Clinical Textbook of Addictive Disorders 3rd ed - R. Frances, S. Miller, A. Mack (Guilford, 2005) WW

440 IV. SPECIAL POPULATIONSweight), women reach higher blood alcohol levels than men. This fact is partlyrelated to alcohol’s distribution in total body water, because women have agreater proportion of fat and less body water than do men. In addition, menhave higher levels of the enzyme alcohol dehydrogenase (ADH) in the gastricmucosa, leading to increased metabolism in the stomach (first-pass metabolism)and less absorption into the male bloodstream. Other differences includegreater variability in blood alcohol concentrations, faster alcohol metabolism,and reduced acute tolerance to alcohol in women compared to men, leading tomore intense and less predictable reactions to alcohol consumption in womenthan in men (Blume & Zilberman, 2004).Gender differences in the pharmacology of other drugs are less well studied.The differences in body composition noted previously produce longer halflivesin lipid-soluble drugs such as diazepam and oxazepam in women. Intranasalcocaine administration produces higher subjective effects accompanied byhigher plasma levels in men compared to women. Variations in women´splasma levels according to menstrual cycle phases have also been reported(Zilberman & Blume, 2004).Health EffectsChronic heavy alcohol use has been linked to many serious medical complicationsin both sexes (National Institute on Alcohol Abuse and Alcoholism,2000). However, many of these complications develop more rapidly in women,with a lower level of alcohol intake. Included are hepatic steatosis and cirrhosis,hypertension, anemia, malnutrition, gastrointestinal hemorrhage, peptic ulcer,and both peripheral myopathy and cardiomyopathy. Both human immunodeficiencyvirus (HIV) infection and other sexually transmitted diseases are linkedto substance use disorders in women (Center on Addiction and SubstanceAbuse, 1996). Seventy percent of currently HIV-infected women acquired thevirus either through injection drug use or during sexual relations with a druginjectingpartner, compared to less than half of HIV-infected men. Addictedwomen, particularly those dependent on crack cocaine or heroin, often becomeinfected by exchanging sex for drugs or by engaging in prostitution to obtainmoney for drugs.Alcohol and other drug use is closely linked to smoking in women. Mortalityfor lung cancer in U.S. women surpassed breast cancer mortality in 1986 tobecome the leading cause of cancer death. The risks for coronary artery disease,obstructive lung disease, peptic ulcer, and early menopause, as well as cancersof the mouth, larynx, esophagus, stomach, bladder, and cervix are increasedin female smokers (Zilberman & Blume, 2004), as is the risk for breast cancerin female drinkers (National Institute on Alcohol Abuse and Alcoholism,2000).