Buccelli C, Della Casa E, Paternoster M, Niola M, Pieri M
Department of Advanced Biomedical Science-Legal Medicine Section, University of Naples "Federico II", Naples, Italy.
Department of Advanced Biomedical Science-Legal Medicine Section, University of Naples "Federico II", Naples, Italy.
Forensic Sci Int. 2016 Aug;265:89-95. doi: 10.1016/j.forsciint.2016.01.014. Epub 2016 Jan 22.
Gender differences in substance use/abuse have been the focus of research in the last 15 years. Initiation, use patterns, acceleration of disease course, and help-seeking patterns are known to be influenced by gender differences with regard to biological, psychological, cultural and socioeconomic factors. This paper presents a systematic review of published data on gender differences in the use/abuse of psychoactive and psychotic drugs, focusing on the importance of a multidisciplinary approach. The basis for this paper was obtained by Medline searches using the search terms "human" and "gender", combined with individual drug names or "drugs of abuse". The reference lists of these papers were further checked for other relevant studies. The gender difference in drug abuse is more evident in adults than in adolescents (13-19 years): adult men are 2-3 times more likely than women to develop drug abuse/dependence disorders and approximately 4 times as likely to have an alcohol use disorder. Such prevalence rates have not been observed in adolescents. Differences between men and women involve: (i) the biological response to the drug, (ii) the progression to drug dependence, and (iii) the comorbid psychiatric diagnoses, which may be due to both sociocultural factors and innate biological differences. A crucial role played by ovarian hormones (oestrogens and progesterone) has been documented in both human and animal model studies. Epidemiological data on how particular psychobiological and physiological characteristics in females influence vulnerability to both drug addiction and toxicological consequences of drugs are still in their infancy. Significant gaps remain in our knowledge, which are primarily attributable to the lack of empirical data that only a systematic and multidisciplinary approach to the topic can generate. The introduction of gender into forensic toxicological evaluations may help elucidate the relationship between the body's absorption of abused drugs (alone or in combination) and the onset of intoxications, both lethal and none.
物质使用/滥用方面的性别差异在过去15年一直是研究的重点。已知药物使用起始、使用模式、疾病进程加速以及寻求帮助的模式会受到生物、心理、文化和社会经济因素方面的性别差异影响。本文对已发表的关于精神活性药物和精神药物使用/滥用方面性别差异的数据进行了系统综述，重点关注多学科方法的重要性。本文的基础是通过使用搜索词“人类”和“性别”，结合个别药物名称或“滥用药物”在Medline数据库中进行检索获得的。还进一步检查了这些论文的参考文献列表以查找其他相关研究。药物滥用方面的性别差异在成年人中比在青少年（13 - 19岁）中更为明显：成年男性发生药物滥用/依赖障碍的可能性是女性的2至3倍，发生酒精使用障碍的可能性约为女性的4倍。在青少年中未观察到此类患病率。男性和女性之间的差异包括：（i）对药物的生物学反应，（ii）发展为药物依赖的进程，以及（iii）共病的精神科诊断，这可能是由于社会文化因素和先天生物学差异共同导致的。在人类和动物模型研究中均已证明卵巢激素（雌激素和孕酮）发挥着关键作用。关于女性特定的心理生物学和生理特征如何影响药物成瘾易感性以及药物毒理学后果的流行病学数据仍处于起步阶段。我们的知识仍存在重大空白，这主要归因于缺乏只有通过对该主题采用系统的多学科方法才能产生的实证数据。将性别因素纳入法医毒理学评估可能有助于阐明人体对滥用药物（单独或联合使用）的吸收与中毒发作（包括致命和非致命中毒）之间的关系。
