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Women's Treatment Must Address Co-existing Psychological Disorders

The Substance Abuse and Mental Health Services Administration (SAMHSA) has determined that women who are dealing with multiple challenges such as substance abuse, mental disorders, and trauma are best treated with an integrated approach that addresses all of these challenges.

This conclusion – which was expressed in a December 2004 press release – was reached after an analysis of data that had been collected from more than 2,000 women during SAMHSA’s five-year Women, Co-occurring Disorders and Violence Study (WCDVS):

Women in the study who received counseling that addressed all three aspects of their lives together improved more than women in usual care. Women's symptoms also improved when they participated in the planning, implementation, and delivery of their own integrated services.

Integrated services that involved the women themselves in treatment decisions cost the same as usual care and produced better outcomes, making the services cost-effective.

About the Study

According to information on the WCDVS website, “knowledge gained from the study is expected to be useful in advancing national, state and local policy that affects how the various service systems respond to women with co-occurring disorders who have histories of violence.”

The study was conducted as a collaborative effort by three SAMHSA components: the Center for Substance Abuse Treatment, the Center for Mental Health Services, and the Center for Substance Abuse Prevention.

“The nature and impact of trauma remains too often misunderstood or neglected,” SAMHSA Administrator Charles Curie said in the release that announced the study’s findings. “Many women suffer tremendously as a result of misdiagnosis, mistreatment, an absence of integrated care, and a lack of a voice in their own treatment. The [WCDVS] results provide a roadmap for recovery for women with co-occurring disorders and trauma histories.”

The Prevalence of Trauma

Statistics provided by the National Trauma Consortium (NTC) indicate that a history of physical or sexual abuse is a common reality for individuals who are struggling to overcome psychological disorders or substance abuse:

  • As many as 80 percent of men and women in psychiatric hospitals have experienced physical or sexual abuse, most of them as children.
  • The majority of adults diagnosed with Borderline Personality Disorder or Dissociative Identity Disorder were abused as children.
  • Up to two-thirds of both men and women who are receiving substance abuse treatment report childhood abuse or neglect.
  • Almost nine out of every ten alcoholic women were sexually abused as children or suffered severe violence at the hands of a parent.

SAMHSA’s annual National Survey on Drug Use and Health cements the connection between substance abuse, psychological disorders, and trauma, especially among women. In one year alone, the survey found that more than four million American adults (two million men and more than two million women) met the diagnostic criteria for both “serious mental illness and a substance abuse disorder.”

Meeting the Needs of Traumatized Patients

In a June 2004 report by the NTC entitled “Enhancing Substance Abuse Recovery Through Integrated Trauma Treatment,” the authors addressed the need for – and benefits of – implementing integrated efforts to address trauma and related psychological disorders during the treatment of women who are dependent upon alcohol or other drugs:

The relationship between interpersonal violence/trauma and substance use disorders is significant and complex. The prevalence of physical and sexual abuse among women in substance abuse treatment programs is estimated to range from 30 percent to more than 90 percent, depending on the definition of abuse and the specific target population.

There is a critical need to address trauma as part of substance abuse treatment. Misidentified or misdiagnosed trauma-related symptoms interfere with help seeking, hamper engagement in treatment, lead to early dropout, and make relapse more likely.

“Ideally,” wrote the “Enhancing Substance Abuse” authors, “substance abuse treatment programs will create trauma-informed environments, provide services that are sensitive and responsive to the unique needs of trauma survivors.”

These observations echoed the “guiding principles” of the WCDVS, one of which was the call for “a more widespread and comprehensive recognition that violence and trauma significantly impact a person's belief system, self-perception and relationships with others.”

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