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					                                                       Gender Differences in Alcohol and Drug Use Severity and
                                                       Psychopathology in Clients with Co-Occurring Disorders
                                                              Laurel Mangrum, Richard Spence & Michelle Steinley-Bumgarner
                                                                                    University of Texas at Austin, Addiction Research Institute

Introduction                                                               COPSD Client Characteristics                                                                                                                                                                                                                                         Results and Conclusions
The co-occurrence of psychiatric and substance use disorders
(COPSD) and the effects of comorbidity on the clinical presentation                Demographic and Social                                                                                                           Problem Days Past Month at Admission                                                                                        Analyses of demographic and social variables revealed that women were
and outcomes of substance abuse treatment are growing areas of                        Characteristics                                                                                                                                                                                                                                           more likely to have children, be living in a group or institutional setting, and
study. Early studies in this area focused on severely mentally ill                                                                                                                                                                                                                                                                              had higher levels of legal involvement. By contrast, men were older and had
                                                                                                                                                                                                             30                                                                                                                                 higher homelessness rates. In the areas of substance use and psychosocial
(SMI) populations and led to the development of specialized                                                              Female                   Male                                                              Female    Male                                                                                                              problems, men were more likely to use alcohol as a primary substance, had
integrated treatment programs for these clients. As research                                                              (n = 86)               (n = 127)
                                                                                                                                                                                                                                                                                                                                                more years of primary substance use, and reported more problem days
progresses, studies are focusing on identifying client characteristics      Mean Age                                        33.5                   40.6       †
                                                                                                                                                                                                             25                                                                                                                                 related to substance use relative to women. Women more often used
that may be associated with clinical features and outcomes. In this         Race/Ethnicity
                                                                                                                                                                                                                                                                                                                                                powder cocaine, crack, and opiates as primary substances and reported
                                                                               Black                                        1%                     7%
line of research, gender has been explored as a potential factor               Hispanic
                                                                               White
                                                                                                                            49%
                                                                                                                            49%
                                                                                                                                                   55%
                                                                                                                                                   36%
                                                                                                                                                                                                                                                                                                                                                more problem days related to medical, employment, family, social, and
                                                                                                                                                                                                             20
affecting symptom presentation and treatment response in COSPD                 Other                                        1%                     2%
                                                                                                                                                                                                                                                                                                                                                psychological issues at admission to treatment. Although women had been
clients with SMI. Studies to date suggest that women are more




                                                                                                                                                                                      Problem Days
                                                                            Marital Status                                                                                                                                                                                                                                                      using their primary substances for a shorter period of time than men, they
                                                                               Married/Cohabitating                         20%                    24%
likely to have children, a greater history of victimization and                Divorced
                                                                               Never Married
                                                                                                                            41%
                                                                                                                            39%
                                                                                                                                                   40%
                                                                                                                                                   36%                                                       15
                                                                                                                                                                                                                                                                                                                                                displayed evidence of greater substance use severity; higher proportions of
associated traumatic stress, more medical problems, and may be                                                                                                                                                                                                                                                                                  women reported engaging in polysubstance use and daily use of primary
                                                                            Has Children                                   38%                     24%        *

more willing or able to identify relationship and psychiatric                                                                                                                                                                                                                                                                                   substances over the past six months. Further, there were no differences
                                                                            Years of Education                              12.2                   11.9
problems, whereas men tend to have higher levels of legal                                                                                                                                                    10                                                                                                                                 between men and women in age of first substance use or substance abuse
                                                                            Employment                                                                                                                                                                                                                                                          treatment history, suggesting that women entered treatment more quickly
involvement. Findings in the area of substance use and psychiatric             Employed                                     13%                    13%
                                                                               Unemployed                                   81%                    82%                                                                                                                                                                                          than men after initiating substance use. Comparisons among diagnostic
severity are inconsistent but trends suggest that men may present              Not In Labor Force                           6%                     5%
                                                                                                                                                                                                              5                                                                                                                                 categories revealed that women had higher rates of posttraumatic stress
more severe substance use symptoms and women greater                        Living Situation
                                                                               With Family                                 54%                     63%        †                                                                                                                                                                                 disorder but no gender differences were found in the rates of other non-
psychiatric distress. These extant studies, however, are limited to            Group Quarters
                                                                               Living Alone
                                                                                                                           12%
                                                                                                                           6%
                                                                                                                                                   5%
                                                                                                                                                   7%                                                                                                                                                                                           substance use disorders. On psychiatric measures, men displayed greater
                                                                                                                                                                                                              0
COPSD clients with SMI and may not generalize to individuals with              Insitutional Setting
                                                                               Homeless
                                                                                                                           16%
                                                                                                                           12%
                                                                                                                                                   1%
                                                                                                                                                   24%
                                                                                                                                                                                                                      Medical*        Employment***        Family***            Social*          Psychological**        Drug/Alcohol***         levels of psychiatric severity on standardized self-report and clinician ratings
non-severe co-occurring psychiatric disorders.                              Legal Status                                                                                                                                                                                                                * p < .02, ** p < .01, *** p < .0001
                                                                                                                                                                                                                                                                                                                                                in the areas of phobic anxiety, paranoia, and psychoticism. At discharge,
                                                                               Any Legal Involvement                       33%                     18%        *
                                                                               DWI Past Year                                6%                      7%                                                                                                                                                                                          analyses of ancillary service use indicated that men received more types of
                                                                               PI Past Year                                 4%                      2%
The current study examines gender differences in a sample of                   Other Arrests Past Year                     11%                      5%                                                                                                                                                                                          services and were more likely to receive housing, food assistance,
COPSD clients entering substance abuse treatment that includes              * p=.02, † p=.0001                                                                                                                                                                                                                                                  transportation, and peer mentoring, whereas women more frequently
both severe and non-severe mental illnesses. The purpose of the
                                                                                                                                                                                                                                     Ancillary Services Received                                                                                obtained medical care and prescription services. No gender differences were
study is to determine if gender characteristics in this sample,                                                                                                                                                                                                                                                                                 found in length of stay, treatment completion, or abstinence rates at
                                                                                                                                                                                                                                                                                                                                                termination of treatment.
containing a wider array of psychiatric disorders, are similar to those   Treatment History and Substance Use                                                                                                100%

found in previous studies of SMI populations.                                                                                                                                                                          Female      Male
                                                                                                                                                                                                                                                                                                                                                Consistent with previous findings in the SMI population, the current analyses
                                                                                                                                 Female               Male
                                                                                                                                   (n = 86)          (n = 127)                                                                                                                                                                                  revealed that women were more likely to have children, had higher rates of
                                                                                                                                                                                                             80%
                                                                            Substance Abuse Treatment                                                                                                                                                                                                                                           posttraumatic stress disorder, displayed higher medical problems, and
                                                                               Previous Detox                                       61%                69%

Sample and Method                                                              Number of Previous Detox
                                                                               Previous Non-Detox
                                                                               Number of Previous Non-Detox
                                                                               Attended AA Past 30 Days
                                                                                                                                     1.8
                                                                                                                                    76%
                                                                                                                                     1.8
                                                                                                                                    49%
                                                                                                                                                        1.7
                                                                                                                                                       78%
                                                                                                                                                        1.8
                                                                                                                                                       31%        ***
                                                                                                                                                                              Percentage Receiving Service
                                                                                                                                                                                                                                                                                                                                                reported more psychosocial problem compared to men. Contrary to past
                                                                                                                                                                                                                                                                                                                                                results, however, women were more likely to be legally involved relative to
                                                                               Number of AA Meetings Attended                       11.6                7.5       **                                         60%                                                                                                                                men and reported comparable rates of alcohol and other substance related
                                                                            Emergency Room Visit Past Year                                                                                                                                                                                                                                      arrests during the past year. Further, the results of this study did not support
The sample consisted of 213 clients entering substance abuse                                                                        39%                35%
                                                                                                                                                                                                                                                                                                                                                trends noted in other studies in which men tended to display greater severity
treatment who subsequently qualified for the Texas Co-Occurring             Substance Use History
                                                                               Age of First Use of Primary                           21                19.5                                                                                                                                                                                     in substance use and women in psychiatric symptoms. In this sample, men
                                                                                                                                                                  ‡
State Incentive Grant (COSIG) based on the presence of a comorbid              Years of Use of Primary
                                                                               History of IV Drug Use
                                                                                                                                    12.7
                                                                                                                                    58%
                                                                                                                                                       21.1
                                                                                                                                                       56%
                                                                                                                                                                                                             40%
                                                                                                                                                                                                                                                                                                                                                displayed greater severity on psychiatric measures and received a wider
non-substance use disorder determined though the Mini International         Primary Substance                                                                                                                                                                                                                                                   array of ancillary services, yet reported less social and psychological problem
                                                                               Alcohol                                              21%                47%        †
Neuropsychiatric Interview (MINI). The sample was recruited                    Cocaine                                              19%                10%                                                                                                                                                                                      days at admission to treatment compared to women. Conversely, females
                                                                               Crack                                                18%                10%
between March 2005 and January 2006 from six state-funded                      Opiates                                              32%                26%
                                                                                                                                                                                                             20%                                                                                                                                presented relatively greater substance use severity but reported higher levels
                                                                               Marijuana                                             3%                 4%
substance abuse treatment programs participating in the COSIG                  Other                                                 7%                 3%                                                                                                                                                                                      of psychosocial distress and less problems related to substance use. These
project. The total sample was 60% male, 53% Hispanic, 41% White,            Polysubstance Use                                       51%                37%        *                                                                                                                                                                             findings suggest that a differential pattern of awareness may exist regarding
and 7% Black.                                                               Frequency of Use of Primary                                                                                                       0%
                                                                                                                                                                                                                                                                                                                                                the effects of psychiatric and substance use severity on life functioning, with
                                                                               No Use                                                5%                 2%        †                                                    Housing**      Food Asssitance***   Transportation***   Medical Care***       Prescriptions*         Peer Mentoring***   males more readily admitting to problems related to substance use and
                                                                               Less than Monthly                                     1%                 3%
                                                                                                                                                                                                                                                                                                       * p < .005, ** p < .001, *** p < .0001
                                                                               1-3 Times Per Month                                   1%                 6%                                                                                                                                                                                      females more open to acknowledging the effects of social and psychiatric
Men and women were compared on demographic variables, MINI                     1-2 Times Per Week                                    1%                 8%
                                                                               3-6 Times Per Week                                   18%                29%                                                                                                                                                                                      problems. The possible presence of differential gender effects on client
psychiatric diagnoses, substance use characteristics, psychiatric              Daily                                                74%                52%
                                                                                                                                                                                                                                                                                                                                                reporting has significant clinical implications for the assessment process and
severity, ancillary services, and treatment characteristics.                Average Days of Use of Primary
                                                                                                                                                                                                                                                                                                                                                highlights the importance of using a variety of measures and informant
                                                                             Past 30 Days                                           14.1               15.7
Psychiatric severity measures included the Brief Symptom Inventory                                                                                                                                                                                                                                                                              sources to corroborate the client’s problem presentation. In addition, gender
(client report) and the Brief Derogatis Psychiatric Rating Scale
                                                                            * p=.05, ** p=.04, *** p < .02, † p=.01, ‡ p=.0001
                                                                                                                                                                                                                                              Psychiatric Severity
                                                                                                                                                                                                                                                                                                                                                differences in problem awareness may also indicate the need for treatment
(clinician rating). Demographic, substance use, and treatment                                                                                                                                                                                                                                                                                   programming and interventions tailored toward increasing recognition of the
                                                                                                                                                                                                                                                                               Female                       Male
characteristics data were obtained from the Behavioral Health                                                                                                                                                                                                                  (n = 86)                   (n = 127)                             broader and interactive effects of substance use and psychiatric problems on
Integrated Provider System (BHIPS), which is the mandatory data
                                                                                    Diagnostic Characteristics                                                                                                                                                                                                                                  social functioning.
                                                                                                                                                                                                                    Brief Symptom Inventory
collection and outcomes monitoring system for state-funded                                                                           Female                  Male
                                                                                                                                                                                                                       Somatization                                             59.1                         61.3
                                                                                                                                      (n = 86)            (n = 127)
substance abuse treatment providers in the state of Texas. One                                                                                                                                                         Obsessive-Compulsive
                                                                                                                                                                                                                       Interpersonal Sensitivity
                                                                                                                                                                                                                                                                                57.5
                                                                                                                                                                                                                                                                                56.5
                                                                                                                                                                                                                                                                                                             57.9
                                                                                                                                                                                                                                                                                                             56.8
                                                                           Primary Substance Use Diagnoses
component of the COSIG project consists of a voucher program                  Alcohol                                                   21%                  45%        **?
                                                                                                                                                                                                                       Depression
                                                                                                                                                                                                                       Anxiety
                                                                                                                                                                                                                                                                                54.1
                                                                                                                                                                                                                                                                                54.1
                                                                                                                                                                                                                                                                                                             55.4
                                                                                                                                                                                                                                                                                                             54.8
designed to provide ancillary services to COPSD clients to support            Cocaine                                                   33%                  20%                                                       Hostility
                                                                                                                                                                                                                       Phobic Anxiety
                                                                                                                                                                                                                                                                                53.7
                                                                                                                                                                                                                                                                                55.1
                                                                                                                                                                                                                                                                                                             55.8
                                                                                                                                                                                                                                                                                                             58.9           *
                                                                              Opioid                                                    25%                  24%
the treatment and recovery process. Data regarding COSIG voucher              Polysubstance                                              7%                   3%                                                       Paranoid Ideation                                        56.9                         60.1          ***

services received were also available from BHIPS. Continuous
variables were analyzed using between groups t-tests and
                                                                              Other

                                                                           Non-Substance Use Diagnoses
                                                                                                                                        14%                   9%
                                                                                                                                                                                                                       Psychoticism
                                                                                                                                                                                                                       Global Severity Index
                                                                                                                                                                                                                       Positive Symptom Distress Index
                                                                                                                                                                                                                       Postive Symptom Total
                                                                                                                                                                                                                                                                                56.3
                                                                                                                                                                                                                                                                                56.8
                                                                                                                                                                                                                                                                                55.4
                                                                                                                                                                                                                                                                                58.1
                                                                                                                                                                                                                                                                                                             59.4
                                                                                                                                                                                                                                                                                                             58.1
                                                                                                                                                                                                                                                                                                             55.5
                                                                                                                                                                                                                                                                                                             63.9
                                                                                                                                                                                                                                                                                                                           **


                                                                                                                                                                                                                                                                                                                           ‡
                                                                                                                                                                                                                                                                                                                                                Acknowledgements
categorical variables were assessed using X2 analyses.                        Depression                                                41%                  50%                                                    Brief Derogatis Psychiatric
                                                                              Bipolar                                                   42%                  35%                                                    Rating Scale
                                                                              Dysthmia                                                  14%                   9%                                                       Somatization                                              2.2                          2.8                               The authors acknowledge the Texas Department of State Health Services
                                                                              Hypomania                                                  2%                   5%                                                       Obsessive-Compulsive                                      2.3                          2.1                               (TDSHS), Mental Health and Substance Abuse Services Division for their
                                                                              Panic Disorder                                            33%                  24%                                                       Interpersonal Sensitivity                                 3.2                           3
                                                                              Obssessive-Compulsive                                     31%                  28%                                                       Depression                                                3.4                          3.1                               assistance in providing data for this study. We also acknowledge the treatment
                                                                              Posttramatic Stress                                       40%                  23%        ‡                                              Anxiety                                                   3.1                           3                                providers participating in the COSIG project for contributing client data and
                                                                              Generalized Anxiety                                       42%                  46%                                                       Hostility                                                 1.4                          1.7
                                                                                                                                                                                                                                                                                                                                                recognize their continuing efforts to enhance services for clients with co-occurring
 Presented at the Research Society on Alcoholism                              Psychotic                                                  2%                   5%                                                       Phobic Anxiety
                                                                                                                                                                                                                       Paranoid Ideation
                                                                                                                                                                                                                                                                                 2.1
                                                                                                                                                                                                                                                                                 1.5
                                                                                                                                                                                                                                                                                                              2.3
                                                                                                                                                                                                                                                                                                              2.1         †                     disorders.
 Conference, Baltimore, Maryland, June 26, 2006                            ** p=.005, ‡ p=.009
                                                                                                                                                                                                                       Psychoticism
                                                                                                                                                                                                                       Global Severity Index
                                                                                                                                                                                                                                                                                 1.4
                                                                                                                                                                                                                                                                                 4.7
                                                                                                                                                                                                                                                                                                              2.2
                                                                                                                                                                                                                                                                                                              4.8
                                                                                                                                                                                                                                                                                                                          ‡


                                                                                                                                                                                                                    * p=.03, ** p=.02, *** p < .01, † p=.002, ‡ p=.0001
                                                                                                                                                                                                                                                                                                                                                The findings and conclusions of this in this presentation are the opinions of the
                                                                                                                                                                                                                                                                                                                                                authors and do not necessarily reflect the official position of TDSHS.

				
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