Men and women are not the same: Sex differences in addiction research

You may not have realized it, but men and women are different. Really.

When ot comes to drugs, men and women are differentThough the statement may seem like the most unnecessary, obvious, expression since the dawn of time, it’s surprising how rarely the importance of these differences comes up when we talk about addiction. Still, there’s little doubt that if our hormones, brain development, and even our reaction the to exact same stories aren’t the same, the way we react to drugs, or to addiction treatment, are likely gender specific as well. In fact, while men are almost twice as likely to meet criteria for addiction, women seem to move from casual use to addiction more quickly. Let’s explore some addiction research findings that may tell us why.

Social stress, drug use, and addiction

If you’ve gone through high-school, you know that boys and girls have different sort of social interactions. Women develop tightly knit cliques that aim to protect them from being fully ostracized while keeping out those who may cause trouble within the fold.

Indeed, when researchers compared cocaine using men and women, they found much greater neural activation in the drug-seeking brain regions of women during social stress (things like exclusion, being put down, and such) than were found for men or for women who didn’t use drugs. Similar findings have been reported for a neuroprotective hormone called DHEAS, which was found to be lower in women and in cocaine addicts, signaling their increased vulnerability to stress-induced immune problems. It’s hard to tell which came first, but social stress “triggered” these women’s systems a lot more than it did men. And the differences change behaviors too – Research in monkeys found that while male monkeys used more cocaine if they were “losers” (lower on the social ladder), female monkeys who were “leaders” were found to use more cocaine when given a chance.

Obviously, social standing and events mean different things, and bring about different reactions to drugs, for men and women.

Drug use, the brain, and gender

Not only do men and women act differently when it comes to drugs, but differences have been found in the specific brain changes associated with drug exposure between the sexes!

Research in rats has shown that brain changes following prenatal (before birth) exposure to cocaine are different between males and females and that they interact with exposure to social stimulation. In humans, researchers found differences in brain volume, and its association with early trauma, emotional, and physical, neglect between boys and girls at risk for substance abuse problems. Other work found that the prenatal cocaine exposure was more greatly associated with memory problems in women than men.

Sex (gender) and drugs – the takeaway

So, men and women are not the same. Not a big surprise I know, but the specific ways in which the two sexes react to the intake of drugs and the differences in their responses to stress that may motivate them to use at different times can become important factors to consider both in prevention AND in addiction treatment setting. For instance, it seems that we’d want to look at the possibility that drug prevention efforts should look at social-standing among adolescents when determining might need the most attention. Also, if exposure to drugs affects the brain differently in the different sexes because of differences in the concentration of protective hormones, it’s possible that the specific aspects of treatment that require focus might be different too.

Some food for thought…

Trauma and Addiction – The often ignored reality about addiction

In previous post, I’ve talked about some of the links between addiction concepts like cravings and trauma disorders like PTSD (see here). The reality is that there is a closer link between addiction and trauma that is often overlooked.

I spend a lot of time on this site covering some of the neuroscience that explains why the repeated use of addictive substances can lead to the kind of behavior that is so common in addiction. Still, most of that neuroscience ignores the portions of a person’s life that come before the actual drug use. The one exception would have to be all my writing on impulsivity, and some work on the relationship between early life stress (or trauma) and depression, which is known to be associated with drug abuse.

The way I see it, there are at least 3 distinct stages to addiction :

  • What happens before drug use.
  • What happens once chronic drug use begins.
  • What happens once a person stops using.

Though we often like to pretend otherwise, trauma is a common part of the first stage.

How do we define trauma?

In this context, trauma is any event that affects a person in a way that can be seen to have caused a substantial, long term, psychological disturbance. The key to this way of looking at trauma is its subjective nature.

Things like divorce, bullying, rejection, or physical injury can all be considered traumatic if the subjective experience can be thought to conform to this definition. Anything counts as long as it leaves a painful emotional mark.

While we’re all pretty adapt at covering up such trauma, the emotional pain often needs to be soothed and a good way to soothe it is with drugs that make it temporarily go away. The first drink of alcohol, or hit of some other drug, will often take care of that.

The reality of early trauma and addiction

Some call the experience of covering up the pain of trauma with drugs “self-medication” (though the term also applies to other situations), some dislike the term, but I think the fact remains that often, emotional pain can begin a search that often leads to risky behaviors and drugs.

I’m nowhere near calling self-medication the only reason for drug abuse as some others do, but I think it’s an important factor and one that can’t be ignored. As the stigma of emotional pain, or emotional responding in general, is reduced, people’s ability to deal with such pain in a healthy way should lead to a reduction in seemingly helpful, but ultimately self-destructive behaviors.

One of the most useful roles of psychotherapy for addicts is in dealing with the trauma in a healthy, constructive manner. This way the shame, guilt, and other negative emotions associated with it stop guiding the person’s behavior. While this is rarely enough to stop the need for self-medication by itself, it can be a very useful part of a comprehensive treatment plan. It’s important to remember that once someone has entered the realm of chronic drug use, there are brain and body changes that can often trump whatever the reason for beginning drug use was.

The ignored reality about addiction is that it often has an origin in behavior and unfortunately, trauma is often that starting point.

Women, Trauma and HIV Transmission

Co-authored by Jamie Felzer

Just how much can the events of a traumatic childhood affect the likelihood of contracting HIV or other serious diseases in later life? Unfortunately, recent research shows that the effect can be profound, especially for women.The silver lining may be in our ability to reduce later HIV transmission by providing better intervention services post-trauma.

Childhood Trauma, Women and HIV/AIDS

In ways both surprising and predictable, it seems that even very early childhood trauma can be firmly linked to high risk behaviors and a higher risk of contracting HIV. And with AIDS now reported by the US Department of Heath & Human Services as the leading cause of death for African-American women between the ages of 25-34 (and the perhaps even more sobering H&HS assessment that African-American women are a staggering 21 times more likely to die from AIDS compared to non-Hispanic white women), this crisis has a particular impact on women of color.

The obvious conclusion is that those subjected to childhood trauma are more likely to engage in risky behavior in an attempt to relieve some of the chronic stress that often accompanies such experiences. Drug use, unprotected sex, heavy drinking and other accompanying behaviors can all seem like appropriate responses to mental and emotional stress, but that stress can also inhibit one’s ability to make safe choices in this context. This naturally leads to an increased risk for contracting sexually transmitted diseases and blood-borne pathogens. Factor in the simple biological reasons why women may be at an elevated risk of contracting HIV through any one encounter, and it becomes clear that many at-risk young women are not receiving adequate education on how to protect themselves against this threat.

Many young women with a history of trauma and elevated lifetime stress from sexual assault, violence or any of the myriad stressors that accompany low socioeconomic status may be inadvertently putting themselves at greater risk for contracting HIV and AIDS. As mentioned, these risks can commonly come from unsafe sex and the abuse of unknown drugs, potentially with non-sterile needles. Without a strong support system to help them adequately process the short and long-term effects of trauma, many young women end up developing symptoms of chronic anxiety and depression, conditions that can alter behavior and even ultimately lead to demonstrated higher rates of mortality. That these conditions also often co-exist with other health issues linked to lower socioeconomic status such as obesity and heart disease serves to further compound this risk. Stress has even been shown to speed the progression of the AIDS virus, making the disease itself more deadly.

And with a full 1/3 of the female population having reported some form of sexual assault or similar violent trauma, the sad reality is that the risks for contracting HIV among young women are, if anything, growing. It seems that one way to attack the HIV pandemic is by improving prevention, as well as intervention, services, for women affected by such early trauma. It might be a way to kill two, or even more, birds with one stone.

Ancestry, Addiction, and trauma – Addiction research into genetic differences based on race

We all know that drug use and drug related crimes are a big problem within African American communities. It’s not a secret, but it can be interpreted very differently by different people. Do the differences between African Americans and Americans from European descent mean that Black people are simply meant to have more problems?

A recent study suggests that at least when it comes to addictions, the opposite might be true.

A genetic study of addiction and ancestry

Researchers at the New Jersey VA (Veterans’ Affairs) office collected data from 407 addicted African American patients as well as from 457 comparison participants at a local hospital’s ophthalmology clinic. Like in most studies of this nature, both groups was screened for other psychiatric problems and participants from the control group were excluded from the study if they showed any signs of addiction problems themselves.

The researchers then used 186 different genetic markers that relate to ancestry to determine the proportion of African, European, and Asian descent for each participant. After following this up with some questionnaires about childhood trauma and an estimations of participant socioeconomic status (things like income, education, age, etc.), the researchers ran analyses to see if African ancestry was related to drug problems, childhood trauma, and poverty.

The ancestry of the participants was verified to be mostly (average 80%) African, with European, Middle East, and Central Asia contributing between 5% and 7% more.

What did they find?

Addiction research about race and genetics - The proportion of African ancestry among the different groupsThe first interesting finding was the fact that patients with alcohol, cocaine, or opiate dependence had lower proportion of African ancestry than non addicted individuals. The differences ranged from 5% to 3% but certainly reached significance levels. Since its already known that Europeans are more likely to show alcohol, but not drug, problems, the researchers checked to see if that was the factor responsible for the difference – it wasn’t.

Interestingly, even though childhood abuse or neglect were very much related to addiction in this sample (as we’ve talked about before), there was no relationship between African Ancestry and abuse or neglect.In fact, the two factors that were almost significant (childhood physical and sexual abuse) showed trends similar to those for addiction – African descent was associated with lower problems in those areas.

The final, and not surprising finding, had to do with an association between African ancestry and lower socioeconomic status. The differences in these categories were significant for income and education. This finding can almost serve as a validity check on the whole experiment, since census data has long shown lower SES for African Americans in the united States.

What does this all mean?

Okay, I know this isn’t necessarily the easiest study to understand, so let’s break it down:

Given the known drug problems among African Americans, the researchers wanted to know if African descent could have something to do with underlying genetic factors that make it more likely that Black individuals will end up as drug addicts. There are a host of genetic differences between Europeans, Asians, and Africans, and this was a way to get at a lot of them in one shot. The problem is that African Americans are also poorer than many European Americans, and since poverty is a known risk-factor for addiction, meaning it makes it more likely that someone will end up an addict, the researchers were interested in separating the two. They threw trauma in because it, like poverty, has already been shown to be related to addiction.

The results seemed to indicate that the two factors (poverty and addiction) as indeed separate. While African descent was associated with more poverty, it was actually found to be associated with less drug, and alcohol problems. This suggests that it’s the poverty, and all the factors associated with it, that may be driving the higher addiction rates among African Americans and not some predisposition to drug problems.

The good news is that this suggests that efforts at improving the SES and quality of life for African Americans in the United States will indeed lower their substance abuse rates. In fact, when it comes down to it, this research suggests that European Americans are the ones we need to watch for in terms of genetic risk for addiction.

As always, limitations

As usual, we need to remember that these are associations and don’t prove causality. Also, given the very specific sample used (veteran addicts), the results should be replicated in other populations. Lastly, remember that the ancestry-based differences weren’t huge, but given the fact that this was a strictly African American sample, that’s probably part of the package. Again, more research with  broader populations should help to resolve that.

Citation:

Francesca Ducci, Alec Roy, Pei-Hong Shen,Qiaoping Yuan, Nicole P. Yuan,  Colin A. Hodgkinson, Lynn R. Goldman, and David Goldman (2009). Association of Substance Use Disorders With Childhood Trauma but not African Genetic Heritage in an African American Cohort. American Journal of Psychiatry, 166, 1031-1040.