In two population-based studies, researchers found more drug use and heavy drinking among bisexual and lesbian women than among heterosexual women (Diamant et al. 2000). Gender-appropriate and culturally responsive health care improves both short- and long-term outcomes, not just for women with substance use disorders but also for clients with almost any type of healthcare problem. Certain health issues are unique to women; others affect women disproportionately compared to men; and still others have a different effect on women than on men. To add to these gender differences, the National Institutes of Health (NIH) has identified critical racial and ethnic disparities in health that result in different outcomes or consequences in some groups. Other factors such as sexual orientation also have been shown to affect health status (Dean et al. 2000).

• Further, though people who use a substance may not have a substance use disorder, they may benefit from receiving culturally informed prevention and early-intervention services.
• The following section provides a review of research on the prevalence and risk of alcohol-related problems in different subgroups of women defined by race/ethnicity, socioeconomic status, and sexual minority status.
• It is not unusual for older patients to show poor compliance with the recommended use of their medications (Menninger 2002).
• Statistical data on the use of various psychoactive substances indicate a narrowing of previous differences in substance use between men and women.
• As noted earlier, this review reflects a predominant focus in the literature on racial/ethnic and socioeconomic disparities.

Emotional differences in drinking

Alcohol dependence in an older woman may be observed first when she presents at an acute-care medical setting with complaints such as depression, memory loss, frequent falls, or chronic pain that may have been exacerbated by alcohol. This is an appropriate time to intervene and discuss the benefits of sobriety as well as treatment options. Women with early-onset alcohol dependence have a high incidence of major depression, anxiety, and bipolar disorder and simply continue their drinking habits as they age (CSAT 1998d). They are more likely than those with early-onset use to have begun or increased drinking in response to a recent loss such as death or divorce. Both groups appear to use alcohol almost daily outside the home and at home alone and Women and Alcoholism are likely to use alcohol to respond to hurts and losses (CSAT 1998d). Although Asian and Pacific Americans constitute about 4 percent of the population, they represent less than 1 percent of admissions to substance abuse treatment facilities in 1999.

• For example, widowed women were found to be three times more likely than married women to drink heavily (The National Center on Addiction and Substance Abuse at Columbia University CASA 1996).
• For many women, participating in tribal activities gave them a sense of belonging—some for the first time (Berkowitz et al. 1998).
• To date, more research is needed to examine the effectiveness of CBT with ethnically diverse adult populations with substance use disorders.
• If, for example, a woman is arrested for driving under the influence, the chances are significant that the person in authority knows her or her family (Boyd 1998).

Physical differences in drinking

The definition of family is expansive and includes not only immediate and extended family members determined by blood and marriage, but also other members of the community. Among women, family ties, loyalties, cultural expectations, and beliefs can serve as a protective factor against substance abuse (Joe 1996). Moreover, the concept and value of interrelatedness among family, community, environment, and the spiritual world is essential in many Asian and Pacific Island cultures, and these tenets should be woven throughout the treatment program and clinical services (for an overview of treating Asian- and Pacific-American clients and their families, refer to Chang 2000). Our results also echo Bauer’s (2014) recommendations for methodological application of intersectionality in public health, in particular through approaches to construct models that make intersectional effects visible to readers 5. Here we presented one approach to structuring analytical models that helps readers understand how the impact of factors (intersecting identities and experience of discrimination) differed across strata (men and women).

Recent Findings

In 2013, the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5)12 was released, which replaces DSM-IV alcohol abuse and dependence diagnoses with a single AUD diagnosis that is classified as mild, moderate, and severe. While alcohol and drug patterns vary little across most age groups in urban and rural settings, emerging patterns among rural youth show a rise in use—thus providing a forecast of potential patterns of abuse and dependence. While rural and urban areas experience similar drug-use problems, the consequences may be greater in rural areas because of limited access to health care and substance abuse treatment. For example, only 10.7 percent of hospitals in rural areas offer substance abuse treatment services compared to 26.5 percent of metropolitan hospitals (Dempsey et al. 1999). This study continues the efforts to conceptualize and operationalize intersectionality in public health research and contributes to a developing body of literature that applies intersectionality theory to understand health disparities 3,4,5,6,7,8. We provide empirical data to support the “intersectionality paradox” argument and suggest that researchers should not assume that health risks increase with each additional minority status.

• However, this was done consciously, knowing that the PubMed database is one of the databases containing high-quality peer-reviewed publications.
• For many Native-American women, the journey to reclaim their identities and culture is central to recovery (Brems 1996).
• After obtaining informed consent from respondents, the NSDUH uses computer-assisted self-interviews to collect data on substance use, including substances used and information about misuse.
• Older years are filled with many adjustments and challenges, often including loss of spouse and close friends, retirement, and reduced income.
• Research to understand how oppression shapes and interacts with sociocultural and psychophysiological mechanisms (e.g., social norms, allostatic load) to influence drinking may also help shed light on inconsistent results in the literature.

Observers and researchers of women’s drug use point to the specific characteristics of this group, but especially to the difficulties women encounter when deciding to seek treatment. The image established in the social space of men with an addiction problem differs significantly from that of women suffering from addiction, who face ostracism and stigmatization during the development of addiction and during treatment attempts 13,14,15,16. Negative attitudes toward women experiencing addiction are related to the consequences attributed to women who use these substances, including unwanted pregnancy, prostitution, and transmission of infectious diseases 5. In addition, women who are mothers suffering from addiction have a complicated situation stemming from the stigma they experience compared to non-mothers and the need to balance parental responsibilities with participation in therapy, often lasting several weeks in an inpatient setting 17.

Environmental Factors: the Role of Intimate Partner Violence

If sexuality is expressed without jeopardizing family integrity and the individual’s role in the family, then it may be tolerated (Chan 1997). Many Asians find it difficult to conceive of losing that familial connection and are therefore uncomfortable with assuming a minority sexual identity. Given this context, it is likely that Asian Americans who are openly lesbian probably are relatively acculturated. Chan (1989) found that, although they identify both with their Asian-American and lesbian identities, most of these women identify more strongly as lesbian. Social support for treatment is known to be important in helping women stay in treatment and avoid relapse.