This month is Women’s History Month, dedicated to uplifting women’s voices throughout history. Something that is infrequently discussed is women with Substance Use Disorder (SUD) and their recovery treatment options. Substance Use Disorders have historically been considered a male problem, something that women did not struggle with. This was not the case, however, as women have struggled with SUDs the same as men, just silently.
Women and Substance Use Disorders
Elvin Morton Jellinek was one of the first people to push for the medicalization of alcoholism. Through his 1946 study, he defined five different types of alcoholism and detailed how they progressed in several stages:
- Alpha – the earliest stage of substance use. Alcohol use in this stage would cause social and personal problems, but the person can stop if they want to.
- Beta – heavy drinkers who consume alcohol every day. They do not suffer from dependence or experience withdrawal symptoms when they try to stop.
- Gamma – those at this stage have developed a tolerance to alcohol and cannot control their drinking. Substance use would now be classified as a disease.
- Delta – the same as gamma, but with the inability to stop rather than loss of control.
- Epsilon – the most advanced stage of alcoholism, manifesting as periodic alcoholism.
Jellinek was also involved in developing the Jellinek Curve, detailing the path from SUD development to recovery. This curve spans from occasional drinking down into complete defeat and alcoholism before ending in a desire for help that progresses towards recovery.
The problem with this study and the Jellinek Curve is that there were no women involved. The questionnaire that Jellinek gave to participants in the study was only relevant to white, male, middle-class people. Therefore, the treatments that grew from this model did not take into account the specific needs of women. When looking at how the disease progressed, nobody knew how it might differ in women, as the study drew from men’s experiences exclusively.
Throughout history, women have not been considered when looking at SUDs. For example, the Temperance Movement of the 1800s did not target female drinking. Women were expected not to drink, and if they did, they were vilified for being unfit mothers and wives. There was no support for women struggling with alcohol, despite the prevalence of alcohol abuse at the time.
This stereotype of abstinent women has persisted to this day. It is a myth that women are less likely to suffer from a Substance Use Disorder because the numbers are fairly even.
Current data shows clear-cut differences in how men and women experience Substance Use Disorders. Women are more likely to relapse than men, and the side effects are much stronger for men than women. Despite this, there is often no specialized SUD treatment for women specifically.
Causes of Substance Use Disorders in Women
The causes of SUD for women can differ from the causes for men. Although there is no one definitive cause, factors that influence substance use in women include:
- Sexual violence – many women in treatment for an SUD report being sexually or physically abused. Those who have been sexually assaulted or raped are ten times more likely to abuse substances than the general public.
- Chronic pain – women experience more chronic pain than men and are more likely to be prescribed opioid painkillers. These painkillers can be highly addictive, and the number of overdose deaths from prescription drugs has more than quadrupled since 1999.
- Mental health – women struggling with depression, loneliness, low self-esteem, and many other mental health issues are at a higher risk of developing a Substance Use Disorder.
Women are also less likely to seek treatment for their SUDs. Some fear losing their children while in rehab and do not want to be viewed by others as bad mothers. Reaching out for help should not come with this anxiety; women and mothers deserve better.
A Connective Model
When people enter rehab, the most common model they encounter is a disconnected one. They are expected to give up their phones, say goodbye to their loved ones, and disengage from the outside world for weeks on end. While removing the triggers found in everyday life can serve some people well, this lack of connection can be crushing for others.
This is true for women especially. For women who enter treatment with families and children at home, a lack of connection can affect them negatively, and having no way to connect with their loved ones can hinder their treatment.
Johann Hari famously stated that the opposite of addiction is connection. He believes that a person’s environment can influence the development of SUDs, and a lack of social connection can cause people to turn to substances as a way to cope. This theory is backed up by the famous Rat Park experiment, in which rats were placed in a large cage filled with entertainment, food, and other rats. When given the option to use drugs, many rats chose not to. However, rats kept isolated decided to take water laced with morphine, even when given fresh water to drink.
Although the findings of Rat Park have some limitations in the human world, this has many implications for a connective model of SUD treatment. Keeping people isolated from the outside world while trying to treat them for an SUD is counterintuitive to the outcome that is desired.
Gender-specific treatment for substance use disorders can provide care tailored to the female experience. Women are often more comfortable discussing their experiences with motherhood, sexism, and sexual abuse with other women, and they can become uncomfortable with men present, especially those who have suffered abuse at the hands of men.
There is a body of research that confirms that involving the family in recovery is highly beneficial. Family members can offer emotional support and understanding to women in treatment and provide vital connections.
Gender-specific treatment allows treatment providers to consider women-specific issues that may not be adequately addressed in mixed-gender settings. These issues, along with sexual abuse, can include:
- Societal issues and stigma – women face many societal issues and stigmas that can influence an SUD. Treatment can be more effective when women are supported in handling issues such as childcare, homecare, work, and family responsibilities.
- Co-occurring disorders – women more commonly experience co-occurring mental health conditions such as depression and anxiety, which need to be addressed separately in order for SUD treatment to be effective.
- Relationship issues – women can benefit from couples therapy in treatment as it allows them to connect deeply with their partner and access support throughout and after treatment.
Women may also need more support than men to seek and receive treatment. As they are often the primary caretakers of children, they may feel unable to attend residential rehab, especially if they are unsupported by their family or partners. More support is needed to enable women who are struggling with SUDs find the best treatment for their needs.
Substance Use Disorder treatment for women is often sadly lacking in gender-specific options that specifically target women’s issues thanks to the history of SUDs focusing only on men and many people thinking that women didn’t struggle with SUDs.
This must change. By focusing more on a connective element, involving the loved ones of women, and introducing support that can help mothers with parenting and their home life, practitioners can transform treatment to be more supportive for women.
 Becker, Jill B et al. “Sex differences, gender and addiction.” Journal of neuroscience research vol. 95,1-2 (2017): 136-147. doi:10.1002/jnr.23963
 DG Kilpatrick, CN Edumuds, AK Seymour. Rape in America: A Report to the Nation. Arlington, VA: National Victim Center and Medical University of South Carolina (1992).
 “Opinion | Painkiller Overdoses in Women (Published 2013)”. Nytimes.Com, 2022, https://www.nytimes.com/2013/07/08/opinion/painkiller-overdoses-in-women.html.