Academic journal article Indian Journal of Psychiatry

Substance Use in Women: Current Status and Future Directions

Academic journal article Indian Journal of Psychiatry

Substance Use in Women: Current Status and Future Directions

Article excerpt

Byline: Rakesh. Lal, Koushik. Deb, Swati. Kedia

Alcohol and substance use, until recently, were believed to be a predominantly male phenomenon. Only in the last few decades, attention has shifted to female drug use and its repercussions in women. As the numbers of female drug users continue to rise, studies attempt to understand gender-specific etiological factors, phenomenology, course and outcome, and issues related to treatment with the aim to develop more effective treatment programs. Research has primarily focused on alcohol and tobacco in women, and most of the literature is from the Western countries with data from developing countries like India being sparse. This review highlights the issues pertinent to alcohol and substance use in women with a special focus to the situation in India.

Introduction

Psychoactive substance use, until recently, has largely been perceived as a male problem and research, as a result, has been largely androcentric and insensitive to gender variations. Historically, women using substance have always been frowned upon. Rules on acceptability dates back as far as laws of Hammurabi [sup][1] in the west and the Manusmriti in India which states that, " a wife who drinks wine … may be abandoned at any time ." [sup][2] Only around the mid 1970s, partly prompted by the then ongoing women's liberation movement, institutes like the National Council on Alcoholism and Drug Dependence and National Institute on Alcohol Abuse and Alcoholism started making efforts to garner scientific and public attention on gender issues. [sup][3] Subsequently, with the feminization of HIV epidemic and the obvious role of drug use in catalyzing its spread, focus on women and substance use became necessary.

Worldwide, alcohol use in women has received the widest attention. While problems related to illicit substance use and their treatment mirror the issues related to alcohol use in many ways, important differences also do exist, warranting need for independent research. The singular theme that cuts across any substance use in women in any country, however, is the intense stigma suffered by these women, which acts as a significant barrier to treatment and encourages the victimization of drug using women. [sup][2] This review attempts to highlight such problems unique to substance using women, as knowledge of such issues is necessary for developing effective services and planning appropriate interventions. [sup][4]

Epidemiology

Gender differences in substance use have been consistently observed in the west, in general population as well as in the treatment-seeking samples, with men exhibiting significantly higher rates of substance use, abuse, and dependence. [sup][5],[6] The National Epidemiologic Survey on Alcohol and Related Conditions (NESARC; n = 43,093) conducted in the US reported that men were 2.2 times more likely than women to have abused various substances and 1.9 times more likely to have substance dependence. [sup][6] Data from the National Household Survey on Drug Abuse (NHSDA) in 2000 from US similarly showed that 5% of women, as compared to 7.7% men, presently used illicit substances. However, studies suggest that in the last couple of decades, this gender gap has narrowed. [sup][7] Compared to the surveys of 1980s that reported 5:1 male/female ratio of alcohol-use disorders, [sup][8] the ratio dropped to approximately 3:1 in a 2007 survey. [sup][9] Further, in a recent 2012 study amongst 41.5 million illicit drug users, more than 42% were women, suggesting a male/female ratio of 1.4:1 at the present time. [sup][10] In case of prescription drug abuse, several studies actually report their use to be higher in women than men, particularly for narcotic analgesics and tranquilizers. [sup][11] Other alarming features brought to light by the NHSDA include the fact that rates of substance use were almost similar between girls and boys in the age groups of 12-17 years (9. …

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