Canada Drug Rehab

By Cathy Patterson-Sterling, MA, RCC

Director of Family Services, Sunshine Coast Health Center

Research and studies show that the impact of addiction on men and women can be different for both genders. Here are some differences at a glance

Men:

• are more likely to have a drug abuse or alcohol abuse problem than women
• have much higher rates of chemical dependence than women for all ages except the 12 to 17 year age group
• tend to higher rates of “social drinking” when compared to women
• tend to start using cocaine recreationally as a way to bond with other men. Women, on the other hand, typically initiate recreational cocaine use as a way to bond with the men in their lives

Women:

• tend to proceed more rapidly to drug dependence compared to men
• tend to have higher rates of “social smoking” when compared to men 
• are more vulnerable to HIV/AIDS through injection drug use when compared to men. Approximately two thirds of AIDS cases among women result from injection drug use. AIDS is now the fourth leading cause of death among women 15 to 44 years
• tend to begin abusing drugs at a later age than their male counterparts
• who have been treated for drug addiction have a higher incidence of childhood sexual when compared to men. Studies indicate that up to 70% of women in drug abuse treatment reports have histories of physical and sexual abuse with victimization beginning before the age of 11
• who have been treated for drug addiction have a higher rate of disordered eating when compared to men. For example, as many as 55% of bulimic patients are reported to have drug and alcohol use problems.Overall, 15-40% of females with drug abuse or alcohol problems have been reported to have eating disorder syndromes, usually involving binge eating
• have higher rates of co-existing substance abuse disorders and other psychiatric disorders compared to men. Data from a study on female crime victims, for example, indicate that those suffering from post-traumatic stress disorder (PTSD) were 17 times more likely to have major drug abuse problems than non-victims

Women who seek addiction treatment are in need of female-sensitive services for a wide range of medical problems, mental disorders, and psychosocial problems. Furthermore, there is a stronger likelihood that women with addictions have been victimized earlier in life so this means that they have special psychological and psychiatric needs. For this reason, non-punitive and non-coercive treatment facilities are recommended for female populations.

One can conclude from the information above that women have very specific treatment needs especially considering that their cocaine addictions may start out as attempts to connect intimately in relationships and that women also have a higher incidence of medical and co-existing mental health issues compared to men. With the above differences in mind, one can also make a strong case for gender-specific treatment in which men’s drug and alcohol programs are designed for men’s needs and the same is provided for women with their exclusive issues. 

If gender-specific treatment is the gold standard, then the question remains as to why so many men and women remain in co-ed treatment settings. Is this simply a case of economics - ensuring as many admissions as possible? Or does co-ed treatment have some special redeeming qualities in terms of care for clients? The writer will leave it to the reader to ponder such controversial questions.

References

www.alcoholaddiction.org - “Men vs. Women in Substance Abuse” - April 13, 2008
www.4therapy.com - “Women Often Experience Addiction Differently Than Men”

Stepanie S. Covington Ph.D., LCSW - Center for Gender and Justice

By Daniel Jordan

I received an email the other day from a women’s-only drug treatment center in the United States. As I read the article entitled, “Women Find Success at Female-Only Addiction Treatment Programs,” it reminded me that when people talk about the need for gender-specific treatment what they are really referring to is all-female treatment. Rarely, if ever, do I read an article pointing out the advantages of male-only treatment. 

After nearly five years serving an exclusively male clientele, I see the need to expand the definition of gender-specific treatment to include men. “Traditional” addiction treatment, often provided in a co-ed setting, has not done a good job of addressing the unique needs and characteristics of its clientele, often to the detriment of both sexes.

The Forces Behind the Womens-Only Treatment Movement

In her article, “Helping Women Recover: A Comprehensive Integrated Treatment Model,” Dr. Stephanie S. Covington, a leading advocate for womens-only treatment, writes a brief but telling history of the treatment of women’s addictions. Describing how women were essentially “invisible” in the field of addiction recovery until the late 1960s, Dr. Covington attributes this to “strong social taboos” against women who used drugs and alcohol to excess.

Internal Forces for Change

For many years, a small but vocal group of treatment industry insiders has expressed concern about the male-dominated origins of traditional addiction treatment. Much of their concern hinges on the two “cornerstones” of traditional addiction treatment programs in the United States: (1) the Alcoholics Anonymous (AA) movement of the 1930s and (2) the pioneering work of addiction researcher E. Morton Jellinek in the 1940s. The concern with Alcoholics Anonymous is its founding by Bill W., Dr. Bob and other men working with a mutual support group of mostly men, particularly in the early days of AA. Similarly, the concern with Dr. Jellinek was how he based his influential research on a population that was almost exclusively male. As a result, according to Dr. Covington, traditional treatment has always consisted of programs made “by men, for men.”

Furthermore, advocates for change have observed how traditional, co-ed treatment has made it difficult for women to discuss sensitive issues such as sexual abuse, parenting, and eating disorders. Brenda Iliff, Clinical Director at Hazelden Foundation, describes the treatment experience for women when Hazelden was still co-ed: “women tended to sidestep many issues when in the presence of men.” In some cases, she and other professionals would actually discourage women from talking about certain topics with male clients. “Most women will hesitate to talk about trauma issues in front of men, or about areas where they have failed as a parent,” Iliff says. “We even had women who wouldn’t eat in front of men because of issues surrounding body image. *” This behaviour, while no longer an issue at Hazelden since the opening of its Womens Recovery Center in 2006, continues today in other treatment centers with co-ed environments.

(*) Source: Celebrating Women’s Differences (March, 2007) Addiction Professional Magazine.

External Forces

Coinciding with the feminist movement, Dr. Covington points out that “taboo subjects” such as incest, domestic violence and addiction were openly discussed by health professionals and the general public for the first time in the 1960s and 70s.  In 1976, the U.S. Congress responded to pressure from feminist organizations and treatment advocacy groups by funding specialized women’s treatment for the first time.

Since those early days, treatment centers with specialized programs for women now exist all over North America. While the author could not locate data showing the actual number of female-only treatment programs, statistics from the National Survey of Substance Abuse Treatment Services show that among the 13,771 addiction treatment facilities (outpatient, residential, hospital inpatient) in the United States surveyed in 2006, 32 % of these programs offered at least one special program or group for adult women while 14.2 % had a similar option for pregnant or postpartum women.

How Male-Only Treatment Can Enhance Spirituality in an Addiction Treatment Setting

While traditional treatment does not necessarily encourage discussion on gender-specific issues, it does address the critical issue of spirituality in recovery. However, in a co-ed environment, the ability of clients to experience spirituality is hindered by the presence of a mixed-sex peer group. At Sunshine Coast Health Center, the opportunity for our male clients to connect to their spiritual selves seems to coincide with their reconnection with, what author Herb Goldberg * describes as, the “Lost Art of Buddyship:” the experience of having a sharing, caring, and loving relationship with another man. For many of our male clientele, the last time they have had a true “buddy” may go back to grade school. Thus, in a male-specific treatment center the experience of having a “higher power” is fostered by a setting that encourages fellowship.

(*) Source: The Hazards of Being Male: Surving the Myth of Masculine Privilege (1976) Herb Goldberg, Ph.D.

How Male-Only Treatment Can Enhance Programming

While Dr. Covington’s description of traditional treatment being a “program designed by men for men” may be true, one cannot simply conclude that male-specific issues have always been part of the curriculum in traditional treatment. Assigned reading typical of traditional treatment programs - the Big Book, Came to Believe, Living Sober, the Twelve Steps and Twelve Traditions, etc. - makes little mention of the unique challenges of being a man in the modern world.

Within a treatment environment that encourages self-disclosure, women in female-only treatment programs have, to varying degrees, enhanced their programs by addressing issues not considered appropriate for co-ed treatment. The Center for Substance Abuse Treatment (CSAT) has identified 17 essential issues (1) for women in substance misuse treatment, seven of which include:

1. an attachment to unhealthy interpersonal relationships
2. interpersonal violence, including incest, rape, battering, and other abuse
3. eating disorders
4. sexuality, including sexual functioning and sexual orientation (2)
5. parenting
6. appearance, overall health and hygiene
7. child care and custody

Men in gender-specific settings can also benefit from an open discussion on many (though not always the same) subjects considered “taboo” in co-ed treatment. While The Center for Substance Abuse Treatment (CSAT) has provided, as shown above, a list of  essential issues for women in substance misuse treatment, no such “official,” research-supported list for men in substance misuse treatment could be located by the author. The closest thing to a list was found in a book written by staff at Hanley Center, a male-only residential treatment center located in Florida. Titled Men’s Healing: A Toolbox for Life, authors Alam Lyme, David Powell, and Stephen Andrew identify five areas to help men understand the how and why of their behaviour, including:

1. father/son relationships
2. anger and aggression
3. emotional isolation
4. spiritual disconnection
5. sexual issues

(1) Source: Center for Substance Abuse Treatment (1994) Practical Approaches in the treatment of women who abuse alcohol and other drugs. Department of Health and Human Services, Public Health Service.

(2) Note: for more information on female sexuality and addiction see Women, Addiction and Sexuality by Stephanie S. Covington, Ph.D.

Conclusion 

Ten years ago, in a NIDA article entitled “Gender Matters in Drug Abuse Research,” then NIDA Director Dr. Alan I. Leshner stated, “Evidence from NIDA’s gender-related research indicates that prevention and treatment strategies that address gender differences can be more effective than one-size-fits-all approaches in preventing drug abuse and relapse following treatment.” Without a movement to call their own and a lack of advocacy from treatment insiders, gender-specific treatment for men has not kept up with treatment for women. Perhaps the need for male-only treatment will be part of a larger, more powerful movement advocating for individualized therapy that is more focused on the unique characteristics of the client. One can only hope.

About the Author

Daniel Jordan is the General Manager of Sunshine Coast Health Center and hopes that these postings will help  take away some of the mystery often associated with addiction and its treatment.

Printed Resources - Men as a Special Population

For more resources related to men with addictions see the Special Population section of the Sunshine Coast Health Center website.

I Don’t Want to Talk About It: Overcome the Secret Legacy of Male Depression (2000) discusses how men attempting to escape depression fuel many of the problems we think of as typically male – difficulty with intimacy, workaholism, alcoholism, abusive behavior, and rage. Terence Real.

Men’s Healing: A Toolbox for Life (2008) is a book written about male-only treatment for addiction and the unique needs of men with addictions. Alan Lyme, David J. Powell, Stephen Andrew.

Message in a Bottle: Stories of Men and Addiction (1997) shares the stories of alcoholics whom he helped treat, detailing how traditional treatments for addiction fail to meet the needs of men. Jefferson A. Singer.

Touchstones: A Book of Daily Meditations for Men (1986) begin with quotations from sources as varied as William Shakespeare, Wendell Berry, Michael Spinks, and Woody Allen and conclude with affirmations that underscore the lessons of intimacy, integrity, and spirituality. David Spohn.

Wisdom to Know: More Daily Meditations for Men (2005) serves as a practical and spiritual compass for men making their way along the often-tumultuous recovery journey. Hazelden Foundation.

Printed Resources - Women as a Special Population

For more resources related to women with addictions see the Special Population section of the Sunshine Coast Health Center website.

Best Practices: Treatment and Rehabilitation for Women with Substance Use Problems contains a selected bibliography of women-specific addiction information. Health Canada.

The Fight Within: A Story of Women in Recovery (2005) relays the human side of addiction and its consequences. Using narrative as a counseling tool, female clients collaborate with a group facilitator to process their own stories, which appear as a collection of writings. Norma Miller.

Goodbye Hangovers, Hello Life: Self-Help for Women (2003) the founder of Women for Sobriety explains the self-help system she devised to cure herself of alcoholism and discusses the special problems of the woman alcoholic. Jean Kirkpatrick.

The Handbook of Addiction Treatment for Women (2002) offers a historical context on the issue of women and addiction, examines the myriad challenges of the female addict, and includes recommendations for choosing a course of treatment. Shulamith Lala Ashenberg, Stephanie Brown.

Highs and Lows: Canadian Perspectives on Women and Substance Use (December 2007) Centre for Addiction Mental Health ISBN 978-0-88868-534-6.

A Place Called Self: Women, Sobriety, and Radical Transformation (2004) helps readers unravel painful truths and confusing feelings in their newfound sobriety. Stephanie Brown, Yvonne Pearson.

Recovering Women: Feminisms and the Representation of Addiction (2000) analyzes women’s addiction and recovery from a feminist perspective. Melissa Pearl Friedling.

Social and Behavioral Aspects of Female Alcoholism: An Annotated Bibliography (1980) includes 488 annotated references to journal articles about the social and behavioral aspects of female alcoholism divided into 9 subject categories. Paul H. Chalfant, Brent S. Roper.

Substance and Shadow: Women and Addiction in the United States (1999) Stephen R. Kandall

Substance Use Among Women: A Reference and Resource Guide is a compilation of theoretical, empirical, and clinical knowledge concerning key topics associated with substance use among women. Ann M. Pagliaro, Louis A. Pagliaro.

Substance Use Among Women in the United States (1997) Office of Applied Studies, Substance Abuse and Mental Health Services Administration (SAMHSA).

A Woman’s Spirit: More Meditations for Women (1994) is a collection of wise, compassionate daily meditations for women now living a sober life and seeking spiritual fulfillment. James Jennings, Karen Casey.

Women and Alcohol: Contemporary and Historical Perspectives (1997) records the widespread and persisting ambivalence or hostility in many cultures towards the relation of women with alcohol by reference to religious and social pressures, gender roles and stereotypes. Moira Plant.

A Woman’s Way through the Twelve Steps (2000) is a workbook designed to help a woman find her own path through the twelve steps. Stephanie S. Covington. 

Women, Sex & Addiction: A search for love & power (1989) shows women how they can learn to experience their sexuality as a source of love and positive power and sex as an expression that honors the soul as well as the body. Charlotte David-Kasl.

Women Under the Influence (2006) documents the physical and emotional effects of substance abuse in girls and women and explores the role of advertising and entertainment industries in popularizing various substances of abuse. Joseph A. Califano.