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Substance Use in Women


Women and men may face unique issues when it comes to substance use, as a result of both sex and gender. Sex differences result from biology, or being genetically female or male, while gender differences are based on culturally defined roles for men and women, as well as those who feel uncomfortable identifying with either category; such roles influence how people perceive themselves and how they interact with others (ORWH, 2015; Wizemann & Pardue, 2001). Sex and gender can also interact with each other to create even more complex differences between men and women.

Examples of Sex and Gender Influences in Smoking Cessation

Image of XX over XY showing chromosome makeup

Sex Difference:  Women have a harder time quitting smoking than men do. Women metabolize nicotine, the active ingredient in tobacco, faster than men.  Differences in metabolism may help explain why nicotine replacement therapies, like patches and gum, work better in men than in women.  Men appear to be more sensitive to nicotine's pharmacologic effects related to addiction.

Male and Female symbols

Gender Difference:  Although men are more sensitive than women to nicotine's addiction-related effects, women may be more susceptible than men to non-nicotine factors, such as the sensory and social stimuli associated with smoking.

For example, women and men sometimes use drugs for different reasons and respond to them differently, and substance use disorders may manifest differently in women than in men. A substance use disorder occurs when a person needs alcohol or a drug to function normally and stopping use leads to withdrawal symptoms. Some of the unique issues women who use drugs face are further complicated during pregnancy and breastfeeding. Most new mothers and mothers-to-be realize that drugs, including tobacco and alcohol, can be passed on to their babies (both while in the womb and via mothers' milk) and cause them harm. Women should also know that some substances can impact their reproductive cycles, increasing the likelihood of infertility (Eggert et al., 2004; Joesoef et al., 1993; Tolstrup et al., 2003) and early onset of menopause (Schoenbaum et al., 2005). (See Substance Use While Pregnant and Breastfeeding)

Unfortunately, it can be difficult for a person with a substance use disorder to quit, and some women with such disorders fear that seeking help while pregnant or afterward could cause them legal or social problems. Communities can build support systems to help women access treatment as early as possible (SAMHSA, 2009), ideally before becoming pregnant. If a woman is unable to quit before becoming pregnant, treatment during pregnancy improves the chances of having a healthier baby at birth (Daley et al., 2001; Svikis et al., 1997).

Women have unique needs that should be addressed during substance use disorder treatment. Effective treatment should incorporate approaches that recognize sex and gender differences, understand the types of trauma women sometimes face, provide added support for women with child care needs, and use evidence-based approaches for the treatment of pregnant women (SAMHSA, 2011). (See Sex and Gender Differences in Substance Use Disorder Treatment)

Despite the many differences between men and women, for many years most animal and human research has traditionally used male subjects. To find out more about how women might differ from men to inform better treatment approaches, federal agencies have developed guidelines to promote the inclusion of women in research (NIH, 2001; Clayton & Collins, 2014). (See The Importance of Including Women in Research)


  • Clayton JA, Collins FS. Policy: NIH to balance sex in cell and animal studies. Nature. 2014;509:282-283.
  • Daley M, Argeriou M, McCarty D, Callahan JJ Jr, Shepard DS, Williams CN. The impact of substance abuse treatment modality on birth weight and health care expenditures. J Psychoactive Drugs. 2001;33(1):57-66.
  • Eggert J, Theobald H, Engfeldt P. Effects of alcohol consumption on female fertility during an 18-year period. Fertil Steril. 2004;81(2):379-383.
  • Joesoef MR, Beral V, Aral SO, Rolfs RT, Cramer DW. Fertility and use of cigarettes, alcohol, marijuana, and cocaine. Ann Epidemiol. 1993;3(6):592-594.
  • National Institutes of Health (NIH). Amendment: NIH Policy and Guidelines on the Inclusion of Women and Minorities as Subjects in Clinical Research. http://grants.nih.gov/grants/guide/notice-files/NOT-OD-02-001.html. Released October 9, 2001. Accessed July 7, 2015.
  • Office of Research on Women's Health (ORWH). How sex and gender influence health and disease [infographic]. https://orwh.od.nih.gov/sex-gender/sexgender-influences-health-and-disease/infographic-how-sexgender-influence-health. Accessed July 7, 2015.
  • Schoenbaum EE, Hartel D, Lo Y, et al. HIV infection, drug use, and onset of natural menopause. Clin Infect Dis. 2005;41(10):1517-1524.
  • Substance Abuse and Mental Health Services Administration (SAMHSA). Addressing the Needs of Women and Girls: Developing Core Competencies for Mental Health and Substance Abuse Service Professionals. Rockville, MD: Substance Abuse and Mental Health Services Administration; 2011. HHS Publication No. (SMA) 11-4657.
  • 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. HHS Publication No. (SMA) 09-4426.
  • Svikis DS, Golden AS, Huggins GR, et al. Cost-effectiveness of treatment for drug-abusing pregnant women. Drug Alcohol Depend. 1997;45(1-2):105-113.
  • Tolstrup JS, Kjaer SK, Holst C, et al. Alcohol use as predictor for infertility in a representative population of Danish women. Acta Obstet Gynecol Scand. 2003;82(8):744-749.
  • Wizemann TM, Pardue M-L, eds, Committee on Understanding the Biology of Sex and Gender Differences. Exploring the Biological Contributions to Human Health: Does Sex Matter? Washington, DC: National Academies Press; 2001.

This page was last updated September 2016

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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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