National Institute on Drug Abuse Treatment Recommendations from NIDA's Conference on Drug Addiction and the Health of Women

Broad Scope

1. Because women and men use drugs for different reasons, how should treatment for drug abuse differ for each sex? Should treatment programs include different pharmacologic substances for women and men?
2. There is commitment at the Federal, State, and local levels to making women's drug treatment programs comprehensive, but there is little research to support this or any other particular drug treatment approach for women. Thorough trials, data analysis, and follow up are needed to determine their effectiveness. More research is needed to determine what services women are being offered or receiving when they enter drug treatment. What are the treatment outcomes in different types of programs? Are some women more responsive to certain types of treatment than others?
3. More research is needed on sex differences in psychosocial and behavioral drug treatment approaches and on treatments for women, including pregnant women. What psychosocial interventions are particularly effective in reducing some women's urge to take drugs?
4. Research is needed on treatment efforts with women and adolescent girls who do not have children; most previous research has focused on those who have children.
5. Self-esteem, life options, and environmental and socialization factors should be considered in the design of psychosocial treatments for women.
6. More research is needed on helping drug abusers change drug-using behaviors and on methods to ensure that the behavior changes endure. Although contingency techniques have been found to reduce use of alternative drugs such as methadone in treatment programs (i.e., heroin addicts on methadone treatment who use cocaine as an alternative), individuals sometimes revert to drug-using behaviors when rewards are stopped. Researchers need to find ways to help the desired behavior endure in the absence of rewards.
7. More research is needed on how to assist women with their efforts at harm reduction and the use of new strategies for harm reduction. How can treatment services be modified to complement the efforts of women to reduce the harm of drug abuse? Women who use drugs need more information about how drugs affect their health so that their efforts at harm reduction are more successful.

Pregnancy

1. Research is needed to answer some of the drug-related questions facing obstetricians. For example, should women who are addicted to heroin go through drug detoxification during pregnancy? If so, how should the fetus be monitored during the drug detoxification process?
2. What is the appropriate method for treating depression and other psychiatric conditions in pregnant women? Risks exist in both prescribing and not prescribing drugs to treat depression in pregnant women.

Characteristics

1. It is important to determine the characteristics of women who do not get into treatment. What are the barriers for different groups? Researchers should examine the large national data bases to identify the characteristics of women in drug treatment. Data are needed on income, health insurance coverage, age, marital status, sexual orientation, number and ages of children, race and ethnicity, housing situation, and primary language spoken. Type and severity of drug problems, psychiatric problems, history of sexual and other physical abuse, and HIV status are other factors that need to be analyzed.
2. Which groups of women need intensive drug treatment?
3. What are the characteristics of women who receive drug treatment from their personal physician versus those who receive it from a publicly funded program versus those who receive treatment from a privately funded program?

Comorbidity and Treatment Modalities/Pharmacotherapies

1. It is important to assess comorbid psychiatric conditions and analyze levels of drug addiction. More effective treatments for anxiety, depression,and other disorders comorbid with drug depedence may reduce the prevalence of drug abuse in women.
2. What is the appropriate method for treating depression and other psychiatric conditions in drug abusing women, particularly pregnant women? Risks exist in both prescribing drugs and not prescribing drugs to treat depression in pregnant women.
3. The effectiveness of cognitive behavioral treatments for depression and anxiety should be carefully examined in a comprehensive treatment setting.
4. What combinations of behavioral therapies and pharmacotherapies provide the most effective treatment of anxiety, depression, and other psychiatric conditions in women in general and in drug-addicted women in particular? Practitioners typically give inadequate doses or inadequate combinations of therapy which can be worse than providing no treatment at all.
5. Research is needed on antisocial and depressive behaviors, both singly and in combination, in drug-abusing women, because women are more likely to seek treatment for depression than for antisocial behaviors.
6. Research should target the effects of specific treatments on specific sites of action, receptors, or physiologic systems which have been affected or damaged by a drug of abuse.
7. Few studies examine sex differences in the effects of psychoactive drugs in humans, and most studies of these drugs are done on young male medical students. More research is needed on the effects of psychoactive medications on women of childbearing age, particularly pregnant women, and how women's hormones and menstrual cycles may influence the effects of these drugs.
8. Almost no preclinical research has been conducted with female subjects on the effects of serotoninergic compounds, or even with a mix of female and male subjects. Of approximately 1,600 experiments conducted on serotonin's effect on anxiety in nonhuman animal models, nearly 100 percent were conducted with male subjects only. Preclinical psychopharmacologic studies are the precursors to clinical trials, and therefore, this research is necessary to discover the most effective treatments of anxiety and depression for women. Given that there are sex differences in the serotonin system, and that serotonin is linked to defensive behaviors, it is important to conduct preclinical research in psychopharmacology using female nonhuman animals. A special initiative is needed to ensure that this preclinical research is conducted, just as special efforts were made to require the inclusion of women in other federally funded clinical trials.

Violence

1. The efficacy of clinical interventions designed to prevent future assaults should be studied.
2. Researchers who seek to develop more effective interventions for women must address complex family relationships and the intergenerational patterns of family violence and alcohol and other drug problems.
3. Researchers need to focus more on the structural and sociocultural factors that keep women in the cycle of drug abuse and violence. Individual and cultural differences need to be recognized when developing intervention strategies and support systems for women experiencing partner violence or drug abuse.
4. How does partner violence affect a woman's treatment outcomes? Treatment programs for drug abuse must take into account the significance of violence and the woman's history of victimization. More needs to be learned about the personal characteristics that enable some women to endure violent and adverse conditions.

HIV/AIDS

1. Women with HIV infection are at risk of developing a variety of sexually transmitted diseases and other gynecologic problems. Research is needed on what diseases are specific to women with HIV and how they are manifested. Clinical manifestations that are specific to women need to be investigated thoroughly, including the efficacy of new HIV therapies in treating these diseases.
2. Research is needed on how best to identify women who are at high risk of HIV infection, particularly women drug users; make services available to them; consult with them before and during pregnancy about azidothymidine (AZT) intervention; and implement treatment that is effective and likely to have the desired outcomes.

Effects of Punitive Actions

1. Researchers need to examine and discuss the findings of studies that claim to be successful in controlling drug abuse by prosecuting pregnant women who are addicts. Although such findings may not be considered scientifically valid by most researchers, some members of the community may use the information to justify further prosecutions of women who abuse.
2. Research is needed to document some of the punitive community approaches to women, particularly pregnant women, who abuse drugs. What are the effects of these punitive approaches on the health of these women and the likelihood of their completing drug treatment?
3. Women drug abusers, particularly those who are pregnant, want and need health care services, but they will end contact with health care providers who appear to judge, blame, or humiliate them because of their drug use. Drug treatment services should be designed to ease the problem of women avoiding or dropping out of drug treatment programs?

Lesbian Issues

1. Information is needed to determine if there are differences in treatment outcomes among lesbian, bisexual, and heterosexual women as well as treatment differences in terms of race and ethnicity. The characteristics of successful drug abuse programs in the lesbian community need to be identified.

Ethnic/Racial/Cultural Issues

1. Psychosocial predictors of drug abuse and AIDS risk or sexual risk behaviors should be identified for individual racial and ethnic minority groups of women so that culturally appropriate interventions can be designed, developed, and evaluated.
2. Individual and cultural differences need to be recognized when developing intervention strategies and support systems for women experiencing partner violence or drug abuse.
3. More studies are needed to examine the racial and ethnic differences in the factors associated with health behaviors and correlates of drug abuse in women. These studies will help to develop more effective intervention programs for drug-abusing women from different racial and ethnic groups.

African-American

1. Research is needed on how to address the need of many drug-abusing African-American women for external support and extended family systems. How can a new sense of family and community involvement be developed?
2. How can the needs of African-American women be recognized, and what incentives will help them confront depression and avoid drugs.
3. Research is needed to identify the qualitative experiences of African-American women and combine this information with analytic research so that more effective drug abuse treatment programs can be developed.

Hispanic

1. Studies are needed to determine the effectiveness of drug treatment for Hispanic women.
2. Research is needed on which drug treatment programs and services are most effective in meeting the needs of Puerto Rican women who abuse drugs. What are the differences between women who receive treatment and those who do not?

Native American

1. Research is needed on drug abuse treatment strategies that are appropriate to the needs of American Indian women. Better health education and outreach strategies are needed.

 

[Previous Section][Table of Contents][Next Section][W&GR Home]

NIDA Home | Site Map | Search | FAQs | Accessibility | Privacy | FOIA (NIH) | Employment | Print Version _ The National Institute on Drug Abuse (NIDA) is part of the National Institutes of Health (NIH) , a component of the U.S. Department of Health and Human Services. Questions? See our Contact Information. Last updated on Thursday, February 21, 2002.