Alcohol and Drug Rehab for Women

Author

Terri Beth Miller

About the Author

Medical Reviewer

Sendra Yang

About the Reviewer

Rehab For Women: How Gender Impacts Addiction and Recovery

Addiction does not discriminate. It is an equal opportunity destroyer. It sees no color, no ethnicity, no class, and no gender. It strikes whenever, wherever, however, and whomever it can. But that does not mean that physiology and culture have no impact on the evolution of the disease or its treatment. In fact, gender can play a powerful role in the emergency of addiction and in its progression.

Because of these significant gender-based differences, strategies based in evidence for treating substance use disorders (SUD) in men often yield suboptimal results in women. On the other hand, recovery programs aligned to the unique biological, social, and cultural needs of women have shown immense promise.¹

What is Gender Specific Treatment?

As the name suggests, gender specific treatment refers to single-sex only addiction recovery programs. Specialized programming differs from traditional mixed gender treatment methods in that they are designed to address the particular social, cultural, and psychobiological needs, goals, and challenges of the target group (i.e., adult women, adult men, adolescent girls, adolescent boys, pregnant and postpartum women, women with young children, etc.).

A woman-only rehab, for example, serves a two-fold purpose. First, it is designed to foster a sense of community among women in recovery, helping them to overcome the often profound social and familial stigmas ascribed to women experiencing addiction. Research has shown, for instance, that women are significantly less likely than men to seek addiction treatment, due in large measure to the fear of the personal and social repercussions they may face once their addiction has been revealed.²

In addition to helping overcome gender-based stigmatization, rehab for women supports truly personalized, evidence-based care. They are founded upon the recognition that addiction in women often charts a very different course than that experienced by men and that women’s path to recovery will also often look quite different from that of men.

For example, there is mounting evidence that, due to fundamental physiological differences, the effects of substance exposure tend to be amplified and lasting in women than in men. Women also tend to become dependent more quickly, to experience more intense withdrawal symptoms and post-detox cravings, and, therefore, to have a higher risk of relapse than men.^3.4

And then there are the psychosocial differences between men and women in regard both to the “acceptability” of addiction recovery and its feasibility. Women continue to act as the primary caregivers in the home and, as such, they often require additional support, including specialized treatment protocols for pregnant women and breastfeeding mothers. Women with children may seek out programs that allow them to bring their young ones with them into residential care.

Women who are experiencing addiction also often bring with them a history of trauma, ranging from past sexual abuse to current domestic violence. This is often aligned with co-occurring mental health disorders, ranging from post-traumatic stress disorder (PTSD) to anxiety to depression.⁵ Rehab for women is specialized to identify and address the unresolved traumas and co-occurring conditions that so often accompany women’s substance addiction.

How Do Drugs and Alcohol Affect Women Differently?

As shown above, chemical substances, whether alcohol, illicit drugs, or prescription drugs, often have a markedly different effect on women than on men. This is due to myriad factors, from anatomical differences (i.e. lower average body weight, less muscle mass, higher body fat distribution) to metabolic ones (i.e. differences in hormonal functioning).

Alcohol, for example, tends to metabolize far more slowly in women than in men, resulting not only in higher blood alcohol levels but also to longer periods of intoxication.^6,7 There is also mounting evidence that women who abuse alcohol are at a substantially higher risk than men for developing a wide range of illnesses, including cirrhosis, cardiovascular disease, and some forms of cancer. Alcohol-related neurological changes, including brain shrinkage, also tend to be greater in women.⁸

Opioids, too, have been shown to impact women differently than men.⁹ Not only are women more likely than men to be prescribed, and to use, opioid medications for the treatment of pain, but they may also be less sensitive to its analgesic effects, prompting them to consume higher and more frequent doses. This often accelerates the progression to dependency.

What Are the Unique Needs of Women in Rehab?

As touched upon above, women bring with them a variety of needs unique to them, including gender-specific biological, social, and cultural approaches to recovery. Women-focused programming is designed to address the unique physiological features of addiction in women, including the often rapid progression to dependency, the heightened intensity of withdrawal symptoms and post-detox cravings, and the resulting increased risk of relapse.

In addition, rehab for women typically involves a whole-person approach, including specialized services to support women during pregnancy, to facilitate their integration of recovery treatment and child and family care, and to address past histories or current experiences of sexual and/or domestic violence. Thus, in addition to comprehensive physical and mental health care, women in recovery often need substantive social support. This may range from housing and food assistance to vocational training and career coaching.

Because women are also less likely to enter – and remain in – treatment, they also often require significant community support. This may include, for example, peer mentoring and relationship counseling. As the stigmatization of addiction can be particularly dire for women,  support in educating family members, friends, and colleagues is often vital to the client’s healthy reintegration into her home, workplace, and community.

In addition, because women’s fears of losing their children once an addiction has been revealed is often one of the most formidable obstacles to entering treatment, parental legal assistance, family intervention and counseling, and social services support are also often a cornerstone of women’s recovery programs.

Women who are pregnant or breastfeeding require still more specialized care to ensure health and wellbeing, as well as that of her children. Addiction treatment for pregnant women and nursing mothers can be both safe and highly effective when appropriate protocols are used.¹⁰ This may include, for example, treatment with methadone or buprenorphine for pregnant women experiencing opioid addiction.

Common Treatment Methods Used in Women’s Rehab

Women-only addiction recovery programs encompass all the standard levels of care, including detox, intensive inpatient, inpatient, intensive outpatient, outpatient, and aftercare services. However, the amount of time and the exact protocols used at each level will vary depending upon the specific program and the unique needs of the woman.

In general, however, rehab for women takes a comprehensive approach that promotes physical, psychological, spiritual, and social wellness. This typically involves intensive individual, group, and family counseling, combined with recovery-focused life skills training, including courses in coping, self-care, stress and anger management, and relapse prevention.

Depending on the client’s individual needs and goals and the accreditation and certification of the program she is enrolled in, medication-assisted treatments (MAT) may be prescribed during detox and through early recovery. These medications may also be used in maintenance doses for an indefinite period following acute care.

Social and family support, such as employment and childcare assistance, parenting courses, and family reintegration, are also critical components of women’s addiction treatment.

Many programs also offer an array of complementary therapies, including art and music therapy, meditation and mindfulness courses, yoga, exercise and nutrition therapy, acupuncture, massage, and animal therapy, to name only a few.

Trauma-informed care is also typically an important feature of rehab for women. In addition to psychotherapy, trauma resolution treatments may include eye movement desensitization and reprocessing (EMDR), treatment with psychotropic medications, and other evidence-based, trauma-focused therapies.

Rehab for Women: Treating Co-Occurring Disorders

It has been estimated that 3% of adult women in the United States, or more than four million women, have a co-occurring addiction and mental, behavioral, or physical health disorder.¹¹ This may include mood disorders (depression, anxiety, etc.), PTSD, personality disorders (i.e. borderline personality), attention deficit hyperactivity disorder (ADHD), eating disorders, obsessive-compulsive disorders (OCD), hepatitis, HIV, and other comorbidities.

There is also evidence that persons with dual diagnoses, or co-occurring disorders, tend to have more severe addiction disease, a greater risk of relapse, and more adverse outcomes, including early mortality and higher rates of suicidal ideation and self-harm.¹²

For this reason, specialized treatment protocols for women with co-occurring disorders is critical to recovery. This typically includes a comprehensive approach that combines addiction treatment with robust psychiatric and/or medical care. Patient stabilization, physical and mental health assessments, medication induction and maintenance, and disease management and prevention are standard for the treatment of women with co-occuring conditions.

Learn more about co-occurring disorders and dual diagnosis.

Addressing Addiction and Pregnancy

Supporting the recovery of women who are pregnant or who may become pregnant is a critical mission for most women-only rehabs. Women experiencing an active addiction while pregnant are at significantly higher risk of miscarriage, preterm delivery, and maternal and fetal death. Their children, likewise, are vulnerable to birth defects, fetal alcohol syndrome (FAS), and neonatal abstinence syndrome (NAS), potentially resulting in severe, life-long disability and even death.^13,14

Medically supervised addiction treatment during pregnancy can help women safely detox from drugs and alcohol. Likewise, the use of evidence-based pharmacotherapy, such as methadone and buprenorphine, can mitigate symptoms of withdrawal, promote sustained sobriety, and reduce the risk of pre and postnatal complications for both mother and child. These treatments may also be effective for infants experiencing NAS.^15,16

Addiction and Bipolar Disorder

As has been shown, substance use disorders (SUD) are often accompanied by co-occurring mental illnesses, particularly mood disorders. Among the most significant of these is bipolar disorder, a common mood disorder marked by extreme fluctuations in mood and affect. Persons with bipolar disorder experience rapid swings from depression to mania, often experiencing insomnia, paranoia, rage, suicidal ideation, self-harm, delusions, and even psychotic episodes.

Characterized by impulsivity, risk-taking, and extreme emotional volatility, persons with bipolar disorder frequently turn to substances in an effort to self-medicate. Alcohol’s depressant effects, for example, may be used to quiet the anxiety and hyperactivity of a manic episode. Illicit stimulants, on the other hand, may be sought to escape a depressive low and trigger a euphoric “manic” high.

Women who are experiencing co-occurring addiction and bipolar disorder must address both conditions concurrently if true, and sustained, recovery is to be achieved. This often involves the use of psychotropics to help regulate the patient’s mood and end the extreme highs and lows of bipolar. This also helps to mitigate the risk that the withdrawal of drugs and/or alcohol will trigger an extreme manic or depressive episode.

Learn more about substance abuse and bipolar disorder.

Therapies and Treatment Options

As has been seen, women-only rehabs typically deploy a constellation of treatment strategies to address clients varied and evolving needs.

These generally include:

• Psychotherapy, including individual, group, and family counseling
• Medication assisted treatment (MAT)
• 12 step and 12 step alternative programming
• Addiction education and recovery-focused life skills development
• Social support services and family, community, and workplace reintegration programs
• Dual diagnosis care
• Trauma-informed care
• Comprehensive, medically supervised care for pregnant and breastfeeding women

Resources:

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