Examination of both men and women with co-occurring disorders show no remarkable difference with their substance use disorders but when the mental health diagnosis for both genders was compared it shows significant differences in that while women with substance abuse history were mostly diagnosed with affective disorder, the men in the other hand show comorbidity of substance use and schizophrenia and/or personality disorder (Phillips, et al., 2010). Studies do show that some of the common features associated with women diagnosed with substance misuse are a history of childhood sexual, physical, and/or emotional abuse (Lotzin, et al., 2019; Phillips, et al., 2010), and these are risk factors associated with the development of mental health illness (Lotzin, et al., 2019). It is estimated that between 30 to 90% of all the women abusing or addicted to substance use have a childhood history of sexual abuse and that not less than 30 % of all the women diagnosed with mental health disorders report a history of childhood trauma and studies do show a link between the severity of the childhood trauma to the severity of the symptomologies of both their substance misuse and mental health symptoms (Lotzin, et al., 2019; Phillips, et al., 2010).
Findings from various substance abuse treatments show that women who participate in treatment do display medical and social problems, including mental health disorders and psychological distress that are complex and diverse, also common are high rates of a childhood history of abuse and trauma, and other socioeconomic problems (Lincoln, et al., 2006).
The prevalent co-occurring disorders common among women
For long studies on co-occurring disorders focused on men but recently researchers have started paying very close attention to co-occurring substance use and mental health disorders in women due to the high-risk behavior and the complex physiological, psychological, and socioeconomic problems associated with comorbidity in women. Among women diagnosed with substance use disorders studies do show that up to 90% of those in treatment report a history of childhood sexual abuse thus making them very susceptible to Post-traumatic Stress Disorder (PTSD) (Phillips, et al., 2010). Findings from studies do show a correlation between PTSD and childhood trauma thus making PTSD more prevalent among women than men.
Some of the common features of PTSD include re-experiencing (intrusive memories and nightmares of the trauma, strong feelings of distress when reminded of the event, and feeling as though the event were happening again), hypervigilance (indicating enhanced threat sensitivity, having difficulty falling or staying asleep, having trouble concentrating, and constantly being on guard or feeling like danger is lurking around every corner), and avoidance of places, activities or things that could remind a person of the traumatic event (Lotzin, et al., 2019). When the co-occurring mental health and substance abuse disorders were examined for the different classes of substances it was discovered that women still have a rate that is twice that of men for the prevalence of current episode PTSD for opioid use disorder, cocaine use disorder, cannabis use disorder or sedative use disorder (Lotzin, et al., 2019). In addition to PTSD which is the most common mental health disorder in women with substance abuse disorders, other serious co-occurring mental health disorders include depression, anxiety, eating disorders, borderline personality disorders. Other less common co-occurring mental health disorders among women with substance abuse disorder are schizophrenia and bipolar disorder (Phillips, et al., 2010; Tracy, & Johnson, 2007).
- Co-occurring Substance Abuse and PTSD in Women. Studies of women and co-occurring substance misuse and mental health disorders do show a high rate of co-occurring trauma-stress disorders such as PTSD and substance abuse disorders, particularly among women. Research studies show that up to 90% of women seeking treatment do report a history of sexual, emotional, and physical abuse (Hien, et al., 2009; Phillips, et al., 2010).
- Co-occurring Substance Abuse and Major Depression Disorder (MDD) in Women. Comparing the propensity of both men and women with substance use history to suffer from depression studies do show that women are twice more likely to suffer from co-occurring substance and depression disorders. Findings from several studies do show that more than 50% of the women diagnosed with substance use disorders have a comorbid depression disorder (Davis, et al., 2008).
- Co-occurring Substance Abuse and Anxiety Disorder in Women. Women with histories of childhood physical or sexual trauma do show a high prevalence of co-occurring substance abuse and mental health disorders. Findings in studies show that women who experience childhood abuse end up being diagnosed with PTSD, depression, and anxiety later in adulthood (Larson, et al., 2005).
- Co-occurring Substance Abuse and Eating Disorder in Women. Cohen and colleagues (2010), on examining numerous studies of women in treatment and the community found a very strong association in women between substance misuse and eating disorders. Studies also show that 30.1% of women who seek treatment for alcohol disorders do meet the criteria for eating disorders.
- Co-occurring Substance Abuse and Borderline Personality Disorders in Women. Some of the characteristic features of individuals with borderline personality disorder include very intense emotional responses to adverse events and their slower turn to normal or baseline functionality. In other words, they have a serious problem regulating their emotions. This problem is even compounded for those with co-occurring substance use disorders (Axelrod, et al., 2011). Lee and colleagues (2015), in their study, reveals that around 1% of the general population meet the diagnostic criteria for borderline personality disorder but that the estimate skyrocket to 65% for individuals seeking treatment with substance abuse diagnosis. Examining a sample of offenders newly admitted in different prison treatment programs Zlotnick and colleagues (2008), noticed that significantly more women in prison treatment programs were more likely to report a lifetime of psychiatric disorders and borderline personality disorder. In addition, compared with the general population women in prison were twice as likely to report or be diagnosed with a borderline personality disorder.
The Impact of Domestic Violence and the Development of Co-Occurring Disorders
One of the common features of women receiving treatment for either mental health or substance use disorders is that most of them report a history of domestic violence. Findings from studies do show that up to 62% of women in treatment do attest to the fact that they have been victims of domestic violence whether it be emotional, physical, and/or sexual violence or abuse (Phillips, et al., 2010). For most of the women in treatment, their mental health and substance abuse problems stem from their long history of struggle with interpersonal violence which is associated with their traumatic history and the development of substance abuse and mental health disorders (such as, PTSD, low self-esteem, anxiety, and depression) ( Andrews, et al., 2019; Phillips, et al., 2010).
Findings Associated with Co-Occurring Disorders in the Female Prison Service
Incarcerated women often present a very complex history of being assaulted and also being involved in criminal activities. Women in prison are more vulnerable to be diagnosed with poor mental health and substance use problems (Nargiso, et al., 2014; Phillips, et al., 2010). Studies do show that dually diagnosed women in the prison systems are more likely to be involved in criminal activities than those in the general population. At least 75% of women in the prison system have a co-occurring diagnosis for mental health and substance use disorders. Women in prison struggle with multiple life stressors that put them at high risk in their re-entry into the community. The lack of adequate social support and services designed to address high-risk factors as identified by Narciso and colleagues (2014) to include; “severe structural and social barriers, such as poverty, discrimination, homelessness, histories of trauma and abuse, unemployment, limited education, limited treatment options, dependence on drug-using or abusive partner for shelter, economic support, or transportation to legally mandated treatment and other visits, and sometimes families and friendship networks in which there are no non-using members” has the potential to compromise the ability of these women to effectively deal with these challenges.
Since women are in treatment whether it be mental health treatment or substance abuse treatment service there is ample evidence to show that women do have unique treatment needs compared to men in treatment. Studies do show that in cases where treatment programs do consider specific treatment needs and concerns for women such as childcare and other health and social needs and were gender-specific, clients do report better treatment outcomes compared to services that did not (Clark, et al., 2008). Most often than not women seeking treatment for mental health and substance abuse have a history of sexual, physical, and emotional abuse, and it is more likely that in some cases the perpetrators of these abusive acts maybe also in treatment along with these women making it very difficult for them to fully address their needs therapeutically during mixed group sessions in treatment. Therefore, making it all the more very sensible to have gender-specific treatment programs.
Andrews, N. C. Z., Motz, M., Bondi, B. C., Leslie, M., & Pepler, D. J. (2019). Using a
Developmental-Relational Approach to Understand the Impact of Interpersonal Violence in Women Who Struggle with Substance Use. International Journal Of Environmental Research And Public Health, 16(23). https://doi-org.proxy1.ncu.edu/10.3390/ijerph16234861
Axelrod, S. R., Perepletchikova, F., Holtzman, K., & Sinha, R. (2011). Emotion regulation and
substance use frequency in women with substance dependence and borderline personality disorder receiving dialectical behavior therapy. The American Journal Of Drug And Alcohol Abuse, 37(1), 37–42. https://doi-org.proxy1.ncu.edu/10.3109/00952990.2010.535582
Clark, C., Young, M. S., Jackson, E., Graeber, C., Mazelis, R., Kammerer, N., & Huntington, N.
(2008). Consumer perceptions of integrated trauma-informed services among women with co-occurring disorders. The Journal Of Behavioral Health Services & Research, 35(1), 71–90.
Cohen, L. R., Greenfield, S. F., Gordon, S., Killeen, T., Jiang, H., Zhang, Y., & Hien, D. (2010).
Survey of eating disorder symptoms among women in treatment for substance abuse. The American Journal On Addictions, 19(3), 245–251. https://doi-org.proxy1.ncu.edu/10.1111/j.1521-0391.2010.00038.x
Davis, L., Uezato, A., Newell, J.M., & Frazier, E. (2008). Major depression and comorbid
substance use disorders. Current Opinions in Psychiatry, 21(1), 14-8.
Larson, M. J., Miller, L., Becker, M., Richardson, E., Kammerer, N., Thom, J., Gampel, J., &
Savage, A. (2005). Physical health burdens of women with trauma histories and co-occurring substance abuse and mental disorders. Journal of Behavioral Health Services & Research, 32(2), 128–140. https://doi-org.proxy1.ncu.edu/10.1007/BF02287262
Lee, N. K., Cameron, J., & Jenner, L. (2015). A systematic review of interventions for co-
occurring substance use and borderline personality disorders. Drug & Alcohol Review, 34(6), 663–672.
Lotzin, A., Grundmann, J., Hiller, P., Pawils, S., & Schäfer, I. (2019). Profiles of Childhood Trauma
in Women With Substance Use Disorders and Comorbid Posttraumatic Stress Disorders. Frontiers in Psychiatry, 1.
Nargiso, J. E., Kuo, C. C., Zlotnick, C., & Johnson, J. E. (2014). Social Support Network
Characteristics of Incarcerated Women with Co-Occurring Major Depressive and Substance Use Disorders. Journal of Psychoactive Drugs, 46(2), 93–105. https://doi-org.proxy1.ncu.edu/10.1080/02791072.2014.890766
Phillips, P., McKeown, O. & Sandford, T. (2010). Dual diagnosis: Practice in context. Oxford, UK:
Tracy, E. M., & Johnson, P. J. (2007). Personal social networks of women with co-occurring
substance use and mental disorders. Journal of Social Work Practice in the Addictions, 7(1–2), 69–90. https://doi-org.proxy1.ncu.edu/10.1300/J160v07n01_05
Zlotnick, C., Clarke, J. G., Friedmann, P. D., Roberts, M. B., Sacks, S., & Melnick, G. (2008).
Gender differences in comorbid disorders among offenders in prison substance abuse treatment programs. Behavioral Sciences & The Law, 26(4), 403–412. https://doi-org.proxy1.ncu.edu/10.1002/bsl.831