Celebrating Women`s Differences

With all of the discussion of gender-specific addiction treatment services currently taking place in the field, it is somewhat hard to believe that just over a generation ago almost no organizations were offering gender-separate programs structured to meet the needs of women and their families.

The Residence XII treatment organization in Kirkland, Washington is in its 26th year of operation and stands as one of the oldest programs established to create gender-separate services for women. Its founders saw that women who were exiting treatment programs populated largely by men were attending 12-Step meetings in the community but not benefiting from the process. What began as a mission to start a sober house for women has since grown into a full-service operation encompassing inpatient, intensive outpatient, relapse prevention, continuing care, and family services, says Executive Director Sharon Chambers.

“I'm a believer in gender-separate treatment,” Chambers says. “Just as women don't want to talk about certain issues in the presence of men, men don't want to talk about things like sexual abuse and domestic violence in front of women, either.”

“It's important to separate the genders in early recovery in particular,” says Brenda Iliff, clinical director of the Women's Recovery Center operated by the Hazelden treatment organization in Center City, Minnesota. “But you also have to think about the tiny treatment center out there that can't necessarily do that. There we want to strive to be sensitive to gender [issues] even in mixed groups.”

Learning from the research

Even before the actual treatment process begins, women's relationship to substances and to treatment tends to differ from that of men. “Many years ago the Big Book said that women go down faster than men, but we didn't know why,” Iliff says. “Now we know that one drink for women has twice the impact, and that women have less of the enzyme that breaks down alcohol.”

Chambers adds that women often are referred to treatment differently from men, with referrals from a therapist or family member more common than for men who often enter treatment via an employer or the courts. And once they are in treatment, she says some of the traditional approaches don't tend to work well.

“Women are processors,” Chambers says. “Going to smaller groups will work better for them. Women need to be heard and encouraged.”

The federal Center for Substance Abuse Treatment (CSAT) has identified 17 critical areas of focus for women's treatment. They range from gender-specific factors related to addiction's onset and consequences to barriers to a healthy life such as low self-esteem, unhealthy interpersonal relationships, eating disorders, and isolation related to a lack of support systems.

Iliff considers many of these issues to be topics that women will tend to sidestep when in the presence of men. In some cases, she and other professionals actually encourage women not to talk about certain topics with male clients. For example, men in a mixed-gender group may use a female client's comment about having sold sex during an addiction as a stigmatizing point that will be brought up later on in treatment, she says.

“Most women will hesitate to talk about trauma issues in front of men, or about areas where they have failed as a parent,” Iliff says. “We even have women who won't eat in front of men,” because of issues surrounding body image.

As research has looked more at the factors relevant to women's addiction, treatment, and recovery, a gradually increasing number of treatment organizations have begun providing specialized programs for women. Data from the National Survey of Substance Abuse Treatment Services show that among the 11,578 facilities nationwide that accepted female clients in 2005, 41% offered at least one special program or group for women. Larger facilities of 120 clients or more were considerably more likely to offer such programs than were facilities of 14 or fewer clients.

Facilities that offered special programs for women also were more likely to see the benefit of offering tailored services for other groups, including men, elderly individuals, and persons with HIV/AIDS, according to the federal data.

“We need all types of treatment,” says Iliff. She believes that young women in particular can benefit from a women-only environment because it eliminates the distractions brought on by having men nearby. Yet many women's programs do tend to have some male counselors on staff, and for some women a male counselor might eventually become one of the few positive male influences in their lives.

“The research doesn't say that you do better with a male or a female counselor. The research says you do better in gender-specific groups,” Iliff says.

Holistic approaches

Renaissance House in the community of Bisbee, Arizona, southeast of Tucson maintains a 12-Step foundation but has incorporated into it every imaginable health- and wellness-related intervention, creating what it calls a “transformational recovery community” for women. “We're here to love these women to health,” says Vicki French, clinical director of the facility, where women can reside with their children during treatment.

French believes the various interventions under the “wellness” umbrella will become a prevailing trend in the provision of specialized services for women. “Addiction is a bio-psycho-social-spiritual problem, but most conventional programs look at just the psychological,” she says.

At Renaissance House, women are exposed to a variety of activities designed to highlight the mind-body-spirit connection, from yoga to tai chi to monthly sweat lodge sessions. Program staff members realize that not every activity will suit everyone in the program. “But we want them to try it,” French says. “We encourage them to keep working on it. We know that when some women leave here, the last thing they'll ever want to do again is yoga. But for others it will be a part of their life forever.”

At Hazelden's Women's Recovery Center, all clients receive a formal fitness evaluation that assists in establishing realistic and individualized goals. “Some of our clients have been on the couch for years,” Iliff says. “Some will decide to come in twice a week to swim. For others, the goal may be simply to move for 20 minutes a day.”

She adds that for women who have experienced the ravaging effects of methamphetamine addiction, having some fitness goals is absolutely essential. “We tell them that the Steps will change their heart, but exercising will help their brain,” she says.

“These women, many of whom haven't been successful at anything else, find they can make furniture,” French says. They work three days a week in the woodshop and then two days a week at an art gallery where the chairs are sold, learning the skills involved in operating a retail business.

Barriers to overcome

While the provision of women's treatment appears to be maturing, the director of one of the most established programs says many challenges remain. As with all addiction treatment in general, programs such as Residence XII struggle with insurance limitations. Nearly all clients in the residential program at Residence XII are either financing their own treatment or are covered by private insurance.

“A lot of what we have to do is build linkages for these women to the community, because many of them are only here while their treatment is considered medically necessary,” Chambers says.

However, other kinds of challenges can surface when centers work with public sector clients. At one time, Residence XII had a small contract with the state to operate residential treatment beds for indigent women, but the organization ended the arrangement because it balked at state regulatory requirements that facilities accept clients on any types of medication. “We don't take patients on opiate substitution medications,” Chambers says.

Chambers believes the addiction field still has a distance to go in fully defining the key elements of gender-specific treatment, and being precise about what it means to offer gender-specific services. What she does know is that after having worked in both women-only and mixed-gender programs, she sees women-only programs as offering a high level of professional satisfaction.

“In this work in general you save lives, but I'm particularly passionate about this type of program because it's for an underserved population,” Chambers says.