Gender Differences

in Dependence Symptoms
and Psychiatric Severity in Adolescents
with Substance Use Disorders
Suzanne E. Thomas
Deborah Deas
Dani R. Grindlinger
ABSTRACT. One hundred adolescent inpatients (42% female) seeking
treatment for a substance use disorder (SUD) were compared by gender
on several substance use and psychiatric variables. Adolescents were assessed with the Comprehensive Addiction Severity Index (C-ASI) and
other standardized assessment instruments. Results showed that females
were more likely than males to endorse dependence symptoms and report experiencing dependence symptoms at a younger age. Females also
progressed faster to regular use of drugs than males. Females were more
likely than males to begin substance use with cigarettes, whereas males
typically began substance use with alcohol. Suicidality was more common in females, but groups did not differ on the prevalence of depression
diagnoses or on previous psychiatric treatment history. Future studies
are needed to investigate possible physiologic/psychologic bases of the
greater susceptibility for females to report substance dependence symptoms. [Article copies available for a fee from The Haworth Document Delivery

Service: 1-800-HAWORTH. E-mail address: <docdelivery@haworthpress.com>

Website: <http://www.HaworthPress.com> 2003 by The Haworth Press, Inc. All
rights reserved.]

Suzanne E. Thomas, PhD, is Assistant Professor, Deborah Deas, MD, is Associate

Professor, and Dani R. Grindlinger, BS, is a former project coordinator at the Center
for Drug and Alcohol Programs in the Institute of Psychiatry at the Medical University
of South Carolina, Charleston, SC 29425.
Address correspondence to: Suzanne Thomas, PhD, CDAP, 4 North, Institute of
Psychiatry, MUSC, 67 President Street, Charleston, SC 29425 (E-mail: thomass@musc.edu).
Journal of Child & Adolescent Substance Abuse, Vol. 12(4) 2003
http://www.haworthpress.com/store/product.asp?sku=J029
2003 by The Haworth Press, Inc. All rights reserved.
10.1300/J029v12n04_02

19

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JOURNAL OF CHILD & ADOLESCENT SUBSTANCE ABUSE

KEYWORDS. Adolescent, substance, gender, dependence, drug

In the past decade, increased attention has been given to how individuals with substance use disorders (SUD) differ by gender in their clinical presentation (Dawson and Grant, 1993; Gomberg, 1993; Mezzich et
al., 1994; Opland et al., 1995; Piazza et al., 1989; Robbins, 1989). Evidence shows that in adults, the progression to substance dependence
and the physical effects of substance misuse may differ markedly between the gendersparticularly in those with alcohol problemswhere
females progress faster through stages of substance use and experience
alcohol-related health problems sooner than men (Piazza et al., 1989;
Randall et al., 1999). More recently, reports suggest that similar gender
differences might also be present in adolescents with SUD.
Relevant reports on adolescents with SUD suggest that males typically begin substance use at a younger age than females, but differences
in quantity and frequency of use are either non-existent or clinically insignificant (Opland et al., 1995; Stewart and Brown, 1995). Importantly, while males and females are generally similar in their substance
use practices, females may be more likely than males to show the signs
of misuse. For example, Opland and colleagues (Opland et al., 1995)
examined gender differences in a large sample of treatment-seeking,
drug-abusing adolescents using the Personal Experience Inventory
(PEI) (Winters and Henly, 1989). They found that the frequency of drug
use was slightly higher in males for marijuana and cocaine, and higher
in females for amphetamine use; there were no gender differences in the
frequency of alcohol use. When these differences in drug use frequency
were statistically controlled, females reported significantly more physical symptoms of dependence than males. No differences in physical dependence symptoms were observed, however, when group means were
unadjusted (such that the effects of drug use frequency were not removed). Also, Brown and colleagues (Brown et al., 1998) reported a
tendency for adolescent females in their inpatient populations to report
more alcohol and drug withdrawal symptoms than males using the Customary Drinking and Drug Use Record (CDDR). Groups did not differ,
however, on the number of DSM-III-R dependence symptoms endorsed. Stewart and Brown (Stewart and Brown, 1995) reported that despite the fact that male and female adolescents in their sample were similar in quantity and frequency of use, females reported significantly
more alcohol and polysubstance withdrawal symptoms. While none of
these effects were hypothesized a priori, the findings support that more

Thomas, Deas, and Grindlinger

21

studies are warranted specifically to investigate gender differences in

dependence symptoms in adolescents with SUD.
Gender differences have also been reported in psychiatric functioning in affected adolescents. Higher rates of conduct disorder have been
found in males with SUD in both community and clinical samples
(Boyle et al., 1992; Hovens et al., 1994). Females often have higher rates
of depression (Bukstein et al., 1992; Rohde et al., 1996) and more suicidality (Deykin and Buka, 1994). These reports and others are consistent
with other clinical reports that males (with and without SUD) often
show externalized psychopathological behaviors, while females are
more likely to have internalized psychopathology (Scaramella et al.,
1999).
The present study was conducted to compare male and female inpatient substance abusers on several substance-related and psychiatric
variables, including age of first use, progression to regular use, endorsement of dependence symptoms, psychiatric diagnoses, and family functioning. The primary hypothesis tested was that females report greater
incidence of symptoms of physical dependence, and/or report them at a
younger age. Also of interest was whether the females progressed faster
to regular substance use (as suggested by Mezzich et al., 1994), and
whether the incidence of specific psychiatric diagnoses was similar across
genders.
METHODS
Participants
Participants were 100 adolescents (58 males and 42 females), aged
12-18 yrs (M = 15.3 yrs, SD = 1.35), who were consecutively admitted
to the inpatient unit of the Adolescent Substance Abuse Program at the
Institute of Psychiatry at the Medical University of South Carolina. Parents or guardians were informed of the study at the time of admission,
and informed consent and assent were obtained from the parent/guardian and adolescent, respectively.
Assessment
Adolescents were assessed for psychiatric disorders using the Child
Schedule for Affective Disorders and Schizophrenia (K-SADS) (Chambers et al., 1985), a widely used diagnostic instrument with good psycho-

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JOURNAL OF CHILD & ADOLESCENT SUBSTANCE ABUSE

metric properties (Orvaschel, 1985). Substance use disorder diagnoses

were made using a modified version of the Structured Clinical Interview for DSM-IV (SCID-R) (Martin et al., 1995), which addresses
symptoms of substance use disorders most relevant to adolescents. The
SCID-R has been shown to have acceptable inter-rater reliability and
concurrent validity (Martin et al., 2000; Martin et al., 1995; Martin et
al., 1996). The Comprehensive Addiction Severity Index for Adolescents (CASI) (Meyers et al., 1995) was used to assess problem severity
and psychopathology in areas often associated with drug/alcohol use in
adolescents. The CASI is modeled after the Addiction Severity Index
(ASI) developed by McLellan and colleagues for use in adults (McLellan
et al., 1992). The CASI has strong psychometric properties (Meyers et
al., 1995). It provides indices of severity in seven areas of functioning:
1.
2.
3.
4.
5.
6.
7.

substance use,
legal problems,
family relationships,
personal/social relationships,
school work,
employment, and
psychiatric functioning.

The gender comparisons in the present study focused primarily on substance use variables, family relationships, and psychiatric functioning.
Assessment occurred during the first three days following inpatient
admission. An MD-level child and adolescent psychiatry fellow administered the K-SADS and the SCID-R. A licensed social worker or psychologist with relevant training administered the CASI. A parent/guardian was present with the adolescent during the K-SADS assessment.
When the CASI and the SCID-R were administered, only the clinician
and the adolescent were present.
Data Analysis
Gender groups were compared with chi-square tests of independence
and t-tests on all variables of interest. Strength of relationship for non-parametric tests was determined with a fourfold point correlation coefficient
or Cramers statistic (V). Eta-squared values were calculated for t-tests.
Strength of relationship values range from 0 to 1.0, and reflect either a
weak (0-.09), moderate (.10-.25) or strong ( > .25) relationship between
the variables of interest (Keppel, 1991).

Thomas, Deas, and Grindlinger

23

RESULTS
Demographics
Gender groups were similar on most demographic variables, except
that males were older than females by an average of 6 months, t(98) =
2.42, p = .02 (eta2 = .06). Males were also more likely to be employed
than females, !2(1) = 5.44, p = .02 (V = .23). There was a non-significant trend for females to be more likely than males to be enrolled and attending school, !2(1) = 3.61, p = .06 (V = .19). Groups were similar on
ethnicity, religious preference, referral source, and current living situation. Most of the participants (52%) lived with their biological mother
alone. Fifteen percent (15%) lived with both biological parents, and
26% lived with neither biological parent. Most of the participants were
referred to treatment by family members (28%), by a professional
(30%), or by the court (17%). The remaining 25% were either self-referred, referred by school counselors, or by social service workers.
Groups were equally likely to have received previous outpatient
treatment for substance use problems. Most clients (79%) admitted using substances in the month prior to entry into treatment. There were no
gender differences in frequency of substance use. On average, clients
reported using drugs or alcohol every other day in the month before assessment. Groups were similar on their reported drug of choice. Marijuana was the drug of choice for most clients (67%), followed by
alcohol (17%), and other drugs (9%). Tobacco was reported as the drug
of choice by 7% of clients. These data (by gender) are presented in Table 1.
Substance Use
Several differences between males and females were revealed regarding symptoms of dependence. For example, tolerance (as defined
by the need to consume greater amounts to achieve a similar effect as
when the substance was first used regularly) was reported by 61% of females and 40% of males, !2(1) = 3.96, p = .046 (V = .20). More females
than males reported that alcohol was taken in larger amounts than intended (65% and 37%, respectively), !2(1) = 6.40, p = .011 (V = .25), reflective of loss of control. Compulsive use was equally prevalent among
males and females (about 23% of each group endorsed experiencing
compulsive use), but there was a trend for females to report that compulsive use began at a younger age than males, t(21) = 2.03, p = .06 (eta2 =
.16). Withdrawal was also endorsed equally (and rarely) between
the groups (12 males and 8 females reported experiencing withdrawal), but females experienced the onset of withdrawal at a younger

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JOURNAL OF CHILD & ADOLESCENT SUBSTANCE ABUSE

TABLE 1. Demographics
Males

Females

58

42

15.6 (1.2)

14.9 (1.3)

Caucasian

74%

81%

African-American

26%

19%

Family

29%

26%

Professional

28%

33%

Court

21%

12%

N
Age (M, SD), range = 12-18
Ethnicity

0.02
ns

Referral source

Other

p value

ns

22%

29%

Enrolled and attending school

72%

88%

0.06

Employed (past 11 months)

48%

24%

0.02

Received past outpatient treatment for SUD

37%

27%

ns

Marijuana

69%

63%

Alcohol

17%

16%

Tobacco

5%

11%

Other drugs

9%

10%

14.8 (12.9)

13.5 (11.9)

Drug of choice

Number days substance use in past 30 days* (M, SD)

ns

ns

* Mean based only on those subjects (N = 79) who reported using, on at least one day within the past
month.

age than males, t(18) = 2.62, p = .02 (eta2 = .28). Lastly, a greater percentage of females (58%) than males (28%) reported being bothered by
issues with substance abuse, !2(1) = 8.43, p < .01 (V = .29). Few subjects reported ever using substances for the relief of or to avoid withdrawal symptoms (11% of males and 14% of females, difference not
significant). Percentages and group means for these data are presented
in Figures 1 and 2.
Genders differed on their reports of the first substance used, !2(3) =
9.37, p = .02 (V = .31). Where males were more likely to have begun
substance use with alcohol, more females reported using tobacco first.
Few females began their substance use with marijuana (17%) or with alcohol (24%). Table 2 presents data for specific drugs of abuse.
Tobacco Use
Males and females did not differ on the frequency or quantity of tobacco use. Fifty-nine percent of males (n = 34) and 67% of females (n =

Thomas, Deas, and Grindlinger

25

28) females reported using tobacco (i.e., smoking cigarettesthe preferred route of administration) more than once per day in the past year.
The average number of cigarettes smoked per day did not differ by gender (both smoked around 14 cigarettes per day). The age of first use (12
years) and age of regular use (13 years) was also similar between genders. Regular use for tobacco and all substances is defined as use at least
weekly during the past month.
Alcohol Use
Despite the fact that females tended to endorse more symptoms of
dependence, genders did not differ on the percentages that met criteria
for alcohol dependence or abuse. Twenty-six percent (26%) of the sample met criteria for alcohol dependence; an additional 30% met criteria
for abuse. Gender groups also did not differ on the frequency of alcohol
use. Thirty-three percent of males and 44% of females drank at least
FIGURE 1. A greater percentage of females than males reported tolerance and
loss of control over substance use, p < .05. Loss of control was measured by
the subjects self-report that (s)he had often taken alcohol/drugs in larger
amounts or over a longer period of time than intended. Compulsive use was
measured by the subjects self-report that (s)he felt an overpowering need to
use substances; felt enslaved to substances; felt substances controlled your
life; focused almost exclusively on substances; or experienced a strong desire
or sense of compulsion to use substances.

Percentage endorsing each symptom

100
90

Males

80

Females

70
60
50
40
30
20
10
0
Tolerance
N = 43

Withdrawal
N = 22

Loss of control
N = 42

Compulsive use
N = 25

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JOURNAL OF CHILD & ADOLESCENT SUBSTANCE ABUSE

FIGURE 2. Mean age at which dependent symptoms were experienced. Females reported a younger age withdrawal (*p = .02) and a trend for a younger
age of compulsive use ( p = .06).
18
Males

17

Mean age of onset

Females
16
15
14
13
12
Tolerance
N = 42

Withdrawal
N = 20

Compulsive use
N = 23

once per week in the past year. Quantity measures for alcohol were not
available for analysis. Most clients, regardless of gender, reported that
they drank to feel the effects (versus drinking to experiment or to go
along with peers), and most clients (90%) reported that they drank with
others rather than alone. Males and females did not differ on the age of
first use of alcohol; both groups tried alcohol around age 12 or 13. The
age at which regular use of alcohol occurred also did not differ between
the groups. Typically, regular use began near age 14. There was, however, a small but significant effect of gender in the number of years
elapsed between first use and regular use, t(75) = 2.15, p = .04 (eta2 =
.06). On average, females began drinking on a regular basis approximately six months after they tried alcohol, whereas males regular use
did not begin until more than one year after trying alcohol (see Table 2).
Marijuana Use
The vast majority of males (97%) and females (95%) reported trying
marijuana. The frequency of use was also similar between the genders:
Approximately 54% of males and 57% of females used marijuana regularly (at least once per week), and about 29% of each group used daily.

Thomas, Deas, and Grindlinger

27

Significantly more females met the criteria for marijuana abuse than
males, !2(1) = 7.39, p < .01 (V = .27); there was a trend for more males
to meet criteria for marijuana dependence, !2(1) = 3.84, p = .06 (V =
.20). Most clients (83%), regardless of gender, reported using with others (friends, co-workers) rather than alone. Reasons for use were also
similar for each gender: Almost half of the clients reported using marijuana to feel the effects (rather than using to experiment, to medicate
psychiatric symptoms, or to go along with peers). Groups did not differ
on the average age of first use of marijuana (M = 13 yrs) nor on the age
at which regular use began; however, as with alcohol use, there was a
gender effect for females to show faster progression to regular use from
first use of marijuana, t(87) = 2.05, p = .045 (eta2 = .05). Females began
using marijuana regularly within six months of initiating use; males began using regularly, on average, one year after their first use.
Family Relationships
In general, where gender groups differed, the differences suggested
greater family problems among females in the sample. For example,
more females (55%) than males (33%) reported that they felt that they
could not confide in their parents, !2(1) = 4.84, p = .03 (V = .22). A
greater percentage of females than males (36% vs. 17%) reported that
they felt their parents had unrealistic expectations of them, !2(1) =
TABLE 2. Substance Use Variables
Variables

Males

Females

26%

41%

First substance used

Tobacco

p value
0.02

Alcohol

40%

24%

Marijuana

29%

17%

Age first tried alcohol (M, SD)

12.4 (2.9)

13.0 (2.1)

Age first tried marijuana (M, SD)

12.7 (2.3)

13.2 (1.5)

ns

Years to regular alcohol use from first use (M, SD)

1.2 (2.1)

0.5 (.91)

0.04

Years to regular marijuana use from first use (M, SD)

1.0 (1.9)

0.4 (.65)

0.05

29%

22%

ns

Alcohol dependence diagnosis

ns

Alcohol abuse diagnosis

25%

37%

ns

Marijuana dependence diagnosis

41%

22%

0.06

Marijuana abuse diagnosis

41%

68%

< .01

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JOURNAL OF CHILD & ADOLESCENT SUBSTANCE ABUSE

4.43, p = .04 (V = .21). Although not statistically significant, a trend was

found that females were more likely to report that they felt a lack of
family rules, structure or supervision (21% females, 9% males), !2(1) =
3.32, p = .07 (V = .18).
Other variables showed no differences between the genders, including whether adolescents felt that their parents consistently enforced
rules and whether the adolescents felt that their parents were aware of
their substance use. On average, 23% of the sample reported that their
parents did not enforce rules consistently, and 85% of the sample said
that they did not believe that their parents were aware of the extent of
their substance use.
Psychiatric/Emotional Problems
In general, females reported more psychiatric problems (from the
CASI) than males in this sample (Table 3). For example, females had a
higher incidence of past suicidal ideation, !2(1) = 5.08, p = .02 (V = .22).
Females were also more likely to have attempted suicide in the past,
!2(1) = 6.82, p = .01 (V = .26), and more females reported past self-mutilation than males, !2(1) = 7.93, p = .005 (V = .28).
Interestingly, groups did not differ on their history of psychiatric
treatment. The majority of the sample (60%) had received previous outpatient treatment for psychological/emotional problems, and 43% of
the sample had received prior inpatient treatment for psychological
problems, but there was no difference in the percentage of each gender
reporting previous psychiatric treatment. There was also no difference
in the percentage of each gender that had been prescribed medications
for psychological problems.
Diagnoses from the K-SADS revealed few gender differences in the
incidence of positive diagnoses for psychiatric disorders. There was a
very low incidence of anxiety disorders9% of the sample was diagnosed with an anxiety disorder, the incidence of which did not differ
across genders. The incidence of affective disorders was higher (64%),
but there was also no difference observed in the incidence across genders. The most common diagnosis was disruptive disorders; 82% of the
sample was diagnosed with either conduct disorder, oppositional-defiant disorder (ODD), or attention-deficit/hyperactivity disorder (ADHD).
There was a non-significant trend for males to be diagnosed more often
with a disruptive disorder than females, !2(1) = 3.67, p < .10 (V = .19).
Specific analyses conducted on each type of disruptive disorder showed
that genders did not differ significantly in the incidence of ODD or

Thomas, Deas, and Grindlinger

29

ADHD, but more males than females were diagnosed with conduct disorder, !2(1) = 5.37, p < .05 (V = .23). Table 3 shows percentages of positive diagnoses by gender for each disorder.
DISCUSSION
Gender differences in substance use and the consequences of misuse
have been reported extensively in adults with substance use disorders
(SUD), and especially in adults with alcohol problems. It is widely accepted that in alcoholic adult populations, males drink more than females, yet females show telescoped development of alcohol-related
problems (defined by a faster progression to dependence and more physical problems as a result of alcohol use) (Blankfield, 1990; Piazza et al.,
1989; Randall et al., 1999). Recently, investigators and clinicians have
focused on gender differences in adolescents with SUD, and the results
are generally in agreement with those of the present study. These differences may be important to consider for future treatment and prevention
efforts.
The most marked finding in the present study was that male and female adolescents with SUD differed on whether and when they experienced physical symptoms of dependence (or at least in their propensity
to report these symptoms). Females were more likely to endorse dependence symptoms and report experiencing symptoms at a younger
age, despite the fact that the genders did not differ on frequency of use
(quantity of use for alcohol and marijuana was not assessed).
Since males and females in this study did not differ in their drug of
choice (which was marijuana for both genders), drug of choice does not
account for the gender differences in dependence symptoms. Genders
may have differed, however, in the number of substances used. In a general adolescent population, investigators found that adolescents who
used multiple substances were more likely to endorse multiple criterion
symptoms for abuse/dependence (Harrison et al., 1998). If females in
the present study used more substances than males, this difference
could explain why females endorsed more dependence symptoms. This
explanation is unlikely, though, since historically, any differences between the genders (both in the general population and in treatment settings) have usually been in the direction of males using a greater number
of different drugs than females (Brown et al., 1998; Stewart and Brown,
1995). This assumption cannot be confirmed in the present study, however, since the number of drugs used was not available for analysis.

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TABLE 3. Psychiatric Problems
Males

Females

p value

Any anxiety disorder diagnosis

5%

15%

ns

Any affective disorder diagnosis

58%

73%

ns

54%

61%

ns

88%

73%

ns

MDD, MDE, or Depressive disorder NOS

Any disruptive disorder
Conduct disorder

25%

7%

< .05

Oppositional-defiant disorder

61%

63%

ns

Attention deficit/Hyperactivity disorder

22%

10%

ns

34%

57%

0.02

Past suicidal ideation

Past suicide attempts

31%

57%

0.01

Past self-mutilation

17%

43%

< .01

Previous outpatient psychiatric treatment

60%

61%

ns

Previous inpatient psychiatric treatment

44%

42%

ns

Prescribed medications for psychiatric problem

62%

56%

ns

Related to the higher endorsement of dependence symptoms by females is the finding that females were faster to progress from first use to
regular use for both alcohol and marijuana. In fact, on average, they
progressed to regular use of these drugs in about half the time as the
males. Similar findings have been reported by other investigators. For
example, Whitmore and colleagues (Whitmore et al., 1997) found that
while the males in that sample had an earlier onset of first drug use than
females (by about one year), there was not a gender difference in the age
at which males and females began using substances regularly, thus implying that females progressed faster to regular use. Mezzich and colleagues (Mezzich et al., 1994) reported on a population of adolescents
with SUD and conduct disorder. In that population, females progressed
faster than males from first use (of both alcohol and marijuana) to substance dependence diagnosis. It is reasonable to suspect that both the
earlier onset of dependence symptoms and the increased number of dependence symptoms in adolescent females in our sample are related to
their faster progression to regular use. Of particular interest is the relationship between the faster progression to regular use and symptoms of
dependence: Is there a cause/effect relationship, and if so, which condition precedes the other? The fact that very few subjects (and equal percentages across the genders) reported ever using substances to relieve
withdrawal symptoms suggests that it is unlikely that females regular

Thomas, Deas, and Grindlinger

31

use was driven by symptoms of dependence. Whether this result reflects

an early form of telescoping, and whether a six month faster progression
rate in girls is clinically significant merits closer investigation with prospective studies.
A third explanation for our results is that females are more likely to
report physical symptoms than males, not necessarily because they are
more likely to experience them, but because they do not feel the same
reservation that males might about admitting having symptoms which
could connote physical weakness, such as symptoms of physical dependence and loss of control or powerlessness over drugs. This propensity for minimal reporting of physical symptoms of dependence has
been reported in several studies using adult subjects both with and without alcohol dependence (Davis and Morse, 1987; Dawson and Grant,
1993).
Our findings on indices of psychiatric/emotional health support that
our sample is similar to other adolescent samples reported in the literature. Specifically, our rates of comorbid psychiatric disorders are similar to and sometimes lower than those found in other studies (Clark et
al., 1997; Grilo et al., 1995; Hovens et al., 1994; Whitmore et al., 1997).
A higher incidence of suicidal ideation in females in an adolescent substance abusing sample has also been reported elsewhere (Deykin and
Buka, 1994). We found few gender differences in the rates of psychiatric diagnoses. Importantly, no gender differences were observed in the
prevalence of affective or anxiety disorders. While females in our sample did endorse more psychiatric and family problem items on the CASI
than males, few females (n = 8) reported that they ever used drugs for
the purpose of self-medicating psychiatric/emotional problems. It is unlikely, then, that adolescent females in our sample were quicker to develop dependence symptoms because they were relying on drugs/alcohol
to treat psychiatric symptoms.
There are several limitations in the present study which should be
considered when interpreting the results. First, multiple comparisons
were made, and no correction procedures were used to maintain type I
error rate. Correction procedures would have made the alpha level prohibitively low (" = .003), such that none of the observed gender differences would have reached statistical significance, despite the fact that
many of them are clinically relevant. It was decided a priori to conduct
the comparisons with exploratory freedom, and to provide effect sizes
with each report of significance. Most of the effects were small to moderate in size, which suggests that other studies are warranted to replicate
the findings. Also, in the interest of brevity, the presentation of results is
limited mainly to those variables for which a gender effect was observed. Gender groups were more similar than different on most of the
CASI items, including the majority of items addressing family prob-

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JOURNAL OF CHILD & ADOLESCENT SUBSTANCE ABUSE

lems, social functioning, and legal issues. Most of the adolescents in the
study sample reported that marijuana was their drug of choice, so the results may be less representative of adolescents who primarily use (and
prefer) alcohol. Similarly, the sample of adolescents in this study was
limited to treatment-seeking, Caucasian and African-American adolescents (the only two ethnic groups significantly represented in the area).
The results may not generalize to a more diverse population or to adolescents who are less severely affected (e.g., outpatient samples).
Although preliminary, the results of the present study add to the
growing evidence that male and female adolescents with SUD differ in
their clinical presentation. Taken in combination with other reports,
these results suggest that females may be particularly vulnerable to or
may be greater endorsers of substance dependence symptoms. Future
studies should investigate the physiologic and psychologic basis of this
increased sensitivity in females and their faster progression to regular
substance use.
REFERENCES
Blankfield, A. Female alcoholics: II. The expression of alcoholism in relation to gender and age. Acta Psychiat Scand, 81: 448-452, 1990.
Boyle, M., Offord, D., Racine, Y., Szatmari, P., Fleming, J. and Links, P. Predicting
substance use in late adolescence: Results for the Ontario Child Health Study follow-up. American Journal of Psychiatry, 149: 761-767, 1992.
Brown, S. A., Myers, M. G., Lippke, L., Tapert, S. F., Stewart, D. G. and Vik, P. W.
Psychometric evaluation of the Customary Drinking and Drug Use Record
(CDDR): A measure of adolescent alcohol and drug involvement. Journal of
Studies on Alcohol, 59: 427-438, 1998.
Bukstein, O., Glancy, L. and Kaminer, Y. Patterns of affective comorbidity in a clinical
population of dually diagnosed adolescent substance abusers. American Journal of
the Academy of Child and Adolescent Psychiatry, 31: 1041-1045, 1992.
Chambers, W., Puig-Antich, J., Hirsch, M., Paez, P., Ambrosini, P., Tabrizi, M. and
Davies, M. The assessment of affective disorders in children and adolescents by
semistructured interview. Test-retest reliability of the schedule for affective disorders and schizophrenia for school-age children, present episode version. Arch Gen
Psychiatry, 42: 696-702, 1985.
Clark, D. B., Pollock, N., Bukstein, O. G., Mezzich, A. C., Bromberger, J. T. and Donovan, J. E. Gender and comorbid psychopathology in adolescents with alcohol dependence. Journal of the American Academy of Child and Adolescent Psychiatry,
36: 1195-1203, 1997.
Davis, L. J. and Morse, R. M. Age and sex differences in the responses of alcoholics to
the Self-Administered Alcoholism Screening Test. Journal of Clinical Psychology,
43: 423-430, 1987.
Dawson, D. A. and Grant, B. F. Gender effects in diagnosing alcohol abuse and dependence. Journal of Clinical Psychology, 49: 298-307, 1993.

Thomas, Deas, and Grindlinger

33

Deykin, E. Y. and Buka, S. L. Suicidal ideation and attempts among chemically dependent adolescents. American Journal of Public Health, 84: 634-639, 1994.
Gomberg, E. S. Gender issues. In: Galanter, M. (Ed.) Recent developments in alcoholism: Ten years of progress, Vol. 11, New York: Plenum Press, pp. 95-107, 1993.
Grilo, C. M., Becker, D. F., Walder, M. L., Levy, K. N., Edell, W. S. and McGlashan,
T. H. Psychiatric comorbidity in adolescent inpatients with substance use disorders.
Journal of the American Academy of Child and Adolescent Psychiatry, 34:
1085-1091, 1995.
Harrison, P. A., Fulkerson, J. A. and Beebe, T. J. DSM-IV substance use disorder criteria for adolescents: A critical examination based on a statewide school survey.
American Journal of Psychiatry, 155: 486-492, 1998.
Hovens, J. G., Cantwell, D. P. and Kiriakos, R. Psychiatric comorbidity in hospitalized
adolescent substance abusers. Journal of the American Academy of Child and Adolescent Psychiatry, 33: 476-483, 1994.
Keppel, G. Design and analysis: A researchers handbook (3rd Edition), Englewood
Cliffs, NJ: Prentice Hall, 1991.
Martin, C., Pollock, N., Buckstein, O. and Lynch, K. Inter-rater reliability of the SCID
alcohol use disorders section among adolescents. Drug and Alcohol Dependence,
59: 173-176, 2000.
Martin, C. S., Kaczynski, N. A., Maisto, S. A., Bukstein, O. M. and Moss, H. Patterns
of DSM-IV alcohol abuse and dependence symptoms in adolescent drinkers. Journal of Studies on Alcohol, 56: 672-680, 1995.
Martin, C. S., Kaczynski, N. A., Maisto, S. A. and Tarter, R. E. Polydrug use in adolescent drinkers with and without DSM-IV alcohol abuse and dependence. Alcoholism: Clinical & Experimental Research, 20: 1099-1108, 1996.
McLellan, A. T., Kushner, H., Metzger, D., Peters, R., Smith, I., Grissom, G., Pettinati,
H. and Argeriou, M. The fifth edition of the Addiction Severity Index. Journal of
Substance Abuse Treatment, 9: 199-213, 1992.
Meyers, K., McLellan, A. T., Jaeger, J. L. and Pettinati, H. M. The development of the
Comprehensive Addiction Severity Index for Adolescents (CASI-A): An interview
for assessing multiple problems of adolescents. Journal of Substance Abuse Treatment, 12: 181-193, 1995.
Mezzich, A., Moss, H., Tarter, R., Wolfenstein, M., Ya-Chen, H. and Mauss, R. Gender differences in the pattern and progression of substance use in conduct-disordered adolescents. American Journal on Addictions, 3: 289-295, 1994.
Opland, E. A., Winters, K. C. and Stinchfield, R. D. Examining gender differences in
drug-abusing adolescents. Psychology of Addictive Behaviors, 9: 167-175, 1995.
Orvaschel, H. Psychiatric interviews suitable for research with children and adolescents. Psychopharmacology Bulletin, 21: 737-745, 1985.
Piazza, N. G., Vrbka, J. L. and Yeager, R. D. Telescoping of alcoholism in women alcoholics. International Journal of the Addictions, 24: 19-28, 1989.
Randall, C. L., Roberts, J. S., Del Boca, F. K., Carroll, K. M., Connors, G. J. and
Mattson, M. E. Telescoping of landmark events associated with drinking: A gender
comparison. Journal of Studies on Alcohol, 60: 252-260, 1999.
Robbins, C. Sex differences in psychosocial consequences of alcohol and drug abuse.
Journal of Health & Social Behavior, 30: 117-130, 1989.

34

JOURNAL OF CHILD & ADOLESCENT SUBSTANCE ABUSE

Rohde, P., Lewinsohn, P. and Seeley, J. R. Psychiatric comorbidity with problematic

alcohol use in high school students. Journal of the American Academy of Child and
Adolescent Psychiatry, 35: 101-109, 1996.
Scaramella, L. V., Conger, R. D. and Simons, R. L. Parental protective influences and
gender-specific increases in adolescent internalizing and externalizing problems.
Journal of Research on Adolescence, 9: 111-141, 1999.
Stewart, D. G. and Brown, S. A. Withdrawal and dependency symptoms among adolescent alcohol and drug abusers. Addiction, 90: 627-635, 1995.
Whitmore, E. A., Mikulich, S. K., Thompson, L. L., Riggs, P. D., Aarons, G. A. and
Crowley, T. J. Influences on adolescent substance dependence: Conduct disorder,
depression, attention deficit hyperactivity disorder, and gender. Drug and Alcohol
Dependence, 47: 87-97, 1997.
Winters, K. C. and Henly, G. A. Personal Experience Inventory (PEI) Test and Manual, Los Angeles, CA: Western Psychological Services, 1989.

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