Managing alcohol and drug addiction in female patients

Did you know that more than 18% of women in Australia exceed the recommended guidelines for alcohol consumption, which places them at risk of alcohol use disorder and alcohol dependence, which are under-detected in women compared to men?  

Alcohol use disorder (AUD) and substance use disorder (SUD) are characterised by repeated alcohol or drug consumption, which has led to symptoms of dependence or social problems. Dependence is an inability to control alcohol or substance use, prioritisation of use over other activities or responsibilities, and physiological features such as tolerance or withdrawal symptoms.

Women may use alcohol or drugs to cope with issues such as domestic violence and mental health conditions or may use substances alongside a partner.

General practice is an ideal environment to screen for problematic alcohol use, AUD and SUD, and various screening tools exist, such as the Alcohol Use Disorders Identification Test (AUDIT). Where alcohol or substance use disorder is suspected, a brief intervention can be provided within general practice.

For women with a diagnosis of AUD or SUD, management of withdrawal alongside psychosocial intervention is the first-line treatment. It is important to understand that women face unique barriers to accessing treatment, such as childcare issues and the risk of judgement or stigmatisation, and women with AUD or SUD must be treated in a non-judgemental and compassionate manner.

Most women can safely cease alcohol intake in the community with supportive counselling and medical therapy with benzodiazepines such as diazepam. Withdrawal from other substances, such as opiates, may require referral to specialist drug rehabilitation services.

Ongoing pharmacological therapy may be considered for women with moderate-to-severe AUD following medicated alcohol withdrawal if necessary and in association with psychosocial support. Acamprosate, naltrexone and disulfiram are available in Australia for AUD. Pharmacological support for SUD depends on the substance being used, e.g. Buprenorphine for opiate dependence.

The general practitioner must support the patient and address any side effects and potential impacts on general health.

Psychosocial therapies are a key aspect of the ongoing management of AUD and SUD and may include cognitive behavioural therapy, motivational interviewing or residential rehabilitation programmes.

The general practitioner may facilitate regular follow-up appointments, which can help maintain accountability and provide ongoing support. Potential triggers, coping strategies, and crisis support can be discussed during these appointments.

Women should be signposted to support organisations such as Alcoholics Anonymous, Narcotics Anonymous (NA), SMART Recovery and online support groups.

Women with substance use problems are at higher risk of domestic violence, so it is important to ask about this. When managing women with a substance or alcohol use disorder, it is also important to consider if there are any children involved and be mindful of the possibility of child protection concerns.

All women who are of reproductive age should be reviewed for contraception, irrespective of alcohol or substance use. However, women should be specifically counselled about the risks of alcohol and substance use in pregnancy.

Women are also at greater risk of physical health complications such as liver disease, cardiovascular issues, and reproductive health problems due to substance abuse, so it is important to screen for these.

Managing addiction in female patients requires an individualised and compassionate approach that acknowledges factors related to dependence that are unique to women.

Dr Samantha Miller, MBChB

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References

•    Australian Bureau of Statistics (2023). Alcohol Consumption. https://www.abs.gov.au/statistics/health/health-conditions-and-risks/alcohol-consumption/latest-release 
•    Australian Institute of Health and Welfare (2024). Alcohol: Overview. https://www.aihw.gov.au/reports-data/behaviours-risk-factors/alcohol/overview 
•    National Health and Medical Research Council (2020). Australian guidelines to reduce health risks from drinking alcohol https://www.nhmrc.gov.au/about-us/publications/australian-guidelines-reduce-health-risks-drinking-alcohol 
•    Australian Institute of Health and Welfare (2024). Alcohol, tobacco & other drugs in Australia. https://www.aihw.gov.au/reports/alcohol/alcohol-tobacco-other-drugs-australia/contents/about 
•    Australian Institute of Health and Welfare (2024). Pregnant and breastfeeding women’s use of alcohol and other drugs. https://www.aihw.gov.au/reports/alcohol/pregnant-breastfeeding-women-alcohol-drugs 
•    National Institutes of Health (2024). Understanding Alcohol Use Disorder. https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/understanding-alcohol-use-disorder 
•    National Institute on Drug Abuse (2020). Substance Use in Women. https://www.drugabuse.gov/