Unique Needs of Women in Substance Abuse Treatment
Until the early 1990s, men were the primary focus of research conducted on substance dependence and abuse. U.S. agencies finally started requiring studies to be federally funded so more women could enroll. Since then, researchers have found that there are indeed gender differences in certain types of addiction, and substance abuse in women is now more apparent.
These gender differences have become significantly important in substance abuse treatment. Your needs as a patient are unique, so the treatment programs should also be unique. Substance abuse treatment programs are tailored to treat these specific needs, particularly when it comes to women and addiction.
Voyage understands that addiction is different in women than in men. We understand that gender differences play a big role in treating substance abuse. For instance, as a woman, you might be struggling with dual diagnosis addiction. You may be confronted with a substance or alcohol dependency, as well as a mood disorder, such as depression, or an eating disorder, such as anorexia or bulimia.
There are unique emotional and physical health concerns that women face outside of alcohol or substance abuse addiction. That’s why we maintain a unique treatment for women with substance abuse. We offer state-of-the-art and gender-responsive support to encourage you to regain control of your life.
It’s been well documented that men experience consistently higher rates of substance use, abuse and dependence. However, the number of women struggling with drug and alcohol addiction continues to grow.
As one of the leading recovery centers for women, Voyage is committed to helping women suffering from addiction get the treatment they need to stay sober. Our team of experienced counselors specializes in working with women who have co-occurring mental health and substance use disorders.
Women’s Unique Needs in Treatment
Hormones are not the only factor that influences the differences between women and men. There are also certain metabolic disparities at play between the two genders. As a female, psychotropic drugs can affect you differently, so you would require a different type of treatment.
Women who take prescription or illicit drugs or consume alcohol may develop substance use addiction or substance-related health problems faster than men.
Treatment may progress differently for substance abuse in women. When entering treatment, women have reported using certain drugs for shorter periods of time, but their addiction tends to progress more quickly.
There are cultural and societal implications to consider as well. Society places different attitudes on women than it does on men with respect to substance abuse and treatment. The effects of these societal attitudes should be addressed in rehab because it can add additional pressure. A multidisciplinary and integrated treatment approach for women is required to increase the chance of rehabilitation success in the long-term.
Let’s look at four reasons why women have different needs in addiction treatment:
- Biology. Various studies show that women experience more challenges when using drugs than men. An article published in the Journal of Substance Abuse found that women who were addicted to drugs used them more often than men. Women were also found to focus on harder drugs. Studies indicate that if you’re a woman, you are in some way hardwired to have a more serious addiction than a man, possibly because of your biology.
As a woman, you’re on the average smaller than a man, so you have smaller muscles and lighter bones. This allows you to keep your weight down as you age. This also means your body has fewer tissues. When you don’t adjust your drug dose to accommodate your size, it can overwhelm your body. Larger doses can alter your brain chemistry, which can lead to compulsive behavior and cause more damage.
- Life Circumstances. For women as a group, life circumstances carry significant weight, which requires specialized treatment. For instance, sexual and physical trauma that leads to post-traumatic stress disorder (PTSD) is often seen in women who suffer from addiction. This means substance-abusing women with PTSD may reap significant benefits from gender-specific addiction programs.
- Chemistry. Your chemistry makeup could leave you more susceptible to addiction as a woman. Studies that involved several tests performed on laboratory animals suggest that female animals show more awareness of the rewarding properties of drugs than male animals. It’s believed that estrogen is the reason behind their heightened ability.
These studies show that estrogen appears to awaken the brain’s receptors for drugs. Once awakened, they transmit profound and prompt pleasure signals. Your brain is designed to become aware of and seek out intense pleasurable signals again. If you experience heightened levels of bliss as a woman because of estrogen, as your brain becomes flooded with more signals, you’re more likely to develop an addiction and more cravings.
- Pregnancy. If you expose yourself to tobacco, drugs and alcohol while pregnant, you also expose your developing fetus, which can have potentially long-term and damaging effects. Smoking while you’re pregnant increases the risk of infant mortality, stillbirth, preterm birth, slowed fetal growth, sudden infant death syndrome, respiratory problems and low birth weight. If you drink while you are pregnant, fetal alcohol spectrum disorders can become present in your child, causing possible behavioral and cognitive problems and low birth weight.
If you use certain drugs like opioids while pregnant, you can cause your newborn to have withdrawal syndrome or neonatal abstinence syndrome (NAS). This leads to higher risks of respiratory problems, seizures, low birth weight, feeding difficulties and even death.
Although the FDA has not approved any medications to treat pregnant women with opioid dependence, a comprehensive drug treatment program combined with prenatal care and methadone maintenance can improve many of the adverse outcomes of drug abuse. Newborns who were exposed to methadone during pregnancy will experience withdrawal symptoms and require treatment. Buprenorphine is another recent medication used to treat opioid dependence, and it has been found to produce fewer NAS symptoms than methadone in babies. For these reasons and more, if you are pregnant and require treatment for drug use, it’s essential that you are closely monitored.comprehensive drug treatment program combined with prenatal care and methadone maintenance can improve many of the adverse outcomes of drug abuse. Newborns who were exposed to methadone during pregnancy will experience withdrawal symptoms and require treatment. Buprenorphine is another recent medication used to treat opioid dependence, and it has been found to produce fewer NAS symptoms than methadone in babies. For these reasons and more, if you are pregnant and require treatment for drug use, it’s essential that you are closely monitored.
Substance Abuse and Women
Although no two people suffering from addiction are alike, there are several common factors that have been identified as contributing to substance abuse in women. Understanding how these interconnected mechanisms can lead to addiction and/or influence the rehab process is a key step in developing a treatment plan that will set you on the road to recovery.
Let’s take a look at the top 10 unique needs of women in treatment:
1. Responding Differently to Drugs and Alcohol
Biological differences between men and women affect how their bodies react to addictive substances. For example, consider the differences in alcohol use between men and women. It’s well known women become legally intoxicated with fewer drinks, due to their smaller size, higher proportion of body fat, and lower volume of body water.
Hormone levels also play a role in the biological differences between males and females struggling with addiction. In women, the follicular phase of the menstrual cycle, when estradiol levels are high and progesterone is low, is associated with a greater response to stimulants. When progesterone levels are highest, women have a stronger response to smoked cocaine.
Medical professionals use the term telescoping to refer to the fact that women are known to develop substance abuse disorders and health-related problems in less time than their male counterparts. Telescoping occurs with lower doses of a substance as well, especially in relation to alcohol, cannabis and opioids.
2. Hesitating to Seek Treatment Due to Cultural Differences
Cultural expectations regarding appropriate gender roles can have a significant impact in patterns of substance abuse among women, often serving to increase their reluctance to seek treatment. One of the biggest cultural barriers to substance abuse treatment is women are more likely to define themselves in terms of their social relationships.
While a man often describes himself in terms of his occupation, women view themselves as mothers, wives, daughters and friends. Because of this, a family history of substance abuse may have a more profound effect on women than men. SAMHSA reports women who abuse substances are more likely than men to report having had alcoholic relatives, including alcohol-dependent parents.
The general public’s tendency to judge females struggling with addiction more harshly is another significant barrier for women. A man with a drug or alcohol problem is often viewed as someone who has simply made a mistake or shown poor judgment, but a woman with the same issue gets labeled as being a failure for neglecting her loved ones.
If she is sexually victimized while under the influence, the public blames her for putting herself in a risky situation instead of blaming her abuser for taking advantage of her vulnerability. These inherently sexist expectations lead women to develop intense feelings of guilt and shame surrounding their substance abuse. To recover, they need to work with a treatment team that praises their willingness to seek help and shows them they can move forward with their lives regardless of what has happened in the past.
Finally, minority women often face added barriers to seeking substance abuse treatment that may not be understood by their health care providers. For example:
- Native-American communities often consider alcohol consumption to be a normal part of life. A woman who abstains may be losing out on an experience that is considered a primary family activity.
- Asian- and Pacific-American women may report a cultural desire to “save face” or avoid embarrassing their family by going to great lengths to hide their substance abuse.
3. Struggling to Pay for Rehab
The National Women’s Law Center reports 1 in 7 women are living in poverty. Poverty rates are highest for minority women, women without post-secondary education, and single mothers, but even white married women with college degrees tend to earn less than their male peers.
The relationship between poverty, women and substance abuse is complicated. Obviously, there are many low-income men and women who do not struggle with addiction. However, people living in poverty are often tempted to turn to drugs and alcohol to reduce stress and cope with their financial worries.
When an addiction takes hold, they may start purchasing drugs or alcohol instead of paying their bills or lose their jobs because of erratic behavior. This worsens their economic situation, further increasing the desire to turn to substance abuse for a temporary escape.
Low-income women struggling with addiction are often reluctant to seek help because they believe recovery will be cost-prohibitive. The passage of the Affordable Care Act includes psychotherapy, counseling, and inpatient treatment for substance abuse disorders as part of the 10 essential health benefits that must be covered by all non-grandfathered plans. Medicaid also provides coverage for substance abuse treatment on a more limited basis.
Private charitable associations and non-profit groups are often able to help low-income women obtain the resources they need to ensure adequate child care and transportation to and from appointments. However, women may require some assistance locating these organizations.
4. Being a Victim of Domestic Violence
The National Coalition Against Domestic Violence states 1 in 3 women have been victims of physical violence from a partner within their lifetime, with 1 in 5 women experiencing severe domestic violence and 1 in 7 women experiencing stalking. Domestic violence affects women of all ages, races and socioeconomic backgrounds, although women between the ages of 18 and 24 are statistically the most vulnerable.
A victim of domestic violence may face the following barriers to treatment:
- Her abuser may pressure her to continue using, even though she wants to stop.
- Her abuser may keep her isolated from family and friends who can provide emotional support.
- Her abuser may forbid her from seeking paid employment and restrict her access to the finances needed to pay for treatment.
- Her abuser may threaten to harm her children or take the children away from her if she displeases him.
Victims of domestic violence often require legal services to help free them from their abuser before they can begin the treatment process. The danger posed by an abusive partner must be dealt with first, as a woman must feel safe enough to confront her substance abuse.
5. Dealing With Sexual Abuse
Sexual abuse, including childhood molestation, date rape or sexual assault by a stranger, is a traumatic event with a strong correlation to drug and alcohol abuse. In one of the first studies looking at female addiction, researchers found 74 percent of women struggling with addiction reported sexual abuse in their history. These women were also found to be more likely to have been victims of incest, rape and prolonged abuse by one or more perpetrators.
A woman who has been sexually abused may turn to alcohol or drugs as a self-soothing mechanism. Being under the influence temporarily lets her escape painful memories and distressing feelings, especially if her abuse has led to depression and/or post-traumatic stress disorder.
When treating victims of sexual abuse and other traumas, psychiatrist Judith Herman advocates a three-stage treatment model focusing on safety, remembrance and mourning, and reconnection:
- First, women must learn to feel safe in their bodies and in relation to other people.
- Second, they must have a safe place to tell their trauma stories and mourn their old selves.
- Third, the reconnection stage focuses on developing a new self and creating a brighter future as part of the ongoing recovery stage of addiction treatment.
6. Needing Unique Treatment for Women With Substance Abuse and Eating Disorders
According to the National Eating Disorders Association, nearly 50% of people who seek treatment for eating disorders are also abusing drugs and alcohol. This is a rate 5 times greater than the general population. Both eating disorders and substance abuse are thought to be caused by an interplay between genetic, biological, environmental and psychological factors.
The type of eating disorder a woman suffers from may influence her patterns of substance abuse. Women with bulimia often abuse alcohol to facilitate the cycle of regurgitation and duration. Abuse of diet pills, laxatives, weight loss supplements, thyroid medications and psychostimulants such as Ritalin is common among those with anorexia.
Substance abuse treatment for women with eating disorders is crucial. Women who have eating disorders and drug or alcohol addiction are at a higher risk for cognitive impairment, cardiovascular disease, lung disease, cancer, HIV/AIDs, and Hepatitis B or C if they do not see treatment for both issues. Since eating disorders and substance abuse problems both manifest as avoidance-based coping strategies, successful treatment needs to address both problems in an integrated way.
7. Addressing Depression
The Mayo Clinic reports that women are twice as likely as men to be diagnosed with depression. Women who suffer from depression often describe themselves as feeling persistently sad, anxious or empty. They have a loss of interest in activities they once enjoyed and experience trouble sleeping or difficulty concentrating. Depression can also cause headaches, chronic pain and digestive disorders that don’t respond to traditional forms of treatment.
The hormonal differences between men and women are thought to play a key role in why women suffer from depression at a higher rate. Menstruation, pregnancy and childbirth can cause dramatic fluctuations in estrogen and progesterone that can disrupt that the body’s flow of serotonin and other mood-controlling chemicals. The female brain does not process serotonin as rapidly. Additionally, women are more sensitive to low-levels of corticotropin-releasing factor (CRF), a hormone that regulates the body’s stress responses.
Aside from hormonal differences, depression in women may be linked to physical, sexual and/or emotional abuse. Social support is well known as a key component of mental health, but being victimized by a friend or family member can shake a woman’s reliance on these networks. Stephanie S. Covington writes:
“For an adult man, the risk for abuse comes from being in combat or being a victim of crime. His risk is from ‘the enemy’ or from a stranger. For an adult woman, the primary risk is again in her relationship with the person to whom she says, ‘I love you.’ Clinically, it is very possible that this may account for the increase in mental health problems for women. In short, it is more confusing and distressing to have the person who is supposed to love and care for you do harm to you than it is to be harmed by someone who dislikes you or is a stranger.”
Women who are mistreated and victimized by the people around them start to withdraw as a form of self-protection. Social isolation increases the risk of depression, which is a significant risk factor for drug and alcohol addiction. People with depression often turn to drugs and alcohol as a form of self-medication.
They may be afraid to seek medical treatment for their illness, due to the common misconception in popular culture that depression is a sign of weakness. But self-medication can have disastrous consequences. A woman who starts off having a glass or two of wine when she’s feeling blue may soon start to find her drinking is spiraling out of control.
To ensure a lasting recovery, a woman struggling with depression needs to find a way to boost her mood that doesn’t involve substance abuse Here are some things she might try:
- Antidepressant medication
- Talk therapy
- Holistic remedies such as meditating, exercising or spending more time outdoors
Art therapy, whether in the form of drawing, painting, sculpting or playing music, can also be useful as a way for women in recovery to constructively deal with painful thoughts and emotions.
8. Treating Post-Traumatic Stress Disorder
Post-traumatic stress disorder (PTSD) is often associated with military veterans who have returned from war, but the reality is this condition can be caused by any traumatic event. In women, PTSD is most often linked to having been the victim of physical or sexual assault.
The National Institute on Drug Abuse states as many as 80 percent of women seeking addiction treatment have a history of being victims of physical and/or sexual abuse. Although not all of these women have been diagnosed with PTSD, it’s not unreasonable to assume many meet the criteria. Time reports over 50 percent of people with addictions suffer from PTSD as well or have had PTSD in the past.
Exposure therapy, which involves introducing memories and reminders of past trauma to reduce symptoms such as flashbacks and bouts of intense anxiety, is the standard approach to treating PTSD. At one point, experts thought exposure therapy for patients with addiction and PTSD could lead to an increase in drug or alcohol use. However, this theory has since been disproven. Not only is abstinence is not required for PTSD treatment to work, but addressing PTSD symptoms while simultaneously treating the drug and alcohol addiction can put women on a quicker road to recovery.
9. Ensuring the Health of an Unborn Child
An unplanned pregnancy can be overwhelming for any woman, but those who are struggling with substance abuse have special concerns during this time. A pregnant woman has to focus on her own health as well as the health of her baby.
Since it’s legal and easily obtained, alcohol is the most commonly abused drug in our society. Our Moment of Truth reports roughly 1 in 13 pregnant women report drinking alcohol within the last month, with 1 in 71 women admitting to binge drinking or having more than four drinks at one time. Drinking is thought to be most harmful during the first three months of pregnancy. However, it’s recommended pregnant women abstain from alcohol entirely.
Alcohol use during pregnancy can lead to a baby born with fetal alcohol spectrum disorders (FASD). The most serious of these disorders is fetal alcohol syndrome (FAS), which is characterized by growth retardation, mental retardation, delayed development and distinctive facial features such as flattened cheeks, a small jaw and small eyes with drooping upper lids. Other problems associated with children of women who abuse alcohol while pregnant include:
- Premature birth
- Intellectual disabilities
- Behavior problems
- Birth defects in a baby’s heart, brain or other vital organs
- Vision impairment
- Hearing problems
- Speech and language delays
The March of Dimes reports about 1 in 20 women abuse street drugs during pregnancy. This includes cocaine, ecstasy, methamphetamines, heroin, marijuana and prescription drugs obtained illegally and used without a doctor’s supervision. Street drugs are associated with the following problems:
- Preterm labor
- Low birth weight
- Infections passed to baby during pregnancy or birth, including Hepatitis C and HIV
Neonatal abstinence syndrome (NAS) can also be a concern, although this condition is mostly associated with opioid use during pregnancy. This includes heroin as well as prescriptions such as Vicodin, OxyContin and Percocet.
Some women abuse both alcohol and drugs while pregnant. This greatly increases the risk of harm to the unborn child.
10. Addressing Concerns About Parenting
Women who are not currently pregnant but already have children are often motivated to seek treatment when they realize what their addiction is doing to their children. A mother who is struggling with substance abuse may:
- Get behind on her rent, have her utilities shut off, or be unable to buy food for her child because her money is being spent to feed her addiction
- Leave the child unattended or in the presence of poor daycare providers while she is using
- Experience severe mood swings that lead children to feel unsafe in their home
- Become physically aggressive toward her children
- Forget key parenting tasks, such as picking a child up from school or making arrangements to go to the library to help a child complete an important research project, because she was distracted by her substance abuse
- Drive under the influence with the child in the car, leading to the potential of serious injury or death
Substance abuse by a parent is the most common reason children are placed into foster case, with Spark Action indicating drug or alcohol addiction by one or both parents is a factor in 75 percent of all placements. Mothers who have their children placed into foster care will not be able to regain custody until they’ve demonstrated they can provide a safe environment for their children. This will involve successfully completing a drug or alcohol rehab program as well as parenting classes.
Statistics on Substance Abuse in Women
When it comes to the rates of substance abuse, gender differences are continuously noticed in the general population. Some of these statistics include:
- Death from prescription painkillers has increased dramatically in women. In 2010, there were 6,600 deaths, which is four times more than deaths from heroin and cocaine combined.
- About 13 percent (15.8 million) of women who are 18 years of age or older used illicit drugs during the past year.
- A woman goes to the ER every three minutes for misuse or abuse of prescription painkillers, and each day more than 40 women die from overdosing on drugs, including prescription painkillers.
- High rates of eating disorders have been found among women who have substance-use disorders, specifically bulimia.
- Substance abuse rates are greater in women with a binge-eating disorder and who also have a history of physical or sexual abuse.
- Rates of sexual or physical abuse are high among women seeking treatment for substance abuse, ranging from around 50 to 95 percent. A high percent of these women developed trauma-related symptoms associated with a PTSD diagnosis.
- When compared to men, women begin using drugs at an older age. The average age for women to start using alcohol or drugs is around 20, according to SAMHSA’s 2004 Treatment Episode Data Set.
Substances Most Commonly Abused by Women
The following four substances are most commonly abused by women:
- Alcohol. A commonly abused substances in the US, alcohol poses an addiction problem for about 12 percent of women, versus 20 percent of men. The drinking gender gap has been closing since the ‘70s, and it is now more socially acceptable for women to drink. Women develop alcohol addiction more quickly than men, so this trend is a concern. As a woman, you can suffer alcohol-related issues like liver damage, skeletal damage, brain atrophy, or heart damage more quickly than men, leaving you more vulnerable to alcohol effects. Women have more fatty tissue and less water, so their organs sustain more exposure to the alcohol because fat retains it and water dilutes it.
Also, enzymes and alcohol dehydrogenase (ADH) are lower in women. These enzymes break alcohol down in your liver and stomach. Women have less of them, so they absorb more alcohol in the bloodstream.
“Women simply need to be more cautious than males in terms of the amount of drinking they do,” says Charles Lieber of the Mount Sinai School of Medicine and lead author of the Gender differences in pharmacokinetics of alcohol study published in Alcoholism: Clinical and Experimental Research.
- Prescription Drugs/Opioids. Prescription drugs are quite addictive, particularly if you’re using them in a manner that is not consistent with their labeling or they weren’t prescribed to you. A study published in the journal Addictive Behavior found that women had a significantly higher likelihood to both hoard unused medications and use sedatives to enhance their prescription painkillers.
As a woman, you’re more likely to receive opioid prescriptions because your gender makes you prone to suffer from fibromyalgia and other chronic pain conditions. Also, you are more likely to visit the emergency room for opioid abuse than men.
- Stimulants. Women are equally as likely to use and abuse stimulants like methamphetamine or cocaine. However, there are gender differences with their use. For instance, women have been reported to use methamphetamine at a younger age than men.
- Marijuana. Although men have been reported to be almost three times more likely to smoke marijuana daily, you could progress to dependence more quickly and experience more damaging medical effects as a woman.
Women’s Patterns of Substance Abuse
You face more difficult challenges as a woman, according to the Harvard Medical School:
- You have higher chances of progressing from simply using a substance to becoming addicted to it.
- You have a higher tendency to develop social and medical consequences from addiction.
- You are also more likely to find it harder to quit using addictive drugs.
- You also have a higher chance of relapse if you quit.
Because of these unique challenges, women require different types of substance abuse treatment.
Familial Substance Abuse
If you have a relative with a substance use disorder, you’re more likely to develop the disorder as well. A few studies have shown that when parents abuse substances, it can influence their children to develop substance abuse as well. Males and females are equally affected by familial substance abuse, but women have a predominance of alcohol dependence of up to 50 times higher than if they didn’t have a parent with a substance abuse.
Substance Abuse Treatment for Women
Over the past 20 years, increasing amounts of evidence reveal that women who have substance addictions usually face certain challenges that men don’t. Knowing these gender differences and gaining a better appreciation should help you avoid abusing substances and allow clinicians to better help women achieve sobriety.
Voyage offers tailored programs for your unique and individual needs as a woman. As part of the JourneyPure network of treatment centers, we recognize these gender differences and offer treatment plans that are personalized to your life situation.
Although women struggling with substance abuse issues do face unique challenges, help is available. Voyage uses an integrative model of treatment that incorporates a focus on mental wellness, fitness, nutrition and resolution of any co-occurring disorders. This approach has been proven to be effective at helping promote a sustained, lasting recovery. Contact us at (615) 939-9294 to learn more.