AGES (15–64 years)
Males (%)
Females (%)
1997
86.4
70.5
1999
83.2
67.2
2001
85.2
70.9
2003
84.5
68.4
2005
84.0
69.2
2007
80.4
66.4
2009
84.4
72.7
Binge drinking 2009
21.0
8.6
Government Survey on the Use of Drugs in Secondary Education (ESTUDES; 14–18 years)
1994
82.4
82.4
1996
81.4
82.0
1998
80.7
83.1
2000
74.8
75.8
2002
74.3
75.3
2004
79.0
80.5
2006
78.4
80.7
2008
80.8
81.7
2010
74.9
75.2
Binge drinkers 2010
52.2
53.5
The percentages for are also higher than those for women with regard to excessive alcohol consumption. The consumption of five or more alcoholic drinks at a single event (binge drinking) is higher among men, whose pattern of alcohol consumption is of a higher intensity and frequency than that of women. In this sense, the Spanish data are no different to the European context [6]. Among school-goers, there are slightly more binge-drinkers among girls, reversing the relationship that occurs in the general population. It has been observed that, as age increases, alcohol consumption decreases, becoming more moderate [7].
As for tobacco use, as Table 14.2 reveals, it is the adult men who smoke most in general terms, whilst in other age groups we can find equality between the sexes. On the other hand, school-girls smoke more than school-boys, with significant differences between the two. It is possible that the smoking of tobacco has been influenced by transition from junior school to secondary school, as the age for this has lowered, with its consequent effects on the rites of passage and cultural meanings associated with tobacco use [8].
Table 14.2
Tobacco use (last 12 months, DGPNsD)
AGES (15–64 years) | Males (%) | Females (%) |
1997 | 55.0 | 38.7 |
1999 | 50.3 | 39.2 |
2001 | 51.5 | 40.5 |
2003 | 53.0 | 42.6 |
2005 | 47.2 | 37.5 |
2007 | 46.0 | 37.6 |
2009 | 48.4 | 37.0 |
Daily 2009 | 36.2 | 27.2 |
ESTUDES (14–18 years) | ||
2008 | 36.0 | 40.1 |
2010 | 28.1 | 36.4 |
Daily 2010 | 11.0 | 13.6 |
That female school-goers drink and smoke more than their male counterparts may be related to various factors. First, female adolescents today share the same spaces and participate in the same leisure rites as their male counterparts. In previous decades, the leisure environments and times were different for both sexes and the acceptance of women’s incorporation in all social settings and scenes has been gradually increasing. Second, there are few studies that approach the relationship between female tobacco and alcohol use and advertising in detail, although there is no doubt that it has a strong impact on adolescents. For example, women and adolescent girls are major users of the light cigarettes and the tobacco companies are aware of this fact, incorporating the female image into their advertising campaigns. In the same way, alcohol advertising is associated with images of its social and public use, in which women are highly represented. In other words, the slogan of one alcoholic drink that says “it’s a man’s thing” is no longer an advertising device, as it would exclude female adolescents and young girls, who are important customers for the alcohol industry. Third, legal or illegal drugs can be a substitute for or an inhibitor of food consumption, as are alcohol, tobacco, and psychotropic substances, leading to lower food consumption and therefore becoming a means of weight control [9,10]. The image of the female body is an important advertising device, and establishes standards of identification. Fourth, it is likely that female adolescents and girls find themselves in a dilemma regarding a conflict of roles: the traditional female role models are not relevant to the new generations in which gender roles are being redefined. Finally, drugs, as we will subsequently discuss, are a source of pleasure, fun, and a search for new sensations, which are motivations not previously associated with women [11].
14.2.2 Psychotropic Drug Use
When we talk of psychotropic drugs, we are referring to a series of pharmaceutical products that are used for a wide range of mental health disorders or illnesses, ranging from stress to personality disorders. In our explanation of this pattern of use we will focus on those drugs that are used to treat anxiety, stress or other psychological illnesses, such as tranquillizers and sedative–hypnotics.
We find two types of psychotropic drug use in the general population: first, that prescribed by GPs or mental healthcare doctors as a treatment for some psychological disorders or illnesses; and second, personal use without medical prescription for similar reasons or circumstances. In both cases, women predominate.
In a study about the use of psychotropic substances among women [12, 13] it became evident that women are prescribed with psychotropic drugs twice as frequently as men when they attend GPs or mental health care services. Alongside gender, age is another key variable. The prescription of psychotropic drugs to women is related to a series of characteristics:
More women than men attend health consultations in which they discuss their illnesses. In other words, they are frequent attenders, meaning that they are more likely to be medicated.
Psychiatric morbidity associated with women oscillates between 20 % and 34 % compared with men, for whom the percentages vary between 8 % and 22 %.
A higher number of women are diagnosed with anxiety and depressive disorders, while personality and substance abuse disorders prevail among men. In other words, more anxiety, depression, and insomnia problems are diagnosed in women than in men.
Around 50 % of patients who visit GPs have a psychosocial-related query, and this is higher among women than men.
There is a tendency to treat as illnesses and medicate those disorders that are associated with the various life stages of women (premenstrual syndrome, postnatal depression, menopause, etc.). In other words, the tendency is to classify a female’s subjectivity as pathological when its origin lies in the specific biological characteristics of the woman’s body.
Many psychological illnesses that are treated with psychotropic drugs are related to the development of the women’s gender roles, these being the origin or cause of their illnesses, and which lead to the medication or prescription of psychotropic drugs.
As Goudsmit [14] suggested from a female-centered perspective, there is a supposition among medical professionals that women exaggerate their complaints and express their illnesses externally, thus generating stereotypes of women as hypochondriacs. Any errors or gender biases in the diagnosis lead to two outcomes: on the one hand, no other factors that may be causing the woman’s illness are reviewed or investigated, with important repercussions for women’s health. On the other hand, as we have already said, the medication of women’s psychosocial illnesses, not considering alternative treatments when the source is the living conditions or social situations.
The medication or self-medication processes for psychotropic substances are not recent; we can trace their origins back to the 1950s and 1960s when the Spanish people had extensive healthcare coverage and the healthcare processes were more clearly defined in the medical community. Together with this situation, the growth and advance of the drug industry made numerous products available on the market to mitigate the illnesses and disorders of the Spanish people.
Thus, surveys carried out in the 1980s were already revealing a higher prevalence in the use of psychotropic drugs by women [15]. We may say that these concern the psychotropic substances most frequently used in the last 40 years, mainly by women and about which there are very few single-subject studies. It may be that the secondary role given to women’s illnesses, how they are deemed to be of little severity and women’s disorders being deemed psychological issues, has led us to ignore one of the biggest uses of psychotropic drugs in Spain.
We have extracted data about the use of tranquillizers and hypnotics without medical prescription from the two PNsD surveys, which we show in Table 14.3:
Table 14.3
Use of psychotropic drugs without prescription (last 12 months, DGPNsD)
AGES (15–64 years) | Males (%) | Females (%) |
2005 | 1.1 | 1.3 |
2007 | 1.2 | 1.4 |
2009 | 1.9 | 1.9 |
ESTUDES (14–18 years) | ||
2008 | 7.7 | 11.0 |
2010 | 8.4 | 12.3 |
The differences found in the PNsD’s home-based surveys are similar between sexes, but for school-goers, again, the percentages are higher among girls.
The survey on drug use among the female population carried out in 2000 by EDIS for the Women’s Institute of Spain (Instituto de la Mujer de España), indicated that users of tranquillizers were 35 years of age and over, with a low level of education, usually married or widows, and were pensioners, housewives, unemployed, and professionals of all social classes. For hypnotics, some older ages were recorded, of 50 years and over; these were separated women and widows, also with a low level of education, professionals, housewives, and pensioners. These characteristics tally with those recorded in other studies [12].
14.2.2.1 Reasons for and Circumstances of Use
The reasons for taking psychotropic drugs are essentially related, as we have previously mentioned, to psychosocial disorders experienced by women and that may be different depending on the moment or stage of their life they are at. Thus, stress faced with entering the job market and professional development, together with a lack of female role models to replace the traditional ones may be a triggering factor among younger women; an overload of work outside and inside the home, playing the role of carer and mother, plus other social demands that hinge on them may be the cause of disorders among middle-aged women; finally, their traditional role as housewives and the loneliness they faced when their children leave home may lie behind the illnesses and disorders of older women [12]. Ultimately, the conflict of gender roles, the absence of new female role models, and the lack of public acknowledgement of the traditional roles played contribute toward the dissatisfaction, illnesses, and conflicts that women experience and that they mitigate with psychotropic drugs, whether self-medicated or by prescription.
Thus, the work of the EDIS, the Sociological Research Team, clearly indicated how women acquire psychotropic substances from medical professionals or family members. The guidelines for self-care at home and the current self-medication processes lead to the transmission of knowledge about pharmaceutical products for treating various ailments among members of the family group, for example, a female transmission from mother to daughter. Therefore, the doctor was specified as the source for obtaining tranquillizers and hypnotics by the female group that the EDIS studied (96 %), but the PNsD surveys revealed how it is not difficult for women and school-goers to receive or access these pharmaceutical products.
Some risk factors have been related to the use of psychotropic drugs among women [12, 16]. Of these, we highlight the following: the double working day, as a result of not only having a job, but also responsibilities in and out of the home, financial insecurity, conflicts with partners, stress, personal insecurity and dissatisfaction, work conditions and future expectations, the care of sick older and younger family members, which falls upon the women, the crisis of identity in the balance of the gender roles played, or situations of dependency and subordination to the husband. Not forgetting the relationship between the methods learnt for dealing with conflict in gender socialization and the use of psychotropic drugs [17, 18].
Ultimately, women are the biggest users of psychotropic drugs, via both medical prescriptions and self-medication, and this use is greatly linked to the gender stereotypes projected around female health by both the prescribers and the rest of society [13].
14.2.3 Opiate Use
In this section on the use of opiates, will we will focus on heroin, bearing in mind that the users of this substance are usually multiple substance users. Other opiates such as methadone or morphine are mainly used in a therapeutic context, without ruling out that these may be subject to different uses.
The prevalence and incidence of heroin use has been dropping over the last two decades. The same does not apply to requests for treatment for the dependency on illegal drugs which, as we will see later, has a greater presence, and in recent years it has been taken in combination with cocaine and other drugs.
Since it erupted onto the national scene and its subsequent expansion in the late 1970s, heroin use has been concentrated among men, with female users being in the minority, especially in the early days [19]. The first groups of users of this substance determined its pattern of use, partly imported from other countries where its use previously began and spread. Afterward, some changes were observed to this pattern of use that were related to new social circumstances, such as AIDS, the type of heroin on the black market or the social representation of its compulsive users.
14.2.3.1 Data on Use
Before heroin use spread, the data we have on the use of opiates are scarce, dispersed, and barely accurate. However, some works [20–22] have indicated that heroin use was preceded by the use of morphine. According to the cases analyzed by González Duro [20] this concerned middle-aged women, who started taking morphine by medical prescription or who were related to medical professionals. They were women from a well-off social class, whose intravenous use was integrated, concealed, self-controlled, and not socially relevant. The censuses of morphine addicts treated and supplied with morphine during the dictatorship era also revealed similar characteristics. This high feminine presence in the use of morphine greatly contrasted with the subsequent use of heroin in which women would be in the minority. We will most probably find the reasons behind this if we compare the two sociocultural contexts, and analyze the woman’s role in each.
The prevalence of heroin use in the surveys on this subject show very small percentages compared with other illegal drugs. This situation is evident in all the surveys, from the first to the current ones. Thus, quoting one of the surveys from the 1980s, by the Spanish General Directorate of Public Health in 1984 [15], 0.9 % of people had taken heroin in the last year (1.6 % of the men and 0.3 % of women). In the home-based surveys on drugs from 1995 to 2009 by the PNsD we also observe very low prevalence, between 0.1 % and 0.8 %, which continues to drop among both men and woman (Table 14.4).
Table 14.4
Use of heroin (Last 12 months, DGPNsD)
AGES (15–64 years) | Males (%) | Females (%) |
1995 | 0.8 | 0.3 |
1997 | 0.4 | 0.1 |
1999 | 0.2 | 0.0 |
2001 | 0.2 | 0.0 |
2003 | 0.2 | 0.1 |
2005 | 0.2 | 0.1 |
2007 | 0.1 | 0.0 |
2009 | 0.1 | 0.0 |
ESTUDES (14–18 years) | ||
1994 | 0.5
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