Women’s Issues in Chemical Dependency Treatment
An Abbreviated Review of the Literature
Jennifer Nyakundi
Pioneer Recover Center
March 12, 2010
Throughout the history of substance abuse treatment, counselors focused only on addiction and assumed that other issues would resolve themselves throughout the recovery process, or would be dealt with by another mental health professional at a later time. Additionally, many of the interventions were based on the needs of addicted men. (Covington, 2008) The Big Book of Alcoholics Anonymous (the manual for many twelve step AA meetings), for instance, was written by a man and speaks mostly from a man’s perspective of chemical dependency.
Research demonstrates that addiction treatment services for women need to be based on an integrated and women-centered approach that acknowledges their psychosocial needs. (Covington, 2008, p.377) Covington states “the keys to developing effective services for women are acknowledging and understanding their life experiences and the impact of living as a female in a male based society.” Covington goes on to identify common themes in the lives of addicted women. These include: shame and stigma, physical and sexual abuse, relationship issues including; fear of losing children, fear of losing partner, needing a partner’s permission to obtain treatment; treatment issues including: lack of services for women, not understanding women’s treatment, long waiting lists, and lack of childcare services; and lastly, systemic issues including: lack of financial resources, lack of clean sober housing, and poorly coordinated services. (Covington, 2008, p. 378)
Finkelstein, VandeMark, Fallot, Brown, & Cadiz define trauma as “experiencing, witnessing, or being threatened with an event or events that involve actual serious injury, a threat to the physical integrity of one’s self or others, or possible death. The responses to these events include intense fear, helplessness, or horror.” The rate of sexual and physical abuse among women in substance abuse treatment programs is estimated to range from 30 percent to more than 90 percent, depending on the definition of abuse and the specific target population. (Finkelstein, VandeMark, Fallot, Brown, & Cadiz, 2004, p.1) Gil-Rivas, Grella, & Prause, 2009 found that in individuals with co-occurring disorders sampled from 11 substance abuse treatment programs in Los Angeles County, CA a staggering 98.5 percent experienced at least one lifetime trauma exposure event. Over one third met the criteria for Post-Traumatic Stress Disorder (PTSD). (Gil-Rivas, Grella, & Prause, 2009, p.308)
There is longitudinal evidence that after an assault, the odds of both alcohol and drug use significantly increase among women with no previous history of substance use or assault. This same study found that drug use increases the risk for future assault, which then leads to an increase in substance use. (Walters, & Simoni, 1999) Since a large proportion of sexual victimization events involve drug or alcohol use, there has been much theoretical and research interest in the causal link between alcohol and drug use and subsequent sexual victimization. (Testa, VanZile-Tamsen, & Livingston, 2007)
Some women, mainly American Indian women, have to contend with multiple cumulative traumas (from the last two centuries) including colonizing events such as relocation to reservations, local tragedies including high rates of motor vehicle accidents and homicides, and interpersonal victimization such as the disproportionately high levels of violence perpetrated against American Indian women and children. (Walters, & Simoni, 1999).
Covington states “Although the addiction treatment field considers addiction a “chronic, progressive disease,” its treatment methods are more closely aligned to those of the acute care medical model than the chronic disease model of care.” Covington recommends a recovery model that is more in line with disease management approaches to other chronic health problems, focusing on quality-of-life outcomes as defined by the individual and family. She further recommends offering a broader range of services earlier with pre-treatment (recovery priming), recovery mentoring through primary treatment, and would extend services and treatment well beyond the traditional medical services model with post-treatment recovery support services. (Covington, 2008, p.379)
Covington cites Dr. Judith Herman and defines trauma as a “disease of disconnection.” She presents a three stage model for trauma recovery 1.) Safety, 2.) Remembrance and mourning, and 3.) Reconnection. Covington cites Herman who emphasizes that a trauma survivor who is working on safety issues needs to be in an all women’s recovery group until they begin stage three, reconnection (Covington, 2008, p.382) she also states that a woman who is stabilized in her addiction treatment may begin stage two trauma work of remembrance and mourning.
Addicted women are more likely to experience the following co-occurring disorders: depression, dissociation, post-traumatic stress disorder, other anxiety disorders, eating disorders and personality disorders. Mood disorders and anxiety disorders are the most common. Women are commonly diagnosed as having “borderline personality disorder” (BPD) more often than men. Many of the descriptors of BPD can be viewed differently when one considers a history of childhood and adult abuse. The American Psychiatric Association is considering adding the diagnosis of “complex PTSD” in the next edition of the DSM (Herman 1997) (Covington, 2008, p. 382)
Gil-Rivas et. al. identify that one implication of the present findings is that “it may be beneficial to assess individuals’ anxiety sensitivity and their tendency to use avoidance as a form of managing anxiety/depressive symptoms. In addition, beliefs and expectations regarding the extent to which substance use can help ameliorate distress symptoms may contribute to the resumption of substance use.” (Gil-Rivas, Grella, & Prause, 2009, p.310) Based on this information it would likely be helpful to obtain BDI (Beck Depression Inventory) and BAI (Beck Anxiety Inventory) scale information throughout the treatment process.
Finkelstein, VandeMark, Fallot, Brown, & Cadiz, 2004 caution that “For women with active substance use and women in early recovery, the focus on treatment should be on stabilization, safety, and understanding the links between trauma and substances use and abuse, not on the telling of the traumatic story.” With this, the client will be able to be strengthened, supported, and helped to learn and engage in new coping strategies before she moves into later stages. (Finkelstein, VandeMark, Fallot, Brown, & Cadiz, 2004, p.1)
Pioneer Recovery Center understands and addresses the needs specific to women’s issues in chemical dependency treatment by employing trauma informed services; utilizing evidence based practices; and female specific and evidence based treatment curriculums including: The Living in Balance Curriculum from Hazelden, A Woman’s Way Through the Twelve Steps books and workbooks by Stephanie Covington, the Connections Shame Resilience Curriculum from Hazelden, and Seeking Safety by Lisa Najavits, as well as an expressive art therapy group. Our counselors are Native American and understand racism, discrimination, and micro-aggressions that female minorities face. Our program incorporates Motivational Interviewing, Cognitive Behavioral Therapy, Family Systems Therapy, Dialectical Behavioral Therapy Skills. We have a licensed psychologist, MA in Counseling Psychology, Masters of Science and Education and Education in Community Counseling, three Licensed Alcohol and Drug Counselors, and 3 LPNs on staff. We bring in speakers related specifically to women in treatment, such as the Range Women’s Advocates.
It is our belief that helping women in with chemical dependency issues involves more than simply educating and treating the chemical dependency. It involves addressing underlying issues and supporting the client throughout the continuum of care. Pioneer Recovery Center is female owned and operated. We believe in modeling healthy female roles, and honoring where each individual woman comes from and her life experience. Our setting can be described as calm, quiet, and home-like. We have no more than ten women at a time, each woman has her own room. We have art work on the walls by Jane Evershed, a Minnesota artist.
References:
Finkelstein, N, VandeMark, N, Fallot, R, Brown, V, & Cadiz, S. (2004). Enhancing substance abuse recovery through integrated trauma treatment. CSAT: National Trauma Consortium
Gil-Rivas, V, Grella, C, & Prause, J. (2009). Substance use after residential treatment among individuals with co-occurring disorders: the role of anxiety/depressive symptoms and trauma exposure. Psychology of Addictive Behaviors, 23(2), 303-314.
Walters, K, & Simoni, J. (1999). Trauma, substance use, and HIV risk among urban American Indian women. Cultural Diversity and Ethnic Minority Psychology, 5(3), 236-248.
Testa, M, VanZile-Tamsen, C, & Livingston, J. (2007). Prospective prediction of women's sexual victimization by intimate and nonintimate male perpetrators. Journal of Consulting and Clinical Psychology, 75(1), 52-60.
Zenere, F. (2005). Tragedy at red lake: epilogue. Retrieved from http://www.nasponline.org/publications/cq/cq341redlake.aspx
Covington, S. (2008). Women and addiction: a trauma-informed approach. Journal of Psychoactive Drugs, 5(Nov), 377-385.
Brown, Brene. (2007). I thought it was just me (but it isn’t). New York, NY: Gotham Books.
Covington, Stephanie. (2000). A Woman’s way through the twelve steps workbook. Center City, MN: Hazelden Publishing & Educational Services.
Covington, Stephanie. A Woman's way through the twelve steps. Hazelden Publishing & Educational Services, 2000. Print.
