Women and substance abuse

12 World Health • 48th Year, No. 4, July-August 1995 Women and substance abuse Pia Bergendahl & Lee-Nah Hsu on the develop- ing fetus are of serious concern. Especially, women and their partners should be made aware of the risks when alcohol, tobacco and other legal substances are used during pregnancy. Women 's tolerance to most drugs is lower than that of men. The use of psychoactive In most countries, psychoactive substance use has traditionally been a problem affecting males. But with the rapid social and eco- nomic changes over the past few decades, there has been a dramatic increase in this problem among women in both developed and devel- oping countries. Examples of this can be found all over. • In one European country between 1970 and 1985, deaths related to alcohol dependence increased tenfold for men and 20-fold for women . • In one African country, tobacco, alcohol, tranquillizers , cannabis and stimulants are now increas- ingly used by women, and more recently cocaine and heroin are also available. • In one Asian country, while the use of psychoactive substances is still low among women, their use by men is having a major impact on women and families. Among the poorest, up to a third of total family income may be spent on alcohol and tobacco products. Women and men respond differently to alcohol and drugs, women having a lower tolerance to most substances. Since many women substance users are of child-bearing age, the effects substances facilitates the spread of HIV infec- tion through sexual contact or needles shared by injecting drug users . In many societies drug use, drug dealing and prostitution are closely connected; consequently the women involved are at high risk of infection with HIV and other sexu- ally transmitted diseases . Inadequate health c:are Services for women substance users are often non-existent or limited, especially in the developing world. Where treatment or rehabilitation programmes do exist, the special needs of women are usually not addressed. For example, women might need help to arrange for the care of their children before entering treatment. During treatment feelings of guilt and shame, as well as diffi- culties in relationships, should be considered. While men more often use alcohol and illicit drugs, many women turn to prescription drugs , such as tranquillizers. In addition, they often consume alcohol and drugs at home, so that their abuse problem is less publicly visible. Among adolescents alcohol and inhalants are commonly used sub- stances. Although young women are less likely to be users of illicit drugs , their use of cannabis, amphetamines, heroin and other illicit drugs is increasing, and the use of multiple drugs is common. As for tobacco, the increasing prevalence of tobacco smoking among women is alarming. In many developed countries the number of women smokers is rising to the same level as that of men. In developing countries more and more girls start smoking. In spite of well-known health hazards , tobacco products continue to be aggressively mar- keted , targeting women with false messages of emancipation, espe- cially in developing countries. Women as resources To deal with these problems the focus must be on both men and women, taking into account the effects on the family and children. Women who do not use substances can suffer from their use by a partner or other family members; for in- stance, a family's income for food, health care and education may be spent on alcohol, tobacco or drugs. Domestic violence is often associ- ated with alcohol or other drug use. At all levels- international, national and local - the issue of women and substance use is increas- ingly being recognized, as is the important role of women. Women assume the major responsibility for health care within the family, and are often concerned about the social and health situation in the community. Thus women, especially if training and education can be provided, are instrumental in preventing substance abuse and its potential harmful consequences. • Or Pia Bergendahl is with the Programme on Substance Abuse, World Health Organization, 121 I Geneva 27, Switzerland. Or Lee-Nah Hsu is with the Demand Reduction Section, United Notions International Drug Control Programme, P. 0. Box 600, 1400 Vienna, Austria.