Women's health, long neglected in medical research, stepped into the spotlight at a NIDA-sponsored conference held last September to assess the current state of scientific knowledge about addiction and women's health. In addition to showcasing what is known about women and drug abuse, NIDA hosted the conference to identify the many gender-related issues that the field of drug abuse research needs to address to meet the health needs of women.
"NIDA wants to hear from you," Dr. Loretta P. Finnegan, NIDA's former senior advisor on women's issues, told the nearly 200 scientists, health care professionals, treatment practitioners, representatives of women's groups, and policy and program staff from NIDA and other Federal agencies who attended the landmark conference on Drug Addiction Research and the Health of Women. "We want to know what we have missed. We want to know what we can do to improve our research priorities with regard to women. And, most of all, we want to improve the situation for those women who are suffering from drug addiction," said Dr. Finnegan, who now directs the Women's Health Initiative at the National Institutes of Health.
NIDA Director Dr. Alan I. Leshner told conference participants that NIDA is placing a high priority on research on drug addiction among women, noting that "historically, drug abuse research has focused primarily on men, as has most health research. Drug abuse may present significantly different challenges to women's health, may progress differently in women than in men, and may require different treatment approaches. And that, of course, is why we're here," Dr. Leshner said.
"Not only does this conference mark the demise of male-only research, it also signals a new era in NIDA's approach to research on women," said Richard A. Millstein, NIDA's deputy director. "While we can say with some accuracy that NIDA has had a long history of studying women and gender differences, the fact is that most of those studies have been among pregnant women and their offspring," Millstein said. "We need to expand beyond that to look at women independently, not just in relation to their status as mothers of children," he said.
NIDA is expanding its research on women to gain a better understanding of drug abuse and addiction and their impact on women's health. Some photos taken from NIDA videotape "Door to Recovery"Conference participants from a wide range of disciplines heeded the call from NIDA policymakers to raise the critical questions that the Institute needs to address as it expands its research agenda on women, drug abuse, and addiction. For 2 1/2 days, scientists and practitioners presented gender-related findings from epidemiologic, basic, clinical, and health services research studies and discussed the implications of these findings for the prevention and treatment of drug abuse, addiction, and related diseases such as HIV/AIDS among women. The fact that nearly 70 percent of AIDS cases among women are drug related coupled with the rapid rise of AIDS among women makes it imperative that we address drug abuse problems in women, said Dr. Mary Jeanne Kreek, a NIDA-funded researcher at Rockefeller University, in her keynote address to the conference.
Conference presentations covered such topics as:
- the nature and extent of drug abuse among women. Speakers pointed to a lack of reliable epidemiological data on drug abuse among different groups of minority women and among women of different sexual orientation;
- the many factors thought to be involved in the etiology of drug use among women, including childhood and adolescent sexual victimization, partner violence, and anxiety disorders and depression, which are much more prevalent among women than men;
- a history of inadequate and inappropriate treatment of women's anxiety and affective disorders, resulting in overprescription and abuse of psychotherapeutic medications;
- biological and behavioral mechanisms that may underlie women's patterns of drug use and differences in how drugs affect men and women. For example, animal and human studies indicate a possible link between the menstrual cycle of women addicts and drug seeking;
- the medical and health consequences of drug abuse, which include disruption of women's menstrual cycles, reproductive function, and immune function and a high risk of contracting HIV/AIDS;
- the psychiatric consequences of drug abuse, which include phobic, depressive, and antisocial personality disorders;
- the social and behavioral consequences of drug abuse, such as homelessness and high-risk sexual behaviors;
- the legal consequences of drug abuse, such as the criminalization and prosecution of drug-abusing mothers, particularly those from minority groups;
- the impact of negative social, economic, and legal circumstances on drug abuse and addiction among African- American, Native-American, Hispanic, Asian/Pacific Islander, and lesbian women.
Taken together, conference presentations underscored that the causes, correlates, pharmacokinetics, mechanisms, and consequences of drug abuse and addiction vary considerably in men and women. Yet, as a number of speakers pointed out, most drug abuse prevention and treatment interventions have been shaped by men's characteristics and needs.
Drug abuse prevention and treatment interventions for girls and women need to respond to specific gender-based risk factors, such as childhood sexual abuse, partner violence, and the prevalence of anxiety and depressive disorders, a number of researchers said. For example, the high incidence of anxiety and depression among women suggests that psychosocial and behavioral treatments might be particularly effective for women, said Dr. Karla Moras of the University of Pennsylvania.
Researchers and practitioners alike also need to acknowledge that women who abuse drugs are not a homogeneous group, noted several conference participants. Adolescents, pregnant women, housewives, older women, women from different ethnic groups, and lesbians may all experience significant variations in the factors that lead to drug abuse and addiction. For example, the effects of racism and community violence may contribute to making African-American women more vulnerable to depression and substance abuse. In like manner, a disproportionately large percentage of lesbians appear to suffer from drug and alcohol disorders that may be related to their having to deal with negative societal responses to their sexual orientation, said Marj Plumb of the National Center for Lesbian Rights.
Overall, NIDA's conference on addiction and women's health indicated that "despite some promising findings, the basic take-home message is that there are more gaps in knowledge about women in all areas of drug abuse research than there are findings," said Millstein. NIDA plans to start filling those gaps by incorporating into its agenda recommendations from conference participants that the Institute support more research on the impact of women's biology, environment, relationships, and experiences on health behaviors, Millstein said.
"As we all strive to move the concerns of women to a higher level in our overall priorities, we can be proud that we've done so much. But, we have a great deal more to accomplish," summed up Dr. Finnegan, who headed the NIDA Women's Advisory Committee, which organized the conference.