Why Have Overdose Rates Risen for Middle-Aged Women?

The role of body image and weight concern in drug use.

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Drug overdoses have skyrocketed in a population you might not expect: Middle-aged women.

A recent report published by the Centers for Disease Control and Prevention (CDC) reviewed death-certificate data from individuals who died in the United States between 1999 and 2017 (VanHouten, Rudd, Ballesteros, & Mack, 2019). Results revealed that drug overdose death rates increased 260% from 1999 to 2017 among women aged 30-64 (from 4,314 deaths to 18,110). Broken down further, death rates increased about 200% among women aged 35-39 and 45-49; 350% among those 20-24 and 40-54, and almost 500% in women aged 55-64.

These findings lead us to ask: What leads to such stark increases in drug-related deaths in middle-aged women?

One likely contributing factor is societal pressure to be thin, which often leads to body image and weight-related concerns in women. A growing number of women report body weight and shape dissatisfaction as a primary motivator for both legal and illicit drug use (Brecht, O’Brien, Mayrhauser, & Anglin, 2004; Warren, Lindsay, White, Claudat, & Velasquez, 2013). For example, in a sample of 350 adult methamphetamine users, Brecht and colleagues (2004) found that 36% of female participants started using drugs because of a desire to lose weight (compared to 7% of males). Similarly, in a sample of 297 adult women in substance abuse treatment, my colleagues and I found that 48% of participants started using drugs (in part) to lose weight; 69% were concerned about their weight while in recovery; and 43% were concerned that gaining weight could trigger relapse following treatment (Warren, et al., 2013).

Furthermore, consistent with weight concerns, women are increasingly using drugs that lead to increased mood and decreased appetite. In the recent CDC report (VanHouten, et al., 2019), the type of drugs used that lead to overdose changed from 1999 to 2017. Specifically, drug overdose deaths increased drastically for those using synthetic opioids (1,643%), heroin (915%), benzodiazepines (830%), prescription opioids (485%), and cocaine (280%). While most of these drugs are opioids used for pain management(which also tend to produce a sense of euphoria, making them attractive), stimulants (like cocaine and ecstasy) are increasingly popular among women because common side effects are increased energy, elevated mood, elevated metabolic functioning, and loss of appetite (Office of National Drug Control Policy, 2008).

Despite the clear relationships between substance abuse and body image/weight concerns among women, very few existing substance abuse treatment programs that include body image, weight, eating pathology, and health knowledge as core intervention targets (Lindsey, Warren, Velasquez, & Lu, 2012). Consequently, my colleagues and I created and tested a 12-week supplemental health and body image curriculum for women with weight and body image concerns who are in substance abuse treatment, called Healthy Steps to Freedom (HSF; Lindsey et al., 2012). Outcome data from 124 adult women revealed that thin-ideal internalization, body dissatisfaction, and eating disorder symptoms significantly decreased after HSF program participation, whereas health-related behaviors (e.g., increased healthy food consumption) and knowledge (e.g., understanding of basic nutrition, exercise) increased.

The Naked Truth is This:
Middle-aged women are dying from drug overdoses at increasingly high rates. Although this is often not the stereotypical demographic we picture when we think of “drug addicts,” middle-aged women are increasingly using drugs, in part because of body weight and shape concerns. Consequently, it is critical that researchers and treatment providers understand and address body image components of drug use in women.

Copyright Cortney S. Warren, Ph.D., ABPP


Lindsay, A., Warren, C. S., Velasquez, S., & Lu, M. (2012). A gender-specific approach to improving substance abuse treatment for women: The Healthy Steps to Freedom (HSF) program. Journal of Substance Abuse Treatment,43,61-69.

Mazure, C.M., & Fiellin, D.A. (2018). Women and opioids: Something different is happening here. Lancet, 392, 9–11.

Office of National Drug Control Policy. (2008). State of Nevada: Profile of drug indicators. Retrieved from https://www.ondcp.gov/statelocal/ nv/nv.pdf.

VanHouten, J.P., Rudd, R.A., Ballesteros, M.F., & Mack, K.A. (2019). Drug overdose deaths among women aged 3064 years—United States, 1999—2017. Morbidity and Mortality Weekly Report, 68(1), 1-5. Retrieved from https://www.cdc.gov/mmwr/volumes/68/wr/mm6801a1.htm

Warren, C. S., Lindsay, A., White, E., Claudat, K., & Velasquez, S. (2013). Weight-related concerns related to drug use for women in substance abuse treatment:  Prevalence and relationships with eating pathology.Journal of Substance Abuse Treatment, 44,494-501.

Dr. Cortney S. Warren, PhD, ABPP

Exposed to a diversity of cultures and lifestyles from an early age, Dr. Cortney was intrigued by the ways cultural and environmental conditions affected the psychological well-being of individuals, groups, and even whole societies.


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