The Stateswoman Archive

Women Who Abuse Substances: Who Are They?

by Francine, Feinberg, Psy.D., CICSW

The image of the alcohol or drug addicted woman conjures up a rather irrational repulsion in many people. This is especially true if the woman is pregnant and/or a mother. The stigma attached to these women causes much misunderstanding of the problem.

Until recently, little has been understood about the specific elements critical to the development of substance use disorders in women and the mechanisms by which they work. Even though it may never be entirely clear, there are some identifiable factors that seem to be clearly associated with this disorder in women. One thing is very clear: when comparing the substance use experience between genders, there are important differences.

There are distinct risk factors that predispose women to substance use. We now know that there is a greater occurrence of over-all dysfunction found in the childhood families of female substance abusers. These women are far more likely than men to have experienced childhood sexual abuse, to have an early separation from parents through divorce or death, to have experienced parental deprivation, rejection and/or violence in their family of origin, and to have parents that are addicted. In addition, we know that, in general, women are more likely to be poor with fewer job opportunities and be the primary or only person caring for children or other family members. Compared to men that abuse substances, women are more likely to be juggling multiple roles and less likely to have support from a partner.

Given what we now know about the childhoods of women that abuse substances, it is not a surprise to learn that recent surveys report that 86% of women diagnosed with the abuse and dependence of alcohol also have a mental illness. There is a very high level of depression, anxiety and post-traumatic stress that began long before the abuse of alcohol or drugs.

Starting and continuing substance use is often described by women as an attempt at intimacy with a partner. It is through their relationship with men who purchase, prepare and dispense drugs that women continue their use. Men tend to be introduced to these substances by male peers during either social interactions or as part of the drug trade.

The kinds of chemicals used also appear to differ for men and women that become abusers. Men are twice as likely to abuse alcohol and illegal drugs, however, women far outnumber men in the abuse of prescription drugs and use a greater variety of drugs. The pattern of consumption also appears to differ. Women tend to fall into an all or nothing type pattern, while the range is more varied for men.

Many consequences result from the abusing of drugs. For women, the results tend to be more personal and self-destructive. For men, the consequences tend to be societal and destructive to others. For example, women are much more likely to be victimized while under the influence, while men are more likely to be the victimizer in the same circumstances.

The progression from use to addiction seems to be faster in women, with a greater risk of developing health related problems with more severe consequences as compared to men. The devastating effects are apparent much sooner, with severe consequences related to female reproductive organs, suicide, contraction of HIV/AIDS, and death. There are sexual, menstrual and reproductive problems, with an increased risk of breast cancer. Women develop liver disease more readily, seriously and rapidly with shorter drinking histories and lower levels of alcohol.

The barriers to treatment for women are numerous. Few programs have the resources to combine the medical, prenatal, substance abuse and mental health care that is needed. The multitude of services required for women tend to be fragmented, with no organizing body to assist impaired women to obtain needed services. Funding revolves around one issue or problem, rather than the woman and her family as a whole entity in need of service. Mothers and/or pregnant women, in response to real or perceived punitive actions by authorities, do not enter treatment while pregnant for fear of loss of their children to the child welfare system and incarceration. Because women tend to be the caretakers, they may find it difficult to enter treatment because they are caring not only for their own children, but other family members as well. Women also may fear reprisal from significant others and family members.

There are other practical issues that sometimes keep women from treatment. They may fear losing their jobs, and lack transportation and/or childcare. Women with prior treatment histories fear another failure, while others have had negative treatment experiences. Some women are trying to meet the stipulations of the child welfare, TANF and criminal justice systems, leaving them feeling overwhelmed and fearful to take on another commitment. Once women do decide to seek help, they often run into funding issues, wait lists and few programs that will serve them while they are pregnant. Many women are simply afraid to let go of the alcohol and drugs because they help them cope with their overwhelming situations. In addition, the majority of women who abuse substances do not believe that they have it within their power to make a difference in their own lives and the lives of their children, making treatment seem like a fruitless endeavor.

Stigma plays one of the largest roles in keeping substance abusing women from the help they need. It is often overlooked by medical professionals and social workers. However, most of all, women are deeply ashamed and this shame keeps them from reaching out for help.

The seeds of substance abuse can be found within the psychosocial context of each woman’s history, her current life situation, and her biology. All of this is influenced by her gender and the discrimination, victimization and inequity that many women face strictly because they are female. For the vast majority of women substance use is an attempt to cope with devastation. However, despite this, women are finding the strength to overcome their substance use. Through treatments that are designed with an understanding of women’s issues, and with their connection to healthy relationships, women are regaining control of their lives. We must support these women, not judge or stigmatize them, so that they can live healthy lives and be contributing members of our society.

Francine Feinberg is the Executive Director, Meta House, Inc., 414-962-1200. Meta House offers residential, day and out-patient treatment programs with supportive transitional housing and aftercare to women with substance use disorders.

This article first appeared in the March 2002 issue of the Wisconsin Women’s Network newsletter The Stateswoman.