National Institute on Drug Abuse (NIDA) Substance Use in Women · 2020-03-09 · Sex and Gender Differences in Substance Use Disorder Treatment ... (e.g. greater sensitivity to visual

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NationalInstituteonDrugAbuse(NIDA)SubstanceUseinWomenLastUpdatedJanuary2020https://www.drugabuse.gov

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TableofContentsSubstanceUseinWomen

Summary

SexandGenderDifferencesinSubstanceUse

SubstanceUseWhilePregnantandBreastfeeding

SexandGenderDifferencesinSubstanceUseDisorderTreatment

OtherSexandGenderIssuesforWomenRelatedtoSubstanceUse

TheImportanceofIncludingWomeninResearch

WherecanIgetfurtherinformationaboutsubstanceuseinwomen?

References

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Summary

Peoplemayfaceuniqueissueswhenitcomestosubstanceuse,asaresultofbothsexandgender.Sexdifferencesresultfrombiologicalfactors,suchassexchromosomesandhormones,whilegenderdifferencesarebasedonculturallydefinedrolesformenandwomen,aswellasthosewhodonotidentifywitheithercategory.Genderrolesinfluencehowpeopleperceivethemselvesandhowtheyinteractwithothers. Sexandgendercanalsointeractwitheachothertocreateevenmorecomplexdifferencesamongpeople.WhiletheNIHisworkingtostrengthenresearchonsex/genderdifferencesacrossdomainsofhealth,currentevidenceislimited;forthepurposeofthisreport,maleandfemalesubjectsidentifyassuchacrossbothsexandgender.

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ExamplesofSexandGenderInfluencesinSmokingCessation

SexDifference:Womenhaveahardertimequittingsmokingthanmendo.Womenmetabolizenicotine,theactiveingredientintobacco,fasterthanmen.Differencesinmetabolismmayhelpexplainwhynicotinereplacementtherapies,likepatchesandgum,workbetterinmenthaninwomen.Menappeartobemoresensitivetonicotine'spharmacologiceffectsrelatedtosubstanceusedisorder.

GenderDifference:Althoughmenaremoresensitivethanwomentonicotine'saddiction-relatedeffects,womenmaybemoresusceptiblethanmentonon-nicotinefactors,suchasthesensoryandsocialstimuliassociatedwithsmoking(e.g.greatersensitivitytovisualandolfactorycuesastriggersandgreaterconcernaboutweightgainwhilequitting).

Sources:ORWH,2015;NIDA,2002

Forexample,womenandmensometimesusedrugsfordifferentreasonsandrespondtothemdifferently.Additionally,substanceusedisorderscanmanifestdifferentlyinwomenthaninmen.Asubstanceusedisorderoccurswhenapersoncontinuestousedrugsoralcoholevenafterexperiencingnegativeconsequences.

Someoftheuniqueissueswomenwhousedrugsfacerelatetotheirreproductivecycles.Somesubstancescanincreasethelikelihoodofinfertility andearlyonsetofmenopause. Substanceuseisalsofurthercomplicatedduringpregnancyandbreastfeeding.Pregnantwomenusingdrugs,includingtobaccoandalcohol,canpassthosedrugstotheirdevelopingfetusesandcausethemharm.Similarly,newmothersusingdrugscanpassthosetotheirbabiesthroughbreastmilkandcausethemharm.(SeeSubstanceUseWhilePregnantand

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Breastfeeding)

Unfortunately,itcanbedifficultforapersonwithasubstanceusedisordertoquit,andsomewomenwithsuchdisordersfearthatseekinghelpwhilepregnantorafterwardcouldcausethemlegalorsocialproblems.Communitiescanbuildsupportsystemstohelpwomenaccesstreatmentasearlyaspossible, ideallybeforebecomingpregnant.Ifawomanisunabletoquitbeforebecomingpregnant,treatmentduringpregnancyimprovesthechancesofhavingahealthierbabyatbirth.

Women,pregnantornot,haveuniqueneedsthatshouldbeaddressedduringsubstanceusedisordertreatment.Effectivetreatmentshouldincorporateapproachesthatrecognizesexandgenderdifferences,understandthetypesoftraumawomensometimesface,provideaddedsupportforwomenwithchildcareneeds,anduseevidence-basedapproachesforthetreatmentofpregnantwomen. (SeeSexandGenderDifferencesinSubstanceUseDisorderTreatment)

Despitethemanydifferencesbetweenmenandwomen,formanyyearsmostanimalandhumanresearchhastraditionallyusedmaleparticipants.Tofindoutmoreaboutsexandgenderdifferencestoinformbettertreatmentapproaches,federalagencieshavedevelopedguidelinestopromotetheinclusionofwomenandanalysesofsexandgenderdifferencesinresearch. (SeeTheImportanceofIncludingWomeninResearch)

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SexandGenderDifferencesinSubstanceUse

Menaremorelikelythanwomentousealmostalltypesofillicitdrugs, andillicitdruguseismorelikelytoresultinemergencydepartmentvisitsoroverdosedeathsformenthanforwomen."Illicit"referstouseofillegaldrugs,includingmarijuana(accordingtofederallaw)andmisuseofprescriptiondrugs.Formostagegroups,menhavehigherratesofuseordependenceonillicitdrugsandalcoholthandowomen. However,womenarejustaslikelyasmentodevelopasubstanceusedisorder. Inaddition,womenmaybemoresusceptibletocraving andrelapse, whicharekeyphasesoftheaddictioncycle.

Researchhasshownthatwomenoftenusedrugsdifferently,respondtodrugsdifferently,andcanhaveuniqueobstaclestoeffectivetreatmentassimpleasnotbeingabletofindchildcareorbeingprescribedtreatmentthathasnotbeenadequatelytestedonwomen.

IllegalDrugs

Marijuana(Cannabis)

Similartootheraddictivedrugs,fewerfemalesthanmalesusemarijuana. Forfemaleswhodousemarijuana,however,theeffectscanbedifferentthanformaleusers.Researchindicatesthatmarijuanaimpairsspatialmemoryinwomenmorethanitdoesinmen, whilemalesshowagreatermarijuana-inducedhigh.

Inonestudyspecifictoteenagers,malehighschoolstudentswho

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smokemarijuanareportedpoorfamilyrelationshipsandproblemsatschoolmoreoftenthanfemalestudentswhosmokemarijuana. However,afewstudieshavesuggestedthatteenagegirlswhousemarijuanamayhaveahigherriskofbrainstructuralabnormalitiesassociatedwithregularmarijuanaexposurethanteenageboys.

Animalstudiesshowthatfemaleratsaremoresensitivetotherewarding, pain-relieving, andactivity-alteringeffectsofmarijuana'smainactiveingredient,delta-9-tetrahydrocannabinol(THC).Manyofthesedifferenceshavebeenattributedtotheeffectsofsexhormones, althoughrodentresearchalsopointstothepossibilitythattherearesexdifferencesinthefunctioningoftheendocannabinoidsystem,thesystemofbrainsignalingwhereTHCandothercannabinoidsexerttheiractions.

MarijuanaUseDisorder

Men Women

Similarities

Atleastoneothermentalhealthdisorder

Lowrateofseekingtreatment

Differences

Othersubstanceusedisorders

Antisocialpersonalitydisorder

Severityofdisorder

Panicattacks

Anxietydisorders

Disorderdevelopsmorequickly

Forbothsexes,marijuanausedisorderisassociatedwithanincreasedriskofatleastoneothermentalhealthcondition,such

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asdepressionoranxiety.However,menwhoareaddictedtomarijuanahavehigherratesofothersubstanceuseproblemsaswellasantisocialpersonalitydisorders.Bycontrast,womenwhoareaddictedtomarijuanahavemorepanicattacks andanxietydisorders. Althoughtheseverityofmarijuanausedisordersisgenerallyhigherformen,womentendtodevelopthesedisordersmorequicklyaftertheirfirstmarijuanause. Ratesofseekingtreatmentformarijuanausedisorderarelowforbothsexes.

Stimulants(CocaineandMethamphetamine)

Researchinbothhumansandanimalssuggeststhatwomenmaybemorevulnerabletothereinforcing(rewarding)effectsofstimulants,withestrogenpossiblybeingonefactorforthisincreasedsensitivity. Inanimalstudies,femalesarequickertostarttakingcocaine—andtakeitinlargeramounts—thanmales.Womenmayalsobemoresensitivethanmentococaine'seffectsontheheartandbloodvessels.Incontrast,femaleandmalecocaineusersshowsimilardeficitsinlearning,concentration,andacademicachievement,evenifwomenhadbeenusingitlonger.Femalecocaineusersarealsolesslikelythanmaleuserstoexhibitabnormalitiesofbloodflowinthebrain'sfrontalregions.Thesefindingssuggestasex-relatedmechanismthatmayprotectwomenfromsomeofthedetrimentaleffectsofcocaineonthebrain.

Asformethamphetamine,womenreportusingthedrugbecausetheybelieveitwillincreaseenergyanddecreaseexhaustionassociatedwithwork,homecare,childcare,andfamilyresponsibilities.Weightlossisanotherincentivewomenciteformethamphetamineuse—andonereportedsignificantlymorebywomenthanbymen. Womenalsoreportusingmethamphetaminebecausetheybelieveitwillincreaseenergy

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anddecreaseexhaustionassociatedwithwork,homecare,childcare,andfamilyresponsibilities. Womenwhousemethamphetaminealsohavehighratesofco-occurringdepression.

Womentendtobeginusingmethamphetamineatanearlieragethandomen, withfemaleuserstypicallymoredependentonmethamphetaminecomparedtomaleusers. Womenarealsolesslikelytoswitchtoanotherdrugwhentheylackaccesstomethamphetamine. Inaddition,aswithothersubstances,womentendtobemorereceptivethanmentomethamphetaminetreatment.

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MDMA(Ecstasy,Molly)

ResearchsuggeststhatMDMAproducesstrongerhallucinatoryeffectsinwomencomparedtomen,althoughmenshowhigherMDMA-inducedbloodpressureincreases. Thereissomeevidencethat,inoccasionalusers,womenaremorepronethanmentofeelingdepressedafewdaysaftertheylastusedMDMA. BothmenandwomenshowsimilarincreasesinaggressionafewdaysaftertheystopusingMDMA.

MDMAcaninterferewiththebody'sabilitytoeliminatewateranddecreasesodiumlevelsintheblood,causingapersontodrinklargeamountsoffluid.Inrarecases,thiscanleadtoincreasedwaterinthespacesbetweencells,whichmayeventuallyproduceswellingofthebrainandevendeath.Youngwomenaremorelikelythanmentodiefromthisreaction,withalmostallreportedcasesofdeathoccurringinyoungfemalesbetweentheagesof15and30. MDMAcanalsointerferewithtemperatureregulationandcauseacutehyperthermia,leadingtoneurotoxiceffectsandevendeath.

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Heroin

Comparedwithmen,womenwhouseheroinare:younger

likelytousesmalleramountsandforashortertime

lesslikelytoinjectthedrug

moreinfluencedbydrug-usingsexualpartners

Researchsuggeststhatwomentendtousesmalleramountsofheroinandforlesstime,andarelesslikelythanmentoinjectit.Mostwomenwhoinjectheroinpointtosocialpressureandsexualpartnerencouragementasfactors. Onestudyindicatesthatwomenaremoreatriskthanmenforoverdosedeathduringthefirstfewyearsofinjectingheroin,butitisunclearwhythismightbethecase.Onepossibilityisthatwomenwhoinjectheroinaremorelikelythantheirmalecounterpartstoalsouseprescriptiondrugs—adangerouscombination.Womenwhodonotoverdosewithinthesefirstfewyearsaremorelikelythanmentosurviveinthelongterm.Thiscouldbeduetodifferencesintreatmentandotherenvironmentalfactorsthatimpactheroinuse.

PrescriptionDrugs

Prescriptiondrugmisuseistheuseofamedicationwithoutaprescription,inawayotherthanasprescribed,orfortheexperienceorfeelingselicited.Prescriptiondrugmisusecanbedangerousifmixedtogetherwithoutaphysician'sguidance,ormixedwithotherdrugsoralcohol.

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PrescriptionOpioids

Someresearchindicatesthatwomenaremoresensitivetopainthanmen andmorelikelytohavechronicpain, whichcouldcontributetothehighratesofopioidprescriptionsamongwomenofreproductiveage. Inaddition,womenmaybemorelikelytotakeprescriptionopioidswithoutaprescriptiontocopewithpain,evenwhenmenandwomenreportsimilarpainlevels.Researchalsosuggeststhatwomenaremorelikelytomisuseprescriptionopioidstoself-treatforotherproblemssuchasanxietyortension.

Apossibleconsequenceofprescriptionopioidmisuseisfataloverdose,whichcanoccurbecauseopioidssuppressbreathing.In2016,7,109womenand9,978mendiedfromprescriptionopioidoverdose(atotalof17,087)*whichisabout19womenperdaycomparedtoabout27mendyingfromoverdosingonprescriptionopioids.However,from1999to2016,deathsfromprescriptionopioidoverdosesincreasedmorerapidlyforwomen(596percentorsevenfold)thanformen(312percentorfourfold).Womenbetweentheagesof45and54aremorelikelythanwomenofotheragegroupstodiefromaprescriptionopioidoverdose.

*Notethatinthisinstance,“prescriptionopioids”includesotheropioidsandmethadone(ICD-10codesT40.2-T40.3).

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Anti-AnxietyMedicationsandSleepingAids

Womenaremorelikelytoseektreatmentformisuseofcentralnervoussystemdepressants, whichincludesedativessometimesprescribedtotreatseizures,sleepdisorders,andanxiety,andtohelppeoplefallasleeppriortosurgery.Womenarealsomorelikelythanmentodiefromoverdosesinvolvingmedicationsformentalhealthconditions,likeantidepressants.Antidepressantsandbenzodiazepines(anti-anxietyorsleepdrugs)sendmorewomenthanmentoemergencydepartments. Becausewomenarealsomoreatriskthanmenforanxiety andinsomnia, itispossiblethatwomenarebeingprescribedmoreofthesetypesofmedications;greateraccesscanincreasetheriskofmisuseandleadtosubstanceusedisorderoroverdose.

OtherSubstances

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Alcohol

Ingeneral,menhavehigherratesofalcoholuse,includingbingedrinking.However,youngadultsareanexception:girlsages12to20haveslightlyhigherratesofalcoholmisuseandbingedrinkingthantheirmalecounterparts.

Drinkingoverthelongtermismorelikelytodamageawoman'shealththanaman's,evenifthewomanhasbeendrinkinglessalcoholorforashorterlengthoftime. Comparingpeoplewithalcoholusedisorders,womenhavedeathrates50to100percenthigherthandomen,includingdeathsfromsuicides,alcohol-relatedaccidents,heartdisease,stroke,andliverdisease. Inaddition,therearesomehealthrisksthatareuniquetofemaledrinkers.Forexample,heavydrinkingisassociatedwithincreasedriskofhavingunprotectedsex,resultinginpregnancyordisease,andanincreasedriskofbecomingavictimofviolenceandsexualassault.Inaddition,drinkingaslittleasonedrinkperdayisassociatedwithahigherriskofbreastcancerinsomewomen,especiallythosewhoarepostmenopausalorhaveafamilyhistoryofbreastcancer.

Inaddition,menandwomenmetabolizealcoholdifferentlyduetodifferencesingastrictissueactivity.Infact,afterdrinkingcomparableamountsofalcohol,womenhavehigherbloodethanolconcentrations. Asaresult,womenbecomeintoxicatedfromsmallerquantitiesofalcoholthanmen.

MoreinformationonsexandgenderdifferencesinalcoholuseisavailablefromtheNationalInstituteofAlcoholAbuseandAlcoholism(NIAAA).

Nicotine(Tobacco)

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Researchindicatesthatmenandwomendifferintheirsmokingbehaviors.Forinstance,womensmokefewercigarettesperday,tendtousecigaretteswithlowernicotinecontent,anddonotinhaleasdeeplyasmen. Womenalsomaysmokefordifferentreasonsthanmen,includingregulationofmoodandstress. Itisunclearwhetherthesedifferencesinsmokingbehaviorsarebecausewomenaremoresensitivetonicotine,becausetheyfindthesensationsassociatedwithsmokinglessrewarding,orbecauseofsocialfactorscontributingtothedifference;someresearchalsosuggestswomenmayexperiencemorestressandanxietyasaresultofnicotinewithdrawalthanmen.

Riskofdeathfromsmoking-associatedlungcancer,chronicobstructivepulmonarydisease,heartdisease,andstrokecontinuestoincreaseamongwomen—approachingratesformen. Accordingtodatacollectedfrom2005to2009,approximately201,000womendieeachyearduetofactorsrelatedtosmoking—comparedtoabout278,000men. Somedangersassociatedwithsmoking—suchasbloodclots,heartattack,orstroke—increaseinwomenusingoralcontraceptives.

ThenumberofsmokersintheUnitedStatesdeclinedinthe1970sand1980s,remainedrelativelystablethroughoutthe1990s,anddeclinedfurtherthroughtheearly2000s.Becausethisdeclineinsmokingwasgreateramongmenthanwomen,theprevalenceofsmokingisonlyslightlyhigherformentodaythanitisforwomen.Severalfactorsappeartobecontributingtothisnarrowinggendergap,includingwomenbeinglesslikelythanmentoquitandmorelikelytorelapseiftheydoquit.

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SubstanceUseWhilePregnantandBreastfeeding

Researchshowsthatuseoftobacco,alcohol,orillicitdrugsormisuseofprescriptiondrugsbypregnantwomencanhaveseverehealthconsequencesforinfants.Thisisbecausemanysubstancespasseasilythroughtheplacenta,sosubstancesthatapregnantwomantakesalsoreachthefetus. Recentresearchshowsthatsmokingtobaccoormarijuana,takingprescriptionpainrelievers,orusingillegaldrugsduringpregnancyisassociatedwithdoubleoreventripletheriskofstillbirth. Estimatessuggestthatabout5percentofpregnantwomenuseoneormoreaddictivesubstances.

Regularuseofsomedrugscancauseneonatalabstinencesyndrome(NAS),inwhichthebabygoesthroughwithdrawaluponbirth.Mostresearchinthisareahasfocusedontheeffectsofopioids(prescriptionpainrelieversorheroin).However,datahasshownthatuseofalcohol,barbiturates,benzodiazepines,andcaffeineduringpregnancymayalsocausetheinfanttoshowwithdrawalsymptomsatbirth. Thetypeandseverityofaninfant'swithdrawalsymptomsdependonthedrug(s)used,howlongandhowoftenthebirthmotherused,howherbodybreaksthedrugdown,andwhethertheinfantwasbornfulltermorprematurely.

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RisksofStillbirthfromSubstanceUseinPregnancy

Tobaccouse—1.8to2.8timesgreaterriskofstillbirth,withthehighestriskfoundamongtheheaviestsmokers

Marijuanause—2.3timesgreaterriskofstillbirth

Evidenceofanystimulant,marijuana,orprescriptionpainrelieveruse—2.2timesgreaterriskofstillbirth

Passiveexposuretotobacco—2.1timesgreaterriskofstillbirth

Source:Tobacco,druguseinpregnancy,2013

Symptomsofdrugwithdrawalinanewborncandevelopimmediatelyorupto14daysafterbirthandcaninclude :

blotchyskincoloring

diarrhea

excessiveorhigh-pitchedcrying

abnormalsuckingreflex

fever

hyperactivereflexes

increasedmuscletone

irritability

poorfeeding

rapidbreathing

seizures

sleepproblems

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slowweightgain

stuffynoseandsneezing

sweating

trembling

vomiting

Effectsofusingsomedrugscouldbelong-termandpossiblyfataltothebaby:

birthdefects

lowbirthweight

prematurebirth

smallheadcircumference

suddeninfantdeathsyndrome(SIDS)

RisksofSuddenInfantDeath(SIDS)

Childrenborntomotherswhobothdrankandsmokedbeyondthefirsttrimesterofpregnancyhaveatwelvefoldincreasedriskforsuddeninfantdeathsyndrome(SIDS)comparedtothoseunexposedoronlyexposedinthefirsttrimesterofpregnancy.NewinformationfromtheNIHSafePassageStudycallsforstrongerpublichealthmessagingregardingthedangersofdrinkingandsmokingduringpregnancy.

IllegalDrugs

Marijuana(Cannabis)

Moreresearchneedstobedoneonhowmarijuanauseduring

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pregnancycouldimpactthehealthanddevelopmentofinfants,givenchangingpoliciesaboutaccesstomarijuana,significantincreasesinthenumberofpregnantwomenseekingsubstanceusedisordertreatmentformarijuanause,andconfoundingeffectsofpolysubstanceuse. A2017opinionpostedbytheAmericanCollegeofObstetricsandGynecology(ACOG)suggeststhatcannabiseffectsonfetalgrowth(e.g.,lowbirthweightandlength)maybemorepronouncedinwomenwhoconsumemarijuanafrequently,especiallyinthefirstandsecondtrimesters.ACOGrecommendsthatpregnantwomenorwomencontemplatingpregnancyshouldbeencouragedtodiscontinueuseofmarijuanaformedicinalpurposesinfavorofanalternativetherapyforwhichtherearebetterpregnancy-specificsafetydata.

ArecentstudysuggeststhatcannabisusemorethandoubledamongpregnantwomenintheUnitedStatesfrom2010-1017. Cannabisusewasmorecommonduringthefirsttrimesterthanduringthesecondandthird.Between2002-2003and2016-2017,past-monthcannabisuseincreasedfrom3.4%to7.0%amongpregnantwomenoverallandfrom5.7%to12.1%duringthefirsttrimester.Thestudyincludedinformationfrom467,100womenaged12-44whoparticipatedintheNationalSurveyonDrugUseandHealth(NSDUH).Researchersalsoconcludedthatpast-monthclinician-recommendedcannabisusewaslowamongpregnantwomen,andnonmedicalusewaslowerthanamongnonpregnantwomen,possiblyreflectingtheAGOCrecommendations.

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Thereisnohumanresearchconnectingmarijuanausetothechanceofmiscarriage, althoughanimalstudiesindicatethattheriskformiscarriageincreasesifmarijuanaisusedearlyinpregnancy. Someassociationshavebeenfoundbetweenmarijuanauseduringpregnancyandfuturedevelopmentalandhyperactivitydisordersinchildren. Thereissubstantialevidenceofastatisticalassociationbetweenmarijuanasmokingamongpregnantwomenandlowbirthweight. Researcherstheorizethatelevatedlevelsofcarbondioxidemightrestrictfetalgrowthinwomenwhousemarijuanaduringpregnancy.Evidenceismixedrelatedtoprematurebirth, althoughsomeevidencesuggestslong-termusemayelevatetheserisks. Giventhepotentialofmarijuanatonegativelyimpactthedevelopingbrain,theAmericanCollegeofObstetriciansandGynecologistsrecommendsthatobstetrician-gynecologistscounselwomenagainstusingmarijuanawhiletryingtogetpregnant,duringpregnancy,andwhiletheyarebreastfeeding.

Somewomenreportusingmarijuanatotreatseverenausea

Source:Martinetal.,2015

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associatedwiththeirpregnancy; however,thereisnoresearchconfirmingthatthisisasafepractice,anditisgenerallynotrecommended.Womenconsideringusingmedicalmarijuanawhilepregnantshouldnotdosowithoutcheckingwiththeirhealthcareprovider.AnimalstudieshaveshownthatmoderateconcentrationsofTHC,whenadministeredtomotherswhilepregnantornursing,couldhavelong-lastingeffectsonthechild,includingincreasingstressresponsivityandabnormalpatternsofsocialinteractions. Animalstudiesalsoshowlearningdeficitsinprenatallyexposedindividuals.

Humanresearchhasshownthatsomebabiesborntowomenwhousedmarijuanaduringtheirpregnanciesdisplayalteredresponsestovisualstimuli,increasedtrembling,andahigh-pitchedcry,whichcouldindicateproblemswithneurologicaldevelopment.Inschool,marijuana-exposedchildrenaremorelikelytoshowgapsinproblem-solvingskills,memory, andtheabilitytoremainattentive. Moreresearchisneeded,however,todisentanglemarijuana-specificeffectsfromthoseofotherenvironmentalfactorsthatcouldbeassociatedwithamother'smarijuanause,suchasanimpoverishedhomeenvironmentorthemother'suseofotherdrugs. Prenatalmarijuanaexposureisalsoassociatedwithanincreasedlikelihoodofapersonusingmarijuanaasayoungadult,evenwhenotherfactorsthatinfluencedruguseareconsidered. MoreinformationonmarijuanauseduringpregnancyinNIDA'sMarijuanaResearchReport.

Despitevarioussurveys,theprecisenumberofwomenwhousemarijuanawhilepregnantisunclear.Onestudyfoundthatwomenwereabouttwiceaslikelytoscreenpositiveformarijuanauseviaadrugtestthantheystateinself-reportedmeasures.Thissuggeststhatself-reportedratesofmarijuanauseinpregnantfemalesisnotanaccuratemeasureofmarijuanauseandmaybeanunderestimation.

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Verylittleisknownaboutmarijuanauseandbreastfeeding.OnestudysuggeststhatmoderateamountsofTHCfindtheirwayintobreastmilkwhenanursingmotherusesmarijuana. SomeevidenceshowsthatexposuretoTHCthroughbreastmilkinthefirstmonthoflifecouldresultindecreasedmotordevelopmentat1yearofage. TherehavebeennostudiestodetermineifexposuretoTHCduringnursingislinkedtoeffectslaterinthechild'slife.Withregularuse,THCcanaccumulateinhumanbreastmilktohighconcentrations. Becauseababy'sbrainisstillforming,THCconsumedinbreastmilkcouldaffectbraindevelopment.Givenalltheseuncertainties,nursingmothersarediscouragedfromusingmarijuana. Newmothersusingmedicalmarijuanashouldbevigilantaboutcoordinatingcarebetweenthedoctorrecommendingtheirmarijuanauseandthepediatriciancaringfortheirbaby.

Stimulants(CocaineandMethamphetamine)

Itisnotcompletelyknownhowapregnantwoman'scocaineuseaffectsherchild,sincecocaine-usingwomenaremorelikelytoalsouseotherdrugssuchasalcohol,tohavepoornutrition,ortonotseekprenatalcare.Allofthesefactorscanaffectadevelopingfetus,makingitdifficulttoisolatetheeffectsofcocaine.

Researchdoesshow,however,thatpregnantwomenwhousecocaineareathigherriskformaternalmigrainesandseizures,prematuremembranerupture,andplacentalabruption(separationoftheplacentalliningfromtheuterus). Pregnancyisaccompaniedbynormalcardiovascularchanges,andcocaineuseexacerbatesthesechanges—sometimesleadingtoseriousproblemswithhighbloodpressure(hypertensivecrisis),spontaneousmiscarriage,pretermlabor,anddifficultdelivery.Babiesborntomotherswhousecocaineduringpregnancymayalsohavelowbirthweightandsmallerheadcircumferences,andareshorterinlengththanbabiesborntomotherswhodonotusecocaine.Theyalsoshowsymptomsofirritability,hyperactivity,

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tremors,high-pitchedcry,andexcessivesuckingatbirth. Thesesymptomsmaybeduetotheeffectsofcocaineitself,ratherthanwithdrawal,sincecocaineanditsmetabolitesarestillpresentinthebaby'sbodyupto5to7daysafterdelivery. Estimatessuggestthatthereareabout750,000cocaine-exposedpregnancieseveryyear.

Pregnantwomenwhousemethamphetaminehaveagreaterriskofpreeclampsia(highbloodpressureandpossibleorgandamage), prematuredelivery,andplacentalabruption.Theirbabiesaremorelikelytobesmallerandtohavelowbirthweight. Inalarge,longitudinalstudyofchildrenprenatallyexposedtomethamphetamine,exposedchildrenhadincreasedemotionalreactivityandanxiety/depression,weremorewithdrawn,hadproblemswithattention,andshowedcognitiveproblemsthatcouldleadtopooreracademicoutcomes.

MDMA(Ecstasy,Molly)

MoreresearchisneededontheeffectsofMDMAuseduringpregnancy.WhatresearchexistssuggeststhatprenatalMDMAexposuremaycauselearning,memory, andmotorproblemsinthebaby.

Heroin

Heroinuseduringpregnancycanresultinneonatalabstinencesyndrome(NAS)specificallyassociatedwithopioiduse.NASoccurswhenheroinpassesthroughtheplacentatothefetusduringpregnancy,causingthebabytobecomedependentonopioids.Symptomsincludeexcessivecrying,high-pitchedcry,irritability,seizures,andgastrointestinalproblems,amongothers.

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Medications

PrescriptionandOver-the-Counter(OTC)Drugs

Pregnancycanbeaconfusingtimeforwomenfacingmanychoicesaboutlegaldrugs,liketobaccoandalcohol,aswellasprescriptionandover-the-counter(OTC)drugsthatmayaffectthedevelopingfetus.Thesearedifficultissuesforresearcherstostudybecausescientistscannotgivepotentiallydangerousdrugstopregnantwomen.Herearesomeoftheknownfactsaboutpopularmedicationsandpregnancy:

Therearemorethan6millionpregnanciesintheUnitedStateseveryyear, andabout9outof10pregnantwomentakemedication. TheU.S.FoodandDrugAdministrationissuedrulesondruglabelingtoprovideclearerinstructionsforpregnantandnursingwomen,includingasummaryoftherisksofuseduringpregnancyandbreastfeeding,adiscussionofthedatasupportingthesummary,andotherinformationtohelpprescribersmakesafedecisions.

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Evenso,weknowlittleabouttheeffectsoftakingmostmedicationsduringpregnancy.Fewerthan10%ofprescriptionshaveenoughinformationtodeterminefetalrisks. Thisisbecausepregnantwomenareoftennotincludedinstudiestodeterminesafetyofnewmedicationsbeforetheycomeonthemarket. Onestudyshowsthatuseofshort-actingprescriptionopioidssuchasoxycodoneduringpregnancy,especiallywhencombinedwithtobaccoand/orcertainantidepressantmedications,isassociatedwithanincreasedlikelihoodofNASintheinfant.

AlthoughsomeprescriptionandOTCmedicationsaresafetotakeduringpregnancy,apregnantwomanshouldtellherdoctoraboutallprescriptionandover-the-countermedications,andherbalordietarysupplementssheistakingorplanningtotake.Thiswillallowherdoctortoweightherisksandbenefitsofamedicationduringpregnancy.Insomecases,thedoctormayrecommendthecontinueduseofspecificmedications,eventhoughtheycouldhavesomeimpactonthefetus.Suddenlystoppingtheuseofamedicationmaybemoreriskyforboththemotherandfetusthancontinuingtousethemedicationwhileunderadoctor'scare.Thiscouldalsoincludemedicationstotreatsubstanceusedisorders—somethingthatisdiscussedinfurtherdetailinthe"SexandGenderDifferencesinSubstanceUseDisorderTreatment."

SomeprescriptionandOTCmedicationsaregenerallycompatiblewithbreastfeeding.Others,suchassomeanti-anxietyandantidepressantmedications,haveunknowneffects, somotherswhoareusingthesemedicationsshouldconsultwiththeirdoctorbeforebreastfeeding.Nursingmothersshouldcontacttheirinfant'shealthcareprovideriftheirinfantsshowanyofthesereactionstothebreastmilk:diarrhea,excessivecrying,vomiting,skinrashes,lossofappetite,orsleepiness.

OtherSubstances

SeeCDCTreatingforTwowebpage

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Alcohol

AlcoholusewhilepregnantcanresultinFetalAlcoholSpectrumDisorders(FASD),ageneraltermthatincludesFetalAlcoholSyndrome,partialFetalAlcoholSyndrome,alcohol-relateddisordersofbraindevelopment,andalcohol-relatedbirthdefects.Theseeffectscanlastthroughoutlife,causingdifficultieswithmotorcoordination,emotionalcontrol,schoolwork,socialization,andholdingajob.MoreinformationcanbefoundontheNIAAAFetalAlcoholExposurewebpage.

Fetalalcoholexposureoccurswhenawomandrinkswhilepregnant.Alcoholcandisruptfetaldevelopmentatanystageduringapregnancy—includingattheearlieststagesbeforeawomanevenknowssheispregnant.

Thereiscurrentlylittleresearchintohowanursingmother'salcoholusemightaffectherbreastfedbaby.Whatsciencesuggestsisthat,contrarytofolklore,alcoholdoesnotincreaseanursingmother'smilkproduction,anditmaydisruptthebreastfedchild'ssleepcycle. TheAmericanAcademyofPediatricsrecommendsthatalcoholdrinkingshouldbeminimizedduringthemonthsawomannursesanddailyintakelimitedtonomorethan2ouncesofliquor,8ouncesofwine,ortwoaveragebeersfora130-poundwoman.Inthiscase,nursingshouldtakeplaceatleast2hoursafterdrinkingtoallowthealcoholtobereducedoreliminatedfromthemother'sbodyandmilk.Thiswillminimizetheamountofalcoholpassedtothebaby.

Nicotine(TobaccoProductsande-Cigarettes)

Almost10percentofpregnantwomenintheUnitedStateshavesmokedcigarettesinthepastmonth. Carbonmonoxideand

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nicotinefromtobaccosmokemayinterferewiththeoxygensupplytothefetus.Nicotinealsoreadilycrossestheplacenta,andconcentrationsofthisdruginthebloodofthefetuscanbeasmuchas15percenthigherthaninthemother. Smokingduringpregnancyincreasestheriskforcertainbirthdefects,prematurebirth,miscarriage,andlowbirthweightandisestimatedtohavecausedmorethan1,000infantdeathseachyear. Newbornsofsmokingmothersalsoshowsignsofstressanddrugwithdrawalconsistentwithwhathasbeenreportedininfantsexposedtootherdrugs.Insomecases,smokingduringpregnancymaybeassociatedwithsuddeninfantdeathsyndrome(SIDS),aswellaslearningandbehavioralproblemsandanincreasedriskofobesityinchildren.Inaddition,smokingmorethanonepackadayduringpregnancynearlydoublestheriskthattheaffectedchildwillbecomeaddictedtotobaccoifthatchildstartssmoking. Evenamother'ssecondhandexposuretocigarettesmokecancauseproblems;suchexposureisassociatedwithprematurebirthandlowbirthweight,forexample.

Researchprovidesstrongsupportthatnicotineisagatewaydrug,makingthebrainmoresensitivetotheeffectsofotherdrugssuchascocaine. Thisshowsthatpregnantwomenwhousenicotinemaybeaffectingtheirfetus'sbraininwaystheymaynotanticipate.Additionally,e-cigarettes(ore-vaporizers)sometimescontainnicotine.Therefore,thoseproductsmayalsoposearisktothefetus'shealth.Moreresearchisneeded.

Similartopregnantwomen,nursingmothersarealsoadvisedagainstusingtobacco.Newmotherswhosmokeshouldbeawarethatnicotineispassedthroughbreastmilk, sotobaccousecanimpacttheinfant'sbrainandbodydevelopment—evenifthemotherneversmokesnearthebaby.Thereisalsoevidencethatthemilkofmotherswhosmokesmellsandmaytastelikecigarettes.Itisunclearwhetherthiswillmakeitmorelikelythatexposedchildrenmayfindtobaccoflavors/smellsmoreappealinglaterinlife.

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SecondhandSmoke

NewbornsexposedtosecondhandsmokeareatgreaterriskforSIDS,respiratoryillnesses(asthma,respiratoryinfections,andbronchitis),earinfections, cavities, andincreasedmedicalvisitsandhospitalizations. Ifawomansmokesandisplanningapregnancy,theidealtimetoseeksmokingcessationhelpisbeforeshebecomespregnant.

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SexandGenderDifferencesinSubstanceUseDisorderTreatment

Therearemorementhanwomenintreatmentforsubstanceusedisorders.However,womenaremorelikelytoseektreatmentfordependenceonsedativessuchasanti-anxietyandsleepmedications. Inaddition,althoughmenhavehistoricallybeenmorelikelytoseektreatmentforheroinuse,therateofwomenseekingtreatmenthasincreasedinrecentdecades.

Substanceusedisordersmayprogressdifferentlyforwomenthanformen.Womenoftenhaveashorterhistoryofusingcertainsubstancessuchascocaine, opioids, marijuana, oralcohol.

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Source:2014SAMHSATEDS

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However,theytypicallyentersubstanceusedisordertreatmentwithmoreseveremedical,behavioral,psychological,andsocialproblems.Thisisbecausewomenshowaquickerprogressionfromfirstusingthesubstancetodevelopingdependence.

Manywomenwhoarepregnantorhaveyoungchildrendonotseektreatmentordropoutoftreatmentearlybecausetheyareunabletotakecareoftheirchildren;theymayalsofearthatauthoritieswillremovetheirchildrenfromtheircare.Thecombinedburdensofwork,homecare,childcare,andotherfamilyresponsibilities,plusattendingtreatmentfrequently,canbeoverwhelmingformanywomen.Successfultreatmentmayneedtoprovideanincreasedlevelofsupporttoaddresstheseneeds.

WomenandSmokingCessationTreatment

Researchshowsthatwomenarelesslikelytotrytoquitsmokingandmorelikelytorelapseiftheydoquit. Nicotine-replacementoptions,suchasthepatchorgum,arenotaseffectiveforwomenasformen,andnicotinewithdrawalmaybemoreintenseforwomen.Nicotinecraving andwithdrawal varyacrossthemenstrualcycle,whichmayfurthercomplicateawoman'sattemptstoquit.

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Thestressontheheartduetosmokingonepackofcigarettesperdayistheequivalentofbeing90poundsoverweight.

Somewomencontinuetosmokebecausetheyareafraidtheywillgainweight.However,researchshowsonlyamodestweightgainafterquitting.Theaveragesmokergains6to10poundsafterquittingsmoking,butcertaindietandlifestylechangescanreducetheriskofweightgain.Ifapersondoesgainweight,theaveragepersonlosesmuchoftheextraweightwithin6months. Infact,long-termquittersgain,onaverage,only2pounds. Mostimportantly,thehealthbenefitsofquittingsmokingfarexceedtherisksofgainingafewpounds.Quittingalsodecreasesrisksforvarioustypesofcancers,heartattack,andlungdisease.

SubstanceUseDisorderTreatmentforMothersandTheirBabiesWhilePregnantorBreastfeeding

Apregnantwomanshouldaskformedicalhelptostopherdruguse.Ifsheattemptstosuddenlywithdrawfromaddictivedrugsandalcoholwithoutmedicalassistance,shecouldbeputtingherfetusatrisk.

Intensiveoutpatienttreatment,whichprovidesahighertreatmentlevelthantraditionaloutpatientprogramsbutdoesnotrequirestructuredresidentialliving,hasproducedpositiveresultsforpregnantwomen.Pregnantwomenaremorelikelytostayinthesetreatmentprogramsiftheyprovideservicessuchaschildcare, parentingclasses,andvocationaltraining.

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Federallawrequiresthatpregnantwomenreceivepriorityadmissionintopubliclyfundedsubstanceusedisordertreatmentprograms,allowingthemtobypasswaitinglistsandgainimmediateadmissionwhenabedinaresidentialprogramisavailable.Theprimarytreatmentprovidermustsecureprenatalcareifapregnantwomanisnotalreadyreceivingsuchcare.State-levelcontactsforthisprogramareavailablefromhttps://www.samhsa.gov/sites/default/files/ssadirectory.pdf

Inaddition,itisimportanttomonitornewbornsofsubstance-usingmothersforsymptomsofwithdrawalandprovidepropertreatmentifnecessary.Treatmentofdrugdependencyinnewbornsdependsontheseverityofsymptomsand,whilenonpharmacologicaltreatmentsarepreferred,itsometimesmayincludehospitalizationinordertoreceiveintravenousfluidsandmedications.Thesemedicationsaregraduallytaperedoffuntiltheinfantadaptstobeingdrug-free.

TreatingOpioidUseDisordersinPregnantWomen

Pregnantwomenwhoareaddictedtoopioidpainrelieversorheroinfacespecialproblemsbecausethebabycanbeborndependent.Currently,theU.S.FoodandDrugAdministrationhasnotapprovedmedicationstotreatopioid-dependentpregnantwomen,butmethadoneorbuprenorphinemaintenancecombinedwithprenatalcareandacomprehensivedrugtreatmentprogramcanimprovemanyoftheadverseoutcomesassociatedwithuntreatedopioidusedisorder. Ingeneral,itisneitherrecommendednornecessaryforpregnantwomentoceasemethadoneorbuprenorphinetreatment. However,newbornsexposedtomethadoneduringpregnancycanrequiretreatmentforwithdrawalsymptoms.

Somestudiessuggestthatbuprenorphine(Suboxone ,Subutex )hassomeadvantagesoversingle-dosemethadoneasatreatmentforopioidusedisorderinpregnantwomen.Infantsborntomotherstreatedwithbuprenorphinehadfewersymptomsofdependenceand

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reducedlengthofhospitalstaycomparedtothosetreatedwithmethadone.

Pregnantwomenwhotakebuprenorphineforopioidusedisorderduringpregnancyshouldbeawarethattheamountofbuprenorphinepassedthroughbreastmilkmaybeinadequatetopreventopioidwithdrawalintheirinfant.Insomecases,treatmentoftheinfantmayberequired.

Pregnantwomenwhoareaddictedtoopioids,eveniftheyareintreatment,shouldmonitortheirbabiesfordrowsiness,inadequateweightgain,andfailuretomeetdevelopmentalmilestones—especiallyinyounger,exclusivelybreastfedinfants.Althoughunlikely,ifabreastfedbabyofawomanonbuprenorphinetherapyshowssignsofincreasedsleepiness,difficultyfeedingorbreathing,orlimpness,ahealthcareprovidershouldbecontactedimmediately.Infantsshouldbeobservedforwithdrawalsignsifbreastfeedingisabruptlystopped.

AsforinfantsbornwithNASduetoopioids,recoverycanrequirehospitalizationandpossiblytreatmentwithmorphineormethadonetorelievesymptoms; researchershavealsostudiedbuprenorphineforthispurpose. Thereissomeevidencethatbuprenorphineissuperiortomorphineintreatinginfantswithopioid-relatedNAS.ANIDA-fundedstudypublishedfoundthattreatingNASbabieswithsublingualbuprenorphineresultedinashorterdurationoftreatmentthanoralmorphine.Italsoresultedinashorterlengthofhospitalstay,withsimilarratesofadverseevents.

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OtherSexandGenderIssuesforWomenRelatedtoSubstanceUse

Co-OccuringMentalHealthDisorders

Manywomenwithsubstanceusedisordersarealsodiagnosedwithothermentaldisorders.Thisisimportantbecauseinteractionsbetweenillnessescanworsenthecourseofboth.Patientswhohavebothasubstanceusedisorderandanothermentalhealthconditionoftenhavesymptomsthataremorepersistent,severe,andresistanttotreatmentcomparedwithpatientswhohaveeitherdisorderalone.Bothdisordersshouldbetreatedatthesametimetoimprovethelikelihoodofsuccess.Althoughmenaremorelikelythanwomentoreportbothamentalhealthandsubstanceusedisorderwithinthepastyear,womenaremorelikelytosufferfromcertainmentalhealthconditions,suchasdepression, anxiety,post-traumaticstressdisorder(PTSD), andeatingdisorders. Somewomenreportusingsubstancestorelievestressornegativeemotions. Inaddition,womenaremorevulnerabletodevelopingsubstanceuseorothermentalhealthdisordersfollowingdivorce,lossofchildcustody,orthedeathofapartnerorchild.

MoreinformationaboutcomorbiditycanbefoundinNIDA'sResearchReport.

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Women,Violence,andSubstanceAbuse

Morethan1in3womenhaveexperiencedphysicalviolenceatthehandsofanintimatepartner,includingarangeofbehaviorsfromslapping,pushing,orshovingtosevereactssuchasbeingbeaten,burned,raped,orchoked. Victimsofviolenceareatincreasedriskofchronichealthconditions,includingobesity,chronicpain,depression,andsubstanceuse. Inrecognitionoftheseverityofviolenceagainstwomenandtheneedforanationalstrategytoaddressthisissue,in1994CongressenactedtheViolenceAgainstWomenActtoholdoffendersaccountableandtoprovideservicestovictims. In2013,PresidentObamareauthorizedtheActtoexpandprogramsforreachingespeciallyvulnerablepopulations.

TheInstituteofMedicineandtheU.S.PreventiveServicesTaskForce(USPSTF)haverecommendedthatcliniciansscreenandcounselforinterpersonalviolence.Tohelpmeetthatneed,theAffordableCareActof2010(Section2713)requiresthathealthinsuranceproviderscoverallpreventiveservicesrecommendedbytheUSPSTFwithoutcopaysordeductibles.However,improvedpreventionandscreeningguidelinesareneededtohelpcliniciansidentifythosewhoneedhelpandlinkthemtothecaretheyneed.

RaceandEthnicity

Womenofcolormayfaceuniqueissueswithregardtodruguseandtreatmentneeds.Forexample,African-AmericanandAmericanIndian/AlaskaNativewomenaremorelikelythanwomenofotherracialandethnicgroupstobevictimsofrape,physicalviolence,andstalkingbyanintimatepartnerintheirlifetime.Asdiscussedabove,theseissuesareriskfactorsforsubstanceuseandshouldbeaddressedduringtreatment.MoreinformationcanbefoundinWomenofColor:HealthDataBook.

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TheImportanceofIncludingWomeninResearch

Inthepast,womenwerenotincludedinmostclinicalresearch.Thiswasoftenbasedontwonotions:(1)thatwomenaremorebiologicallycomplicatedthanmen;and(2)asprimarycaregiversofyoungchildren,awomanhadtoomanycompetingtimedemandstoparticipateinresearchstudies. Morethantwodecadesago,NIHestablishedtheOfficeofResearchonWomen'sHealth,inrecognitionthatexcludingspecificsubgroupsfromresearchproducesknowledgethatonlyhelpsaportionofthepublic.In1991,theU.S.DepartmentofHealthandHumanServicesestablishedtheOfficeonWomen'sHealthtoensurethatbroaderpublichealthissuesrelatedtosexandgenderwereaddressed.Sincetheseofficeswereestablished,significantprogresshasbeenmadeinseveralmajorareas:

PolicieshavebeenimplementedensuringthatwomenandminoritiesareincludedinNIH-fundedclinicalresearch

Researchonwomen’shealthandsexdifferenceshasexpanded.

Careerdevelopmentandmentoringprogramshaveincreasedthenumbersofwomen’shealthresearchers.

Researchresultshavebeentranslatedintohealthbenefitsforwomen.

Therehasbeengreatercommunicationtoavarietyofpublicaudiencesaboutsexandgenderdifferencesinbasicandbehavioralscience,aswellasinpublichealth.

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"Rememberthefamousstudy,takeanaspirinadaytokeeptheheartattackaway?Thatstudywasdoneon10,000men.Notonewomanwasincluded.Inastudyoftheagingprocess,theytoldmewomenweren’tincludedbecausetherewasn’taladiesroomavailableforstudyparticipants.Yettheresultsofthesestudieswerebeingappliedtomenandwomen.Ivowedtofixthat."

TheHonorableBarbaraMikulski,U.S.Senator,MarylandAugust16,2010MoreinformationaboutcomorbiditycanbefoundinNIDA’sresearchreportoncomorbidity.

Althoughsignificantstrideshavebeenmadetoincludewomeninclinicalresearch,mostanimal-basedresearchstilltendstoover-relyonmales.Becausethesestudiesareimportantinguidingclinicalstudies,NIHannouncedanewpolicyin2014requiringthatbothsexesberepresentedinNIH-fundedresearchinvolvinganimalandcellmodels.

Sinceitsinception,NIDAhassponsoredresearchonissuesrelatedtowomenandsubstanceuse.Beginningwithanearlyfocusontheeffectsofdruguseonpregnantwomenandthechildrentheycarry,NIDAthenexpandeditsinteresttosponsorresearchintowomen'sspecificsubstanceusedisorderriskfactorsandtreatmentneeds.WhentheHIV/AIDSepidemicemergedinthe1980s,NIDArespondedwithfundingforprojectsongender-specificriskfactorsforinfectionandontheimpactofdruguseonHIVtransmissionbetweenmotherandnewbornandthesubsequenthealthofboth.In1995,NIDAformallyestablishedtheWomenandSex/GenderDifferencesResearchProgramtounderstandtheunderlyingcausesofsubstanceusedisordersandthebestwaystopreventandtreattheminbothmenandwomen.

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WherecanIgetfurtherinformationaboutsubstanceuseinwomen?

Tolearnmoreaboutsubstanceuseinwomen,visittheNIDAwebsiteatwww.drugabuse.govorcontactDrugPubsResearchDisseminationCenterat877-NIDA-NIH(877-643-2644)(TTY/TDD:240-645-0228).

NIDA'swebsiteincludes:

Informationondrugsthatpeopleuseandmisuseandrelatedhealthconsequences

NIDApublications,news,andevents

Resourcesforhealthcareprofessionals,educators,andpatientsandfamilies

InformationonNIDAresearchstudiesandclinicaltrials

Fundinginformation(includingprogramannouncementsanddeadlines)

Internationalactivities

Linkstorelatedwebsites(accesstowebsitesofmanyotherorganizationsinthefield)

InformationinSpanish(enespañol)

NIDAWebsitesandWebpages

www.drugabuse.gov

www.teens.drugabuse.gov

www.easyread.drugabuse.gov

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www.drugabuse.gov/related-topics/women-drugswww.drugabuse.gov/publications/finder/t/160/drugfacts

www.researchstudies.drugabuse.gov

www.irp.drugabuse.gov

ForPhysicianInformation

NIDAMED:www.drugabuse.gov/nidamed

OtherWebsites

Informationonsubstanceuseinwomenisalsoavailablethrough:

SubstanceAbuseandMentalHealthServicesAdministration:www.samhsa.gov

DrugEnforcementAdministration:www.dea.gov

MonitoringtheFuture:www.monitoringthefuture.org

PartnershipforDrug-FreeKids:www.drugfree.org

NIDA’sSubstanceUseinWomenDrugFacts:https://www.drugabuse.gov/publications/drugfacts/substance-use-in-women

NIDA'sEasytoReadDrugUseHurtsUnbornBabies:https://easyread.drugabuse.gov/content/drug-use-hurts-unborn-babies

CDC’sFactSheetonSubstanceUseDuringPregnancy:https://www.cdc.gov/reproductivehealth/maternalinfanthealth/substance-abuse/substance-abuse-during-pregnancy.htm?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Freproductivehealth%2Fmaternalinfanthealth%2Ftobaccousepregnancy%2Findex.htm

TreatmentResources

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Findbehavioralhealthtreatment:https://findtreatment.samhsa.gov

FindSmokingcessationprograms.TheU.S.DepartmentofHealthandHumanServiceshasresourcestohelpawomanquitsmokingathttp://women.smokefree.gov/

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