Florence Thibaut, MD, PhD

Sex-specific differences in various biological functions as well as in brain neuroanatomy and circuits may result in different prevalence, symptomatology, treatment responses, and outcomes in neuropsychiatric and many other disorders.

 In addition, men and women are not equally exposed to psychosocial stressors such as 

 How many sex/gender differences in health are due to biology or to the consequences of behavioral and sociological factors remains to be sorted out. This article will detail how women’s mental health is in need of improvement, and how the 

 has highlighted a number of preexisting difficulties.

Social Determinants and Clinical Realities

Moving Beyond the Enormity Problem: Tackling the Global Refugee Crisis

Challenges and Opportunities Beyond COVID-19

Exploring the Consequences of the COVID-19 Pandemic

Professor Sir Graham Thornicroft, PhD, MSc

Inspiring Collaboration in Cardiovascular Health

The recent mobilization of cardiologists is a perfect example of how we could advance women’s health, especially mental health. In women, 

 is the leading cause of death, causing 35% of all deaths worldwide. Yet it remains underdiagnosed and undertreated, and women remain underrepresented in clinical trials. Apart from common risk factors that are shared by males and females, sex-specific factors such as premature menopause, gestational diabetes, hypertension during 

, preterm delivery, polycystic ovary syndrome, systemic inflammatory and autoimmune disorders may play a 

. Other important and underrecognized risk factors (abuse and intimate partner violence, socioeconomic deprivation), most frequently observed in women, may also play an additional role.

Risk factors that were observed more traditionally in men have increased in women. For example, historically, women have used tobacco, alcohol, or illicit drugs less often than men, and they have consumed alcohol in lower amounts than men. However, over time, the gradual change in the societal role of women and the lessening of social taboos have led to a rise in both the frequency and level of 

alcohol, tobacco, and illicit drug consumption among women

Women usually start using psychoactive substances, including alcohol, as coping strategies to face depression, anxiety, and negative feelings, whereas men usually are more influenced by peers or sensation seeking. Consequently, the greater exposure of women to negative life events such as trauma and violence is a major contributing factor to the narrowing gap between rates of psychoactive drug use among men and women. Sex hormones and differences in pharmacokinetics and neurobiological circuits may also contribute to differences in susceptibility to dependence.

Moreover, men and women are differentially affected by triggers for relapse to drug taking. Potenza et al

 have studied neural correlates of cue-induced craving states in women and men addicted to cocaine and reported sex differences in cue-induced craving, with corticostriatal-limbic hyperactivity being linked to stress cues in women but to drug cues in men. In addition, women suffer more severe consequences of 

, tobacco, and drug use with lower doses than men; they also suffer from pregnancy complications (for review see Fonseca et al, 2021; Thibaut et al, 2019).

 Finally, women have a higher risk of relapse but achieve better results than men when they adhere to specialized treatment. Gender-oriented treatment is needed to take into account gender-related vulnerabilities.

In partnership with the Icahn School of Medicine at Mount Sinai, the journal 

 has convened a cardiovascular disease commission, including experts from 11 countries.

 The commission proposed 10 recommendations to reduce this global burden by 2030, including educating health care providers and patients on early detection; using heart health programs in highly populated and underdeveloped regions; and prioritizing sex-specific research in women on heart disease and intervention strategies.

 We should be inspired by this interesting collaboration in women’s health and create a similar list of recommendations, focusing on prevention, early detection, and treatment, to reduce the global burden of 

The COVID-19 pandemic highlighted the urgent need for sex-specific clinical and pharmacological studies. The fatality rate with COVID-19 and the severity of the disease were higher in men than in women; for every 10 females, there were 15 confirmed cases in males who have died and 18 male intensive care unit admissions.

 The higher death ratio reported in men may be partly explained by more preexisting cardiovascular or metabolic diseases, as well as higher risk-associated behaviors such as alcohol abuse, 

, and less compliance with sanitation measures.

 Hormonal (eg, estrogens) and genetic differences in the immune response may protect women against infectious diseases, but, at the same time, put them at higher risk of autoimmune disorders and inflammatory diseases.

 Yet the COVID-19 pandemic has affected women more than men, both as frontline workers and at home due to lockdown and quarantine measures.

Worldwide, 70% of the frontline health workforce (nurses, midwives, and community health workers) and facility service staff (cleaners, laundry, catering) is made up of women.

 As a consequence, women were more likely to be exposed to the virus.

 For example, in Italy and Spain, 66% and 72% of infected health workers were females, compared with only 34% and 28% of males, respectively (

 Moreover, the severity of COVID-19 was higher in pregnant women, with a higher risk of intensive care unit admission and 

potential risks for the fetus and/or the baby

. Global Perspective: Sex Differences in Health Care Workers Infected With Coronavirus 2019

In addition, psychological consequences of the COVID-19 pandemic were more often observed in women, both in the general population and in COVID-19 positive patients, compared with prepandemic data.

 The mean rate of depressive disorders for females is approximately twice that of males (1.63-3.89), and anxiety disorders are more common in women than in men, increasing two- to threefold in the occurrence of generalized anxiety disorder and personality disorders.

 These preexisting sex differences were even greater after the pandemic, as females were more affected by the pandemic than males for major depressive disorders (B=0.1 [0.1-0.2; 

<.001]) and for anxiety disorders (B=0.1 [0.1-0.2; 

<.001]), especially in the younger age group.

In the same way, in Japan, Tanaka and Okamoto

 reported that, following a decrease by 14% during the first 5 months of the pandemic (February to June 2020), 

 increased by 16% (between July and October 2020), with a larger increase among females and younger populations, compared to males and older populations.

 (PTSD) was reported in one-third of 381 patients who initially sought treatment at the emergency department in Rome (Italy) for severe SARS-CoV-2. Sex (being a female), delirium or agitation, and persistent medical symptoms were associated with PTSD.

Overall, women were more likely to be affected by the economic and social consequences of the COVID-19 pandemic.

 Additional household tasks, lower salaries, and less secure employments were more likely to occur in women compared to men. Riley et al26 have conducted a cross-sectional study in 2020 among 152 women experiencing homelessness and unstable housing in San Francisco. Half of these women experienced moderate-to-severe depressive and anxiety symptoms during the pandemic; these symptoms were associated with increased challenges accessing non–COVID-19 care and managing symptoms for chronic medical conditions.

Women were also at higher risk of domestic violence during the pandemic, with increases found internationally, which may, in turn, induce or aggravate psychiatric symptoms (

International Increases in Violence Against Women Since the Pandemic

Finally, despite different pharmacokinetic and pharmacodynamic properties of many compounds according to sex, medications have been studied essentially in men, and the data obtained about the clinical efficacy and potential adverse effects have been extrapolated to women. In addition, 

 were often excluded from clinical trials. Furthermore, in several cases, adverse events of medications during pregnancy became apparent only after many reports of toxicity to the fetus and/or the newborn (eg, sodium valproate, lithium).

Yet despite known sex-specific differences, sex/gender effects remain largely under-studied in clinical and pharmaceutical trials. For example, 10 prescription drugs were withdrawn from the US market between 1997 and 2000. Eight of these 10 compounds showed higher health risks for women than for men. In 4 cases, they were prescribed more often to women, while the other 4 had more adverse events in women even though they were widely prescribed to both.

 Moreover, of the 350 cases of anaphylaxis after vaccination in adults, reported to the Vaccine Adverse Event Reporting System in the US between 1990 and 2016, 80% were observed in females, with influenza vaccines being most frequently reported.

In the United States, of the 300 new drug applications received by the FDA (1995-2000), only 163 included sex-based pharmacodynamic analysis, and 11 drugs showed a 40% or greater sex difference in pharmacokinetics. This information was listed on the drug label, yet no differences in dosing between males and females were recommended.

 The European Association of Science Editors reported that sex was not reported for 22% to 60% of animals used in biological and immunological preclinical studies. In a study based on 768 trials, 89% reported recruitment of males and females, but less than 1% reported that they analyzed gender effects.

. Among them, 16% stratified analyses by sex, but no studies reported a calculation powered for the analysis of its primary outcome by sex. In fact, a gender-sensitive perspective is urgently needed.

In 2016, the Cochrane Sex/Gender Methods Group published a paper entitled, “Why sex and gender matter in health research synthesis.”

 Clinical and pharmacological research reflects a mostly male perspective, assimilating women to men despite known biological and pharmacological differences. Participation of women of reproductive age in clinical trials is necessary, provided that there is adequate risk protection 

. In the near future, every pharmaceutical compound should clearly mention whether trials were conducted in women or not, and whether different adverse effects might be expected in women. For this purpose, the US National Institutes of Health, the Canadian Institutes of Health Research, and the European Commission have called for sex/gender analyses in all clinical trials. Heidari et al

 have published a procedure for reporting sex and gender information in study design, analysis, and interpretation of the data.

According to a recent statement from Phumzile Mlambo-Ngcuka, former executive director of United Nations (UN) Women, “This is a moment for governments to recognize both the enormity of the contribution women make and the precarity of so many.”

Women are currently facing a number of important issues: financial crisis is gradually developing in this post–COVID-19 period and, as a consequence, mental health issues are likely to grow exponentially. According to the UN, women aged 24 to 34 years are already 25% more likely than men to face extreme poverty.

 As such, the UN recommends allocating additional resources to protect women, putting women at the center of policy changes, and collecting more sex-disaggregated data to analyze the impact of pandemics on women.

 Moreover, the 17 Sustainable Development Goals proposed by the UN offer a unique opportunity to achieve gender equality before 2030,

 which is a key element in sustaining women’s health.

is professor of psychiatry at the University of Paris and University Hospital Cochin-Tarnier, and president of the International Association of Women's Mental Health.

Sex and racial differences in pharmacological response: where is the evidence? Pharmacogenetics, pharmacokinetics, and pharmacodynamics.

2. Howard LM, Ehrlich AM, Garnlen F, Oram S. 

Gender-neutral mental health research is sex and gender biased.

Sex differences in the developing brain as a source of inherent risk.

4. Vogel B, Acevedo M, Appelman Y, et al. 

The Lancet women and cardiovascular disease Commission: reducing the global burden by 2030.

5. García-Moreno C, Riecher-Rössler A, eds. 

6. Thibaut F. Overview of women and addiction. In: Chandra PS, Herrman H, Fisher J, Riecher-Rössler A, eds. 

Mental Health and Illness Worldwide, Mental Health and Illness of Women

7. Potenza MN, Hong KI, Lacadie CM, et al. 

Neural correlates of stress-induced and cue-induced drug craving: influences of sex and cocaine dependence.

8. Fonseca F, Robles-Martínez M, Tirado-Muñoz J, et al.

 A gender perspective of addictive disorders. (Gender, F Thibaut and J Labad Arias, Section Editors).

9. Thibaut F, Chagraoui A, Buckley L, et al. 

WFSBP * and IAWMH ** Guidelines for the treatment of alcohol use disorders in pregnant women.

10. The Sex, Gender and COVID-19 Project. The COVID-19 sex-disaggragated data tracker. Updated October 27, 2021. Accessed November 3, 2021. 

https://globalhealth5050.org/the-sex-gender-and-covid-19-project/the-data-tracker/

11. Johnson HD, Sholcosky D, Gabello K, et al. 

Sex differences in public restroom handwashing behavior associated with visual behavior prompts.

Inborn errors of type I IFN immunity in patients with life-threatening COVID-19.

14. Bastard P, Rosen LB, Zhang Q, et al. 

Autoantibodies against type I IFNs in patients with life-threatening COVID-19. 

15. Tsiambas E, Chrysovergis A, Papanikolaou V, et al. 

Chromosome X riddle in SARS-CoV-2 (COVID-19) - related lung pathology.

16. United Nations. Policy brief: the impact of COVID-19 on women. April 9, 2020. Accessed November 3, 2021. 

https://www.unwomen.org/-/media/headquarters/attachments/sections/library/publications/2020/policy-brief-the-impact-of-covid-19-on-women-en.pdf?la=en&vs=1406

17. Boniol M, McIsaac M, Xu L, et al. Gender equity in the health workforce: analysis of 104 countries. World Health Organization. March 2019. Accessed November 3, 2021. 

https://apps.who.int/iris/bitstream/handle/10665/311314/WHO-HIS-HWF-Gender-WP1-2019.1-eng.pdf

18. Capobianco G, Saderi L, Aliberti S, et al. 

COVID-19 in pregnant women: a systematic review and meta-analysis. 

19. Della Gatta AN, Rizzo R, Pilu G, Simonazzi G. 

Coronavirus disease 2019 during pregnancy: a systematic review of reported cases.

20. Vivanti AJ, Vauloup-Fellous C, Prevot S, et al. 

Transplacental transmission of SARS-CoV-2 infection.

21. COVID-19 Mental Disorders Collaborators. 

Global prevalence and burden of depressive and anxiety disorders in 204 countries and territories in 2020 due to the COVID-19 pandemic.

Uncovering the hidden impacts of inequality on mental health: a global study.

23. Jalnapurkar I, Allen M, Pigott AT. Sex differences in anxiety disorders: a review. 

Increase in suicide following an initial decline during the COVID-19 pandemic in Japan.

25. Janiri D, Carfi A, Kotzalidis GD, et al. 

Posttraumatic stress disorder in patients after severe COVID-19 infection. 

26. Riley ED, Dilworth SE, Satre DD, et al. 

Factors associated with symptoms of depression and anxiety among women experiencing homelessness and unstable housing during the COVID-19 pandemic.

27. UN Women. COVID-19 and ending violence against women and girls. April 6, 2020. Accessed November 3, 2021. 

https://www.unwomen.org/-/media/headquarters/attachments/sections/library/publications/2020/issue-brief-covid-19-and-ending-violence-against-women-and-girls-en.pdf?la=en&vs=5006

28. United States Government Accountability Office. Drug safety: most drugs withdrawn in recent years had greater health risks for women. January 19, 2001. Accessed November 3, 2021. 

https://www.gao.gov/assets/gao-01-286r.pdf

Anaphylaxis after vaccination reported to the Vaccine Adverse Event Reporting System, 1990-2016.

30. Schiebinger L, Leopold SS, Miller VM. 

Editorial policies for sex and gender analysis.

31. Sex/Gender Methods Group. Why sex and gender matter in health research synthesis. Cochrane Methods Equity. 2016. Accessed November 3, 2021. 

https://methods.cochrane.org/equity/sex-and-gender-analysis

32. Heidari S, Babor TF, De Castro P, et al.

 Sex and gender equity in research: rationale for the SAGER guidelines and recommended use.

33. UN Women. Turning promises into action: gender equality in the 2030 Agenda for Sustainable Development. February 14, 2018. Accessed November 3, 2021. 

http://www.unwomen.org/-/media/headquarters/attachments/sections/library/publications/2018/sdg-report-summary-gender-equality-in-the-2030-agenda-for-sustainable-development-2018-en.pdf?la=en&vs=949

Articles

Women are currently facing a number of important issues in mental health. How can clinicians improve this situation? 

Issues in Women’s Health: Global Lessons, Opportunities, and Challenges

Dependence on or harmful use of alcohol and tobacco or illicit drugs is generally higher in men. Epidemiological studies, however, indicate an alarming narrowing in this gender gap especially in adolescents, which may reflect changes in sociocultural patterns rather than biology. Yet, health consequences significantly differ according to gender. In addition, women’s consumption of psychoactive substances during pregnancy may be associated with serious birth and developmental consequences in newborns.

The World Health Organization has defined different risks for occasional and chronic alcohol use in women, which are significantly lower in women: low risk (<20 g/d); moderate risk (>20-40 g/d); high risk (>40 g/d). There is no safe level for tobacco or illicit drug use.

 stratified 68 studies by 5-year birth cohorts from 1891 to 2001. In cohorts born in the early 1900s, males were 3.0 times more likely to drink alcohol (problematic use) and 3.6 times more likely to experience alcohol-related harm. In contrast, among cohorts born in the late 1900s, males were 1.2 times more likely to drink alcohol (problematic use) and 1.3 times more likely to experience alcohol-related harm.

Worldwide, the total alcohol per capita consumption in 2010 was on average 21.2 L and 8.9 L of pure alcohol in male and female drinkers respectively. Europeans and Americans had the highest prevalence of female current drinkers and heavy episodic drinkers-defined as drinking at least 60 g or more of pure alcohol on at least one occasion in the past 30 days (

 were using alcohol during pregnancy in 2010.

 In France, findings indicate that on average 15.8% of women use alcohol during pregnancy.

 The prevalence of reported binge drinking (defined as four or more standard drinks on one occasion) was 3.1% in pregnant women compared with 18.2% in women of childbearing age. Higher rates of substance and alcohol abuse were found among minorities and adolescent LGBT populations.

The highest prevalence of tobacco use was reported in Europe (19.3% of women) followed by the Americas (13.5% of women, 17.5% of men in the US). The prevalence of tobacco use (cigarettes) was very similar among boys and girls in Europe and even higher in girls in the Americas. In the US, 14.9% of pregnant women reported tobacco use in the past month.

The worldwide prevalence of cannabis, amphetamine, cocaine, and opioid use was 0.14%, 0.18%, 0.06%, and 0.14%, respectively in females compared with 0.23, 0.31, 0.14 and 0.31% in males (

). In the US, 12.8% of males and 7.3% of females aged 12 years and older used an illicit drug during the past month in 2015. More men than women aged 12 and up reported using marijuana (10.9% vs 6%), cocaine (0.8% vs 0.4%), and hallucinogens (0.6% vs 0.3%). A notable 

, however, is the non-medical use of tranquillizers and sedatives.

Considering behavioral addictions, the prevalence of food binging (especially chocolate) was higher in women. For sexual addiction, gambling, or internet addiction the prevalence was generally higher in men. For exercise, the results were mixed.

There are important gender differences in terms of pharmacokinetics and pharmacodynamics. The small number of studies on gender differences in addictions is surprising when considering the modulatory role of estradiol in decision making and its interplay with dopamine in modulating reward, motivation, and cognitive processes. Using the same amount of alcohol as men, women usually have greater alcohol blood concentrations, which increases the risk for health problems. Morphine has both a slower onset and offset at Î¼-opioid receptors in women, thus women usually require higher dosages of morphine.

 (especially in those who are using oral contraceptives at the same time).

 In addition, heavy drinking puts women at risk of injuries and death from accidents, as well as unsafe sex, sexual assaults, and violence.

Worldwide, alcohol-attributable mortality is higher in men. Cardiovascular diseases are the most important cause of alcohol-attributable mortality in women. In men, injuries are the most common cause of alcohol-attributable mortality. Health consequences are more frequent in males, which reflects sex differences in the prevalence of alcohol use disoders (AUDs), except for a higher percentage of disability-adjusted life years (DALYs) for cancers and cardiovascular diseases in women.

 The risk of breast cancer increases according to the daily dose of alcohol used with a relative risk (RR) of 5 to 9 with one standard drink daily and of 41 with three to six standard drinks daily.

The protective effect of alcohol at low dose is less clear in women than in men, in whom a clear decrease in RR of ischemic heart disease is observed at doses lower than two to three standard drinks daily. Similarly, the RR of liver cirrhosis increases by 13 with four standard drinks of alcohol in women compared with six standard drinks daily for men.

The worldwide proportion of all deaths attributable to tobacco is 12% among adults aged 30 years and older. Cigarette smoking is the leading cause of preventable disease and death in the US, accounting for more than 1 in 5 deaths. Jemal and colleagues

 found a decrease of annual age-adjusted death rates from almost all cancers among women (including breast cancer) except for lung and bronchus cancer, which has dramatically increased since the 1930s. These findings were confirmed by 

 in a cohort of 1.2 million women followed for 12 years in the United Kingdom with an RR of 21 for lung cancer in women who smoked.

The total burden (DALYs) of drug dependence remained about half in women, the highest number was seen with opioids.

Despite the international consensus recommending total abstinence of psychoactive drug use during pregnancy, prenatal alcohol, tobacco, or illicit drug exposure remains a major public health issue. In particular, alcohol consumption during pregnancy is associated with a large range of adverse effects including spontaneous abortion, stillbirth, weight and growth deficiencies, birth defects, prematurity and fetal alcohol spectrum disorder.

Based on data obtained in seven countries (Australia, Canada, Croatia, France, Italy, South Korea, and the US) on the prevalence of both alcohol use during pregnancy and resulting fetal alcohol syndrome (FAS), 

estimated that 1 in every 67 mothers who consumed alcohol during pregnancy had a child with FAS. Prematurity and low birth weight are also frequently associated with tobacco exposure during pregnancy (smoking or second-hand smoke). The World Federation of Societies of Biological Psychiatry and the International Association for Women’s Mental Health have recently published guidelines for the treatment of alcohol use disorders in pregnant women.

In general, women with addictive behaviors exhibit higher comorbid neuropsychiatric disorders than men (eg, anxiety, depression, stress-related disorders) which are, in turn, more likely to trigger craving and relapse in women. Women are also more likely to have a lower socioeconomic status (eg, lack of education, lower job status, worse financial situation, violent partners, history of sexual violence).

Weight control also plays an important role in women who use tobacco. Women may be using alcohol or tobacco to better fit the societal norm.

Other factors underlying sex differences in tobacco use were identified in several studies: pleasure/rewarding, compulsion, and gesture are important in both men and women. In contrast, transgression as well as psychostimulant effects of tobacco might play a greater role in women who smoke. In women, restrictions, lack of availability of a drug on the legal market, or the price 

Men and women are also differentially affected by environmental triggers for relapse to drug taking. Potenza and colleagues

 reported sex differences in neural correlates of cocaine-induced craving. Corticostriatal-limbic hyperactivity was linked to stress cues in women but to drug cues in men. In the same way, women are also less sensitive to the reinforcing effects of nicotine but more sensitive to social cues.

Women are more likely than men to encounter barriers that prevent them from seeking or continuing treatment (eg, economic barriers, family responsibilities, comorbid psychiatric disorders, feeling shame). Worldwide, female outpatients are still underrepresented in specialized treatment settings. Often, women seek substance abuse treatment in primary care and mental health settings. In the US, many women now appear at least as likely as men to engage in and complete treatment. Nevertheless, African American women as well as women with lower incomes or who have psychological problems or greater severity of addictive disorders are less likely to continue with treatment. Yet, addiction treatment is at least as effective in women as in men.

Despite a higher prevalence of substance use observed in men, women begin using drugs at younger ages. They develop addiction more quickly with a stronger motivation to take drugs and have different propensities to relapse. Despite this, female outpatients are still underrepresented in specialized treatment settings. Training care providers in primary care and mental health settings may help to identify and refer women to specialty addiction services. Providing services such as child care, also helps keep women in treatment. Finally, raising public awareness about the risks of alcohol, tobacco, and illicit drug use during pregnancy is crucial, especially in all women of childbearing age.

The National Center on Substance Abuse and Child Welfare

WHO Guidelines for Identification and Management of Substance Use and Substance Use Disorders in Pregnancy

Women and Smoking: A Report of the Surgeon General

National Institute on Alcohol Abuse and Alcoholism. Gender and Use of Substance Abuse Treatment Services

Dr Thibaut is Professor of Psychiatry, University Hospital Cochin (site Tarnier), Faculty of Medicine Paris Descartes, INSERM U 894, Centre Psychiatry Neurosciences, Paris, France.

Birth cohort trends in the global epidemiology of alcohol use and alcohol-related harms in men and women: systematic review and metaregression

 Oh S, Reingle Gonzalez JM, Salas-Wright CP, et al. 

Prevalence and correlates of alcohol and tobacco use among pregnant women in the United States: evidence from the NSDUH 2005-2014

 MÃ¥rdby AC, Lupattelli A, Hensing G, Nordeng H. Consumption of alcohol during pregnancy: a multinational European study. 

 Marshal MP, Friedman MS, Stall R, et al. Sexual orientation and adolescent substance use: a meta-analysis and methodological review. 

 Reisner SL, Poteat T, Keatley J, et al. Global health burden and needs of transgender populations: a review. 

 Results from the 2014 National Survey on Drug Use and Health. 2014. 

 Fattore L, Melis M. Sex differences in impulsive and compulsive behaviors: a focus on drug addiction. 

 MacLaren VV, Best LA. Multiple addictive behaviors in young adults: student norms for the Shorter PROMIS Questionnaire. 

 Sarton E, Olofsen E, Romberg R, et al. Sex differences in morphine analgesia: an experimental study in healthy volunteers. 

 Allen AM, Weinberger AH, Wetherill RR, et al. 

Oral contraceptives and cigarette smoking: a review of the literature and future directions

. November 18, 2017; Epub ahead of print.

 Rehm J, Shield KD, Roerecke M, Gmel G. Modelling the impact of alcohol consumption on cardiovascular disease mortality for comparative risk assessments: an overview. 

 SchÃ¼tze M, Boeing H, Pischon T, et al. Alcohol attributable burden of incidence of cancer in eight European countries based on results from prospective cohort study. 

 Jemal A, Thun MJ, Ries LA, et al. Annual report to the nation on the status of cancer, 1975-2005, featuring trends in lung cancer, tobacco use, and tobacco control. 

 Pirie K, Peto R, Reeves GK, et al; Million Women Study Collaborators. 

The 21st century hazards of smoking and benefits of stopping: a prospective study of one million women in the UK

 Degenhardt L, Whiteford HA, Ferrari AJ, et al. Global burden of disease attributable to illicit drug use and dependence: findings from the Global Burden of Disease Study 2010. 

Estimation of national, regional, and global prevalence of alcohol use during pregnancy and fetal alcohol syndrome: a systematic review and meta-analysis

 Thibaut F, Chagraoui A, Buckley L, et al. World Federation of Societies of Biological Psychiatry and International Association for Women’s Mental Health Guidelines for the treatment of alcohol use disorders in pregnant women. 

 Thibaut F. Women and addiction. In: Chandra PS, Herrman H, Fisher J, Riecher-RÃ¶ssler A, Eds. Mental Health of Women and Girls. New York: Springer; 2018: In press.

 Potenza MN, Hong KI, Lacadie CM, et al. 

Neural correlates of stress-induced and cue-induced drug craving: influences of sex and cocaine dependence

Dependence on alcohol and tobacco or illicit drugs is generally higher in men, but the gender gap is narrowing at an alarming rate, especially in adolescents.

Florence Thibaut, MD, PhD

Articles

Issues in Women’s Health: Global Lessons, Opportunities, and Challenges

Gender Differences in Addiction: Clinical Implications