While men drink more than women and are addicted to alcohol at a higher rate, women tend to develop an addiction more quickly than men, and the physical and mental health problems associated with chronic alcohol abuse occur more quickly and intensely in women.
Women and men differ in a number of ways when it comes to developing an addiction, getting treatment, and recovering for the long-term.
How Alcohol Affects Women Differently Than Men
When it comes to drinking alcohol, men and women have crucial biological and behavioral differences that govern how they drink alcohol and respond to it, how quickly alcohol affects them and how alcohol affects their health.
Dehydrogenase is the enzyme that begins the alcohol metabolization process. Women have 50 percent less of this enzyme than men do and therefore metabolize alcohol more slowly. This means that alcohol stays in the blood longer in women.
Alcohol is less diluted in women than in men due to differing amounts of muscle, fat and water. Women have a higher percentage of body fat than men, and men have a higher percentage of muscle than women do. Additionally, a woman’s body is composed of 45 to 50 percent water, while a man’s body is composed of 55 to 65 percent water. Since there is far less blood in fat than in muscle, and women have a lower fluid volume, alcohol is more concentrated in a woman’s bloodstream.
Hormone fluctuations throughout the menstrual cycle leaves women more vulnerable to prolonged intoxication and a stronger effect of alcohol during the week before the beginning of a menstrual cycle. Oral contraceptives also make women more sensitive to the effects of alcohol.
Studies of gender differences in motives for alcohol use have found that women are more likely to drink alcohol to ease stress and other negative emotions, while men are more likely than women to drink alcohol to enhance positive emotions.1
Telescoping is a phenomenon that has been consistently seen in studies concerning gender and substance use disorders. Telescoping is an accelerated progression from the initial abuse of a substance to addiction. Numerous studies show that while more men than women develop an addiction, women progress more quickly from substance abuse to addiction. When they enter treatment, women typically have a more severe addiction and more medical, behavioral, social and psychological problems than their male counterparts.
While more men than women develop an addiction, women progress more quickly from substance abuse to addiction.
Abuse, Addiction and Dependence
Alcohol abuse, addiction and dependence are not the same thing. Understanding the mechanics of each is crucial for knowing how to find the right kind of help.
Alcohol abuse involves using alcohol in a way that causes problems in your life or that puts you in high-risk situations. Problems caused by alcohol abuse may include financial troubles, relationship problems, legal issues or health problems. High-risk situations may include driving under the influence, having unprotected sex or walking in a dangerous area of town.
The most common type of alcohol abuse is binge drinking, which is characterized as drinking enough alcohol in the space of two hours to raise your blood alcohol level to .08 percent. For women, this is typically four drinks.
Chronic alcohol abuse can lead to addiction, which is characterized by the compulsive use of alcohol despite the problems it’s causing in your life. Addiction is marked by changes in brain function and structure related to memory, learning and pleasure. Each time you use alcohol, the brain makes strong connections between the act of using and the pleasure it produces. Over time, those connections become increasingly stronger and may eventually cause intense cravings that are similar in nature to cravings for food or sex.
Once an addiction develops, it generally takes more than good intentions or willpower to stop drinking, according to the National Institute on Drug Abuse.2 This is because addiction usually involves highly complex underlying issues such as trauma, mental illness, high levels of stress or family dysfunction.
Just as it takes time for an addiction to develop, it takes time to re-learn healthy ways of thinking and behaving. With the help of various treatment therapies, addiction can be sent into remission for the long-term.
Just as it takes time for an addiction to develop, it takes time to re-learn healthy ways of thinking and behaving.
Like addiction, dependence is the result of changes in brain structure and function. With chronic alcohol abuse, the brain changes its chemical functioning in order to compensate for the presence of alcohol in the body, which leads to tolerance. Tolerance is characterized by needing increasingly larger doses of alcohol in order to get the desired effects. The higher your tolerance, the more alcohol you need, and the more alcohol you drink, the more brain function changes to compensate.
A tipping point may be reached wherein your brain begins to function more normally when alcohol is present than when it’s not. At this point, withholding alcohol will cause brain function to begin to rebound, leading to withdrawal symptoms. Tolerance and the onset of withdrawal symptoms are signs of physical dependence on alcohol.
Tolerance and the onset of withdrawal symptoms are signs of physical dependence on alcohol.
It’s possible to be addicted to a substance without being physically dependent on it. Dependence is addressed through detox, which is the process of letting traces of a substance leave the body so that brain function can begin to return to normal and dependence can be broken. Medical detox through a high-quality treatment program involves administering various medications as needed to reduce the intensity of withdrawal symptoms and shorten the duration of detox.
Treating dependence doesn’t have an effect on the addiction, which is far more complex and requires a holistic approach that includes both traditional and complementary treatment therapies.
Alcoholism and Women’s Health
While more men than women abuse and are addicted to alcohol, excessive drinking has a more profound effect on women’s health.
The risk of cirrhosis of the liver and other liver diseases is higher for women than it is for men.3 Women are also more vulnerable to brain damage related to alcohol than men are, and they’re at a higher risk than men of developing heart disease and cancer of the mouth, esophagus, throat, liver, colon and breast.
Women—especially those of college age—who chronically abuse alcohol are also at a higher risk than the general population of being sexually assaulted, including raped. The National Institute on Alcohol Abuse and Alcoholism cites studies that have estimated that at least 25 percent of all American women and 50 percent of college-age women have been sexually assaulted, and 18 percent of all women and 27 percent of college-age women have been raped.4 Binge drinking is a risk factor for sexual assault. Research shows that the risk increases when both the perpetrator and the victim have been drinking.
The Role of Mental Illness in Addiction in Women
Women with co-occurring disorders are more likely than men to have post-traumatic stress disorder, depression, anxiety and eating disorders, according to the University of California at Berkeley, which also points out that they’re also more likely than men to be poor and to have fewer job skills, less education and more children.5 They often have a history of homelessness and victimization as well.
Women with co-occurring disorders are more likely than men to have post-traumatic stress disorder, depression, anxiety and eating disorders.
When a mental illness co-occurs with an addiction, it’s known as a dual diagnosis or co-occurring disorders. To ensure the best possible outcome of treatment, the disorders involved in a dual diagnosis need to be treated at the same time, each in the context of the other.
Mental illness is often a factor in the development of a substance use disorder. Particularly in women, post-traumatic stress disorder, or PTSD, plays a significant role in developing an addiction. PTSD is the set of symptoms that result after experiencing or witnessing a traumatic event and is characterized by nightmares, anger, flashbacks and emotional numbness.
A Harvard Medical School review of 49 studies involving women who abuse drugs found that up to 59 percent of women in addiction treatment had PTSD, a rate that’s about three times higher than the rate of PTSD in male counterparts.6 Between 55 and 99 percent of the women with PTSD reported a history of repetitive physical or sexual abuse, most of which occurred before the age of 18.
Anxiety & Depression
According to Harvard Medical School, women are twice as likely as men to develop major depression, and they have higher rates of seasonal affective disorder and chronic depression.7 Thirty-three percent of women will experience an anxiety disorder in their lifetime, compared to 22 percent of men. Experts cite hormones, brain chemistry and environment as reasons for the higher prevalence of anxiety and depression in women.
Anxiety and depression are among the most common mental illnesses that co-occur with substance use disorders. Many women self-medicate with alcohol, which may seem at first to help with anxiety and depression. But alcohol almost always makes anxiety and depression worse as brain function changes and affects the activity of key brain chemicals involved in these mental illnesses.
Alcohol almost always makes anxiety and depression worse as brain function changes and affects the activity of key brain chemicals involved in these mental illnesses.
Ninety percent of all cases of anorexia nervosa and bulimia nervosa are reported in women. Among women with a substance use disorder, around 40 percent have a co-occurring eating disorder. Eating disorders are serious psychiatric problems with serious consequences, including a dramatically increased risk of mortality. Specialized treatment for an eating disorder that co-occurs with a substance use disorder is essential for successful recovery from both disorders.
The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM) is the definitive diagnostic tool for mental disorders, including substance use disorders. Prior to the fifth edition of the DSM, alcohol abuse, alcohol addiction and alcohol dependence were considered separate diagnoses. With the DSM-5, however, these are all combined under the heading of alcohol use disorder, or AUD. An AUD will be classified as mild, moderate or severe, depending on how many of the eleven diagnostic criteria are met.8
To diagnose and classify an AUD, individuals are asked to answer the following diagnostic questions:
In the past year, have you:
Ended up drinking more or for a longer period of time than you intended?
Found yourself unable to cut back or stop drinking despite wanting to?
Spent a great deal of time drinking or recovering from drinking?
Craved a drink so badly that it was all you could think about?
Ended up neglecting responsibilities at home, work or school due to drinking or recovering from drinking?
Continued drinking even though it was causing problems with your relationships with family or friends?
Cut back on hobbies and activities you once enjoyed so you could drink?
Found yourself more than once in a high-risk situation while under the influence that put your safety at risk, such as having unprotected sex or walking in a dangerous area of town?
Continued to drink despite feeling anxious, depressed or physically ill?
Had to drink more than before in order to achieve the desired effects or found that your usual number of drinks had less effect than before?
Experienced the onset of withdrawal symptoms when the effects of alcohol were wearing off, such as a racing heartbeat, restlessness, insomnia, hallucinations, tremors or seizure?
Answering yes to two or three criteria denotes a mild AUD. Four or five applicable criteria denotes a moderate classification and six or more indicate a severe AUD.
The Substance Abuse and Mental Health Services Administration stresses that recovering from an alcohol use disorder is a highly personal endeavor, and no single pathway to recovery works for every individual.9 A high-quality rehab program works with each client to develop a highly individualized treatment plan that considers an individual’s recovery goals, personal preferences, cultural influences and a number of other factors.
Recovering from an alcohol use disorder is a highly personal endeavor, and no single pathway to recovery works for every individual.
A holistic approach to treatment leads to the best possible outcomes.10 A holistic approach is one that considers issues of mind, body and spirit and addresses the whole person and any needs or issues that are present, including the need for mental or medical health care services, legal or financial assistance, housing issues and vocation or education needs.
According to the Substance Abuse and Mental Health Services Administration, there are four major dimensions that support a life in recovery, and a high-quality treatment program will strive to help clients develop in these areas to improve their chances of long-term, successful recovery:9
Health. Good health is essential for successful recovery. Clients work to improve their physical and mental health by addressing crucial issues, engaging in healthy habits and a high level of self-care, and making informed choices that promote good health and emotional well-being.
Home. Having a safe place to live is essential for reducing stress and triggers that commonly lead to relapse.
Purpose. A strong sense of purpose in life is important for continued recovery. Engaging in meaningful activities like attending school or working, caring for family members, volunteering or working on creative pursuits is essential for maintaining motivation and momentum for recovery.
Community. A sense of belonging is a powerful deterrent for relapse. Having healthy and meaningful relationships with family, friends and peers provides a high level of support and friendship that helps to increase well-being and hope for the future.
A wide range of recovery programs address the unique needs of particular populations. Programs cater to a wide range of demographics, from LGBT populations to people with specific religious affiliations. Any quality program, however, will respect and take into consideration during treatment the beliefs, preferences, self-identity and cultural or linguistic backgrounds of all clients.
Why Many Women Don’t Seek Treatment for Alcoholism
Women seek treatment at a lower rate than men do for a number of reasons.
Stigma. The stigma of addiction tends to be stronger for women than it is for men.
Time. Mothers in particular may eschew treatment because they are the primary caretaker of minor children and don’t have the luxury of time to devote to treatment, especially an in-patient program.
Custody. In many cases, women are afraid of losing custody of their children, either to the state or to a relative or the children’s father.
Finances. Women receive lower wages than men and may not feel they can afford treatment, especially if they’re a single parent.
Shame and guilt. Women feel a great deal more shame and guilt about addiction than men typically do, and they may feel unworthy of help or fear what others will think of them.
Women’s Treatment Issues and Needs
A high-quality treatment program must address an individual’s multiple needs in order to be successful, and women face a number of unique issues in treatment that men don’t. They also recover differently than men. According to the Office of National Drug Control Policy, a women’s-only treatment program crafts its programming to address the specific needs, risks and consequences of addiction that are more often associated with women.11 Some of the special considerations for women in treatment include:
Relationship needs. Relationships are powerful motivators for women in treatment, according to the Hazelden Betty Ford Foundation.12 Women need to feel like they belong, and they need to feel a connection with others. Women-only treatment programs promote healthy relationships with other women.
The need for empowerment. Treatment for women should be a program of action wherein women learn to trust themselves, become self-reliant, and learn to question things.
Mental health issues. Women have different mental health concerns than men do. A large number of women enter treatment with PTSD, depression, anxiety or an eating disorder, and these need to be addressed in conjunction with the alcohol addiction.
Trauma. Because so many women in treatment have a history of sexual or physical abuse, a program that caters to women will provide a safe, supportive environment in which to delve into these issues. For sexual abuse survivors in particular, a women-only program will preclude having to discuss sensitive issues in the presence of men.
Childcare. Women with children are often unable to attend outpatient counseling sessions or enter an inpatient program due to family responsibilities. A number of treatment programs provide childcare, and residential programs that house a woman and her children are becoming more popular.
Prenatal care. Women who are pregnant have important prenatal needs, and finding a treatment program that addresses these needs is essential for recovering while pregnant.
There is Hope
The Substance Abuse and Mental Health Services Administration stresses that hope is the foundation of recovery. Hope is the belief that things can get better, and that a future free of addiction is possible. By drawing on inherent strengths, talents and values and facing challenges with the belief that they can be overcome, you can work through your issues and come out of treatment stronger than before.
Through treatment, you’ll learn the skills and strategies you need to overcome cravings, stress and other triggers, and you’ll improve your self-esteem and identify purpose in life. Treatment works, and it can dramatically improve your sense of well-being and your overall quality of life for the long-term.
Greenfield, S. F., Sudie, E. B., Lawson, K., & Brady, K. T. (2010, June). Substance Abuse in Women. Psychiatric Clinic of North America, 33(2), 339-355. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3124962/
DrugFacts: Understanding Drug Use and Addiction. (2016, August). Retrieved from https://www.drugabuse.gov/publications/drugfacts/understanding-drug-use-addiction
Fact Sheets – Excessive Alcohol Use and Risks to Women’s Health. (2016, March 7). Retrieved from https://www.cdc.gov/alcohol/fact-sheets/womens-health.htm
Abbey, A., Zawacki, T., Buck, P. O., Clinton, A. M., & McAuslan, P. (n.d.). Alcohol and Sexual Assault. Retrieved from https://pubs.niaaa.nih.gov/publications/arh25-1/43-51.htm
Women with Co-Occurring Mental Illness and Substance Abuse. (2005, May). Retrieved from http://aia.berkeley.edu/media/pdf/dual_dx_2005.pdf
Swan, N. (1998, July). Exploring the Role of Child Abuse in Later Drug Abuse. Retrieved from http://archives.drugabuse.gov/NIDA_Notes/NNVol13N2/exploring.html
Depression. Retrieved from https://www.health.harvard.edu/topics/depression
Alcohol Use Disorder: A Comparison Between DSM-IV and DSM-5. (2016, July). Retrieved from https://pubs.niaaa.nih.gov/publications/dsmfactsheet/dsmfact.pdf
Recovery and Recovery Support. (2015, October 5). Retrieved from https://www.samhsa.gov/recovery
National Drug Control Strategy. (2014). Retrieved from https://www.whitehouse.gov/sites/default/files/ndcs_2014.pdf
Women and Treatment. (n.d.). Retrieved from https://www.whitehouse.gov/ondcp/women-treatment
Iliff, B. (n.d.). Women, Addiction, and Ongoing Recovery: Unique Challenges of Women. Retrieved from http://www.hazeldenbettyford.org/articles/iliff/unique-challenges-of-women-and-addiction