Factors affecting entry into substance abuse treatment: Gender differences among alcohol-dependent Alaska Natives

This article reports the results of an investigation of alcohol treatment among Alaska Natives admitted to treatment in Anchorage, Alaska. The time between the age at which they were diagnosed as alcohol dependent and first treatment was similar for men and women. Women were more likely to be parents and reported more contact with health and mental health providers, but these factors were not associated with elapsed time to alcoholism treatment; type of health care professional consulted about problems was associated with elapsed time to treatment for women. Among men, acting as a parent, lifetime depression, and type of professional consulted were significantly associated with elapsed time to treatment. The effect of lifetime depression and parenting on elapsed time to treatment for men raises important questions about the significance of these two factors among other racial and ethnic groups. Key words: access; Alaska Natives; alcoholism; gender differences; treatment ********** Epidemiological studies indicate that alcohol abuse and dependence occur about twice as often among men as among women (Chang, 1997; Weisner & Schmidt, 1992). However, women are underrepresented among individuals entering treatment for alcohol abuse, dependency, and related problems (Beckman, 1994; Dawson, 1996). Although there is some indication that the underutilization of alcohol treatment by women is changing, men have persistently outnumbered women in treatment by a ratio of almost 4:1 (Chang; Weisner & Schmidt). Among individuals in treatment for alcoholism, the proportion of women increased from 22 percent in 1982 to 29 percent in 1993 (U.S. Department of Health and Human Services [DHHS], 1997). This coincided with a similar national increase in specialized treatment services for women (DHHS). Several explanations have been postulated to account for differences in treatment utilization between men and women. Some have focused on the male-oriented characteristics of treatment services that may discourage female participation (Schober & Annis, 1996; Walitzer & Connors, 1997), whereas others have identified gender-specific intrapersonal and social barriers that can impede treatment access (Beckman, 1994; Vogeltanz & Wilsnack, 1997; Weisner & Schmidt, 1992). Research indicates that women are less likely than men to recognize drinking as the source of problems encountered (Beckman; Chang, 1997), and they are more likely than men to seek medical or mental health services where their problems with alcohol are underrecognized (Amodei, Williams, Seale, & Alvarado, 1996; Mendelson & Mello, 1998; Vogeltanz & Wilsnack; Weisner & Schmidt). Fear of stigmatization, shame, and guilt related to drinking and concerns about leaving or losing their children to obtain treatment are additional obstacles more likely confronted by women than men (Beckman). Conversely, men are more likely to be identified for treatment through the criminal justice system (O'Connor, Horwitz, Gottlieb, Kraus, & Segal, 1993) and employee assistance programs (Blume, 1990), to have an alcohol history taken and be identified as alcoholic when seen in medical settings (Amodei et al., 1996; Chang, 1997; Dawson, Dadheech, Speroff, Smith, & Schubert, 1992), and to engage a broader range of helping services for their drinking problems (Weisner & Schmidt, 1992). The differences notwithstanding, men and women are similar in their need for and ability to benefit from treatment. A high degree of consistency has been found across genders in the timing and appearance of alcohol-related life experiences, among treated and untreated alcohol-dependent individuals (Schuckit, Anthenelli, Bucholz, Hesselbrock, & Tipp, 1995). Although women, typically, are reported to initiate drinking at later ages than men (Brady & Randall, 1999), contradictory evidence exists as to whether they also enter treatment earlier (Brady & Randall) or after approximately the same length of drinking history as men (M. …