Gender comparison in the history of addiction, specific psychopathology, behavioural covariates of heroin craving, and heroin Post-Traumatic Stress Disorder spectrum during Agonist Opioid Treatment

Introduction: Gender health is an interdisciplinary issue of medicine, raised by the need to account for sex-related influences on physiology and pathophysiology, that is, how symptoms, prevention strategies and treatment should vary by sexual gender. Methods: The basic purpose of this study is to estimate the magnitude of differences between females and males regarding the natural course of heroin addiction, the psychopathology specific to HUD, the behavioural covariates of heroin craving and the Heroin-Post Traumatic Stress Disorder Spectrum (H-PTSD/S) during an Agonist Opioid Treatment (AOT). Results: Our female patients tend to have a higher educational level and live in a family context more often than their male peers. They achieve the same level of adjustment as males during treatment and have a similar addiction history, with the same baseline grade of severity of addictive symptoms. Nevertheless, they are more depressed along the “Worthlessness/Being Trapped” (W/BT) dimension, have prominent panic anxiety more often than males, and, most conspicuously, they react differently to traumatic and loss events. They report perception of loss in relation to a higher number of events, and their reactions are more intense, with higher severity of post-traumatic stress disorder symptoms, such as flashbacks and avoidant behaviour. They are also more likely to display a H-PTSD/S clinical picture such as that reported for L’Aquila earthquake survivors. Conclusion: A female-tailored AOT treatment programme is already necessary and achievable in the approach to heroin addiction.