____________________________________ Substance Use Disorders: Assessment and Treatment, 2nd Edition
GENDER Based on 2015 national survey data, illicit drug or alcohol use among persons aged 12 or older is higher for males than for females. However, nonmedical use of psychotherapeutic drugs tends to be higher for females than for males aged 12 to 17 (Center for Behavioral Health Statistics and Quality, 2016). When looking at gender differences, it is worth noting that women tend to experience significantly shorter time intervals between the initiation of substance use (e.g., alcohol) and the onset of significant related problems and treatment entry. This disparity has been attributed to a variety of biological, socioeconomic, psychological, and cultural factors that affect women (Greenfield, 2016; Lal et al., 2015), in an editorial in the Journal of Alcohol and Drug Education , which summarized the differences between SUDs in men and women. According to Sharma, 2021, women are usually late starters to substance use; they begin using substances as a result of the influence of men in their lives, such as a spouse or boyfriend; they more often suffer from a comorbid psychiatric problem, such as depression, anxiety, or a mood disorder; and they usually seek treatment earlier in the course of their addiction. Furthermore, women’s problems related to substance use interfere with functioning in more areas of life as compared with their male counterparts. Research going back to the 1990s seems to indicate that, for women, gender-specific group therapy may be a better treat- ment choice than a mixed group of men and women or even individual therapy (Greenfield et al., 2013). Several factors bolster this assertion: • Female sociocultural development may emphasize the importance of relationships, shared experience, and caregiving. These factors play a significant role in a group treatment setting. • Sexism and relationships with men tend to encourage gendered assumptions about appropriate behavior for women. These assumptions, coupled with societal disapproval of women’s use of substances, may simultaneously aggravate the behavior and prevent help seeking. • Stress, trauma, and mental illness are frequently factors in women’s substance use. For example, intimate partner violence may play a role in the development of substance use among at least some women. Women and men use substances for different reasons, with women more likely to self- medicate or use substances to ease stress or pain, possibly while attempting to fulfill gendered social roles, having a history of abuse and traumatization, and experiencing relationship problems with few social supports. Being in a mixed group with men may be extremely uncomfortable for women who have been victimized by men. Stigma also plays a role. Substance abuse has traditionally
5. Engaging in activities that are not compatible with substance use. 6. Identifying and engaging in new activities that do not involve substance use. 7. Preparing for and developing a coping plan during triggering situations. 8. Assisting family members in ways to suggest treatment to their loved one. Adolescent children of parents who are in substance use treatment should have special consideration. For example, parents’ may need to focus not only on learning how to engage in and maintain abstinence but also to teach their children substance use refusal skills and coping strategies. Adolescents and children of substance-using parents can seek support from Al-Anon (including Alateen) and Nar-Anon, as well as from the National Association for Children of Alcoholics. (See the Resources section of this course.) These support groups help children of parents who use substances to connect with others, learn about substance use, and prevent substance use problems from developing among themselves. SOCIAL SUPPORTS Social support can be key in the recovery process. Social sup- port can be a special struggle for individuals who engage in substance use because, much of the time, their support system has consisted of individuals who also used substances. There- fore, often the choice of abstinence is also a choice of isolation. It is essential to assist clients with regaining social support in their recovery process. Furthermore, this population also often requires assistance with finances and vocational rehabilitation. Therefore, treatment should include social work interventions that provide help in obtaining financial support, adequate and safe housing, legal assistance, vocational assistance, and social support. It is in this respect that local, state, and federal policies can play a critical role in providing essential social supports that enable recovery and require advocacy by service providers as well as clients.
SUBSTANCE ABUSE PROBLEMS IN DIFFERENT CONTEXTS
Substance abuse and dependence vary according to age and gender, sexual orientation, and other factors. Within the total population of individuals with substance use disorders (SUDS), there are groups that require special attention. This section examines substance abuse problems in the follow- ing contexts: gender, sexual identity and gender expression, youth, older adults, co-occurring disorders, intellectual dis- ability, physical disability, military veterans, incarceration, and homelessness.
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