WOMEN IN MIND: Young women and substance abuse: Understanding vulnerabilities and building on strengths

Editor's Notes

1. Potent opioid (euphoria effects)High dosePurityMore socially acceptable than heroinPossible to circumvent delivery system: chew, snort, injectEasy accessInadequate monitoring
2. http://www.youtube.com/watch?v=xQZNP3p4k2g
3. Source Where Pain Relievers Were Obtained for Most Recent Nonmedical Use among Past Year Users Aged 12 or Older: 2011-2012 (NSDUH)
4. 2. People of Introduction and Relationship Status: Women are more likely to be introducedto and initiate alcohol and drug use through significant relationships including boyfriends,spouses, partners, and relatives. According to the National Center on Addiction and SubstanceAbuse and Columbia University (CASA) research report, females are often introduced tosubstances in a more private setting (2003). In addition, marital status plays an important roleas a protective factor in the development of substance use disorders.3. Drug Injection and Relationships: Even though women are less likely to inject drugs thanmen, research suggests that women accelerate to injecting at a faster rate than men (Bryantand Treloar 2007). When women inject drugs for the first time, they are more likely than menwho are first-time injectors to be introduced to this form of administration by a sexual partner(Frajzyngier et al. 2007). Women are more likely to be involved with a sexual partner who alsoinjects. While various personality and interpersonal factors influence needle sharing amongwomen (Brook et al. 2000), women are more likely to inject with and borrow needles andequipment from their partner, spouse, or boyfriend. Among women who use with their sexualpartners, Bryant and Treloar (2007) highlight a division of labor where men are responsible forobtaining, purchasing, and injecting the drug for them. Thus, needle sharing and drug usingwith a sexual partner may engender a sense of emotional intimacy among women or refl ectinequity of power in the relationship. Other “people of introduction” besides sexual partnersare groups that are predominantly female. While women may initiate drug injection throughrelational means, it is important to recognize that some women are as likely to initiate druginjection on their own.
5. 2. People of Introduction and Relationship Status: Women are more likely to be introducedto and initiate alcohol and drug use through significant relationships including boyfriends,spouses, partners, and relatives. According to the National Center on Addiction and SubstanceAbuse and Columbia University (CASA) research report, females are often introduced tosubstances in a more private setting (2003). In addition, marital status plays an important roleas a protective factor in the development of substance use disorders.3. Drug Injection and Relationships: Even though women are less likely to inject drugs thanmen, research suggests that women accelerate to injecting at a faster rate than men (Bryantand Treloar 2007). When women inject drugs for the first time, they are more likely than menwho are first-time injectors to be introduced to this form of administration by a sexual partner(Frajzyngier et al. 2007). Women are more likely to be involved with a sexual partner who alsoinjects. While various personality and interpersonal factors influence needle sharing amongwomen (Brook et al. 2000), women are more likely to inject with and borrow needles andequipment from their partner, spouse, or boyfriend. Among women who use with their sexualpartners, Bryant and Treloar (2007) highlight a division of labor where men are responsible forobtaining, purchasing, and injecting the drug for them. Thus, needle sharing and drug usingwith a sexual partner may engender a sense of emotional intimacy among women or refl ectinequity of power in the relationship. Other “people of introduction” besides sexual partnersare groups that are predominantly female. While women may initiate drug injection throughrelational means, it is important to recognize that some women are as likely to initiate druginjection on their own.
6. 2. People of Introduction and Relationship Status: Women are more likely to be introducedto and initiate alcohol and drug use through significant relationships including boyfriends,spouses, partners, and relatives. According to the National Center on Addiction and SubstanceAbuse and Columbia University (CASA) research report, females are often introduced tosubstances in a more private setting (2003). In addition, marital status plays an important roleas a protective factor in the development of substance use disorders.
7. progress faster than men from initial use to alcohol anddrug-related consequences even when using a similar or lesser amount of substances
8. Sex Differences in Stress Reactivity and Relapse to Substance AbuseSex differences in neuroendocrine adaptations to stress and reward systems may mediate women’s susceptibility to drug abuse and relapse.18 Several studies have examined sex differences in stress response (eg, subjective, autonomic) and relapse.18,19 Among substance-dependent subjects, attenuated neuroendocrine stress response in women (ie, blunted adrenocorticotropic hormone and cortisol) has been shown following exposure to stress and drug cues.20 This hypothalamic-pituitary-adrenocortical (HPA) dysregulation in women may be one key to enhanced vulnerability to relapse in response to negative affect, as it may be associated with greater emotional intensity at lower levels of HPA arousal.21
9. Menstrual Cycle (Check Greenfield paper)Substances disrupt menstrual cycle phases menstrual cycle phases affect substances Fertility Substances can effect fertility Cocaine & Opioids  secondary amenorrhea & risk of unplanned pregnancies Prenatal care may be delayed as woman does not know she’s conceived (Shimi Kang)
10. 75% of women in treatment for alcohol dependence report childhood sexual abuse Severity of SUD directly related to # of violent assaults a women has experienced* Substance use may  vulnerability of women to re-traumatization and re-victimization*Jacobsen 2001; Chandler & McCaul 2003 , UN 2004 (Shimi Kang)
11. Women use substances as a means of coping (self-medication) or to increase social desirability (low self-esteem)
12. Childhood trauma sexual abuse physical abuseAdolescence/Young Adulthood rape abusive relationships75% of women in treatment for alcohol dependence report childhood sexual abuse Severity of SUD directly related to # of violent assaults a women has experienced* Substance use may  vulnerability of women to re-traumatization and re-victimization*Jacobsen 2001; Chandler & McCaul 2003 , UN 2004 (Shimi Kang)
13. Childhood trauma sexual abuse physical abuseAdolescence/Young Adulthood rape abusive relationships75% of women in treatment for alcohol dependence report childhood sexual abuse Severity of SUD directly related to # of violent assaults a women has experienced* Substance use may  vulnerability of women to re-traumatization and re-victimization*Jacobsen 2001; Chandler & McCaul 2003 , UN 2004 (Shimi Kang)
14. Childhood trauma sexual abuse physical abuseAdolescence/Young Adulthood rape abusive relationships75% of women in treatment for alcohol dependence report childhood sexual abuse Severity of SUD directly related to # of violent assaults a women has experienced* Substance use may  vulnerability of women to re-traumatization and re-victimization*Jacobsen 2001; Chandler & McCaul 2003 , UN 2004 (Shimi Kang)
15. Greater rates of concurrent Axis I & SUD1 More likely to have suffered from trauma1 Anxiety more of a factor for women2 Women with dual diagnosis have less access to treatment3 1 UN 2004, 2ICPE, 3Baker 2001
16. Estimates of rates of occurrence in womenCo-morbidity with substance use disorders?increased rate of opioid use disorders ?medicating anxiety and depression
17. Discriminatory acts range from mundane slights to devastating violent actsWomen may experience varied levels of discrimination that affect their substance use and their recoverySubstance use may become a way of coping with the additional stresses of discriminationWhen women experience more than one type of discrimination the effect can be compoundedDiscrimination can result in fewer educational and employment opportunities, lower SES, fewer housing choices and poorer health outcomeLess access to health care and difficulty in getting to treatmentLeads to negative health consequences and psychological distress
18. http://www.youtube.com/watch?v=RtXJ-iY5TFk
19. If I have hepatitis C and get pregnant, can I pass it on to my baby?The risk of HCV transmission to the baby is low compared to other viruses such as hepatitis B or HIV. Approximately 5 out of 100 mothers who have HCV might pass it to their babies before or at the time of birth.If a mother has both hepatitis C and HIV, the risk of the baby getting hepatitis C is much higher than when the mother is infected with hepatitis C alone. Anywhere from 22 to 36 out of 100 babies born to hepatitis C and HIV positive mothers will become infected with hepatitis C.Can I do anything to reduce the risk of passing it to my baby?Unfortunately, there is currently no effective way to prevent or reduce the risk of hepatitis C transmission to the baby.The mode of delivery (caesarian or vaginal) does not seem to affect the rate of transmission but firm evidence is lacking.However, for mothers infected with both hepatitis C and HIV, there are medications that can significantly reduce the risk of passing HIV to the baby.
20. Parental warmth: Agrawal et al., 2005: Tip Manual p. 20Marriage appears to be protective whereas separated never married or divorced are at great risk for addictionParental warmth: High parental warmth = less likely to initiate use, abuse substances, and become dependent on substancesPartner support: Key motivator that brings women to treatment; more likely to accept helpReligious and spiritual practices: Associated with reduced risk for substance use, relapse preventionHealthy coping skills
21. Women who present to opioid treatment have a broader range of collateral symptomatology such as greater psychiatric comorbidity, medical problems, employment and family/social impairmentWomen seeking treatment have more severe problems, are younger, have lower education levels, and lower incomes then men seeking treatment
22. Barriers to treatment are: Intrapersonal, interpersonal, sociocultural, structural, and systemicIntrapersonal: Individual factors including health problems, psychological issues, cognitive functioning, readiness/motivationInterpersonal: Relational issues including significant relationships, family dynamics, support systemsSociocultural: Stigma, bias, racism, inequity in health services, attitudes of health care providers towards womenStructural: Program characteristics, design, restrictionsSystemic: Larger systems including country, province, local agencies that generate polices and laws, health insurance and drug coverage, economy
23. Assuming that a woman is resistant to treatment because she is other-focused in the program is a form of gender biasUse their ability to be other-focused as a tool for motivation for recovery
24. Another off label use…taper off for individuals physically dependent but not addicted
25. Few studies on women so inconclusive evidence on treatment outcomes, but current research suggests that:Women and men are equally likely to complete treatmentTreatment outcomes as good as men’sWomen less likely to relapse then men in treatment. When they relapse it’s due to substance abusing romantic partners, or personal problems before relapseBetter long-term recovery outcomes then men