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

Male-biased drug use is a consistent finding in contemporary epidemiology, yet it remains unclear whether this pattern reflects universal features of human behavior or is primarily a product of industrialization, commercialization, and recent socio-political change. Because most “global” evidence derives from urban or industrialized populations, little is known about how gendered substance use unfolds across small-scale, rural, and Indigenous societies. To address this gap, we systematically examine ethnographic evidence of female psychoactive substance use across 171 societies in the Standard Cross-Cultural Sample.Using 1,397 drug-by-document cases identified in the Human Relations Area Files OCM category 276 (“Recreational and Non-Therapeutic Drugs”), we document (1) the prevalence of male and female drug use; (2) regional and subsistence variation; (3) substances most frequently associated with female use; and (4) the cultural contexts of women’s consumption, identified through text analysis and exploratory factor and cluster analyses.Findings reveal a robust cross-cultural pattern: women’s drug use is consistently less frequent and more culturally regulated than men’s. Gender disparities appear in every world region and subsistence system, though with varying magnitude in part due to the density of ethnographic reporting. Textual descriptions most often situate women’s use in low-dose, domestic, and socially embedded contexts. Exploratory factor and cluster analyses identify four latent domains structuring female drug-use contexts – prestige-regulated substances, ceremonial and social-sharing practices, medicinal and low-intensity uses, and high-risk entheogenic rites – highlighting the culturally patterned environments in which women’s drug use occurs.These findings provide the first global, ethnographically grounded test of whether low female drug use is a cross-cultural regularity and establish the empirical basis needed to evaluate biocultural, political-economic, and evolutionary explanations of gendered substance use.