Gender Differences in Drug Addiction and Treatment: Implications for Social Work Intervention with Substance-Abusing Women Lani Nelson-Zlupko, Eda Kauffman, and Martha Morrison Dore This article draws on current addiction research to describe the unique characteristics and treatment needs of chemically dependent women and how they differ from those of chemically dependent men. it explores similarities between women who are drug addicted and all women who experience gender-based oppression. The authors suggest that drug use is a coping strategy that some women adopt to manage this oppression. Finally, the article looks at traditional drug treatment programs, which have been designed to treat male addicts and fail to address the treatment needs of women. The authors offer an alternative treatment model designed to meet those needs. Parallels between characteristics of this alternative treatment model and social work practice are drawn, and opportunities and strategies for social workers to intervene with female addicts are identified. Key words: addiction; gender differences; substance abuse; treatment; women pendent women differ from their male coun- terparts in specific ways: patterns of drug use, psychosocial characteristics, and physiologi- cal consequences of drug use. Research as well as clinical experience also shows that chemically de- pendent women have a great deal in common with nonaddicted women in this society. Such findings point to gender-specific differences that warrant careful attention in planning and provi- sion of treatment. Data collected over the past decade demonstrate that women are more likely to abuse licit drugs and men are more likely to abuse illicit drugs (Corrigan, 1987; Sutker, 1981). C= research indicates that chemically de- 45 ‘Women who develop chemical dependency are more likely to describe the onset of their drug use as sudden and heavy, and men more often de- scribe a gradual, progressive pattern of use (Herrington, Jacobson, & Benger, 1987; Wilsnack, 1982). In addition, there is evidence to suggest that addicted women frequently come from fami- lies in which one or more family members are also addicted (Cook, D'Amanda, & Benciavengo, 1981; Forth-Finegan, 1991) This article highlights research on the ways in which chemically dependent women experience drug addiction and, in particular, ways in which they differ from chemically dependent men, waysin which chemically dependent women resemble nonaddicted women in this society, and ways in which traditional treatment models fail to meet the differential treatment needs of chemically de- pendent women. The authors draw on this re- search to describe an alternative approach to treatment and to identify opportunities and meth- ods for social work intervention with substance- abusing women | Gender-Specific Charact Chemical Dependency Patterns of Drug Use A larger number of women than men abuse licit drugs such as tranquilizers, sedatives, psycho- active drugs, hypnotics, and stimulants. Women, far exceed men in their medical and nonmedical use of prescription drugs and are more likely to obtain these drugs from “legitimate” sources, including physicians. Although the type of licit drug used and patterns of use vary somewhat according to age, geographical location, socio- economic background, and educational level, rates of licit drug abuse are greater for women than men in every age group, in each geographical location, and at every socioeconomic level (Sutker, 1981). Research also suggests that women are more frequently involved in multiple sub- stance abuse—addiction to more than one mood- altering substance—than men (Celentano & McQueen, 1984). Chemically dependent women are also more likely than men to use drugs in isolation and in private rather than in public places (Marsh & Miller, 1985; Reed, 1985). Male clients in treat- ment for chemical dependency describe using drugs in bars and in other social settings, whereas female clients describe using drugs at home. These women also report having few to no friends and very limited social networks (Rhoads, 1983) Onset of Drug Abuse Many addicted women in treatment report that they began using drugs after a specific traumatic event in their lives (Doshan & Bursch, 1982; Kane-Cavaiola & Rullo-Cooney, 1991; Reed, 1985). Incest and rape are commonly cited pre- cipitating events for drug use among women (Volpe & Hamilton, 1982-1983), and rates of sexual and physical abuse reported by women in. treatment run as high as 75 percent (Forth- Finegan, 1991; Root, 1989; Roshenow, Corbett, & Devine, 1988). Other traumatic events that pre- cipitate heavy drug use in women include sudden physical illness, accidents, and disruptions in family life (Reed, 1985). Women who may have forgotten or repressed stich events experience sig nificant increases in drug use on the emergence of memories and flashbacks associated with these events, and relapse is highly correlated with symptoms of posttraumatic stress disorder (Root, 1989). Psychosocial Characteristics It is more likely than not that addicted women come from families in which drugs were used as a primary coping strategy by one or more family members. There is also evidence, particularly from alcoholism research, of a genetic component to addiction, although this factor is less clear in the case of other mood-altering substances and, even in alcoholism, less clear for women than for men (Blankfield, 1991; Forth-Finegan, 1991). Ad- dicted women are more likely than men to be in relationships with drug-using partners or spouses (Reed, 1985). Addicted women often have a history of overresponsibility in their families of origin (Bepko, 1989; Bepko & Krestan, 1985), and stud- ies indicate that they have experienced greater dis- ruption in their families than their male counter- parts (Blume, 1990; Mumme, 1991). They tend to carry primary responsibility for child care and the care of others in their families, and they are less likely than their male counterparts to have some- one actively supporting them in treatment (Kane- Cavaiola & Rullo-Cooney, 1991; Reed, 1985). In fact, many addicted women are discouraged from participating in treatment by a family member who perceives the addict's involvement in treat- ment as a threat to her ability to care for the fam- ily. Whether these findings are related to a greater tendency in women to report such problems is unclear; however, clinicians have found that chemically dependent women in treatment fre~ quently speak of problems and disruptions such as desertion and death in their families of origin (Gomberg & Lisansky, 1984). In addition to interpersonal stressors, chemi- cally dependent women are more likely to experi- ence affective disorders, whereas chemically de- pendent men are more likely to demonstrate sociopathic behavior and engage in criminal acts Social Work / Volume 40, Number I / January 1995 — 46(Blume, 1990; Kane-Cavaiola & Rullo-Cooney, 1991). Among addicted women in treatment who do report criminal involvement, common charges include shoplifting and soliciting for prostitution. Although many chemically dependent women in treatment reported that they supported their drug habits through petty larceny and prostitution, men in treatment stated that they relied on rob- bery, con games, and burglary (Sutker, 1981). Chemically dependent women in treatment are much more likely to be involved in civil actions involving issues of child custody, separation and divorce, and landlord-tenant disputes than in criminal proceedings (Reed, 1985). Substance-abusing women also experience higher levels of guilt, shame, depression, and anxiety about theiraddiction than men (Reed, 1985; Underhill, 1986; Volpe & Hamilton, 1982 1983; Wilsnack, Wilsnack, & Klassen, 1984). In addition, like women in general, women who are chemically dependent report more negative feelingsabout their bodies than their male counter- parts; they are also at higher risk for eating disorders (Marsh & Simpson, 1986) In general, chemically depen- dent women have been found to have lower expectations for their lives than male addicts, and they express greater preoccupation with simply surviving and mini- mizing discomfort than getting ahead in life (Root, 1989). As a group, they have less educa~ tion, fewer marketable skills, fewer work experi- ences, and fewer financial resources than chemi- cally dependent men (Hagan, 1987; Marsh & Miller, 1985; Reed, 1985). Most chemically depen- dent women who enter treatment are unemployed and have not been employed within the preceding year (Marsh & Simpson, 1986; Sutker, 1981). Chemically dependent women are more likely than men to be dependent on a family member or on public assistance for survival (Marsh & Simpson, 1986), yet they are also more likely to be primary caretakers of children. Physiological Impact of Drug Use Physically, women experience more detrimental consequences of drug use at lower dose levels and ina shorter amount of time than men (Doshan & Physically, women experience more detrimental consequences of drug use at lower dose levels and ina shorter amount of time than men. Bursch, 1982; Gallant, 1990; Marsh & Miller, 1985). The higher percentage of fatty tissu male bodies, coupled with a lower percentage of body water, results in slower absorption rates for drugs, which in turn leads to greater concen- trations of these substances in the bloodstream (Blume, 1990; Corrigan, 1987). The result is greater risk of physiological damage and over- dose among women, even when controlling for body weight. Women who abuse drugs are known to get “sicker quicker” than men and suffer higher levels of fatty liver, hypertension, anemia, and gastrointestinal disorders (Corrigan, 1987). Women also experience gender-specific repro- ductive and gynecological complications as a re- sult of drug abuse. Women who abuse drugs are at high risk for infertility, vagi- nal infections, repeat miscar- riages, and premature di (Blume, 1990; Little & Ervin, 1984; Marsh & Miller, 1985). Women also tend to alter their intake of drugs in conjunction with gender-specific biological events such as pregnancy, men- struation, menopause, miscar- riage, abortion, and infertility (Blume, 1990; Finnegan, 1976; Reed, 1981; Volpe & Hamilton, 1982-1983). Volpe and Hamil- ton noted that increased drug use at these times occurs only when the event is perceived as problematic by a woman and that some women experience a decrease in drug use during these events when they perceive them as rewarding, Indeed, studies show that pregnancy and child- birth are points at which intervention can be ef- fective for some women, Research indicates that pregnant chemically dependent women who re- ceive prenatal care as well as ongoing assistance with child care after delivery have higher retention rates in treatment and develop healthier mother child bonding (Chan, 1986) fe- Similarities between Addicted and Nonaddicted Women Drug-addicted women, although differing from drug-addicted men in many ways, have a great deal in common with other women in our society. Women, addicted and nonaddicted, share similar life experiences including physical and sexual Neison-2upko, Kaufman, and Dore / Gender Differences in Drug Addiction and Treatment — 47abuse, effects of socioeconomic disadvantage, and problems with interpersonal relationships (Hagan, Finnegan, & Nelson-Zlupko, 1992). Addicted and nonaddicted women alike re- sand sexual harassment than their male counterparts (NiCarthy, Fuller, & Stoops, 1987). Women from every race, socioeconomic class, and educational background are denied access to positions of power, status, and economic security more often than men (Abramovitz, 1988; Gomberg & Franks, 1979; Piven & Cloward, 1979; Reed, 1981). De- spite progress made by the women's movement, women in the United States continue to fill posi- tions of unpaid domestic labor and retain primary responsibility for child care without adequate re- muneration (Goldberg & Kremen, 1990). Women who work outside the home face discriminatory hiring and wage practices, and women who par- ticipate in the paid work force are less likely than men to hold positions of power. Women in the United States experience much higher rates of poverty than men, and female-headed households constitute the largest percentage of impoverished families (Goldberg & Kremen, 1990) Across class, race, age, and geographical lines, women in the United States exhibit lower levels of self-esteem and higher levels of anxiety and de- pression than men (Cloward & Piven, 1979; Gomberg & Franks, 1979; Guttentag, Salasin, & Belle, 1980). Chemically dependent women, like many other women, report feeling helpless and unable to change their life circumstances (Root, 1989; Williams, 1987) Studies demonstrate that these con a detrimental psychological and social effect on women. Women who are repeatedly placed in po- sitions of dependence on others for survival expe- rience low self-esteem, lack confidence in their ability to make decisions, and feel hopeless about the future (Williams, 1987). In many ways, the drug-addicted woman re- flects the dependence and oppression of all women in this society. She experiences a dispro- portionate amount of trauma in her life without the resources necessary to alter these unfavorable conditions. Drug abuse, for many women, results from attempts to cope with oppressive conditions. Unfortunately, drug use provides only temporary respite and eventually exacerbates rather than ameliorates problems resulting from inequitable conditions for women. port more physical abuse, sexual abu: ‘ions have Differential Responses to Drug Treatment ‘Traditionally, women have fared poorly in drug and alcohol treatment programs relative to men. Rates of entry into treatment, retention, and completion of treatment are significantly lower for female clients than for male clients (Beckman & Amaro, 1984; Blume, 1990; Reed, 19855 Stevens, Arbiter, & Glider, 1989). | Many characteristics of addicted women, as well as of women in general, not only contribute to drug dependence, but often present formidable barriers to treatment. Financial hardship, social isolation, and greater physiological complications keep addicted women from ready access to or effective use of traditional drug treatment programs, Addicted women frequently cite child care as a major obstacle to participation in treatment. Women are more likely than men to carry pri- mary responsibility for caretaking in the family, and women tend to experience greater apprehen- sion about relinquishing the role of caretaker to enter treatment than do men (Zankowski, 1987) For many women, particularly those of lower so- cioeconomic backgrounds, alternative child care is unaffordable or unavailable. Very few drug treat- ment programs offer on-site child care or provide help in making child care arrangements. And most residential treatment facilities do not allow parents to bring their children with them into treatment. In her study of one inpatient treatment program, Zankowski found that the most com- monly cited reason for women to leave treatment prematurely was related to the care of dependent children, Even when a woman was able to make alternative caretaking arrangements, she was likely to face resistance or hostility from family mem- bers who felt dependent on her (Reed, 1981), and she may have been discouraged from continuing treatment (Beckman & Amaro, 1984), Another major obstacle to treatment for women is mistrust of the social services system and of service providers. This distrust may stem in part from the fact that treatment providers are unlikely to be trained in and sensitized to women's issues and are likely to view female cli- ents in negative ways (Stevens et al, 1989; Zankowski, 1987). Female addicts are often de- scribed by treatment providers as difficult, noncompliant, and unresponsive to treatment (Marsh & Simpson, 1986). Sexism and sex role stereotyping have been found to be commonplace Social Work / Volume 40, Number I / January 1995 48in drug treatment programs (Levy, 1981). More- ‘over, addicted women are more likely than ad- dicted men to experience some form of sexual ha- rassment while in treatment, either by a staff member or by another client (Marsh & Simpson, 1986; Sutker, 1981), ‘Women’s failure rates in traditional drug treat- ment programs are not surprising given that such, programs have been designed primarily by men for male clients and that their approaches have been informed by research conducted on male substance-abusing populations. As a result, tradi- tional drug treatment programs frequently use an aggressively confrontational approach with clients designed to break through the layers of denial thought common to those with sociopathic char- acteristics. Relapse is met with a represent a much higher proportion of the clientele, Women in drug treatment state that this gender imbalance is most keenly felt in group therapy sessions in which there may be only one woman in a group of 10 or more members. In such circumstances, women often withdraw from. the discussion or fail to address issues of personal significance (Woodhouse, 1990). In traditional drug treatment programs, par- ticipants are often encouraged to engage in ca- thartic sessions in which secrets are divulged. Al- though this can be experienced as a cleansing activity for some, for a sexually or physically abused woman, the experience of being pressured into public confession often leaves her feeling reviolated (Marsh & Simpson, 1986), particularly if she has not yet been helped punitive response rather than ex- ploration of environmental fac- tors that may have contributed to resuming drug use. Clinical evidence suggests that male clients are more likely to experience denial of their drug problem, and females are more likely to experience acute guilt and shameinacknowledging their drug use and inability to sustain sobriety (Zankowski, 1987).Con- frontational approaches, which serve toenhance guiltand shame, have been found to be counter- Alternative treatment models hold that value cannot be given to the variety of struggles and coping responses of women when the individual is defined only by her addiction. to acquire the skills necessary to protect herself or to cope with memories of the abuse. Alternative Drug Treatment for Women New forms of treatment have been developed in response to the failure rates of women in traditional drug treatment pro- grams. These programs reflect a philosophy that focuses on the strengths of each individual and uses her experiences, both past and present, as learning tools rather than as sources of productive with female substance abusers (Reed, 1985; Zankowski, 1987) Many traditional drug treatment programs base their treatment approach on the 12 steps of Alcoholics Anonymous, which are a set of pi ciples developed by alcohol-dependent men, Al- coholies Anonymous, which promotes reliance on a male deity, is grounded in patriarchal thinking; some believe this philosophy further promotes female dependence on others and discourages self-reliance (Berenson, 1991). Female representation is low in both staff and clientele in most drug treatment programs Typically, there is a disproportionate number of male staff members in positions of authority, leaving few female role models for women in treatment (DiMatteo & Cesarini, 1986; Marsh & ‘Simpson, 1986). And although most programs treat both male and female addicts, males typically grief and shame (Walker, Eric, Pivnick, & Drucker, 1991). This philosophy is based, in part, on feminist theory, which recog- nizes the historical and current oppression of, women in this society by acknowledging the ways in which some women are economically disadvan- taged, financially dependent, and lacking in marketable job skills (Nichols, 1985; Reed, 1985; Stevens et al., 1989; Volpe & Hamilton, 1982 1983; Zankowski, 1987). Alternative treatment models also recognize women’s universal ex- periences of physical, verbal, psychological, and sexual mistreatment (Miller, 1991; Mondanaro et al., 1982). ‘As women’s realities are recognized for their complexities, so too are individual women recog- nized as complex. Alternative treatment models, hold that value cannot be given to the variety of struggles and coping responses of women when Nelson-Zlupko, Kauffman, and Dore / Gender Differences in Drug Addiction and Treatment — 49the individual is defined only by her addiction. The stressors for women are many, and chemical dependency is viewed as just one of a myriad of issues facing women in treatment (Nichols, 1985s Pasick & White, 1991). Alternative models understanding drug use as a coping mechanism are central to understanding the root cause of drug use for women (Mason, 1991), Women often use chemicals to cope with what appear to be unsurmountable stressors. Chemical use may actually succeed as a coping mechanism for a period of time. At some point, however, the negative effects of drug use outweigh its benefits (Woody, 1989). Having realized that this method of coping is no longer reliable or ef- fective, the chemically dependent woman is often ata loss for productive alternatives. When viewed from this standpoint, itis clear why drugs become an integral part of some ‘women’s lives, In alternative treatment, women identify components of the environment that are unhealthy and oppressive and that trigger the use of drugs. Having identified these sources of struggle and stress, women can then be helped to develop and use effective, safe, and nondestructive alternative coping strategies (Anglin, Hser, & Booth, 1987; Woodhouse, 1990). Alternative treatment uses a team approach that incorporates the contributions ofa variety of disciplines, including mental health, social ser vices, medicine, and nutrition, Staff relations are based on a nonhierarchical model of open and direct communication and responsibility sharing that provides a positive model of interdependent relationships for women in treatment. A strong female presence on the staff communicates accep- tance of competent, self-directed women to cli- ents (DiMatteo & Cesarini, 1986) Other components of alternative treatment include education about women’s general and reproductive health, family planning services, and appropriate referral for medical services, essential to providing women with the ability to take charge of their own bodies and reproductive rights (Woodhouse, 1990). Volpe and Hamilton (1982-1983) advocated for careful presentations about sexuality, menstruation, birth control, pregnancy, and childbirth to empower women with knowledge of the choices available to them. ‘Mumme (1991) encouraged the fostering of sexual autonomy in female clients by helping, them identify and express their sexual desires, preferences, and limits as a means of addressing and healing the effects of abus On-site child care, when possible, or referral to accessible, affordable off-site care is essential to give women the ability to combine their care- giving roles with time and attention to their own recovery (Walker et al., 191). Case management that addresses such issues as domestic violence, welfare assistance, vocational issues, housing, and legal services provides recovering women with the tools they need to be financially stable as well as an opportunity to learn skills of self-advocacy (DiMatteo & Cesarini, 1986). Parenting classes enhance the treatment expe rience by increasing feelings of adequacy in the parenting role, by encouraging healthy parent— child bonding, and by fostering self-esteem in the chemically dependent mother (Lief, 1985). This, component of drug treatment for women be- comes critically important in light of the recent political trend toward punishing pregnant drug- addicted women by incarcerating them for child abuse. This punitive response not only fails to ad- dress the problem of a woman’s drug use but also prevents therapeutic intervention at a time when she may be most open to working toward sobriety (Blume, 1990). All-femnale groups in alternative treatment pro- grams provide positive role modeling and help normalize feelings, develop interpersonal skills, and build support networks and, through shared experiences, help women recognize societal pat- terns of female oppression (Reed, 1985; Volpe & Hamilton, 1982-1983). Creating an emotionally safe and supportive environment allows women in treatment to address issues of sexual, physical, and emotional abuse at a rate and intensity appro- priate for each individual. Recognition of women’s ability to survive horrific experiences gives them the ability to move beyond the abuse and create environments in which they are not revictimized. Social Work Intervention with Chemically Dependent Women Alternative treatment approaches are needed to work effectively with drug-addicted women. So- cial workers, because of their holistic, person-in- environment training, are well equipped to use these approaches. In the areas of outreach, treat- ment, and advocacy, social workers can adapt their skills to effectively engage these clients. Social Work / Volume 40, Number I / January 1995Outreach Social workers are often located in settings that provide them with access to drug-dependent women at times when these women may be most open to treatment. For example, social workers in health care settings and family planning agencies who interact with pregnant chemically dependent women can effectively link them with treatment programs using a nonjudgmental approach. Rather than using confrontational scare tactics or trying to shame a pregnant woman into accepting drug treatment, both of which often lead to heightened guilt and increased drug use, the social worker can encourage women to seek treatment by acknowledging their struggles as well as their efforts at coping with a hostile environment Social workers who interact with chemically dependent women during pregnancy must be sen- sitive to the different ways in which pregnancy is viewed by individual women. If'a woman views her pregnancy as an opportunity for sobriety, the social worker should assist her in identifying obstacles that have prevented her from achieving sobriety thus far, rather than blame her for her continued drug use. Chemically dependent ‘women are likely to experience financial hardship, low self-esteem, isolation, and lack of family sup- port for treatment. As skilled case managers, so- cial workers can link such clients with resources to address these and other environmental and psy- chological barriers to treatment. Social workers in child welfare agencies also frequently encounter chemically dependent ‘women who have become involved with protec- tive services. Such workers ofien find themselves, angry and frustrated with women who aby drugs at the expense of their children’s safety and well-being. Some may try to motivate a drug- dependent mother to seek treatment by threaten- ing her or confronting her with the risks to her children, Others may require a woman to com- plete treatment to retain custody of her children. Given the evidence that traditional drug treatment programs fail to meet the needs of women and their high dropout rates in such programs, itis important that social workers seek out alternative programs that address women addicts’ special needs. ‘Treatment Many similarities exist between alternative treat- ment approaches to chemically dependent women and standard social work practice. Social workers customarily focus on identifying and working with clients’ strengths, an essential element in fos- tering effective treatment with chemically depen- dent women. Central to working with these women is acknowledging that their drug use is a coping strategy that has, at times, been effective in creating an escape from myriad environmental stressors. Social workers have traditionally under- stood the impact of the environment on the indi- vidual and have worked at the interface of the two. Social workers recognize the full range of coping behaviors and the need to replace unsue- cessful methods of coping with more successful strategies, Social work's emphasis on client em- powerment also recognizes the need to help cli- ents learn new ways of addressing environmental obstacles to self-actualization. Social workers can help women identify such social forces as sexism, racism, and interpersonal violence as triggers of drug use. Advocacy Social workers frequently play an active role in advocating on behalf of clients. They can become effective advocates for chemically dependent women by first educating themselves about the unique treatment needs of such women. Next, social workers can advocate for the development of alternative treatment programs sensitive to these unique needs; they can also offer training and consultation to traditional drug treatment programs that fail to address women’s needs. Fi nally, at the policy level, social workers can a tively work to influence changes in social policies that oppress women and contribute to chemical dependency. Policies addressing such issues as sexual harassment, interpersonal violence, and economic inequality must be developed and supported. Conclusion The chemical dependence of women, especially mothers and mothers-to-be, is a social and per- sonal tragedy that touches almost all areas of so- cial work practice. Its critical that social workers empower themselves with knowledge about the special issues and needs of this client population and actively resist the punitive, unproductive, and sexist thinking that is currently influencing legis- lative and judicial policy with regard to chemically dependent women. ll Nelson-Zluako, Kauffman, and Dore / Gender Differences in Drug Addiction ond Treatment — 31References Abramovitz, M. (1988). 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Norton, Wilsnack, 5. C. (1982). Alcohol abuse and alcoholism in women. In E, M. Pattison & E. Kauffman (Eds.), Encyclopedia handbook of alcoholism: (pp. 718-735). New York: Gardner Press Wilsnack, S. C., Wilsnack, R. W., & Klassen, A. D. (1984). Sex differences and alcoholism in primary affective illness. British Journal of Psychiatry, 113, 972-979, u Nelson-Zlupko, Kauffman, and Dore / Gender Differences in Drug Addiction and TreatmentWoodhouse, L. D. (1990). Anexploratory study ofthe | — use off history methods to determine treatment | Lani Nelson-Zlupko, MSW, LCSW, is therapist, needs for female substance abusers. Response fo the | Family Center, Jefferson Medical College, 1201 Victimization of Women and Children, 13(3), 12 Chestnut Street, Philadelphia, PA 19107. Eda Woody, G. (1989). From theory to practice: The Kauffman, MSW, LCSW, is therapist the Bridge planned treatment of drug users. International four. Counseling Center, Philadelphia, Martha Morrison nal of the Addictions, 24, 673-708. Dore, PhD, ACSW, is associate professor, School of Zankowski, G, L. (1987). Responsive programming. Social Work, Columbia University, New York Meeting the needs of chemically dependent women. _ccepted April 4.1992 Alcoholism Treatment Quarterly, 4(4), 33-65. At Devereux... a helping hand is just a phone call away 1-800-345-1292 In a nationwide network, Devereux provides services, to individuals of all ages who have a wide range of emotional disorders and/or developmental disabilities Devereux services include + residential treatment centers + community-based group homes + day treatment programs + transitional living + acute and partial hospitalization + foster care homes unseling and therapy Devereux Since 1912 + aftercare programs Social Work / Volume 40, Number I / January 1995 54