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…

The appeal of anonymous internet sex – Weiner is not alone

I’m going to come right out and say it – I’ve been in Anthony Weiner’s shoes.

Anthony Weiner resignsFortunately for us, my family and I didn’t have to go through all of this on public television and no-one asked me to resign my position because my sexual misdeeds were never publicized. But after all my efforts and successes quitting the drug addiction that had plagued my life I had to deal with a darker, more secret, set of issues that almost brought down everything I’d worked so hard to build. Sex can be tricky.

So yes, somewhere out there are explicit pictures I sent to women I met online although I had long ago erased the sexy pictures they had sent my way. It was part of the purging process I went through with my wife as we tried to build our trust after a simply devastating betrayal; a long purging process that to some extent is still going on more than a year after everything came out. Like I said: Sex – tricky.

The day I was found out was probably the most embarrassing, gut-wrenching, ego-shattering day I will ever experience. It trumped going through a cavity search on my way to jail or seeing my family in the courtroom as I plead guilty to count after count in my drug case. There’s nothing quite as humbling as standing in front of the person you love admitting you betrayed them, lied to them, and did so repeatedly with multiple people.

A number of pieces I read on the topic suggested that feeling “hot” or “sexy” was the most important factor in Weinergate prompted me to write this piece even though I’ve obviously been mulling this over since the whole Weiner-sex thing became public. There is no doubt that impressing these random women and getting their approval of my sexuality was an important part of the appeal for me and it’s true that this is not something many men experience in their everyday life. Still, I don’t think it was the only part and it certainly didn’t feel like the most important.

As I’ve written about numerous times in regard to my drug use and addiction, I have impulsivity issues. I always have and likely always will although I’ve learned to function relatively well with them. The problems arise when the behaviors I engage in are kept private and for me, online sex-chatting with women was a pretty normal thing that had started in the days of MySpace and continued on unabated. The problem was that I obviously wasn’t going to let anyone in on the extent of it. When I would get in relationships online chatting would take a backseat,  but it never really disappeared.

There’s something appealing, at least for someone like me, about the idea of unattached women who are ready to act a little “dirty” whenever we were both in the mood without really expecting anything in return. The more involved I got the more resources I found for finding these women and the more effort I put into impressing them so I could get what I wanted in return. In some ways, it gave me a way to hold onto the freedom of being single without having to cross some imaginary physical boundary I had convinced myself was the real version of “cheating” I knew I wasn’t to cross (full disclosure – I’d already done that).

When you combine a long single life, the immediate gratification of online sex-chatting/image-swapping, and bad impulse control you end up with some pretty messy results. I ended up using every opportunity I could to get a glimpse of the next picture a woman sent me, read an explicit message, or follow up on a response to a picture I’d sent. I no longer had drugs and this semi-anonymous sex was my quick fix. The rush was very similar and given the relationship between my old meth use and sex it makes a lot of sense.

At first I’d diagnosed myself as a sex-addict, which seemed fitting given my experience with drugs and my previously-mentioned impulsivity. Now I think that at least a good portion of it has to do with the above influences along with a pretty distorted view of the male-female relationship I had put together from my early exposure to porn. But I’ll leave at least some of that to a later date.

For now, whether it offends others or not, I feel Anthony Weiner’s pain. I am almost certain that as deliberate as this behavior seems to everyone else it had become so compartmentalized in Anthony’s head that even he didn’t know the extent of it. Shameful, taboo, and somewhat compulsive behaviors tend to do that. I know they did for me. I hope he gets to keep his family as I got to keep mine. It took a lot of work and understanding from my amazing wife, but it’s possible. Sex is tricky, especially when it’s secret.

Alcohol – Blackouts, Brownouts and how they affect your body

Do you remember what you did last night? Have you ever not remembered what you did after drinking? Drinking alcohol affects the brain and can cause lasting damage including, but not limited to, slips in memory. These memory slips can be due to lack of blood flow to brain areas that are important for memory consolidation and are commonly known as blackouts. Contrary to what popular belief, blackouts often occur in social drinkers and don’t seem to be related to age or level of alcohol dependence.


Blackouts and the Blood Alcohol Content (BAC) rate

Amnesia, or memory dysfunction, can begin to occur even with as few as one or two drinks containing alcohol. However, as the amount of alcohol intake increases so does the probability of memory impairment. Although heavy drinking alone will not always cause blackouts, heavy drinking of alcohol on an empty stomach or “chugging” alcoholic drinks often does cause blackouts.

The estimated BAC (blood alcohol content) range for blackouts begins at levels .14%- .20%. Individuals who reached high BAC levels slowly experienced far less common occurrences of blackouts. Additionally, while blackouts lead to forgetting entire events that happened while intoxicated, some individuals experience an inability to recall only parts of an event or episode (these are often called brownouts).

Blackouts can occur to anyone who drinks too much too fast. In a survey of college students, males and females experienced an equal number of blackouts, although men consumed a significantly more alcohol.

Although brain damage could potentially occur from heavy alcohol consumption, there is no evidence that blackouts are caused by brain damage per se. However, if brain damage is caused from excessive alcohol use, some studies show improvements in brain function with as little as a year of abstinence. Regardless of the possibility of reversing any effects, alcohol use causes damage in different areas of the body (including the liver), and those damages have been shown to occur more quickly among females.

Co-authored by Jamie Felzer



1. White, Aaron M., Signer, Matthew L., Kraus, Courtney L. and Swartzwelder, H. Scott(2004). Experiential Aspects of Alcohol-Induced Blackouts Among College Students, The American Journal of Drug and Alcohol Abuse,30:1,205 — 224

2. Alcohol Alert (2004) . Alcoholic Brain Damage. Alcohol Research & Health, Vol. 27.

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.