Recovering from substance abuse is not easy for anyone, regardless of sex or gender. However, for women, substance abuse and recovery present unique challenges that might not be apparent to those who know them, including their friends and family. Even some medical professionals who diagnose and/or treat them might not fully understand how they are affected by substance use.
It is clear, however, that gender must be considered when treating women for substance dependence, whether they are in active addiction or recovery.
Gender differences between men and women regarding substance use and addiction have long been studied. Researchers have determined that while both groups might use the same substances, they do not use them in the same ways or for the same reasons. Their use also has different consequences and outcomes for them.
Women’s biology and gender influence why they experience substance use and addiction differently from men, the National Institute on Drug Abuse (NIDA) says. These differences also shape how women are treated for substance use disorders and why the treatment they receive is different from the approach used for men.
Substance use in women affects their biological functions, such as the menstrual cycle, hormones, fertility, pregnancy, breastfeeding, menopause, and more.
According to NIDA, substance use also can:
Women also use addictive substances in smaller amounts than men for less time before becoming dependent on or addicted to them. They also use substances for different reasons, including:
Women also self-medicate with substances to combat a host of mood disorders, including depression. They also may pick up drugs or alcohol as they face loneliness and stress and struggle with body image and self-esteem. They also may use substances to cope with an eating disorder or to bond with an intimate partner who might have introduced them to the drug they now use.
Women are also likely to self-medicate drugs and alcohol if they are survivors of trauma. The American Psychological Association shares that women are at increased risk of experiencing adverse consequences long after encountering a negative event, and they are twice as likely as men to develop post-traumatic stress disorder (PTSD).
Women may use substances to avoid dealing with the flashbacks or nightmares they encounter after going through something very painful and life-changing. They also may struggle with insomnia, irritability, or feel tired most of the time.
Other reasons women use include wanting to please their romantic partner.
Whatever the reason, many women who use substances end up developing an addiction they must work hard to overcome.
Women and men use many of the same substances, although research indicates that men are more likely to use nearly all kinds of illegal drugs, according to the NIDA. Men are also more likely to end up in the emergency room for overdose and other health-related issues.
“For most age groups, men have higher rates of use or dependence on illicit drugs and alcohol than do women,” NIDA says.
However, women are just as likely as men to develop a substance use disorder, the national agency says, and they are more vulnerable to cravings and relapse. Hormonal shifts in women are partly responsible for this and higher rates of addiction among them, according to a Vanderbilt University article.
The National Institute on Alcohol Abuse and Addiction (NIAAA) has reported that while traditionally men drink more alcohol than women, data in recent years suggests the gap between them regarding alcohol use is shrinking.
A JAMA Psychiatry analysis found that high-risk drinking has increased among women in recent years. “Notable increases were found among women,” and the rate of alcohol use went up by nearly 60 percent between 2012 and 2013, the study says.
Researchers attributed the rise in drinking to relaxed social norms, increased career and education opportunities, and the pressures of balancing a career and raising a family.
Long-term drinking is more damaging to women’s health than it is to men’s, several health organizations report. According to NIDA, this holds true even if women have been drinking for a short time.
The NIAAA reports that women risk damaging their heart, liver, and brain health if they engage in unhealthy drinking practices. Alcohol abuse also puts women at increased risk of developing cancer and fetal alcohol spectrum disorder.
Women are more likely than men to use prescription opioids, and their death rates from these medications and heroin are increasing faster than the rate of men dying from these drugs, according to the WSU Insider of Washington State University.
NIDA highlights research showing that because women are more sensitive to pain, they are more likely to use prescription opioids to cope with chronic pain, even if they do not have a doctor’s prescription for the medicines they use. It also points to research that suggests women turn to prescription pain medications to cope with chronic mental health problems, such as anxiety and tension, among others.
Women are also at risk of having adverse reactions if they take medications and then use another substance, such as alcohol, purposely, or by mistake.
As previously mentioned, research shows men use illegal drugs more than women do. However, women do use them, and such use can adversely affect their health.
Radiology published research concluding that methamphetamine (meth, crystal meth for short) and cocaine, two stimulant drugs, can affect women’s brains differently from men’s.
Brain scans done on study participants showed that the women who no longer used the stimulant drugs had less gray matter brain tissue than the men in the study, who showed little to no change.
A NIDA study found that women are more sensitive to cocaine. According to the report, “Women report more intense highs from cocaine than men do, and they become addicted to the drug more rapidly. Studies have shown that the female hormone estradiol contributes to these differences, but not how.”
Women who are either a) in active addiction but undergoing a substance use treatment program or b) completed substance use treatment and are now living in full-time sobriety are considered as being on the recovery spectrum.
While refraining from substance use is one of the main parts of recovery, women who are new to it or further along in their journey face specific challenges as a result of their substance use. These issues do not disappear just because a woman has quit using.
No matter where a woman is in her recovery journey, she will need support and services that address her mental and physical health needs. Some of these might be better suited for gender-responsive treatment that takes several factors into account, including her age, ethnicity, marital status, parenting status, and more.
As mentioned earlier, hormones and a menstrual cycle could trigger a woman in recovery to crave the substances she wants to stop using and return to substance use, which is known as relapse. Relapse is an expected part of addiction recovery, NIDA says. Relapse rates can be anywhere between 40 to 60 percent, which is similar to other chronic illnesses, such as high blood pressure and diabetes.
A woman who has been through extended treatment, such as a program that took place in a residential or partial hospitalization setting for at least 30 days or longer, may want to continue treatment in an outpatient program, which offers flexible schedules and opportunities to receive quality treatment that can keep her focused on healthy ways to cope with daily recovery.
She might also have to change her environment, meaning she may have to make friends with people with the same goals in mind and make other changes that promote her recovery.
Many people who misuse substances also have a mental health disorder that they may or may not know they have. The disorder may have gone undiagnosed or been misdiagnosed, and there is a possibility that some women develop mental illness after chronically misusing substances. An assessment during medical detox at a facility can help detect any undiagnosed mental health disorders a woman entering treatment might have.
It is common for people to have both disorders at the same time or to have one follow the other. Comorbidity or dual diagnosis are terms that describe this condition. A woman in recovery might want to find a program that treats both conditions at the same time, which gives her a better chance to effectively manage both. Without a program in place that professionally treats people with comorbid disorders, a person will do more harm to themselves, possibly make one or both illnesses worse.
A mental health professional, such as a psychiatrist, is the best person to diagnose mental health disorders. Always seek the opinion of a professional, who should consult the current edition of the Diagnostic and Statistical Manual of Mental Disorders.
The general public’s perception of addiction is changing as awareness grows that the disease is a medical issue, not a moral one. Still, change takes time and doesn’t come easy, so women in recovery might find themselves facing people who do not understand substance dependence. This could lead to them feeling rejected, judged, criticized, bullied, and other negative emotions that could lead to stress and possibly relapse.
Some of the women going through this are mothers, or they might come from a disadvantaged background and do not have the money or resources to find out where to get help.
The unfortunate thing about addiction stigma is that people will continue to hide their challenges with substance dependence, leaving them to deal with their condition on their own. That only makes the problem worse and puts the person at risk of overdosing and possibly dying.
Some say women, such as those who are mothers or mothers-to-be, are judged more harshly for their struggles with substance addiction, which only compounds an already complicated problem.
It is important that women in recovery seek out supportive spaces to stay encouraged and focused on what they want so that they can stay healthy in body and mind. Some people might hear negative comments from parents, relatives, friends, or colleagues, and that could be just the message that makes them give up on living sober. Fighting addiction stigma takes time and education, but for women in recovery, the focus should be on healing and putting their lives back together.
They might need to cut back on time spent with negative people and find supportive people who can meet them where they are on their journey right now and help move them to a place of safety and recovery.
Many women in recovery are starting over completely. They might need guidance with writing a resume and cover letter to apply for a job, applying for a spot for their child in daycare, or getting into transitional housing that requires sober living.
Some addiction treatment facilities offer services in aftercare programs that help women in recovery manage life situations such as these. Aftercare programs also help people in recovery learn life skills, such as budgeting their personal finances, learning how to shop for and cook healthy meals, and more.
These programs offer structure, guidance, and support. They also offer a sense of community that encourages people to establish healthy relationships and continue on their journey to live substance-free.
Women who are battling a substance use disorder, and those in recovery could benefit from treatment programs that specifically offer care that takes their unique needs and challenges into consideration.
Such programs can directly address the issues women face and help them better understand how substance abuse affects them and what their options are for treating them.
Some women may feel more comfortable being in a women-only environment for multiple reasons. This setting can offer comfort, safety, and nurturing care that can guide women toward therapies and other treatments and services that can benefit them.
At Pathway to Hope, we help our clients find their new beginning and connect them to the care they deserve. If you or a loved one is struggling with substance dependence, call us today. We want to hear from you and help you reach your sobriety goals.
(January 2020). Sex and Gender Differences in Substance Abuse. National Institute on Drug Abuse (NIDA). from https://www.drugabuse.gov/publications/drugfacts/substance-use-in-women
NIDA. (2020, January). Sex and Gender Differences in Substance Use. from https://www.drugabuse.gov/publications/research-reports/substance-use-in-women/sex-gender-differences-in-substance-use
"Trauma." American Psychological Association. from https://www.apa.org/advocacy/interpersonal-violence/women-trauma
"Women and Alcohol." National Institute on Alcohol Abuse and Alcoholism. U.S. Department of Health and Human Services, 24 Feb. 2020. from https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/women-and-alcohol