While young men in addiction treatment may have exhibited little success in forming relationships at all, young women are generally more likely to have had a history of unhealthy or all-consuming relationships, with trauma prominent in many of these cases.
Treatment leaders who work with young women say they often have to work painstakingly to nurture healthy relationships in this population, whether with peers, authority figures, or family members.
“One of the things we do a lot of teaching on is how to have healthy communication and interaction as peers,” says Katie Schultz, clinical supervisor for female services at Hazelden in Minnesota. “We pride ourselves on the fact that this is a peer-driven unit.”
Adds Schultz's colleague Brenda Servais, PhD, a psychologist and senior clinician with Hazelden, “Most young women don't really have much of an idea about how to communicate with other women their age.”
Hazelden's program for young women up to age 25 has been undergoing an expansion that will result in a 32-bed capacity, at a time when opioid use continues to be prominent in this population and average age of use continues to decline. Hazelden does not separate the youngest women in the 12-to-25 age group from the older women in that population; the role of their educational pursuits constitutes the only prominent difference in the treatment schedules for the two groups.
“The younger peers can learn from the older, and vice versa,” says Servais.
Yet as the director of another women's program treating a broader age range points out, interactions between older and younger patients still need to be carefully monitored. “Sometimes the older patients want to take the younger ones under their wing, but as a way not to focus on themselves,” says Shannon Trainor, executive director of the Crossroads treatment organization based in Scarborough, Maine.
The clinical staff colleagues at Hazelden say it is often insightful to see how family-of-origin issues play out in the early days of treatment for these young women, in terms of how they relate to others.
“Every day we look at how they observe themselves in their relationships,” says Schultz. “Over the course of three weeks, they start to identify their individual needs, vs. their wants. They also identify that we have rules, and they will start to hold their peers to a standard.”
Trainor says family dynamics pose a particular challenge in treating this population because in many cases the young woman remains significantly dependent on parents from a financial standpoint and otherwise. “Presenting an ultimatum is very difficult for parents,” she says, “Their biggest fear becomes, 'What if my child dies out on the streets?'”
For this age group, one's cellphone acts as the lifeline, and this is an area where parents can assert some leverage in the relationship, Trainor suggests. She adds that parents must learn to establish healthy boundaries and not to continue prioritizing the focus on the child over that of their marriage.
“I often say, 'If you're not following the rules, why would your child?'” Trainor says.
Family background also will often have an effect on how a facility structures the treatment team. While the primary clinical staff for the women's program at Hazelden is female, a young woman whose life has been characterized by the absence of a father figure will be exposed to positive male role models on the support staff. Servais says that working with professionals of either gender can be beneficial for young women.
Besides the common trauma background that is seen with many of the female patients in Hazelden's program, it is also very rare to see a young woman who is undergoing her first treatment experience, especially given the likelihood of comorbid conditions in this group. “Some of our patients have already gone through multiple eating-disorder programs,” Schultz says, for example.
New program in Maine
At the beginning of February, Crossroads marked the opening of a residential program for women that Trainor says fills a significant need for a holistic treatment site for women with private insurance or self-pay means. “Everything is primarily state-funded here,” she says.
Crossroads converted a former halfway house site, located in an historic home, to accommodate the Back Cove Residential Program. Trainor said in a news release, “After losing state funding for our halfway house program, we took a good look at the services that were needed for women in Maine and beyond and responded. This program addresses each woman with mind, body and spirit in focus—treating the whole person—and not just the addiction.”
Complementary services such as yoga, equine therapy and acupuncture will be offered at the Back Cove Residential Program, which officially opened Feb. 3.
Despite the numerous challenges and converging issues affecting young women in treatment, there is great hope associated with the opportunity to offer extended care to this population. The majority of the residential beds in Hazelden's female program are designated for 28-to-35 day treatment stays, with the rest for patients who will stay in treatment even longer.
Schultz says, “The beautiful thing about working with the young population is that they're very resilient.”