Women are less likely than men to enter treatment.
- Women are less likely than men to enter treatment.
- Sociocultural: stigma, lack of partner/family support
- Socioeconomic: child care, pregnancy, fears about child custody
- Children are a big motivator to enter treatment or avoid it.
- Availability of appropriate treatment for co-occurring disorders is important.
- Gender Differences in Treatment I
Few gender differences are evident in:
- Few gender differences are evident in:
- Relapse rates
- When differences are noted, typically women have better:
- Drug treatment outcomes than men
- Shorter relapse episodes
- Are more likely to seek help post-relapse
- Residential programs that include children have better retention rates.
- Gender Differences in Treatment II
- Child care
- Prenatal care
- Gender only and responsive services (e.g., trauma history)
- Mental health and psychiatry services
- Employment services leading to jobs that pay more than minimum wage
- Key Services to Improve Outcomes for Women
Length of stay in treatment
- Length of stay in treatment
- Treatment completion
- Decreased use of substances
- Reduced mental health symptoms
- Improved birth outcomes
- Self-reported health status
- HIV risk reduction
- Ashley et al., 2003; Greenfield et al., 2007
Rapidly address what the woman identifies as her high priority issue, and build a bridge to the other issues
- Rapidly address what the woman identifies as her high priority issue, and build a bridge to the other issues
- Female role models at all levels of hierarchy
- Positive male role models available
- Clear feedback but not aggressive confrontation
- Monitor the intensity, especially for women who are more disturbed
- Sexual boundary issues
Foster greater interaction, emotional and behavioral expression
- Foster greater interaction, emotional and behavioral expression
- More variability in interpersonal style
- Women in mixed groups engage in a more restrictive type of behavior; men show wider variability (and interrupt women more)
Untreated psychiatric disorders, especially depression and trauma sequelae (PTSD)
- Untreated psychiatric disorders, especially depression and trauma sequelae (PTSD)
- Intimate partner
- Underestimating the stress of reunification or ongoing parenting
- Isolation, poor social support
- High level of burden
Women are more likely than men to have co-occurring drug use and mental disorders.
- Women are more likely than men to have co-occurring drug use and mental disorders.
- Women are more likely to have multiple co-morbidity (three or more psychiatric diagnoses, in addition to substance use disorder) than are men.
- Women who use drugs may be using them
- to self-medicate distressing affect.
- Anxiety disorders and major depressive
- disorders are the most common
- co-occurring diagnoses.
- Eating disorders and Post-Traumatic Stress Disorder (PTSD), a common reaction following exposure to violence and trauma, also often co-occur in women with drug use disorders.
- Agrawal et al., 2005; Kessler et al., 1997; Zilberman et al. 2003
- Co-Occurring Mental Health Issues
- 3 out of every 10 women who enter treatment have tried to commit suicide.
- Many of these women are in relationships with individuals who also use licit and illicit substances – and may subject the women to ongoing emotional, physical, and sexual abuse.
- Eggleston et al., Compr Psychiatry, 2009; Jones et al., Counselor, 2009.
- Suicide and Interpersonal Violence
- Physical/Stress Related
- Sleep problems
- Nutritional / Low weight gain
- Substance abuse / Smoking
- Chronic pain
- Inadequate prenatal care
- Pre-term labor
- Fetal fracture / Fetal death
- Placental abruption
- Uterine rupture
- Depression / Suicide
- Poor self-esteem
- Blame and guilt
- Uncontrollable emotions
- Effects of Interpersonal Violence
- Image Credit: “Stop Violence” by geralt
- Women Abuse Screening Tool (WAST) – Short Form
- In general, how would you describe your relationship?
- Do you and your partner work out arguments with…
- Great difficulty, some difficulty, no difficulty
- Correctly classified 92% victim and 100% non-victim
- Takes 4 minutes to complete
- If women endorse these or other questions indicating risk for violence
- Listen to her and believe her
- Acknowledge her feelings and let her know she is not alone
- Let her know that no one deserves to be abused
- Provider her with resources (hotline, women’s shelter)
- Chen et al.. Ann Fam Med 2007
- Screening for Interpersonal Violence
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