Alcohol use disorder, substance use disorder, and addiction
Using drugs illegally and drinking too much alcohol can affect your mental health, physical health, and relationships. Some people who misuse alcohol or drugs become addicted. Addiction is a disease of the brain, but it can be treated. Women may have a harder time quitting certain substances. Women may also need help with resources for child care or elder care when trying to get treatment for alcohol or substance use disorders.
What is addiction?
Addiction is a disease that is based in the brain. It is long lasting and can come back again and again. People with addictions use illegal drugs or misuse prescription drugs, alcohol, or tobacco, even though doing so can cause problems in their lives.
Drug or alcohol use changes the way the brain works over time. This can affect a person’s self-control and ability to make healthy decisions. At the same time, drugs and alcohol cause the brain to create intense cravings, similar to the need for food every day. Most people need treatment and support to stop misusing drugs or alcohol.
What causes alcohol use disorder, substance use disorder, or addiction?
Whether you become addicted to alcohol or other substances can depend on your environment and genetics.
Your environment, including whether you had friends or family who misused drugs or alcohol, can affect your risk of becoming addicted. Children who are abused are more likely to have problems with alcohol, drugs, or tobacco as adults.1,2
Once you start misusing drugs or alcohol, your genetics can play a role in how quickly you become addicted. The chemicals in drugs and alcohol also change the brain and make a person more likely to use them again.3
What is alcoholism or alcohol use disorder?
Alcoholism is also called alcohol use disorder. Alcohol use disorder is a medical diagnosis from a doctor. Alcohol use disorder is a condition in which a person cannot control how much alcohol she drinks. The condition also causes distress or harm in your life.
Alcohol use disorder is chronic, or lifelong, and it can get worse over time and be life threatening. It is a condition that happens in the brain.
How is alcohol use disorder diagnosed?
If you can answer yes to at least two of the following questions, you may have an alcohol use disorder.4 The more questions you answer yes to, the more serious your alcohol use disorder may be.
In the past 12 months, have you:
Ended up drinking more or longer than you meant to?
Wanted to cut down on or stop drinking or tried to but found you couldn’t?
Spent a lot of time drinking, being sick from drinking, or experiencing other side effects from drinking?
Wanted to drink so badly you couldn’t think of anything else?
Had trouble at home, work, or school because of drinking or being sick from drinking?
Continued to drink even though it caused problems with friends or family?
Cut back on activities or hobbies that you liked in order to spend time drinking?
Gotten into a dangerous situation as a direct result of your drinking (such as driving while drunk or having unsafe sex)?
Kept drinking despite feeling that it was making you depressed or anxious?
Had a memory blackout?
Had to drink a lot more to get the same effect?
Found that when you weren’t drinking, you had withdrawal symptoms, like shakiness, trouble sleeping, or nausea?
It is possible to misuse alcohol but not have alcohol use disorder, such as by occasional binge drinking. Binge drinking is also harmful to your health. Alcohol use disorders can also be mild, moderate, or severe.
How common is alcohol use disorder among women?
No one factor can predict whether a woman will have trouble with alcohol. Women who are or have been abused are more likely to develop an alcohol use disorder.5
About 15 million people in the United States have an alcohol use disorder, including nearly 8 million women.6
Alcohol use can start early in life. In one survey, more than 1 in 5 girls and teens ages 12 to 20 said they’d had a drink in the past month.6
Lesbians and bisexual women (especially young women) are at higher risk for drug abuse, heavy drinking, and binge drinking than other women are.7,8
Among women who drink, 13% have more than seven drinks per week.9 According to a recent survey, binge drinking is also on the rise in older women.10 Drinking 4 or more drinks on any given day or drinking more than 7 drinks in a week raises a woman’s risk of developing alcohol use disorder.
How does alcohol abuse or misuse affect women?
Men are more likely than women to misuse alcohol and have alcohol use disorder, but women are more likely to experience harmful health effects from alcohol. Women absorb more alcohol pound for pound than men, and it takes longer for women’s bodies to digest alcohol.
Women who drink while pregnant also put their babies at risk for fetal alcohol spectrum disorder (FASD), which can cause serious problems for the baby during and after pregnancy. FASD can cause physical, mental, and behavioral disabilities. There is no amount of alcohol that has been proven safe to drink during pregnancy.
Alcoholic liver disease. Women are more likely than men to develop liver inflammation (alcoholic hepatitis) and to die from cirrhosis (chronic liver disease).11
Brain disease. Alcoholism can cause diseases of the brain, such as dementia and memory loss, by changing how your cells work or by damaging brain cells.12
Cancer. Alcohol can cause several different types of cancer, including breast cancer. The more alcohol you drink, the higher your risk of a cancer caused by alcohol. Just one drink a day can increase your risk of breast cancer by 5% before menopause and 9% after menopause.13
Heart disease. Long-term, heavy drinking is a leading cause of heart disease.
Osteoporosis. Long-term, heavy drinking, especially during adolescence or young adulthood, greatly weakens bones, increasing the risk of a broken bone later in life.14
Substance use disorder (sometimes called substance abuse) happens when a person’s use of certain drugs or other substances, including alcohol and tobacco, causes health problems or problems at work, school, or home.
Women who misuse alcohol or drugs are more likely to experience harmful effects of substance abuse, including overdose,15 and may also get addicted to drugs and alcohol more quickly than men.16
How common is prescription drug abuse among women?
Nearly 27 million U.S. women (about 13%) have used illegal drugs or misused prescription drugs in the past year.17
Women often abuse prescription drugs for different reasons than men do. Two common reasons women misuse prescription drugs are to lose weight and to fight exhaustion.18 Women also report higher rates of chronic pain and are more likely to be prescribed pain medicine than men are.19
Prescription drug misuse among women is on the rise. According to the Centers for Disease Control and Prevention:19
From 1999 to 2015, deaths from prescription painkiller overdoses increased more than twice as fast among women as among men.20
Each day, about 18 women die of prescription drug overdose.
For every woman who dies of a prescription painkiller overdose, 30 go to the emergency department for painkiller misuse or abuse.
If you or someone you know misuses prescription drugs, get help right away.
Who is at risk for alcohol use disorder or substance use disorder?
A woman is more likely to misuse alcohol or drugs if she experiences:21,22
Parents and siblings with alcohol or drug problems
A partner who drinks too much or misuses drugs
Needing more and more of a drug or alcohol to get the same high
A history of depression
A history of childhood physical or sexual abuse
How can I tell if I have a problem with alcohol or drugs?
Answering the following questions can help you find out whether you or someone close to you has a problem with drinking or drugs.9
Have you ever felt that you drink too much and should cut down?
Have you ever felt bad or guilty about your drinking?
Have you ever had a drink as soon as you woke up to steady your nerves or to get rid of a hangover?
Have you ever used a drug for non-medical reasons?
Has using drugs or alcohol created problems for you at home or at work?
Does your family or friends complain about your drug or alcohol use?
Have you gotten in fights or broken the law because you were on drugs or drunk?
Do you continue to use drugs or alcohol even though you know it’s harmful?
One “yes” answer suggests a possible problem. If you responded yes to more than one question, it is very likely that you have a problem. Talk to a doctor, nurse, or mental health professional as soon as possible. You may need to talk to a psychiatrist, psychologist, or substance abuse counselor. Your doctor may also want to test your blood or urine to help design a treatment program for you.
How is alcohol use disorder treated?
Treatment for an alcohol use disorder depends on how severe it is. Talk to your doctor or nurse about how much you drink. Your doctor or nurse can help find the ways alcohol negatively affects your life and can help you make a plan to stop.
Treatment for alcohol use disorder can include counseling, behavior therapy, and medicine. Some people may need to stay at a treatment center (including sleeping there). Many people also attend support groups, such as Alcoholics Anonymous, to talk to others and get support from people who have had similar problems in the past.
After treatment, some people stop drinking and stay sober. Others have periods of being sober but then start drinking again and may need treatment again. You can get better with treatment and support.
How are substance use disorder and addiction treated?
Treatment for substance use disorder and addiction are often the same. Treatments usually include:
Medicine and behavior therapy, used alone or together
Detoxification treatment, which tries to wean you off the substance as quickly and safely as possible while dealing with withdrawal symptoms
Help from a social worker, caseworker, or other professional to help you change any life circumstances, such as unemployment, that may affect your recovery
Severe substance use disorder and addiction usually — but not always — require staying (and sleeping) at a treatment center.
Some people have a substance or alcohol use disorder or addiction in addition to another mental health condition (such as depression and anxiety). This is common and is often called a co-occurring disorder. Your doctor, nurse, or therapist may recommend treating both disorders at the same time. Tell your doctor, nurse, or a mental health professional about all the symptoms you are experiencing so they can create the best treatment plan for you.
How is treatment for women different from treatment for men?
Although women usually use drugs less often and in smaller amounts than men do, by the time women get treatment, they often have worse symptoms. This is because drugs and alcohol affect women and men differently. Women are more likely to become addicted to drugs or alcohol with smaller amounts of those substances.23
Women may also have a harder time quitting certain substances, especially tobacco products. Women’s bodies process the chemicals in tobacco differently from men’s. Women are not as likely to be successful at quitting tobacco by using a nicotine patch or gum.24Learn about ways to quit smoking, including expert advice and tips from other women, at women.smokefree.gov.
Women may also face unique barriers to getting treatment for drug and alcohol problems. Women may be pregnant or breastfeeding and unwilling to tell someone that they are addicted, because they fear losing custody of their child. Women may be more likely to face additional barriers to treatment, such as needing child care or elder care.
Did we answer your question about alcohol use disorder, substance use disorder, and addiction?
For more information about alcohol use disorder, substance use disorder, and other types of addiction, call the OWH Helpline at 1-800-994-9662 or check out the following resources and organizations:
The Office on Women's Health is grateful for the medical review 2016 by:
The National Institute of Mental Health (NIMH)
The Substance Abuse and Mental Health Services Administration (SAMHSA)
Danielle Johnson, M.D., FAPA, Psychiatrist, Medical Staff President, Chief of Adult Psychiatry, Director, Women’s Mental Health Program, Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati
Cassidy Gutner, Ph.D., Assistant Professor, Department of Psychiatry, Boston University School of Medicine; National Center for PTSD, Women’s Health Sciences Division, VA Boston Healthcare System, U.S. Department of Veterans Affairs
Mark A. Lumley, Ph.D., Professor and Director of Clinical Psychology Training, Department of Psychology, Wayne State University, and his Stress and Health Laboratory team: Jennifer Carty, Heather Doherty, Hannah Holmes, Nancy Lockhart, and Sheri Pegram
Mark Chavez, Ph.D., Chief, Eating Disorders Research Program, NIMH
Kamryn T. Eddy, Ph.D., and Jennifer J. Thomas, Ph.D., Associate Professors of Psychology, Department of Psychiatry, Harvard Medical School; Co-Directors of the Eating Disorders Clinical and Research Program, Massachusetts General Hospital
Kendra Becker, M.S., Clinical Fellow in Psychology, Department of Psychiatry, Massachusetts General Hospital
Michael Kozak, Ph.D., Division of Adult Translational Research and Treatment Development, NIMH
Alicia Kaplan, M.D., Assistant Professor of Psychiatry, Temple University School of Medicine and Drexel University College of Medicine, and Staff Psychiatrist, Division of Adult Services, Department of Psychiatry, Allegheny Health Network, Allegheny General Hospital
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