Barriers to treatment
Women with alcohol problems are less likely than men to have received treatment for alcohol use problems. Reasons for this difference may include:
- Unwillingness to disclose personal information, for reasons of stigma or fear of child protection services
- Child care issues
- Lack of financial resources, especially among older women.
Approaches to treating women's harmful alcohol use
Research on treating and managing alcohol problems in women has revealed some effective approaches:
- Brief interventions can decrease heavy drinking and alcohol-related morbidity (Manwell et al., 2000). These interventions include motivation-for-change strategies, patient education, assessment and direct feedback, contracting and goal setting, behavioural modification techniques and using written materials such as self-help manuals.
- Treatment that is women-specific is more effective than mixed-gender treatment (Blow, 2000).
- Continuing to participate in mutual aid groups once abstinent helps to prevent relapse in women (Blow, 2000).
- Taking naltrexone two hours before an anticipated high-risk situation reduces alcohol consumption in early problem drinkers, particularly women (Enoch & Goldman, 2002).
In addition, women can benefit from:
- Counselling about Canada’s Guidance on Alcohol and Health.
- Pharmacological treatment, such as naltrexone.
- Women-specific mutual aid groups (e.g., Women for Sobriety).
- Parenting support, such as parenting classes or groups.
- Assistance with child care so they can attend treatment.
- Referral to trauma treatment (e.g., related to violence, abuse).
- Assessment and treatment of underlying mood disorders.
All treatment should be trauma-informed and reduce barriers to care while enhancing treatment retention.
Gender-informed care and trauma-informed care
Barriers are obstacles that prevent people from receiving the treatment they need. Some barriers are gender-related, some are socio-economic, and myriad others relate to the important socio-demographic factors that shape our world. When considering gender as a barrier to treatment, we must also consider the concept of intersectionality. An intersectional approach helps us acknowledge a person’s numerous identities (e.g., race, class, ethnicity, sexual orientation, and many possible others) and understand how they might intersect with each other to create a unique, integrated social identity. Gender-informed care should be mindful of intersectionalities, and support and programming should be tailored appropriately.
Studies also show that the great majority of people seeking help for substance use disorders have a history of trauma. Trauma is a complex concept that can relate to a recent single event, a past single event, or chronic repeated trauma. A key component of gender-informed care is recognizing the potential need for trauma-informed care.
It is important to note that a history of trauma affects one’s confidence in reaching out for help, and the likelihood of staying in treatment. Trauma-informed care does not suggest that a disclosure of trauma is necessary. Providing trauma-informed care involves providing a safe treatment environment, one that incorporates choice and control. All aspects of care should be empowering, not re-traumatizing. Services should offer choice, voice, and control.
Trauma-informed care should focus on creating physical, emotional and cultural safety for care providers and clients, and address cultural, historical and gender issues. It prioritizes trustworthiness and honesty among care providers and clients, and incorporates a spirit of collaboration that levels power differences. There should be empowerment for clients to make treatment decisions and a spirit of inclusiveness. A goal of treatment is to build resilience and the ability to grow and recover from trauma. Other treatment goals include coping skills and identifying and building on strengths.
In Alcohol Use:
- Alcohol Use: Home
- Screening
- Assessment
- Treatment
- Managing alcohol use disorders
- Alcoholics Anonymous
- Medications for alcohol use disorders
- Managing alcohol withdrawal
- Alcoholic liver disease
- Treating unhealthy alcohol use in older adults
- Treating unhealthy alcohol use in women
- Managing alcohol use in pregnancy
- Treating co-occurring alcohol use disorders and depression
- Long-term management of co-occurring alcohol use disorder and major depression
- Tools & Resources
- References