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Substance Abuse and the American Woman. INSTITUTION Columbia Univ., New York, NY

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Substance Abuse and the American Woman. INSTITUTION Columbia Univ., New York, NY DOCUMENT RESUME ED 400 494 CG 027 381 TITLE Substance Abuse and the American Woman. INSTITUTION Columbia Univ., New York, NY. National Center on Addiction and Substance Abuse. SPONS AGENCY Bristol-Myers Squibb Foundation, Inc., New York, NY.; Pew Charitable Trusts, Philadelphia, PA. PUB DATE Jun 96 NOTE 308p. PUB TYPE Reports Research/Technical (143) EDRS PRICE MFO1 /PC13 Plus Postage. DESCRIPTORS Alcoholism; At Risk Persons; *Behavior; Drug Abuse; Drug Addiction; *Drug Use; Family Environment; *Females; Literature Reviews; Sex Differences; *State of the Art Reviews; *Substance Abuse ABSTRACT The first comprehensive assessment of substance abuse and women, this report arose from an analysis of more than 1,700 scientific and technical articles, surveys, government reports and books. Results show that American women are closing the gap with men in that they are increasingly likely to abuse substances at the same rate as men. Findings show that women are starting to smoke, drink, and use drugs at earlier ages than ever before. Unlike men, though, women get drunk faster, become addicted quicker, and develop substance abuse-related diseases sooner. Furthermore, at least one of every five pregnant women uses drugs, drinks, or smokes. An enormous gap exists between what experts know about women's substance abuse and what is known and acted on by women and those who care for them. It is recommended that women be made aware of the dangers of substance abuse. Prevention programs must address the reasons why women abuse substances and such programs must identify girls at highest risk. Health professionals, too, must recognize that women will manifest symptoms of substance abuse that are different from those of men, which may include a woman trying harder to hide her substance abuse due to intense shame. Contains approximately 750 references. (RJM) AAA-*AAAAA**AAAAAAA*---AA:c*.AAAAAA-*A*7',AAA**AAAAAAA**************** Reproductions supplied by EDRS are the best that can be made * from the original document. *********************************************************************** The National Center on Addiction and Substance Abuse at Columbia University 152 West 57th Street New York, NY 10019-3310 Substance Abuse and Iphone 212 841 5200 fax 212 956 8020 The American Woman IBoard of Directors Joseph A. Califano, Jr. Chairman and President June 1996 IJames E. Burke James Dimon Mary Fisher Betty Ford Douglas A. Fraser IDonald R. Keough LaSalle D. Leffall, Jr., M.D. Manuel T. Pacheco, Ph.D. "PERMISSION TO REPRODUCE THIS Nancy Reagan MATERIAL HAS BEEN GRANTED BY IE. John Rosenwald, Jr. George Rupp, Ph.D. /14A/ Michael P. Schulhof Barbara C. Jordan (1936-1996) Frank G. Wells (1932-1994) TO THE EDUCATIONAL RESOURCES INFORMATION CENTER (ERIC)." U.S. DEPARTMENT OF EDUCATION Office of Educational Research and Improvement EDUCATIONAL RESOURCES INFORMATION CENTER (ERIC) This document has been reproduced as received from the person or organization originating it. Minor changes have been made to improve reproduction quality. o Points of view or opinions stated in this document do not necessarily represent official OERI position or policy. Funded by:Bristol-Myers Squibb Foundation, Inc. The Pew Charitable Trusts 0 5 2 B ES' COPY AVM LAKE Board of Directors Joseph A. Califano, Jr. Chairman and President of CASA James E. Burke Chairman of the Partnership for a Drug-Free America James Dimon President, Chief Operating Officer and Director of Travelers Group Mary Fisher Founder of Family AIDS Network Betty Ford Chief Executive Officer of the Betty Ford Center in Rancho Mirage, California Douglas A. Fraser Professor of Labor Studies at Wayne State University (former President of United Auto Workers) Donald R. Keough Chairman of the Board of Allen and Company Incorporated (former President of The Coca-Cola Company) LaSalle D. Leffall, Jr., M.D., F.A.C.S. Charles R. Drew Professor of Surgery, Howard University Hospital Manuel T. Pacheco, Ph.D. President of The University of Arizona Nancy Reagan Former First Lady E. John Rosenwald, Jr. Vice Chairman of The Bear Stearns Companies Inc. George Rupp, Ph.D. President of Columbia University Michael P. Schulhof Barbara C. Jordan (1936-1996) Frank G. Wells (1932-1994) Copyright o 1996 by The National Center on Addiction and Substance Abuse at Columbia University 7/96 Advisory Board SHEILA B. BLUME, M.D. WILLIAM A. VEGA, PH.D. Medical Director Professor Alcoholism, Chemical Dependency and University of California Compulsive Gambling Programs at Berkeley South Oaks Hospital School of Public Health SHIRLEY D. COLETTI President Operation Parental Awareness and Responsibility EVELYN DAVIS, M.D. Assistant Clinical Professor of Pediatrics Department of Child Psychiatry Harlem Hospital Center LORETTA P. FINNEGAN, M.D. Director Women's Health Initiative National Institutes of Health MINDY T. FULLILOVE, M.D. Associate Professor of Clinical Psychiatry and Public Health Columbia University THEODORE JOYCE, PH.D. Professor of Economics Baruch College, City University of New York and Research Associate National Bureau of Economic Research SISTER DOROTHY ANN KELLY, O.S.U., PH.D. President College of New Rochelle DOROTHY P. RICE, SC.D. Professor Emeritus University of California at San Francisco Institute of Health and Aging ANNE M. SEIDEN, M.D. Chairman Department of Psychiatry Cook County Hospital ZILI SLOBODA, SC.D. Director Division of Epidemiology and Prevention Research Nationsd Institute of Drug Abuse TABLE of CONTENTS Executive Summary and Foreword 1 Chapter I --The Wrong Way 17 Chapter II -- The Difference 27 Chapter III -- Damage and Death: The Truth and Consequences for Women 45 Chapter IV -- Drugs, Alcohol and Cigarettes During Pregnancy: A Lethal Combination for Mother and Child 69 Chapter V -- Combatting the Problem 95 Chapter VI -- Next Steps: Acting on What We Know and Building Knowledge 131 References 143 5 Executive Summary and Foreword Substance Abuse and The American Woman is the first comprehensiveassessment of the impact on women of all substance abuseillegal drugs, alcohol, tobaccoand prescription drugs. The National Center on Addiction and Substance Abuseat Columbia University (CASA) has conducted an analysis of the available data andmore than 1,700 scientific and technical articles, surveys, government reports and booksover the past two years in an effort to lift the curtains of denial that have hidden the major public healthproblem of women's substance abuse for so long.° As a result of this study,CASA will assemble an issue of the American Journal of Public Health dedicatedto women and substance abuse to be published in the spring of 1997. The results are disturbing. In the worstway, American women are closing the gap with men: Women are increasingly likelyto abuse substances at the same rate as men and women are starting to smoke, drink and use drugs at earlierages than ever before. Women get drunk faster than men, become addicted quicker and develop substanceabuse-related diseases sooner. At least one ofevery five pregnant women uses drugs, drinks or smokes, putting herself and her newborn in great and avoidabledanger. There is an enormous chasm between what the medical andscientific experts know about women's substance abuse and what is known and actedon by women, their husbands A copy of the complete bibliography is available from CASA. To ordercall (212) 841-5227 or fax (212) 956-8020. and friends, their doctors and other health professionals. Toomany of us do not understand the different ways in whichwomen exhibit symptoms of abuse, the distinct risk factors and reasons why women begin to abuse substances, what makes it difficult for themto stop, and that women need treatment tailored to their specific needs.Until we recognize that what's good for the gander may not help thegoose, we will not have effective prevention and treatment programs for women. First, every woman should be aware of the danger in which substanceabuse places her. Women are more vulnerable thanmen to the immediate and long-term consequences of alcohol and drug abuse. Drinking likemen will cause women to develop diseases faster than men. Drug and alcohol abuse make women more likely to be victims ofrape and other violent crimes and abuse. Abusing alcohol while takingprescription drugs places women in the fast lane to dependence. One ofevery two female smokers will die of a tobacco-related disease. Second, prevention programs for girls andwomen must be designed around the reasons why they abuse substances. Preventive programs must identify girlsat highest risk, such as those who have been physicallyor sexually abused. These programs must recognize the link women see between being thin and smokingor using drugs like cocaine and heroin and the overriding importance women attach to being thin.(On any given day, 40 percent of American women are on diets.) They must consider thatwomen may smoke or abuse alcohol and drugs to cope with stress or sexual dysfunction and the likelihoodthat girls are more responsive to peer pressure than boys. Only after accounting for these and other 2 7 1 differences in the reasons why women andmen use tobacco, alcohol and drugs will this nation be able to mount an effective substance abuse preventioncampaign. Third, health professionals (female and male),as well as husbands, friends, teachers- each of usmust become better able to identifywomen who have drug and alcohol abuse problems. Family doctors accustomed to diagnosing drug andalcohol problems in men by external manifestations, such as drunk-driving and frequent fighting,should become better aware that a woman's symptoms are usually inner-directed--depression, anxiety, low self- esteem- -and that a woman's often intense shame can lead her totry harder than a man to hide her substance abuse from family, friends and physicians. Fourth, these two years of work have uncovereda tremendous void in research on women and substance abuse. Much past researchwas conducted on men only; the results were assumed to apply to men and women alikeThe more recent recognition that women's problems require separate attention has servedto underscore how much we do not know.
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