By Britt Gottlich, Psy.D.
Through years of training and practice in the field of substance abuse, I have noticed some interesting gender differences. First, I have found that more men tend to seek substance abuse treatment than women. Second, I have noticed that often the core of what began the substance abuse problem is often different between men and women. Third, it has become evident that men and women do not always gain the same benefits from the same treatment approach. My blog this month explores these interplaying factors, as well as introducing treatment approaches that may better fit the needs of female clients.
“Surveys in the early 1980s estimated the male/female ratio of alcohol-use disorder as 5:1, in contrast to more recent surveys that report a ratio of 3:1” 1. Given these statistics, there is clearly a higher number of men seeking treatment for substance abuse. Supporting research, and my own clinical experience, shows that women may internalize more shame as part of their use, therefore making it less likely they will enter into treatment. For example, hormonal changes, body image issues, increased stress and stressors, or a history of trauma can all play into an individual’s perception of themselves and therefore willingness to seek treatment. So, it is not that there are less women who struggle with substance and alcohol use, but perhaps they are just less likely to ask for help.
One specific area that has been researched extensively is women with a history of childhood sexual trauma. “Clinical studies have found elevated rates of childhood sexual abuse (CSA) in women seeking treatment for alcohol or drug abuse”. 2 Often times, individuals who report a history of abuse describe feelings of guilt and other uncomfortable emotional responses. Substances can act as a means of coping with unresolved trauma and difficult emotions. It is often times an effective form of self-medication for individuals to “numb” the memories or emotional experience that those memories provoke. Research often focuses on sexual trauma in women and substance abuse specifically, however, in my experience there is a link between any type of trauma (physical, sexual and/or emotional) and substance use.
Despite the type of trauma history or emotional stressor that leads a woman into substance abuse, one of the most effective forms of treatment for these women is Dialectical Behavioral Therapy (DBT). DBT is a therapeutic approach that helps provide individuals with life skills that help manage emotions and interact with people more efficiently. DBT consists of four modules: mindfulness, distress tolerance, emotional regulation, and interpersonal effectiveness. DBT was initially created for people with Borderline Personality Disorder, however, research shows it can be used for a number of different disorders including substance abuse. 3
I personally use different elements of DBT with nearly every person I work with, as I believe DBT skills can be beneficial for everyone (myself included!) in any given situation. DBT allows us to learn how to be more in touch with our emotions and control them in times of stress. Often times women that present to individual therapy for substance abuse disorders present with emotional dysregulation. Regardless of the reason behind their emotional regulation (any of the reasons mentioned above), I usually find that approaching therapy through a DBT skill-based lens is the ultimate first treatment approach.
In addition to individual therapy, DBT skills groups can be a helpful treatment approach. These groups allow for individuals to learn and practice skills with the help of other members. Group members will be given skills and homework which are then revisited in group, where group members will provide encouragement and support to each other. Encouragement, support and a sense of community are just a few of the many benefits that group work can provide, as my colleague Dr. Tracey Bassett highlighted in her blog last month about the importance of group work in treatment.
In being able to acknowledge that female clients have different needs than male clients, and that perhaps they struggle differently with treatment barriers, we can begin to take a step in creating more informed and supportive treatment practices. In working in an informed way, we can offer the appropriate skills and support that each person needs. It is my belief, that Once an individual can learn to manage their emotional reactions, they will feel less likely to resort to unhealthy coping skills, therefore not having to rely on substances to cope, and learning that they can rely on themselves and the support built around them.
- Greenfield SF, Back SE, Lawson K, Brady KT. Substance abuse in women. Psychiatr Clin North Am. 2010;33(2):339–355. doi:10.1016/j.psc.2010.01.004
- Maffei, Cesare & Cavicchioli, Marco & Movalli, Mariagrazia & Cavallaro, Roberto & Fossati, Andrea. (2018). Substance Use & Misuse Dialectical Behavior Therapy Skills Training in Alcohol Dependence Treatment: Findings Based on an Open Trial Dialectical Behavior Therapy Skills Training in Alcohol Dependence Treatment: Findings Based on an Open Trial. Substance Use & Misuse. 53. 10.1080/10826084.2018.1480035.
- Wilsnack, Sharon & Vogeltanz, N & Klassen, A.D. & Harris, T. (1997). Childhood sexual abuse and women’s substance abuse: National survey findings. Journal of studies on alcohol. 58. 264-71. 10.15288/jsa.1997.58.264.