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Women¶s Intervention

Heather R. Hayes Joyce Sundijne Francesca McCarter

Dr. Benjamin Rush ( 17451813 )
Dr. Rush - the ³Father of American Psychiatry´ was the first American doctor to propose that ³intemperate individuals´ be

In the 19th Century, physicians began to view addiction as a disease, rather than a moral failing

Treatment facilities sprang up across the nation to basically Detox Most didn¶t accept women. Too difficult to treat Addiction was far more progressed because of social pressure on women to hide their drinking

Martha Washington Societies were 1staddiction treatment centers specifically designed for women. Founded in early 1840¶s. Treatment organized by women, for women with alcohol/drug problems.

Women¶s temperate groups called ³industrial homes´ Most treatment centers called ³inebriate asylums´ or ³farms´ Women not treated until latter part of 19th century.

Uterus and ovaries sometimes recommended removing surgically as a cure of last resort for alcoholic women. Practice of sterilization continued until 1950¶s

Late 19th and early 20th century women faced some obstacles that today¶s women continue to face like shortage of treatment and stigma

Viewed that they were different and a threat to men Initial exclusion from AA In the 1940¶s, separate women¶s groups of AA emerged Women often accused of being lesbian or wild - kept many women from attending AA.

In a 1946 AA newsletter, a male member noted the following reasons why women should not be allowed in AA meetings: The percentage of women who stay in AA is low. Many women form attachments too intense ± bordering on the emotional. So many women want to run things.

Too many women don¶t like women. Women talk too much. Women are a questionable help working with men and visa versa. Sooner or later, a woman-on-themake sallies into a group, on the prowl for phone numbers and dates. A lot of women are attentiondemanders.

Few women can think in the abstract. Women¶s feelings get hurt too often. Far too many women cannot get along with the non-alcoholic wives of AA members.

Women and Opioid Addiction

Women and Opioid Addiction
In the 19th and 20th Centuries, huge numbers of women are exposed to opioid medications, either through prescription by doctors or through the marketing of patent medications Most of the nation¶s 250,000 opiate addicts are white, middle-to-upper-class women, often housewives and socialites

Believed a cure for masturbation, violent hiccoughs and ³female troubles´ like morning sickness, nervousness and nymphomania. Prescribed opiates for conditions sounding like today¶s PMS

The Civil War (1861-1865)
Morphine was given to injured and/or dying soldiers as well as to the anguished wives and mothers back home.

Unpleasant gastric side effects taking opium orally so devised other methods like enemas, suppositories, skin patches, crude syringes.

Dr. Alexander Wood perfected a hypodermic needle. Enthusiastically promoted because it worked quickly and thought to not be addictive many became morphine addicts.

Dr. Wood¶s (inventor of morphine) wife died of a drug overdose by hypodermic needle.

Patent Medications
The Patent Medicine industry advertised drugs containing opiates as ³women¶s friends´ or ³mother¶s helpers´ It also promoted medicines for symptoms of teething, regulating infants¶ bowels, as well as to pacify wailing babies and irritable children

During the early 1900¶s, there were approximately 50,000 patent medicines containing opiates available in stores or by mail order in the United States.

The Harrison Act restricted the use of narcotics and made illegal the non-medical use of narcotics Repercussions were immediate with addicts flocking to sanatoriums and hospitals Women received little sympathy, concern or help 1950¶s tranquilizer Miltown

End of the 1960¶s, 2/3 of users of psychoactive drugs - Valium and Librium - were women. In 1960¶s, amphetamines were heavily promoted as appetite suppressants for weight conscious women. Later switching to cocaine. Marijuana use dramatically increased among women in the 1060¶s as well as LSD.

The 1980¶s brought crack /cocaine followed by synthetic drugs and currently methamphetamines. The 1980¶s brought crack/ cocaine onto the scene, followed by the synthetic drugs of the rave scene in the 1990¶s (XTC).

Vancouver: Massive death rate found for women with addiction 
Women in the study were 47 times more likely to die than the average woman in B.C. Men in the study were 22 times more likely to die than the average man in B.C.
Spittal PM, Hogg RS, Li K, et al. Drastic elevations in mortality among female injection drug users in a Canadian setting. AIDS Care, 2006. Feb:18(2): 101-8

National Center on Addiction and Substance Abuse (CASA, Columbia University) 
6 million women are addicted in the US  More than 7.5 million women abuse prescription pills  More than 2.5 million women abuse illicit drugs  Heavy drinking teen girls:  5 X more likely to have sex  1/3 less likely to use protection  Alcohol is involved in 73% of all rapes and 70% of domestic violence

Men and women have different needs in treatment for addiction

CASA Study: Columbia University

Women have more guilt and shame over their addiction Women do not believe that addiction is an illness Women are more likely to have been a victim of incest Men can get forgiveness much easier than women Double standards on sexual behaviors for men and women

Alcohol is processed slower in females, therefore causing more physical damage Fetal Alcohol Syndrome and effects create a daily reminder of the shame and fear in the addicted woman Women are more apt to have been exploited by men, sexually, psychologically and emotionally, making choosing treatment more problematic 9 out of 10 Women stay with addict husband... 1 out of 10 men stay with the addicted wife

Issues of abortion, miscarriage, adoption are serious problems for the addicted woman Women addicts are more isolated, therefore have little or no support group Women addicts face social chastisement of a greater magnitude than men Alcoholic women experience an increased magnitude of sex-biased attitudes, social stigma, double standards. Women from other cultures are oppressed as a group

Myths around alcoholic women¶s promiscuity place women at increased risk for sexual assault and rape. Blaming the victim is alarming in its proportions. Women are especially susceptible to being influenced by their peers, significant others and their families. Women are often the primary caretakers of children...that must be addressed.

Admission following an intervention requires sensitivity on the part of the treatment staff

The Center for Substance Abuse Treatment (CSAT)
³In view of the possibility that the client may have experienced sexual abuse, it is preferable, for the first point of with a female.´

Over the years women¶s roles have been redefined, providing them more autonomy and more opportunity than ever before. Today¶s modern women are in a constant balancing act between their careers and family In boardroom by day and the family room by night, many women do it alone as single parents The tides of change have also brought about the equality of substance abuse and addiction

Women can become addicted faster, even though consuming smaller amounts. As women mature, their tolerance for substances decreases

Woman¶s Issues
Self-esteem issues Body image issues Gender-based discrimination Balancing recovery with parenting (especially the single parent) Difference in physiologic response of women patients to drugs (i.e. Tolerance differences)

Internalization of stress
Women are more likely to internalize the stress of life events, causing them to become more depressed and anxious Girls are more likely to divert stress though substance use and this can ultimately lead to substance abuse It is this combination of a women¶s stress and self-image that can predispose women to depression and the use of substances to self medicate the symptoms

Child Abuse
Child abuse can predispose children to substance abuse 1 in 4 college women report haven been sexually abused More than one in five high school girl¶s have reported some form of abuse, being either physical and/or sexual in nature

Adult women who were abused as children are significantly more likely to drink to intoxication, experience alcoholrelated problems such as alcohol dependency and to abuse both prescription and illicit drugs

A comprehensive assessment will help the interventionist develop the foundation and map for a healthy beginning

Women¶s Issues
Increased likelihood of Depression and other cooccurring disorders Internalization of stress/ high anxiety Higher incidence of trauma Pregnancy issues/breastfeeing/Post-partum Abortion/miscarriage Hormonal issues STDs/HIV Doctors more likely to prescribe women patients medications, less likely to diagnose as addicted

Women¶s Issues
Body image issues/Eating Disorder Internal consequences Balancing recovery with parenting (especially the single parent)/childcare issues Difference in physiologic response of women patients to drugs (i.e. Tolerance differences) Lack of financial independence

Cultural Issues
Cultural knowledge of systems (closed vs open) Gender issues within culture Proper and appropriate behaviors Sensitivity Shame Religious Considerations

Interventionist should able to work with PTSD and Dissociative Disorders Grounding techniques Danger of re-traumatization Gender of Clinician Eating Disorder assessment Self-mutilation assessment Appropriate treatment placement Dangers of the ³Surprise Model´

Domestic Violence
Victim¶s safety must be the first consideration Abused person must agree to a safety plan if the Batterer refuses treatment (i.e. Safe House) Placement of patient in a treatment facility equipped to handle rage/violence issues Placement of a facility that treats PSTD/Battered woman¶s syndrome

Safety Withdrawal Issues Suicidality Violence Run Away potential Child endangerment

Know the mandatory reporting laws
Suicide Homicide Child Abuse/Neglect Elder Abuse

Adolescent Girls
As young women¶s bodies begin to experience the hormonal changes brought on by puberty and natural growth, their risk of substance use is heightened.

Young woman who mature faster than their peers are at an increased risk for negative outcomes including substance use and abuse Girls that attain sexual maturity earlier have an increased possibility of engaging in substance abuse earlier and in greater quantities then their peers who reach sexual maturity later The link between increased testosterone levels and substance use may also explain the tendency for early maturing girls to spend more time with older, more risk taking peers

Teenage girls who report low self-esteem are much more likely to report substance use or abuse. Body image plays a significant role in the development of self-esteem of younger girls. Younger girls tend to associate weight loss with being prettier and popular whereas older girls specifically associate it with being more attractive.

Treatment of Adolescent Girls
Habilitation vs. Rehabilitation Eating Disorder/Body Image Self-esteem Nurturing Sexuality/Relationship Issues Self-mutilation Abusive Relationships Educational/vocational issues

Any Questions?

Heather R. Hayes, M.Ed., LPC 110 Veteran¶s Memorial Boulevard Suite 250-J Cumming, Georgia 30040

Joyce Sundin, CCDC II, NCAC II, CPGCIntervention Specialist 4649 Sunnyside Avenue North #342Seattle WA 98103 206-634-0434 FAX: 206-634-0263eM: Web:

Francesca McCarter Intervention Resources Francesca McCarter AIS P. O. Box 125 Buckeystown, Maryland 21717 Office: 301-831-8910 Cell: 240-409-1637 Fax: 301-695-0406