The field of addiction recovery often places more importance on male issues than female issues. If you look at the Big Book of Alcoholics Anonymous, you’ll find a chapter titled, “To Wives”, assuming that men are alcoholics and women need to understand how to deal with their partner’s drinking problem. Well, times they are a-changin’! Although the field is still dominated by male clientele, in the last twenty years treatment providers have been trying to figure out how to acknowledge and incorporate the unique needs of women into the treatment process.
It’s a valuable venture, but in trying to understand what makes the most sense in gender-informed treatment we need to take a hard look at our own biases and how they inform the treatment process. Here’s a quiz to test your gender knowledge:
Give your first knee jerk reaction… men or women:
- Whose addiction is likely to progress more rapidly?
- Who is likely to enter treatment earlier in the process?
- Who is more likely to have co-occurring disorders?
Whose addiction is likely to progress more rapidly?
It is generally agreed that women’s addiction progresses at a quicker rate than men’s. At present, research suggests that even though men are two to four times more likely to suffer from addiction, women become addicted more rapidly and experience the consequences of substance use sooner than their male counterparts.
Who is likely to enter treatment earlier in the process?
Men are more likely to enter treatment earlier than women. There are a few explanations for this. One hypothesis is that substance use is less stigmatized for men so there’s not as much conflict about acknowledging the issue and entering treatment. On the other hand, women are more likely to endorse other mental health symptoms and receive treatment from mental health professionals than to enter treatment specifically targeting substance use. In addition, women struggle with factors such as access to childcare and affordability. Finally, with fewer women’s programs, access to addiction-specific services may be a barrier.
Who is more likely to have co-occurring disorders?
Research has consistently shown that women have more complicated clinical pictures, including abuse, post-traumatic stress disorder (PTSD), anxiety disorders and mood disorders. In fact, Drug and Alcohol Dependence published research in 2008 that stated: “Women, compared to men, had less severe lifetime substance use problems but a higher pattern of psychiatric, medical, social/family, and employment problems; they also had more positive expectations and opinions about treatment.”
This last topic raises the question of research bias. It has been my experience that many men come through treatment with significant trauma, struggling with identity issues and suffering from significant psychiatric conditions in addition to substance use disorder. However, society, for whatever reason, has not given the same level of attention to the sexual mistreatment of men.
According to the DSM-5:
Gender likely has…effects on the experience of a disorder that are indirectly relevant to psychiatric diagnosis. It may be that certain symptoms are more readily endorsed by men or women, and that this contributes to differences in service provision (e.g., women are more likely to recognize a depressive, bipolar, or anxiety disorder and endorse a more comprehensive list of symptoms than men. (p. 15)
Gender-Specific Treatment: Helpful or Divisive?
When looking at tailoring specialized treatments for men and for women, gender-specific groups have been a key strategy. The rationale is that gender-specific groups create a safe space to discuss issues that may not be as openly discussed in mixed gender groups. For men, this includes topics such as trauma, sexual abuse, male identity, expressing insecurities and vulnerabilities. For women, these can be sexual trauma, body image issues andself-esteem issues. There is not enough clear evidence to assert that gender-specific groups are more effective than gender-mixed groups—more research is needed to substantiate or disprove efficacy.
At Sober College, we have found gender-specific groups to be an effective and necessary strategy in treatment. However, we are also aware that this may be due to the age-specific treatment we provide. In young adult mixed-gender groups the sexual tension is palpable and definitely detracts from the therapeutic process.
A Moving Image
The biggest lesson I have learned as a clinician is that no matter how much knowledge and experience I have gained, I don’t always know what is best. I come in with biases and I constantly need to modify my approach in order to fit the needs of individuals to a clinical picture that doesn’t fit the mold—men with severe co-dependency, high functioning women who enter treatment with minimal outside issues. In a way, as well-intentioned as it is, gender-specific treatment can be limiting.
Overall, gender-specific treatment strategies play an important role in the healing process. Gender-specific intervention has been shown to be helpful for women in helping them overcome psychosocial stressors and other psychiatric conditions while helping them paint a picture of a well-balanced life. I think that same comprehensive intervention model could be considered for men. Perhaps, at the end of the day, all of this is less of a gender-specific thing and more of a person-specific thing—but that’s for another article saved for another time.