4 Unique Challenges Women Face in Substance Use Recovery

By Kelsey Mudge, LMFT

Introduction

Women face unique challenges when it comes to substance use, which can differ from those experienced by men. While neither experience is inherently greater or more difficult than the other, it's essential to acknowledge that women may encounter distinct barriers and circumstances in their journey with substance use. According to Azzopardi “Women who use substances do so at different rates, have different patterns of use, and have different consequences than men who use substances.” (Azzopardi, et.al, 2022)

There are a variety of differences, however, I will highlight these specific differences:

• Barriers to treatment

• Risk factors

• Onset of use

• Phsyical consequences

4 unique challenges

1. Barriers to treatment

   Barriers to treatment refers to the obstacles that can prevent someone from accessing or fully engaging in the care they need. Here are some potential barriers to treatment for women.

   • Lack of child care- it can be difficult for mothers to find affordable childcare before entering into a residential or in-patient facility

   • Judgment from family- there is typically more stigma for women than men when it comes to substance use

   • Legal issues or fear of legal issues (CPS)

   • Lack of gender specific treatment settings- there are more male-specific treatment settings than female

   • Lack of staff training on gender specific needs of women- since there are less options for women when it comes to treatment, there is also less training for women-specific challenges.

   • Difficulty balancing multiple roles and familial obligations with the time needed to participate in services- women often take on different family roles: wife, mother, daughter, aunt, etc. This can make it difficult to leave the family dynamic and seek treatment.

   • Transportation problems

   • Inability to pay for services

   • Greater likelihood of co-occurring medical issues- there are a variety of medical issues that could be a barrier for women seeking treatment
     

2. Risk factors

Risk factors are characteristics or conditions that increase the likelihood of developing a particular substance use disorder. Having one or more risk factors doesn’t guarantee a diagnosis, but it can raise a person’s vulnerability. Understanding risk factors can help individuals and providers recognize early warning signs and take proactive steps toward prevention and support. Here are some risk factors specific to women when it comes to substance use:

• Exposure during childhood to chaotic or violent households

• Exposure during childhood to parental substance use

• Being burdened with adult responsibilities as a child

• Presence of psychiatric disorders such as posttraumatic stress disorder and depressive disorders

• Intimate partner violence

• Major-life transitions such as divorce or losing custody of  child (cite source)

3. Onset of use

The reason for onset of use also varies with women. Here are some themes that came up for women when asked about the onset of use:

• Relationship issues and stressors

• An intimate relationship with a male to uses substances (Azzopardi et al, 2022)

• An effort to control their weight

• A way to cope with exhaustion

• A way to cope with behavioral symptoms 

• A means of coping with pain symptoms

4. Physical consequences

There are also difference in the physical experiences women have with substance use. Below are a few consequences/ health concerns women face:

• Effects of alcohol

  • Women have lower level of alcohol dehydrogenase, the enzyme that metabolizes alcohol. This leads to a higher concentration of alcohol in the blood of women. 

  • The negative effects on the liver appear to be greater for women even though the amount and frequency of their alcohol consumption may be lower than men. More women die annually of cirrhosis. 

  • Heavy alcohol use has also been correlated with greater risks of breast cancer, menstrual problemes, infertility, hypertension, neurological damage, and cardiovascular disorders (La et al, 2015)

  • Regular use of alcohol can also increase the risk of ovulation disorders and infertility (Van Heertum and Rossi, 2017)

• Effects to the heart

  • Women who use substances experience more negative effects on their hearts and blood vessels compared to men (Nida 2020). 

• Effects of opioids

  • Women have a higher incidence of chronic pain and may be more likely to develop an addiction to opioids (Roberts etal, 2020, Paller et al 2009). 

  • Hormones also impact the opioid neurotransmitter systems resulting in women having a greater physical dependence on opioids than men. Additionally, women with both chronic pain and opioid use disorder experience more severe symptoms of opioid withdrawal (Huhn et al, 2019)

• Pregnancy

  • Alcohol use during pregnancy is associated with fetal alcohol spectrum disorders. These disorders lead to physical and behavioral consequences in offspring, as well as cognitive dysfunction and learning disabilitues. Recent estimates reported by the CDC indicate that nearly 12% of pregnant women drink alcohol nearly 4% of pregnant women binge drink. The rate of alcohol use during pregnancy doubled for unmarried women compared to married women and the rate of binge drinking tripled for unmarried women (Denny et al 2019)

  • The use of stimulants is associated with adverse perinatal outcomes including low birth weight and preterm labor. There is not much known about how safe stimulants are to use while breastfeeding. The CDC found that there has been an increase in women being diagnosed with ADHD and taking stimulants for treatment. Women taking stimulants are more likely to have a baby born with a birth defect than women who do not. Pregnant people should talk with their healthcare providers about managing adhd during pregnancy and in the postpartum period (CDC 2020). 

  • Women who use methamphetamines during pregnancy are more likely to have a baby that is small for gestational age. Additionally, the babies score lower on tests regarding verbal and long-term spatial memory (ACOG 2021)

  • In the postpartum period, women use substances at higher rates than pregnant women. A bidirectional relationship exists between substance use and postpartum distress, meaning that (Prevatt et al 2017)

    • Women with depression may turn to substance use during the postpartum period to relieve negative affect.

    • Women who previously used illicit substances appear to be at greater risk of experiencing postpartum distress.

  • Substance use during the postpartum period has a high potential for disrupting mother-infant attachment, negatively impacting caregiving, and increasing the risk of involvement with child protective services (Parolin and Simonelli, 2016). 

• Other health risks

  • Other health risks associated with substance use disorders include unplanned pregnancy, accidents, and suicide.

Conclusion

Understanding the unique ways substance use impacts women is crucial for providing compassionate, effective care. From the barriers that prevent access to treatment, to the specific risk factors, onset patterns, and physical consequences, it's clear that women's experiences with substance use are complex and deeply influenced by personal, societal, and biological factors.

If you or someone you know is struggling with substance use, know that help is available—and you don’t have to face it alone. The first step may feel overwhelming, but it’s also the most powerful. Whether you're seeking support for yourself or looking to better understand the experiences of women with substance use, reaching out to a mental health professional can make all the difference.

You deserve care that recognizes your unique experiences and meets you where you are. Contact me today to learn more about individualized therapy and support designed specifically for women navigating substance use and recovery.

@kelseymudgetherapy

Works Cited

• Azzopardi et al., 2022 (Vogue – opioid crisis as a women’s health issue) Vogue

• Florida Atlantic University study on alcohol-related deaths and ADH activity The SunNew York Post

• First-pass alcohol metabolism and gastric ADH differences (NEJM, PubMed) PubMedStandard of CareIntechOpen

• Chronic opioid use in women with endometriosis and related health outcomes PubMed

• Hormonal influence on opioid misuse (rat study, WashU) WashU Medicine

• Opioid-induced endocrinopathy and hormonal effects Wikipedia+1