Addiction is a highly personal experience that affects each individual differently. The factors and circumstances that lead to someone developing addiction are many, and you may be surprised to find out that one of the elements to consider is gender. For years, the only subjects in addiction research were men. This bias has hindered the field of addiction treatment in examining and accommodating the specific issues women face when it comes to treatment and recovery.
In recent decades, we have started to see more women included in studies. The results of this crucial inclusion have revealed significant differences in the way addiction impacts women compared to men. Understanding these differences is essential to finding the right treatment program.
How Gender Influences Substance Abuse Rates
The clearest effect of the relationship between gender and addiction is visible in the rates at which men and women abuse drugs and alcohol. Historically, men have always been more likely to struggle with substance abuse. However, there is some evidence that this has been changing over the decades. One study examined rates of substance abuse by gender over several decades, detecting a growing equalization between men and women.
In the 1980s, for example, the male/female ratio of alcohol abuse was estimated at 5:1. More recent survey showed that the gap narrowed to a male/female ratio of about 3:1.
Notably, age has a significant impact on drug use between the genders. Data from the Substance Abuse and Mental Health Services Administration (SAMHSA) indicates that in youth ages 12 to 17, the use of illegal drugs is approximately equal.
Men still tend to struggle with substance abuse in greater numbers. The National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) is the largest study of substance abuse in recent years. It shows that men are 2.2 times likelier than women to abuse drugs and 1.9 times more likely to develop a drug dependence.
How Gender Influences the Abuse of Specific Substances
While there is a higher incidence of addiction in men vs. women, it’s also important to understand the different ways in which women engage with various substances and how that can affect their experience with addiction and recovery.
While men continue to abuse alcohol at higher rates, women may experience more damage due to alcohol use. The phenomenon called “telescoping” describes the shorter time women experience between starting to use alcohol and having serious alcohol-related problems that lead to a need for treatment. The tendency for telescoping is likely the result of multiple biological, psychological, cultural and socioeconomic factors.
One principal reason for women becoming addicted to alcohol faster than men is the lower total percentage of water in the body, which means they need less alcohol to become intoxicated than men do. Additionally, women don’t metabolize alcohol as quickly due to lower levels of alcohol dehydrogenase in the digestive system. Overall, these effects lead to women becoming drunk with less consumption.
The reasons men and women abuse alcohol are different, as well. Men tend to drink to reinforce social bonds or to enhance positive emotions, whereas women drink more to alleviate stress or other negative emotions. Women are also more likely than men to have other psychiatric disorders co-occurring with their alcohol use disorder, increasing the need for appropriate dual diagnosis treatment. Unfortunately, women are also significantly less likely to seek treatment than men.
Stimulants, sometimes referred to as “uppers” are drugs that amp up alertness and energy. Some common stimulants include methamphetamine, cocaine and prescription medications for attention-deficit/hyperactivity disorder (ADHD). SAMHSA data suggests that rates of stimulant abuse are similar for men and women, with about 1.9 million people reporting that they have used methamphetamine within the last year.
Disturbingly, more pregnant women have been increasing victims of methamphetamine dependence. In 1994, eight percent of the women admitted to federally funded treatment programs were in for meth, but by 2006, it was 24 percent.
Women may be more susceptible to stimulant addiction due to their different hormone makeup. Estrogen is shown to increase the effects of stimulants. In studies that discuss cocaine abuse, women report feeling more high and having a more increased heart rate than men do.
Opioid abuse and addiction have become an epidemic in the past couple of decades, but some studies show the growth of the problem has disproportionately affected women. Men are more likely to die from a prescription overdose, but women have experienced a more significant increase in overdoses related to opioids. Prenatal opioid use is also growing, and the number of babies born with neonatal abstinence syndrome (NAS) increased more than five-fold from 2004 to 2014.
Part of this problem may be the overprescription of opioids to women. One study showed that women are more likely to be prescribed opioids and given higher doses for longer periods — all factors that strongly contribute to the likelihood of developing an addiction.
Women struggle with illicit opioid use when it comes to heroin, too. Women use smaller quantities of heroin for shorter periods and are less likely to inject it. One element unique to gender is the introduction to intravenous injection by a sexual partner. About 51 percent of women are first injected by a male sexual partner, while 90 percent of men get their first injections from a friend. This supports the idea that women who inject heroin and other intravenous drugs are more heavily influenced by social pressure from a partner.
Marijuana, or cannabis, is the most common illicit drug used in the United States. Around 43.5 million people report having used marijuana in the last month. Men are more than twice as likely to be daily marijuana users. They have been shown to have more opportunities to initiate marijuana use,and they start using it about a year earlier than women on average.
Women with a cannabis use disorder are more likely to have or develop mood and anxiety disorders associated with internalizing emotions. Men addicted to cannabis are more likely to have externalizing disorders, which direct emotions inappropriately outward toward the environment and others in it.
Due to its federal illegality, there is little research on how marijuana affects women on a biological basis. However, one study suggests that women are more likely to develop a dependence on cannabis as a result of female hormones worsening the effects of withdrawal symptoms.
Gender-Based Differences in Treatment Outcomes
It stands to reason that if there is a difference in drug addiction between genders, there is a difference in treatment outcomes, too. The overall ratio of men to women in federally funded treatment is about 2:1 and has remained steady for several decades. Women are simply less likely to enter substance abuse treatment.
One key difference is the path women take to treatment facilities. Men are more likely to be referred to treatment through the criminal justice system, while about twice as many women as men are referred to treatment through community agencies like welfare or healthcare providers.
Once women begin a treatment program, however, gender does not act as an indicator of treatment retention, completion of a program or the outcome of the treatment. The factors that most commonly interfere with favorable outcomes are financial resources, mental health issues and less severe addictions. Better treatment retention is associated with characteristics such as:
- Better psychological health
- Higher personal stability
- Adequate social support
- Lower anger levels
Social and Cultural Factors That Impact Addiction
Women face a variety of social and cultural hurdles that can worsen addiction and make them less likely to seek the treatment they need. The following five circumstances unique to women should inform a quality addiction treatment program specific to gender.
1. General Stigma
Stigma against those who struggle with addiction, and even those who actively pursue treatment, is a reality for both genders. Women, however, tend to experience greater guilt and shame around the topic of addiction. Women report experiencing greater stigma than men do when it comes to addiction and treatment.
Substance abuse in women has historically been considered an act of selfishness and moral failure. Given the role of women as a central moral figure in the family unit, they feel greater pressure to appear as though they have everything together. For many women who have their own families, admitting to addiction and needing help is a sign that they are harming their family and should feel shame for it. They may also be subjected to the idea that seeking treatment places a burden on their family as well as society.
Trauma, the psychological damage that occurs as the result of an overwhelmingly stressful event, is an immense factor in the development of addiction. About 80 percent of women receiving addiction treatment have had at least one traumatic experience.
Sexual assault is the primary source of trauma for women. While one in five women in the general population will experience this traumatizing event, the number is as high as 72.9 percent among women seeking substance abuse treatment.
Post-traumatic stress disorder (PTSD) is another issue to be aware of. Men are more likely to experience traumatic events at least once in their lifetime, but women are twice as likely to develop PTSD as a result of such an event. Acknowledging this difference and its effect on addiction is paramount to creating effective gender-based treatment programs.
3. Financial Inequalities
Unfortunately, finances are always a factor in the treatment of addiction, and they are one of the top reasons women in particular don’t seek treatment. Lower pay, less income and a higher likelihood of poverty often limit the resources women can use to seek treatment and support services.
Financial inequality affects women after treatment is over, as well. It’s well-documented that access to post-treatment care and basic necessities like transportation and housing help improve outcomes, but women struggle more often to pay for them.
4. Mental Health Disorders
The co-occurrence of addiction and other mental health disorders makes it much more complex to treat both conditions. Women are significantly more prone to common mental health problems like depression, anxiety and eating disorders. In fact, almost twice as many women experience depression as men. Mental health disorders greatly decrease the likelihood that someone will take steps to secure appropriate treatment.
Eating disorders are a condition that mostly affects women. About 75 percent of people with anorexia nervosa are women, and they are often hesitant to talk about it due to the stigma. However, the quarter of anorexia sufferers who are men are even more stigmatized because people assume that men don’t get eating disorders. Treatment programs that are separated by gender offer a more personalized approach to mental health disorders like these, by taking into account the different societal pressures that led to the disorder.
Addiction can arise as a result of any mental health disorders as individuals attempt to self-medicate. Substance abuse also worsens the symptoms of mental health disorders, leading to a cycle that is challenging to break. In combination with the increased stigma women face, a mental health disorder can easily stop a woman from seeking out treatment.
Research indicates that up to 70 percent of women who do enter addiction treatment have children. While the majority of fathers who enter treatment have the advantage of another person as the primary caregiver — usually the mother — women are less likely to have this benefit. This often results in difficulties with treatment attendance, as there is no one else to fill the care gap.
Pregnancy is also a concern for women struggling with addiction. Prenatal use of drugs or alcohol may cause birth defects or neonatal abstinence syndrome, yet expectant mothers may not seek treatment due to a fear that discovery of their drug use will lead to their baby being taken away.
Expectant mothers may also believe that medication-assisted treatment (MAT), the most effective form of addiction treatment to date, is not an option for pregnant women. However, the American College of Obstetricians and Gynecologists actively recommends the use of MAT for pregnant women seeking treatment for opioid addiction. Lack of resources and misconceptions about treatment unfortunately stop many women from getting the help they need to ensure their babies are born as healthy and drug-free as possible. The risks of continuing to abuse drugs or alcohol far outweigh the minimal risks associated with treatment.
Gender Differences in Substance Abuse Treatment
Addiction treatment programs have always been standardized for the needs of men. While women can find great success in generalized programs, there are some specific needs that, if met, may increase their chances of success in recovery.
1. Sexual Healthcare
Women have concerns regarding sexual healthcare that men do not. Treatment for women should include services that monitor things like menstrual health and other aspects of sexual health.
Both men and women should have access to screenings for sexually transmitted diseases, as addiction often leads to risky behaviors that increase the risk of contracting one. Addictions to substances like heroin increase the need for this access due to the prevalence of disease contracted from shared needles.
2. Supportive Therapies
Women generally have lower self-esteem than men do. “Tough love” approaches that seek to dismantle a person’s denial about drug use can work well for men but may only serve to traumatize women further. Of course, every woman is different, but a more effective approach for many women is based on trust, understanding and awareness, rather than an aggressive push to change behavior.
3. Childcare and Family Support
Treatment programs that offer childcare or can provide resources to help women access and arrange childcare help improve outcomes for women. Without the stress of wondering what to do with children during treatment sessions, women can better focus on engaging with treatment and pursuing recovery goals.
Family therapy is also an effective way to improve treatment for women who have families. It can help the family understand how to support the person in recovery. When families can better support the person in recovery, there is less chance of relapse, and the whole family unit will learn healthy habits that make it possible to sustain recovery.
The Benefits of Single-Gender Addiction Treatment
Gender-specific programming is one of the most effective ways to improve treatment outcomes for certain people. The number of women who have a history of experiencing violence or sexual abuse is high enough that offering programs specific to women is imperative for effective treatment.
It is common for women who have suffered from these issues to experience symptoms of anxiety or panic when asked to be emotionally vulnerable in a group that includes men. Separating into gender-based groups can help calm these nerves and make participants more open to engagement with therapy and other treatment activities. One study of participants in a women-only group reported significantly greater satisfaction with treatment as compared with a gender-inclusive group.
Women also benefit from an approach that prioritizes support, a collaborative approach and building self-confidence. A collaborative approach where the therapist acts as a partner to the woman in identifying and changing negative emotions and behaviors is the most effective.
Men face their own challenges in addiction recovery, with difficulty expressing emotions taking the forefront. There is significant societal pressure to meet unattainable standards of masculinity, as defined by appearing dominant at all times. This pressure often results in severe impairment in the ability to identify and process emotions, which leads men to address their emotions with substance abuse.
Developing emotional intelligence in a safe space is essential to men’s recovery, and it is often easier to do this in a single-gender program. Opening up in group therapy feels more natural when you know that the people around you have experienced the same pressures and perhaps some of the same circumstances you have. Having these shared experiences can help build trust and remove some of the fear of judgment that stops people from fully engaging.
Gender-Based Addiction Treatment at Gateway
When you or someone you care about is struggling with addiction, you want to find the most effective method of treatment possible. Oftentimes, the best solution is to choose a gender-specific treatment program. Rehabilitation for men and rehabilitation for women offer the same evidence-based treatment techniques with the addition of methods and approaches that cater to the specific needs of each gender. Participants are often motivated to be more open and more vocal when surrounded by people of their gender who are experiencing addiction within the same societal roles.
Gateway Foundation is a leader in evidence-based treatment, including gender-based techniques. We have treated more than one million patients during our 50-year history. We have developed a deep understanding of how individualized treatment can improve outcomes, and we strive to give every patient the customized care they need to build the strongest foundation for recovery.
If you are concerned that addiction is taking over your life and you don’t know what to do about it, Gateway is here to help. We urge you not to wait another day while substance abuse continues to erode your quality of life. Give Gateway a call at (877) 505-4673 or contact us online. We can answer the questions you have about addiction, treatment and the road to recovery so you can begin your journey to sobriety.