Sex differences in self-reported executive function, anxiety and depression symptoms among young adults in substance use disorder treatment

Introduction Substance use disorders (SUD) are more prevalent among males than females, but recent evidence suggests this gap is narrowing. This shift highlights the need to better understand sex differences in cognitive and psychological characteristics among individuals with SUD. This study aims to explore sex differences in self-reported executive functioning and psychological distress and their associations with severity of SUD symptoms among young adults in SUD treatment.Methods Data were collected from 97 inpatients (mean age = 23.3 ± 2.6 years) at a SUD treatment center for young adults in Oslo, Norway. Within two weeks of admission, participants completed questionnaires evaluating alcohol and drug-related problems, executive functioning, and psychological distress at intake. These measures were compared between males and females using Welch's t-tests, and the relationships between psychological distress and executive function and severity of drug-related problems were evaluated using Spearman's correlations and linear regression in the whole sample and within each sex.Results Both males (n = 65) and females (n = 32) reported high levels of polysubstance use. A majority of the sample scored above the clinical cut-off levels for executive dysfunction (71%) and psychological distress (85%). Females reported more executive function challenges than males in several areas including emotional control (pFDR FDR = 0.003). Regression analyses demonstrated associations between increased executive dysfunction and psychological distress and severity of drug use disorder in the whole sample and among males.Conclusion These findings emphasize the high psychiatric comorbidity among SUD patients, with females showing elevated executive dysfunction alongside anxiety symptoms. Females in SUD treatment may represent a more clinically severe subgroup. Routine assessment of executive functioning is warranted, and future studies should clarify these associations and their relevance for targeted interventions.