Gender Responsive Residential Treatment Services for Substance Use Disorders
For decades, research has demonstrated the importance of gender-responsive services (see Center for Substance Abuse Treatment, 2009). Not simply for the obvious reasons one would expect—that co-ed treatment programs often contend with the distraction of sexual tension between residents, creating a less than optimal treatment environment—but because men and women recover differently.
Generally, men are socialized to suppress feelings, creating an expectation that men present as “strong, non-emotional” individuals (Greer, 2005). Yet when they enter treatment, men are expected to not only identify feelings for which they have no experience, but to share those feelings openly with men and women alike. Male behaviors in a group setting are often competitive in nature, not supportive as the therapeutic milieu calls for.
Conversely, women are socialized to identify feelings and freely share those feelings in group settings. In co-ed programs, the tendency of women is to focus on helping others, particularly men, which only serves to take the focus from their own recovery on helping others. So why do co-ed programs continue to dominate the residential treatment market?
If treatment program operators were to honestly answer the question as to why services are not separated by gender, the bottom line would be finances. It’s more expensive to operate two gender specific homes, and one can never know if the referrals coming on any given day will be mostly male or female. This scenario creates the potential for empty beds, which places a financial hardship on operators. Co-ed facilities are financially safer for the operator, but not necessarily better treatment for the recovering person.
What are the important components of gender-specific services?
For women, it’s important to focus on the issues that are unique to women that often contribute to their substance use disorder. More specifically, relationships, family roles, health, trauma and co-occurring disordered eating.
Initially many women use substances to connect with others as a social medium, but as the disease progress, they actually disconnect from others. Therefore, in treatment the focus is on the woman’s relationships to others and herself. Utilizing a relational model in the provision of residential services is of paramount importance (Covington & Surrey, 1977, 2000).
Women tend to be family focused and as a result of the disease, may have burned bridges with those they love the most. Ensuring that a family focused model is embedded in the program creates a safe place to address some of the issues that contributed to the progression of the disease, as well as address how to re-enter the family system post treatment, in a way that is healthy and in support of one’s recovery (Center for Substance Abuse Treatment, 2007). Offering family sessions and a family program is critical to providing a comprehensive residential treatment program for women.
Research furthermore supports the use a developmental perspective (Center for Substance Abuse Treatment, 2009). Women have very specific developmental milestones that are different from men, including health-related issues such as childbirth. As a result, groups need to address these milestones.
Studies show a strong connection between trauma and substance use disorders (Covington, 2008). Therefore, staff members at treatment centers need to be “trauma informed,” and create a low-stimulant environment, taking care to create quiet spaces and reduce signage and noise. Having blankets and other comforting items placed around the facility are simple ways to creating a “sanctuary” for recovery. Having specially trained trauma specialists on staff is of great value to women struggling with trauma.
Last, but certainly not least, is the importance of a creating a women’s program that includes staff who are qualified in treating co-occurring disordered eating. The prevalence of substance use disorders with co-occurring disordered eating is not a new phenomenon, yet very few programs exist that address both in an integrated fashion. Both have obsessive thinking qualities, with cravings, compulsions, and ritualistic behavior (Ressler, 2008), yet they are often treated sequentially rather than in an integrated fashion. Treating the addictive process (behavior and thinking), through “whole person care” will have better outcomes than treating each individual addictive disorder (Maxwell, Tobey, Barron, Bateman, & Ward, 2014).
If all of these clinical reasons aren’t enough to demonstrate the need for gender specific services, a study just recently released by the National Institute on Drug Abuse (NIDA) showed that women in gender specific services were much more likely to obtain successful employment 12 months post treatment than those in a co-ed program.
In conclusion, providers must take the leap into providing gender-specific treatment as an evidence based practice, if there is hope to increasing abstinence rates among those afflicted with substance use disorders.
Center for Substance Abuse Treatment. (2009). Treatment Improvement Protocol, Series 51 (SMA#09-4426). Rockville, MD: Substance Abuse Mental Health Services Administration.
Center for Substance Abuse Treatment. (2007). Family centered treatment for women with substance use disorders: History, key elements and challenges (contract 270-03-7148). Rockville, MD: Substance Abuse Mental Health Services Administration.
Covington, S. (2008, November). Women and addiction, a trauma informed approach. Journal of Psychoactive Drugs, 40(Suppl 5), 377-385.
Covington, S., & Surrey, J. (1977, 2000). The relational model of women’s psychological development: implications for substance abuse. In S. Wilsnack & R. Wilsnack (Eds.), Gender and alcohol: Individual and social perspectives, (pp. 335-351). New Brunswick, NJ: Rutgers Center of Alcohol Studies.
Greer, M. (2005, June). Keeping them hooked in. Monitor on Psychology: A Publication of the American Psychological Association, 36(6), 60. Retrieved from http://www.apa.org/monitor/jun05/hooked.aspx
Maxwell, J., Tobey, R., Barron, C., Bateman, C., & Ward, M. (2014, March). National approaches to whole-person care in the safety net. Prepared for the Blue Shield of California Foundation. San Francisco, CA: John Snow, Inc. Retrieved from www.jsi.com/JSIInternet/Inc/Common/_download_pub.cfm?id=14261&lid=3
Ressler, A. (2008). Insatiable hungers: Eating disorders and substance abuse. Social Work Today, 8(4), 30.