• Seventy percent of women substance abusers in treatment were sexually abused as children, compared to 12 percent of men.
• Working women are 89 percent more likely to drink heavily than homemakers. Women who are without work are 400 percent likelier to drink heavily than women who are working full or part time.
• Seventy percent of all women with AIDS report sharing needles or having sex with an injection drug user.
• Although correlation must be proven, while the number of children in foster care jumped from 280,000in 1986 to 429,000 in 1991, the percentage of children under age four who were exposed prenatally to drugs doubled from 29 percent to 62 percent.

These statistics scream out that women seem to be in denial of the implications of alcohol, drugs and nicotine. The results of the substances are the gravest of threats to the healthy lives of newborns and women.

For women who are addicted, denial becomes a way of life. They develop relationships with alcohol or drugs that replace other relationships to become the loves of their lives. The dance begins with addiction, a slow, smooth, romantic embrace. The dance continues until the beat becomes faster and harder, and finally the lights go dim. Women begin to live in this surreal, irrational world until denial becomes an integral part of the illness. Only later, during treatment, do such women begin to realize how powerful alcohol and/or drugs have become in their lives. They have loved, worshipped and centered their lives around their addictions, but once the denial is smashed, the dance of denial can end and the lights can be turned back on.

How bad does the situation have to get before an addict seeks help? How despicable does the woman have to appear before family, friends and herself before someone forces an intervention or permits total ruin to finish the dance? Must she be half dead before anyone takes action? Must those who care simply wait until a suicide attempt, divorce, cirrhosis of the liver, brain damage or loss of job force another woman over the edge? The majority of women in treatment centers are farther along the fatal swing of the disease pendulum than are men. They are often older and more likely to be abandoned by their spouses and families.

For the woman herself, the stigma of addiction is almost unbearable. She has broken a taboo, setting up her isolation from polite society. She is wife and mother, meant to be helping others, giving up her own desires for her husband and children instead of greedily assuaging her own desires. Though society often accepts alcoholism and public intoxication in men, for women it is a disgrace, so the woman user is a victim of that double standard.

For women, addictions are linked to sexual assault, unwanted pregnancies, diseases such as lung cancer, cirrhosis, and AIDS, skyrocketing prison populations and child abuse and neglect. These conditions are both the underlying causes and keys to prevention in other women, for if the basic reasons for beginning to use substances can be ameliorated, there is hope that women in the future will avoid the trap. Some strategies to prevent the onset of alcohol and drug problems are:

• Dual addictions must be addressed in material produced for women.
• Biomedical findings on PMS, physical differences and effects of addictions on progression of other diseases have been under-emphasized. For example, new evidence shows differences in metabolism affect intoxication and menstruation.
• Relationship of alcohol and other drug use to factors such as smoking, eating disorders, depression, AIDS,fetal alcohol effects, domestic violence, rape and incest must be emphasized.
• Intervention must be begun to stop the effect of subtle messages in advertising and articles of women's magazines that glamorize drinking.
• Emphasis of self-empowerment and individual responsibility is important as part of a comprehensive approach.
• Treatment programs that reinforce a woman's personal attributes are needed.
• Information on high-risk characteristics such as genetic predisposition for women who are children of alcoholics must be put in the hands of those most vulnerable.
• Necessary adjunct series that increase participation and full completion of programs such as child care,transportation, accessibility and availability of services in neutral settings must be put in place.
• We must train doctors to spot inner-directed signals and health consequence of women's substance abuse.
• We can use pregnancy as a window of opportunity to get women in treatment.

Prevention can be found in a variety of settings: schools, churches, workplace and service clubs. Preventionists agree that the task must be a partnership, a joint venture in which total responsibility rests with no one individual, agency or family, but within the community.

References Engs, R.C. "Women: Alcohol and Other Drugs." Dubuque, IA: Kindall/Hunt Publishing, (1990). Kimball, B.J. "The Alcoholic Woman's Mad, Mad World of Denial and Mind Games." MN: Hazelden. The National Center on Addiction and Substance Abuse at Columbia University 1996 Report. "Substance Abuse and American Woman."