Risk Factors
Men were once the only persons studied and treated for substance abuse. However, a 2013 Substance Abuse and Mental Health Services Administration (SAMHSA) survey of 67,500 individuals reported that 5.8 percent of the surveyed women aged eighteen and older had past-year substance dependence or abuse, indicating the need for studies of women and substance abuse. In addition, women account for approximately 33 percent of persons seeking treatment, making them the fastest growing population of substance abusers in the United States.
Women generally turn to substance abuse for different reasons than do men. Women often seek the comfort of a substance to help deal with a psychological diagnosis, such as anxiety, depression, post-traumatic stress disorder, or an eating disorder. Men typically abuse substances secondary to impulsive or aggressive behavior problems. Women also abuse more frequently than men to deal with social concerns and pressures, such as family stressors or a traumatic event, including physical, sexual, and emotional abuse. Women who abuse substances are more likely to be in a relationship with another substance abuser or in a relationship in which their partner is in control.
The female body reacts differently to substances than does the male body. Although less likely overall to develop an addiction, women who do become addicted do so faster and develop medical concerns more rapidly than do men. Women do not present for treatment as frequently as men because of gender-related barriers.
Women who use substances are more likely than men to have children, to be unemployed, and to receive medical assistance. Other risk factors for substance abuse are young age and lower educational status. These differences lead to unique barriers to treatment, including financial concerns, fear of being stigmatized by society as weak or helpless, feeling guilt or shame, and concerns of losing child custody.
Alcohol Abuse
In comparison to men, women drink alcohol less frequently. When women drink, they are more likely to engage in binge drinking, defined as five or more drinks on one occasion, than to engage in heavy constant alcohol consumption, defined as five drinks per day over several days. Alcoholism is underdiagnosed in women because of the public perception that most alcoholics are men.
Women who abuse alcohol have more health concerns related to its use than do men because of the way a woman’s body processes alcohol. A woman absorbs and metabolizes alcohol differently because she has a higher concentration of alcohol in the blood; has less of the enzyme called alcohol dehydrogenase, which metabolizes alcohol; and has larger amounts of estrogen, which may increase the risk for liver disease. These factors cause higher levels of alcoholic hepatitis after a shorter duration of drinking and a greater proportion of deaths from cirrhosis of the liver. Women, are twice as likely as men of developing alcoholic hepatitis. Women alcohol abusers also have an increased risk for heart disease, breast cancer, osteoporosis, gastric ulcers, and neurological complications.
Teenage girls are particularly sensitive to the effects of alcohol because the alcohol decreases levels of hormones, including estrogen. Normal growth and timing of puberty might be delayed by alcohol abuse during these formative years.
Another significant health issue is alcohol consumption during pregnancy
, whereby the fetus becomes at risk for developing either fetal alcohol syndrome or fetal alcohol effects. No safe level of alcohol consumption has been determined for pregnancy, and all women are discouraged from drinking any form of alcohol through gestation.
Fetal alcohol syndrome compromises a constellation of symptoms, such as mental retardation and birth defects that include congenital heart problems, behavioral problems, and characteristic facial features. The greatest risk for fetal alcohol syndrome occurs when there is heavy alcohol consumption through the entire pregnancy.
Fetal alcohol effects generally occur when there have been lower levels of alcohol consumption; these effects may include some findings of fetal alcohol syndrome. Women who are older, educated, and in better economic standing are at greatest risk for increasing alcohol consumption in pregnancy. Teenagers who drink before pregnancy are most likely to continue drinking during pregnancy.
Drug Abuse
Female substance abusers who enter treatment are more likely to use drugs than partake in heavy alcohol consumption. Methadone, the primary abused drug for which women seek treatment, may be categorized as an illicit substance or as an abused medication (such as a psychotropic prescription). Women are more likely than men to be prescribed psychotropic medications for an underlying mental illness.
Women metabolize a drug’s components at a slower rate than do men. The prolonged exposure to these toxic ingredients leads to an increased risk for health concerns. Women who abuse drugs often experience irregular menstrual cycles and decreased fertility because of the suppression of endocrine and sex hormones. Although both men and women drug users are at risk for contracting an infectious disease from shared needles, women infected with the human immunodeficiency virus show a more rapid progression to acquired immunodeficiency syndrome than do men. Drug use also suppresses the immune system and allows for more rapid viral replication.
As with alcohol abuse, drug use in pregnancy is of utmost concern because of the risk for birth defects and disorders and adverse pregnancy outcomes. The primary substances reported to be used during pregnancy include heroin, cocaine, crack cocaine, marijuana, and amphetamine. Abuse of these substances leads to pregnancy complications that include miscarriage, low birth weight, premature delivery, intrauterine fetal demise, and stillbirth. These substances also can lead to neonatal dependence, meaning the baby is born addicted to the substance the mother used during pregnancy, from which the newborn must endure medical detoxification and remain in the hospital for an extended time because of withdrawal. Social services will often remove the newborn from the mother's home because of this exposure. Newer research suggests an increased risk for the child to have developmental delays, both motor and cognitive.
Prevention and Treatment
Women’s risk factors must be addressed to successfully target the specific needs of women in treating substance abuse. Even though women and men do similarly well in completing treatment, the challenge is women’s access to treatment.
Often women underestimate the role alcohol or drug abuse plays in contributing to their illness, and they overestimate the contribution of the mental illness to their medical and emotional concerns. It is important to address both the substance abuse and the additional comorbid psychological diagnoses. This may be accomplished by a combination of psychotherapy and pharmacotherapy.
Women often feel uncomfortable sharing their experiences in the company of men; therefore, many treatment centers offer gender specific and gender separate programs. Women are also more likely to have a negative perception of treatment, and specific centers have specially trained therapists and physicians who are sensitive to and aware of the unique challenges in treating female substance abusers. These facilities also have accommodations for increased access to care. For example, provision of childcare at the site of treatment relieves the financial burden of paying for this service and the worry of having to care for children while in recovery.
Transportation services to and from the treatment facility also increase the likelihood of arrival for routine appointments, as it alleviates the recovering addict’s financial and logistical burden of travel. As part of the treatment process, education about substance abuse in pregnancy should be provided for current or future mothers, education that includes discussion of the risks for birth defects and disorders and other adverse pregnancy outcomes.
Data indicate that while the aforementioned services would benefit women in treatment, only a minority of treatment centers actually have these accommodations. Because of the psychological and emotional risk factors, the significant and life-threatening health effects, and the barriers to treatment, further research is needed to better understand the implications of substance abuse in women and the best methods for treatment and prevention.
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