Gender Differences in Cocaine Use Disorders

Gender Differences in Cocaine Use Disorders

While men continue to have a higher rate of current cocaine use than women, the gap is narrowing (Van Etten and Anthony, 1999; SAMHSA, 1996). Some studies have reported that women co-caine abusers differ from men in several respects, including re-sponses to the direct administration of cocaine.

Much of the research on substance abuse treatment effi-cacy is based predominantly on male samples. Cocaine depend-ence in women is as severe as that in men, however women often receive less treatment for their substance abuse (McCance-Katz et al., 1999). Studies have also suggested that cocaine depend-ence can develop more rapidly in women than in men. Cocaine is one of the most frequently abused illicit drugs during pregnancy (SAMHSA, 1999). It has been estimated that 0.1% of pregnant women are cocaine users (SAMHSA, 1999). The risks of cocaine and other substance abuse during pregnancy are significant not only for women but also for their unborn children who may be at increased risk of vascular injury to the central nervous system. Abuse of cocaine has been linked to placental abruption, preterm labor, and low birth weight. Abuse and neglect of children are also common consequences of parental addiction Recent stud-ies have suggested that children exposed to cocaine in utero do not appear to have permanent sequelae attributable to maternal cocaine abuse.

Relationship of Psychiatric Disorders to Cocaine Abuse and Dependence

Several studies have documented the high rate of comorbid psy-chiatric disorders in cocaine abusers entering treatment. These disorders include mood disorders (major depressive disorder, bipolar disorders), schizophrenia, post traumatic stress disor-der, attention-deficit hyperactivity disorder, anxiety disorders and antisocial personality disorder. Mood disorders often tem-porally follow the onset of cocaine abuse in patients presenting for treatment, while attention-deficit hyperactivity disorder and antisocial personality disorder precede the onset of cocaine abuse (McMahon et al., 1999; Clure et al., 1999). However, while high levels of depressive symptoms during treatment were associated with greater craving for cocaine, alcohol and other substances, only limited evidence exists regarding the influence of depres-sion on treatment course and outcome (Carroll et al., 1995; Brown et al., 1998; Simpson et al., 1999).

It is important to note that comorbid psychiatric illnesses are common among cocaine users. Furthermore, the diagnosis of a comorbid primary psychiatric disorder can be challenging to make in cocaine abusers because psychiatric symptoms may be the result of cocaine abuse or acute abstinence. When psychiatric disorders cooccur with cocaine use disorders, it is important to provide treatment for both disorders. Cocaine use disorders will not generally resolve with treatment of the psychiatric disorder alone, nor will substance abuse treatment resolve a comorbid psychiatric disorder.