High rates of substance use disorder (SUD) in men have been well-documented for years. But women are just as susceptible to addiction, and outdated treatment approaches may hinder their recovery.

Research on SUD points to significant differences in personal, social, and even neurobiological factors that place women at risk and impede their recovery. Understanding these differences is key to determining why women become addicted and how treatment efforts can be tailored to them to help boost recovery rates.

 

Addiction linked to personal, social issues

According to research published by the Gateway Foundation, men are up to 2.2 times more likely to abuse illicit drugs or alcohol compared with women.

How men and women become addicted differently. Gateway Foundation.

 

However, the National Institute on Drug Abuse (NIDA) noted that women fall victim to SUD at rates approximately equal to those of men—and women are more likely to crave drugs or alcohol and relapse, even while in treatment.

Sex and gender differences in substance use disorder treatment. National Institute on Drug Abuse.

 

There are many reasons why a person may develop SUD, but women face a variety of personal, social, and cultural influences that impact addiction rates.

For example, many women have reported feeling stigmatized as a result of their addiction issues. Mistrust in clinicians and in the healthcare system as a whole lead many to avoid treatment or withdraw from it earlier, according to research published in Substance Abuse.

Cockroft JD, Adams SM, Bonnet K, et al. “A scarlet letter”: Stigma and other factors affecting trust in the health care system for women seeking substance abuse treatment in a community setting. Substance Abuse. 2019;40(2):170–177.

 

The Gateway Foundation research suggests that approximately 80% of women in treatment for addiction experienced at least one traumatic event, most commonly sexual assault, and physical violence.

Past trauma experiences are linked to the development of addiction and other problems, including PTSD, which may further hinder treatment efforts.

Like PTSD, other mental health conditions make SUD more likely. Women are often diagnosed with comorbid psychiatric illnesses, such as depression, anxiety, and eating disorders. In many cases, these women use illicit substances to mediate negative emotions and relieve stress, ultimately increasing the likelihood of addiction.

 

 

Neurobiological factors play a key role

When compared with healthy controls and men, women who are addicted to substances like alcohol, nicotine, stimulants, cannabis, or heroin show a thinner insula cortex, according to an article published by Frontiers in Global Women’s Health.

Cornish JL, Prasad AA. Sex differences in substance use disorders: a neurobiological perspective. Front Glob Women’s Health. 2021;2:778514.

 

This deep, central region of the brain is important for a variety of functions and is linked to risk-reward behavior. The thinning may be responsible for altered motivational circuits, including those involved in stress reactivity and interoceptive states.

 

Key gender differences in SUD treatment

Unfortunately, a one-size-fits-all approach to substance abuse treatment is still relatively common, according to the NIDA research. While women typically have a shorter history of substance use, they are more likely to enter treatment with concurrent behavioral, medical, psychological, and sociocultural issues.

Women face significant challenges to recovery, according to the Gateway Foundation. Many are less secure financially, which may prohibit the completion of treatment programs. They often receive lower pay or generally have less income as a result of staying at home to care for children or other family members. Inadequate housing and unequal access to basic necessities may also factor into relapse rates.

The Gateway Foundation research suggests that up to 70% of women in addiction treatment are also mothers. Since women are often primary caregivers, this may prevent many from successfully completing treatment if alternative childcare arrangements cannot be arranged. Additionally, pregnant women with SUD may hesitate to seek treatment for fear of their infants being taken away.

 

Support is key

For clinicians treating women with substance use issues, supportive therapies and other interventions should be used to tailor treatment to each patient. As relationships are based on trust, it is important to reserve judgment and be open and honest during patient encounters.

Addiction is a complex disease further complicated by sex differences between men and women. Clinicians should be prepared to address women-specific issues while treating SUD to help as many patients as possible succeed.