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

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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

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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.

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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.

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The Administrations 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
• SAMHSAs Mission Statement Building Resilience
  and Facilitating Recovery further emphasizes a
  strong commitment to recovery.

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SAMHSAs 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
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SAMHSAs 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
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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

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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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.
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Two Problemmatic Declaratives
I Cant Stop!
I Wont Stop!
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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.
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Source 2001 SAMHSA Treatment Episode Data Set
(TEDS).
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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).
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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).
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Although budget concerns require a tight
balancing of priorities, the Administration is
requesting an increase in Substance Abuse funds
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SAMHSA Funding for Children Families
(Dollars in thousands)
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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

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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

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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

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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
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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
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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
20121-127 (2001)
Clark et al, J of Substance Abuse Treatment
20121-127 (2001) Substance Abuse Treatment
20121-127 (2001)
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Traumatic Events and SA Treatment Patients cont.
Clark et al, J of Substance Abuse Treatment
20121-127 (2001)
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If we dont ask, they wont 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 dont inquire about the effects of
  a traumatic event, many patients will not discuss
  them

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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
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Where We Are Going
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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

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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

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Many Pathways to Recovery

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

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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

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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 ATTCs and other mechanisms

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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

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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.

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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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www.samhsa.gov
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Ordering and Funding Information
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