IntroductionWomen, compared to men, face a more severe pattern of cocaine dependence. Sex differences in the profile of cocaine dependence have indicated that women, relative to men, transition faster from first use to entering treatment [1], which may be explained by women abusing cocaine via more addictive routes more quickly and reporting a more rapid progression of drug dependence [2]. In addition, cocaine dependent women report shorter cocaine-free periods [3], have an increased incidence of relapse [4], experience greater cocaine craving in response to psychological and physical stressors [5], and have a greater tendency to report relapses with an impulsive quality [6]. There is also evidence of sex differences in the profile of dependence on other drugs such as prescription opiates [7] and methamphetamine [8,9] that have indicated a more severe impact of substance abuse in women compared to men, including exacerbation of cognitive impairments associated with stimulant dependence [9]. Compared to cocaine-dependent men, cocaine-dependent women are also more likely to attempt suicide [10,11] and addicted women exhibit poorer nutrition than addicted men [12]. Together, these findings indicate that a critical aspect in sex differences in addiction may include altered evaluation of the choice to engage in drug taking versus nondrug experiences, such as food and other pleasurable activities.Sex differences in psychostimulant dependence may be explained by the effects of gonadal hormones, including fluctuations across the female reproductive cycle. For women, the subjective experience of using cocaine is more or less pleasurable, depending on what phase of the menstrual cycle they are in at the time of drug intake [13,14]. In addition, progesterone administration can diminish the positive effects of cocaine in women, but not men [15,16]. Accordingly, evidence from human laboratory studies indicates that there are roles for hormones in cocaine responsiveness and that the ability of hormones to modulate cocaine responsiveness is sexually differentiated. However, the direction of sex differences in stimulant reinforcement can sometimes be dose-dependent. For instance, one study that
AbstractMen and women express sexually dimorphic patterns of cocaine abuse, such that women progress faster from initially trying cocaine to becoming dependent upon the drug and display a greater incidence of relapse. Sex differences in response to cocaine are also seen in the laboratory in both humans and animal models. In this review, animal models of cocaine abuse that have reported sex differences in appetitive reinforcement are discussed. In both human and animal studies, sex differences in the subjective and behavioral effects of cocaine are often related to the female reproductive cycle and ovarian hormones. As a comparison, food reinforcement studies have shown the opposite profile of sex differences and the impact of sex steroids on food intake and response rate. In contrast, limited attention has been given to "choice" models i...