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Women and Substance Abuse
Women and Substance Abuse

Women and Substance Abuse

Substance use disorders are complicated illnesses that present unique threats to women's health.

January 18, 2016

Medical research finds that women who consume alcohol, tobacco or other drugs may develop substance use disorders and/or substance-related health problems faster than men.

Recent surveys show that alcohol consumption is most common among:

  • women in their 20s and early 30s
  • women who are divorced or separated, women who are unmarried and living with a partner or women who never married

Before discussing problems with the use of alcohol, it is important to understand the different levels of drinking. Alcohol consumption occurs across a continuum related to risk and levels of consumption. At the low end is abstinence, or avoidance of alcohol altogether.

Low-risk drinking is defined as drinking within the recommended limits published by the National Institute on Alcohol Abuse and Alcoholism (NIAAA). For men up to the age of 65, these limits are no more than four drinks in one day AND no more than 14 drinks in a week. For nonpregnant women up to the age of 65, and for both healthy men and women over the age of 65, the recommended limits are no more than three drinks in one day AND no more than seven drinks in a week. The NIAAA also recommends having somedays when you do not drink. If you drink within these limits, you will reduce your chances of developing an alcohol use disorder and related health problems.

Those who drink above the NIAAA limits are engaged in what is often termed risky or hazardous use, which is a pattern of alcohol consumption that increases the risk of harmful consequences for the user or others. Harmful use is alcohol consumption that results in consequences to physical and mental health. Finally, alcohol dependence is a disorder that includes three or more of the following symptoms: tolerance,withdrawal, inability to limit amount consumed or time spent drinking, desire or unsuccessful attempts to reduce drinking, great deal of time spent drinking or recovering from effects of alcohol, neglect of important life activities because of drinking,and continued drinking despite the realization that alcohol is causing or making worse a physical or psychological problem.

For most women, responsible drinking is the consumption of no more than one standard drink per day. A standard drink contains about 14 grams of alcohol (0.6 fluid ounces or 1.2 tablespoons), which is equivalent to one 12-ounce bottle of beer or wine cooler;8 to 9 ounces of malt liquor; one 5-ounce glass of wine; or 1.5 ounces of 80-proof distilled spirits. Keep in mind that the alcohol content of different types of beer, wine and distilled spirits can vary quite substantially.

This is intended to measure the amount consumed on a single day and does not represent an average over several days. (In other words, if you don't drink all week and then drink seven drinks on Saturday, it's not the same as having one drink a day.)

The limits for women over 65 are intended for healthy women. Women who havechronic health conditions or take certain medications may have increased risks from drinking alcohol. Additionally, health care providers are less likely to detect increased alcohol use in men and women over age 65.

According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), women are more vulnerable to alcohol-related organ damage, trauma and interpersonal difficulties:

  • Liver damage: Women develop alcohol-induced liver disease faster than men even if they consume less alcohol. Plus, women are more likely than men to develop alcoholic hepatitis and die from cirrhosis (liver disease).
  • Brain damage: Studies of brains via magnetic resonance imaging (MRIs) show that women may be more vulnerable to alcohol-related brain damage than men.
  • Heart disease: Among heavy drinkers, women develop heart disease at the same rate as men, despite the fact that women consume 60 percent less alcohol than men over their lifetimes.
  • Breast cancer: There is emerging evidence of a link between moderate or heavy alcohol consumption and an increased risk for breast cancer.
  • Violence: College women who drink are more likely to be the victims of sexual abuse than those who don't. And high school girls who drink are more likely to be the victims of dating violence than those who don't.
  • Accidents: After having just one drink, a 140-pound woman reaches a blood alcohol level that increases her risk of being killed in a single-vehicle crash.
  • Women are more likely than men to use a combination of alcohol and prescription drugs.
  • Women may begin to abuse alcohol and drugs following depression, to relax on dates, to feel more adequate, to lose weight, to decrease stress or to help them sleep at night.

Poor self-esteem is a major issue for most women who develop problems with drugs and alcohol. The following factors may also increase a woman's risk for developing substance use disorders:

  • A history of physical or sexual abuse. Physical and sexual violence against women is common when one or both partners have been drinking or using drugs. Women also are more likely to drink or use drugs when their partners do.
  • Depression, panic disorder and post-traumatic stress disorder.Women who abuse alcohol also have much higher rates of eating disorders.
  • Family history. Researchers know that there is a strong family (genetic) component to addiction.If you have a family history of addiction, you should be aware of your risk for developing dependency, especially during stressful periods in your life.

So, why are women more vulnerable to the effects of alcohol?

Women develop serious alcohol problems more rapidly than men, and at lower doses, a process called "telescoping." This is partially because women's bodies absorb alcohol faster than men's because of a difference in the way a key enzyme works.The enzyme, alcohol dehydrogenase (ADH), breaks down alcohol before it enters the bloodstream. But this enzyme is less active in women than in men. Also, women have a smaller ratio of water to fat than men. That means there's less water to dilute the alcohol and more fat to capture it. One positive difference: Women seem to eliminate alcohol from their bodies faster than men.

Hormonal fluctuations in women may affect how alcohol is metabolized. Some women report feeling the effects of alcohol more quickly or strongly when they drink at certain times during their menstrual cycle.

Alcohol affects almost every organ in your body. Serious health problems associated with excessive alcohol use include but are not limited to:

  • brain damage
  • cancer
  • pancreatitis
  • increased risk for sexually transmitted diseases
  • liver disease
  • high blood pressure and other forms of heart disease
  • malnutrition (specifically thiamine deficiency)
  • anemia
  • heavy menstrual flow, irregular cycles or premenstrual pain
  • premature menopause
  • osteoporosis
  • diabetes
  • circulation problems
  • respiratory disease
  • alcohol poisoning
  • sexually transmitted diseases

Alcohol poisoning occurs when high quantities of alcohol are consumed in one session. It can lead to coma and death. The lethal dose for alcohol is about .35 to .40 percent, or about five times the legal limit (0.08) in most states. However, death can occur from alcohol poisoning at lower levels, especially for women. For a 120-pound man or woman drinking very quickly, it would only take eight to 10 drinks in an hour to reach the lethal level.

Alcohol Use and College Students

For women, binge drinking is consuming four or more drinks in one session, usually within about two hours. It is most common among women between the ages of 18 to 25. This type of heavy, episodic drinking causes most of the alcohol-associated harm occurring on campuses and in students'lives. Collegedrinkingprevention.gov, an organization supported by the NIAAA, reports the following statistics concerning alcohol use and college students:

  • Each year, 1,825 college students between the ages of 18 and 24 die, and 599,000 are injured as a result of alcohol-related incidents, including car crashes.
  • About 696,000 students between the ages of 18 and 24 are assaulted each year by a fellow student who has been drinking.
  • About 97,000 students between ages 18 and 24 are victims of sexual assault or rape each year due to alcohol consumption.
  • Each year, 400,000 students have unprotected sex and more than 100,000 students report having been too intoxicated to know whether or not they consented to sex.
  • About 25 percent of college students suffer academically because of their drinking habits.
  • More than 150,000 college students develop alcohol-related health problems every year, and between 1.2 percent and 1.5 percent of students say they tried to commit suicide within the past year as a result of drinking or drug use.
  • More than 3.3 million students between the ages of 18 and 24 report driving drunk each year.

Substance Use and Older Women

Substance use, including cigarettes, alcohol and misuse of psychoactive prescription drugs (sedatives, tranquilizers and other drugs that affect the mind or behavior), is also a problem for American women 60 years old and older.

Older women are at greater risk for substance use disorders in part because tolerance levels decrease as people age. Some studies suggest that older women are at greater risk for developing a substance use disorder even if they use smaller amounts than younger women. Yet this is often a hidden problem, going undetected by health care professionals, family and friends. Substance abuse symptoms in older women are often erroneously attributed to other factors, such as anxiety or depression.

Also, older women are less likely to discuss their alcohol use or misuse of prescription drugs with their health care professional, in part because of the stigma their generation attached to alcoholism and mental disorders. Additionally, health care professionals are less likely to address addiction problems in this population.

There are different types of excessive alcohol use in the elderly: early onset and late onset. Those who have been using alcohol at levels above the recommended limits for many years and reached age of 65 are called "hardy survivors" and belong to the early onset group; those who begin abusing alcohol later in life belong to the late onset group.

This distinction is particularly important in women since those who have early onset are at higher risk for alcohol-related health issues. Both groups are at increased risk for injury however, especially falls, and for depression, suicide and malnutrition.

Alcohol and Pregnancy

The damaging effects of alcohol on pregnant women and their unborn babies are well documented. Like many other drugs, alcohol easily passes from a mother to her baby through the placenta.Prenatal alcohol exposure is the single greatest preventable cause of mental retardation.

One of the greatest risks of alcohol use during pregnancy is fetal alcohol spectrum disorder (FASD) and fetal alcohol syndrome (FAS),the most severe form of FASD.Low birth weight,congenital anomalies, severe behavioral and neurological problems and learning and physical disabilities are some symptoms experienced by infants and children exposed to alcohol in the uterus.

Children diagnosed with FAS suffer the severest damage related to alcohol exposure, including facial changes and mental retardation.

For the mother, alcohol use during pregnancy has been associated with high blood pressure, miscarriage,premature delivery, stillbirth and anemia.

There is no safe level of alcohol consumption during pregnancy. Women who are planning to become pregnant or who are sexually active and might become pregnant should refrain from alcohol use, since damage can occur before a woman realizes she is pregnant.

Prescription and Over-the-Counter Drug Use and Women

Misuse of, abuse of and dependence on prescription drugs are major health problems for women. Two-thirds of all tranquilizers, such as diazepam (Valium), chlordiazepoxide (Librium) and alprazolam (Xanax), are prescribed to women. Other examples of prescription drugs used frequently by women include sedatives such as triazolam (Halcion) and estazolam (ProSom); analgesics like meperidine (Demerol) or other types of painkillers such as oxycodone mixed with aspirin (Percodan)or guaifenesin mixed with codeine (Brontex); and stimulants such as methylphenidate (Ritalin),sibutramine (Meridia) and dextroamphetamine (Dexedrine).

When used to treat the medical conditions for which they were approved at the recommended dose, these drugs are safe and effective, rarely leading to addiction or abuse. But when not used properly, they can lead to addiction and death, especially when used in combination with alcohol or other drugs.

Women are more likely to use narcotic pain relievers for nonmedical use than men, and they are more likely to mix prescription drugs with alcohol.

Many women start taking a medication for a health problem, such as anxiety, muscle spasms or pain, but then use it longer and in greater amounts than intended or without close supervision by a health care professional. In most cases, developing a physical dependence on a certain drug causes your body to build up tolerance to it, requiring more of the drug to have the same effect.

In these cases, abruptly stopping use of the drug may result in rebound withdrawal signs. This doesn't necessarily mean you were abusing the drug or developed an addiction to it, because sometimes long-term use is appropriate. That's why it's so important that you only take prescription drugs under the supervision of a health care professional.

Misuse of prescription drugs can cause a variety of health problems in addition to physical dependence, including headaches, confusion, drowsiness, fainting and lowered or elevated blood pressure.

For some prescription drugs, adverse effects increase dramatically if you mix them with alcohol. This combination increases the risk of injuries from falls and car accidents and can be deadly. Be sure to consult with your health care provider or pharmacist about the use of alcohol when taking any prescription drug.

Over-the-counter (OTC) pain relievers and fever reducers can also cause health problems if used with alcohol. If you have three or more alcoholic drinks a day, you may be at increased risk for liver damage or stomach bleeding if you take these medications.

Illicit Drug Use and Women

Studies have found that more than 4 million women need treatment for drug problems. The health risks of illegal drug use go beyond the effects of the drugs themselves. Illicit drug use (such as heroin, cocaine or marijuana) often leads to behavior that puts women at increased risk for HIV,hepatitis and other sexually transmitted diseases (STDs).


Also known on the street as smack, horse, H, junk or scag, heroin is the most commonly abused narcotic. Narcotics are drugs that produce an insensibility or stupor. The term narcotic is most often used to refer to derivatives of the opium poppy (an annual poppy cultivated as the source of opium) or chemically similar synthetics created in a lab. Heroin was a commonly prescribed medicine in the early 20th century, until its addictive potential was realized. It breaks down to morphine in the body.

Narcotics act on the nervous and digestive systems to control pain, relieve diarrheaand suppress coughing. When prescribed for pain relief, narcotics are usually taken by mouth. Narcotics slow body functions such as circulation, breathing and digestion.They cause your blood vessels to relax and your heart rate to slow, lowering blood pressure. Narcotics make you feel drowsy, groggy and confused. A common characteristic of heroin use is "nodding," a semiconscious state in which the person may appear to be nodding off to sleep.

Like most other drugs that are abused, narcotics can make you feel a sense of euphoria, contentment and physical relaxation. The "high" usually lasts about three to four hours. When heroin is injected or smoked, the abuser experiences an instant period of intense pleasure known as a "rush." The more you use narcotics, the more tolerant your body becomes, requiring higher doses to achieve the same results. Eventually, the user reaches a plateau at which no amount of the drug is sufficient. When the user reaches this level, the person administers the drug just to delay withdrawal sickness.

Street heroin is sold in powder form and has a bitter taste. Heroin is generally inhaled or injected and sometimes smoked. There is a high prevalence of hepatitis C, HIV and AIDS among heroin users due to sharing of contaminated syringes, which has resulted in a decline in the number of intravenous (IV)users. Today, many heroin addicts sniff the powder into their nostrils or heat it on foil to inhale the vapors. Heroin is also sometimes mixed with tobacco or marijuana and smoked in a pipe or cigarette.

The consequences of heroin use include:

  • dry, itchy skin, skin infections and abscesses
  • constipation and loss of appetite
  • menstrual irregularity
  • fluctuating blood pressure and slow or irregular heartbeat
  • dependence, addiction
  • hepatitis B and C and HIV/AIDS caused by use of dirty needles
  • stroke and heart attack caused by blood clots
  • cardiac arrest,coma and death from accidental overdose


Cocaine is one of the oldest known drugs. In the early 19th century, this stimulant was used as an ingredient for many types of tonics prescribed to treat a variety of illnesses. However, the source of cocaine—coca leaves—has been ingested for thousands of years in mountainous regions of Peru and Bolivia where the coca bush is found. Though it can be prescribed by physicians today as a local anesthetic, cocaine is a commonly abused drug and was very popular in the '80s and '90s.

Cocaine comes in two chemical forms: hydrochloride salts (the powdered form) and "crack" (a smokable "freebase" form produced through a reaction with an alkaline substance such as baking soda). The powdered form can be injected into a vein after it's dissolved in water, or inhaled. When sold by drug dealers, the powdered form of cocaine is often diluted with sugar, starch or other substances. The freebase form of cocaine can be smoked.

Cocaine stimulates the nervous system,causing your heart rate and blood pressure to increase and your blood vessels to constrict, which is why abusers often suffer heart attacks and strokes. The initial effects of cocaine use are increased alertness, energy, self-confidence and loss of appetite.However, as these effects wear off, the user is left feeling depressed, fatigued, jumpy, fearful and anxious.

Crack is the slang name for the highly potent form of freebase cocaine processed from powdered hydrochloride into a substance that can be smoked. Crack looks like white chunks, rocks or chips and "cracks" when it is smoked. Crack is less expensive to produce and buy than cocaine. It is typically smoked in a pipe, and users inhale the fumes.

The effects of crack are similar to other forms of cocaine, only more intense and more immediate. Users seem to become addicted to it more quickly than to other forms of cocaine.

The consequences of cocaine abuse are:

  • irregular heartbeat, heart attack and heart failure
  • strokes and seizures
  • fluid in the lungs and other lung disorders
  • paranoia,depression, anxiety disorders and delusions
  • aggressive, violent behavior
  • an increased risk of hepatitis and HIV for users who inject the drug intravenously
  • increased and indiscriminate sexual activity often accompanies use and addiction, further increasing risk of HIV and other STD infection.

Pregnant women who use cocaine have a higher risk of miscarriage and premature labor. Its use has also been associated with low birth-weight babies and developmental problems.


"Pot" is by far the most commonly used illegal drug. It may also be the most insidious drug, because most people don't realize how dangerous it is. Since the 1990s, most marijuana contains significantly more THC (delta-9-tetrahydrocannabinol, the active ingredient in the drug) than marijuana used in the 1960s and 1970s. Thus, the effects of smoking part of a single 21st-century marijuana cigarette produces more profound and debilitating effects than smoking several marijuana cigarettes in the 1970s would have.

Marijuana is usually smoked, either in a pipe or a loosely rolled cigarette known as a "joint."Joints are infrequently (and usually unknown to the user) laced with the potent hallucinogen PCP or other drugs that substantially alter the effects of marijuana. Marijuana can also be brewed into tea or mixed in baked products like cookies or brownies.

The effects of smoking are usually felt in a few minutes and peak in 10 to 30 minutes. They include dry mouth and throat, increased heart rate, impaired coordination and balance, delayed reaction time and diminished short-term memory. Marijuana can impair driving and lead to accidents, and its effects may be worse in combination with alcohol. Larger doses can cause more intense reactions such as paranoia.

The most familiar long-term effect of marijuana use is impaired learning ability. Research shows that marijuana use limits your ability to absorb and retain information. In testing, users often show a reduced ability to memorize information and demonstrate lower math and verbal skills.

Aside from the mind-altering effects of marijuana, it also carries consequences similar to cigarette smoking. According to some studies, if you smoke one joint, it is thought that you are exposed to the same amount of cancer-causing chemicals as if you smoke five tobacco cigarettes, and smokers can experience frequent respiratory infections, including chest colds, bronchitisemphysemaasthma and sinusitis.A novice marijuana user is more likely to experience anxiety, panic attacks and paranoia.

The health consequences of associated with heavy marijuana use include:

  • delayed onset of puberty and reduced sperm count of men
  • dbnormal menstrual cycles and irregular ovulation forwomen
  • impaired perception, diminished short-term memory, loss of concentration and coordination, impaired judgment and decreased ability to judge distance and speed—all of which lead to increased risk of accidents
  • damage to respiratory, reproductive and immune systems


Also known as speed, crank, meth, crystal-meth and glass, methamphetamine is a powerful stimulant that produces increased alertness and elation. Its effects are similar to cocaine but last longer. Easily made with inexpensive over-the-counter ingredients in makeshift laboratories, methamphetamine is cheaper to produce than cocaine.

Methamphetamine can be swallowed, smoked, snorted or injected. In powder form, it can be mixed with water and injected in the veins or sprinkled on tobacco or marijuana and smoked. Chunks of clear, high-purity methamphetamine are called ice, crystal or glass. It looks like rock candy and is smoked like crack cocaine.

Women use methamphetamine at the same rate as men, and almost half of methamphetamine users are women, unlike with other illicit drugs, such as heroin and cocaine. Additionally, methamphetamine use is seen among women in rural areas and among middle-class women, unlike cocaine and heroin users, who are more often from poor urban populations. Treatment is often less available in rural areas.

Women may be more attracted to methamphetamine for its promise of weight loss and treatment of depression symptoms.

Low doses of methamphetamine can make you feel alert and energetic. With continued use, however, the pleasurable feelings can disappear. The user soon needs to take higher doses more often to achieve the same effects. Someone using methamphetamine is easily agitated. One minute she is calm and content, the next she is angry and fearful. Addicts may pick at imaginary bugs on their skin and become obsessed with repetitive actions.

The crash that follows a methamphetamine binge involves agitated depression and an intense craving for more of the drug. These feelings soon give way to exhaustion and long, deep sleep—again followed by severe depression. During this last phase,the potential for suicide is very high.

The consequences of methamphetamine use include:

  • nausea, vomiting, diarrhea and dramatic weight loss to the point of emaciation
  • insomnia and sleep disturbances
  • severe damage to the teeth
  • skin sores and infections as a result of picking at imaginary bugs
  • psychotic symptoms such as anxiety, paranoia, depression, hallucinations including the sensation of bugs crawling on the skin and feelings of hopelessness (These symptoms can sometimes last for months or years after methamphetamine abuse has ceased.)
  • permanent damage to the heart that can result in increased blood pressure, chest pain, headaches and increased risk for stroke and heart attack
  • severe structural and functional changes in areas of the brain associated with emotion and memory that may be partially reversible
  • increased risk of sexually transmitted diseases, such as HIV and hepatitis

Methamphetamine causes different health consequences in women than in men and requires different approaches. This is particularly true with pregnant women and women with young children.

Methamphetamine use during pregnancy can increase the mother's blood pressure and heart rate. This can result in an increased risk of premature delivery or miscarriage, restricted fetal growth and increased lethargy in newborns. Additionally, methamphetamine constricts blood vessels in the placenta. This means there is less blood flow to the fetus,and the baby receives less oxygen and nutrients. The drug can also pass through to the placenta, which increases the fetus's blood pressure. This can result in stroke or heart damage, as well as slow fetal growth.


Also called MDMA (3,4-methylenedioxymethamphetamine), Ecstasy use has, in recent years, become increasingly popular with teenagers in club or dance settings. It is a synthetic, illegal drug that has characteristics of both stimulants and hallucinogens.It is typically produced in capsule or tablet form and is usually taken by mouth, although health care professionals have documented cases in which people injected or snorted the drug. Researchers have found that women may experience more intense psychoactive effects of Ecstasy than men. Ecstasy interferes with learning and memory and may produce damaging changes in brain structures and chemistry. It increases heart rate and blood pressure and can disable the body's ability to regulate its own temperature.

There is now a large body of evidence that links heavy and prolonged MDMA use to confusion, depression, sleep problems, persistent elevation of anxiety and aggressive/impulsive behavior. Because of its stimulant properties, when used in club or dance settings, it enables users to dance vigorously for extended periods but can also lead to severe rises in body temperature (hyperthermia), as well as dehydration,hypertension and even heart or kidney failure in susceptible people.

Researchers at the University of Amsterdam studying brain blood flow patterns in male and female chronic users of Ecstasy found that women who use the drug may be more likely to develop neurological problems than men.

The consequences of MDMA use include:

  • confusion
  • depression and severe anxiety
  • sleep problems
  • drug craving
  • increased heart rate and blood pressure
  • involuntary teeth clenching
  • nausea, blurred vision, faintness and chills or sweating

In high doses, MDMA can interfere with the body's ability to regulate temperature. Rarely, this can lead to a sharp increase in body temperature, which can result in liver, kidney and cardiovascular system failure or even death.

Recent research suggests that MDMA may also impair some types of cognitive or memory tasks.

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