Women and Substance Use Disorder

Women Experience Addiction Differently

And women-centric treatment approaches are helping them through it.

When it comes to addiction, gender plays a big part. Women often get addicted for different reasons than men, they go into treatment for different reasons, and they get and stay sober for different reasons.

The good news about all that is that the addiction treatment women receive is evolving to account for those differences, and women are the better for it.

How women become addicted

Research and anecdotal evidence have identified at least three paths to addiction that may be more prevalent for women than men. The first and most troubling involves past or ongoing trauma.

Here at Lakeview Health, we find that around 75 percent of our women patients have had at least one traumatic event in the past that might be contributing to their addiction. Among men, both at our center and nationally, the incidence of trauma is also high, but it looks to be more like 50 percent.

A second path women often take to addiction more often than men is by way of their medical care. The path often goes like this: Women are more likely than men to see their doctors for anxiety, pain, depression, and several other conditions. At which point they are sometimes prescribed medication for those conditions—and they get addicted. Many then gravitate to opioids, which deepens their addiction. An alarming federal government statistic: From 1999 to 2015, deaths from prescription painkiller overdoses rose more than twice as fast among women than men. ¹

Important note: We providers are a lot more aware of this situation with prescription medicines than we once were, and we’re doing better by our patients through such measures as prescribing non-opioid medications and pain relievers. But there’s still room for improvement.

A third path to addiction that women tend toward: They follow their male partners, rather than the other way around, toward harder and more addictive drugs. Unfortunately, women also tend to have a lower tolerance than men to these drugs. This means they get addicted more quickly, and end up in treatment.

Women get sicker faster

The reasons behind this “sicker quicker” phenomenon aren’t well studied yet, but we’re learning more every day.

The fact is, for physiological and probably hormonal reasons, women tend to get addicted more quickly than men do, and get sicker more quickly as well—with such things as liver disease, high blood pressure, and a host of other chronic ailments.

An example: At my place of work, women will come to us after struggling with alcohol use disorder (AUD) for two years, let’s say. Some of these women are in really rough shape. They’re badly addicted, and they’re sick with one or more chronic conditions exacerbated by their addiction. The men we see, on the other hand, often take as much as five to ten years to get to that same level of addiction and sickness.

It’s heartbreaking to see this level of distress in our female patients, and it’s why it is so important to get the word out to women in this country that they need to get help sooner rather than later. Don’t put it off; get help now.

Serious side effects from alcohol abuse among women

Men are more likely to suffer from alcohol use disorder (AUD) than women, but women are more likely to suffer serious health effects from it. That’s according to the Office on Women’s Health at the U.S. Department of Health and Human Services (HHS). Two factors behind this may be that women absorb more alcohol pound for pound than men, and it takes longer for women to digest and process it.

According to the HHS, women who misuse alcohol are at higher risk than men of:

• Alcohol-related liver disease: Women are more likely to die of cirrhosis of the liver.
• Brain disease: AUD increases risk of conditions such as dementia and severe memory loss.
• Cancer: AUD can cause several types of cancer, including breast cancer. The more a woman drinks, the higher the risk of cancer caused by alcohol.
• Heart disease: Long-term, heavy drinking is one of the main causes of heart disease in women and men.
• Osteoporosis: Long-term, heavy drinking, especially during adolescence or young adulthood, can weaken bones and increase the risk of osteoporosis later in life. ²

The barriers to treatment can be harder to overcome for women

The unfortunate situation is that even when women are hurting, when they know they have substance use disorder, and when they’re sure that starting treatment would be their best move, women are less likely to take that step than men.

The reasons for this include:

• Women tend to feel more shame and guilt about the issues around having SUD, including going to treatment for it.
• Women tend to be less independent financially than men, so they’re less able to afford treatment and to take off work.
• Women tend to do the majority of the parenting, so they’re more likely to say “no way, I can’t leave the kids now, maybe later.”
• Women are sometimes in a relationship where their partner doesn’t support the idea of addiction treatment for some reason (you don’t need it, you’re not that kind of person, you need to look after the kids, and so on).

These therapies are showing real promise for women

Two therapies that are working well for women with SUD include trauma-informed care and gender-responsive treatment.

Trauma-informed care is exactly what it sounds like: an acknowledgment and awareness of the impact of trauma on a person’s life. This provides a more complete picture of the SUD patient’s situation—past and present. And it shifts the care focus from “What’s wrong with you?” to “What happened to you?” Given the high incidence of trauma in women with SUD, it’s no wonder this type of care is having such a positive impact.

Gender-responsive treatment (GRT) is addiction care specifically designed to treat men and women differently. In the residential treatment setting, men and women stay in separate residences, but the gender split runs through everything—from the design of the physical environment to the programming to the issues covered during therapy sessions. The benefits of this GRT for women include:

• It allows women to more easily share about social pressures, expectations, and other personal experiences.
• It helps eliminate any potential distractions that may occur during treatment.
• It helps women get back in touch with self-care, relaxation, and building community with each other.

5 things to look for in a women’s SUD program

According to the Substance Abuse and Mental Health Services Administration (SAMHSA), a women’s program based on the gender-responsive treatment approach will normally include the following:

1. In-house medical expertise in women’s unique health concerns and conditions.
2. An essential, starting-point understanding that the use of drugs or alcohol in no way makes a woman morally or ethically suspect.
3. A strong trauma-informed care component that runs throughout the center’s programming (past or ongoing trauma tends to be common in women with SUD).
4. A strengths-based approach that makes use of a woman’s personality and skill strengths to build resiliency, coping strategies, competence, and quality of life.
5. A high level of training in and awareness of GRT principles among all staff, including clinicians, administration, and support staff.³

A notable and long overdue trend

As in many areas of health and medicine, the research done on addiction and addiction treatment historically focused on the male population. It was conducted on male subjects by male researchers.

That is finally changing. Women with SUD are benefitting greatly from the new women-centric research, as treatment protocols and strategies are evolving to reflect the new findings. I believe this trend in the addiction field will continue, and that’s a great thing.

Footnotes:

1. https://www.womenshealth.gov/mental-health/mental-health-conditions/alcohol-use-disorder-substance-use-disorder-and-addiction
2. https://www.womenshealth.gov/mental-health/mental-health-conditions/alcohol-use-disorder-substance-use-disorder-and-addiction
3. https://store.samhsa.gov/sites/default/files/d7/priv/sma15-4426.pdf