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Changes in women's social role over the past years likely influenced the gender gap in substance use and substance-related disorders, with potentially significant prevention and treatment implications. The authors reviewed the literature about gender differences in prevalence estimates and course of substance-related disorders. Male-to-female ratios of prevalence estimates of substance use are narrowing in different countries. The initiation of substance use is progressively taking place at younger ages, the trend being more dramatic among women as compared to men. Women's accelerated progression to dependence (so-called "telescoping effect") is a robust finding among alcohol-dependent individuals, although the effect seems to be weaker among younger individuals. As for other drugs, the literature is weaker and further research is needed. It is concluded that women's earlier age of initiation of substance use, faster progression to dependence and under-representation in addiction treatments should be addressed in future health care planning.