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Gender Responsiveness in Services for
Substance Use Disorders
Julie Cushman LMSW, ACSW, CAADC
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Identify at least three barriers that impact a women’s
ability to obtain services for substance use disorders.
Identify at least five ways the professional can assist
in overcoming barriers to services.
Increase knowledge of a least three ways
professionals can create gender responsive
programming.
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 Course of illness different than men/Telescope Effect
 Females advance more rapidly & escalate into addiction
faster.
 Metabolic differences- experience negative
physiological consequences sooner with less use.
 More medical, psychiatric and social consequences.
 Treatment needs different & more complex than men.
 Co-existing psychiatric disorders
 Parental Stress
 Trauma History
 Specific Barriers
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 Systemic - impede the development of services that
respond to women’s needs.
 Structural - policies and practices at the service or
program level that make it difficult for women to
access substance use treatment.
 Social, Cultural, & Personal - related to the social and
cultural norms that exist, which include women’s
roles and behavior that is considered appropriate;
women’s lack of empowerment in many societies; and
societal and community norms and attitudes about
women who have substance use problems.
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Lack of decision-making power
Limited awareness of gender differences
Lack of knowledge of women with substance use
problems and their treatment needs
Lack of appropriate gender-responsive and lowcost, evidence-based treatment models
Differences in the organization and funding of
health services
Need for a comprehensive array of services
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Childcare
Transportation
Services for pregnant women
Location & cost of treatment programs
Rigid program schedules
Waiting lists
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Denial of admission to women using psychoactive
medication
Service coordination
Lack of identification, referral, & intervention in
primary care and other sectors
• Lack of diagnosis or misdiagnosis
Information on treatment options
Physical safety
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Fear of leaving children/losing custody of children
Lack of support from family or partners
• Family history of substance abuse
• Involvement with substance abusing partners
Substance use perceived as solution, not problem
Lack of information of services (Straussner, 2004)
Lack of confidence in the effectiveness of treatment
 Stigma, shame, & guilt
 Low self-esteem
 Trauma History
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Social Service Agencies
Physician
Attitudes
Supervisor
Reluctance to address
Family
Not able to assess,
diagnosis
Gaps in referral network
Teacher
Punitive
Friends
Enforcement agencies
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Go where women can be found
Focus on reducing stigma
Encourage women to seek treatment by
acknowledging their struggles as well as their
efforts at coping in their environment
“Love women into treatment”
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Addiction is not an isolated disease
• Women have a variety of issues and needs
such as economic independence, genderrole expectations, low self worth, etc.
Interactions of biological, psychological,
cognitive, social development and
environmental variables are all considered
Identify benefits of harm reduction services.
Current instruments may not take into
account gender differences.
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 Women are heterogeneous and diverse
• Require a comprehensive assessment to identify and meet
individual needs that is made from a biopsychosocial and
sociocultural perspective
• External factors: Cultural, Religion, Family, Peers
• Social factors: Situation, social relations, social structures
 Misuse, Abuse & Dependency - Result of external
forces that act as social stressors (unemployment,
poverty, violence, etc.)
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Developed primarily by men concerned with
types of problems experienced more frequently
by men
• Basic assumptions and program
models/services tend to be male responsive
Despite 30 years of research and advocacy, AOD
services remain more accessible and appropriate
for men in most locations
Concerns about women are often primarily
related to pregnancy
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1960s
Generic Treatment – male as client
1970s
Gender Differences – biological, parenting,
psychosocial
1980s
Gender Specific – separate facilities, childcare or
child live-in, transportation, special groups or
services
1990s-2000s
Gender Responsive – trauma informed, relational
theory, strengths-based
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Definition
Creating an environment through site selection,
staff selection, program development, content,
and material that reflects an understanding of
the realities of the lives of women and girls and
that addresses and responds to their strengths
and challenges.
Source: Bloom, Owen & Covington (2004)
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 Acknowledge that gender makes a difference
 Create an environment based on safety, respect and
dignity
 Develop policies, practices and programs that are
relational and promote healthy connections to
children, family, significant others and the
community
 Attend to the relevance and influence of various
caregiver roles women often assume
Source: Bloom, Owen, and Covington, 2003; TIP 51: Addressing the Specific Needs of Women
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Address substance use, trauma and mental health
issues through comprehensive, integrated and
culturally relevant services
Validation of behaviors that have allowed survival
to reduce shame and guilt
Provide women with opportunities to improve
their socioeconomic status
Recognize societal attitudes towards women who
abuse substances; stigma and stereotypes
Establish a system of comprehensive and
collaborative, community services
Source: Bloom, Owen, and Covington, 2003; TIP 51: Addressing the Specific Needs of Women
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Take the trauma into account
Avoid triggering trauma reactions and/or
traumatizing the individual
Adjust the behavior of workers and the
organization to support the individual’s coping
capacity
Allow survivors to manage their trauma
symptoms successfully to promote access,
retention and benefit from services
Source: Fallot and Harris (2001)
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Adequate treatment period is crucial
Individual & group counseling (women only)
Co-occurring disorders treated in an integrated
way
Medication as needed
Uses components of Feminist Theory, Self-inRelation Theory, the Empowerment Model and
Strengths Perspective
Recovery is a long term process & frequently
requires multiple treatment episodes
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Supportive therapy - warmth, empathy, connection
during crisis
Confrontation based on awareness, understanding
and trust
Collaborative approach with client that is active,
optimistic and builds on client’s strengths and ability
to solve problems
Treatment shares with client what has helped others
in the past and client is the expert on what will work
for her
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Type of Treatment Services
• Gender specific groups
• Various services all in one location
• Initially receive greater intensive care
• Individual counseling
• On-site childcare and transportation
Therapeutic Alliance & Counselor Characteristics
• Trust & Warmth vs. Problem-Solving approach
• Female staff
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Women in gender-specialized programs:
Use more services throughout treatment than
women in traditional coed program
Have higher rates of abstinence
More likely to see themselves as doing well in
treatment
Twice as likely to complete gender specialized
program
Source: Nelson-Zupko, et al (1996), Messina et al (2012)
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Identify the types of barriers for entering and engaging in
substance use treatment (systemic, structural, and cultural,
social and personal barriers) in the following vignette and
ways to overcome these barriers.
Lisa is a 28-year-old, single/never married, Hispanic, mother
of three children (ages 2, 4, 7, and 10). She has a history of
alcohol and opioid dependence and became pregnant with her
youngest son while using Vicodin. She is currently taking
Suboxone that she is getting from an ex-boyfriend. She is
residing with an acquaintance in a rural area, has unreliable
transportation. She has no close friendships. She has a family
history of addiction. She called a substance use treatment
agency in her community but was unable to schedule an
appointment due to not having childcare for her youngest two
children.
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An “Ideal” System for AOD Prevention
and Treatment for Women
All Women
Women Informed Health Promotion
Universal Prevention
Women with
Risk Factors
Women-Focused Selected
& Indicated Prevention
Women Developing
AOD problems
Better & Earlier Outreach & Case Finding,
Accurate Screening and Assessment,
Brief Treatment, Engagement
Women in Need
Of Treatment
Assessment
Fewer Barriers to
Treatment
More WomenInformed, Friendly
& Centered
Services &
Programs
Better
Outcomes
Less
Relapse
Fewer Women
with AOD
Problems &
their
Consequences
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Questions/Comments
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 Binswanger, I. A., Merrill, J. O., Krueger, P. M., White, M. C., Booth, R. E., & Elmore, J. G. (2010).
Gender differences in chronic medical, psychiatric, and substance-dependence disorders
among jail inmates. American Journal of Public Health, 100, 476-482.
 Bloom, B., Owen B., & Covington, S. (2003). Genders-responsive Strategies: Research, Practice,
and Guiding Principles for Women Offenders. Washington, DC: National Institute of
Corrections.
 Bloom, B., Owen, B., & Covington, S. (2004). Women offenders and gendered effects of public
policy. Review of Policy Research, 21, 31-48.
 Center for Disease Control : http//www.cdc.gov
 Fallot, R., and Harris, M. (2001) A trauma-informed approach to screening and assessment
New Directions for Mental Health Services 89, 23–31.
 Grella, C. (2008). From generic to gender-responsive treatment: Changes in social policies,
treatment services, and outcomes of women in substance abuse treatment. Journal of
Psychoactive Drugs, 40, 327-343.
 http//www.elementsbehaviorhealth.com/addiction-treatment/women-have-special-needs-in
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substacne-abuse-treatment/
http//www.ncadi.samhsa.gov
Messina, N., Calhoun, S., and Warda, U. (2012) Gender-Responsive Drug Court Treatment: A
Randomized Controlled Trial. Criminal Justice and Behavior 39(12):1539-1558
National Eating Disorder Association: http://www.nationaleatingdisorders.org
National Institute on Drug Abuse: http://www.drugabuse.gov
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 Nelson-Zlupko, L., Dore, M. M., Kauffman, E., & Kaltenbach, K. (1996). Women in recovery:
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Their perceptions of treatment effectiveness. Journal of Substance Abuse Treatment, 13, 51-59.
Sherman, Carl.,(June 2006) NIDA NOTES 20(6).
Straussner, S.L. (Ed.). (2004). Clinical work with substance-abusing clients. 2nd ed. New York:
The Guilford Press.
Substance Abuse and Mental Health Services Administration: http://www.samhsa.gov
U.S. Department of Health and Human Services: TIP 51-Substacne Abuse Treatment: Addressing
the Specific Needs of Women. http://www.samhsa.gov
Women Under the Influence. (2009, May 28). New York City, NY: Columbia University.
Retrieved July 24, 2009 from,
http://www.casacolumbia.org/absolutenm/templates/Publications.aspx?articlesid=421&zoneid
=52
pictures/graphs obtained from Google Images
Resources:
 Stephanie Covington, Helping Women Recover: allows women to examine their relationships
and support systems
 Lisa Najavits, Seeking Safety and Woman’s Addiction Workbook: assists women in
understanding healthy and unhealthy boundaries, strategies for identifying persons who can
be positive (supportive) or negative (destructive) influences on their recovery, tactics for
enhancing or minimizing those influences and activities to enhance support from other
women
 Monique Cohen, Counseling Addicted Women: A Practical Guide : provides client and staff
activities surrounding relationship issues
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