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.
Slade and colleagues1 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 (Figure 1). In the US, 10% to 11% of women were using alcohol during pregnancy in 2010.2 In France, findings indicate that on average 15.8% of women use alcohol during pregnancy.3 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.4,5
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.2
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 (Figure 2). 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 exception, however, is the non-medical use of tranquillizers and sedatives.6
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.7,8
Dr Thibaut is Professor of Psychiatry, University Hospital Cochin (site Tarnier), Faculty of Medicine Paris Descartes, INSERM U 894, Centre Psychiatry Neurosciences, Paris, France.
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