Past the sipping point…..
All we need is gossip and alcohol” says one greeting card. Another reads “Birthdays I like. It’s the morning after that I hate.” Scribed across a third is “A drop of wine never hurt anyone. Must be why a whole bottle makes you feel a whole lot better.” The accompanying illustrations encourage female bonding over booze. And these sentiments are not in slim company. Greeting cards designed for women to exchange tend to concentrate on alcohol and celebrate vices. Social media, too, is saturated with drinking humor.
While funny, the ideas also provide a level of permission. Not only is it okay to drink, but it’s okay to overdo it. Charlotte (her name has been changed at her request), age 42, remembers the dismissive laugh she shared with her drinking friends: “We would joke that ‘We aren’t alcoholics. Alcoholics go to meetings! We’re just drunks.’” Amongst her comrades, the behavior was normalized. They told each other that excessive drinking was acceptable and fun.
Women Versus Men
Substance abuse treatment centers serve a population primarily addicted to alcohol and/or prescription medications. “Men are more likely to become addicts in general,” states Laura Makey, a member of the board of directors for Women For Sobriety (WFS) and a recovering alcoholic. “Women tend to become addicts more quickly than men and to have a harder time quitting.”
Lifestyle changes that cause emotional stress, such as a new baby, a death in the family, a divorce, a child moving out, etc., trigger substance use in women. Men are drug-cued—seeing the substance or passing by the place where it is purchased triggers use.
Six-million women in the U.S. alone are estimated to be dependent on alcohol, as reported by The National Center on Addiction and Substance Abuse at Columbia University. According to the National Institute of Alcohol and Alcoholism (NIAAA), 13 percent of women who use alcohol intake more than seven drinks per week. In addition, prescription pill use tends to be a problem predominant among females. Dr. Paul Browne, M.D., director of Maternal-Fetal Medicine at Georgia Regents Medical Center, notes, “Women are more likely to become addicted to prescription narcotics than men. A lot of it has to do with women being more likely to seek healthcare than men.” According to The National Center on Addiction and Substance Abuse at Columbia University, over 7.5 million women and girls misuse or abuse prescription drugs each year. Use of heroine, an inexpensive alternative to prescription narcotics, is also on the rise. Over 2.5 million women abuse or are dependent on illicit drugs like heroine and cocaine.
The health risks for women who use drugs and alcohol are far greater than those for men. The NIAAA states that 5.3 million U.S. women drink in a way that threatens their health and safety. “A man’s drinking doesn’t impact his unborn child’s development,” says Makey. Use of alcohol during pregnancy is known to cause Fetal Alcohol Syndrome, a cluster of birth defects affecting growth and development of the infant. Alcohol also impairs the efficiency of nutrient absorption by the mother’s body. Since the unborn baby receives its nutrition from the mother, its health is affected as well.
Narcotics interfere with calorie intake, suppressing the appetite. Babies born to mothers with narcotics addictions tend to be underweight. Unlike alcohol, narcotics do not cause birth defects, but withdrawal from narcotics during pregnancy can cause miscarriage or pre-term delivery. Babies born to mothers using narcotics may go into life-threatening withdrawal after birth.
Women who drink to excess, whether pregnant or not, run a higher risk than men of developing alcoholic hepatitis. They are more likely than men to die from cirrhosis of the liver. They are more likely than male alcoholics to suffer alcohol-induced brain damage. Their chances of breast cancer increase and their fertility goes down. Female alcoholics experience early onset of menopause.
Addiction also has social ramifications. Female addicts are viewed as sexually promiscuous. Use of alcohol and drugs increases a woman’s chances of being a victim of violence or sexual assault. Women hide their substance use to avoid losing their children, their job, or their marriage, thus delaying intervention.
The Pattern of Addiction
Addiction is insidious. It begins with direct or indirect permission. A friend says it’s okay to have a glass of wine with lunch or a doctor prescribes a pill. Continued and increasing use is bolstered by justification: “I stay at home all day with the kids so I deserve a few drinks to unwind,” or “these pills give me energy and they’re legal so they must be safe.”
Justification leads to increasing use accompanied by denial. Self-talk like, “I’m not an alcoholic because I didn’t drink while I was pregnant” or “I take a few pain pills but I’m taking care of my responsibilities” takes over. At the same time, though maybe suppressed, there’s some level of recognition that other people don’t use or obsess over the substance in the same way. Since fear of losing one’s children, what others will think and/or committing to never using the substance again creates a barrier to seeking help, a major, usually tragic, turning point event is what forces the person to enter treatment.
“No one wakes up in the morning and says, ‘today I’m going to become an addict,’” says Anne H. Moss, M.Ed., a licensed professional counselor and certified advanced drug and alcohol counselor with Bradford Health Services. Makey agrees, “It happens so slowly.” Addiction is a chronic disease with benign beginnings. Its victims start out sipping a glass of wine over lunch with friends or taking a pill to control pain or anxiety or letting loose at a party and trying little cocaine “just this once.”
Cali Estes, M.S., an internationally certified addictions and drug counselor and the owner of The Addictions Coach in Miami, Fla., reports a rising trend in “drinking” playgroups. The children play while the moms chat and imbibe a couple of glasses of wine. “It usually starts in the group with one person who has that mentality (that it’s okay),” says Estes. She encourages the other women to indulge with her. For some of these mothers, “It goes from being a once a week thing to an every day thing,” she says.
Mallory, age 22, a resident of Hope House Augusta, is a sales rep and the mother of a 3-year-old son. She’s also recovering from an addiction to pain pills. After her C-section, the physician sent her home with a prescription for pain medication. It didn’t take long before taking the pills had nothing to do with relief from her incision. She says, “Pain pills gave me energy and motivation to get up and do what I had to do in the morning. It got so I couldn’t get out of bed without taking something.”
Charlotte, whose son is now almost 7 years old, would tell herself she earned a drink after staying home with him all day. “Didn’t I deserve a few drinks at the end of a long day with a baby? It became a reward system for me,” she says.
Denial exacerbates substance abuse. Mallory applauded her dedication to taking care of her son even while under the influence of narcotics. Yes, she admitted, she was taking pills to get through her day, but she was at home with her child. Charlotte gives a similar description of her denial: “I was holding down a good job and I was getting promotions and raises. My bills were getting paid, my house was clean and nobody seemed to know I was getting hammered every night so I must not be a true alcoholic.” Like many women, she used the nine months of sobriety during her pregnancy as additional evidence that her alcohol use was not problematic.
After her son’s birth, she decided not to breast feed and resumed drinking, which she managed to keep “within reason” for the first year. Gradually the alcohol use increased. She’d start a little earlier each day and drink a little more. “Before long I was drinking in the morning, then sleeping it off while my son took his afternoon nap. I kept that hidden from my husband. Then I’d drink my usual amount in the evenings when he got home. The gap between the two drinking sessions got closer and closer together,” says Charlotte.
Mothers and Substance Abuse
The news media have recently pointed attention to tragedies in which mothers driving under the influence have catapulted themselves and their family members into tragic accidents. The common thread between the stories is that no one knew or suspected the mothers had substance abuse problems. In June, a Sacramento, Calif., mother was arrested for driving under the influence and causing the death of her 12-year-old son who was a passenger when the SUV crashed. In September, a Miramar, Fla., mother was arrested in her 6 year old’s elementary school carpool pick-up line for driving under the influence. A Google search finds numerous stories of this kind. The National Highway Traffic Safety Administration reports arrests of women for DUI increased 30 percent from 1998-2007.
In the early stages of substance abuse, it’s relatively easy for a person to hide. Usage is controlled to fit within the patterns of family life and is reserved for times when mom is alone or with only the children. “Women are closet drinkers,” says Makey, “especially mothers.” She says of her own alcoholism that private time was drinking time. Mothers drink at home alone or in the car alone. Sippy cups are used to disguise the alcohol. Bottles are disposed of in other people’s garbage or recycling. Pills are taken to treat a “legitimate” malady of which the husband is aware. He may have even encouraged her to seek medical attention.
As use of substances accelerates, warning signs emerge. “The first signs are always inappropriate behavior,” notes Dr. Browne. Lapses in childcare or personal grooming are clues. Maybe she hides alcohol in unusual places, like the linen closet or the mop bucket or on a shelf in the garage. Does she refuse to answer the phone or run an errand after a certain time in the afternoon or evening? Possibly the bank statement shows frequent cash withdrawals.
Is mom nodding out, slurring her speech or moving in slow motion? Is she counting pills, concerned about running out, or is she seeing the doctor more frequently than expected? Perhaps there are repeated periods of time during which she is off-the-grid—not at work, not at home, not answering her cell phone—without a reasonable explanation. A family history of drug and alcohol abuse is a red flag, too.
Makey adds, “If a woman really doesn’t have a problem, you should be able to discuss it with her without her being defensive.” The sufferers of addiction, even while caught up in obsessing over their next drink or next pill, may toy with the idea that they have a problem before justification and denial jump in to shut down the thought. “If you think you have a problem,” says Moss, “then you probably do.”
Barriers To Seeking Help
“Seventy percent of women in treatment were sexually abused as a child,” says Moss. “Thirty to 59 percent of women in drug treatment suffer from post-traumatic stress disorder (PTSD).” Many have been victimized as a result of their addiction. To enter treatment means to face the past and its influence on the present. Humiliation and remorse associated with addiction are magnified by emotions surrounding abuse or other painful experiences. Moss, says, “There’s so much shame and guilt built into it. That’s what hurts people who need to be in treatment.” Moss reminds her patients and their families, “This is a brain disease.”
Dr. Browne explains, “There’s new genetic research that suggests addictive personalities run in families. There may be genetic pre-disposition for addiction.” In that respect, drug and alcohol addiction is a chronic illness mediated by stress and biology and manifested in behavior. Just like a patient isn’t blamed for contracting cancer or heart disease, sufferers of addiction aren’t responsible for susceptibility to their disease.
Treatment, however, is a scary prospect for women and for mothers in particular. They worry that if they reveal their substance use, they may lose their children or their marriage or both. Anxiety also arises over how the children will be cared for while Mom receives treatment. Lack of suitable childcare prevents some women from getting the help they need.
Because they are driven by their craving for the substance, they can’t imagine life without it. Mallory says, “My biggest fear about seeking treatment was the thought of never using again. I just did not think I had it in me.” Charlotte echoes Mallory, saying, “My biggest fear about addressing the problem was that it would turn out I really was an alcoholic and I really would have to quit for good.”
Worries about labeling weigh on the minds of women, as well. “The stereotype,” says Elicia Taylor, the clinical director of Hope House Augusta, “is that it’s not the girl next door, but often times it is.” Mallory is the prototypical girl-next-door. She’s attractive and intelligent, well-spoken and compassionate. No one would peg her as a drug user.
Charlotte resisted treatment because she dreaded identifying herself as an alcoholic. She says, “Alcoholics are downtrodden, dirty, homeless, clinging to a bottle in a bag sitting on the curb, stumbling around town, etc. I didn’t want to be one of them. I knew that is how everyone perceives an alcoholic.” This is where clinicians like Taylor come in. She says, “We want to dispose of the myth that a substance abusing woman looks a certain way.” Estes, adds, “Society condemns women and forgives men.” Removing blame, stigma and the threat of losing custody of children improves the likelihood that a woman will seek treatment.
Unfortunately, it takes a major event to force the issue. Estes states, “It all comes to a head because it spirals out of control.” Charlotte’s turning point came after spending a day at a cookout with friends. She left the party drunk with her 2-year-old son buckled in the back seat. Driving under the influence, wrecking her car with her 2-year-old in the back seat and getting arrested on the side of the road in front of her son and her parents turned out to be the worst and best thing that ever happened to her. Likewise, serving a jail sentence for stealing put Mallory on the path to recovery.
The National Center on Addiction and Substance Abuse at Columbia University reports that 92 percent of women who need treatment do not get it. Despite the overwhelming acceptance of the 12-step method popularized by AA and NA, these groups and the process fit the needs of men better than those of women. “It’s a lot of telling war stories,” explains Estes. “Women don’t connect with that.” Recounting the gory details of things done under the influence of or in pursuit of alcohol and drugs bonds men. “Women find it excruciating to live it over and over again,” says Makey. For women, the retelling of these events is embarrassing. Men receive high-fives while women are tagged with negative labels.
Organizations and businesses offering an alternative to AA and NA are gaining in popularity. Women For Sobriety reaches female substance abusers through the 13 statements of the New Life Acceptance Program. Statement nine reads, “The past is gone forever.” Other treatment programs, like Estes’s The Addictions Coach, dig to the root problem, repair that and then aid the client in developing momentum to move forward.
An emerging strategy in the treatment field is the use of recovery coaches who monitor the patient in her home 24/7 to ensure she isn’t drinking or using. As of January 2014, recovery coaches will be required to achieve national certification. The downside of this type of treatment is that insurance companies don’t cover it.
Along with behavioral intervention, drug protocols may be used to treat substance abuse. Antabuse is for short-term use under supervision to treat alcoholism. It induces illness in reaction to ingestion of even a small amount of alcohol. Naltrexone, recently approved by the FDA to treat alcohol dependence, blocks the buzz attained from alcohol, reducing the craving. It’s most effective when used regularly and paired with behavior modification. The drugs methadone and suboxone control cravings and symptoms of withdrawal from narcotics (pain medications and heroine).
Recovering from substance abuse and addiction isn’t easy. It’s hard work. It requires a person to take an honest look at herself, to face her past and take ownership of her future. “Treatment just starts the process. She has to do the work to not relapse,” says Taylor.
At the time of interviewing Mallory, she had been in recovery for nine months, a milestone of which she is very proud. “I love going to meetings. I just got a job. I’m a respected citizen. I never would have thought that a year ago,” she confides. “My heart was in the right place. I just couldn’t get my head there.” Her head is there now, and she works daily to keep herself, her son, her head and her heart together and focused on success.