Issues women face in recovery

Recovery Month is an international observance that highlights the fact that addiction treatment and mental health services can enable those with a mental and/or substance use disorder to live a healthy and rewarding life. Each September, thousands of prevention, treatment, recovery programs and services around the world celebrate their successes and share them with their neighbors, friends, and colleagues in an effort to educate the public about recovery, how it works, for whom, and why.  

Locally, we are highlighting the interaction between women and recovery with a specific focus on barriers to treatment.  Worldwide statistics suggest that women are underrepresented in Substance use treatment. The data suggest that anywhere between 25-40% of clients in treatment at any given time, are women.  On Island, these statistics are even lower.  Recent data from The Department of Counseling Services show that 20% of active clients that are in treatment for substance use, are women.  This article seeks to highlight the underrepresentation of women in recovery, and some of the many barriers women face in recovery.

Historically the underrepresentation of women in recovery was attributed to the fact that prior to the 1960’s; many people were not looking at the world through a "gender lens". Understanding women from a social science perspective began during the second wave of the women's movement (1960's through 1970's).  It wasn't until researchers began to question science’s conclusions that women’s issues in recovery began to surface.

Most users will not seek treatment on their own; contact with treatment largely depends on other persons or agencies (e.g. family members, health care providers, government agencies, the legal system etc).  The likelihood that a substance abuse problem will be identified appears to differ by gender. Forexample, compared with men, substance abuse problems among women, particularly older women are less likely to be identified in health care settings. 

Compared with male substance abusers, female substance abusers tend to have more physical problems, and are more vulnerable than males to the physiological effects of substance use.  Given this information, it is not entirely surprising that upon contact with health services, women are more likely to be referred for mental health or medical intervention, as opposed to substance abuse treatment.  More often than women, men will be mandated to treatment by the criminal justice system. The strong correlation between drugs and criminal behavior amongst men is a factor that contributes to higher rates of identification.
 
In addition to various medical problems, the substance abusing woman is at increased risk for psychological problems. Co morbid psychiatric disorders, such as depression, anxiety, bipolar affective disorder, phobias, psychosexual disorders, eating disorders, or posttraumatic stress disorder are found more in women than in men.  This can affect their interaction with treatment in many ways.  For example, the depressed woman might know that she needs treatment but due to her disorder, might lack the motivation necessary to do so; or the substance abusing woman with anxiety disorder might be paralyzed by the thought of attending treatment. 

One of the biggest issue women faces as it pertains to recovery, is stigmatization and the accompanying shame.  The size of our Island nation lends itself to more frequent occurrences of stigmatization, as even the slightest variation increases the possibility that it will be detected.   Drug use is one of those variations that carry a heavy stigma anywhere in the world.  Both men and women experience the stigma attached to drug use, they differ however in the degree to which it is experienced.  It has been found that the stigma is much greater for women because of gender-based stereotypes that hold women to different standards. 

Men’s drug and alcohol use is more socially tolerated and sometimes condoned as acceptable “machismo” behavior, whereas drinking and drugging on the part of women engender greater social disapproval and are considered adverse to traditional female roles of mother and wife.  Fueling the already high stigmatization that women user’s experience, is the assumption and belief that women who uses drugs and abuses alcohol also engages in prostitution to fuel their addiction.  These demoralizing assumptions also contribute to the women not attending treatment.  Women tend to feel exacerbated shame due to their roles as primary caretakers and nurturers. 

Women, especially The Caymanian woman, were historically considered the backbone of the family.  Traditionally the Caymanian woman had to maintain 2 roles; she looked after the affairs of the house while earning a living to support her family. She was asked to be strong, tough and rugged, but also nurturing, loving and protective.  Compounding the role of traditional Caymanian women is the high rate of absentee fathers. The fall from grace women users’ experience, when they perceive others as seeing them as “unfit” and “less than”; is much easier to disregard than to confront.  Attending treatment would most likely lead to addressing the issues that gave rise to the identification of a problem and the acceptance that the problem is real; a task that might be overwhelming to the female user. 

Added to the stigmatization and shame, the female user is highly fearful.  There are many reasons as to why fear affects women in recovery; but it specifically focuses on 2 areas. Generally speaking, women are usually the main care providers in the family. For some women drug users, parenthood can be a barrier to treatment, as theyfear the involvement of children's services could mean their children will be taken away. Some women look at attending treatment as admitting that they are unfit mothers. Most men users tend to be absentee fathers and thus this issue tends to be female dominated.  Even the female user who desires to attend treatment encounters concerns with parenting. Women in treatment are more likely to be responsible for the care of children, to have more children living in their homes, and to be more concerned about issues related to children than men. 

Without securing childcare issues, the female user who wants to attend treatment will encounter logistical issues that can interfere with treatment outcomes.  Another reason why the female experience is characterized by fear is that, in some situations attending treatment might be putting her at increased risk.  Research has shown that female users are more likely to have using partners than men users.  The female user that desires to attend treatment might not get the support and encouragement she needs to develop the motivation necessary to address her issues.  As a matter of fact, she is more likely to experience the opposite.  Seeking treatment may create a serious problem for the relationship; she is more likely to be discouraged, threatened or even abused than encouraged 

The issues women face in recovery could not be fully explained in such a relatively small article.  The article's main intent was to highlight some of the many gender specific issues experienced by female users.  The Department of Counseling Services is committed to Client directed therapy that is sensitive to the complex issues of those who we serve.  The 3 arms of the department work cohesively as a unit and in partnership with outside agencies to increase the possibility of sufficiently addressing all therapeutic needs. Join us as we celebrate Recovery Month.

Greg Miller is a Counsellor (Community Based) with the Cayman Islands Department of Counselling Services