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

448 IV. SPECIAL POPULATIONSTABLE 20.3. Special Considerations in Women’s Treatment• Psychiatric assessment for comorbid disorders; date of onset for each(primary/secondary).• Attention to past history and present risk of physical and sexual assault.• Assessment of prescription drug abuse/dependence.• Comprehensive physical examination for physical complications andcomorbid disorders.• Need for access to health care (including obstetric care).• Psychoeducation to include information on substance use in pregnancy.• Child-care services for women in treatment.• Parenting education and assistance.• Evaluation and treatment of significant others and children.• Positive female role models (among treatment staff; self-help).• Attention to guilt, shame, and self-esteem issues.• Assessment and treatment of sexual dysfunction.• Attention to the effects of sexism in the previous experience of thepatient (e.g., underemployment, lack of opportunity, and rigid sex roles).• Avoidance of iatrogenic drug dependence.• Special attention to the needs of minority women, lesbian women, andthose in the criminal justice system.marizes the special emphases that have been found helpful in treating thesewomen. For pregnant women, the provision of prenatal care, along withwomen-centered programming, has been shown to improve both treatmentretention and birth outcomes (Ashley et al., 2003).The good news is that specific program components for women can beadded to existing programs, and staff sensitivity can be improved by training.The bad news is that, in a large survey, only 19% of addiction programsreported providing special programming for pregnant or postpartum women,and only 28% offered women´s programming at all (Office of Applied Studies,2000). We can and must do better.PREVENTIONEffective primary prevention of alcohol, tobacco, and other drug dependence inwomen has received little research attention, with the exception of specificpublic education campaigns to prevent FAS. Such efforts have proven moreeffective in persuading light and moderate drinkers to abstain during pregnancythan in persuading the heaviest alcohol consumers. Thus, screening in medicaland obstetric practice remains essential.In designing educational approaches in the schools and for the generalpublic, it is important to remember the double-edged sword quality of societal