title: Challenges in detecting and diagnosing substance use in women in the acute psychiatric department: a naturalistic cohort study.
abstract: BACKGROUND
  This study examines sex differences in substance use and substance use disorder in the acute psychiatric department, and possible interactions between sex and clinical and social factors associated with this phenomenon.
  
  
  METHODS
  Data concerning substance use were collected in a naturalistic cohort study (n = 384, 51.6% male, 48.4% female) in an acute psychiatric department. Recent intake of substances at admission, diagnosis of substance use disorder and demographic and socioeconomic information were recorded. At admission, serum and urine samples were analysed for substance use and breath analysis was performed for alcohol levels.
  
  
  RESULTS
  Twice as many men as women were diagnosed with substance use disorder, whereas there were no gender differences in the number of positive toxicology screenings. Toxicology screening revealed the use of non-prescribed medication with addiction potential in 40% of both female and male patients many of whom did not report this in the admission interview. A low level of education in men and absence of parental responsibility in women showed a statistically significant interaction with a current diagnosis of substance use disorder.
  
  
  CONCLUSIONS
  Despite no sex differences in positive toxicology screenings in the acute psychiatric department, twice as many men as women are diagnosed with substance use disorders. The use of prescription drugs with addiction potential was widely under-reported by both sexes, in patients with no prescriptions for the medications. Women with no parental responsibility are overrepresented among those diagnosed with substance use disorder, as are men with a low level of education.
  
  
  BACKGROUND
  The study is registered with the ClinicalTrials.gov identifier NCT01415323.
authors.affiliation: Department of Tiller DPS, St Olavs University Hospital, Trondheim, Norway. torill.sallaup@gmail.com.|Department of Neuroscience, Faculty of Medicine, The Norwegian University of Science and Technology, Trondheim, Norway. torill.sallaup@gmail.com.
authors.forename: Torill Vassli
authors.identifier: http://orcid.org/0000-0002-5773-2283
authors.initials: TV
authors.lastname: Sallaup
authors.affiliation: Department of Neuroscience, Faculty of Medicine, The Norwegian University of Science and Technology, Trondheim, Norway.|Department of Østmarka, St Olavs University Hospital, Trondheim, Norway.
authors.forename: Arne Einar
authors.initials: AE
authors.lastname: Vaaler
authors.affiliation: Department of Neuroscience, Faculty of Medicine, The Norwegian University of Science and Technology, Trondheim, Norway.|Department of Østmarka, St Olavs University Hospital, Trondheim, Norway.
authors.forename: Valentina Cabral
authors.initials: VC
authors.lastname: Iversen
authors.affiliation: Department of Neuroscience, Faculty of Medicine, The Norwegian University of Science and Technology, Trondheim, Norway.|Department of Østmarka, St Olavs University Hospital, Trondheim, Norway.
authors.forename: Ismail Cuneyt
authors.initials: IC
authors.lastname: Guzey
mesh_terms: D000328:Adult; D001944:Breath Tests; D015331:Cohort Studies; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D009664:Norway / Q000453:epidemiology; D011567:Psychiatric Department, Hospital / Q000706:statistics & numerical data*; D012727:Sex Characteristics; D015813:Substance Abuse Detection / Q000379:methods; D019966:Substance-Related Disorders / Q000097:blood / Q000453:epidemiology* / Q000652:urine; D055815:Young Adult
keywords: Acute psychiatry; Sex differences; Substance use; Substance use disorders