Abstract
Crack cocaine use disorder (CUD) has been related to sex differences. This work aimed to compare the severity of drug use and the severity of other negative related outcomes in males and females with CUD. A total of 1344 inpatients (798 males and 546 females) with crack cocaine use disorder (CUD) were evaluated by a detailed multidimensional clinical assessment, including addiction severity and trauma exposure. Linear regression predicted higher drug use severity (β = 0.273, p < 0.001) and more problems in domains related to childcare issues (β = 0.321), criminal involvement (β = 0.108), work-related problems (β = 0.281) and social support impairments (β = 0.142) for females, all with p < 0.001. Alcohol problems were predicted to be higher in males (β = -0.206, P < 0.001). Females had higher rates of other mental disorders, particularly trauma and stress-related disorders (OR: 3.206, CI: 2.22, 4.61). Important sex differences also emerged in trauma history and HIV infection prevalence. CUD has a more severe clinical presentation among females facing early abstinence. Sex differences in the CUD course indicate the need for consideration of sex-specific interventions and research.
Highlights
Cocaine use disorder is a chronic relapsing disorder characterized by drug-seeking behaviors, such as lack of control, social malfunctioning and risky drug use [1]
We found sex differences in the severity of drug use and psychosocial problems across multiple clinical domains in a sample of crack cocaine users who were in early abstinence
The P-value for adjusted result refers to the significance level for sex in the adjusted model. indicates that the remaining model is significant at the last step of the linear regression, with p < 0.05. indicates that the remained model is significant at the last step of the linear regression, with p < 0.001
Summary
Cocaine use disorder is a chronic relapsing disorder characterized by drug-seeking behaviors, such as lack of control, social malfunctioning and risky drug use [1]. Females have higher rates of HIV [12] and comorbid psychiatric disorders, but personality disorders are more prevalent in males [13] Such differences may arise from multiple biopsychosocial factors, including hormones, cultural shaping and emotional vulnerability, for example. Highly prevalent among cocaine users [20], is a predictive risk factor for addiction [21]; evidence shows that this effect could be true for females but not males [22, 23]. Such negative events seems to worsen withdrawal and depressive symptoms in females [24]. A study with 227 cocaine users revealed that females have higher rates of bipolar disorder, posttraumatic stress disorder and psychotic-induced disorders [26]
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