The patterns, consequences, and reasons that women abuse alcohol and other drugs differ from those of men. This article reviews such male-female disparities by focusing on selected studies of alcohol, marijuana, cocaine, and opiate use among women. Given existing variations in the research methods used in these studies, it is necessary to acknowledge certain caveats when interpreting the findings. For example, definitions of terms such as "heavy use" may shift over time; definitions of terms such as "alcohol abuse," "alcoholism," "drug use," and "drug abuse" may differ from study to study.(1)
In addition, although men and women may exhibit different profiles of alcohol and other drug use, studies often do not include issues pertinent to women, such as effects of these substances on the menstrual cycle or on pregnancy, when they address issues important for men. More regrettably, in some cases, studies may include data that are obtained from both women and men, but the results are not differentiated by gender (Mello 1983; Mello et al. 1989; Lex 1987).
THE SCOPE OF ALCOHOL AND OTHER DRUG ABUSE
In general, men consume more alcohol or use illicit (i.e., illegal) drugs more than do women. However, information about people in treatment for abuse of alcohol and other drugs has shown that although proportionately more men abuse alcohol, a higher proportion of women abuse other drugs (figure 1). (Figure 1 omitted) In a survey of treatment facilities, alcoholism was diagnosed in fewer women (38.2 percent) than men (47.9 percent); other drug problems were diagnosed in more women (36.4 percent) than men (26.7 percent); and both alcohol and other drug problems were diagnosed with the same frequency in women and men (25 percent) (Substance Abuse and Mental Health Services Administration [SAMHSA] 1993). Although it might have been predicted that more men than women would have alcohol problems, the finding that equal proportions of women and men have sought treatment for concurrent problems with alcohol and illicit drugs was unexpected. The higher proportion of women than men in treatment for illicit drug abuse also was surprising.
Women in treatment for alcoholism frequently have been found to abuse one or more other drugs as well. Compared with their nonalcoholic peers, alcoholic women in one study (Gomberg 1989) reported having used more cocaine (29 percent versus 16 percent), heroin (8 percent versus 1.5 percent), or marijuana (53 percent versus 50 percent). The youngest alcoholic women (ages 20 to 29) typically reported using combinations of alcohol and illicit drugs, whereas the older alcoholic women (in their late thirties and forties) were more likely to use alcohol along with medications, mainly tranquilizers, prescribed by a physician. Accordingly, issues of multiple substance abuse should be considered when planning treatment facilities to meet women's needs and when obtaining substance abuse histories from women seeking help for abuse problems.
SURVEY DATA OF ALCOHOL AND OTHER DRUG USE
Household Survey Data
The national household surveys, initially conducted by the National Institute on Drug Abuse (NIDA) and now by SAMHSA's Office of Applied Studies, are conducted at 1- to 3-year intervals and are intended to provide estimates of the prevalence of alcohol, tobacco, and illicit drug use among the civilian U.S. population ages 12 and older. The 1992 survey interviewed almost 29,000 persons in groups of 118 sampling units (geographically based areas that include households, college dormitories, and homeless shelters) but did not interview transient populations such as homeless people not living in shelters.
Alcohol Use. Among the vast majority of survey respondents over age 12 who had used alcohol at least once during their lifetime, slightly more were male (NIDA 1993) (table 1). (Table 1 omitted) This pattern also was true for the approximately two-thirds of respondents who had used alcohol during the previous year and the one-half who had used it during the previous month. …