OBJECTIVE: REDUCE DRUG ABUSE AND USE AMONG WOMEN
Rationale: Detailed information on women's drug use is limited. Data that examines gender and race-ethnicity and age are rarely published.32 The 1997 National Household Survey on Drug Abuse found that 34.3% of white women, 19.2% of Latinas, and 24.9% of African-American women reported using an illegal drug in their lifetime. This survey, presents an incomplete assessment of total drug use since it did not include women who were homeless, in colleges and universities, or in institutionalized populations.
We do know that drug addiction has increased steadily among girls and women and, in the case of certain drugs, more rapidly than among boys and men.33 From 1992 to 1997, for example, regular use of cocaine increased for women while men's cocaine use declined slightly.34 Addiction to legally prescribed drugs is also a more serious problem for women than men.35 Emergency room visits by women because of drug-related problems rose 35% between 1990 and 1996.36
Women who abuse drugs often face a greater social stigma than men because they fail to fulfill our society's standard for female morality as well as their traditional role as the stabilizing force in the family.37
The extent of drug use among women, the causes of addiction, and its effect on women's lives and bodies are not fully understood because addiction has traditionally been treated as a male disease.38 However, the problem of drug addiction among women cannot be separated from other aspects of their social conditioning. Studies of women who seek treatment for alcohol and other drug problems have revealed a dramatic connection between domestic violence, childhood abuse, and substance abuse.39 Women substance abusers have high levels of depression, anxiety, and feelings of powerlessness, and low levels of self-esteem and self-confidence.40 Punishing women strips them of control over their lives, exacerbates underlying problems, and fails to provide any strategy for long-term prevention.
Policy makers must recognize the connection between drug addiction among women and other health, social and economic problems that women face. The only effective way to address drug abuse is simultaneously to address the problems of violence and sexual abuse, unsafe housing, unemployment, stereotyped sexual roles, lack of health care and lack of child care which contribute to the depression and hopelessness that are underlying causes of substance abuse.
The barriers to treatment for women must be addressed. First, only 41% of women who need drug treatment actually receive it.41 Second, most programs are based on male-oriented models that are not geared to the needs of women. The lack of accommodations for children is one of the most significant obstacles to treatment for women.42 Most clinics do not provide child care and many residential treatment programs do not admit women with children.43
Treatment programs have traditionally failed to provide the comprehensive services -- including prenatal and gynecological care, contraceptive counseling, appropriate job training, and counseling for sexual and physical abuse -- that women need. The typical focus on individual pathology may exclude social factors, such as racism, sexism and poverty that are essential to an understanding of drug abuse in women.
Recommendation 1: Fund prevention programs that target women.
Federal and state governments must increase the amount of funding for prevention efforts that target women and girls about the risks of alcohol and drug use. Prevention strategies and programs must be community-based and sensitive to women's diverse cultural backgrounds and must be developed with significant input from women from local communities.
A critical component of a comprehensive national drug prevention strategy for women is widely available needle exchange programs. AIDS is the third leading cause of death among women of reproductive age in the United States, and the number one cause of death for African-American women.44 In 1997, women accounted for 22% of AIDS cases, compared to seven percent in 1985. Among teenage women ages 13 to 19, the number of cumulative AIDS cases multiplied over 16 times between June 1989 and December 1997; for women ages 20 to 24 the number has multiplied more than nine times. Injection drug use accounted for 28% and 14% of cases in women of these age groups, respectively.45 Women constitute the fastest growing group of new HIV cases in the United States.46
Recommendation 2: Increase services for women.
SAMHSA funding for women reached its peak in 1994 when gender-specific demonstration programs only represented three percent of SAMHSA's total budget. SAMHSA funding designated for women has dropped 38% since 1994.47
Congress should mandate increased funding for treatment facilities designed specifically for women. The goal should be universal access to both outpatient and residential treatment services for all women who are addicted to drugs and alcohol.
Federal and state guidelines must be established to ensure that programs are geared specifically to the needs of women. Guidelines should be flexible enough, however, to enable local programs to adjust to the particular needs and experiences of the communities they serve.
Programs must be designed to overcome the current barriers to women's access to and participation in treatment. The following features are essential to increasing the accessibility of treatment for women:
Recommendation 3: Fund research on women's experiences
Congress should increase the amount and proportion of funding devoted to research that explores the particular experience of women who abuse alcohol and other drugs. Federal funding of research projects should be greatly expanded. The research should answer the following questions about women and drug abuse:
This research should not focus solely on the effects of drug use during pregnancy but throughout a woman's life span. All research should be done in the context of delivery of health care and its purpose should be to improve the health of all women.
32 Drug Strategies. (1998). Keeping Score, 1998: Women and Drugs:
Looking at the Federal Drug Control Budget. Washington, DC: Drug
33 Drug Strategies (1998), citing NIDA, Monitoring the Future, 1975-97; Drug Strategies (1998), citing SAMHSA, November 1997, Preliminary Estimates from the 1996 Drug Abuse Warning Network. SAMHSA (November 1997).
34 SAMHSA. (1998, August). Preliminary Results from the 1997 National Household Survey on Drug Abuse
35 H.A. Pincus, T.L. Tanielian, S.C. Marcus, M. Olfson, D.A. Zarin, J. Thompson and J.M. Zito. (1998). "Prescribing Trends in Psychotropic Medications: Primary Care, Psychiatry, and Other Medical Specialities." JAMA. 279(7), 526-531.
36 Drug Strategies (1998) citing SAMHSA (1997, November), Year End Preliminary Estimates from the 1996 Drug Abuse Warning Network. Washington, DC.
37 Roberts, Dorothy. (1991). Women, Pregnancy, and Substance Abuse. Washington, DC: Center for Women's Policy Studies.
38 Millstein, Richard A. (1998, December). "Gender and Drug Abuse Research." The Journal of Gender-Specific Medicine. 1(3); see also Roberts, Dorothy. (1991).
39 SAMHSA. (1997). Substance Abuse Treatment and Domestic Violence. Washington, DC: SAMHSA.
40 Dansky, B.S., Saladin, M.E., Brady, K.T., Kilpatrick, D.G., and Resnik, H.S. (1995). "Prevalence of Victimization and Post Traumatic Stress Disorder Among Women With Substance Use Disorders: Comparison Telephone and In-Person Assessment Samples." The International Journal of Addictions. 30(9). 1079-1099.
41 Woodward, A., Epstein, J., Gfroerer, J., Melnick, D., Thoreson, R., and Willson, D. (1997 Spring). "The Drug Abuse Treatment Gap: Recent Estimates." Health Care Financing Review. Vol. 18, No. 3. Table 3, p. 15.
42 Paone, D., Chavkin, W., Willets, I., Friedman, P., and Des Jarlais, D. (1992) "The Impact of Sexual Abuse: Implications of Drug Treatment." Journal of Women's Health. 1(2). p. 149-153.; see also Roberts. (1991).
43 Breitbart, V., Chavkin, W., and Wise, P. (1994). "The Accessibility of Drug Treatment for Pregnant Women: A Survey of Programs in Five Cities." American Journal of Public Health. 84 (10).
44 Anderson, , R.N., Kochanek, K.D, and Murphy, S. L. (1997). "Report of Final Mortality Statistics, 1995." Monthly Vital Statistics report, 45. (11) Supplement 2. Hyattsville, MD: National Center for Health Statistics.
45 Centers for Disease Control, 1997, HIV/AIDS Surveillance Report 9, 2. Atlanta, GA: Centers for Disease Control.
46 Centers for Disease Control, 1996, HIV/AIDS Surveillance Report, 8, 2. Atlanta, GA: Centers for Disease Control.
47 Drug Strategies. (1998).