When it comes to addiction, sex matters. A new brain imaging study by Yale School of Medicine researchers suggests stress robustly activates areas of the brain associated with craving in cocaine-dependent women, while drug cues activate similar brain regions in cocaine-dependent men. The study, expected to be published online Jan. 31 in the American Journal of Psychiatry, suggests men and women with cocaine dependence might benefit more from different treatment options.

"There are differences in treatment outcomes for people with addictions who experience stress-induced drug cravings and those whose cravings are induced by drug cues," said Marc Potenza, professor of psychiatry, child study, and neurobiology and first author of the study. "It is important to understand the biologic mechanisms that underlie these cravings."

The researchers conducted functional magnetic resonance imaging scans of 30 cocaine-dependent individuals and 36 control subjects who were recreational drinkers. While undergoing brain scans, researchers then presented subjects with personalized cues (situations or events) the participants had indicated were personally stressful and other cues involving cocaine or alcohol.

As expected, cocaine-dependent individuals showed greater activation in broad regions of the brain linked to addiction and motivation than the control subjects. Patterns of activation between the groups, however, differed markedly in men and women when presented with stress or drug cues.

Potenza said the findings suggest that women with cocaine dependence might benefit from stress-reduction therapies that specifically target these cravings. Men, on the other hand, might derive more benefit from elements of cognitive behavioral therapy or 12-step programs based on the principles of Alcoholics Anonymous.

The senior author of the paper is Rajita Sinha of Yale. Other Yale authors are Kwang-ik Adam Hong, Cheryl M. Lacadie, Robert K. Fulbright, and Keri L. Tuit.

The study was supported by the Yale Stress Center, Women's Health Research at Yale, the Connecticut Department of Mental Health and Addiction Services, and grants from the National Institutes of Health and its Office of Research on Women's Health.