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Demographics of Drug Abuse: Rates in Men vs. Women

Overall, men are more likely than women to use nearly every type of illicit drug.

Overdose deaths for men are typically higher than they are for women for almost every substance of abuse. Men are also more likely to abuse alcohol and tobacco (legal substances) than women.

Females may have different patterns of substance abuse. Due to differences in metabolism and weight, they may respond to substances differently than men.

Prevalence rates regarding drug use and misuse for 2017 come from the data provided by the Substance Abuse and Mental Health Services Administration (SAMHSA). When available, the rates regarding gender differences in the diagnosis of substance use disorders come from the American Psychiatric Association’s (APA) Diagnostic and Statistical Manual of Mental Disorders – Fifth Edition.

Differences for Alcohol Use/Misuse

Men have higher rates of alcohol use, binge drinking, and heavy drinking compared to women, except for women between the ages of 12 and 20, who may have slightly higher rates of binge drinking than men of the same age.

The general data for 2017, according to SAMHSA, shows this about alcohol use and misuse:

  • About 220 million people over the age of 12 admitted to some lifetime use of alcohol.
  • About 170.7 million men over the age of 12 admitting to using alcohol within 2017.
  • About 109.4 million females admitting to using alcohol in 2017.
  • About 38 million men admitting to binge drinking at least once in 2017.
  • About 28.6 million women admitting to binge drinking in 2017.
  • About 11 million men admitting to heavy alcohol use in 2017.
  • About 5.7 million women admitting to heavy alcohol use in 2017.

Binge drinking is defined as having five or more drinks on one occasion for men and four or more drinks on one occasion for women. Heavy drinking is defined as engaging in binge drinking behavior five or more days within the same 30-day period (monthly).

Alcohol Use Disorders

Passed out person next to bottle and a glass of alcohol

Risk factors for alcohol abuse include binge drinking behavior and heavy drinking. According to APA, men are diagnosed with alcohol use disorders at a rate greater than women (12.4 percent prevalence rate in males; 4.9 percent in females).

Research suggests that women are more susceptible to the detrimental health effects of alcohol abuse than men, even if the woman has been using less alcohol or abusing alcohol for a shorter period of time.

Females tend to have higher death rates (50 to 100 percent higher) than men from alcohol abuse or alcohol-related issues. This includes deaths from alcohol-related disorders like stroke or liver disease, cancer, suicide, or alcohol-related accidents.

Part of the reason for this is that women metabolize alcohol differently than men. After drinking the same amount of alcohol, women tend to have higher blood alcohol concentrations than men, making them more susceptible to the effects of alcohol abuse.

Tobacco Use and Abuse

According to the 2017 figures provided by SAMHSA:

  • About 170.5 million people over the age of 12 admitted to some lifetime use of tobacco products.
  • About 74.7 million people admitted to using a tobacco product in 2017.
  • About 46.3 million men admitted to using a tobacco product in 2017.
  • About 28.4 million women admitted to using a tobacco product in 2017.

According to APA, cigarettes are the most commonly used tobacco product and the product most commonly associated with a diagnosis of a tobacco use disorder.  Over 90 percent of people diagnosed with a tobacco use disorder are cigarette smokers.

Rates of tobacco use disorders are slightly higher among adult males (14 percent) than females (12 percent) in the United States.

Research studies have suggested that the smoking behavior of females differs from males. Females may smoke fewer cigarettes per day, may not inhale as deeply as men do, and may be more likely to use cigarettes with lower nicotine or tar counts.

Although rates from tobacco-related diseases/conditions are higher in men than they are in women, these issues are increasing at a faster rate in women than they are in men. In 2014, the Centers for Disease Control and Prevention (CDC) reported that from 2005 to 2009, about 201,000 women died every year due to smoking-related issues compared to 278,000 men.

Thus, the substances associated with the highest rates of substance abuse in both men and women are most likely tobacco products, especially cigarettes, and alcohol.

Cannabis (Marijuana) Use and Abuse

Although animal research has suggested that female rodents are more sensitive to the reinforcing effects of cannabis products than males, the data indicates that fewer women than men use marijuana. The legalization of marijuana in many states may result in some evening out of use between men and women.

According to SAMHSA, in 2017:

  • About 134.7 million people admitted to lifetime use of a cannabis product.
  • Overall 51.8 million people admitted to using a cannabis product within the last year.
  • About 70.7 million males admitted to lifetime use of a cannabis product; about 29 million women admitted to using cannabis within the previous year.
  • About 64 million females admitted to lifetime use of a cannabis product; about 17.5 million admitted to using cannabis in 2017.

APA reports that the prevalence of cannabis use disorders is 2.2 percent among adult males and 0.8 percent among adult females. However, within those who are 12 to 17 years old, the prevalence rates are 3.8 percent for males and 3 percent for females. One of the risk factors for developing a substance use disorder as an adult is a history of substance use and abuse as a child or adolescent.

Male high school students who use cannabis appear to have more problems, such as family-related disputes and school-related issues, than females, suggesting that other factors may be at play regarding the use of cannabis products in males and females.

Long-term cannabis abusers often have lower levels of achievement, higher levels of unemployment, and a greater rate of co-occurring mental health diagnoses. This figure is consistent over males and females; however, males tend to have higher rates of other co-occurring substance use disorders than females who are diagnosed with a cannabis use disorder as an adult.

Simulants

Women may be more susceptible to the reinforcing effects of stimulants. Studies suggest that high levels of estrogen may increase their sensitivity.

Based on the current data, men are still more likely to use stimulant medications that women. According to the 2017 figures provided by SAMHSA:

  • About 40.5 million people admitted to lifetime use of cocaine; about 5.9 million admitted to past-year use of cocaine.
  • About 4 million males and 2 million females admitted to past-year use of cocaine.
  • About 14.7 million individuals admitted to lifetime use of methamphetamine. Of these, about 1.6 million individuals admitted to using meth within the past year.
  • About 1 million men admitted the past-year use of methamphetamine. This figure was 589,004 for women.
spilled pills

APA groups the abuse of all stimulants in one category, but it does differentiate prevalence rates between cocaine abuse and non-cocaine-related stimulant abuse. The prevalence of stimulant use disorders for stimulants other than cocaine is about 0.2 percent for both men and women. The prevalence of stimulant use disorders (amphetamine type) in women between ages 12 and 17 is slightly higher than it is for men (0.3 percent for females compared to 0.1 percent for males). This may reflect greater use of these drugs by young women in an attempt to lose weight.

The prevalence of stimulant use disorder as a result cocaine use is estimated to be 0.4 percent among males and 0.1 percent among females. The highest prevalence of this diagnosis in men occurs among those 18 to 29 years old.

Again, women may be more vulnerable to the reinforcing effect of stimulant drugs. For drugs like methamphetamine, women appear more likely to use the drug to cope with fatigue, while men look for its psychoactive effects.

Opioids

Abuse of opioids has taken centerstage in the United States due to the opioid epidemic. Opioids are powerful central nervous system depressant medications that comprise a large group of illicit drugs and prescription medications.

According to the 2017 data provided by SAMHSA:

  • About 5.3 million people admitted to some lifetime use of heroin, with 886,000 people admitting to using heroin.
  • About 600,000 men and about 286,000 women admitting to using heroin in 2017.
  • About 1.8 million men admitted to misusing prescription pain relievers in 2017. This figure was roughly 1.5 million females.
  • According to the CDC, about 17 percent of the U.S. population over the age of 18 was prescribed a prescription opioid in 2017.
  • Of prescription opioids, those containing hydrocodone have the highest rate of use and misuse. This includes Vicodin, Lortab, and others.

Men have a prevalence rate of opioid use disorders, at about 0.49 percent, compared to 0.26 percent of females. APA reports that the diagnoses of opioid use disorders occurs at a male-to-female ratio of about 1.5:1 for opioids other than heroin and at a ration 3:1 for heroin.

However, females who use heroin are more likely to begin their use of the drug at a younger age, are less likely to inject it, and are more likely to be influenced by romantic or sexual partners to use heroin. Some research suggests that women may be more likely to use prescription opioids without a prescription that men.

The rate of overdose deaths due to opioids has risen much faster for women than for men.


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Anxiolytics and Sleeping Aids

Anxiolytics include medications like benzodiazepines and barbiturates that are primarily designed to treat anxiety. They are in the group of drugs known as tranquilizers. Sedatives are medications designed to induce sleep.

According to the data provided by SAMHSA in 2017:

  • About 5.9 million people admitted to using a tranquilizer.
  • About 3 million males admitted to using a tranquilizer. About 2.9 million females did.
  • About 1.35 million individuals admitted to using a sedative in 2017.
  • About 629,000 males admitted to using a sedative. This figure was 722,000 for females.

APA diagnosis abuse of sedatives and anxiolytics in the same category as a sedative, hypnotic, or anxiolytic use disorder. The prevalence of this disorder is slightly higher in adult males (0.3 percent) than females (0.2 percent). However, among 12 to 17 year olds, the prevalence is higher for females (0.4 percent for females compared to 0.2 percent for males).

Women may be more likely to be prescribed these medications than men. Women may be more likely to overdose and die of an overdose with this class of drugs than men.

Other General Issues

In general, men are more likely to develop or be diagnosed with a substance use disorder than women. Men are likely to begin to abuse drugs or alcohol due to peer pressure.

Women may transition from substance misuse to the development of a substance use disorder much more quickly than men. According to APA, women are more likely to use illicit substances in an attempt to self-medicate themselves (either to deal with physical issues like fatigue or pain, or to deal with stress).

Women may be more likely to suffer untoward side effects from substance abuse, but men are more likely to experience more severe withdrawal symptoms from alcohol and some other drugs.

Treatment

Men in recovery appear to have longer average periods of abstinence than women do as a group, but substance use disorder treatment is effective for males and females equally.

The number of males who enter substance use disorder treatment overall is far greater than the number of females. The rate is disproportional to the prevalence rates for men and women with different types of substance use disorders.

Substance abuse treatment programs should be tailored to fit the special needs of the person in addition to adhering to empirically validated principles. Organizations like the National Institute on Drug Abuse suggest that specialized treatment services for women should be a focus of treatment programs in order to offer the additional supports that women may need.

This means that women may require more specialized approaches than men.  For instance, many women may get greater benefit from women-only treatment groups than from mixed groups. This environment can allow them to address their unique issues with greater confidence. 

SOURCES

(February 2009) Nicotine pretreatment increases dysphoric effects of alcohol in luteal-phase female volunteers. International Journal of Environmental Research and Public Health. Retrieved August 2019 from https://europepmc.org/articles/pmc2672357

(October 2018) National Survey on Drug Use and Health: Detailed Tables. Substance Abuse and Mental Health Services Administration. Retrieved August 2019 from https://www.samhsa.gov/data/sites/default/files/cbhsq-reports/NSDUHDetailedTabs2017/NSDUHDetailedTabs2017.pdf

(2013) The Diagnostic and Statistical Manual of Mental Disorders – Fifth Edition. American Psychiatric Association

(October 2018) Fact Sheets- Binge Drinking. Centers for Disease Control and Prevention. Retrieved August 2019 from https://www.cdc.gov/alcohol/fact-sheets/binge-drinking.htm

(November 2015) Sex and gender-related differences in alcohol use and its consequences: Contemporary knowledge and future research considerations. Drug and Alcohol Dependence. Retrieved August 2019 from https://www.researchgate.net/profile/Victor_Karpyak/publication/281470180_SY03_TRANSLATIONAL_INVESTIGATION_OF_THE_OPIOID_SYSTEM_IN_ALCOHOLISM_SY03-1_GENDER_EFFECTS_ON_ASSOCIATION_BETWEEN_PDYN_SEQUENCE_VARIATION_WITH_ALCOHOL_DEPENDENCE_AND_RELATED_PHENOTYPES/links/572d0ff308ae7441518e6b5a/SY03-TRANSLATIONAL-INVESTIGATION-OF-THE-OPIOID-SYSTEM-IN-ALCOHOLISM-SY03-1-GENDER-EFFECTS-ON-ASSOCIATION-BETWEEN-PDYN-SEQUENCE-VARIATION-WITH-ALCOHOL-DEPENDENCE-AND-RELATED-PHENOTYPES.pdf

Women. National Institute of Alcohol Abuse and Alcoholism. Retrieved August 2019 from https://www.niaaa.nih.gov/alcohol-health/special-populations-co-occurring-disorders/women

(November 2015) The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General, 2014 Us Department of Health and Human Services Atlanta, GA: Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion. Centers for Disease Control and Prevention. Retrieved August 2019 from https://onlinelibrary.wiley.com/doi/abs/10.1111/dar.12309

(November 2010) Sex difference in cell proliferation in developing rat amygdala mediated by endocannabinoids has implications for social behavior. Proceedings of the National Academy of Sciences. Retrieved August 2019 from https://www.pnas.org/content/107/47/20535.full

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