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, and may also get addicted to drugs and alcohol more quickly than men.

Women face unique issues when it comes to substance use, in part influenced by:

• sex—differences based on biology
• gender—differences based on culturally defined roles for men and women

Scientists who study substance use have discovered that women who use drugs can have issues related to hormones, menstrual cycle, fertility, pregnancy, breastfeeding, and menopause. In addition, women themselves describe unique reasons for using drugs, including controlling weight, fighting exhaustion, coping with pain, and attempts to self-treat mental health problems.

Science has also found that:

• Women often use substances differently than men, such as using smaller amounts of certain drugs for less time before they become addicted.
• Women can respond to substances differently. For example, they may have more drug cravings and may be more likely to relapse after treatment.
• Sex hormones can make women more sensitive than men to the effects of some drugs.
• Women who use drugs may also experience more physical effects on their heart and blood vessels.
• Brain changes in women who use drugs can be different from those in men.
• Women may be more likely to go to the emergency room or die from overdose or other effects of certain substances.
• Women who are victims of domestic violence are at increased risk of substance use.
• Divorce, loss of child custody, or the death of a partner or child can trigger women's substance use or other mental health disorders.
• Women who use certain substances may be more likely to have panic attacks, anxiety, or depression.

Substance use during pregnancy can be risky to the woman’s health and that of her children in both the short and long term. Most drugs, including opioids and stimulants, could potentially harm an unborn baby. Use of some substances can increase the risk of miscarriage and can cause migraines, seizures, or high blood pressure in the mother, which may affect her fetus. In addition, the risk of stillbirth is 2 to 3 times greater in women who smoke tobacco or marijuana, take prescription pain relievers, or use illegal drugs during pregnancy. Surveys suggest that more women are using marijuana during pregnancy, which has health professionals concerned. The American College of Obstetrics and Gynecology (ACOG) suggests that marijuana can result in smaller babies, especially in women who use marijuana frequently in the first and second trimesters. ACOG recommends that pregnant women or women wanting to get pregnant should stop using marijuana, even if it is for medical purposes, and discuss options with their doctors that will be healthier for their babies.Pregnant women should check with their health care provider before using any medicines or substances.

When a woman uses some drugs regularly during pregnancy, the baby can go through withdrawal after birth, a condition called neonatal abstinence syndrome (NAS). Research has shown that NAS can occur with a pregnant woman's use of opioids, alcohol, caffeine, and some prescription sedatives. The type and severity of a baby’s withdrawal symptoms depend on the drug(s) used, how long and how often the mother used, how her body breaks down the drug, and if the baby was born full-term or prematurely.

Symptoms of NAS in a newborn can develop immediately or up to 14 days after birth. Some of these symptoms include:

• blotchy skin coloring
• diarrhea
• excessive or high-pitched crying
• fever
• increased heart rate
• irritability
• poor feeding
• rapid breathing
• seizures
• sleep problems
• slow weight gain
• trembling
• vomiting

Also, substance use by the pregnant mother can lead to long-term and even fatal effects, including:

• birth defects
• low birth weight
• premature birth
• small head size
• sudden infant death syndrome

Some substances, such as marijuana, alcohol, nicotine, and certain medicines, can be found in breast milk. However, little is known about the long-term effects on a child who is exposed to these substances through the mother’s milk. Scientists do know that teens who use drugs while their brains are still developing could be damaging their brain’s learning abilities. Therefore, similar risks for brain problems could exist for drug-exposed babies. Given the potential of all drugs to affect a baby’s developing brain, women who are breastfeeding should talk with a health care provider about all of their substance use.

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.

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.

Nearly 27 million U.S. women (about 13%) have used illegal drugs or misused prescription drugs in the past year.

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. Women also report higher rates of chronic pain and are more likely to be prescribed pain medicine than men are.

Prescription drug misuse among women is on the rise. According to the Centers for Disease Control and Prevention:

• From 1999 to 2015, deaths from prescription painkiller overdoses increased more than twice as fast among women as among men.
• 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.

A woman is more likely to misuse alcohol or drugs if she experiences:

• 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

Many women with substance use disorders are also diagnosed with other mental disorders. This is important because interactions between illnesses can worsen the course of both. Patients who have both a substance use disorder and another mental health condition often have symptoms that are more persistent, severe, and resistant to treatment compared with patients who have either disorder alone. Both disorders should be treated at the same time to improve the likelihood of success. Although men are more likely than women to report both a mental health and substance use disorder within the past year, women are more likely to suffer from certain mental health conditions, such as depression, anxiety, post-traumatic stress disorder (PTSD), and eating disorders. Some women report using substances to relieve stress or negative emotions. In addition, women are more vulnerable to developing substance use or other mental health disorders following divorce, loss of child custody, or the death of a partner or child.

Women of color may face unique issues with regard to drug use and treatment needs. For example, African-American and American Indian/Alaska Native women are more likely than women of other racial and ethnic groups to be victims of rape, physical violence, and stalking by an intimate partner in their lifetime. As discussed above, these issues are risk factors for substance use and should be addressed during treatment.

More than 1 in 3 women have experienced physical violence at the hands of an intimate partner, including a range of behaviors from slapping, pushing, or shoving to severe acts such as being beaten, burned, raped, or choked. Victims of violence are at increased risk of chronic health conditions, including obesity, chronic pain, depression, and substance use. In recognition of the severity of violence against women and the need for a national strategy to address this issue, in 1994 Congress enacted the Violence Against Women Act to hold offenders accountable and to provide services to victims. In 2013, President Obama reauthorized the Act to expand programs for reaching especially vulnerable populations.

The Institute of Medicine and the U.S. Preventive Services Task Force (USPSTF) have recommended that clinicians screen and counsel for interpersonal violence. To help meet that need, the Affordable Care Act of 2010 (Section 2713) requires that health insurance providers cover all preventive services recommended by the USPSTF without copays or deductibles. However, improved prevention and screening guidelines are needed to help clinicians identify those who need help and link them to the care they need.

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.
• 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.

Answering the following questions can help you find out whether you or someone close to you has a problem with drinking or drugs.

• 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.

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.

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.

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. Learn 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.

It is important to note that treatment for substance use disorders in women may progress differently than for men. Women report using some substances for a shorter period of time when they enter treatment. However, women's substance use tends to progress more quickly from first use to addiction. Withdrawal may also be more intense for women. In some cases, women respond differently than men to certain treatments. For instance, nicotine replacement (patch or gum) does not work as well for women as for men.

If a pregnant woman attempts to suddenly stop using drugs and alcohol without medical help, she can put her fetus at risk.

It can be hard for any person with a substance use disorder to quit. But women in particular may be afraid to get help during or after pregnancy due to possible legal or social fears and lack of child care while in treatment. Women in treatment often need support for handling the burdens of work, home care, child care, and other family responsibilities.

Specific programs can help pregnant women safely stop drug use and also provide prenatal care. Certain types of treatment have shown positive results, especially if they provide services such as child care, parenting classes, and job training. Medications such as methadone and buprenorphine, combined with the treatments described above, can improve outcomes. Some babies will still need treatment for withdrawal symptoms. However, outcomes are better for the baby if the mother takes treatment medicine during pregnancy than if she continues to use opioids.

• Women face unique issues when it comes to substance use. These differences are influenced by sex (differences based on biology) and gender (differences based on culturally defined roles).
• Research has found many differences in how women and men use substances and react to substances. For example, women use drugs in smaller amounts than men, but they can experience the effects more strongly.
• Using substances while pregnant can harm the health of a pregnant woman and her fetus.
• More women are using marijuana during pregnancy than in past years, which could result in smaller babies and goes against the advice from the top medical group representing obstetricians.
• The use or misuse of some drugs while pregnant, especially opioids, can cause a newborn infant to experience withdrawal symptoms, a condition known as Neonatal Abstinence Syndrome (NAS).
• Substance use in women tends to develop into addiction more quickly than in men.
• It can be difficult for women to get help for a substance use problem during or after pregnancy because of social or legal fears. They may also lack child care while in treatment.
• Treatment programs should take these issues into consideration and offer child care, job training, and parenting classes.
• In the past, women were not included in clinical research. Federal agencies have made significant efforts to ensure that all subgroups of people are included and that issues related to sex and gender are being studied.