Among the strengths of our study is the larger number of the MA subjects included in the analysis compared to other studies to date. To our knowledge, our study is also the first to examine the severity and symptoms of MA-dependence, as well as MA-dependence associated factors according to sex. These findings may be important implications for sex-specific approaches to the treatment of MA users in Thai substance treatment centers, and perhaps in other populations as well. For example, if replicated, particular attention to the symptomatic management of MA withdrawal in females may be warranted or, in terms of policy, the government should provide a strategy to carefully monitor female MA-users based on the results showing that females were more likely to be MA dependent and to use MA more heavily than males. In addition, greater research into the shared association of, nicotine dependence, in both sexes, seems warranted. Certainly, there are some limitations that need to be considered in the context of the current study, including the non-systematic sampling approach alluded to above as well as the relevant secular
