In recent days the most severe public health troubles in the US that is penetrating most races, ethnic, gender, age, educational, religious and socioeconomic groups is the use of psychoactive substances. Mounting public concern has resulted in increased federal funding for enforcement actions and for treatment and prevention programs, and has also produced a corresponding expansion of research on many aspects of drug and alcohol use. Nevertheless, treatment and research efforts that systematically address problems of multiple-substance use, particularly in relation to gender and ethnicity, have been relatively slow to develop (7, 28, 60, 67). While a complete explication of multiple use patterns would be desirable, this paper focuses only on the interrelated patterns of alcohol and heroin use among White and Mexican-American (Chicano) male and female heroin addicts in Southern California. Data on the use of other drugs was not available for the sample studied to allow more comprehensive analysis.
Accumulated empirical evidence suggests that use of alcohol and narcotics are not independent behaviors. A recent study of White and Chicano male narcotics addicts (1) found an inverse relationship between the use of alcohol and heroin, for both ethnic groups, over the lifetime of addiction. This relationship was most evident in the addicts' decreased use of alcohol following their initiation and subsequent addiction to heroin, and in their increased use of alcohol during periods of outpatient drug treatment (in both methadone maintenance and drug-free programs) and following the cessation of addiction. The present study had two goals: 1) to test the generalizability of our earlier finding by using a different addict sample, and 2) to examine variations in lifetime patterns of alcohol and heroin according to addicts' gender and ethnicity. We expected to find an inverse relationship between alcohol use and heroin use for male and female addicts from both ethnic groups.
GENDER AND SUBSTANCE USE:
While interest in the use of multiple substances by narcotics addicts has been increasing (6, 10, 13, 19, 27, 29, 30, 37, 45), the limited empirical literature available has focused almost exclusively on males. Even though female addicts comprise 20 to 25% of the addict population (43, 68) and at least 20% of the alcoholic population (8), there are still very few studies on female narcotics addicts (15, 25, 43, 47, 68, 72), and even fewer studies comparing alcohol and heroin use by male and female addicts.
Research on the relationships between gender and substance use is crucial, given the fact that "among women needing mental health support services, drug and alcohol use problems rank second only to depressive illness" (56). But, in fact, evaluating gender-related differences and commonalities in substance use has become a prominent research goal only in the past decade, partly because of the previous undenepresentation of women in treatment programs and the often erroneous assumption that data on men's substance use are generalizable to women. Consequently, data on substance use among women have been obtained primarily from national household surveys (48, 49), large-scale data collection systems maintained by federal agencies, and school and college surveys (34) rather than in more focused research efforts. A particularly well-documented pattern of substance use in the general population is that men use both illicit drugs and alcohol more often than women, while women use licit (prescription) drugs more often than men (17, 23, 32, 54, 58, 61, 66, 70). This pattern appears to be relatively stable over time, although there are some indications of converging degrees of male and female substance use in the general population (14).
While data on substance abuse among the general population are readily available, comparisons of gender-related differences in substance use among narcotics addicts are generally difficult to perform. Complicating the evaluation of gender-related differences of substance use are methodological flaws in the research, including problems in conceptualization, definition of terms, research design, sampling procedures, instrumentation, and techniques of data analysis (12, 20). Nevertheless, there are sufficient data on gender-based patterns of heroin use to suggest that among the addict population, initial differences in substance use between men and women tend to decline following addiction to narcotics. For example, in the general population, men use illicit drugs more often than women, but studies of heroin addicts suggest that these differences are not pronounced in this group. Once women become addicted, they use at least as much heroin and other drugs as men do (18, 32, 53, 65).
There are, however, some gender-specific differences in the process of becoming addicted to heroin. For example, men are usually initiated into heroin use by male peers and men often initiate women into drug use (33, 70). Women are most often introduced to heroin by their male lovers or spouses, although a fair number of women are initiated by female peers (22, 33, and 59). Following initiation of use, it appears that women become addicted at a faster rate than men and that their levels of heroin consumption tend to be equivalent or greater (59). The occurrence of narcotics addiction in women has greater than before at a faster rate than it has in men over the past 2 decades as suggested by a number of evidences.