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Recovery Plus 20 Feb 2016 Men and women in treatment: the issues Providing culturally and clinically competent mental-health and addiction services requires clinicians to meet their patients in the reality of the patient’s life with compassion and empathy for the patient’s unique needs. Central to these needs are an understanding of and sensitivity to gender differences and the power dynamics inherent in them. Historically, treatment programmes have failed to properly address identity constructs which deviate from a normative standard based on a middle-aged, white male demographic1. True cultural and clinical competency, however, demands different treatment interventions for different gender expressions. These bespoke interventions must address the systemic realities of the patient’s life and consideration of the following. The sociocultural framework in which patients live. This includes the dominant cultural view of gender and the zeitgeist surrounding gender expression and gender roles. This analysis must include the impact of patriarchy and an understanding of feminist theory. Their family of origin. In addition to obtaining a thorough medical and psychological history, clinicians must get a sense of how gender roles manifested in the patient’s family of origin. The interpersonal relationships. Gender roles historically come with prescribed power structures. It is critically important that clinicians understand the pathological power dynamics that are supporting the patient’s illness in order to fashion appropriate interventions and support the patient’s long-term recovery. Their intrapersonal relationship. Everyone has an internal dialogue and self-concept. Men tend to value themselves for “what can I get” while, in contrast, women tend to define their value by “what can I give”. In addition, effective and competent treatment requires clinicians to understand and incorporate the following evidentiary findings relating to addiction and gender differences into their treatment plans. Men are more likely than women to become addicts2. In 2008, the US National Survey on Drug Use and Health found that 11.5% of males aged 12 and older had a substance abuse or dependence problem, compared with 6.4% of females. Women, however, face tougher challenges to getting treatment. It is important to note this gap is narrowing. Women suffer from a phenomenon know as telescoping. Women progress more quickly from using an addictive substance to dependence, addiction and treatment then men. Women who enter treatment do so with a more severe clinical profile than men despite having used less of the substance or having used the substance for a shorter time compared with men3. This means they present with more severe medical, behavioural, psychological and social problems. Hormonal differences impact substance responsiveness. Oestrogen, progesterone, metabolites of progesterone and negative allosteric modulators of the GABA-A receptor, such as DHEA, can influence the behavioural effects of drugs4. The online issue of Recovery Plus will also link you to the author’s presentation at Recovery Plus 2015 – just click the logo shown below when you access us online: Click for presentation Click


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