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Gender differences in addiction severity/Diferencias de genero en la gravedad de la adiccion.

Abstract

Gender has been associated with substance use disorders (SUD). However, there are few studies that have evaluated gender differences in a global and a standardized way, and with a large sample of patients with SUD. Our goal is to analyze the role of gender in addiction severity throughout multiple life domains, using the Addiction Severity Index-6 (ASI-6). A naturalistic, multicenter and prospective study was conducted. A total of 221 patients with SUD (80.1% men) were interviewed with the ASI-6. Our results indicate that the Recent Summary Scores (RSSS) of men and women are similar, with the exception of Psychiatric and Partner-Problems, where women showed higher severity (p = .017 and p = .013, respectively). Statistically significant gender differences were found in certain aspects of the ASI-6 domains: men have more problems of physical health, legal issues, and alcohol and other substance use; and woman score higher in problems of mental health, social network, subjective evaluations of SUD consequences, and treatment needs. These results should be taken into account to improve the identification, prevention, and treatment of SUD.

Keywords: Addiction severity; Gender differences; ASI-6; Substance use disorder.

Resumen

Se ha descrito que el genero es un factor que condiciona los trastornos por uso de sustancias (TUS). Sin embargo, hay pocos estudios que hayan evaluado esas diferencias de genero de manera global, estandarizada y en una muestra amplia de pacientes con TUS. Nuestro objetivo es analizar el rol del genero en la gravedad de la adiccion a traves de los diversos dominios de vida mediante el Addiction Severity Index-6 (ASI-6). Se llevo a cabo un estudio naturalistico, multicentrico y prospectivo con una muestra compuesta por 221 pacientes con TUS (80,1% hombres). Los participantes fueron entrevistados con el ASI-6. Los resultados han mostrado que las Puntuaciones Sumarias Recientes (PSRS) son similares entre hombres y mujeres a excepcion de las correspondientes a Salud mental y Pareja- Problemas, donde las mujeres presentan mayor gravedad (p = 0,017 y p = 0,013, respectivamente). Por otra parte, se han encontrado diferencias estadisticamente significativas en diversos aspectos concretos de las areas contempladas por el ASI-6, que indican que los hombres presentan mas problemas en cuanto a salud fisica, cuestiones legales y uso de alcohol y drogas, y la mujeres en salud mental, red social y la valoracion subjetiva sobre las consecuencias del TUS y la necesidad de tratamiento. Estos resultados deben tenerse en cuenta a la hora de implementar una mejora en la identificacion, prevencion y tratamiento de los TUS.

Palabras clave: Gravedad de la adiccion; Diferencias de genero; ASI-6; Trastorno por uso de sustancias.

Previous data have shown that the gender can modulate the different clinical aspects of substance use disorders (SUD), including prevalence, expression of symptoms, comorbidity, clinical course, severity, choice of treatment, and prognosis (Grella & Lovinger, 2012; Miquel, Roncero, Lopez Ortiz, & Casas, 2011). Thus, women begin consuming at lower doses than men, but their evolution towards abuse and dependence is faster ("telescoping effect") (Alvanzo et al., 2011) and they have greater chances of relapse during withdrawal (Becker & Hu, 2008). On another hand, as noted by Miquel et al. (2011), although there are more men than women with dual pathology (87.5% vs. 12.5%, respectively) in general psychiatry units, the proportion is reversed in drug units (47.5% of women had dual pathology compared to 30.3% of men). In addition, in men, the most prevalent comorbid diagnoses are psychotic and bipolar disorders, whereas in women, they are anxiety and affective disorders (Miquel et al., 2011). This comorbidity of SUD may be predictive of low performance, family difficulties, therapeutic non-compliance, legal issues, etc. (Miquel et al., 2011; Najt, Fusar-Poli, & Brambilla, 2011; Schwinn, Schinke, & Trent, 2010). In terms of physical health problems, female consumers have poorer general health, report more chronic problems, receive more prescriptions and take more medication than men (Green, Grimes Serrano, Licari, Budman, & Butler, 2009; Grella & Lovinger, 2012).

Substance use has been associated with criminal behavior, both in men and women (Green et al., 2009; Palmer, Jinks, & Hatcher, 2010). Traditionally, men show higher rates of violence and crimes against property than women (Castillo-Carniglia, Pizarro, Luengo, & Soto-Brandt, 2014; McMurran, Riemsma, Manning, Misso, & Kleijnen, 2011). However, for several years, the rates of women with legal problems resulting from substance abuse have been increasing significantly (Messina, Grella, Cartier, & Torres, 2010; Palmer et al., 2010).

The study of the relationship between employment and gender in people with SUD has revealed differences that may be mediated by different social roles such as parenthood, child care, the division of homework, etc. (Huang, Evans, Hara, Weiss, & Hser, 2011; Thompson & Petrovic, 2009). For example, male consumers have a longer history of working life and are more predisposed to work than women (Hogue, Dauber, Dasaro, & Morgenstern, 2010).

Moreover, the family may constitute a significant source of protection against substance abuse, and family factors related to substance use may be different for men and women (Kopak, Chen, Haas, & Gillmore, 2012). Women with SUD report more family conflicts, tend to live with their children, and are more likely to be divorced or widowed than are men (Green et al., 2009).

But as seen above, the literature reports gender differences in specific problems caused by SUD, and, to our knowledge, there are no studies that have evaluated these differences globally and comprehensively, with a standardized instrument allowing the determination of possible differences in the severity of these problems in a sample of patients with SUD. Taking the literature reports into account, we hypothesized that there will be gender differences in specific aspects of different life areas of people with SUD, but this is not sufficient to have an impact on the severity profile of the different life domains. Our goal is to examine the impact of gender on addiction severity in the different life domains through the Addiction Severity Index-6 (ASI-6).

Method

Participants

The total sample was made up of 221 patients, of whom 177 (80.1%) were men and 44 (19.9%) women, who presented a SUD (dependence) and who were receiving treatment in one of the 8 centers participating in the project (Unidad de Tratamiento de Conductas Adictivas, SERGAS, Orense; Clinica Asturias, Gijon; Hospital Ramon & Cajal, Madrid; Hospital Sant Pau, Barcelona; Unidad Asistencial de Drogodependencias, Carballo- La Coruna; Centro de Atencion a Drogodependencias San Juan de Dios, Palencia; Centro de Salud Mental Retiro, Madrid; Centro de Salud Mental Teatinos, Oviedo). The inclusion criteria were: (a) being of age, (b) having a main diagnosis of SUD (dependence) according to the International Classification of Diseases ([ICD-10], World Health Organization, 1992) criteria, (c) initiating or changing treatment, and (d) signing the informed consent form. The only exclusion criterion was not signing the informed consent form.

Assessments

Four assessments were performed in the study. The first was performed when including the patient, after he or she had signed the informed consent, and follow-ups were performed at 1, 3, and 6 months. This work only shows the data from the baseline assessment. All patients were administered the Spanish version of the Addiction Severity Index (ASI-6) (Cacciola, Alterman, Habing, & McLellan, 2011; Diaz Mesa et al., 2010).

Addiction Severity Index (ASI-6)

The ASI-6 is a semi-structured and hetero-applied interview that multi-dimensionally assesses addiction severity understood as need for treatment. It consists of 257 items that collect demographic information and data about housing, and assess seven problem areas: physical health, employment and resources, alcohol and drugs, legal status, family and social relationships, and psychiatric area. These problem areas have a similar structure: firstly, objective items to describe the patient's situation in that area and to identify and quantify possible problems; and secondly, subjective items about the patients' appraisal of their life situation in the last 30 days and the importance to them of treatment to solve those situations (rated as none, slight, moderate, substantial or extreme).

The ASI-6 provides a severity profile of the last 30 days made up of the Recent Summary Scores (RSSs) in the 9 primary and 6 secondary scales. These scores are obtained using a mathematical algorithm that only uses some of the items (objective and subjective) that constitute each problem area. The RSSs have a theoretical range from 0 to 100, such that the higher the score, the greater the severity, although the feasible range is specific to each score (see Table 1).

Design

Data for this article were taken from a naturalistic, multicenter, longitudinal, prospective study with a 6-month follow-up. The design features are described in more detail in Casares et al. (2011). The study was approved by the Ethics Committee for the Research Clinic of the Central University Hospital of Asturias (ref. nr. 45/2005) and follows the guidelines of the Helsinki Declaration of 1975, revised in 1983. We obtained informed consent for participation in the study from all the participants and/or their legal representatives before inclusion in the study.

Data analysis

Descriptive analysis (distribution of means and frequencies as a function of the nature of the variables) was carried out to establish the characteristics and profile of the total sample and differentiated by gender. Subsequently, statistically significant differences were established as a function of gender using bivariate analyses (Chi-square with Yates' correction and Fisher's exact test, and Student's t for independent samples). To perform the most appropriate analyses, the five response options of the subjective items were recoded according to their frequency distributions as: None (none and slight), Moderate (moderate) and Extreme (considerable and extreme). We established a 95% confidence level and used the statistical package for Social Sciences SPSS-15.

Results

Sample profile

The mean age of the sample was 41.4 years (SD = 11.5). In terms of marital status, 43.0% were married or living as a couple. In the last 30 days, 61.4% had been in hospital, in a hospitalization unit for alcohol or drugs or a psychiatric unit, prison, a therapeutic community, or a protected flat. Concerning education, 49.3% had compulsory studies (elementary, primary, and secondary). Regarding employment status, 47.3% was active either part-time or full-time. Alcohol was the main substance of reference in the treatment for 54.3% of the participants. Table 2 presents the socio-demographic and consumption data of the patients differentiated by gender. We found no statistically significant gender differences in any of them.

Profile of addiction severity according to the RSSs on the ASI-6 scales

Men and women both showed greater severity on the primary scale of Employment, and on the secondary scales of Partner - Support and Friends - Support. Regarding the impact of gender on the severity of the addiction profile, we only found statistically significant differences in the primary scale of Psychiatric and the secondary scale of Partner - Problems. In both cases, there was higher severity in the women (Table 3).

Physical health

As regards the presence of chronic diseases related to substance use (HIV, tuberculosis, hepatitis, and cirrhosis or other liver diseases), there were no statistically significant gender differences. However, 39.8% of the men compared to 23.3% of the women reported other chronic diseases, and the differences were statistically significant, [chi square] = 4.066, p = .044. On another hand, 13.6% of the men and 2.3% of the women received a pension due to physical disease or disability, [chi square] = 4.513, p = .034. We also found statistically significant differences in the mean number of times that they had been hospitalized for physical health problems: 2.26 times for the men and 1.51 times for the women, t = 2.066, p = .041.

Employment and resources

Statistically significant differences were found, [chi square] = 24.138, p = .007, in terms of the type of work currently performed. Out of the sample, women predominated in sectors of technical and administrative professions and domestic cleaning (specialized, executive, administrative and management professions, sales, clerks and administrative support, services and domestic employees), whereas men carried out manual labor (precision production, trades and repairs, machine operators and supervisors, carriers and removals, manual workers, cleaning equipment, helpers and laborers). The longest full-time work interval was 116.22 (SD = 120.8) months for the men versus 75.7 (SD = 91.7) months for the women, t = 2.401, p = .019.

Alcohol and drugs

We found statistically significant differences in the age at onset of alcohol use such that the men began to drink at a significantly lower mean age (16.0 years, SD = 5.1) than the women (18.5 years, SD = 7.3), t = -2.119, p = .039. Of the men, 27.7% had presented problems to control, reduce, or refrain from drinking alcohol or had spent a longer time drinking compared to 43.2% of women, [chi square] = 3.974, p = .046. In addition, significantly fewer men (21.5%) than women (43.2%) had medical or psychological, occupational, legal or domestic problems due to alcohol use, [chi square] = 8.680, p = .003. We also found statistically significant differences in the perception of craving or the impulse to drink as a problem, present in 27.3% of the men compared with 45.5% of the women, [chi square] = 8.241; p = .004. Considering a daily abusive intake of 5 units of standard drink (USDs) for men and 4 for women, as established in the ASI-6, the men reported a mean regular abusive consumption of 13.02 (SD =12.9) years, and the women of 7.84 (SD =9.0) years, t = 2.794, p = .006.

Regarding illegal drugs, no age differences in the onset for any substance, in days of consumption or abuse, either lifelong or in the last 30 days, were found. No age differences were found for the consumption of sedatives, cocaine, stimulants and hallucinogens. Only in the case of inhalants, age at onset was lower for men (18.2 years, SD = 5.090) compared to women (26.4 years, SD = 9.370), t = -2.448, p = .026. In terms of the lifelong regularity of consumption, men consumed the following substances for significantly more years than women: marijuana (4.7 years, SD = 7.1, vs. 1.7 years, SD = 4.5, respectively), t = 3.311, p = .001, heroin (3.1 years, SD = 5.8, vs. 0.9 years, SD = 2.6, respectively), t = 3.678, p [less than or equal to] .001, and methadone (1.2 years, SD = 3.107, vs. 0.4 years, SD = 1.706, respectively), t = 2.296, p = .023. We found no gender differences in the prevalence of abuse of any of the substances. However, regarding the use of secondary drugs (without a diagnosis of abuse), again men presented consumption patterns significantly more frequently than did women in some substances. Thus, among those who consumed marijuana, 56.5% of the men compared to 35.9% of the women, [chi square] = 5.414, p = .020, had consumed it more than 50 days over their lifetime, and 31.2% of the men compared with 13.6% of the women had consumed heroin on more than 50 occasions, [chi square] = 5.418, p = 0.020. In terms of risk behavior related to substance use, 23.3% of the men had injected drugs at some point in their lives, whereas of the women, only 9.3% had done so, [chi square] = 4.085, p = .043.

No significant differences in economic problems derived from gambling were apparent. However, in the last 30 days, the men had gambled significantly more than the women in games like the lottery, the coupon, football pools, slots machines, bingo, betting on racing, casinos, etc., or any other illegal gambling (2.8 times, SD = 6.3, vs. 0.6 times, SD = 2.0, respectively), (t = 3.892, p [less than or equal to] .001).

Legal situation

At the legal level, men had significantly more problems than women. Of the men, 44.1% had been in jail/prison even though only for a few hours at some point in their lives, whereas of the women, only 20.5% had been in jail, [chi square] = 8.232, p = .004. In the case of arrests, 48.0% of the men and 25.0% of the women had been arrested, [chi square] = 7.573, p = .006.

Family and social relationships

As shown in Table 4, in the last 30 days, a greater proportion of men than of women had spent time with their partners, had had contact with them, and had close friends with current problems of alcohol or drugs. Moreover, in the last 30 days, a higher percentage of women than of men had argued with their partners, their partner had drug or alcohol problems, and they had talked more with friends about their problems and feelings. In addition, a higher percentage of women than men had suffered physical assault or abuse (38.6% vs. 18.9%, respectively, [chi square] = 7.807, p = .005) and sexual abuse (23.8% vs. 2.3%, respectively, [chi square] = 26.171, p [less than or equal to] .001) at some time in their lives.

Mental health

The women's level of mental health was significantly worse than the men's. Thus, a higher percentage of women had tried to commit suicide at some time in their lives (28.6% vs. 10.1%), [chi square] = 9.612, p = .002, and had felt depressed or low or had had sleeping problems in the past 30 days (65.9% vs. 46.1%), [chi square] = 5.462, p = .019. In addition, women were assessed or treated for emotional or psychological problems for the first time at a younger age than men [24.8 years, SD = 9.3, vs. 30.3 years, SD = 11.9), t = 2.293, p = .024.

Subjective assessment of severity and the need for treatment

As shown in Table 5, the women were significantly more concerned about their alcohol consumption, the abusive and traumatic events experienced, and their psychological problems, and they granted more importance to treatment for their consumption and their social relationships with other adults, and for the abuse and trauma suffered. The women also showed a higher tendency than the men to worry about their physical health and the problems associated with drugs. They also considered that achieving abstinence from alcohol, getting treatment for their psychological problems, and feeling more satisfied with their adult relationships was more important than did the men. Furthermore, we observed in the men a tendency to experience more pain or physical discomfort, and they granted more importance to its treatment, and to the need for job counseling, treatment to cease using substances, and counseling in their relation with their children. They felt their current legal problems were more severe, they were more concerned about their relationships with other adults, and they were more satisfied with their free or leisure time.

Discussion

The main goal of this study was to examine gender differences in addiction severity in the different life areas assessed by the ASI-6. In relation to the addiction severity profile, when observing the RSSs, there are few differences, and these show that women's profile is significantly more severe in the life domains related to mental health and couple problems. However, when considering different items of the ASI-6 individually, the men in this study have more problems related to substance use in all life areas, except for those concerning psychological status and the area of social relations, in line with the findings of other studies (Cotto et al., 2010; Kopak et al., 2012; Najt et al., 2011; Palmer et al., 2010).

A global and comprehensive, standardized and universally accepted assessment instrument was used in this study, which has shown that there is no differential addiction severity profile as a function of gender, except for the scales of Mental health and Partner--Problems.

Physical health

The men reported having been hospitalized several times, and a higher proportion of men than of women received a pension for physical-related problems. Among the scarce previous studies, it was found that women have poorer health status (Green et al., 2009; Grella & Lovinger, 2012), although in those cases, the samples were limited to patients with opioid abuse.

Employment and resources

Substance use influences the socio-economic area (Neale, Nettleton, & Pickering, 2014). In our sample, we detected a labor market pattern characterized by the predominance of manual work in men, and of technical, administrative, and commercial professions and domestic work in women. On another hand, women had worked less in full-time jobs, as other studies have shown (Green et al., 2009; Huang et al., 2011). More research is needed to understand how the SUD affects men and women in the workplace (Huang et al., 2011).

Alcohol and drugs

Regarding substance use, coinciding with the literature, men begin consuming at earlier ages, and their consumption is more abusive and regular (Alvanzo et al., 2011; Buu et al., 2014; Green et al., 2009). For their part, the women in the sample, like those from other studies, considered craving as a problem and reported more difficulties to control their alcohol use and more problems associated with consumption (Shand, Degenhardt, Slade, & Nelson, 2011; Thompson & Petrovic, 2009). In our study, we detected a higher percentage of men who injected drugs. This could be because women basically inject with their partners, whereas men have a broader network of family and friends who consume (Werb et al., 2013).

It was found that men had gambled more frequently in the last month, which could be attributed to the vulnerability shared by SUD and pathological gambling, and the differential characteristics of impulsiveness, emotional arousal, and response to stress as a function of gender, etc. (Estevez Herrero, Herrero Fernandez, Sarabia Gonzalvo, & Jauregui Bilbao, 2014; Pilver, Libby, Hoff, & Potenza, 2013; Verdejo-Garcia, Lawrence, & Clark, 2008).

Legal situation

Although, in accordance with other studies (Green et al., 2009; Haas & Peters, 2000), there were more men than women who had been in prison or had been arrested, the severity profile of the Legal Scale did not yield significant gender differences.

Family and social relationships

A broad range of research indicates that the family environment is more dysfunctional in women with SUD than in men (Kopak et al., 2012; Shand et al., 2011). According to our study, there are no major differences in problems in the family setting or in the severity scores of this area, and such problems are limited to the couple context, where the women did present higher severity. According to Cranford, Tennen, and Zucker (2015), following the theory of role incompatibility, consumption would be more incongruent with adult social roles like marriage in the case of women, which could generate more couple problems.

There are no data on the social network of adults with SUD. In our study, men had more friends with problems related to alcohol or other substances than did women. This could be because women tend to make new friends or remake contact with people who do not consume, whereas men have more trouble making new nonconsumer friends, to which is added the lack of family support (Neale et al., 2014).

The higher prevalence of traumatic events in women with SUD than in men (Shand et al., 2011), as well as the greater likelihood of sexual abuse (Neale et al., 2014; Shand et al., 2011) is well documented in the literature. In this sample, the women had been assaulted physically and sexually more frequently than the men, but it was striking that the men had been sexually assaulted a shorter time ago.

The spiritual or religious aspect in SUDS, although less studied, seems to play a considerable role in the treatment and recovery process (Alterman, Cacciola, Dugosh, Ivey, & Coviello, 2010). These data would explain why the women in our sample reported attending religious events more frequently than the men.

Psychiatric area

Although until now, there have been conflicting data on the comorbidity of SUD with other psychiatric diagnoses and gender differences, among people with SUD, mental health problems and thoughts and attempts of suicide seem more prevalent in women (Araos et al., 2014; Saiz et al., 2014; Shand et al., 2011). In this sense, the analyzed sample confirms that there are more women who are depressed and who have attempted suicide, but no differences appeared in the rest of symptoms assessed by the ASI-6. Although other studies found similar results, none of them offers an explanation (Miquel et al., 2011). The severity scores in the area of mental health confirm that women have a worse mental health profile, so the psychological consequences of substance use are higher in women than in men.

Subjective assessment of severity and the need for treatment

To our knowledge, there are no studies on the differences in subjective experiences about the consequences of SUD in the different domains. When was asked for subjective assessment, in our study, the women were significantly more concerned about their consumption of alcohol, stressful life events experienced, and psychological problems, and they granted more importance to the treatment of their consumption and their social relationships with other adults, and of the abuses and traumatic events suffered.

Limitations

Firstly, the low proportion of women in the study sample should be noted. Second, we included patients with all types of substance dependence and, as expected, the legal substance (alcohol) was overrepresented compared to the rest. Finally, it should be taken into account that memory bias, motivations, social desirability, and the subjective perceptions of the interviewed subjects may have influenced the scores obtained. Therefore, it is necessary to be cautious when generalizing the results found in the study.

Conclusion

Our study reveals the existence of gender differences in multiple specific aspects evaluated by the ASI-6. However, these differences are minimized when considering the severity profile of the ASI-6. Nevertheless, women showed a more severe addiction profile in the mental health components and in couple problems, in line with their subjective evaluations of concern and need for treatment of psychological and social aspects.

These findings are of great interest to clinical practice because personalized intervention programs should be developed to attend to each patient differentially and globally, in this case, a function of gender.

However, further studies are needed that allow the establishment of causal relationships to explain severity differences between men and women, as well as prospective studies that include larger and more homogeneous samples regarding gender and substances.

Acknowledgements

This work was financed by the National Plan on Drugs (MSC-05-NDP-2).

Conflict of interest

The authors declare that no there is conflict of interest in this work.

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EVA M. DIAZ-MESA (*), (**), (***); PAZ GARCIA-PORTILLA (*), (**), (***); SERGIO FERNANDEZ-ARTAMENDI (*), (**), (***); PILAR A. SAIZ (*), (**), (***); TERESA BOBES BASCARAN (**), (****); MARIA JOSE CASARES (*****); EDUARDO FONSECA (******); SUSANA AL-HALABI (*), (**), (***); JULIO BOBES (*), (**), (***).

(*)Area de Psiquiatria. Universidad de Oviedo. Espana; (**) Centro de Investigacion Biomedica en Red de Salud Mental, CIBERSAM, Espana; (***) Instituto de Investigacion en Neurociencias del Principado de Asturias, INEUROPA, Espana; (****) Servicio de Psiquiatria. Hospital Universitario de San Juan. Espana; (*****) Departamento de Psicologia. Universidad Complutense de Madrid. Espana; (******) Area de Psicologia Evolutiva y de la Educacion. Universidad de la Rioja. Espana.

Received: July 2015; Accepted: September 2015

Send correspondence to:

Eva M. Diaz Mesa. Area de Psiquiatria--Facultad de Medicina. Calle Julian Claveria 6. Oviedo--33006.

E-mail: evamdmesa@gmail.com
Table 1. Structure and Scores of the Addiction Severity Index
v. 6.0 (ASI-6).

Assessed problem areas       Scales
                             - 9 primary scales (1.1 to 1.9)
                             - 6 secondary scales (2.1 to 2.6) (*)

                             PRIMARY
1. Physical health              1.1. Physical health
2. Employment and resources     1.2. Employment
3. Alcohol use                  1.3. Alcohol
4. Drug use                     1.4. Drugs
5. Legal situation              1.5. Legal
6. Family and social
relationships                   1.6. Family-Children
                                1.7. Family/Social network-Support
                                1.8. Family/Social network - Problems
                             SECONDARY
                                2.1. Partner - Support
                                2.2. Partner - Problems
                                2.3. Adult relatives - Support
                                2.4. Adult relatives - Problems
                                2.5. Friends - Support
                                2.6. Friends - Problems
7. Psychiatric               P  1.9. Psychiatric

Assessed problem areas       Feasible RSS range

1. Physical health           29-78
2. Employment and resources  21-53
3. Alcohol use               38-77
4. Drug use                  31-77
5. Legal situation           43-79
6. Family and social
relationships                48-79
                             27-73
                             36-78
                             32-57
                             47-77
                             41-68
                             44-67
                             37-59
                             46-70
7. Psychiatric               31-79

Note. RSS: Recent Score Summary; P: Primary
(*) Secondary scales and their scoring ranges are shaded in gray.

Table 2. Socio-demographic and Consumer Profile according to Gender.

                              Men (n = 177)     Women (n = 44)    p

Mean Age--years (SD)          41.9 (DT = 11.7)  39.6 (DT = 10.9)  0.242
Civil status - n (%)                                              0.162
Married / Living as a couple  77 (43.5)         18 (40.9)
Divorced / Separated          30 (16.9)          4 (9.1)
Single                        67 (37.9)         19 (43.2)
Widowers                       3 (1.7)           3 (6.8)
Housing in the last
30 days - n (%)
Alone                         28 (90.3)          3 (9.7)
Spouse/Partner                71 (81.6)         16 (18.4)
Children< 18 years            28 (73.7)         10 (26.3)
Parents   58 (85.3)           10 (14.7)
Other adult relatives         28 (71.8)         11 (28.2)
Other non-adult relatives      7 (77.8)          2 (22.2)
Hospital Unit (drugs)          6 (66.7)          1 (100)          0.490
Prison                         3 (33.3)          1 (100)          0.197
Restricted or supervised
housing     5 (83.3)           1 (16.7)          0.346
Hostel/street                  7 (58.3)          0 (0)            0.261
Studies achieved [n (%)]                                          0.313
Compulsory (Elementary,
Primary, Secondary)           85 (48.3)         23 (53.5)
High school / Vocational
training                      69 (39.2)         14 (32.6)
University
(Degree/Postgraduate)         18 (10.2)          6 (14.0)
None                           4 (2.3)           0 (0.0)
Work situation n (%)]                                             0.315
Full-time/part-time           79 (44.9)         25 (56.8)
Unemployed and actively
seeking                       28 (15.9)          8 (18.2)
Outside of the labor market   69 (39.2)         11 (25.0)
Main consumption
substance [n (%)]                                                 0.359
Alcohol                       92 (52.0)         28 (63.6)
Cannabis                      11 (6.2)           2 (4.5)
Cocaine                       33 (18.6)          7 (15.9)
Opiates                       39 (22.0)          6 (13.6)

Note. There were no statistically significant gender differences in
any of the variables.

Table 3. Differential RSS Profile as a Function of Gender.

Scales                                            Men (SD)

PRIMARY    1.1. Physical health                   45.1 (9.2)
           1.3. Alcohol                           51.7 (9.0)
           1.4. Drugs                             40.6 (10.9)
           1.5. Legal                             47.0 (3.3)
           1.6. Family - Children                 49.7 (5.0)
           1.7. Family/Social network - Support   45.0 (12.5)
           1.8. Family/Social network - Problems  43.6 (8.9)
SECONDARY  2.1. Partner - Support                 43.0 (11.4)
           2.2. Partner - Problems                48.9 (6.6)
           2.3. Adult relatives - Support         49.2 (8.9)
           2.4. Adult relatives - Problems        49.1 (7.0)
           2.5. Friends - Support                 48.1 (9.0)
           2.6. Friends - Problems                48.8 (6.2)
P          1.9. Psychiatric                       44.1 (9.2)

Scales                                            Women (SD)

PRIMARY    1.1. Physical health                   42.8 (10.3)
           1.2. Employment                        36.1 (11.7)
           1.3. Alcohol                           54.1 (9.3)
           1.4. Drugs                             38.6 (9.4)
           1.5. Legal                             47.2 (3.7)
           1.6. Family - Children                 50.4 (6.0)
           1.7. Family/Social network - Support   44.2 (9.2)
           1.8. Family/Social network - Problems  49.0 (9.2)
SECONDARY  2.1. Partner - Support                 43.6 (11.4)
           2.2. Partner - Problems                52.4 (8.2)
           2.3. Adult relatives - Support         46.6 (8.3)
           2.4. Adult relatives - Problems        50.9 (7.9)
           2.5. Friends - Support                 47.8 (10.3)
           2.6. Friends - Problems                48.3 (5.5)
P          1.9. Psychiatric                       48.1 (8.4)

Scales                                             Student's t  p

PRIMARY    1.1. Physical health                    1.403        0.162
           1.2. Employment                         1.031        0.307
           1.3. Alcohol                           -1.507        0.133
           1.4. Drugs                              1.048        0.296
           1.5. Legal                             -0.353        0.725
           1.6. Family - Children                 -0.682        0.496
           1.7. Family/Social network - Support    0.465        0.643
           1.8. Family/Social network - Problems  -1.751        0.081
SECONDARY  2.1. Partner - Support                 -0.329        0.742
           2.2. Partner - Problems                -2.570        0.013
           2.3. Adult relatives - Support          1.746        0.082
           2.4. Adult relatives - Problems        -1.530        0.128
           2.5. Friends - Support                  0.178        0.860
           2.6. Friends - Problems                 0.472        0.637
P          1.9. Psychiatric                       -2.406        0.017

Note. RSS: Recent Score Summary; P: Primary.

Table 4. Differences in Social and Family Relations as a Function
of Gender.

                                              Men           Women

In the last 30 days

Has spent time in person with partner- n (%)  107 (97.3)    28 (87.5)
Has had some contact with partner (calls,
internet, etc.) - n (%)                       108 (98.2)    26 (81.3)
Has argued with partner - n (%)                43 (39.4)    18 (64.3)
The partner has a problem with alcohol
or drugs - n (%)                               10 (9.2)     10 (35.7)
Close friends have problems with alcohol
or drugs - n (%)                               29 (27.6)     2 (8.0)
Has talked to friends about feelings or
problems - n (%)                               72 (67.3)    23 (92.0)
Has gone to religious services or
activities promoted by the religious           14 (7.9)      8 (18.2)
community - n (%)

Lifelong

Someone he/she knows physically abused or
assaulted him/her - n (%)                     33 (18.9)     27 (38.6)
Someone he/she knows sexually abused or
assaulted him/her- n (%)                       4 (2.3)      10 (23.8)
Months since the last time - M (SD)           55.2 (61.5)  240.3 (117.1)
Months since he/she saw how someone was
killed, attacked, or seriously
harmed - M (SD)                             139.9 (133.8)  62.1 (47.2)

                                              Statistical test  p

In the last 30 days

Has spent time in person with partner- n (%)   5.052 (a)        0.025
Has had some contact with partner (calls,
internet, etc.) - n (%)                       13.367 (a)        0.000
Has argued with partner - n (%)                5.563 (a)        0.018
The partner has a problem with alcohol
or drugs - n (%)                              12.586 (a)        0.000
Close friends have problems with alcohol
or drugs - n (%)                               4.280 (a)        0.039
Has talked to friends about feelings or
problems - n (%)                               6.134 (a)        0.013
Has gone to religious services or
activities promoted by the religious           4.148 (a)        0.042
community - n (%)

Lifelong

Someone he/she knows physically abused or
assaulted him/her - n (%)                       7.807 (a)        0.005
Someone he/she knows sexually abused or
assaulted him/her- n (%)                       26.171 (a)        0.000
Months since the last time - M (SD)            -3.272 (b)        0.006
Months since he/she saw how someone was
killed, attacked, or seriously
harmed - M (SD)                                 2.927 (b)        0.006

Note.
(a) [chi square]
(b) Student's t

Table 5. Subjective Assessment of Severity and the Need for Treatment
in the past 30 Days

                                                      Men n (%)
                                          None        Moderate

Physical health
Pain or physical discomfort               103 (58.9)  43 (24.6)
Concern about physical health             109 (62.3)  29 (16.6)
Importance of treatment for
physical health                           100 (57.5)  12 (6.9)
Employment and resources
Importance of job counseling              114 (65.5)  11 (6.3)
Alcohol use
Concern about problems with alcohol       128 (72.7)   9 (5.1)
Importance of treatment to quit drinking   94 (53.4)  12 (6.8)
Importance of achieving / maintaining
abstinence from alcohol                    85 (48.3)  13 (7.4)
Drug use
Concern about drug-related problems       130 (75.6)   6 (3.5)
Importance of treatment to quit using
substances                                 96 (54.9)   8 (4.6)
Importance of achieving / maintaining
abstinence
from substances                            86 (49.1)   8 (4.6)
Legal situation
Severity of judicial problems             146 (84.9)   2 (1.2)
Family and social relationships
Satisfaction provided by adult
relationships                              59 (33.5)  57 (32.4)
Concern about problems in adult
relationships                             103 (58.2)  30 (16.9)
Importance of treatment for adult
relationships                             103 (58.5)  20 (11.4)
Satisfaction with leisure                  78 (44.1)  55 (31.1)
Concern about abuse and traumatic
events                                    162 (94.7)   0 (0.0)
Importance of treatment for
traumatic/abusive events                  160 (93.6)   2 (1.2)
Additional need for problems
with children                             126 (95.5)   2 (1.5)
Difficulty in relationship
with children                             131 (99.2)   1 (0.8)
Importance of counseling for
relationship with children                123 (93.9)   3 (2.3)
Mental health
Concern for psychological problems         79 (45.7)  27 (15.6)
Importance of psychological treatment      77 (43.8)  24 (13.6)

                                          Men n (%)
                                          Extreme

Physical health
Pain or physical discomfort               29 (16.6)
Concern about physical health             37 (21.1)
Importance of treatment for
physical health                           62 (35.6)
Employment and resources
Importance of job counseling              49 (28.2)
Alcohol use
Concern about problems with alcohol       39 (2.2)
Importance of treatment to quit drinking  70 (39.8)
Importance of achieving / maintaining
abstinence from alcohol                   78 (44.3)
Drug use
Concern about drug-related problems       36 (20.9)
Importance of treatment to quit using
substances                                71 (40.6)
Importance of achieving / maintaining
abstinence
from substances                           81 (46.3)
Legal situation
Severity of judicial problems             24 (14.0)
Family and social relationships
Satisfaction provided by adult
relationships                             60 (34.1)
Concern about problems in adult
relationships                             44 (24.9)
Importance of treatment for adult
relationships                             53 (30.1)
Satisfaction with leisure                 44 (24.9)
Concern about abuse and traumatic
events                                     9 (5.3)
Importance of treatment for
traumatic/abusive events                   9 (5.3)
Additional need for problems
with children                              4 (3.0)
Difficulty in relationship
with children                              0 (0.0)
Importance of counseling for
relationship with children                 5 (3.8)
Mental health
Concern for psychological problems        67 (38.7)
Importance of psychological treatment     75 (42.6)

                                          Women n (%)
                                          Moderate     Extreme

Physical health
Pain or physical discomfort               12 (27.3)     5 (11.4)
Concern about physical health              4 (9.1)     12 (27.3)
Importance of treatment for
physical health                            3 (7.0)     15 (34.9)
Employment and resources
Importance of job counseling               6 (14.6)    10 (24.4)
Alcohol use
Concern about problems with alcohol        3 (6.8)     22 (50.0)
Importance of treatment to quit drinking   3 (7.0)     26 (60.5)
Importance of achieving / maintaining
abstinence from alcohol                    3 (6.8)     27 (61.4)
Drug use
Concern about drug-related problems        1 (2.4)      9 (21.4)
Importance of treatment to quit using
substances                                 2 (4.7)     13 (30.2)
Importance of achieving / maintaining
abstinence
from substances                            1 (11.1)    15 (35.7)
Legal situation
Severity of judicial problems              0 (0.0)      5 (12.2)
Family and social relationships
Satisfaction provided by adult
relationships                             14 (31.8)    19 (43.2)
Concern about problems in adult
relationships                             12 (27.9)    10 (23.3)
Importance of treatment for adult
relationships                             11 (25.6)    15 (34.9)
Satisfaction with leisure                  9 (20.5)     9 (20.5)
Concern about abuse and traumatic
events                                     7 (17.1)     4 (9.8)
Importance of treatment for
traumatic/abusive events                   2 (4.9)      9 (22.0)
Additional need for problems
with children                              0 (0.0)      1 (3.0)
Difficulty in relationship
with children                              1 (3.2)      0 (0.0)
Importance of counseling for
relationship with children                 2 (6.5)      1 (3.2)
Mental health
Concern for psychological problems         4 (9.5)     25 (59.5)
Importance of psychological treatment      5 (11.4)    27 (61.4)

                                           [chi square]  p

Physical health
Pain or physical discomfort                0.754         0.686
Concern about physical health              1.906         0.386
Importance of treatment for
physical health                            0.008         0.996
Employment and resources
Importance of job counseling               3.177         0.204
Alcohol use
Concern about problems with alcohol       14.626         0.001
Importance of treatment to quit drinking   6.423         0.040
Importance of achieving / maintaining
abstinence from alcohol                    4.282         0.118
Drug use
Concern about drug-related problems        0.132         0.936
Importance of treatment to quit using
substances                                 1.597         0.450
Importance of achieving / maintaining
abstinence
from substances                            2.316         0.314
Legal situation
Severity of judicial problems              0.585         0.746
Family and social relationships
Satisfaction provided by adult
relationships                              1.617         0.445
Concern about problems in adult
relationships                              2.749         0.253
Importance of treatment for adult
relationships                              7.462         0.024
Satisfaction with leisure                  3.347         0.188
Concern about abuse and traumatic
events                                    31.982         0.000
Importance of treatment for
traumatic/abusive events                  14.793         0.001
Additional need for problems
with children                              0.506         0.776
Difficulty in relationship
with children                              1.262         0.261
Importance of counseling for
relationship with children                 1.465         0.481
Mental health
Concern for psychological problems         5.992         0.050
Importance of psychological treatment      5.169         0.075
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Author:Diaz-Mesa, Eva M.; Garcia-Portilla, Paz; Fernandez-Artamendi, Sergio; Saiz, Pilar A.; Bascaran, Tere
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Date:Dec 1, 2016
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