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National Institute on Drug Abuse Women and Sex/Gender Differences Research Director's Report to Council Research Findings Excerpts February, 2003

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Basic Research

Opiate-Induced Analgesia and Role of Stero

In a recent paper, Dr. Theodore Cicero and his associates at Washington University School of Medicine, St. Louis, determined the role of either the organizational or activational sex steroids in mediating gender differences observed in morphine-induced antinociception in the rat. To examine the organizational aspects, male pups were castrated early in life at postnatal days 1 and 2; females were masculinized by large doses of testosterone early in life on postnatal days 1 and 2. Older adult male and female rats were also castrated over a period of 2 months to examine the role of the acute activational effects of the opiates in the already sexually differentiated adult rat brain. The results showed that the gender differences in opiate analgesia were still evident in castrated older adult male and female rats. On the other hand, in male rats castrated early in life at postnatal days 1 and 2, the sensitivity to morphine analgesic effects was similar to females and, in fact, was almost identical to that observed in untreated females. Conversely, in female rats, masculinized by large doses of testosterone early in prenatal life, the morphine dose-response curve shifted to the left, yielding a dose-response curve similar to the dose-effect function seen in normal males. These results suggest that the sex differences that have been observed in morphine induced analgesia are due to the organizational effects of sex steroids in the early development of the rat brain, rather than to their acute activational effects occurring later in adulthood. These findings could be important in determining further gender differences and drug abuse liability. Cicero, T.J., Nock, B., O'Connor, L., and Meyer, E.R. Role of Steroids in Sex Differences in Morphine-induced Analgesia: Activational and Organizational Effects. Journal of Pharmacology and Experimental Therapeutics, 300, pp. 695-701, 2002.

Behavioral Research

Sex Differences in Running-Wheel Attenuation of Cocaine Self-administration in Rats

Previous animal studies have shown that the acquisition of drug self-administration can be reduced by the availability of alternative drug or nondrug reinforcers. Other studies have shown that exercise via wheel running can reduce established oral amphetamine and oral ethanol self-administration. Dr. Marilyn Carroll and her colleagues at the University of Minnesota have now reported that wheel running can also reduce established i.v. cocaine self-administration. The effect, however, occurred in females, but not males. After a baseline of wheel running was established, access to the wheel was terminated and rats were trained to self-administer cocaine (0.2mg/kg). Next, rats were given concurrent access to both cocaine self-administration and the running wheel, followed by a period of access only to cocaine and then a period of wheel only. The researchers found that providing concurrent access to both the wheel and cocaine produced: (A) a suppression of cocaine self-administration (relative to the cocaine-only period) that was significant in females (70.6%), but not in males (21.9%) and (B) a suppression in wheel running revolutions (relative to the wheel-alone period) in both males (63.7%) and females (61.5%). These data indicate that for females, but not males, wheel running can serve as an alternative reinforcer that significantly competes with established cocaine self-administration and that cocaine and wheel running are substitutable reinforcers. These data, along with research with humans indicating that exercise is an aid in human smoking cessation, suggest that exercise may be a useful adjunct in the treatment of cocaine dependence, especially for women. Cosgrove, K.P., Hunter, R.G. and Carroll, M.E. Wheel-Running Attenuates Cocaine Self-administration in Rats - Sex Differences. Pharmacology, Biochemistry and Behavior, 73, pp. 663-671, 2002.

Estrogen Plays a Role in the Acquisition of I.V. Heroin Self-Administration in Female Rats

Prior research from the laboratory of Dr. Marilyn Carroll of the University of Minnesota has shown that female rats acquire i.v. self-administration of both cocaine and heroin faster than male rats. Subsequent work from that laboratory found that blocking of estrogen, either surgically or chemically, reduced the percentage of females that met the acquisition criterion for cocaine self- administration. In the present experiment, Dr. Carroll and her colleagues assessed whether estrogen plays a similar role in heroin self-administration. Acquisition of low-dose (0.0075 mg/kg) heroin self-administration was examined in two estrogen groups, (a) ovariectomized (OVX) females treated with estradiol benzoate (OVX-EB) and (b) sham-operated (SH) females treated with the vehicle (SH-VEH). In a third group, estrogen was surgically blocked via ovariectomy and the females were treated with vehicle (OVX-VEH). The researchers report that the OVX-EB rats met criterion in significantly fewer days than the OVX-VEH (6.4 vs. 12.9) and self-administered more heroin infusions than the OVX-VEH rats. Unexpectedly, the SH-VEH group failed to exhibit faster acquistion than the OVX-VEH group, an outcome for which the researchers discuss several possible explanations. These data join a growing body of literature (from studies both in human subjects and preclinical research) demonstrating that estrogen influences the vulnerability to develop drug abuse behaviors and emphasizes the need for further research aimed at uncovering mechanisms for this effect. Roth, M.E., Casimir, A.G. and Carroll, M.E. Influence of Estrogen in the Acquisition of Intravenously Self-administered Heroin in Female Rats. Pharmacology, Biochemistry and Behavior, 72, pp. 313-318, 2002.

Research on AIDS and Other Medical Consequences of Drug Abuse

AIDS Research

Relationship Among Gender, Depression, and Needle Sharing in a Sample of Injection Drug Users

The findings from this study replicate two prior and consistent findings: (a) Women are more likely than men to share needles, and sharers report higher levels of depression than non-sharers. Both of these findings are important in and of themselves; however, the finding that women who share needles reported the highest level of depression of all groups adds new information to the existing literature about this important public health issue. This suggests that the relationships among gender, depression, and needle sharing are more complex than previously assumed, especially for women. Johnson, M.E., Yep, M.J., Brems, C., Theno, S.A., Fisher, D.G Psychology of Addictive Behaviors, 16, pp. 338-341, 2002.

Alcohol Use Among Out-of-Treatment Crack-Using African American Women

This study categorized the quantity and frequency of alcohol use among African American women who were abusing crack cocaine to explore relationships between categories of alcohol use, demographic variables, cocaine use, co-morbidity, and risky sexual behaviors. Data were collected from 635 out-of-treatment crack cocaine using women in Raleigh/Durham, North Carolina. The women were categorized as light (n=272, 43%), moderate (n=216, 34%) or heavy drinkers (n=147, 23%). The groups were similar in age distribution and marital status. Women classified as heavy drinkers were demographically similar to light and moderate drinkers. Heavy drinkers used more crack cocaine, reported longer crack runs (24 hours or longer in length), and were more likely to engage in sexual risk behaviors, including exchanging sex for drugs, money, or shelter, compared to the other two drinking groups. The heavy drinkers also reported greater psychological distress, including anxiety and post-traumatic stress, and were more likely to report histories of physical, sexual, and emotional abuse. Heavy alcohol use among crack-abusing African American women may be a marker for a host of underlying problems that require special attention. The HIV prevention programs and substance abuse treatment programs that provide services to crack-abusing women should screen for heavy drinking. Women identified as heavy drinkers should undergo more in-depth assessments and receive additional referrals as appropriate. Zule, W., Flannery, B., Wechsberg, W., and Lam, W. Alcohol Use Among Out-of-Treatment Crack-Using African American Women. Am J Drug Alcohol Abuse, 28(3), pp. 525-544, 2002.

Syphilis Among IDU Populations in St Petersburg, Russia

An epidemic of syphilis and other STDs in the Russian Federation is believed to be related to the rise in injection drug use. A study was carried out in collaboration with a nongovernmental Russian charity organization, Foundation Vozyrastcheniye (Return). The program was aimed at providing medical, social, and educational assistance to IDUs in St Petersburg. It was carried out in the form of a special mobile medical unit where doctors and nurses were able to offer basic medical assistance that included exchange of syringes, drug abuse, STD and infectious disease counseling, and screening blood samples for HIV, syphilis, and hepatitis seromarkers. Nine hundred and ten IDUs participating in the program were tested for syphilis, HIV, HCV, and HBV. Sixty-five participants who had laboratory markers for syphilis and 45 syphilis-negative subjects agreed to participate in a questionnaire study. The results indicated that syphilis, HIV, HBV, and HCV were diagnosed in 12%, 0%, 48%, and 79% of drug users respectively. Prevalence of syphilis seromarkers was nine times higher in females than in males, and highly correlated with sex work. The fact that sex workers in particular would continue to have unprotected sex while having syphilis infection suggests that there may be an economic or other motive for having sex without a condom. Syringe sharing was also common in this population, suggesting the possibility of syphilis transmission via this route of exposure. These results suggest that resources to treat and prevent further infections including HIV should be directed toward risk reduction in IDUs and sex workers in St. Petersburg. Karapetyan, A., Sokolovsky, Y., Araviyskaya, E., Zvartau, E., Ostrovsky, D., and Hagan, H. Syphilis Among IDU Populations: Epidemiological Situation in St. Petersburg, Russia. International J STD & AIDS, 13, pp. 618-623, 2002.

Resource Acquisition Strategies of Inner City Women Who Use Drugs

To better understand how women's HIV risk is influenced by environmental factors, researchers conducted life history interviews and assessed the strategies women adopted for acquiring resources (resource acquisition strategies), as well as the costs and obligations associated with such strategies. Interviews were conducted with 28 women who used drugs in two low-income neighborhoods in New York City. The women were 18 years and older, used heroin, crack, or cocaine, and were recruited from out-of-treatment settings between March and November 2000. The majority of women's resources came from illegal sources or from men with whom they had sexual relationships. Three fourths of the women worked in the drug trade, 68% reported stealing and 68% engaged in street based sex work. Most (89%) women had been arrested. The large majority (79%) had current, male sex partners, from whom they received financial and other benefits, including a diminished risk of incarceration. The implicit or explicit trade of sex for a reliable supply of resources severely limited women's ability to implement sex risk reduction. Avoidance of incarceration, primarily for drug-related offenses, as well as access to substantial and varied resources required both for drug use and for daily survival, favored acquiring resources through establishing sex partnerships with men who could supply at least some level of resources. In the context of economic deprivation, most resource acquisition strategies employed by the women increased HIV risks. Miller, M. and Neaigus, A. An Economy of Risk: Resource Acquisition Strategies of Inner City Women Who Use Drugs. International J Drug Policy, 13(5), pp. 399-408, 2002.

Sex Partner Support, Drug Use, and Sex Risk Among Non-Injecting Heroin Users

Researchers examined the extent to which sex partner characteristics, including partner support, influence HIV risk practices among HIV-seronegative non-injecting heroin users. The sample (n=257) was racially/ethnically diverse and predominantly male. More than two-thirds of the respondents reported using heroin with other people in the past 30 days and 30% reported using heroin with sex partners. Three-quarters reported having unprotected sex within the past 30 days; 27% had sex with partners at known risk of being HIV infected. There were no gender differences in terms of sex or drug use practices, but there were differences in sex partner characteristics. Men were significantly less likely than women to have partners who used drugs, receive support from their partners, use heroin with their partners, and have partners at known risk of being HIV infected. For men, increased sex risk was independently associated with having used heroin with sex partners. Women were just as likely to have unprotected sex with partners who provided support as with partners who did not. Moreover, women's partners appeared to pose greater HIV sex risk than men's partners. A disturbing finding was that an awareness of a known increase in HIV risk posed by sex partners was not associated with increased consistent condom use for either men or women. In this analysis, sex partner support was found to discriminate between men who reported unprotected sex and those who did not. Social support may have detrimental as well as beneficial consequences on HIV risk. Miller, M. and Neaigus, A. Sex Partner Support, Drug Use and Sex Risk Among HIV Negative Non-Injecting Heroin Users. AIDS Care, 14(6), pp. 801-813, 2002.

Adherence to Anti-retroviral Therapy and Viral Load in HIV-infected Drug Abusing Women

Based on results from a prospective observational study of a cohort of HIV-infected drug abusing women in Bronx, NY, Dr. Howard and her colleagues of Montefiore Medical Center/Albert Einstein College of Medicine, report that adherence to antiretroviral therapy is not stable over time and that interventions aimed at monitoring and improving long-term adherence in this population are urgently needed. In a cohort of 161 women studied, about 25% of women had a 10% or greater decrease in adherence between consecutive months. Virologic failure occurred in 17% women with adherence greater than 88%, 28% of those with 45-87% adherence, 43% of those with 13-44% adherence, and 17% of those with less than 12% adherence. Factors such as active drug/alcohol use, shorter duration and more frequent antiretroviral dosing, younger age, and lower initial CD4 lymphocyte count predicted poor adherence. Howard, A.A., Arnsten, J.H., Yungtai, L., Vlahov, D., Rich, J.D., Schuman, P., Stone, V.E., Smith, D.K., and Schoenbaum, E.E. A Prospective Study of Adherence and Viral Load in a Large Multi-Center Cohort of HIV-infected Women, AIDS, 16, pp. 2175-2182, 2002.

Condom Use Among Drug-Using Youth in a High HIV-risk Neighborhood

Friedman and colleagues interviewed 196 18-24 year olds living in Bushwick, New York City, who injected drugs or used heroin, cocaine or crack in the prior year with the objective of assessing predictors of consistent condom use in heterosexual relationships in a high HIV-risk environment. Consistent condom use was reported in 26% of 277 non-commercial relationships and in all of 22 commercial relationships. Consistent condom use is more common in relationships that are described as not very close for men (but not women) with peers whose norms are more favorable to condom use, and for subjects who had concurrent sex partners in the last 12 months. The authors conclude that: (1) the lack of relationship between the peer norms of drug-using women and their condom use suggests that they may have little control over condom use in their relationships and this indicates a need for the development of programs to empower young female drug users; (2) the positive association of concurrency to consistent condom use suggests that condom use may be restricting HIV spread in the community and the presence of consistent condom use in all of the commercial sexual relationships may also restrict HIV spread; and (3) prevention efforts should attempt to change peer cultures as a way to develop self-sustaining risk reduction. Friedman, S.R., Flom, P.L., Kottiri, B.J., Neaigus, A., Sandoval, M., Fuld, J., Curtis, R., Zenilman, J.M. and Des Jarlais, D.C. Consistent Condom Use Among Drug-using Youth in a High HIV-risk Neighborhood. AIDS Care. 14(4), pp. 493-507, 2002.

Women, Sex, and HIV: Social and Contextual Factors, Meta-Analysis of Published Interventions, and Implications for Practice and Research

This article is focused on examining social and contextual factors related to HIV-risk behavior for women. Specifically, this article reviews: (1) the literature on selected social and contextual factors that contribute to the risk for the heterosexual transmission of HIV and AIDS, (2) reviews and conduct a meta-analysis of HIV-prevention interventions targeting adult heterosexual populations, and (3) suggests future directions for HIV-prevention intervention research and practice. Results suggest that the HIV-prevention interventions reviewed for this article had little impact on sexual risk behavior; that social and contextual factors are often minimally addressed; and that there was a large gap between research and the practice of HIV-prevention intervention. Logan, T.K., Cole, J., and Leukefeld, C. Women, Sex, and HIV: Social and Contextual Factors, Meta-analysis of Published Interventions, and Implications for Practice and Research. Psychological Bulletin, 128(6), pp. 851-885, 2002.

Epidemiology, Etiology and Prevention Research

Psychiatric Disorders and Substance Abuse Disorders Among Youth in Juvenile Detention

Data are from a large (1829 youth, ages 10-18), random sample of male and female, white, African-American and Hispanic juvenile detainees in Cook County, IL. Among teens in juvenile detention, nearly two thirds of boys and nearly three quarters of girls have at least one psychiatric disorder. These rates dwarf the estimated 15 percent of youth in the general population thought to have psychiatric illness. Even when conduct disorder (common in this population) was excluded, nearly 60 percent of males and more than two-thirds of females met diagnostic criteria for, and also were functionally impaired by, one or more mental or substance use disorder. Half of males and almost half of females had a substance use disorder. Overall, disorders were more prevalent among older youth and females, more than 20 percent of whom had a major depressive disorder. Among boys, non-Hispanic whites had the highest prevalence for most disorders and African Americans the lowest. The exception was separation anxiety disorder, which was more prevalent among African Americans and Hispanics than among whites. Hispanics had higher prevalence than African Americans for panic disorder, obsessive-compulsive disorder and substance use other than alcohol or marijuana disorders. The only categories for which boys had higher prevalence than girls were manic episode, psychotic disorders, any substance abuse disorder, and marijuana use disorder. Longitudinal data are currently being collected on these youth. Teplin, L.A., Abram, K.M., McClleland, G.M., Dulcan, M.K., and Mericle, A.A. Psychiatric Disorders in Youth in Juvenile Detention. Arch. Gen. Psychiatry, 59, pp. 1133-1143, 2002.

Diminished Cortisol Response Among Offspring of Drug-Dependent Fathers

This report examines the salivary cortisol responses in preadolescent sons and daughters of fathers with and without drug-dependence, and the relative role of family environment. The high-risk boys and girls, relative to offspring of controls, demonstrated a diminished cortisol response in anticipation of a moderate stressor. Girls had significantly higher salivary cortisol concentrations, pre- and post-stressor. No association was found between salivary cortisol responses and measures of the family environment, however. These results suggest that there may be a sex difference in salivary cortisol dynamics in at-risk preadolescent children that is unrelated to current family environment. Hardie, T.L., Moss, H.B., Vanyukov, M.M., Yao, J.K., and Kirillovac, G.P. Psychiatry Research, 112(2), pp. 121-131, 2002.

Child Maltreatment and Adulthood Violence: The Contribution of Attachment and Drug Abuse

This study examined the association between child maltreatment and adult violence in a high-risk sample of women with and without a history of cocaine abuse and the contribution of working models of childhood attachment relationships in understanding this association. Results indicated that whereas childhood physical abuse was associated with adult sexual victimization for cocaine-abusing women, sexual abuse was associated with both partner violence victimization and perpetration for comparison women. Insecure working models of attachment were associated with partner violence victimization for comparison women, independent of the effect of sexual abuse. These findings suggest the importance of research focused on understanding the processes by which child maltreatment may lead to later violence and that examines both childhood and adulthood experiences in understanding pathways to adult violence. Feerick, M.M., Haugaard, J.J., and Hien, D.A. Child Maltreatment, 7(3), pp. 226-240, 2002.

Childhood Adversities Associated With Risk for Eating Disorders or Weight Problems During Adolescence or Early Adulthood

A community-based prospective longitudinal study was conducted to investigate the association between childhood adversities and problems with eating or weight during adolescence and early adulthood. A sample of 782 mothers and their offspring were interviewed during the childhood, adolescence, and early adulthood of the offspring. Childhood maltreatment, eating problems, environmental risk factors, temperament, maladaptive parental behaviors and parental psychopathology were assessed during childhood and adolescence. Eating disorders and problems with eating or weight in the offspring were assessed during adolescence and early adulthood. A wide range of childhood adversities were associated with elevated risk for eating disorders and problems with eating or weight during adolescence and early adulthood after the effects of age, childhood eating problems, difficult childhood temperament, parental psychopathology, and co-occurring childhood adversities were controlled statistically. Numerous unique associations were found between specific childhood adversities and specific types of problems with eating or weight, and different patterns of association were obtained among the male and female subjects. Maladaptive paternal behavior was uniquely associated with risk for eating disorders in offspring after the effects of maladaptive maternal behavior, childhood maltreatment, and other co-occurring childhood adversities were controlled statistically. Childhood adversities may contribute to greater risk for the development of eating disorders and problems with eating and weight that persist into early adulthood. Maladaptive paternal behavior may play a particularly important role in the development of eating disorders in offspring. Johnson, J.G., Cohen, P., Kasen, S. and Brook, J.S. Childhood Adversities Associated With Risk for Eating Disorders or Weight Problems During Adolescence or Early Adulthood. American Journal of Psychiatry. 159, pp. 394-400, 2002.

Parental Smoking Cessation May Help Decrease Adolescent Smoking

This study examined the relation of parent smoking cessation and adolescent smoking behavior. Participants were 446 adolescents and their parents who completed a computerized measure of implicit attitudes toward smoking and questionnaires assessing smoking, parenting, and explicit attitudes. Parental smoking cessation was associated with less adolescent smoking, except when the other parent currently smoked. Children's reports of parents' antismoking behavior partially mediated the relation between parental smoking and adolescent smoking. Although children's implicit and explicit attitudes were unrelated to parental smoking, mothers' implicit attitudes were related to both their own smoking and their child's smoking. Findings suggest that parental smoking cessation may help lower risk for adolescent smoking  but only if the other parent does not currently smoke. Chassin, L., Presson, C., Rose, J., Sherman, S.J., and Prost, J. Journal of Pediatric Psychology, 27(6), pp. 485-496, 2002.

Prevention Research

Prevalence of Cigarette Smoking Among Rural Adolescents in the U.S.

Results are reported from a nationwide, U.S. study of cigarette smoking carried out from 1996 to 2000 involving 68,270 adolescents in grades 7 through 12 attending high school or the associated feeder junior high/middle school in a particular community. The sampling design was constructed to include students from a representative sample of rural communities in the United States. Based on responses to cigarette use survey items, students were classified into one of eight user categories, ranging from being a non-user to being a heavy user (i.e., ongoing use of a half a pack or more per day). Hierarchical linear modeling was used to model smoking as a function of grade, gender, region, and community size (rurality). Significant effects were found for rurality, region, grade, and gender. The highest levels of smoking were found for rural adolescents and adolescents living in the South. Males smoked more than females in all regions except the West, where females smoked more. Given that rural adolescents smoke more heavily than do their nonrural peers, researchers should devote more attention to understanding the factors that underlie smoking initiation in rural youth. Aloise-Young, P.A., Wayman, J.C., and Edwards, R.W. Substance Use and Misuse, 37(5-7), pp. 613-630, 2002.

Drug-Moderating Effects of Peer Acceptance and Friendship on Family Adversity

Peer acceptance and friendships were examined as moderators in the link between family adversity and child externalizing behavioral problems. Data on family adversity (i.e., ecological disadvantage, violent marital conflict, and harsh discipline) and child temperament and social information processing were collected during home visits from 585 families with 5-year-old children. Socio-metric methods were used to assess children's peer acceptance, friendship, and friends' aggressiveness in kindergarten and grade one. Teachers rated children on externalizing behavior problems in grade two. Peer acceptance was a moderator for all three measures of family adversity, and friendship was a moderator for harsh discipline. Family adversity was not significantly associated with child externalizing behavior when levels of positive peer relationships were high. These moderating effects generally were not qualified by child gender, ethnicity, or friends' aggressiveness, nor were they accounted for by child temperament or social information-processing patterns. Criss, M.M., Pettit, G.S., Bates, J.E., Dodge, K.A., and Lapp, A.L. Family Adversity, Positive Peer Relationships, and Children's Externalizing Behavior: A Longitudinal Perspective on Risk and Resilience. Child Development, 73(4), pp. 1220-1237, 2002.

Influence of a Substance-Abuse-Prevention Curriculum on Violence-Related Behavior

This study tested the impact of a school-based substance-abuse prevention program, Project Towards No Drug Abuse (TND), on risk for violence. Logistic regression analyses tested whether victimization, perpetration, or weapon carrying differed for intervention students relative to control students in a sample of 850 continuation (high-risk) high school students (aged 14-19 years) who were followed over 12 months. Results showed a higher risk for victimization among male control students. No intervention effect was observed for female students or for perpetration among males. The findings provide limited support for a generalization of TND's preventive effect. Simon, T.R., Sussman, S., Dahlberg, L.L., and Dent, C.W. American Journal of Health Behavior, 26(2), pp. 103-110, 2002.

Services Research

Coping Among Individuals Seeking Private Chemical Dependence Treatment: Gender Differences and Impact on Length of Stay in Treatment

Length of stay in treatment and coping skills predict chemical dependence and abuse treatment outcomes. The researchers explored the interaction of coping strategies and length-of-stay in treatment, while paying particular attention to the effect of gender among 747 (433 men, 314 women) individuals who entered chemical dependence and abuse treatment in a private, managed care facility. Women reported using more emotional discharge (behavioral attempts to reduce tension by expressing negative feelings), cognitive avoidance (cognitive attempts to avoid thinking realistically about problems), resigned acceptance (cognitive attempts to react to problems by accepting them), and seeking support/guidance (behavioral attempts to seek information, guidance, or support) than men. The gender differences for emotional discharge disappeared after the variables of depressive symptom and drug problem severities were controlled. Greater use of seeking alternative rewards (behavioral attempts to participate in substitute activities and create new sources of satisfaction), less use of emotional discharge, and older age were significant predictors of longer length of stay, with no gender differences found. This study provides evidence for identifying and decreasing the use of emotional discharge early in treatment, possibly through the use of intervention strategies such as anger management, cognitive restructuring, or motivational interviewing, as well as encouraging participation in alternative activities. Kohn, C.S., Mertens, J.R., and Weisner, C.M. Alcoholism-Clinical and Experimental Research, 26(8), pp. 1228-1233, 2002.

The Relationship Between Sexual and Physical Abuse and Substance Abuse Consequences

The authors examined the relation between a history of physical and sexual abuse and drug and alcohol related consequences. Cross-sectional data came from 359 male and 111 female patients recruited from an inpatient detoxification unit. The Inventory of Drug Use Consequences was used to measure negative life consequences of substance use. Eighty-one percent of women and 69% of men reported past physical/sexual abuse, starting at a median age of 13 and 11, respectively. The results of bivariate and multivariate analyses indicated that physical and sexual abuse was associated with more substance abuse consequences. For men, age 17 years or younger at first abuse was significantly associated with more substance abuse consequences than an older age at first abuse, or no abuse. For women, the association of abuse with substance use consequences was similar across all ages. Liebschutz, J., Savetsky, J.B., Saitz, R., Horton, N.J., Lloyd-Travaglini, C., and Samet, J.H. Journal of Substance Abuse Treatment, 22, pp. 121-128, 2002.

Intramural Research

Drug Abuse's Smallest Victims: In Utero Drug Exposure

The social and economic impact of drug use on our global population continues to increase leaving no geographical, social or cultural group untouched. The National Institute on Drug Abuse, in one of the few large surveys of maternal abuse, found that 5.5% of mothers reported taking an illicit substance during gestation. Accurate identification of in utero drug exposure has important implications for the care of the mother and child, but can raise difficult legal issues. Society discourages prenatal care with the infliction of harsh criminal penalties. Maternal drug use during pregnancy can be monitored with urine, sweat, oral fluid and/or hair testing. Detection of in utero drug exposure has traditionally been accomplished through urine testing; however, the window of detection is short, reflecting drug use for only a few days before delivery. Monitoring exposure through testing of alternative matrices, such as neonatal meconium and hair, offers advantages including non-invasive collection and detection earlier in gestation. There are many unresolved issues in monitoring in utero drug exposure that urgently require research. These can be divided into research to definitively differentiate drug exposed and non-drug exposed fetuses, determine the most efficient methods to routinely monitor women's drug use, and determine how these drug test results relate to neonatal and maternal outcomes. Research in this area is difficult and expensive to perform, but necessary to accurately assess drug effects on the fetus. By increasing our understanding of the physiological, biochemical and behavioral effects of gestational drug exposure, we may ultimately provide solutions for better drug prevention, treatment and a reduction in the number of drug-exposed children. Huestis, M.A. and Choo, R.E. Forensic Science International, 128, pp. 20-30, 2002.

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