risk factors of substance abuse

risk factors of substance abuse Substance abuse continues to be a growing problem among women, with estimates that up to 6.5 % of females aged 12 and older currently abuse alcohol or illicit drugs
(National Survey on Drug Use and Health.Women have unique
characteristics in terms of their patterns of drug use, risk factors, and the physiologic effects of use compared to men. This subsequently affects their screening, assessment, and treatment considerations. Special populations within this group, especially pregnant women and women with children, have distinctive risks, barriers, and needs. In this chapter, we will further explore these various issues to help best determine strategies for optimal care of this vulnerable population.

Patterns of Use and Risk Factors
Women tend to place a high value on their interpersonal relationships and may subsequently be more easily influenced by them compared to men. Often they are first introduced to substance use through a close relationship such as from a romantic partner, family member, or friend. Although initial use may be in an occasional social context, women may continue to use or even escalate their use as a way to maintain or deepen their relationships, particularly if the partner is a heavy user. Women with substance use disorders are more likely to have addicted partners
than their male counterparts, and these relationships can directly influence their progression to high-risk drug use behaviors, especially their faster acceleration to IV drug use compared to men (Center for Substance Abuse Treatment . Frequently, women will end up becoming dependent on their partners to supply their illicit drug. While marriage can sometimes be a protective factor against development of substance abuse, women who are divorced, separated, or never married tend to have higher incidences of substance use disorders.
Aside from interpersonal factors, other reasons for initiation of substance use can be varied, but some women report a desire to lose weight or have more energy as their initial goal. Because of this, women tend to abuse over-the-counter medications such as laxatives, diuretics, emetics, diet pills, and cough and cold preparations more often than men. Some women may have use precipitated by stressors or negative affect. This can result in initial overuse progressing to abuse of prescription drugs such as pain medications or anxiolytics. The younger women are
when they first begin to use, the higher the risk of the development of dependency and the correlation to severity (Marcenko et al. 2000). Although women tend to begin substance abuse at an older age compared to men, they become dependent more quickly and suffer the consequence of their abuse sooner, a phenomenon
known as telescoping.
Co-occurring mental health disorders are another significant risk factor for drug abuse, and these are more prevalent in women compared to men, with anxiety and depressive disorders experienced most commonly. These disorders may be present prior to initiation of substance abuse, develop as a consequence of use, or develop independently and concurrently. Some substance abuse development may stem
from an effort by the woman to self-medicate symptoms of mental illness. Other times, inadequate dosing of prescription medications for a diagnosed mental health disorder leads to self-adjustment of medication with increasing dosages, more frequent use, or addition of illicit substances to ameliorate symptoms. Personality disorders are also commonly seen in women with substance use disorders, most
notably borderline personality disorder.
Women with substance use disorders also have high rates of trauma and interpersonal violence, with some studies estimating that up to 30–75 % of women in substance abuse treatment programs having been victims of sexual abuse and rape.A history of trauma, especially childhood
sexual abuse, has been found to correlate directly with female drug use and its severity .Substance abuse may stem
from an effort to self-medicate symptoms caused by the trauma. In turn, substance abuse may further increase a woman’s risk of trauma by decreasing her ability to defend herself, altering her judgment, or leading her to have high-risk behaviors.
Individual personality factors may also put a woman at greater risk for substance abuse. Novelty seeking, frequently seen in youth but often extending into adulthood, has been associated with increased initiation of use. Other risk factors include a tendency toward obsessiveness, chronic low levels of anxiety, and difficulty in regulating affect .Certain risk factors such as depression, low selfesteem, and peer pressure have been shown to increase the susceptibility of younger women to substance abuse .Familial influence can carry significant risk in the development and course of substance use disorders in women. A history of substance abuse in either parent increases the risk of abuse in their children whether through genetic influences, environmental influences, or both. The prevalence of alcohol dependence is 10–50 times higher in women who have a parent with a substance abuse disorder compared
with the general population.Women who have to take on adult
responsibilities in childhood, or were raised in chaotic, argumentative, blameoriented, or violent households, are more likely to develop substance abuse. Various socioeconomic factors can also increase risk. Those who face employment or educational discrimination may use substances as a way of coping. Women who have less education, lower incomes, and higher rates of unemployment are more likely to have substance use disorders.