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Why Gender and Age Specific Treatment matters

This is a great article  about gender and age specific treatment written by Kenneth Chance in February 2017 – Frank Say

 

Why Gender and Age Specific Treatment Matters

Introduction

In recent years drug and alcohol treatment programs have grown dramatically in the United States, yet most addiction treatment centers’ programs are designed for all adults, age 18 and older, and both men and women. This broad-based, treatment-for-everyone approach might not be as effective as a gender and age specific alcohol and drug rehab program might be for many who suffer from substance use disorders. This paper outlines only a few reasons why it is important to address the specific treatment needs of both younger and older adults, and why the importance of a gender specific treatment facility.

Age Specific Considerations

Ask any older adult this question: “If you had a choice between going to an alcohol and drug rehab program that has mostly 18-30-year-olds, who are single and still supported financially by their parents’, or, a treatment program where only older adults, most of whom are either currently employed in a career or recently were, and, are either married or have been married – which would you choose?” Most, if not 100% of the time, the latter choice would be made by an older adult.

As a rule, young adults need to learn life skills and how to liberate from their financially supportive parents, while older adults need to re-learn relationship skills, primarily with their significant other. Younger adults may also require educational support to launch into a career, while older adults may need to protect a career already in place, or, learn how to live sober in retirement. These and other life stressors are more suitably treated in an age appropriate clinical setting where group therapy and psychoeducation are focused on the needs of the age appropriate group.

The brain of an individual with a long-term, moderate to severe substance use disorder is handicapped in being able to self-regulate emotional states such as irritability and frustration that often leads to angry outbursts or internalized rage. Additionally, undiagnosed and untreated depressive and anxiety disorders further create emotional states that fluctuate daily, and hourly for the newly detoxed client. The tension created by generational differences in social attitudes and behaviors between older and younger adults only intensify feelings of irritability and frustration among clients, thus creating an atmosphere of “us” versus “them.” An age specific treatment program is therefore more conducive in reducing such tension in the milieu.

Gender Specific Considerations

Gender differences are more than simply physiologic; they include gender programming and socialization, familial roles, social privilege, economic differences, career and educational differences and gender based stereotypes. While some of these differences are obvious, others might not be. For instance, male privilege carries over into the treatment experience and may hinder the male’s ability to make changes in his thought process sufficient to effect much needed behavioral changes for lasting recovery. Similarly, a female’s need for relational expression might be threatened with a male in her treatment program.

Women tend to have less family support when entering treatment than men do. This is compounded when the woman has children under her care, and/or when she is pregnant. Additionally, women tend to have more severe family problems than men, which need to be addressed in treatment.

Sexual posturing between younger men and women occurs naturally as part of the growth process into maturity. When one adds a severe substance use disorder on top of an already abundant hormonal young man or woman, and, when one then removes that substance from the individual, sexual posturing becomes even more of an issue in changing behavior conducive for long-term recovery.

Generally speaking, men tend to be more left-brained oriented in their thought process and are often emotionally numb or, even more disturbing, emotionally inaccessible. This directly impacts the clinical team’s ability to treat the male client, especially in a 30-day treatment program. Misogynistic attitudes must also be considered in effective treatment of substance use disorders with men as disrespect for women may be a factor in relapse prevention. Good clinical work coupled with a thorough fourth step inventory helps men see their part in problems in their relationships with women, and that typically means breaking down the walls of misogyny. This is only one example of the merits of a gender specific treatment program for men.

For women who continue to see themselves dependent upon a male figure for whatever reason, be it financial support or emotional validation, being in a gender specific clinical setting helps them change such a belief so that they may access their true power as an independent and equal woman.

Other Considerations

There are differences in the mental health needs of men and women. For instance, while more women report mental health problems than men do, such as depression for instance, more men commit suicide than women by almost a 4:1 ratio. For this reason, the mental health component of providing treatment solutions for men must adequately screen for and identify their mental health needs. That’s not always easy because men tend to hide mental illness by denying its existence, all the while self-medicating through alcohol and/or drugs.

While women and men experience early childhood trauma, men tend to believe that they can be tough and “gut it out” while women are more likely to act out in negative behavior. Treating trauma for women versus treating it for men is different in how one screens, assesses and delivers evidence-based trauma treatment. Both genders require safety in their treatment facility where professionally trained trauma-informed staffs provide clinical support, especially on weekends. Sexual harassment takes on many forms and staff require education and training in order to prevent and stop such harassment between clients, as well as between clients and staffs.

Taking an antidepressant or a mood stabilizer may be more of a hurdle for men than women as men tend to believe they should be able to function “normally” without medication. This is an example of gender stereotyping that needs to be debunked for the successful treatment of a mental health condition.

When sexual dysfunction, sex addiction, serial relationships and other sexually oriented pathologies are required, having a gender and age specific treatment program is necessary. By placing men and women who suffer from sex addiction in a coed and all-age milieu, the risk of sexual acting out behavior is increased unnecessarily. Having separate groups and residential facilities is not enough. The actual programs should be separated physically on different campuses by age and gender populations and served by different clinicians and staffs to help mitigate the risk of sexually damaging behavior.

Summary

What is presented here is a very high level view of why gender and age specific alcohol and drug rehab programs are a very necessary option within the overall treatment industry. The benefits for the client, the client’s family and the staff are immense. Prior to admitting into a treatment program, one should carefully consider the clinical needs of the client and, when age and gender matters are critical to the success of one’s treatment from a substance use disorder, a gender and age appropriate program might be the better choice.

 

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Effective Addiction Treatment: Modern approaches vs outdated approaches

Great article from NY Times on addiction and modern treatment approaches.

https://well.blogs.nytimes.com/2013/02/04/effective-addiction-treatment/?_

Countless people addicted to drugs, alcohol or both have managed to get clean and stay clean with the help of organizations like Alcoholics Anonymous or the thousands of residential and outpatient clinics devoted to treating addiction.

But if you have failed one or more times to achieve lasting sobriety after rehab, perhaps after spending tens of thousands of dollars, you’re not alone. And chances are, it’s not your fault.

Of the 23.5 million teenagers and adults addicted to alcohol or drugs, only about 1 in 10 gets treatment, which too often fails to keep them drug-free. Many of these programs fail to use proven methods to deal with the factors that underlie addiction and set off relapse.

According to recent examinations of treatment programs, most are rooted in outdated methods rather than newer approaches shown in scientific studies to be more effective in helping people achieve and maintain addiction-free lives. People typically do more research when shopping for a new car than when seeking treatment for addiction.

A groundbreaking report published last year by the National Center on Addiction and Substance Abuse at Columbia University concluded that “the vast majority of people in need of addiction treatment do not receive anything that approximates evidence-based care.” The report added, “Only a small fraction of individuals receive interventions or treatment consistent with scientific knowledge about what works.”

The Columbia report found that most addiction treatment providers are not medical professionals and are not equipped with the knowledge, skills or credentials needed to provide the full range of evidence-based services, including medication and psychosocial therapy. The authors suggested that such insufficient care could be considered “a form of medical malpractice.”

The failings of many treatment programs — and the comprehensive therapies that have been scientifically validated but remain vastly underused — are described in an eye-opening new book, “Inside Rehab,” by Anne M. Fletcher, a science writer whose previous books include the highly acclaimed “Sober for Good.”

“There are exceptions, but of the many thousands of treatment programs out there, most use exactly the same kind of treatment you would have received in 1950, not modern scientific approaches,” A. Thomas McLellan, co-founder of the Treatment Research Institute in Philadelphia, told Ms. Fletcher.

Ms. Fletcher’s book, replete with the experiences of treated addicts, offers myriad suggestions to help patients find addiction treatments with the highest probability of success.

Often, Ms. Fletcher found, low-cost, publicly funded clinics have better-qualified therapists and better outcomes than the high-end residential centers typically used by celebrities like Britney Spears and Lindsay Lohan. Indeed, their revolving-door experiences with treatment helped prompt Ms. Fletcher’s exhaustive exploration in the first place.

In an interview, Ms. Fletcher said she wanted to inform consumers “about science-based practices that should form the basis of addiction treatment” and explode some of the myths surrounding it.

One such myth is the belief that most addicts need to go to a rehab center.

“The truth is that most people recover (1) completely on their own, (2) by attending self-help groups, and/or (3) by seeing a counselor or therapist individually,” she wrote.

Contrary to the 30-day stint typical of inpatient rehab, “people with serious substance abuse disorders commonly require care for months or even years,” she wrote. “The short-term fix mentality partially explains why so many people go back to their old habits.”

Dr. Mark Willenbring, a former director of treatment and recovery research at the National Institute for Alcohol Abuse and Alcoholism, said in an interview, “You don’t treat a chronic illness for four weeks and then send the patient to a support group. People with a chronic form of addiction need multimodal treatment that is individualized and offered continuously or intermittently for as long as they need it.”

Dr. Willenbring now practices in St. Paul, where he is creating a clinic called Alltyr “to serve as a model to demonstrate what comprehensive 21st century treatment should look like.”

“While some people are helped by one intensive round of treatment, the majority of addicts continue to need services,” Dr. Willenbring said. He cited the case of a 43-year-old woman “who has been in and out of rehab 42 times” because she never got the full range of medical and support services she needed.

Dr. Willenbring is especially distressed about patients who are treated for opioid addiction, then relapse in part because they are not given maintenance therapy with the drug Suboxone.

“We have some pretty good drugs to help people with addiction problems, but doctors don’t know how to use them,” he said. “The 12-step community doesn’t want to use relapse-prevention medication because they view it as a crutch.”

Before committing to a treatment program, Ms. Fletcher urges prospective clients or their families to do their homework. The first step, she said, is to get an independent assessment of the need for treatment, as well as the kind of treatment needed, by an expert who is not affiliated with the program you are considering.

Check on the credentials of the program’s personnel, who should have “at least a master’s degree,” Ms. Fletcher said. If the therapist is a physician, he or she should be certified by the American Board of Addiction Medicine.

Does the facility’s approach to treatment fit with your beliefs and values? If a 12-step program like A.A. is not right for you, don’t choose it just because it’s the best known approach.

Meet with the therapist who will treat you and ask what your treatment plan will be. “It should be more than movies, lectures or three-hour classes three times a week,” Ms. Fletcher said. “You should be treated by a licensed addiction counselor who will see you one-on-one. Treatment should be individualized. One size does not fit all.”

Find out if you will receive therapy for any underlying condition, like depression, or a social problem that could sabotage recovery. The National Institute on Drug Abuse states in its Principles of Drug Addiction Treatment, “To be effective, treatment must address the individual’s drug abuse and any associated medical, psychological, social, vocational, and legal problems.”

Look for programs using research-validated techniques, like cognitive behavioral therapy, which helps addicts recognize what prompts them to use drugs or alcohol, and learn to redirect their thoughts and reactions away from the abused substance.

Other validated treatment methods include Community Reinforcement and Family Training, or Craft, an approach developed by Robert J. Meyers and described in his book, “Get Your Loved One Sober,” with co-author Brenda L. Wolfe. It helps addicts adopt a lifestyle more rewarding than one filled with drugs and alcohol

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