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6/11/18
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WomenandAddiction:TreatmentDifferencesandChallenges
JillB.Becker,Ph.D.UniversityofMichigan
PatriciaY.Gurin CollegiateProfessorofPsychologyResearchProfessorMolecular&BehavioralNeuroscienceInstitute
OH
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BECKERLabTHE
Neurobiology of sex differences research groupUtahPSYCHIATRYADDICTIONSUpdateConf2018
DISCLOSURES• IHAVENOCOMPETINGFINANCIALINTERESTSTODISCLOSE
• IAMNOTAPSYCHIATRISTORCLINICALPSYCHOLOGIST– IDONOTTREATPATIENTS
• IDOBASICANIMALRESEARCHONSEXDIFFERENCESINADDICTION
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ThingstoconsiderWhatisaddiction?
Howdoesourdefinitionvarywithdiscipline?Howistreatmentaffectedbydefinition?
Wheredoessex/genderfitin?
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• Neurotransmitters• Genes• PetandfMRIimages• Neuronmorphologyandsynapses
• Neuroplasticity
• Molecularchanges• Electrophysiology• Rewardsysteminthebrain
• Individualdifferencesinvulnerability
Whosedefinition?
Whatarewetreatingandhowdoourdefinitionsimpactapproachesfortreatment?• Neuroscience:Addictionistheconsequenceofcertainsubstancesoractivitiesthatbecomecompulsivebecauseoftheirabilitytoinduceactivityintherewardsystemthatsubsequentlyinduceslong-termchangesinthebrain.Thesechangesinthebrainperpetuatethecontinueddisplayofthebehaviorasitbecomesmoreandmorecompulsive.
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Whatarewetreatingandhowdoourdefinitionsimpactapproachesfortreatment?• Neuroscience:Addictionistheconsequenceofcertainsubstancesoractivitiesthatbecomecompulsivebecauseoftheirabilitytoinduceactivityintherewardsystemthatsubsequentlyinduceslong-termchangesinthebrain.Thesechangesinthebrainperpetuatethecontinueddisplayofthebehaviorasitbecomesmoreandmorecompulsive.• TREATMENT:Changethebrain(medication,CBT,etc)
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Whatarewetreatingandhowdoourdefinitionsimpactapproachesfortreatment?
• Physician – Addictionisanuncontrollable,compulsivecraving,seeking,andengagementinabehaviororactivitythatcontinueseveninthefaceofnegativehealthandsocialoutcomes.• Addictionisabraindisease.• Diagnosis– DSMcriteria.• Treatment- Abstinence
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Whatarewetreatingandhowdoourdefinitionsimpactapproachesfortreatment?• Clinicaltreatmentprovider/SocialWorker• Addictionisseenasadiseasewithgeneticandbraincomponentsthathasconsequencesforthecommunityandthecriminaljusticesystem.• Addictionimpactsnotjusttheindividualbutthefamilyandcommunityinwhichtheaddictionoccurs,soitismorethananindividual’sproblem.Mustbalanceharmreductionvs.prevention.
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Whatarewetreatingandhowdoourdefinitionsimpactapproachesfortreatment?
• Sociologist – Addictionisamoralisticconceptunderstoodfromtheindividualizedperspectiveasdeviantbehaviorandresultsinsocialexclusion.
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Whatarewetreatingandhowdoourdefinitionsimpactapproachesfortreatment?• PublicHealth• Addictionisviewedasapublichealthissuewhichcausesmanynegativecoststopeopleandsociety• Concernedaboutidentifyingriskandprotectivefactors.• Riskandprotectivefactorscanoccuratallsocietallevels,frombiologicalandpsychological,withinrelationshipsandgroupmemberships,butalsowithinschools,workplaces,communities,societalnorms/values,costsandincentives.• Goalistoincreaseprotectiveanddecreaseriskfactors,witharangeofpreventiveapproachestodecreaseincidenceandprevalenceofrisks,earlysignsoftroubleandproblems.
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Whatarewetreatingandhowdoourdefinitionsimpactapproachesfortreatment?• Historian – Notthehistorian’sjobtodefineaddictionbuttodocumenthowdefinitionschangeovertime.
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Whatarewetreatingandhowdoourdefinitionsimpactapproachesfortreatment?• Thenon-academic?Ifsomeoneisanaddicttheymustbeweak,itistheirownfault,theywilllieandcheatandstealanddoanythingfortheiraddiction.Youcan’ttrustanaddict.Theyarenotworthyofourhelp.
• Addictsareweak– lackofwillpower• Addictsareliarsandthieves• Addictsarenottrustworthy• Addictsareself-centered
• Womenwhoareaddictsaredeniedfoodstampsandbabyformula• Pregnantwomenwhoareaddictscanbejailedforharmingtheirunbornbaby• Addictsarebadmothersandbadwomen
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Whatarewetreatingandhowdoourdefinitionsimpactapproachesfortreatment?
• Somedisciplinesfocusonintervention.• Somedisciplinesreportonthescience.• Thoseintreatment/interventionsaythatthescientistspromisethepublicacureforabraindisease- thiscontributestotheproblemofstigmaforthoseaddictedwhentheycontinuetorelapseoruse.•Womenareimpactedmoreseverelywhentreatmentprogramscannotaccommodatechildren.relapsemeansremovalofchildrenfromthehome,pregnantwomenareimprisonedandprograms callforcessationofmethadone/suboxoneduringpregnancy.
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Whatarewetreatingandhowdoourdefinitionsimpactapproachesfortreatment?CommonElements• Braininvolved(neuroscientist,physician,treatmentprovider)
• Individualdifferencesinsusceptibility
• Disagreement• Whosefaultisit?• Naturevs.nurture• Roleofcommunity• ScientistspresumewecangeteverclosertothetruthOtherdisciplinessaymaybe butalwaysdeeplyinfluencedbyculture• Sex/Genderdifferences
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Howdoessex/genderimpacthowwethinkaboutaddiction?
• Neuroscience• Sexdifferencesareincludedoccasionallyasabimodal(maleandfemale)variable.• Sexdifferencesare“controlledfor”bynormalizingdatabysexofsubject.• Analysisoftheinfluenceofgonadalhormonesfindsfemaleaddiction-relatedbrainsystemsandbehaviorsaredifferentiallyinfluencedbyovarianhormones.
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Howdoessex/genderimpacthowwethinkaboutaddiction?• Clinicaltreatmentprovider/SocialWorker• Havedevelopedprinciplesandapproachesforgender-specificandgender-informedapproaches.• Manybasicassumptionsaboutaddictionsandtreatmentweredevelopedbymentoaddressconsequencesmorecommoninmen.Somebasicapproachesareharmfulforwomen,andcanincreasetrauma&depression,theycanlowerself-worth.• Manywomenwithseriousaddictionissueswereabusedaschildrenandtraffickedasadults.Trauma-informedapproachesimproveoutcomes.
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Howdoessex/genderimpacthowwethinkaboutaddiction?• Feminist• Afeministperspectiverecognizesthatconventionalresearchoperatesfrommale-centricparadigmsthatresultinbias,obscuringrealworldhierarchiesandperpetuatinginequalities.• Afeministperspectiveseekstochallengethisbiasandreframetheparadigmsinwaysthatdonotassumethatthemaleperspectiveistheonlyviewanddoesnotproblematizethe“feminine” perspective.
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Howdoessex/genderimpacthowwethinkaboutaddiction?• Feminist• Thefeministperspectivedrawsattentiontothedualaspectofdependencyandsubordinationofwomenwhoareaddicts.• Maleexploitationofwomenisbothacauseandconsequenceofaddictioninwomen.
• Feministperspectivesnotethatawomanwhoisaddictedisgenerallyperceivedaslessgood/moralthanamanwhoisaddictedbecauseofdoublestandards.
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Howdoessex/genderimpacthowwethinkaboutaddiction?
• Feminist•Majortensionwithinfeminism– wetvs.dry• ’Wet’feministposition– womenshouldbeabletoparticipateinaddictiveactivitylikeaman– itisliberatingandasignofincreasingpowerandoptions.• “Dry’feministposition– menuseaddictiveactivitiestohavepoweroverwomensowomenshouldrefrain.
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Howdoessex/genderimpacthowwethinkaboutaddiction?• SocialPsychologist• Genderisonlyapartoftheissuewithregardtohowaddictionisconceptualizedinthecontemporaryworld.• Raceandhistoricaltraumamustalsobeconsideredwithinthepost-colonialframeworkofnon-EuropeanAmericans.• Genderessentialismisverydeep,canvarybycultureandisreinforcedbylanguage.
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Howdoessex/genderimpacthowwethinkaboutaddiction?• Historically• Addictionhasbeen(repeatedly)reconceptualizedasadiseaseratherthansinorlackofwillpower(medicalization).Manypeoplebelievedthatthisshiftwouldremoveoratleastreducestigmaforwomen.• Treatmentmodels,evenwhendesignedforwomen,tendtochannelthewomanbackintostandardrolesofcaregiver,mother,andwifeandreinforcetheadditionalstigmafacedbyaddictedwomenofnotconformingtostandardrolesforwomen.
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Howdoessex/genderimpacthowwethinkaboutaddiction?
CommonElements
• Sexandgenderdifferencesareimportanttoconsiderinresearchandtreatment.
• Disagreement
• Manyfeministsinsocialsciencesandhumanitiesdonotwanttotalkaboutbiologicalsexdifferencesb/cthatconcepthasbeenusedagainstwomeninthepasttodisenfranchisewomen.
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IssuesandObstaclestoTalkingAboutAddictionandTreatmentasWeSeektoBridgeDisciplinesWhatDoesAddictionisaBrainDiseaseMean?• Neuroscienceperspective – Exposuretosubstancesorengaginginactivitiesthatbecomecompulsive,becauseoftheirabilitytoinduceactivityintherewardsystem,subsequentlyinduceslong-termchangesinthebrain.Thesechangesinthebrainunderliethephenomenaofaddiction,makingaddictionabraindisease.Someindividualsmaybemorevulnerableduetogeneticcontributions,ahistoryofabuseorstress,aswellaswhethertheyaremaleorfemale.
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IssuesandObstaclestoTalkingAboutAddictionandTreatmentasWeSeektoBridgeDisciplines
WhatDoesAddictionisaBrainDiseaseMean?Whatthenon-scientisthears!• BiologicalDeterminism – Ifaddictionisabraindiseasethenindividualswhoareaddictedcan’thelpgettingthedisease.Inotherwords,manypeopleassumethatthebraindifferencesarecausativetoaddiction (e.g.,geneticfactors,heredity,fixedfactors)andcannotbechanged.Theirbrainsaregeneticallyorepigeneticallydamagedanditwasinevitablethattheywouldbecomeaddicted.
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IssuesandObstaclestoTalkingAboutAddictionandTreatmentasWeSeektoBridgeDisciplines
WhatDoesAddictionisaBrainDiseaseMean?• Neuroscienceperspective – thebrainhaschanged• BiologicalDeterminism – it’snotmyfault
It’s Official: Being Fat is not Your FaultNational Post 25 June, 2013
Astudyfoundthatoverweightmenandwomenwhoaretoldobesityisadiseasearelessinterestedingoingonadiettoimprovetheirhealth.28January2014:http://www.dailymail.co.uk/health/article-2547768/Labelling-obesity-disease-excuse-not-diet.html#ixzz2z52yMC77
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IssuesandObstaclestoTalkingAboutAddictionandTreatmentasWeSeektoBridgeDisciplinesPowerDynamicsinRelationshipsandAddiction• Substanceuseandeatingdisorders,suchasanorexianervosa,maybeviewedasademonstrationofpowerorrebellionforindividualsorgroups.• Addictionalsomeansalossofpower.• Whobenefitsfrompowerinarelationshipwhenoneorbothareaddicted?• Thereislossofpowerasanaddict(enablingpartnersgainpower),aswellpoweroveraddictioninrecovery.• Framingrecoveryasarestorationofpowertotheindividualcanchangehowoneperceivesthecausesandconsequencesofaddictionandrecovery.
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IssuesandObstaclestoTalkingAboutAddictionandTreatmentasWeSeektoBridgeDisciplinesWhenstudyingaddictiontreatmentinwomen,weencountersomanydifferentfactors:
gender/sexvariationswomenwhoareresilienttoadversitysocialbondsandsupportharassment,stress,minoritystresspregnancyandotherbiologicaleffectsdowomenandmencometoaddictionthesameway?ethnicity,SES,sexuality,etc.caregivingrolesandexpectations
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IssuesandObstaclestoTalkingAboutAddictionandTreatmentasWeSeektoBridgeDisciplines• Dowomenexperiencetheiraddictionsinthesamewayasmenorisitdifferent?• Wecanuseanimalmodelsforvariousaspectsofaddiction,differentsocialrelationships,differentreproductiveexperiences,sociallybondedvs.not,etc.butthemodelsarenecessarilyrestrictedtospecificaspects.• Areallanimalsaregoodmodelstostudyhumanaddiction?• Arealladdictionsthe”same”?
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IssuesandObstaclestoTalkingAboutAddictionandTreatmentasWeSeektoBridgeDisciplines• Ifweeliminatethepolesofmale/menandfemale/womenthenwelosealotoftheattentiontocharacteristicsthatmanywomen/girls(andtransgenderedfolks)haveincommon.
• Differencesarenuancedbutwewantthemtobebimodal.
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IssuesandObstaclestoTalkingAboutAddictionandTreatmentasWeSeektoBridgeDisciplines
•Whendoespayingenough attentiontogender/sex,endupputtingwaytoomuchweightonsexdifferencesasifitisabimodalconstructwheninfactthatisnotnecessarilythecase?
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SexDifferencesinAddictiontoDifferentClassesofDrugsinHumans
From:BeckerJB,Koob GF.Pharmacol Rev,2016,68:242-263.
Drug
Alcohol
Cocaine
OpiatesNicotine
Cannabinoids
Binge/Intoxication
Escalation of use F>M*Amount of intake M>F**Incidence M>F***Escalation of use F>M*Amount of intake F>M**Incidence M>F***Incidence M>F***Stress promotes initiation in women*Females acquire self-administration
at lower doses than males**Amount of intake F>M**Women report enhanced subjective
ratings in response to smoked cannabis and progress from use to disordered use more rapidly than men*
WithdrawalNegative Affect
Negative affect F>M*
Negative affect F>M*
Negative affect F>M*
Preoccupation/Anticipation
Stress or anxiety-induced relapse F>M*
Stress-induced relapse F>M*Cue-induced relapse F>M*Cue-induced craving F>M*
Higher cortisol predicts relapse in women*Lower cortisol and craving predict relapse
in men*Stress promotes relapse in women*
* = qualitative ** = quantitative *** = population
StageofAddictionCycle
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BeckerandKoob (2015)
TYPESOFSEXDIFFERENCES
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SexDifferencesmayreflectdifferentdistributionsofmalesandfemalesforaspectsofaddiction:Femalesmetmoreaddiction-likecriteriathanmalesandprenatallystressedfemaleratsmetmoreaddiction-likecriteriathannon-stressedfemales
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OTHERFACTORSEnvironmentalcontextcandramaticallyaltertherewardingeffectsofaddictivedrugsandunveilfundamentaldifferencesamongdifferentclassesofdrugs.
Therewardingeffectsofaddictivedrugsdonotdepend(entirely)onsharedneuralsubstrates.
ALDOBADIANI
Setting of drug taking in humans
Participants: Individualswithsubstanceusedisorder(DSM-IV-TRorDSM-5)andwithalonghistory(about15yrs)ofbothheroinandcocaineuse
Methods: • Retrospectivereports• Ecologicalmomentaryassessment• Neuropsychologicalandbehaviouraltests• Emotionalvisualimagery• fMRI
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Setting preferences for cocaine vs. heroin usein co-abusers (N = 160)
Caprioli et al., Biol Psychiatry 2009Badiani and Spagnolo, Curr Pharm Des 2013
Cocaine
22.5%
69.4%
Heroin
70.0%
23.1%
50/50outsidethe home
at home
22.5/69.4= 0.32
p<0.0001
70/23.1= 3.03
ALDOBADIANI
CircumplexModelofAffect(Russel1980)
Bidimensional testofaffectivestate
Arousal
Sedation
Unpleasant Pleasant
A novel test for the assessment ofsubjective appraisal of affective states
Arousal
Sedation
Unpleasant PleasantPleasantsedation
Unpleasantsedation
Pleasantarousal
Unpleasantarousal
De Pirro et al., J Neurosci 2018
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Shift in Valence
McNemar’s testp<0.0001
Positivevalence
Negativevalence
Heroin at home Heroin outside the home(mismatch)
De Pirro et al., J Neurosci 2018
ALDOBADIANI
Shift in Valence
McNemar’s testp=0.0014
Positivevalence
Negativevalence
Cocaine at home(mismatch)
Cocaine outside the home
De Pirro et al., J Neurosci 2018
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Drug imagery during fMRI scanningALDOBADIANI
Drug imagery during fMRI scanning
BaselineImagery
DRUGIMAGERY
Rest
VASvividness
60 s
120 s
60 s
Stimulus onset
- Heroin at home- Heroin outside the home- Cocaine at home- Cocaine outside the home
- Home- Outside
the home
De Pirro et al., J Neurosci 2018
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MapofActivation(PFWE <0.05)
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ALDOBADIANI
at home outsidethe home
at home outsidethe home
Opposite patterns of activation of the fronto-striatal-cerebellar network as a function of drug and setting
BOLD
signalchange
COCAINE HEROIN
De Pirro et al., J Neurosci 2018
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Therapeuticapproachestoaddiction(e.g.,EcologicalMomentaryInterventions)shouldtakeintoaccountthedistinctiveeffectsofdifferentclassesofdrugsandreal-worldsettingsofdruguse.
CONTEXTISIMPORTANT!
Real-world settings
Druguser
Druguser
Druguser
Druguser
ALDOBADIANI
GenderedWorlds• Boysandgirlsareperceivedandtreateddifferentlythroughthelifecourseandindifferentcultures- biologicalexplanationsarecommonlyinvokedasthereasons.• Thesocialcontextsexperiencedbymen,women,andthesubgroupswithinthegenders(forinstanceeconomicclassorethnicity)aredifferent.• Thoughourbiologicalelementsare‘plastic’oradaptable(biologyisnotdestiny),theculturalcategoriesrelatedtogenderthatindividualsexperiencerigidlycategorizeindividualsanddifferentiallycolortheirexperiences.
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GenderedWorlds
Howgenderisexperiencedwithinlargerculturesshaperiskandconsequencesrelatedtoaddictions.Forinstance,abuseandtraumaduringdevelopmenthavelongtermeffectsonvulnerabilityforaddictionsandmalesandfemalesaredifferentiallyaffected.
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A.DevelopmentalOrigins
B.StatisticalCharacteristics
C.FunctionalExpressionofTrait
Organizational:geneticand/orhormoneinitiatedtrait
Contingent:internalorexternalfactors(includingepigeneticfactors)actingonasexuallydimorphicindividual
Maletrait
Femaletrait
i.BimodalDistribution
MaleTrait
FemaleTrait
ii.Average/MeanDifference
MaleDistribution
FemaleDistributionOfTraits
iii.FrequencyDistribution
SexDifferenceinBehavioralExpressionofTrait
i.UnderlyingMechanismsDiffer
ii.UnderlyingMechanismstheSame
NoSexDifferenceinBehavioralExpressionofTrait
NoSexDifferenceinBehavioralExpressionofTrait
i.UnderlyingMechanismsDiffer
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SEX DIFFERENCES &SEX DIFFERENCES &SEX DIFFERENCES &SEX DIFFERENCES &GENDERGENDERGENDERGENDER
SOCIAL CONTEXTSOCIAL CONTEXTSOCIAL CONTEXTSOCIAL CONTEXTBIOLOGYBIOLOGYBIOLOGYBIOLOGYADDICTIONSADDICTIONSADDICTIONSADDICTIONSSTIGMASTIGMASTIGMASTIGMAFEMINISMFEMINISMFEMINISMFEMINISM
ADDICTIONSADDICTIONSADDICTIONSADDICTIONS
AVAILABILITY/ACCESSAVAILABILITY/ACCESSAVAILABILITY/ACCESSAVAILABILITY/ACCESSUSE/BEHAVIOR Patterns byUSE/BEHAVIOR Patterns byUSE/BEHAVIOR Patterns byUSE/BEHAVIOR Patterns byPopulationPopulationPopulationPopulationPOSITIVE/NEGATIVEPOSITIVE/NEGATIVEPOSITIVE/NEGATIVEPOSITIVE/NEGATIVEOUTCOMESOUTCOMESOUTCOMESOUTCOMESRISK / PROTECTIVERISK / PROTECTIVERISK / PROTECTIVERISK / PROTECTIVEFACTORSFACTORSFACTORSFACTORS
NEUROSCIENCENEUROSCIENCENEUROSCIENCENEUROSCIENCE
PHARMACOLOGY DRUGPHARMACOLOGY DRUGPHARMACOLOGY DRUGPHARMACOLOGY DRUGACTIONACTIONACTIONACTIONSEX DIFFERENCES &SEX DIFFERENCES &SEX DIFFERENCES &SEX DIFFERENCES &GENDERGENDERGENDERGENDERNEURAL CHANGES WITHNEURAL CHANGES WITHNEURAL CHANGES WITHNEURAL CHANGES WITHADDICTIONSADDICTIONSADDICTIONSADDICTIONSNEURAL CHANGES WITHNEURAL CHANGES WITHNEURAL CHANGES WITHNEURAL CHANGES WITHDRUG USEDRUG USEDRUG USEDRUG USEIMAGING THE BRAINIMAGING THE BRAINIMAGING THE BRAINIMAGING THE BRAINGENETICS ANDGENETICS ANDGENETICS ANDGENETICS ANDADDICTIONADDICTIONADDICTIONADDICTION
PUBLIC POLICYPUBLIC POLICYPUBLIC POLICYPUBLIC POLICYLAWSLAWSLAWSLAWSPUBLIC CAMPAIGNSPUBLIC CAMPAIGNSPUBLIC CAMPAIGNSPUBLIC CAMPAIGNSPUBLIC PROGRAMSPUBLIC PROGRAMSPUBLIC PROGRAMSPUBLIC PROGRAMSDEVIANCEDEVIANCEDEVIANCEDEVIANCE
INTERVENTIONSINTERVENTIONSINTERVENTIONSINTERVENTIONS
COSTCOSTCOSTCOSTEFFECTIVENESSEFFECTIVENESSEFFECTIVENESSEFFECTIVENESSAVAILABILITY OFAVAILABILITY OFAVAILABILITY OFAVAILABILITY OFOPTIONSOPTIONSOPTIONSOPTIONS
PROMOTIE POSITIVEPROMOTIE POSITIVEPROMOTIE POSITIVEPROMOTIE POSITIVEGOALSGOALSGOALSGOALS
ATTITUDESATTITUDESATTITUDESATTITUDES
PSYCHOSOCIOCULTURALPSYCHOSOCIOCULTURALPSYCHOSOCIOCULTURALPSYCHOSOCIOCULTURALFORCESFORCESFORCESFORCES
PSYCHOLOGYPSYCHOLOGYPSYCHOLOGYPSYCHOLOGYSOCIOLOGYSOCIOLOGYSOCIOLOGYSOCIOLOGY
ANTHROPOLOGYANTHROPOLOGYANTHROPOLOGYANTHROPOLOGYECONOMICSECONOMICSECONOMICSECONOMICS
FEMINISMFEMINISMFEMINISMFEMINISMPOLITICAL SCIENCEPOLITICAL SCIENCEPOLITICAL SCIENCEPOLITICAL SCIENCE
TEAM SCIENCETEAM SCIENCETEAM SCIENCETEAM SCIENCETransdiciplinarityTransdiciplinarityTransdiciplinarityTransdiciplinarityMechanismsMechanismsMechanismsMechanisms
Creation of FrameworksCreation of FrameworksCreation of FrameworksCreation of Frameworks'Level' Setting'Level' Setting'Level' Setting'Level' Setting
HISTORYHISTORYHISTORYHISTORY
ATTITUDES TOWARDATTITUDES TOWARDATTITUDES TOWARDATTITUDES TOWARDGENDERGENDERGENDERGENDERATTITUDES TOWARDATTITUDES TOWARDATTITUDES TOWARDATTITUDES TOWARDADDICTIONADDICTIONADDICTIONADDICTIONPRIOR STRATEGIESPRIOR STRATEGIESPRIOR STRATEGIESPRIOR STRATEGIESDRUG AVAILABILITYDRUG AVAILABILITYDRUG AVAILABILITYDRUG AVAILABILITY
GENDER AND ADDICTIONS: EnhancedGENDER AND ADDICTIONS: EnhancedGENDER AND ADDICTIONS: EnhancedGENDER AND ADDICTIONS: EnhancedKnowledge Base & New Insights fromKnowledge Base & New Insights fromKnowledge Base & New Insights fromKnowledge Base & New Insights from
IntegrationIntegrationIntegrationIntegration
Conclusions• Biologicalsexdifferencesareimportantforwhetherandhowsomeonebecomesaddicted.• Biologicalfactorsalonedonotpredictaddictionsorotherphenomena.• Theenvironmentduringprenataldevelopment,infancyandadolescenceaffecttheepigenomeandsubsequentaddictionvulnerability.• Internaleventssuchasdietandexternaleventssuchasstress,neglect,orabusehavedramaticeffectsonaddictionliability,andmalesandfemalesaredifferentiallyaffected.• Contextaffectstheresponsetodrugsofabuseanddifferentclassesofdrugsareaffectedbycontextindifferentways.
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ThankYou!!
UniversityofTexasatAustin3/29/2018
NIDANATIONAL INSTITUTE ON DRUG ABUSE
Office of ResearchOn
Women’s Health
OH
HO
BECKERLabTHE
Neurobiology of sex differences research group