Drug and substance use disorders have been steadily rising since the onset of the COVID-19 pandemic, with 37.309 million current illicit drug users reported among Americans in 2020.¹ Additionally, alcohol consumption rose by 60% during the lockdowns, and alcohol abuse, alcoholism, and alcohol use disorder currently account for up to 6% of deaths (over 3 million people) worldwide.²
While men are more affected by alcohol and substance abuse than women and are three times more likely to die as a consequence, scientists have also determined critical differences in how addiction affects women and their treatment.²
Continue reading to discover definitions of addiction, types of addiction, and implications for treatment for women with substance-related and addictive disorders.
The American Psychiatric Association published the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) in 2013 with several updates on substance-related and addictive disorders. In this current version of the DSM, substance abuse and substance dependence — terms from the DSM-IV — were combined under the term substance use disorder.
Single substance use disorders are now defined individually based on the abused substance. Criteria for determining the severity of substance use disorders were also changed, with new specifiers determining levels from mild to severe.
The DSM-5 no longer includes a diagnosis for polysubstance abuse, meaning that clinicians must determine a patient’s severity level on each substance individually. Substance use disorders (SUDs) are based on criteria ranked into four categories:³
|Impaired control||Social problems||Risky use||Physical dependence|
|“Using more of a substance or more often than intended”||“Neglecting responsibilities and relationships”||“Using in risky settings”||“Needing more of the substance to get the same effect (tolerance)”|
|“Wanting to cut down or stop using but not being able to”||“Giving up activities they used to care about because of their substance use”||“Continued use despite known problems”||“Having withdrawal symptoms when a substance isn’t used”|
|“Inability to complete tasks at home, school, or work”|
Severity levels for substance use disorders range from mild to severe, based on the following criteria:³
- Mild SUD is diagnosed based on a patient exhibiting 2-3 symptoms.
- Moderate SUD is based on a patient exhibiting 4-5 symptoms.
- Severe SUD is diagnosed based on a patient exhibiting six or more symptoms.
Severe substance use disorder is also known as addiction. Doctors and clinicians use the severity level of the SUD to determine an effective treatment plan, with more severe levels requiring more intensive treatment.³
How gender impacts addiction
For most age groups, men far outnumber women in illicit drug use, alcohol use, and substance use disorders. 11.5% of males over 12 have an SUD, compared to 6.4% of females.²
However, women are equally likely to develop SUDs and may be more susceptible to craving and relapse.⁴ Women are also more likely to overdose fatally and comprise more hospital visits due to substance abuse.⁴
Ultimately, women face different obstacles when overcoming substance use disorders, making treatment more challenging for many. Some of the key takeaways of these gender differences include:
- Hormonal differences may make it more difficult for women to overcome drug and alcohol cravings.
- Women are more responsive than men to environmental cues that may trigger a relapse.
- Women develop dependence more quickly than men do.
- Psychologists developed traditional addiction treatment programs based on research on men.
- Women incur the medical and social consequences of addiction faster than men.
Alcohol use disorder (AUD) is one of the most prevalent psychiatric disorders worldwide, affecting almost one-third of American adults at some point in their lives.⁵ AUD contributes to 88,000 annual deaths in the U.S. and costs the country at least $249 billion yearly.⁵
71% of alcohol-related deaths happen to men, and among the 3,504 Americans under 21 who die yearly from excessive drinking, 77.5% are male.² However, this gender gap has been narrowing since the 1970s. With females aged 12-17, 61.5% are more likely to have an alcohol use disorder than males.²
The implications of this narrowing gap are concerning because alcohol use affects women more severely, both physically and mentally. Alcohol-related health issues impact women more rapidly than they do men, including:
- Alcoholic liver disease
- High blood pressure
- Heart disease
- Digestive problems
- Weakened immune system
- Mental health problems
- Social and job-related problems
- Alcohol use disorder (dependence)
Additionally, 97,000 sexual assaults occur yearly involving alcohol on college campuses, demonstrating that women drinkers are more vulnerable to violence and predation.²
Several biological factors make women more susceptible to alcohol-related health issues, including:
Size and body composition
Women tend to weigh less than men, and their bodies are composed differently. Women’s bodies contain a higher ratio of fatty tissue to water, making them retain alcohol rather than diluting it. Women’s organs thus sustain greater exposure over time to alcohol after ingestion.
Women have lower levels of alcohol dehydrogenase and aldehyde dehydrogenase — two enzymes responsible for breaking down alcohol in the liver and stomach. As less alcohol is broken down, more enters the bloodstream.
While researchers don’t know precisely why women are less likely to recover from alcohol dependence than men, one reason may be a reluctance to enter into group therapies such as AA or reach out to other treatment options. Depending on past traumas, women may feel more threatened in mixed-gender settings, although women-only treatment programs have not shown greater effectiveness.
Studies have shown that while women may be more reluctant to enter treatment, they are equally as likely to recover as men.
In 2006, a nationwide study on alcohol use disorder among women and men demonstrated that combined pharmacotherapies and behavioral interventions fared equally well for both genders. This trial involved administering naltrexone (ReVia, Vivitrol) and/or cognitive-behavioral intervention, which was effective compared with the administering of acamprosate, which showed no evidence of efficacy.⁶
Today, doctors and clinicians can administer several pharmacological treatments to patients with AUD in both inpatient and outpatient facilities. These include medications to reduce withdrawal symptoms and delirium tremens, including benzodiazepines such as:⁵
Benzodiazepines carry a high risk of abuse and overdose, so doctors and clinicians must carefully monitor their use, particularly in outpatient treatment.
The FDA currently approves three drugs for the treatment of alcohol use disorder:⁵
Acetaldehyde dehydrogenase inhibitor disulfiram
Approved by the FDA in 1951, acetaldehyde dehydrogenase inhibitor disulfiram inhibits alcoholic euphoria and leads to adverse reactions when a person drinks. They will experience nausea, vomiting, tachycardia, and headaches.
Approved in Europe for alcohol use disorder treatment in 1989, acamprosate targets the glutamate system. However, more recent efficacy trials in the U.S. and Germany have shown it to be ineffective compared to placebos.
As described in the 2006 study above, naltrexone has shown solid effectiveness in treating alcohol dependence. The FDA approved naltrexone for AUD treatment in 1994, and now it is available in an extended-release injectable form. This medication reduces cravings for alcohol and reduces relapse in former heavy drinkers.
Despite a dramatic decrease in smoking over the past several decades, cigarettes still account for approximately 1 in 5 deaths annually and remain the leading cause of preventable disease.⁷ Male smokers outnumber women by a relatively small margin, with 14.1% of males and 11% of females currently smoking.⁷
And while smoking has decreased, e-cigarette use has risen considerably among adolescents and young adults in the past decade, contributing to a rise in nicotine addiction.⁸ While e-cigarettes may seem healthier than traditional cigarettes, they contain high levels of nicotine and other dangerous substances. They also may contribute to more people switching over to smoking down the line.
As with alcohol consumption, women face more severe health risks from smoking than their male counterparts. Smoking is directly responsible for 80% of female lung cancer deaths yearly, and the risk of developing lung cancer rose tenfold for women between 1959 and 2010.⁹
Women smokers are also 22 times more likely to die from COPD than non-smokers, and they have increased risks of developing several types of cancers, including those affecting the:⁹
- Oral cavity
- Uterine cervix
Research shows that quitting smoking may be significantly more difficult for women than men based on how receptors in the brain bind to nicotine differently by gender.¹⁰ Because women have fewer nicotine receptors and are less responsive to the biological effects of nicotine than men, nicotine replacement therapies like gum or the patch may be less effective for women attempting to quit.
Studies have shown that women may have more success with other smoking cessation therapies, including:¹⁰
- Behavioral therapies
- Increased exercise
- Non-nicotine suppression medications
Non-nicotine suppression medications include bupropion (Zyban) and varenicline (Chantix). Bupropion is an antidepressant that helps reduce smoking cravings, while varenicline interacts with nicotine receptors to reduce cravings and block the pleasurable effects of nicotine. These medications have shown equal effectiveness on both genders in the short term.
A combination of counseling and medication may be the best route to cessation for many. Cognitive-behavioral therapy can help smokers find new coping mechanisms, while non-nicotine suppression medications or nicotine replacement therapy can help them avoid physical cravings and temptations.
Other tips for women quitting smoking include:¹⁰
Counteract weight gain
Prepare to counteract weight gain by planning an improved workout regimen when you quit. Nicotine is an appetite suppressant, so your tendency may be to replace the hand-to-mouth action of smoking with eating. Prepare for this by stocking up on healthy snacks and drinks to keep you occupied without piling on pounds. When you have a craving, go for a walk or run to burn off energy and keep your weight down.
Quit at the right time
Time your cessation efforts around your menstrual cycle. In scientific studies, women have shown more success in quitting smoking when they time their quit day 15 days before or after menstruation.
Getting emotional support when quitting smoking is often crucial for success. If there isn’t a local support group in your area, look for resources online. There are hundreds of chatrooms dedicated to smoking cessation, and they can be a welcome relief when you’re deep in craving and need someone to talk to.
Drug abuse and substance disorders affect males more than females, but the gender gap continues to narrow. The most recent statistics show that 22% of males and 17% of females used illicit drugs or misused prescription medications in the past year.¹
The use of all drugs, stimulants included, rose significantly during the COVID-19 pandemic across both genders. Stimulants come in both prescription and illicit forms. Prescription stimulants include:
Illicit stimulants include:
- Bath salts
Research shows that women may be more vulnerable to the reinforcing effects of stimulants and are quicker to start taking cocaine, possibly due to higher estrogen levels.⁴ At the same time, females may also be more sensitive to cocaine’s impacts on the heart and blood vessels.
Weight loss often plays a significant role in women’s use of stimulants, including methamphetamine, cocaine, and others. As with cocaine, women begin using meth earlier than males and become more dependent upon methamphetamines.⁴ The fortunate flip-side is that women are more responsive to methamphetamine treatment than men.
Opioid abuse has skyrocketed in the past decade, with 2.702 million people over 12 qualifying as having an opioid use disorder.¹ Among opioid users, 9.7 million use prescription pain relievers.¹
Women are more likely to receive a prescription for opioid painkillers, and research suggests that they are more likely to abuse these substances to self-treat issues like anxiety and stress.⁴
Medical treatment for opioid addiction has made broad bounds in the past several years, however, offering hope to many users trying to break the cycle. Researchers recommend a combination of medication with behavioral therapy for the most effective results. FDA-approved treatments for opioid addiction include:
- Buprenorphine (Suboxone, Subutex)
- Extended-release naltrexone (Vivitrol)
Fewer women use marijuana than men, but women have more negative effects from the drug than their male counterparts, including:⁴
- Impaired spatial memory
- Brain structural abnormalities
- Activity-altering effects
Marijuana use disorder is associated with an increased risk of other mental health conditions in both men and women, including:⁴
- Panic attacks
And lastly, while more men suffer from marijuana use disorder, women more quickly develop the condition after ingesting cannabis for the first time. Rates for those seeking treatment for marijuana use disorder are low among both genders.
Women and men respond differently to different drugs, and there is far less research on women in addiction treatment. However, as researchers conduct more studies on female responses to various therapies, we gain a greater understanding of these gender differences, allowing for new treatment paths in the future.
 Drug abuse statistics (2022). National Center for Drug Abuse Statistics. Retrieved on June 20, 2022, from https://drugabusestatistics.org/#.
 Alcohol abuse statistics (2022). National Center for Drug Abuse Statistics. Retrieved on June 20, 2022, from https://drugabusestatistics.org/alcohol-abuse-statistics/.
 DSM-5 criteria for addiction simplified (2020, August 20). Addiction Policy Forum. Retrieved on June 20, 2022, from https://www.addictionpolicy.org/post/dsm-5-facts-and-figures.
 Substance use in women research report: Sex and gender differences in substance use (2020, April). National Institute on Drug Abuse. Retrieved on June 20, 2022, from https://nida.nih.gov/publications/research-reports/substance-use-in-women/sex-gender-differences-in-substance-use.
 Witkiewitz, K., Litten, R., and Leggio, L. (2019, September 25). Advances in the science and treatment of alcohol use disorder. Science Advances. Retrieved on June 20, 2022, from https://www.science.org/doi/10.1126/sciadv.aax4043.
 Anton, R., O’Malley, S., et al. (2006, May 3). Combined pharmacotherapies and behavioral interventions for alcohol dependence: The COMBINE study: A randomized controlled trial. National Library of Medicine, PubMed. Retrieved on June 20, 2022, from https://pubmed.ncbi.nlm.nih.gov/16670409/.
 Current cigarette smoking among adults in the United States: Fact sheet (2022, March 17). Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion. Retrieved on June 20, 2022, from https://www.cdc.gov/tobacco/data_statistics/fact_sheets/adult_data/cig_smoking/index.htm.
 Quick facts on the risks of e-cigarettes for kids, teens, and young adults. Centers for Disease Control and Prevention. Retrieved on June 21, 2022, from https://www.cdc.gov/tobacco/basic_information/e-cigarettes/Quick-Facts-on-the-Risks-of-E-cigarettes-for-Kids-Teens-and-Young-Adults.html?.
 Women and tobacco use: Fact sheet (2020, March 13). American Lung Association. Retrieved on June 21, 2022, from https://www.lung.org/quit-smoking/smoking-facts/impact-of-tobacco-use/women-and-tobacco-use.
 How quitting smoking is different for women. Southeast Alaska Regional Health Consortium. Retrieved on June 21, 2022, from https://searhc.org/how-quitting-smoking-is-different-for-women/#.