Philosophy of Working with Substance Abusing Women
The Task Force has established the following six core fundamental principles as the foundation of integrating substance abuse treatment services and work experience training, while focusing on effective treatment of women.
The Self-in-Relation Model or a similar model that is based on the psychological growth of women should be the foundation for recovery.
The Self-in-Relation Model emphasizes the central importance of relationships in women's lives. Since women in this culture have been the "care-takers" of certain aspects of the total human experience, specifically carrying responsibility for the care and maintenance of relationships, this model attempts to address the strengths as well as the problems arising for women from this relational orientation.
The primary motivation for women throughout life is toward establishing a basic sense of connection to others.
Women feel a sense of self and self-worth when their actions arise out of a connection with others. The experience of psychological connection is based on empathy and mutuality in relationships.
Treatment revolves around the role women have in society, therefore treatment services need to be gender specific.
Gender-responsive programs are not simply "female only" programs that were designed for males.
A woman's sense of self develops differently in women-specific groups as opposed to coed groups.
Equality does not mean sameness; in other words, equality of service delivery is not simply about allowing women access to services traditionally reserved for men. Equality must be defined in terms of providing opportunities that are relevant to each gender so that treatment services may appear very different depending on to whom the service is being delivered.
The unique needs and issues (e.g., physical/sexual/emotional victimization, trauma, pregnancy and parenting) of women should be addressed in a safe, trusting and supportive environment.
Treatment and services should build on women's strengths/competencies and promote independence and self-reliance.
The comprehensive case management model is driven by the woman and her family (many issues overlap treatment; her W-2 involvement, trauma, mental health, and domestic violence are very common.)
Utilizing the comprehensive case management model through inter-systems collaboration is recommended.
Even though there are many agencies and systems listed on the model the needs of the woman determine the connections with those agencies and systems that are impacting her life or her family's life.
The case coordinator or "hub" should remain the AODA treatment provider as the woman progresses in recovery.
The model is one of empowerment.
The participant is shown and taught how to access services, advocate for herself and her family, and request services that are of benefit to her and her family.
This experiential learning process is initially taught by the AODA treatment provider, and is woven into recovery.
This tapestry of recovery focuses on empowerment as a learned skill that is taught by all service providers working with the woman and her family.
The ultimate goal for the service system is to weave the woman so well into the fabric of informal support systems that the role of formal services is very small or not needed at all.
Work is an important component in recovery and serves as a vital therapeutic tool.
The structure of W-2 is a benefit to recovery, and treatment providers need to be aware of the work requirement of W-2. Historically, treatment providers were hesitant to encourage patients to return to work or engage in work during the early stages of recovery. Yet, waiting for a client's substance abuse problems to subside before addressing their vocational concerns is not an appropriate strategy for W-2 participants. W-2 participants must engage in work and/or work-related participation requirements, therefore, treatment providers working with W-2 participants must clearly integrate work and/or work-related activities into the overall treatment services provided to clients.
The use of a multi-system approach that is culturally cognizant.
Gender specificity and cultural competence go hand in hand. There are a number of gender and cultural competencies that allow people to assist others more effectively. This requires a willingness and ability to draw on community-based values, traditions, and customs and to work with knowledgeable persons of and from the community. Sue, Arredondo, and McDavis (1991) suggest three broad categories:
- Awareness of one's own assumptions, values, and biases;
- Understanding the worldview of the (gender) and culturally different client; and
- The ability to develop appropriate strategies and techniques.
People that are skilled in these competencies posses the following beliefs and attitudes:
- They are aware of their own (gender) and cultural history and value and respect the differences of others.
- They are aware of how their own gender and cultural background, experiences, attitudes, values and biases influence the psychological process and relationship with others.
- They are able to recognize the limits of their competencies and expertise.
- They are comfortable with gender and cultural differences.
Also, if an agency is providing services to a multi-linguistic population, there should be multi-linguistic resources, including use of skilled bilingual and bicultural translators whenever a significant percentage of the target community is more comfortable with a language other than English.
TREATMENT STANDARDS FOR AODA SERVICES TO WOMEN
To meet the specific needs of women, successful programs begin with an understanding of the emotional growth of women. Current thinking describes women's development in terms of the range of relationships in which women can engage. This is very different from the theories of emotional growth which have been the basis of substance abuse treatment and which apply to the psychological growth of men. The relationship theories for women suggest that the best context for stimulating emotional growth comes from an immersion in empathic, mutual relationships.
The strongest impetus for women seeking treatment is problems in their relationships, especially with their children. A woman's self-esteem is often based on her ability to nurture relationships. Her motivation and willingness to continue treatment is likely to be fueled by her desire to become a better mother, partner, daughter, etc. Programs that meet the needs of women acknowledge this desire to preserve relationships as a strength to be built upon, rather than as a resistance to treatment. When a program operates from this theoretical point of view, the characteristics of the clinical treatment program and its objectives and measures of success are defined very differently from those of traditional treatment programs.
Programs that are designed to meet women's needs tend to be more successful in retaining women clients. For an agency to be able to offer women-specific treatment, its programs must include the following criteria:
Accessibility
There are many barriers that may critically inhibit attendance and follow-through for women and children. They may include child care, transportation, hours of operation, depression, and other signs of mental health issues.
Standard: Agencies/programs shall demonstrate a process to reduce barriers to treatment.
Assessment
Women with children need to be assessed and treated as a unit. Women often both enter and leave treatment because of their children's needs.
Standard: Assessment shall be a continuous process that assesses the client's psychosocial needs and strengths within the family context and through which progress is measured in terms of increased stabilization/function of the individual/family.
Psychological Development
Many of the traditional therapeutic techniques reinforce women's guilt, powerlessness, and "learned helplessness," particularly as they operate in relationships with their children and men.
Standard: Agencies/programs shall demonstrate acknowledgement of the specific stages of psychological development and modify therapeutic techniques according to client needs, especially to promote independence/autonomy.
Abuse/Violence/Trauma
A history of abuse, violence, and trauma often contributes to the behavior of substance abusing and dependent women.
Standard: Agencies/programs must develop a process to identify and address abuse/violence/trauma issues.
Family Orientation
Many women present in a family context with major family ties and responsibilities that will continue to define their sense of self. Drug and alcohol use in a family puts children at risk for physical and emotional growth and development problems. Early identification and intervention for the children's problems is essential.
Standard: Agencies/programs must identify and address the needs of family members through direct service, referral, and/or other processes.
Mental Health Issues
Women with substance abuse problems often present with concurrent mood disorders and other mental health problems.
Standard: Agencies/programs must demonstrate the ability to identify concurrent mental health disorders and develop a process to have the treatment for these disorders take place in an integrated fashion with substance abuse treatment and other health care.
Physical Health Issues
Substance abusing women and their children are at high risk for significant health problems. They are at greater risk for communicable diseases such as HIV, TB, Hepatitis, and sexually transmitted diseases. Prenatal care for substance abusing women is especially important as their babies are at risk for serious physical, neurological, and behavioral problems. Early identification and intervention for children's physical and emotional growth and development and for other health issues in a family is essential.
Physical Health Issues
Substance abusing women and their children are at high risk for significant health problems. They are at greater risk for communicable diseases such as HIV, TB, Hepatitis, and sexually transmitted diseases. Prenatal care for substance abusing women is especially important as their babies are at risk for serious physical, neurological, and behavioral problems. Early identification and intervention for children's physical and emotional growth and development and for other health issues in a family is essential.
Standard: Agencies/programs shall:
Inquire about health care needs of the client and her children;
Make appropriate referrals;
Document client and family health needs, referrals, and outcomes.
Legal Issues
Women entering treatment may be experiencing legal problems, including custody issues, civil actions, criminal charges, and probation and parole.
Standard: Agencies/programs shall document an individual's compliance and facilitate required communication to appropriate authorities within the guidelines of federal confidentiality laws. Additionally, programs will avoid setting up barriers to individual compliance with legal authorities.
Sexuality/Intimacy/Exploitation
A high rate of treatment non-compliance among female substance abusers with a history of sexual abuse has been documented. The frequent incidence of sexual abuse among women substance abusers necessitates the inclusion of problem specific questions during the initial evaluation (assessment) process. Lack of recognition of a sexual abuse history or improper management of disclosure can contribute to a high rate of non-compliance in this population.
Standard: Agencies/programs shall:
Conduct an assessment that is sensitive to sexual abuse issues;
Demonstrate competence to address these issues;
Make appropriate referrals;
Acknowledge and incorporate these issues in the aftercare/discharge treatment plan;
Assure that the client will not be exposed to exploitive situations that continue abuse patterns within the treatment process (coed groups are not recommended early in treatment, physical separation of sexes is recommended in inpatient/residential treatment setting.)
Survival Skills
Women's treatment is often complicated by a variety of problems that must be addressed and integrated into the therapeutic process.
Standard: Agencies/programs must identify and address the client's needs in the following areas, including but not limited to:
- Education and Literacy
- Job Readiness and Job Search
- Parenting Skills
- Housing
- Language and Cultural Issues
- Basic Living Skills
The agency/program shall refer to appropriate services and document both the referrals and outcomes. These services may be provided by working with your local W-2 agency.
Aftercare/Continuing Care
In order for a woman to remain sober after treatment, she needs to be able to retain a connection to the treatment staff and to receive support from appropriate services in the community.
Standard: Agencies/programs shall:
Conduct an assessment prior to discharge to address and plan for the client's aftercare needs;
Design a written plan with the client to meet those needs;
Make and document appropriate referrals as part of the aftercare plan;
Remain available to the client as a resource for support and encouragement for at least one year following discharge.