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Abstract
The survey found that there was a lifetime prevalence of alcohol dependence in men and women of 13.3%, with 9.15% in men and 4.15% in women, yielding a male-to female ratio of 2.2 to 1. Alcohol use disorder rates were higher among men than women and were highest in the youngest cohort (18–29 y). Gender disparity was least among young, non-black individuals, suggesting that alcohol use disorders may have increased among young, non-black women.
Patterns of use and course of illness:
A woman’s drinking pattern was similar to that of her spouse, sibling, or close friends. Contrary to the popular myth, women who have several roles in their life (e.g., mother, career woman) might have lower rates of alcohol problems than women who did not have multiple roles. Women who were divorced, separated, or never married were more likely to drink heavily and experience alcohol-related problems than were women who were married or widowed. Some evidence indicated that certain adverse consequences of alcohol consumption might be disproportionately increased in women when compared with men. For example in one report, 13% of female drivers and 24% of male drivers involved in a fatal motor vehicle accident had a blood alcohol concentration (BAC) of 0.01% or greater.
Drug use disorders:
Prevalence:
There are 3.1 million women in USA who were regular illicit drug users, 3.5 million women who misuse prescription drugs, and 21.5 million who smoke cigarettes.
1) Prescription drug abuse:
Persons with psychiatric disorders were more likely to abuse prescription drugs. Between the ages of 12 and 17 years, girls were more likely than boys to begin prescription drug abuse and are more likely to abuse stimulants and sedatives compared with other prescription drugs. Elderly individuals were more vulnerable to prescription drug abuse and to unintentional misuse and become habituated to prescription medications.
2) Nicotine:
Cigarette smoking was reported in 27.1% of men and 23% of women aged 12 years or older.
Course of illness:
Cigarette smoking is common in women and frequently begins in adolescence. There is correlation between depressed affect in female adolescents and heavy smoking in adulthood. Studies reported that women were more inclined than men to use smoking as a means to reduce stress or emotional distress.
Medical consequences:
Cardiovascular disease is the leading cause of death among women in the United States, resulting in approximately 250,000 deaths annually, Several studies have reported that women may be more susceptible to tobacco carcinogens than men.
3) Marijuana:
The lifetime prevalence of marijuana use in individuals aged 15 to 54 years was 47%, with a lifetime prevalence 51.5% in men and 42.5% in women. The data suggest that marijuana initiation increased in boys and girls, but among girls, the increase was double that of boys in the youngest age group.
Course of illness:
Female twins found that, although environmental influences such as family and peers were important predictors for ever using marijuana, genetic factors had the strongest effect on the vulnerability to develop heavy marijuana use, abuse, or dependence in female subjects. Data suggested that a gender-specific effect on Visio spatial recall may be caused by a persisting effect of marijuana on the brain, even after a period of abstinence; a direct neurotoxic effect of marijuana; or a withdrawal effect from the abrupt discontinuation of marijuan.
4) Opiates:
Female heroin users reported more childhood problems with psychologic symptoms, such as moodiness and anxiety, compared with their male counterparts, who reported conduct problems. Other studies had shown that childhood histories of sexual and physical abuse were highly prevalent among women drug abusers, and there was a greater prevalence of early life problems in female than in male heroin users.
Course of illness:
Women was highly influenced by a male sexual partner who was often a daily heroin user. Women were slightly younger than men at first age of use, and women more often reported using heroin because their partners used heroin, or to decrease physical pain, whereas men reported initiating use to gain peer acceptance or because of curiosity.
Medical consequences:
Opioid use, abuse, and dependence were associated with many medical complications, mainly caused by IV drug use, shared needles may lead to a myriad of infections such as HIV, hepatitis B and C, and Staphylococcus aureus and other agents that cause endocarditis.
5) Cocaine:
The rates of cocaine use increased between 2000 and 2001 from 0.5% to 0.7%. The proportion of women with a history of smoking cocaine for 11 years or longer was 42% in 1998, compared with 50% of women who reported smoking cocaine for more than 5 years in 1992.
Course of illness:
Women consumed similar quantities of cocaine as compared with men but by more addictive routes (by smoking or intravenous [IV] routes) and experienced a more rapid progression to drug dependence.
Medical consequences:
Many medical complications were associated with cocaine use, and cocaine might adversely affect multiple organ systems, such as the cardiovascular, gastrointestinal, pulmonary, and central nervous systems.
Etiological factors of addiction in women:
Biogenetic Predisposition:
Twin studies have shown that genetic factors play an important role in the initiation of smoking and, even more so, in determining which smokers become persistent, long-term users.
Psychologic Factors: The Response to Environmental Stressors:
It has been posed that women became addicts because of a specific loss or trauma-related experiences in their lives. Other research noted a specific link between the presence of addiction and trauma histories, violence, and co-existing mental illness. In-treatment populations of women with addiction were known to have high rates of past sexual abuse and physical and psychologic abuse. Gender Similarities and Differences: The Prevalence and Course of Alcohol- and Other Substance-Related Disorders
The initiation of substance use was progressively taking place at younger ages, the trend being more dramatic among women as compared to men. Women’s accelerated progression to dependence (so-called “telescoping effect”) was a robust finding among alcohol-dependent individuals, although the effect seemed to be weaker among younger individuals. It was concluded that women’s earlier age of initiation of substance use, faster progression to dependence and under-representation in addiction treatments should be addressed in future health care planning. Alcohol- and drug-related disorders were reported to be more prevalent among women since the Second World War.
PREVALENCE ESTIMATED OF SUBSTANCE-RELATED:
Disorders among women:
Studies show that approximately 5% of the women have alcohol-related disorders (male-to-female ratio–MFR = 5:1) and another 5% have drug-related disorders (MFR = 1.5:1).
Course of illness:
Among elderly individuals with alcohol-related disorders, the only gender difference observed was the age of onset of problem drinking that occurred significantly later in women. Compared to an earlier sample, a significant convergence of female patients’ drinking patterns to that of males was observed.
Progression to Alcohol Dependence:
Data described that the time between the first alcohol problem and the first treatment was shorter for women than men, regardless of psychopathology .
There was evidence of a shorter interval between the age of initiation of regular alcohol use and the age of seeking treatment, ranging from 11.6 vs. 15.0 years, respectively, for women and men in inpatient treatment to 20.7 vs. 22.5 years in outpatient treatment. Sex Differences in Vulnerability to Drug Self-Administration.
Societal views on drug use might also serve to constrain drug use among women. Historically, drug use among women had been viewed more negatively than drug use among men, and these views might be, at least in part, responsible for the lower rates of use and abuse among women.
There was also evidence to suggest that despite the lower rates of use and abuse, women might be more vulnerable than men on several aspects of addiction. For example, women met criteria for drug dependence more quickly, and they entered treatment programs sooner than men.
Women were also more likely to experience craving following exposure to drug-related cues than were men, and they were more likely to relapse owing to stress and depression, suggesting that women and men might differ on vulnerability to relapse to drug use during drug abstinence periods.
Effect of substance use disorder on women physiology:
Effect of alcohol on hormones :
Reproductive dysfunction might be found in both men and women who used and abuse alcohol. Women who abuse alcohol might have an ovulatory cycles and luteal phase dysfunction, which could lead to menstrual abnormalities and impaired fertility.
Alcohol use in both pre- and postmenopausal women seemed to be associated with an increased risk of breast cancer. Many studies reported that the risk of breast cancer was increased by moderate to heavy alcohol consumption, although another study found no increased risk when one drink per day was the maximum drinking level reported.
Effect of alcohol on Pregnancy and nursing women:
Fetal alcohol syndrome was defined by four criteria: maternal drinking during pregnancy (may be confirmed or unconfirmed); a characteristic pattern of facial anomalies (short palpebral fissures and abnormalities of the premaxillary zone(e.g., flat upper lip, flattened philtrum, flat midface); growth retardation and brain damage, which was often manifested by neurodevelopmental abnormalities, such as small head size at birth; and structural brain abnormalities with corresponding neurologic hard and soft signs.
Alcohol-related neurodevelopmental disorder included one or more congenital defects, including malformations and dysplasias of heart, bone, kidney, and vision or hearing systems, in the presence of confirmed maternal alcohol exposure.
Peak alcohol levels in mothers’ milk and blood occurred approximately 30 minutes to 1 hour after consumption and decline thereafter, although there were substantial individual differences in alcohol elimination rates in breast milk and timing of peak levels. Based on these studies, it might be counterproductive for a mother to drink alcohol before nursing.