1. Kendall P. Weinberg, M.Ed., LPC Director, MARR Women’s Recovery Center
Women and Addiction
Kendall P. Weinberg, M.Ed., LPC
Director, MARR Women’s Recovery Center
CAPTASA
Lexington, KY
January 25, 2013
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3. The Spiral of Addiction and Recovery (Covington, 1997)
Transformation
Recovery
(expansion)
Addiction
(constriction)
“Alone in their homes, they simply pulled the shades down, stopped answering the phone and disappeared into their ever contracting world.” (Dayton, 2003)
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4. Why do we need this lecture?
Research including female subjects is still fairly new - 8%
Rates of addiction/alcoholism females mirror rates for males
Booming senior population -  Recognition / Over prescribing
Factors contributing to addiction / recovery more complex for females
“Feminization of Higher Education” = more impaired female professionals in healthcare and professional settings
“Good moms don’t use drugs and alcohol” – Shame kills and stigma still more prevalent for female addicts/alcoholics
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5. SHAME
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6. SHAME “Who do you think you are?” “You’ll never be good enough.”
*Connections: A 12-Session Psychoeducational Shame-Resilience Curriculum. Brené Brown, Ph.D., LMSW, 2009
“Who do you think you are?”
Unworthy, unlovable, incapable, inadequate,
broken, weak, flawed…
“You’ll never be good enough.”
Hide your faults, disappear, pretend to be perfect, or transform into what others expect of you.
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7. Keys to Shame Resilience
*Connections: A 12-Session Psychoeducational Shame-Resilience Curriculum. Brené Brown, Ph.D., LMSW, 2009
Authenticity
Emotionally honest, set boundaries, be vulnerable
Exercise compassion for self / others
Let go of what we are supposed to be; Embrace who we are
Love and Belonging
Internal sense of belonging vs. Search for external acceptance / approval
Trying to “fit in” or “be cool” gets in the way of true belonging
We are worthy of love; allow ourselves to be deeply seen / known
Love the ordinary and imperfect parts of ourselves
Practice forgiveness and self-compassion
A Resilient Spirit
Tell our stories practicing hope & gratitude while embracing vulnerability
Honor faith and intuition
Value perseverance and rest
Hold joy and laughter sacred
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8. Women and Addiction Physiological Factors
Evolutionary Psychological Factors
Relationship Factors
Considerations for Treatment of Female Addicts
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9. Physiological Factors
All fetal brains are structured as female until 8 weeks gestation
Females = sprout connections in communication / emotion centers – 11% more neurons
Males = MIS + Testosterone defeminize brain structure; growth in sex / aggression centers
Females have a larger Hippocampus
Hub for emotion & memory formation / fight or flight response
Females better equipped to read facial expressions / hear vocal tones
1st 3 months girls’ skills in eye contact / facial gazing increase 400%
Little to no increase for boys; increased ability to track objects in motion
Difference in Serotonin systems
Prevalence of mood / anxiety disorders for women
Females become intoxicated faster / addicted faster (Telescoping)
Mortality rates are higher for female substance abusers (50-100x)
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10. Physiological Factors: Hormonal Shifts
Estrogen:
Promotes social interest
Provides a sense of well-being
Causes one to feel more socially relaxed
Causes one to seek intimacy with others
Spikes during the 1st two weeks of monthly cycle
Testosterone:
Trigger for sexual desire
Men have on avg x more testosterone than women
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11. Physiological Factors: Hormonal Shifts
Progesterone:
Causes increased irritability
Causes women to seek aloneness
Increases reactivity to relationship stress
Curbs sexual desire
Peaks during 2nd half of monthly cycle
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12. Progesterone Peaks
Estrogen &
Testosterone peak

13. Physiological Factors: Hormonal Shifts
Oxytocin:
Triggers / Is triggered by intimacy – the “cuddle hormone”
Reduces stress
Estrogen fuels Oxytocin and Dopamine (REWARD!) production
Oxytocin / Dopamine = PLEASURE akin to cocaine or heroin
(+) Chemical reaction of being “In Love”
INTENSE – shares neural circuits with states of obsession, mania, intoxication, thirst, hunger
REJECTION = Drop in Oxytocin / Dopamine / Estrogen (-) chemical reaction mimics withdrawal symptoms
Relationships = huge relapse risk factor in all stages of recovery
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14. Evolutionary Psychological Factors:
“Our modern skulls house a stone age mind…”
Females
Males
Connection = Survival
Connection requires honed social skills
Conflict alerts that connection may be threatened; out of group? SHAME?
Security: Use ability to read faces, discern vocal tones, anticipate others’ needs and respond to unspoken cues
Threats: Connections can help to deal with threat /danger - Tend and Befriend
Self-esteem = ability to sustain intimate relationships
Major Treatment goal for women =
Fix your picker / Find your voice
Achievement = Survival
Achievement requires competition
Conflict may provide opportunity to secure elevated status within group
Security: Increased social status allows easier defense of territory / leverage of power / obtain resources
Threats: Fight or Flight more likely; avoid appearance of vulnerability
Self-esteem = ability to gain independence
Major Treatment goal for men =
Learn to connect / Vulnerability OK
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15. Relationship Factors for Female Addicts:
Relationships are primary
Ruptures in primary relationships = Trauma
History of Physical Abuse / Sexual Abuse / Emotional Abuse / Abandonment / Active Neglect / Passive Neglect / Divorce / Separation / Loss of Loved Ones / Severe Illness
Trauma breeds more trauma:
Untreated symptoms of PTSD Self Medication (Behaviors / Chemicals)
Continued / Escalation of Victimization
Pattern of Trauma Reenactment
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16. Relationship Factors for Female Addicts:
More likely to come from substance abusing / dysfunctional family
How much – When - If to include family / significant others in treatment if they are part of cycle of abuse?
More likely to be divorced, separated or widowed.
Females begin / maintain use to develop or maintain intimate relationships
Males begin / maintain use with friends or related to drug trade activities
Minimal / Conditional support for recovery
“When are you coming home?”
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17. How to incorporate these issues into successful addiction treatment…
So, women are
Physiologically / Neurologically / Evolutionarily built for relationships and they flourish when they can connect to others in a healthy way…
How to incorporate these issues into successful addiction treatment…
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18. Considerations for Treatment of Female Addicts:
Provide Safety:
Single gender groups vs. Mixed gender groups
Realign relationship patterns / Decrease risk for repeated victimization
Shame and Stigma = “Good moms don’t abuse drugs/alcohol” or core message of “I’m bad / worthless / broken / incapable.”
Address Trauma History:
Space to tell the story / Feel the emotions / Normalize grief
Teach HEALTHY coping skills / Conflict resolution / Normalize conflict
Attachment (anxious / avoidant vs. secure) / Normalize vulnerability / Reaffirm instincts
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19. Considerations for Treatment of Female Addicts:
Address Co-morbidity (Psychiatric Dx’s) Simultaneously:
Depression (70%) persists into recovery, Bi-Polar, Anxiety
Eating disorder % for those seeking addiction treatment
Borderline / Dependent Personality Disorder vs. Narcissistic and /or Anti-social traits (more prevalent for males)
Address Co-morbidity (Biological Dx’s):
HIV / AIDS / Hepatitis / HPV – more likely to contract
Cirrhosis / Cardiac functioning / Chronic Pain / Thyroid / Hormonal Shifts / Somatization / GI Symptoms
Pregnancy / Post-Abortion / Infertility / Pre- & Post- Menopause
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20. Treating the Addicted Woman:
Establish a Healing Environment
Safety
Connection
Empowerment
Health
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21. Treating the Addicted Woman:
Establish a Healing Environment
Authenticity
Emotional Honesty, boundaries, vulnerable, compassion for self/others, embrace who you are
Love and Belonging
Internal sense of belonging, worthy, deeply seen/known, love imperfections, practice forgiveness / self-compassion
A Resilient Spirit
Tell stories w/ hope / gratitude, honor faith / intuition, value perseverance & rest, hold joy and laughter sacred
Safety
Connection
Empowerment
Health
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22. References
Aries, E. (1976). Interaction patterns and themes of male, female, and mixed groups.
Small Group Behavior, 7, 7-18.
Brizendine, L. (2006). The Female Brain. New York NY: Morgan Road Books.
Brown, B. (2009). Connections: A 12-Session Psychoeducational Shame-Resilience Curriculum. Center City, MN: Hazelden.
Covington, S. (1997). Helping Women Recovery Curriculum, A Program for Treating Addiction. Center City, MN: Hazelden.
Dayton, T. (2003). Psychodrama and the treatment of addiction and trauma in women. In J. Gershoni (Ed.), Psychodrama in the 21st century: Clinical and educational applications (pp ). New York, NY: Springer Publishing Company, Inc.
Najavits, L.M., Weiss, R.D., & Shaw, S.R. (1997). The link between substance abuse and posttraumatic stress disorder in women: A research review. The American Journal on Addictions.
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23. References
Priyadarsini, S. (1986). Gender-role dynamics in an alcohol therapy group. In D.L. Strug, S. Priyadarsini, & M.M. Hyman (Eds.) Alcohol interventions: Historical and sociocultural approaches (pp ). Binghamton, NY: Haworth.
Substance Abuse and Mental Health Services Administration, Office of Applied
Studies. (May 20, 2005). The DASIS Report: A Comparison of Female and Male
Treatment Admissions: Rockville, MD
Studies. (August 5, 2005). The NSDUH Report: Substance abuse and
dependence among women. Rockville, MD
Tuchman, E. (2010). Women and Addiction: The importance of gender issues in
substance abuse research. Journal of Addictive Diseases, 29,
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24. References
Vander Kolk, B. (1996). Psychological Trauma. Washington, D.C.: American
Psychiatric Press, Inc.
Weiss, S.R.B., Kung, H.K., & Pearson, J.L. (2003). Emerging Issues in gender and
ethnic differences in substance abuse and treatment. Current Women’s Health
Reports, 3,
Wetherington, C.L. (2007). Sex-Gender differences in drug abuse: A shift in the
burden of proof? Experimental and Clinical Psychoparmacology, 15(5),
Zaidi, Z.F. (2010). Gender differences in Human Brain: A Review.
The Open Anatomy Journal, 2,
Zhao, Y., Encinosa, W. An Update on Hospitalizations for Eating Disorders,
1999 to HCUP Statistical Brief #120. September, Agency
for Healthcare Research and Quality, Rockville, MD.
us.ahrq.gov/reports/statbriefs/sb120.pdf
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