ADP Workshop: Women and Substance Abuse Treatment: Findings and Policy Approaches

1. ADP Workshop: Women and Substance Abuse Treatment: Findings and Policy Approaches Suzanne Gelber, MSW, Ph.D. Avisa Group, Berkeley CA June 18, 2008

2. Topics To Be Covered • Context and Findings • Policy Approaches Based on Findings • Role of the state government/ADP • CA Resource Issues • Final Remarks

3. Context Context of Women’s Treatment • Since the 1970’s there has been some recognition that women have special needs in substance abuse treatment; women who are substance dependence suffer special stigma • Today only 24% of 11,000 treatment programs nationally report having treatment services targeted to women’s needs; most of these services are embedded in co-ed treatment programs • Male-oriented treatment approaches and organizational leadership persist and dominate, especially in criminal justice settings where old style therapeutic communities are prevalent, if there is treatment offered at all • There has been decreasing attention and action at the medical and clinical policy levels about the special needs of women at risk of or in treatment for substance dependence • Policy has yet to recognize with broad policy innovations that women differ substantially in their needs in substance abuse treatment by age, cultural identity, clinical and medical status, geographic origin, parenting status, experience of physical and sexual trauma, economic status • Treatment specific to women’s needs requires targeted and substantial funding that helps support treatment, continuing care, social and economic normalization, not further stigmatization

4. Findings (1) • Findings: • Gender and cultural disparities in treatment access and approaches • Treatment specific to women’s needs often gets lost in the shuffle in non-specialized co-ed programs that lack female leadership • Nationally and in CA there is a lack of women-led and women-specific treatment programming, and especially for distinct cultural groups • Women’s substance use levels are increasing, especially alcohol and prescribed opiates and methamphetamine • Older women and female adolescents who are substance dependent receive scant, if any, specific attention in programming • Treatment programs often fail to address specific cultural groups appropriately, if at all • Medical and psychiatric consequences of substance dependence are frequently more serious for women than for men but this is often not reflected in funding or program design • Minority cultural “protection” against females becoming substance dependent fails as acculturation proceeds

5. Findings (2) • Many newly arrived and existing cultural/ethnic groups such as American Indians live in relative or absolute poverty, in areas where outlets for alcohol and drugs are prevalent and levels of violence are high and persistent • Women have special diagnostic and screening issues and tend to present in medical and primary care settings not sensitive to making substance abuse diagnoses • Medical co-morbidities common to substance dependent women are not being adequately addressed in many areas • Women have social and economic needs around poverty, lack of education and occupational skills, child care issues, domestic violence issues that are often ignored or met only in crisis circumstances or episodically • Women have a “telescoped” course of substance dependence illness that means they need to be recognized and treated earlier and more comprehensively than is now the case • Women’s experience of domestic violence, sexual and physical abuse, histories of extreme trauma, poverty and stigmatization are not being addressed adequately in substance abuse prevention and treatment programs • There are not enough evidence-based practices recognized or disseminated that are specific to women and cultural groups, nor is there funding to support much research or implementation of what has been successful • Funding crises at the state level make it even more difficult to address issues of women’s substance dependence but they cannot be used as an excuse for not acting at the policy level in counties and states

6. Policy Approaches Based on Findings • Gender/cultural disparities in access and programming • Set standards • Training • Performance criteria • Disseminate good and promising practices • Focus • Women’s treatment lost in shuffle • Renew focus • Obtain high profile female leadership • Sponsor innovative programming across state • Convene review and improvement groups • Enhance county and state focus on women’s prevention and treatment

7. Policy Approaches to Findings • Lack of female-specific programming • Census of programs • Epidemiological assessment of women’s needs across the state with monitored goals for improvement • Older and adolescent women who are substance dependent receive scant attention or funding • Assess situation and reallocate existing funds • Develop new programs • Write grants • Solicit new funding • Treatment programs do not address cultural identity-specific treatment needs • Training program and specific initiative for African American, Latino, Asian, American Indian and other special cultural groups in treatment • Develop and disseminate best practices

8. Policy Approaches • Serious medical consequences and negative health status of women who are substance dependent • Make funding contingent on adequacy of medical support and linkage to primary care • Fund competent medical directors for programs full time • Conduct clinical reviews and trainings regularly • Minority/cultural “inoculation” against female substance abuse wanes as acculturation proceeds • Address at community and cultural group level • Involve stakeholders • Connect to CSAP initiatives • Focus on groups at greatest risk

9. Policy Approaches and Solutions • Poverty of neighborhoods where many female substance abusers live • Promote economic development for women of all ages • Provide after-school programs • Link women to community groups, spiritual groups, employers, schools • Teach and train women to help one another more often and more effectively • Use media approaches to effectively alert communities to resources that do exist • Women presenting in areas w/o substance awareness/expertise • Fund SBIRT that focuses on women as well as men • Set aside funding to help women at risk access primary and specialty care

10. Policy Approaches • Medical co-morbidity not well addressed • Support training of SA program medical and clinical staff • Require tighter primary care linkage • Require competent medical directors in current practice • Support MD training about women substance abusers and their special needs and risks • Issues of poverty, lack of education, social issues, domestic violence not addressed adequately • Create statewide initiative with county representation • Commission a thorough report • Communicate with state Office of Women’s Health, Medicaid, Corrections, Criminal Justice, Education and other systems and stakeholders

11. Policy Approaches • Women at greater risk of quicker medical deterioration due to substance dependence • Create public awareness campaign to reach health/social sectors, religious and cultural leaders • Encourage identification of women at risk and provide targeted funding for their needs • Educate primary care and ER physicians • Recognize leaders and reward their efforts • Inadequate treatment attention to women as victims of domestic violence, abuse, trauma, poverty and excessive stigma • Create PR campaign to raise awareness of these issues • Sponsor sub-task force to assess and address specific problems in treatment in both co-ed and female-only programs • Set aside funding for training and sponsorship of women leaders and staff in programs

12. Policy Approaches • Inadequate amount of research/dissemination of EBP’s specific to women’s needs that are also focused on cultural groups • Expand training at county and state levels via ATTC and other tools • Sponsor research and implementation of promising approaches • Publish!!!! • Threatened Funding • Adopt a more entrepreneurial approach to funding and fund raising that nurtures stakeholders and funders who will address women and children’s issues; • Focus on women’s issues has declined • Invigorate Office of Women’s Treatment at state and county levels • Create a buzz about new initiatives • Cultivate stakeholders • Create public information campaign to target specific key stakeholders and sustain interest • Sponsor studies that show that identifying and treating women substance abusers has especially high cost-effectiveness for public funding • Support researchers and clinicians in the field • Connect to NIDA and other Federal initiatives.

13. Role of Counties, State and ADP • Need to create active taskforce and stakeholder group at county and state/ADP levels – must be cross disciplinary, cross-regional • Enhance funding and focus on women-specific access, prevention and treatment issues • Consider enhancing cross-systems’ funding and linkage via interagency taskforce at Cabinet or sub cabinet level • Publish and disseminate women-specific promising practices, sponsor assessment and training events and reports, keep the pressure on and monitor initiatives (CQI)

14. Final Remarks: Revitalize, Refresh, Redirect, Renew Focus • Revitalize women’s treatment with a new focus, new leadership, new assessments and organizational tools and funding, building on existing structures at ADP and county levels • Coordinate and direct at a high level so as to encourage community and stakeholder visibility • Create high profile inter-agency task force at state level on needs of women and children in prevention and treatment • Include medical component, cultural and client participation, mental health, child welfare, corrections and criminal justice, education • Consider NM Collaborative Model • Renew the focus women and their children’s treatment at the height of the women’s movement • Emphasis on quality and promising practices • Recognition for excellence • Attention to “disquality” and ending unjust disparities • Adapt approaches to cultural groups, using their representatives to vet design, implementation • Connect to advocacy community and create ongoing stakeholder advocacy group to support innovations

15. Recommendations • Sponsor neutral assessment of existing programs and needs at county and state levels, disseminate results and publish a plan of improvement annually • Adopt a comprehensive entrepreneurial social marketing orientation to this initiative at county and state levels in order to maximize impact and funding