ABSTRACT
Differences in trauma-related experiences and substance use behaviors among women and men have received increasing attention over the past few decades. The term sex typically describes physiological and biological factors that categorize individuals as males or females, and the term gender refers to socially constructed roles and behaviors (Lips, 2007). Differences between women and men may be best conceptualized as an interaction between their experiences within their gendered sociocultural environment and their sex-based physiology. Historically, both trauma and substance use have been understudied in female, transgender, queer, or other nonbinary populations, perhaps in part because alcohol use has traditionally been considered a cis male “masculine” activity and because the concept of trauma was originally circumscribed to the experiences of combat veterans and prisoners of war. Starting in the 1970s, scholars and frontline clinicians worked to call attention to the role of trauma and increasing rates of substance use in the lives of women and girls (van der Kolk, 2007; Stevens, Andrade, & Ruiz, 2009). However, until the early 1990s, there remained a lack of sex and gender analyses in studies of individuals with substance use and mental health issues. In 1998, the Substance Abuse and Mental Health Services Administration (SAMHSA) launched a large-scale research initiative to study substance use, mental health, and trauma in women to identify how existing services could be modified to better meet clients’ needs (Salasin, 2005). While research elucidating the implications of sex and gender for posttraumatic stress disorder (PTSD) and substance use disorder (SUD) comorbidity is still in its early stages, sex- and gender-related factors have been observed in clinically relevant variables such as substance use motivation, reactions to trauma, and access and response to treatment. Accordingly, selection of sex- and gender-sensitive treatment strategies may improve therapy outcomes.52
