Treatment Services for Women with Substance Use Disorders

The literature on women and substance use disorders repeatedly emphasizes the need to improve access to treatment and to expand services to address the unique needs of women. Shulamith Lala Ashenberg Straussner and Stephanie Brown, (whose book is reviewed in this issue), are key researchers in the area of women and addiction treatment and they assert that there are still innumerable institutional barriers to women receiving the treatment they need. They cite lack of gender specific treatment models offering comprehensive treatment, misdiagnosis or failure to diagnosis by health care practitioners, and inadequate knowledge about services, as major impediments for women (2002). To some extent, the shrinking dollar in the current managed health care environment has put limits on the expansion of women’s programs and in the ongoing comprehensive services needed to assist them with recovery. Further, enormous stigma still exists and insurance coverage and treatment resources remain inadequate. Ashenberg Straussner and Brown (2002) state, “women still face countless major hurdles to seeking help and using it” (p. 561). “Hurdles to treatment utilization and to treatment effectiveness for women include societal, familial, and individual obstacles” (p. 256). Even those women with insurance and other means to pay for treatment are often challenged to find appropriate treatment in their communities. Of additional concern is the downward age trend in first use of alcohol and other psychoactive substances by women and a major increase in binge drinking and problem use of substances among college age women. Since the early 1990’s binge drinking in women attending all-women’s colleges in the United States has increased by 125% (Wechsler et al., 2002). In the same study conducted in 2001, the investigators found that there had also been a remarkable increase in the number of women who reported being drunk on 10 or more occasions in the previous month (Wechsler et al., 2002). One can only assume that many of these women are at greater risk for life problems as a result of substance abuse. Another consideration is the potential for triggering a substance use disorder which can be precipitated in susceptible individuals by repeated binge drinking or episodes of excessive use of other psychoactive drugs. This may translate into a greater need for women’s treatment services in the years to come. As the need for drug treatment services for women grows, it will be cost effective in the long run to offer multiple services on site. Not only do women need assessment for co-occurring disorders such as anxiety, chronic depression, bi-polar disorder and post traumatic stress disorder, they need assessment for eating and impulse control disorders. A phenomenon that seems to be more common in addicted women than men is the tendency to form significant relationships with abusive partners (both heterosexual and lesbian partners) and this needs attention in treatment. If any of the aforementioned problems are present in addicted women, specialized long-term treatment and other support are necessary for successful recovery. Other support needed includes life skills coaching, social support, child care services, legal services, psychiatric/psychological services, as well as career counseling and training. Success in recovery is most likely achieved when one’s life is closely aligned with mainstream lifestyles, which include a healthy self-esteem, involvement in mutually satisfying interpersonal relationships, and the perception that one is a contributing member of society as, for example: In work/career and/or as a parent or volunteer.