The Women's Recovery Group Study: a Stage I trial of women-focused group therapy for substance use disorders versus mixed-gender group drug counseling

Novel Insights into Addiction Management: A Meta-Analysis on Intervention for Relapse Prevention

Background and Objectives: Addiction and relapse prevention of alcohol and drug users is a real problem globally. Studies report different pharmacological and non-pharmacological methods in preventing relapse with varying ranges of results across the time of relapse. The study aims to identify novel insights into relapse prevention for high-risk alcohol and drug addiction across diverse global populations, ages, and intervention types during detoxification. Materials and Methods: This meta-analysis followed PRISMA guidelines, synthesizing 12 eligible studies published between 2013 and 2023, totaling 2162 participants. Data extraction and statistical analysis were conducted using Python-based libraries. Regression models were applied to examine the influence of age, gender, and intervention type on the mean relapse period. Results: 12 studies with 2162 patients were identified. These studies examined substances, interventions, and demographics, highlighting male predominance in addictive behaviors. OSL regression assessed factors influencing mean relapse periods, finding that age explained 44.2% of the variability (p = 0.0131). The male percentage explained 17.1%, but the significance was inconclusive, as was the female gender's negligible impact (14.7% variability). Intervention types significantly influenced relapse periods, supported by a large F-statistic. Linear regression showed no consistent trend in relapse periods, with declining research post-2018. Forest plots indicated disparities in relapse periods due to treatment or methodology. Most participants were high-risk drug users, though alcohol use was also represented. A declining trend in publication rates after 2018 was observed. Conclusions: Age and intervention type were identified as key factors influencing relapse duration, while gender and substance-specific effects require further study. The findings underscore the need for more targeted, gender-sensitive, and context-aware treatment strategies.

Outcomes of bio-psycho-social-spiritual community-based drug rehabilitation program for voluntary vs. court-mandated clients in the Philippines

This study sought to evaluate the outcomes of a community-based rehabilitation program for voluntary and court-mandated drug users in the Philippines. Participants went through a bio-psycho-social-spiritual group-based program that aimed to develop their recovery skills and life skills. The program also included family modules to enhance their knowledge of drug use, its effects, and the role of family in recovery. A cohort design was used with pre- and posttest surveys administered before and immediately after the program. The sample consisted of 105 voluntary clients and 118 court-mandated clients who underwent screening or drug dependency evaluation and were recommended for community-based treatment. The program was conducted weekly by trained paraprofessionals. Results reveal significant improvements in recovery and life skills, well-being, quality of life, and family support for both voluntary and court-mandated clients. No significant differences were found between groups, suggesting that community-based interventions are a viable alternative to inpatient or treatment in closed settings for both voluntary and court-mandated clients.

Evidence of telescoping in females across two decades of US treatment admissions for injection drug use: 2000-2020

Background

People who inject drugs (PWID) have an increased risk of soft tissue infection, drug overdose and death. Females may be particularly vulnerable due to barriers to substance use disorder (SUD) treatment entry, stigma, and telescoping, or the greater severity in substance use-related comorbidity and consequences despite a shorter history of use. We set out to identify sex differences in United States injection drug use (IDU).

Methods

The Treatment Episode Dataset-Admission (2000-2020) provided data to identify PWID undergoing their initial SUD treatment admission. Mann-Whitney U test, chi-square, and Spearman correlations were used for ordinal variables, categorical variables, and to assess similarity of male/female trends over the 21 years, respectively. The probabilistic index (PI) and Cramer's V provided effect sizes for Mann-Whitney U tests and chi-square tests, respectively.

Results

A total of 13,612,978 records existed for cases entering their initial treatment. Mapping to a history of IDU left 1,458,695 (561,793 females). Females had a higher prevalence among PWID across all 21 years; IDU trends were essentially identical between males and females (r = 0.97). Females endorsed beginning their primary substance later in life (PI = 0.47, p < 0.0001) and entered treatment after a shorter period of substance use (PI = 0.57, p < 0.0001).

Conclusions

We saw evidence of telescoping among PWID with a SUD entering their initial episode of treatment. Interventions should be implemented prior to the transition to IDU, and this window of opportunity is shortened in females. Utilizing gender-responsive treatment options may be a way to increase treatment-seeking earlier in the disease course.

Recovering Safety: A Pilot Study of a Women's Empowerment Group for Survivors of Intimate Partner Violence with Substance Use Disorders

This pilot study examined the feasibility and satisfaction of the Recovering Safety group, an outpatient empowerment, psychoeducational skills group for women with substance use disorders (SUDs) who have experienced intimate partner violence (IPV). Patient satisfaction, empowerment, and safety were assessed at three time points. Participants (N=8) reported high satisfaction with the group and rated the IPV-informed content, women-only participants, and female therapist as important factors; empowerment increased from pre- to post group. These results support initial feasibility; further study of such treatments is needed to examine efficacy of this group intervention.

Identifying the most common barriers to opioid agonist treatment in an Australian setting

BACKGROUND

Opioid use disorder is a public health concern in Australia. Opioid agonist treatment (OAT) is effective at treating and minimising harm from opioid use disorder, yet is underused in Australia due to client barriers. Although these barriers have been reported, the barriers that are most important to clients is unclear. The aim of this paper was to determine the most important OAT barriers to Australian clients.

METHODS

A cross-sectional, self-completed survey was given to 204 opioid-dependent clients who attended needle and syringe sites in Australia. Participants were given 15 OAT barrier statements, which they answered using a 5-point Likert scale (1=strongly disagree, 2=disagree, 3=neutral, 4=agree and 5=strongly agree). The Likert scale data are presented using the count method and the mean Likert scores (for the whole sample and for subgroups).

RESULTS

The two methods determined that the four most important barriers to OAT were stigma, lack of support services, no flexibility and enjoy using opioids. Furthermore, those who used prescription opioids (compared with heroin) were female or non-binary (compared with male), were not currently using OAT (compared with current OAT), were younger (compared with older) and had high dependence scores (compared with low dependence scores) were impacted more by certain OAT barriers.

CONCLUSIONS

Policies around improving support services, reducing stigma and increasing flexibility would be beneficial to reduce barriers to OAT in Australia. Second, certain groups were more vulnerable to OAT barriers, emphasising the importance to better tailor opioid treatment programs to these specific populations to increase treatment engagement.

Substance use disorders and treatment in Asian American and Pacific Islander women: A scoping review

BACKGROUND AND OBJECTIVES

Asian American Pacific Islanders (AAPIs) face unique barriers in seeking treatment for substance use disorders (SUD) and are less likely than the general population to receive treatment. Barriers specific to AAPI women may be especially significant given identified gender and racial differences in SUD prevalence and treatment. This review examines rates of SUD in AAPI women and summarizes the literature on SUD treatment for AAPI women.

METHODS

Data from 2016 to 2019 National Survey on Drug Use and Health (NSDUH) surveys were extracted to summarize rates of SUD. A scoping review of the literature on AAPI women and SUD treatment was conducted; eight articles published from 2010 to present were reviewed.

RESULTS

The prevalence of SUDs among AAPI women increased overall, although rates of SUDs were generally lower in AAPI women compared to their male counterparts. Patterns of gender differences in SUDs varied for subpopulations of AAPI women. There is limited research on treatment utilization and access for AAPI women. The few studies that examined treatment outcomes found favorable outcomes for AAPI women; research on culturally adapted interventions was promising but nascent.

DISCUSSION AND CONCLUSIONS

Literature on SUD treatment for AAPI women is limited. The availability of more culturally tailored treatments addressing the specific needs of AAPI women may lead to more acceptability and treatment utilization for this group. Additional research is needed to elucidate the unique barriers to treatment AAPI women face.

SCIENTIFIC SIGNIFICANCE

With rising rates of substance use in AAPI women, there is a need to develop and test effective SUD treatments adapted for AAPI women.

A Qualitative Assessment of the Treatment Needs of Women with Concurrent Eating and Substance Use Disorders in a Residential Setting

Objectives: Eating and substance use disorders (SUD) are generally treated separately, leaving eating disorders (ED) overlooked within substance use treatment. The frequent co-occurrence of SUD and ED is well documented. Despite their many similarities and frequent co-occurrence, these two disorder types continue to be largely treated separately-either sequentially, with the most severe disorder addressed first, or concurrently but in separate programs. Our study, therefore, responds to this lacuna of data on patient and provider treatment needs for integrated ED and SUD treatment, centering the perspectives of women with lived experience of ED and SUD to support the development of therapeutic groups for women in treatment programs. Methods: This study was designed as a needs and assets assessment to determine the needs and priorities of women with concurrent ED and SUD for developing group programs. Participants for the needs assessment included both staff members (n = 10) and women receiving treatment (n = 10) who were recruited from a 90-day residential treatment program for women with SUD in British Columbia, Canada. Interviews and focus groups conducted with participants were audio-recorded and transcribed verbatim. Data were thematically analyzed and coded using Dedoose software. Results: Six key themes emerged from the qualitative data and were organized into sections with sub themes. An overarching premise from both staff and program participants was the need for concurrent therapeutic programming, nutritional support, and medical monitoring. The six discrete themes that were elicited included the similarities between ED and SUD, gaps in treatment, community support, family involvement, program participant treatment suggestions, staff treatment suggestions, and family involvement. Conclusions: Throughout this qualitative study, the need for screening and assessment of both disorders along with integrated treatment was stressed by participants, both program participants and staff alike. These findings complement current literature and suggest that pursuing concurrent treatment design may be helpful in addressing unmet program participant needs and could provide a more holistic framework for recovery.

A systematic review of gender-responsive and integrated substance use disorder treatment programs for women with co-occurring disorders

Background: Integrated and gender-responsive interventions, designed to target co-occurring substance use and psychiatric disorders in women, may be effective in addressing gender-specific challenges.Objectives: This systematic review aims to identify integrated gender-responsive substance use disorder treatments for women, summarize evaluations of these treatments, and address gaps in the literature.Methods: We searched PsycINFO, PubMed, and MEDLINE on September 24, 2021, and March 10, 2022. Included articles were randomized-controlled trials, secondary analyses of naturalistic studies, or open-label studies of integrated and gender-responsive treatments from any year that assessed both substance use and mental health/trauma outcomes.Results: We identified N = 24 studies (participants = 3,396; 100% women) examining Seeking Safety, Helping Women Recover and Beyond Trauma, A Woman's Path to Recovery, Modified Trauma Recovery and Empowerment Model (TREM), Breaking the Cycle, VOICES, Understanding and Overcoming Substance Misuse, Women's Recovery Group, Female Specific Cognitive Behavioral Therapy, and Moment by Moment in Women's Recovery. Across treatments there were significant improvements over time; Seeking Safety, Helping Women Recover, and TREM were associated with significantly better substance use and mental health outcomes relative to the comparison groups.Conclusions: Integrated gender-responsive treatments are a promising approach to treating women with co-occurring substance use and mental health concerns, and broad clinical implementation stands to benefit women. However, there remains a lack of studies evaluating substance use treatments in women with severe mental illness (e.g., psychotic-spectrum disorders) who differ in their needs and capacity.

Facing Pain Together: A Randomized Controlled Trial of the Effects of Facebook Support Groups on Adults With Chronic Pain

Despite the popularity and affordances of social media groups for people with chronic conditions, there have been few controlled tests of the effects of these groups. This randomized controlled superiority trial examined the effects of Facebook groups on pain-related outcomes and tested whether a professional-led group leads to greater effects than a support group alone. We randomly assigned 119 adults with chronic pain to one of two Facebook group conditions: a standard condition (n = 60) in which participants were instructed to offer mutual support, or a professional-led condition (n = 59) in which the investigators disseminated empirically-supported, socially-oriented psychological interventions. Four groups were run (2 standard, 2 professional-led), each lasting 4 weeks and containing approximately 30 participants. Measures were administered at baseline, post-intervention, and 1-month follow-up. Across conditions, participants improved significantly in primary outcomes (pain severity and interference; medium-large effects) and a secondary outcome (depressive symptoms; small-medium effect), and they retained their outcomes 1 month after the groups ended. The 2 conditions did not differ on improvements. Overall, this study supports the use of social media groups as an additional tool to improve chronic pain-related outcomes. Our findings suggest that professional intervention may not have added value in these groups and that peer support alone may be driving improvements. Alternatively, the psychosocial intervention components used in the current study might have been ineffective, or more therapist direction may be warranted. Future research should examine when and how such guidance could enhance outcomes. PERSPECTIVE: Findings from this randomized trial support the use of both standard and professional-led Facebook groups as an accessible tool to enhance the lives of adults with chronic pain. This article provides direction for how to improve social media groups to optimize outcomes and satisfaction for more users.

A recreational group intervention based on Relational Cultural Theory for women experiencing substance use disorders in Australia: A protocol

Gender differences exist in the progression, initiation and maintenance of substance use disorders (SUDs). Women encounter unique barriers to accessing treatment for their SUDs and commonly report higher perceptions of stigma around their substance use. Currently, there is a paucity of women-specific treatment options that address their perception of stigma and shame regarding SUDs. The Women of the West (WOW) programme is a pilot study that explores the subjective acceptability and feasibility of participating in a recreational and relational skill development group for women with SUDs. The pilot study adopts qualitative research methods including focus groups and interviews with ten participants who self-identify as women experiencing SUDs and two programme facilitators. The programme's primary aim is to promote participants' relational skills with peers in an enjoyable, and therapeutic environment. It is anticipated as participants develop their relational skills with peers, their sense of stigma regarding their SUDs and social isolation will decrease. Ultimately this can promote their long-term recovery from SUDs and overall well-being. Findings from this study will provide direction for future programme development and treatment services seeking to promote better outcomes for women with SUDs.

An Experimental Study of a Peer-Facilitated Violence Prevention Program for Women in Prison

The literature has shown a strong correlation between victimization and violence. As the majority of treatment programs for violence and the associated research have been focused on men, it is vital that services are also oriented to the needs of women who perpetrate violence. Beyond Violence (BV) was developed to fill the gap in violence prevention programming for justice-involved women with histories of violence victimization and perpetration. This randomized controlled trial reports the results of a peer-facilitated model of the BV program implemented in a women's prison. Women volunteered for the intervention and the study. Participants were randomized to either the 20-session BV condition or to a waitlist control (WC) condition. All 145 participants were asked to complete a preintervention (Time 1) and postintervention (Time 2) survey that included validated measures to assess for depression, anxiety, PTSD, anger/aggression, and emotional dysregulation. Preliminary analyses of the background characteristics and preintervention outcome scores showed no significant differences between the groups at Time 1, indicating that randomization was successful. Separate ANCOVAs were run for 13 outcomes measured using the pretest scores from study participants as the covariate and group assignment as the independent variable. Hypotheses were predominantly supported, and findings showed that the BV participants had significant reductions in the majority of the outcome measures at the postintervention assessment when compared to the WC participants. Future research should continue to explore the advantages of peer-facilitated program models and should incorporate postrelease outcomes to assess change over time.

How Adverse Childhood Experiences and Gender Shape Perceptions of Synthetic Drug Use and Desistance in Yunnan, China

Past research on illicit drug use and desistance has primarily been conducted in western countries, relied on quantitative data, and given little attention to potential gender differentiation. Utilizing qualitative data, we explore gender differences in how illicit drug users perceive the onset of use, whether or not they connect this to adverse childhood experiences (ACEs), and why they quit. The work is based on a sample of 24 informants from Yunnan. Women link onset of use to adverse childhood experiences (ACE) and report quitting primarily for their children. Men found support from their families helpful in ending illicit drug use. This adds qualitative support to theoretical work done by Wu and colleagues, Zhang, and Zhang and Demant who argue that familial attachment is critical in desistance. Utilizing a gendered lens, we gain and nuanced understanding of illicit drug use and links to ACEs which may better inform intervention programs.

Understanding women’s help-seeking for problematic and unhealthy alcohol use through the lens of complexity theory

Purpose

It is well established that women face multiple barriers accessing treatment for problematic and unhealthy alcohol use, but less is known about how their interconnected problems affect how they seek help from, and access, alcohol-treatment services. This study aims to explore the dynamic nature of women’s help-seeking for problematic and unhealthy alcohol use and how this can be compounded by unsuitable treatment services, especially when women present with complex needs.

Design/methodology/approach

Thirteen semi-structured interviews with women who had accessed alcohol-support services were conducted, audio-recorded, transcribed and analysed thematically using the complexity theory.

Findings

For women with complex needs, the process of seeking help may trigger unpredictable behaviours, health or social problems and intermittent serial access to treatment. Current services do not always address women’s holistic needs. Unless services focus on addressing interconnected problems – including historic trauma – they may compound the complexity of women’s problems. Complexity theory offers novel insights into this process, a concept not applied to problematic and unhealthy alcohol use treatment previously.

Research limitations/implications

Services should adopt the complexity-focused perspective featured in this study. While the authors acknowledge the increase in gender-responsive provision, the limitations of this study include a small sample size, the self-selecting nature of the sample and retrospective reporting. Participants were recruited and selected by service staff resulting in gatekeeping and possible sampling bias.

Practical implications

Services should adopt non-linear approaches to treatment. Implementing complexity approaches to treating women’s problematic and unhealthy alcohol use should capture the dynamics, complexity and non-linear nature of women’s help-seeking journeys as well as their internal and external responses that may result in relapse. The authors recommend complexity-focused, multiple-component and integrated collaborative strategies to address not only addiction but also all components of women’s needs, including past trauma.

Originality/value

Applying complexity-thinking to help-seeking experiences for alcohol treatment and recovery services is novel and proved useful in understanding the variety of women’s experiences and how these interact with their help-seeking behaviours, including treatment environments.

Psychosocial Interventions for Alcohol and/or Drug Misuse and Use Disorders in Women: A Systematic Review

Background: Although men and women who misuse substances have different needs, no rigorous systematic literature review has been conducted examining psychosocial substance use interventions for women across a broad range of types of therapeutic approaches and populations. Materials and Methods: PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were used to guide this review. English language, peer-reviewed research articles indexed in PubMed, PsycINFO, CINAHL Complete, and Web of Science through May 6, 2021, were searched. Peer-reviewed articles were included in the review if they were written in English; described a randomized controlled trial of a psychosocial intervention to reduce substance misuse and related problems in women; and reported quantitative data on alcohol or illicit drug use as an outcome that was linked to the interventions. Results: A total of 51 articles met eligibility criteria, reflecting a broad array of interventions with different levels of methodological rigor. Several, but not most, interventions were tailored to meet the needs of specific subgroups of women, but evidence regarding the efficacy of tailoring was inconclusive. Overall, 61% of studies reported one or more positive substance-related intervention effects, with target substance (alcohol only vs. other drugs only or both alcohol and other drugs) and intervention dosage associated with intervention success. Conclusions: Fewer studies targeting alcohol only reported one or more positive intervention outcomes. This warrants further study, given that polysubstance use is the norm, not the exception. Future research might also focus on reducing treatment barriers to women, as this has the potential to improve overall treatment outcomes for this population.

Women's and men's experiences in group therapy for substance use disorders: A qualitative analysis

BACKGROUND AND OBJECTIVES

This thematic analysis of qualitative interviews from participants in Stage II randomized controlled trial examined women's and men's experiences in group therapy for substance use disorders (SUDs).

METHODS

Interviews were conducted with 77 women and 38 men after completion of either the gender-specific Women's Recovery Group (WRG) or mixed-gender Group Drug Counseling (GDC). Interviews were coded for themes using a deductive approach with a coding scheme modified from the Stage I trial. Satisfaction was measured quantitatively posttreatment.

RESULTS

Participants had high satisfaction scores with no significant differences between groups. Women in GDC rated group gender composition as less helpful than those in WRG. In the GDC group, women more frequently discussed the theme of self-perception (e.g., feelings of comfort, safety, shame) compared with men. Men overwhelmingly expressed the benefits of having women in the group, whereas women expressed advantages and disadvantages of mixed-gender groups and preference for single-gender groups. Guilt and shame were discussed by women and men; however, only women discussed stigma and its important role in their addiction and recovery.

DISCUSSION AND CONCLUSION

Men more frequently endorsed the helpfulness of mixed-gender groups than did women while women appreciated the enhanced support in single-gender SUD groups. Issues of stigma are especially salient for women.

SCIENTIFIC SIGNIFICANCE

Men and women express differences in their experiences of SUD group therapy. Only women endorse stigma as an obstacle to their treatment and recovery. Tailoring treatment to meet women's and men's needs may enhance engagement, retention, and clinical outcomes.

The Perceptions of Women About Their High Experience of Using Crack Cocaine

INTRODUCTION

The aim of this study was to explore the perceptions of women about their experience in using crack cocaine, discussing their motivations for using it and the repercussions in their lives.

OBJECTIVE

To investigate these experiences, a qualitative exploratory study was conducted, using the inductive thematic analyses of the content.

METHODS

Eight female crack cocaine users took part in this study. They were assessed by a semi-structured interview, addressing the crack cocaine use experience. Four main themes emerged in the interviews: (1) crack cocaine "high" experience; (2) symptoms related to crack cocaine use; (3) circumstances of crack cocaine use; and (4) crack cocaine use consequences.

RESULTS

The main perceptions reported by the users were related to a feeling of being disconnected to the world preceded by a pleasant experience, especially during the first moments of use. They revealed that the drug fulfills a key role of coping strategy to handle with negative thoughts, emotions or life experiences. An important influence of social issues was reported in relation to the onset of crack cocaine use. Negative consequences and significant impact on their lives appeared in their reports, regarding the loss of family ties, involvement with prostitution, traumatic experiences and violence.

CONCLUSION

Taking together all women's perceptions suggests that beyond the positive immediate rewarding effect, the maintenance of use might be related to the dissociative experience and self-medication role, acting as negative reward by relieving of negative life experiences that, in turn, are both cause and consequence of the drug use.

Meeting the Needs of Families Involved in the Child Welfare System for Parental Substance Abuse: Outcomes From an Effectiveness Trial of the Families Actively Improving Relationships Program

Limited evidence-based practices exist to address the unique treatment needs of families involved in the child welfare system with parental substance abuse. Specifically, parental opioid and methamphetamine abuse have increased over the last decade, with associated increases of families reported to the child welfare system. The Families Actively Improving Relationships (FAIR) program was developed to address the complexities of these families. Evidence-based strategies to address the interrelated needs of parents—including substance abuse and mental health treatment, parent skills training, and supportive case management to improve access to ancillary needs—are integrated in an intensive community outpatient program. This study examined the clinical effectiveness of FAIR when delivered in a Medicaid billable outpatient clinic. Parents (n = 99) were randomized either to the immediate FAIR condition or to the Waitlist (WL) condition, using a dynamic wait-listed design, with all parents provided the opportunity to eventually receive FAIR. Outcomes show statistically and clinically significant reductions in parental opioid and methamphetamine use, mental health symptoms, and parenting risk, and improvements in stability in parents receiving FAIR. Providing services to families who require travel in excess of 20 miles for sessions has challenging implications for program costs under a Medicaid structure. Study outcomes highlight the need for policies to support funding of intensive family-based programs.

A review of research-supported group treatments for drug use disorders

This paper reviews methodologically rigorous studies examining group treatments for interview-diagnosed drug use disorders. A total of 50 studies reporting on the efficacy of group drug use disorder treatments for adults met inclusion criteria. Studies examining group treatment for cocaine, methamphetamine, marijuana, opioid, mixed substance, and substance use disorder with co-occurring psychiatric conditions are discussed. The current review showed that cognitive behavioral therapy (CBT) group therapy and contingency management (CM) groups appear to be more effective at reducing cocaine use than treatment as usual (TAU) groups. CM also appeared to be effective at reducing methamphetamine use relative to standard group treatment. Relapse prevention support groups, motivational interviewing, and social support groups were all effective at reducing marijuana use relative to a delayed treatment control. Group therapy or group CBT plus pharmacotherapy are more effective at decreasing opioid use than pharmacotherapy alone. An HIV harm reduction program has also been shown to be effective for reducing illicit opioid use. Effective treatments for mixed substance use disorder include group CBT, CM, and women's recovery group. Behavioral skills group, group behavioral therapy plus CM, Seeking Safety, Dialectical behavior therapy groups, and CM were more effective at decreasing substance use and psychiatric symptoms relative to TAU, but group psychoeducation and group CBT were not. Given how often group formats are utilized to treat drug use disorders, the present review underscores the need to understand the extent to which evidence-based group therapies for drug use disorders are applied in treatment settings.

An Exploratory Study of Sex and Gender Differences in Demographic, Psychosocial, Clinical, and Substance Use Treatment Characteristics of Patients in Outpatient Opioid Use Disorder Treatment with Buprenorphine

As treatment expansion in the opioid epidemic continues, it is important to examine how the makeup of individuals with opioid use disorder (OUD) is evolving. Treatment programs are increasingly utilizing buprenorphine, an effective OUD medication. This exploratory study examines sex and gender differences in psychosocial, clinical and substance use treatment characteristics of a clinical population in outpatient medication treatment for OUD with buprenorphine. This is a secondary data analysis from a cross-sectional survey study with retrospective medical record review conducted with patients recruited from an office-based opioid treatment clinic between July-September 2019. Participants on buprenorphine for at least 28 days at time of survey completion were included (n=133). Differences between men and women were explored with Pearson χ2 and Fisher's Exact Tests for categorical variables and T-Tests for continuous variables. The sample was 55.6% women and nearly three-fourths Black (70.7%). Mean days in current treatment episode was 431.6 (SD=244.82). Women were younger and more likely to be unemployed, identify as a sexual minority, and live alone with children than men. More women than men had a psychiatric comorbidity. Women reported more prescription opioid misuse while men had more heroin only opioid use. More men reported comorbid alcohol use and a history of drug overdose. One-third of participants reported recent discrimination in a healthcare setting due to substance use. As buprenorphine-based outpatient treatment programs continue to expand, present study findings support evaluation of the unique needs of men and women in order to better tailor OUD-related services and improve treatment outcomes.

Sex Differences in Opioid Use Disorder Prevalence and Multimorbidity Nationally in the Veterans Health Administration

Opioid use disorder (OUD) is a significant problem among US veterans with increasing rates of OUD and overdose, and thus has substantial importance for service delivery within the Veterans Health Administration (VHA). Among individuals with OUD, several sex- specific differences have begun to emerge regarding co-occurring medical, psychiatric and pain-related diagnoses. The rates of such multimorbidities are likely to vary between men and women with OUD and may have important implications for treatment within the VHA but have not yet been studied. Methods: The present study utilized a data set that included all veterans receiving VHA health care during Fiscal Year (FY) 2012 (October 1, 2011 through September 30, 2012), who were diagnosed during the year with opioid dependence or abuse. VHA patients diagnosed with OUD nationwide in FY 2012 were compared by sex on proportions with OUD, and among those with OUD, on sociodemographic characteristics, medical, psychiatric and pain-related diagnoses, as well as on service use, and psychotropic and opioid agonist prescription fills. Results: During FY 2012, 48,408 veterans were diagnosed with OUD, 5.77% of whom were women. Among those veterans with OUD, few sociodemographic differences were observed between sexes. Female veterans had a higher rate of psychiatric diagnoses, notably mood, anxiety and personality disorders, as well as higher rates of pain-related diagnoses, such as headaches and fibromyalgia, while male veterans were more likely to have concurrent, severe medical co-morbidities, including hepatic disease, HIV, cancers, peripheral vascular disease, diabetes and related complications, and renal disease. There were few differences in health service utilization, with women reporting greater receipt of prescriptions for anxiolytic/sedative/hypnotics, stimulants and lithium. Men and women did not differ in receipt of opioid agonist medications or mental health/substance use treatments. Conclusions: There are substantial sex-specific differences in patterns of multimorbidity among veterans with OUD, spanning medical, psychiatric and pain-related diagnoses. These results illustrate the need to view OUD as a multimorbid condition and design interventions to target such multimorbidities. The present study highlights the potential benefits of sex-specific treatment and prevention efforts among female veterans with OUD and related co-occurring disorders.

Adaptation and Pilot Testing of the Women's Recovery Group for Young Adults (WRG-YA)

Gender specific substance use disorder treatment has demonstrated promise in adult women, but is relatively unexplored in young adults. To address the specific needs of young adult females, the manual-based Women's Recovery Group (WRG) was adapted for women ages 18-25. Treatment engagement and retention, group cohesiveness, satisfaction, and substance use outcomes were measured during group treatment and at 1-month follow up. This pilot supports the feasibility and initial acceptability of the adapted form of the WRG for young adults. Data from this study may inform future gender specific treatment approaches for substance use disorders in younger populations.

Women’s views on barriers and facilitators for seeking alcohol and drug treatment in Belgium

Aims:

Although treatment barriers are different for men and women, research is dominated by males’ and practitioners’ perspectives rather than women’s voices. The purpose of this study in Belgium was to identify and obtain a better understanding of the barriers and facilitators for seeking treatment as experienced by substance (ab)using women themselves.

Methods:

In-depth interviews were conducted with 60 female substance users who utilise(d) outpatient and/or residential treatment services. A content analysis was performed on women’s personal accounts of previous treatment experiences as well as their experiences with services along the continuum of care, resulting in practical implications for the organisation of services.

Results:

Female substance users experience various overlapping – and at times competing – barriers and facilitators when seeking treatment and utilising services. For most women, the threat of losing custody of their children is an essential barrier to treatment, whereas for a significant part of the participants it serves as a motivation to seek help. Also, women report social stigma in private as well as professional contexts as a barrier to treatment. Women further ask for a holistic approach to treatment, which stimulates the healing process of body, mind and spirit, and emphasise the importance of feeling safe in treatment. Participants suggested several changes that could encourage treatment utilisation.

Conclusion:

Our findings demonstrate the need for a gender-sensitive approach within alcohol and drug services that meets the needs of female substance users, as well as gender-sensitivity within prevention and awareness-raising campaigns, reducing the stigma and facilitating knowledge and awareness among women and society.

Sex and Gender Effects in Recovery From Alcohol Use Disorder

The current article provides a brief summary of biopsychosocial gender differences in alcohol use disorder (AUD), then reviews existing literature on gender differences in treatment access, retention, outcomes, and longer-term recovery. Among psychotherapies for AUD, there is support for the efficacy of providing female-specific treatment, and for female-only treatment settings but only when female-specific treatment is included. However, despite mandates from the National Institutes of Health to do so, there is little work thus far that directly compares genders on outcomes of specific psychotherapies or pharmacotherapies for AUD. Although existing research has mixed findings on sex and gender differences in overall outcomes, there are more consistent findings suggesting different mechanisms of behavior change among men and women in AUD treatment and long-term recovery. Thus, more work is needed that attends to gender and sex differences, including planning studies that are structured to examine not only gender-differentiated outcomes in treatment response, but equally important, differences in treatment access and attendance as well as differences in mechanisms of change in drinking behavior.

Gender Difference in Substance Use and Psychiatric Outcomes Among Dually Diagnosed Veterans Treated in Specialized Intensive PTSD Programs

OBJECTIVES

Posttraumatic stress disorder (PTSD) is a problem of growing importance among female veterans, which is especially challenging when accompanied by comorbid substance use disorder (SUD). Since women are still a small minority of Veterans Health Administration (VHA) patients, there is concern that outcomes among dually diagnosed women may be worse than among men.

METHOD

National program evaluation data were collected at admission and 4 months after discharge from 7,074 dually diagnosed veterans including 203 women (2.9%) treated at 57 specialized intensive VHA PTSD treatment programs between 1993 and 2011. Multiple regression was used to compare clinical change in women and men adjusting for baseline differences.

RESULTS

Women showed no significant differences from men in measures of substance use or total PTSD symptoms at admission although they were more likely to have experienced sexual trauma and less likely to report combat exposure. With adjustment for these differences, there were no significant gender differences in length of stay, satisfaction with treatment, or measures of change in substance use or total PTSD symptoms 4 months after discharge. Reductions in an index of days of substance use was associated with reduction in total PTSD symptoms among both women (R = 0.33; p = .01) and men (R = 0.44, p < .0001) with no significant gender difference.

CONCLUSION

No significant gender differences were observed in substance use or PTSD outcomes, despite the extreme minority status of women in VHA programs. Highly vulnerable women can benefit as much as men, even when treatment is not formally tailored to address gender-specific needs.

Gender discrimination and illicit drug use among African American and European American adolescents and emerging adults

Objective: The present study aimed to characterize the association of perceived gender discrimination and illicit drug use among a sample of African American (AA) and European American (EA) adolescent girls and young women. Method: Data were drawn from a high-risk family study of alcohol use disorder of mothers and their offspring (N = 735). Multinomial regressions were used to examine whether experience of offspring and maternal gender discrimination were associated with offspring illicit drug use (cannabis, cocaine, ecstasy, PCP, opiates, hallucinogens, solvents, sedatives, or inhalants). Outcomes included offspring age of drug use initiation (age ≤ 14) and lifetime heavy drug use (≥ 50 times) of 1 or more illicit substances. Interactions between race and offspring gender discrimination were modeled to assess for race differences. Results: Results revealed that gender discrimination was associated with a greater likelihood of offspring early initiation (relative risk ratio [RRR] = 2.57, 95% CI [1.31, 5.03]) versus later initiation (RRR = 1.33, 95% CI [0.80, 2.24]). Offspring gender discrimination was associated with offspring heavy drug use (RRR = 2.09, 95% CI [1.07, 4.06]) and not associated with moderate/light use (RRR = 1.44, 95% CI [0.86, 2.42]), but post hoc tests revealed no significant group differences. Conclusions: Findings suggest that perceived offspring gender discrimination is associated with early drug use initiation. Gender discrimination, particularly at an early age, has a potential to cause harm, including drug use. Implementation of policies that foster environments that eliminate gender bias and discrimination at an early age should be prioritized. Gender-responsive treatment merits consideration by substance use treatment providers. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Determinants and Prevention Strategies of Substance Abuse in Pacific Countries: A Systematic Review

OBJECTIVES

People abuse substances like drugs, alcohol, and tobacco for different reasons, including pleasure, improved performance and vigilance, relief of depression, curbing hunger, and weight control. In this review, we sought to identify the determinants and prevention strategies that have been undertaken to minimize the issue of substance abuse.

METHODS

The systematic review was conducted following the Cochrane Library Guidelines and PRISMA checklist. We searched six online databases to identify studies from January 2000 to July 2017.

RESULTS

Only peer-reviewed studies published in the English language that had full text accessible were included. We reviewed 19 studies; only one was quasi-experimental and the majority were descriptive studies. The determinants of substance abuse identified include personal, faciliatory/promotor, environmental, and social factors. The prevention strategies identified use culturally appropriate and gender-sensitive treatments, and identify sources of strength in families, community, individual, and even spiritual.

CONCLUSIONS

Substance abuse poses significant public health risks and therefore requires adequate interventions such as educating and informing individuals of the health risks associated with substance abuse and must be considered locally to promote the well-being of people.

Treatment Interventions for Women With Alcohol Use Disorder

Women with alcohol use disorder (AUD) experience more barriers to AUD treatment and are less likely to access treatment than men with AUD. A literature review identified several barriers to women seeking help: low perception of a need for treatment; guilt and shame; co-occurring disorders; employment, economic, and health insurance disparities; childcare responsibilities; and fear of child protective services. Women entering treatment present with more severe AUD and more complex psychological, social, and service needs than men. Treatment program elements that may reduce barriers to AUD treatment include provision of childcare, prenatal care, treatment for co-occurring psychological problems, and supplemental social services. Research has suggested that outcomes for women are best when treatment is provided in women-only programs that include female-specific content. To date, research on treatments tailored to the individual needs of women is limited, but research on mechanisms of change has suggested the importance of targeting anxiety and depression, affiliative statements in treatment, abstinence self-efficacy, coping skills, autonomy, and social support for abstinence. Future research should focus on early interventions, linkages between primary care or mental health clinics and AUD treatment settings, and integrated treatments for co-occurring AUD and other disorders. Further research should also explore novel treatment delivery approaches such as digital platforms and peer support groups.

The relationship between perceived stress and depression in substance use disorder treatment

BACKGROUND

Depression is highly prevalent among individuals with substance use disorders (SUDs), especially women, and has been noted to improve during SUD treatment. Perceived stress is independently related to severity of depression and substance use disorders (SUDs) as well as recurrence of symptoms and relapse following treatment. The aim of this study was to investigate among adults enrolled in SUD treatment whether levels of perceived stress and substance use over the course of treatment were related to reduction in depression.

METHODS

This is a secondary analysis of data from the Women's Recovery Group Study. Women (n = 100) were randomized to either single- or mixed-gender group therapy and men (n = 58) received mixed-gender group therapy. Measures of substance use, perceived stress and depressive symptoms were collected for 6 months following treatment completion. In this study, we used lagged mixed models to investigate whether levels of substance use and perceived stress at each time point were associated with changes in depression at the subsequent time point.

RESULTS

Results indicated that depressive symptoms significantly improved over time. Both substance use and perceived stress were associated with subsequent depressive symptoms. Importantly, stress was associated with symptoms when controlling for substance use, suggesting that changes in depressive symptoms were not solely attributable to levels of substance use.

CONCLUSIONS

These results suggest that both stress and substance use are associated with improvements in depressive symptoms in substance use disorder treatment. Although preliminary, these results provide further support for the importance of targeting stress reduction in people with substance use disorders.

Percepções de Profissionais sobre Atendimentos em Saúde para Mulheres Usuárias de Crack

Resumo As percepções dos profissionais de saúde que atendem mulheres usuárias de crack podem auxiliar no aprimoramento dos atendimentos. Assim, este estudo objetivou compreender essas percepções. Se trata de um estudo qualitativo, com 33 participantes divididos em três grupos focais submetidos à análise temática. Estabeleceram-se dois eixos centrais: a) usuárias de crack e b) serviços de saúde. Posteriormente, identificaram-se oito temas e seis subtemas. No primeiro eixo destacaram-se: características das usuárias, ausência de rede de apoio, violência, estigma de gênero, prostituição e comorbidades clínicas. No segundo ressaltaram-se as dificuldades na articulação entre os serviços e questões a serem aprimoradas, como: prevenção na atenção básica, motivação dos profissionais, serviços específicos para mulheres, especificidades da gestação e combate ao estigma. A partir dos resultados, foram identificados e discutidos os desafios e as potencialidades que se dão nos atendimentos de mulheres usuárias de crack.

The Women's Recovery Group for Individuals with Co-occurring Substance Use and Eating Disorders: Feasibility and Satisfaction in a Residential Eating Disorders Program

Despite the high rate of co-occurring eating disorders (EDs) and substance use disorders (SUDs) in women, there is a lack of integrated treatment. This study implemented the Women's Recovery Group (WRG), a gender-specific group therapy for women with SUDs, in an ED residential treatment program to assess the feasibility and satisfaction of the WRG for women with co-occurring SUDs and EDs. Women (N = 24) were enrolled in the study if they were aged 18 years or older and engaged in the WRG as part of their treatment. Patient and therapist satisfaction with the WRG were assessed post-treatment, and craving to use substances was measured at enrollment and post-treatment. Participants reported moderate satisfaction with the WRG, and therapists reported above average satisfaction with the WRG. Craving to use substances in the environment in which one previously used significantly decreased from enrollment to post-treatment. In its current form, the WRG was feasible to implement in ED residential treatment. Participants indicated that they would have liked more information on co-occurring EDs, self-image/self-esteem, shame and guilt, and maintaining sobriety at college. These results support the need for modifications to the WRG to better integrate treatment for women with co-occurring EDs and SUDs.

Building a Group-Based Opioid Treatment (GBOT) blueprint: a qualitative study delineating GBOT implementation

BACKGROUND

Group-Based Opioid Treatment (GBOT) has recently emerged as a mechanism for treating patients with opioid use disorder (OUD) in the outpatient setting. However, the more practical "how to" components of successfully delivering GBOT has received little attention in the medical literature, potentially limiting its widespread implementation and utilization. Building on a previous case series, this paper delineates the key components to implementing GBOT by asking: (a) What are the core components to GBOT implementation, and how are they defined? (b) What are the malleable components to GBOT implementation, and what conceptual framework should providers use in determining how to apply these components for effective delivery in their unique clinical environment?

METHODS

To create a blueprint delineating GBOT implementation, we integrated findings from a previously conducted and separately published systematic review of existing GBOT studies, conducted additional literature review, reviewed best practice recommendations and policies related to GBOT and organizational frameworks for implementing health systems change. We triangulated this data with a qualitative thematic analysis from 5 individual interviews and 2 focus groups representing leaders from 5 different GBOT programs across our institution to identify the key components to GBOT implementation, distinguish "core" and "malleable" components, and provide a conceptual framework for considering various options for implementing the malleable components.

RESULTS

We identified 6 core components to GBOT implementation that optimize clinical outcomes, comply with mandatory policies and regulations, ensure patient and staff safety, and promote sustainability in delivery. These included consistent group expectations, team-based approach to care, safe and confidential space, billing compliance, regular monitoring, and regular patient participation. We identified 14 malleable components and developed a novel conceptual framework that providers can apply when deciding how to employ each malleable component that considers empirical, theoretical and practical dimensions.

CONCLUSION

While further research on the effectiveness of GBOT and its individual implementation components is needed, the blueprint outlined here provides an initial framework to help office-based opioid treatment sites implement a successful GBOT approach and hence potentially serve as future study sites to establish efficacy of the model. This blueprint can also be used to continuously monitor how components of GBOT influence treatment outcomes, providing an empirical framework for the ongoing process of refining implementation strategies.

Comparing Outcomes of Women-Only and Mixed-Gender Intensive Posttraumatic Stress Disorder Treatment for Female Veterans

Although most female veterans treated in specialized intensive Veterans Health Administration (VHA) posttraumatic stress disorder (PTSD) programs receive services in settings in which over 95% of participants are men, two programs include only women. Whether outcomes for women with PTSD are superior in women-only programs has not been evaluated. National program evaluation data on 1,357 women veterans from 57 sites were collected at program entry and 4 months after discharge. With adjustment for differences in baseline characteristics, outcomes of women in two women-only programs (n = 469) were compared with those from 55 mixed-gender programs (n = 888), using mixed models with random effect for site. The primary outcome was total PTSD symptom level, with supplementary information on PTSD assessment subscales, substance use, and other outcomes. At program entry, female veterans in women-only programs had lower scores on measures of total PTSD symptoms, p = .013, d = -0.24, and on several subscales. Adjusting for these differences, there were no significant differences between program types in terms of PTSD total score or scores on secondary measures. In women-only programs, veterans had longer lengths of stay and were rated by their clinicians to have a higher level of commitment to therapy at discharge. Thus, women-only programs did not show superior outcomes; however, compared to participants in mixed-gender programs, those in women-only programs had longer lengths of stay, higher levels of commitment to therapy, and were more likely to participate in posttreatment outcome assessments following discharge.

Individual gender and group gender composition as predictors of differential benefit from mindfulness-based relapse prevention for substance use disorders

OBJECTIVES

Mindfulness-based relapse prevention (MBRP) is an effective group-based aftercare treatment for substance use disorders (SUDs), yet few studies have examined moderators of MBRP efficacy. This secondary data analysis evaluated individual gender and group gender composition (e.g., proportion of women relative to men in each therapy group) as treatment moderators of MBRP.

METHODS

The analysis sample included 186 individuals with SUDs randomized to MBRP or relapse prevention (RP) as an aftercare treatment. Outcomes included number of heavy drinking days and drug use days at the 12-month follow-up.

RESULTS

There were no treatment moderation effects for models with heavy drinking days as the outcome (all ps > .05). Group gender composition, but not individual gender, moderated the effect of treatment condition on drug use days (p < .01). Individuals who received MBRP had significantly fewer drug use days at 12-months than those who received RP, but only among individuals in therapy groups comprising one-third or more women (p <0 .0001). Specifically, all women and men who received MBRP in groups with one-third or more women were abstinent from drugs at month 12, whereas those in RP groups with one-third or more women had an average of about eight drug use days at month 12 (corresponding to a large between-treatment condition effect size).

CONCLUSIONS

Group-based MBRP may be more efficacious than group-based RP, particularly when women compose at least one-third of the therapy group. Further research is warranted on gender and group gender composition as moderators of MBRP.

A positive screen for military sexual trauma is associated with greater risk for substance use disorders in women veterans

Military sexual trauma (MST) is a significant public health issue associated with adverse psychiatric outcomes, including heightened risk for suicide, posttraumatic stress disorder, depression, and substance use disorders. Recently, research has begun exploring gender-linked disparities in mental health outcomes for individuals who experience MST. The current study assessed whether women who screened positive for MST were at disproportionately higher risk for diagnoses of alcohol-use disorder (AUD) or drug-use disorder (DUD) relative to men. Veterans Health Administration (VHA) clinical data were extracted for 435,690 military veterans who separated from the military between 2004 and 2011 and had at least 5 years of follow-up data after their initial VHA visit until the end of fiscal year 2014. Logistic regression models examined the main and interactive effects of gender and screening positively for MST as predictors of AUD and DUD. MST positive screens were associated with increased rates of both AUD and DUD across genders. Although rates of both AUD and DUD were higher among men, the increased rate of diagnosis associated with MST positive screens was proportionally higher for women than men (interaction adjusted odds ratios = 1.43 and 1.17 for AUD and DUD, respectively), indicating the presence of a gender-linked health risk disparity. This disparity was more pronounced for AUD than DUD (p < .01). The current study adds to previous literature documenting increased risk for women exposed to MST. These findings support efforts to reduce the occurrence of MST and continued use of MST screening measures within the VHA. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Sex differences in neural mechanisms mediating reward and addiction

There is increasing evidence in humans and laboratory animals for biologically based sex differences in every phase of drug addiction: acute reinforcing effects, transition from occasional to compulsive use, withdrawal-associated negative affective states, craving, and relapse. There is also evidence that many qualitative aspects of the addiction phases do not differ significantly between males and females, but one sex may be more likely to exhibit a trait than the other, resulting in population differences. The conceptual framework of this review is to focus on hormonal, chromosomal, and epigenetic organizational and contingent, sex-dependent mechanisms of four neural systems that are known-primarily in males-to be key players in addiction: dopamine, mu-opioid receptors (MOR), kappa opioid receptors (KOR), and brain-derived neurotrophic factor (BDNF). We highlight data demonstrating sex differences in development, expression, and function of these neural systems as they relate-directly or indirectly-to processes of reward and addictive behavior, with a focus on psychostimulants and opioids. We identify gaps in knowledge about how these neural systems interact with sex to influence addictive behavior, emphasizing throughout that the impact of sex can be highly nuanced and male/female data should be reported regardless of the outcome.

Group therapy for women with substance use disorders: In-session affiliation predicts women's substance use treatment outcomes

In-session affiliation among members is a hypothesized mechanism of action of group therapy for women with substance use disorders (SUDs). We evaluated group affiliation as an independent predictor of SUD treatment outcome in women (n = 100), 18 years or older diagnosed with substance dependence, who were randomized to the single-gender Women's Recovery Group (WRG) or mixed-gender group therapy (Group Drug Counseling; GDC). Affiliative statements made by members in both groups were measured for 39 women in each treatment arm. We studied the relationship between frequency of affiliative statements categorized in quintiles and the trajectory of days of any drug use during 3 months treatment and 6 months post-treatment using a Poisson regression model with estimation via generalized estimating equations. Furthermore, we investigated whether the effect of affiliation on substance use was moderated by group therapy type. The relationship between amount of affiliation and substance use reduction was non-linear. At the end of the treatment phase (3 months), women who experienced the highest level of affiliation (>65 affiliative statements on average) were found to reduce substance use by about 1.75 days more (p-value = 0.02) than women who experienced the lowest level of affiliation (<26). The effects of affiliation persisted 6 months post-treatment and were moderated by therapy group, whereby women enrolled in the single-gender WRG appeared to benefit more from affiliation post-treatment. Training therapists to facilitate verbal affiliation may provide added therapeutic benefit to group therapy for women with SUDs.

Need for women-centered treatment for substance use disorders: results from focus group discussions

Background

There are few women-centered treatment programs for substance use disorder. We therefore undertook an exploratory study to better understand the treatment experience, barriers, and facilitators of mothers with substance use disorder.

Methods

We conducted two focus groups with a total of ten women with a history of substance use disorder in Kingston (Canada). Women were recruited from a community program for mothers with substance use disorder. The focus groups were recorded, and the resulting data were transcribed, coded, and thematically analyzed. Barriers, facilitators and treatment needs were identified.

Results

The mean age of the participants was 31.1 years, 30% were currently using substances, and 60% had a child in their care. A key concern for women regarding substance use treatment was the welfare of their child(ren). Agencies charged with child protection were a barrier to treatment because women feared disclosing substance use would result in loss of child custody. In contrast, when agencies stipulated that women must attend treatment to retain custody, they facilitated treatment engagement. Other barriers to treatment included identifying treatment programs and completing admission requirements, wait times, counselor ability to address woman-centered issues, fear, safety, and stigma. Women’s personal motivation for treatment was a facilitator. Suggestions to improve treatment programs included to allow children to accompany their mothers, involvement of peer support, and women-only programs.

Conclusions

This small but novel study provides important data to inform treatment programming for mothers with substance use disorders.

Gender Differences in Perceived Unmet Treatment Needs Among Persons With and Without Co-occurring Disorders

This study examined gender differences in perceived unmet treatment needs among persons with and without co-occurring substance use disorders and serious mental health conditions. Data were drawn from the 2008-2013 National Survey on Drug Use and Health (unweighted N = 37,187) to test the hypothesis that the relationships between diagnosis and perceived unmet treatment needs differ as a function of gender. Compared to individuals with a substance use disorder or severe mental illness, those with co-occurring disorders were more likely to report perceived unmet needs for substance abuse and mental health treatment. Gender significantly moderated the relationship between diagnosis and unmet needs, suggesting that men with co-occurring disorders might be more adversely affected. Findings highlight the need for better understanding of gender-diagnosis differences with respect to unmet needs for substance abuse and mental health care.

Do women with complex alcohol and other drug use histories want women-only residential treatment?

BACKGROUND

Women-only addiction services tend to be provided on a poorly evidenced assumption that women want single-sex treatment. We draw upon women's expectations and experiences of women-only residential rehabilitation to stimulate debate on this issue.

METHODS

Semi-structured interviews were undertaken with 19 women aged 25-44 years [currently in treatment (n = 9), successfully completed treatment (n = 5), left treatment prematurely (n = 5)]. All had histories of physical or sexual abuse, and relapses linked to relationships with men. Interviews were audio-recorded, transcribed verbatim, coded and analysed inductively following Iterative Categorization.

FINDINGS

Women reported routinely that they had been concerned, anxious or scared about entering women-only treatment. They attributed these feelings to previous poor relationships with women, being more accustomed to male company and negative experiences of other women-only residential settings. Few women said that they had wanted women-only treatment, although many became more positive after entering the women-only service. Once in treatment, women often explained that they felt safe, supported, relaxed, understood and able to open up and develop relationships with other female residents. However, they also described tensions, conflicts, mistrust and social distancing that undermined their treatment experiences.

CONCLUSIONS

Women who have complex histories of alcohol and other drug use do not necessarily want or perceive benefit in women-only residential treatment.

What do women want? Women want services tailored to their needs

Commentary to: Do women with complex alcohol and other drug use histories want women‐only residential treatment?

Individual versus group female-specific cognitive behavior therapy for alcohol use disorder

OBJECTIVES

To test group-based Female-Specific Cognitive Behavioral Therapy (G-FS-CBT) for women with Alcohol Use Disorder (AUD) against an individual Female-Specific Cognitive Behavioral Therapy (I-FS-CBT). This aims of this paper are to describe G-FS-CBT development, content, feasibility, acceptability, group process, engagement in treatment, and within- and post-treatment outcomes.

METHODS

Women with AUD (n=155) were randomly assigned to 12 manual-guided sessions of G-FS-CBT or I-FS-CBT; 138 women attended at least one treatment session.

RESULTS

Women in G-FS-CBT attended fewer sessions (M=7.6) than women in I-FS-CBT (M=9.7; p<.001). Women in both conditions reported high satisfaction with the treatments. Independent coders rated high fidelity of delivery of both G-FS-CBT and I-FS-CBT. Therapeutic alliance with the therapist was high in both conditions, with I-FS-CBT being slightly but significantly higher than G-FS-CBT. In the first six weeks of treatment, women in both treatment conditions significantly reduced their percent drinking days (PDD) and percent heavy days drinking (PHD) by equivalent amounts, maintained through the rest of treatment and the 12month follow up with no treatment condition effects. Women reported significant improvement in all but one of the secondary outcomes during treatment; gains made during treatment in depression, anxiety, autonomy, and interpersonal problems were maintained during the follow-up period, while gains made during treatment in use of coping skills, self-efficacy for abstinence, self-care, and sociotropy deteriorated over follow up but remained improved compared to baseline.

CONCLUSIONS

Findings support the feasibility, acceptability, and efficacy of a group format for female-specific CBT for AUD, a new 12-session, single gender, community friendly, group therapy with programming specifically for women. Similar, positive outcomes for individual and group treatment formats were found for drinking, mood, coping skills, self-confidence, interpersonal functioning, and self-care.