Gender-specific profile of substance abusing women in therapeutic communities in Europe

In this first chapter, the substance abusing women as a hidden population will be discussed. Women have been overlooked by clinicians and researchers for a long time, therefore, research, treatment and service provision has been designed from a purely male point of view. This also holds for the therapeutic community (TC), a treatment modality widely used for substance abusing men, and later on for special target groups, including women. The third part of this chapter discusses the importance of studying differences between men and women in order to improve the gender-based quality of treatment programmes. The European BIOMED II “Improving Psychiatric Treatment in Residential Programmes for Emerging Dependency Groups” (IPTRP) project, which provided data of men and women in TC treatment, is described. This chapter ends with a description of the aims and general methodology of this dissertation. General introduction 17 1.1 SUBSTANCE ABUSING WOMEN: HIDDEN POPULATION? 1 For a long time, substance abuse has been seen as a male problem (Goldberg, 1995). Theorisations and research on addiction were restricted to the outline of male paths of evolution, without paying the least attention to the specific factors of the female population (Ezard, 1998). Women’s drug addiction was considered as an extension of men’s drug addiction till the end of the 1980s. Possible reasons for this negligent attitude could be found in the fact that women were outnumbered by men and therefore their substance abuse problems were less noticed (Ettorre, 1994). However, it was probably also less interesting to invest in women’s drug addiction from an economical point of view (Ezard, 1998; Marsh, Colten, & Tucker, 1982). It was not until two decades ago that clinicians and researchers gradually became interested in the drug-specific characteristics of women. This increased awareness was related to the negative consequences of the woman’s substance abuse on the different aspects that define the functions of the woman (procreative, maternal, social, etc.) (Finkelstein, 1994). Later on, influenced by the feminist movement, there was attention for differences between substance abusing men and women and for the position of women within the “traditional” substance abuse treatment system (Abbott, 1994; Butler, 1990; Wald, Harvey, & Hibbard, 1995). Whereas previous research findings on men had been inappropriately generalized to women, it now became clear that the addiction affects women in another way than men, due to biological and societal differences (Brady & Randall, 1999; Ettorre, 1994). Therefore, women may have other treatment needs, which are not met within the traditional care (Reed, 1987). Men are the greatest consumers of substance abuse treatment, which was therefore developed from a purely male point of view. Women are still a minority among the substance abuse treatment population with a gender ratio of approximately 4 to 1, although this may differ between different substance abuse treatment modalities (Vanderplasschen, Colpaert, Lievens, & Broekaert, 2003). The question remains, however, whether this gender distribution has to be seen within the lower prevalence of drug abuse among women or a lack of equal opportunity and subtle discrimination by inadequate drug service provision. 1 This subchapter is mainly based on: De Wilde, J., & Vandeplasschen, W. (2003) Manvrouwverschillen bij personen in behandeling voor drugproblemen. In W. Vanderplasschen, K. Colpaert, K. Lievens & E. Broekaert, De Oost-Vlaamse drughulpverlening in cijfers: kenmerken, zorggebruik en uitstroom van personen in behandeling (Orthopedagogische Reeks Gent 15). Gent: Universiteit Gent, Vakgroep Orthopedagogiek.