Women using alcohol and other drugs (AOD) face unique challenges and risk factors. Alcohol and other drugs have differential physiological effects on women when compared to men. For example, women who abuse narcotics present with a history of heavier drug use than men; women start using cocaine at a younger age, and are more rapidly addicted. Women also experience the negative physical consequences of alcohol use at lower levels of consumption, along with more severe medical problems, when compared to men who have similar drinking patterns (Doweiko, 2006). Genetic factors incur an added risk of developing AOD dependence, however, the risk increases significantly when there is a history of childhood physical or sexual abuse (Cash & Wilke, 2003). In a literature review of victimization and substance abuse, Logan, Walker, Cole, and Leukefeld (2002) found considerable evidence indicating strong associations between both childhood and adult experiences of trauma, and subsequent alcohol and substance use. Thus, women who have been exposed to childhood and adolescent sexual abuse are at greater risk of developing subsequent use and abuse of substances. One view maintains that stress caused by trauma can cause long-term changes in brain biology and brain structure because of the release of stress hormones. Another possible explanation for the increased risk among women who have experienced trauma is the view that substance use and abuse is a coping mechanism that helps these women manage negative emotions, depression, feelings of shame and guilt, anxiety, anger and low self-esteem. Victimization is also strongly correlated with a high rate of mental health issues, such as PTSD, depression and anxiety disorders. Conversely, the risk of victimization is increased by the use of substances because of the situations and activities that are involved in using and obtaining substances. Moreover, substances impair decision making and increase a woman’s vulnerability to victimization. Women who have a history of prior trauma are at increased risk for re-victimization, perhaps as a result of common traits that victims of trauma often develop such as low self-esteem, shame, and passivity (Logan et al., 2002).

Women often face significant barriers to obtaining treatment. An important factor is responsibility for children. Appropriate childcare is lacking for mothers who want or need to attend treatment programs. Access to outpatient services is negatively impacted by lack of transportation and time constraints for women with children. Very few residential programs include children in treatment, or provide children’s services for women who require more intensive levels of treatment, resulting in lower participation of women in substance abuse treatment. Another barrier to treatment is fear of losing custody of children, especially among pregnant women (Greenfield et al., 2006). Women receiving public assistance are often concerned about losing entitlement benefits, and therefore may avoid seeking treatment. Additional barriers include lack of awareness of services and treatment options, and lack of family or partner support for treatment because many substance abusing women live in environments that support continued substance abuse, or live with partners who also abuse substances (Swift & Copeland, 1998). Finally, women may not receive needed substance abuse treatment because of the absence of coordinated services for co-occurring disorders. Many women experience symptoms of depression, anxiety, and post traumatic stress, in addition to substance abuse. As a result, women often access mental health treatment services initially, which may not address their substance abuse treatment needs (Greenfield et al., 2006). In conclusion, treatment programs must be designed to reduce or eliminate barriers to treatment, and consider the unique risk factors faced by women who use AOD.