Clinical Textbook of Addictive Disorders 3rd ed - R. Frances, S. Miller, A. Mack (Guilford, 2005) WW

CHAPTER 20Addictive Disorders in WomenSHEILA B. BLUMEMONICA L. ZILBERMANWhy write a chapter on women? Alcoholism and other addictions have traditionallybeen considered problems of men. The classical studies that haveshaped our understanding of the nature and course of these diseases, fromJellinek’s (1952) research on phases of alcoholism to Vaillant’s (1995) 45-yearlongitudinal study of alcohol abuse in an inner-city and college cohort, limitthemselves to male subjects. The earliest screening tools were developed formen. (The first version of the Michigan Alcohol Screening Test contained aquestion about the subject’s wife, which only later was changed to “spouse.”)Treatment methods and programs were also initially designed for male patients,and it was not unusual for women suffering from addictive disorders to behoused on general psychiatric wards, while men were in special units. Maleorientedtreatment models, like the so-called boot camps for addicts in thecriminal justice system, were “adapted” for women simply by subjecting them tothe same program, including masculine clothing and haircuts. Early studies thatincluded information about women often failed to analyze or report these data(Blume, 1980). Although there has been improvement, gender bias in addictionresearch remained evident in the 1990s (Brett, Graham, & Smythe, 1995).In spite of these limitations, a growing body of research has identifiedmale–female differences in the way addictions develop and in treatment needs.This chapter summarizes some of the more clinically relevant features of addictivedisorders in women. A number of recent reviews are available (Blume &Zilberman, 2004; Center on Addiction and Substance Abuse, 1996; Graham &Schultz, 1998; Zilberman & Blume, 2004), as are several federal publications on437