Barriers to treatment confront women from the outset, and it’s no surprise that most women with a Substance Use Disorder are never treated for it. Compared to men with Opioid Dependence women are likely to be at a socioeconomic and educational disadvantage, to be underemployed or unemployed, and to have primary child-care responsibilities. Their Opioid Dependence comes on more quickly, and they progress more rapidly to serious consequences. Yet women tend to see their substance abuse as stress-related, a temporary crutch that will go away without treatment.
Women are less likely than men to know how and where to get treatment. Typically, they refer themselves, sometimes prompted by family or friends, or are referred by the criminal justice system or social service agencies. Men usually are referred by employers, doctors, or the legal system—sources generally considered more knowledgeable about treatment options.
Women may consider private residential clinics too time-consuming, expensive, and tightly regulated to be an option. Television and print media lead many to think that treatment means substance withdrawal, and that methadone is a drug to avoid. So it’s no surprise that women account for less than half of treatment admissions for opioid abuse.
Reasons Why Women Don’t Seek Treatment
According to Susan M. Gordon, PhD, in addition to misperceptions about programs, internal barriers include low motivation for treatment, denial of problems, psychological problems, internalization of negative social attitudes toward women with Substance use disorders, self-definition, and independent attitudes about help-seeking and self-reliance. Dr. Gordon is director of research at the Caron Foundation Treatment Center in Wernersville, Pennsylvania.
In particular, depression and anxiety may lead women to delay or do without treatment. Studies suggest that high levels of estrogen can enhance the stress response in subcortical regions of the brain, contributing to the higher prevalence of depression and anxiety in women.
Many women with an Substance Use Disorder have a history of sexual, emotional, or physical abuse, as well as suicidal thoughts and attempts. Post-traumatic stress disorder is common, resulting from trauma or abuse. If a woman with an Substance Use Disorder has a history of emotional, physical, or sexual abuse perpetrated by men—and most do—the very idea of a treatment environment that includes men can be distressing.
Societal Effects on Women
Women are more likely than their male counterparts to have a drug-using partner supporting her drug use. These women generally receive little encouragement to enter treatment, and may instead encounter resistance.
Health professionals are less likely to identify substance abuse in women than in men; often they refer women to mental health care providers instead of treatment programs. Women themselves are partly responsible; they often choose psychological or psychiatric help rather than substance abuse treatment. Shame and guilt, or lack of awareness of the significance or severity of their addiction, may keep them from sharing their substance history with the mental health provider. So their true problem may go undiagnosed, and they lose the opportunity for treatment for their Substance Use Disorder.
Society stigmatizes women who abuse substances. Especially women who have children or are pregnant. Communities and families often fail to provide the support women need, including child care and encouragement to enter treatment.
“Once a woman has developed an addiction, she deviates more from the female norm, compared with a man with an addiction,” according to Drs. Dorte Hecksher and Morten Hesse, writing on Women’s Issues. She’s viewed by some—and often by the woman herself—as a “fallen woman.” She worries about the disapproval of friends, family, co-workers, and employers, if she enters substance abuse treatment, especially if she is pregnant, or a mother. Her concerns about providing child care and the possibility of losing custody are a heavy burden.
Reasons Women Refuse Treatment
Denial. “Breaking the denial is a necessary first step to assisting substance-dependent women to get into treatment,” according to Ozietta D. Taylor, PhD, MEd, LCPC, assistant professor at Coppin State University, Baltimore, Maryland. The Taylor reference below discusses ways of using methods of intervention to help get a woman into treatment.
Socioeconomic barriers. Substance-abusing women are less likely than men to have insurance or full-time jobs, and public funding often means a long wait. Getting to a program is another issue; many don’t have a car or driver’s license, or even money for public transportation.
Therapies and relationships. Men tend to enter treatment with an aggrandized sense of self, according to addictions and trauma expert Claudia Black, PhD, while women are more likely to have a diminished view of themselves, because of their primary role as caregiver. Dr. Black is a senior fellow at The Meadows, a trauma and addiction treatment facility in Wickenburg, Arizona.
Women entering treatment have different needs than men. According to Mary Jeanne Kreek, MD, of The Rockefeller University, “a strong positive correlation exists between troubled relationships, family violence, sexual abuse and poor self-esteem as integral factors in substance abuse among women.” These factors don’t apply to men, and lack of gender-specific services in treatment programs is a definite barrier for women.
Programs can do little to overcome barriers generated by the patient and by society, but the opportunities are many once women reach treatment.
More Women Should Receive Treatment
In particular, women need substance abuse treatment that is multimodal and addresses social services such as vocational rehabilitation. Comprehensive services can mean the difference between treatment failure and success.
Factors encouraging treatment retention include supportive therapy, a collaborative therapeutic alliance, and onsite child care and children’s services. For women who have lost child custody, comprehensive services can be a powerful motivational tool to stay in therapy. Pregnant women especially need comprehensive services. It’s estimated that as few as four percent of women are pregnant when entering treatment, and the services they sorely need are difficult to come by.
Successful treatment often means walking a fine line. Some women believe they are expected to maintain relationships, even abusive ones, and dependency or economic factors may motivate them to do so. If a woman’s drug use has involved a relationship with a spouse or significant other, OUD treatment may threaten that relationship—and the woman’s physical well-being.
Caregivers need to keep this in mind, and avoid focusing on maintaining relationships while excluding women’s other important needs. The importance of a woman’s building support and relationships with female peers is essential. The insight of other women in treatment can help her work through a troublesome relationship, and, if necessary, break it off.
According to Dr. Gordon of the Caron Foundation, programs that increase the chances women will complete treatment comprise mixed-gender programs, services for women, and integrated treatment for co-occurring psychological and physical conditions.
Dr. Gordon believes that “internal and social barriers present more daunting obstacles” than treatment program barriers, and she calls for a change in public attitudes, “if women are to reduce their own feelings of shame and sense of denial.”
She maintains that these are not impossible goals. “Public education campaigns have eliminated the stigma from cancer, and have increased dramatically the numbers of people who are screened, diagnosed and successfully treated for this disease. We can achieve the same results for addiction in women.”
We’re Here To Help
We at Arrow Passage Recovery understand the stigma’s associated with Women’s addictions. We also know that women should receive treatment just as much as men to help them get clean and sober. Don’t hesitate to call us, one of our outstanding addiction specialists will guide you through our treatment process and how we can help you beat your addiction today.
