Gender Similarities and Differences in the Treatment, Relapse, and Recovery Cycle

Abstract

This study explores the influence of gender on changes in recovery status among participants in a longitudinal study. The study sample (N = 1,202; 60% female) is recruited on referral to treatment, and annual interviews are conducted from Years 2 to 6 following intake. At each annual observation, participants are classified into one of four statuses (recovery, treatment, incarcerated, and using), and the transitional probabilities and correlates of transitioning from one status to another are estimated. About 80% of the participants changed status at least once over the followup period. Women are one third less likely to transition from recovery to using; the predictors of transitioning to different statuses vary by gender. The implications of gender as a moderator of the recovery process are discussed. Keywords gender differences; longitudinal follow-up; relapse; transition; recovery The concept of addiction as a chronic disorder, requiring long-term management much like other chronic disorders, has been widely disseminated and generally accepted within the substance abuse treatment field (McLellan 2002;McLellan et al. 2000;McLellan et al. 2005). Yet this way of conceptualizing addiction is still lacking in detailed empirical description (Anglin, Hser, and Grella 1997;Anglin et al. 2001). In particular, there is limited understanding of how frequently individuals change from one status to another during the recovery cycle (e.g., from abstinence to using or vice versa or from using into treatment) or about the correlates that accompany these changes in status. Prior research has shown that a majority of individuals relapse at some point following a treatment episode, and many of them subsequently reenter treatment (Grella, Hser, and Hsieh 2003). To study addiction as a chronic disorder, it is useful to take a "life course perspective," in which drug use, treatment, relapse, and recovery are not viewed as discrete events but rather as stages in a cyclical process where prior experiences of drug use and treatment influence later experiences (Hser, Longshore, and Anglin 2007;Scott, Foss, and Dennis 2005;Williams 2003). . Women tend to initiate drug and alcohol use later than men but progress faster to dependence (Greenfield et al. 2007). Moreover, men and women are subject to different social influences on their initiation of substance use; women more often report that initiation occurs within the context of sexual or interpersonal relationships, whereas men are more likely to report experimentation or peer influence as the context for drug use initiation (Frajzyngier et al. 2007;. Gender Differences in Drug Use and Treatment ParticipationSecond, gender differences are evident in the processes related to treatment initiation, including the social influences that may support or inhibit treatment entry and the referral pathways into treatment Weisner and Schmidt 1992). Women are more likely than men to enter treatment via the mental health and child welfare systems, whereas men are more likely to enter treat...

Cost Variation among Subpopulations of Diverted Drug Offenders under California’s Proposition 36

“…This finding may not be surprising given the lack of any specific implementation language in SACPA in regard to the possible mental health needs of participants, though it is still troubling and needs to be addressed with, as one option, the provision of appropriate integrated services. Moreover, these results are congruent with the prior finding [52] that the SACPA program is much less effective for women than for men and other research indicating that mental illness is much more common among women than among men [43].…”

“…In addition to the already mentioned subpopulations, it is important to note the specific effect of gender on the presentation of SUDs and on SUD treatment in particular, due to its substantial effect on SUD histories, treatment processes, and treatment outcomes [39][40][41][42][43][44][45][46][47][48][49].…”

“…Women with SUDs often enter drug treatment with more severe problems than men related to criminality, SUD histories, mental health disorders, employment, drug use among partners or family members, and childcare responsibilities [39][40][41][42][43][44][45][46][47].…”

“…Criminal history has previously been shown to have a stronger effect on treatment participation and outcomes for men [43,46], whereas psychiatric disorders and victimization histories appear to have a particularly negative impact on treatment outcomes for women [46,48,49]. In addition, on treatment entry, women exhibit different attitudes than do men, such as greater problem recognition, less selfefficacy to remain abstinent in high-risk situations, and greater reliance on coping strategies [47], all of which are factors that may differentially influence outcomes.…”

The female therapist and the client’s gender

“…For instance, women attached more importance to discussing the treatment programme and influencing their path through the treatment system. Taking this into account may increase women' satisfaction and promote their retention in treatment [24,30] .…”