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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 EffectFemales 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 disordersParental StressTrauma HistorySpecific 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 powerLimited awareness of gender differencesLack of knowledge of women with substance
use problems and their treatment needsLack of appropriate gender-responsive and
low-cost, evidence-based treatment modelsDifferences in the organization and funding
of health servicesNeed for a comprehensive array of services
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Childcare TransportationServices for pregnant womenLocation & cost of treatment programsRigid program schedulesWaiting lists
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Denial of admission to women using psychoactive medication
Service coordinationLack of identification, referral, &
intervention in primary care and other sectors• Lack of diagnosis or misdiagnosis
Information on treatment optionsPhysical safety
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Fear of leaving children/losing custody of childrenLack of support from family or partners
• Family history of substance abuse• Involvement with substance abusing partners
Substance use perceived as solution, not problemLack of information of services (Straussner, 2004) Lack of confidence in the effectiveness of treatmentStigma, shame, & guiltLow self-esteemTrauma History
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Physician
Family
Teacher
Enforcement agencies
Friends
Supervisor
Social Service Agencies
Attitudes
Reluctance to address
Not able to assess, diagnosis
Gaps in referral network
Punitive
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Go where women can be foundFocus on reducing stigmaEncourage 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 • 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
• 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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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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1960sGeneric Treatment – male as client1970sGender Differences – biological, parenting,
psychosocial1980sGender Specific – separate facilities,
childcare or child live-in, transportation, special groups or services
1990s-2000sGender Responsive – trauma informed,
relational theory, strengths-based19
DefinitionCreating 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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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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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 accountAvoid triggering trauma reactions and/or
traumatizing the individualAdjust 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)
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Adequate treatment period is crucialIndividual & group counseling (women only)Co-occurring disorders treated in an
integrated wayMedication as neededUses 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• 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 26
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 withRisk Factors
Women Developing AOD problems
Women in NeedOf Treatment
Women Informed Health PromotionUniversal Prevention
Women-Focused Selected & Indicated Prevention
Better & Earlier Outreach & Case Finding, Accurate Screening and Assessment, Brief Treatment, Engagement
AssessmentFewer Barriers to Treatment
More Women-Informed, Friendly& CenteredServices & Programs
Better OutcomesLess Relapse
Fewer Women with AOD Problems & their Consequences
An “Ideal” System for AOD Prevention and Treatment for Women
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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 33
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/absolutenm/templates/Publications.aspx?articlesid=421&zoneid=52
pictures/graphs obtained from Google Images
Resources: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 34
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