A Gender Perspective of Addictive Disorders Current Addiction Reports

An emerging literature base shows that alcohol inequities based on sexual orientation and gender identity vary at the intersection of race and ethnicity. The somewhat consistent pattern in the extant literature is that such inequities exist between Black, Indigenous, and People of Color (BIPOC) SGM individuals and their heterosexual peers of the same race/ethnicity. Other work has examined racial differences in alcohol use outcomes within SGM groups, and patterns of findings are less clear and vary by age group. Some studies aggregated racial and ethnic groups into one BIPOC group, which ignores known racial and ethnic differences in drinking patterns as well as differences in the long-term effects of drinking (e.g., racial differences in AUD or alcohol-related consequences but not quantity or frequency of alcohol use). Additionally, other studies aggregated across adulthood without considering developmental changes in drinking across the lifespan. The most important aspects seem to be drug policy changes, especially in Georgia, where current policy in this area–as the study authors suggest–maintains the sociocultural conditioning of negative attitudes toward drug users-especially toward women.

• In addition, women transition from substance abuse to addiction much more frequently and quickly than men; they are more likely to self-medicate with illicit substances; they are more susceptible to the health consequences of substance abuse, overdosing, and they experience relapse more often than men 7,12.
• More than 56 percent of rural women respondents report unmet medical needs and telephone disconnection as the most prevalent hardships, followed by food insufficiency, housing problems, improper winter clothing, and utility disconnection (USDA 2007).
• Similarly, the centrality of family ties may provide motivation for treatment and a sense of responsibility to family.
• Thus, research and initiatives to address discrimination and prejudices should pay close attention to the deleterious impacts of discrimination on women’s health, and future studies should continue to investigate effects of different types of discrimination and variations of effects between men and women.
• Virtually no research exists to understand unique risk factors or considerations for approaches to care for people with SUD who identify as two or more races.

Environmental Factors: the Role of Intimate Partner Violence

• This socioeconomic status paradox has been studied mostly outside of the United States and has been observed for a variety of alcohol outcomes.
• This phenomenon is more intense in women taking estrogen contraceptives, but not if they are taking progesterone-based contraceptives 31.
• Similarly, women in rural areas may know the law enforcement authority and, perhaps, know the substance abuse treatment provider as well.
• In addition, poverty rates in rural settings are three times higher for widows than for married women (USDA 2007).
• They may choose not to be seen going to the counselor’s office or may have a preexisting relationship with the counselor.

While research remains limited in the area of treatment approaches and strategies, literature is beginning to reflect promising practices for African-American women. According to TEDS (HHS 2008a), alcohol accounted for 25 percent of substance abuse treatment admissions among African-American women. While most research highlights differences in alcohol use patterns between African-American women and men, and between African-American women and other diverse groups of women, little attention is given in reporting on the diversity of use among African-American women within their cohort group and throughout their lifespan.

How Racism and Bias Influence Substance Use and Addiction Treatment

In the few studies that are available, findings are inconclusive regarding the efficacy of separate treatment groups. Only 6 percent of substance abuse treatment services offer special programs or group therapy for gay men and women (SAMHSA 2005). For a comprehensive overview of treatment issues among lesbian and bisexual women, review SAMHSA’s Center for Substance Abuse Treatment (CSAT) manual, A Provider’s Introduction to Substance Abuse Treatment for Lesbian, Gay, Bisexual, and Transgender Individuals (CSAT 2001b). This manual provides information to administrators and clinicians about appropriate diagnosis and treatment approaches that will help ensure the development or enhancement of effective lesbian, gay, bisexual, and transgender (LGBT)-sensitive programs. While the multiple jeopardy approach also investigates the impacts of multiple social identities and statuses, this perspective assumes that disadvantages accumulate in an added-burden or additive fashion.

• Since it may be difficult to address the needs of older women in residential treatment programs (where the majority of clients are much younger), treatment may be more effective when delivered at senior centers, congregate meal sites, outpatient geriatric medical programs, nursing homes, home care programs, or peer outreach (Cohen 2000).
• Recent research calls attention to potential explanations involving the life course, differential vulnerability, and access to care.
• NSDUH survey language uses the word doctor, but other providers could prescribe these substances, depending on state scope-of-practice laws.

Neurobiological Basis of Sex Differences

• Early on in treatment, counselors need to assess how the current substance-related problems affect the family’s culture and how the culture affects the current presenting issues.
• A limitation of the current study is the search for materials for analysis in only one database of scientific articles.
• In the United States 17,23,24,25 and Canada 26,27, where drug treatment appears to be at high standards, stigma is still a significant and ongoing problem.
• National survey data show greater prevalence of DSM-IV AUD among White women compared to other racial/ethnic groups.
• Only a tiny percentage of women and men who try any psychoactive substance will develop an addiction 7, but the problems experienced by women drug abusers are a consequence of fundamental differences in this group compared to men.
• Evidence suggests that adolescent psychoactive substance use can cause psychotic symptoms and mental disorders in later years 65,66,67.

Several studies have examined sex differences in stress response (e.g., subjective, autonomic) and relapse 53, 54. Future interventions also must integrate intersectional and social justice approaches to reduce and ultimately eliminate alcohol inequities among SGM people. The former group requires changes in women’s sociocultural patterns and, especially, in the roles attributed to women, but in this case, the change process appears to be more complex than simply introducing appropriate health policies. For many women, losing custody of their children is a significant threat and a barrier to treatment, although, for a significant proportion of participants, it is sometimes a motivation to seek help.

Childhood adversity and mental health comorbidity in men and women with opioid use disorders

DSM-IV alcohol abuse prevalence was higher in White women compared to Black women before midlife (younger than age 45), and higher than DSM-IV alcohol abuse prevalence of Latinas in all but the oldest age group (ages 65 and older). Among the most notable differences in SUD rates by race and ethnicity were the higher rates of four different SUDs (alcohol, marijuana, opioid use disorder, and all SUDs combined) for those reporting two or more races and for AI/AN adults compared to the median group for each SUD. Virtually no research exists to understand unique risk factors or considerations for approaches to care for people with SUD who identify as two or more races. This is an important gap given that this population is rapidly growing and has elevated substance use and SUD rates (CBHSQ, 2021; Jones & Bullock, 2012).

Treatment seeking and utilization among women with substance use disorders

These differences are likely the result of gender-specific biological mechanisms interacting with sociocultural influences and life stressors that affect women and men differently 9. Data from some studies underscore the importance of sex hormones in modulating drug effects in women 11. In addition, women transition from substance abuse to addiction much more frequently and quickly than men; they are more likely to self-medicate with illicit substances; they are more susceptible to the health consequences of substance abuse, overdosing, and they experience relapse more often than men 7,12. In this article, sexual minority women, including bisexual women and lesbians, are defined based on sexual orientation. Bisexual women were most likely to report alcohol problems, with 70% reporting lifetime problems in contrast to 29% of heterosexual women. Limited research on alcohol and drug abuse has focused on issues related to sexual orientation (Hughes and Eliason 2002).

Risk Factors

Briefly, this is a two-year, six-wave longitudinal cohort study that involved 3418 racially/ethnically diverse students (ages 18 to 25 years) from seven colleges and universities in Georgia. Schools are located in both rural and urban settings and include two public universities/colleges, two private universities, two community/technical colleges, and one historically black university. Our project was approved by the Emory University and ICF Institutional Review Boards (IRBs) as well as the IRBs of the participating colleges and universities. Data collection began in Fall 2014 and consisted of self-report assessments via an online survey every four months for two years (during Fall, Spring, and Summer). Other sex/gender-specific medical problems to mention, related to drug use, are infertility, abortion, vaginal infections, and premature delivery. Sex differences in neuroendocrine adaptations to stress and reward systems may mediate women’s Women and Alcoholism susceptibility to drug abuse and relapse 53.

“La Casita” (which means “the little house” in Spanish) is a residential chemical dependency treatment program designed to meet the needs of low-income Hispanic/Latina mothers. The treatment program places emphasis on the importance of family and its critical role in promoting therapeutic change. La Casita integrates culturally relevant strategies and Hispanic/Latina cultural values with other effective treatment approaches, such as, “simpatia” (the promotion of pleasant social relationships), “lineality” (importance of authority figures in the solution of problems), and “reciprocity” (giving back, in some way, what was given). By adapting these cultural values in treatment, women have an opportunity to use their ethnic heritage as a catalyst for recovery (CSAT 2003b). For starters, women are more likely to be depressed and anxious than men — and are also more commonly victims of sexual violence — and drinking can be one way that women cope with these experiences. Data for the current study came from Project DECOY (Documenting Experiences with Cigarettes and Other Tobacco in Young Adults).

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The heritability of SUDs is variable depending on the substance, from 0.39 for hallucinogens to 0.72 for cocaine 57. As the case of alcohol, nicotine plasma concentrations are higher among women than in men and these concentrations are achieved more quickly. This phenomenon is more intense in women taking estrogen contraceptives, but not if they are taking progesterone-based contraceptives 31. According to the Annual Homeless Assessment Report to Congress (2008), nearly 3 percent of Americans experience homelessness at any one time. Approximately 23 percent are chronically homeless with homelessness disproportionately affecting African Americans (44 percent of the total homeless population).

What women who use drugs have to say about ethical research: findings of an exploratory qualitative study

Although African-American lesbian and bisexual women may receive support from fewer sources than African-American heterosexual women when they are in treatment for alcohol dependence, the quality of that support appears the same for the two groups (Mays et al. 1994). African-American gay women may prefer counselors of the same race who identified themselves as lesbians (Matthews and Hughes 2001). The rates of unemployment, poverty, and education; poor health status; and alcohol and drug use vary by Tribe and by region.