Men and Women From the Stride Clinical Trial: An Assessment of Stimulant Use Severity At Residential Treatment Entry

Purpose: Gender differences in substance use severity were examined in a treatment-seeking sample of stimulant drug abusers. General population studies report more drug use and higher rates of drug dependence for men than women. These gender differences are less pronounced or even reversed when examined in treatment populations. A focus on gender-specific issues is needed for planning and implementing stimulant abuse interventions.

Methods: Data were baseline measures from STRIDE (Stimulant Reduction Intervention using Dose Exercise) a NIDA Clinical Trials Network study (CTN-0037), comparing exercise to health education as treatments for stimulant abuse or dependence (Trivedi et al., 2011). Participants were men (n=181) and women (n=121), ages 18-65, in residential treatment, with self-reported past 30-day stimulant use and DSM-IV past-year stimulant abuse or dependence. Among excluded individuals were those determined medically unfit for exercise, opiate dependent, pregnant, prescribed beta blockers or opioid replacement therapy, or a safety risk for psychiatric (e.g., psychosis) or other issues. Baseline substance use severity measures included the Timeline Followback and Substance Use Diary, Stimulant Selective Severity Assessment-for withdrawal symptoms, and Addiction Severity Index-for problems associated with drug use. Stimulant use disorders (SUD), determined by the Composite International Diagnostic Interview, were categorized as 1) cocaine use disorder (CUD) only; 2) CUD+other SUD (e.g., methamphetamine); and 3) other SUD only.

Results: Baseline demographics showed men older than women (41.1 ±10.8 years and 35.6 ±9.9 years, respectively) and more likely to report a high school education or greater. Both men and women were primarily never married or previously married. Men were mostly black (51.9%) or white (41.4%) with fewer Hispanics (5.5%) or other races/ethnicities (3.3%). Women were white (51.2%), black (29.8%), and Hispanic (17.4%) and 5.0% other races/ethnicities. Both gender differences and similarities in substance use severity were identified. Women were more likely to report dual stimulant use disorders; 34.2% met criteria for a CUD+other SUD, 48.1% CUD only, and 17.5% other SUD only. Most men met diagnosis for CUD only (66.5%) versus CUD+other SUD (27.4%) and other SUD only (6.1%). Women reported higher median past-30 day cocaine (men-8.0; women-11.0) and methamphetamine (men-9.5; women-20.0) use days than men. Women also reported greater withdrawal symptom severity from stimulants. While men had more problems than women on the ASI alcohol subscale, women had more employment, family, and psychiatric problems and similar problems on the drug use, legal, and medical subscales.

Conclusions and Implications: Women in this study of stimulant abusers entered treatment younger, but with greater stimulant use severity compared with men. Women reported more severe stimulant withdrawal symptoms, a measure previously associated with greater risk for relapse and treatment drop-out. Further research is needed to identify factors affecting greater stimulant severity in women. Gender-specific effects of stimulant abuse (e.g., women require larger amounts than men to experience similar drug effects) related to physiologic differences have been identified. Other putative risk factors from this study may include employment, family, and psychiatric problems. The relationship of eating disorders to stimulant use severity is also an area for potential research.