Your Choice for Recovery and Change

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• Your Choice for Recovery and Change.
• 3800 Packard Road Suite 210
• Ann Arbor, MI 48108

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Women and Addiction

• Gender Responsiveness in Services for
• Substance Use Disorders
• Julie Cushman LMSW, ACSW, CAADC

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Objectives

• Identify at least three barriers that impact a
  womens 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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Need ForGender Responsive Services

• 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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Barriers to Treatment
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Barriers to Treatment

• Systemic - impede the development of services
  that respond to womens 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 womens roles and behavior that is
  considered appropriate womens lack of
  empowerment in many societies and societal and
  community norms and attitudes about women who
  have substance use problems.

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Systemic Barriers

• 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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Structural Barriers

• Childcare
• Transportation
• Services for pregnant women
• Location cost of treatment programs
• Rigid program schedules
• Waiting lists

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Structural Barriers Continued

• Denial of admission to women using psychoactive
  medication
• Service coordination
• Lack of identification, referral, intervention
  in primary care and other sectors
• Lack of diagnosis or misdiagnosis
• Information on treatment options
• Physical safety

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Social, Cultural, Personal Barriers

• Fear of leaving children/losing custody of
  children
• Lack of support from family or partners
• Family history of substance abuse
• 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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Barriers to Intervention
Social Service Agencies
Physician
Supervisor
Attitudes Reluctance to
address Not able to assess, diagnosis Gaps in
referral network Punitive
Family
Friends
Teacher
Enforcement agencies
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Gender Responsiveness in Outreach, Screening
Assessment
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Outreach

• 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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Screening and Assessment

• Addiction is not an isolated disease
• 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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Screening and Assessment

• Women are heterogeneous and diverse
• Require a comprehensive assessment to identify
  and meet individual needs that is made from a
  biopsychosocial and sociocultural perspective
• External factors Cultural, Religion, Family,
  Peers
• 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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Gender Responsiveness in Treatment
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History of Substance Abuse Field

• Developed primarily by men concerned with types
  of problems experienced more frequently by men
• 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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Evolution of Treatment

• 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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Gender Responsive Treatment

• 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)

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Guiding Principles

• 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

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Guiding Principles (continued)

• 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

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Trauma Informed Services

• 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 individuals coping
  capacity
• Allow survivors to manage their trauma symptoms
  successfully to promote access, retention and
  benefit from services
• Source Fallot and Harris (2001)

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Effective Treatment

• 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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Factors That Influence Retention for Women In
Treatment

• 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 clients
  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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Factors That Influence Retention for Women In
Treatment (Continued)

• Type of Treatment Services
• Gender specific groups
• Various services all in one location
• Initially receive greater intensive care
• Individual counseling
• On-site childcare and transportation
• Therapeutic Alliance Counselor Characteristics
• Trust Warmth vs. Problem-Solving approach
• Female staff

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Outcomes

• 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)

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ACTIVITYPUTTING IT ALL TOGETHER

• 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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An Ideal System for AOD Prevention and
Treatment for Women
Women Informed Health Promotion Universal
Prevention
All Women
Women with Risk Factors
Women-Focused Selected Indicated Prevention
Women Developing AOD problems
Better Earlier Outreach Case Finding,
Accurate Screening and Assessment, Brief
Treatment, Engagement
More Women- Informed, Friendly
Centered Services Programs
Better Outcomes Less Relapse
Fewer Women with AOD Problems their Consequences
Assessment Fewer Barriers to Treatment
Women in Need Of Treatment
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Questions/Comments
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References

• 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, 2331.
• 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-tre
  atment/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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References

• 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. 2nd ed. New York
  The Guilford Press.
• 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/ab
  solutenm/templates/Publications.aspx?articlesid42
  1zoneid52
• 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 Womans
  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