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

20. Addictive Disorders in Women 4471992). In a longitudinal study of 5,000 treated alcoholics, the mortality rate formen was three times the expected rate, whereas for women it was 5.2 times thecomparable rate in the general public (Lindberg & Agren, 1988).TREATMENT OF ADDICTIVE DISORDERS IN WOMENAlthough utilization of treatment resources for alcoholism has increased duringrecent years, women remain underrepresented in treatment. When women dolook for help, they are more likely to use mental health services and other facilitiesnot specific to addiction (Weisner & Schmidt, 1992). The reasons for this,including social stigma, denial, and the frequent failure to diagnose women,have been mentioned. In addition, however, the most common current, organizedcase-finding methods (e.g., drinking driver programs, drug courts, andemployee assistance programs) are primarily useful for identifying male alcoholics/addicts.Appropriate settings for identifying women in need of treatmentwould be medical settings of all kinds (including mental health facilities) andfamily counseling services. Unfortunately, organized screening in health facilitiesis the exception rather than the rule, and women identified in these settingsare usually in late stages of addiction.Research on the effectiveness of treatment for women has employed a widevariety of methods (Ashley, Marsden, & Brady, 2003). In general, adult womenand men treated together in the same specialized addiction programs doabout equally well (Vannicelli, 1986). A recent study reported that althoughproblem-drinking women started off more symptomatic than men, they actuallydid better than men at the 8-year follow-up in different interventions. Particularly,women seem to benefit from maintained Alcoholics Anonymous (AA)attendance (Timko, Moos, Finney, & Connell, 2002). Studies of specialwomen´s programming have shown positive effects, although few have employedrandom assignment techniques. Research supports the value of addingchild care, mother–child residential programming, all-female counselinggroups, and supplemental women-focused educational sessions (e.g., sexual andreproductive counseling, assertiveness, parenting, and communication skillstraining) (Ashley et al., 2003). Comprehensive programming, combining severalof these specific components, is also effective. Whether women-only programsare superior to mixed programs is still not well established. The only publishedrandom-assignment study found a superior outcome in a 2-year follow-upof 100 alcoholic women randomly assigned to a specialized women’s clinic comparedto 100 assigned to a mixed-sex treatment (Dahlgren & Willander, 1989).A women-only self-help program, Women for Sobriety, is thriving in someparts of the country (Kaskutas, 1996), while the number of women utilizing AAis also growing, and women-only AA groups are available in some areas. Basedon what is known about the characteristics of addicted women, Table 20.3 sum-