Are There Differences Between Men and Women in Addiction?
Table of Contents
- Stage of Drug Use
- Menstrual Cycle
- Alcohol
- Nicotine
- Methamphetamine and Cocaine
- Opioids
- Heroin
- Marijuana
- MDMA (Ecstasy, Molly)
- Summary
- Treatment
There are a lot of things that can differentiate the effect of illicit drugs and addiction in different people. Up until the 1990’s, drug abuse was only studied in men. Thus, the field had a lot of catching up to do in terms of studying the effects on women. Biologically, males and females work in different ways, and so it follows that they would respond in different ways to drug use too. It should be noted that social and cultural aspects are an important factor too in how drug use affects the male and female genders differently. It is because of these differences that females may face many difficulties that males do not. This is not to say that both genders don’t experience their own sets of challenges.
1. Stage of Drug Use
First, there are differences in the way males and females experience the different stages of drug use. The associated stages are:
- Initiation – Drug is first tried
- Escalation – Drug use is ramped up in terms of amount and frequency of use
- Maintenance – Addictive behavior established
- Withdrawal / Abstinence – Drug use is halted
- Relapse – Drug use resumed after period of not using
For males, the social aspect of belonging may be the greatest factor that influences the initiation stage, where taking risks is elevated in order to fit in with their group. For females, they are more likely to have been prescribed drugs as their first time, especially with painkillers, as women historically have been perceived to experience pain greater than men, whether it be because they are more likely to report it than men due to sociological factors, or because of biological factors that may make them more susceptible in some cases. Women are also more likely to self medicate with drugs.
At the escalation phase, women tend to ramp up drug use quicker than men and are more susceptible to becoming addicted than men.
Women stabilize at a higher maintenance dose than men do and they also experience the negative side effects to a greater degree than men.
While at the abstinence phase, different drugs have different effects on withdrawal symptoms for each sex. For example, men experience greater withdrawal symptoms for alcohol, while for women, the negative affect from nicotine withdrawal is greater.
Should relapse occur, women are more susceptible to this happening, while men typically abstain longer than women.
2. Menstrual Cycle
For women, there’s an extra factor that plays into their response to drugs. As in drug addiction, there are also different stages of menstruation that affect the body’s response to drugs. This appears to be most prominent in the initiation stage where the effects of the drug may be felt more intensely depending on the stage of menstrual cycle a woman is in. The stages are:
- Follicular – follicle develops in ovary and hormone, estradiol, increases (10-12 days)
- Periovulatory – estradiol causes release of luteinizing hormone leading to ovulation (2-4 days)
- Luteal – estradiol and progesterone initially released in high concentrations (10-12 days)
Menstruation happens towards the end of the luteal phase, where concentrations of hormones start tapering off, unless there is a pregnancy.
The ovarian hormones, estradiol and progesterone, are able to move into the brain easily, and as such, can interact with any drugs taken.
When concentrations of estradiol are high during the follicular phase, amphetamine and cocaine can have more intense effects, as compared to luteal phase. Thus, in the 10-12 days after menstruation, a woman may be more susceptible to becoming addicted to these drugs, taking them faster into the escalation phase of drug use.
On the other hand, alcohol use was also found to be higher during the “premenstrual” phase in women.
Some studies also suggest it’s harder to quit smoking during the luteal phase. It may be best to start the abstinence phase during the follicular stage, which occurs 10-12 days after menstruation.
In summary, the menstrual cycle seems to highly affect the initiation phase, ramping up the speed of addiction. No significant effects have been found to this end once regular maintenance dosing was reached. However, there are implications for when one should set their quit date for certain drugs.
3. Alcohol
In the United States, the rates of alcohol abuse are high, with 22% of males and 13% of females binge drinking in 2019. However, the gender differences in alcohol addiction seem to be waning over time as alcohol consumption has become more socially acceptable for females in modern times.
Here, women are more likely to become addicted faster, as well as incurring damage to the liver and brain faster than men.
Treatments such as psychotherapy, medication, and groups all seem to work equally effectively for both males and females, with co-ed programs performing similarly to female-only programs. However, it has been seen that females are not as likely as males to start treatment, which could be due to various sociocultural factors that lead to stigmas.
4. Nicotine
In 2019, around 34.1 million American adults reported being cigarette smokers, with about 15% being males and 13% being females.
Women are more susceptible to the negative health effects of smoking than men, with a higher chance of getting lung cancer, and double the chance of getting a heart attack as men. They also find it harder to quit than men, and are more likely to relapse too.
Some studies suggest that for women, environmental triggers may give them cravings (such as drinking alcohol at the same time), while men are more affected biologically than environmentally. This has implications for treatment, with evidence that nicotine replacement therapy might not be as effective for women as men.
Thus, for women, the nicotine patch does not work as well as for men.
However, certain medications that don’t involve nicotine-replacement, such as varenicline (Chantix) and bupropion (Zyban) seem to work equally well for both men and women.
A combination of counseling and medication will increase the chances of quitting for both men and women. Treatments such as CBT may help.
It should also be noted that quitting smoking is most effective during the follicular stage of menstruation (10-12 days after menstruation) and least effective during the luteal phase (the 10-12 day period including and prior to menstruation).
5. Methamphetamine and Cocaine
Stimulants like methamphetamine and cocaine are equally likely to be used by both sexes. However, women are more likely to ramp up use from initiation into dependency than men, especially during the 10-12 days following menstruation, in addition to being more prone to relapse.
Men, on the other hand, do not seem to experience notable changes based on levels of testosterone or estrogen and other sex hormones in their system.
Environmental cues may play a part in triggering cravings here too, moreso for women than men, which may have implications for treatment methods that have a psychological component for women.
6. Opioids
Women are more likely to be prescribed opioids for a multitude of reasons. One of them being, women are more susceptible to having chronic pain conditions like fibromyalgia, as well as women being more prone to reporting pain.
Little research has been done on the differences between the sexes in opioids, but treatment is available.
7. Heroin
This is in the opioid class of drugs, though not one that is prescribed. Thus, the social implications of its usage, especially in the initiation stage are different. For heroin, females are more likely to have been introduced to it by a sexual partner injecting them, while males are more likely to have had a friend inject them for the first time.
Women also tend to use smaller amounts for a smaller amount of time, and are less prone to injecting it.
8. Marijuana
Males are more likely than females to be diagnosed with Cannabis Use Disorder. However, females are more likely to ramp up use faster and experience more intense withdrawal symptoms.
9. MDMA (Ecstasy, Molly)
MDMA causes stronger highs and hallucinations in women, as well as causing depression more frequently on the comedown for them. On the flip side, men may experience larger blood pressure increases.
Estrogen, which is high during the mid-follicular and mid-luteal phases of the menstrual cycle, plays a role in increasing the stimulant effects of MDMA. Estrogen levels drop after ovulation and towards the end of the menstrual cycle though.
Progesterone plays a complex role as well in moderating the response of females to MDMA. However, the exact effects and associated risks are unclear and more research is needed.
10. Summary
In general, the differences between the genders are as follows:
For Females:
- More likely to have been prescribed painkillers the first time
- More likely to self-medicate
- Tend to escalate use quicker
- More at risk for getting addicted
- Stabilize at higher maintenance dose
- Experience greater negative affect from nicotine withdrawal
- More susceptible to relapse
- Added layer of complications due to menstrual cycle
For Males:
- Sociocultural norms lead men to take more risks, which increases chance of initial use
- Not as likely to self-medicate
- Don’t escalate as quickly
- Less at risk getting addicted
- Stabilize at lower maintenance dose
- Experience greater withdrawal effects for alcohol
- Less susceptible to relapse, longer abstinence times
- Don’t seem to be affected by sex hormones (male or female)
11. Treatment
While each drug has its own unique set of challenges that may differ between the sexes, a variety of care and treatment for substance abuse are available. At New Choices, we take a holistic approach to recovery and take into account the many individual differences between people to come up with the right treatment plan for you.
