Substance Use Disorders: Sex Differences and Psychiatric Comorbidities

Objective: This article reviews sex differences in psychiatric comorbidity among individuals with substance use disorders and, in particular, the clinical significance of these differences for treatment outcome among women. Method: We undertook a computerized search of major health care databases. To enhance the search, we drew prior relevant articles from the reference list. Results: Women with alcohol and other drug use disorders present higher rates of psychiatric comorbidity, particularly mood and anxiety disorders, than do men. Moreover, the comorbid diagnosis, particularly of depression, is more often primary in women, while in men the comorbidity is more often secondary to the substance abuse diagnosis. In addition, there is evidence that psychiatric comorbidity is associated with distinct, sex-specific outcomes for substance use treatment. Conclusions: Sex differences in the clinical presentation of substance-dependent individuals with psychiatric comorbidity present specific treatment challenges and opportunities.