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Abstract: Despite rising rates of substance use disorders (SUD) in women and the narrowing of the SUD gender prevalence ratio in the U.S., large knowledge gaps in gender-specific treatment remain. The NIDA Clinical Trials Network (CTN) Gender Special Interest Group (GSIG) has provided opportunities to bring the gender lens to national multi-site clinical trials, ancillary studies, secondary data analyses, recommendations for data collection and demographic data, among other contributions to CTN and the SUD treatment field. This commentary provides background on gender differences and the knowledge gap, a history of the CTN GSIG, and its accomplishments via gender specific trials and key secondary analyses. The commentary will close with future directions and recommendations for research including improving the inclusion of intersectional identities in recruitment reach and analyses, reproductive health, pregnant and parenting people, and methodological considerations for clinical trials to enhance capacity to collect and understand data related to gender.

Abstract:

The opioid epidemic continues to evolve and impact all groups of people. Moreover, there are concerning trends among women. The aim of this article is to provide a review of opioid use disorder in women and the implications for treatment.

The NIDA Clinical Trials Network Gender Special Interest Group (SIG), a group comprised of investigators and providers from throughout the network, conducted a nonsystematic review of the literature to examine: 1) the epidemiology of opioid-related hospitalizations and deaths of women; 2) co-occurring pain, anxiety disorders, and trauma among women with opioid use disorder; 3) evidence for opioid agonist treatment of pregnant women with opioid use disorder; and 4) implications for treatment of women with opioid use disorder and next steps for research and practice.

The current opioid epidemic has produced important differences by sex and gender with increased rates of use and overdose deaths in women. Significant mental health concerns for women include co-occurring psychiatric disorders and suicide. Expanding medication treatment for perinatal opioid use disorder is crucial. While effective treatments exist for opioid use disorder, they are often not accessible, and a minority of patients are treated.

Conclusions: The end to the opioid epidemic will require innovative multi-systemic solutions. There are significant practice gaps in preventing rising death rates among women by opioid overdose, treating co-occurring psychiatric disorders and pain, and treating perinatal women with opioid use disorder and their infants. Research on sex and gender differences, and the intersection with race/ethnicity and US region, is critically needed and should include treatment implementation studies to achieve wider access for women to effective prevention, early intervention, and treatment.

Abstract:

This symposium presented findings from the National Drug Abuse Treatment Clinical Trials Network focused on gender differences in four different studies: Stimulant Abuser Groups to Engage in 12-Step (STAGE-12, CTN-0031); Web Delivery of Evidence-Based, Psychosocial Treatment for Substance Use Disorders (CTN-0044); Screening, Motivational Assessment, Referral and Treatment in Emergency Departments (SMART-ED, CTN-0047); and Stimulant Reduction Intervention Using Dosed Exercise (STRIDE, CTN-0037).

Presentations included:

Introduction

Elizabeth A. Wells, PhD, University of Washington
Gender Differences in Response to a 12 Step Engagement Intervention.

Aimee N.C. Campbell, PhD, MSW, Columbia University in the City of New York
Gender Differences in Acceptability and Treatment Outcomes of a Web Based Psychosocial Intervention.

Audrey Brooks, PhD, University of Arizona
Gender Differences in Treatment Access and Outcome Following an ED SBIRT Intervention.

Therese K. Killeen, PhD, Medical University of South Carolina
Stimulant Reduction Intervention Using Dosed Exercise: Gender Differences/Treatment Acceptability.

Discussant: Shelly F. Greenfield, MD, MPH, Harvard Medical School

Related protocols: CTN-0031, CTN-0037, CTN-0044, CTN-0047

Abstract:

This ancillary investigation by the CTN Gender Special Interests Group (SIG) examined gender differences in the rates and correlates of HIV sexual and drug risk behaviors in a sample of clients participating in five multi-site trials of the National Drug Abuse Treatment Clinical Trials Network (CTN). HIV sexual risk behaviors and drug risk behaviors in the past 30 days were assessed at treatment entry. Measures of recent substance use, psychiatric severity, abuse history, social relations, legal involvement, and housing stability were examined in models predicting sex and drug risk behaviors. In the sample of 1429 individuals, 39% had used both opioids and stimulants in the last 30 days, 21% had used stimulants only, and 17% used opioids only. Men were more likely to report injection drug use, but no other differences in drug risk behaviors were found. Women were more likely to report multiple partners, unprotected sex with regular partners, and greater engagement in high risk sexual behaviors overall. Women with greater alcohol use engaged in higher drug risk behaviors, while impairment in social relations was related to less engagement in sex risk behaviors for men. Stimulant use, sexual abuse history, drug use severity, and legal involvement were all associated with engagement in higher risk sexual behaviors for both women and men.

In conclusion, rising rates of HIV in women highlight the need to identify factors associated with risk behaviors in women. Women were less likely to report condom use with a regular partner, suggesting that condom use in an ongoing relationship may be discouraged by the male partner and reflect poorer negotiation skills. The association of alcohol use and psychiatric symptoms with risk behaviors may be the result of inferior negotiation skills or reflect social affiliation needs of vulnerable women.

Related protocols: CTN-0039-S

Abstract:

This study, a product of the CTN Gender Special Interest Group (SIG) surveyed publicly funded addiction treatment programs to increase understanding of treatment options for persons with co-occurring eating and substance use disorders. Data were collected between 2002 and 2004 from face-to-face interviews with program directors of a nationally representative sample of 351 addiction treatment programs. It was found that half of the programs screen patients for eating disorders, of which 29% admit all persons with eating disorders, and 48% admit persons with eating disorders of low severity. Few programs attempt to treat eating disorders. Programs that admit and treat patients with eating disorders are more likely to emphasize a medical-psychiatric model of addiction, use psychiatric medications, admit patients with other psychiatric disorders, and have a lower caseload of African-American patients.

In conclusion, it appears that, generally, patients with co-occurring eating and substance abuse do not appear to receive structured assessment or treatment for eating disorders in addiction treatment programs. These results highlight the need for education of addiction treatment professionals in assessment of eating disorders.

Abstract:

This paper, a product of the CTN Gender Interest Group, reviews the literature examining characteristics associated with treatment outcome in women with substance use disorders. A search of the English language literature from 1975 to 2005 using Medline and PsycInfo databases found 280 relevant articles. Ninety percent of the studies investigating gender differences in substance abuse treatment outcomes were published since 1990, and of those, over 40% were published since the year 2000. Only 11.8% of these studies were randomized clinical trials. A convergence of evidence suggests that women with substance use disorders are less likely, over the lifetime, to enter treatment compared to their male counterparts. Once in treatment, however, gender is not a significant predictor of treatment retention, completion, or outcome. Gender-specific predictors of outcome do exist, however, and individual characteristics and treatment approaches can differentially affect outcomes by gender. While women-only treatment is not necessarily more effective than mixed-gender treatment, some greater effectiveness has been demonstrated by treatments that address problems more common to substance-abusing women or that are designed for specific subgroups of this population. There is a need to develop and test effective treatments for specific subgroups such as older women with substance use disorders, as well as those with co-occurring substance use and psychiatric disorders such as eating disorders. Future research on effectiveness and cost-effectiveness of gender-specific versus standard treatments, as well as identification of the characteristics of women and men who can benefit from mixed-gender versus single-gender treatments, would advance the field.