Substance Use Disorders In Women Research Articles

Predicting Co-Occurring Mental Health and Substance Use Disorders in Women: An Automated Machine Learning Approach

Significant clinical overlap exists between mental health and substance use disorders, especially among women. The purpose of this research is to leverage an AutoML (Automated Machine Learning) interface to predict and distinguish co-occurring mental health (MH) and substance use disorders (SUD) among women. By employing various modeling algorithms for binary classification, including Random Forest, Gradient Boosted Trees, XGBoost, Extra Trees, SGD, Deep Neural Network, Single-Layer Perceptron, K Nearest Neighbors (grid), and a super learning model (constructed by combining the predictions of a Random Forest model and an XGBoost model), the research aims to provide healthcare practitioners with a powerful tool for earlier identification, intervention, and personalised support for women at risk. The present research presents a machine learning (ML) methodology for more accurately predicting the co-occurrence of mental health (MH) and substance use disorders (SUD) in women, utilising the Treatment Episode Data Set Admissions (TEDS-A) from the year 2020 (n = 497,175). A super learning model was constructed by combining the predictions of a Random Forest model and an XGBoost model. The model demonstrated promising predictive performance in predicting co-occurring MH and SUD in women with an AUC = 0.817, Accuracy = 0.751, Precision = 0.743, Recall = 0.926 and F1 Score = 0.825. The use of accurate prediction models can substantially facilitate the prompt identification and implementation of intervention strategies.

Insomnia as a Risk Factor for Substance Use Disorders in Women.

Gender differences exist for both insomnia and substance use disorders. Women show a higher prevalence of insomnia and increased susceptibility to the effects of drugs than men. Importantly, a growing body of evidence suggests that insufficient sleep predicts and puts individuals at a higher risk for substance use and associated psychosocial problems. However, the role of insomnia in substance use disorders among women remains poorly understood. The present article discusses gender differences in insomnia and in substance use disorders and reviews evidence suggesting that an increased prevalence of insomnia may be a risk factor for substance use disorders in women.

Trauma and Substance Use Disorder: Breaking the Cycle in Women

Trauma and substance use disorder present a complex and intertwined challenge, particularly affecting women who experience unique gender-specific barriers to recovery. Understanding how substance use functions as a coping mechanism for the effects of trauma is imperative to developing effective prevention and treatment strategies. Barriers to recovery in women with trauma and substance use disorder include criminalization of substance use, gender-specific stigma toward substance use, and physiological effects of trauma on coping and resilience. Breaking the cycle of trauma and substance use disorder in women requires a holistic, multifaceted approach that underscores eliminating stigma, promoting resilience, and increasing supportive community.

Sex/Gender Differences in the Time-Course for the Development of Substance Use Disorder: A Focus on the Telescoping Effect.

Sex/gender effects have been demonstrated for multiple aspects of addiction, with one of the most commonly cited examples being the "telescoping effect" where women meet criteria and/or seek treatment of substance use disorder (SUD) after fewer years of drug use as compared with men. This phenomenon has been reported for multiple drug classes including opioids, psychostimulants, alcohol, and cannabis, as well as nonpharmacological addictions, such as gambling. However, there are some inconsistent reports that show either no difference between men and women or opposite effects and a faster course to addiction in men than women. Thus, the goals of this review are to evaluate evidence for and against the telescoping effect in women and to determine the conditions/populations for which the telescoping effect is most relevant. We also discuss evidence from preclinical studies, which strongly support the validity of the telescoping effect and show that female animals develop addiction-like features (e.g., compulsive drug use, an enhanced motivation for the drug, and enhanced drug-craving/vulnerability to relapse) more readily than male animals. We also discuss biologic factors that may contribute to the telescoping effect, such as ovarian hormones, and its neurobiological basis focusing on the mesolimbic dopamine reward pathway and the corticomesolimbic glutamatergic pathway considering the critical roles these pathways play in the rewarding/reinforcing effects of addictive drugs and SUD. We conclude with future research directions, including intervention strategies to prevent the development of SUD in women. SIGNIFICANCE STATEMENT: One of the most widely cited gender/sex differences in substance use disorder (SUD) is the "telescoping effect," which reflects an accelerated course in women versus men for the development and/or seeking treatment for SUD. This review evaluates evidence for and against a telescoping effect drawing upon data from both clinical and preclinical studies. We also discuss the contribution of biological factors and underlying neurobiological mechanisms and highlight potential targets to prevent the development of SUD in women.

Psycho-Social and Morbidity of Substance Use Disorder in Women

Substance abuse disorder is a major and worldwide concern that cursed countries and mankind. Psychosocial factors influences differ across the person and may contribute to the development of physical and mental disorders. The research aimed to investigate the impact of psychological factors (Self-esteem, Depression, Anxiety, and Decision-Making Confidence) and social factors (Childhood Problems, Hostility, Risk-taking, and Social Conformity) that predictors of substance use disorder in women. en cross-sectional survey design was used in this study. Drug Abuse Screaming Test (DAST) and psychosocial functioning scale were used to collect data on women (N=200). The purposive sampling technique was employed for sample selection; moreover, the snowball technique was also used as the drug-addicted women recommended the other women. Results of the study ravels that psychosocial factors were a significant predictor of substance use disorder in women. The finding of the multiple regression analysis reveals that psychosocial factors were significant predictors of substance use disorder in women [R2 =.46, F (1,142)14.26, p<.01]. In conclusion, this study highlights some psychological (Self-esteem, Anxiety, Decision-making confidence) and social factors (Childhood problems, Risk-taking, and social conformity) that are valuable predictors of substance use disorder in women. These findings may help clinicians to develop treatment and policy guidelines for the prevention of drug addiction in women.

Effect of Motivational Enhancement Therapy on Patterns of Substance Abuse in Postpartum Women: A Randomized Clinical Trial

Introduction: As a biopsychosocial phenomenon, substance abuse is a major public health problem with negative economic, social, and cultural consequences. Objective: This study aims to determine the effect of Motivational-Enhancement Therapy (MET) on substance abuse patterns in postpartum women with Substance Use Disorder (SUD). Materials and Methods: This clinical trial was conducted on 60 eligible postpartum women with SUD (30 in the intervention group and 30 control), who were selected using a random sampling method from the postpartum unit of a hospital in Kerman, Iran in 2019. The participants in the intervention group attended four individual MET sessions and received four telephone follow-ups. All participants completed a researcher-made substance use pattern checklist before and after the intervention. Data analysis was carried out using McNemar’s test, paired t-test, independent t-test, Fisher’s exact test, and chi-square test. A P<0.05 was considered statistically significant. Results: The mean age of women was 29.25±5.89 years, and most of them were housewives with elementary education. A significant reduction was observed in the number of opium (P=0.008) and methadone (P=0.003) users after the intervention. Moreover, there was a significant difference in the amount of opium and methadone use (P<0.05). However, no significant difference was found between the two groups in the method and frequency of substance use before and after the intervention. Conclusion: MET is effective in the type and amount of opium and methadone used in postpartum women with SUD. Therefore, it can be used along with other treatments for the treatment of SUD in women after delivery.

Sex Differences in Plasma Lysophosphatidic Acid Species in Patients with Alcohol and Cocaine Use Disorders.

Preclinical evidence suggests a main role of lysophosphatidic acid (LPA) signaling in drug addiction. Recently, we reported alterations in the plasma concentrations of LPA species in patients with alcohol use disorder (AUD). As there are sex differences in drug addiction, the main aim of the present study was to investigate whether relevant LPA species (16:0-LPA, 18:0-LPA, 18:1-LPA, 18:2-LPA and 20:4-LPA) were associated with sex and/or substance use disorder (SUD). This exploratory study was conducted in 214 abstinent patients with lifetime SUD, and 91 healthy control subjects. The SUD group was divided according to the diagnosis of AUD and/or cocaine use disorder (CUD). Participants were clinically assessed, and plasma samples were collected to determine LPA species and total LPA. We found that LPA concentrations were significantly affected by sex, and women showed higher concentrations than men. In addition, there were significantly lower 16:0-LPA, 18:2-LPA and total LPA concentrations in patients with SUD than in controls. Namely, patients with CUD and AUD + CUD showed lower LPA concentrations than controls or patients with AUD. In conclusion, our data suggest that LPA species could be potential biomarkers for SUD in women and men, which could contribute to a better stratification of these patients in treatment programs.

Setting the policy agenda for the treatment of substance use disorders in Iran

BackgroundDrug use is one of the most common public health problems globally. This study was done to analyze the agenda-setting of policies related to substance use disorder treatment in Iran since 1979.MethodsThe current qualitative study was done through document review and interviews with policymakers and executives. Purposive sampling with snowball strategy was considered for sampling. Semi-structured interviews were done. A total of 22 documents were examined, and the data were saturated with 32 interviews. Kingdon's Multiple Streams Framework was used to analyze the data.ResultsThe results indicated the intersection of problem stream, policy stream, political stream, and opening the opportunity window. In the problem stream, the rapid growth of AIDS among people who inject drugs (PWID), the decrease in the average age of first drug use, the increase in the prevalence of substance use disorder in women, the ineffectiveness of compulsive treatment, and criminological perspectives played key roles. The policy stream included criminological perspective and war on drugs, and harm reduction. The political stream included announcing general anti-narcotics policies by the Supreme Leader of Iran and understanding the need for treatment, rehabilitation, harm reduction, and social support for substance use disorder by officials and policymakers.ConclusionsFor a long time in Iran, policies based on the war on drugs were the dominant approach, and then, policies based on harm reduction and patient-centeredness were considered. The ideology and political parties influenced the executive apparatus's policy stream in this area. In countries with an ideological approach, the political stream plays a critical role in setting issues on the agenda. Therefore, policy entrepreneurs can put the points on the agenda by attracting the attention of political forces to the issue.

Discovering the pros and cons of participation of Iranian women with substance use disorder in women’s only narcotics anonymous meetings and offering strategies for harm reduction: A grounded theory study

Women with substance use disorder participate in women’s only narcotics anonymous meetings. Therefore, this study aimed to discover the advantages and disadvantages of Iranian women’s participation in this type of meetings. Accordingly, this research was done in Behboud Gostaran Hamgam Women’s Rehab Center in Tehran. The research method was a qualitative method of grounded theory, and samples of the research were chosen by theoretical sampling method. Data was collected using in-depth, face-to-face, unstructured interviews and nonparticipation observations. First, 4 women with substance use disorder who had referred to the center to quit addiction were interviewed. The researcher then interviewed 2 informant groups of the center’s medical staff, consisting of 2 social workers and 2 mentors with long-term experience in the field of women’s addiction, and at the end of each interview, the interviews were analyzed. Finally, according to theoretical sampling principles and achieving saturation, the researcher participated in the women’s only narcotics anonymous meetings, which were held weekly inside the center, and took notes on the content of the sessions in relation to the purpose of the study. After each session, the notes were analyzed and finally, after participating in 4 sessions, saturation was achieved by the researcher. By analyzing the research data, the theme of pros of participating in the women’s only narcotics anonymous meetings, and the theme of cons of participating in the women’s only narcotics anonymous meetings were yielded. Using the research findings could enhance the quality of these meetings.

Pediatric surgery and future risk of cocaine, opioid, cannabis, and other substance use in women: longitudinal cohort study

BackgroundSubstance use is problematic in young women, particularly in pregnancy. We sought to determine whether pediatric surgery is associated with the subsequent risk of adolescent or pregnancy-related illicit drug use, including cocaine, opioids, cannabis, and other drugs. MethodsWe analyzed a cohort of 167,119 girls aged five years or less in Canada with 4,693,444 person-years of follow-up. We tracked the girls over time between 1989 and 2018. The main exposure measure was pediatric surgery before 20 years of age. The main outcome included subsequent hospitalizations for substance use disorders and substance use in pregnancy. We estimated hazard ratios and 95% confidence intervals (CI) for the association of pediatric surgery with the later risk of substance use, using Cox proportional hazards regression models adjusted for patient characteristics. ResultsPediatric surgery was associated with 2.08 times the risk of future hospitalization for substance use disorders (95% CI 1.96-2.22) and 1.48 times the risk of substance use in pregnancy (95% CI 1.35-1.62), compared with no surgery. Associations were stronger for girls who had surgery under general anesthesia and were present regardless of age at first surgery or total number of surgeries. Pediatric surgery was associated with the use of cocaine, opioids, cannabis, and other illicit substances later in life. ConclusionsThis study suggests that pediatric surgery may be associated with future substance use disorders in women, including substance use at pregnancy. Further study is needed to determine whether surgery may have a causal role in later drug abuse by women.

A comparison of psychosocial adjustment among children of women who received behavioral couples therapy versus individually based therapy for substance use disorder

BackgroundChildren of women with substance use disorder (SUD) exhibit elevated risk for psychosocial adjustment problems. However, little research has examined whether women's SUD treatment is beneficial for their children. In comparison to individually based therapy (IBT), behavioral couples therapy (BCT) is superior for reducing women's SUD problems and improving their intimate partner relationships. The current study sought to examine whether BCT is more efficacious than 12-step-oriented IBT for reducing psychosocial adjustment problems among the children of women with SUD. MethodsThe study obtained the data from two larger randomized clinical trials, both of which compared BCT plus IBT versus IBT alone for women with SUD. Participants were women (N = 75) and their male partners who had an identified target child between the ages of 6 and 16 years old (M = 10.63). Most (62%) were the biological child of both partners, and 92% lived with the couple. Both partners completed the Child Behavior Checklist (CBCL) in relation to the target child at baseline, post-treatment, and 6-month follow-up. ResultsComparisons of CBCL scores from baseline to following treatment mostly showed significant improvement in BCT + IBT but not IBT. Generalized estimating equations, which controlled for baseline CBCL, showed better retainment of treatment gains for mother-reported internalizing CBCL scores in BCT + IBT, but the study found no other between treatment differences. ConclusionThese findings suggest that BCT + IBT produces more consistent improvements for children of women with SUD versus IBT.

Yoga for Substance Use Disorder in Women: A Systematic Review.

It has been suggested that yoga may be an effective adjunct intervention in the management of substance use disorders (SUD). Additionally, women with SUD require different treatment approaches than men. The objective of this study was to critically evaluate the evidence for the effectiveness of yoga, specifically for women, as part of treatment for SUD. Nine electronic databases were searched from inception to January 2020. Randomized controlled trials (RCT) that evaluated any type of yoga, including yoga as a component of mindfulness-based treatment, against any type of control in individuals with any type of addiction were eligible. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Checklist and Statement, methodological quality was appraised using Physiotherapy Evidence Database (PE Dro) criteria. Ten RC Ts (eight mixed-gender and two female-focused) met the eligibility criteria. Most of these RCTs were small to medium-sized, with various methodological and analytical flaws and deficits. The types of addictions included in these studies were alcohol, drug, and nicotine addiction. Most RCTs suggested that various types of yoga, primarily Hatha Yoga and its components, led to favorable or equivalent results for SUD as an adjunct to control or treatment-as-usual interventions. There are limited results on the impact of yoga for SUD specifically focused on women and their unique needs. Although the results of mixed-gender articles are encouraging, large RCTs with gender-specific subanalyses are required to better determine the benefits specific to women incorporating yoga for SUD.

Yoga for Substance Use Disorder in Women: A Systematic Review

To critically evaluate the evidence for the effectiveness of yoga, specifically for women, as part of treatment for substance use disorder (SUD).

Gender Disparities in Patients With Alcoholic Liver Disease Evaluated for Liver Transplantation.

The morbidity and mortality from alcohol-related liver disease (ALD) is increasing in the United States. However, little is known about gender differences in evaluation and listing for liver transplantation (LT) in patients with ALD. This is a retrospective review of adult patients with ALD evaluated for LT at a single transplant center from January 1, 2010, to March 1, 2017. Univariate, multivariate, and time-series analyses were performed. Among the 949 patients with ALD evaluated, mean age was 53 years, 84% were Caucasian, and 33% were women. The median model for end-stage liver disease score was similar between the genders. Women were less likely to be listed for LT (10% versus 19%; P < 0.05). The proportion of women not listed due to active substance use was significantly higher versus men (42% versus 35%; P < 0.05), while the frequency of medical contraindications was comparable between the genders. During a median follow-up of 416 days (range: 0-2784), listed women with ALD were less likely to undergo transplantation (42% versus 47%; P < 0.05). Men with ALD were 95% more likely to be listed and 105% more likely to be transplanted compared to women with ALD. While men had more lifetime substance use and related consequences, women had more psychiatric comorbidities and were less likely to be listed due to active alcohol and opioid use. Early detection and effective treatment of psychiatric and substance use disorders in women with ALD may improve their transplant eligibility.

Longitudinal effects of interoceptive awareness training through mindful awareness in body-oriented therapy (MABT) as an adjunct to women’s substance use disorder treatment: A randomized controlled trial

BackgroundTraining in interoceptive awareness is a promising behavioral approach for improving substance use disorder (SUD) treatment. This study examined the longitudinal effects of Mindful Awareness in Body-oriented Therapy (MABT) as an adjunct to women's SUD treatment. MABT teaches interoceptive awareness skills to promote self-care and emotion regulation. MethodsWomen in intensive outpatient treatment for SUD at three community clinics were recruited and randomly assigned to one of three study conditions Treatment as Usual (TAU) + MABT, TAU + Women's Health Education (WHE), and TAU only. Four assessments were delivered over one year (N = 187) baseline, 3, 6 and 12 months to examine primary outcome of percent days abstinent from substance use, and secondary outcomes of emotion dysregulation, craving, psychological distress, mindfulness and interoceptive awareness. Changes in outcomes across time were assessed using multilevel mixed effects linear regression. ResultsSubstance use improved significantly for MABT vs. TAU at 6 months and 12 months. Positive longitudinal effects on secondary outcomes for MABT were evident on respiratory sinus arrhythmia (RSA), a physiological index of emotion regulation; on craving; and on interoceptive awareness skills. Analyses based on participants who completed >75% of the intervention sessions revealed additional immediate significant improvements for MABT vs. TAU and WHE on depressive symptoms and emotion regulation difficulties and longitudinal improvement on mindfulness skills. ConclusionsResults show MABT to be efficacious for longitudinal health outcomes to support women's recovery as an adjunct to community-based SUD treatment.

A randomized controlled trial of a gender-focused addiction model versus 12-step facilitation for women veterans.

Substance use disorder (SUD) has increased among women, including military veterans, yet SUD treatment was historically designed for males. This randomized controlled trial compared 12 individual sessions of a gender-focused SUD recovery model, A Woman's Path to Recovery (WPR) to an evidence-based, non-gender-focused SUD model, 12-Step Facilitation (TSF) for 66 women veterans with current severe SUD. The primary outcome was substance use; secondary outcomes were associated problems (e.g., psychological); coping skills, and 12-step attendance, with assessment at baseline, end-of-treatment, and 3-month followup. Substance use decreased over time, with no difference between conditions. Decreases occurred from baseline to end-of-treatment and baseline to followup and, for drug severity, also from end-of-treatment to followup. Effect sizes were large for alcohol and medium otherwise. Secondary outcomes were largely consistent with this pattern of improvement. Urinalysis/breathalyzer supported self-report. Treatment attendance was 62% for WPR and 57% for TSF (not significantly different). Twelve-step group attendance, surprisingly, did not increase in either condition. WPR provides a useful addition to women's SUD treatment options, with outcomes no different than an established evidence-based model, TSF. Both showed positive impact on substance use and related areas. Our lack of differences based on gender-focus may reflect women veterans being acculturated to a male military environment. Limitations include lack of an untreated control, a sample limited to veterans, and use of a large effect size for power assumptions. This is the first RCT of a gender-focused approach for women veterans with SUD. (Am J Addict 2018;27:210-216).

Sex differences in substance use disorders: focus on side effects.

Although sex differences in several aspects of substance use disorders (SUDs) have been identified, less is known about the importance of possible sex differences in side effects induced by substances of abuse or by medications used to treat SUDs. In the SUD field, the perception of certain subjective effects are actively sought, while all other manifestations might operationally be considered side effects. This article was aimed at reviewing sex differences in side effects induced by alcohol, nicotine, heroin, marijuana and cocaine and by medications approved for alcohol, nicotine and heroin use disorders. A large body of evidence suggests that women are at higher risk of alcohol-induced injury, liver disease, cardiomyopathy, myopathy, brain damages and mortality. The risk of tobacco-induced coronary heart disease, lung disease and health problems is higher for women than for men. Women also experience greater exposure to side effects induced by heroin, marijuana and cocaine. In addition, women appear to be more vulnerable to the side effects induced by medications used to treat SUDs. Patients with SUDs should be advised that the risk of developing health problems may be higher for women than for men after consumption of the same amount of substances of abuse. Doses of medications for SUD women should be adjusted at least according to body weight. The sex differences observed also indicate an urgent need to recruit adequate numbers of female subjects in pre-clinical and clinical studies to improve our knowledge about SUDs in women.

Gender differences in the relationship between gambling problems and the incidence of substance-use disorders in a nationally representative population sample

BackgroundCross-sectional studies have demonstrated gender-related differences in the associations between problem-gambling severity and substance-use disorders; however, these associations have not been examined longitudinally. We aimed to examine the prospective associations between problem-gambling severity and incident substance-use disorders in women versus men. MethodsAnalyses were conducted using Wave-1 and Wave-2 NESARC data focusing on psychiatric diagnoses from 34,006 non-institutionalized US adults. Inclusionary criteria for pathological gambling were used to categorize Wave-1 participants as at-risk/problem gambling (ARPG) and non-ARPG (i.e. non-gambling/low-frequency gambling/low-risk gambling). Dependent variables included the three-year incidence of any substance-use disorder, alcohol-use disorders, nicotine dependence, drug-use disorders, prescription drug-use disorders, and illicit drug-use disorders. ResultsSignificant gender-by-ARPG status interactions were observed with respect to the three-year incidence of nicotine dependence and prescription drug-use disorders, and approached significance with respect to incident alcohol-use disorders. ARPG (relative to non-ARPG) was positively associated with nicotine dependence among women (OR=2.00; 95% CI=1.24–3.00). ARPG was negatively associated with incident prescription drug-use disorders among men (OR=0.30; 95% CI=0.10–0.88)). Finally, ARPG was positively associated with incident alcohol-use disorders among men (OR=2.20; 95% CI=1.39–3.48). ConclusionsGambling problems were associated with an increased 3-year incidence of nicotine dependence in women and alcohol dependence in men. These findings highlight the importance of considering gender in prevention and treatment initiatives for adults who are experiencing gambling problems. Moreover, the specific factors underlying the differential progressions of specific substance-use disorders in women and men with ARPG warrant identification.

Mindful awareness in body-oriented therapy as an adjunct to women's substance use disorder treatment: A pilot feasibility study

This study examined mindful awareness in body-oriented therapy (MABT) feasibility as a novel adjunct to women's substance use disorder (SUD) treatment. As an individual therapy, MABT combines manual and mind–body approaches to develop interoception and self-care tools for emotion regulation. A 2-group randomized controlled trial repeated-measures design was used, comparing MABT to treatment as usual (TAU) on relapse to substance use and related health outcomes. Sixty-one women were screened for eligibility, and 46 enrolled. Participants randomized to MABT received 8 weekly MABT sessions. Results showed moderate to large effects, including significantly fewer days on substance use, the primary outcome, for MABT compared with TAU at posttest. Secondary outcomes showed improved eating disorder symptoms, depression, anxiety, dissociation, perceived stress, physical symptom frequency, and bodily dissociation for MABT compared with TAU at the 9-month follow-up. In conclusion, it is feasible to implement MABT in women's SUD treatment, and results suggest that MABT is worthy of further efficacy testing.

Association of Clinical Characteristics and Cessation of Tobacco, Alcohol, and Illicit Drug Use during Pregnancy

Pregnancy is a time of relative urgency and opportunity for the treatment of substance use disorders in women, yet little is known about modifiable factors that contribute to successful abstinence. We examined self-worth, depression, anxiety, and novelty seeking in the context of substance use cessation during pregnancy in a sample of women with a high prevalence of substance abuse. Subjects were 448 birth mothers who participated in a prospective adoption study. Discontinuation rates were: tobacco 22.2%, alcohol 64.7%, marijuana 77.2%, and other drugs, 73.7-100%. Depression, anxiety, and novelty seeking were lower among women who discontinued substance use, compared to those who did not. Self-worth was higher in women who discontinued substance use. Among 110 polysubstance users, the number of substances discontinued during pregnancy was correlated with depression, anxiety, and self-worth in the hypothesized direction. Possible clinical implications are discussed.