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DEPARTMENT OF HEALTH AND HUMAN SERVICES U.S. National Institutes of Health , NIDA Conference Planning Committee Loretta P. Finnegan, M.D*, Chair, Office of the Director^ Lula Beatty, Ph.D., Chief, Special Populations Office J.C. Comolli, R.N., Office on AIDS Katherine Davenny, M.P.H., Clinical Medicine Branch, Division of Clinical and Services Research Ronald L Herning, Ph.D., Neuroscience Branch, Division of Intramural Research Coryl Jones, Ph.D., Epidemiology Research Branch, Division of Epidemiology and Prevention Research Sheryl Massaro, M.F.A., Public Information Branch, Office of Science Policy and Communications Ann Montgomery, R.N., M.A., Clinical Trials Branch, Medications Development Division Lisa Onken, Ph.D., Treatment Research Branch, Division of Clinical and Services Research Elizabeth R. Rahdert, Ph.D., Treatment Research Branch, Division of Clinical and Services Research Adele B. Roman, M.S.N., R.N., Office of the Director Zili Sloboda, Sc.D., Director, Division of Epidemiology and Prevention Research Pushpa V. Thadani, Ph.D., Basic Neurobiology and Biological Systems Research Branch, Division of Basic Research Linda B. Thomas, B.S., Office of the Director Cora Lee Wetherington, Ph.D., Women’s Health Coordinator ^ Dr. Finnegan is now Director, Women's Health Initiative, Office ofthe Director, National Institutes of Health. Drug Addiction Research Women and the Health of Summary Executive 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 HEALTH LtN^Y NIH OCT I I 2005 CBm BLDG 11. 18 DU BETHESOA. KHl 20«-11SO U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health National Institute on Drug Abuse 5600 Fishers Lane MD Rockville, 20857 Two publications have been produced based on the scientific research conference “Drug Addiction Research and the Health of Women,” which was held on September 12H4, 1994, in Tysons Comer, VA, and was sponsored by the National Institute on Dmg Abuse. This volume. Drug Addiction Research and the Health of Women: Executive Summary, contains condensed versions of the conference presentations A as well as the ensuing discussion sessions. companion volume. Drug Addiction Research and the Health of Women, builds on the conference presentations and provides greatly expanded reviews of research in this field. To obtain copies of either publication contact the National Clearinghouse for Alcohol and Drug Information (NCADI), RO. Box MD D800^NCADT64 2345, Rockville, 20847-'2345, (622^3464) or see its World Wide Web site: http://www.health.org. COPYRIGHT STATUS All material in this volume is in the public domain and may be used or reproduced without permission from the Institute or the authors. Citation of the source appreciated. is DISCLAIMER Opinions expressed in this volume are those of the presenters and do not necessarily reflect the opinions or official policy of the National Institute on Drug Abuse or any other part of the U.S. Department of Health 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 of the studies reported herein. National Institute on Drug Abuse NIH Publication No. 98-4289 May Printed 1998 tO T? j word r ore ^7^ \l^^8 Alan Leshner, Ph.D. I. Drug abuse and addiction are among the most pressing health and social issues facing our Nation, 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 characteriS' tics and needs. Because women traditionally have been underrepre- sented in research studies and drug abuse treatment groups, the effects of drug abuse are far less understood for women than for men. But the scientific evidence generated thus far suggests that drug abuse and addiction present 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 knowledge 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 of Women.” This 2-day meeting brought together leading researchers to present state-of-the-science findings, discuss research issues and challenges confronting the field, and lay the framework for NIDA’s research agenda in this important area. This volume contains condensed versions of the conference presentations as well as the ensuing discussion sessions. These summaries and discussions emphasize the gaps in knowledge regarding women and drug abuse that existed then and that, unfortunately, continue to exist today. iii A companion volume, Drug Addiction Research and the Health of Women, contains greatly expanded reviews of research in this field. Alan Leshner, Ph.D. I. Director National Institute on Drug Abuse Parklawn Building, Room 10^05 5600 Fishers Lane MD Rockville, 20857 ForsalebytheU.S. GovernmentPrintingOffice SuperintendentofDocuments,MailStop: SSOP,Washington,DC 20402-9328 ISBN 0-16-049570-9 Contents Foreword iii Opening Session Welcome and Opening Remarks Loretta P. Finnegan, M.D. Senior Adviser on Womens Issues Office of the Director, National Institute on Drug Abuse 1 Welcome From the Office of Research on Women’s Health Vivian W. Finn, M.D. Associate Director for Research on Womens Health Office ofResearch on Womens Health 1 Welcome From the National Institute on Drug Abuse Alan I. Leshner, Ph.D. Director, National Institute on Drug Abuse 3 Welcome From the U.S. Public Health Service Susan Blumenthal, M.D., M.P.A. J. Deputy Assistant Secretary for Health (Womens Health) Assistant Surgeon General Office on Womens Health, U.S. Public Health Service 4 The History of Drug Abuse and Women in the United States M.D Stephen R. Kandall, 8 Keynote Address: Neurobiological Correlates of the Addictions: Findings From Basic and Treatment Research Mary Jeanne Kreek, M.D 17 Epidemiology Epidemiology of Drug Use and Abuse Among Women Denise B. Kandel, Ph.D 24 V Biological/Behavioral Mechanisms Drug Abuse and Reproduction in Women Nancy K. Mello, Ph.D 29 Sex Differences, Drugs, and Defensive Behavior D. Caroline Blanchard, Ph.D 33 Biological/Behavioral Mechanisms Panel Sex Differences and Hormonal Effects on Drug Seeking David C.S. Roberts, Ph.D 37 Smoking, Eating, Stress, and Drug Use: Sex Differences Neil E. Grunberg, Ph.D 39 Translating Basic Research Into the Clinical Setting M.D James R. Woods, Jr. 42 , Treatment Women Psychosocial and Behavioral Treatments for Karla Moras Ph.D 49 , Pharmacology: Sex-Specific Considerations in the Use of Psychoactive Medications Sidney Schnoll, M.D., Ph.D 52 Researcher/Sex Issues M.S.W Jacqueline Wallen Ph.D. 55 , , Service Provider/Treatment Access Issues Shirley D. Coletti, D.H.L 58 Etiology TThe Etiology and Genetic Epidemiology of Psychiatric and Drug Disorders Among Women Kathleen R. Merikangas, Ph.D 66 VI Etiology Panel Childhood and Adolescent Precursors to Drug Use Judith S. Brook, Ed.D 74 Victimization and Posttraumatic Stress Disorder Dean G. Kilpatrick, Ph.D 77 Harm Reduction Marsha Rosenbaum, Ph.D 80 Stress and Coping Among Women R. Lorraine Collins, Ph.D 83 Consequences Medical and Health Consequences of HIV/AIDS and Drug Abuse Peter A. Selwyn, M.D., M.P.H 86 Social and Behavioral Consequences Rafaela R. Robles, Ed.D 90 Consequences Panel The Consequences of Drug Dependence on Social Supports, High'Risk Sexual Behaviors, and Homelessness Adeline Nyamathi, R.N., Ph.D 93 Psychiatric Sequelae of Drug Abuse Linda B. Cottier, Ph.D 96 Partner Violence Brenda A. Miller, Ph.D 99 Prevention Links Between Prevention and Treatment Karol L. Kumpfer, Ph.D 102 vii Intervention Intervention, Outreach, and Special Needs Kathy Sanders^Phillips Ph.D 107 , Legal and Criminal Justice Issues Women Punishing for Their Behavior During Pregnancy: An Approach That Undermines the Health of Women and Children Lynn M. Paltrow, J.D 113 Crosscutting Issues Panel Women African-American and Trauma: Depression, Drugs, and Families Sheryl Brissett'Chapman, Ed.D., A.C.S.W., L.LC.S.W. 117 Drug Abuse and HIV Among Lesbians M.N.A Marjorie Plumb, 120 J. Women Hispanic Margarita Alegn'a Ph.D 123 , Research Needs of American Indian Women PamelaJumper-Thurman, Ph.D 127 Closing Session Concluding Remarks David Mactas J. Director, Center for Substance Abuse Treatment 131 Toward the Development of a Drug Abuse Research Agenda on the Health of Women Richard A. Millstein Deputy Director, National Institute on Drug Abuse 132 Conference Speakers 138 viii