CSAT’s Co-Occurring and Other Functional Disorders Cluster Group

Colleen Clark, Ph.D Florida Mental Health Institute Tampa, Florida

One of the newest buzzwords in mental health and substance abuse these days is “gender-specific” programming. What most people are really talking about are research, programs, training, and treatment for women that are based on a deeper understanding of women. In the past it has been assumed that “one size fits all.” One approach was to design all programs for men and women and ignore differences. Another potentially more destructive approach has been to base research and treatment on findings of work with men only and not attempt to understand if they also apply to women.

Gender differences: Men and women suffer mental disorders at the same rate, however the types of disorders differ. Men are more likely to have substance use and antisocial personality disorders. Women are more likely to have anxiety, affective, and somatization disorders.

 

There are also gender differences in physiological responses to alcohol. Women develop adverse health consequences from the use and abuse of alcohol and other drugs over shorter time periods and with lower consumption than men. This phenomenon results in women entering substance abuse treatment at generally the same ages as men, but with shorter histories of substance abuse and more severe consequences.

More than men, women minimize the harmfulness of their drinking and tend to be supported in their drinking by their spouses. Because of the stigma attached to female alcoholism, the female alcoholic is likely to seek help from health care professionals rather than from substance abuse programs.

Although men have a greater risk of exposure to many traumatic events, the prevalence of PTSD is higher in women than men in some studies; a difference accounted for by women’s greater likelihood of developing PTSD after experiencing traumatic events. For example, being a witness to violent events that occur to others led to significantly higher rates of PTSD in exposed women than exposed men.

Although men are more often in physically dangerous situations, women are at higher risk as children and adults to be targets of personal violence. In a prospective study of female rape victims, 94% of the women met symptom criteria for PTSD within 2 weeks following the assault. Over time, rates of PTSD decreased, but 47% continued to meet PTSD criteria 3 months post-rape.

There is some evidence that the link between PTSD and substance abuse may be stronger among women than men:

  • Women using alcohol are more likely to be sexually victimized than men.
  • Women in outpatient drug abuse treatment are significantly more likely than male participants to report a history of sexual and physical abuse.

Implications for Treatment Considering the sociocultural context A traumatic event is one that overpowers one’s ability to cope. In working with any group that is generally or often powerless, it is vital to take into consideration their roles, pressures, and even stereotypes reflected in our society.

For women and female children, traumatic events can feed into one’s sense of powerlessness, including:

  • Physical powerlessness
  • Emotional dependence
  • Economic dependence

The issue or concept of empowerment is more than a clich in working with women that are survivors of trauma. Some of the most healing work is around becoming stronger physically stronger, financially independent, more in control of painful emotions and around building a positive image of oneself as a woman.

It also means it is vital that we look at the role of power in the treatment settings in which we work.

  • Issues in individual therapy–including male therapist–female client.
  • Issues in substance abuse treatment settings and models that emphasize ones powerlessness over substances.
  • Issues in mental health or inpatient hospitalization settings, including issues of seclusion.
  • The context and needs of women’s daily lives.

A report from the National Women’s Resource Center reviews the recent literature on gender-specific programming and finds that these models have many basic tenets in common. The overarching principle appears to be that comprehensive services and treatment must be based on understanding the context and needs of women’s daily lives. Such services:

  • Identify and build on women’s strengths;
  • Avoid confrontational approaches;
  • Teach coping strategies, based on women’s experiences, with a willingness to explore women’s individual appraisals of stressful situations;
  • Arrange for the daily needs of women, such as childcare;
  • Have a strong female presence on staff;
  • Promote bonding among women.

Finkelstein (1996) emphasizes the importance of reconceptualizing models for women with the understanding of the importance of relationships in their lives. For example:

  • Being married to a person with a substance abuse problem is a stronger risk factor in developing their own substance abuse problems for women than for men.
  • Women with children often avoid both substance abuse and homeless services out of legitimate concern that they may lose custody of their children.
  • Women are much more likely to be homeless because of relationship issues than men.

The substance abuse field has been a leader in understanding that a woman’s relationships with her children or substance-abusing partner, for example, can influence both recovery and relapse (Clark, 1999). Mental health researchers, clinicians and survivors have, however, informed the field of the impact of abuse in the development of mental health symptoms. Programs for women with dual disorders are coming more and more to see that interventions are only a small part of a woman’s life and to be successful, must see the woman in relation to herself, her family and her community.

When feeling overwhelmed with the many issues to consider in designing or providing treatment, trauma, mental health, substance abuse, gender, ethnicity, I find it helpful to follow a simple maxim: Listen to the client. Let the women tell you the realities of their lives and what they use to reach recovery. Their voice is our most powerful tool!

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