Could Birth Control Help Women Beat Addiction?

By Crystal Ponti 01/31/17

A new study suggests hormones can make women more susceptible to addiction, so could the birth control pill help with recovery?

A woman holding and looking questioningly at a blister pack of pills.
Multi-use medication?

Hormonal fluctuations can wreak havoc on a woman’s body. From PMS to menopause, the ups and downs can trigger weight gain, depression, and exhaustion, among other inconveniences that affect how women work, play, and communicate. Now, a new study suggests hormones might also make women more susceptible to addiction, specifically cocaine, and that birth control could be the key to helping some women kick the habit.

The study, which was conducted at the Icahn School of Medicine at Mount Sinai and published in the journal Nature Communications, found that estrogen intensifies the brain's dopamine reward pathway and demonstrated that cocaine has its most potent effects during the estrous/menstrual cycle, when release of estrogen is at its highest. 

“When we started our research, we started with a small pilot study using both male and female animals [mice] to see if they were the same [attributed the same levels of pleasure from exposure to cocaine]. We actually thought they might be, but what we found is that females were really, really strong and were rewarded more by the drug,” says Dr. Erin Calipari, PhD, co-first author on the paper and a postdoctoral fellow at the Icahn School of Medicine.

She says her team was surprised by the early findings. When the mice were put into an environment linked to drugs, especially females at the height of their estrous cycle, it stimulated a dopamine reward signal even without cocaine use. The female mice spent more time on the side of their cages where the cocaine had previously been administered. “We wondered if it was something inherent to the different sexes, and what we discovered was that it seemed to be regulated by hormones. It was an interesting discovery.”

The study underscores the need to study both sexes, together and independently, in order to develop optimized treatments for drug addiction. “We need to have more specialized treatment for drug abusers, because the mechanisms that are driving the addiction are likely different,” Dr. Calipari said in a previous interview.

The 2013 National Survey on Drug Use and Health indicated that close to 12 percent of American males age 12 and older were currently using illegal drugs, compared with just over 7.3 percent of females in the same age group. Dr. Calipari says the findings from her research back up other studies that show that while men make up a larger percentage of total drug addicts, women are more likely to stay hooked and unable to shake the habit.

“When you look at opportunity, there are more male addicts. The opportunities are there because they tend to be more impulsive and in situations where there are already drugs,” Dr. Calipari says. “But when you go in and break it down, women actually consume more drugs, become addicted faster after first use, and have a harder time quitting.”

She is quick to point out that whether hormones influence female drug addiction is hard to say, because there are so many confounding factors in humans. For one, it’s hard to tell if the hormones are just there or if it is part of a cycle, something that her team is currently investigating. In animal models, like those used in the study, variables can be controlled. There are also other factors to consider in humans, including stress and anxiety, which women experience differently than men.

Kristie Overstreet, a Licensed Professional Clinical Counselor and Certified Addiction Professional, reminds us that, “Addiction doesn’t discriminate and has the ability to take control of someone’s life.” She is excited by the study’s findings. “Any advantage we have to fight and possibly prevent addiction must be explored,” she says.

One possible avenue: hormonal birth control. The findings show estrogen, the female sex hormone, intensifies the release of dopamine, the so-called “feel-good” hormone. In the female mice, estrogen affected the quantity of dopamine released and also how long the dopamine stayed in the reward pathways. If addiction is related to a woman’s cycle, hormonal birth control could be used to normalize the cycle and associated cravings.

An estimated 9.7 million American women currently take the pill, which is a tiny percentage of the 125.9 million adult women in the U.S. Aside from being a major form of contraceptive, hormonal birth control is also used to treat acne, irregular or absent menstrual periods, endometriosis, Polycystic Ovary Syndrome, and other disorders.

The team did uncover a correlation between the mice and humans. Women have previously reported to addiction investigators that they experience a greater “high” from cocaine during their menstrual cycle, a time when estrogen levels spike. Dr. Calipari believes the strong reaction in the female mice could be applicable to other addictive substances too, such as heroin, alcohol, and tobacco.

But additional research is not without some major hurdles. According to WebMD, normal estrogen levels vary widely between women. Large differences are typical in a woman on different days, or between two women on the same day of their cycles. These differences will challenge researchers as they continue to explore hormonal fluctuations and addiction.

Overstreet is optimistic. “This study is very promising and may be a new weapon in the fight against addiction,” she says. “Women are affected by their hormone cycles emotionally, physically, and mentally. This study gives us hope that awareness and monitoring women’s hormone cycles may assist in preventing cocaine addiction and future relapse. This could be a huge asset in helping women understand the association of their physiological body and their ability to recover from addiction.”

The National Institutes of Health recently funded a separate, three-year study to assess if fluctuating hormone levels influence women’s risk for addiction. Lead researcher Linda Perrotti, MPhil, PhD, of the University of Texas, Arlington, said in a press release, “Our study on hormonal effects could lead to customizable and differentiated addiction treatment and prevention measures for men, women, women on hormone-based birth control, post-menopausal women, and women on hormone replacement therapy.”

There is still much work that needs to be done in determining the viability and efficacy of hormonal birth control as a treatment option for substance abuse. “Birth control would not cure addiction, but it could improve treatment outcomes in substance abuse disorders,” Dr. Calipari notes.

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Crystal Ponti is a science, health, and technology reporter from Downeast Maine. She has written for the The Washington Post, The New York Post, Smithsonian Magazine, NPR, and Salon. Follow her on Twitter @crystalponti.