Prior to World War II, the prevalence of women who were diagnosed with alcoholism or an alcohol use disorder was considered to be relatively rare. Many women who abused alcohol prior to World War II were closet drinkers, homeless, or had severe mental health issues. Alcohol use in women became much more accepted after World War II due to a generalized acceptance of women’s drinking in public places, more women attending college, and more women entering the workforce. In addition, the purchasing power of women was significantly elevated, and there was a reduction in gender stereotypes.
According to the majority of research studies, including data provided by the Substance Abuse and Mental Health Services Administration (SAMHSA), overall, men are more likely to use all types of illicit drugs, more likely to use alcohol, more likely to have experienced an overdose, and more likely to develop a substance use disorder, such as an alcohol use disorder, than women. In addition, over most age groups, men are diagnosed with disorders, including alcohol use disorders, far more often than women, but women are just as likely as men to develop substance use disorders based on the proportions of individuals who use drugs or alcohol.
In addition, women may be more susceptible to experiencing cravings for alcohol than men, and women may be more susceptible to relapse than men. The development of an alcohol use disorder may also progress differently in women than it does for men.
Research indicates that women often have a significantly shorter history of abusing alcohol than men before they are diagnosed with an alcohol use disorder, demonstrating a quicker progression from first use to developing an alcohol use disorder. In addition, women often enter treatment for alcohol use disorders with more severe psychological, medical, and social issues that men do, but they enter treatment less often. SAMHSA has reported that the breakdown for individuals in treatment for alcohol use disorders is 25 percent women and 75 percent men.
A Double Standard
There is a double standard when it comes to how society views drinking among men and women. While men often get a pass on their alcohol consumption, women tend to get viewed in a negative light. Drinking alcohol is often associated with lowered sexual inhibitions, especially in women. This connection leads society to labeling alcohol consumption among women with the same double standard they are given for their sexual behavior. This double standard can lead women to hiding their drinking behaviors, which goes hand in hand with why some women do not seeking treatment even when they know they have a problem.
Why Many Women with Alcohol Use Disorders Do Not Seek Treatment
Many of the reasons that women use alcohol are similar to the reasons that men use alcohol; however, women in treatment for alcohol use disorders often have significantly different experiences that men do. According to the book Women Under the Influence, there are various reasons for this.
- Women in treatment for alcohol use disorders are five times more likely than men to have a history of sexual abuse. For many, this is embarrassing and disturbing, and it may keep a number of women from seeking treatment.
- Women often begin abusing alcohol to deal with the effects of a crisis, such as a divorce, losing a child, or unemployment. In addition, women are more likely to begin drinking heavily after a child grows up and leaves the home. These issues are often difficult for women to discuss and may keep them from treatment.
- Women are often assigned the role of caregiver in their families. This may make it difficult for many women to enter treatment and discuss their issues freely.
- Specific issues, such as with childcare, may keep women from seeking treatment.
- Women with children may not enter treatment for fear that their children may be taken away from them.
- Women who have spouses who also have alcohol use disorders may be victims of domestic violence, and this may hinder their participation in treatment.
In addition, in the past, research studies often did not include women. For example, the Jellinek model, the famous model of alcoholism that defines different types of alcoholism and is often referred to in Alcoholics Anonymous, was originally developed using only a small number of male subjects who attended Alcoholics Anonymous meetings. Other past research studies did not include women, and specific adjustments in treatment or in the development of treatment protocols for women were not considered.
Other Issues Associated with the Stigmatization of Women with Alcohol Use Disorders
There are other issues that contribute to the stigmatization of women with alcohol use disorders.
- According to the American Psychiatric Association (APA), rates of alcohol use disorders are greater among adult men (12.4 percent) than adult women (4.9 percent). This does not apply to a diagnosis of binge drinking where adolescent or young adult women are diagnosed more often than adolescent or young adult men. These figures may contribute to the notion that alcohol abuse among women is not a significant or important issue.
- Women metabolize alcohol differently than men. In most cases, women become intoxicated and are subject to ill effects of alcohol use at significantly lower amounts than men.
- Women tend to have a greater number of medical issues associated with alcohol abuse than men, even if they have been drinking for a significantly shorter length of time.
- Women have alcohol-related mortality rates that are 50-100 times higher than men, due to liver damage, suicide, or alcohol-related accident.
- It is not unusual for anyone with an alcohol use disorder to have a comorbid or co-occurring mental health disorder, but men are more likely to report a mental health issue co-occurring with substance abuse than women.
- Despite the above information, according to APA, women are more likely to suffer from certain types of mental health issues, such as depression, anxiety, trauma- and stressor-related disorders, and eating disorders, that are comorbid with alcohol use disorders than men.
These issues have contributed to the stigma associated with women who abuse alcohol, leading to the notion that women are inherently weaker, less involved in treatment, and less likely to benefit from treatment.
Specific Issues That Should Be Addressed for Women with Alcohol Use Disorders
When treatment professionals or researchers discuss differences that should be considered for specific groups of individuals with alcohol use disorders, it is not meant that the overall approach to treatment should be substantially different. As it turns out, there is a general overall outline or blueprint that is followed in the treatment of alcohol use disorder regardless of an individual’s background. Briefly, the general outline consists of:
- Assessment: This involves evaluating the physical, psychological, emotional, and social functioning of the individual to identify target areas that need to be addressed.
- Medical detox: Placement in a physician-assisted withdrawal management program may be needed.
- Therapy: This can consist of individual sessions, group sessions, or a combination of both. Therapy is the cornerstone of any recovery program.
- Medical care: Individuals should utilize medically assisted treatments, such as medications, as needed.
- Treatment for co-occurring disorders: Any comorbid conditions, including mental health issues, should be addressed along with the individual’s alcohol use disorder.
- Peer support groups: Individuals should be encouraged to participate in social support groups, such as Alcoholics Anonymous.
- Complementary treatments: Other interventions can enhance the effectiveness of the overall treatment program, including complementary and alternative forms of treatment, such as art therapy, exercise programs, meditation, etc.
- Treatment duration: Individuals should remain in treatment for a significant length of time. Many resources suggest that certain types of treatment could continue indefinitely, such as social support group participation.
Although the blueprint is the same, each treatment plan should be adjusted according to the individual’s needs. According to the book Treating Women with Substance Use Disorders: The Women's Recovery Group Manual, there are some special issues that should be addressed with women who have alcohol use disorders.
- While one’s family and children are important, women should enter recovery programs to improve themselves instead of rationalizing that treatment will help others.
- Treatment should address any comorbid conditions, particularly issues with depression, anxiety, eating disorders, and/or trauma- and stressor-related disorders.
- Treatment providers should be aware of the increased potential that women in recovery from alcohol use disorders may also suffer from abuse or domestic violence. When these conditions are present, they should be addressed immediately and efficiently.
- It should be stressed that recovery is a slow process and feeling better does not mean that one is “cured.”
- Women in recovery often need to develop their own personal identity as opposed to only identifying as a “wife,” “mother,” “caregiver,” etc.
- Many women respond best to mentoring from other women who are in recovery. In addition, many women in recovery find that mentoring others in recovery increases the effectiveness of their own recovery program.
Overall, research suggests that treatment outcomes for women with alcohol use disorders are similar to outcomes for men with alcohol use disorders. Even though there is a standard blueprint that is followed in the treatment of an alcohol use disorder, the National Institute on Drug Abuse recognizes that there is no single approach to treatment that is appropriate for everyone. Individuals have different needs and situations, and treatment plans should be adjusted to fit the needs of each individual. This includes adjusting formalized alcohol use disorder treatment protocols to fit the specialized needs of women. By understanding and focusing on the specific issues that women have, the stigma associated with women who have alcohol abuse issues can be significantly reduced over time.
- Office of Research on Women’s Health, Office of the Director, and the National Institute on Alcohol Abuse and Alcoholism.Alcohol: A Women's Health Issue.. NIH Publication. No. 15 4956. Published 2003. Revised 2015.
- Slađana Dragišić Labaš. Alcohol use: social aspect, gender differences and stigmatization. Alcoholism and Psychiatry Research 2016;52:51-64 Received December 20, 2015, accepted after revision April 11, 2016.