Psychosocial Gender Differences

• Alcohol and cocaine dependent women often date the onset of their pathological use to a stressful event.
• The primary motivators for women to enter treatment are physical, mental health and family issues…while men are most influenced by job and legal problems (ie. DUIs). 88 percent of alcoholic women attributed entry into treatment to feeling "very low and depressed."
• Long-standing religious and cultural beliefs that women should minimize their alcohol and substance use have served a "protective function;" however, with greater empowerment of women, their risks for addiction have escalated. Hence, women experience a TRIPLE STIGMA:
  • Disorder is "self-inflicted"
  • After being held to a higher moral standard, the shame felt from "fall from grace" is more intense.
  • Viewed as more promiscuous.
• Research shows that alcoholic women are not more promiscuous - only eight percent of regular drinkers were less particular about their sexual partner…while 60 percent experienced sexual aggression from someone else who was drinking. Women’s level of drinking was not a factor. Women who drink in bars (presence of drinking males) are more likely to be victimized.
• 67 percent of alcoholic women have been sexually abused by an older adult during childhood versus 28 percent of non-alcoholic women. Alcoholic women reported experiencing more incidents over a longer period of time. In families of alcoholic parents, the father is often not the aggressor. Rather, lack of protection for the child permits abuse of others.
• History of sexual assault is associated with a three times greater risk for alcoholism, four times for drug addiction.
• Alcoholic women experience significantly more spousal violence (though not caused by it - control/power issues of the man are the reason). 16 percent are raped during drinking history. Women assaulted under the influence are still held more responsible than the perpetrator – society still blames the victim.
• Addicted women are more likely to suffer from emotional problems before and after onset of use. Accurate diagnosis and follow-up are crucial to improve outcomes. Addicted women have significantly higher levels of psychiatric symptoms and dual diagnoses.
• For women, sexual dysfunction and depression predict onset of drinking five years later.
• Female alcoholic patients exhibit higher levels of depression, anxiety, low self-esteem, shame and guilt.
• Depression is most common and has the same characteristics as in non-alcoholics. Rates of lifetime history of major depression were three times that of the general population of women. In a clinical sample of alcoholics, 52 percent of women had at least one major depression versus 32 percent of alcoholic men but it was the primary diagnosis in 66 percent of these women versus 41 percent of men.
• Addicted women also have higher rates of co-occurring anxiety, eating disorders, sexual dysfunction, and borderline personality disorder…while male patients have more antisocial behavior and pathological gambling.
• A history of suicide attempts is more frequent in female chemical dependents and four times greater than in other women. Most attempts occur between 20-29 years old. Women who commit homicide have a high prevalence of alcoholism and personality disorders.

Excerpted from Sheila Blume, MD "Women: Clinical Aspects," Substance Abuse: A Comprehensive Textbook, Third Edition, 1997, Editors: Joyce Lowinson, Pedro Ruiz, Robert Millman, John Langrod and summarized by Eileen Beyer, Psy. D., CAC Diplomate.