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Office on Women's Health

Alcohol and Substance Abuse

The abuse of alcohol and other legal and illicit drugs is a serious and continuing problem among American women. Approximately 120,000 deaths are attributed to alcohol and drug use each year. In 1998, the health and societal costs of alcohol and substance abuse were estimated at $238 billion.

Nearly 4.1 million women in this country currently use illicit drugs, and over 1.2 million misuse prescription drugs for non-medical reasons. In 1997 and 1998, 4.5 million women ages 15 to 44 were current illicit drug users, including 1.6 million who had children living with them. Only 3.2 percent of pregnant women were current drug users. However, the rate increased to 6.2 percent among women who had a child under age 2 and who were not pregnant. Women account for an estimated 37 percent of illicit drug users in this country.

Women are less likely to use or abuse alcohol than are men. Death rates among female alcoholics, however, are 50 to 100 percent higher than those of their male counterparts. In 1998, 2.1 percent of American women were heavy drinkers; 8.6 percent were binge drinkers (more than five drinks at one time); and 45.1 percent of women had at least one alcoholic drink in the past month. Among teenage girls in 1997, 40 percent reported some alcohol consumption in the past month, and 29 percent reported binge drinking.

Heavy drinking during pregnancy has been clearly associated with severe birth defects, including mental retardation, nervous system disorders, abnormal features of the face and head, and retarded growth. The effects of moderate drinking (one to two drinks per day) are not well-established, so the only known safe level of drinking during pregnancy is total abstinence. In 1996, 16.1 percent of pregnant women reported any alcohol use; 1.3 percent reported binge drinking; and 0.5 percent reported heavy drinking (five or more drinks per day) in the past month.

Many women who abuse drugs or alcohol have histories of mental illness. Seventy percent report having been sexually abused before the age of 16, and more than 80 percent say they have a family member addicted to drugs or alcohol. These factors complicate the course of their illness and treatment planning. Women who abuse alcohol or drugs are also at higher risk for HIV/AIDS, tuberculosis, oral and pharyngeal cancer, injury, and sexually transmitted diseases (STDs).

AIDS and HIV

Long considered a man’s disease, HIV/AIDS is a public health problem among women. It is the fifth leading cause of death among women ages 25 to 44 and the third leading cause of death among African American women in this age group.

Between July 1998 and June 1999, 10,841 new AIDS cases among adult and adolescent women were reported. From 1985 to 1999, the proportion of AIDS cases reported among women increased from 7 percent to 23 percent. Among 13- to 19-year-olds, girls constituted 50 percent of all AIDS cases reported in 1998. By June of 1999, a total of 114,621 women were reported to have AIDS, and 77 percent of women diagnosed with AIDS were African Americans and Latinas.

Fortunately, increased screening for HIV among reproductive-age women and more effective therapies to reduce perinatal transmission of HIV have been quite effective. They have contributed to the 75 percent decline in the proportion of infants diagnosed with perinatally acquired AIDS since 1993.

The most common mode of HIV infection among adult and adolescent women is through heterosexual contact, followed by intravenous drug use. Significant gender differences are manifest throughout the course of the illness as well as in the mode of infection. These differences indicate the need for gender-sensitive treatment and prevention strategies to stem the spread of AIDS.