According to the National Institute on Drug Abuse, women are more likely to suffer from chronic pain, and thus be more likely to take opioids for a longer time. Data from the Department of Women’s Health indicates that between 1999 and 2015, the number of deaths caused by prescription opioids among women has seen a 471% increase, as compared to a 218% increase among men.
Given this information, it is becoming increasingly clear that opioid abuse among women not only needs to be analyzed from the unique perspective of women, but the subsequent treatment for abuse should also be crafted to address that perspective.
What Are Opioids?
According to NIDA, opioids represent a type of drug that can include illicit substances, such as heroin or synthetic substances (fentanyl), as well as pain relievers like hydrocodone, oxycodone, morphine, codeine, and others.
All these substances work their way towards the brain or body and start interacting with the brain’s opioid receptors, thus blocking the feeling of pain and making the patient feel a slight sense of pleasure or relief. The CDC states that within the boundaries of a prescribed medical treatment, these substances are perfectly safe to use, but warns that long-term exposure may lead to abuse.
What Are Opioid Dependence, Opioid Abuse, and Opioid Addiction?
Opioid dependence is a consequence of long-term opioid usage, particularly in the case of patients who go over the recommended dosage. There are differences between the notions of “dependence,” “abuse,” and “addiction” from a medical standpoint. Dependence means a patient physically or mentally craves for the drug.
A patient can be dependent when they feel an uncontrollable impulse to take the medication, even though they are no longer suffering from any pain. Continuing to seek these substances after the prescribed treatment period, increasing the dosages and combining them with other drugs can ultimately lead to opioid abuse, and lastly to addiction.
Common Reasons Why Women Become Dependent or Addicted to Opioids
The Department of Women’s Health identifies two major pathways in understanding addiction rates among women: biological and social.
Unfortunately, there is not enough data regarding the biological pathways for women’s opioid abuse to reach a definite conclusion. However, analysis of other forms of addiction might lead to a reasonable answer.
For instance, the DWH took the examples of nicotine and alcohol addiction, two substances that have been far more studied than opioids. Women are known to metabolize nicotine faster than men, and as a consequence, they respond less efficiently to nicotine replacement therapies.
In the case of alcohol, studies have shown that women require fewer drinks in a shorter period than men to become highly intoxicated. The reason may have to do with the fact that women’s body contains less water and more fat tissues than men’s. As such, women can have a higher concentration of alcohol in their body even if they’ve not consumed as much alcohol as men.
Such biological differences between genders can make women highly susceptible to substance abuse. Regarding opioid addiction, the CDC notes that women can become physically dependent on these pain medications easier than men.
Although women tend to use smaller amounts of drugs over a shorter period, they are no less at risk of dependence. This behavioral component of drug use, when combined with the biological characteristics (higher body fat percentage, hormones, metabolic rates) might explain why women can easily form an opioid dependency.
Social pathways primarily relate to the history of a patient’s relationships, from childhood and on to adulthood. They can play a critical role in leading women onto a path of substance abuse. Studies have mentioned that many women are likely to form a substance addiction while in an intimate relationship, especially if the partner is also abusing the drug. Other risk factors include psychological and emotional distress, two major influencers for women that are not as widespread among men’s substance abuse catalysts.
Other social pathways include:
- Physical, mental, or emotional abuse;
- Neglect felt during childhood;
- A family history of substance abuse;
Considering Mental Health Issues for Women and Substance Abuse
Mental illness is, unfortunately, an extremely common pairing with those suffering from substance addiction. The connection between the two is so strong that many studies have tried to see if there are any causative roles between them. However, though they are not mutually exclusive, it doesn’t seem to be the case.
Instead, the Substance Abuse and Mental Health Administration calls such conditions dual disorders (or co-occurring disorders) and opts to treat them as stand-alone issues. Reportedly 55.8% of people suffering from co-occurring disorders do not receive any treatment for their conditions, while only 7.4% will receive care for both, the mental illness and the addiction.
Women can be affected by mental issues differently than men. Depression and anxiety are two of the disorders that have been statistically more prevalent among women. The National Institute on Mental Health indicates the existence of certain forms of depression that are unique to women (such as postpartum depression, a condition from which a percentage of the women who have recently given birth can suffer).
Shifts in hormone levels can also lead to women having some particular mental afflictions, such as the premenstrual dysphoric disorder. Though other forms of mental issues (like schizophrenia) don’t show any differences between genders, the NIMH suggests that men and women experience mental disorders differently and that the sex of the patient can influence the evolution of the affliction.
When combining the particular biological and social pathways that lead women to substance addiction with the data on how mental disorders specifically affect women, the most obvious conclusion one can reach is that addiction, as a whole, must be studied from the perspective of each gender. Understanding how men are affected by such issues in comparison to women can then result in a more effective treatment plan.
Signs and Symptoms of Opioid Abuse in Women
When an individual, particularly a woman, is confronted with an addiction, they may display a variety of signs indicative of their condition. The severity of these signs may vary, depending on an array of external factors, such as the type of opioid abused, co-occurring issues, family history, and others. Some of the signs and symptoms may include:
- Compulsive use of the drug (opioid abuse);
- Going to the doctor with the sole purpose of acquiring painkiller prescriptions. Some patients will even go to different doctors at the same time to get a higher dosage than usual;
- Disengaging with social activities;
- Declined performance at school or work;
- Putting others at risk, such as driving a car while under the effect of the drug while children or others are also present;
- Difficulty moving or performing simple tasks;
- Extreme agitation;
- Heart palpitation;
- Difficulty breathing.
- Mood swings;
- Memory loss;
- Cravings for opiates or other drugs;
- Difficulty concentrating.
Moreover, certain details related to a patient’s family history may also be indicative of substance abuse. Such risk factors are:
- Substance abuse within the family;
- Easy access to a drug supply;
- Violence and domestic abuse;
Due to the extreme bond formed between the individual and the drug, ceasing to take opioid substances can lead to a rather difficult process of withdrawal. Some symptoms people may experience include:
- Mood swings;
- Muscle pains;
- Profuse sweating;
Given the challenging levels of withdrawal, it is common for individuals to cease their detox process and take another dosage of opiates to relieve their pain. Still, over time the body will no longer be able to process the substances, and patients may face the risk of overdosing.
In fact, opioid tolerance is a key reason why many women will gradually increase their dose. Over time, the usual dosage won’t generate the same pleasant effect for the patient, so they will seek higher quantities to get the desired effect, thus increasing the dangers of overdosing. This is often a catalyst for common forms of opioid abuse.
Signs of an opiate overdose:
- Feeling cold;
- Slurred speech;
- Difficulty breathing;
Treatment Options for Women
Women who want to overcome their opiate abuse or addiction must do so under strict medical supervision. The intensity of the withdrawal symptoms places them at a constant risk of relapse, as they might take another dose just to improve their condition. Detox centers can offer women specialized care, both regarding medical detoxification and subsequent recovery therapy. Together, these treatment plans specifically designed for women can help achieve a positive, drug-free outcome.
Individual therapy is the most common form of treatment for those battling with addiction. Patients participate in one-on-one sessions with a professional psychiatrist or therapist to process feelings, thoughts, emotions, and help create a new drug-free mindset.
Women, in particular, are far more dependent on the bonds they form with family and friends. During treatment at a rehab facility, patients can often feel disconnected and alone, even abandoned by loved ones. Group therapies are meant to reassure these women and allow them to form new, meaningful connection within the center. Patients can act as each other’s support system, making the process of recovery more bearable.
Given their tighter connection with the outside world, women in rehab centers also participate in family therapies meant to repair the relationships damages through the course of the addiction. These treatments are not only beneficial for the patient, but also for family members and friends. They can better understand what their loved one is experiencing, acquire the necessary knowledge to cope with the situation and handle the addiction.
Other Forms of Therapy
Most rehab centers will offer a variety of behavioral and experimental treatments for their patients. Women can follow a treatment plan focused on providing a holistic care, particularly with the addition of several physical activities combined with medical and psychological care:
Inpatient vs. Outpatient Care
Patients seeking an inpatient care will enroll into the detox clinic, where they will be under the constant supervision of a team of professionals. However, particularly in the case of women, some circumstances prevent a patient from committing to such a program.
Single mothers or caregivers cannot afford to disconnect entirely from their daily lives and focus on their treatment. As such, they are more likely to follow an outpatient program, where they must make weekly visits to the clinic, but don’t have to remain on the premise. Still, at least for the medical detox stage, patients should stay under supervision until the withdrawal symptoms improve.
Treatment for Pregnant Women
It is vital for pregnant women who are suffering from an opioid addiction to seek treatment as soon as possible. Ignoring this issue can result in:
- Reduced fetal growth;
- Premature labor;
- Placental abruption;
- Fetal death.
Unfortunately, expecting mothers fear seeking treatment, thinking that the detox process (and the medication prescribed during it) might affect the fetus. Still, NIDA recognizes that both methadone and buprenorphine are effective treatment options for pregnant women as they:
- Reduce prenatal withdrawal;
- Stabilize the fetus’ opioids levels;
- Offer mothers better prenatal care;
- Increase maternal HIV treatment and reduces the chances of transmitting the virus to the child.
Other opioid addiction treatments include:
- Medical treatments in a hospital (where patients typically take Methadone during withdrawal);
- AA-type groups or support groups;
- 12 step programs.
The Treatment Process
There are several stages of overcoming an opioid addiction:
During this stage, the body is thoroughly cleansed of the abused substance. The patients are supervised continuously during the detoxification process to keep their condition under control and manage any consequent risks. Some medication may be provided during this step to relieve some symptoms.
Each patient will present with their own set of symptoms. Women seeking treatment in a detox facility require individualized care that will address their particular needs. Otherwise, the risk of relapsing might increase. As such, patients are assessed soon after their arrival at the facility and a medical staff trained in dealing with addiction and other co-occurring issues will create a treatment plan with the proper medication and subsequent therapies.
Once the medical detox has finished, the patient will then undergo a series of therapies based on the treatment plan designed for them. These therapies take a holistic approach to overcoming addiction tied to opioid abuse, focusing not only on the physical side effects but also the mental and emotional issues it generates. Patients can work on any underlying issues that may have led to the addiction during this stage.
Patients should be aware that fighting an addiction does not end once the recommended treatment plan is over. In truth, women might experience some of the biggest stepping stones in their recovery once they re-enter society and leave the center. As such, it is vital that they continue their treatment even after returning home.
The most significant obstacle women will face is craving. Although therapy can help them handle them successfully, it is hard to estimate how severe they will be. By continuing to come to treatment, or to take part in support groups, women can have a better chance at avoiding relapse.
A Chance at a Drug-Free Life
Multiple studies seem to indicate that while comparable, men and women react differently to drug addiction. As such, the therapy itself must be individualized based on the particular issues women face, both biological and of social in nature. Detox centers that offer care exclusively for women are the best chance of a clean, opioid-free life.