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TIP 51 Specific Needs of Women
Instructor: Dr. Dawn-Elise Snipes PhD, LPC-MHSP
Executive Director, AllCEUs
Objectives
– Identify how the needs of men and women may differ
– Discuss conditions that are more typically diagnosed in women
– Highlight changes that can be made to increase access, engagement and retention of women in treatment
Introduction
– 6.2% females over 12 in the US have a substance use disorder
– AN was only associated with oppositional defiant disorder, not other psychiatric diagnoses
– Eating disorders among adolescents was often associated with functional impairment and suicidality
– BN and BED were associated with suicide attempts
Define the Problem
– Women have different physical responses to substances (impacted by smaller quantity)
– Women with substance use disorder have greater susceptibility to as well as earlier onset of serious medical problems and disorders (> problems, <doses, < time)
– Pregnancy is a significant concern
– Women who abuse substances are more likely than other women to have co-occurring disorders
– Women who have substance use disorders are more likely to have been physically or sexually traumatized and subjected to interpersonal violence
Influence of Relationships
– Significant relationships and family history play an integral role in the initiation, pattern of use, and continuation of substance abuse for women
– From a sociocultural perspective, women (more than men) tend to define themselves in terms of their webs of social relationships
– Women are more likely to be introduced to and initiate alcohol and drug use through significant relationships including partners, and family members
– Significant relationships and other adult family members may substantially influence and impact women’s behavior associated with treatment seeking, support for recovery, and relapse
– Women may have less support from family/partners than do men for seeking treatment.
– For women, pregnancy, parenting, and childcare influence alcohol and drug consumption and increase the likelihood of entering and completing substance abuse treatment
Women and Children
– Women are much more likely than men to enter treatment because it affects child custody
– If they are able to have their children in treatment, women are more likely to enter treatment, participate and stay in the program, and maintain abstinence
Unique Roles
– Women are more likely to encounter obstacles across the continuum of care as a result of caregiver roles, gender expectations, and socioeconomic hardships
– Women with substance use disorders have enhanced treatment needs related to pregnancy, care of children, and other caregiver roles.
Sources of Stress
– Overall, women report more interpersonal related stress in relation to negative affect whereas men report more legal and work-related stressful life events
Risk Factors
– Familial Substance Abuse
– Family of Origin Characteristics
◦ chaotic, argumentative, blame-oriented, and violent households.
◦ families where they take on adult responsibilities as a child, including household duties, parenting of younger children, and emotional support of parents
Statistics…
– Being Single or Divorced
◦ Approximately 11 percent of divorced or separated women and 16 percent of women who have never married (in age range of 18 to 49 years) abuse or are dependent on alcohol or an illicit drug compared to only 4 percent of married women (SAMHSA 2004).
– Partner who uses substances
Personal High-Risk Characteristics
– Personal characteristics
◦ Poor self image
◦ Low Self Esteem
◦ High Anxiety
◦ Difficulty Self-Soothing
◦ Sensation Seeking (Crisis Prone/Drama)
◦ Depressive Features
◦ Childhood Trauma (Numb, Sociability, Vigilance)
– Timeline Exercise
Drugs of Choice
– Women are significantly more likely to use and abuse prescription medications, including anxiolytics (antianxiety medications) and narcotic analgesics (pain medications), than are men
Conditions More Common in Women
– Pregnancy
– PMDD
– Polycystic Ovarian Syndrome
– Menopause
– Migraines (18%/3%)
– Hypertension after age 50
– Rheumatoid Arthritis
– Irritable Bowel
– Restless Legs
– Lupus
– Fibromyalgia (90%/10%)
◦ “It is a neurochemical disease,” says Yunus, who points out that people with fibromyalgia show a higher than average amount of substance P, a neurotransmitter that signals pain, and a lower than average amount of serotonin, a neurotransmitter that inhibits pain.
Barriers to Treatment
– Intrapersonal: Individual factors including health problems, psychological issues, cognitive functioning, motivational status, treatment readiness, etc.
– Interpersonal: Relational issues including significant relationships, family dynamics, support systems, etc.
– Structural: Program characteristics including treatment policies and procedures, program design, and treatment restrictions.
– Sociocultural: Social factors including cultural differences; the role of stigma, bias, and racism; societal attitudes; disparity in health services; attitudes of healthcare providers toward women; and others.
– Systemic: Larger systems including Federal, State, and local agencies that generate public policies and laws; businesses including health insurance companies; and environmental factors such as the economy, drug trafficking patterns, etc.
Treatment retention
– Family/SO Support
– Avoiding relationships in treatment
– Women over 21
– More Education
– Criminal Justice or Child Protective Services Involvement
– Pregnancy
– Trauma informed, supportive, strengths based approach (i.e Seeking Safety)
Overview of What Can Be Done
– Acknowledge the importance and role of socioeconomic issues and differences among women.
– Promote cultural competence specific to women.
– Recognize the role and significance of relationships in women’s lives
– Address women’s unique health concerns
– Endorse a developmental perspective.
– Attend to the relevance and influence of various caregiver roles that women often assume throughout the course
– Recognize that ascribed roles and gender expectations across cultures affect societal attitudes toward women who abuse substances.
– Adopt a trauma-informed perspective.
– Utilize a strengths-based model for women’s treatment.
Summary
– Everyone needs to have basic needs, safety and social support needs met
– Women face some unique challenges based upon
◦ Sociocultural expectations (esp. caregiving)
◦ Medical and mental health conditions more common in women