ADP Workshop: Women and Substance Abuse Treatment: Findings and Policy Approaches

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ADP Workshop Women and Substance Abuse
Treatment Findings and Policy Approaches

• Suzanne Gelber, MSW, Ph.D.
• Avisa Group, Berkeley CA
• June 18, 2008

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Topics To Be Covered

• Context and Findings
• Policy Approaches Based on Findings
• Role of the state government/ADP
• CA Resource Issues
• Final Remarks

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Context

• Context of Womens Treatment
• Since the 1970s there has been some recognition
  that women have special needs in substance abuse
  treatment women who are substance dependence
  suffer special stigma
• Today only 24 of 11,000 treatment programs
  nationally report having treatment services
  targeted to womens needs most of these services
  are embedded in co-ed treatment programs
• Male-oriented treatment approaches and
  organizational leadership persist and dominate,
  especially in criminal justice settings where old
  style therapeutic communities are prevalent, if
  there is treatment offered at all
• There has been decreasing attention and action at
  the medical and clinical policy levels about the
  special needs of women at risk of or in treatment
  for substance dependence
• Policy has yet to recognize with broad policy
  innovations that women differ substantially in
  their needs in substance abuse treatment by age,
  cultural identity, clinical and medical status,
  geographic origin, parenting status, experience
  of physical and sexual trauma, economic status
• Treatment specific to womens needs requires
  targeted and substantial funding that helps
  support treatment, continuing care, social and
  economic normalization, not further
  stigmatization

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Findings (1)

• Findings
• Gender and cultural disparities in treatment
  access and approaches
• Treatment specific to womens needs often gets
  lost in the shuffle in non-specialized co-ed
  programs that lack female leadership
• Nationally and in CA there is a lack of women-led
  and women-specific treatment programming, and
  especially for distinct cultural groups
• Womens substance use levels are increasing,
  especially alcohol and prescribed opiates and
  methamphetamine
• Older women and female adolescents who are
  substance dependent receive scant, if any,
  specific attention in programming
• Treatment programs often fail to address specific
  cultural groups appropriately, if at all
• Medical and psychiatric consequences of substance
  dependence are frequently more serious for women
  than for men but this is often not reflected in
  funding or program design
• Minority cultural protection against females
  becoming substance dependent fails as
  acculturation proceeds

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Findings (2)

• Many newly arrived and existing cultural/ethnic
  groups such as American Indians live in relative
  or absolute poverty, in areas where outlets for
  alcohol and drugs are prevalent and levels of
  violence are high and persistent
• Women have special diagnostic and screening
  issues and tend to present in medical and primary
  care settings not sensitive to making substance
  abuse diagnoses
• Medical co-morbidities common to substance
  dependent women are not being adequately
  addressed in many areas
• Women have social and economic needs around
  poverty, lack of education and occupational
  skills, child care issues, domestic violence
  issues that are often ignored or met only in
  crisis circumstances or episodically
• Women have a telescoped course of substance
  dependence illness that means they need to be
  recognized and treated earlier and more
  comprehensively than is now the case
• Womens experience of domestic violence, sexual
  and physical abuse, histories of extreme trauma,
  poverty and stigmatization are not being
  addressed adequately in substance abuse
  prevention and treatment programs
• There are not enough evidence-based practices
  recognized or disseminated that are specific to
  women and cultural groups, nor is there funding
  to support much research or implementation of
  what has been successful
• Funding crises at the state level make it even
  more difficult to address issues of womens
  substance dependence but they cannot be used as
  an excuse for not acting at the policy level in
  counties and states

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Policy Approaches Based on Findings

• Gender/cultural disparities in access and
  programming
• Set standards
• Training
• Performance criteria
• Disseminate good and promising practices
• Focus
• Womens treatment lost in shuffle
• Renew focus
• Obtain high profile female leadership
• Sponsor innovative programming across state
• Convene review and improvement groups
• Enhance county and state focus on womens
  prevention and treatment

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Policy Approaches to Findings

• Lack of female-specific programming
• Census of programs
• Epidemiological assessment of womens needs
  across the state with monitored goals for
  improvement
• Older and adolescent women who are substance
  dependent receive scant attention or funding
• Assess situation and reallocate existing funds
• Develop new programs
• Write grants
• Solicit new funding
• Treatment programs do not address cultural
  identity-specific treatment needs
• Training program and specific initiative for
  African American, Latino, Asian, American Indian
  and other special cultural groups in treatment
• Develop and disseminate best practices

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Policy Approaches

• Serious medical consequences and negative health
  status of women who are substance dependent
• Make funding contingent on adequacy of medical
  support and linkage to primary care
• Fund competent medical directors for programs
  full time
• Conduct clinical reviews and trainings regularly
• Minority/cultural inoculation against female
  substance abuse wanes as acculturation proceeds
• Address at community and cultural group level
• Involve stakeholders
• Connect to CSAP initiatives
• Focus on groups at greatest risk

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Policy Approaches and Solutions

• Poverty of neighborhoods where many female
  substance abusers live
• Promote economic development for women of all
  ages
• Provide after-school programs
• Link women to community groups, spiritual groups,
  employers, schools
• Teach and train women to help one another more
  often and more effectively
• Use media approaches to effectively alert
  communities to resources that do exist
• Women presenting in areas w/o substance
  awareness/expertise
• Fund SBIRT that focuses on women as well as men
• Set aside funding to help women at risk access
  primary and specialty care

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Policy Approaches

• Medical co-morbidity not well addressed
• Support training of SA program medical and
  clinical staff
• Require tighter primary care linkage
• Require competent medical directors in current
  practice
• Support MD training about women substance abusers
  and their special needs and risks
• Issues of poverty, lack of education, social
  issues, domestic violence not addressed
  adequately
• Create statewide initiative with county
  representation
• Commission a thorough report
• Communicate with state Office of Womens Health,
  Medicaid, Corrections, Criminal Justice,
  Education and other systems and stakeholders

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Policy Approaches

• Women at greater risk of quicker medical
  deterioration due to substance dependence
• Create public awareness campaign to reach
  health/social sectors, religious and cultural
  leaders
• Encourage identification of women at risk and
  provide targeted funding for their needs
• Educate primary care and ER physicians
• Recognize leaders and reward their efforts
• Inadequate treatment attention to women as
  victims of domestic violence, abuse, trauma,
  poverty and excessive stigma
• Create PR campaign to raise awareness of these
  issues
• Sponsor sub-task force to assess and address
  specific problems in treatment in both co-ed and
  female-only programs
• Set aside funding for training and sponsorship of
  women leaders and staff in programs

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Policy Approaches

• Inadequate amount of research/dissemination of
  EBPs specific to womens needs that are also
  focused on cultural groups
• Expand training at county and state levels via
  ATTC and other tools
• Sponsor research and implementation of promising
  approaches
• Publish!!!!
• Threatened Funding
• Adopt a more entrepreneurial approach to funding
  and fund raising that nurtures stakeholders and
  funders who will address women and childrens
  issues
• Focus on womens issues has declined
• Invigorate Office of Womens Treatment at state
  and county levels
• Create a buzz about new initiatives
• Cultivate stakeholders
• Create public information campaign to target
  specific key stakeholders and sustain interest
• Sponsor studies that show that identifying and
  treating women substance abusers has especially
  high cost-effectiveness for public funding
• Support researchers and clinicians in the field
• Connect to NIDA and other Federal initiatives.

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Role of Counties, State and ADP

• Need to create active taskforce and stakeholder
  group at county and state/ADP levels must be
  cross disciplinary, cross-regional
• Enhance funding and focus on women-specific
  access, prevention and treatment issues
• Consider enhancing cross-systems funding and
  linkage via interagency taskforce at Cabinet or
  sub cabinet level
• Publish and disseminate women-specific promising
  practices, sponsor assessment and training events
  and reports, keep the pressure on and monitor
  initiatives (CQI)

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Final Remarks Revitalize, Refresh, Redirect,
Renew Focus

• Revitalize womens treatment with a new focus,
  new leadership, new assessments and
  organizational tools and funding, building on
  existing structures at ADP and county levels
• Coordinate and direct at a high level so as to
  encourage community and stakeholder visibility
• Create high profile inter-agency task force at
  state level on needs of women and children in
  prevention and treatment
• Include medical component, cultural and client
  participation, mental health, child welfare,
  corrections and criminal justice, education
• Consider NM Collaborative Model
• Renew the focus women and their childrens
  treatment at the height of the womens movement
• Emphasis on quality and promising practices
• Recognition for excellence
• Attention to disquality and ending unjust
  disparities
• Adapt approaches to cultural groups, using their
  representatives to vet design, implementation
• Connect to advocacy community and create ongoing
  stakeholder advocacy group to support innovations

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Recommendations

• Sponsor neutral assessment of existing programs
  and needs at county and state levels, disseminate
  results and publish a plan of improvement
  annually
• Adopt a comprehensive entrepreneurial social
  marketing orientation to this initiative at
  county and state levels in order to maximize
  impact and funding