**Preface to "Sex, Gender and Substance Use"**

Welcome to this special collection of articles on Sex, Gender and Substance Use. While substance use research, prevention and treatment have been ongoing for decades, sex and gender science is in its relative infancy, with much work yet to be done on integrating sex and gender considerations into substance use research, practice and policy.

Substance use is a significant global public health issue. Its impact on individuals, families, communities, health and criminal justice systems, social cohesion, and governments is costly, sometimes deadly, and often experienced as intractable. Substance use is viewed through many different lenses, including moral, legal, social and psychological. It can also be viewed as a personal problem, a social or economic issue, a cultural practice and/or a criminal activity. Each of these lenses often leads to different social and legal responses, and very different understandings of the dynamics of substance use.

In all cases, however, substance use needs to be viewed with a sex and gender lens in order to fully understand and to respond to it most effectively. Sex-related factors affect how female and male bodies respond to substances, treatments and often differentially develop related diseases and conditions. These factors include hormones, anatomy, metabolism, reproductive systems, genetics and organ function. Such factors differentially affect safe levels of use, speed to intoxication or dependence, and responses to pharmaceuticals, therapeutics, etc. Recognizing such sex-related differences has led to sex-specific health advice regarding safe levels of alcohol consumption, for example. It is now established that females should drink less than males for these reasons.

Gender-related factors are somewhat more temporal and culturally driven, but no less impactful on substance use patterns, prevalence and responses to policy and treatment. Issues such as gender roles and norms, identities, and institutional gender regulations and laws affect the consumption practices of women and men, girls and boys, and gender diverse people. Such factors act on both men and women to differentially affect who takes up substance use, how they access substances and their subsequent patterns and trends. Noting these gender-related factors leads us to consider issues such as power and decision-making differences between men and women in relationships, high rates of substance use among gender minorities and the different impacts of gendered marketing of legal substances such as alcohol and tobacco on women and men. Such research has established, for example, that men use substances more than women and in higher quantities and may be affected by dominant masculinities that increase risk taking and decrease help seeking.

In this Special Issue Book, the authors address and report on sex, gender and sex-gender interactions in detail, and apply them to the analysis of prevalence and trends, interventions and programs, and substance use disorders. These papers consider legal and illegal drugs including alcohol, nicotine, cannabis, opioids and polydrug use, and draw on data from many different countries and cultures. They explore different gendered roles such as fathers, mothers, pregnant women and adolescents. The authors consider the interactions of substance use with other issues, such as intimate partner violence and abortion policy, as well as tailored treatment programs. In summary, the articles in this issue reflect just some of the many ways in which sex and gender affect substance use and responses to substance use.

> **Lorraine Greaves** *Editor*

International Journal of *Environmental Research and Public Health*
