Specific Needs of Women and Primary Caregivers in Co-Occurring Disorders Treatment | SAMHSA TIP 51

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TIP 51 Specific Needs of Women
Instructor: Dr. Dawn-Elise Snipes PhD, LPC-MHSP
Executive Director, AllCEUs

Objectives
– Identify how the needs of men and women may differ
– Discuss conditions that are more typically diagnosed in women
– Highlight changes that can be made to increase access, engagement and retention of women in treatment

Introduction
– 6.2% females over 12 in the US have a substance use disorder
– AN was only associated with oppositional defiant disorder, not other psychiatric diagnoses
– Eating disorders among adolescents was often associated with functional impairment and suicidality
– BN and BED were associated with suicide attempts

Define the Problem
– Women have different physical responses to substances (impacted by smaller quantity)
– Women with substance use disorder have greater susceptibility to as well as earlier onset of serious medical problems and disorders ( problems, doses, time)
– Pregnancy is a significant concern
– Women who abuse substances are more likely than other women to have co-occurring disorders
– Women who have substance use disorders are more likely to have been physically or sexually traumatized and subjected to interpersonal violence

Influence of Relationships
– Significant relationships and family history play an integral role in the initiation, pattern of use, and continuation of substance abuse for women
– From a sociocultural perspective, women (more than men) tend to define themselves in terms of their webs of social relationships
– Women are more likely to be introduced to and initiate alcohol and drug use through significant relationships including partners, and family members
– Significant relationships and other adult family members may substantially influence and impact women’s behavior associated with treatment seeking, support for recovery, and relapse
– Women may have less support from family/partners than do men for seeking treatment.
– For women, pregnancy, parenting, and childcare influence alcohol and drug consumption and increase the likelihood of entering and completing substance abuse treatment

Sources of Stress
– Overall, women report more interpersonal related stress in relation to negative affect whereas men report more legal and work-related stressful life events

Statistics…
– Being Single or Divorced
◦ Approximately 11 percent of divorced or separated women and 16 percent of women who have never married (in age range of 18 to 49 years) abuse or are dependent on alcohol or an illicit drug compared to only 4 percent of married women (SAMHSA 2004).
– Partner who uses substances

Drugs of Choice
– Women are significantly more likely to use and abuse prescription medications, including anxiolytics (antianxiety medications) and narcotic analgesics (pain medications), than are men
Conditions More Common in Women
– Pregnancy
– PMDD
– Polycystic Ovarian Syndrome
– Menopause
– Migraines (18%/3%)
– Hypertension after age 50
– Rheumatoid Arthritis
– Irritable Bowel
– Restless Legs
– Lupus
– Fibromyalgia (90%/10%)
◦ “It is a neurochemical disease,” says Yunus, who points out that people with fibromyalgia show a higher than average amount of substance P, a neurotransmitter that signals pain, and a lower than average amount of serotonin, a neurotransmitter that inhibits pain.

Overview of What Can Be Done
– Acknowledge the importance and role of socioeconomic issues and differences among women.
– Promote cultural competence specific to women.
– Recognize the role and significance of relationships in women’s lives
– Address women’s unique health concerns
– Endorse a developmental perspective.
– Attend to the relevance and influence of various caregiver roles that women often assume throughout the course
– Recognize that ascribed roles and gender expectations across cultures affect societal attitudes toward women who abuse substances.
– Adopt a trauma-informed perspective.
– Utilize a strengths-based model for women’s treatment.

Summary
– Everyone needs to have basic needs, safety and social support needs met
– Women face some unique challenges based upon
◦ Sociocultural expectations (esp. caregiving)
◦ Medical and mental health conditions more common in women

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