Addiction, whether to drugs, alcohol, or prescription pills affects nearly 23.5 million Americans and an average of 1 in 10 over the course of their lives. Of those, nearly one third are women, and that rate sometimes approaches over 40% depending on the drug, especially in areas where drug use and alcohol are prevalent.
While it has historically been believed that women were simply less susceptible to addiction, data shows that most women are less likely to be exposed, but after exposure, the rates of addiction are almost the same.
It’s also a well accepted fact in the scientific community that men and women show different symptoms and react differently to the same illnesses. For example, sex differences in depression have been understood and used during treatment for decades. Women show different psychological and physiological symptoms than men, and this affects how they can be treated and what works for treatment.
While the first studies on gender differences in addiction were undertaken in the 1970s, many treatment programs are still old fashioned, based on male addiction, and based on male reactions to addiction, anxiety, and depression. In addition, most of the studies on gendered addiction have only been completed since the 1990s. This is crucial for the millions of women addicted to drugs and alcohol who have difficulty in seeking out appropriate treatment.
Getting treatment for any addiction requires an in depth knowledge of how addiction works, and how it affects both genders. Understanding the differences can also help you to seek out an appropriate addiction treatment center that will treat you or your loved one for gender specific addiction treatment needs.
Differences in Addiction Between Men and Women
Where men are typically exposed quickly and addicted quickly, women generally show temperance, and take smaller quantities of their substance of choice for much longer. Quantities are typically increased much more slowly as tolerance increases, meaning that most women are addicted more slowly than men. However, their addictions are also more often unnoticed, because they build up to them slowly. As a result, many women fail to seek help, even when their substance dependence is well past their idea of controlled use.
Many women also focus heavily on hiding addiction, thanks to a history of stigma and shame. This results in part from gendered stereotypes of the masculine alcoholic as an acceptable and even ‘cool’ figure, versus the feminine alcoholic and drug user who is associated with promiscuity, poor parentage, and otherwise shamed for behaviors not associated with the addiction. As a result, there is a significant amount of denial in addicted women, who often deceive themselves about the depth of their addiction or dependence.
Differences in Psychological Addiction
Women often become addicted for different reasons than men. Where men are more susceptible to exposure, stress, and issues such as child abuse, poverty, and racism, many women are more susceptible to drug use for stress, sexual assault, racism, poverty, shame, isolation, physical abuse, poverty, and discrimination. Therefore, the reasons that women begin substance dependency can be more complex, and is often heavily based on family and relationships at home and at work. While some women do become addicted through exposure, especially younger women in college or poor settings, the majority use alcohol or drugs as a coping mechanism, whether they realize it at the time or not.
The psychological responses in men are often to build up a grandiose false sense of self that must be challenged in order to break through an addiction. In 1976, Alcoholics Anonymous created descriptive terms including King Baby, Inflated Self Ego, and Grandiosity to use to describe this inflated sense of self created by addiction, but in women, the problem is typically the opposite. Where men use substances of choice to build themselves up and to project an image of themselves, women typically diminish their sense of self in order to accommodate the substance as well as the people in their lives.
Female addicts show similar outward signs of self-obsession, primarily because their lives are constricted around a substance, but this often results from self-neglect, in which the self is ignored in favor of the substance, while simultaneously maintaining an outward appearance to friends and family. Therefore, treatment of women’s addiction cannot focus around deflating the ego, but rather on building it up and helping the woman to grow and recover.
In turn, many women cite their substance abuses as a comfort, replacing that of a partner, making up for an abusive relationship, filling in for empathy from family, or reducing the sting of trauma and sexual abuse.
While comorbidity, or dual diagnosis is usually listed at 40%, women are significantly more likely to become addicted to substances when faced with abuse. While men and women are more likely to become addicts if abused as children, women are more likely to be abused as adults during interpersonal relationships, resulting in a significantly higher ratio of abused women than men becoming addicts. In one study 74 percent of the addicted women reported sexual abuse, 52 percent reported physical abuse, and 72 percent reported emotional abuse.
Gender Differences in Treatment
Approaching addiction by gender typically requires a conscious shift in approach and methods. Where men must be reduced, women must be built up. Traditional addiction treatment methods, including those in AA, do not typically approach issues first, which leaves women still vulnerable to recurring addiction. This same problem crops up when treating veterans with PTSD, who must be treated for PTSD before substance abuse can be appropriately treated. Because many women turn to substance abuse as a coping or comfort mechanism, it is crucial that these issues be approached and solved before working through the issues of substance abuse and dependence. Judith Herman, writer of Trauma and Recovery, suggests using the following stage method to treat women with addictions.
- Stage 1– Establish safety so that women feel safe from their trauma, abusers, and addiction
- Stage 2 – Use a remembrance and mourning stage to help women get over traumatic incidents that could trigger relapse. This stage is about stabilization.
- Stage 3 – Reconnect to build the woman up, build her sense of self, and develop a future.
The psychology and reasoning behind women’s addictions also lead to a number of additional conclusions that many rehabilitation centers and clinics are beginning to integrate into their treatment programs. Many of these are espoused by Stephanie S. Covington, Ph.D., L.C.S.W., who specializes in women’s addiction and is one of the leading experts on gendered addiction in the United States.
Separating Genders for Support Groups and Treatment – In stage 1 of recovery, women must be made to feel safe, and this typically means separation from men. In addition to many women suffering at the hands of typically male abusers, women must be made to feel comfortable enough to share and create ideas, and traditional masculine dominated conversations, where a woman may feel less important or even talked over, are significantly less helpful.
Create a Focus on Women’s Issues in Addiction – The Treatment of Women with Substance Abuse Problems outlined 16 areas where women typically need treatment in order to overcome addiction. This paper was released as part of Public Law 102-321, the ADAMHA Reorganization Act, creating the Center for Substance Abuse Treatment (CSAT) and the introduction of the Women and Children’s Branch (WCB). These 17 points are:
- Gender specific causes of addiction such as rape and emotional abuse
- Low self-esteem
- Discrimination or hate crimes
- Poor family relationships
- Unhealthy or abusive personal relationships
- Interpersonal violence, including incest, rape, battering, and other abuse
- Eating disorders
- Sexuality, including sexual functioning and sexual orientation
- Grief related to the loss of children, family members, partners, and alcohol and other drugs
- Appearance, health, or hygiene
- Appearance and overall health and hygiene
- Poor life development
- Child care and child custody
These points are mostly a contrast to men’s issues, which revolve around stress, poverty, work, family relationships, and exposure.
Foster Self Respect and Dignity – Where men typically build up their ego, women typically neglect themselves. For this reason, an environment which fosters self respect, dignity, and empowerment is crucial to overcoming the hurdles of addiction and preventing relapse. Building up mutual support groups, reliance, and helping addicted women to build themselves is crucial to achieving this.
A Holistic Approach– Many addicts suffer from comorbidity, or dual diagnosis, but women are more than 70% likely to have a dual diagnosis, where men are only 40% likely. This is hugely important for treatment, where women’s issues must be approached as a whole in order to ensure that problems do not trigger a relapse before they are treated. This does line up with comorbidity treatment for men, especially those with PTSD, as many addicted women suffer from trauma, emotional or physical, which must be treated.
Women are just as susceptible to substance abuse and dependence as men, but are less likely to be exposed or guilted into it through peer pressure. However, women are more likely to turn to substances, whether prescription, alcohol, or illicit, as a comfort in the face of problems that are beyond their control (Stress, abuse, work, poverty, relationship issues, etc) and while they show more temperance than men at the start, are just as likely to become addicted over time, without showing warning signs or being visibly addicted. This ties into a slow increasing of doses over time, as well as the stigma associated with female addiction, resulting in most women spending a significant amount of time and energy in hiding their addictions.
Where men typically become addicted quickly and show signs quickly, women build up over time and therefore are often addicted for much longer than male counterparts. Because the psychological impact and reasons of addiction, as well as the initial exposure, are often different for women, most women require a significantly different therapeutical approach than men. And, while many stereotypes suggest that women are more likely to experience cravings but have an easier time with withdrawal, these simply aren’t true. Instead, the primary differences lie in how women approach substances, how they become addicted, and their reasons for being addicted.
Some 40% of rehabilitation clinics have adopted gender differentiated treatment for men and women, and those that do are much more successful with long-term treatment than those that don’t. If you are seeking treatment for yourself or for a loved one, it is crucial that you look for a professional who differentiates men’s and women’s addictions, and who can treat the problems behind the addiction as well as the addiction itself.
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