Women face gender-specific challenges in fighting addiction and alcoholism
06/20/2014 12:00 AM
06/27/2014 11:26 AM
Men Are From Mars, Women Are From Venus, trumpeted a popular book in the 1990s.
Author John Gray didn’t sell 50 million copies of his book and spark a pop culture fire by telling us anything most of us hadn’t learned by grade school. Men and women are different. Gray just focused on the interpersonal perspective — how we communicate and how these gender differences can lead to conflict.
Here’s another significant way in which the sexes differ: addiction, its aftermath and treatment.
Take alcohol. Men and women metabolize drinks differently.
“Depression is more frequent in women than in men; addiction is more frequent in men than women, but if women have a problem of addiction or alcoholism, there is more likely of having other psychiatric problems like depression. The likelihood they were exposed to trauma is higher,’’ said Dr. Ihsan Salloum, professor of psychiatry and behavioral sciences and chief of the Division of Substance and Alcohol Abuse at the University of Miami Miller School of Medine.
Women also experience different influences and relapse triggers, according to the Hanley Center, a residential treatment center for women ages 18-46 in West Palm Beach.
The National Institute for Alcohol and Alcohol Abuse estimates that about 5.5 million women drink alcohol at levels that place their health at risk. Double that number for men, said Dr. John Eustace, medical director at the South Miami Hospital Addiction Treatment and Recovery Center. Alcohol abuse can result in liver damage, hepatitis, brain disease, breast cancer and heart disease.
A report from the Substance Abuse and Mental Health Services Administration (SAMHSA) and U.S. Department of Health and Human Services found that in 2012 there were more than 1.7 million substance abuse treatment admissions domestically. Alcohol was the most frequently reported primary substance at treatment admission among all racial and ethnic groups. The average age at admission among alcohol-only admissions was 41.
Males, aged 12 and older, represented 67 percent of admissions to these treatment centers in 2012, down from 70 percent in 2002, suggesting that more women were beginning to seek help. For example, 41 percent of the patients at South Miami Hospital’s Addiction Treatment & Recovery Center are women, compared to 10 percent in the 1980s and ’90s, said Eustace.
About two-thirds, 66 percent, of alcohol-only admissions nationwide were non-Hispanic whites, followed by blacks and Hispanics at 13 percent each.
Depression, which can stand alone or be a by-product of alcohol abuse, given alcohol’s depressive effect on the central nervous system, impacted women at twice the rate of men, according to a national drug use and health study by SAMHSA. Among adults aged 18 or older, an estimated 14.8 percent (31.6 million adults) had experienced at least one major depressive episode in their lifetime. Females (10.3 percent) were almost twice as likely as males (5.6 percent) to report a recent past year episode.
Heroin and prescription drug addiction are on the rise among affluent women, according to a 2014 survey from Caron Treatment Centers, parent company of the Hanley Center. Women cited anxiety (65 percent), depression (67 percent) and a critical internal voice (69 percent) as significant factors for their addiction. The top three stressors were relationships with parents and siblings (63 percent), romantic relationships (60 percent) and work (49 percent).
Addiction on the brain
Addiction, for both genders, impacts the brain’s medial forebrain bundle, also known as as the reward target of the body that gets activated whenever an individual engages in an activity perceived as pleasurable, which can include eating and sex. Physical changes to the brain, brought about by the release of dopamine when pleasure centers are tapped, can render people vulnerable to over use.
You eat, you enjoy, you eat again and derive nourishment to sustain life. Similarly, sex feels good, we procreate, the species survives. But drugs —and alcohol is a drug — causes the brain to release dopamine in a disproportional quantity compared to regular pleasurable activity like eating, having sex or exercising. The brain is not built for such over-stimulation and as a result the pleasure centers of the brain require a larger hit to derive the same sensation and addiction can take root.
Genetics is a risk factor but there is not a sex link gene to determine whether a person becomes addictive or not, Eustace said. “The risk for addiction, in general, is higher if there is a first-order relative that is identified. A female grandparent doesn’t mean the girls are more at risk. It’s equal between the male and the female,” he said.
A woman’s physiological make-up makes her stand apart from her male counterparts, even when their size doesn’t differ by much.
“An ounce-and-a-half of alcohol is going to be metabolized differently in women than men regardless of their size,” said Eustace.
Take two 135-pound individuals, a man and a woman. Give each a glass of alcohol.
“Women physiologically have less of a chemical called alcohol dehydrogenase. That is the chemical that immediately begins to break alcohol down into a less toxic, less neurobiologic chemical. So when the woman takes that ounce-and-a-half of ethyl alcohol it’ll be metabolized much slower. Now, if they take another ounce-and-a-half an hour later, rather than starting the process over like the men, there’s going to be an accumulative effect.,” Eustace said.
Weight equality aside, still other factors come into play. The “volume of distraction,” Eustace said.
“The same 135-pound person, the male is more likely to have more percentage of body muscle than fat. What that’s important is that alcohol gets distributed in fat and water substances more so than muscle and alcohol dehydrogenase is much more prevalent in muscle tissue than in fat or water. So right away, the male who takes an ounce-and-a-half will start to digest it both in their stomach and in their muscles, whereas in a woman it will be distributed in a larger volume and slower metabolism so the risk of a toxic effect of the drug goes up more in women than men.
And more often, men are bigger than women. “Because of this, there is less distribution of alcohol in the body and because of more fat content women might be exposed to a higher percent of alcohol in the brain compared to men,” Salloum said.
“That’s the physiological and biological reason, it’s not that men are tougher by some macho formula: ‘I can hold my booze and you can’t.’ It isn’t that at all. That would be a sociological mistake,” Eustace said.
Another property of alcohol is that it is a central nervous system depressant.
“Part of its pharmacology is to depress nerve conduction,” Eustace said. This can lead to a toxic effect when overused. The general guidelines suggest that women consume no more than seven ounces of alcohol per week and no more more than four ounces at any one sitting over the course of an evening, he recommends.
Salloum agreed, adding that men’s make-up can tolerate about 14 ounces a week. “Any more than that could be unhealthy drinking,” he said.
For women who drink socially, or for relief of tension, anxiety, the depressant properties of the beverage can become toxic even if the goal is innocent. “That’s part of the seductive nature of the drug,” Eustace said. “That’s where brain disorders, cardiomyopathy, fatty liver, bone marrow suppression, the risk of malnutrition, all come from the toxic effect of alcohol.”
Kevin Bandy, clinical director of Hanley Center, said that when women seek treatment at the venue the majority of them reported depression, anxiety and a critical internal voice, that subconscious inner monologue that says things like, ‘I’m not a good mother. I’m not going to be able to get well. How am I going to meet friends for drinks after work?’
“One interesting thing about gender is that women are able to identify that they have that critical inner voice,” Bandy said. “That voice is not gender specific. I found our study interesting that the women identified it as something that is a trigger for them.”
The concept of having to “hit bottom” before seeking treatment can also be a dangerous exercise for women given the physiological differences in metabolism of drugs and alcohol. “Externally motivated people actually do better in treatment — people who have something to get sober for. They don’t want to lose family. Lose jobs. They are on probation. Those people have better results,” Bandy said, also noting that group therapy, for which women generally gravitate more toward than men, is more effective.
“Group therapy has the highest rate of efficacy for substance abuse treatment. Makes sense. We live, thrive and exist in systems. Group therapy offers us a chance to be part of a system,” he said.
“When people drink heavily they get depressed,” Salloum said. “Heavy drinkers, 80 percent would tell you they are depressed and 30 percent might have clinical depression when you ask in a more structured way. Clinical depression, independent from alcohol, does improve when you get away from drinking, but the depression still needs to be treated.”
Medications, in pill form and injections, that block the opioid endorphins in our systems that lead to cravings are among the treatment options, as well as therapy at recovery centers and ongoing, post-treatment counseling.
Other triggers to recognize and circumvent include surrounding stigmas — ‘Now I’m an addict in recovery. How will I be seen at my place of employment and seen by my peers? How can I go out with my friends? What can I say?’
Said Bandy: “An informed population just understands and tolerates people and accepts them for who they are.”
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