Friday, December 7, 2007

Substance Abuse and Women

Women Have Different Patterns Of Alcohol Abuse
Women drink less alcohol than men any way you look at. Women are more likely to be non-drinkers, start drinking at an older age, consume smaller quanties when they do drink, drink less frequently, and binge less than their male counterparts. But, she is more likely to drink alone. Nevertheless, many women have alcohol abuse or alcoholism problems. About 4% of women have a current problem and 8% ever have had a problem with alcohol. Women are at risk for alcoholism with 1 to 1 1/2 drinks per day vs 4 for men.

Women's alcoholism and their relationships with a husband or signficant other is complex. Most people know that alcoholic men keep their wives while alcoholic women are divorced by their husbands. But this may actually be a good thing. Many women alcoholics stop once divorced of separated. Women who live alone are more likely to develop alcoholism. But this is not because they are unhappy being alone (married women are much likely to be depressed). It is because because men and women alike feel more comfortable commenting on and re-directing a woman's behavior. They will intervene much sooner. There is greater social pressures on women to confrom, so their drinking either must be hidden from others. Since this is difficult to do with a housemate not doing it is often the result.

There does not seem to be any differences in the genetic tendency towards alochol abuse. A typical woman who comes for treatment is about the same age as a man. But while he has had years of gradual escalation, her problem evolved rather quickly. Her drinking was likely triggered by specific events and she came to treatment because of health or relationship (not job or legal problems like men) affects of the drinking. Women suffer more damage to the liver and other health problems with comparable amounts (standardized by weight) than similar men, so there are more health problems sooner.

Women and Other Substance Abuse
Women are more likely to be addicted to prescription drugs than illegal. They combine them with alcohol. Stimulants (cocaine, methaphetamine, even Phen-Fen) are used at about the same rate as men. But women's motivation is often weight loss or to temporarily counter depression that is more common in women.

Women are more likely to start and continue smoking for weight control.

Substance Abuse -- The Consequences For Women
Alcohol use is associated with higher rates of breast cancer and osteoporosis. They are more prone to liver disease. Menstrual disorders and impaired childbearing potential are associated with both alcohol and drugs. Specifically, heavy, irregular, paninful periods and PMS are implicated. Women smokers go through menopause earlier. While unplanned pregnancy is a consequence of addiction, it is also one of women's strongest motivators to quit.

Female drug users have a much higher rate sexually transmitted disease, including AIDS. This is due to having unprotected sex with high risk partners while stoned. Male to female transmission is always higher. Also, drug addicted women trade sex for drugs.

Substance Abuse Treatment For Women
While many women prefer all-female treatment groups, there is no clear cut evidence that they have better outcomes than their co-ed counterparts. The practice of "an intervention" or other confrontational initiation of therapy by others is one that often backfires when used on women. Many women are already overly concerned with what others think of them and how their behavior impacts their loved ones. They are not in denial, unaware, or unconcerned about the impact, as this practice is intended to correct. Rather they are hiding their behavior to avoid the social stigma and shame to which they are more sensitive. Women are more likely to perceive an Intervention as an attack and cut off contact the social support network that iniated it, because she feels like she has let them down and/or they don't care about her. This loss can prevent her from getting the treatment she needs rather than facilitate it.

Women are more likely to start treatment in a non-substance abuse setting, such as a therapist, and emergency room, or a primary care doctor. This may be linked to the fact that women have more low self-esteem and psychological problems that coincide with substance abuse. Women abusers have more anxiety and depression. Sometimes, these problems are addressed by their doctors, but the substance abuse is overlooked. Sexual abuse, violence or trauma, eating disorders, and dissociative disorders are also common in female substance abuse. Again, the substance abuse issue may be lost in these.

Women's treatment may include addressing some of her underlying coping skills and life situations that tend to lead women abuse substances. Assertiveness training, family or marital or parenting counseling, recovery for sexual or physical abuse, and practical help to achieve economic self-sufficiency can be included.


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