Substance Use Recovery & Treatment for Women

While there is not as much research on women with addictions as there is on men, the National Institute on Drug Abuse shares that women often “use drugs differently, respond to drugs differently, and can have unique obstacles to effective treatment.”¹

Just as women use and react differently to substances, in some instances women also respond to treatment differently than men. No single type of treatment is appropriate for everyone.

For these reasons, and because women have specific biological, psychological, and social needs, substance use disorder treatment for women should be different from treatment for men. When women’s specific needs are addressed, women have improved engagement, retention, and treatment outcomes.²

In this article, you’ll learn about:

• Why addiction treatment should differ between men and women.
• Women and alcoholism.
• Other substance abuse and addiction among women.
• What to consider when choosing treatment.
• How to get help for substance abuse and addiction.

Why Addiction Rehab Should be Different for Women

How are men and women different in their addiction? Although there are many reasons why women require a different approach to rehab, some of the more prevalent reasons include that women:²

• Develop substance abuse disorders faster than men.
• Metabolize alcohol differently than men. This may also be true for illicit drugs, but research is limited.
• Develop more complications and severe problems from alcohol use more rapidly than those men.
• Report that stress, relationship issues, and negative emotions instigate substance use more frequently than men.
• May be more influenced by the combination of environmental factors and genetics. For example, if a woman has a genetic predisposition to addiction and is exposed to factors in her environment that can trigger substance abuse, she may be more likely to become addicted than a man in a similar situation.
• Are often trauma survivors, which makes trauma-based approaches especially important for addressing both the addiction and underlying trauma issues.
• Often connect with their romantic partners through the use of substances and are more likely to have partners who abuse substances.
• Have biological differences that need to be considered during treatment. These can include the way women metabolize drugs and alcohol and the impact of drugs and alcohol on a woman’s menstrual cycle, hormone levels, as well as their gastrointestinal, neuromuscular, and cardiac systems.

Further, women who are pregnant and abuse drugs or alcohol expose their unborn child to these substances and require a careful approach to detox and treatment that takes both the mother’s and the baby’s health into consideration.²

Women & Alcoholism

One of the main reasons that alcohol affects women differently than men is that women have different physiological reactions to alcohol.

Generally speaking, women usually weigh less than men. As alcohol mainly resides in body water, “pound for pound, women have less water in their bodies than men.”³ This means that women will experience a higher blood alcohol concentration after drinking the same amount as a man, which creates a higher risk of developing alcohol-related problems, such as alcohol use disorder.³

Research shows than women become intoxicated after drinking half as much and develop cirrhosis of the liver more quickly than men.⁴

Women also experience higher risks of medical issues that can be impacted by alcohol abuse, such as liver damage, heart disease, and breast cancer.³

Women who are abuse alcohol while pregnant increase both the risk of preterm labor and the risk of physical, cognitive, and behavioral problems in their unborn children.⁵ These problems can be a part of fetal alcohol spectrum disorders (FASD), such as fetal alcohol syndrome.

Some women may also be more susceptible to binge drinking. For example, research has found that women who experience trauma may be more likely to binge drink.⁶

One study showed that young women who experienced physical and sexual abuse by their romantic partners were more likely to engage in binge drinking. Another study found that exposure to adverse childhood experiences (traumatic events that occur between the ages of 0-17, such as violence or abuse) were highly correlated with binge drinking among adult women.²

Drug Abuse & Addiction Among Women

Most research shows that men are more likely to use and develop dependence on all types of illicit drugs. However, women who abuse drugs are just as likely to develop a substance use disorder. They may even be more likely to experience cravings and relapse.^{1, 7}  

In some instances, women also report having different reasons for abusing drugs—such as controlling weight, fighting exhaustion, coping with pain, and attempting to self-treat mental health problems—than men.⁷

Women use drugs differently than men. They often use smaller amounts of substances for less time before they become addicted.  They may be more likely to start using drugs as a result of trauma, divorce, custody issues, domestic violence, or death of a partner. They may also be more likely to experience mental health issues, such as anxiety or depression, as a result of substance abuse.⁸

Women’s bodies react differently to drugs. Drug abuse can have a negative impact on hormones, menstrual cycle, fertility, pregnancy, breastfeeding, and menopause.⁸ One study explains that female hormones like estrogen and progesterone may impact the behavioral response women have to drugs.

For example, during the follicular phase of a woman’s cycle, when estradiol is high and progesterone is low, women may respond more to stimulants like cocaine. Women may be more affected by the hormonal response to stress, which may explain why they are more likely to experience relapse when they feel negative emotions. ⁸

Women often have different reactions to specific substances than men. Research has shown that women who use marijuana have increased spatial memory issues. Some studies have also shown that teenage girls who use marijuana have a greater risk of structural abnormalities in the brain often seen with regular marijuana exposure.¹

Women may be more affected by the reinforcing effects of stimulants like cocaine and methamphetamine. Some research has suggested that this may be due to the effects of stimulants on estrogen. Women’s hearts and blood vessels may also be more affected by stimulants.¹

Additionally, women report different reasons for using methamphetamine than men, with expectations of an increase in energy and decrease in exhaustion associated with work, home care, childcare, and family responsibilities. Women are also much more likely than men to use meth in the hopes of losing weight.¹

Research has shown that women are more likely to have chronic pain than men, which may explain why they are more likely to abuse prescription opioids/pain killers. Women are also more likely to abuse prescription drugs as a way of self-medicating psychological issues such as anxiety or tension.¹

Treatment Considerations

It’s difficult to seek help for substance abuse. When you look for help for yourself or a loved one, there are specific things you should take into account and address in order to meet the unique needs of the woman looking for addiction treatment.

Some of these considerations include:^{3, 7, 9}

• Societal roles, such as the view of women as caregivers. This can impact whether a woman decides to seek out treatment. Specifically, issues related to childcare can play an important role in treatment engagement. Studies have shown that women are more likely to experience positive treatment outcomes when they are offered childcare and parenting classes. Women need support in handling issues related to the combination of work, home care, childcare, and other family responsibilities.
• The stigma attached to a woman seeking out treatment when pregnant. Women may be afraid to seek help during or after pregnancy.
• Abuse and history of trauma. For example, a woman with a history of sexual abuse may not want to participate in group therapy with men. Underlying trauma needs to be addressed in treatment.
• Co-occurring disorders, such as eating disorders, anxiety, and mood disorders. In order for treatment to be effective, it must address both the addiction and the co-occurring disorder(s).
• Relationship issues. Several studies have shown that women are more likely to have successful outcomes when their partners are included in the treatment process, providing that the relationship is not violent.

Addiction Treatment for Women

Specific therapies, like those listed below have been found to be helpful for women struggling with addiction.^{3, 10}

Gender-Responsive Treatment (GRT)

This form of treatment uses two programs, Helping Women Recover and Beyond Trauma, which were developed to treat women’s unique relational needs, promote pro-social behaviors, and encourage “psychological growth.” There is also a specific component for women in the criminal justice system.

Relational-Model Approach

This therapeutic model “affirms the power of connection and the pain of disconnection for women, with repeated disconnections having adverse consequences for mental health.”² It focuses on the importance of relationship-building for women in recovery and how substance abuse treatment is often the first place where they are offered the opportunity to do so in a healthier manner.

Trauma-Informed Approach

Women with substance abuse issues often struggle with underlying trauma, which, if not addressed, can lead to relapse or difficulty in recovery. This approach helps women understand and cope with the effects of violence on their recovery and functioning.

Intensive Outpatient Treatment

This model, in which people live at home but attend treatment at least 3 days per week, has shown positive results for women who are pregnant or breastfeeding. Women are more likely to stay in these programs when they are offered childcare, parenting classes, and vocational training.

Couples Therapy

Couples therapy can be helpful for recovery, provided that the relationship is stable and supportive. Some studies have found that including a woman’s partner in therapy improves short-term outcomes.

Family Therapy

In many instances, family therapy can help create a safe, accepting environment for the person using to return to after treatment. It can also begin the healing process in contentious relationships. One study found that family therapy was “an effective component for women in an outpatient substance abuse treatment program.”²

Get Help Today

A case manager, social worker, or counselor is usually able to refer female clients to women-only programs.

You can also consult your family doctors or gynecologists for referrals. This can be especially helpful for expecting mothers, as most physicians ask about substance abuse during screenings with pregnant women.¹¹

Some additional supportive options include:

• Women for Sobriety (WFS): This nonprofit organization is specifically for women, with a focus on recovery in the 12-Step model. This is a mutual support group with meetings all over the United States and Canada as well as an online forum for immediate help.
• Narcotics Anonymous (NA): Support group meetings are sometimes divided by gender to help participants focus on recovery without distractions.
• Veterans Administration programs: The VA offers medical treatment, including mental and substance abuse treatment, to veterans of the U.S. armed forces. Some of these options may be divided by gender.

References:

1. National Institute on Drug Abuse. (2018). Substance Use in Women: Sex and Gender Differences in Substance Use.
2. Substance Abuse and Mental Health Services Administration. (2009). Substance Abuse Treatment: Addressing the Specific Needs of Women. Treatment Improvement Protocol (TIP) Series, No. 51. HHS Publication No. (SMA) 13-4426. Rockville, MD: Substance Abuse and Mental Health Services Administration.
3. National Institute on Alcohol Abuse and Alcoholism. (2019). Women and Alcohol.
4. Greenfield, S. (2002). Women and alcohol use disorders. Harvard Review of Psychiatry, 10(2), 76-85.
5. Ornay, A. & Ergaz, Z. (2010). Alcohol abuse in pregnant women: effects on the fetus and newborn, mode of action and maternal treatment. International Journal of Environmental Research and Public Health, 7(2), 364-379.
6. Kachadourian, L.K., Pilver, C.E., & Potenza, M.N. (2014). Trauma, PTSD, and binge and hazardous drinking among women and men: findings from a national study. Journal of Psychiatric Research, 55, 35-43.
7. National Institute on Drug Abuse. (2019). Sex and Gender Differences in Substance Use.
8. Greenfield SF, Back SE, Lawson K, Brady KT. (2010). Substance abuse in women. Psychiatric Clinics of North America. 33(2), 339-55.
9. National Institute on Drug Abuse. (2018). Women and Drugs: Brief Description.
10. National Institute on Drug Abuse. (2018). Substance Use in Women: Sex and Gender Differences in Substance Use Disorder Treatment.
11. Coleman-Cowger, V., Snead, C., & Schulkin, J. (2018). Obstetrician-Gynecologists’ referral practices for substance use during pregnancy. Clinical Obstetrics, Gynecology and Reproductive Medicine, 4.