Clinical Textbook of Addictive Disorders 3rd ed - R. Frances, S. Miller, A. Mack (Guilford, 2005) WW

20. Addictive Disorders in Women 449attitudes. The goal of reducing the social stigma attached to the female addictmust be balanced against that of preserving the cultural expectation thatwomen will practice abstinence or moderation. Straightforward informationshould be provided about women’s sensitivity to alcohol; principles for the safeuse of prescribed psychoactive drugs; the health effects of tobacco, alcohol, andother drugs particular to women (e.g., breast cancer, birth defects, and obstetriccomplications); the dangers of using substances to “medicate” feelings of inadequacyor sexual problems; and the special risks of women from alcoholic families.These general education efforts are particularly important, because thealcoholic beverage industry has targeted women as a “growth market,” linkingdrinking in their advertisements with youth, beauty, sexual attractiveness, andsuccess. Such advertising sends messages that can alter the cultural norms thatprotect women. Likewise, cigarette advertising aimed at women stressing slimnessand “liberation” (e.g., the slogan “You’ve come a long way baby”) tends tomake smoking more socially acceptable for women and adolescent girls.Because smoking is more strongly associated with the use of illegal drugs in girlsthan boys (Center on Addiction and Substance Abuse, 1996), smoking amongadolescent girls should be a priority prevention target.In addition to general population efforts, specific alcohol/drug preventiontechniques should be aimed at high-risk groups such as adolescent and adultdaughters of alcoholics/addicts, victims of physical and sexual abuse, womenentering new social groups with different drinking customs (e.g., college freshmenand women entering the military), women undergoing stressful life transitions(e.g., divorce, widowhood, childbirth, and reentry into the labor force),and women acting as caretaker for a chronically ill relative. Such risk groupscan be helped to develop self-esteem and coping skills that do not involve substanceuse.Laws and their applications also exert an important influence on substanceuse disorders in women. Recently, the resources of the criminal justice systemhave been used to initiate prosecution of women who use alcohol and otherdrugs during pregnancy. Such women have been charged with “prenatal childabuse” or “delivery of controlled substances to a minor” (via the umbilicalcord). Although many cases have been thrown out of court, and many convictionshave been reversed on appeal, the result of these policies has been lessoften prevention of substance use than deterring pregnant substance users fromseeking either prenatal or addiction treatment (Harris & Paltrow, 2003).In summarizing this overview of use and abuse of psychoactive substancesby girls and women in the United States, it is clear that our society has strongfeelings about such use but has not translated those feelings into an adequateinvestment in prevention, treatment, and research. Let us hope that a renewedfocus on the problems of women will stimulate medical and social policymakersto rethink the priority devoted to this issue.