Until fairly recently, substance use researchers focused their efforts almost exclusively on men. Only toward the end of the last century did scientists start to explore more thoroughly how drug and alcohol use affects women. The gender differences turned out to be quite significant.
In the United States, the male population still presents with higher rates of addiction, but that gender gap is now disappearing quickly, in part due to the ongoing opioid addiction epidemic.
It’s no secret that women are physiologically different from men. They have two X-chromosomes where men have only one. As a result, the female endocrine system features a number of sex-specific hormones that makes it quite different from their male counterparts.
This also means they respond differently to substance use. Hormonal differences can make women more sensitive than men to the effects of some drugs. Often, smaller amounts have a stronger effect on women, and they can become addicted to drugs and alcohol more easily.
For example, women are typically more vulnerable to the effects of alcohol. On average, they weigh less than men and, pound for pound, a woman’s body contains more fatty tissue and less water. Fat retains alcohol while water dilutes it. Females also have lower levels of two enzymes that break down alcohol in the stomach and liver. That means they absorb more alcohol into the bloodstream.
Linda Dahl notes in Loving Our Addicted Daughters Back to Life that “differing hormones affect the way women and men respond to stress, as do psychological and sociological differences. These distinctions affect women and men differently both in terms of their addiction and their recovery.”
Approximately 1.8 million women are abused each year in the United States, writes addiction specialist Stephanie Covington. “A history of trauma drastically increases the likelihood that a woman will abuse alcohol or other drugs.” Dr. Covington is a pioneer in the field of women’s issues, addiction, and recovery. Her Helping Women Recover curriculum forms the basis for the gender-specific approach to treatment at Lakeview Health.
Quite often the trauma behind the addictive behavior involves domestic violence and/or sexual abuse. According to CDC data, an astonishing 18.3 percent of American women report experiencing rape at some time in their lives. For men, the figure is only 1.4 percent. Clearly, sexual violence is a crime that disproportionately traumatizes women. And trauma can easily be a path to addiction.
WHO data suggests that victims of sexual assault are 13 times more likely to abuse alcohol and 26 times more likely to abuse drugs. They also more likely to develop posttraumatic stress disorder or anxiety issues, which very often coincide with substance use disorders.
Other traumatic events that can trigger women’s substance use include divorce, the death of a partner or child, or the loss of custody of children. “It’s hard for those who have not had traumatic experience or studied trauma to imagine the pain of these lives,” writes addiction expert Maia Szalavitz in Unbroken Brain. When interviewing crack-addicted mothers for the book, she learned that “their childhoods were a litany of sexual abuse, physical abuse, neglect, death, violence, disease, poverty, bullying, and just loss after loss after loss. The stories are not the exception, they are the rule.” (Unbroken Brain, page 65)
Both men and women face significant barriers to treatment, but studies show that women who abuse drugs are less likely to seek help.
They are often the main caregiver in their family, taking care of children and sick relatives. Using drugs and alcohol to cope with stress and get relief from painful emotional states when you’re expected to take care of the family carries a strong stigma. The perceived shame is often a strong disincentive for women to seek help for their addiction problem. The strongest possible censure is reserved for women who use drugs and alcohol while pregnant or who neglect their children because of their substance use disorder.
Low self-esteem and attachment to unhealthy relationships are not empowering women to seek a healthy lifestyle. On the contrary, those relationships can be toxic. According to a study by the National Institutes of Health, women are far more likely than men to be introduced to heroin injection by a sexual partner, and women report feeling more influenced by social pressure as a result.
All of the above suggest that dealing with trauma, shame, and stigma needs to play a central role in the recovery of many women.
For Stephanie Covington, a healing environment should be characterized by safety, connection, and empowerment. It’s an environment free of physical, emotional, and sexual harassment.
Lakeview’s new Women’s Center provides such an environment. The opening of The Rose of Lakeview completes the transition to full gender-responsive addiction treatment at Lakeview. Taking into account all the differences in the way women and men respond to specific treatment approaches improves the prospects for long-term recovery.
“We examined everything relating to treatment,” says Dr. Philip Hemphill, Lakeview’s chief clinical officer, “including the hiring of staff, the way the program is developed, and the content of the sessions—to ensure that they all address the reality women face when approaching treatment.”
Dr. Covington’s program addresses four areas in particular: self, relationships, sexuality, and spirituality. Interviews with women in recovery indicate that these four areas reflect the major aspects of life that change during the recovery of women and the most common triggers for relapse if not addressed.
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