WOMEN AND ADDICTION: TREATMENT ISSUES AND …

1 THE SOURCE, VOLUME 10, NO. 1 - THE NATIONAL ABANDONED INFANTS ASSI STANCE RESOURC E CENTERWOMEN AND ADDICTION: TREATMENT ISSUES AND INNOVATIVEPROGRAM MODELSThis article explores the extent to, and ways inwhich, gender and related factors affect substanceabuse TREATMENT for WOMEN involved in the criminalsystem. To illustrate these ISSUES , we draw upon theexample of the Crossroads program, operated by theCenter for Community Alternatives in New York, Need for Gender Specific TreatmentThere is considerable evidence of the link betweenmaternal substance abuse and child abuse andneglect. In 1994, 77 percent of the 50,000 reports ofchild abuse and neglect filed in New York Cityinvolved substance abuse and 36,000 of the 47,000(77%) New York City children in foster care hadbiological parents who were substance abusers(CASA, 1996).

2 The chemical dependency of womenhas had an impact on the criminal court as have been the fastest growing population inthe criminal justice system. In 1986, there were410,300 WOMEN under correctional supervision in ; by 1996 the number doubled to 859,400 ( of Justice, 1999). Most WOMEN in thecriminal justice system, regardless of offense, havesubstance abuse problems (Wellisch, Prendergast,Anglian, 1994). Despite the effect of drug abuse onwomen and their families, WOMEN s TREATMENT needstend to be overlooked and/or has shown that WOMEN differ significantlyfrom men in terms of their pathways into crime anddrug addiction (Daly, 1994) as well as their socialand psychological characteristics (Wellisch et al.)

3 ,1994; Wald, 1995). Symptoms of WOMEN s addictionare typically inner directed appearing as anxiety,shame, and depression, whereas male manifestationsof addiction are more visible and external drunkdriving, fighting and assault (CASA,1996).The evidence with respect to the role that geneticsplays in addiction is less clear for WOMEN than formen (Svikis, Velez, and Pickens, 1994). WOMEN do,however, report more family history of drinking thando men (Finkelstein, Kennedy, Thomas and Kearns,1997). Research on neurotransmitters such asdopamine and seratonin have largely been conductedon animals and have not distinguished effects bygender (Finkelstein et al., 1997; Wilcox, Gonzales,and Erickson, 1994).

4 More research has been doneon gender-specific physiological consequences ofdrug use. The phenomenon known as telescoping suggests that WOMEN experience more severeconsequences of drug use over shorter periods oftime than do men (Finkelstein et al., 1997; CASA,1996; Blume, 1990; Nespor, 1990; Reed, 1987). WOMEN s blood alcohol levels are higher than men sof the same weight for similar levels of consumptiondue to differences in gastric metabolism, differencesin body fat and body water levels (CSAT, 1994; Dealand Gavaler, 1994). Adverse health consequencesfor WOMEN include increased risk for liver disease,sexual dysfunction, menstrual and pelvic problems,heart disease and breast cancer (Finkelstein et al.)

5 ,1997; CASA, 1996). Of special concern is thegrowing incidence of HIV among WOMEN . Womenface multiple risk factors for HIV, most of whichrelate to drug use ( , their own or sex partner sdrug use, and their work as prostitutes in order toobtain drugs).There are also unique social contexts to WOMEN saddiction that are in large part associated withTHE SOURCE, VOLUME 10, NO. 1 - THE NATIONAL ABANDONED INFANTS ASSI STANCE RESOURC E CENTER relationships with male partners and the greater socialstigma attached to WOMEN s use of drugs. Womenoften begin their drug use as part of a commonactivity with boyfriends; female addicts are morelikely than male addicts to have a partner who usesillegal drugs (Lex, 1995).

6 WOMEN also use drugs as aform of comfort or numbing at the demise of arelationship (Amaro, 1995). Violent and abusiverelationships are strong contributors to femalesubstance abuse. WOMEN s roles as caretakers andnurturers may cause them to ignore or deny their drugabuse especially because they fear the loss of theirchildren. Family reliance on the woman as caretakeroften leads family members to deny or minimize theproblem as well. Men s drug and alcohol use is moresocially tolerated and sometimes condoned asacceptable machismo behavior whereas drinkingand drugging on the part of WOMEN engender greatersocial disapproval and are considered antithetical totraditional female roles of mother and social stigma also affects the ways professionalstreat female addicts reflected by a reluctance toidentify substance abuse problems in WOMEN or morepunitive and negative attitudes toward femalepatients/clients (Chasnoff, 1989; Beckman, 1994;Finkelstein et al.)

7 , 1997). TREATMENT IssuesThese contextual ISSUES contribute to low self-esteem,poor coping skills, and mental health problems,notably depression, post traumatic stress disorder,eating disorders, anxiety and increased risk ofsuicide. Additionally, whereas chemical dependencyknows no class or race boundaries, drug-addictedwomen who are involved in the court system mostoften come from poor and/or minority communitiesand experience myriad socioeconomic problems(Mitchell, 1993). These include lack of job skillsand/or employment experience, limited access totransportation, lack of child care and , effective TREATMENT for WOMEN must beholistic, addressing not just drug use, but underlyingproblems that contribute to drug use and provided to WOMEN addicts must be set in acontext that empowers them, improves coping skills,and helps them to develop functional supportnetworks and greater life stability (Falkin, Wellisch,Prendergast, Kilian, Hawke, Natarajan, Kowaleswkis,and Owen, 1994).

8 Effective programming forwomen builds on their strengths, , a competency-based approach (Nelson-Zlupko, Kauffman, andMorrison, 1995), rather than the more traditionaldeficit , it is important that program staff candevelop authentic, caring, and trusting relationshipswith clients (Finkelstein et al., 1997). TREATMENT forwomen must recognize that WOMEN are not amonolithic genetic entity, but rather a diversepopulation with experiences and coping skillsinfluenced as much by race, ethnicity, and class as bygender (Banyard and Graham-Bermann, 1993).There is also growing agreement that WOMEN -onlyprograms can best meet the needs of WOMEN whoabuse drugs and alcohol (Morash and Bynum, 1995;Falkin et al.)

9 , 1994; CASA, 1996). TREATMENT issuesthat are most important to WOMEN s abuse of drugs,such as domestic violence and sexual assault, areamong the most uncomfortable to disclose in acoeducational group. Therefore, if the program is notfor WOMEN only, it should offer extensive gender-specific TREATMENT sessions. Peer support is alsoeffective for WOMEN by providing supportivenetworks and role models for success. Similarly,case management is an especially effective servicedelivery strategy for WOMEN enmeshed in unstable,chaotic, and fragile lives and who are often involvedin multiple systems including family court, socialservices, child welfare, public housing, theirchildren s school systems, and the criminal TREATMENT Model for WOMEN : TheCrossroads ProgramCrossroads is a substance abuse day treatmentprogram for WOMEN offenders operated by the Centerfor Community Alternatives (CCA) to serve as analternative to incarceration in New York delivers a range of services intended toaddress holistic manner, while ensuringaccountability to the courts and criminal justicesystem.

10 Although the program relies heavily on agroup model, individual case planning remains acritical program component. Case management andcourt advocacy assist clients in negotiatingfragmented human services, child welfare systems,and Family Court to secure housing and entitlementsand to address domestic violence and child custodyissues. Crossroads provides the following services: group and individual substance abuse counseling; survivors groups (related to sexual abuse anddomestic violence); HIV/AIDS services;THE SOURCE, VOLUME 10, NO. 1 - THE NATIONAL ABANDONED INFANTS ASSI STANCE RESOURC E CENTER acupuncture to aid in detoxification and relapseprevention; urinalysis; family groups; parenting groups; job readiness, vocational counseling, employmentplacement; life skills training; mental health counseling and medication (whenwarranted); family and criminal court advocacy services.