What does gender-responsive treatment mean? Why does it matter?
The term, “gender-responsive” means, “creating an environment through site selection, staff selection, program development, content, and material that reflects an understanding of the lives of women and girls and responds to their strengths and challenges” (Covington & Bloom, 2008). When look for treatment for a woman seeking recovery from alcohol or drug addiction and co-occurring mental health disorders, it is important that you search for a program that is sensitive to the unique needs of women. Not only are gender-responsive treatment providers aware of the unique needs of women seeking addiction recovery, but they take the steps necessary to implement their sense of awareness into practice by creating an environment designed for women to feel safe and developing programming specifically for women to heal.
Many treatment providers are gender-informed, meaning that they understand that women face different challenges than men. There are many rehab facilities for addiction and mental health disorders that are women only, but fail to implement the other factors necessary for women to gain the skills they need in recovery. While creating a space only for women to heal is a great first step, there are other factors that should be considered when treating women with addiction and co-occurring mental health disorders. Here are some key factors that should be considered when selecting a treatment center for a woman seeking recovery:
Environment: An appropriate environment for women to heal should provide comfort, safety, and structure. Women seeking recovery are often uncomfortable in their own skin and have been taught that the world around them is an unsafe place. Providing a clean, welcoming, and warm space allows women to begin to feel comfortable enough to do the work necessary to heal. If the environment lacks warmth, is too chaotic, or feels like an institution, it may take women longer to let their guards down and begin to heal. When women first enter rehab for drug or alcohol dependence, they are often hypervigilant, fearful, anxious, and depressed – walking into a facility that challenges those negative emotions by providing warmth, positivity, and comfort provides women with a sense of safety.
While visually appealing décor, cleanliness, and physical comfort contribute to physical safety of women, there should also be a team of trustworthy and welcoming providers that are committed to delivering ethical and effective treatment services that offer an environment of emotional safety. It is important for all treatment providers to be well-trained and sensitive to women’s issues, as they are responsible for the implementation of programming and contribute to the way in which an environment feels when a women in need of help walks through the door.
Trauma: Part of providing a safe place for women to heal from addiction and mental health disorders is by understanding that many of these women have experienced trauma. When treating women living with addiction and co-occurring mental health disorders, it is important that providers are prepared to address emotional, physical, and sexual trauma that these women have endured. Many treatment providers are informed, or have an understanding that trauma plays a role in the cycle of their patient’s addiction – however, few programs are equipped to provide the safety and programming necessary for women to heal from their trauma. Simply acknowledging the role that trauma plays in addiction is only scratching the surface. By understanding that drug and alcohol dependence may be merely a symptom of a deeper rooted issue related to trauma allows treatment providers to direct treatment in a way that promotes more sustainable results.
Relationships: Women are, by nature, more relational – meaning that women tend to worry more about relationships with others, including their families, kids, partners, spouses, and friends, and will often sacrifice their own well-being in effort to keep maintain a relationship. This also means that women tend to seek out groups and relationships in every setting. Teaching women how to navigate unhealthy behaviors in relationships through empowerment, boundary setting, and communication skills will provide them with the insight to make better choices and learn that it is okay to take care of themselves. Part of being a gender-responsive treatment center also means that the staff must be trained to model the same principles they are trying to teach. To foster and teach healthy relational practices, the environment must be free from any form of harassment, both among staff and patients. While it is not the expectation that all women in rehab for drugs and alcohol at any given time will become life long friends, it is important to create a structure that gives women the opportunity to connect with themselves and others in a more respectful manner.
It is also important to have programming and structure designed for women to increase their capacity to have meaningful relationships with their families and children. Women, more so than men, tend to not seek treatment until their addiction has escalated to the point where they have lost their meaningful relationships and stable environment, had their kids removed from their care, or they have experienced things like homelessness or incarceration.
Additionally, part of creating a safe environment also means that treatment providers should use caution when determining who is allowed to enter the treatment facility. This includes outside providers, other members of the community, patients that are not a good fit for the program, and patient visitors. Allowing individuals into the treatment facility for patient visitation or otherwise that may compromise the safety of the women in treatment should never be permitted. Many women in treatment may struggle to identify the abusive nature of their relationships and fail to understand the policies put into place to keep them and others safe. Such issues should be addressed by a provider competent in intimate partner violence and relational gender dynamics. Regardless of the situation, no rehab facility should allow any visitor onto the premises that compromises the physical or emotional safety of any patient or staff member.
Mental Health: Many rehab facilities and providers that work with women living with an addiction tend to contribute to problems these women face by labeling them with heavy mental health diagnoses. Women in treatment with men are often blamed for being too distracting, too sexual, or crazy – yet fail to address the male counterparts role in the unhealthy dynamics. When treatment providers fail to appropriately assess women for post traumatic stress disorder, co-occurring eating disorders, or other mental health issues, women are given labels and prescribed medications that prevent them from the opportunity to address the underlying issues contributing to their addiction. What providers who give diagnoses do not realize is that diagnosing a woman with a severe mental health disorder based on a ten minute or less psych evaluation in an unsafe environment is a label that they will carry with them for years. Many providers do not understand the power they carry when providing a diagnosis and how those labels may contribute to the way in which a woman sees herself and is treated by others for a lifetime.
Although treatment tends to be primarily driven by insurance companies, who demand to see a diagnosis and prescription medications used for treatment – it is the responsibility of a good provider to gather enough information about any patient’s condition to provide an accurate diagnosis and to give the patient information necessary to make empowered and informed decisions about their bodies and healthcare. Furthermore, any gender-responsive treatment provider should understand that many symptoms displayed by women (e.g., insomnia, depression, and anxiety) may be more related to PTSD or side effects of alcohol and drug use or withdrawal than a severe mental illness. There will always be some instances where women are in fact struggling with a severe mental illness (e.g., bipolar disorder, schizophrenia, borderline personality disorder, etc.) – however, it is nearly impossible to determine such diagnoses when anyone has been actively using drugs, alcohol, or engaging in an addictive behavior for years or are withdrawing from substances.
When looking for a rehab facility for yourself or a loved one, you should look for a place that offers a truly holistic approach, as they will be more likely to diagnose and treat the whole person, not merely the symptoms. Holistic treatment is of utmost importance for the treatment of women living with addiction because these providers will work collaboratively to address the biological, social, psychological, and spiritual factors that contribute to the reported or observed symptoms.
Independence and Empowerment: Women coming to treatment for addiction will often need services that provide them with a new sense of empowerment by teaching them how to become more self-sufficient. While many women living with an addiction have found ways to survive and cope with pain in unhealthy ways, they have usually never been taught healthy coping skills and how to live independently without the use of substances or by depending on others in exchange for their safety. Part of any gender-responsive treatment program should teach women how to become more self-sufficient and how to use their strengths to generate income and live healthier lives. Not only do women need to learn how to sustain a healthy, recovery-oriented lifestyle, but they also need to learn how to restructure their lives in a way that ensures their basic human needs (e.g., food, water, shelter, healthy relationships, etc.) are being met. Part of this type of programming should also include skills that many women living with a long-term addiction have never been taught, such as: how to make a bed, how to budget money, how to write a resume, how to bake or cook simple things, why drinking water is important, and other general day-to-day life skills. While it is of utmost importance to learn recovery skills and healthy coping, learning how to balance recovery and daily life responsibilities may be overwhelming for many in rehab facilities. Teaching women how to find balance in their lives will help them feel confident in their recovery and empowered in their decisions.
Mind-Body Connection: It is not uncommon for women living with an addiction to feel detached from their own bodies. Long-term use of drugs and alcohol severely impact one’s physical health – thus, creating a disconnection from the body, including feelings of emotional and physical pain, hunger cues, and a general sense of comfort in one’s own skin. Women often face unreasonable body image standards placed on them by the media, their families and friends, or other toxic messages they have absorbed during their lives. All of these negative messages tend to formulate the way in which a woman feels in her own body – perpetuating the cycle of poor self-image and a constant need for external validation. When working with women in early recovery, it is important that any program provides women with the opportunity to connect with their bodies and learn to develop a new appreciation for themselves. It is important to recognize that these women will probably feel an overwhelming amount of emotion in their bodies, as they have been numbing out any feelings through the use of drugs, alcohol, or an addictive behavior. Teaching women how to connect with the emotional experiences in their bodies allows them to navigate stored emotional wounds from the past and slow down the process of reacting to every uncomfortable feeling they may experience.
Social Dynamics: Gender-responsive providers should be aware of the social dynamics that women experience in their lives. Some of these social dynamics include, but are not necessarily limited to, the beliefs that society and different cultures hold about women who use drugs or alcohol. Historically, women are less likely to receive family support while in treatment and more likely to be shamed from their drug and alcohol dependence than their male counterparts. There is also an immense amount of unspoken societal demands on women to be nurturing, chaste, and caretakers of children – which presents a unique set of barriers among women seeking treatment for addiction. Women are also more likely to be financially dependent on someone else and more likely to have to ask permission prior to going to treatment. Another consideration regarding social dynamics is that women living with an addiction to drugs or alcohol are more than likely to have experienced sexual trauma and are more likely to experience sexual or physical abuse when they are in their active addiction. This is related to social dynamics, as women are often seen as objects, not humans, and are more physically vulnerable to experience abuse.
All in all, when considering a treatment placement for a woman seeking recovery from an addiction to drugs, alcohol, or an addictive disorder, it is important to select a program that is gender-responsive. Many treatment centers will offer “women only” programming, which may only consist of a single group for women. Other treatment centers will be exclusively for women, but they may neglect key pieces of programming that contribute to a truly gender-responsive program.
All those seeking recovery from addiction deserve the opportunity to find treatment that is best suited for their needs. Drug and alcohol rehabilitation is an investment, so be sure to ask questions about the investment you are choosing for yourself or a loved one.