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The Stigma of Addiction: Women and Children

The Stigma of Addiction: Women and Children

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Having worked in addiction health care for nearly four decades, I have found the stigma behind substance-related disorders to be one of the most crippling hindrances to widespread recovery. This stigma, exacerbated among pregnant women or women with children, forces many afflicted women to avoid seeking essential health care services.

The need for treatment and the desire to seek it out is clearly present, as documented from the very history of Alcoholics Anonymous (AA). The group was started between two men from Ohio trying to overcome their dependence on alcohol. The group spread to the UK in March 1947, when their first meeting was held at a classy London hotel. By 1949, there were regular meetings every Tuesday and Thursday in London, and membership exceeded one hundred attendees (Alcoholics Anonymous Great Britain, 1997). Currently, there are hundreds of AA meetings each week in London. Yet, substance use disorder (SUD) statistics continue to show a tremendous chasm between those who need treatment and those who are actually receiving it.

According to the National Institute on Drug Abuse (NIDA), “In 2013, an estimated 22.7 million Americans (8.6 percent) needed treatment for a problem related to drugs or alcohol, but only about 2.5 million people (0.9 percent) received treatment at a specialty facility” (2015).

Across the pond in the UK, NHS statistics showed that “Deaths related to drug misuse are at their highest level since comparable records began in 1993” and in addition, “6 percent of eleven-year-olds said they had tried drugs at least once, compared with 24 percent of fifteen-year-olds” (NHS Digital, 2017). 

Furthermore, the Centers for Disease Control and Prevention (CDC) state that approximately 120,000 babies a year are born with birth defects (2015). CDC guidelines state that prenatal exposure to alcohol “is commonly cited as the leading preventable cause of birth defects and developmental disabilities” (Gerberding, Cordero, & Floyd, 2004). Despite this, there is still a failure to reach the millions of women who may need drug and alcohol addiction services. Helping a pregnant woman recover from drug addiction, or preventing her addiction, is a direct approach to combatting addiction and its many other side-effects among all sectors of the population. Because of the intergenerational spread of this disease, treating women can be a direct method of preventing SUDs among both men and women in future generations, or at least diminishing the negative effects of addiction. I have found that when women recover, their family system also enters recovery. 

I always refer to a book called Men are from Mars, Women are from Venus (1992) by Dr. John Gray. One of the most long-lasting truths I got out of this book is that women are gatherers; they collect information, they like to talk, and they nurture others in their family system. This, of course, affects the way we need to serve women in recovery. 

However, the Minnesota Model—one of the first forms of treatment—was developed by men for men. The Addiction Severity Index was developed by Dr. Tom McClellan to collect data and do assessments of military men (Samet, Waxman, Hatzenbuehler, & Hasin, 2007). So, much of the early instruments and models that we have were worked on by men and for men; they worked for a predominantly male population. It was not until 1994 that the greatest body of data was collected on five thousand women in the US through the Center for Substance Abuse Treatment (CSAT; Greenfield, Back, Lawson, & Brady, 2010). They funded demonstration projects throughout the US to collect data on best practices for women, pregnant women, and women with children in a residential setting. I was blessed to chair that cross-site evaluation when I worked at a program called Seabrook House in southern New Jersey. Data on these women were tracked against what services were provided and how well they did postdischarge. They were provided case management services on the back-end of treatment while integrating back into community. All of these women were either pregnant or parenting and brought their children to treatment with them. They all received between six months and one year in residential care. These services were vastly different than anything that had existed in the research prior to 1994. They validated that services such as Seeking Safety (a research-based trauma curriculum), EMDR, EFT, mindfulness, and equine therapy are excellent tools in our toolboxes for treating women for their addiction and their trauma (Greenfield et al., 2010). 

 

A large part of the failure to reach women lies in the deep stigma associated with the disease. According to Livingston, Milne, Fang, and Amari, “Several studies have identified stigma as a significant barrier for accessing health care” (2012). Women with substance use problems are more likely than men to have experienced trauma and to have higher rates of concurrent psychiatric problems, as discussed in SAMHSA’s Trauma and Justice Strategic Initiative (SAMHSA, 2011). Not only are women exposed to the unique stigmas behind addiction during pregnancy, but they are also more likely to be facing additional mental health concerns and prior trauma. As health care professionals, we need our services to not only be more open and inviting to women who resist entering treatment, but to also understand the many layers of resistance and suffering they are going through. In general, women enter treatment with less education, and with less resources to pay for the care they need, however the intensity and duration of care they need is much more significant than men (Greenfield et al., 2010). This is known as “telescoping,” the phenomena of women presenting with a more severe clinical profile than a man who used the same or more of the substance, for an equivalent or longer length of time (Greenfield et al., 2010). 

Bridging the gaps across the pond: understanding those in need: Despite some cultural variations, the US and the UK share a common language and so much history. I recently spoke at the Recovery Plus addictions symposium in London and truly believe we can use our unique similarities to work together to understand this epidemic with better data and a broader range, and to identify the unique cultural aspects that could be preventing our women and families from seeking or receiving treatment. We need to share a discourse and spread it among our peers to reduce the stigma that addiction sufferers go through in their search for recovery, and to encourage them to pursue treatment. 

The popularity of AA and other services speaks to the strong, universal desire that addiction sufferers have to attain recovery. We should seek to understand what is refraining so many others from participating in recovery services. Would a greater diversity of niche health care services—such as those specialized for women with children or specific racial and cultural communities—encourage more participation? For some, a broader (or anonymous) service might help them feel that their individual identity is less exposed, reducing feelings of stigmatization. How does childcare play a part in meeting these individuals where they are? The goal should be to eventually lead recovery towards dedicated, in-house care so we can understand the people we serve more personally, and help them combat the lasting afflictions that resonate from a life of addiction, as well as prepare them for the many hardships they will overcome in a life after treatment. To get there though, we have to work together to help them take their first steps.

References

Alcoholics Anonymous Great Britain. (1997). Historical data: The birth of AA, its growth and the start of AA in Great Britain. Retrieved from http://www.alcoholics-anonymous.org.uk/About-AA/Historical-Data

Centers for Disease Control and Prevention (CDC). (2015). Facts about birth defects. Retrieved from https://www.cdc.gov/ncbddd/birthdefects/facts.html
Gerberding, J. L., Cordero, J., & Floyd, R. L. (2004). Fetal alcohol syndrome: Guidelines for referral and diagnosis. Retrieved from https://www.cdc.gov/ncbddd/fasd/documents/fas_guidelines_accessible.pdf
Gray, J. (1992). Men are from Mars, Women are from Venus. New York, NY: Harper Collins. 
Greenfield, S. F., Back, S. E., Lawson, K., & Brady, K. T. (2010). Substance abuse in women. The Psychiatric Clinics of North America, 33(2), 339–55. 
Livingston, J. D., Milne, T., Fang, M. L., & Amari, E. (2012). The effectiveness of interventions for reducing stigma related to substance use disorders: A systematic review. Addiction, 107(1), 39–50. 
National Institute on Drug Abuse (NIDA). (2015). Nationwide trends. Retrieved from https://www.drugabuse.gov/publications/drugfacts/nationwide-trends
NHS Digital. (2017). Statistics on drugs misuse: England, 2017. Retrieved from http://www.content.digital.nhs.uk/catalogue/PUB23442
Samet, S., Waxman, R., Hatzenbuehler, M., & Hasin, D. S. (2007). Assessing addiction: Concepts and instruments. Addiction Science & Clinical Practice, 4(1), 19–31.
Substance Abuse and Mental Health Services Administration (SAMHSA). (2011). Leading change: A plan for SAMHSA’s roles and actions 2011–2014. Retrieved from https://store.samhsa.gov/shin/content/SMA11-4629/01-FullDocument.pdf
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