Transcript Women and Addiction

The Case for Gender Separate
Treatment
Kendall P. Weinberg, M.Ed., LPC
Doug N. Brush, B.S., CACII
Director, MARR Women’s Recovery
Center
Director, MARR Men’s Recovery
Center
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Objectives

How the process of active addiction
differs for men and women

How the recovery process differs for men
and women

Benefits and challenges of addressing
differences using gender separate
treatment philosophy
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History of Gender Separate
Treatment at MARR

1975 Men’s residence (+) contracted outpatient treatment

1980 Women’s residence - separate from men (+)
contracted outpatient treatment (same facility)

1988 Separate in-house day treatment programming for
men and women

1990’s Ongoing development of gender specific
programming

2003 Separate recovery communities
(Lawrenceville and Doraville= 20 miles)
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The Jellinek Curve
(Covington, 1997)

In 1945, AA mailed 1600 questionnaires

158 responses

113 valid responses

98 responses described similar patterns

15 responses “differed so greatly” they were thrown out
(sample too small to analyze separately)

50+ years of the Jellinek Curve

1994 NIH issues guidelines requiring the inclusion of
women in NIH-funded studies on drug abuse/dependence
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The Spiral of Addiction and Recovery
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.”
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Physiological Factors
for Females

Female brain centers for language / hearing have 11% more
neurons

Have a larger Hippocampus (hub for emotion / memory
formation)

Better equipped to read facial expressions / hear vocal tones

Become intoxicated faster / addicted faster

Mortality rates are higher for female substance abusers (50100x)

Hormonal shifts:

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Estrogen, Testosterone, Progesterone, Oxytocin
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Progesterone Peaks
Estrogen &
Testosterone peak
Evolutionary Factors for
Females:

Survival = Connection = Successful connections = Self-Esteem
 Biologically wired to sustain / nurture / respond to relationships
 Keeping social harmony helps sustain connection & avoid danger
 Conflict alerts women that a connection may be threatened


Use ability to read faces / hear vocal tones to anticipate others’ needs,
respond to unspoken cues and quell the threat
Use relationship skills (or manipulation) to compensate for lack of
power (physical / societal / political / economic)

Fight/Flight vs. Tend & Befriend or “Mean Girls”
Males:

Survival = Achievement = Independence =

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Self-Esteem
Conflict may provide boost to self-esteem; competition
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Relationship Factors
for Female Addicts

Relationships are primary
Ruptures in primary relationships = Trauma
History of physical abuse / sexual abuse / abandonment
More likely to be divorced, separated or widowed.

Trauma breeds more trauma
Untreated


Females begin / perpetuate drug use to develop or maintain
intimate relationships
More likely to come from substance abusing / dysfunctional family
How

symptoms of PTSD
Self medication = continued / escalation of victimization
/ When to include family / SO’s in treatment if they are part of cycle of abuse?
Males: begin / maintain use w/ friends or in context of drug trade activities
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So, women are physiologically built for
relationships and they flourish when they can
connect to others in a healthy way…
How to incorporate these issues into successful
treatment…
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Considerations for Treatment
of Female Addicts:

Provide Safety:




Address Trauma History:




Space to tell the story / feel the emotions
Teach HEALTHY coping skills / conflict resolution
Attachment
Address Co-morbidity (Psychiatric Dx’s) Simultaneously and Ongoing:




Single gender groups vs. mixed gender groups
Realign relationship patterns / Decrease risk for repeated victimization / Normalize Grief
Shame / Stigma = “Good moms don’t abuse drugs/alcohol.”
Depression (70%), Bi-Polar
Eating disorder (72% for those under 30)
Borderline Personality Disorder vs. Anti-social traits
Address Co-morbidity (Biological):



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HIV / AIDS / Hepatitis
Cirrhosis / Chronic Pain / Thyroid / Hormonal Shifts
Pregnancy / Post-Abortion / Infertility / HPV
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Treating the Addicted Woman
Establish a Healing Environment
Health
Empowerment
Connection
Safety
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Core issues for Males
Entering Treatment
•
•
•
•
•
•
•
Trust
Building Intimacy
Focus on commonness vs.
differences
Identification of emotions
Emotional honesty
Foundational recovery
Break through denial
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•
•
•
•
•
•
•
Acceptance
Surrender
Accountability
Manage anger (fear, pain)
Fear of intimacy
Behavioral symptoms
Sexual abuse
Early sexual experiences
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Trappings of Mixed
Gender Treatment

Rescuing

Emotional safety

Fixing

Nothing to offer

Avoiding self


Focusing on others
Relationships = sex in
early recovery

Stress of mixing
sexes

Task oriented
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Challenges/Benefits in
Gender Separate Tx
Challenges
Benefits

Separate facilities: Cost

Safety

Separate facilities: Policies

Embraces gender differences

Building support within non-

Increased LOS
recovery community

Clearer definition of
boundaries
Reduced cross over in
recovery communities
(less pairing off)
Decrease opportunity for
continued victimization



Separate staff
Exposure to healthy
boundaries with opposite sex?
Additional training for staff
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References

Aries, E. (1976). Interaction patterns and themes of male, female, and mixed
groups. Small Group Behavior, 7, 7-18.

Brizendine, L. 2006. The Female Brain. New York, NY: Broadway Books.

Covington, S. 1997, Helping Women Recovery Curriculum, A Program for Treating
Addiction, Hazelden, Center City, MN.

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
American Journal on Addictions.

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 sociocultural approaches (pp. 179-196). Binghamton, NY: Haworth.
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References

Vander Kolk, B. 1996 . Psychological Trauma. Washington, D.C.:
American Psychiatric Press, Inc.

Wetherington, C.L. (2007). Sex-Gender differences in drug abuse: A shift
in the burden of proof?. Experimental and Clinical
Psychopharmacology, 15(5), 411- 417.

DASIS Report, 2005

NSDUH report, 2006
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