Although research evidence points to a challenge for some women in flourishing in coed substance use treatment programs and groups, this does not mean that mixed-gender programs can't take meaningful actions to become more responsive to women's needs in treatment.
Two individuals who will be co-presenting a workshop session on gender dynamics in mixed-gender settings at this summer's National Conference on Addiction Disorders (NCAD) in St. Louis say some of these actions can and should take place right at the front door. Fran Basche and Deborah Werner, senior program managers at Advocates for Human Potential, Inc., urge facility leaders to conduct a walk-through of their operation to understand better what a woman might experience the first time she enters a treatment program.
“She's scared—she's not sure where she's going,” Werner says. “If a group of men are smoking in front of the building, she may feel she's on display the first time she walks in.” Also, “Is the program's waiting area comfortable? Is it well-lighted at night?”
Werner and Basche say they intend to offer attendees of the workshop some “low-hanging fruit” that they can easily implement to benefit women in their coed programs and groups. The Aug. 23 workshop at the conference, sponsored by the publishers of Addiction Professional, is titled “Gender Matters: Supporting Women in Coed Settings.”
While much of the research regarding women's experiences in treatment has focused on gender-separate settings, the reality remains that most women in real-world practice settings find themselves in mixed-gender programs and therapy groups. The 2012 National Survey of Substance Abuse Treatment Services (N-SSATS) found that only about 1 in 3 substance use disorder treatment facilities offers a women-only program or group; the surveyed facilities included both women-only and coed treatment organizations.
Therefore, “We want those [coed] services to be gender-responsive as well, says Werner. Advocates for Human Potential has worked with the Substance Abuse and Mental Health Services Administration (SAMHSA) to provide guidance to the treatment community on gender-specific issues; this work has included the release of a core competencies document titled Addressing the Needs of Women and Girls: Developing Core Competencies for Mental Health and Substance Abuse Service Professionals.
Werner and Basche consider it important for all staff members in a treatment program to have some familiarity with women's experiences and how they differ from men's. This will help to ensure that mixed-gender groups address in some way the issues central to many women's lives.
“There needs to be an understanding that women may have additional caregiving responsibilities,” says Basche. “As important as her addiction may be to her, she also may have a whole bunch of people that she's making dinner for,” referring to one example of the impact of family relationships. These everyday realities have to be considered, as they carry a potentially critical impact on women's progress in treatment.
The sexes' treatment experience
Werner and Basche also say programs need to remain aware of the differences between how women and men experience addiction and its treatment, although they add that in general there probably are more similarities than differences overall. For each gender, there will be topics it doesn't want to talk about in front of members of the opposite sex (for women, those subjects include body image, sexuality and economic factors).
Werner adds, “In a coed group, women will tend to defer to men, or they will take the role of helping to bring men's feelings out.”
In addition, the genders' perceptions of progress in treatment likely will differ. “There is some research that suggests that women keep coming back to treatment when they feel that there are people there who care about them, while men keep coming back if they feel they are getting something out of it, which could be as clear-cut as getting rid of a court case, for example,” says Werner.
Finally, the sexes' expectations for themselves in the treatment setting is likely to show a gender gap. “Women experience more stigma around addiction than men, particularly if they're parenting or pregnant,” says Werner. “Women also tend to have low self-efficacy. They're walking in not expecting to be successful.”
Basche adds, “Programs need to be as non-judgmental as possible. They need to convey hope as opposed to shame.”
The co-presenters of the NCAD session intend to use experiential exercises and small-group problem-solving techniques as vehicles for delivering their message at the conference. The Aug. 23 session will take place from 2:15 to 3:45 p.m.