Sex and gender differences in substance use disorders

McHugh, R. Kathryn; Votaw, Victoria R.; Sugarman, Dawn E.; Greenfield, Shelly F.

doi:10.1016/j.cpr.2017.10.012

Cited by 1,076Substance Abuse Treatment and OutcomesSex and Gender in HealthcareGambling Behavior and Treatments

Sex and gender differences in substance use disorders

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McHugh, R. Kathryn, Votaw, Victoria R., Sugarman, Dawn E., Greenfield, Shelly F.·2018·Clinical Psychology Review

DOI 10.1016/j.cpr.2017.10.012PMC PMC5945349

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Abstract

The gender gap in substance use disorders (SUDs), characterized by greater prevalence in men, is narrowing, highlighting the importance of understanding sex and gender differences in SUD etiology and maintenance. In this critical review, we provide an overview of sex/gender differences in the biology, epidemiology and treatment of SUDs. Biological sex differences are evident across an array of systems, including brain structure and function, endocrine function, and metabolic function. Gender (i.e., environmentally and socioculturally defined roles for men and women) also contributes to the initiation and course of substance use and SUDs. Adverse medical, psychiatric, and functional consequences associated with SUDs are often more severe in women. However, men and women do not substantively differ with respect to SUD treatment outcomes. Although several trends are beginning to emerge in the literature, findings on sex and gender differences in SUDs are complicated by the interacting contributions of biological and environmental factors. Future research is needed to further elucidate sex and gender differences, especially focusing on hormonal factors in SUD course and treatment outcomes; research translating findings between animal and human models; and gender differences in understudied populations, such as those with co-occurring psychiatric disorders and gender-specific populations, such as pregnant women.

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Women have lower concentrations of gastric alcohol dehydrogenase and lower total body water, leading to higher blood alcohol levels and greater intoxication after consuming equivalent amounts of alcohol as men.
“For example, women have lower concentrations of gastric alcohol dehydrogenase, the primary en zyme for alcohol metabolism, and a lower total percentage of body water, leading to higher blood alcohol levels and greater levels of in toxication after consuming equivalent amounts of alcohol as men 334 .”
From Substance use disorders: a comprehensive update of classification, epidemiology, neurobiology, clinical aspects, treatment and prevention (2023) · cites this paper as [334]
The Biological Sex Differences in Substance Use section (page unavailable) says women have lower gastric alcohol dehydrogenase activity and lower total body water, resulting in higher blood alcohol concentrations and greater intoxication after equivalent alcohol consumption. It does not establish a lower concentration of the enzyme itself or call it the primary enzyme for alcohol metabolism. (LLM, conf=0.86)
Experimental — accuracy not yet measured
Research suggests sex and gender differences in SUD are narrowing.
“research suggests sex and gender differences in SUD are narrowing and should continue to be monitored among the college student population (McHugh et al., 2018).”
From The substance use disorder treatment gap among US college students: Findings from the 2021 National Survey on Drug Use and Health (2024) · cites this paper as McHugh et al., 2018

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Self-citation

Authors: McHugh, R. K., Votaw, V. R., Sugarman, D. E., & Greenfield, S. F.
Affiliations: Harvard University (US)
McLean Hospital (US)
Corresponding author: McHugh, R. Kathryn
ORCID: McHugh, R. Kathryn
Votaw, Victoria R.
Sugarman, Dawn E.
Greenfield, Shelly F.
Venue: Clinical Psychology Review
Publisher: Elsevier BV
Published: 2018-12
Volume: 66
Pages: 12-23
ISSN: 0272-7358 (ISSN-L)
DOI: 10.1016/j.cpr.2017.10.012
PMC: PMC5945349
OpenAlex: W2767393753
Cited by: 1,076
References: 211
Citations by year: 2026: 118 · 2025: 174 · 2024: 170 · 2023: 184 · 2022: 132 · 2021: 122 · 2020: 127 · 2019: 38 · 2018: 9
FWCI: 6.30
Type: journal article
Language: en
Open access: bronze
doi.org
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/legal/tdmrep-license (tdm)
www.elsevier.com/open-access/userlicense/1.0/ (am, 356 d)
Locations: Clinical Psychology Review (acceptedVersion)
PubMed (publishedVersion)
Europe PMC (PubMed Central) (acceptedVersion)
PubMed Central (acceptedVersion)
Funders: NIDA (UG1 DA015831, K23 DA035297)
Topics: Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Sex and Gender in Healthcare
Social Sciences › Psychology › Clinical Psychology › Gambling Behavior and Treatments
Keywords: sex differences, gender differences, substance use disorders, women, men, brain structure and function, endocrine function, metabolic function, hormonal factors, gender roles, psychiatric comorbidity, pregnancy, animal-to-human translation
MeSH terms: Female, Humans, Male, Sex Characteristics, Sex Factors, Substance-Related Disorders

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