Why Women Need Trauma-Informed Addiction Treatment
“Society judges women with addiction more severely.” So wrote addiction specialist Stephanie Covington in A Woman’s Way Through The Twelve Steps. That is by no means the only gender-specific challenge for women in recovery.
For a long time, women suffering from addiction were as good as invisible. That invisibility was largely caused by strong social taboos against women’s use of alcohol and other drugs. In fact, it was illegal in the United States to show a woman drinking in a movie or advertisement until the 1950s.
As a result, addiction treatment programs were initially designed for a predominantly male patient population, as the majority of addicts going into treatment were men. Later, treatment programs proceeded on the assumption that established methods would be equally effective for women. More recent research indicates that addiction treatment addressing the specific needs of women—such as their relationships with partners, families, and children, as well as any history of physical and sexual abuse—is more effective for women than traditional programs.
Lakeview Health uses a gender-responsive approach and will open a new women’s center in June. The 54-bed facility will provide housing for women in treatment and serve as the location for their detox, medical care, and primary therapy. Stephanie Covington’s Helping Women Recover curriculum forms the basis for Lakeview’s approach. Facility-wide training of staff in the new model began in January.
Sarah Kovach is the clinical manager of the new women’s program. “We know that women have unique challenges when they come to treatment,” she says. “They often have to leave their families behind, and encouraging women to focus on themselves is a struggle because our culture continues to sanction such behavior as selfish.”
According to Dr. Covington, women learn in recovery “how to put less energy into controlling other people and events, and invest more energy in taking care of [themselves]” (A Woman’s Way Through The Twelve Steps). Her treatment model recognizes that female addicts often have histories that include three elements: substance abuse since early adolescence, developmental delays caused by damaging relationships, and multiple traumas, which often include physical and sexual abuse.
Damaging relationships and sexual abuse at the hands of men are common traumatic experiences for women with substance use disorders. Approximately 1.8 million women are abused each year in the United States. In her study of addiction, Unbroken Brain, Maia Szalavitz explains that “one third to one half of heroin injectors have experienced sexual abuse, with the sexual abuse rates for women who inject roughly double those for men.” Often the abuse was not a single incident but a long series of attacks, frequently perpetrated by a relative or a family friend.
Such traumatic episodes dramatically increase the likelihood of alcohol or drug addiction for females. Because addicted women have a high rate of abuse in their lives, a gender-specific treatment program needs to address trauma. All Lakeview, staff have been trained in trauma-informed care. Separate treatment programs for women and men make a big difference as well.
“Group therapy will be the main modality in the new women’s center, focusing on four core aspects: self, relationship, sexuality, and spirituality,” says Kovach. Patients in the women-only groups will be able to work on their recovery without male distractions or feelings of intimidation.
Covington’s points out in Helping Women Recover that “interviews with women in recovery indicate that these four areas reflect the major aspects of life that change during recovery and the most common triggers for relapse if not addressed.” According to Dr. Covington, “Women recover in an environment that facilitates healing—one that is characterized by safety, connection, and empowerment. Safety means that rules of conduct provide appropriate boundaries, creating an environment that is free of physical, emotional, and sexual harassment.”
“In the relationship module, women are able to discuss the relationship roles they acquired in early childhood and what kind of impact those roles had on their adult relationships, with male partners for example,” explains Kovach.
Building strength and promoting female empowerment instead of relying on punitive measures is at the heart of the Covington model.