As the 2013 National Survey on Drug Use and Health revealed, there is a gender dimension to drug use. With an eye on male versus female patterns of drug use, the survey found:
Further, according to the National Institute on Drug Abuse (NIDA), nearly 50 percent of all women age 15-44 have used drugs at least once in their lives. This statistic supports an important point – anyone can use drugs, many Americans have, and with continued use, everyone is at risk for addiction.
As NIDA further discusses, AIDS has become the fourth leading cause of death in women. More than 70 percent of women with AIDS contracted HIV through drug-related behavior (either self-abuse of intravenous drugs or having sexual relations with a man who injects drugs). While there is no cure for HIV/AIDS, this disease is preventable. Throughout the US, clean needle programs are available to provide sterile needles to intravenous drug users and also to safely dispose of used syringes.
The Substance Abuse and Mental Health Services Administration (SAMHSA) provides a comprehensive report on how clinicians can address the special needs female substance abusers may present in treatment. It is important to note that any discussion about women’s needs is generalized, there are exceptions, and men may face similar issues. Treating a woman’s specific needs includes substance abuse treatment professionals taking into account the woman’s:
For many women, relationships directly impact their self-esteem and disconnections in relationships can directly lead to a diminished perception of oneself. Disconnections often involve relationships where there is an imbalance of power with the result that a woman thinks she has little or no voice and feels disempowered. In extreme cases, a disconnection can involve physical or sexual abuse.
Women in relationships with a high disconnection are not only at risk for drug abuse, but also under-treatment. The disconnection may be occurring presently and/or have occurred in the past as part of a family dynamic. SAMHSA urges clinicians to be sensitive to relationship dynamics in a female substance abuser’s present life and family history because repeated disconnections can damage healthy personality development, fuel drug abuse, and be a factor in relapse. SAMHSA further advises clinicians to offer therapeutic treatment geared toward improving relationship skills, including:
As SAMHSA discusses, many women abuse drugs or alcohol to cope with trauma and loss related to relationships with romantic, or once romantic, partners (female and male partners included). According to one study, a woman’s substance abuse is usually connected to her relationship with her partner, therefore achieving sobriety but maintaining the relationship can present a relapse risk. SAMHSA advises clinicians to set aside their own opinions about the unhealthy relationship a patient may presently be in and to motivate the patient to honestly examine the relationship.
Clinicians are also advised to be mindful of any financial dependence that a woman may have on a partner as well as any issues related to children the couple may have. Safety must always be the top priority, and in cases of domestic violence, clinicians will need to be prepared to provide referrals to domestic violence professionals as well as shelters. Lastly, where safety is not an issue, clinicians should consider the pros and cons of involving the partner in the female substance abuser’s recovery program.
Healthy sexual relations are an important factor in one’s feelings of self-worth. Drug abuse is a major challenge to a healthy sex life. Further there is a stereotype of female substance abusers which holds that they are promiscuous, although the same stigma is generally not associated with male drug abusers. This stereotyping can put drug-abusing women at risk of being the victims of sexual misconduct as well as damaging their self-image and body identity.
A woman’s perception of her sexuality may change when she recovers but not always with a positive result. As SAMSHA reports, in one study, female drug abusers reported that sexuality was one of the main areas of change in their life during the period of time from drug dependence to sobriety, and this change proved to be a major relapse trigger. To counteract this tendency, SAMHSA advises clinicians to work with female patients to tease out connections between drug abuse and sexuality, sexual identity, sexual abuse, body image and any fears surrounding sexual activity.
Drug treatment for women with children must take into account the woman’s parenting role. Female drug abusers who are also parents are at risk for under-treatment of drug abuse because they may lack child care or harbor a fear that authorities will take custody of the children (men who are the primary caregivers for their children could also face these issues). A woman with children will often experience parenting as central to her identity.
SAMHSA recommends that treatment for these women includes therapy that addresses their maternal role and provides for the physical and mental health care needs of the children; addiction treatment specialists may have to collaborate with an appropriate child welfare service provider. As SAMHSA notes, research supports that women in drug rehab most often report that they want to be good mothers. This desire can motivate recovery and help to keep a female patient in treatment.
As the SAMHSA report points out, there are numerous considerations and treatment recommendations involved in drug rehab for women. A common theme, however, is learning about the woman’s family arrangement and social network in order to address any obligations, such as child care, which she may have. In some instances, it is enough that drug treatment addresses drug abuse. At other times, there may be additional concerns at issue that require even greater sensitivity in providing treatment services.
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Integrated Treatment of Substance Abuse & Mental Illness