Female Substance Use Disorder Gender

Female Substance Use Disorder

Gender Affects Relationships Between Drug Abuse and Psychiatric Disorders, an article in the National Institute on Drug Abuse (NIDA), NIDA Notes (Swan, 1997), reports that when women had the dual problem of depression and drug abuse, depression episodes occurred first, and drug dependency came second.

In a study conducted by Dr. Kathleen T. Brady and associates at the Medical University of South Carolina - examining gender differences in psychiatric disorders among 100 abusers of alcohol and cocaine abusers who had sought treatment - about 48% of the men, and 70% of the women had a "comorbid affective or anxiety disorder." And 68% of the women seeking treatment had one or more of other mental disorders including "passive-aggressive, obsessive-compulsive, and antisocial personality disorders."

Women "are significantly more likely than men," the research asserts, to have a diagnosis of panic disorder prior to their getting involved in heavy drug use: "panic disorder" is manifested in "sudden attacks of acute anxiety or terror" that may not be controllable, the article explains. Eighteen percent of the women (and 10% of the men) were diagnosed with the psychiatric problem of panic disorder; 46% of the women and only 24% of the men suffered "posttraumatic stress disorder" (PTSD) before cocaine their dependence problem.

The researchers described PTSD as "emotional shock ignited by the threat of death or actual or threatened injury resulting in fear, feelings of helplessness or horror, and recurrent memories." Dr. Brady noted that among the women who suffered PTSD, 77% of those women had suffered PTSD prior to cocaine addiction; and a further explanation for this high number was related to "the sexual and physical victimization of women" during childhood or adulthood.

Among the other psychiatric problems women in the study showed was "social phobia," which is defined as "extreme shyness and fear of embarrassment and humiliation"; this phobia was found to be 1.5 times more common in women who also had drug dependence issues than in men with the same dual problem.

What also emerged from this study of particular interest is that the use of cocaine actually activates depressive episodes "that linger after the period of euphoria and withdrawal," according to Brady.

Women and Substance Abuse, a piece in Clinical Psychiatry News (Peters, 2002), suggests that though "male substance abuse is still more prevalent than female substance abuse," women "are catching up" to the male abuse patterns. These trends are reported based on research from the Caron Foundation, a treatment center for addiction in Pennsylvania. Further, female substance abusers are more likely than women "who do not use drugs or alcohol" to have been physically or sexually abused," and those abusing women also have "higher rates of psychiatric and medical problems" such as sexually transmitted diseases, depression, and hypertension," the research concludes, collaborating portions of materials presented in the paragraph above.

Men and Women May Process Cocaine Cues Differently, a research article in the National Institute on Drug Abuse (NIDA NOTES) (Whitten, 2004)), explains women are "more likely to seek cocaine abuse treatment in response to co-occurring depression." They are also more likely than men to "remain abstinent after treatment," and also they are more likely to "relapse in response to interpersonal problems and negative feelings."

Cocaine-addicted women, the NIA article explains, "also demonstrate greater craving than men in response to drug cures." Moreover, this information, which results from the first brain-imaging study of women who are hooked on cocaine and suffer intense cravings for cocaine, "may point to neurological sources of these differences."

The doctors who conducted the research - they do research at the Emory School of Medicine in Atlanta - used "positron emission tomography (PET) to measure drug-craving-related changes in regional cerebral blood flow...in eight cocaine-addicted African-American women aged 35 to 46. These women had been "off" cocaine for one to fourteen days, and while lying in the PET scanning device, each of the eight women were obliged to listen to a one-minute recording of themselves reading a script about their personal experiences in getting the drug and looking forward to the sensations of using it.

One woman's script went like this, according to the Whitten article: "I start thinking about how good it's going to feel to take that first hit...with my eyes wide open I take the lighter out of my pocket, put it to the stem, and get ready to take that first, good blast..."

The brain scans taken during the time the women listened to the scripts verified that "the mental imagery of the cocaine-related script induced a greater urge to use cocaine than the nature or anger script." Blood flow changes between the time they were relaxed and not thinking about the drug, and when they heard the tapes, compared with findings from eight cocaine-addicted men going through the same process, showed women have less intense cravings than men do.

The PET studies show, according to Dr. Steven Grant, of NIDA's Division of Clinical Neuroscience, Development and Behavioral Treatments, that "the male and female abusers crave the drug for different reasons or hope to achieve different results from taking the drug." This knowledge could lead to more effective and gender-focused treatment for women drug abusers.

In Harms Way: Suicide in America is an article from the National Institute of Mental Health (NIMH, 2003), connects drug abuse (by females and males) with suicide. According to data provided by the NIMH, suicide is the 11th leading cause of death in America; and while it is the 8th leading cause of death for males, it is the 19th leading cause of death by females. And over 90% of all people who kill themselves suffer from depression and/or substance abuse disorder, often in combination with other mental disorders.

Interestingly, while more than four times as many men as women commit suicide, women report attempting to kill themselves during their lifetime "about three times as often as men." Bottom line on that statistic: either men are better at suicide, or more determined to get it done than women. But both are likely to be depressed and on dependent on drugs. The risk factors for women who may be contemplating suicide are "depression, alcohol abuse, cocaine use, and separation or divorce."

Relational systems change: implementing a model of change in integrating services for women with substance abuse and mental health disorders and histories of Trauma, a research study published in the Journal of Behavioral Health Services & Research (Markoff, et al., 2005), reports on how the "relational systems change" model helped make the delivery of services to troubled women more effective.

This article speaks to the fact that the services offered to women who have both mental health problems and substance abuse problems have not been as effective, in many cases. It shows that there are researchers trying to create better models for women who have the dual problem of mental health deficiency and drug abuse. The study that this article explains was based on the federally funded Women Embracing Life and Living (WELL) project and the Substance Abuse and Mental Health Services Administration's Women, Co-occurring Disorders and Violence (WCDV) "cooperative agreement."

Research was conducted between the years 1998 and 2002, and the model for the "relational systems change" dynamic was derived from the Institute for Health and Recovery, according to the article. The bottom line results achieved through the use of the relational systems change model - bringing about positive psychological development changes by using relationships (not just group therapy or one-on-one therapy) as a vehicle - were very positive.

The best environment for emotional growth and change," the writers of this article report, "is within the context of one or more mutual, empathic, authentic relationships." The nurturing of these relationships "allow individuals to better understand themselves and others," and this understanding leads to the patient's desire for "more connection," and there is a feeling created through the process "of excitement and zest that stimulates people to action."

The research which utilized the relational model encompasses women's "relational histories" and also women's current relationships within the treatment environment; these forms of treatment include "healthy connections" and also incorporate "disconnections" like trauma and violence that had been visited upon the women in the study.

Mutuality, authenticity, empathy, and empowerment" are principles that were used in the relational systems therapy; the therapy was carried out at three "large human service agencies" which served women in three communities in eastern Massachusetts. What was interesting about the professional interaction with the women prior to the delivery of relational systems therapy work was that none of the three agencies interviewed the women about the history of violence, sexual abuse, or trauma prior to their being admitted for health care.

Existing violence services [for women] were primarily delivered by community agencies that had varying degrees of relationship with substance abuse and mental health organizations," the article points out. Interagency collaboration was not a priority with regard to the services provided for the women, and, beyond the obvious need for communication between the three (and other related communication service agencies), the lack of collaboration caused "frustration" among the female consumers of these services; "...in their view, rather than promoting wholeness and recovery, the experience recreated the secrecy of abuse and fed the stigma associated with each of the three issues."

In the hopes of a more well-organized approach to providing these key services to women, the WELL project instituted a mechanism for promoting strategy and collaboration changes at the state, regional, and local levels. The WELL project also recommended an open dialogue between agencies as to better systems to put in place, and suggested giving individuals within each area of service "freedom to make change at any given moment" when a better approach can be taken by a trained professional healthcare provider.

Predominantly Female Caseloads: Identifying Organizational Correlates in Private Substance Abuse Treatment Centers, a piece in the Journal of Behavioral Health Services & Research (Tinney, et al., 2004), speaks to the issue of the need for healthcare providers to be meeting "distinctive treatment needs" at the private substance abuse treatment centers. This is another research paper that points to the fact that women's needs have been neglected in the genre of health care for substance abuse.

A vitally important fact that has received "much less attention in investigations of women and treatment," the authors explain, is that "researchers have not adequately explored the organization attributes associated with treating higher percentages of women" in private facilities. This is unacceptable, the article continues, because the private sector "dominates the substance abuse treatment industry in number."

For example, in a National Survey of Substance Abuse Treatment Services referenced by the article, it is pointed out that "the proportion of private not for profit (61%) and private for-profit (25%) facilities constitutes the majority of treatment facilities in the United States."

With the huge percentage of private drug dependence treatment facilities dwarfing those run by government at various levels, it seems highly appropriate that gender-specific programming should be investigated, and in this article, some results of those inquiries are available. First, since women generally rely more on government-subsidized insurance, and private facilities are less likely to provide those funds, women are at a disadvantage in private centers. Secondly, private facilities rely in many cases on "fee-for-service" payers, again putting women at a disadvantage. Thirdly, private centers can chose which groups, and genders, to market to, based on demands and trends, which is "perhaps to the detriment of minority groups, like women," the article continues.