Transcript Women and Addiction

Women and Addiction
Kendall P. Weinberg, M.Ed., LPC
Director, MARR Women’s Recovery Center
CAPTASA
Lexington, KY
January 25, 2013
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The Spiral of Addiction and Recovery
(Covington, 1997)
Transformation
Recovery
(expansion)
Addiction
(constriction)
“Alone in their homes, they simply pulled the shades down, stopped answering
the phone and disappeared into their ever contracting world.” (Dayton, 2003)
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Why do we need this lecture?
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Research including female subjects is still fairly new - 8%
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Rates of addiction/alcoholism females 12-17 mirror rates for males
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Booming senior population -  Recognition / Over prescribing
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Factors contributing to addiction / recovery more complex for
females
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“Feminization of Higher Education” = more impaired female
professionals in healthcare and professional settings
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“Good moms don’t use drugs and alcohol” – Shame kills and
stigma still more prevalent for female addicts/alcoholics
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*Connections: A 12-Session Psychoeducational Shame-Resilience Curriculum. Brené Brown, Ph.D., LMSW, 2009
• “Who do you think you are?”
•
Unworthy, unlovable, incapable, inadequate,
broken, weak, flawed…
• “You’ll never be good enough.”
• Hide your faults, disappear, pretend to be perfect, or
transform into what others expect of you.
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Keys to Shame Resilience
*Connections: A 12-Session Psychoeducational Shame-Resilience Curriculum. Brené Brown, Ph.D., LMSW, 2009
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Authenticity
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Emotionally honest, set boundaries, be vulnerable
Exercise compassion for self / others
Let go of what we are supposed to be; Embrace who we are
Love and Belonging
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Internal sense of belonging vs. Search for external acceptance / approval
Trying to “fit in” or “be cool” gets in the way of true belonging
We are worthy of love; allow ourselves to be deeply seen / known
Love the ordinary and imperfect parts of ourselves
Practice forgiveness and self-compassion
• A Resilient Spirit
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Tell our stories practicing hope & gratitude while embracing vulnerability
Honor faith and intuition
Value perseverance and rest
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Hold joy and laughter sacred
Women and Addiction
•
Physiological Factors
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Evolutionary Psychological Factors
•
Relationship Factors
•
Considerations for Treatment of Female
Addicts
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Physiological Factors
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All fetal brains are structured as female until 8 weeks gestation
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Females = sprout connections in communication / emotion centers – 11% more neurons
Males = MIS + Testosterone defeminize brain structure; growth in sex / aggression centers
Females have a larger Hippocampus
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Hub for emotion & memory formation / fight or flight response
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Females better equipped to read facial expressions / hear vocal tones
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1st 3 months girls’ skills in eye contact / facial gazing increase 400%
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Little to no increase for boys; increased ability to track objects in motion
Difference in Serotonin systems
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Prevalence of mood / anxiety disorders for women
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Females become intoxicated faster / addicted faster (Telescoping)
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Mortality rates are higher for female substance abusers (50-100x)
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Physiological Factors:
Hormonal Shifts
Estrogen:
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Promotes social interest
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Provides a sense of well-being
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Causes one to feel more socially relaxed
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Causes one to seek intimacy with others
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Spikes during the 1st two weeks of monthly cycle
Testosterone:
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Trigger for sexual desire
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Men have on avg. 10-100x more testosterone than women
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Physiological Factors:
Hormonal Shifts
Progesterone:
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Causes increased irritability
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Causes women to seek aloneness
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Increases reactivity to relationship stress
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Curbs sexual desire
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Peaks during 2nd half of monthly cycle
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Progesterone Peaks
Estrogen &
Testosterone peak
Physiological Factors:
Hormonal Shifts
Oxytocin:
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Triggers / Is triggered by intimacy – the “cuddle hormone”
Reduces stress
Estrogen fuels Oxytocin and Dopamine (REWARD!) production
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Oxytocin / Dopamine = PLEASURE akin to cocaine or heroin
(+) Chemical reaction of being “In Love”
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INTENSE – shares neural circuits with states of obsession, mania,
intoxication, thirst, hunger
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REJECTION = Drop in Oxytocin / Dopamine / Estrogen
(-) chemical reaction mimics withdrawal symptoms
Relationships = huge relapse risk factor in all stages of recovery
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Evolutionary
Psychological Factors:
“Our modern skulls house a stone age mind…”
Females
Males
Connection = Survival
Achievement = Survival
Connection requires honed social skills
Achievement requires competition
Conflict alerts that connection may be
threatened; out of group? SHAME?
Conflict may provide opportunity to secure
elevated status within group
Security: Use ability to read faces,
discern vocal tones, anticipate others’
needs and respond to unspoken cues
Security: Increased social status allows
easier defense of territory / leverage of
power / obtain resources
Threats: Connections can help to deal
with threat /danger - Tend and Befriend
Threats: Fight or Flight more likely; avoid
appearance of vulnerability
Self-esteem = ability to sustain intimate
relationships
Self-esteem = ability to gain independence
Major
Treatment goal for women =
Major Treatment goal for men =
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Fix your picker / Find your voice
Learn to connect / Vulnerability OK
Relationship Factors
for Female Addicts:
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Relationships are primary
Ruptures in primary relationships = Trauma
History of Physical Abuse / Sexual Abuse / Emotional
Abuse / Abandonment / Active Neglect / Passive
Neglect / Divorce / Separation / Loss of Loved Ones /
Severe Illness
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Trauma breeds more trauma:
Untreated symptoms of PTSD
Self Medication (Behaviors / Chemicals)
Continued / Escalation of Victimization
Pattern of Trauma Reenactment
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Relationship Factors
for Female Addicts:
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More likely to come from substance abusing / dysfunctional family
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How much – When - If to include family / significant others in treatment if they
are part of cycle of abuse?
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More likely to be divorced, separated or widowed.
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Females begin / maintain use to develop or maintain intimate
relationships
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Males begin / maintain use with friends or related to drug trade activities
Minimal / Conditional support for recovery
“When are you coming home?”
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So, women are
Physiologically / Neurologically / Evolutionarily
built for relationships and they flourish when
they can connect to others in a healthy way…
How to incorporate these issues into successful
addiction treatment…
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Considerations for Treatment
of Female Addicts:
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Provide Safety:
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Single gender groups vs. Mixed gender groups
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Realign relationship patterns / Decrease risk for repeated
victimization
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Shame and Stigma = “Good moms don’t abuse drugs/alcohol”
or core message of “I’m bad / worthless / broken / incapable.”
Address Trauma History:
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Space to tell the story / Feel the emotions / Normalize grief
Teach HEALTHY coping skills / Conflict resolution / Normalize
conflict
Attachment (anxious / avoidant vs. secure) / Normalize
vulnerability / Reaffirm instincts
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Considerations for Treatment
of Female Addicts:
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Address Co-morbidity (Psychiatric Dx’s)
Simultaneously:
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Depression (70%) persists into recovery, Bi-Polar, Anxiety
Eating disorder - 30-35% for those seeking addiction treatment
Borderline / Dependent Personality Disorder vs. Narcissistic and
/or Anti-social traits (more prevalent for males)
Address Co-morbidity (Biological Dx’s):
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HIV / AIDS / Hepatitis / HPV – more likely to contract
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Cirrhosis / Cardiac functioning / Chronic Pain / Thyroid /
Hormonal Shifts / Somatization / GI Symptoms
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Pregnancy / Post-Abortion / Infertility / Pre- & Post- Menopause
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Treating the Addicted
Woman:
Establish a Healing Environment
Health
Empowerment
Connection
Safety
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Treating the Addicted
Woman:
Establish a Healing Environment
•
Authenticity
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Love and Belonging
Health
Empowerment
Connection
•
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Internal sense of belonging, worthy,
deeply seen/known, love imperfections,
practice forgiveness / self-compassion
• A Resilient Spirit
•
Safety
Emotional Honesty, boundaries,
vulnerable, compassion for self/others,
embrace who you are
Tell stories w/ hope / gratitude, honor faith
/ intuition, value perseverance & rest, hold
joy and laughter sacred
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References
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Aries, E. (1976). Interaction patterns and themes of male, female, and mixed groups.
Small Group Behavior, 7, 7-18.
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Brizendine, L. (2006). The Female Brain. New York NY: Morgan Road Books.
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Brown, B. (2009). Connections: A 12-Session Psychoeducational Shame-Resilience
Curriculum. Center City, MN: Hazelden.
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Covington, S. (1997). Helping Women Recovery Curriculum, A Program for Treating
Addiction. Center City, MN: Hazelden.
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Dayton, T. (2003). Psychodrama and the treatment of addiction and trauma in
women. In J. Gershoni (Ed.), Psychodrama in the 21st century: Clinical and
educational applications (pp.175-196). New York, NY: Springer Publishing
Company, Inc.
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Najavits, L.M., Weiss, R.D., & Shaw, S.R. (1997). The link between substance abuse
and posttraumatic stress disorder in women: A research review. The
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American Journal on Addictions.
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References
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Priyadarsini, S. (1986). Gender-role dynamics in an alcohol therapy group. In D.L.
Strug, S. Priyadarsini, & M.M. Hyman (Eds.) Alcohol interventions: Historical
and
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sociocultural approaches (pp. 179-196). Binghamton, NY: Haworth.
Substance Abuse and Mental Health Services Administration, Office of Applied
Studies. (May 20, 2005). The DASIS Report: A Comparison of Female and Male
Treatment Admissions: 2002. Rockville, MD.
http://www.samhsa.gov/data/2k5/genderTX/genderTX.htm
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Substance Abuse and Mental Health Services Administration, Office of Applied
Studies. (August 5, 2005). The NSDUH Report: Substance abuse and
dependence among women. Rockville, MD.
http://www.oas.samhsa.gov/2k5/women/women.htm
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Tuchman, E. (2010). Women and Addiction: The importance of gender issues in
substance abuse research. Journal of Addictive Diseases, 29, 127-138.
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References
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Vander Kolk, B. (1996). Psychological Trauma. Washington, D.C.: American
Psychiatric Press, Inc.
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Weiss, S.R.B., Kung, H.K., & Pearson, J.L. (2003). Emerging Issues in gender and
ethnic differences in substance abuse and treatment. Current Women’s Health
Reports, 3, 245-253.
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Wetherington, C.L. (2007). Sex-Gender differences in drug abuse: A shift in the
burden of proof? Experimental and Clinical Psychoparmacology, 15(5), 411-417.
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Zaidi, Z.F. (2010). Gender differences in Human Brain: A Review.
The Open Anatomy Journal, 2, 37-55.
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Zhao, Y., Encinosa, W. An Update on Hospitalizations for Eating Disorders,
1999 to 2009. HCUP Statistical Brief #120. September, 2011. Agency
for Healthcare Research and Quality, Rockville, MD. http://www.hcupus.ahrq.gov/reports/statbriefs/sb120.pdf
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