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Transformational treatment for women

May 15, 2011
by Carol Ackley
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Stephanie Covington shares insights on the key ingredients of gender-responsive services

Stephanie S. Covington, PhD, is a clinician, author, organizational consultant and lecturer. Recognized for her pioneering work in the area of women's treatment issues, Dr. Covington specializes in the development and implementation of gender-responsive services in both the public and private sectors. She has published extensively, including four manualized treatment programs.

I have worked together with Dr. Covington for 14 years developing and promoting gender-responsive, trauma-informed services for women and girls. At a recent training, the two of us took time out to discuss our work together, as well as Dr. Covington's significant impact on the field of substance use treatment.

ACKLEY: As one of the pioneers of women's treatment, can you describe the evolution of treatment for women, in this country and around the world?

COVINGTON: The whole concept of treatment for women began in the 1970s and it came out of the women's movement of the ′60s and ′70s when women got together in consciousness-raising groups and talked about the reality of their lives. In those groups, women began to talk about childhood sexual abuse, domestic violence and addiction to alcohol and other drugs. Out of that came a lot of social services that we provide today without even thinking much about it now.

So in the 1970s, people began to realize that perhaps women needed treatment for alcohol and drug use. That was the beginning, and then people talked about gender-specific services for women. But in most places that just meant women were in a group with other women but were getting exactly the same treatment as men. Now we've evolved from that time period and we realize that there are specific issues that women need to address. They need to be addressed, often, in ways that are different from how you might provide co-ed treatment or men's treatment. Today we talk about being gender-responsive and that means looking through the lens of the reality of women's lives, and seeing what's reflected back to us and then addressing those issues.

So in some ways what we see now as substance abuse treatment for women is no longer that historic kind of single-focused intervention. We realize there are multiple issues that need to be worked on simultaneously.

ACKLEY: I know you've done some work with the United Nations looking at the issue of substance abuse and women around the world. What are some of the differences in women's treatment services in other countries?

COVINGTON: Women around the world actually share some of the same issues such as shame and stigma, physical and sexual abuse, relationship issues, and not having adequate treatment. One difference is that in this country most of our treatment programs are abstinence-based and even those programs that are harm reduction programs here generally have abstinence on their continuum. In other parts of the world where they have harm reduction programs, many of those programs do not even consider abstinence as an option or a consideration.

The other thing around the world is we see fewer services for women, and even though we know that there is a scarcity of treatment in this country it is even less available for women in many parts of the world.

Essential elements

ACKLEY: What are some of the most important components in developing treatment services for women?

COVINGTON: Besides the obvious, such as focusing on a woman's substance abuse, I think that in order to be gender-responsive and to provide adequate services for women, all programs need to be trauma-informed. Everyone needs to understand what trauma is, what the typical responses are to trauma, as well as helping women develop coping skills.

I think another piece that is often overlooked is the treatment environment itself. Many programs have environments that are not therapeutic environments. There are still some leftovers from the old treatment model of being confrontational and harsh, but hopefully we're moving away from that. Unfortunately, I can give you an example. There's a program that still exists in the middle part of the United States, a therapeutic community where women still put on dunce caps and sit in the corner if they break one of the rules. It's outrageous.

ACKLEY: We've noticed in our treatment programs for women at River Ridge [Treatment Center] that a lot of the women have had multiple treatments. When we introduce trauma-informed treatment to them and teach them, as you just said, about how this impacts their lives they are so surprised. For many of them, it's the first time anyone ever talked about this, and for many of them it is the main source of their relapse triggers.

COVINGTON: I think what you've just said is absolutely critical and I have found the same thing. Many women with multiple treatments are usually really surprised when the trauma issue is mentioned. No one ever mentioned this connection to addiction. No one had ever asked them what had happened in their lives, and they are surprised that this would be part of the treatment process and yet it becomes, for many women, the critical piece to maintaining any kind of sobriety or having any quality of recovery. So this isn't just a little add-on to a program; I think this is a core ingredient to providing good services for women.

ACKLEY: What do you think is important for treatment programs, training-wise, if they can't provide trauma-specific services or don't have mental health services available on site? How can they become at least trauma-informed?