Sex and Gender Differences in Substance Use Disorder Treatment
There are more men than women in treatment for substance use disorders. However, women are more likely to seek treatment for dependence on sedatives such as anti-anxiety and sleep medications (TEDS, 2012). In addition, although men have historically been more likely to seek treatment for heroin use, the rate of women seeking treatment has increased in recent decades. By 2010, there were nearly equal numbers of male and female heroin users seeking treatment (Cicero et al., 2014).
Substance Use Disorder Treatment Admissions (all drugs)
Source: 2012 SAMHSA TEDS
Substance use disorders may progress differently for women than for men. Women often have a shorter history of abusing certain substances such as cocaine (Haas & Peters, 2000), opioids (Hernandez-Avila et al., 2004), marijuana (Khan et al., 2013; Hernandez-Avila et al., 2004; Ehlers et al., 2010), or alcohol (Hernandez-Avila et al., 2004; Mann et al., 2005; Randall et al., 1999). However, they typically enter substance use disorder treatment with more severe medical, behavioral, psychological, and social problems. This is because women show a quicker progression from first using the substance to developing dependence (Greenfield et al., 2010).
Many women who are pregnant or have young children do not seek treatment or drop out of treatment early because they are unable to take care of their children; they may also fear that authorities will remove their children from their care. The combined burdens of work, home care, child care, and other family responsibilities, plus attending treatment frequently, can be overwhelming for many women. Successful treatment may need to provide an increased level of support to address these needs (SAMHSA, 2006).
Women and Smoking Cessation Treatment
Research shows that women are less likely to try to quit smoking and more likely to relapse if they do quit (Piper et al., 2010). Nicotine-replacement options, such as the patch or gum, are not as effective for women as for men, and nicotine withdrawal may be more intense for women (Perkins & Scott, 2008; Langdon et al., 2013). Research shows that nicotine craving (Franklin et al., 2004) and withdrawal (Weinberger et al., 2015) vary across the menstrual cycle, which may further complicate a woman's attempts to quit.
Some women continue to smoke because they are afraid they will gain weight. However, research shows only a modest weight gain after quitting. The average smoker gains 6 to 10 pounds after quitting smoking, but certain diet and lifestyle changes can reduce the risk of weight gain. If a person does gain weight, the average person loses much of the extra weight within 6 months (Tobacco Research and Intervention Program, 2000). In fact, long-term quitters gain, on average, only 2 pounds (Quitting Smoking Benefits Health Despite Weight Gain, 2013). Most importantly, the health benefits of quitting smoking far exceed the risks of gaining a few pounds. For example, the stress on the heart due to smoking one pack of cigarettes per day is equivalent to being 90 pounds overweight. Quitting also decreases risks for various types of cancers, heart attack, and lung disease (Tobacco Research and Intervention Program, 2000). The U.S. Department of Health and Human Services has resources to help a woman quit smoking.
Substance Use Disorder Treatment for Mothers and Their Babies While Pregnant or Breastfeeding
A pregnant woman should ask for medical help to stop her drug use. If she attempts to suddenly withdraw from addictive drugs and alcohol without medical assistance, she could be putting her fetus at risk (Jones et al., 2010). Federal law requires that pregnant women receive priority admission into publicly funded substance use disorder treatment programs, allowing them to bypass waiting lists and gain immediate admission when a bed in a residential program is available. The primary treatment provider must secure prenatal care if a pregnant woman is not already receiving such care (SAMHSA, 2009). State-level contacts for this program are available from SAMHSA (PDF, 517KB).
Intensive outpatient treatment, which provides a higher treatment level than traditional outpatient programs but does not require structured residential living, has produced positive results for pregnant women. Pregnant women are more likely to stay in these treatment programs if they provide services such as child care (Chen et al., 2004), parenting classes, and vocational training (McMurtrie et al., 1999; Volpicelli et al., 2000).
In addition, it is important to monitor newborns of substance-using mothers for symptoms of withdrawal and provide proper treatment if necessary. Treatment of drug dependency in newborns depends on the severity of symptoms and may include hospitalization in order to receive intravenous fluids and medications. These medications are gradually tapered off until the infant adapts to being drug-free.
Treating Opioid Use Disorders in Pregnant Women
Pregnant women who are addicted to opioid pain relievers or heroin face special problems because the baby can be born dependent (a condition called neonatal abstinence syndrome, or NAS). Currently, the U.S. Food and Drug Administration has not approved medications to treat opioid-dependent pregnant women, but methadone or buprenorphine maintenance combined with prenatal care and a comprehensive drug treatment program can improve many of the adverse outcomes associated with untreated opioid use disorder (Jones et al., 2010; Meyer et al., 2015). In general, it is neither recommended nor necessary for pregnant women to cease methadone or buprenorphine treatment (SAMHSA, 2009; Meyer et al., 2015). However, newborns exposed to methadone during pregnancy still require treatment for withdrawal symptoms.
Recent studies suggest that buprenorphine (Suboxone®, Subutex®) has some advantages over methadone as a treatment for opioid addiction in pregnant women. Infants born to mothers treated with buprenorphine had fewer symptoms of dependence and reduced length of hospital stay compared to those treated with methadone (NIDA, 2012).
Pregnant women who take buprenorphine for opioid addiction during pregnancy should be aware that the amount of buprenorphine passed through breast milk may be inadequate to prevent opioid withdrawal in their infant. In some cases, treatment of the infant may be required (LACTMED: Buprenorphine, 2015).
Pregnant women who are addicted to opioids, even if they are in treatment, should monitor their babies for drowsiness, inadequate weight gain, and failure to meet developmental milestones—especially in younger, exclusively breastfed infants. Although unlikely, if a breastfed baby of a woman on buprenorphine therapy shows signs of increased sleepiness, difficulty feeding or breathing, or limpness, a health care provider should be contacted immediately. Infants should be observed for withdrawal signs if breastfeeding is abruptly stopped (LACTMED: Buprenorphine, 2015).
- Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration, Treatment Episode Data Set (TEDS). Table 2.1a. Admissions aged 12 and older, by gender and age at admission according to primary substance of abuse: 2012. www.samhsa.gov/data/2K14/TEDS2012NA/TEDS2012NTbl2.1a.htm. Accessed July 7, 2015.
- Chen X, Burgdorf K, Dowell K, Roberts T, Porowski A Herrell JM. Factors associated with retention of drug abusing women in long-term residential treatment. Eval Program Plann. 2004;27(2):205-212.
- Cicero TJ, Ellis MS, Surratt HL, Kurtz SP. The changing face of heroin use in the United States: a retrospective analysis of the past 50 years. JAMA Psychiatry. 2014;71(7):821-826.
- Ehlers CL, Gizer IR, Vieten C, et al. Cannabis dependence in the San Francisco Family Study: age of onset of use, DSM-IV symptoms, withdrawal, and heritability. Addict Behav. 2010;35(2):102-110.
- Franklin TR, Napier K, Ehrman R, Gariti P, O'Brien CP, Childress AR. Retrospective study: influence of menstrual cycle on cue-induced cigarette craving. Nicotine Tob Res. 2004;6(1):171-175.
- Greenfield SF, Back SE, Lawson K, Brady KT. Substance abuse in women. Psychiatr Clin North Am. 2010;33(2):339-355.
- Haas AL, Peters RH. Development of substance abuse problems among drug-involved offenders. Evidence for the telescoping effect. J Subst Abuse. 2000;12(3):241-253.
- Hernandez-Avila CA, Rounsaville BJ, Kranzler HR. Opioid-, cannabis- and alcohol-dependent women show more rapid progression to substance abuse treatment. Drug Alcohol Depend. 2004;74(3):265-272.
- Jones HE, Kaltenbach K, Heil SH, et al. Neonatal abstinence syndrome after methadone or buprenorphine exposure. N Engl J Med. 2010;363(24):2320-2331.
- Khan SS, Secades-Villa R, Okuda M, et al. Gender differences in cannabis use disorders: results from the National Epidemiologic Survey of Alcohol and Related Conditions. Drug Alcohol Depend. 2013;130(1-3):101-108.
- LACTMED: Buprenorphine. TOXNET Toxicology Data Network. Bethesda, MD: U.S. National Library of Medicine. http://toxnet.nlm.nih.gov/cgi-bin/sis/search2/r?dbs+lactmed:@term+@DOCNO+338. Revised May 5, 2015. Accessed July 7, 2015.
- Langdon KJ, Leventhal AM, Stewart S, Rosenfield D, Steeves D, Zvolensky MJ. Anhedonia and anxiety sensitivity: prospective relationships to nicotine withdrawal symptoms during smoking cessation. J Stud Alcohol Drugs. 2013;74(3):469-478.
- Mann K, Ackermann K, Croissant B, Mundle G, Nakovics H, Diehl A. Neuroimaging of gender differences in alcohol dependence: are women more vulnerable? Alcohol Clin Exp Res. 2005;29(5):896-901.
- McMurtrie C, Rosenberg KD, Kerker BD, Kan J, Graham EH. A unique drug treatment program for pregnant and postpartum substance-using women in New York City: results of a pilot project, 1990-1995. Am J Drug Alcohol Abuse. 1999;25(4):701-713.
- Meyer MC, Johnston AM, Crocker AM, Heil SH. Methadone and buprenorphine for opioid dependence during pregnancy: a retrospective cohort study. J Addict Med. 2015;9(2):81-86.
- National Institute on Drug Abuse (NIDA). Principles of Drug Addiction Treatment: A Research-Based Guide, Third Edition. Bethesda, MD: National Institutes of Health; 2012. NIH Publication No. 12-4180.
- Perkins KA, Scott J. Sex differences in long-term smoking cessation rates due to nicotine patch. Nicotine Tob Res. 2008;10(7):1245-1250.
- Piper ME, Cook JW, Schlam TR, et al. Gender, race, and education differences in abstinence rates among participants in two randomized smoking cessation trials. Nicotine Tob Res. 2010;12(6):647-657.
- Quitting Smoking Benefits Health Despite Weight Gain [research update]. Bethesda, MD: National Institutes of Health. http://www.nih.gov/researchmatters/march2013/03252013smoking.htm. Published March 25, 2013. Accessed July 7, 2015.
- Randall CL, Roberts JS, Del Boca FK, Carroll KM, Connors GJ, Mattson ME. Telescoping of landmark events associated with drinking: a gender comparison. J Stud Alcohol. 1999;60(2):252-260.
- Substance Abuse and Mental Health Services Administration (SAMHSA). Substance Abuse: Clinical Issues in Intensive Outpatient Treatment. Rockville, MD: Substance Abuse and Mental Health Services Administration; 2006. Publication No. (SMA) 06-4182.
- Substance Abuse and Mental Health Services Administration (SAMHSA). Substance Abuse Treatment: Addressing the Specific Needs of Women. Rockville, MD: Substance Abuse and Mental Health Services Administration; 2009. Publication No. (SMA) 09-4426.
- Tobacco Research and Intervention Program, H. Lee Moffitt Cancer Center & Research Institute, University of South Florida. Forever Free: A Guide To Remaining Smoke Free. Booklet 3: Smoking And Weight. Tampa, FL: H. Lee Moffitt Cancer Center & Research Institute, University of South Florida; 2000.
- Volpicelli JR, Markman I, Monterosso J, Filing J, O'Brien CP. Psychosocially enhanced treatment for cocaine-dependent mothers: evidence of efficacy. J Subst Abuse Treat. 2000;18(1):41-49.
- Weinberger AH, Smith PH, Allen SS, et al. Systematic and meta-analytic review of research examining the impact of menstrual cycle phase and ovarian hormones on smoking and cessation. Nicotine Tob Res. 2015;17(4):407-421.
Cite this article
NIDA. (2016, September 20). Substance Use in Women. Retrieved from https://www.drugabuse.gov/publications/research-reports/substance-use-in-women
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