In recent decades, more focus has been given to differences between men and women when it comes to substance use disorders. Several gender differences have been observed, in each phase of addiction and recovery.
In terms of raw numbers, more men than women use substances – men are about twice as likely to consume drugs and alcohol as women are. (The exception to this is prescription painkillers and tranquilizers, where studies suggest women are on equal footing with men). The women who do use drugs and alcohol, a number which is on the rise, are more vulnerable to developing problems stemming from those substances, and to struggle throughout the recovery process.
Women move more quickly through the stages of addiction, from initial exposure to a substance to dependence upon it. It takes less of a substance to affect a woman’s physiology, and health impacts are more severe. Women are more sensitive to cravings, experience more vivid mental emotional suffering during withdrawals, and are more prone to relapse.
Although the topic merits a lot more research, one consideration is the role of women’s hormones. As every woman knows, our hormonal systems are complex, such that we experience several hormonal shifts every month. These variations notoriously affect our mood, thoughts, and physical sensations.
It is perhaps no surprise that the hormonal aspect of the female experience interfaces with the topic of addiction. In this blog, we’ll look closer at what is currently known about women’s hormones and addiction.
Understanding hormones and their functions
Hormones are tiny molecules that travel throughout the systems of the body, serving as chemical messengers. Chemical messengers are substances that communicate commands to activate or inhibit a body part or system.
Hormones are produced by glands, and are part of our endocrine system. They are released into the bloodstream and carried to organs and tissues, where they act upon those organs and tissues to excite or dampen them.
Hormones are responsible for balancing the body’s many systems, including metabolism. They are critical for restoring homeostasis, keeping body systems regulated and in check. Hormones also circulate in the brain, where they are intimately involved in triggering and modulating the stress response.
How do hormones impact addiction?
Stress is connected to the release of a hormone called cortisol, which generates the uncomfortable feelings of stress, dread and agitation we feel when the body perceives a danger or threat to our survival or belonging to the herd.
High levels of cortisol over a sustained period of time is what leads to chronic stress. Too much cortisol in the body is linked to vulnerability to addiction, and also describes what happens to the body after traumatization.
Serotonin and dopamine are two other hormones which are involved in regulating mood and behavior. Adrenalin, oxytocin (the “love hormone”) and endorphin (the body’s natural painkiller) are hormones, too. Each of these hormones has a job which can be temporarily boosted or reduced through using drugs, alcohol, and prescriptions.
People who fall into the trap of addiction do so because these powerful systems of mood regulation, pain modulation, and reward become dysregulated through the introduction of chemicals which are foreign to the body. The dazzlingly complex operation of hormones in creating the human experience is still only slightly understood, but it has been established that hormones are affected, hijacked and depleted by substance abuse.
Which certain hormone phases are connected with addiction?
The primary female sex hormones are progesterone and estrogen. These two hormones are important throughout the entire life cycle of women, affecting puberty, menstruation, PMS, pregnancy, menopause, and elderhood.
During reproductive years, estrogen is high during the first two weeks of a woman’s menstrual cycle. In this phase, women are more likely to experience feelings of happiness, positive mood, and to experience less cortisol and adrenalin, two hormones linked to the discomfort of stress and trauma.
Progesterone appears once ovulation occurs. Progesterone is linked to the area of the brain that is responsible for triggering a sense of alarm when perceiving danger, and is believed to be the cause of the moodiness associated with PMS. Progesterone is connected to higher levels of cortisol, which explains why women feel irritable and sensitive to stressors, as well as to triggers of traumatic memory during this phase.
Women who have a predisposition to higher levels of cortisol to begin with, such as happens with trauma, are likely to seek some sort of modulating substance during these two weeks of the cycle, whether it be eating fatty, high calorie foods or turning to drugs and alcohol. Women who are in recovery are more prone to relapse during these two weeks.
The operations of these hormones and the ways that they interact with other hormones like serotonin, dopamine, cortisol, oxytocin, and endorphins is incredibly intricate, subtle, and complex. It is important not to oversimplify, nor to imagine that any of these hormones operates out of a context of supreme interdependence.
It is safe to acknowledge, however, that during phases of the cycle when we experience higher amounts of progesterone, as during PMS, we are more likely to experience the feelings of unease and unhappiness which underly self-medicating behaviors.
What is estrogen’s link to substance abuse?
Estrogen is linked to sensitivity to pleasure. The interactions between addictive substances and estrogen may be such that women’s response to addictive substances is especially powerful during this stage, as one study on the effects of stimulants like cocaine in women has indicated (https://www.nature.com/articles/ncomms13877). This suggests that women who have high estrogen levels may be more likely to become addicted to substances, as well as to form a powerful association between getting high and this stage of the menstrual cycle.
How does progesterone lower drug seeking behaviors?
When progesterone levels fall, estrogen becomes the dominant hormone, which may make women more sensitive to the effects of drugs and alcohol. During progesterone-dominant phases, women experience less sensitivity and responsiveness to the same chemical substance.
What are key hormones involved in substance use disorders?
Several hormones have an important role in the body when it comes to substance abuse and recovery. Awareness of these hormones and their relevance to addiction may inform the way that we approach treatment.
Cortisol
Released by the adrenal glands in response to a perception (or memory) of danger or threat, cortisol is often called “the stress hormone”. Cortisol prepares the body to act swiftly, as may be needed to run away from, fight off, or freeze to mitigate the effects of harm.
Cortisol is intended by nature to be a short-term, emergency solution, and it works by spiking blood sugar levels to fill the body with energy, momentarily suppressing the restorative, digestive, and immune systems. The condition of chronically high cortisol levels is also present in people with trauma and people who have high levels of stress as a daily experience.
People who experience chronically high levels of cortisol are at risk to develop substance use disorders. Elevated cortisol levels also increase the risk of relapse once in recovery.
Serotonin
Serotonin is a neurotransmitter influencing mood, sleep, and appetite. Serotonin levels are believed to explain the presence of mood disturbances like depression and anxiety. Drugs and alcohol change the level of available serotonin in the body. This impact on serotonin levels explains why people who are used to chronic mood disturbances tend to turn to drugs and alcohol to try to change serotonin levels. It also explains why, after drugs and alcohol have depleted serotonin levels, people will experience depression and anxiety symptoms.
Dopamine
Dopamine is the neurotransmitter connected to the brain’s reward circuit. Dopamine is released when we are behaving in ways that led to social or physiological rewards in the past. Dopamine feels pleasurable, and it is meant to reinforce behaviors that are good for the physiology’s health and longer term survival. Drugs and alcohol are believed to hijack the reward system, releasing dopamine artificially, even though we are not behaving in life-affirming ways.
Endorphins
Endorphins are produced naturally in the body when we experience pain. Endorphins interact with the brain’s opiate receptors, lessening pain and creating feelings of euphoria. Endorphins are meant to be released only in occasional cases of injury and pain. Opioids and other addictive substances were designed to bind to the same receptors in the brain, to induce euphoria and numbing. They are highly addictive due to the combination of painkilling and euphoria-boosting. Problematically, using substances reduces the body’s ability to produce endorphins naturally.
Norepinephrine
Essential for alertness and focus, norepinephrine is a hormone and neurotransmitter involved in the body’s high arousal system, or fight-flight. Stimulants like cocaine affect norepinephrine levels, temporarily boosting energy and concentration, while also triggering anxiety and leading to severe dependence.
GABA (Gamma-Aminobutyric Acid)
GABA is a neurotransmitter that inhibits nervous system activity, creating feelings of calm and relaxation. It works as a brake, dampening the effects of other hormones and helping the body to move into parasympathetic, or restoration and digestion states. Substances like tranquilizers and alcohol enhance GABA’s effects, initially creating feelings of well-being, and eventually leading to greater feelings of anxiety and cravings to use.
Gender differences in hormonal impact
The differences between men and women due to hormones have implications for treatment. Women can experience greater success in recovery from addiction when armed with the awareness of how their hormones influence mood, motivation, stress, and sensitivity. By tracking their hormonal cycles in tandem with substance abuse treatment, women can be prepared for phases of the month which represent different challenges, and take proactive steps to protect themselves from fluctuations in mood and urges to act destructively.
Hormonal changes across life stages
Fluctuating hormone levels affect women’s responsiveness to substances and vulnerability to relapse. Understanding how hormones feature in different stages of a woman’s life can be helpful for supporting recovery. Here is an overview of how stages of life imply different hormonal considerations.
Adolescence
During adolescence, girls experience extreme fluctuations in sex hormones, making them more susceptible to risk-taking behaviors such as experimentation with drugs and alcohol. They are also more sensitive to the effects of alcohol and drugs. Exposure to drugs and alcohol during adolescence is highly correlated to long-term problems with neurotransmitter functioning, and vulnerability to addiction.
Pregnancy
During pregnancy, women experience a wash of hormones that can affect urges to use substances. Estrogen and progesterone changes impact stress and mood levels. Using substances during pregnancy can harm mother and fetus significantly.
Menopause
The decrease in estrogen associated with menopause may be experienced as depression, anxiety, and rapid fluctuation between moods. Women who have a history of using substances to cope with their unpleasant sensations and emotions are at a greater risk of relapse during this phase of life.
The role of stress and coping mechanisms
The role of stress is extremely important in addiction. When the stress system is activated, cortisol levels increase and positive feeling hormones and neurotransmitters are inhibited.
When experiencing chronic stress, the body is exposed to toxic levels of cortisol, which has negative health effects, leading to disease. When cortisol is present in the bloodstream, it is experienced subjectively as unease, dread, and agitation. When the nervous system is permanently dysregulated, a person can’t easily reduce cortisol back to normal levels naturally.
Being in a state of frequent cortisol activation, as happens when we grew up in an environment of many survival threats, leads women to self-medicating behaviors. These behaviors occur out of desperation to get a break from over-activation of sensations of dread, fear, and lack of safety.
During recovery, it is important to understand the role of stress, and to find coping mechanisms that heal chronic hyperarousal, such as tools from somatic therapy, yoga, nutrition, and mindfulness based therapies.
Integrating Hormonal Considerations into Treatment Plans
When working with women to recover from substances, hormonal considerations can be incorporated into treatment plans. Hormone levels may be tested, menstrual cycle tracking included as a part of teaching self-care and stress management practices, and stage of life considered in terms of hormonal impacts for women.
Impact of Hormones on Substance Use Disorders
In gender specific addiction treatment, such as that offered by Villa Kali Ma, the role of hormones in creating lasting peace and feelings of wellbeing in recovery can be safely explored. The impacts of hormonal phases and fluctuations can be acknowledged and incorporated into healing work, to support women to understand their experiences and needs more compassionately. Each woman is unique and deserves to be met where she is at, hormonally as well as in every other way.
