Not so long ago, addiction was seen as a “man’s problem.” In recent years, addiction research has broadened its focus to include the differential impact addiction has in the lives of both men and women. We know more than ever about the biological and psychosocial factors that affect how men and women experience addiction.
So in the battle of the sexes, who “wins” in addiction recovery? At first glance, men may appear to have the upper hand as women tend to progress more quickly into chemical dependency and face serious consequences faster than men. However, women are less likely to struggle with addiction than men and fare just as well in treatment. In the end, it’s a draw. Neither sex is better or worse off; they simply experience addiction and recovery in different ways.
Who Wins: Women
Drug and alcohol addiction are more prevalent among men than women. According to the National Institute on Alcohol Abuse and Alcoholism, men are twice as likely as women to meet the criteria for drug addiction in their lifetime (though rates of prescription drug abuse are about equal). The disparity appears to be even greater for alcohol abuse, with men struggling at three times the rate of women.
Who Wins: A Draw
Different factors predispose men and women to addiction. Studies have found that men tend to use drugs to amplify positive moods and cope with social and behavioral problems, while women are more likely to self-medicate emotional and psychological issues. Anxiety, depression, borderline personality disorder and eating disorders more commonly affect women and can increase their risk of drug use. Men, by contrast, are more often affected by antisocial personality disorder, which may or may not increase the risk of drug use.
For women, relationships, childhood trauma, stress, parental drug use and home environment, victimization, and co-occurring psychiatric disorders precipitate substance abuse and relapse. Interestingly, women are often introduced to drugs and drug use rituals like sharing needles by a boyfriend, spouse or other significant relationship, and drug use becomes a way to cement these connections. Women are also more likely than men to use stimulant drugs such as nicotine, cocaine and amphetamines to suppress appetite or manage weight.
Biology plays an important role in the development of addictions, especially for women. Women get drunk after consuming smaller amounts of alcohol than men and, as the result of less total body water and certain metabolizing enzymes, have higher blood alcohol concentrations after drinking the same amount of alcohol as men. Studies have also implicated estrogen in the development of addiction. In addition to affecting dopamine release, hormonal changes impact women’s “sensitization” to drugs (the long-term changes that occur in the brain as a result of drug use). A growing body of research links the phases of a woman’s menstrual cycle with her response to, craving for and ability to quit using drugs.
Who Wins: Men
There is no real “winner” when it comes to the consequences of addiction. Everyone suffers extreme hardship as a result of chemical dependency. But in a side-by-side comparison, women tend to experience more serious drug-related medical, social and psychiatric consequences more quickly than men. They progress more rapidly than men from use to dependence to treatment (a phenomenon called “telescoping”) and, despite using smaller amounts and being addicted for a shorter period of time, their symptoms are often as severe as men’s by the time they get to rehab.
Women are also at risk of specific consequences that are less likely to impact men, including certain physical complications (e.g., women are more likely to develop lung cancer and have a heart attack from smoking) as well as victimization, abuse, depression and post-traumatic stress disorder.
Barriers to Treatment
Who Wins: Men
Both men and women face significant barriers to treatment, but studies show that women who abuse drugs are less likely to seek help. Practical concerns such as cost, child-care arrangements, lack of social support, and responsibilities at home and work, along with the heightened stigma of being a female addict, are among the hurdles women face.
Response to Treatment
Who Wins: A Draw
Once women find their way into treatment, they are just as likely as men to stay there and have comparable abstinence and relapse rates as men. Some studies suggest that women have the upper hand in recovery, with shorter relapse periods and greater willingness to seek help after a relapse. Like men, women may benefit from services that are sensitive to their specific needs; for example, family/group therapy, parenting education, treatment for mental disorders and other supportive approaches.
Although the similarities are more striking, the reality is men and women are different – in some ways that are intriguing but insignificant, and in other ways that have some bearing on the way we live. When it comes to addiction and mental health, there are no winners or losers but the differences between men and women undoubtedly impact the course of treatment and recovery.