Substance Use Disorders in Women

Alcoholism and the use of illegal drugs was initially considered to be a man’s disease, but the use of addictive substances now affects at least 4 million American women 18 years of age or older (Sanders, 2011).  SU has a devastating effect on both men and women; nevertheless, according to Sanders (2011), the use of intoxicating substances tends to cause more harm to women because of the physiological, psychological, and sociological differences between men and women.  For example, SU in women has been principally associated with mental illnesses such as depression (Anton, 2010).  According to statistics, up to 25% of women seeking treatment for SUDs are primarily diagnosed with major depressive disorder and secondarily diagnosed with an SUD (Sanders, 2011).  According to Tracy, Munson, Peterson, and Floersch (2010), “approximately 6.5 million adult women in the United States have been diagnosed with a SUD” (p. 258).

When a woman is addicted to drugs or alcohol, she is essentially disconnected, which can result in increasingly diminished self-worth and isolation (Covington, 2008).  According to Covington (2008),

a SUD is considered to have occurred when a relationship with a drug is pursued and believed by the individual to be essential in spite of continuing negative consequences.  The relationship with the drug is at least as important to the individual as relationships with people. (p. 5)


It is the view of many SUD specialists that alcoholism can be considered a disease of isolation (Flores, 2012).

Panchanadeswaran and Jayasundara (2012) conducted an exploratory study of the various frameworks related to vulnerability, illicit drug use, and parenting, on 19 women who were presently engaged in SU treatment services.  Social isolation appeared to be a primary causal factor contributing to women’s use of drugs and/or alcohol (Panchanadeswaran & Jayasundara, 2012).  The information obtained from this study indicated the importance of social relationships for women and the impact that social isolation and disconnection can have as a causal factor in women developing an SUD.  In addition to that, as previously reported, SUDs can also contribute to increased isolation: The interpersonal skills of individuals with SUDs begin to decay because individuals who become dependent on intoxicating substances cannot properly regulate their emotions, self-care, self-esteem, and relationships (Anton, 2010). 

 Rundell, Brown, and Cook (2012) conducted a study of 95 female young adults by use of an online questionnaire that measured perceived parental rejection, poor self-esteem, and drinking alcohol as a method of coping.  Study results found that female participants who considered themselves as having experienced parental rejection demonstrated a strong presence of negative self-esteem (Rundell et al., 2012).  Respondents reported a belief that parental rejection may have contributed to their having a stronger motivation for the use of alcohol as a method of coping (Rundell et al., 2012).  The results of this study also suggested that young women might choose to drink alcohol as a way of attempting to cope with low self-esteem.  Sanders (2011) noted that many women recovering from SUDs have reported feelings of low self-esteem and worthlessness, which they believed to have influenced considerably their use of drugs and/or alcohol.  These women further reported that they used alcohol or other drugs to mask their feelings of inferiority and that they continued to use intoxicating substances in an attempt to feel whole or complete (Sanders, 2011).

Miller (1986) explained (as cited in Covington, 2008) that isolation, abuse, and shame can all result in a woman developing depression, which may lead to (a) diminished zest and vitality, (b) lack of clarity and confusion, (c) reduced self-worth, and (d) turning away from relationships.  Borelli et al. (2010) measured attachment disparities in 69 women based on the Adult Attachment Interview (AAI) scales and found that compared to securely attached women, insecure–dismissing and insecure–unresolved women would be at a much higher risk of having a diagnosed SUD.  Borelli et al. (2010) further discovered by the use of two AAI scales that the SUDs could be associated with a deterioration of attachment and unresolved loss or trauma. 

Affi, Henriksen, Asmundson, and Sareen (2012) conducted a study examining the association between five different types of childhood traumas (e.g., physical abuse, sexual abuse, emotional abuse, physical neglect, and emotional neglect) and several kinds of SUDs (e.g., alcohol, sedatives, tranquilizers, opioids, amphetamines, cannabis, cocaine, hallucinogens, heroin, and nicotine).  Data were obtained from the National Epidemiological Survey of Alcohol and Related Conditions (NESARC) and conducted on a nationally representative United States sample of adults aged 20 years and older.  Study results indicated that “childhood maltreatment among women, but not men, was associated with alcohol abuse or substance dependence early in childhood, which was linked to excessive drinking in later adulthood” (p. 678).  Findings obtained from this study are extremely important because they might assist in the understanding that many mental health conditions including social isolation may be associated with traumatic experiences and the development of SUDs in women.

A holistic model of SUDs should be considered from a systems perspective (Covington, 2008).  This perspective requires looking at the complete woman in an effort to understand her relationship with substances in every aspect of herself, which includes her physical, emotional, and spiritual aspects.  When considering a woman with an SUD, it is important to understand her personal problems, her relationships with family members, loved ones, in addition to understanding her local community and society in order to view all of the aspects of her life systemically and holistically.  This will allow a complete understanding of her life history from both a systems and a SU perspective.  Recovery from SUDs can be an extremely difficult and challenging personal endeavor and relapse rates are often high (SAMHSA, 2010).  External factors are often referred to as triggers that can precipitate relapse (Khantzian, 2011).  Relapse triggers can be associated with attachment or relationships because individuals with SUDs have difficulty establishing and maintaining healthy intimate interpersonal relationships (Flores, 2012).  According to Flores (2012),

individuals with SUDs are unable to appropriately regulate affect and in many       cases, are also unable to identify what they are feeling or identify what it is that     they feel.  They are also unable to draw on their own internal resources    because there aren’t any.  They remain in constant need of self-regulating             resources provided internally “out there.”  Since painful, rejecting, and shaming    relationships are the cause of their internal deficits, they cannot turn to others to get what they need or have never received. (p. 83)

In an era of biological psychiatry where sustained emphasis is placed on the brain mechanism of pleasure and reward to explain continued SU and relapse, there is an analogous need to be altered (Khantzian, 2011).  This need is a result of personally attempting to attend to the range and quality of feelings or affect states that can and eventually do result in relapse (Khantzian, 2011).

A crucial component of the recovery process is based on the fact that problems women experience cannot be treated in isolation (Covington, 2008).  Evidence shows that unresolved childhood psychological distress can continue to have an effect later in life (Keren & Mayseless, 2013).  Problematic behavior carries over into adulthood, and for individuals with SUDs, these problems might hinder their recovery because so much of the ability to overcome their use of addictive substances can be related to their attachment deficiencies (Flores, 2012).  Even when an individual with an SUD does not have a history of attachment difficulty, these difficulties invariably develop as a consequence of SU (Lackings, 2012).  Until women with SUDs are able to relinquish unhealthy attachment styles (e.g., insecure avoidant, insecure ambivalent, insecure disorganized) and develop the capacity for healthy interpersonal affect regulation (e.g., secure attachment and mutuality), they continue to remain vulnerable by substituting one compulsion or addictive behavior (e.g., alcohol, drugs, gambling) for another (Lackings, 2012).  Treatment for SUDs may need to focus on attachment issues to rebuild or repair current relationships.  Understanding early childhood attachment to the biological mother for women with SUDs may provide a starting point as to whether women with SUDs need to learn or relearn how to form healthy attachments to people rather than with their substance of choice.

Interventions with women attempting to recover from SUDs should provide a holistic framework that helps women recognize those vulnerabilities that can be detrimental to their recovery process.  These interventions also require assisting women with SUDs to learn how to transfer their relationships with illicit drugs and/or alcohol to sources of growth-fostering, healthy connections with other individuals (Covington, 2008).  An attachment-focused approach can pave the way in addressing the emotional processes that affect behavior and healthy mental functioning (Fletcher et al., 2015).  Helping individuals process how their early attachment behaviors may have influenced their SUD could offer healthy alternatives to achieving optimal emotional regulation and interpersonal support (Fletcher et al., 2015).

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Melanie Burton, Ed.d, LCSW, LADC


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