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Sex and gender in addiction research and therapy Verena Metz & Gabriele Fischer 1 Abstract Historically, addiction research has neglected the scientific focus on women, and most studies have been conducted on male patients only, with the concluding results generalised to the female population . The role of sex and gender differences in susceptibility to the development of addictive disorders , and their consequences for prevention and treatment strategies require detailed studies, as do the increasing prevalence rates of addictive disorders among adolescents and the aging population. This literature review synthesises evidence of sex and gender differences in substance-related and substance-unrelated addictions, with particular emphasis on women's health. These differences are described in view to epidemiological and etiological factors, onset and course of illness, symptomatology , comorbidity, as well as treatment. Current research findings on gender aspects referring to specific licit (nicotine, alcohol, prescription drugs) and illicit (cocaine, heroin) substances as well as substance-unrelated conditions (pathological gambling, internet addiction) are presented. However, evidence-based science on differences between men and women in addictive disorders is still underrepresented in that target area, in addition to the fact that currently findings of different types of studies applying varied methods are reported. Finally, a critical discussion highlights common methodological flaws and limitations in research on sex and gender differences, and emphasizes the need for the implementation of a sex and gender-sensitive methodology in evidence-based studies. Verena Metz & Gabriele Fischer 102 2 Introduction Research in psychiatry focusing on sex and gender differences takes various aspects into account, ranging from the availability of services, epidemiological and etiological considerations, the metabolisation of drugs, to gender-specific stigmatisation or patient satisfaction and retention in treatment. Multiple issues play an important role in clinical practice and deserve special attention, although there are still several topics that have not been thoroughly studied so far, since there is a general lack of addressing sex and gender aspects regarding psychiatric, particularly addictive disorders, in medical research. The objective of this literature review is to present the clinically most relevant, well-established and current research findings regarding prevalence, epidemiological factors, symptomatology, as well as treatment of substance-related and substance -unrelated addictive disorders. Special consideration is given to substance abuse during pregnancy and its effects on the infant. The review is based on literature search using PubMed, indicating search terms for the specific addictive disorders and ‘sex differences’ or ‘gender differences’ combined with the main issues addressed (‘epidemiology’, ‘treatment’, ‘onset’ etc.), and selecting the most recent publications. Research on gender issues in medical healthcare revealed that women have to consult a doctor twice as often as men in order to have their symptoms taken seriously , and that diagnoses more often are psycho-somatic conditions than in men who tend to get a somatic diagnosis. Men less frequently fulfil the necessary criteria for a psychiatric illness than women who clearly outweigh the male patients in prevalence rates of anxiety and depressive as well as somatoform disorders; the prevalence of schizophrenia is equally high among both sexes, but regarding addiction , a completely different picture can be observed (1–4). 2.1 Differences between women and men in prevalence of addictive disorders In general, men are two to three times more likely to develop substance abuse or dependence, and are affected four times more often by an alcohol use disorder than women; the prevalence of illicit substance use is also much higher in the male adult population (10.2% men versus 6.1% women reportet illicit substance use in the last month in an national survey in the United States 2005). However, the frequency of non-medical use of prescription drugs is almost equally high among men and women (2.7% versus 2.6%), and generally a trend towards narrowing of maleto -female prevalence ratios can be observed in many Western countries (2–5). Sex and gender in addiction research and therapy 103 Special consideration should be given to the increasingly high substance use among the young population in Europe, which is rising particularly among women, and constitutes a major public health issue. Figure 1 presents prevalence rates of lifetime use of different substances among 15- to 16-year-old students from 15 European countries (6). The figure also shows that the gender gap regarding the preponderance of male patients is narrowing. It should be noted that these data were collected in a standardised way via group-administered, anonymous questionnaires, so the calculated prevalences might be biased through self-assessment. Figure 1: Prevalences...


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