Female Drug Use in the Ethnographic Record: A Cross-Cultural Analysis of Presence, Variation, and Cultural Context

Abstract

Male-biased drug use is a consistent finding in contemporary epidemiology, yet most global evidence derives from urban and industrialized populations. As a result, little is known about gendered substance use in small-scale societies, leaving unresolved whether male-biased drug use reflects universal features of human behavior or is primarily a product of industrialization. To address this gap, we examine ethnographic evidence of female substance use across 171 societies in the Standard Cross-Cultural Sample using 1397 ethnographic cases from the Human Relations Area Files. We document the presence of male and female drug use descriptions, regional and subsistence-based variation, substances associated with women’s use, and the cultural contexts in which female consumption occurs. Results reveal that women’s drug use is consistently less frequent and more culturally regulated than men’s across all world regions and subsistence economies, with variation in magnitude. Exploratory factor and cluster analyses identify four domains structuring female drug-use contexts: prestige-regulated substances, ceremonial and social practices, medicinal use, and high-risk entheogenic rites. Together, these findings demonstrate that low female drug use is a cross-cultural regularity while highlighting patterned variation in the contexts of women’s consumption, providing a comparative foundation for evaluating biocultural, political–economic, and evolutionary explanations of gendered substance use.