William L. White, M.A.
Senior Research Consultant
Lighthouse Institute
Chestnut Health Systems

Family History	Nature (genetic risk) and nurture (developmental experience) interact to influence vulnerability for addiction. Addicted women are more likely to have family trees in which members have suffered from alcohol and other drug related problems 74% of the more than 4,500 women treated in Project SAFE reported one or both parents suffered from alcoholism; more than 90% reported a history of addiction in their family tree. "These findings suggest that the role of genetic factors in the etiology of alcoholism (in women) is substantial and that at least half of the total liability to alcoholism (in women) is a result of genetic factors." Kendler, K., Heath, A., Neale, M. Kessler, R. And Eaves, L. (1992) A Population-based Twin Study of Alcoholism in Women Journal of the American Medical Association 268(14):1877-1882.
Family Markers	Addicted women are more likely than their non-addicted counterparts to have: Family and extended family members who use alcohol and other drugs, use these substances excessively, and experience problems related to such use. Family and extended family members who totally abstain from the use of alcohol and other drugs. Family and extended family members who die as a result of accidents, suicide, homicide or alcohol/drug-related medical problems. Family and extended family members diagnosed with vaguely defined emotional disorders ("nervous breakdowns") or with depression and anxiety disorders. Family and extended members who married alcoholics.
Developmental Markets	A high percentage of addicted women were sexually abused as children. This sexual abuse was characterized by multiple traumagenic factors: early onset of abuse, long duration of abuse, multiple perpetrators, perpetrators who were drawn from the family or whose presence was sanctioned by the family, violence or the threat of violence involved in the abuse, more invasive forms of sexual abuse, and an escalation of abuse following breaking silence. The pre-adolescent and adolescent years of many addicted women were characterized by mild to severe emotional-behavioral problems such as learning disabilities (particularly ADHD), depression, runaway behavior, and promiscuity.
Early Drinking History	Addicted women are more likely to have experienced an earlier age of onset of alcohol and other drug exposure than non-addicted women. Many addicted women report euphoric recall of their first contact with alcohol and other drugs and atypically high tolerance from the onset of drinking and drug use.
Onset of Problem Use	The onset of excessive alcohol and other drug use is more likely in women to be associated a particular life event. The most frequent of these events include childbirth, relationship crisis/loss, breast removal, hysterectomy, and loss of partner, child, or parent.
Progression	Most addicted women’s drug use is characterized by a predictable pattern of self-acceleration. Key warning signs in the progression of alcoholism in women included: Increased tolerance, personality change while drinking, drinking more before menstrual periods, memory blackouts, neglect of food, pre-drinking drinking, guilt about drinking, binges, tremors, and lowered tolerance for alcohol. Four late stage symptoms of alcoholism in women that are early or middle stage symptoms for men include: sneaking drinks, gulping drinks, persistent remorse, and devaluing personal relationships. Key warning signs in the progression of cocaine addiction include: using cocaine to lose weight diversion of family resources for cocaine spending time with certain people to get access to cocaine trading sex for cocaine impaired sleep and eating habits using cocaine at more frequent intervals during a bings (i.e., "snorting" cocaine every 30 minutes instead of every hour, then every 20 minutes, etc.) experiencing increased intensity of dysphoria following a binge shifting from intranasal to intravenous administration or smoking of cocaine using drugs which you normally avoid for the purpose of reducing post-cocaine dysphoria taking money from a savings account, IRA, or investments in order to buy cocaine using credit cards to get cash advances for cocaine buys selling cocaine or obtaining it for others in order to get free cocaine increase in drug hunger (craving/"jonesing")
Speed of Progression	Alcoholism progresses faster in women than in men. Women develop medical problems, such as cirrhosis of the liver, with less total drinking time and less total volume of alcohol consumed than do men.
Defense Structure	Addicted women, like their male counterparts, develop an elaborate defense structure that is designed to do three things: sustain drinking or drug use, escape the consequences of alcohol/drug use, and maintain self-esteem. The mechanisms of this defense include denial, minimization and projection of blame. The area of greatest denial/minimization for addicted women is often related to the sphere of parenting. Many addicted women, before and during early stages of treatment, deny or minimize the impact of their addiction on their children. A large percentage of addicted women admitted to project SAFE between 1986 and 1996 entered with a defensive style characterized by what has been called the "dependency cluster." The components of this cluster are passivity, learned helplessness, learned hopelessness and dependence (upon drugs, toxic relationships, and enabling institutions).
Assessment Spheres	The assessment of substance abuse disorders in women is based on the assessment of spheres of consequences. More specifically, the assessment probes the effects of alcohol and drug use upon physical health; the selection, stability and quality of intimate relationships; mother-child relationships; emotional health; and lifestyle--social, recreational, occupational functioning. In general, the assessment seeks to discover the number and severity of consequences a woman has experienced as a result of her drug use.
Biological Markers	Biological markers of drug USE include laboratory detection of drugs in blood, urine or hair samples. Biological markers of addiction include: increased tissue tolerance (the need to consume larger quantities of the drug to produce the same, desired effect) an identifiable withdrawal syndrome that accompanies cessation of drug use, the presence of cellular craving for the drug, laboratory findings, such as elevated gamma-glutamyltransferase (GGT) levels as a confirmation of heavy drinking, or elevated serum glutamic oxaloacetic transaminase (SGOT) levels as a confirmation of liver injury. diagnosis of alcohol- or other drug-related medical disorders. Medical indicators of alcoholism in women are most frequently manifested in liver pathology, gynecological disorders and obstetric complications, and increased risk of breast cancer.
Behavioral Essence of Addiction	The behavioral essence of addiction is the presence of continued (compulsive) drug-seeking and drug-using behavior in spite of medical contraindications (e.g., pregnancy) or adverse consequences (e.g., arrest, divorce, loss of children), and loss of control over the amount of alcohol or some other drug consumed or the amount of time spent drinking or using.