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New Book Examines Why Women Abuse Drugs

WASHINGTON, February 9, 2006 – Compared to boys and men, girls and women become addicted to alcohol, nicotine and illegal and prescription drugs, and develop substance-related diseases at lower levels of use and in shorter periods of time, according to Women Under the Influence, a new book by The National Center on Addiction and

Substance Abuse (CASA) at Columbia University.  The 292-page book, the first of its kind and the product of 10 years of research funded by the Bristol-Myers Squibb Foundation, is being published by The Johns Hopkins University Press.

The book, an exhaustive analysis of substance abuse among girls and women, reveals that 15 million girls and women use illicit drugs and misuse prescription drugs, 32 million smoke cigarettes and six million are alcohol abusers and alcoholics.  

“Our failure to confront the special needs of girls and women with substance abuse problems is inexcusable.  The one size fits all prevention and treatment approach, largely driven by male substance abuse, has condemned millions of girls and women to tragic episodes of abuse and addiction that have ruined too many lives,” said Joseph A. Califano, Jr., CASA’s chairman and president and former U.S. Secretary of Health, 
Education and Welfare.  “This book reveals that substance abuse affects all kinds of women–rich and poor, young and old, urban and rural, professional and homemaker.”

“Women Under the Influence is a call to lift the stigma that keeps so many women from seeking help,” said Peter R. Dolan, a CASA board member and chief executive officer of Bristol-Myers Squibb Company.  “It provides a template for parents, healthcare professionals, teachers, and public officials to recognize the special needs of girls and women and take action to address those needs.”

Women Under the Influence finds that at similar or lower levels of use, women develop more rapidly than men alcohol-related diseases like cirrhosis and hypertension, brain damage from alcohol abuse and Ecstasy, lung cancer and respiratory diseases like emphysema and chronic bronchitis from smoking.  Women are likelier to develop depression, anxiety and eating disorders which are closely linked to smoking and alcohol and drug abuse.  Women who use sedatives, anti-anxiety drugs and hypnotics are almost twice as likely as men to become addicted to such drugs.

Because their bodies contain less water and more fatty tissue and because of decreased activity of the enzyme (ADH) that breaks down alcohol, one drink for a woman commonly has the impact of two drinks for a man.  Moderate or heavy drinking increases the risk of breast cancer.  Among alcohol abusers, older women suffer memory loss and mental deterioration after fewer years of drinking than older men.

A single cigarette smoked by a woman has nearly the same carcinogenic effect as two smoked by a man.  Girls exhibit symptoms of nicotine dependence more rapidly than boys.  Among smokers, women develop more severe respiratory diseases than men.  Smoking while using oral contraceptives increases the risk of heart disease.  Smoking in early adolescence increases the risk of breast cancer.

Why Women Abuse Substances

Girls and young women are likelier than boys and young men to abuse substances in order to lose weight, relieve stress or boredom, improve their mood, reduce sexual inhibitions, self-medicate depression, and increase confidence. 

Women in substance abuse treatment are more than five times likelier than men (69 percent vs. 12 percent) to have been sexually abused as children and girls and women are likelier than men to suffer eating disorders, both of which are major risk factors for substance abuse. 

Women are more likely than men to say their heavy drinking followed a crisis, such as miscarriage, divorce, unemployment or recent departure of a child from the home.  Older women are likelier than older men to self-medicate with alcohol and prescription drugs in order to deal with loneliness, financial insecurity or loss of a spouse.

Closing the Gender Gap

Women Under the Influence reveals that for girls, the substance abuse gender gap has closed.  High school girls drink, smoke and use illegal drugs as much a their male classmates.  Misuse of controlled prescription drugs such as painkillers, tranquilizers, stimulants and sedatives is higher among girls (14.1 percent) than boys (12.8 percent). 

The gender gap remains significant, but is beginning to close when it comes to alcohol-related fatal car crashes: from 1977 to 2000, there was a 13 percent increase in the number of women drivers involved in such crashes, compared to a 29 percent decrease for male drivers.

“The most powerful force in dealing with this health problem will be women armed with knowledge about the gender differences in substance abuse,” said Susan Foster, CASA’s vice president and director of policy research and analysis, who directed the research efforts that produced Women Under the Influence.  “At the same time, we can no longer tolerate a lack of training and knowledge about substance abuse and women among health care professionals.” 

Different Pathways for Different Ages

A woman’s path to substance abuse and addiction is influenced by genetic factors, friends, family history, availability of substances and marketing of tobacco, alcohol and prescription drugs.  Women Under the Influence traces the different pathways to substance abuse among women at various stages of life.  For example:

• Girls and young women from the ages of eight to 22 face increased risk during early puberty and transitions to middle school, high school and college. 

• Adult women from 23 to 59 years of age face increased risk experiencing divorce, the burden of caring for elderly parents, and concerns about the effects of aging.

• Mature women 60 years of age and older face increased risks in circumstances such as an empty nest, debilitating illness, financial insecurity, loss of a husband and depression.

Racial/Ethnic Differences

Women Under the Influence discloses that substance abuse among women varies by race and ethnicity.  White women are likelier to drink (51 percent) than Hispanic (36 percent), black (33 percent) or Asian (30 percent) women.  White women also are more likely to abuse prescription drugs (20 percent) than Hispanic (13 percent), black (12 percent) or Asian (eight percent) women.  Rates of illicit drug abuse and addiction are higher for black women (1.8 percent) than for white (1.1 percent), Asian (0.7 percent) or Hispanic (0.6 percent) women. 

Physician Failure

Physicians are less likely to consider and diagnose addiction in women than in men, and women are 48 percent likelier to be prescribed narcotic, anti-anxiety or other mood altering drugs (even though women who use such drugs are twice as likely as men to become addicted to them).  Presented with a description of early alcoholism in a 60-year-old woman, only one percent of physicians offered the correct diagnosis.  More than 40 percent of pediatricians fail to diagnose drug abuse among girls.  Pediatrician screening for adolescent substance use is uncommon.  Even when physicians do such screening, they are unlikely to provide guidance to their young patients.

Only eight percent of women requiring treatment receive it, leaving eight million women in need of treatment without it.  Only 38 percent of treatment facilities have programs tailored to the unique needs of women, and only 19 percent have programs for pregnant or post-partum women.

Women Under the Influence makes a number of recommendations to address the needs of women covering parental education, training of healthcare professionals and educators, marketing of tobacco and alcohol products, and insurance coverage of substance abuse screening and treatment.

The Bristol-Myers Squibb Foundation works to create meaningful and sustainable improvements in the health and education of people around the world, through partnerships and innovations that actively fulfill the company mission – to extend and enhance human life.  It provides funding and mobilizes company expertise for programs in women’s health, biomedical research, science education, global HIV/AIDS, health education, and product donation.

CASA is the only national organization that brings together under one roof all the professional disciplines needed to study and combat all types of substance abuse as they affect all aspects of society.  CASA has issued 59 reports and white papers, has conducted demonstration projects focused on children, families and schools at 131 sites in 57 cities and counties in 26 states, and has been testing the effectiveness of drug and alcohol treatment, monitoring 15,000 individuals in more than 200 programs and five drug courts in 26 states.  CASA is the creator of the nationwide Family Day initiative – the fourth Monday in September – that promotes parental engagement as a simple and effective way to reduce children’s risk of smoking, drinking and using illegal drugs.  To become a CASA member, please visit www.casacolumbia.org and click “Become a Member” or send an e-mail to membership@casacolumbia.org for more information.

Women Under the Influence
The National Center on Addiction and Substance Abuse at Columbia University
foreword by Joseph A. Califano, Jr.
312 pages 6 x 9  Publication date:  February 9, 2006
0-8018-8227-3 $50.00 hardcover
0-8018-8228-1 $20.00 paperback