Women in Substance Abuse Treatment

Results from the Alcohol and Drug Services Study (ADSS)

This report discusses the need for substance abuse treatment programming for women and summarizes evidence about the effectiveness of such programming.

The report compares characteristics of male and female clients discharged from substance abuse treatment and estimates the availability of substance abuse treatment programming targeting women’s needs.

Finally, the report provides new information about the relationship between gender, substance abuse treatment programming for women, and retention in treatment.

This chapter includes a brief history of how gender has been addressed or ignored in sentinel substance abuse treatment research studies.

The chapter examines current data about gender differences in substance abuse treatment utilization, substance use epidemiology, social context and etiology of substance use, barriers to receiving treatment, physiological consequences of substance use, and retention in substance abuse treatment.

In addition, a brief introduction to the Alcohol and Drug Services Study (ADSS) is presented, followed by an overview of the remaining chapters in this report.

Women in Substance Abuse Treatment – Gender is an important variable to consider in substance abuse treatment research. The proportion of females among substance abuse treatment clients has increased over the past decade, and female clients currently constitute about one third of the treatment population.

Reports have shown that female substance abusers experience a number of barriers to receiving treatment, including child care responsibilities, stigmatization, and inability to pay for treatment.

Female substance abusers are more vulnerable than male substance abusers to some of the physiological effects of substance use, and substance abuse among females is rooted more often in psychosocial problems and traumatic life events. These important gender differences suggest the need for specialized treatment programming for women.

Women in Substance Abuse Treatment: Results from the Alcohol and Drug Services Study (ADSS) presents an in-depth analysis of substance abuse treatment clients and facilities, with a special focus on women.

First, an introduction provides a brief history of how gender has been addressed in previous substance abuse treatment studies, along with an overview of current data about gender differences. Next, a literature review summarizes current information about substance abuse treatment programming for women.

Then, results from analyses of data from a nationally representative sample of substance abuse treatment facilities and treatment clients from ADSS provide new insights into gender differences among substance abuse treatment clients, the availability of substance abuse treatment programming for women, and the extent to which women-focused services are associated with treatment retention. Finally, a discussion of the findings suggests implications and future research.

The in-depth review of current data and research findings on substance abuse treatment programming for women (Chapter 2) places special emphasis on evaluations of effectiveness of such programming. Substance abuse treatment programming for women includes diverse services provided by treatment facilities that aim to reduce the barriers women face to entering and staying in treatment and to address the specific substance abuse–related problems of women.

Such treatment may include the following:

! ancillary services, such as childcare or transportation services, intended to increase female clients’ access to substance abuse treatment;

! services intended to address the specific needs of women, such as prenatal care and well-baby care; and

! admissions for women only, creating a unique treatment environment that is more focused on women’s issues than is mixed-gender treatment.

Substance abuse treatment programming for women, which is not available at all substance abuse treatment facilities, may substantially improve how long female clients remain in treatment.

Key highlights from Chapter 2 include the following:

The substance abuse treatment system has increasingly recognized the need for programming for women during the last 35 years.

Services offered may be available only to a limited number of clients.

Substance abuse treatment programming specifically designed for women, such as provision of childcare services, prenatal care services, women-only treatment, mental health services, and supplemental services and workshops addressing women-focused topics, can be beneficial in improving treatment outcomes.

Improved outcomes include changes in substance use, mental health symptoms, perinatal/birth outcomes, employment, self-reported health status, and HIV risk reduction.

Subsequent chapters in this volume provide insight into the gender differences in demographic characteristics of substance abuse treatment clients, the organizational characteristics of facilities that offer women’s substance abuse treatment programming, and the treatment facility and client correlates of treatment retention as measured by completion of planned treatment and length of stay (LOS) in treatment.

Data for these analyses are from 2,395 substance abuse treatment facilities and 5,005 treatment clients in ADSS, which was conducted for the Substance Abuse and Mental Health Services Administration (SAMHSA), part of the U.S. Department of Health and Human Services (DHHS). Key highlights of the analyses results are provided below:

Characteristics of Substance Abuse Treatment Clients

Females and males in substance abuse treatment were similar on a number of
demographic characteristics. However, at admission to treatment, female clients
were more likely than male clients to have children (Chapter 4).
Among clients in outpatient non-methadone treatment, – female clients were less likely than male clients to be employed full-time and more likely to be unemployed.
Medicaid was more likely to be the primary source of payment for treatment among female clients than among male clients; and
female clients were more likely than male clients to be admitted for drug abuse instead of alcohol abuse (Chapter 4).

Nationally, about 32 percent of clients in substance abuse treatment were female, although this percentage varied by type of care: 30 percent of clients in outpatient non-methadone facilities (the most common type of care), 39 percent of clients in outpatient methadone, 36 percent in nonhospital residential facilities, and 28 percent in hospital inpatient facilities were female (Chapter 5).

Facilities That Offer Substance Abuse Treatment Programming for Women

An estimated 13 percent of substance abuse treatment facilities offered childcare services, and 12 percent offered prenatal services. Of all substance abuse treatment facilities, 6 percent served women only, 37 percent offered special programs for women, and 19 percent offered special programs for pregnant women (Chapter 5).

The availability of substance abuse treatment programming for women varied by type of care. A larger proportion of nonhospital residential facilities served women only then did other types of facilities, and outpatient methadone facilities were less likely than other types of facilities to offer childcare services.

Special programs for women overall were more likely to be offered in nonhospital residential or outpatient methadone facilities than in other types of care. Special programs for pregnant women were more likely to be offered in outpatient
methadone facilities than in other types of facilities (Chapter 5).

Compared with mixed-gender facilities, women-only facilities served higher proportions of blacks and clients whose primary source of payment was public payment other than Medicaid and Medicare. Women-only facilities also were more likely to offer childcare services, prenatal care services, transportation services, and special programs for women than were mixed-gender facilities (Chapter 5).

Compared with facilities that did not offer childcare services, a larger proportion of female clients were served by facilities that offered childcare services. Facilities offering childcare services also were more likely to offer prenatal care services, transportation services, and special programs for women than were facilities without childcare (Chapter 5).

Treatment Retention

The rate of treatment completion was lower for women than for men in nonhospital residential or outpatient non-methadone facilities. However, after controlling for client and facility characteristics, gender was not associated with completion of planned treatment (Chapter 6).

Women averaged shorter stays in nonhospital residential treatment than men, but the LOS was similar among women and men in other types of care. After controlling for client and facility characteristics, gender was not associated with LOS (Chapter 6).

Among women, receiving treatment at women-only facilities or at facilities offering child care services was not associated with completion of planned treatment, after controlling for client and facility characteristics. However, women who received treatment at women-only facilities or facilities offering child care services stayed in treatment longer than women who received treatment in mixed-gender facilities or facilities not offering child care services, after controlling for client and facility characteristics (Chapter 6).

Gender is an important variable to consider when designing and analyzing studies in all areas and at all levels of biomedical and health-related research (Wizemann & Pardue, 2001).

Consideration of gender and dissemination of data regarding gender differences, or lack thereof, has been recommended by the Institute of Medicine (IOM). Gender is especially important in substance abuse treatment services research because the background characteristics, substance abuse patterns, and personal histories of female substance users may differ from those of males.

As such, treatment programming designed specifically for women is needed to address not only women’s substance abuse-related problems but also their special needs and barriers to treatment.

Although many service providers acknowledge and address gender differences among substance abuse treatment clients, these differences and the programming that addresses them have not been adequately studied.

At the national, State, and local levels, policymakers and service providers need new knowledge to understand how male and female substance abuse treatment clients differ in terms of sociodemographic and substance use characteristics and retention in treatment.

Information about the availability and effectiveness of substance abuse treatment programming for women can help guide public policy about how the treatment system should be structured.