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Women Across the Lifespan A National Conference on Women, Addiction and Recovery

Women Across the Lifespan A National Conference on Women, Addiction and Recovery. H. Westley Clark, MD, JD, MPH Director Center for Substance Abuse Treatment Substance Abuse and Mental Health Services Administration. President George W. Bush State of the Union – January 28,2003.

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Women Across the Lifespan A National Conference on Women, Addiction and Recovery

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  1. Women Across the LifespanA National Conference on Women, Addiction and Recovery H. Westley Clark, MD, JD, MPH Director Center for Substance Abuse Treatment Substance Abuse and Mental Health Services Administration

  2. President George W. BushState of the Union – January 28,2003 • “…Addiction crowds out friendship, ambition, moral conviction, and reduces all the richness of life to a single destructive desire.”

  3. President George W. BushState of the Union – January 28,2003 • “…Let us bring to all Americans who struggle with drug addiction this message of hope: the miracle of recovery is possible, and it could happen to you.”

  4. The Administration’s Direction • The Bush Administration established drug reduction goals in the National Drug Control Strategy. • Reducing drug use by 10 percent within two years • Reducing drug use by 25 percent within five years • SAMHSA’s Mission Statement Building Resilience and Facilitating Recovery further emphasizes a strong commitment to recovery.

  5. SAMHSA’s Goals • Accountability: establish systems to measure performance • and ensure accountability • Capacity: build, enhance and maintain treatment infrastructure and capacity • Effectiveness: enable all communities and providers to deliver effective treatment services Enhancing Capacity Assuring Effectiveness Promoting Accountability

  6. SAMHSA’s Role Administering Substance Abuse Prevention and Treatment Block Grant Programs Promoting Evidence-Based Treatment Practices Supporting Clinical and Administrative Education and Training Programs Promoting Community-Based Service Availability and Quality Providing TA and Capacity-Building Tools Supporting a Nationwide Toll Free Referral Hotline Regulating and Training the Field in Pharmacologic Therapies

  7. Conference Topics • Co-occurring Disorders • Treatment Capacity • Prevention and Early Intervention • Addressing Needs of Children and Families • Homelessness • Infectious Diseases • Criminal Justice • Trauma and Violence

  8. Current Facts • Women are less likely than men to report current use of illicit drugs (6.4% versus 10.3%) • Nevertheless, the rate of non-medical use of prescription drugs is similar between women and men (2.6% versus 2.7%) Office of Applied Studies (2003) Results from the 2002 National Household Survey on Drug Use and Health

  9. Current Facts • Among youths aged 12-17, girls are less likely to use illicit drugs compared with boys (10.9% versus 12.3%) • The rate of non-medical use of prescription drugs is higher for girls than boys (4.3% versus 3.6%) • The rate of marijuana use is less for girls than for boys (7.2% versus 9.1%) Office of Applied Studies (2003) Results from the 2002 National Household Survey on Drug Use and Health

  10. Past Month Illicit Drug Use among Youth Aged 12-17, by Gender: 2002 Percent Using in Past Month Office of Applied Studies (2003) Results from the 2002 National Household Survey on Drug Use and Health

  11. Current Facts • In 2002, 44.9 percent of females aged 12 or older were current drinkers compared with 57.4 percent of males. • For the youngest age group (12-17), females and males had comparable rates of current alcohol use in 2002 (17.9 percent of females and 17.4 percent of males). Office of Applied Studies (2003) Results from the 2002 National Household Survey on Drug Use and Health

  12. Current Facts • Among women aged 15 to 44 in 2002, 53.4 percent used alcohol and 23.4 percent reported binge drinking in the month prior to the survey. • These rates were significantly higher than the rates for pregnant women of that age (9.1 and 3.1 percent, respectively). Heavy alcohol use was relatively rare (0.7 percent) among pregnant women. Office of Applied Studies (2003) Results from the 2002 National Household Survey on Drug Use and Health

  13. Current Facts • Among youths aged 12 to 17, girls were slightly more likely than boys to smoke (13.6 vs. 12.3 percent) • In 2002, 31.1 percent of women aged 15 to 44 smoked cigarettes in the past month compared with 17.3 percent of pregnant women of the same age group. Office of Applied Studies (2003) Results from the 2002 National Household Survey on Drug Use and Health

  14. Percentages of Women Aged 21 to 25 Reporting Past Month Substance Use, by Marital Status: 2002 Percentage Office of Applied Studies (2003) Results from the 2002 National Household Survey on Drug Use and Health

  15. Percentages of Women Aged 26 to 34 Reporting Past Month Substance Use, by Marital Status: 2002 Percentage Office of Applied Studies (2003) Results from the 2002 National Household Survey on Drug Use and Health

  16. Percentages of Women Aged 35 to 49 Reporting Past Month Substance Use, by Marital Status: 2002 Percentage Office of Applied Studies (2003) Results from the 2002 National Household Survey on Drug Use and Health

  17. Percentages of Married Women Aged 21 to 49 Reporting Past Month Substance Use, by Whether at Least One Child Younger Than Age 18 Lived in Their Home: 2002 Office of Applied Studies. (2003). Results from the 2002 National Survey on Drug Use and Health: National findings

  18. Substance Dependence or Abuse in the Past Year among Persons Aged 12 or Older by Gender: Percentages 2002 Percentage Office of Applied Studies (2003) Results from the 2002 National Household Survey on Drug Use and Health

  19. Received Substance Abuse Treatment in the Past Year among Persons Aged 12 or Older by Gender: Numbers in Thousands, 2002 Thousands Office of Applied Studies (2003) Results from the 2002 National Household Survey on Drug Use and Health

  20. Received Substance Abuse Treatment in the Past Year among Persons Aged 12 or Older by Gender: Numbers in Thousands, 2002 Thousands Office of Applied Studies (2003) Results from the 2002 National Household Survey on Drug Use and Health

  21. Perceived Need for Treatment for an Illicit Drug Use in the Past Year among Persons Aged 12 or Older by Gender: Numbers in Thousands, 2002 Thousands Office of Applied Studies (2003) Results from the 2002 National Household Survey on Drug Use and Health

  22. Most Women Who Needed Treatment for an Illicit Drug Problem Did Not Feel A Need for Treatment Felt No Need for TX Felt Need for TX Female Male

  23. The perpetuation of substance use disorders is facilitated by the denial of the impact of the problems associated with those disorders and by the powerful reinforcing properties of substances of abuse which produce those disorders. The demand for illicit drugs is also associated with the denial of impact and the failure to recognize the association between illicit drug consumption and the problems.

  24. Two Problemmatic Declaratives I Can’t Stop! I Won’t Stop!

  25. Number of Substance Abuse Treatment Facilities Source: Office of Applied Studies, Substance Abuse and Mental Health Services Administration, Uniform Facility Data 1996-1999; National Survey of Substance Abuse Treatment Services (N-SSATS), 2000.

  26. All Admissions, by Age Group and Sex in 2001 Source: 2001 SAMHSA Treatment Episode Data Set (TEDS).

  27. Type of Care Provided by Substance Abuse Treatment Facilities, by Whether Facilities Provided Special Programs or Services for Women: 2000 Percent of Facilities Source: 2000 SAMHSA National Survey of Substance Abuse Treatment (N-SSATS).

  28. Other Special Groups Served by Substance Abuse Treatment Facilities, by Whether Facilities Provided Special Programs or Services for Women: 2000 Percent of Facilities Source: 2000 SAMHSA National Survey of Substance Abuse Treatment (N-SSATS).

  29. Although budget concerns require a tight balancing of priorities, the Administration is requesting an increase in Substance Abuse funds

  30. SAMHSA Funding for Children & Families (Dollars in thousands)

  31. Block Grant Set-aside – Women Treatment Services • Increase the availability of treatment services designed for pregnant women and women with dependent children • FY 2004 243 Million • FY 2005 244 Million

  32. CSAT Allotments - Children and Families for FY 2003-2005(estimate) –Programs of Regional and National Significance • FY 2003 $ 24.6 Million • FY 2004 $ 33.7 Million • FY 2005 $ 33.7 Million

  33. National Comorbidity SurveyCo-occurring substance use disorders and mental disorders • 42.7% of individuals with a 12-month addictive disorder had at least one 12-month mental disorder • 14.7% of individuals with a 12-month mental disorder had at least one 12-month addictive disorder

  34. Defining Co-Occurring Disorders • Individuals who have at least one mental disorder as well as an alcohol or drug use disorder. • While these disorders may interact differently in any one person (e.g., an episode of depression may trigger a relapse into alcohol abuse, or cocaine use may exacerbate schizophrenic symptoms), at least one disorder of each type can be diagnosed independently of each other. SAMHSA Report to Congress at page 2

  35. Rates of Serious Mental Illness among Adults Aged 18 or Older, by Age and Gender: 2002 Percent with Serious Mental Illness Office of Applied Studies (2003) Results from the 2002 National Household Survey on Drug Use and Health

  36. PTSD in SA Treatment Patients • 29% of the sample of methadone treated patients met the criteria for life time PTSD • 53% - women • 14% - men • 55% of those with a history of PTSD reported symptoms in the past 6 months Clark et al, J of Substance Abuse Treatment 20:121-127 (2001) Clark et al, J of Substance Abuse Treatment 20:121-127 (2001) Substance Abuse Treatment 20:121-127 (2001)

  37. Traumatic Events and SA Treatment Patients cont. Clark et al, J of Substance Abuse Treatment 20:121-127 (2001)

  38. If we don’t ask, they won’t tell • It is important for SA treatment providers to recognize that traumatic events leave their imprints of patients • Disasters, terrorist attacks, and other generalized traumatic events may activate pre-existing PTSD or compound the effects of previous trauma • If clinicians don’t inquire about the effects of a traumatic event, many patients will not discuss them

  39. Receipt of Substance Use Treatment or Mental Health Treatment • Among adults with co-occurring SMI and a substance use disorder, the rate of specialty substance use treatment during the past year was similar among females (11%) and males (16%) • Females with co-occurring disorders were more likely than males to receive mental health treatment (54% versus 39%) Office of Applied Studies (2003) Results from the 2002 National Household Survey on Drug Use and Health

  40. Where We Are Going

  41. Promote Partnerships • Create forums in which SAMHSA and private organizations can develop collaborative strategies to improve alcohol and drug treatment and recovery services • Promote communication and collaboration among: • States and communities • Service providers • Academic institutions • Researchers • People in Need of Treatment • People in Recovery to provide an efficient, seamless system of services

  42. Promote Partnerships, (continued) • Continue to expand partnerships with: • Prevention • Mental Health • Primary healthcare providers • Child welfare agencies • Faith-based organizations • Criminal justice system • Schools • Business Community • Labor Community to enhance appropriate, quality service delivery in all health and human services

  43. Many Pathways to Recovery • A voice for the recovery community • Peer-to-peer recovery support services • RCSP • Credentialing • Faith-based • 12-Step Programs

  44. Enhance System Effectiveness • Facilitate consensus on quality of care and treatment outcomes • Support implementation of evidence-based practices that guide screening, intervention, assessment, engagement, individual and group therapies, relapse prevention, and continuing care • Develop reimbursement mechanisms that: • Incorporate performance requirements • Ensure support for system reinvestment

  45. Develop the Workforce • Conduct a nationwide addiction treatment and peer to peer workforce survey and develop a comprehensive report on the state of the workforce • Establish national addiction professional minimum competency standards • Develop ongoing data collection of information about the changing characteristics of the workforce • Continue dissemination of research findings and evidence-based clinical and organizational practices through the ATTC’s and other mechanisms

  46. Workforce Demographics • Gender: Majority of direct service staff is female (data ranges from 57 –60%; 70% of new counselors are female); Majority of management staff are male • Age: Average age of direct service staff was mid-forties to 50 years old; 75% of workforce over 40; many people enter the field in their late-30s • Race and Ethnicity: 75-90% of workforce is White; private agencies have fewer minority staff than public agencies

  47. Workforce Burnout • As we develop strategies to recruit people into the workforce, we must develop strategies to keep people in the workforce. • Career Ladders, Burnout Reduction, and Adequate Compensation are essential components of any comprehensive workforce strategy.

  48. Reduce Stigma • Promote stigma reduction for persons in alcohol/substance abuse treatment and recovery • Respect their rights • Treat recovering persons like those suffering from other illnesses • Support educational initiatives that inform the public about the effectiveness of treatment • Promote the dignity of persons in treatment and recovery

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