Treatment Needs for Women With Alcohol Problems.

Do women require alcoholism treatment that differs from that for men? And if they do, what components should be included oriented treatment? Until now, these questions have generated much rhetoric but few empirical data. Researchers and service providers have designed treatment components for female patients, incorporating results from clinical and survey studies of women with alcohol problems.(1) Yet the effects of these approaches on treatment outcome rarely are evaluated directly. For example, because investigators have found that alcoholic women tend to have lower self-esteem than do alcoholic men (Beckman 1994), some programs have developed treatment components designed to bolster self-esteem. Yet the effects of these components, by themselves or in combination with other treatment services, on women's treatment outcome or even on increasing self-esteem have not been studied adequately. This article reviews the characteristics of women-sensitive alcoholism treatment and discusses specific aspects and risk factors for women's alcohol abuse that should be addressed in a women-sensitive treatment program. It also examines differences in treatment outcomes for women and men and considers data on the effectiveness of women-only treatment programs. DESIGNING TREATMENT PROGRAMS FOR WOMEN Some of the causes and consequences of alcohol abuse may differ between women and men, thereby necessitating gender-specific treatment approaches. Yet women with drinking problems are not a homogeneous group with homogeneous needs. They fall into subgroups with specific characteristics, such as age, ethnicity, sexual orientation, prior experiences of violence and sexual abuse, and type and severity of symptoms. These subgroup differences also can have implications for treatment content. To receive optimal treatment, patients should be matched to treatment approaches that recognize their specific problems and lifestyles (Lindstrom 1992). In certain cases, this patient-treatment matching may require separate treatment programs for subgroups of alcohol-abusing women (e.g., pregnant women and minority women). More often, an individualized treatment plan can be developed that, within the general program, combines specific treatment components and intensities for each patient. In the age of managed care, this approach may provide the most effective combination of services to women at the lowest cost. What Is Women-Oriented Alcoholism Treatment? Several characteristics define a women-oriented treatment program (Reed 1987): * It is delivered in a setting that is compatible with women's interactional styles and personal orientations; for example, it takes into consideration women's need for and responsiveness to social relationships. It takes into account gender roles, female socialization (i.e., how women are brought up to occupy traditionally female roles in family and society), and women's status in society (e.g., many areas of society and family have a patriarchal power structure). * It does not exploit women; for example, it does not allow sexual harassment of female patients nor does it support passive, dependent roles for women. * It addresses women-specific treatment issues. Such a treatment philosophy can be incorporated into a mixed-gender program but may require women-only groups, female therapists, or both as part of the treatment. A women-oriented treatment approach requires the availability of a broad range of coordinated treatment components (see box). These include family services, chemical dependency education, development of parenting skills, training to develop self-esteem and coping mechanisms, vocational/educational counseling and training, and legal assistance (Reed 1987). Women's use of alcoholism services and treatment outcome also are likely to be improved by the availability of additional services, which may remove barriers to women's treatment entry (see sidebar). …