Gender Differences in Drug Addiction: Neurobiological, Social, and Psychological Perspectives in Women – A Systematic Review
Shakila Jahan Shimu 1*, Sakurul Islam 2
Journal of Primeasia 6(1) 1-13 https://doi.org/10.25163/primeasia.6110194
Submitted: 07 December 2024 Revised: 31 January 2025 Published: 04 February 2025
Abstract
Drug addiction is a complex issue influenced by biological, psychological, and social factors. Historically, substance use disorders (SUDs) have been studied primarily in men, overlooking crucial gender differences. However, emerging research reveals that women exhibit unique drug use patterns, distinct neurobiological responses, and specific psychosocial challenges in addiction and recovery. Understanding these differences is essential for developing gender-sensitive prevention and treatment approaches. Neurobiologically, sex hormones such as estrogen and progesterone modulate drug sensitivity, leading to a faster progression from initial use to dependence in women. The mesolimbic dopamine system and prefrontal cortex demonstrate sex-specific activity, influencing cravings, reward processing, and relapse vulnerability. Additionally, hormonal fluctuations and stress responses contribute to more severe withdrawal symptoms and increased relapse risk in women. Social and psychological factors further differentiate addiction in women. They are more likely to use substances as a coping mechanism for trauma, anxiety, and depression. Gender roles and societal stigma discourage help-seeking, while caregiving responsibilities, economic dependence, and intimate partner relationships create additional treatment barriers. Women also face heightened risks of substance-related violence and exploitation Despite these challenges, gender-responsive interventions incorporating trauma-informed care, mental health support, and social empowerment strategies have shown promising outcomes. Addressing co-occurring psychiatric disorders and providing childcare support can enhance rehabilitation success. However, addiction research remains predominantly male-focused, necessitating a paradigm shift toward inclusive, gender-sensitive treatment frameworks. This review synthesizes neurobiological, social, and psychological perspectives to guide more effective, tailored interventions for women.
Keywords: Gender differences, drug addiction, neurobiology, social factors, psychological perspectives
References
Afifi, T. O., Cox, B. J., Martens, P. J., Sareen, J., & Enns, M. W. (2010). Demographic and social variables associated with problem gambling among men and women in Canada. Psychiatry Research, 178(2), 395-400. https://doi.org/10.1016/j.psychres.2009.10.003
Allen, A. M., Allen, S. S., Lunos, S., & Hatsukami, D. (2010). Severity of withdrawal symptomatology in follicular versus luteal quitters: The combined effects of menstrual phase and withdrawal on smoking cessation outcome. Addictive Behaviors, 35(8), 749-752. https://doi.org/10.1016/j.addbeh.2010.03.009
Altell, G. (2011). La prevención de la violencia contra la mujer asociada al abuso de alcohol y otras drogas. In Libro de Actas del “Noveno Congreso Sobre la Violencia Contra la Mujer”. In Proceedings of the 2nd International Congress XLVII Jornadas Nacionales De Socidrogalcohol, Alicante, Spain (Vol. 30).
Andersen, S. L., & Teicher, M. H. (2000). Sex differences in dopamine receptors and their relevance to ADHD. Neuroscience & Biobehavioral Reviews, 24(1), 137-141. https://doi.org/10.1016/S0149-7634(99)00055-9
Anker, J. J., & Carroll, M. E. (2011). Females are more vulnerable to drug abuse than males: Evidence from preclinical studies and the role of ovarian hormones. Current Topics in Behavioral Neurosciences, 8, 73-96. https://doi.org/10.1007/7854_2010_93
Benoit, T., & Jauffret-Roustide, M. (2016). Improving the management of violence experienced by women who use psychoactive substances. Strasbourg: Council of Europe. Available online: https://rm.coe.int/improving-the-management-of-violence-experienced-by-women-who-use-psyc/168075bf22 (accessed on 14 April 2024).
Bobes, J., Bascarán, M. T., Bobes-Bascarán, M. T., Carballo, J. L., Díaz Mesa, E. M., Flórez, G., & Sáiz, P. A. (2007). Valoración de la gravedad de la adicción. Aplicación a la gestión clínica y monitorización de los tratamientos. Madrid: Ministerio de Sanidad y Consumo.
Bowen, S., Chawla, N., & Marlatt, G. A. (2009). Mindfulness-based relapse prevention for addictive behaviors: A clinician's guide. Guilford Press.https://doi.org/10.1037/t68971-000
Buisman-Pijlman, F. T. A., Sumracki, N. M., Gordon, J. J., Hull, P. R., Carter, C. S., & Tops, M. (2014). Individual differences underlying susceptibility to addiction: Role for the endogenous oxytocin system. Pharmacology Biochemistry and Behavior, 119, 22-38.https://doi.org/10.1016/j.pbb.2013.09.005
Cohen & Hien, 2006 - Treatment outcomes for women with substance abuse and PTSD who have experienced complex trauma (Psychiatr. Serv., 57, 100-106).https://doi.org/10.1176/appi.ps.57.1.100
Covington, S. S. (2008). Women and addiction: A trauma-informed approach. Journal of Psychoactive Drugs, 40(sup5), 377-385.https://doi.org/10.1080/02791072.2008.10400665
Degenhardt, L., Charlson, F., Ferrari, A., Santomauro, D., Erskine, H., Mantilla-Herrara, A., ... & Whiteford, H. (2018). The global burden of disease attributable to alcohol and drug use in 195 countries and territories, 1990-2016: A systematic analysis for the Global Burden of Disease Study 2016. The Lancet Psychiatry, 5(12), 987-1012. https://doi.org/10.1016/S2215-0366(18)30337-7
Demirakca, T., Ende, G., Kämmerer, N., Welzel-Marquez, H., Fauth-Bühler, M., Hermann, D., & Mann, K. (2011). Effects of alcoholism and continued abstinence on brain volumes in both genders. Alcoholism: Clinical and Experimental Research, 35(9), 1678-1685.https://doi.org/10.1111/j.1530-0277.2011.01514.x
El-Bassel, N., Gilbert, L., Witte, S., Wu, E., & Chang, M. (2005). Intimate partner violence and substance abuse among minority women receiving care from drug treatment clinics. Journal of Substance Abuse Treatment, 29(1), 31-40.
Fattore, L., & Melis, M. (2016). Sex differences in impulsive and compulsive behaviors: A focus on drug addiction. Addictive Behaviors, 52, 1-11.
Folch, C., Casanova, J., Majó, X., Meroño, M., González, V., Colom, J., Brugal, T., & Espelt, A. (2020). Mujeres que usan drogas inyectadas y violencia: Necesidad de una respuesta integrada. Adicciones Revista Socidrogalcohol, 33, 299-306. https://doi.org/10.20882/adicciones.1322
Goldstein, J. M., Jerram, M., Poldrack, R., Ahern, T., Kennedy, D. N., Seidman, L. J., & Makris, N. (2019). Sex differences in prefrontal cortical brain activity during fMRI of auditory verbal working memory. Neuropsychology, 33(1), 19-28.
Grant, B. F., Saha, T. D., Ruan, W. J., Goldstein, R. B., Chou, S. P., Jung, J., Zhang, H., & Hasin, D. S. (2017). Epidemiology of DSM-5 drug use disorder: Results from the National Epidemiologic Survey on Alcohol and Related Conditions-III. JAMA Psychiatry, 74(6), 556-564. https://doi.org/10.1001/jamapsychiatry.2017.0113
Grella, C. E. (2008). Gender-responsive drug treatment services for women: A summary of current research and recommendations for drug court programs. Behavioral Sciences & the Law, 26(4), 467-483. https://doi.org/10.1002/bsl.825
https://doi.org/10.1016/j.jsat.2005.03.001
Jessup, M. A., Humphreys, J. C., Brindis, C. D., & Lee, K. A. (2003). Extrinsic barriers to substance abuse treatment among pregnant drug-dependent women. Journal of Drug Issues, 33(2), 285-304. https://doi.org/10.1177/002204260303300202
Kaskutas, L. A. (1994). Women's participation in Alcoholics Anonymous: Recovery and treatment implications. Journal of Substance Abuse Treatment, 11(2), 89-95.https://doi.org/10.1016/0740-5472(94)90075-2
Linehan, M. M., Schmidt, H., Dimeff, L. A., Craft, J. C., Kanter, J., & Comtois, K. A. (1999). Dialectical behavior therapy for patients with borderline personality disorder and drug-dependence. American Journal on Addictions, 8(4), 279-292.https://doi.org/10.1080/105504999305686
Liu, S., & Mager, N. A. D. (2016). Women's substance abuse treatment: The role of trauma and mental health. Journal of Substance Use, 21(1), 75-78. https://doi.org/10.3109/14659891.2014.947373
Lotzin, A., Grundmann, J., Hiller, P., Pawils, S., & Schäfer, I. (2019). Profiles of childhood trauma in women with substance use disorders and comorbid posttraumatic stress disorders. Frontiers in Psychiatry, 10, 674. https://doi.org/10.3389/fpsyt.2019.00674
Martínez-Redondo, M., & Arostegui Santamaría, E. (2021). Situación en España de la violencia de género y el abuso de sustancias. In Revisión de la Evidencia y Propuestas para el Abordaje Conjunto de la Violencia de Género y el abuso de Sustancias en los Servicios de Atención; Delegación del Gobierno para el Plan Nacional sobre Drogas, Ministerio de Sanidad: Madrid, Spain. Available online: https://pnsd.sanidad.gob.es/profesionales/publicaciones/catalogo/catalogoPNSD/publicaciones/pdf/2021_DGPNSD_Violencia_genero_abuso_susustancias.pdf (accessed on 14 April 2024).
Mechtcheriakov, S., Brenneis, C., Egger, K., Koppelstaetter, F., Schocke, M., & Marksteiner, J. (2007). A widespread distinct pattern of cerebral atrophy in patients with alcohol addiction revealed by voxel-based morphometry. Journal of Neurology, Neurosurgery & Psychiatry, 78(6), 610-614.https://doi.org/10.1136/jnnp.2006.095869
Meyers et al., 2022 - The Intersection of Gender and Drug Use-Related Stigma: A Mixed Methods Systematic Review and Synthesis of the Literature (Drug Alcohol Depend., 223, 108706). https://doi.org/10.1016/j.drugalcdep.2021.108706
Molina et al., 2020 - Psychosocial Intervention in European Addictive Behaviour Recovery Programmes: A Qualitative Study (Healthcare, 8, 268).https://doi.org/10.3390/healthcare8030268
Molina et al., 2022 - Los programas de recuperación en la intervención de los trastornos por abusos de sustancias: Buenas prácticas europeas (Rev. Española Drogodepend., 47, 33-46)https://doi.org/10.54108/10003
Molina Fernández, A. J. (2023). La recuperación de adicciones en Europa: Teoría, modelo y métodos.
Molina Fernández, A., Saiz Galdós, J., Cuenca Montesino, M. L., & Gil Rodríguez, F. (2021). Models of recovery: Influence of psychosocial factors on substance use recovery. Journal of Substance Use, 27, 310-315.https://doi.org/10.1080/14659891.2021.1941348
Najavits, L. M., Weiss, R. D., & Liese, B. S. (2002). Group cognitive-behavioral therapy for women with PTSD and substance use disorder. Journal of Substance Abuse Treatment, 22(2), 87-96.https://doi.org/10.1016/S0740-5472(02)00219-2
Najavits, L. M., Weiss, R. D., & Shaw, S. R. (1998). The link between substance abuse and posttraumatic stress disorder in women. American Journal on Addictions, 7(1), 273-283.https://doi.org/10.1111/j.1521-0391.1997.tb00408.x
Nicoletti, A., Baschi, R., Cicero, C. E., Iacono, S., Re, V. L., Luca, A., Schirò, G., & Monastero, R. (2023). Sex and gender differences in Alzheimer's disease, Parkinson's disease, and Amyotrophic Lateral Sclerosis: A narrative review. Mechanisms of Ageing and Development,https://doi.org/10.1016/j.mad.2023.111821
Polak et al., 2015 - Gender considerations in addiction: Implication for treatment (Curr. Treat. Options Psychiatry, 2, 326-338).https://doi.org/10.1007/s40501-015-0054-5
Shimu, S. J., Patil, S. M., Dadzie, E., Tesfaye, T., Alag, P., & Wieckiewicz, G. (2024). Exploring Health Informatics in the Battle against Drug Addiction: Digital Solutions for the Rising Concern. Journal of Personalized Medicine, 14(6), 556. https://doi.org/10.3390/jpm14060556
Sinha, R. (2008). Chronic stress, drug use, and vulnerability to addiction. Annals of the New York Academy of Sciences, 1141(1), 105-130. https://doi.org/10.1196/annals.1441.030
Sultana, A., Jahan Shimu, S., Jakanta Faika, M., Islam, T., Ferdous, N.-E.-., & Nessa, A. (2023). Bangladeshi parents’ knowledge and awareness about cervical cancer and willingness to vaccinate female family members against human papilloma virus: a cross sectional study. International Journal Of Community Medicine And Public Health, 10(10), 3446–3453. https://doi.org/10.18203/2394-6040.ijcmph20232830
Volkow, N. D., & McLellan, A. T. (2016). The neurobiology of addiction: A neurocircuitry analysis. The Lancet Psychiatry, 3(8), 760-773.https://doi.org/10.1016/S2215-0366(16)00104-8
Zilberman, M. L., Tavares, H., Blume, S. B., & el-Guebaly, N. (2003). Substance use disorders: Sex differences and psychiatric comorbidities. Canadian Journal of Psychiatry, 48(1), 5-13. https://doi.org/10.1177/070674370304800103
View Dimensions
View Altmetric
Save
Citation
View
Share