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National Institute on Drug Abuse -  NIDA NOTES
Director's Column
Volume 10, Number 1
January/February 1995

Filling the Gender Gap in Drug Abuse Research

By Dr. Alan I. Leshner, NIDA Director

Drug abuse and addiction among women are major public health problems. More than 4.4 million women currently use illicit drugs, and women make up more than 37 percent of the illicit-drug-using population. Yet, as with the other major diseases of our time, most research on addiction has been conducted with men.

In recent years, the National Institutes of Health has implemented a new initiative to promote research on women's health. To ensure that the field of drug abuse is in the vanguard of this exciting new era of women's health research, NIDA is expanding its agenda to increase our understanding of drug abuse and addiction and their impact on women's health. Our expanded research on addiction and women's health will look at differences between men and women who abuse drugs. Across our entire research portfolio, from basic science to clinical applications, we will be supporting studies that examine gender differences in vulnerability and resilience to drug dependence; in metabolism and the effects of drugs; in the medical, behavioral, and social consequences of drug abuse; and in the prevention and treatment of drug abuse.

We will be expanding our research on
how addiction affects the progression of AIDS in women.

Most of what we already know about women and addiction has come from years of NIDA-supported research on drug abuse during pregnancy and the impact of a woman's drug use on her offspring. This research has been both needed and appropriate because drug abuse during pregnancy affects the health of more than 5 percent of all pregnant women and their children, according to NIDA's recently released National Pregnancy and Health Survey. (See story in this issue)

While continuing NIDA's research on prenatal drug abuse, we have been working to broaden the scope of this research to reflect the fact that drug abuse affects women regardless of their maternal role. In 1993, NIDA issued program announcements to stimulate research on the causes and consequences of drug abuse among women of all ages, to assess gender differences in the behavioral effects of abused drugs, and to promote studies of drug abuse treatment for women of child-bearing age. NIDA's AIDS program announcements have addressed partner notification of HIV-infected drug users and strategies to reduce sexual practices that put women at risk of contracting HIV. We have held technical reviews at which researchers discussed methodological issues in the study of drug abuse among women and the impact of drug abuse and HIV infection on women and children. And NIDA's Medications Development Division has worked to ensure that the percentages of women in our clinical trial of potential drug abuse treatment medications reflect the gender makeup of the drug-abusing population.

Last September, NIDA's Women's Advisory Committee organized a landmark conference on drug addiction and women's health. At the conference, researchers and practitioners discussed what we know, what we don't know, and what we should be doing to fill the gaps in our knowledge about women and drug abuse. (See story in this issue)

In response to recommendations from participants at our women's conference, we will be working to conduct more research on biological and behavioral mechanisms of drug abuse among women. And we will be considering the effects of race, ethnicity, sexual orientation, and psychological and socioeconomic circumstances on the use and abuse of drugs by women.

We also will be expanding our research on how addiction affects women's health, including how addiction affects the progression of AIDS in women. Nearly 70 percent of AIDS cases among women are related to their use of injecting drugs or to their having sex with an injecting drug user. NIDA's national AIDS community outreach programs have educated drug-dependent women about AIDS risk factors and strategies to change their high-risk behaviors. We are now emphasizing the need to explore the links between drug abuse and AIDS among women in all areas of our research agenda.

We already know that there are differences between men's and women's vulnerability to HIV infection and risk behaviors. Furthermore, AIDS appears to progress differently in men and women. We need to know why these differences exist to design more targeted interventions.

From the time they are diagnosed with HIV infection, women die of AIDS much more rapidly than men do. Research findings presented at NIDA's women's conference suggest this apparent accelerated course of HIV infection may occur because HIV-positive women enter treatment at much later stages of infection than men do. We need more research to find out why women infected with HIV wait so long before presenting themselves for treatment. Among the possible avenues for gender-based exploration are the role of social and cultural stigmas and the availability, accessibility, and appropriateness of AIDS treatment for drug-dependent HIV-positive women.

The expanded women's research program that we have launched reflects NIDA's commitment to filling the gender gap that exists in drug abuse research, prevention, and treatment. To carry out that commitment, we have established a women's health issues group at NIDA to coordinate and monitor our women's research efforts. With the assistance and guidance of scientists, public health and drug abuse prevention and treatment practitioners, and the members of NIDA's national advisory bodies, we will be working to ensure that research on addiction and women's health ultimately reveals the biological and behavioral factors we need to address to improve drug abuse prevention and treatment for women.

From NIDA NOTES, January/February 1995

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