Gender And Complications Of Substance Abuse

Does gender have an influence on whether a drug has complications? There is limited research available to answer this question, for many studies include men only. In general, women drink less often and in smaller amounts than men do, and they suffer fewer ALCOHOL-related problems and less dependence (WITHDRAWAL) symptoms. Women use illicit drugs less often than men do, although women have a higher consumption of prescription tranquilizers, sleeping pills, and over-the-counter drugs. Thus, the differences seen between the genders in complications largely reflect the differences in the respective patterns and prevalence of their alcohol and drug use.

The effects of the drugs are relatively similar between men and women. For example, in a heavy drinking and heavy SMOKING sample population, there is little difference in the mortality rates between men and women. Alcohol- and drug-using women are more likely to have partners who are alcohol and drug users. Such women are often victims of violence. Illicit-drug-using women frequently support their drug habits by prostitution, putting themselves at risk for sexually transmitted diseases (STDs) including HUMAN IMMUNODEFICIENCY VIRUS (HIV) and hepatitis B, even if they are not needle users. Accidents and trauma related to substance abuse are more common in men. The skid-row lifestyle is more common in men. Men report DRINKING AND DRIVING more often than women.

ALCOHOL

Women appear to be more susceptible than men are to alcohol-related LIVER damage. For women, cirrhosis may develop with consumption of 20 grams of alcohol (1-2 drinks) per day—as compared to 80 grams (6 drinks) per day for men. Women alcoholics have death rates 50 to 100 percent higher than their male counterparts. Women develop hypertension, obesity, anemia, malnutrition, and gastrointestinal hemorrhage at lower alcohol consumption levels and with a shorter time course of drinking. Women become intoxicated after drinking smaller quantities of alcohol than do men. For an equivalent dose of alcohol corrected for body weight, women absorb alcohol faster and reach a higher peak BLOOD ALCOHOL CONCENTRATION compared to men. These differences can be explained, in part, by the lower total body water of women compared to men. With a higher percentage of fat and lower water content, there is less volume in which to dilute the alcohol, and its concentration is therefore increased. Women also produce less stomach alcohol dehydrogenase—the enzyme responsible for breaking down alcohol. This leads to higher blood alcohol levels, since less is metabolized as it passes through the wall of the stomach and, therefore, as compared to men, more alcohol gets into the bloodstream. There may also be some hormonal or immune effects that account for the increased damage in women.

TOBACCO

Women are at risk for all the same health complications of smoking as are men. The differences seen in the 1990s largely reflect the lower prevalence of women smokers in past generations. For example, as smoking rates have increased in women, lung cancer rates have also increased.

REPRODUCTION

A woman's drinking pattern may be influenced by the mood changes associated with the phases of the menstrual cycle, and her blood alcohol level actually measures higher during the premenstrual period for any given amount of alcohol. This may make it difficult for a woman to predict the effects of her drinking. Oral contraceptives interact with cigarette smoking in contributing to coronary heart disease in women. Cigarette smoking is also correlated with an earlier onset of menopause. In her role as childbearer, a woman's substance use may have harmful effects on the FETUS and newborn. These effects may be related to her lifestyle, such as poor nutrition and poor prenatal care, or to the toxic effects of the drugs themselves resulting in fetal growth retardation, at-birth neonatal abstinence syndrome (withdrawal), and neurobehavioral abnormalities in the child.

Alcohol, tobacco, and illicit drugs like COCAINE and HEROIN are all associated with decreased fertility, increased rate of spontaneous abortion (miscarriage), and decreased birthweight in the newborn. The severely dependent woman may stop menstruating altogether. Menses resume, however, when abstinence or stabilization on methadone maintenance is achieved.

(SEE ALSO: Fetal Alcohol Syndrome; Pregnancy and Drug Dependence; Women and Substance Abuse)

BIBLIOGRAPHY

AMERICAN PSYCHIATRIC ASSOCIATION. (1994). Diagnostic and Statistical Manual of Mental Disorders-4th ed. (DSM-IV). Washington, DC: Author.

BEERS, M. H., & BERKOW, R. (Eds.) (1999). The Merck Manual of Diagnosis and Therapy, 17th ed. Whitehouse Station, NJ: Merck Research Laboratories.

CENTER FOR SUBSTANCE ABUSE PREVENTION. (2000). Alcohol, Tobacco and Other Drugs (ATOD) Resource Guide for Lesbians, Gay Men, and Bisexuals. Rockville, MD: National Clearinghouse for Alcohol and Drug Information.

FORD, J. A. (1999). Substance Abuse: A Strong Risk, Often Overlooked. Window on Wellness, 3, Summer 1999. Dayton, OH: Substance Abuse and Disability Issues, Wright State University School of Medicine.

GAY, LESBIAN, BISEXUAL, AND TRANSGENDERED (GLBT) HEALTH. (2000). Substance Abuse. New York: GLBT Health.

GRELLA, C. E., & JOSHI, V. (1999). Gender differences in drug treatment careers among clients in the national drug abuse treatment outcome study. American Journal of Drug and Alcohol Abuse, 25, 385-406.

HEALTH EDUCATION UNIT, THE UNIVERSITY OF SYDNEY (AUSTRALIA). (1998). Drug Use by Young Males. New South Wales, Australia: The University of Sydney, Faculty of Education.

KALANT, O. J. (ED.). (1980). Alcohol and drug problems in women. New York: Plenum.

NATIONAL COUNCIL ON ALCOHOLISM AND DRUG DEPENDENCE (NCADD). (2000). Use of Alcohol and Other Drugs Among Women. New York: NCADD.

NATIONAL INSTITUTE ON ALCOHOL ABUSE. (2000). Clinical Trials for Alcohol Abuse. Bethesda, MD: U. S. National Library of Medicine.

RIGOTTI, N. A., LEE, J. E., & WECHSLER, H. (2000). US college students' use of tobacco products: results of a national survey. Journal of the American Medical Association, 284, 699-705.

SMITH, W. B., & WEISNER, C. (2000). Women and alcohol problems: a critical analysis of the literature and unanswered questions. Alcohol in Clinical Experimental Research, 24, 1320-1321.

WILSNACK, S. C., & BECKMAN, L. J. (EDS.). (1984). Alcohol problems in women. New York: Guilford Press.

JOYCE F. SCHNEIDERMAN

REVISED BY REBECCA J. FREY