Fonseca Francina, Robles-Martínez María, Tirado-Muñoz Judit, Alías-Ferri María, Mestre-Pintó Joan-Ignasi, Coratu Ana Maria, Torrens Marta
Addiction Research Group (GRAd), Neuroscience Research Program, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain.
Institut de Neuropsiquiatria i Addiccions, Hospital del Mar, Barcelona, Spain.
Curr Addict Rep. 2021;8(1):89-99. doi: 10.1007/s40429-021-00357-9. Epub 2021 Feb 16.
Substance use disorders (SUD) affect differentially women and men. Although the prevalence has been reported higher in men, those women with addictive disorders present a more vulnerable profile and are less likely to enter treatment than men. The aim of this paper is to present an overview of how sex and gender may influence epidemiology, clinical manifestations, social impact, and the neurobiological basis of these differences of women with SUD, based on human research.
The differences in prevalence rates between genders are getting narrower; also, women tend to increase the amount of consumption more rapidly than men, showing an accelerated onset of the SUD (telescoping effect). In respect to clinical features, the most important differences are related to the risk of experience psychiatric comorbidity, the exposure to intimate partner violence, and the associated high risks in sexual and reproductive health; and those who are mothers and addicted to substances are at risk of losing the custody of children accumulating more adverse life events. Some of these differences can be based on neurobiological differences: pharmacokinetic response to substances, sensitivity to gonadal hormones, differences in neurobiological systems as glutamate, endocannabinoids, and genetic differences.
Specific research in women who use drugs is very scarce and treatments are not gender-sensitive oriented. For these reasons, it is important to guarantee access to the appropriate treatment of women who use drugs and a need for a gender perspective in the treatment and research of substance use disorders.
物质使用障碍(SUD)对女性和男性的影响存在差异。尽管据报道男性中的患病率更高,但患有成瘾性障碍的女性表现出更脆弱的特征,且比男性更不容易接受治疗。本文旨在基于人体研究,概述性别如何影响患有SUD的女性在流行病学、临床表现、社会影响以及这些差异的神经生物学基础方面的情况。
性别之间的患病率差异正在缩小;此外,女性往往比男性更快地增加消费量,显示出SUD的发病加速( telescoping效应)。在临床特征方面,最重要的差异与经历精神共病的风险、遭受亲密伴侣暴力的情况以及性健康和生殖健康方面的相关高风险有关;而那些吸毒成瘾的母亲有失去孩子监护权的风险,且会积累更多不良生活事件。其中一些差异可能基于神经生物学差异:对物质的药代动力学反应、对性腺激素的敏感性、神经生物学系统如谷氨酸、内源性大麻素的差异以及基因差异。
针对吸毒女性的具体研究非常匮乏,且治疗并非以性别敏感为导向。因此,确保吸毒女性能够获得适当治疗以及在物质使用障碍的治疗和研究中需要纳入性别视角非常重要。