Anxiety Disorders: Medical University of South Carolina

Upadhyaya HP, Deas D, Brady KT, Kruesi M. · Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC 29425, USA. · J Am Acad Child Adolesc Psychiatry. · Pubmed #12410071 No free full text.

Abstract: OBJECTIVE: To review the current state of knowledge of psychiatric comorbidity in adolescent cigarette smokers. METHOD: assisted literature search was conducted and seminal articles were cross-referenced for comprehensiveness of the search. For each disorder, a synopsis of knowledge in adults is provided and compared with the knowledge in adolescents. RESULTS: Psychiatric comorbidity is common in adolescent cigarette smokers, especially disruptive behavior disorders (such as oppositional defiant disorder, conduct disorder, and attention-deficit/hyperactivity disorder), major depressive disorders, and drug and alcohol use disorders. Anxiety disorders are modestly associated with cigarette smoking. Both early onset (<13 years) cigarette smoking and conduct problems seem to be robust markers of increased psychopathology, including substance abuse, later in life. In spite of the high comorbidity, very few adolescents have nicotine dependence diagnosed or receive smoking cessation treatment in child and adolescent psychiatric treatment settings. CONCLUSIONS: There is increasing evidence for high rates of psychiatric comorbidity in adolescent cigarette smokers. Cigarette smoking in adolescence appears to be a strong marker of future psychopathology. Child and adolescent psychiatry treatment programs may be a good setting for prevention efforts and treatment, which should focus on both nicotine dependence and psychiatric disorders.

Ballenger JC, Davidson JR, Lecrubier Y, Nutt DJ, Jones RD, Berard RM, Anonymous00103. · Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston 29425-0742, USA. · J Clin Psychiatry. · Pubmed #12108825 No free full text.

This publication has no abstract.

Ballenger JC, Davidson JR, Lecrubier Y, Nutt DJ, Lydiard RB, Mayer EA, Anonymous00102. · Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston 29425-0742, USA. · J Clin Psychiatry. · Pubmed #12108822 No free full text.

This publication has no abstract.

Lydiard RB. · Mood and Anxiety Program, Medical University of South Carolina, Charleston 29425, USA. · J Clin Psychiatry. · Pubmed #12108820 No free full text.

Abstract: Irritable bowel syndrome (IBS) is a common and potentially disabling functional gastrointestinal disorder characterized by abdominal pain and altered bowel patterns. A significant amount of clinical and research data suggest the importance of the brain-gut interaction in IBS. This review examines the observed high prevalence of psychiatric disorders in patients with IBS. The published literature indicates that fewer than half of individuals with IBS seek treatment for it. Of those who do, 50% to 90% have psychiatric disorders, including panic disorder, generalized anxiety disorder, social phobia, posttraumatic stress disorder, and major depression, while those who do not seek treatment tend to be psychologically normal. Both physiologic and psychosocial variables appear to play important roles in the development and maintenance of IBS. Recent information suggests that the association of IBS and psychiatric disorders may be more fundamental than was previously believed. A brain-gut model for IBS is presented, and the role of traumatic stress and corticotropin-releasing factor as modulators of the brain-gut loop is discussed. Finally, the rationale for the use of psychotropic agents in the treatment of IBS with or without psychiatric symptoms is presented.

Ballenger JC, Davidson JR, Lecrubier Y, Nutt DJ, Roose SP, Sheps DS, Anonymous00101. · Medical University of South Carolina, Department of Psychiatry and Behavioral Sciences, Charleston 29425-0742, USA. · J Clin Psychiatry. · Pubmed #12108818 No free full text.

This publication has no abstract.

Horner MD, Hamner MB. · Mental Health Service, Ralph H. Johnson Department of Veterans Affairs Medical Center, Charleston, South Carolina 29401, USA. · Neuropsychol Rev. · Pubmed #12090717 No free full text.

Abstract: This paper reviews the literature on performance on standard neuropsychological tests among individuals with posttraumatic stress disorder (PTSD). Of 19 studies, 16 reported impairment of attention or immediate memory (or both); however, most of these studies included PTSD patients with significant psychiatric comorbidity, so that the extent to which the observed deficits are specifically attributable to PTSD remains unclear. Other potential confounds, including medical illness, substance abuse, and motivational factors, further preclude definitive conclusions at present. Results of structural and functional neuroimaging studies of PTSD are also summarized. Two studies have reported correlations between hippocampal volume and cognitive findings in PTSD patients; functional studies have indicated specific findings in limbic regions, although the relationship of these results to neuropsychological performance remains to be explored.

DeVane CL, Grothe DR, Smith SL. · Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston 29425, USA. · J Clin Psychiatry. · Pubmed #11890560 No free full text.

Abstract: The past decade has witnessed the introduction of a diverse group of antidepressants from a variety of distinct chemical classes, each with their own specificity for neurochemical transmitters, receptors, and cytochrome P450 isozymes. This review focuses on nefazodone, a distinct antidepressant with efficacy for the treatment of depression with depression-related anxiety symptoms, an established tolerability profile, and a multimodal mechanism of action. Relevant pharmacologic and pharmacodynamic effects are summarized that support nefazodone as an attractive choice for both the short- and long-term treatment of depression.

Ballenger JC. · Department of Psychiatry and Behavioral Science, Medical University of South Carolina, Charleston 29425, USA. · J Clin Psychiatry. · Pubmed #11577786 No free full text.

Abstract: gamma-Aminobutyric acid (GABA), serotonin (5-HT), and norepinephrine (NE) have each been implicated in the putative pathophysiology of anxiety, and patients with generalized anxiety disorder (GAD) demonstrate dysregulation of these neurotransmitters. In addition, neurobiological studies have demonstrated that these neurotransmitter systems are extensively interrelated. As a result, drugs that affect serotonergic systems may also, directly or indirectly, affect other neurotransmitter systems including GABA and NE. In recent years, clinical pharmacology studies have demonstrated that pharmacotherapeutic agents that target more than one neurotransmitter system are more effective than agents that target a single system, presumably due to synergistic mechanisms. Agents that modulate more than one neurochemical have a broader spectrum of action and may facilitate the attainment of remission among patients with moderate to severe GAD, who are likely to have comorbid psychiatric illnesses such as depression. Preclinical and clinical data supporting the role of GABA, 5-HT, and NE in the pathophysiology of GAD are reviewed here. The pharmacotherapeutic agents that modulate these neurotransmitter systems and have been proved efficacious in reducing the symptoms associated with GAD are also summarized.

Ballenger JC, Davidson JR, Lecrubier Y, Nutt DJ, Kirmayer LJ, Lépine JP, Lin KM, Tajima O, Ono Y. · Medical University of South Carolina, Department of Psychiatry and Behavioral Sciences, Charleston 29425-0742, USA. · J Clin Psychiatry. · Pubmed #11434419 No free full text.

Abstract: OBJECTIVE: To provide primary care physicians with a better understanding of transcultural issues in depression and anxiety. PARTICIPANTS: The 4 members of the International Consensus Group on Depression and Anxiety were James C. Ballenger (chair), Jonathan R. T. Davidson, Yves Lecrubier, and David J. Nutt. Five faculty invited by the chair also participated: Laurence J. Kirmayer, Jean-Pierre Lepine, Keh-Ming Lin, Osamu Tajima, and Yutaka Ono. EVIDENCE: The consensus statement is based on the 5 review articles that are published in this supplement and the scientific literature relevant to the issues reviewed in these articles. CONSENSUS PROCESS: Group meetings were held over a 2-day period. On day 1, the group discussed the review articles, and the chair identified key issues for further debate. On day 2, the group discussed these issues to arrive at a consensus view. After the group meetings, the consensus statement was drafted by the chair and approved by all attendees. CONCLUSION: The consensus statement underlines the prevalence of depression and anxiety disorders across all cultures and nations while recognizing that cultural differences exist in symptom presentation and prevalence estimates. In all countries, the recognition of depression by clinicians in the primary care setting is low (generally less than 50%), and the consensus group recommends a 2-step process to aid the recognition and diagnosis of depression. In line with the low recognition of depression and anxiety disorders is the finding that only a small proportion of patients with depression or anxiety are receiving appropriate treatments for their condition. Biological diversity across ethnic groups may account for the differential sensitivity of some groups to psychotropic medication, but this area requires further investigation.

Ballenger JC. · Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston 29425, USA. · J Clin Psychiatry. · Pubmed #11430617 No free full text.

Abstract: Treating anxiety disorders to remission should be the goal of all practitioners. A remitted patient should be well, both in symptoms and function, and be indistinguishable from a never-ill counterpart. The definition of remission in patients with anxiety disorders should also be clear, practical, and easy to use. It is useful to measure response in an objective way, such as with standardized instruments appropriate for the disorder, and to develop remission criteria specific to each disorder. This article proposes remission criteria, using standardized measures, for 5 common anxiety disorders: panic disorder, social anxiety disorder, generalized anxiety disorder, obsessive-compulsive disorder, and post-traumatic stress disorder.

McRae AL, Brady KT. · Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President Street, PO Box 250861, Charleston, SC 29425, USA. · Expert Opin Pharmacother. · Pubmed #11336629 No free full text.

Abstract: Sertraline (Zoloft, Pfizer) has been shown in numerous controlled studies to have similar efficacy to other selective serotonin (5-HT) re-uptake inhibitors (SSRIs) in the treatment of depression and anxiety disorders. Further research is indicating that the efficacy of sertraline extends even beyond the treatment of depression and anxiety to include utility in eating disorders, premenstrual dysphoric disorder (PMDD) and possibly substance abuse treatment. Along with other SSRIs, sertraline offers several advantages over older antidepressants, including improved patient tolerability, low risk of lethality in overdose and no dependence potential. In head-to-head comparisons, sertraline appears to be at least as well-tolerated as other SSRIs and may even have a more favourable side effect profile. Low potential for pharmacokinetic drug interactions is another advantage of sertraline. Unlike fluoxetine, fluvoxamine and paroxetine, sertraline is not a potent inhibitor of any of the cytochrome P450 isoenzyme systems. As a result of its proven efficacy, good tolerability and lack of pharmacokinetic interactions, sertraline should be considered first-line in the treatment of anxiety and depressive disorders.

Falsetti SA, Davis J. · National Crime Victims Research and Treatment Center, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA. · Psychiatr Clin North Am. · Pubmed #11225511 No free full text.

Abstract: This article describes the latest nonpharmacologic therapies for generalized anxiety disorder. In addition, a review of available nonpharmacologic treatment outcome studies and studies that compare the efficacy of pharmacologic and nonpharmacologic treatment is presented. The authors conclude that, of the nonpharmacologic therapies available, cognitive-behavioral therapy may be the preferred first-line treatment. Results of comparison studies have suggested that medication acts more quickly than does therapy in reducing symptoms, whereas therapy has more long-lasting effects. The authors recommend that further research be conducted in identifying the essential components of treatment and the most efficacious treatment combinations.

Brawman-Mintzer O. · Mood and Anxiety Disorders Program, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA. · Psychiatr Clin North Am. · Pubmed #11225503 No free full text.

Abstract: GAD is a severe, chronic, and distressing illness that often requires long-term management. Considerable progress has been made in the ability to help these patients. New antidepressants, such as venlafaxine, and the SSRIs provide an important treatment alternative to "traditional" anxiollytic treatments, which include the benzodiazepines, buspirone, and the TCAs; however, comparative efficacy and the effects of psychiatric comorbidity, long-term treatment, and relapse prevention are areas requiring further investigation.

Lydiard RB. · Mood and Anxiety Program, Medical University of South Carolina, Charleston, USA. · J Clin Psychiatry. · Pubmed #11206030 No free full text.

Abstract: Social anxiety disorder is an extremely common and potentially disabling psychiatric disorder. Generalized social anxiety disorder, a subtype of the disorder, is believed to be the most common and most severe form. It is also the form that is most often associated with other psychiatric disorders. Unless the clinician has a high index of suspicion, social anxiety disorder may remain undetected. The clinical and treatment implications of the most common psychiatric comorbidities associated with social anxiety disorder are discussed in this article, with a focus on major depression, panic disorder, posttraumatic stress disorder, and alcohol abuse/dependence. Other psychiatric disorders and some medical conditions commonly associated with social anxiety disorder are briefly mentioned. Finally, a differential diagnosis of social anxiety disorder is described. Individuals who present for treatment of other anxiety disorders, mood disorders, or alcohol/substance abuse disorders should be considered at risk for current but undetected social anxiety disorder.

Labbate LA, Warden DL. · Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 109 Bee Street, Charleston, SC 29401, USA. · Curr Psychiatry Rep. · Pubmed #11122967 No free full text.

Abstract: Psychiatric syndromes are common in patients with traumatic brain injury. Patients may develop typical disorders of mood, anxiety, or psychosis, in addition to changes in personality and cognition. The frequency of these syndromes and potential pharmacologic treatments for these psychiatric syndromes are just coming to light. There are, unfortunately, a dearth of placebo-controlled trials to guide treatment, although numerous treatments are suggested in the literature. This article reviews the existing studies of clinical syndromes related to brain injury and possible pharmacologic treatments.

Frueh BC, Hamner MB, Cahill SP, Gold PB, Hamlin KL. · Veterans Affairs Medical Center, Medical University of South Carolina, USA. · Clin Psychol Rev. · Pubmed #11057375 No free full text.

Abstract: Psychometric studies have consistently shown that combat veterans evaluated for posttraumatic stress disorder (PTSD) appear to overreport psychopathology as exhibited by (a) extreme and diffuse levels of psychopathology across instruments measuring different domains of mental illness, and (b) extreme elevations on the validity scale of the MMPI-MMPI-2, in a "fake-bad" direction. The phenomenon of this ubiquitous presentational style is not well understood at present. In this review we describe and delineate the assessment problem posed by this apparent symptom overreporting, and we review the literature regarding several potential explanatory factors. Finally, we address conceptual and practical issues relevant to reaching a better understanding of the phenomenon, and ultimately the clinical syndrome of combat-related PTSD, in both research and clinical settings.

Anton RF. · Alcohol Research Center, Medical University of South Carolina, Charleston 29425, USA. · Addiction. · Pubmed #11002915 No free full text.

Abstract: "Craving" for alcohol needs improved definition and measurement. This review provides a rationale for considering at least certain aspects of craving as having obsessive and compulsive features. As such, there may be phenomenological, but not necessarily etiological, overlap with obsessive-compulsive disorder. There are increasing data that suggest a neuroanatomical overlap between addiction/craving and obsessive-compulsive symptoms. The self-rated Obsessive Compulsive Drinking Scale (OCDS), based on the Yale-Brown Obsessive Compulsive Scale for heavy drinking interview (YBOCS-hd), was developed to assist in the examination of certain aspects of "craving" in alcoholics. The development, reliability, face validity, congruent validity and predictive validity of the OCDS are presented and discussed in this paper. The utility of the OCDS as a measurement tool in cognitive-behavioral and pharmacological alcoholism treatment research is highlighted. The potential of this instrument as a research and clinical tool for the understanding and evaluation of alcohol dependence needs further evaluation.

Anton RF. · Center for Drug and Alcohol Programs, Medical University of South Carolina, Charleston, USA. · Alcohol Res Health. · Pubmed #10890811 No free full text.

Abstract: Although many alcoholics experience craving, researchers have not yet developed a common, valid definition of the phenomenon. Numerous models of the mechanisms underlying craving have been suggested, however. One of those models--the neuroadaptive model--suggests that the prolonged presence of alcohol induces changes in brain-cell function. In the absence of alcohol, those changes cause an imbalance in brain activity that results in craving. Furthermore, the adaptive changes generate memories of alcohol's pleasant effects that can be activated when alcohol-related environmental stimuli are encountered, even after prolonged abstinence, thereby leading to relapse. Similarly, stressful situations may trigger memories of the relief afforded by alcohol, which could also lead to relapse. Neurobiological and brain-imaging studies have identified numerous brain chemicals and brain regions that may be involved in craving. Psychiatric conditions that affect some of these brain regions, such as depression or anxiety, also may influence craving. A better understanding and more reliable assessment of craving may help clinicians tailor treatment to the specific needs of each patient, thereby reducing the risk of relapse.

Lydiard RB. · Institute of Psychiatry, Medical University of South Carolina, Charleston 29425, USA. · Clin Ther. · Pubmed #10815647 No free full text.

Abstract: OBJECTIVE: This article reviews the prevalence, diagnosis, and treatment of generalized anxiety disorder (GAD). BACKGROUND: Patients with GAD often present to primary care physicians; frequently the disorder manifests with somatic symptoms that have no identifiable physiologic foundation. Accurate diagnosis and treatment often prove elusive, and health care resources are inappropriately consumed in the management of a wide array of complaints, including headache, noncardiac angina, fatigue, insomnia, or abdominal discomfort. Early diagnosis and intervention are critical; GAD is frequently associated with other anxiety and mood disorders, major depressive disorder among them. The differential diagnosis of GAD is complex, including medication side effects and substance-related dependence or withdrawal phenomena, as well as endocrine, neurologic, cardiorespiratory, and autoimmune disorders. CONCLUSIONS: GAD is differentiated from adjustment disorder with anxiety because only GAD can manifest without identifiable emotional stressors; it is differentiated from panic disorder largely on the basis of the chronicity of GAD and the episodic, abrupt nature of panic attacks, with the involvement of at least 4 autonomic, cardiopulmonary, neurologic, or other symptoms. In addition to psychotherapy, education, lifestyle modifications, and social support, several pharmacologic agents may be appropriate therapy for GAD. Given the chronic, nonremitting, relapsing character of GAD, use of benzodiazepines, which confer short-term relief, is usually ill-advised in long-term treatment because these agents can impair cognitive and psychomotor function, interact with various central nervous system depressants (eg, alcohol), and exhibit substantial potential for abuse, tolerance, dependence, and withdrawal effects. Buspirone and certain antidepressants, including the dual noradrenergic-serotonergic reuptake inhibitor venlafaxine, represent first-line therapy for GAD.

Brady KT, Killeen TK, Brewerton T, Lucerini S. · Institute of Psychiatry, Medical University of South Carolina, Charleston 29425, USA. · J Clin Psychiatry. · Pubmed #10795606 No free full text.

Abstract: Posttraumatic stress disorder (PTSD) commonly co-occurs with other psychiatric disorders. Data from epidemiologic surveys indicate that the vast majority of individuals with PTSD meet criteria for at least one other psychiatric disorder, and a substantial percentage have 3 or more other psychiatric diagnoses. A number of different hypothetical constructs have been posited to explain this high comorbidity; for example, the self-medication hypothesis has often been applied to understand the relationship between PTSD and substance use disorders. There is a substantial amount of symptom overlap between PTSD and a number of other psychiatric diagnoses, particularly major depressive disorder. It has been suggested that high rates of comorbidity may be simply an epiphenomenon of the diagnostic criteria used. In any case, this high degree of symptom overlap can contribute to diagnostic confusion and, in particular, to the underdiagnosis of PTSD when trauma histories are not specifically obtained. The most common comorbid diagnoses are depressive disorders, substance use disorders, and other anxiety disorders. The comorbidity of PTSD and depressive disorders is of particular interest. Across a number of studies, these are the disorders most likely to co-occur with PTSD. It is also clear that depressive disorder can be a common and independent sequela of exposure to trauma and having a previous depressive disorder is a risk factor for the development of PTSD once exposure to a trauma occurs. The comorbidity of PTSD with substance use disorders is complex because while a substance use disorder may often develop as an attempt to self-medicate the painful symptoms of PTSD, withdrawal states exaggerate these symptoms. Appropriate treatment of PTSD in substance abusers is a controversial issue because of the belief that addressing issues related to the trauma in early recovery can precipitate relapse. In conclusion, comorbidity in PTSD is the rule rather than the exception. This area warrants much further study since comorbid conditions may provide a rationale for the subtyping of individuals with PTSD to optimize treatment outcomes.

Austin LS, Godleski LS. · Department of Psychiatry and the Behavioral Sciences, Medical University of South Carolina, Charleston, USA. · Psychiatr Clin North Am. · Pubmed #10623977 No free full text.

Abstract: Common psychiatric responses to disasters include depression, PTSD, generalized anxiety disorder, substance-abuse disorder, and somatization disorder. These symptom complexes may arise because of the various types of trauma experienced, including terror or horror, bereavement, and disruption of lifestyle. Because different types of disaster produce different patterns of trauma, clinical response should address the special characteristics of those affected. Traumatized individuals are typically resistant to seeking treatment, so treatment must be taken to the survivors, at locations within their communities. Most helpful is to train and support mental health workers from the affected communities. Interventions in groups have been found to be effective to promote catharsis, support, and a sense of identification with the group. Special groups to be considered include children, injured victims, people with pre-existing psychiatric histories, and relief workers.

Ballenger JC. · Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston 29425, USA. · Biol Psychiatry. · Pubmed #10599485 No free full text.

Abstract: The progress in developing effective treatments for the five principal anxiety disorders (ADs) in adults--panic disorder (PD), social phobia (SP), obsessive compulsive disorder (OCD), generalized anxiety disorder (GAD), posttraumatic stress disorder (PTSD)--has been rapid in the past 15 years. There are now well-controlled clinical trials documenting effective pharmacological and psychological treatments for all of these disorders, although generally the evidence is better developed for some disorders than for others. Both the pharmacological treatments and the effective psychological treatments for each disorder will be briefly reviewed. The available data for combination treatment will be reviewed and comparisons of the two types of treatment will be made. This review will contain at least brief reviews of what the treatments involve and attempt to describe how well they work. Many studies unfortunately report only the percentage of patients who "improve" without quantifying the clinical significance of those responses. Data underlining clinical response in terms of the percentage of patients who have an "excellent," "marked," or "moderate" response, and the percentage of patients with a "clinically significant" response will be reported whenever available. Other clinically relevant issues such as length of treatment-relapse rates upon discontinuation and side effects will be presented. As such, this article should provide a brief but comprehensive review of the treatment of these disorders in adults.

Lydiard RB, Falsetti SA. · Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston 29425, USA. · Am J Med. · Pubmed #10588175 No free full text.

Abstract: This report highlights various considerations regarding the potential effects of concurrent psychiatric conditions and a history of abuse in patient volunteers for clinical trials in irritable bowel syndrome (IBS). Even though many studies have used psychological rating scales to assess personality and psychological traits of patients with IBS, the prevalence of the different psychiatric diagnoses (i.e., categorical assessment) in patients with IBS has only recently been assessed systematically. Recent studies of treatment-seeking patients have indicated that the majority of individuals (50% to 90%) who seek treatment for IBS have a lifetime history or currently have one or more common psychiatric conditions: major depressive disorder, generalized anxiety disorder, panic disorder, social phobia, somatization disorder, and posttraumatic stress disorder. Traditional clinical wisdom is that the presence of a psychiatric disorder increases the likelihood that an IBS patient will seek treatment. However, recent data suggest that IBS and psychiatric disorders are associated regardless of treatment-seeking status. Patients with psychiatric disorders should be included in clinical IBS studies, because this reflects the actual patient population. Extrapolating from the psychiatric literature, inclusion of patients with IBS with mild to moderate anxiety or depression is warranted.

Sonne SC, Brady KT. · Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, USA. · Psychiatr Clin North Am. · Pubmed #10550858 No free full text.

Abstract: Bipolar disorder and substance abuse commonly co-occur. In fact, as many as 50% of individuals with bipolar disorder have been found to have a lifetime history of substance abuse or dependence. This article discusses the very important comorbidity of bipolar disorder as it is complicated by substance abuse, focusing on the prevalence, course, diagnostic considerations and treatment.

Brady KT, Randall CL. · Department of Psychiatry, Medical University of South Carolina, Charleston, USA. · Psychiatr Clin North Am. · Pubmed #10385931 No free full text.

Abstract: Despite the fact that the rate of substance abuse and dependence is higher among men than it is among women, the prevalence rates, especially the more recent ones, indicate that a diagnosis of substance abuse is not gender specific. From the emerging literature on gender differences over the past 25 years, male and female substance abusers are clearly not the same. Women typically begin using substances later than do men, are strongly influenced by spouses or boyfriends to use, report different reasons for maintaining the use of the substances, and enter treatment earlier in the course of their illnesses than do men. Importantly, women also have a significantly higher prevalence of comorbid psychiatric disorders, such as depression and anxiety, than do men, and these disorders typically predate the onset of substance-abuse problems. For women, substances such as alcohol may be used to self-medicate mood disturbances, whereas for men, this may not be true. Although these comorbid disorders might complicate treatment for women, women are, in fact, responsive to treatment and do as well as men in follow-up. Gender differences and similarities have significant treatment implications. This is especially true for the telescoping phenomenon, in which the window for intervention between progressive landmarks is shorter for women than for men. This is also true for the gender differences in physical and sexual abuse, as well as other psychiatric comorbidity that is evident in female substance abusers seeking treatment. The barriers to treatment for women are being addressed in many treatment settings to encourage more women to enter treatment, and family and couples therapy are standard therapeutic interventions. Negative consequences associated with substance abuse are different for men and women, and gender-sensitive rating instruments must be used to measure not only the severity of the problem but also to evaluate treatment efficacy. To determine whether gender differences observed over the past 25 years become less demarcated in comparisons of younger cohorts of substance abusers in the future will be interesting. Changing societal roles and attitudes toward women, the increase in women entering the workplace, in general, and into previously male-dominated sports and professions, in particular, may influence not only opportunities to drink but also drinking culture. Some gender differences likely will remain, but other gender differences will probably also emerge. The comparison of male and female substance abusers promises to be a fruitful one for researchers. The translation if the research findings to the treatment community to improve treatment outcome for both sexes will be an equally exciting challenge for the field.