone-based programs to improve outpatient treatment outcomes among women.

Gender Differences in Triggers of Stimulant Use Based on the National Survey of Prisoners in Japan

There are a few studies on gender differences in terms of reasons and motives for methamphetamine use. Purpose/Objectives: To examine gender differences in triggers of methamphetamine use Methods: We provided a questionnaire survey to 699 inmates who were incarcerated because of violation of the Stimulants Control Act. Results: The results of DAST-20 (the severity of drug dependence) moderately correlated with the applicable numbers of the 37 situational triggers and 34 emotional triggers for stimulant use, respectively. Regarding gender differences, items including "when having sex" [46.3% (men) vs. 25.3% (women)], "when I have some money" (39.4% vs. 25.3%), and "after getting paid from work" (22.1% vs. 11.4%) were applicable in a significantly higher proportion in males (p < 0.001 and p = 0.008, respectively), whereas items including "worried about the body shape" (3.5% vs. 31.2%) and "after quarreling with someone" (11.7% vs. 29.1%) were applicable in a significantly higher proportion in females (p < 0.001 for both comparisons). Further, most trigger (emotions) items that exhibited gender differences were significantly higher in females. Many females answered that they had used drugs to relieve discomfort symptoms associated with menstrual periods. Conclusions/Importance: Thus, the awareness of important factors including learning how to deal with negative emotions (e.g. depression), repairing self-image, and recognizing physical and emotional changes associated with the menstrual cycle is helpful in providing proper care and treatment of drug addiction in females.

Impact of methadone treatment initiated in jail on subsequent arrest

BACKGROUND

There are limited data from randomized trials about the impact of starting methadone treatment in jail on subsequent arrest after release for adults with opioid use disorder (OUD).

METHODS

Official arrest records were obtained for 212 participants with OUD who were enrolled in a three-group randomized controlled trial of initiating methadone treatment in jail either with or without patient navigation vs. enhanced treatment-as-usual in Baltimore, Maryland. Participants treated for opioid withdrawal in jail were assigned to: 1) interim methadone (IM) with patient navigation (PN; IM + PN); 2) IM without PN (IM); or 3) enhanced treatment-as-usual (ETAU). Participants in both IM groups were able to continue treatment at a community-based methadone treatment program with counseling upon release, while ETAU participants received overdose information and a city-wide treatment assessment/referral number. Likelihood of arrest, time to first subsequent arrest, and severity of arrest charges in the 12 months following release were examined for: 1) combined IM + PN and IM groups compared to ETAU; and 2) IM + PN compared to IM.

RESULTS

Within 12 months of release from the index incarceration, 50.5% of the sample had been arrested. The majority of arrest charges (71%) were for low-level, nonviolent crimes. On an intention-to-treat basis, there were no significant differences between the combined IM + PN and IM groups vs. ETAU or IM + PN vs. IM in the likelihood of arrest, time to first subsequent arrest, or severity of arrest charges.

CONCLUSION

Initiating IM with or without PN during pretrial detention did not have a significant effect on subsequent arrest during a 12-month post-release follow-up compared to not starting methadone maintenance during detention, despite the high rate of methadone treatment entry in the community following release. This finding may be attributable to the considerable attrition from treatment in the community or other systematic factors. Additional interventions may be needed to reduce the likelihood of subsequent arrest.

The Nexus Between Drug and Alcohol Treatment Program Integrity and Drug Court Effectiveness

The literature supporting the efficacy of drug courts continues to grow. Much attention and research has focused on recidivism rates for participants, and generally address the question of, do drug courts work? The current state of drug court practice is a process that relies heavily on the drug and alcohol treatment services that are offered to clients. Many treatment programs, and the treatment philosophy that underlies their approach to solving substance abuse, offer vague and eclectic approaches that oftentimes do not meet the diverse needs of their clients related to gender, culture, and specific cognitive impacts on the brain caused by drug use. We argue that a move toward the use of evidence-based practice, coupled with quality assurance measures for treatment providers, will promote best practice and will ensure program integrity that leads to effective and long-lasting drug court programs.

Gender differences in recovery consequences among heroin dependent patients after compulsory treatment programs

Studies on recovery patterns and how baseline factors influence recovery consequences among heroin dependent patients have shown mixed results. This study is aimed at describing the gender differences in long-term recovery patterns and exploring the predictors of negative recovery consequences by gender among heroin dependent patients in Shanghai, China. At baseline, this study recruited 503 heroin dependent patients discharged from Shanghai compulsory rehabilitation facilities in 2007 and 2008. In this cohort study, the baseline data was then linked with participants’ 5-year follow-up data from official records. Generalized Estimating Equations (GEE) were used to compare males with females in terms of the presence of negative consequences (incarceration, or readmission to compulsory treatment, or both), in the subsequent 5-years after their discharge from compulsory treatment. Ordinary least squares (OLS) regression was used to explore factors associated to the time length of negative consequences in 5 years after the discharge for males and females separately. Our findings indicate that female heroin dependent patients tend to have less negative recovery outcomes than male patients. Male patients with a life-time history of poly drug use and female patients with borderline personality disorder are especially at risk of incarceration and readmission into compulsory treatment programs.

Substance use in women: Current status and future directions

Alcohol and substance use, until recently, were believed to be a predominantly male phenomenon. Only in the last few decades, attention has shifted to female drug use and its repercussions in women. As the numbers of female drug users continue to rise, studies attempt to understand gender-specific etiological factors, phenomenology, course and outcome, and issues related to treatment with the aim to develop more effective treatment programs. Research has primarily focused on alcohol and tobacco in women, and most of the literature is from the Western countries with data from developing countries like India being sparse. This review highlights the issues pertinent to alcohol and substance use in women with a special focus to the situation in India.

Alcohol and drug use among adolescents: and the co-occurrence of mental health problems. Ung@hordaland, a population-based study

OBJECTIVES

The use of alcohol and drugs is prevalent among adolescents, but too little is known about the association between debut of alcohol and drug use, problematic use and concurrent mental health. The aim of the study was to investigate the cross-sectional association between debut of any alcohol or drug use and alcohol-related and drug-related problems and mental health. We also wanted to examine potential interactions between gender and age, and alcohol-related and drug-related variables.

DESIGN

Cross-sectional study.

SETTING

Population-based sample of Norwegian adolescents.

PARTICIPANTS

Data stem from the large population-based ung@hordaland study (N=9203), where all adolescents aged 17-19 years living in Hordaland county (Norway) were invited to participate. The main independent variables were debut of alcohol and drug use, alcohol consumption and the presence of alcohol and drug problems as measured by CRAFFT.

OUTCOMES

The dependent variables were self-reported symptoms of anxiety, depression, inattention and hyperactivity. Statistical analyses included logistic regression models.

RESULTS

Debut of alcohol and drug use were associated with symptoms of depression, inattention and hyperactivity (crude ORs 1.69-2.38, p<0.001), while only debut of drug use was associated with increased symptoms of anxiety (OR=1.33, CI 95% 1.05 to 1.68, p=0.017). Alcohol-related and drug-related problems as measured by CRAFFT were associated with all mental health problems (crude ORs 1.68-3.24, p<0.001). There was little evidence of any substantial age or gender confounding on the estimated associations between alcohol-related and drug-related measures and mental health problems.

CONCLUSIONS

Early debut of alcohol and drug use and drug problems is consistently associated with more symptoms of mental health problems, indicating that these factors are an important general indicator of mental health in adolescence.

A new survey of methamphetamine users in treatment: who they are, why they like "meth," and why they need additional services

The quality and quantity of illicit methamphetamine has recently increased due to introduction of a new precursor, 1-phenyl-2-propanone (P2P). This paper updates the problems associated with methamphetamine use. Methamphetamine-using clients (N = 222) entering a Texas program participated in computer-assisted interviews in 2010 and 2011 about routes of administration, other drugs used, severity of dependence, mental and physical health, perceived risks and benefits of use, family history, and abuse and neglect experienced as children and adults. Special needs of this population include therapies for trauma, gender-focused counseling, safe housing, and prevention messages to discourage use of the drug.

Acceptance and commitment therapy versus cognitive behavioral therapy in the treatment of substance use disorder with incarcerated women

OBJECTIVES

This randomized controlled study compared acceptance and commitment therapy (ACT), cognitive-behavioral therapy (CBT), and a control group.

METHOD

The participants were 50 incarcerated women diagnosed with current substance use disorder. Two psychologists carried out pre- and posttreatment assessment and a 6-month follow-up assessment using the following instruments: Anxiety Sensitivity Index, Addiction Severity Index-6, Mini International Neuropsychiatric Interview, and Acceptance and Action Questionnaire.

RESULTS

The study shows that the women who received treatment benefited differentially from the interventions. At posttreatment, CBT was more effective than ACT in reducing anxiety sensitivity; however, at follow-up, ACT was more effective than CBT in reducing drug use (43.8 vs. 26.7%, respectively) and improving mental health (26.4% vs. 19.4%, respectively).

CONCLUSION

ACT may be an alternative to CBT for treatment of drug abuse and associated mental disorders. In fact, at long-term, ACT may be more appropriate than CBT for incarcerated women who present serious problems.

The Severity, Frequency, and Variety of Crime in Heroin-Dependent Prisoners Enrolled in a Buprenorphine Clinical Trial

Data were obtained on four dimensions of criminal activity (frequency, variety, severity, and income) from male and female prisoners (N = 200) with preincarceration heroin dependence who participated in a randomized clinical trial of buprenorphine treatment. The article examines the above-mentioned dimensions of crime and their relationships with demographic characteristics, substance use, legitimate employment, drug treatment episodes, and psychological problems. Results largely show several important similarities to results on previous prison inmate cohorts with histories of heroin addiction, although the present sample may have more of a tendency toward violent crime than earlier cohorts of heroin-dependent offenders. This study's findings may have implications for the design of appropriate treatment interventions for prisoners with preincarceration heroin dependence that address not only substance use but also criminal activity.

Disparities in completion of substance abuse treatment between and within racial and ethnic groups

OBJECTIVE

To evaluate disparities in substance abuse treatment completion between and within racial and ethnic groups in publicly funded treatment in Los Angeles County, California.

DATA SOURCE

The Los Angeles County Participant Reporting System with multicross-sectional annual data (2006-2009) for adult participants (n = 16,637) who received treatment from publicly funded programs (n = 276) for the first time.

STUDY DESIGN

Retrospective analyses of county discharge and admission data. Hierarchical linear regressions models were used to test the hypotheses.

DATA COLLECTION

Client data were collected during personal interviews at admission and discharge for most participants.

PRINCIPAL FINDINGS

African Americans and Latinos reported lower odds of completing treatment compared with Whites. Within-group analysis revealed significant heterogeneity within racial and ethnic groups, highlighting primary drug problem, days of drug use before admission, and homelessness as significant factors affecting treatment completion. Service factors, such as referral by the criminal justice system, enabled completion among Latinos and Whites only.

CONCLUSIONS

These findings have implications for reducing health disparities among members of racial and ethnic minorities by identifying individual and service factors associated with treatment adherence, particularly for first-time clients.

A Randomized Clinical Trial of Methadone Maintenance for Prisoners: Prediction of Treatment Entry and Completion in Prison

The present report is an intent-to-treat analysis involving secondary data drawn from the first randomized clinical trial of prison-initiated methadone in the United States. This study examined predictors of treatment entry and completion in prison. A sample of 211 adult male prerelease inmates with preincarceration heroin dependence were randomly assigned to one of three treatment conditions: counseling only (counseling in prison; n= 70); counseling plus transfer (counseling in prison with transfer to methadone maintenance treatment upon release; n= 70); and counseling plus methadone (methadone maintenance in prison, continued in a community-based methadone maintenance program upon release; n= 71). Entered prison treatment (p <. 01), and completed prison treatment (p< .001) were significantly predicted by the set of 10 explanatory variables and favored the treatment conditions receiving methadone. The present results indicate that individuals who are older in age and have longer prison sentences may have better outcomes than younger individuals with shorter sentences, meaning they are more likely to enter and complete prison-based treatment. Furthermore, implications for the treatment of prisoners with prior heroin dependence and for conducting clinical trials may indicate the importance of examining individual characteristics and the possibility of the examination of patient preference.

Gender differences in sense of coherence, perceived social support, and negative emotions among drug-abstinent israeli inmates

This study examines gender differences in the sense of coherence, perceived social support, and negative emotions among drug-abstinent Israeli inmates. One hundred nineteen inmates have participated in this study (65 men and 54 women). The findings indicate that among female inmates, abstinence of more than a year is related to a decrease in sense of coherence and to an increase in their perceived friend support. In contrast, among male inmates, abstinence of more than a year is related to an increase in sense of coherence and no change at all in their perceived friend support. In addition, hostility level is lower and sense of coherence is higher when the length of abstinence exceeds a year among male inmates. In contrast, among female inmates hostility level is higher when the sense of coherence is lower, without any connection to the length of abstinence. The implications of these findings to treatment intervention are discussed.

Gender-specific factors associated with community substance abuse treatment utilization among incarcerated substance users

This article describes the independent correlates of preincarceration community substance abuse treatment utilization for male and female offenders currently participating in prison-based treatment. As part of the National Institute on Drug Abuse-funded Criminal Justice Drug Abuse Treatment Studies cooperative agreement, this protocol was implemented by four collaborating research centers. Males with a history of treatment utilization were more likely to be older, to have used crack, and to have had a greater number of arrests, and they were less likely to be arrested for a violent charge. Females with previous treatment were more likely to have been hospitalized for a health condition and were significantly more likely to have lived with someone else before prison rather than in their own home. These findings suggest that factors associated with preincarceration treatment utilization differ by gender, which may have important implications for correctional-based treatment assessment, reentry planning, and transitional case management.

Troubled parents, motivated adolescents: predicting motivation to change substance use among runaways

Runaway adolescents engage in high rates of substance use and report significant family and individual problems. However, in general, adolescents report low motivation to change their substance use. Because a higher level of motivation for changing substance use is associated with greater substance abuse treatment success, identifying variables associated with motivation for change can be useful for enhancing treatment success. In this study, predictors of motivation for changing substance use were examined among 140 shelter-recruited adolescents and their parents/primary caretakers. Several findings were noteworthy. A perceived negative family environment increased parents' and adolescents' depressive symptoms, which increased adolescent's motivation to change. Also, greater severity of adolescent substance use predicted higher motivation to change. Consideration of the family environment and parent problems when addressing motivation for changing substance use among these adolescents might be important foci for motivational interventions and future research.

Factors mediating and moderating the relationship between gender and utilization of health care among Puerto Rican drug users in New York

This study examined factors that mediate and moderate the relationship between gender and utilization of mental health and medical services in the past year among Puerto Rican drug users (308 females; 892 males) recruited in New York City. Experience of sexual or physical abuse, injection drug use, relationship variables (e.g., having a sexual partner who is an injection drug user), and serious or chronic mental/medical conditions were used as potential mediators and moderators. Both sexual and physical abuse mediated gender effects on use of mental health services. Having chronic medical problems mediated the relationship between gender and utilization of medical and mental health services. Significant interaction effects of gender by depression, physical abuse, and HIV sero-status on utilization of medical services were found. Health (particularly mental health) care was under-utilized by both women and men, despite high rates of depression and chronic medical conditions. The finding of under-use of medical services by HIV-positive drug users (particularly by HIV-positive women) indicates a need for further efforts to engage all HIV-positive persons in care. The findings also indicate an on-going need for mental and other health services for drug users who have been victims of abuse.

Gender comparisons of factors associated with drug treatment utilization among Puerto Rican drug users

OBJECTIVE

This study examined gender-specific effects of social bonds, network characteristics, and other factors on drug treatment enrollment among Puerto Rican drug users.

METHOD

Participants (425 women; 1,374 men) were recruited in New York and Puerto Rico in 1998-2003.

RESULTS

Gender differences were found: education (< high school/GED) and having a sex partner who is an injection drug user (IDU) were significantly related to current enrollment in drug treatment (EDT) for women; for men, having an IDU friend (negatively) had a main effect on EDT, and having an IDU friend also had a significant interaction effect with their own injection drug use on EDT. For both women and men, recruitment site (New York), having health insurance, and prior methadone treatment were significant predictors of EDT.

CONCLUSION

The findings may be useful in developing gender-differentiated drug counseling and treatment efforts that engage women's sex partners and men's friendship networks to build support for drug treatment.

Violence against women with HIV risk and recent criminal justice system involvement: prevalence, correlates, and recommendations for intervention

This research note examines the prevalence and correlates of intimate partner violence (IPV) and other violence (OV) among women (N = 529) at risk for HIV and with histories of criminal justice system involvement. The 3-month prevalences of IPV and OV were 31.2% and 18.7%, respectively. IPV was associated with having a current main partner, substance use, sexual risk behavior, trading sex, anxiety, depression, and lower self-esteem. OV was associated with no current employment or schooling, unstable housing, drug use, trading sex, anxiety, depression, and lower self-esteem. The high prevalence of violence demonstrates the need for intervention in this population; the correlates show that effective interventions must address the complex issues in these women's lives.

Gender similarities and differences in the treatment, relapse, and recovery cycle

This study explores the influence of gender on changes in recovery status among participants in a longitudinal study. The study sample (N = 1,202; 60% female) is recruited on referral to treatment, and annual interviews are conducted from Years 2 to 6 following intake. At each annual observation, participants are classified into one of four statuses (recovery, treatment, incarcerated, and using), and the transitional probabilities and correlates of transitioning from one status to another are estimated. About 80% of the participants changed status at least once over the follow-up period. Women are one third less likely to transition from recovery to using; the predictors of transitioning to different statuses vary by gender. The implications of gender as a moderator of the recovery process are discussed.

Gender differences in DUI offenders in treatment in Texas

OBJECTIVE

This is a study of 8,464 adult women and 21,155 adult males who entered substance abuse treatment in Texas between 2000 and 2005. Participants were either on probation for driving under the influence (DUI), were referred to treatment by DUI probation, or had been arrested for DUI in the past year.

METHODS

The female and male clients were compared on demographic characteristics, substance use patterns, DSM-IV diagnoses, and levels of impairment. T tests and chi square tests were used to determine significance and multivariate logistic regression identified predictors of completing treatment and being abstinent at follow-up.

RESULTS

The proportion of females who were sent to treatment as a result of DUI increased from 27% in 2000 to 32% in 2005. Females were significantly more likely than males to be White (73% vs. 56%), to have used substances a shorter period of time (17 vs. 19 years), to be seeking custody to regain their children (11% vs. 2%), to meet the DSM criteria for drug dependence (32% vs. 23%), to have injected drugs (31% vs. 23%), to have used substances daily (42% vs. 40%), to have a depressive disorder (16% vs. 7%) or bipolar disorder (12% vs. 5%), and to be have been in treatment before (60% vs. 49%). In contrast, males were more likely to be alcohol dependent (49% vs. 44%). Females were less likely to complete treatment (67% vs. 72%) and reported significantly more days of problems on the 6 domains of the ASI at both admission and at 60-day follow-up. Furthermore, at follow-up, they were more likely to be living with someone who abused alcohol or used drugs (9% vs.7%).

CONCLUSIONS

Although females comprised only 29% of the DUI treatment admissions, they were more impaired and experienced more problems than their male counterparts. The findings indicate that additional resources, including treatment for co-occurring mental health problems and living in sober households, may be keys to helping these women achieve abstinence and prevent additional DUI episodes.

Retention and illicit drug use among methadone patients in Israel: a gender comparison

OBJECTIVES

To examine gender differences or similarities regarding the retention rate in the course of a 13-month treatment and in long-term retention up to 14 years among 2,683 patients treated in eight (of 10) methadone maintenance clinics located in communities in Israel.

METHODS

The study is based on a computerized set of data on 2,683 (331 female and 2,352 male) patients older than 18 years of age (mean age=43.30 SD=8.53) who underwent treatment in one of eight methadone maintenance programs in Israel sometimes (or all the time) between January 1, 1991 and October 30, 2005.

RESULTS

79.6% of the patients had a 100% retention rate in the 13-month time slot examined. The survival curves for the long-term retention show that retention in treatment was similar for both female and male patients. However, long-term retention is higher among female patients aged 31-40.

CONCLUSION

It is premature to conclude that there are no gender differences in retention since there seem to be different profiles of female patients, characterized by different retention rates, as implied by the great variability in the females' retention behavior found in the regression analysis.

Organizational- and individual-level correlates of posttreatment substance use: a multilevel analysis

In addressing the need to study the effects of organizational factors on individual-level treatment outcomes, this study used hierarchical models to examine the organizational- and individual-level correlates of posttreatment substance use. Risk for posttreatment use varied significantly across organizations. Factors in the external institutional environment of facilities significantly influenced risk for use: managed care regulation increased the risk, whereas Joint Commission on the Accreditation of Healthcare Organizations accreditation decreased it (p < .01 for both). On the individual level, longer treatment episodes and treatment completion reduced the risk (p < .01 for both) after controlling for client characteristics. The benefits of length of stay in treatment were modified by elements of the external institutional environment and organizational treatment technology. The ameliorative effects of prolonged treatment were reduced by higher levels of managed care regulation, organizational monitoring, caseload size (p < .01 for all), and proportion of degreed staff (p < .05). The results highlight the influence of organizational factors on posttreatment use.

Women-only and mixed-gender drug abuse treatment programs: service needs, utilization and outcomes

OBJECTIVES

This prospective longitudinal study examined service needs, utilization and outcomes for 189 women in women-only (WO) programs and 871 women in mixed-gender (MG) programs.

METHODS

The Addiction Severity Index was administered at both intake and the 9-month follow-up interview to assess clients' problem severity and outcomes, and the Treatment Service Review was given at the 3-month interview to measure service utilization. Treatment completion and arrests were based on official records.

RESULTS

Compared to women in MG programs, women in WO programs were more likely to be White, less educated, physically abused in the past 30 days and in residential treatment (as opposed to outpatient treatment). Women in WO programs also had greater problem severity in a number of domains including alcohol, drug, family, medical and psychiatric. They utilized more treatment services and had better drug and legal outcomes at follow-up compared to women in MG programs. Program type was not predictive of treatment retention/completion or outcomes in other domains (i.e., alcohol, employment, family, medical and psychiatric).

CONCLUSIONS

The greater problem severity of women treated in WO programs and their better drug and legal outcomes suggest that these specialized services are filling an important gap in addiction services.

Substance abuse treatment entry, retention, and outcome in women: a review of the literature

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 drug misuse and related problem behaviors among arrestees in the UK

Traditionally, the addiction literature has focused on male drug users and less attention has been given to female users. More recently, research investigating gender differences in drug use and associated problem behaviors has emerged. This article contributes to the growing research base by drawing on data collected from structured interviews with 2,682 male and 453 female arrestees conducted as part of the New English and Welsh Arrestee Drug Abuse Monitoring (1999-2002) program. Clear gender differences in drug use and associated behaviors are identified. Women were found to be more serious drug users and to experience more associated problems than men. The research and policy implications of the research are discussed and the study's limitations are noted.

Gender differences in long-term drug treatment outcomes in Chicago PETS

Few long-term follow-up studies of substance abusers have examined gender differences. In the current study, gender differences were examined at 36 months following residential or outpatient drug-free treatment among 951 participants in the Chicago Target Cities Project, the majority of whom were female (62%) and African American (93%). There were no differences in the proportion of men and women who reported any alcohol or drug use at the 36-month follow-up, with an overall reduction of 41% from intake. Greater proportions of men were incarcerated or employed, whereas greater proportions of women had returned to treatment, lived with their children, lived with a substance user, or had interpersonal problems. Women, as a group, had greater increases over time in self-help participation, free time spent with family, non-using family/friends, and employment. Although both men and women showed significant improvements following treatment, gender differences persisted in several areas of psychosocial functioning related to recovery.

Treatment outcomes among women and men methamphetamine abusers in California

This prospective longitudinal study examined treatment outcomes among 1,073 methamphetamine-abusing patients (567 women, 506 men) from 32 community-based outpatient and residential programs in 13 California counties. Data were collected at intake and at 3 months and 9 months after admission. With one exception, improvements from baseline to follow-up were observed in all areas measured by the Addiction Severity Index for both women and men in either modality. Compared to men, women demonstrated greater improvement in family relationships and medical problems, and similar improvement in all other areas, despite the fact that more women were unemployed, had childcare responsibilities, were living with someone who also used alcohol or drugs, had been physically or sexually abused, and reported more psychiatric symptoms. Implications for service improvement are discussed.