Does addiction affect women differently than it does men? This question has been studied for decades, with plenty of evidence indicating that gender influences how the illness presents. Still, the topic of women and addiction needs to be further addressed if we are to improve recovery outcomes.
If someone tells you to picture an addict, what do you see? Chances are, the person you imagine is male. This is inevitable, given that men are far more represented in media about addiction than women are.
Looking at statistics surrounding treatment, this representation may not seem surprising. In 2020, almost two-thirds of people attending rehab were men. In addition, a lot of expert literature on addiction reads as male-focused.
Unfortunately, this is not because women experience lower rates of addiction. Rather, barriers to treatment, along with a history of neglect of the study of addiction in women, has led to gender-specific challenges in recovery.
What challenges do women with substance use disorders face? And what does gender have to do with addiction in the first place?
Addiction in Women: The Biological Differences
When discussing the gender differences of addiction and addiction treatment, it is natural to assume that it is a function of societal expectations and traditional gender roles being at play. These factors are relevant, and we will explore them further below, but the divergence is not just due to external forces.
Addiction actually impacts men and women differently to biological factors. Most significant are the hormones which are more elevated in women, including estrogen and progesterone. Estrogen is particularly influential as it amplifies the effects of drugs like cocaine and amphetamines.
Not only does this make developing an addiction more likely during certain phases of the menstrual cycle, but it also raises the risk of relapse during recovery. When major changes occur in the menstrual cycle, such as during and after pregnancy and in menopause, a woman’s vulnerability increases.
Hormones are just one explanation, along with the body’s stress response and metabolism, for the particular way in which addiction tends to occur in women. Known as ‘telescoping’, the addiction may develop more quickly than in men, even when using relatively small doses.
Another physical factor in addiction in women is body composition differences. Women are likely to have a higher body fat percentage and less water weight than men, which can cause higher blood-alcohol levels and lead more quickly to inebriation.
Society’s Impact on Female Substance Abuse
Of course, the differences for women with substance abuse problems go far beyond the physical. Societal expectations and female experience are central to the roots of addiction, its consequences, and access to treatment.
For many women, addiction is connected to trauma. Women are more likely than men to have suffered emotional, physical, or sexual abuse. Looking for a way to counteract the negative effects of these experiences, substances have a strong appeal. They can temporarily distract from painful memories, numb out shame and anxiety, and increase confidence. But these effects are brief, leading to the urge to use more.
Another risk factor for substance use in women is the pressures faced when navigating society. Prejudice still exerts a significant influence on women’s safety, job opportunities, salaries, and responsibilities. Addiction can stem from a desire for a temporary escape from difficult realities of everyday life.
The roles ascribed to women in much of society are also relevant. Caretaking of others, a common expectation of women, is known to lead to increased stress levels and is connected to higher risks of mental illness and addiction. This makes women who both take care of their families and work in caretaking jobs like nursing or hospice support especially vulnerable.
Physical and environmental influences clearly impact the emergence of addiction in women. But is this relevant to treatment?
Gender and Addiction Treatment
There is a plethora of evidence that indicates the differences of addiction in women are relevant to treatment. In fact, these gender-specific issues impact whether women get treatment in the first place.
Barriers to Treatment
As we mentioned, almost two thirds of rehab attendees are men and it is not because they use substances at much higher rates. Rather, women face significant barriers in accessing treatment, from the oppressive power of stigma to the practicalities.
Stigma
There is still a stigma surrounding addiction regardless of gender. However, women face additional stigma. They are more likely to be labeled ‘irresponsible’ or ‘immoral’ for using substances. Women with children who become addicted to drugs or alcohol are perceived by some as ‘bad mothers’.
Women therefore might avoid seeking treatment out of the fear of people knowing that they have a substance use disorder. They therefore try to tough it out, exacerbating the problem and potentially leading to worse outcomes.
Practicalities
Taking time off to go to rehab is not easy for most people in our fast-paced world. Even with protections in place to prevent workplace discrimination due to health, it can be tough to leave projects incomplete or hand over important assignments.
However, it can be much harder for women and especially mothers. Many women, whether or not they have a paying job, are the main caregiver for their children. Spending time in rehab requires finding alternative childcare options for an extended period of time. This is not only difficult, but also extremely expensive. And, if they are on unpaid leave from work, it will be a double financial hit.
Additionally, women are more likely to have economic difficulties than men or lack transportation.
These issues can make occasional sessions difficult to arrange, even if they choose not to go to a residential rehab.
Gender-Specific Recovery Approaches
Unfortunately, there are societal problems that will only be solved with major change over the course of many years. We do not live in a world in which free childcare for all is a possibility. There will also be some level of stigma surrounding addiction in women for the foreseeable future.
That’s not to say that we’re not making progress in gender-specific addiction care. On the contrary, experts now have a better understanding of women’s challenges in addiction treatment than ever before. Treatment programs and rehabs accommodate custom treatment approaches for female participants.
Here are some of the gender-specific recovery approaches being embraced within the addiction treatment sphere:
Trauma-Informed Care
Trauma is a major risk factor for addiction for women. Without taking the trauma into account, the risk of relapse is higher, as the underlying issue has not been resolved. This does not only affect women, as men with addiction may also suffer from trauma, but it does make the inclusion of trauma-informed care all the more important.
Trauma-informed care is treatment that places importance on looking into the residual effects of historical trauma. It helps the person process that trauma, identifying the wounds that still need to heal and providing the path to healing.
In instances where the person is still being subjected to trauma, as is the case with a person in an abusive relationship, treatment takes context into account and places an emphasis on finding a way out of the situation.
Gender-Specific Environments
One of the reasons treatment can be difficult for women to fully engage with is that they do not feel as safe as men to share or contribute. This may be due to trauma, but it can also be the result of years of being expected to be quiet and demure. Many men, having never been expected to keep their thoughts to themselves, have the confidence to speak at length. In coed spaces, women can end up feeling unheard and it is no one’s ‘fault’.
Treatment groups which are specifically for women can provide the space for women to feel safe and supported. With greater participation and engagement, they have a greater sense of agency over their recovery, leading to more sustainable health.
Holistic Therapies
Holistic therapies like mindfulness and yoga have been integrated into the programs of the best rehab centers for all genders. Evidence shows that they are extremely effective at improving treatment outcomes. For women, these therapies can be even more healing. This may be due to gender expectations – holistic therapies are wrongly thought of by some people as feminine pursuits and certain men are reluctant to embrace them.
Conclusion
Gender differences in addiction and treatment exist. There are no easy fixes for some of the issues that create challenges for women with addiction. Nonetheless, with gender-specific approaches to care, the outlook is brighter than ever before.
Sources
NIDA: Substance Use in Women Research Report
SAMHSA: 2023 National Survey on Drug Use and Health
Alcohol Research and Health: Gender and Use of Substance Abuse Treatment Services
NIDA: Sex and Gender Differences of Importance to Addiction Science
