The first comprehensive assessment of substance abuse and women, this report arose from an analysis of more than 1,700 scientific and technical articles, surveys, government reports and books. Results show that American women are closing the gap with men in that they are increasingly likely to abuse substances at the same rate as men. Findings show that women are starting to smoke, drink, and use drugs at earlier ages than ever before. Unlike men, though, women get drunk faster, become addicted quicker, and develop substance abuse-related diseases sooner. Furthermore, at least one of every five pregnant women uses drugs, drinks, or smokes. An enormous gap exists between what experts know about women's substance abuse and what is known and acted on by women and those who care for them. It is recommended that women be made aware of the dangers of substance abuse. Prevention programs must address the reasons why women abuse substances and such programs must identify girls at highest risk. Health professionals, too, must recognize that women will manifest symptoms of substance abuse that are different from those of men, which may include a woman trying harder to hide her substance abuse due to intense shame. Contains approximately 750 references. (RJM)