Historically speaking, much of past research on substance use and addiction has been focused on male subjects. Over the past 15 years, however, there has been a significant growth in attention to gender differences in substance abuse.

An extensive review of literature published between 1975 and 2005 on substance abuse treatment among women found that 90 percent of articles about the relationship between substance abuse and gender has been published after 1990, indicating that it is a relatively new area of study. There is increasing recognition among the scientific community of the biological and psychosocial differences between men and women that influence the prevalence of substance abuse, how substance abuse presents, comorbidities with other disorders, and approaches to treatment.

Differences In Rates of Substance Abuse

The vast majority of studies confirm that drug and alcohol use disorders are consistently higher among men than among women. In one of the most recent of these types of studies, the National Institute on Alcohol Abuse and Alcoholism’s National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) surveyed more than 40,000 adults and found that 13.8 percent of men versus 7.1 percent of women had a diagnosable drug use disorder, indicating men were twice as likely to have a drug use disorder.

The discrepancy in alcoholism between the genders were even greater, with one study finding that twelve-month prevalence rates of alcohol abuse were almost 3 times higher among men than among women — 6.9 percent of men versus 2.6 percent of women.

Rates of prescription drug abuse between men and women, however, are close. The National Survey on Drug Use and Health (NSDUH) reported that the twelve-month prevalence rates of pain reliever abuse was 1.4 percent for men versus 1.1 percent for women between 18 to 25 years old, and 0.5 percent for men versus 0.4 percent for women 26 years and older.

Differences In Initiation and Patterns of Substance Use

The Substance Abuse and Mental Health Services Administration (SAMHSA) and the Center for Substance Abuse Treatment (CAST) created Treatment Improvement Protocols that serve as a guideline for approaching treatment. Of these, Treatment Improvement Protocol (TIP) 51 addresses the particular characteristics and needs of women who are afflicted with substance abuse disorder.

According to TIP 51, personal relationships have a larger influence on women than on men when it comes to substance use. Many women who use substances are introduced to them by a family member, close friend, or romantic partner. Familial relationships are particularly influential, with the parental use of alcohol increasing the likelihood of alcohol use by at least 50 percent. Female substance abusers are also more likely to have partners who are substance abusers as well. Rituals and high-risk behavior surrounding substances, such as needle-sharing, are directly influenced by significant relationships.

Women also respond more to their home environment than men do. Living in violent, argumental, and generally chaotic conditions is more likely to push women toward substance abuse. Marriage acts as a protective force for women against substance abuse, with separated, divorced, and single women at greater risk. Similarly, women are more likely to alter their pattern of use depending on their responsibilities as a caregiver.

Early life stresses, especially childhood sexual abuse, are more common among women. These stresses are associated with higher risk of substance abuse in general, putting women at greater risk. Women who experience violence in adulthood are at similar risk, compounded by the fact that alcohol and drug abuse place women at higher risk for repeated victimization, thus perpetuating a cycle of victimization and substance abuse.

Substance use tends to escalate more quickly in women. Earlier patterns of use, such as the amount and frequency of substance use as well as the age of their first exposure, is positively linked with a higher risk of dependency. Substance use also tends to progress more quickly to substance-related consequences in women. On average, females experience more medical, psychiatric, and social consequences of substance abuse than males.

Differences in Comorbidities

According to TIP 51, females with substance abuse disorders are more likely than males to have co-occurring conditions such as depression, anxiety, posttraumatic stress, and eating disorders.

One study examined gender differences in the onset of major depression episodes and alcohol dependence. The data set showed that women with major depression episodes were more than 7 times as likely as women without major depression episodes to have developed alcohol use disorder at the 2-year follow-up point, whereas men with major depression episodes were not found to be at higher risk for alcohol use disorder.

The Substance Abuse and Mental Health Services Administration (SAMHSA) reports that 5 percent of women versus 3.1 percent of men with substance abuse disorder report having a co-occurring disorder.

Differences in Treatment

TIP 51 contains information about the best way to approach substance abuse treatment among females. These treatment guidelines, called “Core Principles of Gender-Responsive Treatment,” include:

  • Recognizing the role and significance of personal relationships in women’s lives.
  • Acknowledging the importance and role of socioeconomic issues and differences among women.
  • Adopting a trauma-informed perspective.

Understanding gender differences in substance abuse disorders helps us better understand how to treat substance abuse disorders effectively and meaningfully.

Call Fort Recovery today to ask about our women-specific treatment options. Contact us at 844.332.1807 to get started!


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