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AIM – While gender differences in substance use/problems have been found to be smaller in more gender-equal countries such as Sweden, gender-specific norms still prevail, and women’s (mis)use continues to be more condemned than men’s. This article analyses and discusses similarities and differences between the sexes in alcohol and drug treatment in terms of men’s and women’s treatment experiences, consumption/problems, social situation, and life-domain problems. METHOD – 1865 respondents were interviewed (structured interview) at the beginning of a new treatment episode in 2000–2002 in Stockholm County (sample representative of those starting a new treatment episode for alcohol or drug problems in Stockholm County). Responses are cross-tabulated by sex and multivariate logistic regression is used to predict whether men or women have more severe problems in various life domains of the Addiction Severity Index (ASI composite scores). RESULTS – Bivariate analyses showed that women and men differ significantly in their treatment experiences. Women are more likely to have contact with mental health services, whereas men tend to deal more with the criminal justice system. The sexes do not differ in alcohol and drug problem severity, but women are more likely to have problems with pharmaceuticals. In contrast to the hypothesis, it turned out that men, not women, are more marginalised as concerns housing, income, family situation, lack of friends. Women report more problems related to family, social life and mental/physical health, while men report higher criminality and financial problems. CONCLUSIONS – There are no gender differences among the clients in the treatment system when it comes to substance problem severity but differences occur concerning the clients’ social situation and different life-domain problems. As men are more socially exposed a focus on women may obscure problems among men.

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