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Women in Substance Abuse Treatment: Results from the Alcohol and Drug Services Study (ADSS)
Abstract
Acknowledgments This report was prepared by the Office of Applied Studies (OAS), Substance Abuse and Mental Health Services Administration (SAMHSA), RTI International (a trade nameof Research Triangle Institute) of Research Triangle Park, North Carolina, and Synectics for Management Decisions, Inc., of Arlington, Virginia, under Contract No. 283-99-9018. At SAMHSA, Thomas M. Brady co-edited the report, and Theodora Fine, Sharon Amatetti, Peter Delany, and Al Woodward provided review comments. At RTI, Olivia Silber Ashley was co-editor, and Mary Ellen Marsden was senior advisor. B. Kathleen Jordan, Kara Riehman, and Wendee M. Wechsberg provided review comments. Also at RTI, Molly Aldridge, Catherine Aspden, Kyung-Hee Bae, Michael Bradshaw, Jessica Cance, Larry Crum, Jennie L. Harris, Mindy Herman-Stahl, Amy Hernandez, Jennifer J. Kasten, Kellie M. Loomis, Alex Orr, Barry Weaver, Nathan West, and Megan Williams provided research or writing assistance; Diane G. Caudill produced the graphics; Catherine A. Boykin and Loraine G.Monroe assisted with the tables; Joyce Clay-Brooks, Linda Fonville, and Judith Cannada provided document preparation support; Teresa F. Gurley and Pamela Couch Prevatt readied files for the SAMHSA printer and Web site; and D.J. Bost, Richard S. Straw, K. Scott Chestnut, Jason Guder, and Jeff Novey copyedited and proofread the report. At Synectics, Sameena Salvucci, Leigh A. Henderson, Alisa Male, Albert Parker, and Lev S. Sverdlov provided statistical, research, and writing support. Final report production was provided by Beatrice Rouse, Coleen Sanderson, and Jane Feldmann at SAMHSA. Public Domain Notice All material appearing in this report is in the public domain and may be reproduced or copied without permission from SAMHSA. However, this publication may notbe reproduced or distributed for a fee without the specific, written authorization of the Office of Communications, SAMHSA, U.S. Department of Health and Human Services (DHHS). Citation of the source is appreciated. Suggested citation: Brady, T. M., & Ashley, O. S. (Eds.). (2005). Women in substance abuse treatment: Results from the Alcohol and Drug Services Study (ADSS)(DHHS Publication No. SMA 04-3968, Analytic Series A-26). Rockville, MD: Substance Abuse and Mental Health Services Administration, Office of Applied Studies. Disclaimer
... The self-identification of problematic use was complicated for participants in the study by feelings of shame and the fear of experiencing discrimination. Women who use drugs may be more susceptible to feeling stigmatised than men [28], and are reported to be more likely to experience stigma as a barrier to treatment [29]. Countering stigma is a key competency for professionals working with this group [30]. ...
... Countering stigma is a key competency for professionals working with this group [30]. Green (2006) found that women were most likely to seek help for substance use in primary healthcare and mental healthcare [28], highlighting the need for effective engagement for both AOD and non-AOD services. It also suggests a role for specialist treatment programs for methamphetamine use disorder to work with and upskill healthcare professionals in non-specialist AOD and other healthcare settings. ...
... Now that I'm over it and I've realised what I've been through I can talk and express it. " (Participant 2, age[25][26][27][28][29][30] SDS 11). when seeking help, participants emphasised the challenge in communicating their distress to healthcare workers."No ...
Background
Australia has a high prevalence of regular use of methamphetamine. While half of people who use methamphetamine regularly are women, they make up only one third of people seeking treatment for methamphetamine use disorder. There is a lack of qualitative research into the facilitators and barriers to treatment for women who use methamphetamine regularly. The study seeks a better understanding of the experiences and treatment preferences of women who use methamphetamine, to inform person-centred changes in practice and policy that break down barriers to treatment.
Methods
We conducted semi-structured interviews with 11 women who frequently use methamphetamine (at least once a week), and who are not engaged in treatment. Women were recruited from health services surrounding a stimulant treatment centre at an inner-city hospital. Participants were asked about their methapmhetamine use and health service needs and preferences. Thematic analysis was completed using Nvivo® software.
Results
Three themes were developed from participants’ responses around experiences of regular methamphetamine use and treatment needs: 1. Resistance of stigmatised identity including dependence; 2. Interpersonal violence; 3. Institutionalised stigma. A fourth set of themes on service delivery preferences were also elicited, including continuity of care, integrated health care, and provision of non-judgmental services.
Conclusion
Gender-inclusive health care services for people who use methamphetamine should actively work to address stigma, support a relational approach to assessment and treatment, and seek to provide structurally competent health care that is trauma and violence informed, and integrated with other services. Findings may also have application for substance use disorders other than methamphetamine.
... Research has recently suggested that women face unique structural (e.g., limited access to educational, employment and childcare opportunities) and psychosocial barriers (e.g., disempowered and violent interpersonal relationships, history of victimization, self-esteem and self-efficacy issues) that may hinder their attempts at substance abuse (SA) treatment engagement and completion (Brady & Ashley, 2005;Greenfield & Grella, 2009;Sun, 2007). Furthermore, research also indicates that these gender-specific structural and psychosocial issues may be deeply intertwined with women's pathways into SA, and may play a pivotal role in long-term, post treatment abstinence success (Grella & Greenwell, 2007;Uziel-Miller, Lyons, Kissiel, & Love, 1998). ...
... Since all of our participants were newer to an abstinent lifestyle, and living in what could be considered as potentially stressful, confusing, and frustrating drug-free environments, they may have been especially (1) motivated to seek information about their progress in relationship to others, as well as especially (2) affected by these automatic social comparisons after they had been conducted. In addition, the tendency to engage in this maladaptive behavior may be increased as women newer to SA recovery often report social support and emotional regulatory skill deficits linked to their substance abusing pasts (Berking et al., 2011;Blume & Marlatt, 2009;Brady & Ashley, 2005;Breslin et al., 2010). ...
... However, we suggest that women may continue to need assistance in understanding the power of SCs and how they are influenced by relationships with others. Disappointingly, research has illustrated that a large proportion of disadvantaged minority clients do not continue outpatient SA treatment regimens because they are unable to pay for services (Brady & Ashley, 2005). We suggest that psychosocial training could be one possible bastion against relapse, where women may learn to identify potentially dangerous patterns in their own thinking about themselves and their relationships with others, and to realize how these thoughts could endanger their own recovery. ...
The Relational Theory of Addiction hypothesizes that women’s substance abuse SUD development and (SA) recovery experiences differ from men’s because of women’s tendency to form nested self-concepts and increased relative desire for close interpersonal connections. We suggest that these two differences may have a dynamic and complex influence on recovery success, particularly for women living in group sober homes. This project uses Relational and Social Cognitive Theories as theoretical springboards to investigate the link between Tendency to Engage in Automatic Negatively Affected Social Comparisons (TEANSAC) and Sober Housemate Harmony (SHH) on women’s individual perceptions of Abstinence Specific Self-Efficacy (ASSE). We administered short surveys to women (N = 25) that had recently left inpatient SA treatment and were currently living in a group sober home to assess TEANSAC, SHH and ASSE. Results illustrated that higher TEANSAC scores predicted lower ASSE scores. However, SHH did not predict ASSE scores. Finally, an interaction effect was found in which SHH moderated the relationship between TEANSAC and ASSE. Specifically, we found that highly harmonious sober homes may buffer against the negative effects of increased TEANSAC scores. This project suggests that social cognitive and interpersonal variables may be important factors to consider for women’s long-term recovery success.
... Gender differences are not just documented in prevalence rates; several studies report differences in alcohol's biological and pharmacological effects in men and women (Lancaster, 1994;Thomason, 2002;Wasilow-Mueller and Erickson, 2001;Brady and Ashley, 2005;Nolen-Hoeksema, 2006). Alcohol-related mortality rates are higher for women (Jarque-Lopez et al., 2001, van de Walde et al., 2002, Guitart et al., 2015, while physical effects and health consequences are experienced more rapidly (van de Walde et al., 2002;Mann et al., 2005) and severely (Ceylan-Isik, McBride and Ren, 2010). ...
... Generally, women tend to develop drinking problems as a result of stress or trauma (Allan and Cooke, 1985). Sexual and/or physical abuse, whether in childhood or from a spouse, are widely reported precursors of alcohol dependence in women (Duncan, Walz and Yep, 2005;Kruk and Sandberg, 2013), as this population group often uses alcohol as a way to self-medicate the emotional trauma of sexual assault, abuse and violent attacks (; Brienza and Stein, 2002;Miranda et al., 2002;Brady and Ashley, 2005;Covington, 2008). ...
... Compared to men, women face significant barriers to treatment that might differ from men, such as childcare, experiences of victimization and domestic violence, financial difficulties, trauma, unemployment, and risks of losing child custody (Greenfield et al., 2010;Krentzman et al., 2012). Limited research in substance use treatment indicates that addressing differential needs and offering gender-specific services, such as incorporating childcare, can improve outcomes (Brady and Ashley, 2005). The examination of these factors, as well as gender differences in recovery from alcohol dependence, specifically have received less attention (McCaul et al., 2019). ...
Women's heavy drinking is often rooted in trauma and histories of abuse, while socio-cultural factors affect both the initiation of use as well as pathways to recovery. Research has largely focused on the epidemiology of alcohol use, and considerably fewer studies have examined the elements that facilitate recovery and the socio-cultural specificities that affect women's lives. To address this gap, we conducted a qualitative meta-synthesis in which we employed a holistic approach to exploring women's pathways into alcohol dependence and towards recovery. Twenty-three qualitative studies from 1998 to 2018 were identified from relevant databases and synthesized to delineate the mechanisms that led to dependence and how these affected recovery processes. Results highlight the complex interplay between adverse childhood experiences, sense of 'self', and wider dynamics of power. Alcohol was initially used as a corrective agent and as a tool of temporary empowerment, regulating structural and familial imbalances. However, drinking became progressively compulsive and overpowered every aspect of life. Initiation of recovery was often hindered by shame and stigma and facilitated by belonging to and being accepted by recovery groups and a revision of 'the self' within wider social structures. Implications for treatment, policy, and practice are discussed.
... In contrast, there was a lack of close connections with physician-based services, highlighting a potential target for future quality improvement initiatives in this sector. The funders had no role in study design, data collection recommended that substance use services for women attend to their unique needs and contexts, and reduce barriers that make it difficult for women to participate in substance use services (e.g., lack of childcare, fear of loss of child custody, limited services for pregnant women, provider stigma) [3][4][5][6][7][8][9][10][11]. Integrated treatment programs have been developed that cater to women who are pregnant or parenting, using case management and service partnerships to overcome the traditional fragmentation of service sectors and offer a comprehensive array of health and social services. ...
... At a conceptual level, integrated treatment programs are guided by a set of core principles and practices, including: care that is holistic, empowering, and tailored to women's needs; strong investment in staff and organizational health; innovative and coordinated partnerships; and supportive policies from multiple service sectors [18]. Specific service complements vary but commonly include specialized substance use services, maternal and child mental health care, pre-natal and primary care, child protection services, parenting programs, child-minding, and supports for social determinants of health (e.g., housing, income supports, transportation assistance) [3,11,16,19]. Programs typically rely on strong collaborative arrangements for service delivery, sometimes with services co-located under a single roof (i.e., a one-stop shop model), with others relying to a greater or lesser extent on formal and informal partnerships with agencies in their communities (i.e., distributed service model). The key idea across service models is that by working together through cross-sectoral and collaborative networks, service providers are better able to meet the complex needs of women and their children [3,20]. ...
... Programs typically rely on strong collaborative arrangements for service delivery, sometimes with services co-located under a single roof (i.e., a one-stop shop model), with others relying to a greater or lesser extent on formal and informal partnerships with agencies in their communities (i.e., distributed service model). The key idea across service models is that by working together through cross-sectoral and collaborative networks, service providers are better able to meet the complex needs of women and their children [3,20]. ...
Integrated treatment programs for pregnant and parenting women who use substances operate at the intersection of multiple service systems, including specialized substance use services, the broader health system, child protection, and social services. Our objectives were to describe the composition and structure of community care networks surrounding integrated treatment programs in selected communities in Ontario, Canada. We used a two-stage snowball method to collect network data from 5 purposively selected integrated treatment programs in communities in Ontario. Front-line staff with integrated treatment programs identified their top 5 service partners, who were then contacted and asked to provide the same information (n = 30). We used social network analysis to measure the cohesiveness, reciprocity, and betweenness centrality in the integrated treatment program’s ego network. We described network composition in terms of representation of different service types. Across communities, common service partners were child protection, substance use or mental health services, parenting and child support, and other social services. Primary and pre-natal care, opioid agonist therapy, and legal services were rarely named as partners. Networks varied in network cohesiveness, as indicated by connectivity between the service partners and reciprocal ties to the integrated treatment programs. Integrated treatment programs commonly brokered the connections between other service partners. Findings suggest that these integrated treatment programs have achieved a level of success in developing cross-sectoral partnerships, with child protection services, parenting and child support, and social services featuring prominently in the networks. In contrast, there was a lack of close connections with physician-based services, highlighting a potential target for future quality improvement initiatives in this sector.
... Consequently, the children of individuals with an SUD are more likely to have a lower socioeconomic status, experience problems in academic and social development, and are more likely to use illicit substances in adolescence [1,3,4]. Despite these impacts, access to treatment options for SUDs remains challenging for parents and particularly for mothers [5,6]. ...
... Historical data indicate that men may be more likely to seek treatment for an SUD than women, and ongoing efforts have stressed the need for dedicated treatment for women [6,7]. The U.S. Department of Health and Human Services, Office of Women's Health recommends that treatment programs work to eliminate gender disparities in substance use treatment and research, but few programs offer services tailored to the specific needs of women [8,9]. ...
In the U.S., 12.3% of children live with at least one parent who has a substance use disorder. Prior research has shown that men are more likely to seek treatment than women and that the barriers are different; however, there is limited research focusing specifically on opioid use disorder (OUD). We sought to understand the barriers and motivators for parents with OUD. We conducted a qualitative study by interviewing parents with OUD who were part of an outpatient treatment program. Interviews followed a semi-structured format with questions on access to and motivation for treatment. The interviews were recorded and transcribed using OpenAI software. Transcripts were coded by two separate reviewers and then analyzed for themes using Atlas.ti. We interviewed 14 individuals; 3 were men, and 3 of the women identified as LGBTQ+. The participants ranged in age from 27 to 54 years old. All participants had a least one child. Gender differences existed. Mothers reported experiencing more barriers—notably, a lack of childcare, shame, and guilt—while fathers reported higher levels of support from family. Both mothers and fathers identified their children as a motivation for recovery, albeit in differing ways. Mothers and fathers with OUD experience different barriers to treatment and also rely on different resources. Prior efforts to increase access to treatment for parents have focused on physical barriers; however, our research supports the need for expanded treatment services for families and efforts to address the stigma of substance abuse disorder, but more efforts are also needed to address stigma.
... While women use health services more frequently than men in general [15], women may face distinct barriers to receiving treatment for SUDs [16][17][18][19][20][21][22] and specific subgroups of women may be less likely to receive treatment than men [23]. For example, stigma has been found to specifically deter pregnant women and women with children from seeking treatment for substance use [24][25][26], but whether stigma or other factors resulted in less likelihood of treatment services use among women with SUDs than men with SUDs remains poorly studied [27]. ...
... The absence of gender differences in the proportions of the population who received SUD treatment stands in contrast to the well documented findings that women generally are more likely to use health services than men [15], and specifically more likely to use mental health services [36,37]. As noted earlier, previous studies suggest that women may face distinct barriers to receiving treatment for SUDs, including a need for child care and specific concerns about stigma [16][17][18][19][20][21][22]. It is possible that these barriers equalize likelihood of substance abuse treatment between women and men, perhaps suppressing the more commonly observed finding that women are more likely to seek and receive diverse health services than men. ...
In spite of evidence of increasing prevalence of substance use disorders (SUDs) among women, there is little information on gender differences in SUD treatment use. Nationally representative survey data were used to compare specialized SUD treatment among women and men with past-year DSM-5 SUD diagnoses (N = 5,789, 42.8% women). An estimated 10.7% of women and 9.9% of men (p = 0.45) received SUD treatment. Those who received treatment among both men and women had more problems than others. Five variables were independently associated with receipt of past-year treatment in both women and men and while five others were independently associated with receipt of treatment for only one gender. Interaction analysis, however, revealed no statistically significant gender differences in any correlate of treatment receipt. Although men were more likely to have SUDs than women, there were no significant differences by gender in rates or correlates of service use.
... Women who misuse alcohol, face multiple barriers to seeking treatment, which impact on their help-seeking behaviour (Brady and Ashley, 2005). Research suggests that, obstacles affecting more women than men include physical ill-health; psychosocial, financial, sociocultural and socio-structural issues (Schober and Annis, 1996;Boffetta and Hashibe, 2006); histories of sexual, physical and/or psychological abuse (Angove and Fothergill, 2003) and/ or childhood trauma (Small et al., 2010;Magnusson et al., 2011). ...
... A study by Neale et al. (2018) identified poor relationships between female residents in women-only settings such as hostels and prisons and questioned whether same gender services can be effective. However, Brady and Ashley (2005) stress that women do have different treatment needs, they argue it is necessary to offer women specific provision and set out recommendations for women-only substance misuse services. ...
Purpose
It is well established that women face multiple barriers accessing treatment for problematic and unhealthy alcohol use, but less is known about how their interconnected problems affect how they seek help from, and access, alcohol-treatment services. This study aims to explore the dynamic nature of women’s help-seeking for problematic and unhealthy alcohol use and how this can be compounded by unsuitable treatment services, especially when women present with complex needs.
Design/methodology/approach
Thirteen semi-structured interviews with women who had accessed alcohol-support services were conducted, audio-recorded, transcribed and analysed thematically using the complexity theory.
Findings
For women with complex needs, the process of seeking help may trigger unpredictable behaviours, health or social problems and intermittent serial access to treatment. Current services do not always address women’s holistic needs. Unless services focus on addressing interconnected problems – including historic trauma – they may compound the complexity of women’s problems. Complexity theory offers novel insights into this process, a concept not applied to problematic and unhealthy alcohol use treatment previously.
Research limitations/implications
Services should adopt the complexity-focused perspective featured in this study. While the authors acknowledge the increase in gender-responsive provision, the limitations of this study include a small sample size, the self-selecting nature of the sample and retrospective reporting. Participants were recruited and selected by service staff resulting in gatekeeping and possible sampling bias.
Practical implications
Services should adopt non-linear approaches to treatment. Implementing complexity approaches to treating women’s problematic and unhealthy alcohol use should capture the dynamics, complexity and non-linear nature of women’s help-seeking journeys as well as their internal and external responses that may result in relapse. The authors recommend complexity-focused, multiple-component and integrated collaborative strategies to address not only addiction but also all components of women’s needs, including past trauma.
Originality/value
Applying complexity-thinking to help-seeking experiences for alcohol treatment and recovery services is novel and proved useful in understanding the variety of women’s experiences and how these interact with their help-seeking behaviours, including treatment environments.
... Women differ from men in their progression to dependence, medical consequence, comorbid mental health issues, history of abuse, trauma and violence and patterns of use [2,61]. They also face unique challenges in accessing and entering treatment programs, where women are under-represented [2,63]. These challenges include fear of losing custody of children, concerns over sexual harassment, child-care availability, perceived stigma, poverty and caring for a partner who also has substance dependence issues [63][64][65]. ...
... They also face unique challenges in accessing and entering treatment programs, where women are under-represented [2,63]. These challenges include fear of losing custody of children, concerns over sexual harassment, child-care availability, perceived stigma, poverty and caring for a partner who also has substance dependence issues [63][64][65]. This study shows that women with higher levels of polysubstance use have increased psychological distress before treatment compared to women using one substance type; however, importantly it shows that after 60 days of treatment there is little difference, thus highlighting the key role of treatment for women. ...
Introduction
Substance use is increasingly prevalent among women. Little research examines subgroups of women with substance use issues to identify their characteristics and thus enable treatment recommendations. The present study used latent class analysis to identify subgroups of substance use among women in substance-use treatment based on use in the 30 days prior to intake and examined changes in mental health and treatment outcomes following 60 days of treatment.
Methods
Participants were women (N = 493) attending specialist non-government substance use treatment services in New South Wales, Australia.
Results
Four distinct classes of substance users were identified: (i) Amphetamine Type Stimulants (ATS) Polysubstance (40.6%, n = 200); (ii) Alcohol Only (33.1%, n = 163); (iii) Cannabis and Alcohol (17.0%, n = 84) and (iv) Other Polysubstance (9.3%, n = 46). Women in the ATS Polysubstance class were the youngest and those in the Alcohol Only class were the oldest.
Discussion and Conclusions
Findings show that classes with high polysubstance use (ATS Polysubstance) differed from the single-substance use class (Alcohol Only). The ATS Polysubstance class had significantly greater improvements in health outcomes after 60 days compared to the Alcohol Only class. These findings suggest that although women with polysubstance use can benefit from substance use treatment, younger women (ATS Polysubstance) may benefit even more than older women (Alcohol Only). Future research should utilise a longitudinal design and examine additional psychosocial characteristics to extend on current findings.
... For caregivers of dependent children, childcare responsibilities can make accessing treatment especially hard (Allen, 1995;Copeland, 1997;Grant, 1997). SUD treatment remains limited despite increased efforts to improve the availability of treatment programs to meet the needs of caregivers with children (Brady & Ashley, 2005;Brendel & Solier, 2009). An estimated 21% of residential treatment facilities have dedicated programming for pregnant women and J o u r n a l P r e -p r o o f 15% provide childcare (Brady & Ashley, 2005).Even when SUD services provide child care, it is unlikely that treatment focusing on the intersection of parenting substance misuse and the children's needs will occur (Hanson et. ...
... SUD treatment remains limited despite increased efforts to improve the availability of treatment programs to meet the needs of caregivers with children (Brady & Ashley, 2005;Brendel & Solier, 2009). An estimated 21% of residential treatment facilities have dedicated programming for pregnant women and J o u r n a l P r e -p r o o f 15% provide childcare (Brady & Ashley, 2005).Even when SUD services provide child care, it is unlikely that treatment focusing on the intersection of parenting substance misuse and the children's needs will occur (Hanson et. al., 2015;Bosk et. ...
Complex trauma is a significant public health problem in the United States (U.S.), occurring in families with chronic and compounding exposures to traumatic stressors like substance misuse, intimate partner violence (IPV) and child maltreatment (Cook et al., 2017). Yet, few programs exist to treat their intersection, challenging our ability to respond effectively and restore positive trajectories for children and families. In this context, there is a need for innovative approaches to treat these intersecting phenomena. In this conceptual paper, we identify three innovative programs that offer integrative approaches to these intersecting challenges. We analyze common elements among these programs, offering a theoretical foundation for fundamental elements of transformative services. Finally, we consider how the Families First Prevention Act could be leveraged for states to adopt and implement these programs. The goal of this conceptual paper is to advance empirical and practical discussions regarding programmatic and policy options for more effectively responding to substance misuse, and IPV in families, and the associated traumas incurred by maltreated children and their caregivers.
... In a study using data from 461 participants in the Women, Co-occurring Disorders, and Violence Study, findings indicated that women who reported being mandated remained in residential treatment longer and had a lower risk of treatment dropout (35%) compared to those who were nonmandated [25]. A large study investigating the treatment outcomes of women in the Alcohol and Drug Services Study, reflecting 2395 SUD treatment facilities (residential and outpatient), found that treatment completion was higher among women referred by the CJ system [26]. Further, in a recent systematic review evaluating 154 independent drug court evaluations [13], findings indicated lower rates of recidivism among drug court participants relative to nonparticipants (decrease of 12 percentage points), which included drug-related criminal activity and drug use. ...
... Prior work has suggested that individuals with SUDs and psychiatric comorbidities may have more difficulty integrating and fully participating in SUD treatment programs [46,47]. This is exacerbated when women who enter into residential SUD treatment are challenged with more severe mental health conditions, overloading treatment retention and completion efforts [18,26,48]. A greater comprehension of this complex interplay of treatment integration and engagement among women with co-occurring disorders and SUD treatment retention may inform improved design of tailored services for this vulnerable subgroup of women. ...
Background:
Court-mandated substance use disorder (SUD) treatment, as compared to nonmandated treatment, has been associated with increased retention and completion. However, whether child protective services (CPS)-mandated women's residential SUD treatment leads to improved treatment retention in comparison to criminal justice (CJ)-mandated and nonmandated treatment remains unclear.
Purpose:
This study compared the number of days retained in residential SUD treatment among three referral sources (CPS, CJ, and nonmandated), while also examining whether having a co-occurring mental health disorder or increased stress, depression, anxiety, and PTSD symptomology contributed to decreased retention. This study tested the hypothesis that women mandated by the CPS and CJ systems would have improved residential SUD treatment retention compared with nonmandated women.
Methods:
Multiple regression analyses were conducted on data for a diverse sample of 245 women (Hispanic: N = 141, Black: N = 50, White: N = 50) mandated or nonmandated (CJ: N = 114, CPS: N = 82, nonmandated: N = 49) into residential SUD treatment to determine each group's treatment retention outcomes.
Results:
Women mandated to SUD residential treatment by the CPS system remained in treatment significantly longer (p = .046), compared to women not mandated, representing a 34.4% increase in retention. Findings further revealed a corresponding 2.3% decrease in retention (p = .048) for each one-unit increase in a patient's stress score, whereas those with a co-occurring mental health diagnosis had a 43.6% decrease in SUD treatment retention (p < .001).
Conclusions:
Policy and clinical considerations include (a) increasing case management support and wraparound services that meet the multiple service needs of women who are nonmandated to residential SUD treatment, and (b) incorporating a more nuanced treatment approach that manages mental health disorders and stress symptomology early in treatment when women are most vulnerable to relapse and treatment dropout.
Trial registration:
ClinicalTrials.gov Identifier: NCT02977988 (first posted November 30, 2016; last update posted October 7, 2019); U.S. NIH Grant/Contract: 5R01DA038648 .
... In a study using data from 461 participants in the Women, Co-occurring Disorders, and Violence Study, ndings indicated that women who reported being mandated remained in residential treatment longer and had a lower risk of treatment dropout (35%) compared to those who were nonmandated [25]. A large study investigating the treatment outcomes of women in the Alcohol and Drug Services Study, re ecting 2,395 SUD treatment facilities (residential and outpatient), found that treatment completion was higher among women referred by the CJ system [26]. ...
... Prior work has suggested that individuals with SUDs and psychiatric comorbidities may have more di culty integrating and fully participating in SUD treatment programs [46,47]. This is exacerbated when women who enter into residential SUD treatment are challenged with more severe mental health conditions, overloading treatment retention and completion efforts [18,26,48]. A greater comprehension of this complex interplay of treatment integration and engagement among women with co-occurring disorders and SUD treatment retention may inform improved design of tailored services for this vulnerable subgroup of women. ...
Background: Court-mandated substance use disorder (SUD) treatment, as compared to nonmandated treatment, has been associated with increased retention and completion. However, whether child protective services (CPS)-mandated women’s residential SUD treatment leads to improved treatment retention in comparison to criminal justice (CJ)-mandated and nonmandated treatment remains unclear.
Purpose: This study compared the number of days retained in residential SUD treatment among three referral sources (CPS, CJ, and nonmandated), while also examining whether having a co-occurring mental health disorder or increased stress, depression, anxiety, and PTSD symptomology contributed to decreased retention. This study tested the hypothesis that women mandated by the CPS and CJ systems would have improved residential SUD treatment retention compared with nonmandated women.
Methods: Multiple regression analyses were conducted on data for a diverse sample of 245 women (Hispanic: N = 141, Black: N = 50, White: N = 50) mandated or nonmandated (CJ: N = 114, CPS: N = 82, nonmandated: N = 49) into residential SUD treatment to determine each group’s treatment retention outcomes.
Results: Women mandated to SUD residential treatment by the CPS system remained in treatment significantly longer ( p = .046), compared to women not mandated, representing a 34.4% increase in retention. Findings further revealed a corresponding 2.3% decrease in retention ( p = .048) for each one-unit increase in a patient’s stress score, whereas those with a co-occurring mental health diagnosis had a 43.6% decrease in SUD treatment retention ( p < .001).
Conclusions: Policy and clinical considerations include (a) increasing case management support and wraparound services that meet the multiple service needs of women who are nonmandated to residential SUD treatment, and (b) incorporating a more nuanced treatment approach that manages mental health disorders and stress symptomology early in treatment when women are most vulnerable to relapse and treatment dropout. ClinicalTrials.gov Identifier: NCT02977988 (first posted November 30, 2016; last update posted October 7, 2019); U.S. NIH Grant/Contract: 5R01DA038648
... Women face gender-specific obstacles that compound the already existing barriers to accessing and attaining addiction treatment [42,80]. Women often are cast into specific roles that carry restrictive social and cultural expectations, which makes it more difficult for them to acknowledge their addiction and seek help [16,42,43]. The punitive approach to addiction is especially pronounced for pregnant or parenting women with SUDs; they are derided as unfit mothers and can face imprisonment on charges of child abuse or neglect and risk losing custody of their children if they admit to using 7 Stigma and Addiction Treatment ...
... Most do not receive these medications despite evidence that they are safe and effective and despite the risks to the fetus of long-term exposure to addictive drugs or to the stressors associated with unmanaged detoxification and withdrawal [49,88]. Practical considerations that typically affect women more than men, such as lack of childcare services, are additional obstacles for women who might require long-term treatment [16]. And although the causes, manifestations, course, and consequences of addiction in women differ in many respects from men (e.g., prevalence of cooccurring disorders, history of trauma), most treatment programs do not adequately take into account these gender differences [41,89]. ...
The history of stigma around addiction and its treatment is long and pervasive. Stigma permeates the public’s perceptions of people with substance use disorders, the self-perceptions of those who have the disease, and the way in which it is addressed on a structural level. Instead of offering evidence-based clinical treatments within a medical setting, addiction typically is addressed outside mainstream health care by providers who are not trained to offer the comprehensive clinical care needed by those who have this complex, chronic condition. Even worse, because of stigma, addiction frequently is criminalized and those who have it often are penalized and denied effective treatment. Stigma even surrounds treatment itself, especially medication-based treatment, which is offered to only a fraction of the people who need it and only under the weight of onerous regulations and restrictions, despite the mounds of scientific evidence attesting to its safety and effectiveness. As drug overdose deaths continue to climb, we cannot afford to wait until stigma is eradicated through widespread public acceptance to treat addiction as a disease. The government, the health care system, the criminal justice system, and employers—the systems in power—must override stigma’s influence by ensuring that addiction is addressed with compassion, by trained health care professionals, using proven clinical treatments. As addiction begins to be viewed as the treatable disease that it is, stigma will recede and we will more effectively be able to contain our nation’s addiction crisis.
... How ever, despite the existence of effective, evidence-based SUD treatments, many woman face access barriers. 2 In addition to individual-level barriers such as treatment preferences, resource limitations, physiological factors, logistical challenges, and competing responsibilities (e.g., work and family), 3,4 barriers to accessing SUD treatment exist at health care system and provider lev els. 5 Identifying and mitigating barriers to SUD treat ment is an emerging women's health services research priority. Previous studies have specifically enumerated the need for women's health services research to develop methods for reducing barriers for women seeking SUD treatment in outpatient settings. ...
... It is well es tablished that women are more likely than men to face challenges in attending regular treatment sessions be cause of family responsibilities. 2,26 In addition, women Veterans face many logistical barriers when seeking VA treatment. 3,15,27,28 Although previous studies of logisti cal barriers have not focused on access to SUD care, our findings extend this work to show that these barriers also have an impact on access to SUD treatment. ...
Introduction: Substance use disorder (SUD) is damaging to women’s health and quality of life. Appropriate treatment can mitigate the effects and health consequences of SUD, yet many woman face access barriers to such treatment. This research seeks to bridge gaps in the current understanding of access to gender-aware care for women Veterans with SUD and to identify ideal treatment program elements for this population. Methods: We interviewed interdisciplinary providers in Los Angeles Veterans Health Administration facilities ( n = 17; psychiatrists, psychologists, social workers, primary care providers, and nurses) and Veterans ( n = 6), identified using purposive snowball sampling, to characterize key components of a non-residential patient-centred SUD treatment program for women Veterans. A semi-structured interview guide elicited current SUD treatment options for women Veterans, barriers to SUD services, and ideal SUD treatment program components. Mutually agreed-on themes were reached using constant comparison. Results: Analyses revealed five key elements of an ideal SUD treatment program for women Veterans: safety (safe and free from harassment in treatment), flexible scheduling (able to accommodate other work and life responsibilities), resourced (no limit to number of visits, staff able to meet needs of comorbidities, on-site child care, etc.), informed providers (providers with access to a comprehensive resource list and aware of easy referral options), and positive (supportive and not punitive). Discussion: The elements identified as necessary for an optimal outpatient SUD treatment program may guide future implementation efforts. SUD programs may not be viable options for women Veterans if they cannot accommodate multidimensional barriers of health care access.
... Some studies reported gender differences in the type, strength, and number of barriers to encounter in seeking treatment (Green, 2006). For example, Brady and Ashley (2005) noted that women were more likely than men to face economic, time, and transportation barriers. However, both males and females must Substance A buse T reatment Services U se: A n Examination... 5 overcome treatment seeking stigma. ...
... This observation is in line with Morgenstern and Bux's (2003) earlier research report that once women were identified as drug abusers, they were less likely than men to be referred for treatment by their employers or schools. Brady and Ashley (2005) explained further that women were m ore likely to face econom ic h ard sh ip s, as well as tim e and transportation barriers. However, both sexes have to deal w ith treatm ent seeking stigma, a factor that has been reported by the respondents in this study as one of the reasons for not seeking treatment. ...
This paper examined the predictive values of individual factors associated with use of substance abuse treatment services in the United States. Anderson and Newm an's (2005) framework fo r evaluating health services utilization was employed as an explanatory model. The data source was the 2012 National Survey on Drug Use and Health (NSDUH 2012). Respondents in the dataset who reported substance dependency problem (n = 6209) in the previous year of the survey were selected to constitute the study sample. The dependent variable was "currently receiving treatment" and the explanatory variables were gender, marital status, age, race, education, employment, income, and health insurance. A bivariate analysis reduced the explanatory variables to five: gender, marital status, age, race, and education, based on their statistically significant correlation with the dependent variable, currently receiving treatment. However, in a multivariate context, only gender, age, and race turned out to be significant predictors of treatment services use. The findings reinforce the importance of gender, age, and race as predisposing determinants of substance abuse services use. It is suggested that these determinants should be given attention in policy making decisions.
... In Green (2006), gender differences were found in substance use treatment outcomes, as women are more likely to face multiple barriers to accessing substance use treatment than men; this makes women fare better on treatment than men. Similarly, women are less likely than men to use illicit drugs and develop drug-related problems (Greenfield, Manwani, & Nargiso, 2003a) especially when they have family members, friends, and partners who use substance and support their use of their substance (Bendtsen, Dahlstrom, & Bjurulf, 2002;Wu &Ringwalt, 2004;Brady & Ashley 2005;Dawson, Grant & Stinson, 2005). In developing countries like Nigeria, availability and misuse of illicit substances among the youth (both male and female) have remained a serious social problem confronting societies (Fareo, 2012;Emmanuel, 2013;Yunusa, 2016). ...
Commercial drivers often engage in long and irregular working hours, and as such suffer back pain, fatigue, stress and thereafter use some psychoactive substance to cope with their job. Even though most studies on substance use have been on general population, limited information is available on the use of substance and roles of socio-demographic factors among commercial drivers. This study therefore examined the roles of socio-demographic factors (age, years of driving, gender and social support) in substance use among commercial drivers in Ibadan, Nigeria.The study employed a cross-sectional design and purposive sampling technique to recruit 250 commercial drivers. A structured questionnaire was used to gather information on socio-demographic information, social support and substance use from the participants. Data were analyzed using descriptive statistics, correlation, Analysis of Variance and Independent t-test analysis. Results showed that years of driving significantly have a positive correlation with substance use. However, duration and hours spent on the driving did not have a significant independent relationship with substance use. Younger participants significantly engage more in substance use than older individuals. Similarly, female participants significantly engage more in substance use than male drivers. Additionally, participants with high social support mostly engage in substance use than participants with low social support. The study concluded that years of driving, age, gender and social support network of the drivers significantly plays an influencing roles in substance usage among commercial drivers in Ibadan. The study recommends that, in the organized substance use and abuse preventive program for drivers, the consideration for drivers’ socio-demographics factors is quite imperative, especially as more females and younger individuals with more social support are getting more involved in substance use.
... In Green (2006), gender differences were found in substance use treatment outcomes, as women are more likely to face multiple barriers to accessing substance use treatment than men; this makes women fare better on treatment than men. Similarly, women are less likely than men to use illicit drugs and develop drug-related problems (Greenfield, Manwani, & Nargiso, 2003a) especially when they have family members, friends, and partners who use substance and support their use of their substance (Bendtsen, Dahlstrom, & Bjurulf, 2002;Wu &Ringwalt, 2004;Brady & Ashley 2005;Dawson, Grant & Stinson, 2005). In developing countries like Nigeria, availability and misuse of illicit substances among the youth (both male and female) have remained a serious social problem confronting societies (Fareo, 2012;Emmanuel, 2013;Yunusa, 2016). ...
This study employed a purposive sampling technique to examine the implementation of substance abuse policy in South Africa with the participation of East London citizens. The study applied a qualitative approach and paradigm that allowed for the description and exploration of the circumstances surrounding substance abuse as discussed by sixteen participants engaged in in-depth interviews and a focus group discussion. Demographically, the participants’ age ranged from 42 to 59 years with a mean of 50.1. The gender distribution was skewed with eleven male and five female participants. Among the participants were fourteen blacks and only two whites. The participants were recruited through a purposive sampling technique. The data were analysed manually through thematic analysis. Inter alia, the study revealed the limited success of substance abuse policies; poor intergovernmental policy implementation; a paucity of qualified human resources and politics and corruption serving as stumbling blocks to proper policy implementation. This study revealed a need to strengthen the monitoring and evaluation of substance abuse policies in South Africa.
... In Green (2006), gender differences were found in substance use treatment outcomes, as women are more likely to face multiple barriers to accessing substance use treatment than men; this makes women fare better on treatment than men. Similarly, women are less likely than men to use illicit drugs and develop drug-related problems (Greenfield, Manwani, & Nargiso, 2003a) especially when they have family members, friends, and partners who use substance and support their use of their substance (Bendtsen, Dahlstrom, & Bjurulf, 2002;Wu &Ringwalt, 2004;Brady & Ashley 2005;Dawson, Grant & Stinson, 2005). In developing countries like Nigeria, availability and misuse of illicit substances among the youth (both male and female) have remained a serious social problem confronting societies (Fareo, 2012;Emmanuel, 2013;Yunusa, 2016). ...
Much of the research concerning women’s alcohol use and misuse has focused on biomedical issues associated with female drinking. In contrast, little attention has been paid to the social dimensions of maternal drinking. Using the Symbolic interactionist’s paradigm, this paper interrogates the social and health consequences of drinking among women of reproductive age. Data were collected using a concurrent mixed research approach (quantitative and qualitative data) Three hundred and seventy-three (373) close-ended questionnaires were analysed, and in-depth interviews were conducted among 12 mothers randomly selected from different occupational backgrounds.
Findings reveal that heavy alcohol intake can cause divorce in marriages, loss of social respect, stigmatisation for the children, and loss of social bonds within the family. The researcher concluded that health and social issues relating to alcohol use can only be understood within the social and cultural context. However, the paper recommends
an all-encompassing approach which involves continuous sensitization of women (especially of reproductive age) on the dangers of maternal alcohol use and the need to implement policies to regulate the production, marketing, and consumption of alcohol.
... In Green (2006), gender differences were found in substance use treatment outcomes, as women are more likely to face multiple barriers to accessing substance use treatment than men; this makes women fare better on treatment than men. Similarly, women are less likely than men to use illicit drugs and develop drug-related problems (Greenfield, Manwani, & Nargiso, 2003a) especially when they have family members, friends, and partners who use substance and support their use of their substance (Bendtsen, Dahlstrom, & Bjurulf, 2002;Wu &Ringwalt, 2004;Brady & Ashley 2005;Dawson, Grant & Stinson, 2005). In developing countries like Nigeria, availability and misuse of illicit substances among the youth (both male and female) have remained a serious social problem confronting societies (Fareo, 2012;Emmanuel, 2013;Yunusa, 2016). ...
Media reports indicate that methamphetamine (mkpulummiri) use is growing among young people in Eastern Nigeria, but empirical research has not been conducted. This article reviews the recent media reportage of methamphetamine use in Eastern Nigeria, presents an empirical account of a methamphetamine user, and synthesizes the available evidence, showing the factors facilitating its use. Available evidence shows that drug trafficking and illegal laboratories are the two main factors encouraging current methamphetamine availability and use in Eastern Nigeria. The NDLEA has discovered illegal laboratories where methamphetamine is produced in Enugu and Asaba. These laboratories were established by drug barons from Eastern Nigeria and their foreign counterparts. Therefore, it is logical to conclude that these local laboratories have largely contributed to the growing methamphetamine epidemic. Media reports indicate that youth organizations and vigilante groups apply corporal punishment by flogging identified users in public but do not highlight how effective this sanction is. While empirical data show that weight control motivates methamphetamine use, the grey literature has blamed youth unemployment. There is an urgent need to conduct empirical research to determine methamphetamine prevalence, the sources, motivations for use, and consequences in Eastern Nigeria. This will facilitate the design of effective interventions to reduce the growing trend. Efforts to discover and dismantle illegal laboratories should not only focus on cities because laboratories set up to evade detection may exist in rural settings. It is vital that the government work with all stakeholders to increase public awareness of the dangers of methamphetamine use in Nigeria and develop mechanisms to support addiction treatment and rehabilitation to prevent social stigma users may face.
... Women and girls are more likely to face barriers to SUD screening and treatment services than men, including economic barriers, family responsibilities, and heightened stigma [26][27][28]. Additionally, sources of mandates to treatment differ for men and women, such that men may have more opportunities to receive treatment. ...
Background: Justice-involved children (JIC) have a high risk for illicit substance use (SU) and substance use disorders (SUD). Females are particularly vulnerable. It is critical that JIC who report current SU are referred for SUD screening to be provided with potentially life-saving treatment services. Florida law and Florida Department of Juvenile Justice (FLDJJ) policy mandate that JIC who report current SU be referred for SUD screening. Evidence suggests a racial referral gap among JIC who require SUD screening, and research on intersectionality suggests that these disparities may be exacerbated for minority females. Therefore, we hypothesize that Black and Latinx females will be less likely to be referred for SUD screening than White children despite reporting current substance use to FLDJJ.
Methods: Multivariate logistic regression was employed to analyze cross-sectional data from FLDJJ on 35,884 JIC who reported SU in the past six months. The main and interaction effects of race and gender on the likelihood of referral for SUD screening were tested. The control variables included substance type, age, household income, current SU problems, history of mental health problems, number of misdemeanors, and risk to recidivate.
Results: There were no significant differences in the likelihood of being referred for SUD screening between White females and White males. However, Black females (AOR= 0.48), Latinx females (AOR= 0.77), and Black males (AOR= 0.76) were significantly less likely to be referred than White males. Black females were half as likely to be referred as White males and females.
Conclusion: This study finds evidence that Black females in the juvenile justice system are significantly underserved. The justice community must leverage these findings to implement protocols that ensure equal services for all children and eliminate gender and racial disparities in SUD screening.
... [29][30][31] Furthermore, previous literature states that women have unique barriers to seeking treatment compared to men: 32 greater economic barriers and family responsibilities, stigma, and social disapproval. 33,34 This shows that there need to be sex-specific strategies when identifying those who need help with AUD. ...
Objective:
Alcohol use disorder (AUD) is a global burden but is also one of the most undertreated mental disorders. This study estimates the treatment rate (i.e., help-seeking status) of high-risk drinkers and factors associated with not receiving treatment in Korea using nationally representative National Health Insurance Service-National Sample Cohort (NHIS-NSC) data.
Methods:
Among 1,025,340 participants, we eliminated those under 20 and those who did not respond to the question regarding alcohol consumption. High-risk drinkers were classified based on their frequency and quantity of alcohol consumption (4 or more drinks for women, 5 or more drinks for men per day on average). In total, 32,225 high-risk drinkers were checked for an actual AUD diagnosis to see their treatment-seeking status.
Results:
Among 32,225 high-risk drinkers, only 1.24% had an AUD diagnosis, showing that over 98% of those who could be diagnosed with AUD are not seeking treatment. Factors associated with not seeking treatment were female sex, BMI higher or equal to 18.6, former smoker, middle-aged, and Charlson Comorbidity Index (CCI).
Conclusion:
Our data show that many high-risk drinkers do not seek treatment in Korea. Experts, policymakers, and clinicians should promote help-seeking behavior for AUD and pay close attention to those at risk of not receiving treatment for AUD.
... This growing literature offers some understanding of client and program factors that play a role in completing treatment [16,17]. Client factors related to differential outcomes by gender are age, race/ethnicity, pregnancy status, and mental health status or symptoms [9,10,18,19], whereas program factors that contribute to successful outcomes for women compared with men include treatment intensity [8,[19][20][21], retention in treatment [22][23][24], targeted services, and support for their roles as parents [25][26][27]. ...
Background
In the United States, the high dropout rate (75%) in opioid use disorder (OUD) treatment among women and racial/ethnic minorities calls for understanding factors that contribute to making progress in treatment. Whereas counseling and medication for OUD (MOUD, e.g. methadone, buprenorphine, naltrexone) is considered the gold standard of care in substance use disorder (SUD) treatment, many individuals with OUD receive either counseling or methadone-only services. This study evaluates gender disparities in treatment plan progress in methadone- compared to counseling-based programs in one of the largest SUD treatment systems in the United States.
Methods
Multi-year and multi-level (treatment program and client-level) data were analyzed using the Integrated Substance Abuse Treatment to Eliminate Disparities (iSATed) dataset collected in Los Angeles County, California. The sample consisted of 4 waves: 2011 (66 SUD programs, 1035 clients), 2013 (77 SUD programs, 3686 clients), 2015 (75 SUD programs, 4626 clients), and 2017 (69 SUD programs, 4106 clients). We conducted two multi-level negative binomial regressions, one per each outcome (1) making progress towards completing treatment plan, and (2) completing treatment plan. We included outpatient clients discharged on each of the years of the study (over 95% of all clients) and accounted for demographics, wave, homelessness and prior treatment episodes, as well as clients clustered within programs.
Results
We detected gender differences in two treatment outcomes (progress and completion) considering two outpatient program service types (MOUD-methadone vs. counseling). Clients who received methadone vs. counseling had lower odds of completing their treatment plan (OR = 0.366; 95% CI = 0.163, 0.821). Female clients receiving methadone had lower odds of both making progress (OR = 0.668; 95% CI = 0.481, 0.929) and completing their treatment plan (OR = 0.666; 95% CI = 0.485, 0.916) compared to male clients and receiving counseling. Latina clients had lower odds of completing their treatment plan (OR = 0.617; 95% CI = 0.408, 0.934) compared with non-Latina clients.
Conclusions
Clients receiving methadone, the most common and highly effective MOUD in reducing opioid use, were less likely to make progress towards or complete their treatment plan than those receiving counseling. Women, and in particular those identified as Latinas, were least likely to benefit from methadone-based programs. These findings have implications for health policy and program design that consider the need for comprehensive and culturally responsive services in methadone-based programs to improve outpatient treatment outcomes among women.
... Fewer studies have systematically investigated outcomes of mandated treatment in women. For example, reporting on characteristics and treatment outcomes among women in the Alcohol and Drug Services Study, encompassing a representative sample of 2395 SUD treatment facilities, Brady and Ashley (2005) reported that the odds of SUD treatment completion were higher in women (primarily White sample) referred by the CJ system. Another study based on data from 461 participants in the Women, Co-Occurring Disorders, and Violence Study found that women who were court mandated stayed in residential treatment longer and had a 35% lower risk of dropout compared to those not court mandated (Amaro et al., 2007). ...
Background
Court-mandated substance use disorder (SUD) treatment, compared to nonmandated treatment, has been associated with increased retention and completion. However, due to limitations of previous studies, whether child protective services (CPS) and criminal justice (CJ) mandated treatment improve treatment completion and retention among women in residential treatment remains unclear.
Purpose
This study investigated differences in treatment completion and progress based on three clinical discharge outcomes (i.e., completer, noncompleter with significant progress, and noncompleter without significant progress). We hypothesized that women mandated by (1) CJ will have a better treatment discharge outcome (i.e., treatment completer and noncompleter with satisfactory progress) compared to women who are CPS mandated; (2) CPS will have a better treatment discharge outcome (i.e., treatment completer and noncompleter with satisfactory progress) compared to nonmandated women.
Methods
Study staff conducted multinomial logistic regression analyses on data for a diverse sample of 161 women mandated or nonmandated (CJ: N = 71, CPS: N = 66, nonmandated: N = 24) into residential SUD treatment to determine each group’s clinically defined treatment discharge outcomes while controlling for covariates.
Results
Multinomial logistic regression analyses revealed that being mandated by the CJ system predicted being a treatment completer compared to those who were CPS mandated (RR = 9.88, p = .009). The study found no differences in discharge status of completer without satisfactory progress between those who were CPS mandated and those who were CJ mandated or nonmandated. For women mandated by the CPS system compared to nonmandated women, the risk of being a treatment completer relative to noncompleters with satisfactory progress was not significant (RR = 1.08, p = .897). Analyses showed that being mandated by the CJ system predicted an improved clinically defined discharge outcome of treatment completer compared to women who were nonmandated to treatment (RR = 10.74, p = .016). In several of the models, drug and alcohol craving was associated with increased odds of being a noncompleter of treatment without satisfactory progress
Conclusions
This study demonstrates that improved treatment completion and discharge status cannot be assumed based solely on being mandated by the CJ or CPS systems. As evidenced by variability in treatment discharge outcomes within and among referral groups, the paper suggests directions for future research.
... 19 Key principles in women's recovery include addressing any experiences of trauma, including incest and rape, fears of losing their children, and parenting challenges and efficacy. [20][21][22][23] Racial and Ethnic Minorities NIAAA 24 points out "certain ethnic and racial minorities as well as other underserved populations experience more negative consequences of illness and premature death than other groups," noting disparities affecting (1) Hispanics/Latinx, (2) Blacks, and (3) Native Americans. The life contexts of racial and ethnic minority individuals with AUD are likely to include more economic hardship, stress, systemic discrimination and prejudice, and compounded disadvantage, as well as fewer recovery resources and supports, compared to the life contexts of non-Hispanic White individuals with AUD. ...
Special emphasis populations in the current context can be defined as groups experiencing health disparities resulting in elevated risk to health, safety, and well-being from drinking alcohol. Individuals from marginalized minority populations often encounter barriers to accessing and receiving effective alcohol treatment due to social inequities and disadvantaged life contexts, which also may adversely affect recovery from alcohol use disorder (AUD). Recovery from AUD often involves the adoption of a stable non-drinking lifestyle (sobriety), increased health and well-being, and increased social connection. Although there has been considerable work on AUD epidemiology among special emphasis populations, little research exists directly examining recovery among racial/ethnic minority populations and/or sexual and gender minority populations. The current narrative review hopes to spark scholarly interest in this critically neglected area. This article opens with a review of special emphasis populations and their alcohol-related risks. Next, definitions of recovery, Alcoholics Anonymous, and culturally adapted recovery models for racial/ethnic minority populations are explored. This is followed by a discussion of factors that may particularly influence recovery among marginalized minority populations. This narrative review concludes with a discussion of research priorities for promoting health equity through studies focused on understanding and supporting recovery from AUD among marginalized minority populations.
... Prior work has suggested that individuals with SUDs and psychiatric comorbidities may have more di culty integrating and fully participating in SUD treatment programs [42,43]. This is exacerbated when women who enter into residential SUD treatment are challenged with more severe mental health conditions, overloading treatment retention and completion efforts [15,44,45]. This suggests further research is needed to obtain a clearer understanding of how co-occurring mental health disorders affect women's treatment integration and engagement and their link to decreased SUD residential treatment retention. ...
Background: Court-mandated substance use disorder (SUD) treatment, as compared to nonmandated treatment, has been associated with increased retention and completion. However, whether child protective services (CPS)-mandated women’s residential SUD treatment leads to improved treatment retention in comparison to criminal justice (CJ)-mandated and nonmandated treatment remains unclear.
Purpose: This study compared the number of days retained in residential SUD treatment among three referral sources (CPS, CJ, and nonmandated), while also examining whether having a co-occurring mental health disorder or certain mental health characteristics (increased stress, depression, anxiety, and PTSD symptomology) contributed to decreased retention. This study tested the hypothesis that women mandated by the CPS and CJ systems would have improved residential SUD treatment retention compared with nonmandated women.
Methods: Multivariate regression analyses were conducted on data for a diverse sample of 245 women (Hispanic: N = 141, Black: N = 50, White: N = 50) mandated or nonmandated (CJ: N = 114, CPS: N = 82, nonmandated: N = 49) into residential SUD treatment to determine each group’s treatment retention outcomes.
Results: Women mandated to SUD residential treatment regardless of source (CPS or CJ) remained in treatment significantly longer (CPS: M = 116.59 days, SD = 65.59, p = .023; CJ: M = 133.86 days, SD = 79.43, p = .028), compared to women not mandated (M = 96.11 days, SD = 72.09), representing a 34.4% and 31.6% increase, respectively. Findings further revealed a corresponding 2.3% decrease in retention (p = .024) for each one-unit increase in a patient’s stress score, whereas those with a co-occurring mental health diagnosis had a 43.6% decrease in SUD treatment retention (p < .001).
Conclusions: This study highlights the importance of future research that examines the impact of referral source, co-occurring mental disorders, and stress on women’s residential SUD treatment retention.
Further research is needed examining the variability in external motivation among referral sources compounded by dynamic intersections of risk associated with having a co-occurring disorder and stress on treatment retention.
ClinicalTrials.gov Identifier: NCT02977988 (first posted November 30, 2016; last update posted October 7, 2019); U.S. NIH Grant/Contract: 5R01DA038648
... Studies have revealed that the percentage of women who use drugs in addiction treatment is very low [5,6]. Women often encounter various personal, social, cultural, and structural barriers to entering treatment, such as a lack of treatment for pregnant women, low level of education, psychiatric disorders, history of trauma, stigma, discrimination, shame, poverty, child care duties, low social support, lack of services in accordance with women's needs, high treatment cost, and rigid treatment schedules [5,[7][8][9]. ...
Background
Relapse is one of the main challenges that must be tackled in the drug addiction treatment. Different factors contribute to the relapse process but it remains unclear how relapse occursin women. Describing the relapse phenomenon in women might be of interest to practitioners and academics. The aim of this study was to explore the relapse experiences of Iranian women with a substance use disorder.Methods
Qualitative in-depth interviews were conducted with women with a substance use disorder. The interviews contained open-ended questions regarding relapse experiences during previous treatment. Interviews were digitally recorded. Data were analyzed using the content analysis method.ResultsIn total, 20 women who use drugs took part in the study. The mean age of the women was 34.57 (age range=9.6years), and the minimum age of participants was 23years. The following five main themes were explored: socioeconomic backgrounds, physical complications of drug withdrawal, psychological burden of drug withdrawal, family atmosphere, and cultural factors. The findings highlighted the different treatment needs in women with a substance use disorder.Conclusions
Based on the interviews, it seems necessary to develop female-specific comprehensive treatment programs by putting more emphasis on pain treatment intervention, relapse prevention, the diagnosis and treatment of mental disorders, couples counseling, and financial support. Furthermore, policymakers should be committed to providing a nonjudgmental social environment to remove or reduce stigma of women with drug use problems.
... Nearly one-fourth protective factor for prevention of addicted women stated having an addicted family or friend as the main cause of their addiction to drug which was consistent with similar studies in other parts of the world. [11][12][13] More involvement of women in addiction can be prevented by taking appropriate control measures in the family with addicted father or spouse. On the other hand, addicted women usually an addicted spouse or partner who not only does not support the woman but also commit violence against them or leaved the relationship. ...
Background:
Women are the first victims in most of social damages and corruptions. However, due to some social and cultural reasons, the most of the drug addiction studies in Iran target male population. Hence, this study aimed to investigate the pattern of substance abuse and prevalence of HIV and hepatitis risk factors among addicted women.
Methods:
This is a cross-sectional study conducted on women referred to methadone maintenance treatment centers of Western Iran (Kermanshah province). Data were collected through interview by a psychologist who is working full time in the centers.
Results:
A total of 138 addicted women were studied. Among whom, 50 individuals were aged >45 years old (36.2%), 135 individuals (97.8%) had a history of substance abuse in their family, and 66 individuals (40.5%) initiated drug use before age 20. The most common substances were opium and crack with a proportion of 76.8% and 9.4%, respectively. Prevalence of positive HIV and hepatitis B among addicted women were 18.8% (26 persons) and 5.0% (7persons), respectively. Three (2.1%) of addicted women with HIV also had HBV. The most commonly HIV transmission were drug injections (30.7%) and unprotected sex (11.5%).
Conclusions:
Although women do not constitute a significant part of substance abuse, increasing trend of women addiction, on one hand, and high prevalence of risk factors related to HIV or hepatitis in women, on the other hand; show that officials and experts are required to seriously consider prevention and harm reduction programs for women.
... Conversely, problems in social relationships in the first 3 weeks of re-entry have been associated with increased rates of substance use and hazardous drinking in the following months [18]. Similarly, lack of support and stigma relating to incarceration history and SUDs impeded treatment engagement [19]. Furthermore, a previous qualitative study identified that challenges inherent to reentry may overwhelm women's ability to prioritize their health and manage negative emotions, contributing to worsening substance use, mental health symptoms, and recidivism [20]. ...
Background
Women recently released from incarceration have increased rates of co-occurring substance use, physical health, and mental health disorders. During re-entry, they face challenges navigating needed health services and social services stemming from these problems. Women’s Initiative Supporting Health Transitions Clinic (WISH-TC) is a primary care program that facilitates treatment access for re-entering women. Strategies include support and navigation assistance from peer community health workers.
Methods
Thirteen participants, of whom 11 had a substance use disorder, completed semi-structured interviews about their experiences in WISH-TC as part of a process evaluation. We conducted a qualitative framework analysis informed by self-determination theory.
Results
WISH-TC supported autonomy as staff helped motivate women to work toward personal health goals. Women were empowered to have their health needs met, and consequently, prioritized attending clinic. Regarding competence, WISH-TC built upon women’s existing knowledge to increase their health literacy and better understand their individual health needs. Relatedness support, both prior to re-entry and ongoing with clinic staff, was key in women’s satisfaction with their care. The clinic made procedural changes in response to the interviews, including providing orientation for the patients and training the clinic in trauma-informed practices.
Conclusions
Our findings highlight the potential of a program for re-entering women, including those with substance use disorders to strengthen their abilities to navigate complex healthcare and societal systems. WISH-TC helped women feel supported, motivated, and competent to address their substance use, physical, and mental health conditions.
... Integrated programs for pregnant and parenting women attempt to reduce common barriers that make it difficult for women to participate in substance use services (e.g., lack of childcare, fear of loss of child custody, limited services for pregnant women, provider stigma) [2][3][4][5][6]. They are designed to offer a holistic and comprehensive mix of services that are trauma-and violence-informed, and focus on maternal and child health promotion and the development of healthy relationships [7][8][9][10]. ...
Background
Women who are seeking services for problematic substance use are often also balancing responsibilities of motherhood. Integrated treatment programs were developed to address the diverse needs of women, by offering a holistic and comprehensive mix of services that are trauma- and violence-informed, and focus on maternal and child health promotion and the development of healthy relationships.
Methods
Using system-level administrative data from a suite of outpatient integrated programs in Ontario, Canada, we described the clients and rates and predictors of treatment participation over a 7-year period (2008–2014; N = 5162).
Results
All participants were either pregnant or parenting children under 6 years old at admission to treatment. Retention (length of time between the first and last visit) averaged 124.9 days (SD = 185.6), with episodes consisting of 14.6 visits (SD = 28.6). The vast majority of women attended more than one visit (87.2%), typically returning within 2 weeks (mean 12.3 days, SD = 11.1). In addition to being pregnant or new mothers experiencing problematic substance use, most were unemployed, on social assistance, and single.
Conclusions
Programs appeared to be able to successfully engage most women in treatment once they accessed the programs. Although rates of treatment participation did vary across subgroups defined by sociodemographic and admission characteristics, effect sizes tended to be small on average, providing little evidence in general of sociodemographic inequities in participation. Further work is needed to study the influence of program-level factors on participation, and how these link to maternal and child outcomes.
... Women also have poorer coping strategies (Timko, Finney, & Moos, 2005) and are more likely to relapse due to negative affect and lack of adaptive coping strategies (Walitzer & Dearing, 2006). Given the additional barriers to attending AUD treatment (Brady & Ashley, 2005) and the risk factors for relapse, it is necessary to develop and implement effective, lifestyle-oriented therapeutic techniques that are easily accessible to women in early alcohol recovery. Helping women engage in physical activity (PA) may be one such technique. ...
... Treatment retention has been defined as "the number of days spent in treatment from the date of admittance to the last date of service" (Roberts & Nishimoto, 2006). Literature points to racial disparities in rates of treatment retention Brady & Ashley, 2005;Brower & Carey, 2003;Campbell, Weisner, & Sterling, 2006;Evans, Spear, Huang, & Hser, 2006;Hser, Joshi, Maglione, Chou, & Anglin, 2001;Jacobson et al., 2007;Milligan, Nich, & Carroll, 2004), with Black individuals having lower treatment retention rates compared with White individuals (Campbell et al., 2006;Davis & Ancis, 2012;Jacobson et al., 2007;King & Canada, 2004;Longshore & Teruya, 2006;McCaul et al., 2001;Milligan et al., 2004;Siqueland et al., 2002;Wolf, Sowards, & Wolf, 2003). Treatment retention is found to be influenced by client factors (Davis & Ancis, 2012), including the level of acculturation (Guerrero, Marsh, Khachikian, Amaro, & Vega, 2013;Vega & Lopez, 2001) and employment status (Davis & Ancis, 2012). ...
Contemporary racism in the United States contributes to health, mental health, and substance use disorder (SUD) disparities among People of Color (POC) compared with White individuals. Despite entering into substance use treatment with a greater severity of SUD and related consequences, POC experience more barriers to treatment engagement, completion, and satisfaction than their White counterparts. As substance use treatment counselors are socialized within institutions of systemic racism, it is important to examine their positioning on racism in relation to their capacity for culturally competent care. This article articulates a need to implement an antiracist framework for substance use treatment.
... 7,8,[21][22][23] Nonetheless, women tend to enter treatment at an earlier age and at an earlier stage of their addiction career, which is generally considered to be a positive outcome factor, 8,24 but evidence, however, also indicates that the proportion of women entering substance abuse treatment facilities is lower than for substance abusing men. 25 Regarding treatment outcome of MMT, different results have been reported. Studies found no gender influences on treatment outcome in retention and drug use, 21,26-29 but revealed positive advantages for men with respect to their economic situation. ...
... Women with SUD had more psychosocial difficulties, mental health problems, and traumatic events as compared with male substance users (Brady and Ashley, 2005). Gender was also shown to be a factor in the initiation of substance use. ...
The purpose of this study is to examine the relative contribution and the relationships between formal (treatment related members) • informal (family members) concrete support and discharge disposition. A total of 172 women interviewed upon intake in one of 3 counties funded substance abuse treatment programs in Cleveland, Ohio. Hierarchical logistic regression was performed to assess the impact of formal concrete support and informal concrete support on the likelihood of a discharge disposition of completed treatment. Formal concrete support showed a statistically significant contribution to discharge disposition, while informal concrete support did not. Findings of this study highlight the importance of formal concrete support. Future research should continue to expand our knowledge of how support from formal treatment services interacts with support from informal (family) networks.
There is a distinct preponderance of female insomniacs when compared to male insomniacs. The aim of this study was to examine possible gender differences in the causes for insomnia, and the phenotypes of insomnia, and to investigate whether gender-specific insomnia diagnosis and treatment could be relevant in clinical practice. Data were collected from 121 insomniac patients by a medical specialist in the framework of normal clinical practice in Germany. The data consist of the patient’s medical history and various sleep-related patient questionnaires. Data from both genders were tested for independence using chi-square tests and Mann–Whitney U tests. We found a correlation between the gender of the patient and insomnia phenotypes in several aspects: concomitant lipometabolic disorders, diabetes mellitus, and high BMIs are more common in male insomniacs (p < 0.05). Frequency of insomnia occurrence in certain age groups, insomnia severity, distribution of SOI (sleep onset insomnia), SMI (sleep maintenance insomnia) and combined SOI + SMI, sleep duration, the time needed to seek medical consultation, trying out sleep-inducing drugs/techniques and the trigger, etiology and familial predisposition of the insomniac disorder were independent of the patient’s gender. We would like to re-evaluate the results with a larger number of patients in a further study.
Policies and programs that aim to minimize wait time to enter opioid use disorder (OUD) treatment and maximize retention respond to potential differences in female and male clients’ risk profiles. We conducted multigroup latent class analysis using significant individual risk factors. Our sample included 13,453 opioid treatment episodes from 135 unique substance use disorder treatment programs in Los Angeles County, California, in four waves: 2011 (66 programs, 1,035 clients), 2013 (77 programs, 3,671 clients), 2015 (75 programs, 4,625 clients), and 2017 (69 programs, 4,106 clients). Groups at risk of waiting longer included clients who were female, had mental health issues, received medication for OUD, had criminal justice involvement, received mandated referrals, had children in child protective services, and had caretaker responsibilities. All clients with children in protective services were likely to wait longer than those not in protective services, but women waited longer. Findings highlight that: (a) women and men in OUD treatment have significant health and social problems; (b) female and male clients have distinct risk profiles; and (c) targeted services responding to risk profiles may improve treatment access and engagement. Findings have implications for health policy and program evaluation and planning in the delivery of treatment services considering gendered risk factors.
This chapter contains quantitative and qualitative data analysis results related to the current treatment duration. The principles of effective SUDs treatment are also discussed here. At the end of the chapter, five machine-generated summaries of relevant scientific papers are included.
Although empirical literature into sex addiction has flourished in the last two decades, the lack of universal agreement, and diagnostic criteria within such studies was reflected in the paucity of treatment provisions for those experiencing compulsive sexual behaviors. Since its ultimate inclusion in the International Classification of Diseases-11 (ICD-11), Compulsive Sexual Behavior Disorder (CSBD) provides a solid foundation in which gold-standard treatment interventions can be designed and implemented. This chapter will provide a theoretical overview of this issue, its biological basis, co-morbidities, prevalence rates, assessment approaches and treatment approaches reported in the literature. While research in CSBD has accelerated and there is evidence that examines the lasting consequences of the disorder, the field has been has subjected to a number of treatment barriers. The implications of these are further discussed.KeywordsCompulsive sexual behavior disorderCompulsive sexual behaviorHypersexualitySex addiction treatmentTreatment interventionsBehavioral addictions
South Africa alongside other low‐middle‐income countries have been some of the hardest hit by the substance use scourge. The study sought to identify and measure treatment barriers among young adults (18–29 years) living with substance use disorders, and then examine the role of gender in the perception of treatment barriers, with a view to establish gender‐based treatment specialty facilities as a strategy to promote treatment seeking among young South African women. Quantitative method was used for this study, employing simple random sampling. Exploratory factor analysis and independent samples t‐tests were used as statistical measures. The identified treatment barriers were found to have a larger effect on females than males. Women were considered less likely to utilise treatment services compared to males. Health promotion practitioners and policymakers can alleviate the situation by establishing gender‐based treatment facilities. that respond better to women's needs.
Objectives
Methamphetamine use is rising globally and we have limited treatments for this. Subgroups within the diverse methamphetamine-using population may have distinct treatment needs. Among a community-recruited sample of people who use crystal methamphetamine, we aimed to identify subgroups and characterize their overdose risk and access to addiction care.
Methods
Data from prospective cohorts of people who use drugs in Vancouver, Canada from 2014-2018 were used to conduct a repeated measures latent class analysis among participants who used crystal methamphetamine. Multivariable generalized estimating equations models were fit to determine the associated factors.
Results
Among 824 eligible participants, a five-class model was identified as the best fit: (1) primary stimulant use (15.7%); (2) women engaged in sex work and opioid use (21.4%); (3) street income generation and opioid use (31.6%); (4) opioid agonist therapy (OAT) patients (22.3%); and (5) men who have sex with men (9.0%). In multivariable analyses, compared to the primary stimulant use group, non-fatal overdose was positively associated with street income generation (adjusted odds ratio [AOR] = 1.49, 95% confidence interval [95% CI]=1.30-1.71), sex work (AOR = 1.38, 95% CI=1.20-1.59) and OAT (AOR = 1.22, 95% CI=1.06-1.41) subgroups; engagement in non-OAT addiction care was negatively associated with street income generation (AOR = 0.81, 95% CI=0.68-0.97) and sex work (AOR = 0.78, 95% CI=0.63-0.98) subgroups.
Discussion
Socioeconomically marginalized subgroups with opioid and crystal methamphetamine co-use were at highest risk of non-fatal overdose and had poorer access to addiction care, highlighting the need for tailored interventions.
Introduction
Traditional treatment programs for substance use disorder (SUD) tend to be male-dominated environments, which can negatively affect women's access to treatment and related outcomes. Women's specific treatment needs have led some providers to develop women-only SUD treatment programs in several countries. In Chile, women-only programs were only fully implemented in 2010. We compared treatment outcomes and readmission risk for adult women admitted to state-funded women-only versus mixed-gender SUD treatment programs in Chile.
Methods
We used a registry-based retrospective cohort design of adult women in women-only (N = 8200) and mixed-gender (N = 13,178) SUD treatment programs from 2010 to 2019. The study obtained data from the National Drug and Alcohol Service from Chile. We used a multistate model to estimate the probabilities of experiencing treatment completion, discharge without completion (i.e., patient-initiated discharge and administrative discharge), or readmission, as well as the likelihood of being readmitted, conditioned on prior treatment outcome. We adjusted models for multiple baseline characteristics (e.g., substance use, socioeconomic).
Results
Overall, 24% of women completed treatment and 54% dropped out of treatment. The proportion of patient-initiated discharges within the first three month was larger in women-only than in mixed-gender programs (19% vs. 12%). In both programs, women who completed treatment were more likely to experience readmission at three months, and one and three years. In the long term, women in the women-only programs were more likely to complete treatment than women in mixed-gender programs (34% vs. 23%, respectively). The readmission probability was higher among women who previously completed treatment than those who had a discharge without completion (40% vs 21% among women in women-only programs; 38% vs. 19% among women in mixed-gender programs, respectively); no differences occurred in the risk of readmission between women-only and mixed-gender programs.
Conclusions
In terms of treatment outcomes and readmission risk, women-only programs had similar results to mixed-gender programs in Chile. The added value of these specialized programs should be addressed in further research.
Over the last 25 years, awareness of the significance of gender differences in addiction has grown exponentially in the United States. International studies of gender differences are scarce but growing in number. Understanding gender differences in epidemiology, etiology, risk and protective factors, clinical presentation, psychiatric comorbidity, course of illness, and treatment outcomes of substance use disorders (SUDs), particularly in developing countries, is critical to the implementation of effective treatment and prevention strategies.
This qualitative analysis looks at women across a continuum of sobriety and affiliation with Alcoholics Anonymous (AA). The sample frame consists of 60 women’s stories as submitted to the Grapevine: The International Journal of Alcoholics Anonymous and explores older women’s recovery experiences within the context of AA. An intersectional interpretive lens is offered in order to look at both gender and age as they relate to recovery from alcohol use disorder (AUD). Findings suggest a comparative difference not only among older women as a group seeking recovery but between those who have late-onset AUD, those who sought help in middle-age, and those women with long-term sobriety affiliated with AA for 20 or more years.
Background:
Despite the narrowing gender gap in the prevalence of substance use disorders, women continue to be vastly underrepresented in substance use services. Relational factors, family responsibilities, mental health, and stigma may present unique barriers encountered by women.
Aims:
The aims of this study were to examine: (1) gender differences in substance use treatment barriers, (2) gender differences in perceptions of stigmatization for seeking substance use treatment, and symptoms of depression, anxiety, and trauma-related stress, and (3) whether perceived stigmatization and mental health symptoms are associated with greater barriers among women.
Methods:
One hundred adults (50% self-identified women) from a substance use and concurrent disorders program in Ontario, Canada, completed a questionnaire package containing measures of sociodemographic information, substance use, mental health, perceived stigma, and substance use treatment barriers.
Results:
Women reported more barriers related to family responsibilities, relational factors, and mental health (p < .01), and higher levels of perceived stigma (p < .01) compared to men.
Conclusions:
Findings from this study contribute to our understanding of treatment barriers and perceived stigmatization among women. This knowledge may be used to aid in the development and delivery of accessible, gender-responsive services that address these barriers and challenge the stigma attached to substance use among women.
Integrating gender in all aspects of health services is important and mental health is no exception. Despite several recommendations regarding the need for gender-sensitive mental health services, the actual availability of these is not clear, both in high and low-income countries. We sought to understand what aspects of gender-sensitive mental health care were considered a priority by global experts in women’s mental health and how satisfied they were with the current availability of these services in their own place of work. A survey with 43 items under 7 domains of gender-sensitive mental health care for women was sent to 150 experts in women’s mental health across the world, of whom 73 responded. Rating on each item was from 0 to 5. While majority of the experts rated most of the items as being very important (median score of 4 and above), some areas that were considered most important included training of mental health professionals in gender sensitivity, having private spaces for examination, using a life course approach to service planning and delivery, and assisting women who find it difficult to navigate the system and mother-baby units. However, satisfaction rates with available services were quite low overall and much lower among experts in low-income countries compared with those from high-income countries. Even in high-income countries, only 6 of the top 20 items were scored as satisfactory by at least 50% of experts. This expert survey method to arrive at consensus on top priorities for improving delivery of gender-sensitive mental health care indicates that at least 72% of the items provided in the survey were considered extremely important. Poor satisfaction of experts in both high- and low-income countries with availability of gender-sensitive services indicates the need for local and global strategic action and multilevel stakeholder engagement.
This article looks at the intersectionality between gender and age as it affects the recovery process in Alcoholics Anonymous (AA). Women remain a minority in AA, just over one third, and young people make up only 12% of AA membership. Although the gendered nature of AA has only recently been uncovered, focus on young people in AA is even less studied. Given their developmental stage, adolescents and young adults do not have the range of life experiences to draw upon as they try to identify with more mature members of AA. In turn, older members do not know necessarily how to bridge the gap in experience. Some young women perceive that they are not taken seriously, are viewed as too emotional, or simply are misunderstood. Alternatively, other young women find guidance and support from older members in the program. Whatever their individual experiences, young women, nonetheless, have to work to fit into the predominately older, male culture that is AA. However, as illustrated in their personal stories, the Traditions and Steps of AA help to facilitate the “fitting in” of all of its members including young, female members.
Background:
Research on women with substance use disorders has expanded, yet knowledge and implementation gaps remain.
Methods:
Drawing from topics discussed at the 2017 meeting of InWomen's in Montreal, Canada, this article reviews key progress in research on substance use among women, adolescents, and families to delineate priorities for the next generation of research.
Results:
The field has seen significant accomplishments in multiple domains, including the management of pregnant women with substance use and comorbid psychiatric disorders, caring for neonates in opioid withdrawal, greater inclusion of and treatment options for LGBTQ + communities, gendered instrumentation, and gender-focused HIV interventions for adolescent girls and women. Women who use alcohol and other drugs often experience other comorbid medical conditions (chronic Hepatitis C and HIV), contextual confounders (intimate partner violence exposure, homelessness, trauma), and social expectations (e.g., as caretakers) that must be addressed as part of integrated care to effectively treat women's substance use issues. Although significant advances have been made in the field to date, gender-based issues for women remain a neglected area in much of substance abuse research. Few dedicated and gender-focused funding opportunities exist and research has been siloed, limiting the potential for collaborations or interdisciplinary cross-talk.
Conclusion:
Given renewed attention to substance use in the context of the burgeoning opioid epidemic and shifts in global politics that affect women's substance use, the field requires a strategic rethink to invigorate a pipeline of future research and researchers.
Self-stigma in addiction occurs when individuals with substance use disorders (SUDs) experience shame based on mythological stereotypes in public stigma, as well as from their own sense of what they take to be shameful about addiction. This process leads to changes in identity in line with negative stigmatising stereotypes. The main source of the shaming process comes from public stigma where powerful others impose upon the individual with SUDs a social world (an ambience) containing false and distorting attitudes and beliefs that are internalised and lead to harmful effects, including further substance use and self-sabotage. A second source of self-stigma is the private shame that individuals feel based on accurate recognition of their situation. This may generate the motivation to heal but typically only when it occurs in a supportive context where public stigma is absent and acceptance by others is present. With the barrier of public stigma removed, or at least lowered, the individual with SUDs will stop self-stigmatising based on the damaging mythology around addiction and so may be given the support he or she needs for self-compassion, and in particular self-trust, in order to recover.
With the growing understanding of substance use problems among special populations like women, gender minority groups, as well as in the geriatric population, there is a drive to develop sensitive interventions catering to their unique needs. This chapter is a short review of psycho-social interventions targeted towards these individuals with specific needs. © 2018 Indian Journal of Psychiatry | Published by Wolters Kluwer - Medknow.
Background and objectives:
Data suggest individuals with substance use disorders (SUD) have high rates of attrition from treatment and exhibit impairments on measures of executive functioning (EF). The primary aim of this pilot study was to investigate if EF is associated with attrition from a 1 month intensive outpatient program (IOP) for SUD, and examine the feasibility of implementing the project.
Methods:
Baseline neurocognitive functioning was assessed by the Cambridge Neuropsychological Test Automated Battery (CANTAB) and the self-reported Behavior Rating Inventory of Executive Functioning (BRIEF-A) questionnaire.
Results:
Thirty subjects enrolled in the pilot study: including 20 "completers" (age 39.5 ± 13.1 years) and 10 "drop-outs" who discontinued the IOP prior to completion (age 32 ± 11.1 years). IOP drop-out was associated with earlier age of substance use onset (all p-values <0.05) and male gender, as well as greater SUD, opiate use, and past week substance use. Overall a high level of executive dysfunction was found on the BRIEF-A and CANTAB assessments, and specific differences emerged between completers and drop outs. However, no statistically significant differences were found between these groups on measures of depression, anxiety, or ADHD.
Conclusions and scientific significance:
Overall, findings from this pilot study suggest high levels of self-reported executive dysfunction, but EF's predictive association with drop-out was limited. Measures of addiction severity were more strongly associated with attrition, suggesting potential utility of brief motivational interventions prior to commencing an IOP may improve retention. Further investigations with larger and more diverse samples are warranted. (Am J Addict 2017;XX:1-8).
This article describes barriers to treatment identified by a sample of substance-abusing/addicted women (mostly African-American). A self-administered questionnaire, the Allen Barriers to Treatment Instrument, was submitted to 97 substance-abusing/addicted women throughout the state of Illinois who were not in treatment. Results showed that the barriers most identified by these subjects included responsibility for child care, lack of insurance or money, and community issues.
Although the link between substance abuse and child maltreatment has been relatively well established, there is a general recognition that this is not a simple cause-effect relationship. The current study explored the relationships among substance abuse, family functioning, and abuse/neglect in a sample of incarcerated substance abusers. Data were gathered on the earlier life experiences of 81 men and women serving sentences in two maximum security prisons, including assessments of their parents' substance abuse problems; levels of family competence within their families-of-origin; their exposure, as children and adults, to physical, emotional, and sexual abuse and physical/emotional neglect; and their own levels of substance abuse. Results showed generally high percentages of parental substance abuse and abuse/neglect, and relatively low levels of family competence. Correlational analyses revealed significant direct and indirect relationships among parental substance abuse, family dynamics, and exposure to both child and adult maltreatment. These four variables were also significantly associated with respondents' own substance abuse in later life, suggesting the potential for continuation of these patterns into successive generations. An intergenerational model of these family and personal functioning variables is presented and implications for service delivery with correctional clients is discussed.
Studies in men suggest that light-to-moderate alcohol intake is associated with a reduction in overall mortality, due primarily to a reduced risk of coronary heart disease. Among women with similar levels of alcohol consumption, an increased risk of breast cancer has been noted that complicates the balance of risks and benefits.
We conducted a prospective study among 85,709 women, 34 to 59 years of age and without a history of myocardial infarction, angina, stroke, or cancer, who completed a dietary questionnaire in 1980. During the 12-year follow-up period, 2658 deaths were documented.
The relative risks of death in drinkers as compared with nondrinkers were 0.83 (95 percent confidence interval, 0.74 to 0.93) for women who consumed 1.5 to 4.9 g of alcohol per day (one to three drinks per week), 0.88 (95 percent confidence interval, 0.80 to 0.98) for those who consumed 5.0 to 29.9 g per day, and 1.19 (95 percent confidence interval, 1.02 to 1.38) for those who consumed 30 g or more per day, after adjustment for other predictors of mortality. Light-to-moderate drinking (1.5 to 29.9 g per day) was associated with a decreased risk of death from cardiovascular disease; heavier drinking was associated with an increased risk of death from other causes, particularly breast cancer and cirrhosis. The benefit associated with light-to-moderate drinking was most apparent among women with risk factors for coronary heart disease and those 50 years of age or older.
Among women, light-to-moderate alcohol consumption is associated with a reduced mortality rate, but this apparent survival benefit appears largely confined to women at greater risk for coronary heart disease.
Change has been noted in some of the group members. For example, one long-term group member who never spoke when she was in a previous group that focused on addiction-related problems has become the role model for other members. In this group, she says, she feels more competent. She is appropriately outspoken and has established relationships with her children which consistently underpin the parent-child boundaries that need to be drawn. One specific issue she resolved involved her 19-year-old son and his girlfriend who was pregnant with the group member's grandchild. By role playing the different positions that each of these people held in the home (the group member was paying the rent and had the right to set the rules, the girlfriend was feeling unaccepted by the group member and was acting out inappropriately, and the son was caught between trying to please the two females), the group member was able to clarify for herself how to approach future conflicts. A second member has improved her relationship with her youngest son (age 3) but still struggles with her 15-year-old daughter. What has been most effective for her was teaching her to count to 10 before responding to what she considers the goading of both of her children. In addition, she was feeling pressured by her mother, in whose house she lives, to have her son toilet trained.(ABSTRACT TRUNCATED AT 250 WORDS)
This article adds to the growing but still limited literature on the role of gender relations in women's addiction and recovery. In-depth interviews were conducted with 35 women randomly drawn from a large study of drug-abusing pregnant women who were recruited into an HIV/AIDS prevention program. These interviews explored conditions surrounding initiation and continuation of drug use, past and current sexual/love relationships, and experiences in the HIV/AIDS prevention program. Throughout the interviews, the women participants consistently voiced feelings stressing the importance of relationships in their lives. At the same time, they expressed a sense of disconnection and deprivation in those relationships. Four areas in which relationships with male partners ran counter to women's needs for connection are discussed in this article: initiation into drug use and supply of drugs, disappointment in men for failure to be providers, experience of violence, and opposition to treatment. The implications of these findings for substance abuse treatment are discussed.
To study patterns of co-occurrence of lifetime DSM-III-R alcohol disorders in a household sample.
Data came from the National Comorbidity Survey (NCS), a nationally representative household survey. Diagnoses were based on a modified version of the Composite International Diagnostic Interview.
Respondents with lifetime NCS/DSM-III-R alcohol abuse or dependence had a high probability of carrying at least 1 other lifetime NCS/DSM-III-R diagnosis. Retrospective reports have suggested that most lifetime co-occurring alcohol disorders begin at a later age than at least 1 other NCS/DSM-III-R disorder. Earlier disorders are generally stronger predictors of alcohol dependence than alcohol abuse and stronger among women than men. Lifetime co-occurrence is positively, but weakly, associated with the persistence of alcohol abuse among men and of alcohol dependence among both men and women.
Caution is needed in interpreting the results due to the fact that diagnoses were made by nonclinicians and results are based on retrospective reports of the age at onset. Within the context of these limitations, though, these results show that alcohol abuse and dependence are often associated with other lifetime DSM-III-R disorders and suggest that, at least in recent cohorts, the alcohol use disorders are usually temporally secondary. Prospective data and data based on clinically confirmed diagnoses are needed to verify these findings.
Clinical studies have found elevated rates of childhood sexual abuse (CSA) in women seeking treatment for alcohol or drug abuse, and elevated rates of alcohol and drug disorders among female psychiatric patients with histories of CSA. The present study examines the relationship of CSA to women's use of alcohol and other drugs in a large, nationally representative sample of U.S. women.
As part of a national survey of women's drinking, 1,099 women were asked about sexual experiences occurring before age 18. Women who reported sexual experiences classified as abusive were compared to women without histories of CSA on nine measures of substance use, self-perception of anxiousness, the occurrence of one or more lifetime depressive episodes, five measures of sexual dysfunction, and early onset of masturbation and consensual sexual intercourse.
Results of logit analyses, controlling for age, ethnicity and parental education, indicated that women with histories of CSA were significantly more likely than women without CSA histories to report recent alcohol use, intoxication, drinking-related problems and alcohol dependence symptoms; lifetime use of prescribed psychoactive drugs and illicit drugs; depression and anxiety; pain that prevented intercourse; and consensual sexual intercourse before age 15.
Findings from this U.S. national sample support those of previous clinical studies and suggest that women's experience of sexual abuse in childhood may be an important risk factor for later substance abuse, psychopathology and sexual dysfunction. Implications of these findings for future research, treatment and prevention are discussed.
Women experience alarming levels of physical and sexual assault, which may lead to escalation of substance use. Reciprocally, evidence from cross-sectional studies indicates that substance use may increase risk of assault. To date, directionality of this relationship remains unclear. This issue is addressed by the present 3-wave longitudinal study in which a national probability sample of 3,006 women were followed for 2 years. Dependent measures were obtained at each wave of the study and included questions about lifetime and new assault status, alcohol abuse, and drug use. Wave 1 use of drugs, but not abuse of alcohol, increased odds of new assault in the subsequent 2 years. Reciprocally, after a new assault, odds of both alcohol abuse and drug use were significantly increased, even among women with no previous use or assault history. For illicit drug use, findings support a vicious cycle relationship in which substance use increases risk of future assault and assault increases risk of subsequent substance use.
Clients entering treatment with cocaine problems are difficult to engage and retain in treatment. Crack users, a subset of cocaine users, are especially difficult to treat. This study investigated whether type of cocaine used (crack or non-crack) was related to retention in treatment. The sample consisted of 900 clients in 13 long-term residential (LTR) programs participating in the national Drug Abuse Treatment Outcome Studies (DATOS). Clients met the DSM-HI-R criteria for cocaine dependence and were at least weekly users of cocaine (including crack). Hierarchical logistic model regression analysis was used to test the relationship between type of cocaine preference and retention. Crack users had lower retention rates than non-crack cocaine users, even after adjusting for covariates. Higher retention was also related to being older, a high school graduate, unmarried, not depressed, alcohol dependent, more motivated for treatment, and having fewer arrests. New strategies to improve retention for crack users through increased client motivation are discussed.
To illuminate the lives of women who are substance abusers, a life history study was conducted on 26 women in treatment for substance abuse. Data collection for this research, including "life line" exercises, focus groups, interviews with women and treatment counselors, and written segment exercises, was therapeutic. Themes of violence (rape and incest), abuse, male dominance, dependence, motherhood issues, and depression emerged as typical in their lives. The experiential sharing of many aspects of their life stories enabled the participants to reflect on their own patterns of drug dependency and view similarities and contradictions in the lives of other women who had abused drugs. It enabled them to gain insight into their own vulnerability to substance abuse and understand that such vulnerability in women is a synergistic phenomenon.
The involvement of women in crack cocaine abuse has had a severe impact on their health, the health of their children and the stability of their communities. Of particular concern has been the development of a system of barter in which crack‐for‐sex exchanges are the means through which women obtain the drug. Earlier studies have suggested that drug abuse may be related to and exacerbated by trauma. In the project described herein, we interviewed women crack users in Harlem to study the relationship between trauma, crack use, and crack‐related sexual behavior. Results suggested the existence of three types of trauma: (1) traumas that predate the respondent's onset of crack use; (2) traumas that were the direct sequelae of crack use; and (3) stigma trauma, that is, trauma that results from membership in a despised or oppressed group. We observed a complex inter‐relationship involving crack use, crack‐for‐sex transactions, and these three types of trauma. Treatment of the eventual co‐morbidity of trauma and addiction is an urgent challenge.
Methods for constructing simultaneous confidence intervals for all possible linear contrasts among several means of normally distributed variables have been given by Scheffé and Tukey. In this paper the possibility is considered of picking in advance a number (say m) of linear contrasts among k means, and then estimating these m linear contrasts by confidence intervals based on a Student t statistic, in such a way that the overall confidence level for the m intervals is greater than or equal to a preassigned value. It is found that for some values of k, and for m not too large, intervals obtained in this way are shorter than those using the F distribution or the Studentized range. When this is so, the experimenter may be willing to select the linear combinations in advance which he wishes to estimate in order to have m shorter intervals instead of an infinite number of longer intervals.
We describe characteristics of women alcohol abusers, risk factors for alcoholism in women, barriers to treatment, and implications and strategies for physicians dealing with alcohol abuse in women patients, including risk assessments and intervention strategies. Alcohol abuse and alcoholism have a different physiologic effect on women than on men. Societal attitudes about women and alcohol and internal (self-perception) and external (environmental) factors can create barriers to the detection and treatment of female alcohol abusers. Physicians are in an excellent position to address the medical, psychologic, and social concomitants of alcoholism and alcohol abuse. The Council on Scientific Affairs recommends that physicians become more active in the prevention, diagnosis, and treatment of alcohol-related problems in women, including the diseases that may be associated with chronic alcohol abuse and the effect of alcohol on the developing fetus. Specific American Medical Association policy and recommendations for physician practice are included.
Imputation methods that assign a selection of respondents’ values for missing i tern nonresponses give rise to an addd,tional source of sampling variation, which we term imputation varLance , We examine the effect of imputation variance on the precision of the mean, and propose four procedures for sampling the rEespondents that reduce this additional variance. Two of the procedures employ improved sample designs through selection of respc,ndents by sampling without replacement and by stratified sampl;lng. The other two increase the sample base by the use of multiple imputations.
Explicit chart review was an integral part of an ongoing national cooperative project, “Using Achievable Benchmarks of Care to Improve Quality of Care for Outpatients with Depression,” conducted by a large managed care organization (MCO) and an academic medical center. Many investigators overlook the complexities involved in obtaining high-quality data. Given a scarcity of advice in the quality improvement (QI) literature on how to conduct chart review, the process of chart review was examined and specific techniques for improving data quality were proposed.
Literature on gender differences among those entering substance abuse treatment is limited. Using data from intake interviews in a large multisite prospective clinical epidemiological study, this study provides the opportunity to explore gender differences with implications for treatment response. Comparisons are made not only between women and men but also between four different treatment modalities.Traditional gender differences were found with regard to age, education and employment. Although some drug use patterns were similar, men reported more alcohol use while women reported more daily use of cocaine. Women reported more problems related to health and mental health. In addition, women reported much greater proportions of past and current physical and sexual abuse. Women also reported greater concerns about issues related to children, although both women and men reported concern about drug treatment affecting custody of children.
Describes the process of restructuring a women's inpatient drug abuse intervention program. Clinical and administrative issues are addressed regarding the process of change at the institutional, staff, and program component levels. Issues related to the special needs of chemically dependent women include low self-esteem, psychosocial stressors/coping skills, role conflict, and dependency. Responsive programming features designed to address the issues of chemically dependent women include seminars, assertiveness training, leisure activities, family counseling, and secondary diagnoses and individualized treatment. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Discusses the cultural emergence, meaning, and future of extended kin networks in the Black community. Of major concern is the support given and received by the elderly in the extended kin network. Implicit within this discussion is the assumption that African-American extended families exist because of cultural, racial, historical, political, social, and economic factors. The ability to maintain the traditional kin network will be challenged by the condition of those who serve in the caregiving and supportive roles. Cultural ways of believing and behaving will encourage the kin network to absorb its needy members. The kin system will probably become increasingly vulnerable in light of the few resources available to it to meet the multiple demands and needs of different generations. Black families will attempt to redefine themselves to meet the needs of the kin network. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Discusses the financial, legal, and psychosocial constraints of pregnant and postpartum women attempting to recover from alcohol and substance abuse, and describes the role of the Oxford House treatment center in providing a continuation of care for these women. The services offered by Oxford House, linkages provided to progressively-modeled and gender-specific aftercare facilities, and the facilitation of autonomy, respect and mutual support in the healing process are considered. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Interviewed 15 women and their partners who had completed a couples therapy component of a drug treatment program. The interview focused on issues raised in couples therapy that had been helpful to them, the barriers they had found that made it difficult for women to enter drug treatment, and advice they would offer to therapists for improving treatment for women. The women found that most helpful components of couples therapy were the therapists' qualities, the new realizations they had gained, and the impetus therapy provided for them to take new actions. Common cited obstacles included instrumental barriers, societal attitudes, partner resistance to treatment and psychological issues. Respondents felt that therapists should devote more time to couples sessions, understand addiction, and make an effort to include partners. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
OBJECTIVE: To summarize for clinicians recent epidemiologic evidence regarding medical risks of alcohol use for women.
METHODS: MEDLINE and PsychINFO, 1990 through 1996, were searched using key words “women” or “woman,” and “alcohol.” MEDLINE was also searched for other specific topics and authors from 1980 through 1996. Data were extracted and reviewed regarding levels of alcohol consumption associated with mortality, cardiovascular disease, alcohol-related liver disease, injury, osteoporosis, neurologic symptoms, psychiatric comorbidity, fetal alcohol syndrome, spontaneous abortion, infertility, menstrual symptoms, breast cancer, and gynecologic malignancies. Gender-specific data from cohort studies of general population or large clinical samples are primarily reviewed.
MAIN RESULTS: Women develop many alcohol-related medical problems at lower levels of consumption than men, probably reflecting women’s lower total body water, gender differences in alcohol metabolism, and effects of alcohol on postmenopausal estrogen levels. Mortality and breast cancer are increased in women who report drinking more than two drinks daily. Higher levels of alcohol consumption by women are associated with increased menstrual symptoms, hypertension, and stroke. Women who drink heavily also appear to have increased infertility and spontaneous abortion. Adverse fetal effects occur after variable amounts of alcohol consumption, making any alcohol use during pregnancy potentially harmful.
CONCLUSIONS: In general, advising nonpregnant women who drink alcohol to have fewer than two drinks daily is strongly supported by the epidemiologic literature, although specific recommendations for a particular woman should depend on her medical history and risk factors.
Eighty subjects from a specialist women's service (SWS) and eighty subjects from two traditional mixed-sex treatment services (TMS) were recruited to a comparative, longitudinal study of changes in alcohol and other drug associated problems. Both the SWS and the TMS programs were principally based on the traditional disease model and 12-step philosophy but the SWS employed only female staff and provided residential childcare. The SWS succeeded in attracting significantly more lesbian women, women with dependent children, women sexually abused in childhood and with a maternal history of substance dependence than the TMS. Six months following treatment there were no significant differences in any measure of treatment outcome between the two treatment groups. The results suggest that the simple provision of women-only treatment and childcare without changing treatment content does not substantially improve treatment outcome in women with severe alcohol and other drug related problems.
This study examined clinical characteristics and treatment outcomes of older alcohol-dependent men and women in a mixed-age private outpatient chemical dependency program.
The sample comprised 92 patients aged 55 to 77 (63 men and 29 women). The measures consisted of demographic characteristics, alcohol and drug use and dependence, drinking history, health status, psychiatric symptoms, length of stay in treatment, use of Alcoholics Anonymous and 6-month treatment outcomes.
The women reported later initiation of heavy drinking (5+ drinks per occasion) than the men, but had similar drinking levels at the treatment intake interview. At the 6-month follow-up, 79.3% of women reported abstinence from alcohol and drugs in the prior 30 days versus 54.0% of men (p = .02). Greater length of stay in treatment predicted abstinence at 6 months. Among those who were not abstinent, none of the women reported heavy drinking in the 30 days prior to follow-up, whereas nonabstinent men reported a mean (SD) of 4.0 (9.2) heavy drinking days (p = .025).
The results suggest that older women may have better drinking outcomes compared with older men, following treatment for alcohol dependence.
A model to explain treatment retention in terms of process components--therapeutic involvement and session attributes for the 1st month--and patient background factors were tested in long-term residential (LTR), outpatient drug free (ODF), and outpatient methadone (OMT) treatments. The data was collected in the national Drug Abuse Treatment Outcome Studies (DATOS), and included 1362 patients in LTR, 866 in ODF, and 981 in OMT programs. Structural equation models showed there were positive reciprocal effects between therapeutic involvement and session attributes in all three modalities, and these variables had direct positive effects on treatment retention. Motivation at intake was a strong determinant of therapeutic involvement. Other patient background factors were significantly related to retention, including pretreatment depression, alcohol dependence, legal pressure, and frequency of cocaine use.
The paucity of research on the treatment needs of women with substance abuse problems has been a serious impediment to the development of empirically validated treatment programmes. Women continue to be seriously under-represented as research subjects and clients of treatment services. This study compares the characteristics of 80 women attending a specialist women's treatment service with those of eighty women attending two traditional mixed-sex treatment agencies. Women attending a gender-sensitive service were significantly more likely to have dependent children, to be lesbian, to have a maternal history for drug or alcohol problems and to have suffered sexual abuse in childhood. These results suggest that gender-sensitive treatment services may be recruiting women who might not otherwise have sought treatment for their substance dependence problems.
Outcomes for 6 pregnant methadone-maintained opiate-dependent subjects in enhanced treatment were compared to those of 6 women receiving conventional methadone maintenance. Enhanced treatment consisted of weekly prenatal care, relapse prevention groups, thrice weekly urine toxicology screening with positive contingency awards for abstinence, and therapeutic child care during treatment visits in addition to treatment as usual. Treatment as usual included daily methadone, group counseling, and random urine toxicology screening. Study patients differed from the comparison group in three important ways, having fewer urine toxicology screens positive for illicit substances (59% vs. 76%), three times as many prenatal visits (8.8 vs. 2.7), and heavier infants (median birth weight, 2959 vs. 2344 grams). These results suggest that enhanced drug treatment can improve pregnancy outcome and, in particular, reduce low birth weight for this high-risk population.
While considerable amounts of psychological and pharmacological data have been collected on male substance abusers in public treatment facilities, relatively little information is available about the psychosocial characteristics of men in private treatment settings and of women presenting for substance abuse treatment. The present study reviewed the records of 100 male and female cocaine abusers admitted to a private substance abuse treatment program between 1987 and 1989. Patterns of cocaine use and levels of impairment were found to be similar for men and women, with male cocaine abusers more likely to abuse additional substances. Male cocaine abusers were employed more frequently than women and held higher status jobs despite equivalent levels of education. Female cocaine abusers were more likely to be diagnosed with concurrent psychiatric disorders and were more likely to report family histories of substance abuse. Both groups produced elevations on MMPI scales indicating depression, anxiety, paranoid features, and acting-out tendencies. These data suggest that while male and female cocaine abusers show similarities on some measures, there are significant gender differences that may have implications for both research and treatment.
Psychological and demographic variables were analyzed for 136 chemically dependent women treated in a residential therapeutic community. Cocaine users constituted 50% of the sample and were likely to drop out of treatment earlier (p less than .05). Of all the variables studied, only the Beck Depression Inventory scores were significantly higher for clients who terminated treatment prematurely compared to clients who completed treatment. The results point to the need for further research on the role of depression as a predictive factor of retention.
After consuming comparable amounts of ethanol, women have higher blood ethanol concentrations than men, even with allowance for differences in size, and are more susceptible to alcoholic liver disease. Recently, we documented significant "first-pass metabolism" of ethanol due to its oxidation by gastric tissue. We report a study of the possible contribution of this metabolism to the sex-related difference in blood alcohol concentrations in 20 men and 23 women. Six in each group were alcoholics. The first-pass metabolism was determined on the basis of the difference in areas under the curves of blood alcohol concentrations after intravenous and oral administration of ethanol (0.3 g per kilogram of body weight). Alcohol dehydrogenase activity was also measured in endoscopic gastric biopsies. In nonalcoholic subjects, the first-pass metabolism and gastric alcohol dehydrogenase activity of the women were 23 and 59 percent, respectively, of those in the men, and there was a significant correlation (rs = 0.659) between first-pass metabolism and gastric mucosal alcohol dehydrogenase activity. In the alcoholic men, the first-pass metabolism and gastric alcohol dehydrogenase activity were about half those in the nonalcoholic men; in the alcoholic women, the gastric mucosal alcohol dehydrogenase activity was even lower than in the alcoholic men, and first-pass metabolism was virtually abolished. We conclude that the increased bioavailability of ethanol resulting from decreased gastric oxidation of ethanol may contribute to the enhanced vulnerability of women to acute and chronic complications of alcoholism.
The purpose of this article is to define chemical dependency in women as a maladaptive response to inadequate upbringing. A description of the situational and psychological variables that characterize chemically dependent women is offered as well as attributes these women lack that are necessary for effective parenting. The dysfunctional child-rearing patterns and the consequential outcome for the children are also described. Suggestions for clinical intervention are provided.
High attendance levels in an outpatient program by women alcoholics of lower socioeconomic status were not associated with increased abstinence or employment. Social relationships, previous employment and drinking history were, however, related to greater attendance, abstinence and employment.
