U.S. Department of Health and Human Services
Public Health Service
Substance Abuse and Mental Health Services Administration
Center for Substance Abuse Treatment
Division of Clinical Programs
Women and Children's Branch
Rockwall 11, 5600 Fishers Lane
Rockville, MD 20857
This
publication is part of the Center for Substance Abuse Treatment (CSAT),
Division of Clinical Programs' Women and Children's Branch activities. All
material appearing in this volume except quoted passages from copyrighted
sources is in the public domain and may be reproduced or copied without
permission from CSAT or the authors. Citation of the source is appreciated. The
recommended citation is: Center for Substance Abuse Treatment. (1994) Practical
Approaches in the Treatment of Women Who Abuse Alcohol and Other Drugs.
Rockville, MD: Department of Health and Human Services, Public Health Service.
This publication was prepared under
contract No. CSAT-93-0006 from CSAT. Maggie Wilmore served as the Government
project officer.
The opinions expressed herein are those of the contributors to the report and
the contractor, Policy Research Incorporated, and do not reflect the official
position of SAMHSA or any other part of the U.S. Department of Health and Human
Services (DHHS). No official support or endorsement of the Substance Abuse and
Mental Health Services Administration (SAMHSA) or DHHS is intended or should be
inferred. The recommendations presented in this document should not be
considered as substitutes for individualized patient care and treatment
decisions.
For sale by the U.S. Government Printing Office
Superintendent of Documents, Mail Stop: SSOP. Washington, DC 20402-9328
ISBN 0-16-045254-6
"When a woman is unconscious about her starvation, about the
consequences of using death-dealing vehicles and substances, she is dancing,
she is dancing. Whether these are such things as negative thinking, poor
relationships, abusive situations, drugs or alcohol-they are like the red
shoes, hard to pry a person away from once they've taken hold."
"Yes there is pain in being severed from the red shoes. But
it is our only hope. It is a severing that is filled with absolute blessing.
The feet will grow back, we will find our way, we will recover, we will run and
jump and skip again some day. By then our handmade life will be ready. We'll
slip into it and marvel that we could be so lucky to have another chance."
Women Who Run With the Wolves, by Clarissa Pinkola Estes
This document is dedicated to women with substance abuse problems
and to those who support them-
- women who, despite fear and uncertainty, have said
"yes" to the
journey of recovery - we wish them continued growth;
· women who, because of fear, denial, and other obstacles, have
not yet been released from the hold of addiction - we send them
encouragement and support; and
· the families, friends, and clinicians who have supported women
in treatment with compassion, competency, and concern - we
commend them.
Letter
Preface
Foreword
Chapter
1: Introduction 1
Chapter
2: Women and Alcohol and Other Drugs: An Overview
7
2.1 The
Epidemiology of Substance Use Among Women 10
2.1.1
Overview
2.1.2
Trends in Substance Abuse Among Women
2.1.3
Alcohol
2.1.4
Illicit Drugs
2.1.5
Prescription and Over-the-Counter Drugs
2.1.6
Polydrug Use
2.1.7
Women in Treatment
2.2
Correlates of Substance Use Among Women
23
2.2.1
Age
2.2.2
Socioeconomic Factors
2.3
Health Impact of Substance Use on Women
25
2.3.1
Physiological Effects
Sexually
Transmitted Diseases
Tuberculosis
2.3.2
Psychological Effects
2.4
Population Cohorts
35
2.4.1
Older Women
2.4.2
Pregnant and Postpartum Women
2.4.3
Women in the Criminal Justice System
2.4.4
Homeless Women
2.4.5
Lesbian Women
2.4.6
Women with Disabilities
2.4.7
African American Women
2.4.8
American Indian Women
2.4.9
Asian and Pacific Islander Women
2.4.10
Hispanic/Latina Women
Table
of Contents
CHAPTER
3: Treatment of Alcohol and Other Drug Abuse: An Introduction
65
3.1
CSAT's Vision of Treatment 69
3.2
Treatment Methods and Modalities 69
3.2.1
Treatment Methods
3.2.2
Modalities of Care
3.2.3
Treatment of Multiple Drug Use/Abuse
3.3
Knowledge About Effective Treatment for Women 78
3.3.1
Critical Components of Treatment for Women
3.4 Case
Management 83
3.5
Issues Related to Treatment of Alcohol and Other Drug Use in Women
85
3.5.1
Relationships and Other Gender Issues
3.5.2
Issues of Sexuality
3.5.3
Women, Violence, and Substance Abuse
3.5.4
Children
3.5.5 Dual Disorders
CHAPTER
4: Outreach to and Identification of Women
107
4.1
Barriers to Outreach and Treatment 110
4.2
Barriers to Outreach Unique to Population Groups 119
4.2.1
Age Groups
4.2.2
Pregnant and Postpartum Women
4.2.3
Ethnic and Racial Populations
4.2.4
Other Specific Groups of Women
4.3
General Approaches to Effective Outreach Programs
141
4.3.1 Staffing
the Outreach Program
4.3.2
The Product: Designing a Program that
Actually
Meets the Needs of the Women in the Target Population
4.3.3
The Message: Make it Compelling and Appealing
to the
Targeted Women
4.3.4 Delivering the Message: The Message Must Reach the Women
Targeted for Services
4.3.5 Professional and Community Contacts
4.3.6 Reaching Women's Support Groups
Table
of Contents
CHAPTER
5: Comprehensive Treatment for Women
157
5.1 The
Treatment Environment
159
5.2 The
Intake, Orientation, and Assessment Processes 160
5.2.1
The Intake Interview
5.2.2
Orientation to Treatment
5.2.3
Comprehensive Assessment
5.2.4
Treatment Plan
5.3 The
Treatment Process 175
5.3.1
Providing Comprehensive Treatment Services
5.3.2
Strategies for Providing Comprehensive Treatment Services
5.3.3
Addressing Relationships and Related Issues
5.3.4
Addressing the Client's Spiritual Needs
5.3.5
Retaining Women in Treatment
5.3.6
Discharge
5.4
Cultural Sensitivity/Competence 194
5.4.1
Age Groups
5.4.2
Ethnic and Racial Populations
5.4.3 Other Specific Groups of Women
CHAPTER
6:
Continuing
Care and Follow-up
209
6.1
Issues Related to Continuing Care 212
6.1.1
Case Management During Continuing Care
6.1.2
Relapse Prevention and Recovery Skills
6.1.3
Access to Services
6.1.4
Provisions for the Terminally Ill
6.1.5
Women with Dual Disorders
6.1.6
Women, Violence, and Continuing Care
6.2
Community and Interagency Collaboration: Referrals and Resources 223
6.3
Support Groups 225
6.4
Follow-up Strategies and Procedures 226
Table
of Contents
CHAPTER
7: Program Management Issues
231
7.1 Policies
and Procedures
233
7.2 Staff
Training
235
7.3 Staffing
and Gender Sensitivity
237
7.4
Addressing Legal and Ethical Issues in the Program
239
7.5 Linkages
with Other Agencies
243
7.6 Financing
Mechanisms
244
CHAPTER
8: Reflections
249
8.1 Two Key
Themes: Comprehensive Services and Linkages
251
8.2 Do We
Know What Works for Women?
253
8.3 Other
Treatment Design Considerations
255
8.4 We Do
This Because
257
Glossary
of Terms 261
Appendix
A: CSAT's Comprehensive Treatment Model for Alcohol and Other
Drug-Abusing
Women and Their Children 267
Appendix
B: Consent, Confidentiality, Principles of Conduct, and Client
Rights
Forms 277
