Cora Lee Wetherington, Ph.D. Women & Gender Research Coordinator National Institute on Drug Abuse Women Across the Life Span Conference July 12-13, 2004 Baltimore Marriott Inner Harbor
Transcript
Slide 1
Cora Lee Wetherington, Ph.D. Women & Gender Research
Coordinator National Institute on Drug Abuse Women Across the Life
Span Conference July 12-13, 2004 Baltimore Marriott Inner
Harbor
Slide 2
Slide 3
Gender Differences in Drug Abuse u Gender Differences: The
Numbers u Gender Differences: Animal Models u Gender Differences:
Menstrual Cycle u Gender Differences: Predictors & Progression
u Gender Differences: Treatment
Slide 4
Slide 5
Gender Differences: The Numbers Population prevalence data u
Drug use: greater for males than females u Drug dependence: greater
for males than females u 9.2% Males u 5.6% Females (1994 Natl
Comorbidity Survey) Are females less vulnerable to drug abuse than
males?
Slide 6
Gender Differences: The Numbers Calculate use prevalence only
among individuals with opportunity to use individuals with
opportunity to use Van Etten et al. (1999) Study drugs: Marijuana,
Cocaine, Heroin, Hallucinogens Data Source: 1993 NHSDA Findings:
Opportunity to use: greater for males than for females. Among
individuals with opportunity to use : males and females are equally
likely to initiate use.
Slide 7
Opportunity to Use Drugs 0 10 20 30 40 50 60 70
MarijuanaCocaineHallucinogensHeroin Percent Male Female
Slide 8
Percent Use Given an Opportunity
Slide 9
Gender Differences: The Numbers Calculate Dependence Only among
Users: Males and females = likely to become dependent on cocaine
tobacco heroin inhalants hallucinogens analgesics Anthony et al.
(1994) (Data Source: National Comorbidity Survey)
Slide 10
Gender Differences: The Numbers Calculate Dependence Only among
Users: Males more likely than females to become dependent on
marijuana alcohol Anthony et al. (1994) Data Source: National
Comorbidity Survey
Slide 11
Gender Differences: The Numbers Calculate Dependence Only among
Users: Females more likely than males to become dependent on
anxiolytics or sedatives or hypnotics Anthony et al. (1994) (Data
Source: National Comorbidity Survey)
Slide 12
Gender Differences: The Numbers Do prevalence data, adjusted
for opportunity, suggest that females are less vulnerable to drugs
than males ? No. If females are offered drugs, they are as likely
as males to use them: marijuana, cocaine, heroin, hallucinogens.
No. If females use drugs, they are as likely as males to become
dependent; exceptions in both directions. Caveat: Females are less
likely to receive drug offers.
Slide 13
Gender Differences: The Numbers All Age Groups vs. Adolescents
Adolescents
Slide 14
Gender Differences: The Numbers Monitoring the Future Survey
1975 - Present 1975 - Present Annual prevalence of illicit drug use
other than marijuana 12 th graders: > for boys than girls
(exceptions: 1975 & 1981 girls > boys) 10 th graders: >
for girls than boys (since 1991) 8 th graders: > for girls than
boys (since 1991)
Slide 15
Gender Differences: The Numbers Dependence Among Adolescents
Users: (Aged 12-17) Alcohol: males = females Marijuana: males =
females Nicotine: males = females Cocaine : females > males
17.4% vs. 4.7% Kandel et al. (1997 ) Data Source: 1991, 1992, 1993
NHSDA
Slide 16
Gender Differences: The Numbers Patterns of Drug Use
Slide 17
Slide 18
Gender Differences: The Numbers CAVEAT: Usage data are from
treatment samples. Perhaps female heavy users are more likely than
male heavy users to present for treatment.
Slide 19
Gender Differences: The Numbers DATOS Intake Data (n=10,010, 96
programs, 11 cities, 4 modalities) Women, compared to men, were
less likely to have graduated from high school almost half as
likely to be employed more likely to report prior drug treatment
depression, suicidal attempts & thoughts being troubled over
current emotional/psychological problems health problems weekly or
daily illegal activity (but < likely to be CJ involved) more
likely to report physical, sexual abuse or both in year prior to
treatment occurring more than a year prior to treatment Wechsberg
et al. (1998)
Slide 20
Gender Differences: The Numbers Myth: Females are less
vulnerable to drugs than males 1. If given the opportunity, females
are as likely as males to use drugs to become dependent 2.
Adolescent females, compared to males, in 8 th and 10 th grades are
more likely to use any illicit drugs other than marijuana are more
likely to become dependent on cocaine
Slide 21
Gender Differences: The Numbers Myth: Males are more vulnerable
than females 3. Use patterns suggest that women are more likely to
use daily cocaine, heroin, barbiturates use more times per week
cocaine & heroin use more grams per week cocaine 4. Women
presenting for treatment have poorer levels of functioning. Does
this reflect a greater vulnerability to the impact of drugs on
women? (i.e., consequence) Are women with poorer levels of
functioning more vulnerable to drugs than men with poorer levels of
functioning? (i.e., etiologic)
Slide 22
Gender Differences in Drug Abuse u Gender Differences: The
Numbers u Gender Differences: Animal Models u Gender Differences:
Menstrual Cycle u Gender Differences: Predictors & Progression
u Gender Differences: Treatment
Slide 23
Gender Differences: Animal Models Do data from animal
behavioral models suggest that males are more vulnerable to drugs
than females?
Slide 24
Gender Differences: Animal Models Behavioral Models: 1.Amount
of Drug Self-Administered 2.Reinforcing Effectiveness 3.Speed of
Acquisition of Self-Administration 4.Prevalence of
Self-Administration 5.Relapse: Reinstatement following
Extinction
Slide 25
Gender Differences: Animal Models 1. Amount of Drug
Self-Administered Females, compared to males, self-administer more
alcohol Hill, 1978; Lancaster & Spiegel, 1992 caffeine Heppner
et al., 1986 cocaine Morse et al., 1993; Matthews et al., 1999;
Lynch & Carroll,1999 fentanyl Klein et al., 1997 heroin Carroll
et al., 2001 morphine Alexander et al, 1978; Hill, 1978; Cicero et
al, 2000 nicotineDonny et al., 2000
Slide 26
Gender Differences: Animal Models 2. Reinforcing Effectiveness
Females reach higher progressive ratio breakpoint for cocaine
(Roberts et al., 1989) nicotine (Donny et al., 2000) Females have
shorter latency for first nicotine infusion of the session (Donny
et al., 2000)
Slide 27
Gender Differences: Animal Models Progressive ratio breakpoint
(BP) (Roberts et al., 1989) Males: 48.2 Females: 264.1 Females
during estrus: approx. 400 Estrus BP > metestrous/diestrous or
proestrus BP
Slide 28
Gender Differences: Animal Models 3. Speed of Acquisition of
Self-Administration Females acquire self-administration faster than
males cocaine approx 1/2 the # sessions ( Lynch & Carroll,
1999) heroin approx 2/3 the # sessions (Lynch & Carroll, 1999)
nicotine at lowest dose only (Donny et al., 2000)
Slide 29
Gender Differences: Animal Models 4. Prevalence of
Self-Administration (SA) Similar percentage of female rats acquire
heroin SA: 90.0% females vs. 91.7% males (Lynch & Carroll,
1999) More female rats acquire cocaine SA: 70% females vs. 30%
males (Lynch & Carroll, 1999) More female Rhesus monkeys
acquire PCP SA: 100% females vs. 36.4% males (Carroll et al.,
2000)
Slide 30
Gender Differences: Animal Models 5. Relapse: Reinstatement
following Extinction of Cocaine SA Females, compared to males,
exhibit greater reinstatement of extinguished responding relapse
with a lower priming dose Lynch & Carroll (2000)
Slide 31
Gender Differences: Animal Models Behavioral Models: 1.Amount
of Drug Self-Administered 2.Reinforcing Effectiveness 3.Speed of
Acquisition of Self-Administration 4.Prevalence of
Self-Administration 5.Relapse: Reinstatement following
Extinction
Slide 32
Gender Differences in Drug Abuse u Gender Differences: The
Numbers u Gender Differences: Animal Models u Gender Differences:
Menstrual Cycle u Gender Differences: Predictors & Progression
u Gender Differences: Treatment
Slide 33
Hormonal Changes During the Menstrual Cycle Hormonal Changes
During the Menstrual Cycle
Slide 34
Gender Differences: Menstrual Cycle Pharmacokinetics (Humans) :
Cocaine u Pharmacokinetics of i.v. 0.2 and 0.4 mg/kg cocaine: peak
plasma levels time to reach peak plasma level (Tmax) elimination
half life AUC u No differences among males, females (luteal),
females (follicular) Exception: Tmax for 0.4 mg/kg Females
follicular phase: 4.0 min luteal phase: 6.7 min Males: 8.0 min
Mendelson et al. (1999)
Slide 35
Gender Differences: Menstrual Cycle ORAL d-AMPHETAMINE
Subjective effects > follicular than luteal: > feeling of
high > euphoria (ARCI MBG) > energy & intellectual
efficiency (ARCI BG) > liking the drug > wanting the drug
Justice & de Wit (1999)
Slide 36
Gender Differences: Menstrual Cycle SMOKED COCAINE Repeated
doses smoked cocaine (0, 6, 12.5 or 25 mg) In follicular phase (v.
luteal phase) Higher ratings of high Higher ratings of good drug
effect Evans et al. (2002)
Slide 37
Gender Differences: Menstrual Cycle NICOTINE CESSATION STUDY
Quitters in the late luteal phase, vs follicular phase: more
withdrawal symptoms more depressive symptomatology Implications for
timing of initiation of cessation Perkins (2000)
Slide 38
Gender Differences: Menstrual Cycle CUE-INDUCED NICOTINE
CRAVING Follicular phase females reported significantly less
craving than luteal phase females males Franklin et al. (2004)
Slide 39
On a scale of 1 to 10, how much do you desire a cigarette at
this moment? CRAVING SCORECRAVING SCORE F L Early F Late L p