Abstract
Current research into the treatment approaches for individuals with substance abuse and dependency problems have focused on identifying the biopsychosocial factors that result in addiction and the appropriate treatment options for individuals in different stages of the addiction process. Researchers have begun to recognize that demographic characteristics such as age have a bearing upon the effects of drugs on the body, the severity of dependency, and the resulting problems across the lifespan. However, there has been much less attention given to differences in the addictive process and recovery experiences based on gender. This paper reviews studies that explore the unique situation of women who have experienced substance abuse problems. Information about the demographic makeup of women with substance abuse problems and issues which face them over the course of their recovery is explored. In addition, the need for more effective treatment strategies that are appropriate and adequate to address their special concerns is discussed.

Drug use overall continues to be a problem worldwide even though information and education about the dangers of addiction and dependency is more available to more populations than ever before in history (Coombs, 2005). Many attempts to explore differences between various demographic groups substance have compared them using such variables as age, ethnicity, and gender (reword and citation needed). According to the National Epidemiologic Survey on Alcohol and Related Conditions (2010), men are 2.2 times more likely than women to abuse drugs. Men are also 1.9 times more likely to become dependent on drugs. However, the primary differences in drug patterns between men and women involve the types of drugs used. For example, women are more likely to abuse prescription drugs (Westmeyer and Boedicker, 2000). Type of drug used is the only variable that consistently differentiates patterns of substance abuse between women of different ages, races, ethnicities, or socioeconomic status (Brady & Ashley, 2005).

Other differences revealed in the literature concerning drug use among women reported the following findings:
1. Women who abuse drugs and alcohol are more likely to have parents who also abuse these substances.
2. There is a higher than expected number of women abusing alcohol and drugs who have experienced sexual abuse as a young child.
3. Women who abuse drugs are often involved with men who abuse them.
4. Women who abuse drugs and alcohol are likely to have one or more mental disorders, specifically depressive or mood disorders (Hans, 1999).

Literature Review
Women who Abuse Substances and Stress
The relationship between substance abuse and mental disorders has been well documented in research that has sought to find a biological explanation for addiction (Coombs, 2005). More recently, improvements in medical technology have made it possible to explore the effects of trauma on the brain itself. These studies have documented functional and structural changes in the brain among individuals who have experienced severe traumas (American Psychiatric Association, 2012). A relationship between trauma and incidences of substance abuse has been hypothesized and, since females are more likely to experience abuse as children than males, it can be inferred that women with a history of trauma-related stress are more likely abuse substances. However, much of the available literature has failed to focus specifically on these issues as they relate specifically to women.

A 2010 study explored the relationship between a history of early childhood sexual abuse and the development of mood and anxiety disorders. Researchers hypothesized that the hypothalamic-pituitary-adrenal axis could be compromised by stress over a long period of time (Greenfield, Back, Lawson & Brady, 2010). The effect on this axis can make individuals more vulnerable to mental disorders. This study was important in better understanding the ways in which women who use substances are affected biologically by their habits and their past life experiences. It also important highlighted the fact that a high percentage of women who use substances have been sexually abused as young children.

Tests of forty nine women showed that those with a history of childhood abuse exhibited higher levels of ACTH in response to stress than those individuals in the control group (Greenfield, Back, Lawson & Brady, 2010). Those women that were experiencing depression had levels that were three times as high while those who had a history of childhood sexual abuse and a diagnosis of depression had levels that were six times as high (Greenfield, Back, Lawson & Brady, 2010).

The methods used in this study were well designed to include objective measures of physical functioning and measures to document childhood trauma (good). This was an experimental design that would be most likely to produce valid and reliable results (you need to state if it did or did not produce reliable results not if it was “likely”). The primary value of this study in an exploration of the unique characteristics of women who abuse alcohol and drugs is to document the ways in which childhood abuse interacts with other abusive patterns to create long term changes in the way an individual functions.

This study (which study) provided important insights into the effects of early childhood traumas on women. Not only did the authors learn that women who experienced early childhood traumas have a higher rate of mental illness than other in the normal population, they also learned that they are more susceptible to all type of stress. While this study primarily addressed the issue of stress and childhood abuse¸ other studies point to the interrelationship of abuse and alcohol and drug use. The finding also confirmed other studies that identified changes in brain function and structure as well as other bodily changes that appear to be caused by early childhood abuse.

Substance Abuse among Women who are Pregnant
Hans (1999) also attempted to answer questions about the characteristics of women who abuse drugs and alcohol while pregnant. The report indicated that assumptions that substance abuse is most common among the poor, individuals from ethnic cultures, and younger individual are incorrect. Therefore, physicians may tend to overlook substance abuse these problems in individuals that do not fit this demographic. The rates of substance abuse among women who are pregnant are comparable to men regardless of age, race, socioeconomic status.

The results of Hans’ study are important because women who abuse drugs when pregnant are more likely to have problems during pregnancy, to give birth to children with disabilities, to be financially unable to adequately support their children, and to require other services including mental health treatment and child care (Hans, 1999).

Problems in Accessing Treatment
Women with children are not only more likely to be undiagnosed or unrecognized as substance abusers but also are more likely to go without treatment. One reason for this phenomenon is the lack of availability of child care in outpatient substance abuse facilities. Mothers with substance abuse problems are often unable to remain in substance abuse treatment, or even enter into the programs because of a lack of available child care options A literature review by Brown, Vartivan, and Alderksin (2011) discussed the issue of mothers who are more likely to enter into treatment programs, and addresses the difficulties faced not only by mothers with substance abuse problems, but also of single mothers with substance abuse problems. It addresses the changes being made in recent years to substance abuse programs in order to address this particular concern. The 2008 National Survey of Substance Abuse Treatment Services (N-SSATS) was used as the primary means of research in order to answer the research question pose.

The study (Brown, Vartivarian, & Alderks,2011) found that of all the eligible treatment facilities that were surveyed and accepted women, a total of 7,477, only 6.5%, or 484 of those facilities provided some form of childcare. Over half of the substance abuse treatment facilities, that provided child care services for women, were located in metropolitan areas. The researchers explored whether or not the facility required payment for child care services, provided child care services for free, accepted insurance for child care services. Whether or not a sliding scale payment system for child care services was offered depended in large part, whether or not they were non-profit and the type of facility that was being provided (Brown, et al., 2011). Facilities that offered child care services were more likely to have women complete the program. Those that offered free child care had the highest rates of completion.

Treatment Options for Women
A study by Wiseman and O’Boyle (2000) highlighted the issues mentioned above but also explored a more comprehensive list of problems facing women who experience substance abuse problems. The article discussed problems with self-esteem and an inability to cope with life. Mental health problems experienced by women in addition to substance abuse include post-traumatic stress disorder, eating disorders, and an increased risk of suicide. Vocational, legal, and financial problems were noted as well. The authors recommended a strength-based approach to treatments that focus on competencies rather than weaknesses.

This study (Wiseman & O’Boyle, 2000) is important in addressing the interventions that are available to help. It introduces some specific ideas and program designs for comprehensive approaches to treatment for women. While the other articles and studies that have been reviewed present the context for a more in depth exploration, this article and its literature review format rounds out the discussion of women and substance abuse raised by the primary article reviewed for this assignment.

This article offers a modelservices that are offered by a program called Crossroads. The program offers a set of services that are designed to address in some way all of the issues identified by this author. The article is used in this literature review to offer demonstrate the need for services and interventions specially designed to meet the needs of women. Women’s needs in addiction treatment are different from those of males. While many issues involving addictions are common to both males and females, the lives and experiences of women in society are different from those of men.

Need for Appropriate Treatment Programs
While women who abuse substances have the same treatment needs as substance abusers of all demographics, there are other problems and issues that are different not only after the pattern of drug use begins but even as early as childhood. There is a need for more comprehensive treatment programs that can approach recovery from addiction as well addressing other psychosocial issues that have both caused and resulted from the habit of drug abuse.

References
• American Psychiatry Association, Diagnostic and Statistical Manual of Mental Disorders TR V. Washington, DC: American Psychiatric Association 1999. Print.
• Brown, J., Vartivarian, S., & Alderks, C. (2011). Child Care in Outpatient Substance Abuse Treatment Facilities for Women: Findings from the 2008 National Survey of Substance Abuse Treatment Services. Journal of Behavioral Health Services & Research, 38(4), 478-487.
• Brady, T. M., & Ashley, O. S. (Eds.). (2005). Women in substance abuse treatment: Results from
  the Alcohol and Drug Services Study (ADSS) (DHHS Publication No. SMA 04-3968, Analytic Series A-26).
• Rockville, MD: Substance Abuse and Mental Health Services Administration, Office of Applied Studies.
• Coombs, R.H.,(2005). Handbook of Addictive Disorders A Practical Guide to Diagnosis and Treatment, New York: John Wiley and Sons
• Greenfield, S.F., Back, S.E., Lawson, K., and Brady, K.T. (2010). Substance Abuse in Women. Psychiatric Clinics in North America, 33(2): 339-355.
• Hans, SL, (1999) Demographics and psychosocial characteristics of substance abusing pregnant women. Clinics in Perinatology, 26(1): 55-74
• Westermeyer J, Boedicker AE. Course, severity, and treatment of substance abuse among women versus men. Am J Drug Alcohol Abuse. 2000;26(4):523–35
• Wiseman, M. and O’Boyle, K. (2000). Women and Addiction: Treatment issues and innovative program models. The Source, 10(1).