ational Institute on Drug Abuse

SERVICES

RESEARCH EECY
MONOGRAPH
SERIES

ff. :

PSYCHOSOCIAL
CHAR ACTERISTICS

OF
DRUG“ABUSING WOMEN

 

 

 

 

U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE
PUBLIC HEALTH SERVICE
ALCOHOL, DRUG ABUSE, AND MENTAL HEALTH ADMINSTRATION
'' 

 
''PSYCHOSOCIAL Mb
CHARACTERISTICS

OF
DRUG“ABUSING WOMEN

BY

MARVIN R..BURT, PRINCIPAL INVESTIGATOR
THOMAS J. GLYNN
BARBARA J. SOWDER

BURT ASSOCIATES, INC.
BETHESDA, MARYLAND

U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE
Public Health Service
Alcohol, Drug Abuse, and Mental Health Administration

National Institute on Drug Abuse_ |
5600 Fishers Lane
Rockville, Maryland 20857
''7

.)

 

 

 

The Services Research Reports and Monograph Series are issued by the staff of
the Services Research Branch, Division of Resource Development, National Insti-
tute on Drug Abuse. Their primary purpose is to provide reports to the drug
abuse treatment community on the service delivery and policy-oriented findings
from Branch-sponsored studies. These will include state of the art studies, inno-
vative service delivery models for different client populations, innovative treatment
management and financing techniques, and treatment outcome studies.

 

 

 

This report is a product of NIDA contract No. 271-76-4401 to Burt Associates, Inc., 4340 East-

West Highway, Bethesda, Maryland 20014.

The material contained herein does not necessarily reflect the opinions, official policy, or posi-
tion of the National Institute on Drug Abuse of the Alcohol, Drug Abuse, and Mental Health
Administration, Public Health Service, U.S. Department of Health, Education, and Welfare.

DHEW Publication No. (ADM) 80-917
Printed 1979
''HVegzay
Wy 637)
19.79

FOREWORD P UBL

In recent years considerable attention has been given to the status of women as drug abusers

and as clients in drug treatment programs. Studies have shown that women differ from men in
their rates and patterns of drug use. Further, women of all ages are underrepresented in drug
treatment systems supported by the Federal Government. The Client Oriented Data Acquisition
Process (CODAP), the Federal reporting system, found that in 1976, of the 95,000 federally sup-
ported treatment slots, 25,000 (26 percent) were filled by women.

There has been much speculation on the meaning of these statistics. Some investigators have

concluded that women have a lower incidence of opiate addiction. Others have claimed that the
drug treatment programs are not organized or structured to serve female drug abusers since

the programs tend to be dominated by male staff. There have been reports of overt and covert
sexism in drug programs.

Treatment programs have acknowledged the importance of giving special attention to the needs
of women. In developing a strategy to address female issues in the drug treatment field, the
Services Research Branch of the National Institute on Drug Abuse (NIDA) initially elected to
compile a comprehensive review of available information from studies and surveys, from existing
data, and from the literature.

Often research endeavors are initiated and treatment programs designed without the benefit of
exploring that which has gone before. This document on the characteristics of drug-abusing
women attempts to meet that need.

This study, conducted by Burt Associates between June 1976 and December 1977, is a reference
guide that provides information on the research that has been done on the characteristics of
female drug abusers. An effort is made to identify, assess, integrate, and analyze all of the
available data on the characteristics of women's reported drug use patterns, demographic charac-
teristics, and personality attributes. This information is in turn contrasted with comparable
data for males. In addition, discussion is made of the treatment implications of findings pre-
sented.

The report is divided into three major sections as follows:

e Prevalence of Drug Abuse: Household Surveys. The emphasis in this chapter is on national
household surveys which were conducted in 1974-75 and 1975-76.

 

e Characteristics of Male and Female Drug Abusers as Reflected in Data Systems. Here large-
Scale, ongoing data systems which focus on clients who come to the attention of service com-
ponents are surveyed. Also surveyed are selected, small-scale data sets which usually
focused on individual programs.

 

e A Review of the Literature is divided into two parts: characteristics of male and female drug
abusers as reflected in the literature and psychological characteristics of female drug abusers.
Both published and unpublished literature are surveyed.

 

Margruetta B. Hall
Project Officer
National Institute on Drug Abuse

iii

16051
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''CONTENTS

FOREWORD

1, PREVALENCE OF DRUG ABUSE: HOUSEHOLD SURVEYS

Use of Illicit Drugs
Nonmedical Use of Psychotherapeutic Drugs

2. CHARACTERISTICS OF MALE AND FEMALE DRUG
ABUSERS AS REFLECTED BY DATA SYSTEMS

Large-Scale Data Systems
Small-Scale Data Systems
Analysis of the Data

3. A REVIEW OF THE LITERATURE
Characteristics of Male and Female Drug

Abusers as Reflected in the Literature
Psychological Characteristics of Female Drug Abusers

4, CONCLUSIONS
5. DISCUSSION
FOOTNOTES

REFERENCES

page

iii

oOo

30

30
33

70

72

74

77
''Table

1

Figure 1

Table

Table

Table

Table

Table
Table
Table

Table

Table
Table
Table
Table
Table
Table
Table
Table
Table

Table

2

19
ll
12
13
14
15
16
17
18

19

Tables and Figure

Use of Certain Illicit Drugs by Adults
and Youth--1975-76

Medical Experience with Types of Psycho-
therapeutic Drugs Among Females and Males

Nonmedical Experience with Types of Psycho-
therapeutic Drugs Among Subgroups: Prevalence
(Ever Used)--Over the Counter and/or
Prescription, 1975/76

Nonmedical Experience with Psychotherapeutic
Drugs Among Subgroups: Prevalence (Ever Used)
and Recer.-+y of Use (Over the Counter and/or
Prescription), 1975/76

Nonmedical Experience with Prescription Psycho-
therapeutic Drugs Among Subgroups: Trends

in Prevalence (Ever Used), 1975-76

Contacts with Emergency Rooms Due to Drug
Problems--24 Large SMSAs, April 1974-April 1975

Large and Small Data Systems Considered
Age, by Sex

Age, by Sex (Condensed)

Age, by Sex and by Type of Drug Used in
Contacts with DAWN Emergency Rooms and
Crisis Centers

Race/Ethnicity, by Sex

Marital Status, by Sex

Educational Status, by Sex

Employment Status, by Sex

Primary Source of Support, by Sex
Arrests, by Sex

Admission Type, by Sex

Use of Specific Drugs, by Sex

Primary Drug of Abuse, by Sex
Secondary Drug of Abuse, by Sex

vi

page

ll

12

13
15
16
17
19
20
21
23
24
25

26
''Table

Table

Table

Table

Table

Table

20

21

22

23

24

25

Tables and Figure (Continued)

page
Psychotropic Drug Use--Total Percentages 28
Number of Drugs Which Are Used or Cause

Problems, by Sex 29
Treatment Studies 34
Nontreatment Studies 52
Review of Studies Noting Psychological

Characteristics of Female Drug Abusers 60

General Conclusions Regarding Overall
Psychological Functioning of Female vs.
Male Drug Abusers 69

vii
''a

as. ‘sil ii tain aoe ABA aes ce apes
''1. Prevalence of Drug Abuse:
Household Surveys

The data reported in this section are from
household surveys. Like all such surveys,
they have some limitations. For example,
the sample sizes are limited and subject to
sampling variability; the household surveys
exclude persons not living in household units,
such as persons living in dormitories, transi-
ents, or persons with no fixed address; and
the national surveys reported response rates
of slightly less than 80 percent.

This study excludes consideration of drug
use surveys conducted in schools. Several
surveys of school populations have been con-
ducted recently employing varying methodol-
ogies (Butler 1975; Harrison 1974; Hays 1974;
Linder et al. 1974; Michigan Department of
Public Health 1975; San Mateo County 1974).
The results were summarized by Glenn and
Richards (1976) who observed that differences
in nonmedical drug use by school age males
and females appear to be negligible.

The emphasis in this chapter is upon national
household surveys of drug use which were
conducted in 1974-75 (Abelson and Atkinson
1975) and 1975-76 (Abelson and Fishburne 1976)
by the George Washington University Social
Research Group and Response Analysis Cor-
poration. The results of those surveys may
be divided into two categories: use of illicit
drugs and nonmedical use of psychotherapeu-
tic drugs.’

Use of Illicit Drugs

Table 1 depicts use of certain illicit drugs,
by sex. Among adults in 1975-76, there were
no statistically significant’ differences in "cur-
rent use" between females and males, except
for marihuana (male prevalence was higher).
However, male prevalence ("ever used") is
significantly higher for all the drugs indi-
cated.

Among youth, the only statistically significant
male/female difference in "current use" is for
hallucinogens (male prevalence is higher).

Statistically significant male/female differences
in "ever used" occur only for inhalants, mari-

huana, and hashish (male prevalence is

higher).

Nonmedical Use of
Psychotheraputic Drugs

A great deal of confusion exists in the litera-
ture with regard to the use and definition of
such words as "psychotropic," "psychothera-
peutic," and "prescription drugs." These
terms are sometimes used interchangeably.
Psychotropic drugs as defined by Cooperstock
(1976) include all tranquilizing agents (anti-
barbiturates and the nonbarbiturate sedatives)
and stimulants (largely amphetamines and
other amphetaminelike anorexiants). Gener-
ally, this does not include analgesics although
they do affect the central nervous system.

we

The distinction between licit and illicit use of
psychotherapeutic drugs can cause confusion.
One can differentiate the source as being
medical vs. nonmedical, but the definition
remains unclear because many physicians un-
knowingly become the source for illicitly used
psychotropics (Prather and Fidell 1977).
Abelson and Atkinson (1975) and Abelson and
Fishburne (1976) defined "nonmedical use of
psychotherapeutic drugs"" by an individualz
based on a "yes" response to any one (or
more) of the following three items:

e Did you ever take any of these kinds of
pills just to see what it was like and how
it would work?

e Did you ever take any of these kinds of
pills just to enjoy the feeling they give
you?

e Did you ever take any of these pills for
some other nonmedical reason, and not
because you needed it?

Surveys of such drug use or combined med
ical/nonmedical drug use typically find preva-
lence substantially higher among females
(Abelson and Atkinson 1975; Abelson and
Fishburne 1976; Cooperstock 1976; Cooperstock
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''Table 4

NONMEDICAL EXPERIENCE WITH PRESCRIPTION PSYCHOTHERAPEUTIC DRUGS
AMONG SUBGROUPS: TRENDS IN PREVALENCE (EVER USED), 1972-76

 

 

(percentage)
Age/Sex 1972 1974 1975-76

All Youths: age 12-17

Male 5 6 6

Female 8 7 9
All Adults: age 18+

Male 10 9 14

Female 10 5 9

 

Source:

and Sims 1971]; Fejer and Smart 1973; Levine
1969; Manheimer et al. 1968; Mellinger et al.
1971; Parry et al. 1973; Swanson et al. 1973).
For example, a recent household survey of
the U.S. population (figure 1) shows that
psychotherapeutic drug use is significantly
greater among females’ than males.

Table 2 depicts the percentage of nonmedical
use by females and males of over-the-counter
and prescription medications. Among youth,
differences in male/female use of the various
types of drugs are not statistically significant.
Among adults, male prevalence is significantly
higher for "any psychotherapeutic," with
highest prevalence in the 18-25 age group.

In terms of recent nonmedical psychotherapeu-
tic drug use, table 3 indicates no statistically
significant male/female differences in use dur-
ing the "past month" or "past year, not past

month."

Abelson and Fishburne (1976).

Trends in the percentages of males and
females who have ever used psychotherapeu-
tic drugs are shown in table 4. There is little
change shown in use by youth during 1972 to
1975-76; female use is slightly higher during
all 3 years. Male and female use by adults
was equal (10 percent) in 1972, but in 1975-76
female use was lower than male use (9 versus
14 percent).

These data probably disguise the comparative
frequency with which females and males exper-
ience drug problems with psychotherapeutic
drugs because medical use is excluded. Table
5 depicts contacts with emergency rooms due
to drug problems in 24 large Standard Metro-
politan Statistical Areas (SMSAs) during the
time period covered by the national household
surveys cited. Considerably more contacts
were made by females than males for psycho-
therapeutic drug problems. It is also inter-
esting to note that nearly twice as many
female contacts with these emergency rooms
were diagnosed as drug overdose problems
compared to male contacts.
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9 21981
''gathered data from hospital emergency rooms
in Miami and Denver); the Connecticut Mental
Health Center in New Haven, Connecticut.

Analysis of the Data

The analysis will focus upon the percentage
distributions of occurrences for males and

females for each variable examined. There
is concern not only with the distributions for
females and males, but more importantly with
differences between the two groups.

The first step in determining whether differ-
ences between the two groups deserve discus-
sion is to determine whether the differences
are statistically significant. The largest
national data sets (CODAP, DAWN, DARP)
have such a large number of observations
that usual statistical tests of significance will
be inappropriate. However, some of the local
data sets (notably NTA, ASA, and New Haven)
have sufficiently small n's that statistical test-
ing is required .'

Table 6 gives the total number of n's in the
large and small data systems considered, the
number of males and females, and the percent
female.

The second step in discussing differences
between drug-abusing men and women is to
discuss the comparative distributions and
(where multiyear data are available) trends.

Finally, differences in distributions are dis-
cussed in terms of percentage differences for
males and females.

It should be noted again that the numbers of
men and women included in each data set are
often substantially different.

It must be emphasized that this section does
not address prevalence, but rather distribu-
tion of certain characteristics among female
compared to male drug-abusing populations
as contained in each of the data sets analyzed.

A common table format is used to depict data
for each variable discussed across all data
systems examined. This is done to display
inconsistencies and gaps in the data and to
avoid the distracting effects of a series of
collapsing and expanding tables.

Age

6b

National Data Systems. Table 7 indicates that
a consistent pattern of age differences between
viales and females appears to exist in the data

ystems surveyed.

 

The presence of this pattern is best noted if
the age categories are condensed in the man-
ner shown in table 8. There, a larger per-
centage is seen to exist across each CODAP
year, DAWN emergency rooms,” and the DARP
System, of more: (1) females than males in
the under 21 years of age category; (2) males
than females in the 21 to 30 years of age cate-
gory; and (3) males than females in the over
30 years of age category.

An aberration in this pattern is seen among
clients over 30 in the DAWN emergency room
and crisis center facilities. There, the gen-
eral pattern noted above is reversed and the
percentage of males is slightly less than that
for females (27 versus 35 percent and 12 ver-
sus 17 percent, respectively). Data pre-
sented in table 9 indicate the percentage, by
sex and drug, of the total contacts of emer-
gency rooms and crisis centers by clients
30 years old or less and clients over 30 years
of age. These data are presented in order
that the specific drugs which may have influ-
enced the aberration of the male/ female con-
tact pattern might be identified. Inspection
of these data suggest that it is a greater use
of barbiturates, amphetamines, and to a larger
extent, tranquilizers, nonbarbiturate seda-
tives, and nonnarcotic analgesics (i.e., all
legal and often medically prescribed drugs)
which brings women over 30 into emergency
rooms and crisis centers at a greater rate
than males.

The percentage of males and females under
the age of 21 in federally funded treatment
programs declined from 1974 to 1976 (see table
8), but there is still a greater percentage of
females in the "under 21" age group. This
is a consistent pattern in the CODAP data
for all 3 years considered. During this same
period, there were slight increases in the
percentage of both males and females who
were over the age of 30.

In the DAWN medical examiner facilities (sce
table 7), a striking difference exists between
males and females whose deaths are drug re-
lated in some manner. Female deaths are
more than twice as likely to occur in the 36
or older age category than are male; and male
deaths are more likely to occur between 2}
and 30 years of age.

Local Data Systems. Four of the local sys-
tems surveyed (ASA, Wayne County, New
Haven, and Miami [A]) follow the pattern of
a higher proportion of females in the under
21 years of age category and a higher proper-
tion of males over 30 years of age. These
differences, however, as indicated in tables
? and 8, are generally negligible and neither
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''the New Haven nor the Miami (A) differences
are statistically significant.?

The two remaining systems--NTA and the
National Women's Project--do not reflect this
pattern. However, it cannot be determined
whether the NTA differences are statistically
significant. The National Women's Project
data indicate that nearly 80 percent of the
female clients fall into the 20- to 30-year-old
category, while only 5 percent of the female
clients are under 21. These data, also, do
not fit the pattern of the other systems.
Since male comparison data are not available
for this data system, it is difficult to ascer-
tain whether these data are true reversals of
the pattern or artifacts of the particular treat-
ment systems included in the survey.

Race/Ethnicity

National Data Systems. Each of the national
drug treatment data systems gathered informa-
tion on the race/ethnicity of their clients.
These data, summarized in table 10, suggest
several systematic male/female differences on
this variable.

When black and white clients are considered
by sex, the percentage of white male clients
is seen to be greater than the percentage of
black male clients across all national programs
with the exception of the DARP. Similarly,
the percentage of white female clients is
greater across all programs with the excep-
tion of the DARP.

In addition, a consistent pattern of differ-
ences is found not only within racial groups
by sexes but also between male and female
clients. This pattern lies in the magnitude
of the differences found in the percentage of
black vs. white male and female clients in
the CODAP and DAWN systems. In each
CODAP year and component of the DAWN re-
porting system the discrepancy between the
percentage of black and white female clients
is considerably greater than that between
black and white male clients. Thus, for
example, the 1976 CODAP data show a differ-
ence of 26 percent between black and white
female clients (32 vs. 58 percent) but only Il
percent between black and white male clients
(37 vs. 48 percent). Whether this pattern
is a reflection of actual drug use rates for

14

these groups or evidence of underrepresenta-
tion of black female clients in treatment is a
question for future research.

Local Data Systems. The data obtained from
the local systems were analyzed and no sig-
nificant sex by race differences were found
within any one system.?

Females are more likely than males to utilize
a hospital emergency room; the percentage of
black male clients is generally greater than
the percentage of black female clients; and
the percentage of white male clients is gener-
ally smaller than the percentage of white
female clients.

Marital Status

National Data Systems. The Polydrug Project
(see table II) collected data regarding the
marital status of its clients. The results
show that females are more likely to be mar-
ried than males (22 vs. 15 percent). Females
also are more likely than males to be wid-

owed, separated, or divorced.

Local Data Systems. The differences be-
tween males and females are not statistically
significant for NTA, ASA, New Haven, or
HERS.® The University of Miami and Wayne
County data show a considerably higher pro-
portion of females than males as widowed,
separated, or divorced. The National Wom-
en's Project, although not making male/female
comparisons, reported the highest percentage
of separated females (30 percent) of the local
data systems surveyed.

Educational Status

National Data Systems. Educational status
data were collected on a national basis in the
CODAP (1975 and 1976), DARP, and Polydrug
Project systems. Table 12 reveals no clear
pattern of differences in educational status
between male and female clients in these sys-
tems. There is some indication, however,
that male clients are more likely to have com-
pleted 12 or more grades than female clients,
but these differences are not large (Polydrug
Project: 56 vs. 54 percent; CODAP 1975: 48
vs. 42 percent; CODAP 1976: 50 vs. 44
percent).” The DARP system, although not
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17
''collecting data on a "highest grade completed"
basis, nevertheless provides data which also
indicate essentially little male/female client
educational status difference.

Local Data Systems. As indicated in table
12, the local data systems also show no con-
sistent pattern of male/female client educa-
tional status differences. However, compar-
ability is not possible between all of those
systems which collected data on this variable.

New Haven did not use a "highest grade com-
pleted" category and the National Women's
Project did not collect comparative male data.
In the other local systems, none of the male/
female differences is statistically significant,
with the exception of the HERS data.®

Employment Status

National Data Systems. Employment data
were collected for the CODAP (1975-76),
DAWN (three facility types), and DARP sys-
tems. While the percentage of all clients
employed is generally low, females are far
less likely to be employed than males (table
13).° The DAWN data system includes a
housewife category (CODAP did not) and wom-
en who did not report being employed gener-
ally reported being unemployed or being
housewives: Although utilizing different cate-
gories, data collected in the DARP system
appear to coincide with these findings.

 

Data collected by the DAWN Medical Examiner
facilities provide an unexpected finding.
Among both males and females suffering drug
related deaths, employment (at the time of
death) was higher than among the groups of
males and females seeking treatment. The
difference in employment between males and
females in this category (68 vs. 31 percent)
is nevertheless considerable.

A second finding of interest in the DAWN
Medical Examiner facility data concerns the
large percentage (47 percent) of females suf-
fering drug related deaths who were house-
wives. Differences in this category between
females in this data system and others is strik-
ing. The percentage of female housewife
clients in the DAWN Emergency Room data
system is 28 compared to 19 in the DAWN
Crisis Center data system and 47 percent in
the DAWN” Medical Examiner data system.

Local Data Systems. The local data systems
surveyed reveal percentage differences be-
tween male clients and female clients on
employment status similar to those found in
the national data. However, only the Miami
and New H-ven differences are statistically
significant.’

 

The National Women's Project, although lack-
ing comparative male data, follows the other
data systems in reporting high (94 percent)
female unemployment. This is the highest
unemployment rate of all the data sources.

Primary Source of Support

National Data Systems. The Polydrug Project
was the only national data system to collect
information regarding the primary source of
support of its clients. Those data (see table
14) show that females are less likely than
males to have a job as a primary source of
support (23 vs. 30 percent), more likely to
receive welfare (27 vs. 23 percent), more
likely to be dependent upon others (42 vs.
30 percent), and less likely to be dependent
on illegal activities as their primary source
of support (4 vs. ll percent).

Local Data Systems. Four local data sys-
tems--NTA, ASA, Wayne County, and the

National Women's Project--collected information
regarding the primary source of support of
their clients. The NTA and ASA data report
multiple sources of support, while the Wayne
County and NWDRCP report only the primary
source of support. In those systems where
male/female comparisons were made, there
were moderate differences reported. In the
Wayne County system, females are more likely
than males to be receiving welfare assistance.
The other local data systems either did not
report or did not collect this data on males,
NTA, Wayne County, and ASA do report,
however, that females are far more likely to
be dependent on others than are males.
Males are more likely to be desvendent on
illegal activities than females. Additionally,
however, it should be noted that significant
percentages of males and females are involved
in illegal activities as primary sources of
support (see table 14).

Arrests

National Data Systems. As table 15 indicates,
the only national drug abuse data system sur-
veyed which obtained information specifically
concerning arrest history" vas the Polydrug
Project. The proportion of females arrested
(27 percent) is significantly less than males
(57 percent).

 

 

Local Data Systems. The local systems sur-
veyed indicate differences between male and
female arrest patterns, although they are
generally not so strong as those suggested
by the Polydrug data. The differences for
NTA and ASA are not significant; the Miami
(A) and HERS data do indicate significant
differences.'* The Wayne County data, which
constitute too large a sample for statistical
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21
''testing, indicate the same pattern as the
other local data systems concerning arrests--
the percentage of female clients arrested (21)
is less than the percentage of male clients
arrested (27). However, the differences be-
tween males and females in the Wayne County
data are much less than those reported in
the Polydrug Project.

Admission Type

National Data Systems. The CODAP system,
during 1975 and the first 6 months of 1976,

collected information regarding the voluntary
or involuntary admission status of both male
and female clients. The results, given in

table 16 indicate that most client admissions,
regardless of sex, were voluntary.'* Males

had higher percentages of involuntary admis-
sions than females although the differences

were small for both 1975 and 1976.

 

 

Local Data Systems. The local data systems
surveyed follow a pattern similar to that found
in the CODAP data for admission type. Male
clients were more likely than females to be
involuntary admissions; the difference in
male/female involuntary admissions for the
NTA system was statistically significant and
quite large’ (31 percent of the males vs. 6
percent of the females). Differences in the
two other local systems which gathered data
on this variable were in a similar direction.

 

Drugs of Abuse

National Data Systems. Comparability among
the national drug treatment systems on this
variable is difficult to achieve. Each sys-
tem--CODAP, DAWN, DARP, and Polydrug--
collected drug use data in a different manner.
CODAP asked its clients about primary and
secondary'® drug usage; DAWN asked its cli-
ents what drugs they were using at the time
of contact and recorded the first three men-
tioned; Polydrug asked its clients what drugs
they were currently using and recorded all
of them; and DARP asked its clients what
drugs they were using during the 2 months
prior to treatment and recorded all of those
mentioned. Nevertheless, several systematic
similarities may be seen in these data, as
shown in tables 17, 18, and 19.

 

First, the percentage of males using heroin
exceeds the percentage of female heroin users
in each CODAP year as well as each data sys-
tem, although the CODAP system data present
evidence which suggests that this difference
may be becoming attenuated. Table 18 sug-
gests that while the percentage of both males

22

and females listing heroin as their primary
drug of abuse increased between 1974 and
1976, the rise was notably steeper for females.
Whereas the percentage of male clients in-
creased by 3 percent (from 60 to 63 percent)
during these years, females increased by 8
percent (from 50 to 58 percent), suggesting
that heroin as a primary drug of abuse may
be rising more quickly for females than for
males in the CODAP population.

Second, the percentage of female clients abus-
ing psychotropic drugs (i.e., barbiturates,
other sedatives, amphetamines, and tranquil-
izers) is greater than the percentage of male
clients abusing these drugs. It is difficult
to discuss this class of drugs as a group be-
cause both the DAWN and DARP systems col-
lect multiple abuse data, making it impossible
to be specific regarding what percentage of
the population under consideration is using a
particular drug. For example, table 17 indi-
cates that ll percent of the male DAWN Emer-
gency Room clients were using barbiturates
at the time of contact and 25 percent were
using tranquilizers. It is not possible, how-
ever, to say on this basis that 36 percent of
the male clients are using barbiturates or
tranquilizers since there is no way of know-
ing the percentage of overlap; that is, what
percentage of the barbiturate users are also
tranquilizer users.

With this caution in mind, and with the knowl-
edge that, at least for the DAWN clients,
multiple drug use for males and females was
essentially equal, table 20 presents the total
percentages of psychotropic drugs used by
males and females in each data system. The
data in this table indicate that female clients
are more likely than male clients to consider
psychotropics their primary or secondary
drug of abuse (CODAP), to have used one
or more psychotropics during the 2 months
prior to treatment (DARP), and to have used
one or more psychotropics at the time of emer-
gency room or crisis center contact (DAWN).
As indicated previously, the prevalence of
nonmedical use of psychotropics is higher for
males than females, while the prevalence of
medical use is higher for females. The DAWN
data (table 17) show more females than males
contacting hospital emergency rooms and cri-
sis centers. This could suggest that females
are experiencing problems with use of pre-
scribed psychotropics taken for medical rea-
sons,

Finally, tables 17, 18, and 19 indicate that
male clients may be more likely than female
clients to abuse methadone, alcohol, cocaine,
or inhalants.
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26
''Local Data Systems. The NTA, ASA, New

Haven, and Miami (A) data systems each col-
lected data on the overlap basis noted in
several of the national data systems above.
The clients in these systems were asked what
drug(s) they were using during the 2 months
prior to treatment. The Wayne County and
Miami (B) systems asked their clients to list
their primary and secondary drugs of abuse.
The National Women's Project and HERS col-
lected data on their client's primary drug of
abuse.

The data in tables 17, 18, and 19 reveal mixed
patterns of local use. Heroin use is slightly
higher among males than females However, in
New Haven, significantly more females use
heroin than do males coming into treatment.

Viewing psychotropic drug use individually
and as totals (table 20), use is slightly higher
among female clients; however, none of the
differences is statistically significant.'®

- Number of Drugs Which
Are Used or Cause a Problem

National Data Systems. Differences between

males and females on this variable were neg-
ligible, as indicated in table 21.

Local Data Systems. Only one local data sys-
tem, Wayne County, collected data on this

variable. The male/female difference was
small (23 vs. 28 percent) although in the
direction of more polydrug use for females.

27
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29
''3. A Review of the Literature

Characteristics of Male and Female
Drug Abusers as
Reflected in the Literature

Two broad types of studies are addressed in
this section: (1) treatment studies and (2)
nontreatment studies. The numbers refer-
enced in the text refer to the studies listed
in tables 22 and 23. Caution should be exer-
cised in viewing these studies. Inclusion here
does not necessarily indicate a good study
design but rather the presence of a discus-
sion of female or female vs. male drug abuse.

Sex

Treatment Studies. It is not possible, on
the basis of the studies considered here, to
speculate on the percentage of female as op-
posed to male drug abusers in the population.
Few of the samples were drawn with the
intention of collecting a representative (in
terms of sex) group of drug users.

In the majority of those studies in which the
sample was collected either randomly or from
consecutive admissions (10, 17, 19, 20, 21,
22, 24), the percentage of male clients was
greater than that of female clients, although
study 21 suggests that the male/female gap is
declining over time. An exception to the
general finding, however, is study 22, whose
sample consists of clients treated at a hospi-
tal emergency room for acute drug reactions.
In this case, the percentage of female clients
is greater, a finding not unexpected in light
of similar findings on a national basis in the
DAWN data.

Nontreatment Studies. The data in these
studies also were not collected with the inten-
tion of indicating the relative percentage of
male and female drug abusers in the popula-
tion. The one study (IN) in which data were
collected in such a manner as to offer an
indication of this shows that, at least in the
mid-1960s, the percentage of males arrested
for heroin and/or marihuana use in one North-
eastern city was sharply higher than that of
females arrested for the same offenses.

30

A single study, of course, cannot be viewed
as an accurate barometer of the extent of
male vs. female drug abuse in the population.
Seen in the context of the larger data collec-
tion systems described earlier, however, such
an individual finding can serve to further
bolster those more objective results.

Age

Treatment Studies. While the studies being

considered have not attempted to reflect an

accurate representation of the age patterns

of male and female drug abusers in the popu-
lation, they do offer some insight into this

question.

In those studies where the mean age of the
clients is compared for males and females,
little difference exists; where mean age is
given in female only samples the range is
wider, but this appears to be due to the pur-
pose of the particular study, and facility
from which the sample was drawn, rather
than a true indication of the age of female
drug abusers in the _ population.

The one pattern which appears to exist may
be examined among the female samples which
are broken down by age and race categories
(3, 6, 13, 14, 22). In three of these studies
(3, 6, 22) either the mean age or percentage
of white female clients 30 years of age and
over considerably exceeds that of black female
clients. Two of these studies (3, 22), one
covering a hospital emergency room and the
other the NIMH Center at Lexington, gathered
data from consecutive admissions.

Nontreatment Studies. Only one nontreatment
study (7N) presents age data relevant to fe-
male drug abuse. This study indicates that,
among a sample drawn from a female prison
population, heroin users were significantly
(p < 0.01) more likely to be younger than
nonheroin users. No other studies examined
in this category gathered age data in terms
of drug abuse.

Race/Ethnicity
Treatment Studies. Among the studies being

considered here which collected race/ethnicity
data, a majority (1, 5, 8, 12, 14, 16, 17, 19,
''24) dealt with a greater percentage of black
than white female drug abusers. Exceptions
to this finding (4, 6, 13, 22, 23) occur in
emergency room and therapeutic community
settings.

Nontreatment Studies. One study (8N) found
the number of black "narcotics involved"
females to be significantly (p < 0.001) greater
than white females in the same categories.

Marital Status

Treatment Studies. Data on this variable
are collected in several studies (3, 5, 6, 9,
13, 14, 18, 24, 25). No clear pattern of sex
differences was found.

Nontreatment Studies. One study (7N) in
this category gathered data concerning mari-
tal status. This study compared female
heroin users and nonusers among a prison
population. A significant difference was found
between the number of heroin users and non-
users who were divorced, with users being
less likely to be divorced (p < 0.05).

Educational Status

Treatment Studies. Essentially no differences
are seen between males and females in those
studies (3, 5, 6, 14, 16, 17, 25) where educa-
tional status data are gathered. There is,
however, some indication (studies 3, 6, 14)
that white females are more likely to have
either completed high school or a greater num-
ber of grades than black females.

Nontreatment Studies. Educational status in
these studies is entirely dependent upon the
population from which the sample was drawn--
most often this is from a secondary school or
a university (with no nonschool comparison
group). Therefore, no differences between
males and females would be expected and none
are found. Three nonschool studies examined
in this category did not report educational
data.

Current Drug Use

Treatment Studies. Current drug use refers
to usage levels and types recorded at admis-~
sion to treatment. There are no clear differ-
ence patterns between males and females in
this category. Although some differences do
appear between black females and white
females, these findings are limited to individ-
ual studies (3, 22) and should be regarded
cautiously.

Nontreatment Studies. Two studies (2N, 10N)
in this category collected data on current
drug use, which refers to usage levels and

31

types recorded at the time of the study.

One study (2N) indicates heavier use of bar-
biturates, bromides, and tranquilizers by

undergraduate females than males. The sec~
ond study (10N) indicates essentially no dif-
ference between male and female secondary
school students in use of a variety of drugs.

Drug Use History

Treatment Studies. Data concerning a large

number of variables were collected in this

category. However, only two variables--age
at first illicit drug use and source of drugs--
are dealt with by more than two studies.
Since there is little validity in discussing
variables covered in only one or two studies,
the remaining variables and the studies in
which they were investigated are listed below:

Study
No.
Basis of decision/failure to
withdraw 5
Length of time using heroin 25
Source of heroin introduction 25, 27
Source of support for drug habit 13, 25
People drugs were used with 25
Immediate precursor drug to
heroin lL, 8
Age at addiction to heroin 16
History of heroin use 3, 6
Situation at onset of addiction 3
Number of years between first
drug use and first heroin use 3
Ever used specific drugs 6
Length of time between first
heroin use and addiction 13
Number of times volunteered
for treatment 13

Age at first illicit drug use is discussed in
four studies (1, 14, 25, 26). No pattern of
male/female differences is established. Study
14 indicates that males began narcotics use
0.7 year earlier than females; study 25 indi-
cates that males began heroin use 1.1 years
earlier than females.

Source of drugs is discussed in three studie.
(3, 6, 26). Two of these studies, 3 and 6,
deal only with female samples but compare by
race. In both of these studies, black females
were more likely than white females to have
obtained their drugs from a pusher; study 3
indicates that white females were more likely
than black females to have obtained their
drugs from a doctor or a drugstore.

Study 26 compares males and females but does
not break down the comparison by race. This
study indicates that females were significantly
more likely than males to have received their
''drugs from friends (p< 0.05) and that males
were significantly more likely than females to
have obtained drugs by stealing (p< 0.01).
Males were also more likely than females,
although not significantly so, to have received
their drugs from a pusher or by pushing
drugs themselves.

Nontreatment Studies. The studies in this
category did not investigate as wide an array
of variables as did the treatment studies.
Variables which were dealt with in only one
study were time of introduction into cigarette
and/or alcohol use (5N), use of "decrement
producing" or "increment producing" drugs
(2N), drugs “ever used" comparing use by
7th-to-9th-grade and l0th-to-l2th-grade males
and females (10N), and length of time using
drugs (4N).

The only variable which was dealt with in
more than one study (2N, 4N, 9N) was age
at first drug use. The results were inconclu-
sive. One of these studies (4N) found that
females began use of nonspecific’ drugs at a
younger age than males; study 2N also found
that females began drug use at a younger
age than males but only among certain drugs
which were reported (barbiturates, bromides,
and tranquilizers); study 9N, however, indi-
cated that males had earlier initial drug exper-
iences than females.

Criminal Justice History

Treatment Studies. Variables concerning crim-
inal justice history were discussed in only
five studies (5, 9, 14, 23, 25) and compared
by sex in three (5, 14, 25). Study 5 indi-
cated that males were more likely to have com-
mitted illegal acts prior to use of heroin;
study 14 found that males were more likely to
have been arrested at a younger age than
females; and study 25 found a higher per-
centage of males than females referred. to
treatment from the criminal justice system.

Nontreatment Studies. Only one study (8N)
collect ta concerning criminal justice his-
tory. This study utilized an all female sample.
Racial comparisons indicated that among "nar-
cotics involved" arrestees, black females were
arrested more often than white females for
prostitution, larceny, and robbery.

Other Characteristics

Treatment Studies. A wide range of vari-
ables, inappropriate for consideration in
previous categories, were assigned to this
category. Variables treated in only one study
were results of the Rokeach Value Ranking
Test (12), addiction status of spouse (13),
results of depression and anxiety scale

32

administrations (16), results of Personal Ori-
entation Inventory (18), results of a staff/

resident perception of problems questionnaire
(20), MMPI results (23), living arrangements
before treatment admission (26), and IQ (26).

Three variables--family background, employ-
ment/source of support, and suicide thoughts/
attempts--were dealt with in more than one
study. The first of these variables, family
background, is discussed in four studies (3,
13, 15, 24). Investigated were the number
of female treatment program residents from
severely disturbed families (15), the percent-
age of female treatment clients reared in
broken homes (3), occupation classifications
of female treatment clients' fathers (13), and
by whom male and female treatment clients
were raised (24). Only one of these studies
(24) compares males and females, but this
study, in conjunction with two others (3, 15)
indicates that male and female drug abusers
are very often products of a disorganized
family.

The second variable, employment/source of
support, is investigated in three studies (3,
6, 17). One of these studies (17) compares
males and females, while the other two (3,
6) deal only with females (with race compari-
sons). Female treatment clients, especially
black females, appear to experience quite low
employment levels, a condition which, accord-
ing to one study (6), worsened between 1961
and 1967. -

The final variable, suicide thoughts/attempts,
is discussed in three studies (9, 22, 24).
One of these studies (24) indicates that
females had significantly (p < 0.01) more sui-
cidal thoughts and suicide attempts than males.
The other two studies (9, 22) investigated
female drug abusers in private treatment and
emergency room settings. In study 9, 46
percent of the women had attempted suicide,
and in study 22, significantly more white (45
percent) than black (32 percent) females were
being treated for suicide attempts.

Nontreatment Studies. No pattern of differ-
ences emerged from the studies in this cate-
gory since no variable is dealt with by more
than one study. One study (7N) investigated
suicide thoughts/attempts in a female prison
population divided into heroin users and non-
users. The findings are an increment to the
suicide-related studies cited above--a greater
(though nonsignificant) percentage of female
heroin users than nonusers report suicidal
thoughts and suicide attempts.

Other variables discussed are value-issue dif-
ferences among college marihuana users and
nondrug users and noncollege heroin users
''and nondrug users (3N); the male ys. female
percentages of identified addicts in Connecti-
cut during a 3-year period in the mid-1960s
(IN); drug user vs. nonuser (no sex break-
down) differences in parental perceptions
(1IIN); heroin users vs. marihuana only users
vs. nondrug users on several social interac-
tion dimensions (6N); heroin vs. nonheroin
users; urban vs. nonurban; birth and cur-
pe place of living (7N); and source of drugs

Psychological Characteristics of
Female Drug Abusers

There is great potential for misunderstanding
and misusing assessment data in an area that
is controversial in itself, such as the psycho-
logical characteristics of the female drug
abuser. This does not imply, of course, that
study of controversial areas should not be
carried out. Rather, it should encourage
further investigation and reexamination of
already existing data. A necessary element
of this investigation and reexamination, how-
ever, is an awareness of the actual, alleged,
and potential shortcomings of the validity of
the data and instruments being utilized.

Limitations of the Data

There is extensive literature concerning the
psychological characteristics of drug abusers.
Upon examination, however, there are limita-
tions to this literature. First, much of this
literature is based upon clinical impressions
rather than data collected under controlled
conditions. Second, there are numerous
methodological problems with many of these
studies. Sample sizes are generally small
and often not comparable across studies;
there is often little cross-study comparability
of instruments designed to measure the same
or similar characteristics; descriptions of
methodology, sample population, and findings
are incomplete in many studies; control groups
are often lacking; and very few investigations
have concentrated on "normal" as well as
psychopathological attributes of drug abusing
populations, resulting in an emphasis upon
profiles of psychopathology with little or no
portrayal of "normality." Third, and most
relevant for this study, a substantial majority
of the studies in the area deal only with male
drug abusers, or where a sample of males

33

and females is obtained, results are often
not reported by sex.

Given these limitations and the possible con-
founding factors cited earlier, this review
contains only those studies which (a) utilize
specific, nonimpressionistic data, and (b)
report results utilizing either samples of
female and male subjects or female subjects
only. The setting of these criteria has the
effect of narrowing the number of eligible
studies a great deal. This scarcity of eligible
studies thus makes the need for additional
study in this area more _ obvious.

Study Results

A summary of the studies reviewed for this
section may be seen in table 24. Whether
they validate the perceptions of the staff mem-
bers cited in Levy and Doyle (1974) that
female drug treatment clients are implicitly
"sicker" than male clients is not at all clear.
Certainly, these studies note sex differences
on many of the personality dimensions they
investigate. For example, Miller et al. (1973)
found that female and male addicts differed
significantly on ratings on the Rokeach Value
Ranking Test; DeLeon (1974) found greater
evidence of depression and anxiety among
female than male addict clients; and Olson's
results (1964) suggest that female and male
addicts differed on MMPI profiles. Such find-
ings do not, however, indicate that among
addicts, one sex is more pathological or
"sicker" than the other.

Nevertheless, there are several studies which
do reach the general conclusion that female
drug abusers are more psychologically dis-
turbed than male drug abusers. Table 25
describes, in a broad manner, how the stud-
ies reviewed here deal with this issue. As
may be seen in this table, one-third of the
studies reviewed conclude that female drug
abusers function, psychologically, more poorly
than male drug abusers; there are no studies
which report the opposite conclusion. Those
studies which did not utilize a male compari-
son group nevertheless also reported signifi-
cant pyschological difficulties on the part of
the female addicts who were studied. The
largest group of studies (40 percent of those
under consideration here) do not report broad
male/female differences, although each notes
some psychological difficulty in both male and
female drug abusers. One study (Miller et
al. 1973) concludes that the differences found
merely reflect the societal differences between
all males and females, rather than between
male and female drug abusers.

 
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SHIGALS LNSNLVALL

UZ F981

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SHIGALS LNSWLVSUL

7 AGB L

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SAIGALS LNSWLVRLL
77 198

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SHIGALS LNAWLVEML
7 AGB L

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SHIGALS LNSWLVSL

77 P98

 
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TZ GEL

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£7 AGEL

52
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SHIGALS LNSWLVTULNON
£7 A1GBL

53
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SHIGNIS INSNLVSYLNON

£7 G8 L

54
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SHIGALS LNSWLVELLNON
£7 91GB L

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£7 91481

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56
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SHIGALS LNANLVIYLNON
£7 F148 L

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SHIGALS LNSWLVSULNON

£7 1G8L

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SHIGALS LNANLVSYLNON

£7 91981

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v7 FGBL

60
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(penutzuo>)
SUASNAV ONY TTWWAI JO SOLLSIMALVUVHO TVOISOTOHOASd ONILON SHIGNIS 3O MATATY

v7 P1GBL

61
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(penut3uoo)
SUASNV OMA FTWAAA AO SOLLSIMSLWAVHD TVOISOTOHOASA ONILON SAIGAIS JO MaTATY

v7 71981

62
'' 

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(panutzuo>)

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v7 FG’

62
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v7 FG8L

64
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v7 91GB L

65
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(penutzuod)

SUASNAVY OMG FTWWAA JO SOLLSTUHIOVEVHD TVOISOIOHOASd ONILON SHIGALS dO MAIASY

eZ F981

66
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''4. Conclusions

This report on the characteristics of female
drug abusers is based on a structured effort
to identify, collect, and assess all of the
available data sources on drug use patterns,
demographic descriptors as reflected in
national and local drug treatment data systems,
treatment and nontreatment studies, and
psychological descriptions froin published and
unpublished literature.

The data on both female and male drug
abusers were examined to determine if there
are sex-specific drug use patterns, demo-
graphic variables, and psychological character-
istics; to look at trends; and to permit fur-
ther analyses to explore significant differences
between females and males. A summary of
findings identified by data source follows.

For adults (18 and over), the national house-
hold surveys (Abelson and Atkinson 1975;
Abelson and Fishburne 1976) indicate the fol-
lowing:

e For "current use of illicit drugs" there
are no significant differences between males
and females, except for marihuana (current
use for males is substantially higher).
The illicit drugs listed are heroin, cocaine,
other opiates, hallucinogens, inhalants,
marihuana, and hashish.

e The prevalence (defined as "ever used")
of use of all of the illicit drugs is signifi-
cantly higher for males than for females.

e There are no statistically significant male/
female differences reported in current non-
medical use of psychotherapeutic drugs.

e Females report substantially and signifi-
cantly higher prevalence ("ever used") of
nonmedical use of psychotherapeutic drugs.

For youths (12 to 17), the national surveys
indicate:

e@ Females and males report similar "current
use" patterns of heroin, cocaine, mari-
huana, and hashish, but females report
significantly less use of hallucinogens than
males;

e Females report significantly lower use
("ever used") than males of inhalants,
marihuana, and hashish.

The data on prevalence of nonmedical drag
use disguise the comparative extent to which
women and men experience drug problems
because medical use is excluded. According
to DAWN data, women experience more than
twice as many contacts with hospital emer-
gency rooms due to tranquilizers, nearly three
times as many contacts due to nonnarcotic
analgesics, and nearly twice as many due to
nonbarbiturate sedatives. Further, women
are more likely than men to contact emergency
rooms because of problems with barbiturates,
amphetamines, alcohol, and "other drugs";
but men are more likely to contact emergency
rooms because of problems with heroin/mor-
phine, methadone, cocaine, hallucinogens,
inhalants, solvents, aerosols, and nonnarcotic
analgesics. Women are nearly twice as likely
as men to contact hospital emergency rooms
due to a drug overdose.

 

Clearly, the exclusion from this study of
medical use of psychotherapeutic drugs omits
consideration of a substantial proportion of
the drug problems encountered by women.

The following are highlights of the treatment
data:

e Females in traditional treatment programs
are slightly more likely than males to be
under 21 years old and slightly less likely
to be 21 and over. However, this pattern
is reversed in emergency room and crisis
center facilities where females are more
likely to be over 30 years of age; females
who die of drug overdoses are consider-
ably more likely to be over 36. This
reversal is probably attributable to higher
use of psychotherapeutic drugs by females
than males in that age group.

e Female clients entering treatment are less
likely than males to be using heroin,
although there is some evidence to suggest
that the difference is becoming attenuated.
Females are more likely to be abusing
psychotherapeutic drugs, but less likely
to be abusing methadone, alcohol, or
cocaine.

70
''Female, as compared to male, clients are
slightly less likely to be black and sub-
stantially less likely to be Puerto Rican or
Mexican American. Females are more likely
to be, or to have been, married than their
male counterparts.

While there are no differences on education,
females entering treatment are considerably

71

less likely to be employed than males.
They are more likely than males to be
dependent on others or welfare for support
and less likely to be dependent on illegal
activities as their primary source of sup-

port.

Females are less likely to have been
arrested, and less likely than males to
enter treatment involuntarily.
''5. Discussion

The previous sections provide us with infor-
mation concerning the characteristics of female
and male drug abusers according to client
data in national and local drug information
systems, national household surveys, treat-
ment and nontreatment studies, and in some
additional studies of psychological character-
istics. It is clear that, although there is a
great deal of data available, there is still
much to be learned about the characteristics
of female drug abusers.

Drug program data show that men and women
have differing rates of entry into drug abuse
treatment and emergency treatment programs
and that those rates of entry will vary by
age within male and female groups.

Within the female treatment (CODAP) popula-
tion, there are significantly more women in
programs under age 26 than there are women
26 or older. The disparity in these numbers
suggests that either programs are better
geared to the younger female client or that
women's conditions change in some significant
way, limiting their availability for treatment
after age 25. The finding that women in treat-
ment are often responsible for dependent chil-
dren has obvious relevance for this latter
hypothesis. The woman aged 26 and older
then becomes of special concern, Why is
there the dropoff in women entering drug
abuse treatment programing in this age
group? What special programing may be re-
quired to meet this group's special needs?

In addition, the opiate-oriented drug treat-
ment envirenments would appear inappropriate
for large numbers of drug abusing women
who are seen at hospital emergency rooms
and crisis centers. It will be important to
assess the treatment needs of women over
age 30 who receive emergency services for
drug and drug-related problems since that
age group is overrepresented in emergency
treatment relative to other female age group-
ings. What types of services are required
once these women are released from hospital
emergency rooms and crisis centers? Are
existing agencies capable of providing the
desired services to this population?

The available demographic data clearly sug-
gest that women generally have different

72

treatment needs. The employment and
primary source of support data indicate that
female clients in all but emergency rooms and
crisis centers are more likely than males to
be unemployed and/or dependent upon others
or welfare for their support. Females have
fewer and more restricted employment oppor-
tunities than males. The data cited here also
suggest a tendency for females to fall into
somewhat lower educational categories than
males. Moreover, females in treatment pro-
grams are more likely than males to be sepa-
rated or divorced, and to have responsibility
for dependent children.

It has been reported that female drug addicts
have more psychological difficulties than male
addicts. However, it should be observed
that methodological problems have been noted
in many of the psychological studies that have
been conducted. Thus, while studies do sug-
gest sex differences between male and female
clients on many of the personality dimensions
investigated, there is a need for more study
in this area to verify and understand differ-
ences.

Based on the data, it appears that long-term
opiate-oriented treatment programs may not
be appropriate for a large segment of the
female drug abusing population. It is possible
that more women would be encouraged to
participate in the drug treatment service sys-
tem if these services were modified to meet
their needs.

Among the different variables that must be
considered in planning treatment for drug-
abusing women are the following:

1. Age seems to be an important factor to
consider, given the evidence that there
are differences between men and women
in drug use patterns and treatment needs
at different age ranges.

2. Mental health services may be more appro-
priate for women who require emergency
medical treatment for drug problems.
For example, suicide attempts and ges-
tures (using drugs) would be more likely
to require mental health services.
''3. Treatment programs for females must put
more emphasis on such services as female-
oriented vocational training, child day
care facilities, assertiveness training,
increased educational support and oppor-

‘ tunity, and social services. Every effort
should be made to assess the availability
of such services in the community.

Treatment programs should consider local atti-
tudes and conditions in attempting to

—

encourage female clients to seek treatment.
Drug treatment programs need to recognize
the particular stigma attached to female drug
abuse and develop innovative ways to serve
females. Appropriate referral strategies need
to be developed for older women who experi-
ence problems with psychotropic drugs. By
doing so, it is possible that greater numbers
of female abusers may feel more inclined to
seek treatment appropriate to their needs.

73
''FOOTNOTES

CHAPTER 1

the publications referenced did not report prevalence of illicit drug use separately by sex
except for marihuana. We are indebted to Ira Cisin, Ph.D., who provided special tabulations
of the 1975-76 data for use in this analysis.

2Statistical significance is considered here at the 0.05 level.

CHAPTER 2

Istatistical tests are also carried out in one national (Polydrug) and one local (University of
Miami [A]) data set with large n's. These tests are performed in order to demonstrate that,
even with a large number of observations, significant male/female differences are not often
found. Due to the large n's, however, the results of these tests should be regarded with
some caution.

rhe DAWN Medical Examiner facilities are not, of course, considered as treatment facilities.

3The results of chi-square tests are: ASA--X?=7.0, d.f.=2, p < 0.05; New Haven--X?=1.2,
d.f.=2, p < 0.05; Miami (A)--X?=0.2, d.f.=2, p >0.05.

4The X? test for NTA was invalid because the expected frequency was less than 5 for one cell.

The results of chi-square tests were: NTA--X?=0.03, d.f.=l, p >.05; ASA--X7=4.9, d.f.=2,

p > 0.05; Miami--X?=0.9, d.f.=3, p > 0.05; HERS--X?=8.5, d.f.=5, p > 0.05; Polydrug--
X7=0.8, d.f.=2, p > 0.05; New Haven--X?=2.9, d.f.=2, p > 0.05.

othe chi-square test results were: NTA--X?=2.0, d.f.=l, p > 0.05; ASA--X?=1.2, d.f.=l,
p > 0.05; New Haven--X?=1.4, d.f.=l, p > 0.05; Miami (A)--X?=25.7, d.f.=4, p < 0.001;
HERS--X?7=8.4, d.f.=4, p > 0.05; Polydrug--X?=30.8, d.f.=4, p < 0.001.

TEven these small differences may be accounted for by the indication, noted earlier (table 7),
that female clients may be younger than male clients. A greater percentage of females under
18 would tend to suppress the number of females even eligible (by virtue of age) to have com-
pleted 12 grades.

8The chi-square results were: NTA--X*=2.0, d.f.=l, p > 0.05; ASA--X?=7.0, d.f.=4,

p > 0.05; Miami (A)--X7=10.8, d.f.=5, p> 0.05; HERS--X?=23.5, d.f.=4, p < 0.001; Poly-
drug--X?=0.8, d.f.=3, p > 0.05.

tt should be noted that the DARP system collected data on several employment-related vari-
ables and reported them as an index entitled "employment record." Included are employment
history based upon type of work, past and present employment in the year previous to treat-
ment entry, and source of financial support. High scores on this index report reflect steady
employment in skilled positions, while low scores indicate very poor work histories.

lpi results of chi-square tests are: NTA--X?=2, d.f.=l, p > 0.05; ASA--X?2=0, d.f.=l,
p > 0.05; New Haven--X?=4.17, d.f.=l, p < 0.05; Miami (A)--X7=20.2, d.f.=l, p< 0.001.
the DARP system obtained information regarding a variable entitled "criminal history" which
included, but was not limited to, arrest data.

74
''l2the chi-square test results are: NTA--X?=3.48, d.f.=l, p > 0.05; ASA--X?7=0.9, d.f.=l,

p > 0.05; Miami (A)--X?=50.6, d.f.=l, p < 0.001; HERS--X?=106.8, d.f.=l, p < 0.001; Poly-
drag--X?=96.1, d.f.=l, p < 0.001.
134% should be noted that a "voluntary" admission is not necessarily voluntary in the sense that
it is an internally self-motivated act. Legal or family pressure, for example, may result in a
client "volunteering" to enter treatment in the face of less desirable alternatives.

14y 227.9, d.f.=l, p < 0.005.

'51n 1975 and 1976 the CODAP clients were also asked to identify their tertiary problem drug.

These data, however, are considered by NIDA of insufficient validity to report.

05

lore chi-square results comparing male versus female drug use (table 17) are as follows:
Drug Program x* d.f. Pp.
Heroin NTA (expected frequency too small)
Heroin ASA 3.5 1 --
Heroin New Haven ‘4.3 1 <.05
Heroin Miami (A) O45 1 “-
Illegal methadone NTA 0.4 1 os
Illegal methadone ASA 1.8 1 =<
Illegal methadone Miami (A) 3.3 1 --
Barbiturates NTA 0.4 1 --
Barbiturates ASA 1.3 1 ~
Barbiturates New Haven 1.4 1 =
Barbiturates Miami (A) 0.3 1 ==
Amphetamines NTA 0.3 1 —
Amphetamines ASA 0.6 1 --
Amphetamines New Haven 0.3 1 --
Amphetamines Miami (A) 0.4 1 ==
Cocaine NTA 0.6 1 --
Cocaine ASA iil 1, as
Cocaine New Haven 0.1 1 —
Cocaine Miami (A) 4.3 1 -~
Marihuana NTA 0 1 a
Marihuana ASA 5.3 l <.05
Marihuana New Haven 1) 1 ——
Marihuana Miami (A) 93.7 1 <.001
Hallucinogens NTA (expected frequency too small)
Hallucinogens ASA 0. 1 7s
Hallucinogens Miami (A) 6.5 1 <.05
Other drugs NTA (expected frequency too small)
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