Drug addiction research and the health of women

596 Pages·1998·33.8 MB·English

by  Wetherington, Cora Lee

BiB
mm
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
National Institutes of Health

Drug Addiction Research
Women
and the Health of
Editors:
Cora Lee Wetherington, Ph.D., Women’s Health Coordinator
Adele B. Roman, M.S.N., R.N., Deputy Women’s Health Coordinator
NATIONAL INSTITUTES OF HEAl
N!H LIBRARY
10, 10 CENTER DR.
m, MD 208924150
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
National Institutes of Health
National Institute on Drug Abuse
5600 Fishers Lane
MD
Rockville, 20857
Opt
t
ACKNOWLEDGMENTS
W6
Two publications have been produced based on the September 1994
conference “Drug Addiction Research and the Health ofWomen,”
sponsored by the National Institute on Drug Abuse. This volume,
/
DrugAddiction Research and the Health ofWomen, builds on the confer-
ence presentations and provides greatly expanded reviews ofresearch in
A
this field. companion volume, DrugAddiction Research and the Health
ofWomen: Executive Summary, contains condensed versions ofthe
conference presentations as well as the ensuing discussion sessions.
To obtain copies ofeither publication contact the National
Clearinghouse for Alcohol and Drug Information (NCADI), RO. Box
MD
2345, Rockville, 20847-2345, 1-800-NCADI-64 (622-3464) or see
its World Wide Web site: http://www.health.org.
The followingNIDA personnel are acknowledged for their assis-
tance in providing a technical review ofthis publication: Rebecca S.
Ashery, Ph.D.; Lula Beatty, Ph.D.; J.C. Comolli, R.N., M.B.A.; Dorynne
J. Czechowicz, M.D.; Katherine Davenny, M.P.H.; Loretta P. Finnegan,
M.D.; Ronald I. Heming, Ph.D.; CorylJones, Ph.D.; Lisa Onken, Ph.D.;
and Pushpa V. Thadani, Ph.D.
COPYRIGHT STATUS
NIDA has obtained permission from the copyright holders to
reproduce certain previously published material as noted in the text.
Further reproduction ofthis copyrighted material is permitted only as
part ofa reprinting ofthe entire publication or chapter. For any other
use, the copyright holder’s permission is required. All other material in
this volume except quoted passages from copyrighted sources is in the
public domain and may be used or reproduced without permission from
the Institute or the authors. Citation ofthe source is appreciated.
DISCLAIMER
Opinions expressed in this volume are those ofthe authors and do
not necessarily reflect the opinions or official policy ofNIDA or any
otherpart ofthe U.S. Department ofHealth and Human Services.
The U.S. Government does not endorse or favor any specific
commercial product or company. Trade, proprietary, or company names
appearing in this publication are used only because they are considered
essential in the context ofthe studies reported herein.
National Institute on Drug Abuse
NIH Publication No. 98-4290
Printed 1998
Foreword
Alan I. Leshner, Ph.D.
Drug abuse and addiction are among the most pressing health and
social issues facing ourNation, posing serious health risks and often
tragic consequences for those who are afflicted and for their families
and communities. Although extraordinary progress has been made in
understanding these disorders and in finding the best ways to prevent
and treat them, unfortunately, research on drug abuse and addiction
related to women has, until relatively recently, been sorely neglected.
Most drug abuse interventions developed to date, including prevention
and treatment programs, have largely been shaped by men’s characterise
tics and needs. Because women traditionally have been underrepre-
sented in research studies and drug abuse treatment groups, the effects
ofdrug abuse are far less understood for women than for men. But the
scientific evidence generated thus far suggests that drug abuse and
addictionpresent different challenges to women’s health, progress
differently in females than in males, and may require different treatment
approaches and strategies. Moreover, the rapid increase in AIDS cases
among women in recent years makes it all the more critical to address
gender differences as they relate to drug problems.
In an effort to assess and begin to fill the gaps that exist in knowb
edge about drug abuse and women’s health, the National Institute on
Drug Abuse (NIDA), the Federal agency leading the Nation’s research
efforts on drug abuse and addiction, sponsored a national conference
in September 1994 titled “Drug Addiction Research and the Health
ofWomen.” This 2-day meeting brought together leading researchers
to present state-of-the-science findings, discuss research issues and
N
challenges confronting the field, and lay the framework for IDA’s
research agenda in this important area. Condensed versions ofthe
presentations made at the 1994 conference, as well as the ensuing
discussion sessions, are contained in a companion volume, Drug
Addiction Research and the Health ofWomen: Executive Summary.
The chapters contained in this research volume build on the confer-
ence presentations and represent greatly expanded reviews ofresearch
in the field. These indepth, state-of-the-science reviews emphasize that
the causes, correlates, pharmacokinetics, mechanisms, and consequences
ofdrug abuse and addiction vary considerably between men and women.
The authors highlight much ofwhat is known about the epidemiology,
the etiology, and the health, social, and behavioral consequences ofdrug
abuse and addiction. Biological mechanisms underlying these processes
and legal, prevention, and treatment issues surrounding drug abuse
and addiction also are discussed. Taken together, the material clearly
illustrates the breadth and complexity ofdrug abuse-related issues that
affect women’s health. This information also provides afoundation on
whichNIDA can frame a scientifically diverse and vigorous research
agenda with the goal ofensuring that women’s needs related to drug
abuse and addiction are more successfully met.
Alan I. Leshner, Ph.D.
Director
National Institute on Drug Abuse
Parklawn Building, Room 10-05
5600 Fishers Lane
MD
Rockville, 20857
iv
—
Contents
Foreword v
Drug Addiction Research and the Health ofWomen 1
Loretta P. Finnegan, M.D.
Role ofthe Office ofResearch on Women’s Health 5
Vivian W. Pinn, M.D.
Women and Substance Abuse: ANew National Focus 13
SusanJ. Blumenthal, M.D., M.P.A.
—
Women and Addiction in the United States 1850 to 1920 33
Stephen R. Kandall, M.D.
Women and Addiction in the United States
1920 to the Present 53
Stephen R Kandall M.D.
. ,
Keynote Address: Neurobiological Correlates
ofthe Addictions: Findings From Basic
and Treatment Research 81
MaryJeanne Kreek, M.D.
Epidemiology
The Epidemiology ofSubstance Use
and Dependence Among Women 105
Denise B. Kandel, Ph.D.; Lynn A. Warner, M.P.P.; and
Ronald C. Kessler, Ph.D.
Biological/Behavioral Mechanisms
Cocaine Abuse and Reproductive Function in Women 131
Nancy K. Mello, Ph.D.
v
Stress-Related Psychopathology as a Vulnerability
Factor in Drug-Taking: The Role ofSex 151
D. Caroline Blanchard, Ph.D.
Biological/Behavioral Mechanisms Panel
Gender Differences in Cocaine Self-Administration
in Rats: Relevance to Human Drug-Taking Behavior 165
M
DavidC.S. Roberts, Ph.D., and Rachel Phelan, .Sc.
The Relevance ofStress and Eating to
the Study ofGender and Drug Use 173
Neil E. Grunberg, Ph.D., and Laura Cousino Klein, M.S.
Translating Basic Research on Drugs and
Pregnancy Into the Clinical Setting 187
James R. Woods, Jr., M.D.
Treatment
Behavioral Therapies for Female Drug Users:
An Efficacy-Focused Review 197
KarlaMoras, Ph.D.
Pharmacology: Gender-Specific Considerations
in the Use ofPsychoactive Medications 223
Sidney H. Schnoll, M.D., Ph.D., andMichael F. Weaver, M.D.
Need for Services Research on
Treatment for Drug Abuse in Women 229
Jacqueline Wallen, Ph.D., M.S.W.
Service Providers and Treatment Access Issues 237
vi
;
Etiology
Substance Abuse Among Women:
Familial Factors and Comorbidity 245
Kathleen R. Merikangas, Ph.D., andDenise E. Stevens, Ph.D.
Etiology Panel
A
Warriors and Worriers: Longitudinal Study
ofGender Differences in Drug Use 271
Judith S. Brook, Ed.D.; Martin Whiteman, Ph.D.; and
PatriciaCohen, Ph.D.
Victimization, Posttraumatic Stress Disorder, and
Substance Use and Abuse Among Women 285
Dean G. Kilpatrick, Ph.D.; Heidi S. Resnick, Ph.D.;
Benjamin E. Saunders, Ph.D.; and Connie L. Best, Ph.D.
Pregnancy, Drugs, and Harm Reduction 309
Marsha Rosenbaum, Ph.D., and Katherine Irwin
Work Stress, Coping, and Substance Use
Among Female Nurses 319
R. Lorraine Collins, Ph.D.; Gemot Gollnisch, Ph.D.; and
Elizabeth T. Morsheimer, Ed.M.
Consequences
HIV Infection in Women: Implications for
Drug Abuse Treatment and Research 339
PeterA. Selwyn, M.D., M.P.H., and
MarcN. Gourevitch, M.D., M.P.H.
Social and Behavioral Consequences of
Chemical Dependence 355
RafaelaR. Robles, Ed.D.; CarmenA. Marrero, M.P.H.
Tomas D. Matos, M.S.; HectorM. Colon, M.A.;
vii
Lourdes I. Cancel, M.S.; andJuan C. Reyes, M.S.
Consequences Panel
Psychosocial Predictors ofAIDS Risk Behavior
and Drug Use Behavior in Homeless
and Drug'Addicted Women ofColor 365
Adeline Nyamathi, R.N., Ph.D., F.A.A.N.;
JudithA. Stein, Ph.D.; andMary-Lynn Brecht, Ph.D.
Association Between Early or Later Onset of
Substance Use and Psychiatric Disorders in Women 389
Linda B. Cottier, Ph.D.; Arbi BenAbdallah, M.S.; and
WilsonM. Compton, M.D.
PartnerViolence Experiences and Women’s
Drug Use: Exploring the Connections 407
BrendaA. Miller, Ph.D.
Prevention
Links Between Prevention and Treatment for
Drug-Abusing Women and Their Children 417
KarolL. Kumpfer, Ph.D.
Intervention
Factors Influencing Health Behaviors and
Drug Abuse Among LowTncome Black and Latino Women 439
Kathy Sanders-Phillips Ph.D.
,
Legal and Criminal Justice Issues
Punishing WomenforTheir Behavior During Pregnancy:
AnApproach That Undermines the
Health ofWomen and Children 467
M
Lynn Paltrow J.D.
. ,
viii