Do women need specialized alcohol or addiction treatment?

Do women need specialized alcohol or addiction treatment?

A. Tom Horvath, Ph.D., ABPP
There are a number of significant differences between men and women with respect to alcohol problems.  For instance, the same amount of alcohol (adjusted for weight) will have a bigger effect on a woman (because her stomach does not detoxify alcohol as effectively as a man’s stomach does), women may experience more medical complications (and these complications may be difficult to diagnose and therefore ignored longer), alcohol problems appear to develop (progress) faster in women, the effects of alcohol problems may be greater and more complex for women who have substantial responsibilities both at work and with their families, and the changing roles of women in society may create complications for women receiving adequate support for recovery (e.g., women seek treatment at a relatively lower frequency).
For substances other than alcohol, or activity addictions such as gambling, the same types of differences appear to be relevant.  To the extent that women are biologically, socially, psychologically or otherwise different than men, we can expect differences in how addiction affects them.  Given that we have not fully identified and understood male/female differences, we probably still have more to learn about male/female addiction differences.
Do these differences mean that women need different addiction treatment?  To date there is little evidence to suggest that women and men need different treatment.  Unfortunately the studies addressing this issue are few.  However, let’s consider what good treatment for anyone might look like, and then what it might look like for women.

Every individual needs to have addiction treatment which is good treatment.  Good treatment (for any health or emotional/behavioral condition) is responsive to the individual’s unique needs, goals and situation (and responsive as these factors change), treats the individual with respect, adheres to established guidelines for quality care (e.g., competent providers, informed consent, confidentiality), places the individual’s interests above the needs of the providers, and is based on other principles of good care.

Unfortunately, in the US, a significant amount of addiction care does not live up to these standards.  Often US treatment is one-size-fits-all, with providers who may explicitly say “sit down, shut up, and do what I tell you.”  Respect for individuality, informed consent, welfare of the client, and other significant principles, may not be strongly evident in day to day practice.

Assuming a woman is getting good treatment, it would of course be different than the treatment any other woman or man is receiving.  As stated, good treatment is responsive to her unique needs, goals and situation.  Specifically, does she need better child care (during treatment or afterward)? Is she being physically abused?  If she needs to separate from a partner are her financial concerns being addressed?  Is there a history of trauma/rape, particularly one she has never trusted anyone enough to talk about (but drinks/uses to cope with)?  Are her medical problems being fully evaluated by providers experienced and persistent enough to diagnose and treat them? Are the discrimination or harassment she experiences in the workplace or elsewhere being given adequate consideration in the understanding of the stresses that may make escape into addiction appealing to her?  If she is raising children with a partner, is an unfair division of household labor draining her energy and lingering as an unaddressed issue in the relationship?  How well developed is her social network, which needs to include other women, recovering or not, who can support her personal development?  If the time demands from work and family are enormous, is she being supported in creatively carving out some time for herself, her personal relationships, and her personal development?

A group-based treatment program may have difficulty fully addressing the issues just described, as well as the many other issues a woman might bring to treatment.  If a woman is not able to attend a program that is fully individualized (i.e., a program based primarily on individual sessions with group sessions also available), then an option worth considering is a program for women only.  Even if the providers do not have the time available to assist the woman with her unique needs, goals and situation, with luck the other women in the program can be of assistance.