Women with substance use disorders have needs that differ from the needs of men. Although both populations struggle with substance use disorders, women have additional concerns related to the impact that substance use has on their physical health, as well as their roles as primary caretakers of children and in family systems. These additional challenges impact the ability of women to participate in treatment and to access resources. Challenges specific to treating women with substance use disorders include (Center for Substance Abuse Treatment, 2009):
- Acknowledgement of the socioeconomic issues and differences among women
- Recognizing the significance of relationships in women’s lives
- Addressing women’s health concerns
- Attending to the various caregiver roles that women take on in their lives
- Recognition of societal attitudes regarding women who abuse substances
- Commitment to trauma-informed care
- Commitment to a strengths-based approach to treatment
Writers must be cognizant of the above issues in order to effectively serve this discourse community. Stephanie Covington (Covington, 2008) has developed a robust treatment program specifically designed to address the needs of women. She understands that treatment must be holistic and address the whole person, and not just focus on cessation of substance use. James Gee refers to this as “recognition work” (Gee, 1999). Women need to see their stories reflected in the treatment materials developed to address their issues.
Women face different socioeconomic challenges than men. This impacts their ability to access treatment and stay in treatment. Aside from pay disparities (women earn approximately 75% of what men earn in the same jobs), there are also challenges around what type of work women engage in. Many treatment programs require participants to attend groups in the evening. Women with substance use disorders tend to work in service industries and as caretakers. Evenings are when their children are home from school, or they may be providing care for others in the home. Women with substance use disorders often have not completed high school or lack the skills necessary for higher paying jobs. Financial limitations, lack of access to transportation, and lack of appropriate medical care are all barriers that women in recovery must overcome.
I worked as the clinical liaison for a Recovery Court program in Coconino County, Arizona. One of the primary challenges my female clients faced was finding employment that worked with Recovery Court requirements. Men would typically get construction jobs, which meant they worked during the day and typically had weekends off. Women, particularly those who were addicted to methamphetamine, struggled finding work. Many women had extensive damage to their teeth. They had difficulty finding work, because so much of the work that women do involves interacting with the public. They ended up cleaning hotel rooms and working in kitchens, where the hours may not be conducive to meeting Recovery Court requirements. This is an example of the additional challenges that women face when attempting to participate in treatment.
Recovery focused resources that are addressing women’s needs must recognize the importance of relationships in women’s lives. Women are socialized, from childhood, to view themselves in relation to others. They are daughters, wives, and mothers. Culturally, there are prescribed roles that women are socialized to “fit into.” Women who choose to ignore these roles are often ostracized or shamed for failing to conform to societal expectations. There is tremendous pressure on women to conform. Women seeking to recover from substance use disorders must balance this pressure to conform to expected gender norms with the expectation that they make their recovery a priority in life. Treatment programs, 12-step meetings, and outpatient treatment venues often have groups in the evening. This is the time that many women are obligated to spend caring for children, significant others or parents. Women who make themselves a priority and are actively working on recovering from substance use disorders are often pressured by loved ones to skip meetings, ignore court mandates, or call in to scheduled activities. Treatment providers tend to be rigid in their expectations and often have mandatory attendance policies that prohibit women from attending. Additionally, women who are seeking residential treatment, often must find someone to care for their children for months at a time in order to get the help they need. There are very few programs that allow women to keep their children with them while they participate in treatment.
Many women with substance use disorders have been the victims of physical and sexual violence, oftentimes childhood sexual abuse. They are often involved in abusive relationships with partners who are also addicts. This complicates the recovery journey on a few levels. A partner or spouse who is not supportive and becomes abusive and controlling when a woman attempts to get help will destroy any motivation a woman may have for change. Living in fear that she will be abused or living with the symptoms of PTSD make it difficult for women to engage effectively in treatment. Most treatment programs that are designed for women have a strong trauma informed care component.
Writers who are reaching out to the community of women in recovery must be sensitive to these issues. Material that is helpful to women in recovery contains resources to help them overcome these barriers. Lists of local resources for childcare are important. Treatment programs or activities that occur at a variety of times throughout the day are necessary. Resources to address trauma issues are essential. Strategies for juggling caretaking responsibilities and for addressing relationship issues are required to support women. Information on domestic violence shelters, free or reduced cost counseling services, and information about access to medical care are important resources for women.
An understanding of gender specific treatment is essential when working with women in recovery. The demands on women’s emotional energy, time, and resources are significant and effective treatment strategies recognize the unique needs of this community.
References
Center for Substance Abuse Treatment, S. A. a. M. H. S. (2009) Substance Abuse Treatment: Addressing the Specific Needs of Women. In, Treatment Improvement Protocol (TIP). Rockville, MD: Department of Health and Human Services.
Covington, S. S. (2008). Women and Addiction: A Trauma-Informed Approach. Journal of Psychoactive Drugs, 377-385.
Gee, J. P. (1999). An introduction to discourse analysis : theory and method. London ; New York: Routledge.
Women and Recovery 