Substance Abuse: The Feminine Mystique

Despite promising statistics indicating recent declines in youth substance use, more than a quarter of high school girls currently smoke cigarettes and binge drink, almost half drink alcohol regularly, and one in five uses marijuana. Another 4 percent use cocaine and inhalants.

A three-year study by the National Center on Addiction and Substance Abuse at Columbia University suggests why these high rates of use among girls persist. The study, which has profound implications for parents, teachers, health care professionals, policy makers and parish priests, found sharp differences in the world of substance abuse and addiction between girls and young women and boys and young men—and a costly failure of most prevention and treatment programs to take account of those differences.


Girls and young women use—or do not use—cigarettes, alcohol and illegal and prescription drugs for different reasons than do boys and young men. They obtain drugs from different people and in different places. And they get hooked faster and suffer swifter and harsher consequences. The conditions and situations that raise the risk of substance abuse for girls vary, and certain protective factors—notably parental engagement and religion—are likelier to reduce the risk for girls than for boys.

The failure to recognize and act on these dissimilarities may account for the fact that girls are closing the gender gap that historically showed them less likely than boys to abuse substances. Today, high school girls are about equally likely as high school boys to drink and smoke, use inhalants and cocaine, and even more likely to abuse stimulants, tranquillizers and painkillers. In 12th grade, boys are 13 percent likelier than girls to smoke; in ninth grade, boys are only 2 percent likelier to puff away.

Equally troubling, girls are smoking, drinking and using marijuana at younger ages. Asked if they first smoked cigarettes before age 13, almost a quarter of ninth-grade girls answered yes, compared with 18 percent of 12th graders. Responding to the same question about drinking, 35 percent of ninth graders said yes, compared with 18 percent of 12th graders. And when asked about marijuana, 9 percent of ninth graders had smoked it before age 13, compared with only 5 percent of 12th graders.

Girls are more likely than boys to be depressed, have eating disorders or be sexually or physically abused, all of which increase the risk of substance abuse. Girls are likelier than boys to use alcohol and drugs to lose weight, relieve stress, improve their mood, increase confidence, decrease boredom and reduce inhibitions. Girls often cite the pressure to have sex as one of the reasons why they drink to reduce inhibitions. Yet they seem unaware of the grim reality that drinking, especially to excess, increases the chance that they will be victims of date rape or rape.

Considering their far greater interest in being slim, girls displayed remarkable ignorance about alcohol’s impact on their weight. Only 56 percent knew that alcohol is high in calories and contributes to weight gain. A stunning 6 percent thought that drinking helped lose weight; not surprisingly, these girls drank more than the girls who thought alcohol had no impact on their weight.

Girls tend to be offered drugs by a female acquaintance, a young female relative or a boyfriend, whereas boys are likelier to get theirs from a male acquaintance, a young male relative, a parent or stranger. Girls receive offers to smoke, drink or use drugs in private settings like friends’ homes; boys receive them in public settings like parks or on the street.

Key transitions increase risk. Girls experiencing early puberty are at higher risk of substance abuse; by and large puberty is a more difficult emotional and developmental experience for girls. Among teens who move frequently from one home or neighborhood to another, girls are at greater risk than boys of substance use.

In an unprecedented survey, CASA researchers questioned four groups of girls: one at the end of elementary school and then a few months into middle school; three others at comparable periods in the transition from middle to high school, high school to college and college to post-college life. Girls making the move from high school to college show the largest increases in smoking, drinking and marijuana use. The move from elementary to middle school marks the steepest rise in girls’ belief that smoking and drinking are ways to be rebellious and disobey adults. The move from middle to high school saw the sharpest increase in the belief that drinking alcohol was “cool.” On the healthy side, the move out of college saw a drop in drinking and marijuana use (but not in smoking).

One especially interesting finding from the survey deserves further study—and promptly: the coffee connection to substance abuse for girls and young women. Girls who drink coffee are more than four times likelier to smoke and more than twice as likely to drink. High school and college seniors who drink coffee began smoking and drinking at an earlier age. The statistical correlations are so significant that it behooves researchers to explore similarities between the impact of caffeine on the brain and the impact of nicotine, alcohol and illegal drugs, which scientists have found to affect dopamine levels in the brain through similar pathways. Marketers of drinks with high concentrations of caffeine understand its impact: Mountain Dew, with its slogan “feel the rush”; Dr. Pepper, the “friendly pepper upper”; and the drinks sold under the brand names Surge, Jolt and Red Bull.

Girls and young women not only get hooked faster; they get hooked using lesser amounts of cigarettes, alcohol and drugs like cocaine than boys and young men. Girls and young women have greater difficulty quitting smoking. Of particular concern here is the desire of many young girls to be “one of the boys” and go drink for drink with them. But because women have less body water than comparably sized men and because they metabolize alcohol less efficiently, on average one drink has the same impact on a woman that two have on a man.

Girls and young women suffer the consequences of substance abuse and addiction faster and more severely than boys and young men. Girls and young women who abuse substances are likelier to attempt suicide. They are more vulnerable to alcohol-related problems like liver and heart disease, brain damage and psychological pathologies. They are more susceptible to brain damage from Ecstasy, hospitalization from nonmedical use of pain medications and addiction to cocaine.

Some consequences are unique to women. Smoking in early adolescence and even moderate alcohol consumption increase the risk of breast cancer. Smoking or drinking raises the likelihood of menstrual disorders and infertility. Smoking and use of oral contraceptives raise the chances of heart disease.

Parental engagement and religious involvement, while important for both boys and girls, have a greater salutary impact on girls. Moreover, bad relationships with parents are more harmful to girls. Girls CASA surveyed tended to be more religious than boys and hold more favorable attitudes toward religion. The more frequently these girls attended religious services, the less likely they were to smoke, drink or use drugs. This finding is consistent with earlier CASA surveys. The importance of religion to girls declines from elementary school to college, particularly during the high school years.

The findings from this CASA study cry out for an education of parents and the public and a fundamental overhaul of prevention and treatment programs. One-size-fits-all unisex programs—largely developed without regard to gender, often with males in mind—fail to influence millions of girls and young women. Policy makers and researchers must stop acting like Rex Harrison inMy Fair Lady”singing, “Why can’t a woman be more like a man!” Emblematic of this attitude is a study released early this year that found that a drink a day might be beneficial to the heart. That study involved more than 30,000 individuals—all men.

For decades, the for-profit marketers, including the tobacco and alcohol industries, have recognized the importance of shaping campaigns to influence girls and young women. The 1925Lucky Strikecigarette advertising campaign, “Reach for a Lucky instead of a sweet,” was associated with a 200 percent increase in market share.Capricigarette ads claim, “There’s no slimmer way to smoke” and callCapricigarettes “the slimmest slim in town.” And we are all familiar with Phillip Morris’s diabolically seductive brand name,Virginia Slims. The alcohol industry’s move into alcopops—sweetened alcoholic beverages—appeals to the tastes of girls and young women.

The time has come for parents, schools, physicians, clergy, treatment providers and the entire public health community to recognize the different motivations and vulnerabilities of girls and young women. Parents are the first line of prevention. CASA’s survey found that most girls who have conversations with their parents about substance use say that the conversations made them less likely to smoke, drink or use drugs.

The clergy also have a significant role, since religion and spirituality play a particularly protective role for girls and young women. Priests and parish leaders should explore ways to stem the slippage in religious involvement of young girls as they go through high school and college. Health professionals—notably pediatricians, family physicians, obstetricians/gynecologists and even dentists, who often can detect signs of substance abuse or an eating disorder during a routine checkup—should be alert to signs of trouble, routinely screen young female patients for substance use and encourage those in need of help to seek treatment.

The women of America have paid a fearful price in premature death and destroyed lives for our failure to take account of their unique needs. More than 4.4 million women are alcoholics or use alcohol; more than two million use illegal drugs; more than 31 million smoke cigarettes. A 25-percent reduction—a modest estimate if we had programs aimed at the factors that influence girls and young women—might have saved 1.1 million women from becoming alcoholics, 500,000 from drug abuse and eight million from smoking.

When parents, priests and the public health community act on those differences as aggressively as the tobacco and alcohol marketers have, we will begin to see dramatic declines in substance abuse among girls and young women.

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