The objective and aim of this case-control study was to replicate an earlier finding of a significant relationship between prenatal exposure to famine and substance use disorders later in life and to examine the sex ratio at birth in the study populations. We compared the number of addicted individuals in a population prenatally exposed to a severe hunger period with matched individuals in a non-exposed population. The gender distribution of patients with substance use disorders and healthy controls were calculated and all data were quantified as odds ratios. The findings confirm that prenatal exposure to famine is a risk factor to develop substance use disorder later in life. Men are at risk in particular by exposure to famine during the first trimester, women by exposure during the third trimester. The sex ratio men to women at birth was 3 : 1 in the patient groups compared to 1:1 in the healthy controls. The results were discussed in the light of the possible disastrious future consequences for the hunger regions in our world.