Substance Abuse Rates Rise in Women Over Past Two Decades
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ACTORS (singing): Prescription drugs, don’t abuse them. Do what your doctor says when you use them.
SUSAN DENTZER: This puppet show warning about the dangers of substance abuse is nominally aimed at kids.
ACTOR (singing): Your friends may try to tell you they’re cool thing to use. They make you feel real funny, kind of like you’re drinking booze.
SUSAN DENTZER: But an equally important target audience is the mothers of these children. They’re recovering drug and alcohol addicts, and they’re slowly putting their lives back together here at Operation PAR.
That’s a Florida anti-substance-abuse program that treats 40,000 people a year and allows women who are enrolled to bring their kids along.
WOMAN: One of the things about living life on life’s terms is learning to be uncomfortable.
SUSAN DENTZER: Those undergoing treatment here include moms like Niccole B., who’s 27. She tested positive for cocaine use a year ago, when the youngest of her three children was born.
NICCOLE B.: I was, like, I cannot believe that this happened to me, that I turned out to be a mother that put drugs first, instead of her kids.
Addiction is growing among women
SUSAN DENTZER: There are also women like Danielle R., who's trying to kick an addiction to crystal methamphetamine.
DANIELLE R.: I don't know how to explain it. I just basically fell into a hopeless hole, and I didn't see any way out.
SUSAN DENTZER: Women like these are the tip of a growing iceberg, says Susan Foster. She's director of policy at the National Center for Addiction and Substance Abuse at Columbia University.
SUSAN FOSTER, Director of Policy, National Center on Addiction and Substance Abuse: Substance abuse and addiction really is the number-one health problem among women, in terms of the cost of this problem to society, in terms of preventable deaths, in terms of the damage and destruction that occurs to individuals and families across this country.
SUSAN DENTZER: Foster's center at Columbia, known as CASA, has compiled a decade's worth of its research on the subject into a new book. It's called "Women Under the Influence."
SUSAN FOSTER: Ninety-two percent of women in need of treatment in this country do not get it. They're just not getting the help they need.
Rather than decreasing resources for research and for treatment and prevention in this area, which is now happening at the federal level, we ought to be making wise investments in research and in prevention and treatment programs that work.
Women vulnerable to addiction
SUSAN DENTZER: According to CASA's research, 15 million American girls and women use illegal drugs, 32 million smoke cigarettes, and six million are alcohol abusers or alcoholics. The cost, in higher health outlays and related expenses, is estimated at several hundred billion dollars a year.
For decades, far more U.S. males than females have been substance abusers, but that longtime gender gap is now shrinking. High school girls drink, smoke and use illegal drugs as much as their male classmates, and girls abuse prescription drugs, like painkillers, at somewhat higher rates than boys.
Foster says these trends are especially dangerous, given physiological vulnerabilities that women have to addiction.
SUSAN FOSTER: Let's take alcohol, for example. Women have a lower concentration of water in the body and a higher concentration of -- of body fat. So, water dilutes alcohol in the bloodstream, and fat retains it in the body. So, with equal use, women end up with more alcohol in the bloodstream, and it stays in the body longer.
Abuse is a problem as women age
SUSAN DENTZER: Foster says that's a particular problem for women as they age, when the proportion of water to body fat falls still further. She says women will then incur the harmful effects of drinking at far lower levels of consumption than men.
Dr. Nora Volkow is director of the National Institute of Drug Abuse. She says a growing body of brain research reveals other reasons why women are vulnerable to addiction. These include the presence in the female body of the hormone progesterone.
Volkow says progesterone works in the brain to increase levels of the chemical called dopamine, the same brain chemical that drugs stimulate. The effect is especially pronounced in the second half of the menstrual cycle, leading women to crave drugs.
DR. NORA VOLKOW, Director, National Institute on Drug Abuse: Dopamine activates pleasure centers in the brain. And one of the things that progesterone does is, it makes the cells that produce dopamine more sensitive to the effects of drugs. So, for the same dose, you will have a greater bang for your buck.
SUSAN DENTZER: Volkow says other brain research shows that women are more susceptible to pleasurable visual cues, such as alcohol or tobacco advertising.
DR. NORA VOLKOW: The female brain responds much more strongly to these responses, which we call conditioned responses, than the male brain. And, as a result of that, what you can predict is that the female brain, which will be much more driven to want the drug if they are to observe someone else doing it.
SUSAN DENTZER: The social costs of substance abuse can be seen back at Operation PAR in the cases of women like Niccole. She told us she decided to quit taking drugs only after authorities took her three children and placed them in foster care.
NICCOLE B.: I just realized I needed a change, because I wanted my kids back. And I needed a different environment and stuff. So, I just found a rehabilitation center, like here, like PAR.
SUSAN DENTZER: For the past five months, she's been undergoing daily individual and group therapy sessions, and re-learning the skills to live life sober.
Two of Niccole's children recently joined her at Operation PAR for a weekend visit. But the youngest is hospitalized with brain damage, apparently the result of abuse he suffered in his foster family's home.
Danielle told us she granted her parents custody of her 7-year-old son, Truman (ph), while she recovered. Like many female addicts, she also suffers from mental illness, in her case, bipolar disorder.
DANIELLE R.: With the bipolar, you have very low lows, and then you have ups. And I didn't want the depression. I wanted the ups. And I mean I wanted an extreme up.
More attention paid to addiction
SUSAN DENTZER: Danielle is typical, since 98 percent of women undergoing treatment at Operation PAR have at least one other psychiatric diagnosis, often depression or post-traumatic stress disorder.
That's in part related to another stunning statistic: CASA's research shows that 69 percent of women in treatment for substance abuse say they were sexually abused as children.
LESLIE M.: When I arrived at PAR, I certainly wasn't going to talk about that with staff or anyone. It was just something I never disclosed.
SUSAN DENTZER: Leslie M. is a recovered heroin addict who now works as an administrative assistant at Operation PAR. She says her sexual abuse as a child played a role in her addiction, which started with using alcohol as a teenager and culminated in two crime convictions in her 30s.
LESLIE M.: I was court-ordered into Operation PAR for 26 months. I came in, in July of '93, and I concluded my long-term rehab in July of '95. It's the best thing that has ever happened to me in my entire life.
SUSAN DENTZER: The complex interplay of drug addiction, mental illness, and a history of abuse underscores the need for what Operation PAR calls "whole-person treatment." It confronts the constellation of factors, from genetic makeup to life experience, that pushes women into addiction, and keeps them there.
NANCY HAMILTON, CEO, Operation PAR: What's a song that we know that we sing in preschool?
SUSAN DENTZER: Nancy Hamilton is Operation PAR's chief executive officer. She says it's critical that treatment programs tailored for women allow them to bring their children along. A large federally funded study, in which Operation PAR participated, showed why.
NANCY HAMILTON: We found out that women who did not get to bring their children to treatment in our -- at Operation PAR, none of them regained custody of the children, none.
About 68 percent of women who brought their children to treatment, when we followed them up at 12, 18 and 24 months, had regained and maintained custody of their children.
SUSAN DENTZER: That's because those who came with children were able to stay in treatment longer, making it far more likely they would recover and be able to get their families back together.
Even today, recovery is constant work for Leslie, who told us she had been clean, or off drugs, for 16 years. She continues in Narcotics Anonymous, a 12-step recovery program.
LESLIE M.: The message is a message of hope. We do recover. And man, woman, child can get better as a result of intervention and treating the disease and recovery. It's powerful. It's very powerful.
SUSAN DENTZER: And a powerful incentive, experts say, for the nation to devote more attention to the issues of women and substance abuse.