Gender Matters in the Counseling Setting

Throughout history, differences be-tween men and women have been explored with a diversity of opinions postulated. It should come as no surprise, then, that this area of inquiry would arise in the addiction field, as well. Addiction is a biopsychosocial phenomenon, and distinctions between women and men exist in all three of the se realms.

The addiction treatment system in North America was created predominantly by men for men, but researchers, consumers, and practitioners all indicate that treatment factors differ for men and women, and that women are more likely to experience difficulty in navigating the system.1 Still, surprisingly little research has looked into the implications of gender for treatment programs. It has been reported, however, that women tend to have greater problems than men prior to treatment, such as greater psychological distress, more medical problems, and more family and social difficulties.

Yet several studies have indicated that women fare just as well as men in formal substance abuse treatment. For example, no gender differences were noted when studying substance abuse clients with posttraumatic stress disorder.4 The use of coping strategies after treatment has been linked to improved relapse prevention for both sexes.5 And researchers have found no significant gender differences in relapse rates or effort toward recovery.

However, research has uncovered significant differences between the sexes with respect to the process of treatment. It has been documented that during the initial stages of counseling, women will attend a greater proportion of required sessions and will tend to focus more on crisis intervention, personal issues, and conflict. Men, on the other hand, are typically more concerned with their actual use of substances and with legal issues arising from their use.

Women also remain at greater risk of relapse than do men for a variety of reasons. Because women tend to obtain more social support from friends than do men, they may find themselves more often in situations in which they feel pressured into substance use when with these friends, to reciprocate the support. Also, relapse risk is exacerbated when women are in the regular presence of a romantic partner.8 Research has indicated that male partners do not supply the same level of mutual aid and support during and posttreatment that female partners do, and male partners also are more likely to continue their own substance use after the woman's treatment.

Women's coping abilities

Csiernik and Troller conducted an evaluation of a community-based agency's mixed-gender relapse-prevention program using the 36-item Coping Behaviours Inventory to assess clients' coping strategies in response to the urge to drink or use drugs.9 The closed relapse-prevention group had eight consecutive weekly sessions with a cognitive-behavioral focus. Clients were supported if they had a slip or full-blown relapse while enrolled in the group; in return, they were expected to be honest in discussing the circumstances that led to using again and what alternative actions would be taken in the future.

Csiernik and Troller found that clients almost immediately used the relapse-prevention strategies taught to them during group counseling. Clients who completed counseling continued to increase the number and range of alternative coping behaviors two and six months posttreatment, with nearly a 20% change between pretreatment and six-month posttreatment scores. How-ever, when conducting a gender analysis, the researchers discovered that much of the overall group success was a result of significant increases in women's coping strategies and abilities.

There had been a minimal difference in pretest scores between men and women. While the men were doing slightly better six months after counseling, the women's improvement was statistically significant. Women who participated in the mixed-gender counseling groups used more coping strategies and used them more frequently than did men, both during counseling and after leaving the group.

Implications for treatment

With so much promise for women if they can complete treatment, matching services to women's needs becomes a critical factor. For example, a single mother with two young children might not enter a residential program for fear of losing custody of her children or might be unsuccessful in an evening treatment program. Yet she might succeed in the same program if child care is provided. Also, consider the advantage for women with school-age children if a daytime treatment program coincides with school hours rather than an agency's traditional operating hours. This would allow mothers to take their children to school and pick them up at the end of the day, rather than be distracted by concerns for their children's well-being at a time when they are trying to better the lives of themselves and their children.

Gender of the counselor

Diversity's increasing importance in the addiction field highlights the need to recruit, train, and support gender-sensitive counselors so that they are aware of gender issues and feminist-informed practices. In an examination of gender-role stereotypes and interpersonal behavior, Jonker and colleagues looked at how addicted inpatients view their ideal male and female therapist.10 They found that the sex of the therapist is not important when patients consider their ideal counselor. What is important are gender-sensitive counselors—practitioners aware of the common and unique needs of women and men. Gender “neutrality” entails far more than simply using gender-sensitive language. It necessitates exploring issues in society and treatment not only through the lens of a male- created system but also through a feminist-informed perspective, for the benefit of female and male clients alike.

Sex does matter. It always has, even when it was not recognized. There are differences in how and why men and women become addicted, and in their treatment and posttreatment needs. The extent of these differences will continue to be researched, as our knowledge in this important practice area remains too sketchy. However, while we seek to complete the full picture, the outstanding questions remain: Is your organization addressing and attending to these differences? And are you, as a client-centered practitioner, doing likewise?

References

1. Green CA, Polen MR, Dickinson DM., et al. Gender differences in predictors of initiation, retention, and completion in an HMO-based substance abuse treatment program. J Subst Abuse Treatm 2002; 23:285-95.
2. Callaghan R, Cunningham JA. Gender differences in detoxification: Predic-tors of treatment completion and re-admission. J Subst Abuse Treatm 2002; 23:399-407.
3. Marsh JC, Cao D, D'Aunno T. Gender differences in the impact of comprehensive services in substance abuse treatment. J Subst Abuse Treatm 2004; 27:289-300.
4. Triffleman E. Gender differences in a controlled pilot study of psychosocial treatments in substance dependent patients with post-traumatic stress disorder: Design considerations and outcomes. Alc Treatm Quarterly 2000; 18:113-26.
5. Annis HM, Sklar SM. Moser A.. Gender in relation to relapse crisis situations, coping, and outcome among treated alcoholics. Addictive Behav 1998; 23:127-31.
6. Schneider KM, Kviz FJ, Isola ML, et al. Evaluating multiple outcomes and gender differences in alcoholism treatment. Addictive Behav 1995; 20:1-21.
7. Rowan-Szal G, Chatham LR, Joe GW., et al. Services provided during methadone treatment: A gender comparison. J Subst Abuse Treatm 2000; 19:7-14.
8. Rubin A, Stout R, Longabaugh R. Replication and extension of Marlatt's taxonomy: Gender differences in relapse situations. Addiction 1996; 91:S111-S120.
9. Csiernik R, Troller J. Evaluating the effectiveness of a relapse prevention group. J Soc Work Prac in the Addic-tions 2002; 2:29-37.
10. Jonker J, De Jong CA, de Weert-van Oene GH., et al. Gender-role stereotypes and interpersonal behavior: How addicted inpatients view their ideal male and female therapist. J Subst Abuse Treatm 2000; 19:307-12.