How substance use disorders affect women differently

By Sarah Handzel, BSN, RN | Medically reviewed by Amanda Zeglis, DO, MBA
Published December 5, 2022

Key Takeaways

  • Women suffer from substance use disorder (SUD) at approximately equal rates as men, but they are more likely to have cravings and relapse during or after treatment.

  • Women develop addiction issues as a result of many factors, including personal, social, and neurobiological variables.

  • Successful treatment requires clinicians to develop women-specific treatment plans that promote trust and support to help women with addiction succeed.

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 But women are just as susceptible to addiction, and outdated treatment approaches may hinder their recovery.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.[]

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.[]

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.[]

While stigma affects both biological sexes, women are also more likely to have experienced significant trauma at some point in the past.

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.

Related: Why were women drinking more during the COVID-19 pandemic?

Neurobiological factors play a key role

Research also points to fundamental differences in brain structure between men and women that seem to influence addiction and the development of SUD.

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.[]

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.

Previous research indicates women are generally faster to develop a dependence on substances.

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.

Most women benefit from collaborative efforts that build self-confidence. Such approaches may help them stay engaged and successfully complete treatment without relapse.

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.

What this means for you

There are significant differences between men and women. Personal and social issues, as well as neurobiological differences, contribute to addiction. Understanding these factors is key to developing women-specific treatment approaches that help curb addiction and promote complete recovery.

Read Next: Do alcohol cues and cravings affect women differently than men?

In our Women's Health Focus feature, we'll offer insights and practical guidance to support you in providing the comprehensive and personalized care that women need throughout their life stages. We invite you to submit any topic you'd like to see covered and let us know if you'd like to be a guest author.

Share with emailShare to FacebookShare to LinkedInShare to Twitter