Download Professional Women and Addiction

Addictive Disorders in
Professional Women
2007 Tuerk Conference:
Women, Trauma and Addiction
Penelope P. Ziegler, M.D., FASAM
The William J. Farley Center
Williamsburg, VA
Addiction Demographics in Women
• Prevalence of alcoholism
– 18-29
– 30-44
Female 3.83
Female 1.50
Male 9.26
Male 4.58
• Prevalence of other drug
dependence
– Less specific data
– Men > women with illicit drugs
– Women > men with prescription drugs
Prevalence
10
9
8
7
6
5
4
3
2
1
0
Alcohol
St. Drugs
Rx Drugs
F 18-30 M 18-29 F 30-44 M 30-44
Professional Women
• Lower incidence of early onset, rapidly progressive
addiction that impairs academic achievement
• Several studies have found higher than expected
positive family history of alcoholism and other
addictions
– Over-achieving family heroes?
– Experienced caretakers and chaos managers?
• Other common co-occurring issues
– Chronic pain
– Post traumatic stress disorder
– Depression
Identity Issues
• Conflict between social role models
and professional roles
• Lack of professional women as
mentors and role models
• Navigating a male-dominated ocean
• The “double imposter” syndrome
Known Risk Factors for Addiction
• Inborn
– Genetic
– Intrauterine
• Acquired
– Family of origin environment
• Addiction
• Violence
• Sexual, physical abuse
– Co-occurring psychiatric disorders
• Bipolar
• Untreated attention deficit hyperactivity disorder
• Post traumatic stress disorder
– Age of first substance use
Risks and Female Professionals
• Data are questionable but suggestive
• High incidence of genetic and
environmental loading for addiction
– Family role of woman in her family of
origin will influence her recovery
– Unresolved trauma from childhood will
influence her progress in recovery
Women’s Experience in Professional
Education and Training
• Most women encounter sexist attitudes
and discrimination beginning in college
• Depending on the profession, sexual
harassment gets worse as she climbs
the professional ladder during graduate
education and training
• Impacts on self-esteem, job satisfaction
Research Findings
• 2002 AAUW study found that two-thirds of
female college student experience sexual
harassment by older students or faculty
• 2004 study found 50-65% professional
women experience severe sexual harassment
– Job loss or loss of promotions
– Long term financial consequences
– Emotional damage that persists
• For women in traditionally male-dominated
professions, Dall & Maass found
– Women whose appearance and behavior is more
egalitarian are more likely to be harassed
– Less harassment of women who dress and act in
more traditionally feminine manner
In Medicine
• Minnesota Study (2002)
– Residents and medical students statewide
– Women were much more likely than men to report
harassment, especially public humiliation, loss of
professional opportunities due to gender, sexual
gestures, comments and unwanted touching
– Women were also much more likely to report that
harassment had a lasting adverse effect on both career
and emotional wellbeing
• Massachusetts Study (2000)
– Residents and faculty at MGH and BU
– 77% of women vs. 30% of men perceived
gender discrimination
– 51% of women vs. 9% of men thought gender had
held back their careers
– 30% of women reported harassment of quid pro quo
type or worse; no men reported this
“Telescoping” of Women’s Addiction
• Later onset on misuse of intoxicants
– Using alcohol in non-social settings
– Self-medicating with prescription drugs
– Finding relief with illicit drugs
• More rapid progression with earlier
symptoms of dependency
– Guarding supply, doctor shopping, hiding empties,
“cleaning up”
– Trying to control, cut down or quit
– Using despite knowing it was making other
symptoms worse
Shame in the Woman Professional
• Image management
– Seeking help is not consistent with image
of competent professional
– Women fear loss of autonomy
• Increased isolation
– No true peer support system
– Trust issues with fellow professionals
• Struggle against self-destruction
– Many report chronic suicidal ideation
– Motivator is shame and sense of failure
“Self Portrait”
Shame Delays, Complicates Diagnosis
• Women unable to reach out for help
– Using in isolation
– Acting “as if” everything is okay
• Hiding truth of progressing addiction from
self and others
– If help is sought, she appears to be (and may be)
depressed, anxious, physically ill
– Family, medical professionals miss reality of
diagnosis, enable continued use
• Does not fit stereotype of alcoholic, addict
– Still practicing profession
– Too clean, upstanding, well-educated
Co-Occurrence of Addiction and Sexual Trauma
• Studies in women seeking treatment for
sequelae of sexual trauma
– 40-80% meet diagnostic criteria for substance use disorder
(abuse or dependence)
– Many began using drugs to medicate symptoms
• Studies in women entering addiction treatment
– 50-80% have positive history for sexual abuse
– Many have never disclosed trauma prior to treatment
– Commonly PTSD symptoms emerge or worsen as woman
completes detoxification
Relationship of Women’s Addiction and
Sexual Trauma
• Childhood sexual trauma
– Incidence of severe psychopathology depends
on various factors
• Secrecy and shame
• Blame and threats
• Persistence of negative world view
– Children of addicted families at highest risk
• Adult sexual trauma
– Higher incidence of PTSD than other severe
traumas such as combat, terrorism
– Immediate counseling lowers incidence
– Beta blockers may also help
– Self-medication very common
Intimate Partner Violence
• Another shame-based secret
• Professional women no less likely to be
battered than non-professional women
• Professional women less likely
to seek help when being battered
– Usual reasons of fear, intimidation
– Additional shame due to conflict between
professional image and reality of her
perceived helplessness in relationship
Special Issues for Women of Color and
Other Cultural and Ethnic Minorities
• Dealing with the legacy of racism in women’s
self-esteem, assertiveness
– Finding support for education, professional identity
– Finding a support group and mentors within the profession
– Finding a recovery support group
• Dealing with the overt and covert racism
within the profession
• Dealing with society’s racist and ethnic
prejudices as they effect a women practicing
her profession
Special Issues for Lesbians
• External Factors
– Settings for socialization and meeting other women
• Women’s bars.
• Sports activities- usually sponsored by bars, breweries
– Common sexual practices
• Use of sedative drugs for relaxation
• Use of stimulants to increase libido, arousal
• Internal Factors
– Self-medication of unresolved internalized
homophobia/ heterosexism
– Self-medicating symptoms of PTSD which may be
exacerbated by homophobic/ heterosexist
experiences in professional setting
Other Co-Occurring Disorders
• Affective disorders
–
–
–
–
Major depression
Depressive disorder, NOS
Dysthymic disorder
Bipolar disorder
•
•
•
•
Type I, including rapid cycling
Type II
Cyclothymia
NOS
• Anxiety disorders
– Generalized
– Panic, with or without agoraphobia
– PTSD
• Eating disorders
– Bulemia
– Anorexia
– NOS
• Personality disorders
Body Image Issues
• Our culture creates unattainable ideals for
women’s bodies
– Thinness
– Perpetual youth
• Sexual trauma creates a shame-based
identity due to violation of the self through
an attack on the body
• Addiction further distorts body image and
adds more shame via behavior associated
with getting and using alcohol and other
drugs or while under the influence
Chronic Pain and Addiction, Recovery
• Two distinct groups of women
– Women who develop pain syndrome, begin treatment
with opioids, -> addiction to opioids
– Women with past history of addiction which is
re-activated or complicated this opioids prescribed
• Approaches to treating pain safely and
effectively in addicted population
– Use of alternative, non-opioid pain management
strategies and protocols
– Use of written doctor-patient agreements
– Integration of pain management into addiction
treatment program
Treatment Issues for
Professional Women
• Assessment
– Most standardized screening tools designed
for men, focus on behavioral consequences
– Women respond best to unstructured, open-ended
interviews focusing on emotional consequences
– Professional women are especially guarded
• Choosing a treatment program
–
–
–
–
–
Recognizes special needs of professional women
Has gender-specific and mixed groups
Addresses co-occurring disorders
Has cultural competence
Addresses re-entry issues
• Returning to professional practice, monitoring
• Returning to family, relationship
Twelve-Step Programs and Women
• Some barriers frequently encountered
– The Program literature, prayers, God
– Sexist, heterosexist and homophobic attitudes
– Opinions of some members which do not reflect AA
Traditions or majority beliefs
• Meeting choices
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–
–
–
Women’s meetings, GL meetings for lesbians
Closed vs open meetings
Speaker meetings vs discussion meetings
Specialized professional meetings- IDAA, ILAA, etc.
• Relationships in recovery
– The “13th Step”
– Too much too soon
– Too little too late
Spiritual Issues Complicating
Professional Women’s Recovery
• Religious conflicts
– Rejection of gender equality, orientation, and other experiences
by religion of childhood/ family of origin
– Deep-seated sense of rejection by and anger at God
– Skepticism based on scientific training
• Finding a higher power
– A higher power is something beyond self, larger and stronger,
more forgiving
– Initially, may be the group or spiritual advisor/sponsor
– God as a concept can grow to meet one’s needs
• Building a spiritual life to embrace diverse needs
– In Twelve Step programs
– In more inclusive religious groups
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•
•
•
•
Unitarian-Universalist
Many mainstream Protestant churches
Reform Judaism
Metropolitan Community Church
Other spiritual paths