Over the last century, in most Western countries, women have made many great strides in social equality, including winning the right to vote and to equal wages. This chapter describes how and why women may also be gaining ground on their male counterparts in the consumption of alcohol and illicit substances. While women have “come a long way” (a phrase employed in a cigarette advertising campaign in the 1980s) in their drug use, researchers and treatment providers have been slow to identify women's treatment needs, and to develop newer services sensitive to the needs of women with substance abuse or dependence. Thus, we also describe the characteristics of women-sensitive services and recommend that existing services adopt these features. Mostly we concentrate on alcohol abuse and dependence, as alcohol is the substance that has been most well studied in terms of gender differences; many of the general findings extrapolate to other drugs. We do not explicitly address nicotine dependence here.

Epidemiology and clinical issues

Epidemiology of substance use and abuse: gender differences

Surveys of substance abuse and dependence in the general population fairly consistently show overall rates in females to be lower than those in males. For example, the United States (US) Epidemiological Catchment Area (ECA) Study (Helzer et al., 1991) reported an overall rate for alcohol abuse and dependence of 13.6%, with a male:female ratio of around 5:1 (males 23.8%, females 4.6%).