Research Article: Sex-based differences in multidimensional clinical assessments of early-abstinence crack cocaine users

Date Published: June 21, 2019

Publisher: Public Library of Science

Author(s): Breno Sanvicente-Vieira, Diego Luiz Rovaris, Felipe Ornell, Anne Sordi, Leonardo Melo Rothmann, João Paulo Ottolia Niederauer, Jaqueline Bohrer Schuch, Lisia von Diemen, Felix Henrique Paim Kessler, Rodrigo Grassi-Oliveira, Geilson Lima Santana.


Crack cocaine use disorder (CUD) has been related to sex differences. This work aimed to compare the severity of drug use and the severity of other negative related outcomes in males and females with CUD. A total of 1344 inpatients (798 males and 546 females) with crack cocaine use disorder (CUD) were evaluated by a detailed multidimensional clinical assessment, including addiction severity and trauma exposure. Linear regression predicted higher drug use severity (β = 0.273, p < 0.001) and more problems in domains related to childcare issues (β = 0.321), criminal involvement (β = 0.108), work-related problems (β = 0.281) and social support impairments (β = 0.142) for females, all with p < 0.001. Alcohol problems were predicted to be higher in males (β = -0.206, P < 0.001). Females had higher rates of other mental disorders, particularly trauma and stress-related disorders (OR: 3.206, CI: 2.22, 4.61). Important sex differences also emerged in trauma history and HIV infection prevalence. CUD has a more severe clinical presentation among females facing early abstinence. Sex differences in the CUD course indicate the need for consideration of sex-specific interventions and research.

Partial Text

Cocaine use disorder is a chronic relapsing disorder characterized by drug-seeking behaviors, such as lack of control, social malfunctioning and risky drug use [1]. The disorder’s severity is determined by the number and extent of social and behavioral issues. When cocaine is smoked, i.e., consumed as crack cocaine, the withdrawal, effects and prognosis are considered worse than when cocaine is inhaled [2]. However, the etiology, pathophysiology, disorder course and treatment responses vary based on sex differences [3–5].

In this study, we found sex differences in the severity of drug use and psychosocial problems across multiple clinical domains in a sample of crack cocaine users who were in early abstinence. Our findings reinforce that among those with CUD, males and females suffer from different consequences of drug use [8, 11, 12, 45, 46]. This work advances in comparison to a similar previous investigations on sex differences that assessed indexes of disease severity in crack cocaine users [11, 25], since we assessed a larger sample, but most importantly because we considered testing in multiple potentially impacted domains of life, using reliable and valid measures of it. Furthermore, we tested results on the severity of psychosocial problems considering the interference of comorbidities and problems in other areas of life, specially exposure to childhood maltreatment and lifetime victimization. Thus, we provided a more comprehensible and complete piece of data for supporting sex differences in crack cocaine use disorder. Results are relevant for targeting better interventions and identifying specific major problems in males and females who use crack cocaine to primarily address the most common issues. As secondary objectives, we compared males and females in domains other than drug use. Our findings support assumptions of sex-specific trajectories for drug use [19, 47]. Overall, females had a higher severity of problems related to childcare, criminal involvement, employment issues and social support problems, and males showed more severe alcohol-related problems. Additionally, we found females had more CUD-related negative outcomes, such as housing problems, prevalence of HIV and general mental disorders. Males more often had a history of alcohol use than females. These results may be considered to improve prevention strategies and policies; likewise, future directions in research also need to be acknowledged.




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