Foundations of Addictions Counseling 3E David Capuzzi Mark

Foundations of Addictions Counseling, 3/E David Capuzzi & Mark D. Stauffer Chapter 18 Gender, Sex, and Addictions Updated by Melinda Haley, Walden University Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved

Definitions n Gender refers to one’s identity on the spectrum of female to male. n n Sex refers to the physical anatomy of a person. A transgendered person is one who experiences discomfort within the conventional expectation of his/her sex. Foundations of Addictions Counseling, 3 e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved

Definitions n n One who is transsexual feels that his/her gender identity does not match his/her sex. A person who identifies as intersex possesses a mixture of anatomical features typically identified as male and female Foundations of Addictions Counseling, 3 e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved

Gender, Alcohol, and Drug Use and Abuse in the U. S. n n Alcohol was consumed by men, women, and children in colonial times Harriet Martineau 1830’s n Four reasons why women might drink n n n Cultural oppression Vacuousness Self-medication Prescribed medication Led to cultural criticism of women drinkers Foundations of Addictions Counseling, 3 e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved

Use and Abuse in the U. S. n Temperance Movement (Late 1880’s) n n Increase of morality and religious influence The moralization of alcohol use became engrained in societal thinking Virtue and masculinity The relationship between gender and drug use is complex, driven by cultural impressions and moral thinking Foundations of Addictions Counseling, 3 e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved

Gender and Addictions n n No one effective method of treatment for all clients Women’s issues largely neglected in literature n n n Only 29 studies on women alcoholics between 1929 and 1970 “man’s problem” Focus now shifted to illicit drugs Foundations of Addictions Counseling, 3 e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved

Women’s Use Today n n n 6. 5% of women aged 12 years or older use illicit drugs. 47. 1% of women of the same age range identify as “current drinkers. ” Women’s use or abuse of prescriptions drugs equals or exceeds that of me. Foundations of Addictions Counseling, 3 e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved

Men’s and Women’s Use n n n 10. 4% men vs. 5. 7% women aged 12+ have are addicted to substances. Ages 12 -17, rates are the same. Equal in use of stimulants Men use more marijuana, opiates, inhalants Sexes now equal in early drinking behaviors Foundations of Addictions Counseling, 3 e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved

Women and Alcohol: Biological Considerations n Women metabolize differently n n Intoxicated after consuming half as much as men Develop cirrhosis of liver more quickly n Women begin drinking later Drink smaller quantities n Telescoping n n Time between drinking and onset of problems is shorter than that of men Foundations of Addictions Counseling, 3 e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved

Women and Drug Use: Biological Considerations n Health Risks Specific to Women n n n Risk of death Malnourishment Hypertension Sexually transmitted diseases Younger women: accidental death or injury, suicide, overdose Middle-aged women: breast cancer, osteoporosis Older women: fractures due to accidents Foundations of Addictions Counseling, 3 e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved

Hormones and Addiction n n Significant role in development of addiction and relapse Menstrual cycle n n Pre-ovulation – stronger effects from stimulants Post-ovulation – enhanced effects from alcohol and nicotine Foundations of Addictions Counseling, 3 e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved

Psychological Considerations for Addicted Women n n Every DSM diagnosis more common in addicted women than men Anxiety and depression n More likely than men to have affective disorder PRIOR to addiction Women may need more treatment post-addiction Suicide n Alcoholic women are 5 times more likely to attempt suicide; death rate equal to men Foundations of Addictions Counseling, 3 e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved

Social Considerations for Addicted Women n n n Women’s problem drinking linked to relationships Greater risk with family history of addiction More susceptible to social pressures Substance abusing partner more likely Hide drinking out of guilt and shame Those entering treatment have less family support, Lower SES, education, unemployed Foundations of Addictions Counseling, 3 e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved

Addicted Women Who Parent n Babies at risk during pregnancy n n n Fetal Alcohol Syndrome (FAS) Fear of losing children to social services if they seek treatment Lack of child care is a barrier to treatment Foundations of Addictions Counseling, 3 e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved

Women, Addiction, and Violence n n n Men are sexually aggressive to women who drink Women’s use of alcohol also increases risk of nonsexual violence Relationship between addiction and violence n n n Bi-directional Addicted women more likely to be victimized by partners Sexual assault far higher among addicted women Foundations of Addictions Counseling, 3 e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved

Women and Tobacco Use n n Tobacco kills far more than drugs or alcohol each year More women than men smoke n n n More difficult for women to stop Cancer of the cervix, heart disease Use during pregnancy n linked to spontaneous abortion, premature birth, low birth weight, infant’s behavior problems Foundations of Addictions Counseling, 3 e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved

Men and Addiction: Biological Considerations n Physical effects of heavy/chronic drinking n n Increased heart problems Stroke and high blood pressure Men with family history more susceptible ADHD and cocaine abuse linked Foundations of Addictions Counseling, 3 e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved

Men and Addiction: Psychological Considerations n May use to stimulate or suppress feelings n Men more likely to exhibit sociopathology n n n Engage in criminal behavior Men tend to externalize/blame others Aggressive boys more likely to abuse then nonaggressive peers Foundations of Addictions Counseling, 3 e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved

Men and Addiction: Social Considerations n n n More likely to use drugs to socialize Problem use tends to show earlier More legal problems Violence more likely for men when intoxicated Support for treatment more likely n n Family Court system Foundations of Addictions Counseling, 3 e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved

Treatment: Minnesota Model n n n Since 1940 95% of programs based on this model Residential (now more outpatient) with education and 12 step meeting Emphasis on character and spirituality of clients Fails to meet unique needs of women Foundations of Addictions Counseling, 3 e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved

Women’s Responses to Treatment n Minnesota Model paired with 12 -step practices not effective for women n n Mixed-gender group treatment n n Hierarchical, confrontational, non-mutual Focus on individual pathology ignores social context, sexism Power for some women already in short supply Less effective, but some benefits also Women-only groups n n Safer place for sexually abused women Often other services connected: child care, health Foundations of Addictions Counseling, 3 e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved

Women’s Treatment Needs n Counselor/client relationship key n n Individual counseling Collaborate Facilitate freedom to choose success Same-sex counselor option/cultural match Foundations of Addictions Counseling, 3 e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved

Topics for Women’s Treatment n n n Strength building Gender issues Problems in societal context n n Overcoming disadvantage Understanding oppression Advocacy Incest, sexual assault, or sexual Foundations of Addictions Counseling, 3 e Capuzzi & Stauffer n n abuse General and reproductive health Child care Parenting Cutting edge therapies: n n n Yoga, meditation, mindfulness Music/art therapy Acupuncture Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved

Men’s Specific Treatment Needs n n Men outnumber women in treatment 4: 1 Traditional counseling may initially be counterproductive n n n Goal setting, creating lists, homework assignments, and creating contracts Address sense of counseling as “unmasculine” Focus on concrete concerns beyond addiction alone n Help men feel safer to delve into deeper issues Foundations of Addictions Counseling, 3 e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved

Other Factors Specific to Men n These may contribute to positive outcomes n n n Health education Anger management skill training Social-skills training Recreational and leisure opportunity development Men are more often mandated, court-ordered clients Foundations of Addictions Counseling, 3 e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved

Transgendered Clients n Dearth of research n Lumped with LGB community n n Counselors need to understand this population’s issues with discrimination. World Professional Association for Transgender Health’s Standards of Care Foundations of Addictions Counseling, 3 e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved

Intersex Clients n Little literature n Intersex client resilience is likely n Counselors are encouraged to seek specific training Foundations of Addictions Counseling, 3 e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved

Treatment Outcomes n n Women more likely to drop out or relapse than men. Men more likely to enter treatment due to family opposition or court order. Men were more likely to return to treatment following pressure from social institutions. Women were more likely to re-enter at the encouragement of a social worker or counselor. Foundations of Addictions Counseling, 3 e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved

Useful Web Sites n Gender Spectrum n n https: //www. genderspectrum. org/ Women for Sobriety n http: //www. womenforsobriety. org/ Foundations of Addictions Counseling, 3 e Capuzzi & Stauffer Copyright © 2016, 2012, 2008 by Pearson Education, Inc. All Rights Reserved