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Treatment Programs for Women

For decades, research into addiction and substance abuse treatment involved male-dominated studies. In the 1970s, pressed by the women’s movement, research and services specifically tailored to women’s needs finally began to appear.1

Over the next 30 years, scientific studies have attempted to close the gap in knowledge on addiction and have identified some of the unique biological, environmental, and psychological issues that women face when they struggle with substance abuse and addiction. This has led to a better understanding of the unique needs of male and female populations entering treatment and addiction recovery programs.1

Women and men use drugs for different reasons and respond to them differently.2 Although men are more likely than women to use almost all types of illicit drugs, women are just as likely as men to develop a substance use disorder.3

Today we have a better understanding of the unique needs of male and female populations as they struggle with addiction and enter treatment and addiction recovery programs. To effectively treat women, programs must understand and be equipped to understand the types of physical and emotional trauma women sometimes face, provide assistance and support for childcare needs and use the latest evidence-based approaches for treating pregnant women with substance abuse disorders.2

Alcohol and Drug Abuse: Women vs. Men

In 2018, 21.8 million women reported using illicit drugs (vs. 27.2 million men).4 Addictive substances are abused at different rates by men and women, and they affect women differently than they affect men. Women use smaller amounts of drugs than men, but often feel the effects more strongly.5 Substance use in women develops into addiction more quickly than with men.5

Here are some common substances of abuse and the gender differences associated with them:

Alcohol: Alcohol is the most commonly abused substance among people struggling with addiction. Women are less likely than men to drink heavily or moderately.1 Differences in the way women metabolize alcohol results in women becoming intoxicated from drinking a smaller amount of alcohol than men.5

Women also experience negative consequences when consuming alcohol at lower levels and for shorter periods of time than do men. They are at greater risk of suffering alcohol-related health problems including liver damage, cardiovascular disease and brain damage.1 Alcohol consumption also raises the risk of breast cancer.1

Stimulants (cocaine and amphetamines): Rates of  both cocaine and methamphetamine use are comparable for men than women.6,7

Cocaine affects women differently than it does with men. Women report experiencing a more intense high and can become addicted to the drug more rapidly.8 Detrimental effects on the brain are less likely to appear in women vs. men, however, women are more sensitive than men to cocaine’s effects on the heart and blood vessels.5

Similar to cocaine use, women also experience the effects of methamphetamine more intensely than men do.5 A recent study suggests that women are more likely than men to develop problematic use of methamphetamine and transition from recreational use to dependence more quickly.9 Women addicted to methamphetamine tend to be more receptive than men to treatment for their substance use disorder.5

Marijuana: Men use marijuana more frequently and at higher doses than do women.10 However, women develop a dependence on marijuana that progresses to cannabis use disorder more quickly than men. Women also tend to experience more depressive-like symptoms following marijuana consumption.11 Women who are addicted to marijuana are more likely than men to experience panic attacks and anxiety disorders.11 Women are as equally unlikely as men to seek treatment for marijuana use disorder.5

Heroin and Prescription Opioids: Men are more likely to use heroin—which they use in larger amounts and for a longer time period than women. Men are also more likely to inject heroin.5

Women, however, are more likely to struggle with prescription painkillers like oxycodone and hydrocodone.5 This is, in part, because women are more likely to receive prescriptions for opioid painkillers to manage chronic pain.12 Although more men (9,978) than women (7,109) died from prescription opioid overdose in 2016, deaths from prescription opioid overdoses increased more rapidly for women (596% or sevenfold) vs. men (312% or fourfold) from 1999 to 2016.5

Anti-Anxiety Medications and Sleep Aids: Women are generally more likely than men to experience anxiety disorders13 such as PTSD or OCD and mood disorders14 such as depression. This puts them at greater potential risk for developing addictions to benzodiazepine medications, which are commonly prescribed for anxiety, panic attacks, and insomnia. Women are more likely than men to die from overdoses involving medications that treat mental health conditions, like antidepressants and benzodiazepines.5

Why Do These Patterns Emerge?

There are biological and environmental differences  behind substance use and development of substance use disorders.  Women tend to start using substances due to stress, negative affect, and relationships at higher rates than men. In fact, women’s substance use and treatment patterns are significantly influenced by relationships, relationship status, and the effects of a partner’s substance abuse.15

Risk factors for initiation of substance use and the likelihood that women will develop a substance use disorder include:5,15

  • Having a partner with a substance use disorder.
  • Being separated or divorced.
  • Death of a partner.
  • Never having married.
  • Symptoms of depression and anxiety.
  • Post-traumatic stress disorder (PTSD).
  • Eating disorders, such as bulimia or anorexia.
  • Experiencing discrimination.
  • Being a victim of domestic violence or
  • Losing custody of a child.

Men and women who go to treatment for substance use disorders typically have at least one co-occurring mental health disorders. Women are more likely than men, however, to have 3 or more mental health disorders in addition to a substance use disorder.15 Co-occurring disorders may influence the development of a substance use disorder, or they may develop as a result of one.15

The most common psychiatric disorders found in women with substance abuse problems are:1,15

  • Anxiety disorders (especially PTSD).
  • Mood disorders.
  • Eating disorders.
  • Borderline personality disorder.

Reproductive Issues

Substance use can have many effects that effect reproduction, pregnancy and childbirth. Some substances are associated with higher risks of infertility and early onset of menopause.2 Using drugs or alcohol during pregnancy or while breastfeeding can also cause complications and health issues in children.

Pregnant women who use alcohol and drugs, as well as who smoke cigarettes, can pass these drugs along to their fetus and cause harm to their child’s development. Although it’s ideal for a woman to abstain from substance use—including alcohol—before and during pregnancy, evidence shows that treatment for alcohol or drug abuse during pregnancy improves the chances for delivering a healthy baby.1,2

The rates of marijuana use by pregnant women has seen startling increases in recent years.16 In 2017, 3.1% of pregnant women reported daily or almost daily use of marijuana (vs. 1.2% in 2015). This has dropped back down to 1.5% in 2018, still higher than 2015.16 Marijuana use during pregnancy is associated with low birth weight, stillbirth, and preterm birth. It may also cause problems with neurological development, resulting in children suffering from hyperactivity and poor cognitive function.16

Although some survey data report illicit drug use among pregnant women trending down or relatively unchanged,16 the number of amphetamine and opioid-affected births has grown significantly over the last decade.17

Amphetamine-affected births (mostly attributed to methamphetamine) doubled—from 1.2 per 1,000 hospitalizations in 2008-2009 to 2.4 per 1,000 delivery hospitalizations by 2014-2015.17 Babies who were exposed to methamphetamine before birth may be smaller in size and suffer from lethargy as well as heart and brain abnormalities.18

Opioid-affected births quadrupled from 1.5 per 1,000 delivery hospitalizations in 2004-2005 to 6.5 per 1,000 delivery hospitalizations in 2014-2015.17 It’s estimated that 60-80% of infants who were exposed to heroin or prescription opioids while in the uterus will experience symptoms of withdrawal about 48–72 hours after birth. Symptoms and their severity depend on the time, amount and frequency of drug use.19

Treatment and Recovery Programs for Women

Treatment programs focusing on women must consider women’s unique social and economic experiences as well as other factors beyond biological differences in gender.20 These factors have often not been considered as treatment models were designed predominantly around male norms.21 Although everyone with a physical addiction must go through detox, women have specific needs for many factors, including:21

  • Childcare assistance.
  • Pregnancy.
  • Parenting.
  • Domestic violence.
  • Sexual trauma and victimization.
  • Psychiatric comorbidity.
  • Housing.
  • Income support.
  • Social services.

Although there hasn’t been enough research to state definitively which types of therapy work better for women compared to men, treatment centers with the following characteristics may be able to better assist women:1

  • Psychiatric services sophisticated enough to handle the high prevalence of co-occurring disorders in women.
  • Supportive therapies designed around a sensitivity to co-occurring disorders common in women, especially PTSD.
  • Knowledge of and sensitivity to the needs of women who have experienced domestic violence.
  • Proficiency in addressing eating disorders and obesity.
  • Cultural sensitivity and specific attention to differences in race and sexual orientation in addition to gender.

Researchers continue to study gender differences in substance use and treatment for addiction. At the same time, treatment programs are evolving to accommodate every individual’s needs, including those that are gender-specific.

Addiction treatment today means more individualized attention and personal care from doctors and rehabilitation programs, which makes the care provided increasingly effective. When a person in treatment is empowered to help make the decisions related to their own treatment, they will better understand the treatment process and develop realistic expectations of what it means to be in recovery.14

References

  1. Miller, S. C., Fiellin, D. A., Rosenthal, R. N., & Saitz, R. (2019). The ASAM Principles of Addiction Medicine, Sixth Edition. Philadelphia: Wolters Kluwer.
  2. National Institute on Drug Abuse. (2018). Research Report: Substance Use in Women: Summary.
  3. National Institute on Drug Abuse. (2019). Drug Facts: Substance Use in Women.
  4. Center for Behavioral Health Statistics and Quality. (2019). Results from the 2018 National Survey on Drug Use and Health: Detailed Tables.Substance Abuse and Mental Health Services Administration, Rockville, MD.
  5. National Institute on Drug Abuse. (2018). Research Report: Substance Use in Women: Sex and Gender Differences in Substance Use.
  6. Durell, T. M., Kroutil, L. A., Crits-Christoph, P., Barchha, N., & Brunt, D. L. V. (2008). Prevalence of nonmedical methamphetamine use in the United States. Substance Abuse Treatment, Prevention, and Policy, 3(1).
  7. Najavits, L., & Lester, K. (2008). Gender differences in cocaine dependence. Drug and Alcohol Dependence, 97(1-2), 190–194.
  8. National Institute on Drug Abuse. (2017). NIDA Notes: Why Females Are More Sensitive to Cocaine.
  9. Mayo, L. M., Paul, E., Dearcangelis, J., Hedger, K. V., & Wit, H. D. (2019). Gender differences in the behavioral and subjective effects of methamphetamine in healthy humans. Psychopharmacology, 236(8), 2413–2423.
  10. Cuttler, C., Mischley, L. K., & Sexton, M. (2016). Sex Differences in Cannabis Use and Effects: A Cross-Sectional Survey of Cannabis Users. Cannabis and Cannabinoid Research, 1(1), 166–175.
  11. Calakos, K. C., Bhatt, S., Foster, D. W., & Cosgrove, K. P. (2017). Mechanisms Underlying Sex Differences in Cannabis Use. Current Addiction Reports, 4(4), 439–453.
  12. Serdarevic, M., Striley, C. W., & Cottler, L. B. (2017). Sex differences in prescription opioid use. Current Opinion in Psychiatry, 30(4), 238–246.
  13. National Institute of Mental Health. (2017). Mental Health Information: Statistics: Any Anxiety Disorder.
  14. National Institute of Mental Health. (2017). Mental Health Information: Statistics: Any Mood Disorder.
  15. Substance Abuse and Mental Health Services Administration. (2009). Tip 51: Substance Abuse Treatment: Addressing the Specific Needs of Women.
  16. Center for Behavioral Health Statistics and Quality. (2019). Key substance use and mental health indicators in the United States: Results from the 2018 National Survey on Drug Use and Health(HHS Publication No. PEP19‑5068, NSDUH Series H‑54).
  17. Admon, L. K., Bart, G., Kozhimannil, K. B., Richardson, C. R., Dalton, V. K., & Winkelman, T. N. A. (2019). Amphetamine- and Opioid-Affected Births: Incidence, Outcomes, and Costs, United States, 2004–2015. American Journal of Public Health, 109(1), 148–154.
  18. National Institute on Drug Abuse. (2019). What are the risks of methamphetamine misuse during pregnancy?
  19. Centers for Disease Control and Prevention. (2019). Basics About Opioid Use During Pregnancy.
  20. National Institute on Drug Abuse. (2018). Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition): What are the unique needs of women with substance use disorders?
  21. Greenfield, S. F., Back, S. E., Lawson, K., & Brady, K. T. (2010). Substance abuse in women. The Psychiatric Clinics of North America, 33(2), 339–355.
About The Contributor
Ryan Kelley, NREMT
Medical Editor, American Addiction Centers
Ryan Kelley is a nationally registered Emergency Medical Technician and the former managing editor of the Journal of Emergency Medical Services (JEMS). During his time at JEMS, Ryan developed Mobile Integrated Healthcare in Action, a series... Read More