Special Considerations In Diagnosing and Treating Women With Co-occurring Conditions
Women suffering from drug addiction often use more than one drug and are likely to suffer from a co-occurring mental health condition. In fact, the National Institute on Drug Abuse (NIDA) says, “Women who use drugs often suffer from other serious health problems, sexually transmitted diseases, and mental health problems, such as depression.”
Women become addicted to some drugs more quickly than men, which may contribute to making treatment for drug abuse and comorbid mental health disorders more difficult. Women who drink alcohol regularly develop alcohol-related diseases and other health problems sooner than men. In addition to an increased risk of developing brain damage, liver disease, hypertension and heart disease earlier than men who drink, women also self-medicate with alcohol considerably more than men.
The Centers for Disease Control and Prevention (CDC) reports that “Prescription painkiller overdoses are an under-recognized and growing problem for women,” and that deaths among women from prescription painkillers increased by 400 percent since 1999. The CDC indicates that physicians should recognize that women are at higher risk for abuse of prescription painkillers than men and that doctors should follow proper prescribing guidelines, including screening and monitoring for substance abuse and mental health issues.
BMC Women’s Health reported results of the Canadian study, “Women and Substance Abuse Problems,” which explored differences in the prevalence and impact that substance abuse has on the physical health of men and women. The study references research showing that up to two-thirds of women with drug abuse issues may have a co-occurring mental health disorder such as depression, PTSD, eating disorder or panic disorder. Women experience anxiety disorders more often than men with comorbid disorders. Women also are more likely to have experienced violence such as sexual assault, childhood abuse or domestic violence, or to have been a victim of other types of crimes. Data collected from several drug treatment centers showed that over 85 percent of the 98 women in the sample reported being previously victimized. More than 25 percent of women reporting heavy alcohol use also reported feeling sad or depressed in the previous two-week period. Of those, 18.6 percent admitted that they considered suicide on at least one previous occasion.
Having comorbid conditions often results in a cycle with both the comorbid conditions potentially occurring at the same time, or one or the other occurring first with the other occurring afterward. Although people might tend to assume that the drug addiction caused the mental health condition or vice versa, NIDA points out that:
– Drug abuse may bring about symptoms of another mental illness
– Mental disorders can lead to drug abuse
One of the primary issues facing women with co-occurring conditions is their tendency to self-medicate with not only alcohol and prescription painkillers, but also with other drugs to deal with their depression or other mental health symptoms. Women take benzodiazepines for non-clinical reasons twice as often as men. Research also shows that women with co-occurring conditions are more likely than men to suffer from poor self-esteem and poor psychological adjustment.
Women with comorbid conditions often have lower social support levels than women who report only substance abuse and a lower quality of life than women without co-occurring conditions. Women in the justice system might not have access to the comprehensive treatment needed. The National GAINS Center reports that women in the criminal justice system suffer from co-occurring conditions at a rate exceeding twice the rate of men involved in the justice system.
Multiple issues may present barriers to treatment for some women, including fear of their children being taken away, fear of legal repercussions if they admit to drug abuse or a fear of violence from their significant other if they seek help. Lack of access to women’s rehab centers with comprehensive programs that treat women with co-occurring conditions is likely a potential problem for some women. Some women also face economic challenges, such as part-time or low-paying jobs with little to no flexibility in scheduling time off and little to no paid leave. These issues may delay or prevent a woman from seeking treatment.
Professionals at treatment centers for anxiety and depression must recognize that differences do exist between men and women in multiple areas associated with the prevalence and physical health impacts related to substance abuse, as well as with the barriers to treatment. When women seek treatment for one condition, each potential client should be evaluated for the other to either diagnose and treat it or to rule out the existence of comorbid conditions.
Recognizing that environmental, biological, genetic, social and several other factors have the potential to contribute to the development of co-occurring mental health problems and drug addiction is imperative. These factors require that treatment providers develop, implement and update as necessary specific treatment programs that address all the issues related to co-occurring conditions in women. Trauma treatment that is incorporated into mental health retreats for women or in dual diagnosis treatment programs may result in more successful treatment outcomes. Authors of the Canadian study suggest that, “In spite of the overall challenges, advances in gender-specific policy and programming are especially worthy of consideration and could be of tremendous benefit to women and their families.” Gender-specific programs may encourage more women to seek treatment. Successful treatment of co-occurring conditions in women must also focus on individualized case plans rather than a one-size-fits-all treatment program.
Comprehensive treatment programs feature a variety of recovery options based upon specific needs, such as treatment for depression in women, benzo withdrawal treatment, and multiple treatment components for co-occurring substance abuse and mental health conditions. Rehab centers in Arizona offering women access to comprehensive treatment for co-occurring conditions may contribute to more women demonstrating willingness to continue rehab on an outpatient basis after completion of an inpatient women’s recovery center program.