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      Sex-based differences in multidimensional clinical assessments of early-abstinence crack cocaine users

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          Abstract

          Crack cocaine use disorder (CUD) has been related to sex differences. This work aimed to compare the severity of drug use and the severity of other negative related outcomes in males and females with CUD. A total of 1344 inpatients (798 males and 546 females) with crack cocaine use disorder (CUD) were evaluated by a detailed multidimensional clinical assessment, including addiction severity and trauma exposure. Linear regression predicted higher drug use severity ( β = 0.273, p < 0.001) and more problems in domains related to childcare issues ( β = 0.321), criminal involvement ( β = 0.108), work-related problems ( β = 0.281) and social support impairments ( β = 0.142) for females, all with p < 0.001. Alcohol problems were predicted to be higher in males ( β = -0.206, P < 0.001). Females had higher rates of other mental disorders, particularly trauma and stress-related disorders (OR: 3.206, CI: 2.22, 4.61). Important sex differences also emerged in trauma history and HIV infection prevalence. CUD has a more severe clinical presentation among females facing early abstinence. Sex differences in the CUD course indicate the need for consideration of sex-specific interventions and research.

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          Most cited references52

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          Drug Addiction and Its Underlying Neurobiological Basis: Neuroimaging Evidence for the Involvement of the Frontal Cortex

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            The self-medication hypothesis of addictive disorders: focus on heroin and cocaine dependence.

            Recent clinical observations and psychiatric diagnostic findings of drug-dependent individuals suggest that they are predisposed to addiction because they suffer with painful affect states and related psychiatric disorders. The drugs that addicts select are not chosen randomly. Their drug of choice is the result of an interaction between the psychopharmacologic action of the drug and the dominant painful feelings with which they struggle. Narcotic addicts prefer opiates because of their powerful muting action on the disorganizing and threatening affects of rage and aggression. Cocaine has its appeal because of its ability to relieve distress associated with depression, hypomania, and hyperactivity.
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              Sex and gender differences in substance use disorders

              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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                Author and article information

                Contributors
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: InvestigationRole: MethodologyRole: Writing – original draft
                Role: Data curationRole: Formal analysisRole: ValidationRole: VisualizationRole: Writing – review & editing
                Role: InvestigationRole: Methodology
                Role: InvestigationRole: MethodologyRole: Writing – review & editing
                Role: InvestigationRole: Methodology
                Role: InvestigationRole: Methodology
                Role: Data curationRole: MethodologyRole: Validation
                Role: Funding acquisitionRole: Project administrationRole: SupervisionRole: Writing – review & editing
                Role: Funding acquisitionRole: ResourcesRole: SupervisionRole: Writing – review & editing
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: Funding acquisitionRole: InvestigationRole: MethodologyRole: Project administrationRole: ResourcesRole: SupervisionRole: ValidationRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                21 June 2019
                2019
                : 14
                : 6
                : e0218334
                Affiliations
                [1 ] Developmental Cognitive Neuroscience Lab, School of Health Sciences, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
                [2 ] Brain Institute of Rio Grande do Sul, Porto Alegre, Pontifícia Universidade Católica do Rio Grande do Sul, Rio Grande do Sul, Brazil
                [3 ] Department of Psychiatry, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Rio Grande do Sul, Porto Alegre, Brazil
                [4 ] Attention Deficit Disorder Outpatient Program, Hospital de Clínicas de Porto Alegre, Rio Grande do Sul, Porto Alegre, Brazil
                [5 ] Center for Drug and Alcohol Research, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
                [6 ] Laboratory of Immunosenescence, Graduate Program in Biomedical Gerontology, Pontifícia Universidade Católica do Rio Grande do Sul, Rio Grande do Sul, Porto Alegre, Brazil
                University of Sao Paulo Medical School, BRAZIL
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Author information
                http://orcid.org/0000-0002-9922-966X
                http://orcid.org/0000-0002-2195-4407
                http://orcid.org/0000-0001-9911-5921
                Article
                PONE-D-19-03642
                10.1371/journal.pone.0218334
                6588218
                31226126
                db7dac95-d5e5-402c-a17e-e6b4c6f60629
                © 2019 Sanvicente-Vieira et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 17 February 2019
                : 30 May 2019
                Page count
                Figures: 2, Tables: 4, Pages: 19
                Funding
                Funded by: funder-id http://dx.doi.org/10.13039/501100003593, Conselho Nacional de Desenvolvimento Científico e Tecnológico;
                Award ID: 466802/2014-5
                Award Recipient :
                Funded by: funder-id http://dx.doi.org/10.13039/501100004263, Fundação de Amparo à Pesquisa do Estado do Rio Grande do Sul;
                Award ID: 11/1302-7
                Award Recipient :
                Funded by: Secretaria Nacional de Políticas sobre Drogas (SENAD)
                Award ID: 822647/2015
                Award Recipient :
                Funded by: funder-id http://dx.doi.org/10.13039/501100002322, Coordenação de Aperfeiçoamento de Pessoal de Nível Superior;
                Award ID: 001
                Award Recipient :
                Funded by: funder-id http://dx.doi.org/10.13039/100000026, National Institute on Drug Abuse;
                Award ID: R01DA044859
                Award Recipient :
                This study was supported by MCT/CT-Saúde—DECIT/SCTIE/MS, Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) [Grant number 466802/2014-5] to RG-O and [Grant number 478492/2013-8] to LVD; Fundação de Amparo à Pesquisa do Estado do Rio Grande do Sul (FAPERGS) [Grant number 11/1302-7]; Secretaria Nacional de Políticas sobre Drogas (SENAD)/ Ministério da Justiça [Grant number 822647/2015]; Coordenação de Aperfeiçoamento de Pessoal de Nivel Superior – Brasil (CAPES) – [Finance Code 001] to BS-V and JBS; National Institutes of Health (NIH) [Grant number R01DA044859]; and Fundo de Incentivo à pesquisa (FIPE) - Hospital de Clínicas de Porto Alegre / Universidade Federal do Rio Grande do Sul [Grant number 2015-0234] to LVD. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Research Article
                Physical Sciences
                Chemistry
                Chemical Compounds
                Alkaloids
                Cocaine
                Medicine and Health Sciences
                Pharmacology
                Behavioral Pharmacology
                Recreational Drug Use
                Cocaine
                Biology and Life Sciences
                Psychology
                Addiction
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                Medicine and Health Sciences
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                Biology and Life Sciences
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                Addiction
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                Medicine and Health Sciences
                Public and Occupational Health
                Substance-Related Disorders
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                Custom metadata
                Individual data cannot be shared publicly because of ethical concerns. First, because in the informed consent there was no explicit reference to publicly report individual data of each participant. The participants agreed that the results of this research would be publish in scientific journals and scientific meetings, but no explicit consent to their individual information. Second, since this is a study from a single city, with a very unique sample, using individual characteristics as measures, including history of child abuse and violence victimization, the ethical boards of the involved institutions have concerns about the lack of confidentially. Data are available from the Ethical Committee of PUCRS (contact via cep@ 123456pucrs.br ) for researchers who meet the criteria for access to confidential data.

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