For several decades, research into rates of addiction and substance abuse treatment involved male-dominant studies. In the 1990s, however, rates of reported substance abuse and admission to treatment centers among men and women began to change, and researchers realized that substance abuse and addiction were serious problems among women, not just men. For the past 20 years, scientific studies have attempted to close the gap in knowledge on addiction and successful treatment between men and women, and illuminate some of the unique biological, environmental, and psychological issues that women face when they struggle with substance abuse. Although men are typically three times more likely to struggle with substance abuse and addiction, women also experience serious consequences from substance abuse problems.
This field of study has led to a better understanding of the unique needs of male and female populations entering treatment and addiction recovery programs. Women more often need help with childcare and children’s health, since they tend to be primary caregivers. Biological differences such as hormones and muscle mass mean that women and men react differently to different intoxicating substances. Different types of social pressure lead women to abuse different drugs, and higher rates of domestic violence, depression, and anxiety lead women to need more focus on treatment for co-occurring disorders.
Alcohol and Drug Abuse: Women vs. Men
Addictive substances are abused at different rates by men and women, and they affect women differently than they affect men. Here are some common substances of abuse and the gender differences associated with them:
- Alcohol: This is the most commonly abused substance among people struggling with addiction. Roughly 20 percent of men struggle with alcohol abuse, while around 12 percent of women abuse alcohol. However, as with other addictive substances, women are more likely to become addicted to alcohol faster than men, which is called telescoping. Women tend to weigh less and have a higher percentage of body fat than men. This means that alcohol affects women’s physiology faster, so they get drunk faster, and the drug is not flushed from women’s bodies as fast as it is from men’s bodies. Women are less likely to enter treatment to overcome alcohol abuse compared to men, but once women are in these programs, they succeed at the same rate as men. Women are also more likely to remain sober and avoid relapse, compared to men.
- Nicotine: In a 2008 study, 71 million Americans reported that they used tobacco, typically by smoking cigarettes. This divides up into about 35 percent of men and 23 percent of women in the country. Some medical studies suggest that men are more responsive to the physical sensations of smoking, while women typically experience cravings based on social or environmental cues. The study also found that women had a more difficult time quitting, despite experiencing more negative health consequences, especially long-term. Women are more likely to develop lung cancer or a heart condition that leads to a heart attack. Smoking also contributes to an increased risk of breast and ovarian cancers.
- Stimulants (amphetamines): Rates of addiction to cocaine or methamphetamine are equal among men and women. However, women appear to be more likely to try stimulants at a younger age than men, particularly cocaine. Women are also more likely to relapse into stimulant abuse after going through a treatment program.
- Marijuana: Men are three times more likely to regularly use marijuana on a daily basis. However, some initial studies suggest that women are more likely to suffer negative effects when abusing marijuana, such as increased paranoia and depression, and they are also more likely to become dependent on marijuana.
- Opioids: Men are more likely to abuse heroin, but women are more likely to struggle with prescription painkillers like oxycodone and hydrocodone. This is, in part, because women are more likely to receive prescriptions for painkillers to manage chronic pain. Women report higher rates of fibromyalgia than men, for example, so they receive more treatment for these conditions. Since women are exposed to prescription opioids more often, they are more likely to become addicted to these drugs than men. According to the Centers for Disease Control, in 2013, one in three women who went to the emergency room due to overdose had abused prescription painkillers.
- Sleep aids and other prescriptions: Women are generally more likely than men to seek help for sleep disorders, depression, anxiety, post-traumatic stress disorder, and other conditions. This puts them at greater potential risk for developing addictions to benzodiazepine medications, which are commonly prescribed for anxiety, panic attacks, and insomnia. They are also more likely to become addicted to barbiturates, tranquilizers, and nonbenzodiazepine sleeping pills. Women over the age of 45 are more likely than younger female populations to abuse these medications. About 3.5 million women in the US in 2013 struggle with an addiction to prescription medications.
- Illicit drugs: These include heroin, methamphetamine, ecstasy and MDMA, as well as synthetic drugs like bath salts. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), in 2014, 15.8 women in the US over the age of 18 reported using illicit drugs in the past year.
Why Do These Patterns Emerge?
The biological and environmental reasons that trigger addiction in men and women are different. Men are more likely to abuse and become dependent on intoxicating substances to elevate their mood and to cope with behavioral problems like antisocial personality disorder. Women typically become dependent on and addicted to substances to cope with emotional stress, depression, anxiety, or trauma. Women are more likely to abuse substances to lose weight or due to social pressure. Women are also less likely to administer substances like steroids, which could bulk them up. Women struggle more often with two triggers for addiction:
- Intimate partner abuse, sexual abuse, and domestic violence: Women are more likely than men, in general, to be the victims of intimate partner abuse, sexual harassment and abuse, and domestic violence. This can lead to social isolation, a lack of emotional support, and post-traumatic stress disorder. Women who abuse drugs are more likely to become victims of sexual assault, and they are also more likely to use substances to self-medicate after surviving a sexual assault or violence. Substance abuse is also a form of intimate partner abuse. Women who struggle with addiction report being initiated into “drug culture” by partners more often, compared to men.
- Co-occurring mental health concerns: Aside from intimate partner and sexual abuse issues, women are generally more likely to report experiencing mental health issues, such as depression, anxiety, eating disorders, and phobias. Women who struggle with addiction more often report experiencing low self-esteem than men. This can lead women to “self-medicate” with alcohol, nicotine, prescription medications, or illicit drugs. However, women are also more likely to experience negative emotional and mental side effects from consuming intoxicating substances, so this population is more likely to trigger mental health concerns from consuming too much alcohol or drugs. The Center for Substance Abuse Treatment (CSAT) reports that women struggling with co-occurring disorders abused substances differently than men with co-occurring disorders: 46 percent of women abused alcohol primarily; 18 percent abused opiates in some form; 17 percent abused cocaine specifically; 10 percent abused marijuana; 4 percent abused other stimulants like MDMA or meth; and 4 percent abused other drugs. Unfortunately, women who struggle with a co-occurring mental health and substance use disorder are less likely to find a treatment program that addresses both disorders.
Women also struggle uniquely with issues around pregnancy and raising children.
- Pregnancy: Women who struggle with addiction to a substance are more likely to experience sexual assault and engage in risk-taking behaviors, which put them at a higher risk of becoming pregnant. Women who abuse substances while pregnant are more likely to suffer a spontaneous miscarriage, or have a premature child, a child with low birth weight, or a child with fetal abnormalities. Women who are pregnant and struggling with substance abuse problems are disproportionately likely to be arrested and incarcerated, which makes this population less likely to seek help. Fortunately, several states in the US now prioritize pregnant women’s admission into drug treatment programs, without fear of arrest. Women are not likely to begin abusing substances after becoming pregnant, but instead become pregnant while struggling with addiction.
- Childcare: Women who struggle with substance abuse issues are more concerned about the negative impact their treatment may have on their family, so mothers are less likely to report their concerns involving intoxicating substances. This is in part due to their chance of being incarcerated and losing custody of their children. In many cases, women are the sole caregivers for their children, and entering treatment means they will be away from home. Without additional support to take children to school or childcare, women are unable to safely leave their homes for extended periods of time. Women taking care of children are also less likely to have the financial resources to enter treatment.
Women-Focused Treatment and Recovery Programs
Treatment programs focusing on women must consider women’s unique experiences with childcare, social pressure, abuse, and stigma when considering therapies. Although everyone with a physical addiction must go through detox, women often respond to different types of therapy and social support than men do.
Women are typically referred to treatment programs through different avenues. Men are much more likely to be referred into a substance abuse treatment program through the criminal justice system (40 percent for men, 28 percent for women); however, women are more likely to seek help through community services, mental health services, or welfare agencies (15 percent of women, 6 percent of men). This could be in part because women are more likely than men to seek help for mental health concerns, and it is also likely due to women’s concern for their children’s safety.
Although there are not enough studies to state definitively which types of therapy work better for men compared to women, preliminary research suggests that supportive therapies work better for women overcoming addiction. Creating a treatment environment that is nurturing and supportive, rather than confrontational, helps women more, whether they enter individual therapy, family therapy, or group therapy.
Once in treatment, women are as likely to stay in rehabilitation as men, and they are more likely to maintain sobriety. This is especially true of women who have children; they have more outside motivation to maintain their health and wellbeing.
With several differences in treatment, it is important for doctors and clinicians to understand that female patients have different needs and underlying causes when it comes to addiction. Family members and friends can also benefit from this knowledge, so they know how to approach women they are concerned about.
As researchers examine the evidence, treatment programs are growing and changing to accommodate more individual needs and less likely to prescribe one type of therapy for everyone entering treatment. Addiction treatment today means more individualized attention and personal care from doctors and rehabilitation programs, which makes the care provided increasingly effective.