Background To examine gender differences among individuals diagnosed with DSM-IV lifetime cannabis use disorder (CUD). Methods A nationally representative sample of U.S. adults aged 18 years or older that were diagnosed with lifetime CUD (N= 3,297): Men (N = 2,080), Women (N = 1,217). Data were drawn from the 2001–2002 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC, n = 43,093). The survey response rate was 81%. Results Nearly all individuals with CUD had a psychiatric comorbidity (95.6% of men, 94.1% of women). Men with lifetime CUD were more likely than women to be diagnosed with any psychiatric disorder, any substance use disorder and antisocial personality disorder, whereas women with CUD had more mood and anxiety disorders. After adjusting for gender differences in sociodemographic correlates and the prevalence of psychiatric disorders in the general population, women with CUD were at greater risk for externalizing disorders. Men with CUD met more criteria for cannabis abuse, had longer episodes of CUD, smoked more joints, and were older at remission when compared to women with CUD. Women experienced telescoping to CUD. Treatment-seeking rates were very low for both genders, and there were no gender differences in types of services used or reasons for not seeking treatment. Conclusions There are important gender differences in the clinical characteristics and psychiatric comorbidities among individuals with CUD.

Background An extensive clinical literature has noted gender differences in the etiology and clinical characteristics of individuals with alcohol dependence (AD). Despite this knowledge, many important questions remain. Methods Using the 2001 to 2002 National Epidemiologic Survey on Alcohol and Related Conditions (n = 43,093), we examined differences in sociodemographic characteristics, psychiatric and medical comorbidities, clinical correlates, risk factors, and treatment-utilization patterns of men (N = 2,974) and women (N = 1,807) with lifetime AD. Results Men with lifetime AD were more likely than women to be diagnosed with any substance use disorder and antisocial personality disorder, whereas women were more likely to have mood and anxiety disorders. After adjusting for sociodemographic characteristics and gender differences in psychiatric comorbidity in the general population, AD was associated with externalizing disorders and any mood disorder among women only. Men with AD met more criteria, had longer episodes, and were younger at the age of first drink. There were no gender differences in remission rates. Women with AD were more likely to have a family and a spouse with history of alcohol use disorders. Treatment rates were low for both genders, and women were more likely to report social stigmatization as a treatment barrier. Conclusions There are important gender differences in the psychiatric comorbidities, risk factors, clinical characteristics, and treatment-utilization patterns among individuals with lifetime AD.

There is growing concern that results of tightly controlled clinical trials may not generalize to broader community samples. To assess the proportion of community-dwelling adults with cannabis dependence who would have been eligible for a typical cannabis dependence treatment study, we applied a standard set of eligibility criteria commonly used in cannabis outcome studies to a large (N=43,093) representative US adult sample interviewed face-to-face, the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Approximately eighty percent (80%) of the community sample of adults with a diagnosis of cannabis dependence (n=133) would be excluded from participating in clinical trials by one or more of the common eligibility criteria. Individual study criteria excluded from 0% to 41.0% of the community sample. Legal problems, other illicit drug use disorders, and current use of fewer than 5 joints/week excluded the largest percentage of individuals. These results extend to cannabis dependence concerns that typical clinical trials likely exclude most community dwelling adults with the disorder. The results also support the notion that clinical trials tend to recruit highly selective samples, rather than adults who are representative of typical patients. Clinical trials should carefully evaluate the effects of eligibility criteria on the generalizability of their results. Even in efficacy trials, stringent exclusionary criteria could limit the representativeness of study results.