Why gender matters in addiction treatment and relapse care

Gender differences in substance use disorders (SUDs) are well documented globally; however, evidence from psychiatric inpatient populations in sub-Saharan Africa remains limited. In Nigeria, sociocultural norms, stigma, and structural barriers may differentially influence treatment access, clinical presentation, and outcomes among men and women with SUD. This study examined gender differences in substance use patterns, psychiatric comorbidity, treatment outcomes, and relapse among psychiatric inpatients in Nigeria. This retrospective study reviewed the medical records of adults admitted with a primary diagnosis of SUD to a tertiary psychiatric hospital in southeastern Nigeria between 2018 and 2024. Analyses compared male and female patients based on sex as recorded in the clinical records. Data on substance use patterns, psychiatric comorbidity, treatment outcomes, and relapse within six months after discharge were extracted and analyzed using bivariate statistics and multivariable binary logistic regression. A total of 286 patients were included, the majority of whom were male. Men were more likely to present with cannabis use, polysubstance use, and longer durations of substance use, whereas women more commonly presented with opioid use and shorter durations of use. Psychiatric comorbidity was common in both groups, although psychotic disorders predominated among men and anxiety disorders among women. Female patients had longer hospital stays and were more likely to achieve planned discharge following clinical improvement, whereas male patients had higher rates of discharge against medical advice and relapse within six months. Male sex remained independently associated with relapse after adjustment for age, duration of substance use, psychiatric comorbidity, and polysubstance use. Important gender differences were observed in the clinical presentation, treatment outcomes, and relapse of psychiatric inpatients with SUD in Nigeria. These findings support the implementation of gender-responsive addiction services that improve treatment access for women while strengthening relapse prevention, discharge planning, and continuity of care for men.