Today, conservatively
70 percent of men and women in treatment for substance
abuse were raised in a family affected by substance
abuse. These are families of extremes: from enmeshed
to disconnected, and rigid to permissive. These
are troubled families and that means shame based
families. Research indicates immediate family
members of alcoholics are two to seven times more
likely than the general population to develop
problems with alcohol during their lifetime.
Women from substance abuse families
have a history of loss and abandonment in their
lives and alcohol and drugs become a solution
to their many problems. These are women who learned
to minimize and discount their reality. They learned
this as a defense that ultimately became a skill,
long before they became addicted.
In a study of alcoholic women
by Covington and Kohen, 52 percent reported physical
abuse and 74 percent had experienced sexual abuse,
72 percent reported emotional abuse. In contrast,
44 percent of non addicted women reported emotional
abuse, 34 percent reported physical abuse and
50 percent reported sexual abuse.
Evidence shows that women alcoholics/drug
addicts are much more likely to have experienced
childhood physical/sexual abuse, experienced it
in more ways, and experienced it for longer periods
of time than non addicted women.
The National Center on Addiction
and Substance Abuse at Columbia University (1999)
reported, "There is no safe haven for the
abused and neglected children of drug and alcohol
abusing parents. They are the most vulnerable
and endangered individuals in America. They are
costing our country billions of dollars in child
welfare costs today." They are also our adults
filling our courtrooms, prisons, and for the lucky,
our treatment programs.
The connection between addiction
and interpersonal violence is complex and multifaceted.
For example, substance-abusing men are often violent
toward women and children, substance-abusing women
are particularly vulnerable targets for violence,
and childhood and current abuse increase a woman's
risk of substance abuse.
Whether or not the addicted woman
has been subjected to physical or sexual abuse
she most likely has experienced emotional abandonmentÐhaving
to hide a part of who you are in order to be acceptable.
Emotional abandonment is when it is not okay to
make a mistake, to have feelings or needs. While
this is learned as a child for many addicted females,
it is often reinforced in their choice of spouse/partner.
In both the socialization process
and upbringing women learn it is not okay to have
needs, everyone else's needs are more important
than their own. This creates a diminished sense
of self. A part of treatment responsibility is
to help them to believe "I AM WORTHY OF RECOVERY."
As a result of their growing
up years these are women who are often fearful
of anger and avoid conflict. They are fearful
of rejection and have a strong need for outside
approval. This results in a perpetual negation
of self, a lessening of self-esteem in the process.
In dealing with addictions, it
is becoming clear, the more chronic the abuse
as a child, the greater number of addictions one
is likely to develop. Addictions and or disorders
that range from gambling to spending and debt
disorders, to eating disorders, sex addiction
and relationship addictionÑall are common
to the female substance abuser. Without identifying
the possibility of multi-addictions many women
relapse to their primary drug of choice and continue
to act out an addictive lifestyle.
Women with addictive disorders
frequently have co-existing psychiatric disorders,
usually anxiety or affective disorders. The most
pervasive dual diagnosis is posttraumatic stress
disorder (PTSD) and depression. Rates of these
disorders are at least twice as high among women
addicted to alcohol as for women in the general
population.
Anxiety disorders are the most
common psychiatric disorder among women. This
includes panic, phobias, obsessive-compulsive
disorder, stress, PTSD and generalized anxiety.
Estimates are that 30 percent of all women will
experience an anxiety disorder in her lifetime
compared to 61 percent of alcohol dependent women.
According to the National Co-morbidity
Study, affective disorders occur in 24 percent
of women in the general population over their
lifetime, compared to 54 percent of women with
alcohol dependence. Women with alcohol dependence
had higher rates of major depression and mania
than women in the general population.
With a history of physical and
sexual abuse the addicted woman is dissociative,
rageful, anxious, depressed, phobic, and more
at risk for suicide. These are all symptoms of
PTSD. These issues cannot be ignored in the therapeutic
process.
It's quite understandable that
alcohol and drugs can do for this woman something
it doesn't necessarily do for others who have
a stronger sense of self. These are women who
have lived a life of minimization, deprivation
and extremes. Alcohol and drugs provide something
they do not know how to seek naturally.
Many female treatment failures
(those who relapse) may in fact be trauma survivors
who return to alcohol or other drugs in order
to medicate the pain of trauma. By recognizing
the differences provided by female sexuality and
by integrating trauma treatment with addiction
treatment there is less risk of trauma- based
relapse.
Alcohol becomes the reinforcement
in order to feel whole and complete. Some women
become addicted in order to feel and be different,
some to treat anxiety and depression; some want
desperately to fit in, to open up, whereas others
want to shut down. Finding the perfect amount
of alcohol, dose of an amphetamine, or perfect
fix from food is the elusive goal of most addicts.
Becoming addicted almost always is adaptive. It
usually solves a conscious or unconscious problem,
and then it becomes the problem.
Today we recognize there are
fewer and fewer what the author calls "garden
variety" alcoholics, and we see more and
more women addicted to crystal methamphetamine,
ecstasy, cocaine, and heroin. Yet as this author
attends women's groups, be it at The Meadows or
a halfway house, prescription pills are the most
pervasive other drugs abused.
Women seek out doctors for comfort.
Women raised in dysfunctional households or with
abuse have more anxiety, depression, and psychosomatic
health issues. Physicians are notoriously willing
to prescribe medications. This is a dangerous
combination. Doctors both suggest medications
and are manipulated into prescribing medications.
While there has not been any
study on the correlation between prescription
medication abuse and trauma survivors, it would
seem there is a direct connection. Trauma survivors
find legitimate reasons to see the doctor. Then
they discover that prescription pills can do more
for them than they ever thought possible, and
as any addict would do, it is not long before
they are working the system.
A predominant psychosocial issue
that distinguishes women's substance abuse from
men's is the issue of stigma Ð severe social
disapproval. Although society may stigmatize a
male addict as a bum, it rarely attacks his sexuality
or his competencies as a parent. A woman who enters
treatment may come with a heavy burden of shame.
Women internalize guilt, shame, despair and fear,
as they find themselves unable to control their
behavior. Because the stigma is so shameful and
such a potential threat to the family unit, women
and their families may use denial to protect the
status quo. The stigma serves to victimize women
and becomes a treatment barrier. In addition to
the cultural shame for being an addict, these
women come from histories wherein they don't believe
in their worth and values. |
Marriage
& Relationships
