Abstract
This research paper establishes that the problem of substance abuse in the female sex is increasing in most parts of the world. The trend is worrying. Some of the policy changes discussed include the use of specialized care providers, provision of care in the society, and the establishment of more women-specific rehabilitation centers. Issues concerning the course and nature of substance abuse, addiction, recovery, and relapse among this population of female substance abusers have also been discussed.
Various evidence-based approaches to treating substance abuse and addiction in various settings in the selected target population will be tackled in the research paper. The context of a changing health care environment for women substance abusers will also be highlighted. Important therapies such as the nontraditional approaches of motivational therapy, solution-focused brief, and group therapies will take the center stage. SFGT emerges a futuristic treatment modality for women with substance abuse problems.
Introduction
Women are a special population of drug abusers. They provide a challenge to any group or individuals who are working towards their treatment. Like many states in the US, the state of Florida is one of the most affected with the problem of drug abuse among women. The impacts of substance abuse are relatively similar to those in the male population. However, this group of substance abusers also faces special challenges.
Therefore, it is important to examine the impact of substance abuse on this population and its recovery at an individual (micro) and systems (macro) level. This research paper looks at substance abuse in women, evidence-based approaches to the provision of treatment services for them, and any historical and current policy issues that may have prevented or supported treatment-service delivery to this client group.
Relevant Policy Issues
Policies addressing the treatment of substance abuse in women with substance abuse problem have been developed from many research findings. The treatment of the special client group is mostly similar to the male colleagues, although there are few variations in the policies. Zarkin, Dunlap, and Homsi (2004) looked at some of the substance abuse services cost analysis programs (SASCAP) and some of the major policies in the management of substance abuse.
Some of the policy changes include the allocation of scarce drug abuse treatment dollars (Zarkin, Dunlap, & Homsi, 2004). A major policy is the establishment of the Center for Substance Abuse Treatment (CSAT), which is responsible for the treatment of drug abusers.
Grella and Greenwell (2004) and Cowan, Deering, Crowe, Sellman, Futterman-Collier, and Adamson (2003) report a considerable increase in the number of women abusing drugs in the United States.
Grella and Greenwell (2004) noted that non-specialized and mixed gender individuals mostly managed the treatment programs that were in place. However, they were less likely to address the problems of this group of clients. Most of the women who abuse drugs are also treated as outpatients, hence corresponding to treatment for other groups of drug abusers.
Some of the challenges include the existence of few facilities that are dedicated to the treatment of substance dependence in women only. As Grella and Greenwell (2004) state, the women-only providers were more concentrated in the residential facilities. Even though these facilities provide advanced care to the women who are known to be drug abusers, they make up only a small proportion of the treatment system.
However, over the past few years, there has been growing attention to the treatment programs for the women drug abusers globally, especially in the US. Some of the policies that have positively affected funding of programs for treatment of women with the problem include the federal block grant, initiation of projects that are federally funded, and the “women’s set-aside” (Grella, & Greenwell, 2004, p. 378).
The state of Florida has a treatment program for drug abusers. However, the number of women-specific facilities is still small. The program in place in this region is the Substance Abuse and Mental Health (SAMH) program, which operates within the Florida Department of Children and Families (DCF). It is the single-state authority on substance abuse and mental health (Substance Abuse, 2014).
The region also has a treatment and referral system for drug abusers in accordance with the national policy on drug abuse. The US Department of Health and Human Services, specifically the Substance Abuse and Mental Health Services Administration’s (SAMHSA), has a national drug and alcohol treatment referral service, which provides Spanish and English treatment programs for the residents for free and with assurance of confidentiality (Substance Abuse, 2014).
Nature of Substance Abuse, Addiction, Recovery, and Relapse
Substance abuse in women is a common problem as stated above, with millions being affected by the problem. The cause of the substance abuse is dependent on the individual factors and drug characteristics that the individual is abusing (Doweiko, 2008). Harmful drug abuse rarely occurs before teenage, with most of the abusers being over 15 years (McCollum, Trepper, & Smock, 2003). The disorder or habit begins to increase with the increasing age, with a described peak being witnessed in the early 20s (Berg, & Miller, 1992).
In one of the population studies in the US, the prevalence of alcohol dependence was reported at 2% in people aged 12 to 17 years. The incidence was higher in 18- to 20–year-olds, standing at 12% (Grant, Stinson, & Dawson, 2004a). The prevalence of dependence and abuse for the other groups that are older than 20 years is relatively smaller. It decreases with increased age.
Addiction and substance dependence among women substance abusers takes a course that is similar to other groups of dependence. Large proportions of women that are dependent in their 20s will remit later in their life, with some remaining addicted into their later ages (Thoits, 2010). Most of the women who remain dependent and addicted to the substances will develop a more chronic course (Cowan et al., 2003).
They are likely to experience physical and psychological conditions that are associated with the condition. Women with limited social support and stability including being unemployed, without family, and housing are more likely to remain addicted for longer, with their recovery being dependent on these factors (Weiss, Griffin, & Mirin, 1992). Stressful life experiences are a contributor to the problem of drug abuse among women since it influences the treatment course (Taylor, Biswas, & Vaughn, 2012; Minkoff, 2013).
Recovery among the population of women who are drug abusers is better in relation to their male counterparts since most of the drug abusers that seek help are the women group (Berg, & Miller, 1992). The cases of relapse with treatment are common, especially in people who have abused the substance for long. One third of the treated cases of drug abuse are the women who are known to relapse in a 10-year period.
A few of them continue to have the drug abuse problem for life (Russell, & Gockel, 2005). Therefore, the treatment of drug abuse for the women group is dependent on the social support among other factors. Moreover, the recovery of women drug abusers is a function of factors such as social support, pre-morbid personality, and the environment in which they are located (Ruger, Abdalla, Luekens, & Cottler, 2012).
Women have a better recovery from drug abuse compared to their male counterparts. The understanding of this situation is due to the wider support they have and the ease of seeking help. The average period of recovery according to Berg and Miller (1992) is 3 years. However, this period varies among individuals.
Relapse is common in women drug abusers. One third of those who undergo treatment are known to relapse. The treatment of patients without elimination of the predisposing conditions causes them to relapse to their previous state. The chances of treatment after relapse are considered to reduce. Women drug abusers who experience relapse mostly end up abusing drugs for life (Berg, & Miller, 1992). The treatment of women drug abusers who relapse is different from first-time patients.
Evidence-Based Treatment Approaches
Evidence-based substance abuse treatment approaches for the women population have undergone a change over the last few decades. Many studies have been conducted on the most effective methods of treatment, with their findings informing the approaches (Emmelkamp, & Vedel, 2006).
Straussner (2012) is one of the researchers who looked at the evidence-based treatment modalities for substance abuse and the changes that this plan has undergone in history. The researcher states that one useful tool in the diagnosis and management of substance abuse is the Diagnostic and Statistical Manual of Mental Disorders (DSMIV-TR), which has been useful in the management of all genders of substance abusers (Straussner, 2012).
Treatment of substance abuse is mainly approached as an outpatient and inpatient approach. Rehabilitation is a major trend presently and in the past. Detoxification has largely been used, with substitution therapies being applied to treat the drug substance abusers (Straussner, 2012).
Pharmacotherapy has been applied in most of the treatment modalities. In the treatment for alcohol dependence, some of the medications used include disulfuram and naltrexone (Straussner, 2012). Acamprosate is also a medication that has been tried with varying degrees of efficiency in reducing alcohol abuse in the general population and in women.
Behavioral therapies constitute the other evidence-based method of treating substance abuse in women. They have been used successfully in most of the patients in combination with other therapies (Straussner, 2012). According to Straussner (2012, p. 129), “Behavioral therapies help people engage in the treatment and recovery process, provide incentives to remain abstinent, modify their attitudes and behaviors related to substance abuse, and increase skills to handle stress and environmental cues that may trigger craving for AOD.”
Cognitive behavior therapy is another method that is widely used in the management of substance use disorders in women. The technique teaches the affected persons on how to control their thoughts and modify the maladaptive beliefs and cognitive distortions that may be pushing them to the drug abuse (Straussner, 2012).
Motivational enhancement therapy and the Twelve Step Facilitation Therapy (TSF) are widely applied therapies that form the basis of Alcoholic Anonymous and their treatment of substance abuse (Straussner, 2012). Harm reduction is another of the models that have been used in the management of substance abuse.
It originated in Europe with the adoption in the US in the late 80s to prevent the transmission of HIV among substance abusers (Straussner, 2012). Family-focused treatments have also been found to be important in the management of substance abusers.
Current Substance Abuse Treatment System
Traditionally, the treatment of substance abuse in the female population of patients was similar to that of male patients. Evidence provided in this essay, especially in the reviewed literature, suggests that the treatment of this special group of clients is mainly effective if they are treated in their own specialized facility (Knight, Logan, & Simpson, 2001).
The researchers state, “clients who receive services targeted toward their specific needs are more likely to complete treatment and that they have better outcomes at follow-up” (Knight, Logan, & Simpson, 2001, p. 11). Specialized facilities for the provision of treatment for women that are known drug abusers have increased, with an on-going training for more specialists who will cater for the individual needs of this class of patients in this changing environment.
The current management of substance abuse is more focused on the institution of care at the community level, with patients being managed at their homes and in the society. The measures are more effective in the current management of substance abuse in women, as it incorporates some of the social stressors that may be contributing to their substance abuse (Berg, & Miller, 1992; Mott & Gysin, 2003).
In the changing environment of care for groups with special needs, women with substance abuse problems are more affected by changes in the health context. The current substance abuse treatment system is also focused on influencing the psychiatric and social effects of the substance abuse, with a wide use of group therapies as discussed below.
Group Therapies
Heather (2005) explored addictions in the context of being disorders in motivation. He suggested that motivational therapy is an effective measure in management. According to Heather (2005), the use of motivational interviewing presents a good way of dealing with addiction.
The previous trials and use of the same have proved to be effective. Motivational therapy is done to patients to encourage and motivate them to relinquish their substance abuse habits. They are first motivated to have a change in attitude. Motivational enhancement therapy has been used in the management of alcohol abuse disorder with considerable success in combination with other therapies.
The treatment modalities that are combined with motivational therapy require the patient to be motivated to proceed with any treatment, and thus the increased efficiency and efficacy (Berg, & Miller, 1992). Smock, Trepper, Wetchler, McCollum, Ray, and Pierce (2008) looked at the efficacy of the solution-focused group therapy in the management of substance use disorders. The efficacy of the SFGT was remarkable in the study. Treatment of the drug abusers was successful in most of the instances in the study (Smock et al., 2008).
However, the research was focused on the treatment of substance abuse in level-1 substance abusers. Patients who received either SFGT or the traditional treatment approach were reported to improve on either treatment (Smock et al., 2008). Nonetheless, significant improvement was noted in patients who were treated using the SFGT. The researchers concluded that the treatment of substance abuse in patients who are known substance abusers has to take that approach (Smock et al., 2008).
The approach of using SFGT, which is a resiliency-based approach, is gaining popularity among clinicians treating substance abuse in health facilities. The approach provides a feasible method of treatment of the same in any women-specific treatment programs. The popularity in the use also means that clinicians have faith in the method and that they have documented improved outcomes with treatment. The modalities will likely enhance treatment in the current health care environment, with more patients receiving direct care.
Group therapies are more concerned with the treatment of individuals with similar conditions. They are tailor-made to the needs of the unique groups. Very few group therapies deal with the treatment of women who are diagnosed with substance abuse disorders. There should be more attempts to increase the number of women receiving this specialized care (Berg, & Miller, 1992). The above-discussed modalities in the treatment of substance abuse in women might enhance the current health care environment.
The insurance coverage for women drug abusers is a significant part of the changing health environment. Many organizations offer insurance coverage for such patients. This accessibility reduces the cost of treatment for women drug abusers. Patients that are not already insured should be put in the insurance programs to reduce their treatment costs.
It is important to note that most organizations involved in the treatment of women drug abusers charge for these services. This observation is one of the factors that cause those affected not to seek treatment. In the state of Florida, the number of women drug abusers is significantly dropping. This finding can be attributed to the rise of many organizations offering women-specific rehabilitation services.
Conclusion and Recommendations
In conclusion, the course and nature of substance abuse, addiction, recovery, and relapse among this population of women substance abusers has also been discussed. Various evidence-based approaches to treating substance abuse and addiction in various settings in the selected target population have also been discussed.
Recommendations in the management of substance abuse disorder in women are possible from the above research. The future management of the problem needs to be taken in the social setting of patients to ensure that the problems causing them to engage in substance abuse are tackled. The research establishes that poor social support for the patients often ends up complicating their management, with most of patients with poor support structures ending up with relapse.
The management also needs to take a more specialized approach where structures are set to ensure that the facilities taking care of women with substance abuse disorders are treated by a specialized team of practitioners. The client group has established special needs that may be overlooked by the general practitioners who handle other needs in the society.
The other recommendation is that there needs to be education that is more consistent to the public on the effects of substance abuse, with special focus on the specific effects that the client group may experience. The education needs to be in the form of campaigns where the bodies established to deal with the problem of drug abuse constantly engage in the reduction of the main predisposing factors to the problem.
The other recommendation is that treatment modalities discussed in the paper such as SFGT should be widely applied in the management of women who are drug abusers. The use of these modalities will lead to increased success in the management of patients since they present a better success rate. There is also need to carry out more research on the best methods of intervention for this group since there are more knowledge gaps, with the issue continuing to dominate in many parts of the world.
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