Sex differences in cocaine/heroin users: drug-use triggers and craving in daily life.
BACKGROUND
Studies of sex differences have shown that men and women with drug-use disorders differ in course and outcome and in cue-induced activation of putative brain "control network" areas. We evaluated sex differences in daily functioning and subjective events related to drug use with ecological momentary assessment (EMA).


METHODS
EMA data were collected from cocaine- and heroin-using outpatients (72 men; 42 women) in methadone maintenance in 2-5 randomly prompted (RP) entries per day and in participant-initiated entries for heroin or cocaine use or craving, for up to 25 weeks. Urine drug screens were conducted three times weekly. Data were analyzed via repeated-measures logistic regression, using sex as a predictor of responses.


RESULTS
In RP reports, women and men reported significantly different patterns of drug-cue exposure, with women significantly more likely to report having seen cocaine or been tempted to use in the past hour. Women also had higher craving after past-hour exposure to drug cues. In reports of drug use, women, compared to men, were more likely to report that they had used more cocaine than they had meant to, tended to feel guilty more often after drug use, and to have used despite trying not to use.


CONCLUSIONS
These findings provide real-time behavioral evidence that women respond differently than men to exposure to drug cues and to drug use, consistent with laboratory and brain-imaging findings. This information may be useful for development of sex-specific treatment strategies.
Treatment Section, Clinical Pharmacology and Therapeutics Research Branch, Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health, Department of Health & Human Services, Baltimore, MD 21224, United States.
Ashley P
AP
Kennedy
David H
DH
Epstein
Karran A
KA
Phillips
Kenzie L
KL
Preston
D000293:Adolescent; D000328:Adult; D000339:Affect; D000368:Aged; D019970:Cocaine-Related Disorders / Q000523:psychology* / Q000534:rehabilitation; D003463:Cues; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006556:Heroin Dependence / Q000523:psychology* / Q000534:rehabilitation; D006801:Humans; D016014:Linear Models; D008297:Male; D008691:Methadone / Q000627:therapeutic use; D008875:Middle Aged; D009294:Narcotics / Q000627:therapeutic use; D016017:Odds Ratio; D058850:Opiate Substitution Treatment; D012727:Sex Characteristics; D012931:Social Environment; D012959:Socioeconomic Factors; D013315:Stress, Psychological / Q000209:etiology / Q000523:psychology; D015813:Substance Abuse Detection; D055815:Young Adult
D009294:Narcotics; D008691:Methadone
Cocaine; Craving; Drug cues; Ecological momentary assessment; Gender; Heroin; Methadone treatment; Sex differences