While addiction to alcohol and other drugs is an equal-opportunity disease, women are affected differently than men. Generally speaking, women progress faster in addiction than men, face different barriers to getting help, and recover differently. Recognizing these differences can be critical in identifying addiction and determining the most effective treatment options.
Historically, men have a higher reported incidence of substance abuse and dependence, but women are rapidly closing that gap. Young women and middle-aged women, have an almost equal percentage of drug and alcohol abuse and dependence concerns as do men. Until recently, it was not uncommon for a woman to be diagnosed with a medical condition or mental health concern without being asked about her drinking or drug use. Or, if asked, she may have denied the problem. Today, addiction is more readily identified and directly addressed.
The Big Book of Alcoholics Anonymous said years ago that women progress faster than men. Now science is telling us why, and it's not because women are the weaker sex. Physiological differences accelerate the progression of addiction in women compared with men. The female body processes alcohol, and to varying extents other addictive substances, differently than does the male body. Women have less of a stomach enzyme that breaks down alcohol. This leads to greater blood alcohol concentration. Women also have more fatty tissue than men, so alcohol is absorbed better into the bloodstream. One drink for a woman can have twice the physical impact as one drink for a man. Therefore the brain and other organs are exposed to higher concentrations of blood alcohol for longer periods of time and more likely to be damaged.
The stigma attached to addiction can be stronger for women—mothers, in particular—than men. Denial, fear, and shame prevent women from looking honestly at their drinking and drug use, and from asking friends or family for help or consulting a professional. Other common barriers to help for women include child care responsibilities, lower wages/less income, substance abuse by a partner or other family members, fear of losing custody of children, lack of access to resources, or feeling unworthy of help.
Gender-specific programs can be beneficial for some women. Other women may simply need programming that is sensitive to gender issues. Co-occurring mental health conditions such as depression and anxiety need to be sorted out for all people in treatment. Issues women may struggle with that also need to be assessed and their impact on addiction are relationships, eating disorders, food addiction, trauma, as well as hormonal concerns. While none of these cause addiction they can be instrumental in helping people cross that line and also can be instrumental in crossing the line back to active chemical use.
Powerful feelings of shame and guilt deter women from seeking help for addiction, even when their lives depend on it. So it's important to work with addiction professionals who know how to get the client to be accountable without fault-finding or judgment. The old break-them-down-to-build-them-up approach doesn't work because many women already feel broken by the time they reach treatment. Instead, relationships are an important motivator for women in treatment. Women want to belong and feel connected with others.
In treatment and ongoing recovery women's and men's needs are different. Women may need to work on self-reliance instead of reliance on others; a program of action versus a program of feelings; empowerment versus compliance; learning to trust self versus blindly trusting others; learning to respect self and care for self versus focusing care on others. While surrender is part of recovery, learning to question things may be a sign of recovery for women.
Recovery often happens fast for women. Recovery is a natural for women. That's because women are wired for relationships, and recovery from addiction starts with connection. The female brain is very different from the male brain, and it starts in utero with the communication centers being different. Women are wired for connection and many women take their worth from the quality of their relationship. Addiction is an extremely isolating condition. Women lose themselves and their most important relationships to addiction. Much of the healing process of recovery revolves around connecting with others who share the struggle.
Because of being wired differently than men, both in the brain and the in the need for connection, as well as physiologically, early recovery issues are different. The same reasons that led women to start using may lead them back to the chemicals. Issues such as food/body concerns, relieving stress or boredom, improving mood (mental health concerns), reducing sexual inhibitions and intimacy concerns, self-medicating depression, anxiety, pain or sleep issues; and increase self-esteem can be relapse concerns.
Individual high-risk situations can include cravings, beginning or ending romantic relationships, physical pain, spending time alone, hormonal changes, high stress periods or after periods of stress (the aftermath of resentment), milestones in recovery ("I did it!"), anniversary "freakies" (scared of getting that one year), complacency, and boredom.
Women have ongoing issues in recovery that may pop up throughout recovery and make people vulnerable to relapse. These include physical concerns, mental health concerns, filling a void, aging, losses, being miserable with another addiction, the dry drunk phenomenon, self-sabotage, complacency, and character defects.
All issues respond to the solution found in the first day of recovery. It starts with connection with others and asking for help. Ongoing, it's about maintaining an attitude of honesty, openness, and willingness. The same things that work "just for today" can be helpful in the 24 hours that are part of year 10 or year 40. Life on life's terms requires a program of action and growth, for women and men.
Brenda J. Iliff has more than 20 years of experience in the addiction field as both a clinician and health care executive, and is the author of A Woman's Guide to Recovery.