When a man and a woman drink too much alcohol -- by far the most widely abused substance in the country -- they not only do it for different reasons, they also get different results.
Where men may use alcohol to feel "powerful," women usually drink to fight feelings of hopelessness and anger.
Though women generally drink less than men, the risk of alcoholism kicks in a lot faster: Seven or more glasses a week is considered risky for a woman, compared to 14 or more for a man.
Alcoholism also carries greater risks to women. Heavy drinking increases the chances of a woman becoming a victim of violence and sexual assault. Most women who abuse alcohol and drugs -- studies show as many as 80 percent to 90 percent -- have a history of physical or sexual abuse.
Women are more likely than men to develop liver inflammation and to die from cirrhosis. They are more vulnerable to alcohol-induced brain damage and cardiovascular disease. And heavy drinking appears to increase the risk of breast cancer, as well as cancers of the digestive tract.
The stigma for using drugs and alcohol also is greater, and it's often one of the biggest obstacles to a woman seeking treatment. She fears -- rightly -- that she will lose custody of her children if she admits to having a substance abuse problem. Or she's so busy being the caregiver that she puts off asking for help, often for so long that she develops serious ailments.
The numbers, fairly consistent since the 1990s, say it all: Of the 15.1 million people who abuse alcohol, 4.6 million are women, and only 25 percent of them are in traditional treatment, according to the National Institute on Alcohol Abuse and Alcoholism. Women also tend to go more nontraditional routes for help with addiction, looking to either their doctors, therapists or psychiatrists.
During the past decade, segregated treatment has become a key to success for women, providing a more nurturing environment that encourages patients, often childhood victims of physical and sexual abuse, to open up and talk about the traumas that led to their substance abuse.
"Eighty to 90 percent of the women in our treatment program, in all programs, have been significantly abused in their life," says Marsha Nadell Penrose, executive director of The Next Step, a 14-bed intensive treatment center in Albany, N.Y. "It's a vicious cycle: You get abused, which makes you end up drinking. You drink, so you end up getting abused."
But many programs fail to address that cycle. And few programs offer child care.
The Next Step, one of three women's programs in upstate New York, made a deliberate choice not to provide quarters for children, and Penrose thinks it's a double-edged sword.
"The women usually feel terribly guilty when they first get here because their children are in foster care," she says. "I try to tell them to think of this as the only time they can focus just on themselves. I tell them, 'You can't take care of your children unless you're OK.' "
Some studies, however, show that women-and-children programs are twice as successful as women-only programs.
The Mothers' and Toddlers' Program, a National Institutes of Health pilot project in New Haven, Conn., works on the premise that continued drug use actually "hijacks" the maternal drive pathway that emanates from the brain. Over the past two years, it's shown promise in resetting the pleasure-reward effect from drugs like cocaine and heroin by intensifying the relationship between mothers and their young children.
By including children in treatment, "you're tapping into the woman's last thing to go -- her desire to be a good mother," says Norma Radol Raiff, executive director of Sojourner House in Pittsburgh, one of only two residential treatment programs for women in western Pennsylvania. Like most women's programs, it offers child care, therapy and classes on child development, healthy parenting, domestic violence, educational tutoring and remediation. Residents get guidance on planning menus, with trips to the grocery store to help them make healthy decisions.
Today, treatment also may include medication for depression or other mental illness, a direct outcome of new acknowledgement of alcoholism as a disease that creates a host of other issues for both sexes.
The fact that women get an early start with drinking and drugs also shapes treatment strategy. This year, three federal surveys found that binge drinking among girls is growing at a faster rate than boys. A February report from the White House Office of National Drug Control Policy revealed that in 2004, 1.5 million girls started using alcohol, 173,000 more than the number of boys who started drinking. Girls also outpaced boys in using marijuana at younger ages. The report cited stress, such as peer pressure and the trials of being an adolescent in a fast-paced society, as causes, as well as eating disorders, other illegal drug use, prescription drug misuse and low self-esteem.
Girls also find warped messages in advertising and popular culture. Three-quarters of the college coeds surveyed in an American Medical Association report released in early 2006 said they "use alcohol as an excuse to engage in outrageous behavior" on spring break. An overwhelming majority -- 84 percent -- thought images of partying college girls contributed to that behavior; even more agreed these images contributed to men's dangerous behaviors toward women.
"These survey results are extremely disturbing," said AMA president J. Edward Hill, "because it brings up an entirely new set of issues, including increased risk of sexually transmitted diseases, blackouts and violence."
This younger clientele also translates into a different level of care.
"A lot of them are kids who never grew up and now, frequently, they have babies themselves," Penrose says. "They haven't gone through their adolescent years and come through the other side. They need more support. They're much more emotionally fragile. And it takes longer to get through the treatment process."
For a list of women's residential programs updated annually by the federal government, go to the Center For Substance Abuse Treatment's Treatment Locator Service at http://dasis3.samhsa.gov or call (800 ) 662-HELP (4357 ).
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