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By using our site, you agree to our collection of information through the use of cookies. To learn more, view our Privacy Policy. To browse Academia. Objective: Gender features play a fundamental role as risk factors in drug addiction, entailing differences in vulnerability, onset, drug use and clinical trajectories. Even if increasing empirical evidence has attested that drug abuse in emerging adulthood is associated with cognitive impairments, personality disorders and psychological distress, limited research has analyzed these aspects from a gender perspective. The present research focuses on gender differences in youths 18—24 years of age diagnosed with substance use disorders SUDs , in order to detect possible differences between females and males as regards their neuropsychological functioning, clinical profiles and past life experiences. Participants were recruited in a therapeutic community in Venice, Italy. Results: Girls showed less cognitive impairment but higher psychological distress with respect to boys; between the two groups, no differences emerged regarding the personality profiles. The girls' life histories presented more experiences of abuse and maltreatment; they also moved more quickly from substance use to dependence. Boys, instead, were more involved in criminal activity. Conclusions: Given our results, it seems that gender differences manifest early, at emerging adulthood. Consequently, a gender-oriented treatment for drug addiction should be offered even at an early age, focusing on early adverse experiences and their potential traumatic effect on girls. By contrast, young men seem to rely on compromised cognitive functions, which require a specific treatment approach, since they constitute a crucial factor for individual adjustment and treatment outcomes. Results should be interpreted relative to some limitations such as the small sample size and the preliminary and cross-sectional nature of the research , and future studies are required. Adriana Sanudo. Jill Becker. Fortune Journals. Ken Winters. Dhanasekara Pandian. This paper aim to emphasize on the increase in the number of substance abuse among women along with a highlight on the need to understand gender differences in substance use disorders and necessitate having gender specific treatment which address the specific needs of women with substance use problems. With this aim, this article has put an effort to give more insight into gender differences in substance use disorders by elaborating on bio-psycho-social differences. This article also help the mental health professionals to acknowledge the need to have a specific intervention programme which address the issues, needs, strengths and challenges of women with substance use disorder. Jorge Morales Pedraza. China is one of the countries that is systematically increasing its energy demand, and for this reason, it will need, over the next years, the construction of new power generation plants in order to be able to satisfy, in the highest possible percentage, the expected increase in electricity demand. However, for many experts, the boom in Chinese energy demand is a thing of the past. While energy demand previously grew in parallel with the economy, this relationship will weaken in the future, with energy demand growing well below economic growth. One of the reasons that explain this situation is that China is the country with the greatest pressure to achieve high energy efficiency; another is that the country is transforming its economy from one based on heavy industry and the use of fossil fuels for electricity generation to one based on the service sector and the use of renewables for the production of electricity. According to the Energy Institute of Statistical Review of World Energy report, most of the electricity in mainland China is produced from the consumption of fossil fuels 5, The electricity generated by renewables in reached 1, TWh, representing Engenharia Devry. Nahuel Parra. Bob Jessop. Peera Charoenvattananukul. Karan Shelke Patil. Construir, habitar: a casa medieval. Elizabeth G. Lorenzo Tomasin. Claus Feveile. Lyubov A Naydonova. Aggeliki Kotzamani. Dr Kiros Weldegerima. Juan Carlos Correa. Ahmad Raeisi Najafi. Juan Ricardo Serur. Sjoerd van Hoorn. Ching-chang Lee. Monica Lavagna. Proceedings of the two day international conference organised by the Institution of Civil Engineers and held in Beijing on 17—18 September Log in with Facebook Log in with Google. Remember me on this computer. Enter the email address you signed up with and we'll email you a reset link. Need an account? Click here to sign up. Download Free PDF. Related Papers. Revista Brasileira de Psiquiatria Differences in the pattern of drug use between male and female adolescents in treatment. Journal of Neuroscience Research Sex differences, gender and addiction. Difference between men and women in drug use disorders. Fisiologia Humana. European Planning Studies Neoliberalization, uneven development, and Brexit: further reflections on the organic crisis of the British state and society. Alessandra Simonelli, Micol Parolin, Daniela Mapelli, Patrizia Cristofalo, Silvia Cimino, Luca Cerniglia Abstract Objective: Gender features play a fundamental role as risk factors in drug addiction, entailing differences in vulnerability, onset, drug use and clinical trajectories. The present research focuses on gender differences in youths 18—24 years of age diagnosed with substance use disorders SUDs , in order to detect possible differences between females and males as regards their neuropsychological functioning, clinical proiles and past life experiences. Results: Girls showed less cognitive impairment but higher psychological distress with respect to boys; between the two groups, no differences emerged regarding the personality proiles. By contrast, young men seem to rely on compromised cognitive functions, which require a speciic treatment approach, since they constitute a crucial factor for individual adjustment and treatment outcomes. This is true both for the use of drugs such as cocaine, cannabis and heroin and for the abuse of new synthetic nonprescribed psychoactive drugs, which girls may use for their anorectic effect Cranford et al. Several studies have shown that drug abuse has a neurotoxic effect on brain circuitries, leading to structural and functional modiications, particularly in the dopaminergic mesolimbic system of reward Cadet et al. A cascade of neuroadaptations has also been demonstrated Robison and Nestler These structural and functional changes are consequent to continued substance abuse and mediate severe neuropsychological deicits, even in adolescence. It must be said that this altered functioning could be, at the same time, a cause and an effect of drug abuse and addiction Keshavan et al. On one hand, the malfunctioning of speciic cortical regions may foster risky behaviors, impulsivity, a misperception of possible damage and emotional dysregulation, eventually resulting in drug use; on the other hand, this maladaptive functioning could be directly facilitated by the chemical action of the substance, altering both functionally and structurally the above brain regions Wetherill and Tapert Even if the prevalence of drug abuse in adolescence is currently similar among males and females, gender seems to have an effect on the severity and typology of the negative effects drugs have on boys and girls, also impacting the effectiveness of treatment plans Becker and Curry , Fox and Sinha Studies addressing gender-speciic differences in neurocognitive abilities resulting from severe drug exposure are still scarce and have reached mixed results. For instance, Lisdahl and Price have found better outcomes in females, whereas Shrestha and colleagues have demonstrated worse consequences in girls. Drug addiction in adolescence It has been proven that due to a period of speciic vulnerability, the pervasiveness of SUD disorders in adolescence and young adulthood is higher than in other developmental phases, and it is associated with a number of comorbid conditions and impaired psychological functioning Chambers and Potenza From a psychological standpoint, this vulnerability has been connected with the speciic developmental tasks that youths must face, encompassing the onset of puberty resulting in signiicant physical changes and the substantial interpersonal and psychosocial transitions Blos while shifting from a parent- to a peerreferenced functioning. More recently, this view has been integrated by neuroimaging research that has suggested that this phenomenon could be linked to the general immaturity of the cerebral cortex and to an imbalance between the maturation of different regions, leading to affective dysregulation Ismail et al. Gender-speciic differences The studies in this ield have also veriied genderspeciic differences in the development and functioning of brain structures, paths and rhythms of maturation, 2 myelinization and pruning of cerebral circuits in adolescence and young adulthood Gogtay et al. For instance, frontal lobes reach their peak of grey matter at 12 years of age in males and at 11 in females, whereas in parietal lobes, grey matter is highly present at 12 years of age in boys and at 10 in girls. Other regions are not affected by gender in their maturation e. Developmental changes occur in the structure of the social brain in late childhood and adolescence. It is unclear how and if these nonhomogeneities have an effect on the possible onset of psychopathologies or on SUDs in particular. Nevertheless, it has been demonstrated that gender affects SUD vulnerability rates Lezak et al. An important issue related to the gender-based rhythms of maturation of brain regions is that the early development of the prefrontal cortex in females responsible for high cognitive functions may protect girls to a certain extent from severe negative impairments in cognition. This positive effect could be due to drug abuse and generally has its onset in late adolescence usually from 14 years of age , when the prefrontal cortex in females has reached a greater maturation compared to that of their male peers. Thus, girls could show higher impairment in emotion regulation. If, instead, drug use is initiated in pre-, early or mid-adolescence, it is possible that males will be more vulnerable to neurobehavioral and cognitive disturbances Lisdahl and Price , Price et al. Of course, the path to psychopathology is much more complex than a direct link between the neurobiological substratum and psychiatric disorders. Thus, the etiopathogenetic model of developmental psychopathology has considered the role of the environment and of early primary relationships Lenroot and Giedd , Alvarez and Emory In fact, it has been demonstrated that offspring of substanceabuser parents face a two-fold risk for developing SUDs themselves, given the well-established intergenerational nature of the disorder EMCDDA Traumatic experiences in the irst years of life have also been associated with alcohol or drug abuse in later life Craparo et al. As a whole, girls seem to have some robust protective factors against the onset of SUDs, as they show higher levels of education, less criminal activity and earlier contact with SUD treatment, compared with boys, but also manifest more social problems e. Psychological and psychopathological functioning in drug-addicted adolescents Very few studies have addressed the personality traits of young adult patients suffering from substance use disorders and co-occurring personality disorders, and even less attention has been given to the topic in adolescent drug users. Does being a girl make a difference? Table 1. As for emotional-behavioral functioning, SUDs at a young age are associated with high symptoms of anxiety and depression Fergusson et al. These symptomatic manifestations are more evident in girls than in boys Greenield et al. Objectives The present study focuses on gender differences in emerging adults diagnosed with severe substance use disorders to the extent of being referred to residential treatment; speciically, participants were currently in treatment in a therapeutic community in Venice, Italy. In particular, the study intends to provide some results on neuropsychological functioning and clinical proiles in this population, in terms of personality disorders and the severity of symptomatology. Finally, it aims to investigate the role of past life experiences, speciically in childhood and adolescence, on the cognitive and clinical functioning of these subjects. In order to explore these issues, a group of young women with SUDs was compared to a group of men of a similar age, also diagnosed with SUDs. Based on previous literature, we expect that drug addicted young women, with respect to young men, might show a better cognitive proile and a higher severity of symptomatology. We also postulate a different distribution between boys and girls regarding the personality proile and the presence of personality disorders. Finally, it can be hypothesized that girls experienced more adverse life events in their developmental age. The following inclusion criteria were adopted: a meeting DSM-IV-TR APA criteria for substance use disorder; b having spent less than three months in the treatment facility and c age ranging from 18 to 24 years. The administration of the assessment protocol was part of the standard procedure applied upon admission to the therapeutic community; thus, all inpatients who met the inclusion criteria participated in the study, and none refused to take part in it. The assessment took place, on average, 1. At the time of recruitment, participants had been abstinent from drugs for, on average, 3. None of them presented other relevant medical conditions. Two different groups of 20 female and 20 male inpatients were obtained. This study does not require ethics committee approval, because it was carried out according to a noninterventional protocol. All patients gave their informed consent to the anonymous use of their clinical data for this independent study. The onset of drug-related problems occurred during early adolescence for both girls and boys, on average at 13—14 years of age. The irst contact with SUD treatment services occurred between ages 17 and As regards adverse experiences in the developmental age, Instruments Sociodemographic data. The collection of sociodemographic data occurred according the standard protocol adopted by the therapeutic community at admission, using an ad hoc interview format. This is a comprehensive neuropsychological battery ideated and standardized for the Italian population. It includes 16 subtests Digit span, Immediate and Delayed recall prose memory, Interference memory at 10 and 30 seconds, a Trial making test parts A and B, Token test, Word phonemic luency test, Abstract reasoning test, Cognitive estimation test, Test of overlapping igures, Spontaneous drawing, Copy drawing, Clock drawing, and Ideative and ideomotor praxis test. The ENB-2 allows the investigation of several cognitive domains: attention, executive functioning, perception, praxis abilities and comprehension. The battery provides both an assessment of the single cognitive tasks and a total score global cognitive index indicating the overall cognitive proile. Age 15—20, 21—30 years and education lower than 9 years and higher are the two criteria used to identify subgroups of individuals and their respective normative scores. The ifth percentile was used to determine cut-off scores for each subgroup; according to the cut-off score, the performance is classiied into three categories: below average impaired , at the limit and average normative. The battery shows good psychometric characteristics, revealing good differential validity in discriminating normative and clinical groups and suficient test-retest reliability range from 0. It is based on the Q-Sort method, with a ixed score distribution, and it requires the clinician to sort the items into eight categories based on their applicability to the patient, from 7 highly descriptive to 0 not descriptive. In sum, the SWAP provides both categorical and dimensional diagnoses. The reliability of SWAP personality descriptions ranges from 0. This is a self-report measure assessing 90 clinical symptoms on a 5-point Likert scale, ranging from 0 not at all to 4 extremely. The symptoms are factored into nine psychiatric dimensions depression, anxiety, somatization, obsessive-compulsive behavior, interpersonal sensitivity, hostility, phobic anxiety, psychoticism and paranoid ideation , plus altered appetite and disturbed sleep. The psychometric properties of the original version of the checklist show acceptable levels of internal consistency ranging from 0. However, despite the extensive and widespread application of the instrument, some studies have questioned its factorial invariance across different samples Cyr et al. Results Neuropsychological performances in young women and men To fulill our irst aim, the sociodemographical variables capable of inluencing performance on the neuropsychological battery Mondini et al. Table 2 illustrates the descriptive results of the ENB2 performance in the two groups. Interesting differences between genders can also be detected in those tasks tapping into the domain of executive functions, even though the results did not reach statistical signiicance. Male-female differences in the executive domain can be detected in the Abstract Reasoning test, Phonemic luency test, Clock drawing test and the Overlapping igures test; on all these tests, a higher percentage of boys than girls had an altered performance. Table 2. In sum, girls showed signiicantly better cognitive abilities in terms of global proile than boys did, and this result was statistically signiicant; from a descriptive point of view, females had a better performance on tests involving visuospatial skills and executive function, although it was not statistically signiicant. However, young patients with SUDs from both groups showed high rates of impairment on two tests assessing executive function, delineating a cognitive domain of particular concern. Clinical proiles: personality and symptoms in the two groups In regard to the second aim of the study, investigating sex differences in personality functioning and symptomatology, we performed nonparametric statistics to compare males and females. Descriptive data on the SWAP procedure indicated that personality disorders PDs were frequent among young inpatients of both groups. Cluster A disorders were identiied for Histrionic personality disorder was the most common primary diagnosis in boys When both subclinical and clinical traits were taken into account, the histrionic proile remained the most reported, but borderline and dependent features emerged more clearly while the presence of antisocial characteristics was reduced. As regards females, the most frequent diagnoses were histrionic The same abovementioned personality styles were the most reported among girls when both traits and disorders were considered. In sum, according to the DSM categorization, personality disorders were frequently diagnosed in both males and females; Cluster B disorders were the most common, especially the histrionic disorder, irrespective of gender. The primary diagnosis was dependent personality for both young men Histrionic Table 3. Thus, both groups showed high rates of dependent personality functioning, but they differed from each other, since boys presented higher rates of antisocial subclinical and clinical features, while girls presented more histrionic subclinical and clinical traits. Taken together, the results indicated that high rates of young adults with SUDs, of both genders, were diagnosed with at least one personality disorder; boys and girls could not be distinguished by the presence of speciic characteristics regarding the personality functioning. According to DSM classiication, Cluster B disorders were diagnosed most frequently in both groups, especially histrionic and borderline proiles. With regard to the SWAP classiication, dependent personality disorder was the most common diagnosis in both groups, which slightly differed from each other in terms of antisocial functioning in boys and histrionic features in girls. The majority of subjects in both groups reached the clinical range in the two other global indices, the Positive Symptom Total index indicating the number of symptoms complained of and the Positive Symptom Distress index reporting the overall intensity of distress. Comparing the two groups from a descriptive point of view, young female inpatients seemed to reach higher scores in all dimensions scales and global indices of the questionnaire. Statistically signiicant results were detected for some of them, attesting higher psychological distress in girls than in boys. Adverse past experiences Comparing females and males on adverse past experiences, a signiicant difference emerged regarding the time between the irst experiences with drugs and the onset of drug dependence: 2. The two groups were considered separately according to the purpose of identifying potential clusters or proiles that characterized young female and male inpatients. As illustrated in table 5, an inverse association was detected between cognitive abilities and criminal activity in boys; in this group, higher psychological distress also positively correlated with higher scores on the borderline, dependent and dysregulated personality proiles. These latter results resemble those detected in the female group; girls showed a similar positive association between psychological symptoms and borderline, dependent and dysregulated personality characteristics. Discussion The present study aimed to contribute to previous literature on gender differences in substance use disorders, focusing on a speciic group of individuals: patients admitted to residential treatment given the severity of their drug use disorder and aged i. The investigation focused on clinical aspects that are considered highly relevant in terms of treatment outcome and individual adjustment, namely neuropsychological functioning, which plays an important role in individual adjustment and emotional competences Blair and Ursache , McClelland et al. Our irst aim was to investigate sex differences in neuropsychological functioning. Previous research reports gender-based rhythms of prefrontal brain maturation, sex differences among healthy subjects and a possible higher vulnerability to neurobehavioral and cognitive impairments related to drug abuse in boys Crane et al. Based on this data, we postulated that females would score better on neuropsychological tests, and the results conirmed this hypothesis. No statistically signiicant data were obtained for the single tasks included in the assessment battery; thus, the present study could not identify sex differences in speciic neuropsychological domains but rather, only such differences in the broader cognitive proile. From a descriptive point of view, young men performed worse in the domains of visual perception and executive function; girls, instead, scored lower in two tests assessing memory abilities. It is important to acknowledge that currently available results are still scarce and partly inconsistent, with studies reporting in contrast more executive impairments in adolescent girls Medina et al. In respect to the second aim of the study, we expected that women would be more likely to receive a diagnosis of paranoid, borderline, histrionic personality disorders Trull et al. But contrary to expectations, young males and females diagnosed with SUDs could not be distinguished in terms of personality proiles and disorders, according to either DSM or SWAP classiications. Cluster B disorders, in particular histrionic PD, were the most frequent primary diagnoses; however, adopting a dimensional approach, borderline and dependent features were also quite common. Overall, the results depicted a clinical condition of high concern in young adults admitted to inpatient treatment for SUDs, regardless of gender. The high rates of PDs, especially Cluster B disorders, are consistent with the available research speciically targeting this clinical population in this developmental stage Kokkevi et al. Moreover, they reported experiencing psychological distress of higher intensity PTDS than males, as previously attested by other research Fergusson et al. Past life experiences seemed to differentiate the two groups, and the results reached statistical signiicance; girls were more likely to have been exposed to abuse and maltreatment during their developmental age, while males had been more involved in criminal activity. Studies have consistently shown that being a victim of physical or sexual abuse increases the risk of using drugs in adolescence by two to four times Whitesell et al. Past traumatic experiences, such as abuse and maltreatment, are part of a broader constellation of risk factors that characterize women who develop SUDs, including low employment and dysfunctional romantic and family relationships Du et al. These factors tend to exceed the protective contribution offered by potential positive characteristics such as lower criminal activity and higher education Du et al. Girls also moved more quickly from substance use to dependence; other research on gender differences in drug addiction Clinical Neuropsychiatry recognizes strong distinctions with regard to the development of SUDs. Speciically, the period between drug experimentation and the onset of a disorder is more restricted for girls than for boys Palmer et al. This result can also be interpreted in light of a developmental pathway that associates early externalizing problems in childhood, namely oppositional deiant and conduct disorders, with later antisocial behavior and drug use in adolescence and adulthood Elkins et al. As regards girls, research demonstrated that their having experienced early traumatic events often of an interpersonal nature is capable of compromising optimal cognitive development Bennett et al. The inverse association between criminal activity and cognitive abilities in male inpatients is in line with a review study indicating that clinically signiicant frontal lobe dysfunction is associated with aggressive dyscontrol Brower and Price Overall, our study contributes to the literature indicating that sex differences in drug-addicted individuals can be detected as early as adolescence and emerging adulthood and not only in older age. According to the present results, gender differences encompass cognitive proiles, symptomatological distress and adverse past experiences. Consequently, some implications for treatment can be hypothesized. In fact, gender differences do not merely compromise SUD development and the clinical condition Palmer et al. The present results point out that a gender-oriented approach might represent a valuable option, due to the earlier stages of SUD development and the earlier phases of intervention, including early assessment. Second, intervention programs should be ideated and implemented taking into account the speciic constellation of risk factors that characterize young women and young men. Complex trauma mediates the association between early adverse experiences and drug problems in young people aged 16—24 Rosenkranz et al. However, despite the acknowledged need for trauma-focused work Brown et al. Our study may contribute to the topic of gender differences in drug addiction, constituting an original work with respect to the previous literature on this theme. A primary aspect relates to the speciicity of the clinical group, indicating that sex differences in drug-addicted individuals can be detected as early as emerging adulthood and may also affect the domain of neuropsychological functioning. The assessment instruments included in the study are also largely validated and widely used. Finally, some useful considerations can be drawn from the present results in terms of clinical implications, offering indicators for the ideation and implementation of tailored treatment protocols. Besides some strengths, this study has some limitations, the irst being the small size of its samples. However, as reported by Streiner , the sample size does not always represent an obstacle in psychiatric research. Second, the study addresses a very speciic group of individuals with SUDs, in terms of age and the severity of the disorder i. The preliminary and cross-sectional nature of the study constitutes other limits of the research; thus, we cautiously proposed an interpretation of our results, recognizing the limitedness of the study. Replication of the present data is necessary in order to increase conidence in the results and to better guide the clinical implications that the study has preliminarily indicated. 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The vase is decorated with a contour chinoiserie consisting of three Chinese and a boy who walks to a temple surrounded by rocks and trees. The lid is decorated with rocks, flowers and a bird. The vase is marked. Close up of white and grey stones. A pile of big grey rocks in a close up. Some of the rocks have some green moss growing from them. Photographed during a sunny summer day in Finland. Gravel elevator against a blue sky with purple clouds at a commercial harbor. Cobblestones are laid on road. Road repair in city. Gray bricks for repair. New sidewalk. Saucer with eight geese, Saucer with lobed edge, painted on the glaze in blue, red, green, black and gold. On the front of the dish eight geese at rocks, grazing or flying. Porcelain with enamel colors. Top view of some stones on a beach. Perfect for wallpaper. A Broyt tracked loader loads up a Kubota rock dumper truck in a quarry in heavy rain. Pavement are laid on road. A reef is a ridge of material at or near the surface of the ocean. Reefs can occur naturally. Natural reefs are made of rocks or the skeletons of small animals called corals. Reefs can also be artificial—created by human beings. Coral reefs begin to form when free-swimming coral larvae attach to submerged rocks or other hard surfaces along the edges of islands or continents. As the corals grow and expand, reefs take on one of three major characteristic structures — fringing, barrier or atoll. Saucer-dish with flowering plant, Porcelain dish painted on the glaze in blue, red, green, yellow, black and gold. On the shelf a chrysanthemum branch. The inner wall with twice rocks with flowering plants pomegranate, prunus. Four proen on the bottom. Kakiemon style. The river water falling between stones. The material employed Old wall texture, extreme closeup. Just a small part of a wall. Attrition is when material such as rocks and stones carried by waves hit and knock against each other wearing them down. As these materials are worn down sand and rounded beach pebbles are formed. Sea cliffs are one of the clearest examples of sea erosion that we can see. A plunging wave breaks with more energy than a significantly larger spilling wave. The wave can trap and compress the air under the lip, which creates the 'crashing' sound associated with waves. With large waves, this crash can be felt by beachgoers on land. Bell-shaped cup with eight geese, Bell-shaped head with lobed edge, painted on the glaze in blue, red, green, black and gold. On the wall eight geese near rocks, grazing or flying. A Terex rock dumper truck takes a full load of stone in a quarry in heavy rain. Oyster shells cover the beach in Bayou La Batre, Ala. Photo by Carmen K. Game stones texture, pebbles, rocks, boulders seamless pattern. Cartoon background of rocky road or cobble pavement, textured material surface, graphic design templates for landscaping, Vector set. Fichu of needle lace with V-shaped pendulum, The triangular back section contains a large bouquet of daisy, roses, ranunculus and forget-me-nots within a V-shaped band with a circular filling. The ends are tapered. A C-volute pendulum runs in the upper edge. The florets have an imposed relief. Sprinkled pouches are on the stock. Point de gaze de Bruxelles. Download Confirmation Please complete the form below. The information provided will be included in your download confirmation. Download Cancel. Forgotten your password? Next page. Filter by agency collections. No agencies were found for this search. Filter Cancel. Search builder Build your search with words and phrases. Exact phrase. At least one of these words. Without these words. Refine Cancel.
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