Gender-Specific Addiction Treatment

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What is gender-specific addiction treatment?

Gender-specific treatment is a type of addiction treatment program tailored just for women. Prior to the 1970s, only generic programs existed for men and women with little regard for the specific needs of both genders, but ever since the women’s movement in the 1970s, gender-responsive programs for women have proliferated in the 1990s and 200s, and research literature over the last three decades has examined the gender differences in substance use disorders and treatment participation. (1)

Gender-specific substance abuse treatment isn’t just about the biological differences between men and women; it addresses the social and environmental factors specific to women that prompt substance use, according to the National Institute on Drug Abuse (NIDA), and they include the following:

• Motivation for drug use
• Rationale for seeking addiction treatment
• Type of treatment environment
• Most effective treatment
• Consequences for not receiving drug and alcohol treatment

How do men and women differ in their substance abuse and recovery?

Compared to men, women face more barriers to accessing treatment and are likely to seek care in mental health settings or primary care settings than in specialized treatment programs, according to the National Institute on Alcohol Abuse and Alcoholism (NIAAA).

• Compared to men, women progress more rapidly from initial drug use to dependence to drug treatment. This phenomenon of progression through usage milestones is called telescoping. (2)
• Hormonal differences play an important role in the progression from recreational drug use to dependence (3)
• Social influences either encourage or obstruct participation in addiction treatment
• Substance-abusing women show higher levels of anxiety than substance-abusing men in response to stress and presence of drugs and alcohol (4)
• Psychiatric comorbidity
• Outcomes from recent studies of behavioral and pharmacological therapies for SUDs

Why do women initiate substance use?

In general, women initiate substance use at a later age than men, primarily because men have more opportunities to use and women have greater social responsibilities placed upon them by parents. Women are expected to have more responsibilities around the home, and girls are subject to greater parental monitoring than boys. Societal expectations and restrictions naturally limit exposure to drugs and alcohol for women. (5) According to SAMHSA’s Treatment Episode Data Set (TEDS) report (6), the average age of initial use for females is 20 years old. A woman is usually introduced to drug and alcohol use through an influential relationship such as partner, boyfriend or spouse. Reasons for drug initiation most often are triggered by stress, negative emotions, and a desire to lose weight or increase energy. (7)

Risk Factors for Initiation of Substance Use among Women
• Family history. Studies show that women are just as likely as men to develop substance use disorders if their parents have had a history of drug and alcohol abuse. Genetic and environmental factors in family aggregation play an important role in the initiation of drug use among men and women. Women who have a parent with a substance use disorder are 10 to 50 times more likely to develop alcohol dependence, according to research. (8)
• Over-responsibility with family of origin. Girls who have had to take on adult responsibilities as a child, such as raising younger siblings and being the source of emotional support for a parent, are likely to develop a form of chemical dependence. These experiences put girls at significantly higher risk for initial use as early as age 14.
• Relationship status. Among women between ages 18 and 49, about 11% of divorced or separated women and 16% of single women (who have never been married) are reported to have illicit drug abuse, compared to 4% of married women. (9)
• Influential relationships. Being yoked with a partner who drinks or uses drugs increases the woman’s chances of initiating drug use. In adolescence, girls are influenced by peer pressure, and in adulthood, women are introduced to drugs and alcohol by a significant other, and they continue the activity to (A) have something in common with their partner or (B) to maintain the relationship. The partner often supplies the drugs and the woman becomes dependent on her significant other for the substances.
• Personality traits. Risk-taking personalities are strongly associated with initiation of substance use. Women with sensation-seeking personalities are likely to engage in risky sexual behaviors, associate with risky partners, and use illicit drugs and alcohol. Women with these personality traits may exhibit anxiety, obsessiveness, depression, temper tantrums, mood swings, low self-esteem and poor self-image.
• Sexual orientation. Homosexual women reported higher rates of substance use and dependence than heterosexual women. Lesbians are less likely to abstain from alcohol and do not decrease alcohol intake as they grow older.(10) Research also shows a greater prevalence of marijuana use compared to other illicit drugs among lesbians. (11)
• Trauma history. Trauma-related stressors such as physical and sexual violence, domestic violence and childhood abuse are significantly associated with initiation of drug use and development of substance use disorders in women. One study found that 55 to 99% of women with trauma histories had substance abuse addiction, compared to 36 to 51% of women with no trauma history. (12)

Advantages of Gender-Specific Addiction Treatment

Historically, substance abuse treatment has offered cookie-cutter generic approaches to treat drug and alcohol abuse for men and women, but each gender experiences addiction differently and therefore this calls for a more customized approach that separates the sexes and addresses each group’s needs on a deeper level. Gender-specific treatment improves recovery outcomes by:

Cultivating camaraderie and empathy
Men and women are more likely to open up to members of their own gender; they are likely to form a strong camaraderie as they talk authentically about issues that only their own gender would understand.

Providing a safe space for honest discussions
Without the distraction of the opposite sex, group members will feel safer and more comfortable about discussing personal issues as they open themselves up to positive feedback and reinforcement. It helps to know that peers in the group have similar experiences and everyone has the same end goal: life-long recovery from drug and alcohol addiction.

Shifting your focus to what really matters
At this time, your recovery is the most important priority in your life and being in a gender-specific group helps to remove romantic distractions that may become an obstacle to your recovery. Instead of leaving room for attraction that could derail you, gender-specific groups will help you solely focus on your healing and recovery.

Allowing focus time on gender-specific issues
If men and women were in the same group, they would not have time to discuss issues that are only relevant to their own gender. It would make more sense to separate the sexes so that each gender would feel they are spending adequate time resolving gender-specific problems rather than wasting time on issues they don’t understand.

Research shows that gender-based treatment should be included in addiction treatment for the following reasons:
• Some patients may prefer treatment women-focused programs and services provided by women
• As an adjunctive service, gender-specific treatment can optimize treatment outcomes
• It provides an opportunity to focus on gender-specific content
• The environment and treatment process allow for greater comfort and support, especially for women with trauma histories

Gender-Specific Factors That Influence Addiction Treatment for Women

To maximize the retention rates of women in treatment, substance abuse counselors have to consider individual, counselor and environmental variables that affect treatment retention. Some of the treatment issues that face women are as follows: (13)

Role of relationships
Includes family and life partners. Central to women’s identities and self-esteem, relationships play a vital role by either empowering or debilitating women through connections and disconnections. Connections are described as positive relationships that provide mutual support and empowerment. Disconnections are unhealthy relationships that dismantle a partner’s self-esteem and assertiveness, leaving the woman feeling powerless. The severity of disconnection can range from feeling unheard to experiencing physical and sexual violence.

Unhealthy relationships developed in adulthood often mirror the broken family dynamics that prime women for drug and alcohol abuse later in life. Instead of functioning as a safety net and source of support, the family unit was broken by chemical dependence, violence, sexual abuse and other disconnections.

Parenting issues and treatment needs
Includes pregnancy and children. Pregnant women may feel ambivalent about entering addiction treatment due to feelings of shame and guilt for substance use during pregnancy. Counselors must assure pregnant women and mothers that it’s never too late to start treatment and provide educational materials about the harmful effects of drugs and alcohol on the fetus in hopes of steering pregnant women toward treatment. Women should be encouraged to divulge any existing parenting responsibilities and needs so that the clinician can provide referrals to economic resources and social services. Gender-specific treatment provides a safe, secure and comforting environment in which women can openly share about their struggles without fear of judgment.

Co-occurring disorders
Includes anxiety, mood and eating disorders. Women with substance use and mental health disorders are apt to have PTSD; co-occurring disorders are strongly associated with poor psychosocial functioning, poorer treatment outcomes and higher drop-out rates. Women with co-occurring disorders would benefit most from drug rehab centers that provide dual diagnosis treatment. The existence of co-occurring disorders may interfere with the woman’s ability to reunite with her family if she has multiple needs, such as the need for vocational and housing assistance. To retain women in treatment, case managers would need to provide appropriate referrals to optimize the best possible outcome for women and their families.

Success of Gender-Based Addiction Treatment Programs

Studies about the effectiveness of gender-based programs have mixed results, suggesting that mixed-gender treatment is just as effective as gender-specific treatment, but subgroups of men and women who have suffered post-traumatic stress disorder (PTSD) seem to benefit more from gender-responsive treatment programs that address gender-specific factors. For example, women with PTSD who have suffered sexual assault, domestic violence or other trauma would fare better in women-only groups, and men who have PTSD from combat trauma would fare better in men-only groups. Certain women would not seek addiction treatment if gender-specific programs were not available.

References

1 Greenfield, S. F., & Grella, C. E. (2009). What is “women-focused” treatment for substance use disorders?. Psychiatric services (Washington, D.C.), 60(7), 880-2.

2 Lewis, B., Hoffman, L. A., & Nixon, S. J. (2014). Sex differences in drug use among polysubstance users. Drug and alcohol dependence, 145, 127-33.

3 Ramôa CP, Doyle SE, Naim DW, et al. Estradiol as a mechanism for sex differences in the development of an addicted phenotype following extended access cocaine self administration. Neuropsychopharmacology. 2013;38(9):1698–705.

4 Fox HC, Sinha R. Sex differences in drug-related stress-system changes: implications for treatment in substance-abusing women. Harv Rev Psychiatry. 2009;17(2):103–19.

5 van Etten ML, Anthony JC. Male– female differences in transitions from first drug opportunity to first use: Searching for subgroup variation by age, race, region, and urban status. Journal of Women’s Health & Gender-Based Medicine. 2001;10(8):797–804.

6 Substance Abuse and Mental Health Services Administration. Results from the 2003 National Survey on Drug Use and Health: National Findings. Rockville, MD: 2004. (Office of Applied Studies, NSDUH Series: H-25, HHS Publication No. SMA 04-3964)

7 Brecht ML, O’Brien A, Mayrhauser CV, Anglin MD. Methamphetamine use behaviors and gender differences. Addictive Behaviors. 2004;29(1):89–106.

8 Center for Substance Abuse Treatment. Substance Abuse Treatment: Addressing the Specific Needs of Women. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2009. (Treatment Improvement Protocol (TIP) Series, No. 51.) Chapter 2: Patterns of Use: From Initiation to Treatment. Available from: https://www.ncbi.nlm.nih.gov/

9 Substance Abuse and Mental Health Services Administration. Results from the 2003 National Survey on Drug Use and Health: National Findings. Rockville, MD: 2004. (Office of Applied Studies, NSDUH Series: H-25, HHS Publication No. SMA 04-3964)

10 Hughes TL, Wilsnack SC. Use of alcohol among lesbians: Research and clinical implications. American Journal of Orthopsychiatry. 1997;67(1):20–36

11 Cochran SD, Ackerman D, Mays VM, Ross MW. Prevalence of non-medical drug use and dependence among homosexually active men and women in the US population. Addiction. 2004;99(8):989–998.

12 Najavits LM, Weiss RD, Shaw SR. The link between substance abuse and posttraumatic stress disorder in women: A research review. American Journal on Addictions. 1997;6(4):273–283.

13 Center for Substance Abuse Treatment. Substance Abuse Treatment: Addressing the Specific Needs of Women. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2009. (Treatment Improvement Protocol (TIP) Series, No. 51.) Chapter 7: Substance Abuse Treatment for Women.Available from: https://www.ncbi.nlm.nih.gov/books/

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