Is there gender heterogeneity in stimulants use disorders in US?

Prior research has demonstrated the dimensionality of criteria for alcohol and cannabis use disorders. This study examined the dimensionality of cocaine and amphetamine use disorder criteria, the invariance in the latent construct of abuse and dependence criteria and heterogeneity in the individual criteria for cocaine and amphetamine after controlling for differences in the mean total disorder scores across gender in a large, representative sample of the U.S. population. Factor analyses and Item Response Theory (IRT) analyses explored the unidimensionality and psychometric properties of cocaine and amphetamine use disorder criteria. MIMIC and multiple group models examined gender invariance. Cocaine and amphetamine abuse and dependence criteria formed a unidemensional latent trait. Some of the most severe criteria were abuse criteria (e.g., legal problems, neglect of roles) while some dependence criteria (e.g., quit/control) were well represented along the severe end of the continuum. The relative ordering of cocaine and amphetamine abuse and dependence with respect to both severity and discrimination were remarkably similar. For cocaine use disorder, one dependence criterion (withdrawal) and one abuse criterion (hazardous use) showed significant gender heterogeneity, withdrawal exhibiting higher threshold in men and hazardous use in women. There was no gender heterogeneity in amphetamine use disorder. These findings support the validity of the DSM-V dimensional representation of substance use disorders for cocaine and amphetamine. Conversely, they do not support the DSM-IV definition of distinct abuse and dependence categories. Withdrawal and hazardous use of cocaine do not function identically in men and women and need further investigation.