Substance use disorders and women's health

Misuse of illegal and controlled drugs, alcohol, and tobacco constitutes a major national health problem. Though even more frequent in men, substance use disorders (abuse and dependence) are common in women, with overall lifetime prevalence estimated at 18%, not including nicotine dependence. There is evidence to suggest that these rates are increasing in younger cohorts of women. Among pregnant women, 4.6% report binge drinking and an estimated 4% currently use illicit drugs.

Substance misuse affects women and men differently. Substance-dependent women tend to suffer more severe medical and interpersonal consequences than men, and their dependence progresses more rapidly. Women with substance use disorders have different patterns of comorbid psychiatric illnesses, which may in some cases play a role in the etiology of their substance use disorders. Women face multiple barriers to effective diagnosis and treatment of substance use disorders, including stigmatization of substance-misusing women, fear of loss of child custody, treatment programs that are designed for men, and a paucity of treatments, pharmacologic as well as psychosocial, that have been empirically validated in women.

As a physician for women's health care, the obstetrician–gynecologist can play important roles in addressing substance use disorders. These roles may include screening patients by use of questionnaires; providing education, treatment, and referral; advising patients of social and support groups; practicing safe prescription writing; and addressing the needs of adolescents. This issue of the Obstetrics and Gynecology Clinics of North America is designed to provide relevant information and to offer strategies to busy clinicians about more optimal care of women with substance use problems.

It is our desire that this issue inspire and activate attention to issues of substance use for all providers caring for women. We hope that the practical information provided herein will aid in the design, development, and implementation of substance use outreach and treatment programs for women.