Counseling Addicted Women

A Practical Guide

Monique Cohen

• Editorial: SAGE Publications, Inc
• Año: 1999
• ISBN:
  9781452236339
• Edición: 1
• Categoría: Psychologie
• Categoría: Addiction en psychologie

The result of the combined efforts of staff at a substance abuse treatment center, this book provides practical, hands-on guidance for working with addicted women. With staff and client training exercises at the end of each chapter, this comprehensive guide places particular emphasis on the women and their special needs and concerns.

Special issues and populations addressed include: pregnancy and substance abuse; designing treatment programs; homeless women; and substance abuse in the workplace.

PART I

Putting Women’s Substance Abuse in Social and Cultural Context

1	Perspectives on the Socialization of Women

Alcohol is the most widely used psychoactive drug in the United States.¹ More than half of the entire population drinks, and consequently, a large number of drinkers have at one time or another experienced light to extreme alcohol-induced impairment.² We live in a drinking society where even if one does not drink, he or she has been exposed to alcohol at an early age through family, friends, and the media. Approximately 43% of the U.S. adult population has been exposed to alcoholism in the family.³ Our early personal experience with alcohol becomes a major factor in how we view our own and others’ drinking.

Prior to counseling and treating women, it is important for counselors to identify their own personal attitudes toward alcohol, the reasons why people drink in our society, and how drinking and drunkenness are perceived. Reflecting on personal drinking experiences—in ourselves and others—is a good starting point for understanding the complexity of issues involved with alcoholism and drug abuse. This chapter is intended to provide you with an opportunity for personal reflection on backgrounds, attitudes, and feelings about alcohol. Only after personal feelings about alcohol have been explored can you begin a healthy relationship with a female client. By understanding and accepting your own personal attitudes and values, you can become more objective and more empathetic as you uncover the circumstances and history of alcohol use of the women you see in treatment.

You might feel uncomfortable discussing alcohol, drinking, and alcoholism with your women clients because it could raise painful personal issues in your own life. However, until you address your own issues, these concerns can stand in the way of openly and comfortably raising issues of alcohol and alcoholism with clients who might desperately need help with their drinking. Many counselors who have had difficulty discussing alcohol with clients have found it helpful to attend an alcoholism education workshop and to talk with alcoholism professionals. The Staff Training Activities at the end of this chapter provide several exercises that can help you to think about your own concerns with these issues.

Exploring Personal Attitudes Toward Drinking and Drunkenness

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Treatment counselors vary widely in their effectiveness. The main personal characteristics that influence treatment outcomes are interpersonal communication (including therapist’s empathy), genuineness, and respect for patients.⁴

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In the same way as people may hold culturally determined stereotypes about race, there also are strongly embedded attitudes and prejudices toward alcoholism. It was barely a decade ago when counselors, including physicians, could complete many years of health and mental health training without ever addressing alcoholism as a disease. Some of the reasons for this were pessimism about the successful treatment of alcoholics, the view of alcoholism as a moral issue or a psychological symptom, and the image of the alcoholic as a “skid row bum.” For some counselors, lack of education not only contributes to a failure to recognize and diagnose alcoholism but also causes them to avoid dealing directly with clients about alcoholism once it has been diagnosed.

It is not unusual for people to continue to have reservations and personal problems about accepting alcoholism as a disease. In staff training activities, the leader should encourage people in the group to express their opinions and feelings and let them know that most people need time and education to develop an understanding and acceptance of alcoholism as something beyond the individual’s control. You also should be familiar with the standard definition of alcoholism as classified in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV).⁵ As explained by the National Institutes of Health’s Ninth Special Report to the U.S. Congress on Alcohol and Health, the DSM-IV defines alcohol dependence as

a cluster of cognitive, behavioral, and physiological symptoms which indicate that a person continues to drink despite significant alcohol-related problems. Alcohol abuse generally is characterized as repetitive patterns of drinking in harmful situations with adverse consequences including impaired ability to fulfill responsibilities or negative effects on social/interpersonal functioning and health. The term “alcohol-related consequences” refers not to a specific diagnostic category but [rather] to a wide range of alcohol-related problems that includes difficulties with family members and friends, work problems, legal troubles, accidents and casualties, and health consequences. It is important to note that alcohol-related problems do not necessarily involve heavy drinking patterns.⁶

This definition has evolved many times over the past several decades and, no doubt, will continue to be revised as our knowledge of alcoholism grows. Researchers in many fields, from anthropologists and sociologists to physicians and pharmacologists, have contributed to the study of the causes of, and the best methods of treatment for, alcoholism and drug abuse.

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Individual differences in drinking behavior cannot be accounted for by genetic and biological factors alone. Psychologists have identified basic cognitive processes that influence drinking behavior and have shown how those processes might temper the effects of biological factors. Social scientists have determined how family, peer, and social context can influence drinking attitudes and behaviors, and anthropologists have investigated the role that culture plays when determining who drinks, when they drink, and how much they drink. Thus, the risk for alcoholism is determined by a complex interplay of genetic, psychological, and environmental factors.⁷

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Your initial task in working with women on issues of alcohol and alcoholism is to introduce a common language and convey basic education about alcoholism as a disease including signs and symptoms. A woman in the early stages of treatment combines personal denial with honest misconceptions about the nature of alcoholism. By helping the client to understand a simple definition of alcoholism and helping her to look at the signs and symptoms, you send the message that alcoholism can become part of a dialogue based on common understanding. The more you can share cognitive information about alcoholism as a disease in a nonjudgmental way, the safer the woman in treatment feels in revealing her experiences and concerns.

Societal Attitudes Toward Women Alcoholics

The most widely acknowledged issue for alcoholic women is the double stigma they face as both women and alcoholics. When people feel free to express their honest feelings about alcoholic women, responses range from disgust and impatience to a deep caring and respect, depending on the person’s understanding of both women’s issues and alcoholism. Society has tended to accept excessive drinking by men and to encourage it through various social patterns and customs. Drunkenness in women never has been acceptable. It always has been linked with promiscuity, immorality, and “unfeminine” behavior. Women traditionally have occupied a strategic place within the family and society. They have been expected to be responsible for the maintenance of moral and social values. Despite changing social norms, a woman still is expected to live up to a higher standard of moral and social behavior than is a man, especially when she is in the role of a mother. Without education and personal aware...