The Shame Game: Substance Use Disorder in Women

Substance Use Disorder in Women

When you hear the word “addict,” what image pops into your mind? It’s probably not a nurse or a lawyer, or a business owner. And it’s probably not a woman.

Stereotypes and stigmas surrounding substance use disorder (SUD) abound, but if there’s one thing we know at Parkdale Center, it’s that people suffering with SUD do not always match the caricatures we see on TV. We know SUD is an illness that can afflict anyone regardless of age, education, social status, income level, race, religion, or gender.

While many people battling SUD have similar traits and struggles, there are some major differences that can influence their paths to treatment and healing. We’d like to highlight some of the differences that bring women to substance use, substance use disorder, and ultimately, hopefully, to treatment and recovery.

Parkdale Center treats professionals, and many of them share similar stressors. People in demanding work positions are often subject to never-ending demands on their time and often work long hours with little to no breaks. These people are the doers and supporters, and if they can help, they will, no matter their personal sacrifices. Beyond work, they are often raising children, caring for aging parents, and donating time to other causes. Admitting they have a substance use problem is almost unbearable. Entering a treatment program can be almost unthinkable.

When women find themselves battling SUD, they must overcome even stronger stigmas to reach out for help. As Parkdale Center Addiction Counselor Kaitlin Pilipovic explains, historically, women weren’t routinely monitored for substance use disorder. It was thought of as a man’s disease. That stereotype persists, making it all the harder for women to seek treatment. Battling a substance use disorder means they have “failed” as a woman. Pilipovic says, “Shame is one of the strongest barriers to treatment for women.” Women are expected to excel in their careers, be good providers, raise children, keep house, sometimes take care of aging family members – and “do it all without breaking a sweat.” Admitting they have a substance use problem means admitting they are not perfect, which, socially, is extremely difficult for women. Pilopovic adds that many women also worry that if they seek treatment, they will lose their children and destroy their families.

This is supported by the work of the Recovery Research Institute. “The shame, blame, and guilt attached to addiction can be stronger for women, especially mothers. Women report higher levels of stigma than men, and stigma is a known barrier to treatment seeking. Historically, substance use disorder in women was considered a selfish, moral failure, that resulted in intentional harm to the family, child, and in terms of placing a burden on society.” Furthermore, “More generally, women are more likely than men to experience difficulties in attending regular treatment sessions because of family responsibilities and cite being responsible for the child care as one of the biggest barriers to entering treatment. Women with children may also be hesitant to seek treatment for fear of legal action and social service involvement.”

Complicating this even further, mental health disorders commonly co-exist alongside substance use disorder. The National Center for Biotechnology Information of the National Institute of Health tells us “Multiple national population surveys have found that about half of those who experience a mental illness during their lives will also experience a substance use disorder and vice versa.” Here at Parkdale, we find those numbers are consistently higher.

Unfortunately, women are more susceptible to these co-existing mental health problems, which can trigger substance use and complicate treatment. According to the Mayo Clinic, “Women are nearly twice as likely as men to be diagnosed with depression.” The National Alliance on Mental Illness (NAMI) tells us that women also suffer more trauma. Socially, we associate PTSD with men, particularly veterans, but it can result from all manner of traumas, many of them experienced by women. “While PTSD can happen to anyone, statistics show that there is a significant gender difference in the prevalence of PTSD. According to the National Center for PTSD, around 10% of women have PTSD sometime in their lives compared to 4% of men.” Even anxiety disorders are more prevalent in women. As reported by the National Institute on Mental Health (NIMH), “An estimated 19.1% of U.S. adults had any anxiety disorder in the past year. Past year prevalence of any anxiety disorder was higher for females (23.4%) than for males (14.3%).” All these conditions, and many others, complicate their substance use disorder and deepen the shame and stigma women feel, which keeps them from treatment.

Treatment programs typically address these problems similarly for women and men. But even after treatment, women continue to be at a disadvantage. Recovery is time-consuming, hard work. Post-treatment, patients need to focus on their healing by participating in Intensive Outpatient Programs, attending 12 Step and other support groups, practicing stress management, and following a strict schedule. Yet women are often thrown right back into the life which triggered their use in the first place: caretaking, working, and household management. Pilipovic says, “The expectation from [a patient’s] family is that they will return to be the person they were before treatment.” Many women are introduced to substance use by a partner and, after treatment, return to an environment still filled with triggers. Even worse, the pushback women receive when they don’t immediately go back to being all things to everyone can be counterproductive. They may think, “If I’m not good enough sober, then what’s the point?”

For all these reasons, women need more support as they accept they need help and receive treatment for their substance use disorder. They need more support after treatment to rebuild a sober life with healthy boundaries. Of course, men need support throughout the process as well, but the specific challenges women face complicate the course of their substance use disorder and its treatment.

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