The developmental stages of drug involvement and addiction are not necessarily identical for men and women. The path to drug abuse can be more rapid and complex for women and typically includes a pattern of breakdowns in individual, familial, and environmental protective factors and an increase in childhood fears, anxieties, phobias, and failed relationships.
There is growing evidence that the effects of drug abuse and addiction do not always impact men and women in the same manner. For example, data indicate that for several illicit drugs, women may proceed more rapidly to drug dependence than do men. There is also evidence that nicotine dependence in females, relative to males, is controlled less by nicotine and more by psychosocial factors. One of the most devastating consequences of drug use for females is the risk of HIV/AIDS. AIDS is now the fourth leading cause of death among women 15 to 44 years and approximately two thirds of the AIDS cases among women are related to injection drug use. Among the total cases of pediatric AIDS in the US, 54% are related to either maternal injection drug use or maternal sex with an injecting drug user.
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Biological Mechanisms
Research findings indicate that the biological mechanisms involved in drug abuse and dependence are not identical in males and females. For example, a study examining gender and menstrual cycle difference in response to acute intranasal cocaine reported that mean peak cocaine plasma levels in females were higher in the follicular phase than in the luteal, whereas, overall, male subjects achieved the highest mean peak plasma cocaine levels, detected cocaine effects significantly faster than females and experienced a greater number of episodes of intense good effects. Further, research on the thermogenic effects of nicotine and caffeine in male and female smokers has indicated a significant increase in energy expenditure during activity compared with rest, but only in males. However, eating appears to play a more substantial role in the influence of nicotine on body weight in women than in men.
Behavioral Responses
Animal studies have shown that fundamental gender differences may exist in the reinforcing and stimulus properties of abused drugs. On measures of stimulant-induced activity, females exhibit more responsiveness than males; moreover, this responsiveness varies with the estrus cycle. Gender differences have also been reported in self-administration of cocaine, e.g. when cocaine infusions were made contingent upon increasingly higher numbers of bar presses, female rats made substantially more presses than males and their level of cocaine self-administration varied as a function of the estrus cycle.
Initiation/Progression
Research is beginning to show that the progression or developmental stages of drug involvement is not identical for males and females. In the progression from legal drug use to illicit drug use, for example, cigarettes have a relatively larger role for females than for males, and alcohol has a relatively larger role for males than for females. With regard to initiation into illicit drugs, data suggest that women are more likely to begin or maintain cocaine use in order to develop more intimate relationships, while men are more likely to use the drug with male friends and in relation to the drug trade. The onset of drug abuse is later for females and the paths are more complex than for males. For females there is typically a pattern of breakdown of individual, familial, and environmental protective factors and an increase in childhood fears, anxieties, phobias, and failed relationships; the etiology of female drug abuse often lies in predisposing psychiatric disorders prior to abusing drugs.
Sexual Abuse
Childhood sexual abuse has been associated with drug abuse in females in several studies. Some studies indicate that up to 70% of women in drug abuse treatment report histories of physical and sexual abuse with victimization beginning before 11 years of age and occurring repeatedly. A study of drug use among young women who became pregnant before reaching 18 years of age reported that 32% had a history of early forced sexual intercourse (rape or incest). These adolescents, compared with non-victims, used more crack, cocaine, and other drugs (excepting marijuana), had lower self-esteem, and engaged in a higher number of delinquent activities.
Victimization
Furthermore, female drug abusers may have greater vulnerability to victimization than males. For example, in a recent study of homicide in New York City, 59% of white women and 72% of African American women had been using cocaine prior to death compared with 38% of white males and 44% of African American males. Thus, while cocaine is used by more males than females, its use is a far greater risk factor for victimization for women than men. It is, therefore, critical that the factors involved in the relationship between drug abuse and dependence among females, and physical and sexual victimization (including partner violence) be identified and understood.
Pregnant Women
An aspect of drug abuse by women that is of particular concern is the use of drugs during pregnancy. Research indicates that pregnant drug users are at increased risk for miscarriage, ectopic (tubal) pregnancy, stillbirth, low weight gain, anemia, thrombocytopenia, hypertension and other medical problems. Their newborns may have lower birth weight and smaller head size than babies born to nondrug-using mothers. The National Pregnancy & Health Survey was conducted by NIDA for the purpose of providing a national estimate of the number of women who use licit and illicit drugs during pregnancy. Based on a sample of 2,612 women who delivered in 52 hospitals from October 1992 through August 1993, it was estimated that of the approximately 4 million women who deliver live-born children annually in the US, 5.5% or 221,000 women are projected to have used some illicit drug during pregnancy.
Comorbidity
The rate of co-occurring substance abuse disorder and other psychiatric disorders is relatively high for females. Data from a study on female crime victims, for example, indicate that those suffering from post-traumatic stress disorder (PTSD) were 17 times more likely to have major drug abuse problems than nonvictims. Additionally, it has been shown that individuals with a trauma history and PTSD symptomatology utilize substance abuse inpatient services more frequently than do their non-PTSD counterparts. This has lead researchers to speculate that the co-occurrence of substance abuse and PTSD may predict a more severe course than would ordinarily be present with either disorder alone. For females a high correlation appears to exist between eating disorders and substance abuse. For example, as many as 55% of bulimic patients are reported to have drug and alcohol use problems. Conversely, 15-40% of females with drug abuse or alcohol problems have been reported to have eating disorder syndromes, usually involving binge eating.
Recruitment/Retention
Women who abuse drugs face a variety of barriers including barriers to treatment entry, to engagement in treatment, and, long-term recovery. Barriers to entry include a lack of economic resources, referral networks, women-oriented services, and conflicting child-related responsibilities. Because women have many specific needs, a number of components of treatment have been found to be important in attracting and retaining women in treatment. These include the availability of female-sensitive services, non-punitive and non-coercive treatment that incorporates supportive behavioral change approaches, and treatment for a wide range of medical problems, mental disorders, and psycho-social problems. One research study showed that treatment of drug-dependent women was more likely to be successful if treatment was provided in a mutually supportive therapeutic environment and addressed the following issues: psychopathology (e.g., depression), a woman’s role as mother, interpersonal relationships, and the need for parenting education.
Treatment Outcomes
A national study of individuals in drug abuse treatment programs between 1991-93, (the Drug Abuse Treatment Outcome Study or DATOS) showed that women who had at least 28 days of treatment (with at least 14 days in short-term inpatient) had sharp reductions in their use of illicit drugs, HIV risk behavior, and illegal activities. For instance, at intake 84 % of the women who were admitted to long-term residential treatment programs admitted at intake using illegal drugs every day or at least once a week. Twelve months after treatment, only 28% continued to abuse drugs. Short-term inpatient treatment women also showed significant reductions in illegal drug use a year after their treatment with 86% admitting use at intake and 32% reporting use after one year.
