Sex and Gender Differences in Substance Use
Men are more likely than women to use almost all types of illicit drugs (SAMHSA, 2014), and illicit drug use is more likely to result in emergency department visits or overdose deaths for men than for women. "Illicit" refers to use of illegal drugs, including marijuana (according to federal law) and misuse of prescription drugs. For most age groups, men have higher rates of use or dependence on illicit drugs and alcohol than do women (TEDS, 2012). However, women are just as likely as men to become addicted (Anthony et al., 1994). In addition, women may be more susceptible to craving (Robbins et al., 1999; Hitschfeld et al., 2015; Fox et al., 2014; Kennedy et al., 2013) and relapse (Kippin et al., 2005; Rubonis et al., 1994), which are key phases of the addiction cycle. Women of color may face unique issues with regard to drug use and treatment needs. For example, African-American and American Indian/Alaska Native women are more likely than women of other racial and ethnic groups to be victims of rape, physical violence, and stalking by an intimate partner in their lifetime—issues that are risk factors for substance use and should be addressed during treatment. More information can be found in Women of Color: Health Data Book (ORWH/NIH),(PDF, 2.5MB).
Similarly to other addictive drugs, fewer females than males use marijuana (SAMHSA, 2014). For females who do use marijuana, however, the effects can be different than for male users. Research indicates that marijuana impairs spatial memory in women more than it does in men (Makela et al., 2006; Pope et al., 1997). However, males show a greater marijuana-induced "high" (Haney, 2007; Penetar et al., 2005). Male high school students who smoke marijuana report poor family relationships and problems at school more often than female students who smoke marijuana (Butters, 2005). In contrast, animal studies show that female rats are more sensitive to the rewarding (Fattore et al., 2007; Craft et al., 2013), pain-relieving (Craft et al., 2012; Romero et al., 2002; Tseng & Craft, 2001), and activity-altering (Tseng & Craft, 2001; Craft et al., 2012; Wiley, 2003) effects of marijuana's main active ingredient delta-9-tetrahydrocannabinol (THC). Many of these differences have been attributed to the effects of sex hormones (Fattore et al., 2007; Craft & Leitl, 2008; Craft et al., 2012; Fattore et al., 2010; Winsauer et al., 2011), although rodent research also points to the possibility that there are sex differences in the functioning of the endocannabinoid system, the system of brain signaling where THC and other cannabinoids exert their actions (Krebs-Kraft et al., 2010; Craft et al., 2013). A few studies have suggested that teenage girls who use marijuana may have a higher risk of brain structural abnormalities as a result of regular marijuana exposure than teenage boys (Medina et al., 2009; McQueeny et al., 2011).
For both sexes, addiction to marijuana is associated with an increased risk of at least one other mental health issue, such as depression or anxiety. However, men who are addicted to marijuana have higher rates of other substance use problems as well as antisocial personality disorders. By contrast, women who are addicted to marijuana have more panic attacks (Thomas, 1996) and anxiety disorders (Buckner et al., 2012; Buckner et al., 2006). Although the severity of cannabis use disorders is generally higher for men, women tend to develop these disorders more quickly after their first marijuana use (Hernandez-Avila et al., 2004). Rates of seeking treatment for marijuana addiction are low for both sexes (Khan et al., 2013).
Stimulants (Cocaine and Methamphetamine)
Research in both humans and animals suggests that women may be more vulnerable to the reinforcing (rewarding) effects of stimulants, with estrogen possibly being one factor for this increased sensitivity (Evans & Foltin, 2006; Justice & de Wit, 2000; Justice & de Wit, 1999; Anker & Carroll, 2011). In animal studies, females are quicker to start taking cocaine—and take it in larger amounts—than males. Women may also be more sensitive than men to cocaine's effects on the heart and blood vessels. In contrast, female and male cocaine users show similar deficits in learning, concentration, and academic achievement as a result of cocaine use, even if women had been using it longer. Female cocaine users are also less likely than male users to exhibit abnormalities of blood flow in the brain's frontal regions. These findings suggest a sex-related mechanism that may protect women from some of the damage cocaine inflicts on the brain (NIDA Notes, 2000).
Although some women report using methamphetamine to control weight, any effort to enhance physical appearance will disappear over time with the extensive physical damage caused to the skin and teeth. Women also report using methamphetamine because they believe it will increase energy and decrease exhaustion associated with work, home care, child care, and family responsibilities (Cretzmeyer et al., 2003; Brecht et al., 2004). Women who use methamphetamine also have high rates of co-occurring depression (Hser et al., 2005; Zweben et al., 2004; Rawson et al., 2005; Dluzen & Liu, 2008).
Women tend to begin using methamphetamine at an earlier age than do men (Brecht et al., 2004; Hser et al., 2005), with female users typically more dependent on methamphetamine compared to male users (Rawson et al., 2005; Kim & Fendrich, 2002). Women are also less likely to switch to another drug when they lack access to methamphetamine (Brecht et al., 2004). In addition, women tend to be more receptive than men to methamphetamine treatment (Lin et al., 2004; Brecht et al., 2004; Hser et al., 2005; Dluzen & Liu, 2008).
MDMA (Ecstasy, Molly)
Research suggests that MDMA produces stronger hallucinatory effects in women compared to men, although men show higher MDMA-induced blood pressure increases (Liechti et al., 2001). There is some evidence that, in occasional users, women are more prone than men to feeling depressed a few days after they last used MDMA (Verheyden et al., 2002). Both men and women show similar increases in aggression a few days after they stop using MDMA (Verheyden et al., 2002; Hoshi et al., 2006).
MDMA can interfere with the body's ability to eliminate water and decrease sodium levels in the blood, causing a person to drink large amounts of fluid. In rare cases, this can lead to increased water in the spaces between cells, which may eventually produce swelling of the brain and even death. Young women are more likely than men to die from this reaction—with almost all reported cases of death occurring in young females between the ages of 15 and 30 (Campbell & Rosner, 2008; Moritz et al., 2013). MDMA can also interfere with temperature regulation and cause acute hyperthermia leading to neurotoxic effects and even death (MDMA can be fatal in warm environments, 2014).
- likely to use smaller amounts and for a shorter time
- less likely to inject the drug
- more influenced by drug-using sexual partners
Research suggests that women tend to use smaller amounts of heroin and for less time, and are less likely than men to inject it (Powis et al., 1996). Most women who inject heroin point to social pressure and sexual partner encouragement as factors (Bryant et al., 2010; Lum et al., 2005; Dwyer et al., 1994; Powis et al., 1996). One study indicates that women are more at risk than men for overdose death during the first few years of injecting heroin. It is unclear why this might be the case. One possibility is that women who inject heroin are more likely than their male counterparts to also use prescription drugs—a dangerous combination. Women who do not overdose within these first few years are more likely than men to survive in the long term. This could be due to differences in treatment and other environmental factors that impact heroin use (Gjersing & Bretteville-Jensen, 2014).
Prescription drug misuse is the use of a medication without a prescription, in a way other than as prescribed, or for the experience or feelings elicited. Prescription drugs can also be dangerous if mixed together without a physician's guidance, or mixed with other drugs or alcohol.
Pain Relievers (Opioids)
Some research indicates that women are more sensitive to pain than men (Riley et al., 1998) and more likely to have chronic pain (Gerdle et al., 2008), which could contribute to the high rates of opioid prescriptions among women of reproductive age (Ailes et al., 2015). In addition, women may be more likely to take prescription opioids without a prescription to cope with pain, even when men and women report similar pain levels. Research also suggests that women are more likely to misuse prescription opioids to self-treat for other problems such as anxiety or tension (McHugh et al., 2013).
A possible consequence of prescription opioid misuse is fatal overdose, which can occur because opioids suppress breathing. From 1999 to 2010, deaths from prescription pain reliever overdoses increased more rapidly for women (400 percent) than for men (265 percent) (CDC Vital Signs, 2013). In 2010, about 18 women per day (New CDC Vital Signs, 2013) compared to about 27 men (Mack et al., 2013) died from overdosing on prescription pain relievers. Women between the ages of 45 and 54 are more likely than women of other age groups to die from a prescription pain reliever overdose (CDC Vital Signs, 2013).
Anti-Anxiety Medications and Sleeping Aids
Women are more likely to seek treatment for misuse of barbiturates (TEDS, 2012), which includes sedatives sometimes prescribed to treat seizures, sleep disorders, and anxiety, and to help people fall asleep prior to surgery. Women are also more likely than men to die from overdoses of medicines for mental health conditions, like antidepressants. Antidepressants and benzodiazepines (anti-anxiety or sleep drugs) send more women than men to emergency departments (CDC Vital Signs, 2013). Because women are also more at risk than men for anxiety (Anxiety Disorders, n.d.), depression (NIMH, 2009), and insomnia (NHLBI, 1997), it is possible that women are being prescribed more of these types of medications; greater access can increase the risk of misuse and lead to addiction or overdose.
In general, men have higher rates of alcohol use, including binge drinking. However, teens are an exception: Teen boys and girls are similar in rates of current drinking (SAMHSA, 2014).
Drinking over the long term is more likely to damage a woman's health than a man's, even if the woman has been drinking less alcohol or for a shorter length of time (Holman et al., 1996; Piazza et al., 1989). Comparing people with alcohol use disorders, women have death rates 50 to 100 percent higher than do men, including deaths from suicides, alcohol-related accidents, heart disease, stroke, and liver disease (NIAAA, 2008). In addition, there are some health risks that are unique to female drinkers. For example, heavy drinking is associated with increased risk of having unprotected sex, resulting in pregnancy or disease (Rehm et al., 2012), and an increased risk of becoming a victim of violence and sexual assault. In addition, drinking as little as one drink per day can slightly raise the risk of breast cancer in some women, especially those who are postmenopausal or have a family history of breast cancer (NIAAA, 2008).
In addition, men and women metabolize alcohol differently due to differences in gastric tissue activity. In fact, after drinking comparable amounts of alcohol, women have higher blood ethanol concentrations (Frezza et al., 1990; NIAAA, 1999; NIAAA, 2008; Lieber, 2000). As a result, women become intoxicated from smaller quantities of alcohol than men (NIAAA, 1999).
Source: NIAAA (Is your drinking pattern risky?)
More information on sex and gender differences in alcohol use is available from NIAAA.
Research indicates that men and women differ in their smoking behaviors. For instance, women smoke fewer cigarettes per day, tend to use cigarettes with lower nicotine content, and do not inhale as deeply as men (Melikian, 2007). Women also may smoke for different reasons than men, including regulation of mood and stress (Cosgrove et al., 2014). It is unclear whether these differences in smoking behaviors are because women are more sensitive to nicotine, because they find the sensations associated with smoking less rewarding, or because of social factors contributing to the difference; some research also suggests women may experience more stress and anxiety as a result of nicotine withdrawal than men (Torres & O'Dell, 2015).
Risk of death from smoking-associated lung cancer, chronic obstructive pulmonary disease, heart disease, and stroke continues to increase among women—approaching rates for men (Thun et al., 2013). According to data collected from 2005 to 2009, approximately 201,000 women die each year due to factors related to smoking—compared to about 278,000 men (Smoking & Tobacco Use, 2014). Some dangers associated with smoking—such as blood clots, heart attack, or stroke—increase in women using oral contraceptives (Farley et al., 1998).
The number of smokers in the United States declined in the 1970s and 1980s, remained relatively stable throughout the 1990s, and declined further through the early 2000s. Because this decline in smoking was greater among men than women, the prevalence of smoking is only slightly higher for men today than it is for women. Several factors appear to be contributing to this narrowing gender gap, including women being less likely than men to quit and more likely to relapse if they do quit (Piper et al., 2010).
- Ailes EC, Dawson AL, Lind JN, et al (from Centers for Disease Control and Prevention). Opioid prescription claims among women of reproductive age—United States, 2008-2012. MMWR Morb and Mortal Wkly Rep. 2015;64(2);37-41.
- Anker JJ, Carroll ME. Females are more vulnerable to drug abuse than males: evidence from preclinical studies and the role of ovarian hormones. Curr Top Behav Neurosci. 2011;8:73-96.
- Anthony JC, Warner LA, Kessler RC. Comparative epidemiology of dependence on tobacco, alcohol, controlled substances, and inhalants: basic findings from the National Comorbidity Survey. Exp Clin Psychopharmacol. 1994;2(3):244-268.
- Anxiety Disorders. National Institute of Mental Health. www.nimh.nih.gov/health/topics/anxiety-disorders/index.shtml. Accessed July 7, 2015.
- Brecht M-L, O'Brien A, von Mayrhauser C, Anglin MD. Methamphetamine use behaviors and gender differences. Addict Behav. 2004;29(1):89-106.
- Bryant J, Brener L, Hull P, Treloar C. Needle sharing in regular sexual relationships: an examination of serodiscordance, drug using practices, and the gendered character of injecting. Drug Alcohol Depend. 2010;107(2-3):182-187.
- Buckner JD, Heimberg RG, Schneier FR, Liu SM, Wang S, Blanco C. The relationship between cannabis use disorders and social anxiety disorder in the National Epidemiological Study of Alcohol and Related Conditions (NESARC). Drug Alcohol Depend. 2012;124(1-2):128-134.
- Buckner JD, Mallott MA, Schmidt NB, Taylor J. Peer influence and gender differences in problematic cannabis use among individuals with social anxiety. J Anxiety Disord. 2006;20(8):1087-1102.
- Butters JE. Promoting healthy choices: the importance of differentiating between ordinary and high risk cannabis use among high-school students. Subst Use Misuse. 2005;40(6):845-855.
- Campbell GA, Rosner MH. The agony of ecstasy: MDMA (3,4-methylenedioxymethamphetamine) and the kidney. Clin J Am Soc Nephrol. 2008;3(6):1852-1860.
- CDC Vital Signs: Prescription Painkiller Overdoses: A growing epidemic, especially among women. Centers for Disease Control and Prevention. www.cdc.gov/vitalsigns/prescriptionpainkilleroverdoses/index.html. Reviewed July 2, 2013. Accessed July 7, 2015.
- Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration, Treatment Episode Data Set (TEDS). Substance Abuse Treatment Admissions by Primary Substance of Abuse, According to Sex, Age Group, Race, and Ethnicity, Year = 2012, United States. wwwdasis.samhsa.gov/webt/quicklink/US12.htm. Accessed July 7, 2015.
- Centers for Disease Control and Prevention (CDC). The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014.
- Cosgrove KP, Wang S, Kim S-J, et al. Sex differences in the brain's dopamine signature of cigarette smoking. J Neurosci. 2014;34(50):16851-16855.
- Craft RM, Leitl MD. Gonadal hormone modulation of the behavioral effects of Δ9-tetrahydrocannabinol in male and female rats. Eur J Pharmacol. 2008;578(1):37-42.
- Craft RM, Marusich JA, Wiley JL. Sex differences in cannabinoid pharmacology: a reflection of differences in the endocannabinoid system? Life Sci. 2013;92(8-9):476-481.
- Craft RM, Wakley AA, Tsutsui KT, Laggart JD. Sex differences in cannabinoid 1 vs. cannabinoid 2 receptor-selective antagonism of antinociception produced by Δ9-tetrahydrocannabinol and CP55,940 in the rat. J Pharmacol Exp Ther. 2012;340(3):787-800.
- Cretzmeyer M, Sarrazin MV, Huber DL, Block RI, Hall JA. Treatment of methamphetamine abuse: research findings and clinical directions. J Subst Abuse Treat. 2003;24(3):267-277.
- Dluzen DE, Liu B. Gender differences in methamphetamine use and responses: a review. Gend Med. 2008;5(1):24-35.
- Dwyer R, Richardson D, Ross MW, Wodak A, Miller ME, Gold J. A comparison of HIV risk between women and men who inject drugs. AIDS Educ Prev. 1994;6(5):379-389.
- Evans SM, Foltin RW. Exogenous progesterone attenuates the subjective effects of smoked cocaine in women, but not in men. Neuropsychopharmacology. 2006;31(3):659-674.
- Farley TM, Meirik O, Chang CL, Poulter NR. Combined oral contraceptives, smoking, and cardiovascular risk. J Epidemiol Community Health. 1998;52(12):775-785.
- Fattore L, Spano MS, Altea S, Angius F, Fadda P, Fratta W. Cannabinoid self-administration in rats: sex differences and the influence of ovarian function. Br J Pharmacol. 2007;152(5):795-804.
- Fattore L, Spano MS, Altea S, Fadda P, Fratta W. Drug- and cue-induced reinstatement of cannabinoid-seeking behaviour in male and female rats: influence of ovarian hormones. Br J Pharmacol. 2010;160(3):724-735.
- Fox HC, Morgan PT, Sinha R. Sex differences in guanfacine effects on drug craving and stress arousal in cocaine-dependent individuals. Neuropsychopharmacology. 2014;39:1527-1537.
- Frezza M, di Padova C, Pozzato G, Terpin M, Baraona E, Lieber CS. High blood alcohol levels in women – the role of decreased gastric alcohol dehydrogenase activity and first-pass metabolism. N Engl J Med. 1990;322(2):95-99.
- Gerdle B, Björk J, Cöster L, Henriksson KG, Henriksson C, Bengtsson A. Prevalence of widespread pain and associations with work status: a population study. BMC Musculoskelet Disord. 2008;9:102.
- Gjersing L, Bretteville-Jensen AL. Gender differences in mortality and risk factors in a 13-year cohort study of street-recruited injecting drug users. BMC Public Health. 2014;14:440.
- Haney M. Opioid antagonism of cannabinoid effects: differences between marijuana smokers and nonmarijuana smokers. Neuropsychopharmacology. 2007;32:1391-1403.
- Hernandez-Avila CA, Rounsaville BJ, Kranzler HR. Opioid-, cannabis- and alcohol-dependent women show more rapid progression to substance abuse treatment. Drug Alcohol Depend. 2004;74(3):265-272.
- Hitschfeld MJ, Schneekloth TD, Ebbert JO, et al. Female smokers have the highest alcohol craving in a residential alcoholism treatment cohort. Drug Alcohol Depend. 2015;150:179-182.
- Holman CD, English DR, Milne E, Winter MG. Meta-analysis of alcohol and all-cause mortality: a validation of NHMRC recommendations. Med J Aust. 1996;164(3):141-145.
- Hoshi R, Pratt H, Mehta S, Bond AJ, Curran HV. An investigation into the sub-acute effects of ecstasy on aggressive interpretative bias and aggressive mood – are there gender differences? J Psychopharmacol. 2006;20(2):291-301.
- Hser YI, Evans E, Huang YC. Treatment outcomes among women and men methamphetamine abusers in California. J Subst Abuse Treat. 2005;28(1):77-85.
- Is your drinking pattern risky? What's "low-risk" drinking? Rethinking Drinking: Alcohol and your health. National Institute on Alcohol Abuse and Alcoholism. www.rethinkingdrinking.niaaa.nih.gov/IsYourDrinking PatternRisky/WhatsLowRiskDrinking.asp. Accessed July 7, 2015.
- Justice AJ, de Wit H. Acute effects of d-amphetamine during the early and late follicular phases of the menstrual cycle in women. Pharmacol Biochem Behav. 2000;66(3):509-515.
- Justice AJ, de Wit H. Acute effects of d-amphetamine during the follicular and luteal phases of the menstrual cycle in women. Psychopharmacology (Berl). 1999;145(1):67-75.
- Kennedy AP, Epstein DH, Phillips KA, Preston KL. Sex differences in cocaine/heroin users: drug-use triggers and craving in daily life. Drug Alcohol Depend. 2013;132(0):29-37.
- Khan SS, Secades-Villa R, Okuda M, et al. Gender differences in cannabis use disorders: results from the National Epidemiologic Survey of Alcohol and Related Conditions. Drug Alcohol Depend. 2013;130(1-3):101-108.
- Kim JY, Fendrich M. Gender differences in juvenile arrestees' drug use, self-reported dependence, and perceived need for treatment. Psychiatr Serv. 2002;53(1):70-75.
- Kippin TE, Fuchs RA, Mehta RH, et al. Potentiation of cocaine-primed reinstatement of drug seeking in female rats during estrus. Psychopharmacology (Berl). 2005;182(2):245-252.
- Krebs-Kraft DL, Hill MN, Hillard CJ, McCarthy MM. Sex difference in cell proliferation in developing rat amygdala mediated by endocannabinoids has implications for social behavior. Proc Natl Acad Sci U S A. 2010;107(47):20535-20540.
- Lieber CS. Ethnic and gender differences in ethanol metabolism. Alcohol Clin Exp Res. 2000;24(4):417-418.
- Liechti ME, Gamma A, Vollenweider FX. Gender differences in the subjective effects of MDMA. Psychopharmacology (Berl). 2001;154(2):161-168.
- Lin SK, Ball D, Hsiao CC, Chiang YL, Ree SC, Chen CK. Psychiatric comorbidity and gender differences of persons incarcerated for methamphetamine abuse in Taiwan. Psychiatry Clin Neurosci. 2004;58(2):206-212.
- Lum PJ, Sears C, Guydish J. Injection risk behavior among women syringe exchangers in San Francisco. Subst Use Misuse. 2005;40(11):1681-1696.
- Mack KA, Jones CM, Paulozzi LJ. Vital Signs: overdoses of prescription opioid pain relievers and other drugs among women – United States, 1999-2010. Morbidity and Mortality Weekly Report. 2013;62(26):537-542.
- Makela P, Wakeley J, Gijsman H, Robson PJ, Bhagwagar Z, Rogers RD. Low doses of Δ-9-tetrahydrocannabinol (THC) have divergent effects on short-term spatial memory in young, healthy adults. Neuropsychopharmacology. 2006;31:462-470.
- McHugh RK, DeVito EE, Dodd D, et al. Gender differences in a clinical trial for prescription opioid dependence. J Subst Abuse Treat. 2013;45(1):38-43.
- McQueeny T, Padula CB, Price J, Medina KL, Logan P, Tapert SF. Gender effects on amygdala morphometry in adolescent marijuana users. Behav Brain Res. 2011;224(1):128-134.
- MDMA can be fatal in warm environments [news release]. Rockville, MD: National Institute on Drug Abuse; June 3, 2014. www.drugabuse.gov/news-events/news-releases/2014/06/mdma-can-be-fatal-in-warm-environments. Accessed July 7, 2015.
- Medina KL, McQueeny T, Nagel BJ, Hanson KL, Yang TT, Tapert SF. Imaging Study: Prefrontal cortex morphometry in abstinent adolescent marijuana users: subtle gender effects. Addict Biol. 2009;14(4):457-468.
- Melikian AA, Djordevic MV, Hosey J, et al. Gender differences relative to smoking behavior and emissions of toxins from mainstream cigarette smoke. Nicotine Tob Res. 2007;9(3):377-387.
- Moritz ML, Kalantar-Zadeh K, Ayus JC. Ecstacy-associated hyponatremia: why are women at risk? Nephrol Dial Transplant. 2013;28(9):2206-2209.
- National Heart, Lung, and Blood Institute (NHLBI). Problem Sleepiness in Your Patient. Bethesda, MD: National Institutes of Health; 1997. NIH Publication No. 97-4073.
- National Institute of Mental Health (NIMH). Women and Depression: Discovering Hope. Bethesda, MD: National Institutes of Health; 2009. NIH Publication No. 09-4779.
- National Institute on Alcohol Abuse and Alcoholism (NIAAA). Alcohol: A Women's Health Issue. Bethesda, MD: National Institutes of Health; 2008. NIH Publication No. 03-4956.
- National Institute on Alcohol Abuse and Alcoholism (NIAAA). Are women more vulnerable to alcohol's effects? Alcohol Alert. Rockville, MD: National Institute on Alcohol Abuse and Alcoholism; 1999.
- New CDC Vital Signs: Prescription Painkiller Epidemic Among Women [press release]. Atlanta, GA: Centers for Disease Control and Prevention; December 16, 2013. www.cdc.gov/media/dpk/2013/dpk-Prescription%20drug%20overdose.html. Accessed July 7, 2015.
- NIDA Notes: Gender Differences in Drug Abuse Risks and Treatment. National Institute on Drug Abuse. http://archives.drugabuse.gov/NIDA_Notes/NNVol15N4/Tearoff.html. Published September 2000. Accessed July 7, 2015.
- Penetar DM, Kouri EM, Gross MM, et al. Transdermal nicotine alters some of marihuana's effects in male and female volunteers. Drug Alcohol Depend. 2005;79(2):211-223.
- Piazza NJ, Vrbka JL, Yeager RD. Telescoping of alcoholism in women alcoholics. Int J Addict. 1989;24(1):19-28.
- Piper ME, Cook JW, Schlam TR, et al. Gender, race, and education differences in abstinence rates among participants in two randomized smoking cessation trials. Nicotine Tob Res. 2010;12(6):647-657.
- Pope HG Jr, Jacobs A, Mialet JP, Yurgelun-Todd D, Gruber S. Evidence for a sex-specific residual effect of cannabis on visuospatial memory. Psychother Psychosom. 1997;66(4):179-184.
- Powis B, Griffiths P, Gossop M, Strang J. The differences between male and female drug users: community samples of heroin and cocaine users compared. Subst Use Misuse. 1996;31(5):529-543.
- Rawson RA, Gonzales R, Obert JL, McCann MJ, Brethen P. Methamphetamine use among treatment-seeking adolescents in Southern California: participant characteristics and treatment response. J Subst Abuse Treat. 2005;29(2):67-74.
- Rehm J, Shield KD, Joharchi N, Shuper PA. Alcohol consumption and the intention to engage in unprotected sex: systematic review and meta-analysis of experimental studies. Addiction. 2012;107(1):51-59.
- Riley JL III, Robinson ME, Wise EA, Myers CD, Fillingim RB. Sex differences in the perception of noxious experimental stimuli: a meta-analysis. Pain. 1998;74(2-3):181-187.
- Robbins SJ, Ehrman RN, Childress AR, O'Brien CP. Comparing levels of cocaine cue reactivity in male and female outpatients. Drug Alcohol Depend. 1999;53(3):223-230.
- Romero EM, Fernández B, Sagredo O, et al. Antinociceptive, behavioural and neuroendocrine effects of CP 55,940 in young rats. Brain Res Dev Brain Res. 2002;136(2):85-92.
- Rubonis AV, Colby SM, Monti PM, Rohsenow DJ, Gulliver SB, Sirota AD. Alcohol cue reactivity and mood induction in male and female alcoholics. J Stud Alcohol. 1994;55(4):487-494.
- Smoking & Tobacco Use: Tobacco-Related Mortality. Centers for Disease Control and Prevention. www.cdc.gov/tobacco/data_statistics/fact_sheets/health_effects/tobacco_related_mortality/. Reviewed November 21, 2014. Accessed July 7, 2015.
- Substance Abuse and Mental Health Services Administration (SAMHSA). Results from the 2013 National Survey on Drug Use and Health: Summary of National Findings. Rockville, MD: Substance Abuse and Mental Health Services Administration; 2014. HHS Publication No. (SMA) 14-4863. NSDUH Series H-48.
- Thomas H. A community survey of adverse effects of cannabis use. Drug Alcohol Depend. 1996;42(3):201-207.
- Thun MJ, Carter BD, Feskanich D, et al. 50-year trends in smoking-related mortality in the United States. N Engl J Med. 2013;368(4):351-364.
- Torres OV, O'Dell LE. Stress is a principal factor that promotes tobacco use in females [published online ahead of print April 22, 2015]. Prog Neuropsychopharmacol Biol Psychiatry.
- Tseng AH, Craft RM. Sex differences in antinociceptive and motoric effects of cannabinoids. Eur J Pharmacol. 2001;430(1):41-47.
- Verheyden SL, Hadfield J, Calin T, Curran HV. Sub-acute effects of MDMA (+/-3,4-methylenedioxymethamphetamine, "ecstasy") on mood: evidence of gender differences. Psychopharmacology (Berl). 2002;161(1):23-31.
- Wiley JL. Sex-dependent effects of Δ9-tetrahydrocannabinol on locomotor activity in mice. Neurosci Lett. 2003;352(2):77-80.
- Winsauer PJ, Daniel JM, Filipeanu CM, et al. Long-term behavioral and pharmacodynamics effects of delta-9-tetrahydrocannabinol in female rats depend on ovarian hormone status. Addict Biol. 2011;16(1):64-81.
- Zweben JE, Cohen JB, Christian D, et al. Psychiatric symptoms in methamphetamine users. Am J Addict. 2004;13(2):181-190.
This series of reports simplifies the science of research findings for the educated lay public, legislators, educational groups, and practitioners. The series reports on research findings of national interest.