Research to Policy:  California Substance Abuse Research Consortium (SARC) Meetings,  2007

Table of Contents

SARC Supplement No. 5

November 2008

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Editor’s Introduction: California Substance Abuse Research Consortium 2007 — A Focus on Women  — Beth Rutkowski, M.P.H.; Thomas Freese, Ph.D. & Richard Rawson, Ph.D.

Substance Abuse Research Consortium (SARC): Introduction  — Renée Zito

From Generic to Gender-Responsive Treatment: Changes in Social Policies, Treatment Services, and Outcomes of Women in Substance Abuse Treatment  — Christine E. Grella, Ph.D.

Bar Patronage and Motivational Predictors of Drinking in the San Francisco Bay Area:  Gender and Sexual Identity Differences  — Karen Trocki, Ph.D. & Laurie Drabble, Ph.D.       View this article

Tobacco-Related Practices and Policies in Residential Perinatal Drug Treatment Programs — Martha A. Jessup, R.N., Ph.D., C.N.S. & Yeonsu Song, R.N., M.S.

Women with Co-Occurring Disorders (COD): Treatment Settings and Service Needs —Vivian B. Brown, Ph.D. & Lisa A. Melchior, Ph.D.

Women and Addiction: A Trauma-Informed Approach — Stephanie S. Covington, Ph.D., L.C.S.W.

Evaluation of a Trauma-Informed and Gender-Responsive Intervention for Women in Drug Treatment — Stephanie S. Covington, Ph.D., L.C.S.W.; Cynthia Burke, Ph.D.; Sandy Keaton, M.A. & Candice Norcott, Ph.D. (c.)

Childhood Adverse Events and Methamphetamine Use Among Men and Women — Nena Messina, Ph.D.; Patricia Marinelli-Casey, Ph.D.; Maureen Hillhouse, Ph.D.; Richard Rawson, Ph.D.; Jeremy Hunter & Alfonso Ang, Ph.D.

Substance Abuse Among Native Hawaiian Women in the United States: A Review of Current  Literature and Recommendations for Future Research — Van M. Ta, Ph.D., M.P.H. & TeChieh Chen, B.A.

COVER ART — Modified Color Wheel by Judith Kiraly Paxton

 Abstracts

From Generic to Gender-Responsive Treatment: Changes in Social Policies, Treatment Services, and Outcomes of Women in Substance Abuse Treatment

Abstract—In the past three decades, there has been increased recognition of the role of gender in influencing the course of substance use and treatment utilization. Concurrently, a substantial body of research on gender-related issues and substance abuse and its treatment has developed. This article reviews (1) policy initiatives that led to the growth of “specialized” treatment programs and services for women and recent policy changes that influence the provision of substance abuse treatment to women; (2) gender differences in the prevalence of substance use disorders and admissions to treatment; (3) gender differences in treatment needs, utilization, and outcomes, including long-term outcomes following treatment; (4) organizational characteristics of substance abuse treatment providers for women and the types of services provided in these programs; (5) treatment outcomes in gender-specific programs for women; and (6) the effectiveness of evidence-based treatment practices that have either been modified, or have the potential to be adapted, to address the treatment needs of women. This body of research is viewed within the context of a series of paradigm shifts from a generic treatment approach to a focus on gender differences and gender specificity and, most recently, to an emergent focus on gender responsiveness.

Bar Patronage and Motivational Predictors of Drinking in the San Francisco Bay Area:  Gender and Sexual Identity Differences

Abstract—Prior research has found heavier drinking and alcohol-related problems to be more prevalent in sexual minority populations, particularly among women. It has been suggested that differences may be explained in part by socializing in bars and other public drinking venues. This study explores gender, sexual orientation and bar patronage in two different samples: respondents from a random digit dial (RDD) probability study of 1,043 households in Northern California and 569 individuals who were surveyed exiting from 25 different bars in the same three counties that constituted the RDD sample. Bar patrons, in most instances, were at much higher risk of excessive consumption and related problems and consequences. On several key variables, women from the bar patron sample exceeded the problem rates of men in the general population. Bisexual women and bisexual men exhibited riskier behavior on many alcohol measures relative to heterosexuals. Measures of heavier drinking and alcohol-related problems were also elevated among lesbians compared to heterosexual women. Two of the bar motive variables, sensation seeking and mood change motives, were particularly predictive of heavier drinking and alcohol-related problems. Social motives did not predict problems.

Tobacco-Related Practices and Policies in Residential Perinatal Drug Treatment Programs

Abstract—Despite serious health consequences from high rates of smoking among perinatal women, smoking cessation and/or nicotine treatment practices have yet to be broadly adopted into perinatal substance abuse treatment settings. This correlational cross-sectional survey examined tobacco-related policies, practices, knowledge, and attitudes of 31 directors of perinatal residential substance abuse treatment programs in California. We found that the directors’ programs had limited on-site adoption of evidence-based practices for smoking cessation, and that directors had gaps in their knowledge of perinatal tobacco effects. Implications for tobacco policy initiatives in perinatal substance abuse treatment are discussed.   

Women with Co-Occurring Disorders (COD): Treatment Settings and Service Needs

Abstract—Over the past two decades, substance abuse and mental health treatment systems have continued to define and refine interventions for co-occurring disorders (COD) for women. However, there is still a need for improvement of treatment and referral services for women with co-occurring disorders. This article presents data from studies of four types of interventions across a continuum of substance abuse treatment settings for women with co-occurring substance abuse and mental health issues. The studies include: (1) local data from the National Women with Co-Occurring Disorders and Violence Study (WCDVS); (2) a study of process improvement changes made to improve treatment access and retention implemented under the Network for the Improvement of Addiction Treatment (NIATx) and SAMHSA/CSAT’s Strengthening Treatment Access and Retention (STAR) Program; (3) an examination of selected data collected in a large publicly-funded assessment center for substance abuse and mental health disorders; and (4) a study of postpartum depression within a larger evaluation of a comprehensive treatment model for pregnant/postpartum women with substance abuse disorders. The results from these studies provide information that allows both mental health and substance abuse systems and providers to move toward more effective interventions tailored to specific groups of women with COD. The interventions tested include: centralized screening and assessment centers; trauma-informed, integrated treatment; process improvement strategies to improve retention; and screening for postpartum depression in substance abuse and mental health programs.

Women and Addiction: A Trauma-Informed Approach

Abstract—Historically, substance abuse treatment has developed as a single-focused intervention based on the needs of addicted men. Counselors focused only on the addiction and assumed that other issues would either resolve themselves through recovery or would be dealt with by another helping professional at a later time. However, treatment for women’s addictions is apt to be ineffective unless it acknowledges the realities of women’s lives, which include the high prevalence of violence and other types of abuse. A history of being abused increases the likelihood that a woman will abuse alcohol and other drugs. This article presents the definition of and principles for gender-responsive services and the Women’s Integrated Treatment (WIT) model. This model is based on three foundational theories: relational-cultural theory, addiction theory, and trauma theory. It also recommends gender-responsive, trauma-informed curricula to use for women’s and girls’ treatment services. 

Evaluation of a Trauma-Informed and Gender-Responsive Intervention for Women in Drug Treatment

Abstract—There is growing recognition of the complex needs of women with dual diagnoses of substance abuse and mental health disorders. Recent research indicates that 55% to 99% of women with co-occurring disorders have experienced trauma from abuse and that abused women tend to engage in self-destructive behaviors. These women often are not well served by the services found in their communities, which separate substance abuse and mental health programs, despite the fact that research shows that integrated, trauma-informed treatment services will increase the success of their recovery. A recent study examined the use of two gender-responsive, trauma-informed curricula presented in a residential facility for women, 55% of whom had criminal histories. Helping Women Recover and Beyond Trauma are both manualized programs founded on research and clinical practice and are grounded in the theories of addiction, trauma, and women’s psychological development. This treatment model is named “Women’s Integrated Treatment” (WIT). Women who successfully completed the programs were assessed at several points in time on several scales, including trauma symptomology, depression, and substance use before and after the programs. The findings indicated less substance use, less depression, and fewer trauma symptoms (p ≤ .05)—including anxiety, sleep disturbances, and dissociation—after participation in the WIT curricula.

Childhood Adverse Events and Methamphetamine Use Among Men and Women

Abstract—Women report extensive histories of childhood abuse, often leading to addiction. Studies assessing the same effects for men are lacking. This study describes childhood adverse events (CAEs) among methamphetamine (MA)-dependent men and women and assesses the relationship of CAEs to the onset and severity of dependence. Baseline and three-year interview data were collected for 236 men and 351 women. Dependent variables included onset of MA and severity of dependence. Women reported greater occurrence of all types of CAEs than men (28% vs. 13%, p < .01). Familial substance abuse was most predictive of onset for men and of dependence severity for women. The collective impact of CAEs was related to both age of onset and severity. This demonstrates the intergenerational cycle of addition, and indicates the need for early intervention, which could prevent the onset of MA use and reduce the course of addiction.

Substance Abuse Among Native Hawaiian Women in the United States: A Review of Current Literature and Recommendations for Future Research

Abstract—information about and understanding of Native Hawaiian substance abuse and utilization of substance abuse treatment services is limited. this article reviews the literature on the prevalence and factors associated with substance abuse and use of health services among native hawaiian women in the U.S. The literature review included three review and 13 nonreview articles that were published through december 2006. The majority of the articles reviewed did not present findings by gender-ethnic group. The review of the literature suggested a high prevalence of substance abuse, especially among those who were incarcerated. Risk factors for substance abuse included not being married and young age. Native Hawaiian women also had significantly lower health care utilization rates compared to other groups, and were less likely to have seen a health care provider in the past year. Programs should consider involving kupunas (“elders”) in the design and implementation of culturally appropriate programs in order to better serve the needs of Native Hawaiian women. Further research is needed about the rates of substance abuse and barriers and facilitators to treatment so that effective and culturally competent treatment can be provided for this population.