Women are the fastest-growing segment of alcohol and drug users in the United States. In fact, up to 4.5 million women over age 12 in the U.S. have a substance use disorder, 3.5 million misuse prescription drugs, and 3.1 million regularly use illicit drugs. Each year, over 200,000 American women die as a result of alcoholism and drug dependence, with more than 4 million women in need of treatment for their addiction.
While men continue to outnumber women in terms of overall alcohol and drug use, the gender gap has been narrowing. Among girls ages 12-17, the nonmedical use of prescription painkillers, alcohol, methamphetamine, and most other illicit drugs now matches or exceeds that of boys (SAMHSA).
This trend is alarming as women progress faster than men into addiction, even when using a similar or lesser amount of substances, and ultimately suffer more health-related consequences. And, while addiction is an equal opportunity disease, women become addicted differently, start using for different reasons, progress faster, recover differently, and relapse for different reasons than men.
Gender Differences and Alcohol
The female body processes alcohol differently than the male body does. Overall, women tend to weigh less than men, and a woman’s body contains less water and more fatty tissue than a man’s. Because fat retains alcohol while water dilutes it, a woman’s organs sustain greater exposure to the effects of alcohol.
In addition, women have lower levels of specific enzymes that break alcohol down in the stomach and liver. As a result, women absorb more alcohol into the bloodstream. Therefore, the blood alcohol concentration (BAC) will be higher in a woman than a man. That's why one drink for a woman is said to have twice the physical impact as one drink for a man.
Typically, women progress from first use of cocaine, heroin, or marijuana to dependence more quickly than men, and when women do develop drug dependence, they report problems of greater severity and experience more health-related consequences. The pathways leading to drug addiction differ for men and women and the beginning of women's drug-using careers are often related to their relationships with men. Research has also shown that at least 70 percent of women drug users have been sexually abused by the age of 16, and most of these women had at least one parent who abused alcohol or drugs.
For women, the health risks of drug use also go beyond the effects of the drugs themselves. Illicit drug use (such as heroin, cocaine or marijuana) often leads to behavior that puts women at increased risk for sexual assault, HIV, hepatitis and other sexually transmitted diseases.
Abuse of substances such as stimulants, opioids, and some prescription and over-the-counter drugs can cause adverse effects on a woman’s menstrual cycle, gastrointestinal, cardiac, and neuromuscular systems, and a woman’s hormone cycles can cause stronger cravings for drugs at certain times of the monthly cycle.
Social and Environmental Factors
Biology aside, addicted women often have more to juggle than men with similar problems. They’re more likely to live with their children and to have to navigate the child welfare system. Addicted women are more likely than their male counterparts to have sexual and physical abuse histories, and women are twice as likely as men to suffer from mood disorders such as depression along with their addiction, which affects treatment outcomes.
Addicted women also face tremendous stigma which keeps many from getting the help they need.
Alcohol, Drugs and Pregnancy
Alcohol and drug use by pregnant women is associated with numerous complications: spontaneous abortion, prematurity, low birth weight, fetal abnormalities, neonatal abstinence syndrome, and premature separation of the placenta from the uterine wall. Considerable research on alcohol use and pregnant women points out the significant risk of fetal alcohol spectrum disorder (FASD), which involves growth retardation, central nervous system/neurodevelopmental abnormalities, and craniofacial abnormalities.
Drug use early on in pregnancy can affect the developing organs and limbs of the fetus. Even one episode of drug use during this period can affect the development of a child. Often the result is a birth defect or miscarriage. Drug use later in pregnancy can affect development of a baby's central nervous system; and after pregnancy, many drugs can pass through breast milk and harm the baby.
For her own health and the health of her baby, a woman should avoid using alcohol and all drugs, legal and illegal, unless prescribed by her physician, from the time she plans to become pregnant or when she becomes pregnant.
Women and Prescription Drugs
The 2013 National Survey on Drug Use and Health (NSDUH) estimated that 6.5 million Americans misused or abused prescription drugs within the past year. More than half of them were female.
In general, women visit doctors more than men and are more likely to use prescribed medications (such as pain relievers, sleeping pills, tranquilizers). Many of these medications, especially pain relievers, are short-term solutions to temporary problems, though many women have had such prescriptions refilled for decades. As a result, a medication that was originally prescribed for a temporary anxiety or pain problem and has been used continuously for years can now pose a serious risk for physical addiction.
Prescription painkiller overdoses are an under-recognized and growing problem for women, and according to the CDC, deaths from prescription painkiller overdose among women have risen sharply. This rise relates closely to increased prescribing of these drugs over the past decade.
Implications for Treatment
The emotional and spiritual damage done by addiction runs deep, and when a woman is addicted it can impact the entire family system.
In treatment, just as each patient’s needs are unique and a treatment program must be tailored to address those particular needs, attention also must be paid to the special needs of women. What works for men in treatment doesn’t always work the same way for women.
Treatment experts agree that substance abuse treatment for women needs to be approached from the perspective that includes the context of the women’s lives. These include her relationships with family, extended family, and support systems, social and economic environment, and the impact of gender and culture.
Some key indicators of a woman who may be in trouble with alcohol:
- Missing work or skipping child care responsibilities
- Drinking in dangerous situations, such as before or while driving a motor vehicle, transporting kids, etc.
- Being arrested for driving under the influence (DUI/DWI)
- Hurting someone while drinking: emotional/physical abuse
- Continuing to drink even with ongoing alcohol-related tensions with family, friends, workplace, partners
- Increase in the craving for alcohol and the compulsion to drink
- Losing control and the ability to stop drinking once begun
- Experiencing withdrawal symptoms after stopping drinking: nausea; sweating; shakiness, anxiety
- Developing a higher tolerance and having to consume more and more alcohol to get a “high”
There are many signs, both physical and behavioral, that indicate drug use. Each drug has its own unique manifestations but there are some general indications that a person is using drugs:
- Sudden change in behavior
- Mood swings; irritable and grumpy and then suddenly happy and bright
- Withdrawal from family members
- Careless about personal grooming
- Loss of interest in hobbies, friends, and other favorite activities
- Changed sleeping pattern; up at night and asleep during the day
- Red or glassy eyes
- Sniffly or runny nose