Different Approaches to Treatment Considering Sex, Gender and Gender Identity

Substance abuse disorder treatment and addiction medicine in general is a rapidly evolving sphere of healthcare. One of the fastest growing categories of medical and clinical research into the treatment of addiction and co-occurring disorders are the sex and gender specific differences in substance abuse treatment. This research is aimed at understanding what is common and uncommon in different populations with the goal of improving outcomes. Much is known about differences in sex and gender in treatment, but most researchers would argue that there are more unknowns than knowns in best approaches to both medical and clinical care in the course of substance use disorder treatment. So, here’s some of what we already know that’s important to understand and much of what we don’t know that researchers are set to explore.

There are more men than women in treatment programs for alcohol and drug addiction, however, women are more likely than men to seek treatment. Men are much more likely to abuse heroin and/or fentanyl however there is a marked increase in the use of heroin and fentanyl among women. The opposite is true regarding anxiety medication addiction: women are more likely to abuse and seek treatment for anxiety medications like Xanax, Ativan, Klonopin or Valium. Also, woman may develop addiction to substances of abuse faster than men, in medical terms, their progression from use to dependence is typically shorter and they may also present with more significant medical problems faster than men as well. One of the more studied and understood aspects of sexual differences in substance abuse treatment is the role of pregnancy and childcare in women seeking treatment.

Fear and a sense of responsibility plays a significant role in the lives of pregnant women and mothers seeking substance abuse treatment. According to an article from The Center for Child Health Policy at Vanderbilt University, there are many states throughout the U.S. that prosecute pregnant women for drug use and their findings indicate that this does more harm than good. Since most people don’t understand whether their state has the right to prosecute pregnant females for substance abuse or whether or not treatment providers are required to report them to the authorities for substance abuse, many pregnant females avoid treatment, substance abuse related or otherwise, for fear of prosecution. Mothers are also prone to avoid seeking treatment or discontinue treatment out of fear that social services authorities will remove children from their care temporarily or permanently. Moreover, many mothers fail to complete the course of substance abuse treatment because of their parental responsibilities and lack of support.

Researchers are only beginning to understand the specific hurdles to treatment that transgender and gender non-conforming individuals experience. Like women, transgendered and gender non-conforming populations experience trauma more often than males. Trauma and the depression and anxiety that stem from traumatic experiences, often contributes to the development of substance abuse disorders and mental illness, especially when the trauma occurs in children and teens. According to the National Institutes of Health, “…the link between trauma exposure and substance abuse has been well-established. For example, in the National Survey of Adolescents, teens who had experienced physical or sexual abuse/assault were three times more likely to report past or current substance abuse than those without a history of trauma. In surveys of adolescents receiving treatment for substance abuse, more than 70% of patients had a history of trauma exposure.” Treatment facilities that offer gender-specific treatment programs and/or programs that are sensitive to transgender and gender non-conforming populations that practice trauma-informed care may have a higher percentage of positive outcomes.

It’s important to understand substance abuse disorder treatment through the lens of sexual differences, but it’s just as important to research and develop new approaches to treatment with mindfulness of gender identity as well. By recognizing and addressing the unique needs of men, women and transgender and gender non-conforming populations, we should expect an increased number of positive outcomes.