Substance Use in Women Research Report

People may face unique issues when it comes to substance use, as a result of both sex and gender. Sex differences result from biological factors, such as sex chromosomes and hormones, while gender differences are based on culturally defined roles for men and women, as well as those who do not identify with either category. Gender roles influence how people perceive themselves and how they interact with others.1,2 Sex and gender can also interact with each other to create even more complex differences among people. While the NIH is working to strengthen research on sex/gender differences across domains of health, current evidence is limited; for the purpose of this report, male and female subjects identify as such across both sex and gender.

Examples of Sex and Gender Influences in Smoking Cessation

Sex Difference: Women have a harder time quitting smoking than men do. Women metabolize nicotine, the active ingredient in tobacco, faster than men. Differences in metabolism may help explain why nicotine replacement therapies, like patches and gum, work better in men than in women. Men appear to be more sensitive to nicotine's pharmacologic effects related to substance use disorder.

Gender Difference: Although men are more sensitive than women to nicotine's addiction-related effects, women may be more susceptible than men to non-nicotine factors, such as the sensory and social stimuli associated with smoking (e.g. greater sensitivity to visual and olfactory cues as triggers and greater concern about weight gain while quitting).

Sources: ORWH, 2015; NIDA, 2002

For example, women and men sometimes use drugs for different reasons and respond to them differently. Additionally, substance use disorders can manifest differently in women than in men. A substance use disorder occurs when a person continues to use drugs or alcohol even after experiencing negative consequences.

Some of the unique issues women who use drugs face relate to their reproductive cycles. Some substances can increase the likelihood of infertility3–5 and early onset of menopause.6 Substance use is also further complicated during pregnancy and breastfeeding. Pregnant women using drugs, including tobacco and alcohol, can pass those drugs to their developing fetuses and cause them harm. Similarly, new mothers using drugs can pass those to their babies through breast milk and cause them harm. (See Substance Use While Pregnant and Breastfeeding)

Unfortunately, it can be difficult for a person with a substance use disorder to quit, and some women with such disorders fear that seeking help while pregnant or afterward could cause them legal or social problems. Communities can build support systems to help women access treatment as early as possible,7 ideally before becoming pregnant. If a woman is unable to quit before becoming pregnant, treatment during pregnancy improves the chances of having a healthier baby at birth.8,9

Women, pregnant or not, have unique needs that should be addressed during substance use disorder treatment. Effective treatment should incorporate approaches that recognize sex and gender differences, understand the types of trauma women sometimes face, provide added support for women with child care needs, and use evidence-based approaches for the treatment of pregnant women.10 (See Sex and Gender Differences in Substance Use Disorder Treatment)

Despite the many differences between men and women, for many years most animal and human research has traditionally used male participants. To find out more about sex and gender differences to inform better treatment approaches, federal agencies have developed guidelines to promote the inclusion of women and analyses of sex and gender differences in research.11,12 (See The Importance of Including Women in Research)