How your hormones affect your drinking and carrying on

And other things we need to consider about women and substance use

Ah, sweet 16. I turned 50 this year and my mum dug out these photos, because they were taken when she turned 50. Poor Mum. She would have been going through perimenopause, though we didn’t have a word for it back then, which undoubtedly made things even worse. I’ll get to that.

Personally, I was already three years into rage-fuelled substance use. It’s funny, because we tend to think of men’s substance use when we think of expressions of rage, but I was absolutely jet-powered by it. It was always there, inflating inside me, like the Hindenburg awaiting a match.

What was quite gendered about it is that I turned that rage inwards. Angry women don’t tend to dole out king hits. Women are more likely to self-harm: cuts … burns … punitive methods of eating, or not eating. And this all creates complex needs if and when a woman eventually seek treatment.

I didn’t yet know that in three decades time I would calm the fuck down and become Lived Experience Lady. As the author of the addiction memoir Woman of Substances, I’m regularly called upon to talk about my substance use at conferences and events, the latest being at Melbourne’s Florey Institute of Neuroscience and Mental Health (video here). It feels a bit weird being the lived experience elf when my troublesome days are so long gone, but when it comes to talking openly about drugs, I’m of the opinion that those who can, should.

At this event, I had the opportunity to highlight the three topics I think urgently need attention when it comes to women and addiction – but yet which rarely get discussed. And it turned out that my co-speakers – Associate Professor Shalini Arunogiri, who’s the clinical director at Turning Point, and neuroscientist Dr Leigh Walker – would also touch on these topics. THEY’RE IMPORTANT. Let’s go.

1. The hormonal connection

I mean, doh! There are four things to consider here in my view.

One, there are certain times of the cycle that we’re more likely to use and/or relapse. The more obvious time is when we might have PMT, but the other time is around ovulation, when we’re more inclined to take risks. When I was at AA meetings, women talked about this a LOT, but I did not see it in any literature. Why is this not in The Big Book? In fact, why isn’t this hanging from one of those scrolls when you walk through the door of a meeting? They tell you not to get hungry, angry, lonely or tired; they don’t tell you to download the iPeriod app so you can give advance warning to the world you’re about to lose your mind.

Two. Where you are in your cycle also impacts the way in which drugs affect you. This is from my book, Woman of Substances:

It’s weird that this isn’t more of a topic of conversation, because any GP could tell you that a woman’s menstrual cycle causes fluctuations in her renal, cardiovascular, haematological and immune systems, so it stands to reason that these fluctuations would have a knock-on effect on the way a woman’s body processes substances.

Three. Quitting alcohol abruptly instantly plunged me into a hormonal imbalance for two years that was chaotic and supremely unhelpful at a time when I was trying to get my life together. The jury’s out as to whether it’s related to alcohol’s relationship with estrogen or just stress, because I found very few studies and absolutely no literature for the laywoman that mentioned these levels of uncontrollable rage. Again, it was at this point that being around other women in recovery became really, really useful to me, because this was a hot topic of anecdotal conversation. My doctor, stumped, had sent me for a pelvic ultrasound, with no joy. One of my new mates at AA revealed she was sent for a CAT scan.

Four I was told by several clinicians that perimenopause can reawaken early-life traumas. ALSO, if a woman’s that age, she’s in the sandwich generation where you might be looking after kids and also elderly parents, PLUS if you’ve been in a longterm relationship and your kids are leaving home, that relationship might come under the microscope. So it’s a high-risk age before you even throw in the wildly fluctuating hormone levels.

My point is really that I would love to see research around hormones and substance use trickle down into material for clients. Maybe services could encourage women to closely track their cycles so that they know when they’re about to hit a high-risk few days. If they’re just emerging from heavy drug use they’re unlikely to have been that in tune with their bodies.

Also, before I move on from this topic, Dr Leigh Walker, the Florey neuroscientist, mentioned that more research is urgently needed into the way that the birth control pill influences the way we process and desire drugs. I hadn’t even thought of that! I was necking estrogen pills for 15 years straight. I can now blame the pill instead of my parents.

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2. Adult cumulative trauma and the need for more female-only treatment

There are studies that show that men benefit from mixed gender treatment but that the reverse is not so true.

Like many isolated, disenfranchised girls, I gravitated towards older men the way that rejected, disenfranchised boys have gravitated towards the IRA or ISIS. I was a willing pawn awaiting detonation.

This led to cumulative bad sexual experiences, from blacking out and being assaulted; to needing to be wasted to have sex because of traumatic childhood sexual experiences, to having very low social currency because of being perceived as a bad woman.

As a teenager I thought I had way more agency than I did. In fact, years later when I was writing this book, clinician Geoff Corbett, who worked at Mater Young Adult Health Care in Brisbane, told me about some of his young female clients who were involved with dealers.

He said: ‘They might explain to me, “Well actually, I’m exploiting them – I get all these drugs for free.” And then I’m like, “Yes, but you’re also having sex with them.” “Yes, but that doesn’t cost me anything.”

News flash: it does cost you, a lot. Eventually.

These young women are likely to end up in some kind of grim groundhog day of being retraumatised. Professor Jayashri Kulkarni told me: ‘The deliberate self-harm of addictions, or the self-harm of being involved in harmful relationships are all expressions of rage taken inwards, and of really poor self-esteem,’ There’s a masochistic self-fulfilment of the prophecy: “I don’t deserve anything good.” Hence a woman gets involved with the worst kind of relationship.’

In short, there’s so much accumulated sexual trauma, violence and coercion that a woman is likely to have experienced by the time she seeks treatment. And if there was ever a more motivating emotion driving substance use than shame, I’m yet to hear it. So clearly there’s a need for more treatment services that are safe spaces for women to unpack all this.

Side note: I think one of the reasons that sober coaches started to become quite the thing in the past decade is because women in particular are drawn to them because it’s so hard to get into a female-only services.

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3. Women are self-medicating both emotional pain AND chronic pain, but we rarely talk about the latter

We’re good at talking about women and self-medication. The self-medicating woman is a recurring figure in popular culture. She’s Marianne Faithfull’s pill-gobbling tragedy in ‘The Ballad of Lucy Jordan’; perpetually smoking, forever unfulfilled Betty Draper in Mad Men; mean-drunk Martha in Who’s Afraid of Virginia Woolf; and Kirsten, in Days of Wine and Roses, who accidentally sets fire to her apartment and almost kills her child.

Just as ‘hysteria’ was the catch-all condition for frustrated women in Freud’s day, ‘anxiety’ was the buzzword from the mid-twentieth century onwards. Going by these adverts for Serax and Ritalin, the best prescription would have been a more fulfilling life.

But we don’t hear so much about women self-medicating chronic pain: conditions such as endometriosis and fibromyalgia. They could be using ketamine, gummies, weed, opioids, Valium, alcohol, and maybe some ADHD drugs too, to break through the fog.

In recent years there have been a bunch of books about women’s chronic pain and how it’s woefully under-researched.

So now imagine the likelihood that the woman who is self-medicating chronic pain is also self-medicating the accompanying anxiety and depression because she can’t keep up with life.

I’d love to hear your thoughts on these three topics. Have you experienced them? Can services do better? What do GPs need to know? What else do you think is important when it comes to women and drug use?

Thank you to the Florey Institute!