Disclaimer: For academic purpose only

1. Substance use disorder
in women
Ms. Mary Infanta P
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Order of presentation
o INTRODUCTION
o PREVALENCE RATE
o TYPES OF SUBSTANCES
o GENDER DIFFERENCES IN SUBSTANCE USE
o WOMEN AND ADDICTION
o DIAGNOSTIC GUIDELINES
o FACTORS ASSOCIATED WITH SUBSTANCE USE
o TREATMENT PROCESS
o GENDER-SPECIFIC BARRIERS TO TREATMENT
o PSYCHO SOCIAL INTERVENTION
o NGOS WORKING IN THIS FIELD

3. Introduction
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 Alcohol and substance use, were believed to be a predominantly male
phenomenon.
 Only in the last few decades, attention has shifted to female drug use and its
repercussions in women.
 As the numbers of female drug users continue to rise, studies attempt to
understand gender-specific etiological factors, phenomenology, course and
outcome, and issues related to treatment with the aim to develop more
effective treatment programs.

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Globally, some 35 million people are estimated to suffer from drug use disorders and
who require treatment services, according to the latest World Drug Report(2019)
The Report also estimates the number of opioid users at 53 million, up 56 per cent from
previous estimates , and that opioids are responsible for two thirds of the 585,000
people who died as a result of drug use in 2017.
Globally, 11 million people injected drugs in 2017, of whom 1.4 million live with HIV and
5.6 million with hepatitis C.
Global Prevalence of Drug abuse
United Nations office on Drugs and Crime(UNODC)-2019

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Prevalence Rate - INDIA
Magnitude of substance use in INDIA-2019 (National Survey on Extent and Pattern of Substance Use in India)

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Magnitude of substance use in INDIA-2019 (National Survey on Extent and Pattern of Substance Use in India)

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Magnitude of substance use in INDIA-2019 (National Survey on Extent and Pattern of Substance Use in India)

8. Gender Differences in Substance Use
● Women often use substances differently than men, such as using smaller
amounts of certain drugs for less time before they become addicted.
● Women can respond to substances differently. For example, they may have
more drug cravings and may be more likely to relapse after treatment.
● Sex hormones can make women more sensitive than men to the effects of
some drugs.
● Women who use drugs may also experiencemore physical effects on their
heart and blood vessels.
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9. Gender Differences in Substance Use
● Brain changes in women who use drugs can be different from those in men.
● Women may be more likely to go to the emergency room or die from overdose or
other effects of certain substances.
● Women who are victims of domestic violence are at increased risk of substance
use.
● Divorce, loss of child custody, or the death of a partner or child can trigger
women's substance use or other mental health disorders.
● Women who use certain substances may be more likely to have panic attacks,
anxiety, or depression.
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10. Women and addiction
…
● Unique characteristics related to hormones,
fertility, pregnancy, breastfeeding, and menopause
that can impact women’s progression from use to
addiction to struggles with recovery.
● There are culturally defined roles for men and
women that further impact the differences seen in
the two genders and affect the way they seek help.
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Women often becomes addicted
faster than men
It’s used as way of coping with
emotional stress and trauma
Women tend to be socially
stigmatized for seeking rehabilitation
treatment

11. Diagnostic Guidelines
ICD -10
A cluster of physiological, behavioral, and cognitive phenomena in which the use of a substance or a class of
substances takes on a much higher priority for a given individual than other behaviors that once had greater
value.
A definite diagnosis of dependence;
only if three or more of the following have been present together at some time during the previous year:
● (a)a strong desire or sense of compulsion to take the substance;
● (b)difficulties in controlling substance-taking behavior in terms of its onset, termination, or levels of use;
● (c)a physiological withdrawal state when substance use has ceased or been reduced.
● (d)evidence of tolerance, such that increased doses of the psychoactive substance are required in order to
achieve effects originally produced by lower doses
● (e)progressive neglect of alternative pleasures or interests because of psychoactive substance use
● (f)persisting with substance use despite clear evidence of overtly harmful consequences.
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12. FACTORS ASSOCIATED WITH SUBSTANCE USE
BIOLOGICAL FACTORS
● Gender differences in neuroendocrine adaptations.
● As compared to men, women are known to become intoxicated after
consuming smaller quantities of alcohol indicating that women achieve
higher blood alcohol concentrations (BACs) after consumption of the
equivalent amount of alcohol.
● Women meeting the diagnostic criteria for the premenstrual syndrome
are found to drink more heavily than controls and have higher rates of
abuse and dependence.
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13. Genetic and environmental factors
● Genetic influences seem to be greater for men (heritability of 33% for
men and 11% for women). In women, initiation of illicit substances is
found to be shaped more by environmental factors, whereas progression
to abuse or dependence is determined by genetic influences.
● Alcohol use or abuse by spouse or another close family member.
● Transition and lifestyle changes .
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14. Psychological factors and psychiatric comorbidities
● History of early traumatic life events.
● Significant association between substance use and major depression in
women has also been reported.
● Indian studies on treatment-seeking women users have found similar
results with co-morbid depressive disorders in 12%, adjustment disorder
in 5%, somatoform disorder in 3%, anxiety disorder in 2%,
schizophrenia in 2%, obsessive compulsive disorder in 1% and bipolar
affective disorder in 1%.
Winfield I, George LK, Swartz M, Blazer DG. Sexual assault and psychiatric disorders among a community sample of
women. Am J Psychiatry 1990;147:335-41
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15. Socio-cultural factors
● Society expects a woman to a wife, a mother, caretaker, sexual partner, and nurturer,
and when she deviates from these prescribed roles, she tends to face stigma.
● Alcohol use in women is linked with sexual misconduct, neglect of children and
significant others, a set of conditions that cause stigma and social discrimination.
● Factors like poor education status, lack of job, young age at work, early marriage, and
lack of social support increased vulnerability of such females.
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16. Initiation
Adolescent depression
problems in adjustment
Hanging out with older male friends
Peer pressure
Feeling of a sense of glamor & Power
Pubertal changes
Initiation and course of substance use in women
Course
Women progress faster between
landmarks associated with the
developmental course of
alcoholism
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17. Telescoping
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This accelerated progression
of alcoholism in women

18. Consequences of alcohol and substance use in women
Health consequences
liver disease
Menstrual disturbances
Infertility and breast cancer
Hypertension
Cardiovascular mortality
Subarachnoid haemorrhage
Legal Consequences
Prone to participate in
drug-related crimes
Peddling activities
Sex work
Pick-pocketing and
theft charges
Social and familial
consequences
Interpersonal difficulties to
homelessness
Unemployment, Poverty,
and a general
disengagement from the
communities.
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20. Substance Use and Pregnancy
Foetal alcohol spectrum disorder (FASD)
FASD can cause problems with:
● movement, balance, vision and hearing
● learning, such as problems with thinking, concentration, and memory
● managing emotions and developing social skills
● hyperactivity and impulse control
● communication, such as problems with speech, the joints, muscles, bones, and organs, such as
the kidneys and heart
These problems are permanent, though early treatment and support can help limit their impact on a
child's life.
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21. TREATMENT PROCESS
Treatment entry and
treatment-seeking
Alcohol treatment facilities-3.3:1
High-risk drinking 2:1
Alcohol treatment services 3:1-
10:1
Treatment Retention
Longitudinal studies-Gender was
not associated with completion of
planned treatment.
Gender-neutral factors like having
good financial resources and
having fewer mental health
problems, having less-severe
substance use problems, being
employed, older age, and referral
from criminal justice system
results in better outcome
Treatment outcome
No gender differences
in treatment outcome.
Studies that have used
relapse as a measure of
outcome have reported
better outcome for
women as compared to
men.
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22. Gender-Specific Barriers to Treatment
● Women are consistently underrepresented in SUD treatment programs
(Greenfield et al.2007a)
● Sociocultural factors (e.g., shame, lack of spousal/family support)
● Stigma associated with SUDs
● Women living in culturally conservative societies
● More reluctant to leave home for long-term treatment out of fear that
separation from the family will lead to divorce and family instability.
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23. Emerging opportunity to reduce treatment Gap
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Emerging opportunities
to Improve Treatment
Access for Substance
Use Disorders and Other
Comorbid Health Issues
Among Women Enrolled
in WIC (Women, Infants
&Child)
Yukiko
Washio Bradley N
Collins , Linda M
Kilby - 2020
Integrating more
proactive, evidence-
based strategies for
substance use disorders
such as standardized
brief assessments,
advice, and referral
procedures (i.e.,
Screening, Brief
Interventions, and
Referral to Treatment
[SBIRT]), as part of
routine WIC operations.
Integration of such
routine practice would
improve the quality of
care WIC provides to
their clients and families,
while addressing a major
gap in public health by
connecting clients at
high risk for substance
use disorders and
substance-related
problems to much
needed services.

24. PSYCHOSOCIAL INTERVENTION
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Motivation
Improvement
Therapy
Community
Reinforcement
Approach
(CRA)
Relapse
Prevention
• Coping skills
training
• Cognitive
therapy
• Lifestyle
modification
The Matrix
Model
Network
Therapy
Self Help
Approaches
Alcoholics
Anonymous (AA)
Narcotic
Anonymous(AA)
Brief
Intervention
FRAMES
DARES
Multi-Systemic Therapy (MST) Therapeutic Community

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NGOs Working on Substance Abuse among women
Name of the NGO Targeted
Population
Areas of work
NADA India foundation
(Alcohol & Tobacco)
Women, Child &
Youth Welfare
Training and Skill Building,
Education & Research,
Community Wellbeing, awareness
Campaigns
TREDA(Treatment
Rehabilitation and Education
of Drug Abuse (TREDA) )
Men & Women AA & NA Meetings
Alcoholism Treatment
Detoxification
Drug Addiction Treatment
Family Services
Relapse Prevention
Residential Rehabilitation
Substance Abuse Counselling
Yoga and Meditation

26. Conclusion
● There are important gender differences in SUDs that are meaningful for
screening diagnosis, and course of illness.
● There are gender-specific biological and social differences in both the effects and
consequences of substances of abuse that are of critical importance in assessing
individual consequences and determining the best treatment options.
● Timely, tailor made continuum pharmacological interventions combined with
psychosocial interventions may be helpful in reducing substance use and
associated issues among substance-dependent women.
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27. References
● Babor, T.F. and Higgins-Biddle, J.C. (2001) Brief Intervention for Hazardous and Harmful Drinking: A
Manual for use in Primary Care. World Health Organization, Document No. WHO/MSD/MSB/ 01.6b.
● Lal, R., Deb, K. S., & Kedia, S. (2015). Substance use in women: Current status and future directions. Indian
journal of psychiatry, 57(Suppl 2), S275.
● https://www.cdc.gov/ncbddd/fasd/facts.html
● Washio, Y., Collins, B. N., & Kilby, L. M. (2022). Emerging Opportunities to Improve Treatment Access for
Substance Use Disorders and Other Comorbid Health Issues Among Women Enrolled in WIC. Health
Promotion Practice, 15248399211069094.
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