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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 – – – – 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 • • • • • Unitarian-Universalist Many mainstream Protestant churches Reform Judaism Metropolitan Community Church Other spiritual paths