Transcript Women and Substance Abuse - MI-PTE
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Gender Responsiveness in Services for Substance Use Disorders Julie Cushman LMSW, ACSW, CAADC
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Identify at least three barriers that impact a women’s ability to obtain services for substance use disorders.
Identify at least five ways the professional can assist in overcoming barriers to services.
Increase knowledge of a least three ways professionals can create gender responsive programming.
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Course of illness different than men/Telescope Effect
Females advance more rapidly & escalate into addiction faster.
Metabolic differences- experience negative physiological consequences sooner with less use.
More medical, psychiatric and social consequences.
Treatment needs different & more complex than men.
Co-existing psychiatric disorders
Parental Stress
Trauma History
Specific Barriers
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Systemic impede the development of services that respond to women’s needs.
Structural policies and practices at the service or program level that make it difficult for women to access substance use treatment.
Social, Cultural, & Personal related to the social and cultural norms that exist, which include women’s roles and behavior that is considered appropriate; women’s lack of empowerment in many societies; and societal and community norms and attitudes about women who have substance use problems.
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Lack of decision-making power
Limited awareness of gender differences
Lack of knowledge of women with substance use problems and their treatment needs
Lack of appropriate gender-responsive and low cost, evidence-based treatment models
Differences in the organization and funding of health services
Need for a comprehensive array of services
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Childcare
Transportation
Services for pregnant women
Location & cost of treatment programs
Rigid program schedules
Waiting lists
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Denial of admission to women using psychoactive medication
Service coordination
Lack of identification, referral, & intervention in primary care and other sectors
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Lack of diagnosis or misdiagnosis
Information on treatment options
Physical safety
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Fear of leaving children/losing custody of children
Lack of support from family or partners
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Family history of substance abuse
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Involvement with substance abusing partners
Substance use perceived as solution, not problem
Lack of information of services (Straussner, 2004)
Lack of confidence in the effectiveness of treatment
Stigma, shame, & guilt
Low self-esteem
Trauma History
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Physician Family Teacher
Social Service Agencies
Attitudes Reluctance to address Not able to assess, diagnosis Gaps in referral network Punitive Supervisor Friends Enforcement agencies 11
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Go where women can be found
Focus on reducing stigma
Encourage women to seek treatment by acknowledging their struggles as well as their efforts at coping in their environment
“Love women into treatment”
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Addiction is not an isolated disease
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Women have a variety of issues and needs such as economic independence, gender role expectations, low self worth, etc.
Interactions of biological, psychological, cognitive, social development and environmental variables are all considered
Identify benefits of harm reduction services.
Current instruments may not take into account gender differences.
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Women are heterogeneous and diverse Require a comprehensive assessment to identify and meet individual needs that is made from a biopsychosocial and sociocultural perspective
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External factors: Cultural, Religion, Family, Peers
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Social factors: Situation, social relations, social structures
Misuse, Abuse & Dependency - Result of external forces that act as social stressors (unemployment, poverty, violence, etc.)
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Developed primarily by men concerned with types of problems experienced more frequently by men
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Basic assumptions and program models/services tend to be male responsive
Despite 30 years of research and advocacy, AOD services remain more accessible and appropriate for men in most locations
Concerns about women are often primarily related to pregnancy
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1960s Generic Treatment – male as client 1970s Gender Differences – biological, parenting, psychosocial 1980s Gender Specific – separate facilities, childcare or child live-in, transportation, special groups or services 1990s-2000s Gender Responsive – trauma informed, relational theory, strengths-based
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Definition Creating an environment through site selection, staff selection, program development, content, and material that reflects an understanding of the realities of the lives of women and girls and that addresses and responds to their strengths and challenges.
Source: Bloom, Owen & Covington (2004) 20
Acknowledge that gender makes a difference
Create an environment based on safety, respect and dignity
Develop policies, practices and programs that are relational and promote healthy connections to children, family, significant others and the community
Attend to the relevance and influence of various caregiver roles women often assume
Source: Bloom, Owen, and Covington, 2003; TIP 51: Addressing the Specific Needs of Women 21
Address substance use, trauma and mental health issues through comprehensive, integrated and culturally relevant services
Validation of behaviors that have allowed survival to reduce shame and guilt
Provide women with opportunities to improve their socioeconomic status
Recognize societal attitudes towards women who abuse substances; stigma and stereotypes
Establish a system of comprehensive and collaborative, community services
Source: Bloom, Owen, and Covington, 2003; TIP 51: Addressing the Specific Needs of Women 22
Take the trauma into account
Avoid triggering trauma reactions and/or traumatizing the individual
Adjust the behavior of workers and the organization to support the individual’s coping capacity
Allow survivors to manage their trauma symptoms successfully to promote access, retention and benefit from services
Source: Fallot and Harris (2001) 23
Adequate treatment period is crucial
Individual & group counseling (women only)
Co-occurring disorders treated in an integrated way
Medication as needed
Uses components of Feminist Theory, Self-in Relation Theory, the Empowerment Model and Strengths Perspective
Recovery is a long term process & frequently requires multiple treatment episodes
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Supportive therapy - warmth, empathy, connection during crisis
Confrontation based on awareness, understanding and trust
Collaborative approach with client that is active, optimistic and builds on client’s strengths and ability to solve problems
Treatment shares with client what has helped others in the past and client is the expert on what will work for her
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Type of Treatment Services
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Gender specific groups Various services all in one location
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On-site childcare and transportation
Therapeutic Alliance & Counselor Characteristics
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Individual counseling Trust & Warmth vs. Problem-Solving approach
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Initially receive greater intensive care Female staff
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Women in gender-specialized programs:
Use more services throughout treatment than women in traditional coed program
Have higher rates of abstinence
More likely to see themselves as doing well in treatment
Twice as likely to complete gender specialized program
Source: Nelson-Zupko, et al (1996), Messina et al (2012) 27
Identify the types of barriers for entering and engaging in substance use treatment (systemic, structural, and cultural, social and personal barriers) in the following vignette and ways to overcome these barriers.
Lisa is a 28-year-old, single/never married, Hispanic, mother of three children (ages 2, 4, 7, and 10). She has a history of alcohol and opioid dependence and became pregnant with her youngest son while using Vicodin. She is currently taking Suboxone that she is getting from an ex-boyfriend. She is residing with an acquaintance in a rural area, has unreliable transportation. She has no close friendships. She has a family history of addiction. She called a substance use treatment agency in her community but was unable to schedule an appointment due to not having childcare for her youngest two children.
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All Women Women with Risk Factors An “Ideal” System for AOD Prevention and Treatment for Women
Women Informed Health Promotion Universal Prevention Women-Focused Selected & Indicated Prevention
Women Developing AOD problems
Better & Earlier Outreach & Case Finding, Accurate Screening and Assessment, Brief Treatment, Engagement
Women in Need Of Treatment
Assessment Fewer Barriers to Treatment More Women Informed, Friendly & Centered Services & Programs Better Outcomes Less Relapse Fewer Women with AOD Problems & their Consequences 31
Questions/Comments
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Binswanger, I. A., Merrill, J. O., Krueger, P. M., White, M. C., Booth, R. E., & Elmore, J. G. (2010). Gender differences in chronic medical, psychiatric, and substance-dependence disorders among jail inmates. American Journal of Public Health, 100, 476-482.
Bloom, B., Owen B., & Covington, S. (2003). Genders-responsive Strategies: Research, Practice, and Guiding Principles for Women Offenders. Washington, DC: National Institute of Corrections.
Bloom, B., Owen, B., & Covington, S. (2004). Women offenders and gendered effects of public policy. Review of Policy Research, 21, 31-48.
Center for Disease Control : http//www.cdc.gov
Fallot, R., and Harris, M. (2001) A trauma-informed approach to screening and assessment
New Directions for Mental Health Services 89, 23–31.
Grella, C. (2008). From generic to gender-responsive treatment: Changes in social policies, treatment services, and outcomes of women in substance abuse treatment. Journal of Psychoactive Drugs, 40, 327-343.
http//www.elementsbehaviorhealth.com/addiction-treatment/women-have-special-needs-in substacne-abuse-treatment/ http//www.ncadi.samhsa.gov
Messina, N., Calhoun, S., and Warda, U. (2012) Gender-Responsive Drug Court Treatment: A Randomized Controlled Trial. Criminal Justice and Behavior 39(12):1539-1558 National Eating Disorder Association: http://www.nationaleatingdisorders.org
National Institute on Drug Abuse: http://www.drugabuse.gov
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Nelson-Zlupko, L., Dore, M. M., Kauffman, E., & Kaltenbach, K. (1996). Women in recovery: Their perceptions of treatment effectiveness. Journal of Substance Abuse Treatment, 13, 51-59.
Sherman, Carl.,(June 2006) NIDA NOTES 20(6). Straussner, S.L. (Ed.). (2004). Clinical work with substance-abusing clients. 2 nd The Guilford Press.
ed. New York: Substance Abuse and Mental Health Services Administration: http://www.samhsa.gov U.S. Department of Health and Human Services: TIP 51-Substacne Abuse Treatment: Addressing the Specific Needs of Women. http://www.samhsa.gov
Women Under the Influence. (2009, May 28). New York City, NY: Columbia University. Retrieved July 24, 2009 from, http://www.casacolumbia.org/absolutenm/templates/Publications.aspx?articlesid=421&zoneid =52 pictures/graphs obtained from Google Images Resources:
Stephanie Covington, Helping Women Recover: allows women to examine their relationships and support systems
Lisa Najavits, Seeking Safety and Woman’s Addiction Workbook: assists women in understanding healthy and unhealthy boundaries, strategies for identifying persons who can be positive (supportive) or negative (destructive) influences on their recovery, tactics for enhancing or minimizing those influences and activities to enhance support from other women
Monique Cohen, Counseling Addicted Women: A Practical Guide : provides client and staff activities surrounding relationship issues
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