Why Women are Underrepresented in Addiction Treatment

Over the past year, substance abuse has spiked in the U.S. and globally. This change is due largely to the pandemic and its rippling social and economic effects. While substance abuse rates increased across all demographics, women represented the largest increase. According to the Journal of the American Medical Association (JAMA), heavy drinking episodes among women, which is defined as at least four drinks, increased by 41% between 2019 and 2020. However, this is only a snapshot of a larger trend, as substance abuse rates among women has steadily increased over the last decade.

While the trend is troubling, women in addiction treatment may discover gender-associated barriers that prevent meaningful and lasting recovery. Loved ones may discover it’s difficult to persuade women to seek addiction treatment due to a variety of reasons. To counter this, it’s imperative that treatment centers consider the unique needs of women in addiction treatment.

Barriers for Women Considering Addiction Treatment

One of the largest barriers for women considering addiction treatment involves traditional gender roles and stigma. According to a 2004 global case study by the United Nations, there were numerous perceived barriers for women considering treatment: childcare and custody concerns, fear of their partner leaving, lack of pregnancy services, shame and stigma, and lack of gender-responsive treatment options.

While many treatment centers have made strides to meet these concerns, these systemic barriers have proven difficult to overcome. Only a small fraction of treatment centers provide housing for children and/or childcare during treatment sessions, and few non-hospital treatment facilities are equipped to provide pregnancy services. For a single mother without a support system, seeking professional treatment may seem simply impossible.

Culturally, the stigma of a wife or mother seeking treatment is also sadly still prevalent. The “failure” to meet society’s expectations may prevent many women from acknowledging a need for help. In addition, the fear of punitive measures – such as custody investigation or a partner leaving (especially a using one) – may present a daunting barrier for many women.

Gender-Responsive Programming for Women in Addiction Treatment 

While overcoming any cultural and/or systemic barrier to enter treatment is the first step, women in addiction treatment must also engage into a treatment plan that resonates with their unique female experience. Not to generalize – as women are different with varying circumstances, histories, and biological makeups – but there are underlying similarities among women that differentiate them from men. As such, gender-responsive programming may be an essential component of an effective treatment plan.

For example, men do not undergo the hormonal changes associated with pregnancy, ovulation, or menopause. In addition, studies have shown that this hormonal makeup may affect a woman’s behavioral response to substances. Women tend to display a more severe clinical profile when entering treatment, although they may’ve used less substances, in physical relation, over a shorter amount of time than men. In other words, women may be more susceptible to addiction faster, with more severity, than men.

Biological differences aside, the same aforementioned barriers to enter treatment are also topically relevant to a gender-responsive program. From a woman’s relationship with their partner to cultural stigmas associated with women in recovery, programming that incorporates the context of many women’s shared situations and feelings has unsurprisingly proven more effective.

Gender-Specific Treatment Versus Mixed-Gender Treatment

According to a report by Substance Abuse and Mental Health Services Administration (SAMHSA), simply placing women in a same-sex treatment group does not equate to better outcomes or retention rates. However, gender-responsive programming does provide better outcomes. In a practical sense, gender-responsive programming would be conducted in a gender-specific setting, thus indicating the benefits of women-only treatment.

While the benefits of gender-specific programming extend to both men and women, women may especially excel in the environment. Women with a history of abuse from a man may be hesitant or fearful to share their experiences in the presence of male clients or even with a male counselor.

According to scientific studies, women in addiction treatment are also more likely to struggle with co-occurring anxiety disorders than men, and many women also display issues related to self-image and low self-esteem. In fact, many gender-specific treatment facilities for women now also offer eating disorder programming tracks. In these scenarios, gender-specific treatment offers a safe, nurturing environment that responds to these needs.

While women and their unique needs are still underrepresented in addiction treatment, the recovery community is slowly beginning to respond. For example, it is now federal law that publicly funded facilities prioritize admission for pregnant women. Many more facilities are quickly realizing the importance of gender-responsive programming. As we work to culturally destigmatize addiction for all genders, it’s crucial for our community to provide engaging, thoughtful programming that speaks to the unique circumstance, context, and needs of women.