Gender Equality in Addiction Treatment

This is what most people picture when they think of gender equality. But there’s actually much more to it than that. (ChristianChan/Shutterstock)

Gender equality dominates the airwaves as of late, especially insofar as it concerns women. All over the news and social media, we see arguments concerning pay gaps, treatment in the work place, and opportunities for advancement. Every once in a while, we see small victories for gender equality, such as Ringling Brothers hiring the first female ringmaster in their entire 146-year history. But while celebrating these victories, we sometimes forget about other issues that gender might affect. For instance, does one’s gender inform their struggles with addiction and recovery?

To be fair, this applies to more than just men and women. Many already know that, while “sex” is genetic, “gender” is based more on identity. Gender may refer to biological differences, but also refers to masculinity or femininity in the context of social structures and personal beliefs. The discrepancy between these words means little to some, but it makes a difference when discussing issues such as addiction. After all, addiction is a disease that affects us not only biologically, but socially and personally as well. As such, we cannot discuss gender equality in addiction treatment without looking outside of binary definitions of gender.

Before discussing gender equality in treatment, we must assess how addiction affects those of differing sex or gender identities. On one hand, alcoholism and addiction tend to affect us in many similar ways, regardless of demographics. Nonetheless, everyone’s journey through addiction and recovery is deeply personal to them. While all stories bear some similarities, no two stories are completely alike. But while every story is unique in its own way, certain patterns emerge when looking at those of shared gender. By examining these patterns more closely, we may unveil the secret to ensuring gender equality in addiction recovery.

Does Gender Influence Addiction?

Many addicts in the LGBT community use substance abuse to escape feelings of isolation. (Prazis/Shutterstock)

Traditionally, women suffer from alcoholism and addiction at lower rates than men. However, women who drink regularly are actually more likely than men to become alcoholics. In addition, lower rates of metabolism mean that women’s bodies retain drugs and alcohol for longer periods of time. This means that women who regularly engage in substance abuse put themselves at greater risk of physical harm. Liver and brain damage are therefore major concerns for female addicts and alcoholics. Women also suffer from mental and emotional disorders such as anxiety and depression at greater rates than men, resulting in high rates of psychoactive drug abuse among women in the United States.

Unfortunately for American women, gender equality comes with a price. The gender gap concerning addiction rates appears to be closing in recent years. In fact, the United States currently witnesses one of the smallest gender gaps between alcoholics in the entire world. Data indicates that the nation’s wealth informs this trend. As women became more empowered in the 1970s and on, it was the upper class that first took up habitual drinking. Through the years, alcoholism eventually trickled down to the middle and lower classes as well. Now, as women seek gender equality in the work force, a shrinking wage gap leads to greater wealth and more opportunities for substance abuse.

In recent years, the push for gender equality in the gay community has become almost as prominent—if not more so—than gender equality between men and women. But according to the Center for American Progress, substance abuse among homosexuals remains largely overlooked. Data for this group remains sparse, but estimates show gay men as 12.2 times more likely to use amphetamines and 9.5 times more likely to use heroin than straight men. An estimated quarter of all people within the LGBT community abuse alcohol. By contrast, only 5-10% of the general population suffers from alcoholism.

Substance abuse affects the transgender community quite strongly as well. A 2010 survey reports that more than 25% of trans individuals abuse drugs or alcohol. Other reports indicate that the true number might stand at 30% or higher. Compare this to rates of about 9% among those whose gender identity matches their biological sex. Moreover, it appears that substance abuse in the trans community often arises as a coping mechanism due to discrimination or feelings of being misunderstood. The treatment community must account for these numbers when determining the best form of personalized care for such individuals.

Different Experiences in Recovery

Stories of 13th-stepping have caused many women to enter recovery with great trepidation. (Sergey Nivens/Shutterstock)

When considering the unique challenges of women in recovery, we must start before they even enter the doors of a treatment center. Pregnant women and those with childcare concerns often neglect entering treatment for fear of what may happen to their children. Some fear that being labeled an addict or alcoholic will result in the loss of custody. Even seeking recovery outside of treatment scares many women due to stories of harassment at the hands of “13^th-stepping” predators. And while these problems aren’t as common in AA and NA as many are led to believe, the fact that they are common enough to warrant their own neologism is somewhat disturbing.

But aside from social issues, sheer biology makes gender equality difficult to achieve. For instance, women may react differently to medication-assisted treatment (MAT) than men. Truthfully, not enough data exists on the pharmacodynamics of Suboxone in female addicts to form a conclusion one way or another. Nor do researchers currently possess the data to gauge Suboxone’s effects on breastfeeding. This means that women who wish to play it safe must choose to either take an unknown risk or simply forgo MAT entirely. With recovery in the balance, no one should feel forced to make such a choice.

Gay men and women often feel neglected in the search for gender equality in treatment. According to the Advocate’s Manny Rodriguez, this often stems from feelings of isolation. When they enter treatment centers with predominantly straight clientele, they find it hard to relate to anyone. And when they enter treatment centers with special LGBT programs, they find membership on the slim side. Meeting few patients with whom they share similar life experiences, they feel like outsiders. This leaves them battling the exact same feelings against which they struggled outside of treatment. The same feelings they used drugs and alcohol to avoid.

For similar reasons, many transgender addicts and alcoholics cannot find what they would consider gender equality in recovery. In this case, however, the issue arises from much more than sheer attendance rates. In fact, much of this problem stems from the very structure of most  facilities. As noted by May Wilkerson on The Fix:

“Those who do seek treatment are often directed towards inadequate or ineffective services. Medical professionals are often uneducated in trans people’s specific needs, and most in-patient drug rehab centers are segregated by gender—making them an unsafe, alienating space for this population. Even rehabs that market themselves as ‘trans-friendly’ often refuse to provide crucial hormone therapy, misguidedly considering it an ‘elective drug.’”

In other words, many trans addicts do not seek treatment because they feel resigned to see their unique needs unmet. And with most treatment facilities divided into only two housing divisions, non-binary individuals feel neglected. It may therefore take a great deal of time—and numerous infrastructure changes—for most treatment centers to accommodate the needs of the transgender community.

Seeking Gender Equality in Treatment

Addiction does not discriminate, which means that everyone must receive equal access to recovery. (John Arehart/Shutterstock)

Gender equality begins by recognizing that every single person, regardless of sex or gender, faces their own personal demons. We cannot fight addiction by looking solely at chromosomes. Instead, we begin by seeing every patient as their own person, and then determining what this person needs to recover. For instance, those with a history of domestic abuse may benefit from EMDR trauma therapy. Those with custody issues may benefit from our court liaison services. We must identify such issues prior to beginning treatment, and work with patients to give them what they need.

This promise of personalized care affects not only women, but the LGBT community as well. Many homosexuals or transgender individuals require trauma care due to abuse by peers or even family members. In addition, their time in therapy must account not only for their addiction, but also the personal issues that helped fuel their substance abuse. Feelings of isolation and discrimination comprise only two of several complex issues that our counselors must address. We do this not only in one-on-one therapy, but group therapy as well. This allows patients to feel accepted by their group members, learning that they can find people who will support them and respect them for who they are. They will need this type of support network once they leave treatment. Learning to build it now will assist them greatly in the long run.

In the case of the LGBT community, the Center for American Progress recommends that more treatment centers work on building cultural competency. The Substance Abuse and Mental Health Services Administration already works to spread awareness of the specific needs of gay and transgender substance users. By ensuring that more health care students receive competency training, they can increase the number of understanding professionals in the recovery industry. Treatment centers can also work with current staff members to educate them on such issues.

Gender equality in recovery may seem elusive, but rest assured that treatment centers such as Amethyst continue working toward it. Through personalized care and a healthy dose of compassion, we strive to make every patient feel welcome within our walls. As long as more treatment centers continue to make this effort, gender equality in treatment may not lie as far out of reach as it seems. For more information on how we can meet your specific needs, contact us today for more information about our programs.