Research Opportunities for Gender Issues in the Clinical Trials Network (CTN)

United States

The meeting, convened by NIDA in collaboration with the CTN, sought to provide a forum for discussing opportunities and directions for research on gender issues in community substance abuse clinics. The meeting brought together scientists from a range of disciplines, as well as program and project officers from NIDA and the CTN. Speakers presented background data on what is known about gender and substance abuse and described relevant areas for future research. Strategies for incorporating gender research into existing and future protocols were discussed. 

As described at the meeting, there has been considerable progress made in supporting gender-related research over the past 30 years. Initially, little gender research was conducted, except for a small number of studies on pregnancy-related issues. Today, NIDA encourages and supports gender research in all areas of substance abuse, and regards analysis of gender differences as a critical element of good science.

Presentations by participants emphasized some important findings on gender and drug abuse that can serve as the foundation for future work. Some of the key findings described are the following:

• Men are not more vulnerable to developing drug dependence than women; In animal models, females more readily self-administer some drugs than do males, and females may be more vulnerable to relapse.
• Women and men often have different acute responses to drugs which may relate to different responses to treatment and different rates of abstinence.
• Women are often more susceptible to the biopsychosocial sequelae of substance abuse – they often present with more problems and tend to function more poorly than men.
• Women and men may have different motivations for using drugs, for entering or leaving treatment, and for relapsing. These differences have implications for treatment.
• Women and men process information differently and attend to different elements of a treatment. In addition, women and men may have different treatment needs. Therefore, gender-specific treatment programs are warranted.
• Early experience with gender-specific treatment programs indicates that women remain in these programs longer and fare better than in conventional treatment programs.
• Women have particular barriers to affecting behavior change related HIV prevention and other health behaviors.
   

Given these and other findings, there was consensus that research aimed at identifying and characterizing gender differences in drug abuse is critical to developing targeted treatments that are likely to increase abstinence among women. A number of participants stressed the importance of developing assessment tools for use with women. Existing assessment tools were developed on men and may not tap many of relevant aspects of substance abuse in women, including shame, victimization, trauma, parental status, psychiatric co-morbidity and medical illness (e.g., HIV). Similarly, there was consensus that treatment programs should be developed specifically for women, rather than attempting to modify existing treatments geared toward men. Effective women-only programs currently in existence provide pediatric, pregnancy and children’s services; client advocacy/case management; assistance with housing and transportation; peer support groups and social outings. These treatment programs may be uniquely suited to helping women overcome barriers to treatment. There is a need to conduct research on women-only treatment programs in order to identify content and process variables that are likely to support abstinence.

Participants also discussed the need to develop treatments for special populations of female substance abusers, including minority women. Although women from racial and ethnic minority groups use drugs at a lower rate than women who are white, minority women tend to experience more severe consequences of use, including medical, psychiatric, psychosocial, and legal problems. Minority patients have unique barriers to treatment, personal histories, motivations and support systems, each of which should be taken into account and address in treatment programs. Treatment programs need to address cultural and language issues that may interfere with successful treatment. Little is known about how best to address treatment needs in this population, and research needs in this area are numerous.

The need to address gender differences in the context of adolescent substance abuse was also discussed. Almost all substance abuse among adults began in adolescence, and different predictors of drug use have been reported for boys as compared to girls. Similarly, there may be gender differences in co-morbid affective and conduct problems in adolescence. It was suggested that CTN support the development and implementation of an adolescent common assessment battery in order to better characterize adolescent substance abusers and their clinical needs. Presenters described the lack of data on effective treatment approaches for adolescents and recommended that CTN explore treatment models that have been shown to be effective in at least two randomized trials. Traditional family systems therapy, cognitive-behavioral therapy and ecological therapy are good initial candidates. Behavioral or contingency management and pharmacological treatment approaches may also be fruitful.

Following the scientific presentations a brain-storming session took place in an effort to identify ways to incorporate gender issues into the CTN. Strategies for identifying appropriate areas for research were discussed, as were issues related to the use of a common assessment battery. Finally, gender-related questions to be addressed by individual protocols were outlined. Plans for a CTN Interest Group on Gender Issues were discussed as were plans for annual meetings related to gender issues.