Women and Substance Abuse

Gender Transparency

Harry K Wexler, Sally J Stevens

• Publisher: Routledge
• Year: 2014
• ISBN:
  9781317826750
• Edition: 1
• Topic: Psychology
• Subtopic: Mental Health in Psychology
• Index: Psychology

In Women and Substance Abuse: Gender Transparency you'll see what can be done to aid women in some of the world's hardest hit substance abuse hubs, including Rio De Janeiro, Brazil; Philadelphia, Pennsylvania; and New Haven, Connecticut. Filled with timely research and practical solutions, this volume shows you what you can do to aid the tremendous and immediate need for specialized interventions in the lives of women. Women and Substance Abuse considers many of the variables in the lives of women who abuse drugs--race, choice of drug, HIV risk, and drug treatment history--and gives you line-by-line proof of the need for custom-tailored harm reduction strategies for addicted women who are and who aren't engaged in drug treatment therapy. In addition, you'll see why frequent cocaine use, current physical and sexual abuse, and concerns relating to children can alter the success of therapies and treatments. Overall, this unique volume will broaden your understanding of the subject by covering:

• gender differences in risk for gonorrhea infection
• risk factors for women who trade sex for drugs and money
• the role of physicians and prenatal care providers of substance abusing women
• how drug treatment programs can be more multifacted to include planning, prenatal care, and parenting skills
• prison-based therapeutic communities
• long-term residential treatment for women with children, pregnant women, and women without children For every unique woman with a drug problem, there is a unique treatment. Women and Substance Abuse turns away from the lost cause of blanket treatments and takes you into the world's slums and inner-city ghettoes, where the faces of addiction are as diverse as the women who bear its debilitating burdens. You'll see women's drug addiction for what it is--a montage of suffering and pain that only individual and specialized care can cure.

V. EFFECTIVE DRUG TREATMENT STRATEGIES FOR FEMALE SUBSTANCE ABUSERS: PROCESS, OUTCOME AND COST EFFECTIVENESS

Developing Comprehensive Prison-Based Therapeutic Community Treatment for Women

Dorothy Lockwood, PhD
Jill McCorkel, MA
James A. Inciardi, PhD

Dorothy Lockwood is an independent consultant conducting program evaluations, organizational development and training for drug treatment and social service agencies, courts, corrections, and prevention programs. Jill McCorkel was on a fellowship with the Department of Sociology at the University of Delaware at the time of this study. James A. Inciardi is Director of the Center for Drug and Alcohol Studies at the University of Delaware; Professor in the Department of Sociology and Criminal Justice at Delaware; Adjunct Professor in the Department of Epidemiology and Public Health at the University of Miami School of Medicine; a Distinguished Professor at the State University of Rio de Janeiro; and a Guest Professor in the Department of Psychiatry at the Federal University of Rio Grande do Sul in Porto Alegre, Brazil.

SUMMARY. Experience and research have affirmed that treatment works for drug-involved offenders. Nonetheless, adapting these treatment models for drug-involved women offenders remains a challenge. One treatment modality, the therapeutic community (TC), has proven effective for women. This article discusses the adaptations necessary to the TC model to make it appropriate and effective for drug-involved women. Several themes are discussed including the staffing structure, staff-client interactions, the safety of the treatment environment, characteristics of the residential community, programming, and the treatment program’s relationship with various social service agencies. In addition, the program elements specific to effective TCs for women in the criminal justice setting are also discussed. The experiences of developing, implementing and operating a specific TC for drug-involved female offenders provide examples of establishing an effective TC for women. [Article copies available for a fee from The Haworth Document Delivery Service: 1-800-342-9678. E-mail address: [email protected]]

INTRODUCTION

Experience and research have affirmed that treatment works for drug-involved offenders. Indeed, a variety of modalities have proven effective–from therapeutic communities (Lockwood & Inciardi 1993; Wexler, Falkin & Lipton, 1990) and methadone maintenance (Ball & Corty, 1988) to a number of compulsory treatment initiatives (Anglin, 1988; De Leon, 1988; Leukefeld & Tims, 1988). Treatment Alternatives to Street Crime (TASC) programs across the United States have demonstrated that it is possible to combine treatment and correctional management in a number of environments (Cook & Weinman, 1988; Hubbard, Collins, Rachal, & Cavanaugh, 1988). Research within prison settings has also shown success for various treatment approaches (Chaiken, 1989; Forceir 1991; Wexler et al., 1990).

Nonetheless, adapting these treatment models for drug-involved women offenders remains a challenge. Following the National Institute on Drug Abuse’s development of research protocols in 1974, numerous studies have demonstrated that women’s treatment needs and treatment experiences differ markedly from those of men (Center for Substance Abuse Treatment, 1994; Winick, Levine, & Stone 1992). Women, for example, encounter a variety of gender-specific barriers that often discourage their efforts to enter treatment. Barriers to entering treatment involve such obstacles as a woman’s role as primary caregiver to children, limited access to treatment programs, and pregnancy.

Once in treatment, many women face barriers to successful completion. The availability of women-only treatment facilities is extremely limited. Most women enter co-ed programs in which staff members are predominately male and male residents outnumber female residents by ratios of 10 to 1 and higher. Furthermore, treatment regimens and services are designed for male clients and generally fail to address correlates of women’s substance abuse. This situation serves to further marginalize women, and aggravates, rather than alleviates, issues surrounding low self-esteem, self-blaming and learned helplessness. The result is that many women leave treatment prematurely (Beschner, Reed & Mondanaro, 1981; Ramsey, 1980; Reed, 1987; Zankowski, 1988).

The 1980s brought concerns regarding treatment for women to the forefront. The cocaine and crack epidemics produced new profiles of drug abusing women: young, African-American, with several children, from low income neighborhoods, limited educational attainment, little to no vocational experience or skills, extensive sexual abuse victimization, and histories of trading sex for drugs and money (Inciardi, Lockwood, & Pottieger, 1993). Many of these women have flooded the criminal justice system. Drug Abuse Forecasting (DUF) statistics indicate that as many as 88% of female arrestees in some metropolitan areas test positive for illicit drugs (Wish & Gropper, 1991). In addition, the number of women in prisons increased by 200% in some jurisdictions with as many as 80% of incarcerated women in need of drug treatment.

Despite the limited treatment resources available to women, there has been some progress in addressing their treatment needs. The fundamental treatment components essential for effective and appropriate treatment for women have been identified, and a variety of programs have been successful in adapting modalities to incorporate these components. One treatment modality, the therapeutic community (or TC), which was originally designed for and by men, has proven effective both for male offenders (Lockwood & Inciardi, 1993; Wexler et al., 1990) and for women (Stevens, Arbiter & Glider, 1989).

The success of the TC modality for treating women is attributable to its unique philosophy and programmatic structure (for a more general description of therapeutic communities see De Leon & Ziegenfuss, 1986; Yablonsky, 1989). Specifically, treatment in TCs is based on the idea that substance abuse is a disorder of the whole person. This approach invites clients and practitioners to explore the many issues and experiences that frame the client’s substance use, thereby ensuring that gender-specific issues facing women clients will be addressed. Second, TCs seek to improve interpersonal skills and coping strategies so that clients may better handle the problematic situations they encounter in their everyday lives. This theme is particularly salient for women, since many women’s psychiatric disorders are triggered by interpersonal relationships (Jack, 1991; Kessler & McLeod, 1984). In addition, through job assignments and other program activities, TCs teach prevocational and vocational skills, including responsibility and sound work habits. This aspect is of enormous practical importance for drug-involved women, since few have experience in legal jobs. Finally, the rituals and ceremonies which mark rehabilitative progress are easily reformulated to include those specific to the growth and development of women (Stevens et al., 1989).

This article provides an overview of those program elements necessary for the treatment of women substance abusers, and examines the process through which such elements can be successfully implemented into the TC. In addition, we explore the conditions under which a TC for women can prove an effective option for treating incarcerated women offenders. Our analysis is based on data collected during a three-year process evaluation of BWCI Village, a prison-based TC for women in New Castle, Delaware.

ADAPTING THE THERAPEUTIC COMMUNITY MODEL FOR WOMEN

Over the past two decades, a variety of treatment modalities have restructured their programming to better serve women (Ramsey, 1980; Stevens et al., 1989; Wellisch, Anglin & Prendergast, 1993; Zankowski, 1988). Several themes have emerged from these adaptations that appear essential to the development of gender-sensitive treatment. These themes include: the structure of staffing and the nature of staff-client interactions; the “safety” of the treatment environment; characteristics of the residential community; the content of programming; and the treatment program’s relationship with various social service agencies.

First, the structure of staffing is important in TCs because staff members serve as role models for the resident community. Staff members that are unaware of, or minimize women’s treatment needs are likely to foster a treatment environment that is insensitive (and occasionally hostile) to female clients. Preliminary research indicates that having a woman director appears to significantly increase the success of both co-ed and women-only programs (Ramsey, 1980; Stevens et al., 1989). Further, due to multiple and varied treatment concerns for women clients, staff with experience from other professional fields is also essential (Stevens et al., 1989; Zankowski, 1988). Staff with expertise in women’s health care is necessary not only for health reasons, but for educational purposes as well. Many drug-involved women are at high risk for health complications and have little knowledge about health issues, particularly in regard to gynecological care, sexually transmitted diseases, and prenatal care (Inciardi et al., 1993). Staff with knowledge and experience in working with clients on parenting, childhood abuse, and sexual abuse are also essential in providing appropriate and comprehensive treatment to women (Stevens et al., 1989; Zankowski 1988).

Not only is it important to staff programs appropriately, but specialized training is also fundamental. Treatment providers must be cognizant of women’s experiences on the “street,” and their involvement in prostitution, predatory crime, drug networks, and violent relationships. In addition, training on drug-abusing women’s relationships with their children is beneficial (Stevens et al., 1989; Zankowski, 1988). Educating staff in these areas aids counselors in gaining the perspective of their clients, allowing them to better work with the client from “where she is” when she enters the TC. Counselor familiarity and sensitivity to life on the street lessens the chances of clients feeling alienated or hostile toward treatment. Sensitivity training also decreases the risk of staff inadvertently perpetuating or condoning hierarchical or otherwise problematic interactions between women and men within the TC. A trained staff prevents the formation of unhealthy relationships and teaches male and female clients how to interact with one another in ways that encourage mutual respect and understanding.

Second, treatment providers must work to promote a safe environment for women to engage and progress in treatment. One of the first steps is to ensure that program policies encourage a supportive treatment environment. For instance, many TCs use coercion, rewards, and punishment to ensure participation in program activities. Inappropriate use of punishment and/or excessive use of coercion to encourage participation may only serve to alienate women, particularly since decreased participation may be the result of inappropriate activities or an environment that is otherwise hostile to women clients. Punishing women for non-participation without examining the causes of such behavior may perpetuate feelings of alienation, low self-esteem, and lack of trust. A “safe” treatment environment is one that encourages women’s participation through the scheduling of appropriate activities and supportive rewards.

The third requirement for gender-sensitive treatment involves the nature of the community. Much of the TC treatment model is based on group activities and group counseling. Successful group counseling relies on bonding and trust among members. Many women who have been involved in drug use and criminal activity do not trust other women and may find it difficult to trust and bond with others, more generally (Ramsey, 1980). Treatment interventions such as gender specific groups (segregated by sex), individual counseling, leisure activities and seminars may be necessary to teach women to bond in positive ways and develop a sense of trust. In addition, TCs are characterized by a structured hierarchy in which clients gain increased authority as they progress through treatment. Many women involved in drugs and criminal activity are not accustomed to positions of authority and many male clients are not accustomed to women holding positions of power. Seminars, role-taking groups, and staff role models are essential for encouraging women clients to assume positions of authority and in assisting male clients to interact in positive ways with women who are above and below them in the program hierarchy.

Creating a safe equitable environment based on mutual respect between men and women is greatly dependent on establishing the first cohort of female residents who have progressed through the TC process. Establishing this cohort is difficult, primarily because until this is accomplished women residents have no peer role models. Staff may need to implement safeguards and interventions to ensure that the first cohort is established. Two methods of ensuring a stable and strong first cohort are targeted recruiting and over-recruiting. Through targeted recruiting, clients most ready for treatment are selected. This process increases the likelihood that the women will engage in and progress through treatment as a group, eventually becoming role models for newer clients. After the first cohort is recruited, a broader range of clients can be included in the recruitment criteria. Over recruiting ensures that a sufficient number of women enter treatment together to create a critical mass necessary for group acitivities. In this instance, new recruits enter treatment as a group rather than one at a time. Once a cohort is established, clients can enter the program one at a time.

In addition, staff must also be attuned to the development of this cohort and withdraw as soon as the older women residents are promoted into positions of authority. This cohort ensures that women are integrated into the TC structure. It also enables the program to pair older and newer female residents so that the older residents can assist the newer residents in treatment engagement (Stevens et al., 1989).

The fourth condition for successful treatment of women is providing gender specific programming (Reed, 1987). As noted earlier, women’s addiction experiences differ from men’s, and often involve issues surrounding abusive relationships, role overload, and self-derogation. Within TCs, gender specific programming is essential to all treatment interventions including seminars, branch groups, encounter groups, and individual counseling. Focused attention must be paid to developing relationship skills for women. In addition, activities aimed at increasing contact with children and developing parenting skills are necessary. As with men, experience with leisure activities and appropriate use of free time must be addressed in treatment. Ensuring that leisure activities...

Table of contents

• Cover Page
• Half Title page
• Title Page
• Copyright Page
• Dedication
• Other Page
• Contents
• About the Editors
• Preface
• Drug Use and HIV Risk Behavior of Female Substance Abusers
• Differences Between Drug Using Women Who are In and Out of Treatment
• Special Issues of Drug Using Women: Sexually Transmitted Disease and Incidents of Violence
• Physicians' Assessment, Prenatal Care and Pregnancy of Female Substance Abusers
• Effective Drug Treatment Strategies for Female Substance Abusers: Process, Outcome and Cost Effectiveness
• Index