Women encourage women who have problems with alcohol or other
drugs to enter and stay in treatment programs, it is essential for all
treatment providers to incorporate understanding of this population into their
treatment paradigms. This chapter includes information on the following:
· the breadth and depth of alcohol and other drug problems
among women of various ages, races, and socioeconomic
status;
· patterns of alcohol use and other types of drugs abused most
frequently by women of various ages, races, and socioeco
nomic status; and
· health-related issues likely to arise because of alcohol and
other drug use.
With this knowledge, providers of substance abuse treatment services can do the
following:· target specific groups of women in the community who are likely to
have problems with alcohol or other drugs; · identify patterns of abuse and
other health-related problems that clients may be unwilling to self-disclose; ·
forecast client needs more accurately by understanding what the current trends
in alcohol and other drug use indicate for the number and types of clients in
treatment in the coming years; and · gain community support for treatment
initiatives by informing the public about the nature, extent, and impact of the
problem of alcohol and other drugs.
10 Women and
Alcohol and Other Drugs: An Overview
The remainder of
this chapter summarizes the most recent epidemiologic data on alcohol and other
drug abuse among women.
2.1 The
Epidemiology of Substance Use Among Women
2.1.1 Overview
Overall, adequate
data and information about substance abuse by women is scarce. This scarcity
exists in part because a relatively small proportion of substance abuse resources
have been allocated to research designed for the understanding of women and
their problems associated with substance abuse. Also, information from national
data sets is not automatically broken down by gender so that comparisons of
substance use can be made between men and women and among women of different
ages and racial and ethnic groups. Where possible, data and information related
to substance abuse is presented by type of drug and frequency of use. This
helps to avoid problems associated with varying interpretations of
"abuse," "addiction," and "dependence."
The following definitions derived from the Center for Substance Abuse
Treatment's Treatment Improvement Protocol (TIP) for Pregnant, Substance-Using
Women are used in this manual:
· Abuse-the harmful use of a specific substance including
alcohol, tobacco, and other drugs.
· Addiction-a disease process characterized by the continued
use of a specific substance such as alcohol, tobacco, and
other drugs despite physical, psychological, or social harm.
· Dependence-the abuse of alcohol, tobacco, or other drugs
such that to stop using would result in physical or psycho
logical symptoms of withdrawal.
Women and
Alcohol and Other Drugs: An Overview 11
It should be pointed out that
any use of an illegal substance is generally considered to be
"abuse."
The Substance Abuse and Mental Health Services Administration's (SAMHSA)
National Household Survey on Drug Abuse (NHSDA) is the largest national survey of substance abuse in
the United States. The NHSDA is based on the civilian non-institutionalized
population aged 12 and over living in households and institutional group
quarters. These group quarters include college dormitories, rooming houses, and
shelters. Together with the National Institute on Drug Abuse (NIDA)-sponsored
survey of high school students, the SAMHSA survey is the primary source of
national data on the use of alcohol and other drugs. The Drug Abuse Warning Network
(DAWN) is another source of information on drug use patterns. Prior to 1988,
DAWN was not updated in a way that would maintain randomness of selected
hospitals. Since that time, the data have been based on a nationally
representative probability sample of hospitals located throughout the United
States, with the exception of Hawaii and Alaska. Twenty-one oversampled
metropolitan areas are also included.
The limitations of these
surveys, which have been noted by researchers and by the General Accounting
Office, are applicable to the general population as well as to women. For
example, certain groups of women who are undocumented, incarcerated, homeless,
or living in residential or hospital-based treatment programs or nursing homes
are not included as part of the NHSDA sample. Similarly, the high school survey
does not include girls who have dropped out of school, who are runaways, or who
are incarcerated--clearly high-risk populations. The surveys are also limited
because of the respondents' reluctance to answer questions regarding use of any
substance, particularly illegal drugs, given the stigma our society attaches to
drug use, especially by women. Neither of the surveys provides data by
subethnic populations (e.g., Mexican American,
12 Women and
Alcohol and Other Drugs: An Overview
Puerto Rican) or for Native Americans or Asian Americans. Finally,
although increased heroin use by women is of major concern, the survey does not
have a sufficient response rate to allow for disaggregations by race/ethnicity
or age. These limitations must be considered when reviewing the estimates of
substance abuse by women.
2.1.2 Trends in Substance Abuse Among Women
According to the 1992 SAMHSA survey, American women were less
likely to abuse alcohol and other drugs in 1992 than they were in 1976,
reflecting a downward trend over the previous 16 years. However, the estimated
number of women who use or abuse legal or illegal substances is still
startling:
· 2.1 percent of the respondents, or an estimated 2.2 million
women aged 12 and over, had engaged in heavy alcohol use,
which is defined as drinking 5 or more drinks per occasion
on 5 or more days during the previous 30
drug during the month before the NHSDA (see Figure 3),
1.2 percent of the respondents, or an estimated 1.3 million women
aged 12 and over, reported nonmedical use of a psychotherapeutic drug in the
past month (see Figure 6) ;3
0.4 percent of the respondents, or an estimated 419,000 women aged
12 and over, reported using cocaine in the past month (see Figure 4);' and
0.3 percent of the respondents, or an estimated 300,000 women aged
12 and over, reported using crack in the past year.'
Women and
Alcohol and Other Drugs: An Overview 13
The effects of alcohol
and other drug abuse on women's health are clear: In 1990, the death rate for
alcohol-induced causes for Caucasian and African American women was 2.8 per
100,000 and 7.7 per 100,000, respectively. The death rate related to drugs
other than alcohol was 2.5 per 100,000 for Caucasian women and 3.4 per 100,000
for African American women.' In the same year, nearly 9,200 women died of
chronic liver disease or cirrhosis;' 4,159 infants were born with fetal alcohol
syndrome (FAS);g and 3,279 women were diagnosed as having AIDS as a result of
either injection drug use or sexual contact with an HIV-infected injecting drug
user.' In 1992, 210,051 women presented in emergency rooms for episodes related
to drugs other than alcohol; 38,194 of these involved cocaine.'°
2.1.3 Alcohol
Alcohol is the substance
most commonly abused by the general population and by women. The trends in
abuse of alcohol by women are not encouraging. For example, although heavy use
declined between 1985 and 1992, the decrease was slight, and reported heavy use
increased by more than one-third between 1988 and 1992." According to the
1992 NHSDA, 2.1 percent of women aged 12 and over had engaged in heavy alcohol
use in the month prior to the survey (see Figure 1).'2 The 1988 National Health Interview
Survey (the most recent one for which data are available), found that seven
percent of female respondents" (or an estimated 6.6 million women)"
drank at heavy levels in the two weeks prior to the survey. A 1984 national
survey of alcohol problems found that six percent of women reported at least a
moderate problem with alcohol and sixteen percent reported at least a minimal
problem with alcoholY In 1990, the National Institute on Alcoholism and Alcohol
Abuse (NIAAA) estimated that "alcohol abuse and alcohol dependence are
serious problems that affect about 10 percent of adult Americans."'6 Given
an estimated adult female population (women aged 12 and over) of approximately
107million in 1992, it
can be estimated that as many as 10.7 million American women may abuse alcohol.
Heavy alcohol use was reported by 6.5 percent of young women aged 18 to 25 and
0.5 percent of adolescent girls aged 12 to 17." In terms of population
estimates, this indicates that nearly 921,000 young women and more than 50,000
adolescent girls engaged in heavy drinking in 1992.'8
The survey also reported that 12.3 million women, or 11.5 percent of women aged
12 and over, consumed alcohol at least once a week. Women 18 to 25 and 26 to 34
are more likely to consume alcohol once a week than those 35 and over ( I 6
percent, 14.5 percent, and 10.9 percent respectively)." Given that these
are primary childbearing years, this
is noteworthy. In
fact, the 1992 NHSDA also found that 40.4 percent of the women aged 12 and over
reported consuming alcohol in the previous month. More than half (53 percent) of
the women 18-34-the prime childbearing years-reported alcohol consumption in
the previous month. Also of concern is the finding that one in seven adolescent
girls (14.5 percent) reported consuming alcohol in the previous month.'
As Figure 2 shows, Caucasian women are slightly more likely to use alcohol once
a week or more than African American women (12.3 percent compared to 10.4
percent) and much more likely than Hispanic women (8 percent).21
16 Women and Alcohol and Other Drugs: An Overview
A number of researchers
report differences in drinking patterns by gender. For example, men report
higher quantity, frequency, and rates of intoxication at an earlier age then do
women and experience more lifetime symptoms on average." As Figure 1
shows, the gender difference in reported heavy alcohol use decreased from 1985
to 1992. While heavy use by men has steadily declined during this period, heavy
use by women actually increased from 1988 to 1992.
2.1.4 Illicit Drugs
According to the 1992 SAMHSA
Survey on Drug Abuse, slightly more than 4 percent of female respondents over
the age of 12 had used an illicit drug in the previous month, representing an
estimated 4.4 million women (see Figure 3 ).Z3
This estimate is still
significantly lower than the use
reported by men (7.1 percent). The use by women between 1985 and1992 declined
by 44 percent, slightly lower than the decline in use by men (47 percent). Most of these women-2.9 percent of the female respondents
or an estimated 3.1 million women-had used marijuana in the past month,24 and
an estimated 419,000 women had used cocaine in the past month (see Figure 4).Zs
According to the 1992 NHSDA, an estimated 98,000 women used crack in the
past month; however, the number of responses is too small for this estimate to
be reliable.26 As Figure 4 shows, although reported cocaine use by women
decreased substantially between 1985 and 1992, an estimated 419,000 women had
used this drug in the month prior to the 1992 NHSDA.
Notably, for Caucasian women and Hispanic women the decrease in cocaine-related
episodes in emergency rooms between 1988 and 1991 was substantially higher (37
percent and 32.7 percent, respectively), than for the population overall (27
percent). For African American women, the decrease was substantially lower-16
percent."
Only one-tenth of 1 percent (or 0.1 percent) of female respondents reported
using heroin in the past year, but this translates into an estimated 88,000
women. In contrast, 0.2 percent of men (an estimated 236,000) reported using
heroin in the past year. Moreover, 644,000 women, or 0.6 percent of the
population of women 12 years of age and older, reported ever
