While men are around two times more likely to abuse drugs and become dependent on them than women are, as the journal Psychiatric Clinics of North America publishes, women face unique challenges related to substance abuse and addiction. Both biological differences between the sexes as well as gender variations related to environmental and social pressures are involved in drug use initiation and the onset of addiction.
For instance, women may progress sooner through the stages of drug abuse to dependence to addiction than men may, are just as susceptible to addiction, and may suffer from more intense cravings and higher rates of relapse than men, the National Institute on Drug Abuse (NIDA) reports. Almost 13 percent of women aged 18 and older reported past-year illicit drug use, according to the 2014 National Survey on Drug Use and Health (NSDUH) as published by NIDA. Additionally, Harvard Health Publications reports that nearly 6.5 percent of women in the United States battled addiction in 2008.
Gender and Sex Differences Related to Drug Abuse
Differences related to a person’s sex involve variations in biology. A woman’s sex hormones and menstrual cycle may change the way a woman’s body responds to drugs and drug abuse. Drugs can have more physical effects on the heart and blood vessels of women, and women may experience changes in the brain differently than men do. This may play a role in why a woman may use less of a drug at a time, and for a shorter time period, than a man and become dependent more quickly.
Addiction is a brain disease involving both brain chemistry and behavioral aspects, and it generally occurs when a person is physically dependent on a mind-altering substance and is no longer able to control use of said substance. Physical dependence may set in quicker for a woman than a man and is related to changes made to levels of neurotransmitters in the brain that are involved with impulse control, learning, reward processing, emotional regulation, and memory functions. Woman move more quickly from initial drug use into addiction than men do, which is often called telescoping.
Gender refers to roles that are culturally defined for the sexes, and it can influence the way a person will use drugs and suffer from drug addiction. Women often use drugs for different reasons than men do. For example, a woman may be more likely to use drugs to control pain, lose weight, fight exhaustion, and self-medicate mental health issues, NIDA publishes. Women may also abuse drugs as a method of alleviating stress or minimizing negative emotions.
The White House Office of National Drug Control Policy (ONDCP) reports on a study of young girls and women aged 8-22 that indicates that peer pressure, low self-esteem, and depression are heightened risk factors for this population for both substance use and the onset of addiction. A woman may more readily suffer from a mental health disorder and/or issues with substance abuse after a divorce, loss of child custody, or death of a family member. NIDA reports that one in three women has been the victim of intimate partner physical violence, putting them at a higher risk for weight concerns, depression, chronic pain, and drug and alcohol use. Women suffer from post-traumatic stress disorder (PTSD), depression, anxiety, and eating disorders more often than men, which can influence both substance use and the onset of addiction.
Specific Drug Types and Addiction in Women
Just as women may abuse and be affected by drugs differently, they also may use different types of drugs at varying rates than men. Some of the common drugs of abuse among women are highlighted below.
Women go to doctors more often than men and are more apt to report acute and chronic pain; therefore, women are more likely to be prescribed pain relievers than men, NIDA publishes. Women may also be prescribed higher doses of these medications for longer durations than men.
Most prescription painkillers are opioid drugs, which are extremely addictive. Examples include OxyContin (oxycodone), Duragesic (fentanyl), Vicodin (hydrocodone), and Percocet (combination oxycodone product). Using these drugs for an extended period of time, even with a legitimate prescription, can cause the brain and body to become physically dependent on them.
While men still abuse prescription painkillers more often than women, a higher percentage of women who are admitted to addiction treatment programs cite prescription pain relievers as their primary drug of abuse than men, especially those aged 65 and older, the Treatment Episode Data Set (TEDS) of 2011 reports. Also of note, from 1999 to 2010, prescription pain reliever overdose deaths increased by a staggering rate of 400 percent among women, the CDC reports, much greater than the increase among males. For every woman who dies from a prescription painkiller overdose, another 30 seek medical treatment in an emergency department (ED) for painkiller misuse or abuse.
As prescription opioid painkiller abuse and addiction has become so prevalent, many people are making the switch to the cheaper and often more accessible street opiate heroin. Abuse of heroin is skyrocketing in every demographic, even among those groups of people who don’t typically abuse it, such as women, CBS News reports.
Heroin is highly addictive, and like other opioids, it activates pleasure centers in the brain and increases levels of dopamine. The “high” sets in quickly, and it is intense and short-lived. Like prescription opioids, heroin dulls pain and can provide a temporary escape from reality. The CDC warns that individuals who suffer from addiction involving a narcotic painkiller are 40 times more likely to battle heroin addiction, and 45 percent of individuals struggling with heroin addiction are also addicted to prescription painkillers.
Women and men tend to use stimulant drugs at relatively similar rates, albeit potentially for different reasons. Cocaine, methamphetamine, and prescription stimulants (such as those used to treat ADHD like Ritalin and Adderall) speed up functions of the central nervous system while increasing energy, sociability, and wakefulness, and suppressing appetite. A woman may take a stimulant drug as a form of diet or weight control, to combat fatigue, or to stay awake and focused longer.
NIDA warns that cocaine may affect women differently than men, however, making them more sensitive to its reinforcing effects and therefore potentially making them more susceptible to addiction. This may be due to the presence of estrogen.
Cocaine, and stimulant drugs, can cause a powerful “high” that is often short-lived. The “crash that can follow the high may be equally significant and may induce people to take the drug in a “binge” pattern – that is take multiple doses back to back to prolong the pleasant effects. Taking more of these drugs more often increases the odds for becoming dependent on them and subsequently losing the ability to control use of these substances.
Since women typically report more issues with depression, insomnia, and anxiety, and are more apt to seek medical and/or mental health care for these concerns, they are likely prescribed anti-anxiety medications, antidepressants, and sleep aids at higher rates than men. This increases access to prescription medications like benzodiazepines, barbiturates, and antidepressants, potentially increasing the risk to then misuse these drugs. Increased abuse rates often translate into addiction.
These substances have difficult emotional and physical withdrawal symptoms, and dependence can be formed within a short time of using them. Rebound anxiety, depression, and insomnia as well as tremors, seizures, and other significant symptoms are often the result of sedative withdrawal. Women may abuse these drugs as a method of self-medication for mental health issues, running the risk of becoming dependent on and then addicted to them. Women are more commonly admitted to addiction treatment programs for problematic sedative use than men, according to the 2012 TEDS as published by NIDA.
Men are more likely than women to report marijuana as their primary substance of abuse when admitted to an addiction treatment program, the 2011 TEDS publishes. This may be due to differences in the “high” the drug may induce in men than in women. Marijuana may act on the brain of a woman differently than a man, and sex hormones may play a role in the brain and bodily changes brought on by the drug’s use.
Marijuana use and mental illnesses, such as anxiety and depression, are closely linked and women who struggle with marijuana addiction have a greater risk for suffering from anxiety and panic attacks, NIDA warns. Women may become dependent on marijuana more rapidly than men after initiating use, which can influence addiction rates as well.
Men and women react to alcohol differently, and heavy alcohol consumption may affect a woman more significantly than a man, hence the suggested drink guidelines being lower for women than men, the National Institute on Alcohol Abuse and Alcoholism (NIAAA) publishes. This involves biological reasons, such as metabolism, and the fact that women are at a higher risk of developing more complications and problems related to alcohol than men. In fact, one drink may pack twice the physical punch for a woman than a man, the National Council on Alcoholism and Drug Dependence (NCADD) warns, as women tend to weigh less than men, have more fatty tissue, and break down alcohol more slowly than men, leading to a greater rate of absorption into the bloodstream.
Alcohol consumption has become more socially acceptable for women in recent years than it was in the past, and the number of women who drink regularly is climbing, the Wall Street Journal (WSJ) publishes. Women may drink heavily for a variety of reasons, like to cope with stress, social and familial pressures, or due to being the victim of abuse or trauma. As with other substances, greater exposure often raises rates of addiction. Chronic alcohol abuse can create a dependence on the substance, and potentially life-threatening withdrawal symptoms are associated with alcohol withdrawal.
Need for Women-Focused Treatment Methods
Addiction can be a deadly disease, as the CDC reports that 42 women die every day from a prescription drug overdose in the United States. Women are more likely than men to die from an overdose or to go to the emergency room as the result of drug abuse, per NIDA.
As women and men may initiate drug use differently and experience addiction variably, treatment for addiction is often more effective when it is gender-specific and specifically tailored to the unique needs of a woman. A woman may be more inclined to enter into a treatment program where only women are present, resulting in a higher level of comfort for some. Addiction treatment facilities often offer both residential treatment programs and outpatient services designed particularly for women.
Therapy, educational, and life skills training sessions that delve into cultural expectations, gender biases, parenting, and other issues pertaining to women can be beneficial. As women may be more prone to relapse after a period of abstinence, support groups, stress coping mechanisms, and relapse prevention programs can be integral to sustained recovery.
Gender-specific treatment programs can help to remove some social pressures and provide an environment that is conducive to healing. Women may be more willing to open up in group sessions and support group meetings without the presence of the opposite sex. It is important to uncover potential triggers for substance abuse in order to enhance recovery, and since women tend to abuse drugs and alcohol for different reasons than men, behavioral therapy sessions catering to women specifically can be more focused on issues and pressures that may be unique to them. Women may also suffer from co-occurring mental health disorders at the same time they are battling addiction to drugs or alcohol, and these can be addressed in a comprehensive addiction treatment program.
Men and women have unique needs and experiences; therefore, addiction treatment programs should provide specialized care to foster long-term recovery.