Sex disparities in substance abuse research: evaluating 23 years of structural neuroimaging studies

Kimberly E. Lind, Eric J. Gutierrez, Dorothy J. Yamamoto, Michael F. Regner, Sherry A. McKee, Jody Tanabe*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

24 Citations (Scopus)


Background Sex differences in brain structure and clinical course of substance use disorders underscores the need to include women in structural brain imaging studies. The NIH has supported the need for research to address sex differences. We evaluated female enrollment in substance abuse structural brain imaging research and the methods used to study sex differences in substance effects. Methods Structural brain imaging studies published through 2016 (n = 230) were evaluated for number of participants by sex and substance use status and methods used to evaluate sex differences. Temporal trends in the numbers of participants by sex and substance use status were analyzed. We evaluated how often sex effects were appropriately analyzed and the proportion of studies that found sex by substance interactions on volumetric measures. Results Female enrollment increased over time, but remained significantly lower than male enrollment (p = 0.01), with the greatest bias for alcohol and opiate studies. 79% of studies included both sexes; however, 74% did not evaluate sex effects or used an analytic approach that precluded detection of sex by substance use interactions. 85% of studies that stratified by sex reported different substance effects on brain volumes. Only 33% of studies examining two-way interactions found significant interactions, highlighting that many studies were underpowered to detect interactions. Conclusions Although female participation in substance use studies of brain morphometry has increased, sex disparity persists. Studying adequate numbers of both sexes and employing correct analytic approaches is critical for understanding sex differences in brain morphometric changes in substance abuse.

Original languageEnglish
Pages (from-to)92-98
Number of pages7
JournalDrug and Alcohol Dependence
Publication statusPublished - 1 Apr 2017
Externally publishedYes

Bibliographical note

A Corrigendum exists for this article and can be found in Drug and Alcohol Dependence (2017) Volume 176, pp.181-184 at DOI: 10.1016/j.drugalcdep.2017.04.002


  • Female inclusion
  • Grey matter volume
  • Sexual dimorphism
  • Structural brain imaging
  • Substance abuse


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