Understanding women & addiction
Addiction is often discussed as a universal problem. Which it very much is. But many overlook the unique set of issues faced by women dealing with addiction. Cultural expectations, social stigmas, and biological differences all impact substance abuse, addiction, and womens’ decisions to seek treatment. Read more to learn more about women and addiction, their reasons for drug abuse, specific challenges in accessing help and what to look for when seeking treatment.
Substance abuse in women
Both sex and gender can shape a person’s experience with substance abuse. Sex refers to biological differences, while gender differences are based on culturally defined roles and norms. Women face distinct social pressures, some of which can contribute to or make them more vulnerable to drug and alcohol dependence. As a result of pressures, experiences and biology, the primary triggers for drug and alcohol abuse can look different for women.
Key contributors to substance abuse in women include:
- Lowered self-esteem
- Combating fatigue
- Body image issues, to curb hunger and to lose weight
- Coping with trauma
Women & addiction: Substance abuse patterns
Although, overall men have both higher rates of substance abuse and dependency, women are just as likely to develop substance use disorders. Researchers believe that substance use, initiation, escalation, addiction, and relapse may all be impacted by gender and sex. These differences can begin before a person uses substances and may shape their experience with addiction. For instance, girls are more likely to be offered drugs and alcohol by friends, acquaintances and family members in their same age range. Boys, on the other hand, are more likely to be offered substances including alcohol, marijuana and hard drugs by parents, male relatives, or acquaintances. They have a higher chance of receiving these offers in public places than girls do, who are more likely to be offered substances in private settings.
According to SAMHSA’s 2014 TEDS Report, a larger proportion of female adolescents and teens report alcohol as their primary substance of use. Marijuana use, on the other hand, is more heavily reported among male adolescents and teens. This changes with age. Studies also show that overall men experience higher rates of alcohol abuse and dependency. However, this gap is narrowing. In the 1980s men were 5 times more likely to report alcohol use disorders. This has dropped to 3 times more likely to report.
Addiction also develops more rapidly in women. Although they may consume less of a substance, many women move from substance abuse to full blown addiction at a faster rate than men. This is the case when it comes to opioids, marijuana and alcohol. Resultantly, women entering treatment may have more severe addictions, despite having used drugs or alcohol for a shorter amount of time. When it comes to seeking help for their addiction, there are more men than women admitted to treatment programs. Although, women do have a greater likelihood of getting treatment for addiction to sleep and anti-anxiety medications. And a growing number of women are entering rehab for heroin use.
How drug use affects women & addiction develops
When it comes to substance abuse in women, gender-related pressures as well as hormonal, biological and chromosomal factors all play a role in the way women experience addiction. In order to more effectively prevent and treat substance dependence, we must first understand the gender- and sex-specific factors that shape addiction in women. Sex differences are biologically based. On the other hand, gender differences are based on culturally defined roles for men and women. Both of these factors affect women’s experiences with alcoholism and drug dependance. Several other factors also impact women and addiction:
- Biology affects the way women respond to some drugs. Science has shown that females may experience the physical effects of certain drugs differently than males. For instance, hormones, menstrual cycles, fertility, pregnancy, breastfeeding and menopause can all impact the way drugs affect women. According to the National Institute on Drug Abuse (NIDA), sex hormones can even make women more sensitive to some drugs. For instance, during certain phases of the menstrual cycle, women may be more responsive to stimulants like smoked cocaine and cravings may increase. Women also had less feelings of paranoia and heart pounding than men when smoking cocaine. This could cause them to use more of the drug.
- Gender-related pressures impact how and why women become addicted. Many women report initiating and maintaining drug use as a result of gender-related pressures, such as weight control and fighting exhaustion. Women experience pressures to live up to societal norms of beauty, take on extra household responsibilities, and care for their children. According to a survey conducted by the U.S. Department of Labor, working women spend an hour more daily on childcare and household chores than men. This reflects in the amount of time women have for leisure and sleep, which is less than their counterpart. In addition to these responsibilities, women often face added criticisms surrounding their appearance and weight. In order to escape or sometimes meet these pressures, some women turn to drugs, prescription medications, and alcohol to self-medicate.
- Women are more likely to experience certain traumas and intimate partner violence. For many women, trauma is the catalyst that leads them to abuse substances and develop addictions. As many as 1 in 4 women experienced severe intimate partner violence during their lifetime. Exposure to violence in childhood, sexual abuse, incest can also make women more likely to become vicitims of future violence. As a result, many struggle with PTSD, which is associated with addictions. Having a substance use disorder can also increase one’s chances of experiencing further trauma. Other difficult events like divorce, losing child custody or the loss of a spouse can also make women more vulnerable to addiction.
- Certain mental health conditions can increase the risk of substance abuse. Men are more likely to report mental health conditions. However, certain diagnoses are more common among women. These include conditions like depression, anxiety, PTSD, and eating disorders. When a person struggles with addiction and a mental health disorder, things can become more complicated. One condition can worsen the other. Women may use drugs and alcohol to cope with negative emotions. The combination of mental health issues and experiencing traumas like interpersonal violence or sexual abuse can, moreover, addiction issues even more likely.
Substance abuse while pregnant
There is likely a great deal of underreporting when it comes to drug abuse in women. This is especially true for pregnant women, who under-report substance use, likely for fear of judgement or the possibility of losing custody of their baby once born. The 2018 National Survey on Drug Use and Health found that 11.6% of pregnant women reported using a substance during the past month. However, this number is likely too low. A study of pregnant women that used screening instruments found much higher rates; As high as 18.9% of women tested positive for alcohol in their urine, suggesting significant underreporting.
Substance abuse in pregnant women also has a number of immediate and long-term consequences for newborn infants. When a mother uses substances during pregnancy, the baby may actually experience Neonatal Abstinence Syndrome (NAS). This essentially is a state of withdrawal. When alcohol is used during pregnancy, babies may be born with fetal alcohol syndrome, which differs from NAS, but also can cause serious complications.
NAS is also an issue among babies born to opioid abusing women. Opioid use among pregnant women has increased dramatically in recent years, quadrupling between 1999 and 2014. Somewhere between 50 to 80% of babies delivered to opioid-dependent women are born in a state of withdrawal. Opioid use can also affect the pregnant mother’s health, increasing their risk of death.
Neonatal Abstinence Syndrome (NAS) Symptoms
Babies born with NAS may experience symptoms—immediately post birth up and up until 14 days following birth. Symptoms range depending on the amount and type of drug used, the last time it was used and whether or not the baby was born prematurely. Symptoms of NAS tend to be worse when more than one drug is used by the mother. Common symptoms include:
- Excessive or high-pitched crying
- Problems sleeping
- Problems with feeding and sucking
- Sped up heart rate
- Blotchy skin
- Trembling or rapid breathing
- Low weight gain
- Diarrhea or vomiting
- Tight muscle tone or overactive reflexes
- Stuffy nose, sneezing or yawning
For some opioids such as heroin and methadone, serious withdrawal can persist for 4 to 6 months post-birth. In addition to the withdrawal symptoms, there are a number of long-term issues that can result from drug use during pregnancy. These symptoms include:
- Birth defects
- Premature birth
- Poor growth
Because of significant underreporting and increases in the use of certain substances, many pregnant women fail to get the treatment they need. Treatment for pregnant women could reduce the complications for children and mother’s alike.
Women & addiction: Signs of addiction
Whether you yourself struggle or are concerned about a woman in your life, it is important to be aware of the signs and symptoms of addiction. These include:
1. Changes in behavior
Changes can include drastic shifts in mood; increased conflict in relationships with colleagues, friends and family; preventing others from entering personal spaces or looking through belongings; and lying and/or being secretive about where she is going.
2. Inability to meet responsibilities
Those dealing with addiction often struggle to keep up with responsibilities at work and home. Frequently missing work or school, not performing as usual in the workplace, not completing household and childcare responsibilities can all be telltale signs of addiction.
3. Physical problems and health issues
Significant changes in appearance or health can all be indicators of drug and alcohol abuse. Large fluctuations in weight, red eyes, a general lack of energy and motivation or hyperactivity, and neglecting one’s appearance may be signs of an addiction.
4. Financial issues
Maintaining a substance use disorder can be quite costly. Missing cash, stolen objects, and sudden requests for money with no explanation are all indicators that your loved one may be using these items or money to support their habit.
Recognizing the signs of drug abuse is important, as admitting to a drug problem is the first step in getting help. If you think you may have a problem or are concerned about a loved one, contact a treatment center like Liberty Ranch to find out more about treatment options available.
Seeking treatment for women
Whether it is yourself or a loved one, seeking treatment can be an effective and even life-saving option for women dealing with addiction. Our guides offer strategies on how to address your significant other, parent, adult daughter or teenager’s addiction and get help. There are several reasons why getting treatment can be especially helpful to women with addiction:
1. An integrated and personalized approach to recovery
A strong treatment program will help the addict get clean, but it will also focus on more than just sobriety. There are normally other issues in addition to one’s addiction that has led to their current difficulties. Many treatment programs offer therapy, psychiatric services, family counseling, medication management, and life-skills training. Liberty Ranch provides integrated intensive outpatient services. It is important to take a comprehensive approach because normally, there are numerous factors that influence a person’s addiction. For example, many women who struggle with addiction also deal with co-occuring conditions such as anxiety, depression, eating disorders and body dysmorphia. Dealing with these issues as a part of the treatment process is critical to a better outcome.
2. Learning how to cope with difficulty
Entering into a treatment program can help not only address one’s addiction, but also the factors that may have contributed to the addiction. Many lack coping skills when it comes to managing negative emotions, traumas, sadness, and self-doubt. This is important because oftentimes addicts turn to drugs and alcohol as coping mechanisms. Stress, which is common among those who suffer anxiety, is a trigger for drug abuse and relapses among women. Whereas men’s cravings tend to be provoked by drug related cues, stress is the common factor that usually drives cravings in women. Unfortunately, women are prone to more stress-related mental health conditions like anxiety. Treatment helps individuals learn to manage stress and acquire the skills to effectively communicate, problem-solve and deal with triggers.
3. Specialized women’s treatment programs
For a long time, addiction science and programming focused primarily on addiction in men. Meaning the specific issues and needs of women went long ignored. Programs directed specifically toward women can be quite beneficial for a number of reasons.
First, women’s treatment programs focus on the unique experiences of women. The stressors, triggers, and traumas women deal with can be quite different from those of men. Women-focused programs have a clearer understanding of the issues women face and can therefore help women addicts identify and cope with these challenges.
Second, many women addicts and alcoholics are also victims of physical and sexual violence. All-women programs can provide a safe space for women to address these traumas.
Third, many women addicts have children that they are the primary caregivers to. Women-focused programs can incorporate their children into family focused therapies. They may also help with childcare solutions as well as finding legal support if child custody is an issue. Liberty Ranch offers an integrated, evidence-based women’s program that provides a safe space for women to recover and rebuild their lives.
How to support the woman in your life during and post-treatment
It is important to educate yourself on the barriers and challenges women experience when seeking and participating in treatment programs. By better understanding these issues, you can help find ways for your loved one to access proper treatment options as well as be a support system along the way. Once she has completed a program, there are also ways you can participate in her recovery.
Successfully finishing a treatment program is a big and important accomplishment in one’s recovery journey. Following the completion of a treatment program, the woman in your life may struggle to reintegrate and remain sober as the stresses and triggers of regular life return. There are some things that you can do to support her through this process, while avoiding enabling a relapse. Try the following:
- Work on developing healthy communication patterns and participate actively in therapy and family sessions if invited.
- Avoid criticism and judgement. Instead, recognize positive accomplishments, no matter how small they may be.
- Remember that she is responsible for her sobriety and you cannot control her actions or force her to become sober.
- Stress can be a bigger trigger for women. Help her cope with their stress by listening and avoiding judgement.
- Avoid shaming in terms of weight, body issues, and child care.
- Be an outlet and offer emotional support. Be patient and supportive as she processes her emotions and works on the life skills acquired in rehab.
- Educate yourself about the recovery process and consider joining a peer support group for family to learn more about addiction, recovery and how to stop enabling. Groups such as Families Anonymous and Nar-Anon offer a space for loved ones to process their issues, share experiences, and get support from others facing similar situations.
- Understand what people, situations and places may trigger a relapse.
- Avoid situations where substance use is prevalent and common. This might include family events and get-togethers with individuals with whom she previously used drugs or alcohol.
- Create a prevention plan and be aware of what to do and who to contact in the case of a relapse
- Encourage her to follow through with all of the post-treatment plan recommendations provided by the treatment program. This may include helping with transportation and childcare if needed.
- Encourage her to join a sober community, peer support network like Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) or participate in other sober social activities.
- Practice self-care and understand when to take a step back.
Reasons why women don’t seek treatment
Although treatment can be lifesaving for women addicts, many fail to get help. Women facing addiction experience extra hurdles in accessing treatment. Even if they recognize the need for treatment, many women find it difficult to seek help. For women of color, and LGBTQ+ individuals, these hurdles may be further amplified. There are a number of barriers that may prevent women from getting treatment:
- Shame and stigmas around getting treatment: Addicts in general deal with societal judgement. Although addiction is in fact a disease that affects the brain and the body, many people still view it as a moral failure. Women face this stigma as well as other gender-specific judgements that can make it even more challenging to get treatment. In fact, women were more likely to feel shame and embarrassment for being in treatment. Women also take on numerous roles and responsibilities. Many are mothers and the primary caregiver to their children. Mother’s especially face a great deal of judgement surrounding their parenting. Worries about judgment and criticism may prevent them from seeking treatment.
- A lack of quality treatment options for women. As the field of addiction science advances, researchers continue to identify key insights that affect the way treatment is delivered to patients. However, for years clinical research ignored women, favoring male subjects in clinical studies as females were deemed too biologically complex to include. While in recent years, federal agencies such as the National Institutes of Health (NIH) have begun to promote research focusing on women and other subgroups, there remains a deficit of information on the biological and cultural factors that impact treatment options for women today. As a result, many treatment programs and protocols are shaped around men, ignoring some of the distinct needs of women.
- Fears and traumas: Many women in need of treatment have been victims of physical or psychological violence and control. As a result, some may struggle to open up and be vulnerable in mixed gender settings or worry about living in housing with unknown men. Unlike men, they tend to seek treatment in primary care settings or mental health settings. This means, they may have poorer treatment outcomes and go without the specialized addiction treatment services they truly need.
- Financial issues: Some women addicts may want to get treatment but struggle financially to leave work for an extended period of time. If the woman is the primary breadwinner or responsible for supporting her children, she may feel like she can’t afford treatment. Financial control may also be a factor for some, and even a mechanism for abusive behaviors. In some cases, women may be financially dependent on a spouse or significant other who doesn’t support her getting treatment, which makes getting better that much more difficult.
- A lack of childcare: Many women are the primary caregivers to their children. Many women in treatment have one or more child. Having young children can be a huge barrier for women dealing with addiction and alcoholism. Some women may not have a trusted person to leave their children with while getting treatment. Fears of losing custody of a child or unborn baby can add an additional barrier. Our guide on parenting as an addict further details the issues mothers face in getting treatment.
Barriers to treatment for women of color
As described, women in general face a number of challenges in getting treatment for their addiction. These barriers include financial challenges, family responsibilities, shame surrounding addiction, and internalizing mental health issues that make it more difficult to follow through with treatment. The challenge is even greater for women belonging to one or more marginalized groups, many of whom are met with barriers to accessing treatment.
This is the case for black women. Drug use among black women is more likely to be portrayed as criminal behavior than a health issue on popular television. This also lines up how the criminal justice system addresses addiction in black men and women. Black men and women are also more likely to experience criminal consequences for drug use such as incarceration. This can prevent those in need of treatment from accessing the resources they need. As a result of discrimination and bias, African-American women are more likely to experience negative health and social consequences from substance use, such as having their children legally removed from their care.
Additionally, black women are underrepresented in clinical studies, and their health issues are more likely to be ignored or overlooked by medical professionals. This can affect the way in which they receive treatment for their addiction. Hispanic women also face additional barriers in accessing culturally competent treatment. Gender norms, cultural identity, acculturation, and a lack of culturally competent treatment alternatives can influence Hispanic women’s decisions to seek treatment or not. Black and hispanic women and men are less likely than whites to complete treatment programs, largely as a result of socioeconomic factors.
American Indian and Alaska Native women also face several cultural, financial and other barriers in seeking treatment. Similarly, Native American men and women were also less likely to complete treatment programs than white men and women. Like other marginalized groups, they are underrepresented in the addiction sciences and treatment communities. The lack of culturally competent treatment options makes it even more difficult for marginalized groups to access the services they need.
There are a number of issues and pressures experienced by the LGBTQ+ community that may contribute to addiction. One of which is intimate partner violence, which bisexual women and trans women are more likely to experience than heterosexual men and women. Research indicates that gender abuse and depressive symptoms are a strong risk factor for trans women developing addictions. Trauma and hiding one’s identity for fear of judgement, rejection or even physical danger may lead one to cope through drugs and alcohol. Additionally, struggles with alienation as well as stress surrounding the coming out process can serve as a trigger for substance abuse.
Treatment needs can vary within this group. For instance, studies show that lesbians generally receive greater support from friends than family. Thus, they should be incorporated into the treatment process as part of a support system. Trauma and PTSD are also factors that should be considered in treatment for sexual minority women, trans women and the LGBTQ+ community overall. Having a safe, accepting and supportive space that considers the life experiences is integral to addressing addiction in the LGBTQ+ community and creating better treatment alternatives.