Women Across the Lifespan
A National Conference on Women,
Addiction and Recovery
H. Westley Clark, MD, JD, MPH
Director
Center for Substance Abuse Treatment
Substance Abuse and Mental Health
Services Administration
President
George W. Bush
State of the Union – January
28,2003

“…Addiction crowds
out friendship,
ambition, moral
conviction, and
reduces all the
richness of life to a
single destructive
desire.”
President George W.
Bush
State of the Union – January 28,2003

“…Let us bring to all
Americans who struggle
with drug addiction this
message of hope: the
miracle of recovery is
possible, and it could
happen to you.”
The Administration’s Direction

The Bush Administration established drug reduction
goals in the National Drug Control Strategy.



Reducing drug use by 10 percent within two years
Reducing drug use by 25 percent within five years
SAMHSA’s Mission Statement Building Resilience
and Facilitating Recovery further emphasizes a strong
commitment to recovery.
SAMHSA’s Goals
Accountability: establish systems to measure
performance
 and ensure accountability


Capacity: build, enhance and maintain treatment
infrastructure and capacity

Effectiveness: enable all communities and providers to
deliver effective treatment services
Enhancing
Capacity
Promoting
Accountability
Assuring
Effectiveness
SAMHSA’s Role
Promoting
Evidence-Based
Treatment Practices
Administering
Substance Abuse
Prevention and
Treatment Block Grant
Programs
Supporting Clinical
and Administrative
Education and
Training Programs
Promoting
Community-Based
Service Availability
and Quality
Supporting a
Nationwide
Toll Free Referral
Hotline
Providing TA and
Capacity-Building
Tools
Regulating and
Training the Field
in Pharmacologic
Therapies
Conference Topics
Co-occurring Disorders
 Treatment Capacity
 Prevention and Early Intervention
 Addressing Needs of Children and Families
 Homelessness
 Infectious Diseases
 Criminal Justice
 Trauma and Violence

Current Facts
 Women
are less likely than men to report
current use of illicit drugs (6.4% versus
10.3%)
 Nevertheless,
the rate of non-medical use of
prescription drugs is similar between
women and men (2.6% versus 2.7%)
Office of Applied Studies (2003) Results from the 2002 National Household Survey on Drug Use and Health
Current Facts
Among youths aged 12-17, girls are less
likely to use illicit drugs compared with
boys (10.9% versus 12.3%)
 The rate of non-medical use of prescription
drugs is higher for girls than boys (4.3%
versus 3.6%)
 The rate of marijuana use is less for girls
than for boys (7.2% versus 9.1%)

Office of Applied Studies (2003) Results from the 2002 National Household Survey on Drug Use and Health
Past Month Illicit Drug Use among
Youth Aged 12-17, by Gender: 2002
14
12.3
12
10.9
10
9.1
8
7.2
Male
Female
6
3.6
4
4.3
2
0
Any Illict
Marijuana
Prescription Drugs
Office of Applied Studies (2003) Results from the 2002 National Household Survey on Drug Use and Health
Current Facts
 In
2002, 44.9 percent of females aged 12 or
older were current drinkers compared with
57.4 percent of males.
 For
the youngest age group (12-17),
females and males had comparable rates of
current alcohol use in 2002 (17.9 percent of
females and 17.4 percent of males).
Office of Applied Studies (2003) Results from the 2002 National Household Survey on Drug Use and Health
Current Facts
 Among
women aged 15 to 44 in 2002, 53.4
percent used alcohol and 23.4 percent
reported binge drinking in the month prior
to the survey.
 These rates were significantly higher than
the rates for pregnant women of that age
(9.1 and 3.1 percent, respectively). Heavy
alcohol use was relatively rare (0.7 percent)
among pregnant women.
Office of Applied Studies (2003) Results from the 2002 National Household Survey on Drug Use and Health
Current Facts
 Among
youths aged 12 to 17, girls were
slightly more likely than boys to smoke
(13.6 vs. 12.3 percent)
 In
2002, 31.1 percent of women aged 15 to
44 smoked cigarettes in the past month
compared with 17.3 percent of pregnant
women of the same age group.
Office of Applied Studies (2003) Results from the 2002 National Household Survey on Drug Use and Health
Percentages of Women Aged 21 to 25 Reporting
Past Month Substance Use, by Marital Status: 2002
Married
70
Divorced or Separated
58.5
60
Never Married
51
Living with an Unmarried Partner
50
40.4
40.1
40
30
34.8
29.2
27.3
21.4
19.3
20
14.8
17.5
7.2
10
0
Tobacco Use
Binge Alcohol Use
Illicit Drug Use
Office of Applied Studies (2003) Results from the 2002 National Household Survey on Drug Use and Health
Percentages of Women Aged 26 to 34 Reporting
Past Month Substance Use, by Marital Status: 2002
60
50
Married
Divorced or Separated
Never Married
Living with an Unmarried Partner
46.9
38.8
40
35.1
34.1
28.3 27
30
23.5
20
16.3
14.6
9.5 9.6
10
5
0
Tobacco Use
Binge Alcohol Use
Illicit Drug Use
Office of Applied Studies (2003) Results from the 2002 National Household Survey on Drug Use and Health
Percentages of Women Aged 35 to 49 Reporting
Past Month Substance Use, by Marital Status: 2002
60
Married
53.5
Divorced or Separated
50
Never Married
42.8
Living with an Unmarried Partner
40
32.3
29.3
30
22.9
21.2 20.5
20
14.7
13.3
9.2
10
6.8
4.1
0
Tobacco Use
Binge Alcohol Use
Illicit Drug Use
Office of Applied Studies (2003) Results from the 2002 National Household Survey on Drug Use and Health
Percentages of Married Women Aged 21 to 49
Reporting Past Month Substance Use, by Whether
at Least One Child Younger Than Age 18 Lived in
Their Home: 2002
Child Living in Home
30
25.8
25
No Child Living in Home
22.8
20
16.6
14.5
15
10
6.2
4
5
0
Tobacco
Binge Alcohol Use
Illicit Drug Use
Office of Applied Studies. (2003). Results from the 2002 National Survey on Drug Use and Health: National
findings
Substance Dependence or Abuse in the Past Year
among Persons Aged 12 or Older by Gender:
Percentages 2002
14
Male
Female
12.8
12
10.8
10
8
6.1
6
4
4.8
4
2.1
2
0
Illicit Drug
Alcohol
Illicit Drug or Alcohol
Office of Applied Studies (2003) Results from the 2002 National Household Survey on Drug Use and Health
Received Substance Abuse Treatment in the Past
Year among Persons Aged 12 or Older by
Gender: Numbers in Thousands, 2002
2500
2000
1500
1000
Male
Female
2334
1743
1262
1149
951
751
661
367
500
0
Illicit Drug
Alcohol
Both Any Illicit Any Illicit Drug
Drug and
OR Alcohol
Alcohol
Office of Applied Studies (2003) Results from the 2002 National Household Survey on Drug Use and Health
Received Substance Abuse Treatment in the Past
Year among Persons Aged 12 or Older by
Gender: Numbers in Thousands, 2002
Male
Female
6000
5000
4867
4041
4000
3000
2881
2294
2000
826
1000
587
0
Needed Tx for Illicit
Drug
Received Specialty
TX
Did Not Receive
Specialty TX
Office of Applied Studies (2003) Results from the 2002 National Household Survey on Drug Use and Health
Perceived Need for Treatment for an Illicit Drug
Use in the Past Year among Persons Aged 12 or
Older by Gender: Numbers in Thousands, 2002
4500
4041
Male
Female
3835
4000
3500
3000
2500
2294
2139
2000
1500
1000
500
206
155
0
Did Not Receive
Specialty TX
Felt Need for Tx
Felt No Need for TX
Office of Applied Studies (2003) Results from the 2002 National Household Survey on Drug Use and Health
Most Women Who Needed Treatment for
an Illicit Drug Problem Did Not Feel A
Need for Treatment
Felt No Need for TX
Felt Need for TX
5%
7%
93%
Female
95%
Male
The perpetuation of substance use
disorders is facilitated by the denial of
the impact of the problems associated
with those disorders and by the powerful
reinforcing properties of substances of
abuse which produce those disorders.
The demand for illicit drugs is also associated
with the denial of impact and the failure to
recognize the association between illicit drug
consumption and the problems.
I Can’t Stop!
I Won’t Stop!
Number of Facilities
Number of Substance Abuse
Treatment Facilities
18000
16000
14000
12000
10000
8000
6000
4000
2000
0
15239
13455
10641
10860
1996
1997
1998
1999
13428
13720
2000
2002
Years
Source: Office of Applied Studies, Substance Abuse and Mental Health Services Administration, Uniform Facility
Data 1996-1999; National Survey of Substance Abuse Treatment Services (N-SSATS), 2000.
All Admissions, by Age Group
and Sex in 2001
Age
<55
Age
55+
Female
30%
20%
Male
70%
80%
Source: 2001 SAMHSA Treatment Episode Data Set (TEDS).
Percent of Facilities
Type of Care Provided by Substance Abuse
Treatment Facilities, by Whether Facilities
Provided Special Programs or Services for
Women: 2000
100
90
80
70
60
50
40
30
20
10
0
Provided Special Programs/Services for
Women
85
76
Did Not Provide Special Programs/Services
for Women
25
Outpatient
29
Non-Hospital
Residential
18
14
Day Treatment
7
10
Hospital Inpatient
Source: 2000 SAMHSA National Survey of Substance Abuse Treatment (N-SSATS).
Percent of Facilities
Other Special Groups Served by Substance Abuse
Treatment Facilities, by Whether Facilities
Provided Special Programs or Services for
Women: 2000
100
90
80
70
60
50
40
30
20
10
0
Provided Special Programs/Services for
Women
Did Not Provide Special Programs/Services
for Women
58
37
42
29
30
24
8
Dually Diagnosed
Adolescents
Persons with
HIV/AIDS
22
8
Seniors
5
Gays/Lesbians
Source: 2000 SAMHSA National Survey of Substance Abuse Treatment (N-SSATS).
SAMHSA FY 2005 Congressional Justification
(Dollars in millions) cont.
FY 2004 require
Inc/Dec
Although budget concerns
a tight balancing of priorities,
the FY 2005 FY 05 > FY 04
Final
Administration is Conference
requesting an Estimate
Programs
$
%
increase in Substance Abuse funds
Subtotal, MH
Subtotal Sub Abuse
Progr Mgmt……….
B&F………………….
Total SAMHSA…….
PHS Eval (non-add)
Total, SAMHSA BA..
FTEs………………….
862.2
2396.8
91.9
~~~
$3,350.9
(117.0)
$3,233.9
546.0
912.5
50.3
2545.2 148.4
92.5
0.6
~~~
~~~
$3,550.2 $199.3
(121.3)
(4.3)
$3,428.9 $195.0
546.0 ~~~
5.8%
6.2%
0.7%
N/A
5.9%
3.7%
$0
0.0%
SAMHSA Funding for Children & Families
(Dollars in thousands)
FY 2003
$266,801
FY 2004
FY 2005-Estimate
$272,166
Amount
$277,911
+/->FY04
+$5,745
Block Grant Set-aside – Women
Treatment Services

Increase the availability of treatment services
designed for pregnant women and women
with dependent children
– FY 2004
– FY 2005
243 Million
244 Million
CSAT Allotments - Children and Families
for FY 2003-2005(estimate)
–Programs of Regional and National Significance
– FY 2003
– FY 2004
– FY 2005
$ 24.6 Million
$ 33.7 Million
$ 33.7 Million
National Comorbidity Survey
Co-occurring substance use disorders and mental disorders
42.7% of individuals with a 12-month
addictive disorder had at least one 12-month
mental disorder
 14.7% of individuals with a 12-month mental
disorder had at least one 12-month addictive
disorder

Defining Co-Occurring Disorders

Individuals who have at least one mental disorder as
well as an alcohol or drug use disorder.

While these disorders may interact differently in any
one person (e.g., an episode of depression may trigger
a relapse into alcohol abuse, or cocaine use may
exacerbate schizophrenic symptoms), at least one
disorder of each type can be diagnosed independently
of each other.
SAMHSA Report to Congress at page 2
Rates of Serious Mental Illness among Adults
Aged 18 or Older, by Age and Gender: 2002
18
16.3
16
14
12.2
12
10
10
8
6.7
6.3
6
4
Male
Female
3.2
2
0
18-25
26-49
50 or Older
Office of Applied Studies (2003) Results from the 2002 National Household Survey on Drug Use and Health
PTSD in SA Treatment Patients
29% of the sample of methadone treated
patients met the criteria for life time PTSD
53% - women
14% - men
55% of those with a history of PTSD
reported symptoms in the past 6 months
Clark et al,
Clark
J of et
Substance
al, J of Substance
Abuse Treatment
Abuse Treatment
20:121-127
20:121-127
(2001) (2001)
Substance Abuse Treatment 20:121-127 (2001)
Traumatic Events and SA
Treatment Patients cont.
No.
Events
24
46.1%
Men
(n=91)
No.
Events
2
Seeing someone
hurt/killed
Physical assault
20
38.5%
34
54.0%
8
15.4%
27
42.8%
Total
52
100%
63
100%
Events
Rape
Women
(n=59)
%
%
3.2%
Clark et al, J of Substance Abuse Treatment 20:121-127 (2001)
If we don’t ask, they won’t tell
It is important for SA treatment providers to
recognize that traumatic events leave their
imprints of patients
Disasters, terrorist attacks, and other
generalized traumatic events may activate
pre-existing PTSD or compound the effects of
previous trauma
If clinicians don’t inquire about the effects of
a traumatic event, many patients will not
discuss them
Receipt of Substance Use Treatment
or Mental Health Treatment
Among adults with co-occurring SMI and a
substance use disorder, the rate of specialty
substance use treatment during the past year
was similar among females (11%) and males
(16%)
 Females with co-occurring disorders were
more likely than males to receive mental
health treatment (54% versus 39%)

Office of Applied Studies (2003) Results from the 2002 National Household Survey on Drug Use and Health
Where We Are Going
Promote Partnerships

Create forums in which SAMHSA and private
organizations can develop collaborative strategies to
improve alcohol and drug treatment and recovery services

Promote communication and collaboration among:






States and communities
Service providers
Academic institutions
Researchers
People in Need of Treatment
People in Recovery
to provide an efficient, seamless system of services
Promote Partnerships, (continued)

Continue to expand partnerships with:









Prevention
Mental Health
Primary healthcare providers
Child welfare agencies
Faith-based organizations
Criminal justice system
Schools
Business Community
Labor Community
to enhance appropriate, quality service delivery in all
health and human services
Many Pathways to Recovery

A voice for the recovery community

Peer-to-peer recovery support services
 RCSP
 Credentialing

Faith-based

12-Step Programs
Enhance System Effectiveness

Facilitate consensus on quality of care and treatment
outcomes

Support implementation of evidence-based practices
that guide screening, intervention, assessment,
engagement, individual and group therapies, relapse
prevention, and continuing care

Develop reimbursement mechanisms that:


Incorporate performance requirements
Ensure support for system reinvestment
Develop the Workforce

Conduct a nationwide addiction treatment and peer to
peer workforce survey and develop a comprehensive
report on the state of the workforce

Establish national addiction professional minimum
competency standards

Develop ongoing data collection of information about
the changing characteristics of the workforce

Continue dissemination of research findings and
evidence-based clinical and organizational practices
through the ATTC’s and other mechanisms
Workforce Demographics



Gender: Majority of direct service staff is female (data
ranges from 57 –60%; 70% of new counselors are
female); Majority of management staff are male
Age: Average age of direct service staff was mid-forties
to 50 years old; 75% of workforce over 40; many
people enter the field in their late-30s
Race and Ethnicity: 75-90% of workforce is White;
private agencies have fewer minority staff than public
agencies
Workforce Burnout
As we develop strategies to recruit people into
the workforce, we must develop strategies to
keep people in the workforce.
 Career Ladders, Burnout Reduction, and
Adequate Compensation are essential
components of any comprehensive workforce
strategy.

Reduce Stigma

Promote stigma reduction for persons in
alcohol/substance abuse treatment and recovery


Respect their rights
Treat recovering persons like those suffering from other
illnesses

Support educational initiatives that inform the public
about the effectiveness of treatment

Promote the dignity of persons in treatment and
recovery
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