Substance Abuse

Substance Abuse

Substance use disorders are complicated illnesses that present unique threats to women's health. Medical research finds that women who consume alcohol, tobacco and/or other drugs may develop substance use disorders and/or substance-related health problems faster than men.
Recent surveys show that alcohol consumption is most common among:
Women between the ages of 26 and 34
Women who are divorced or separated
Drinking is also more prevalent among Caucasian women than other ethnic/racial groups, although African-American women are more likely to drink heavily.
Before discussing problems with the use of alcohol, it is important to understand the different levels of drinking. Alcohol consumption occurs across a continuum related to risk and levels of consumption. At the low end is abstinence, defined as the consumption of four or fewer standard drinks per year.
Next is low-risk drinking, defined as alcohol use at or below the recommended limits; it doesn't cause problems.
Risky/hazardous use is a pattern of alcohol consumption that increases the risk of harmful consequences for the user or others.
Harmful use is alcohol consumption that results in consequences to physical and mental health.
Finally, alcohol dependence is a disease that includes four symptoms: craving, loss of control, physical dependence and tolerance.
For most women, the recommended drinking limits are no more than three standard drinks per day and no more than seven per week. A standard drink contains about 14 grams of alcohol (0.6 fluid ounces or 1.2 tablespoons) which is equivalent to one 12-ounce bottle of beer or wine cooler; 8 to 9 ounces of malt liquor; one 5-ounce glass of table wine; 3 to 4 ounces of fortified wine; 2 to 3 ounces of cordial, liqueur or aperitif; 1.5 ounces of brandy; or 1.5 ounces of 80-proof distilled spirits. This is intended to measure the amount consumed on a single day and does not represent an average over several days. (In other words, if you don't drink all week and then drink seven drinks on Saturday, it's not the same thing as having one drink a day). Any more than one drink a day is considered heavy drinking for women.
According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), women are more vulnerable to alcohol-related organ damage, trauma and interpersonal difficulties:
Liver damage: Women develop alcohol-induced liver disease faster than men even if they consume less alcohol. Plus, women are more likely than men to develop alcoholic hepatitis and die from cirrhosis (liver disease).
Brain damage: Studies of brains via magnetic resonance imaging (MRIs) show that women may be more vulnerable to alcohol-related brain damage than men.
Heart disease: Among heavy drinkers, women develop heart disease at the same rate as men, despite the fact that women consume 60 percent less alcohol than men over their lifetimes.
Breast cancer: Some studies find a link between moderate or heavy alcohol consumption and an increased risk for breast cancer.
Violence: College women who drink are more likely to be the victims of sexual abuse than those who don't. And high school girls who drink are more likely to be the victims of dating violence than those who don't.
Accidents: Although women are less likely than men to drive after drinking, women have a higher relative risk of dying in a car accident if they're driving even at similar blood alcohol concentrations. Laboratory studies suggest gender differences in the way alcohol affects how driving tasks are performed.
Women are more likely than men to use a combination of alcohol and prescription drugs.
Women may begin to abuse alcohol and drugs following depression, to relax on dates, to feel more adequate, to lose weight, to decrease stress or to help them sleep at night.
Poor self-esteem is a major issue for most women who develop problems with drugs and alcohol. The following conditions may also increase a woman's risk for developing substance use disorders:
A history of physical or sexual abuse. Physical and sexual violence against women is common when one or both partners have been drinking or using drugs. Women also are more likely to drink or use drugs when their partners do.
Depression, panic disorder and post-traumatic stress disorder. For instance, among female alcoholics, 31 percent have some form of anxiety disorder, 19 percent have major depression and seven percent have panic disorder—all much higher than in men. They also have much higher rates of eating disorders. Researchers also now know that there is a strong family (genetic) component to addiction. If you have a family history of addiction, you should be aware of your risk for developing dependency, especially during stressful periods in your life.
So, why are women more vulnerable to the effects of alcohol?
Women develop serious alcohol problems more rapidly then men, but at lower doses, a process called "telescoping." This is partially because women's bodies absorb alcohol faster than men's because of a difference in the way a key enzyme works. The enzyme, alcohol dehydrogenase (ADH), breaks down alcohol before it enters the bloodstream. But in women, this enzyme is less active than in men. Also, women have a smaller ratio of water to fat than men. That means there's less water to dilute the alcohol and more fat to capture it. One positive difference: Women seem to eliminate alcohol from their bodies faster than men.
Hormonal fluctuations in women may affect how alcohol is metabolized. Some women report feeling the effects of alcohol more quickly or strongly when they drink at certain times during their menstrual cycle.
Alcohol affects almost every organ in your body. Serious health problems associated with excessive alcohol use include but are not limited to:
brain damage
liver disease
pancreatitis
increased risk for sexually transmitted diseases
liver disease
high blood pressure and other forms of heart disease
malnutrition (specifically thiamine deficiency)
anemia
heavy menstrual flow, irregular cycles or premenstrual pain
premature menopause
osteoporosis
diabetes
circulation problems
respiratory disease
alcohol poisoning. High quantities of alcohol consumed in one session can lead to coma and death. The lethal dose for alcohol is about .40 percent, or about five times the legal limit (0.8) in most states. However, the lethal dose is related to the dose at which half of the population would die. Death can occur from alcohol poisoning at lower levels, especially for women. For a 120-pound man or woman drinking very quickly, it would only take about nine or 10 drinks in an hour to reach the lethal level.
Substance Use & College Students
For women, binge drinking is consuming four or more drinks in one session. It is most common among women between the ages of 18 to 25. This type of heavy, episodic drinking causes most of the alcohol-associated harm occurring on campuses and in students' lives.
Results of a major, eight-year study involving the drinking habits of thousands of college students found that despite efforts to curb heavy episodic drinking on campuses through alcohol-prevention programs, services, activities and policies, the problem is still severe. Key findings include:
In 2001, approximately two in five (44.4 percent) college students reported binge drinking, a rate almost identical to rates in three previous surveys.
Very little change in overall binge drinking occurred at the individual college level.
A sharp rise (from 24 percent in 1993 to 32 percent in 2001—a 31 percent increase) in frequent binge drinking was noted among women attending all-women's colleges, and a lesser, but still significant increase was found for women in coeducational schools.
The percentages of abstainers and frequent binge drinkers increased, indicating a polarization of drinking behavior first noted in 1997. Basically, although women are drinking less overall, they're drinking more each time they do drink.
More students lived in substance-free housing and encountered college educational efforts and sanctions resulting from their alcohol use.
Half of the underage students who were studied reported obtaining alcohol easily; other students are their primary source. But since 1993, the use of fake identification cards to obtain alcohol illegally has declined, whereas the role of parents as providers of alcohol to underage students has increased.
Having more laws restricting underage drinking or governing the volume of sales and consumption of alcohol in effect is associated with less drinking among underage students.
Substance Use & Older Women
Substance use, including cigarettes, alcohol and misuse of psychoactive prescription drugs (sedatives, tranquilizers and other drugs that affect the mind or behavior), is at epidemic levels for American women 60 years old and older.
Older women are at greater risk for substance use disorders in part because tolerance levels decrease as people age. Some studies suggest that older women are at greater risk for developing a substance use disorder even if they use smaller amounts than younger women. Yet this is often a hidden problem, going undetected by health care professionals, family and friends. Substance abuse symptoms in older women are often erroneously attributed to other factors, such as anxiety or depression.
Also, older women are less likely to discuss their alcohol use or misuse of prescription drugs with their health care professional, in part because of the stigma their generation attached to alcoholism and mental disorders. Additionally, health care professionals are also less likely to address addiction problems in this population. A two-year survey of 400 primary care health care professionals found that less than one percent considered a substance abuse diagnosis when typical signs of alcohol or drug abuse were evident in older women. Instead, they were more likely to diagnose older women with depression and, ironically, to prescribe medications that could aggravate any existing substance abuse problem.
The recommended limits for alcohol consumption are reduced in people age 65 and older. They should consume no more than one standard drink per day or seven standard drinks per week.
There are different types of excessive alcohol use in the elderly: early onset and late onset. Those who have been using alcohol at levels above the recommended limits for many years and reached age of 65 are called "hardy survivors" and belong to the early onset group; those who begin abusing alcohol later in life belong to the late onset group.
This distinction is particularly important in women since those who have early onset are at higher risk for alcohol-related health issues. Both groups are at increased risk for injury however, especially falls, and for depression, suicide and malnutrition.
Alcohol & Pregnancy
The damaging effects of alcohol on pregnant women and their unborn babies are well documented. Like many other drugs, alcohol easily passes from a mother to her baby through the placenta. Prenatal alcohol exposure is the single greatest preventable cause of mental retardation.
One of the greatest risks of alcohol use during pregnancy is Fetal Alcohol Spectrum Disorder (FASD) and Fetal Alcohol Syndrome (FAS), the most severe form of FASD. Low birth weight, congenital anomalies, severe behavioral and neurological problems and learning and physical disabilities are some symptoms experienced by infants and children exposed to alcohol in the uterus.
Children diagnosed with FAS suffer the severest damage related to alcohol exposure, including facial changes and mental retardation.
For the mother, alcohol use during pregnancy has been associated with high blood pressure, miscarriage, premature delivery, stillbirth and anemia.
There is no safe level of alcohol consumption during pregnancy. Women who are planning to become pregnant or who are sexually active and might become pregnant should refrain from alcohol use, since damage can occur before a woman realizes she is pregnant.
Prescription & Over the Counter Drug Use & Women
Misuse, abuse and dependence on prescription drugs is a major health problem for women. Two-thirds of all tranquilizers, such as diazepam (Valium), chlordiazepoxide (Librium) and alprazolam (Xanax), are prescribed to women. Other examples of prescription drugs used frequently by women include sedatives such as triazolam (Halcion) and estazolam (ProSom); analgesics like meperidine (Demerol) or other types of painkillers such as oxycodone mixed with aspirin (Percodan) or codeine (Brontex); and stimulants such as methylphenidate (Ritalin), sibutramine (Meridia) and dextroamphetamine sulfate (Dexedrine).
When used to treat the medical conditions for which they were approved at the recommended dose, these drugs are safe and effective, rarely leading to addiction or abuse. But when not used properly, they can lead to addiction and death, especially when used in combination with alcohol or other drugs.
Prescription drug abuse is the fastest-growing category of substance abuse in women. Women, particularly Caucasian women, are much more apt to abuse prescription drugs than men or women of other ethnic backgrounds. Overall, women are 43 percent more likely to use narcotic pain relievers for non-medical use than men.
Many women start taking a medication for a health problem, such as anxiety, muscle spasms or pain, but then use them longer and in greater amounts than intended or without close supervision by a health care professional. In most cases, developing a physical dependence on a certain drug causes your body to build up tolerance to it, requiring more of the drug to have the same effect.
In these cases, abruptly stopping use of the drug may result in rebound withdrawal signs. This doesn't necessarily mean you were abusing the drug or developed an addiction to it, because sometimes long-term use is appropriate. That's why it's so important that you only take prescription drugs under the supervision of a health care professional.
Misuse of prescription drugs can cause a variety of health problems in addition to physical dependence, including headaches, confusion, drowsiness, fainting and lowered or elevated blood pressure.
For some prescription drugs, adverse effects increase dramatically if you mix them with alcohol. This combination increases the risk of injuries from falls and car accidents and can be deadly. Be sure to consult with your health care provider or pharmacist about the use of alcohol when taking any prescription drug.
Over-the-counter (OTC) pain relievers/fever reducers can also cause health problems if used with alcohol. If you have three or more alcoholic drinks a day, you may be at increased risk for liver damage or stomach bleeding if you take these medications.
Illicit Drug Use and Women
According to a recent survey by the National Institute on Drug Abuse, more than 4 million women need treatment for drug problems. The health risks of illegal drug use go beyond the effects of the drugs themselves. Illicit drug use (such as heroin, cocaine or marijuana) often leads to behavior that puts women at increased risk for HIV, hepatitis and sexually transmitted diseases (STDs).
Heroin
Also known on the street as smack, horse, H, junk or scag, heroin is the most commonly abused narcotic. Narcotics are derivatives of the opium poppy (an annual poppy cultivated as the source of opium) or chemically similar synthetics created in a lab. Heroin was a commonly prescribed medicine in the early 20th century, until its addictive potential was realized. It breaks down to morphine in the body.
Narcotics act on the nervous and digestive systems to control pain, relieve diarrhea and suppress coughing. When prescribed for pain relief, narcotics are usually taken by mouth. Narcotics slow body functions such as circulation, breathing and digestion. They cause your blood vessels to relax and your heart rate to slow, lowering blood pressure. Narcotics make you feel drowsy, groggy and confused. A common characteristic of heroin use is "nodding," a semi-conscious state in which the person may appear to be nodding off to sleep.
Like most other drugs that are abused, narcotics can make you feel a sense of euphoria, contentment and physical relaxation. The "high" usually lasts about three to four hours. When heroin is injected or smoked, the abuser experiences an instant period of intense pleasure known as a "rush." The more you use narcotics, the more tolerant your body becomes, requiring higher doses to achieve the same results. Eventually, the user reaches a plateau at which no amount of the drug is sufficient. When the user reaches this level, the person administers the drug just to delay withdrawal sickness.
Street heroin is sold in powder form and has a bitter taste. Heroin is generally inhaled or injected and sometimes smoked. There is a high prevalence of HIV and AIDS among heroin users due to sharing of contaminated syringes, which has resulted in a decline in the number of intravenous (IV) users. Today, many heroin addicts sniff the powder into their nostrils or heat it on foil to inhale the vapors. Heroin is also sometimes mixed with tobacco or marijuana and smoked in a pipe or cigarette.
The consequences of heroin use include:
dry, itchy skin, skin infections and abscesses
constipation and loss of appetite
menstrual irregularity
fluctuating blood pressure and slow or irregular heartbeat
dependence, addiction
hepatitis B and C and HIV/AIDS caused by use of dirty needles
stroke and heart attack caused by blood clots
cardiac arrest, coma and death from accidental overdose
Cocaine
Cocaine is one of the oldest known drugs. In the early 19th century, this stimulant was used as an ingredient for many types of tonics prescribed to treat a variety of illnesses. However, the source of cocaine—coca leaves—has been ingested for thousands of years in mountainous regions of Peru and Bolivia where the coca bush is found. Though it can be prescribed by physicians today as a local anesthetic, cocaine is a commonly abused drug and was very popular in the '80s and '90s.
Cocaine comes in two chemical forms: hydrochloride salts (the powdered form) and "crack" (a smokable "free-base" form produced through a reaction with an alkaline substance such as baking soda). The powdered form can be injected into a vein after it's dissolved in water, or inhaled. When sold by drug dealers, the powdered form of cocaine is often diluted with sugar, starch or other substances. The freebase form of cocaine can be smoked.
Cocaine stimulates the nervous system, causing your heart rate and blood pressure to increase and your blood vessels to constrict, which is why abusers often suffer heart attacks and strokes. The initial effects of cocaine use are increased alertness, energy, self-confidence and loss of appetite. However, as these effects wear off, the user is left feeling depressed, fatigued, jumpy, fearful and anxious.
Crack is the slang name for the highly potent form of freebase cocaine processed from powdered hydrochloride into a substance that can be smoked. Crack looks like white chunks, rocks or chips and "cracks" when it is smoked. Crack is less expensive to produce and buy than cocaine. It is typically smoked in a pipe, and users inhale the fumes.
The effects of crack are similar to other forms of cocaine, only more immediate (users feel its effects in less than 10 seconds, according to the National Institute on Drug Abuse) and intense. Perhaps because of the rapid and intense effects, users seem to become addicted to it more quickly than to other forms of cocaine.
The consequences of cocaine abuse are:
irregular heartbeat, heart attack and heart failure
strokes and seizures
fluid in the lungs and other lung disorders
paranoia, depression, anxiety disorders and delusions
aggressive, violent behavior
an increased risk of hepatitis and HIV for users who inject the drug intravenously
increased and indiscriminate sexual activity often accompanies use and addiction, further increasing risk of HIV and other STD infection.
Pregnant women who use cocaine have a higher risk of miscarriage and premature labor. Its use has also been associated with low birth-weight babies and developmental problems.
Marijuana
"Pot" is by far the most commonly used illegal drug. It may also be the most insidious drug, because most people don't realize how dangerous it is. Since the 1990s, most marijuana contains significantly more THC (delta-9-tetrahydrocannabinol, the active ingredient in the drug) than marijuana used in the 1960s and 1970s. Thus, the effects of smoking part of a single 21st-century marijuana cigarette produces more profound and debilitating effects than smoking several marijuana cigarettes in the 1970s would have.
Marijuana is usually smoked, either in a pipe or a loosely rolled cigarette known as a "joint." Joints are infrequently (and usually unknown to the user) laced with the potent hallucinogen PCP, or other drugs that substantially alter the effects of marijuana. Marijuana can also be brewed into tea or mixed in baked products like cookies or brownies.
The effects of smoking are usually felt in a few minutes and peak in 10 to 30 minutes. They include dry mouth and throat, increased heart rate, impaired coordination and balance, delayed reaction time and diminished short-term memory. Marijuana can impair driving and lead to accidents, and its effects may be worse in combination with alcohol. Larger doses can cause more intense reactions such as paranoia.
The most familiar long-term effect of marijuana use is impaired learning ability. Research shows that marijuana use limits your ability to absorb and retain information. In testing, users often show a reduced ability to memorize information and demonstrate lower math and verbal skills.
Aside from the mind-altering effects of marijuana, it also carries consequences similar to cigarette smoking. According to some studies, if you smoke one joint, it is thought that you are exposed to the same amount of cancer-causing chemicals as if you smoke five tobacco cigarettes. The health consequences of regular marijuana use include:
More frequent respiratory infections, including chest colds, bronchitis, emphysema, asthma and sinusitis
Delayed onset of puberty and reduced sperm count of men; women who use pot may develop abnormal menstrual cycles and irregular ovulation; pregnant women risk having babies with low birth weights, health problems and developmental delays
Impaired perception, diminished short-term memory, loss of concentration and coordination, impaired judgment and decreased ability to judge distance and speed—all of which lead to increased risk of accidents
Anxiety, panic attacks and paranoia
Damage to respiratory, reproductive and immune systems
Methamphetamine
Also known as speed, crank, meth, crystal-meth and glass, methamphetamine is a powerful stimulant that produces increased alertness and elation. Its effects are similar to cocaine but last longer. Easily made with inexpensive over-the-counter ingredients in makeshift laboratories, methamphetamine is cheaper to produce than cocaine.
Methamphetamine can be swallowed, smoked, snorted or injected. In powder form, it can be mixed with water and injected in the veins or sprinkled on tobacco or marijuana and smoked. Chunks of clear, high-purity methamphetamine are called ice, crystal or glass. It looks like rock candy and is smoked like crack cocaine.
Low doses of methamphetamine can make you feel alert and energetic. With continued use, however, the pleasurable feelings can disappear. The user soon needs to take higher doses more often to achieve the same effects. Someone using methamphetamine is easily agitated. One minute she is calm and content, the next she is angry and fearful. Addicts may pick at imaginary bugs on their skin and become obsessed with repetitive actions.
The crash that follows a methamphetamine binge involves agitated depression and an intense craving for more of the drug. These feelings soon give way to exhaustion and long, deep sleep—again followed by severe depression. During this last phase, the potential for suicide is very high.
The consequences of methamphetamine use include:
sleep disturbances, weight loss, nausea, vomiting, diarrhea and elevated body temperature
skin sores and infections as a result of picking at imaginary bugs
paranoia, depression, irritability and anxiety
increased blood pressure, chest pain, headaches, stroke and heart attack
permanent brain damage
increased risk of HIV and hepatitis infection (for IV drug users)
Methamphetamine use during pregnancy can increase the mother's blood pressure and heart rate. This can result in an increased risk of premature delivery or miscarriage. Additionally, methamphetamine constricts blood vessels in the placenta. This means there is less blood flow to the fetus, and the baby receives less oxygen and nutrients. The drug can also pass through to the placenta, which means the fetus has an increased blood pressure. This can result in stroke or heart damage as well as slow fetal growth.
Ecstasy
Also called MDMA (3,4-methylenedioxymethamphetamine), Ecstasy use has, in recent years, become increasingly popular with teenagers in club or dance settings. It is a synthetic, illegal drug that has characteristics of both stimulants and hallucinogens. It is typically produced in capsule or tablet form and is usually taken by mouth, although health care professionals have documented cases in which people injected or snorted the drug. Ecstasy interferes with learning and memory and may produce damaging changes in brain structures and chemistry. It increases heart rate and blood pressure and can disable the body's ability to regulate its own temperature.
There is now a large body of evidence that links heavy and prolonged MDMA use to confusion, depression, sleep problems, persistent elevation of anxiety and aggressive/impulsive behavior. Because of its stimulant properties, when used in club or dance settings, it enables users to dance vigorously for extended periods but can also lead to severe rises in body temperature (hyperthermia), as well as dehydration, hypertension and even heart or kidney failure in susceptible people.
Researchers at the University of Amsterdam studying brain blood flow patterns in male and female chronic users of Ecstasy found that women who use the drug may be more likely to develop neurological problems than their male counterparts.