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Women's wellness: It's about relationships

March 1, 2010
by Gary A. Enos, Editor
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Programs eye women's family ties, including after treatment

The eye-catching titles in the bookstore's “relationships” aisle have it right, believe the experts in women's addiction treatment: Women indeed are wired differently from men, and in some respects the differences can pose an advantage for their recovery.

“Women's communication center in the brain is bigger,” says Brenda Iliff, formerly clinical director of Hazelden's Women's Recovery Center in Minnesota. “This plays out throughout our life. Recovery's a natural for women. We're wired for relationships, and recovery is about relationships.”

Getting to that recovery goal can prove challenging at times, of course, for women and men alike. Iliff, who this spring assumes the role of clinical director for Hazelden's new treatment facility in southwest Florida, recalls that when women in Hazelden's programs would be asked to tell their “stories” they would tend to focus solely on aspects of their relationships and not delve into their substance-using behaviors at all. This scenario prevailed so often that the program changed the name of what it was looking for in this narrative from “stories” to “usage history,” Iliff says.

In interviews with staff members at Hazelden and at New Directions for Women in Costa Mesa, Calif., it becomes clear that both partner and parenting relationships are seen as critical in how some women end up in treatment, how they fare when they get there, and whether their recovery can be sustained afterwards. It is not that some of these same factors don't come into play for men in treatment as well, but leaders at the two organizations tend to rank relationship factors as somewhat less of a driving force in men's illness and recovery progression.

“A woman in treatment might say, ‘If the people in my life changed, I wouldn't use,’” says Rebecca Flood, New Directions for Women's executive director. “Men are less likely to blame their relationships than women are.”

Adds Flood, “For women, their relationships, as a wife or a sister or a mother, are more relevant in their day-to-day healing. For men, it is often more about what they need to do to get back to work, or into their routines.”

Partner dynamics

The program supervisor for Hazelden's women's extended care program says she has added to the program's assessment phase an internally generated sexual and romantic relationship questionnaire. To Sheila Hermes, obtaining this history carries importance in offering an opportunity to normalize any and all behaviors in which the client might have engaged, from same-sex relationships to terminated pregnancies.

“If we don't ask, it's not volunteered,” says Hermes. “And if we don't talk about it, we keep it under the veil of shame.”

For the clinician, detaching this process and the client answers that ensue from one's own values remains a paramount objective. Ironically, Hermes says the sexual history part of the assessment has generally seemed more threatening to clinicians than to patients, the latter of which have not resisted participating to any great degree.

“Professionals often don't ask these questions because of their own discomfort,” Hermes says.

In evaluating the factors in women's lives that she considers most critical to a healthy and lasting recovery, Hermes places relationships second, behind only a primary focus on the addiction itself and ahead of self-esteem/a feeling of belonging. “It's hard to give women good addiction treatment without invoking the primary relationship in their lives,” she says.

As such, Hazelden makes a concerted effort to engage women's partners in treatment, although Iliff says there are times when that engagement can be too intensely focused as well. “A partner's wanting to have written reports daily about the person in treatment-that's a poor boundary,” she says.

Iliff adds that sexuality often serves as a problematic relapse trigger for women, even after they have made significant progress in their recovery. “I've heard women tell me they've used after a strong recovery,” she says. “They got a life, which is just what we want to see, and they started dating. They didn't want the other person to know they were an alcoholic, so instead they took a drink.”

At New Directions for Women, staff conducts a family assessment for each patient within two weeks of admission. Every significant person in the woman's life receives a bio-psycho-social evaluation, Flood explains. Trauma issues serve as a major focus of the staff's exploration; the federal government research sources that Flood examines state that about 80 percent of female addicts have suffered some form of trauma in their life.

Family functioning after a treatment stay (women with children at New Directions tend to stay in treatment for an extended period of about six months) plays a significant role in long-term outcome. Flood says the family system becomes destabilized during the woman's active addiction, and if the family doesn't somehow get redefined after treatment, relapse almost inevitably will occur. “The woman can work a good program but the family can still be codependent and be stuck behind,” she says.

She adds that the kinds of issues that can harm the relationship between a woman in recovery and her partner aren't all that different from the issues nonrecovering couples grapple with: money, sex, children-all affected by the need to improve communication.

Parenting considerations

Hazelden's Hermes says parenting represents the issue that triggers the most shame in the clients with whom she works. “They have the knowledge that they have negatively impacted their children,” she says. “We try to tell them that it's not about ‘good mom’ or ‘bad mom.’ It's ‘an addicted mom.’”