SUD in females

People may face unique issues when it comes to substance use, as a result of both sex and gender.

• Sex differences result from biological factors, such as sex chromosomes and hormones 

• While gender differences are based on culturally defined roles for men and women, as well as those who do not identify with either category. Gender roles influence how people perceive themselves and how they interact with others. 

• Sex and gender can also interact with each other to create even more complex differences among people

• Women and men sometimes use drugs for different reasons and respond to them differently. 
  For example, women describe unique reasons for using drugs, including controlling weight, fighting exhaustion, coping with pain, and attempts to self-treat mental health problems.

• Women often use substances differently than men, such as using smaller amounts of certain drugs for less time before they become addicted.

• Women can respond to substances differently. For example, they may have more drug cravings and may be more likely to relapse after treatment.

• Sex hormones can make women more sensitive than men to the effects of some drugs.

• Women who use drugs may also experience more physical effects on their heart and blood vessels.

• Brain changes in women who use drugs can be different from those in men.

• Women may be more likely to go to the emergency room or die from overdose or other effects of certain substances.

• Women who are victims of domestic violence are at increased risk of substance use.

• Divorce, loss of child custody, or the death of a partner or child can trigger women's substance use or other mental health disorders

• Women who use certain substances may be more likely to have panic attacks, anxiety, or depression.

• Some of the unique issues women who use drugs face relate to their reproductive cycles. Some substances can increase the likelihood of infertility and early onset of menopause.

• Substance use during pregnancy can be risky to the woman’s health and that of her children in both the short and long term. Most drugs, including opioids and stimulants, could potentially harm an unborn baby. 

• Use of some substances can increase the risk of miscarriage and can cause migraines, seizures, or high blood pressure in the mother, which may affect her fetus. In addition, the risk of stillbirth is 2 to 3 times greater in women who smoke tobacco or marijuana, take prescription pain relievers, or use illegal drugs during pregnancy.

• It is important to note that treatment for substance use disorders in women may progress differently than for men. 

• Women report using some substances for a shorter period of time when they enter treatment. However, women's substance use tends to progress more quickly from first use to addiction. Withdrawal may also be more intense for women. In some cases, women respond differently than men to certain treatments. For instance, nicotine replacement (patch or gum) does not work as well for women as for men.

SUD in pregnancy

The number of women misusing drugs has increased considerably and a significant number of women in the UK presenting to drug misuse services for treatment are of child-bearing age.
Every woman suspected of a positive pregnancy test requires appropriate history-taking, assessment and screening for alcohol and other drug use.

Drug and alcohol use during pregnancy is associated with both maternal and fetal/neonatal outcomes. Maternal outcomes include not receiving adequate prenatal care and fetal outcomes relate to a failure to thrive. Women of child-bearing age who smoke, consume more than two standard drinks a day, or use other drugs, should be informed of the potential risks to both themselves and the fetus, and offered advice and if necessary, told where to get help.
Where harmful, hazardous or dependent use is suspected or confirmed by the obstetrician, a specialist Drug and Alcohol service should be involved.

In collaboration with the Antenatal team, the Drug and Alcohol team can provide specific guidance on treatment and will monitor the patient’s alcohol and other drug use during pregnancy, following the birth of the baby, monitoring is continued by the neonatal team and the Drug and Alcohol teams. If the infant, or an older child, is considered to be at risk, involvement with child protection agencies or departments is mandatory. 
 

The development of the fetus will be affected by factors such as quantity and frequency of use, and gestational stage and drug or alcohol use may lead to: 

• Prematurity
• Low birth weight
• Withdrawal syndromes
• Perinatal mortality
• Teratogenic effects

• Sudden infant death syndrome: increased 4–5 fold in infants born to pregnant drug users
• Respiratory distress
• Convulsions

neonatal abstinence syndrome