Women and Addiction: Treatment Differences and Challenges · • Addiction is seen as a disease with genetic and brain components that has consequences for the community and the criminal

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WomenandAddiction:TreatmentDifferencesandChallenges

JillB.Becker,Ph.D.UniversityofMichigan

PatriciaY.Gurin CollegiateProfessorofPsychologyResearchProfessorMolecular&BehavioralNeuroscienceInstitute

OH

HO

BECKERLabTHE

Neurobiology of sex differences research groupUtahPSYCHIATRYADDICTIONSUpdateConf2018

DISCLOSURES• IHAVENOCOMPETINGFINANCIALINTERESTSTODISCLOSE

• IAMNOTAPSYCHIATRISTORCLINICALPSYCHOLOGIST– IDONOTTREATPATIENTS

• IDOBASICANIMALRESEARCHONSEXDIFFERENCESINADDICTION

UtahPSYCHIATRYADDICTIONSUpdateConf2018

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ThingstoconsiderWhatisaddiction?

Howdoesourdefinitionvarywithdiscipline?Howistreatmentaffectedbydefinition?

Wheredoessex/genderfitin?


• Neurotransmitters• Genes• PetandfMRIimages• Neuronmorphologyandsynapses

• Neuroplasticity

• Molecularchanges• Electrophysiology• Rewardsysteminthebrain

• Individualdifferencesinvulnerability

Whosedefinition?

Whatarewetreatingandhowdoourdefinitionsimpactapproachesfortreatment?• Neuroscience:Addictionistheconsequenceofcertainsubstancesoractivitiesthatbecomecompulsivebecauseoftheirabilitytoinduceactivityintherewardsystemthatsubsequentlyinduceslong-termchangesinthebrain.Thesechangesinthebrainperpetuatethecontinueddisplayofthebehaviorasitbecomesmoreandmorecompulsive.


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Whatarewetreatingandhowdoourdefinitionsimpactapproachesfortreatment?• Neuroscience:Addictionistheconsequenceofcertainsubstancesoractivitiesthatbecomecompulsivebecauseoftheirabilitytoinduceactivityintherewardsystemthatsubsequentlyinduceslong-termchangesinthebrain.Thesechangesinthebrainperpetuatethecontinueddisplayofthebehaviorasitbecomesmoreandmorecompulsive.• TREATMENT:Changethebrain(medication,CBT,etc)


Whatarewetreatingandhowdoourdefinitionsimpactapproachesfortreatment?

• Physician – Addictionisanuncontrollable,compulsivecraving,seeking,andengagementinabehaviororactivitythatcontinueseveninthefaceofnegativehealthandsocialoutcomes.• Addictionisabraindisease.• Diagnosis– DSMcriteria.• Treatment- Abstinence


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Whatarewetreatingandhowdoourdefinitionsimpactapproachesfortreatment?• Clinicaltreatmentprovider/SocialWorker• Addictionisseenasadiseasewithgeneticandbraincomponentsthathasconsequencesforthecommunityandthecriminaljusticesystem.• Addictionimpactsnotjusttheindividualbutthefamilyandcommunityinwhichtheaddictionoccurs,soitismorethananindividual’sproblem.Mustbalanceharmreductionvs.prevention.



• Sociologist – Addictionisamoralisticconceptunderstoodfromtheindividualizedperspectiveasdeviantbehaviorandresultsinsocialexclusion.


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Whatarewetreatingandhowdoourdefinitionsimpactapproachesfortreatment?• PublicHealth• Addictionisviewedasapublichealthissuewhichcausesmanynegativecoststopeopleandsociety• Concernedaboutidentifyingriskandprotectivefactors.• Riskandprotectivefactorscanoccuratallsocietallevels,frombiologicalandpsychological,withinrelationshipsandgroupmemberships,butalsowithinschools,workplaces,communities,societalnorms/values,costsandincentives.• Goalistoincreaseprotectiveanddecreaseriskfactors,witharangeofpreventiveapproachestodecreaseincidenceandprevalenceofrisks,earlysignsoftroubleandproblems.


Whatarewetreatingandhowdoourdefinitionsimpactapproachesfortreatment?• Historian – Notthehistorian’sjobtodefineaddictionbuttodocumenthowdefinitionschangeovertime.


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Whatarewetreatingandhowdoourdefinitionsimpactapproachesfortreatment?• Thenon-academic?Ifsomeoneisanaddicttheymustbeweak,itistheirownfault,theywilllieandcheatandstealanddoanythingfortheiraddiction.Youcan’ttrustanaddict.Theyarenotworthyofourhelp.

• Addictsareweak– lackofwillpower• Addictsareliarsandthieves• Addictsarenottrustworthy• Addictsareself-centered

• Womenwhoareaddictsaredeniedfoodstampsandbabyformula• Pregnantwomenwhoareaddictscanbejailedforharmingtheirunbornbaby• Addictsarebadmothersandbadwomen



• Somedisciplinesfocusonintervention.• Somedisciplinesreportonthescience.• Thoseintreatment/interventionsaythatthescientistspromisethepublicacureforabraindisease- thiscontributestotheproblemofstigmaforthoseaddictedwhentheycontinuetorelapseoruse.•Womenareimpactedmoreseverelywhentreatmentprogramscannotaccommodatechildren.relapsemeansremovalofchildrenfromthehome,pregnantwomenareimprisonedandprograms callforcessationofmethadone/suboxoneduringpregnancy.


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Whatarewetreatingandhowdoourdefinitionsimpactapproachesfortreatment?CommonElements• Braininvolved(neuroscientist,physician,treatmentprovider)

• Individualdifferencesinsusceptibility

• Disagreement• Whosefaultisit?• Naturevs.nurture• Roleofcommunity• ScientistspresumewecangeteverclosertothetruthOtherdisciplinessaymaybe butalwaysdeeplyinfluencedbyculture• Sex/Genderdifferences


Howdoessex/genderimpacthowwethinkaboutaddiction?

• Neuroscience• Sexdifferencesareincludedoccasionallyasabimodal(maleandfemale)variable.• Sexdifferencesare“controlledfor”bynormalizingdatabysexofsubject.• Analysisoftheinfluenceofgonadalhormonesfindsfemaleaddiction-relatedbrainsystemsandbehaviorsaredifferentiallyinfluencedbyovarianhormones.


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Howdoessex/genderimpacthowwethinkaboutaddiction?• Clinicaltreatmentprovider/SocialWorker• Havedevelopedprinciplesandapproachesforgender-specificandgender-informedapproaches.• Manybasicassumptionsaboutaddictionsandtreatmentweredevelopedbymentoaddressconsequencesmorecommoninmen.Somebasicapproachesareharmfulforwomen,andcanincreasetrauma&depression,theycanlowerself-worth.• Manywomenwithseriousaddictionissueswereabusedaschildrenandtraffickedasadults.Trauma-informedapproachesimproveoutcomes.


Howdoessex/genderimpacthowwethinkaboutaddiction?• Feminist• Afeministperspectiverecognizesthatconventionalresearchoperatesfrommale-centricparadigmsthatresultinbias,obscuringrealworldhierarchiesandperpetuatinginequalities.• Afeministperspectiveseekstochallengethisbiasandreframetheparadigmsinwaysthatdonotassumethatthemaleperspectiveistheonlyviewanddoesnotproblematizethe“feminine” perspective.


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Howdoessex/genderimpacthowwethinkaboutaddiction?• Feminist• Thefeministperspectivedrawsattentiontothedualaspectofdependencyandsubordinationofwomenwhoareaddicts.• Maleexploitationofwomenisbothacauseandconsequenceofaddictioninwomen.

• Feministperspectivesnotethatawomanwhoisaddictedisgenerallyperceivedaslessgood/moralthanamanwhoisaddictedbecauseofdoublestandards.



• Feminist•Majortensionwithinfeminism– wetvs.dry• ’Wet’feministposition– womenshouldbeabletoparticipateinaddictiveactivitylikeaman– itisliberatingandasignofincreasingpowerandoptions.• “Dry’feministposition– menuseaddictiveactivitiestohavepoweroverwomensowomenshouldrefrain.


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Howdoessex/genderimpacthowwethinkaboutaddiction?• SocialPsychologist• Genderisonlyapartoftheissuewithregardtohowaddictionisconceptualizedinthecontemporaryworld.• Raceandhistoricaltraumamustalsobeconsideredwithinthepost-colonialframeworkofnon-EuropeanAmericans.• Genderessentialismisverydeep,canvarybycultureandisreinforcedbylanguage.


Howdoessex/genderimpacthowwethinkaboutaddiction?• Historically• Addictionhasbeen(repeatedly)reconceptualizedasadiseaseratherthansinorlackofwillpower(medicalization).Manypeoplebelievedthatthisshiftwouldremoveoratleastreducestigmaforwomen.• Treatmentmodels,evenwhendesignedforwomen,tendtochannelthewomanbackintostandardrolesofcaregiver,mother,andwifeandreinforcetheadditionalstigmafacedbyaddictedwomenofnotconformingtostandardrolesforwomen.


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CommonElements

• Sexandgenderdifferencesareimportanttoconsiderinresearchandtreatment.

• Disagreement

• Manyfeministsinsocialsciencesandhumanitiesdonotwanttotalkaboutbiologicalsexdifferencesb/cthatconcepthasbeenusedagainstwomeninthepasttodisenfranchisewomen.


IssuesandObstaclestoTalkingAboutAddictionandTreatmentasWeSeektoBridgeDisciplinesWhatDoesAddictionisaBrainDiseaseMean?• Neuroscienceperspective – Exposuretosubstancesorengaginginactivitiesthatbecomecompulsive,becauseoftheirabilitytoinduceactivityintherewardsystem,subsequentlyinduceslong-termchangesinthebrain.Thesechangesinthebrainunderliethephenomenaofaddiction,makingaddictionabraindisease.Someindividualsmaybemorevulnerableduetogeneticcontributions,ahistoryofabuseorstress,aswellaswhethertheyaremaleorfemale.


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IssuesandObstaclestoTalkingAboutAddictionandTreatmentasWeSeektoBridgeDisciplines

WhatDoesAddictionisaBrainDiseaseMean?Whatthenon-scientisthears!• BiologicalDeterminism – Ifaddictionisabraindiseasethenindividualswhoareaddictedcan’thelpgettingthedisease.Inotherwords,manypeopleassumethatthebraindifferencesarecausativetoaddiction (e.g.,geneticfactors,heredity,fixedfactors)andcannotbechanged.Theirbrainsaregeneticallyorepigeneticallydamagedanditwasinevitablethattheywouldbecomeaddicted.



WhatDoesAddictionisaBrainDiseaseMean?• Neuroscienceperspective – thebrainhaschanged• BiologicalDeterminism – it’snotmyfault

It’s Official: Being Fat is not Your FaultNational Post 25 June, 2013

Astudyfoundthatoverweightmenandwomenwhoaretoldobesityisadiseasearelessinterestedingoingonadiettoimprovetheirhealth.28January2014:http://www.dailymail.co.uk/health/article-2547768/Labelling-obesity-disease-excuse-not-diet.html#ixzz2z52yMC77


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IssuesandObstaclestoTalkingAboutAddictionandTreatmentasWeSeektoBridgeDisciplinesPowerDynamicsinRelationshipsandAddiction• Substanceuseandeatingdisorders,suchasanorexianervosa,maybeviewedasademonstrationofpowerorrebellionforindividualsorgroups.• Addictionalsomeansalossofpower.• Whobenefitsfrompowerinarelationshipwhenoneorbothareaddicted?• Thereislossofpowerasanaddict(enablingpartnersgainpower),aswellpoweroveraddictioninrecovery.• Framingrecoveryasarestorationofpowertotheindividualcanchangehowoneperceivesthecausesandconsequencesofaddictionandrecovery.


IssuesandObstaclestoTalkingAboutAddictionandTreatmentasWeSeektoBridgeDisciplinesWhenstudyingaddictiontreatmentinwomen,weencountersomanydifferentfactors:

gender/sexvariationswomenwhoareresilienttoadversitysocialbondsandsupportharassment,stress,minoritystresspregnancyandotherbiologicaleffectsdowomenandmencometoaddictionthesameway?ethnicity,SES,sexuality,etc.caregivingrolesandexpectations


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IssuesandObstaclestoTalkingAboutAddictionandTreatmentasWeSeektoBridgeDisciplines• Dowomenexperiencetheiraddictionsinthesamewayasmenorisitdifferent?• Wecanuseanimalmodelsforvariousaspectsofaddiction,differentsocialrelationships,differentreproductiveexperiences,sociallybondedvs.not,etc.butthemodelsarenecessarilyrestrictedtospecificaspects.• Areallanimalsaregoodmodelstostudyhumanaddiction?• Arealladdictionsthe”same”?


IssuesandObstaclestoTalkingAboutAddictionandTreatmentasWeSeektoBridgeDisciplines• Ifweeliminatethepolesofmale/menandfemale/womenthenwelosealotoftheattentiontocharacteristicsthatmanywomen/girls(andtransgenderedfolks)haveincommon.

• Differencesarenuancedbutwewantthemtobebimodal.


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•Whendoespayingenough attentiontogender/sex,endupputtingwaytoomuchweightonsexdifferencesasifitisabimodalconstructwheninfactthatisnotnecessarilythecase?


SexDifferencesinAddictiontoDifferentClassesofDrugsinHumans

From:BeckerJB,Koob GF.Pharmacol Rev,2016,68:242-263.

Drug

Alcohol

Cocaine

OpiatesNicotine

Cannabinoids

Binge/Intoxication

Escalation of use F>M*Amount of intake M>F**Incidence M>F***Escalation of use F>M*Amount of intake F>M**Incidence M>F***Incidence M>F***Stress promotes initiation in women*Females acquire self-administration

at lower doses than males**Amount of intake F>M**Women report enhanced subjective

ratings in response to smoked cannabis and progress from use to disordered use more rapidly than men*

WithdrawalNegative Affect

Negative affect F>M*



Preoccupation/Anticipation

Stress or anxiety-induced relapse F>M*

Stress-induced relapse F>M*Cue-induced relapse F>M*Cue-induced craving F>M*

Higher cortisol predicts relapse in women*Lower cortisol and craving predict relapse

in men*Stress promotes relapse in women*

* = qualitative ** = quantitative *** = population

StageofAddictionCycle


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BeckerandKoob (2015)

TYPESOFSEXDIFFERENCES



SexDifferencesmayreflectdifferentdistributionsofmalesandfemalesforaspectsofaddiction:Femalesmetmoreaddiction-likecriteriathanmalesandprenatallystressedfemaleratsmetmoreaddiction-likecriteriathannon-stressedfemales

Thomas&Becker(2018)

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UtahPSYCHIATRYADDICTIONSUpdateConf

2018

OTHERFACTORSEnvironmentalcontextcandramaticallyaltertherewardingeffectsofaddictivedrugsandunveilfundamentaldifferencesamongdifferentclassesofdrugs.

Therewardingeffectsofaddictivedrugsdonotdepend(entirely)onsharedneuralsubstrates.

ALDOBADIANI

Setting of drug taking in humans

Participants: Individualswithsubstanceusedisorder(DSM-IV-TRorDSM-5)andwithalonghistory(about15yrs)ofbothheroinandcocaineuse

Methods: • Retrospectivereports• Ecologicalmomentaryassessment• Neuropsychologicalandbehaviouraltests• Emotionalvisualimagery• fMRI

ALDOBADIANI

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Setting preferences for cocaine vs. heroin usein co-abusers (N = 160)

Caprioli et al., Biol Psychiatry 2009Badiani and Spagnolo, Curr Pharm Des 2013

Cocaine

22.5%

69.4%

Heroin

70.0%

23.1%

50/50outsidethe home

at home

22.5/69.4= 0.32

p<0.0001

70/23.1= 3.03

ALDOBADIANI

CircumplexModelofAffect(Russel1980)

Bidimensional testofaffectivestate

Arousal

Sedation

Unpleasant Pleasant

A novel test for the assessment ofsubjective appraisal of affective states

Arousal

Sedation

Unpleasant PleasantPleasantsedation

Unpleasantsedation

Pleasantarousal

Unpleasantarousal

De Pirro et al., J Neurosci 2018

ALDOBADIANI

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Shift in Valence

McNemar’s testp<0.0001

Positivevalence

Negativevalence

Heroin at home Heroin outside the home(mismatch)


ALDOBADIANI

Shift in Valence

McNemar’s testp=0.0014

Positivevalence

Negativevalence

Cocaine at home(mismatch)

Cocaine outside the home


ALDOBADIANI

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Drug imagery during fMRI scanningALDOBADIANI

Drug imagery during fMRI scanning

BaselineImagery

DRUGIMAGERY

Rest

VASvividness

60 s

120 s

60 s

Stimulus onset

- Heroin at home- Heroin outside the home- Cocaine at home- Cocaine outside the home

- Home- Outside

the home


ALDOBADIANI

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MapofActivation(PFWE <0.05)

De Pirro et al., J Neurosci 2018UtahPSYCHIATRYADDICTIONSUpdateConf2018

ALDOBADIANI

at home outsidethe home

at home outsidethe home

Opposite patterns of activation of the fronto-striatal-cerebellar network as a function of drug and setting

BOLD

signalchange

COCAINE HEROIN


ALDOBADIANI

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Therapeuticapproachestoaddiction(e.g.,EcologicalMomentaryInterventions)shouldtakeintoaccountthedistinctiveeffectsofdifferentclassesofdrugsandreal-worldsettingsofdruguse.

CONTEXTISIMPORTANT!

Real-world settings

Druguser

Druguser

Druguser

Druguser

ALDOBADIANI

GenderedWorlds• Boysandgirlsareperceivedandtreateddifferentlythroughthelifecourseandindifferentcultures- biologicalexplanationsarecommonlyinvokedasthereasons.• Thesocialcontextsexperiencedbymen,women,andthesubgroupswithinthegenders(forinstanceeconomicclassorethnicity)aredifferent.• Thoughourbiologicalelementsare‘plastic’oradaptable(biologyisnotdestiny),theculturalcategoriesrelatedtogenderthatindividualsexperiencerigidlycategorizeindividualsanddifferentiallycolortheirexperiences.


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GenderedWorlds

Howgenderisexperiencedwithinlargerculturesshaperiskandconsequencesrelatedtoaddictions.Forinstance,abuseandtraumaduringdevelopmenthavelongtermeffectsonvulnerabilityforaddictionsandmalesandfemalesaredifferentiallyaffected.


A.DevelopmentalOrigins

B.StatisticalCharacteristics

C.FunctionalExpressionofTrait

Organizational:geneticand/orhormoneinitiatedtrait

Contingent:internalorexternalfactors(includingepigeneticfactors)actingonasexuallydimorphicindividual

Maletrait

Femaletrait

i.BimodalDistribution

MaleTrait

FemaleTrait

ii.Average/MeanDifference

MaleDistribution

FemaleDistributionOfTraits

iii.FrequencyDistribution

SexDifferenceinBehavioralExpressionofTrait

i.UnderlyingMechanismsDiffer

ii.UnderlyingMechanismstheSame

NoSexDifferenceinBehavioralExpressionofTrait

NoSexDifferenceinBehavioralExpressionofTrait

i.UnderlyingMechanismsDiffer

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SEX DIFFERENCES &SEX DIFFERENCES &SEX DIFFERENCES &SEX DIFFERENCES &GENDERGENDERGENDERGENDER

SOCIAL CONTEXTSOCIAL CONTEXTSOCIAL CONTEXTSOCIAL CONTEXTBIOLOGYBIOLOGYBIOLOGYBIOLOGYADDICTIONSADDICTIONSADDICTIONSADDICTIONSSTIGMASTIGMASTIGMASTIGMAFEMINISMFEMINISMFEMINISMFEMINISM

ADDICTIONSADDICTIONSADDICTIONSADDICTIONS

AVAILABILITY/ACCESSAVAILABILITY/ACCESSAVAILABILITY/ACCESSAVAILABILITY/ACCESSUSE/BEHAVIOR Patterns byUSE/BEHAVIOR Patterns byUSE/BEHAVIOR Patterns byUSE/BEHAVIOR Patterns byPopulationPopulationPopulationPopulationPOSITIVE/NEGATIVEPOSITIVE/NEGATIVEPOSITIVE/NEGATIVEPOSITIVE/NEGATIVEOUTCOMESOUTCOMESOUTCOMESOUTCOMESRISK / PROTECTIVERISK / PROTECTIVERISK / PROTECTIVERISK / PROTECTIVEFACTORSFACTORSFACTORSFACTORS

NEUROSCIENCENEUROSCIENCENEUROSCIENCENEUROSCIENCE

PHARMACOLOGY DRUGPHARMACOLOGY DRUGPHARMACOLOGY DRUGPHARMACOLOGY DRUGACTIONACTIONACTIONACTIONSEX DIFFERENCES &SEX DIFFERENCES &SEX DIFFERENCES &SEX DIFFERENCES &GENDERGENDERGENDERGENDERNEURAL CHANGES WITHNEURAL CHANGES WITHNEURAL CHANGES WITHNEURAL CHANGES WITHADDICTIONSADDICTIONSADDICTIONSADDICTIONSNEURAL CHANGES WITHNEURAL CHANGES WITHNEURAL CHANGES WITHNEURAL CHANGES WITHDRUG USEDRUG USEDRUG USEDRUG USEIMAGING THE BRAINIMAGING THE BRAINIMAGING THE BRAINIMAGING THE BRAINGENETICS ANDGENETICS ANDGENETICS ANDGENETICS ANDADDICTIONADDICTIONADDICTIONADDICTION

PUBLIC POLICYPUBLIC POLICYPUBLIC POLICYPUBLIC POLICYLAWSLAWSLAWSLAWSPUBLIC CAMPAIGNSPUBLIC CAMPAIGNSPUBLIC CAMPAIGNSPUBLIC CAMPAIGNSPUBLIC PROGRAMSPUBLIC PROGRAMSPUBLIC PROGRAMSPUBLIC PROGRAMSDEVIANCEDEVIANCEDEVIANCEDEVIANCE

INTERVENTIONSINTERVENTIONSINTERVENTIONSINTERVENTIONS

COSTCOSTCOSTCOSTEFFECTIVENESSEFFECTIVENESSEFFECTIVENESSEFFECTIVENESSAVAILABILITY OFAVAILABILITY OFAVAILABILITY OFAVAILABILITY OFOPTIONSOPTIONSOPTIONSOPTIONS

PROMOTIE POSITIVEPROMOTIE POSITIVEPROMOTIE POSITIVEPROMOTIE POSITIVEGOALSGOALSGOALSGOALS

ATTITUDESATTITUDESATTITUDESATTITUDES

PSYCHOSOCIOCULTURALPSYCHOSOCIOCULTURALPSYCHOSOCIOCULTURALPSYCHOSOCIOCULTURALFORCESFORCESFORCESFORCES

PSYCHOLOGYPSYCHOLOGYPSYCHOLOGYPSYCHOLOGYSOCIOLOGYSOCIOLOGYSOCIOLOGYSOCIOLOGY

ANTHROPOLOGYANTHROPOLOGYANTHROPOLOGYANTHROPOLOGYECONOMICSECONOMICSECONOMICSECONOMICS

FEMINISMFEMINISMFEMINISMFEMINISMPOLITICAL SCIENCEPOLITICAL SCIENCEPOLITICAL SCIENCEPOLITICAL SCIENCE

TEAM SCIENCETEAM SCIENCETEAM SCIENCETEAM SCIENCETransdiciplinarityTransdiciplinarityTransdiciplinarityTransdiciplinarityMechanismsMechanismsMechanismsMechanisms

Creation of FrameworksCreation of FrameworksCreation of FrameworksCreation of Frameworks'Level' Setting'Level' Setting'Level' Setting'Level' Setting

HISTORYHISTORYHISTORYHISTORY

ATTITUDES TOWARDATTITUDES TOWARDATTITUDES TOWARDATTITUDES TOWARDGENDERGENDERGENDERGENDERATTITUDES TOWARDATTITUDES TOWARDATTITUDES TOWARDATTITUDES TOWARDADDICTIONADDICTIONADDICTIONADDICTIONPRIOR STRATEGIESPRIOR STRATEGIESPRIOR STRATEGIESPRIOR STRATEGIESDRUG AVAILABILITYDRUG AVAILABILITYDRUG AVAILABILITYDRUG AVAILABILITY

GENDER AND ADDICTIONS: EnhancedGENDER AND ADDICTIONS: EnhancedGENDER AND ADDICTIONS: EnhancedGENDER AND ADDICTIONS: EnhancedKnowledge Base & New Insights fromKnowledge Base & New Insights fromKnowledge Base & New Insights fromKnowledge Base & New Insights from

IntegrationIntegrationIntegrationIntegration

Conclusions• Biologicalsexdifferencesareimportantforwhetherandhowsomeonebecomesaddicted.• Biologicalfactorsalonedonotpredictaddictionsorotherphenomena.• Theenvironmentduringprenataldevelopment,infancyandadolescenceaffecttheepigenomeandsubsequentaddictionvulnerability.• Internaleventssuchasdietandexternaleventssuchasstress,neglect,orabusehavedramaticeffectsonaddictionliability,andmalesandfemalesaredifferentiallyaffected.• Contextaffectstheresponsetodrugsofabuseanddifferentclassesofdrugsareaffectedbycontextindifferentways.


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ThankYou!!

UniversityofTexasatAustin3/29/2018

NIDANATIONAL INSTITUTE ON DRUG ABUSE

Office of ResearchOn

Women’s Health

OH

HO

BECKERLabTHE

Neurobiology of sex differences research group

Documents

Women and Addiction: Treatment Differences and Challenges · • Addiction is seen as a disease with genetic and brain components that has consequences for the community and the criminal