Since the 1950’s, the American Medical Association has viewed addiction as a chronic disease in which the body becomes dependent on alcohol and other drugs. With their higher proportion of fat cells, women metabolize alcohol and other drugs differently than men. This often leads to more significant negative impacts to women’s psychological and physical health. The National Institute of Drug Addiction estimates that more than 6.5 million American women are in need of treatment services. According to the Alcohol, Drug Addiction and Mental Health Services Board of Cuyahoga County more than 18,000 women are in need of treatment services in Cuyahoga County.
Each year 200,000 women die from complications of addiction. That figure is four times the number of deaths from breast cancer.
DOES TREATMENT WORK?
First, research to date has conclusively established that treatment can be effective. Researchers have concluded that a longer term addiction treatment with individualized components has substantially improved outcomes.
Second, some clients have better prognoses at the start of treatment than others. The variables that suggest a better prognosis include:
- low severity of dependence and psychiatric symptoms at admission
- motivation beyond the pre-contemplation stage of change
- being employed or self supporting
- having family and social supports for sobriety
Third, some treatment variables have been reliably shown to produce better and more enduring outcomes. The treatment variables associated with better outcomes in rehabilitation include:
- staying in treatment (at least outpatient treatment) longer and being more compliant with treatment
- having an individual counselor or therapist and more counseling sessions during treatment
- participating in voucher-based behavioral reinforcement interventions
- participating in AA, CA or NA following treatment
- having supplemental social services provided for adjunctive medical, psychiatric, and/or family problems
Addiction and Trauma
More than 90% of the women who are engaged in alcohol and other drug treatment services reveal a history of traumatizing events including: childhood molestation, witnessing violence, experiencing a sexual assault, etc. These experiences may have varied and lasting effects such as hypersensitivity to loud noises, difficulty focusing on common tasks, day-time anxiety and sleep disruption. Alcohol and other drugs are is often used to self-medicate in an effort to feel normal and attend to daily tasks such as parenting and work. The addiction begins to spiral as the user requires more and more of a substance in order to feel normal and capable. Women will often suffer in shame and silence, not admitting their pain or addiction to anyone.
The Nature of Addiction
Addiction is a progressive, chronic, primary, relapsing disorder. It generally involves compulsion, loss of control, and continued use of alcohol and other drugs despite adverse consequences.
Addiction, treatment, recovery, and relapse are all dynamic biopsychosocial processes. That is, they are processes influenced by biological, medical, psychological, emotional, social and environmental factors. In turn, these factors are influenced by addiction, treatment, recovery, and relapse.
The primary goal of addiction treatment is to meet the treatment needs of clients. These needs are biological, psychological, and social in nature. Accordingly, the effectiveness of treatment can be measured in terms of the overall biopsychosocial health of clients, including such factors as decreases in substance use, improvements in medical and physical health, improvements in psychosocial functioning, greater employment stability, decreases in criminal justice system involvement, and relapse prevention preparedness.
Source: Overview of Addiction Treatment Effectiveness, U. S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Office of Applied Studies, February 2002
The Columbus Dispatch cited the Henry J. Kaiser Foundation release of a new study finding that Ohio leads the nation in opioid overdose deaths. One in nine heroin deaths across the U.S. occurred in Ohio. To further expand this grim news, Ohio also leads the nation in overdose deaths from synthetic opioids, including fentanyl, carfentanil and U-47700 introduced earlier this year in Lorain County.
As this news is being shared, there is a sense of outrage that the death rate continues to accelerate. We are saddened by the loss of life that is occurring and the lifelong impact of this loss on families. With this public health crisis, there is no safe place. Rural areas, suburbs and the urban communities are all experiencing this loss. With this news, there are increasing efforts to combat this reality.
- Project Dawn offers naloxone nasal spray to opioid addicts and their family members to reverse the effects of an opioid overdose.
- Berea and Olmsted Township Police Departments are encouraging addicts to surrender their opioids and to be referred to a detox or treatment facility.
Opioid Overdoses and Families
Every three hours an Ohioan dies from an accidental and fatal overdose. When first responders and news outlets share photos of a child trying to awaken a parent who has overdosed, this simply deepens the shame and isolation that the parents often feel. They question their ability to be nurturing parents and family. Members often bear the scars from this public health crisis.
Heroin changes the brain chemistry of an addict. She is incapable of making rational decisions. The dopamine in her brain controls her thought processes. The cravings then turn to painful withdrawal, lasting as long 7 to 10 days and resembling the worst symptoms of influenza that can be experienced.
The families and children are clearly the victims. Even if the family is still living together, the reality is that the mother or parents are absent and not being actively involved with families. If an overdose occurs and Narcan reverses the effect of the opioids, the addict wakes very quickly and is oblivious to the trauma to which her family has been subjected.
Addiction is a family health crisis resulting from over-prescribed prescription opioid medications. According to the Pharmacists Board, there were eight opioid prescription drugs prescribed for every Ohio resident. Once the addiction has progressed and the physician will no longer prescribe these medications, heroin is a less expensive and more powerful replacement to alleviate symptoms of pain.
Women and HIV/AIDS
Doctors use simple criteria for diagnosing a Human Immunodeficiency Virus (HIV) infection: A person has HIV if they have a detectable level of the virus on a blood test, or with the exception of babies of HIV-positive mothers, a positive blood test for antibodies (infection-fighting proteins) against the virus. The criteria for diagnosing HIV is slightly different in newborn infants because HIV antibodies can be passed to the baby from the mother before or during birth, but the infant may not actually be infected with the virus. In such cases, the antibodies may be detected in a baby’s blood at birth, but there may be no evidence of antibodies by the time the baby is 12 to 18 months old.
In 2006, the most recent year for which statistics are available, an estimated 56,300 people in the United States were newly infected with HIV. Also, according the Centers for Disease Control and Prevention (CDC), as of 2006, approximately 1,106,400 people in the United States were living with HIV infection, with 21 percent of those undiagnosed.
In the United States:
- Women account for more than one in four new HIV/AIDS diagnoses and deaths caused by AIDS.
- The proportion of AIDS diagnoses reported among women has more than tripled since 1985.
- 71 percent of women diagnosed with AIDS in 2005 (the last year for which detailed data about women is available) contracted the disease through heterosexual sex.
- African Americans constituted 61 percent of women diagnosed with HIV/AIDS in 2005.
- In 2005, girls represented 43 percent of AIDS cases reported among people aged 13 to 19.
- African Americans and Hispanics represent 24 percent of all women in the U.S. but they account for 82 percent of AIDS cases among women.
- African-American women have an HIV prevalence rate nearly 18 times that of white women.
- AIDS is the leading cause of death for African-American women aged 25 to 34.
Drug addiction treatment is cost-effective in reducing drug use and its associated health and social costs.
- Treatment is less expensive than alternatives, such as not treating addicts or simply incarcerating addicts
- For example, the average cost for 1 full year of methadone maintenance treatment is approximately $4,700 per client, whereas 1 full year of imprisonment costs approximately $18,400 per person
- According to several conservative estimates, every $1 invested in addiction treatment programs yields a return of between $4 and $7 in reduced drug-related crime, criminal justice costs, and theft alone
- When savings related to health care are included, total savings can exceed costs by a ratio of 12 to 1
- Major savings to the individual and society also come from significant drops in interpersonal conflicts, improvements in workplace productivity, and reductions in drug-related accidents.
Source: Principles of Drug Addiction Treatment: A Research-Based Guide, National Institute on Drug Abuse, National Institutes of Health, NIH Publication No. 99-4180, October 2001
Women and Substance Abuse
Information on the natural history, clinical presentation, physiology, and treatment of substance use disorders in women is limited. Although women are estimated to comprise 42% of all persons with substance use disorders in the United States, psychosocial and financial barriers (e.g., lack of child care) prevent many women from seeking treatment. Other explanations for women’s underuse of alcohol and drug treatment services may include women’s perception of greater social stigma associated with their abuse of drugs and alcohol.
Once in treatment, women have been found to have a higher prevalence of primary comorbidity. Many women with substance use disorders have a history of physical and/or sexual abuse (both as children and as adults), which may also influence treatment planning, participation, and outcome.
Women also tend to have more family responsibilities and may need more help with family-related problems. There is evidence that increasing the focus of treatment on concerns specific to women, such as adding treatment components that specifically address women’s issues and increasing female staff, improves treatment outcomes for women.
(Practice Guideline for Treatment of Patients with Substance Use Disorders: Alcohol, Cocaine, Opioids, American Psychiatric Association, Am J Psychiatry 152:11, November 2000).
Pregnancy and Substance Abuse
Substance use during pregnancy has the following implications for both the mother the developing fetus:
- the health of the pregnant woman
- the course of the pregnancy
- fetal development
- child development
- parenting behavior
The most well established effect of in utero substance exposure is fetal alcohol syndrome. Reported effects of fetal alcohol syndrome in children exposed to high doses of alcohol in utero include:
- low birth weight
- poor coordination
- neonatal irritability
- retarded growth and development
- craniofacial abnormalities (including microcephaly)
- cardiovascular defects
- mild to moderate retardation
- childhood hyperactivity
- impaired school performance