Historical Perspectives on Alcoholism Treatment for Women in the United States, 1870–1990

Abstract

This article discusses different types of treatment modalities for alcoholic women over more than a century of American history, outlining several key themes. First, the notion that there may be fewer alcoholic women than men, but they are somehow ''sicker'' or more deviant than their male counterparts, has been remarkably persistent. Second, beliefs about maternity and sexuality have long shaped our understanding of alcoholism in women. Third, defining a clinical entity called alcoholism has been particularly difficult in the case of women, for whom any drinking may be viewed as a troublesome behavior. Finally, fitting women into research and treatment models designed for men has been immensely complicated, yet emphasizing gender difference has, in the past, sometimes excluded alcoholic women even more from the care they needed and added to the stigma they faced.

Sex differences, gender and addiction

“…Physicians, psychiatrists and social workers have believed since early in the 20 th century that women escalate alcohol use rapidly once they start (McClellan 2011; McClellan 2017; Kandall 1999). Still, we do not know what makes some individuals at greater risk for addiction.…”

“…Using drugs can be related to social roles; for most of American history, men were much more likely than women to drink alcohol and use illicit drugs recreationally, while women were more likely to be prescribed drugs as medicine (McClellan, 2011;Kandall, 1999;McClellan, 2017). Today however, in adolescents, equal numbers of boys and girls ages 12-17 use illegal drugs (Substance Abuse and Mental Health Services Administration, 2014).…”

“…Within the general population, individuals differ in their risk for addiction due to a range of factors, including genetic and personality traits (Heinrich et al, 2016), experience of trauma or abuse (Boschloo et al, 2011;Stevens et al, 2003;Kachadourian et al, 2014;Lieberman et al, 2016), and sociocultural influences (Felitti et al, 1998;Macleod et al, 2013). Physicians, psychiatrists and social workers have believed since early in the 20th century that women escalate alcohol use rapidly once they start (McClellan 2011;McClellan 2017;Kandall 1999). Still, we do not know what makes some individuals at greater risk for addiction.…”

Aging Effects on Substance Use Among Midlife Women: The Moderating Influence of Race and Substance

“…In particular, the stigma associated with substance use might result in underreporting. During the past century women have experienced considerably more stigma associated with their substance use than men (McClellan, 2011), and research suggests that measures of substance use often fail to capture women's use accurately because of this stigma (Brown, 2011). In addition, there is evidence that stigma varies by ethnicity, with Black and Hispanic substance users enduring greater stigma than White substance users (Smith, Dawson, Goldstein, & Grant, 2010), suggesting that underreporting due to stigma might be an even greater problem among non-White women.…”

Gendered Members of Alcoholics Anonymous: Varieties of Spiritual Experiences in Recovery

“…What stands out for women, however, is the perceived double standard based on traditional gender roles that leaves them feeling like they have been morally deviant, perhaps even more so than their male counterparts. Sometimes referred to as ''doubly deviant'' (Copeland, 1997;McClellan, 2011), the culturally generated double standard that holds women accountable for reproductive capacitychild bearing, parenting, and sexual behavior in general-makes the 1st Step difficult. However, for some women, the shame associated with the double standard and addiction drives them to hit their bottom (Sanders, 2014).…”