Although there are some commonalities between women's and men's use of substances, there are also a number of differences (for example, rates of use for various drugs, biological impacts, risk factors, nature of substance use problems, and recommended responses). Women are less involved with substances than their male counterparts in the general population on most indicators. These differences warrant a separate discussion of women's substance use issues.
Alcohol
The percentage of women who have had at least one drink in the past 12 months is related to age. Women are most likely to be drinkers in the 20-24 age range (85%) and least likely in the over-65 period (58%). At all ages, including the high school years, women are less likely to be drinkers than men, and are significantly less likely to be regular drinkers. They drink appreciably less on a weekly basis and are much less likely to report regular heavy drinking than men. However, the proportion of women doing so increased through the mid-'90s, and this trend was most pronounced among young women 20-24. It is important to bear in mind that women have a lower threshold for the effects of alcohol. Consequently, researchers will often, but not always, consider binge or heavy drinking to be four standard drinks during one occasion for women, rather than the five universally applied. Aboriginal women are more likely than men or than non-Native women to abstain from alcohol. However, when they do drink, they are more likely to drink heavily.
Women are much less likely than men to report driving after drinking. Although a safe level of alcohol use during pregnancy has not been determined, pregnant women considered at risk for FASD are those consuming more than five drinks on one occasion and/or more than seven drinks a week. Among Canadian women, 17-25% report drinking alcohol at some point during a pregnancy, and of those, less than 3% reported drinking five or more drinks on any occasion. Physical dependence on alcohol has negative effects on female reproductive health, including amenorrhea, anovulation, luteal dysfunction, ovarian atrophy, spontaneous abortion, and early menopause.
Tobacco
In all age groups, aside from adolescence, more men smoke than women. About one-third of women smokers smoked during their last pregnancy. Smoking while pregnant becomes less prevalent with age, but the amount smoked increases.
Prescribed medicines
This includes pain pills, sleeping pills, tranquillizers, diet pills, and anti-depressants. A larger proportion of women than men report using at least one mood-altering medicine (23% versus 17%). Between 1985 and 1994, there was a general downward trend in the use of prescribed tranquillizers and sleeping pills that was more pronounced for women. However, this downward trend appears to have halted in the case of women, and the percentage reporting past-month use of selected non-prescription and prescription drugs increased from 1996-97 to 1998-99 in all categories (tranquillizers, antidepressants, pain killers, and sleeping pills), with the exception of diet pills, which remained constant.
Other drugs
In the general population, women are half as likely as men to be current users of cannabis or any illegal drug. Among all women aged 15 and older, less than 5% report current (past 12 months) use of cannabis; other than cannabis, rates of substance use by Canadian women are very low. Women are much less likely to report legal problems, but more likely to report harm to home life than males as a result of their substance use. Effects of prenatal exposure to inhalants can result in severe anomalies similar to alcohol, while some research points to subtle longer-term effects resulting from prenatal cocaine or cannabis use.
In terms of risk factors for substance use problems, many women report being introduced to substance use by a spouse or common-law partner - a pattern that is not common in men. High rates of mental illness, family violence, and sexual abuse have been noted in substance-dependent women, suggesting that many women deal with mental illness and other family problems by using substances - a practice called self-medication. Compared with men, women with substance use and other serious health issues are less likely to access substance abuse treatment services, in part because they are more likely to relate their problems to depression or anxiety than to substance use.
Substance-dependent women report that a sense of guilt and shame represents a large barrier to seeking help for substance use issues. For this reason, those in a position to help need to employ a respectful and non-judgmental approach. Treatment providers need to reframe their programs to focus on intermediary measures, such as self-efficacy, stress management, and decision-making, rather than focusing on substance use alone. An example of a woman-centred approach is a relational model of women's treatment that acknowledges the importance of relationships in a woman's life and gives priority to helping foster healthy connections through the treatment process.
Sources
Canadian Community Epidemiology Network on Drug Use (CCENDU): 2002 national reportDell, Colleen Anne; Garabedian, Karen
Ottawa, ON: Canadian Centre on Substance Abuse, 2003.
Best practices: substance abuse treatment and rehabilitationOgborne, Alan; Roberts, Gary
Ottawa, ON: Public Works and Government Services Canada, 1999.
Best practices: Fetal Alcohol Syndrome/ Fetal Alcohol Effects and the effects of other substance use during pregnancy Roberts, Gary; Nanson, Jo
Ottawa, ON: Health Canada, 2001.