Mixed-gender Programs Research Articles

Treatment outcome and readmission risk among women in women-only versus mixed-gender drug treatment programs in Chile

IntroductionTraditional treatment programs for substance use disorder (SUD) tend to be male-dominated environments, which can negatively affect women's access to treatment and related outcomes. Women's specific treatment needs have led some providers to develop women-only SUD treatment programs in several countries. In Chile, women-only programs were only fully implemented in 2010. We compared treatment outcomes and readmission risk for adult women admitted to state-funded women-only versus mixed-gender SUD treatment programs in Chile. MethodsWe used a registry-based retrospective cohort design of adult women in women-only (N = 8200) and mixed-gender (N = 13,178) SUD treatment programs from 2010 to 2019. The study obtained data from the National Drug and Alcohol Service from Chile. We used a multistate model to estimate the probabilities of experiencing treatment completion, discharge without completion (i.e., patient-initiated discharge and administrative discharge), or readmission, as well as the likelihood of being readmitted, conditioned on prior treatment outcome. We adjusted models for multiple baseline characteristics (e.g., substance use, socioeconomic). ResultsOverall, 24% of women completed treatment and 54% dropped out of treatment. The proportion of patient-initiated discharges within the first three month was larger in women-only than in mixed-gender programs (19% vs. 12%). In both programs, women who completed treatment were more likely to experience readmission at three months, and one and three years. In the long term, women in the women-only programs were more likely to complete treatment than women in mixed-gender programs (34% vs. 23%, respectively). The readmission probability was higher among women who previously completed treatment than those who had a discharge without completion (40% vs 21% among women in women-only programs; 38% vs. 19% among women in mixed-gender programs, respectively); no differences occurred in the risk of readmission between women-only and mixed-gender programs. ConclusionsIn terms of treatment outcomes and readmission risk, women-only programs had similar results to mixed-gender programs in Chile. The added value of these specialized programs should be addressed in further research.

Rates and predictors of brief intervention for women veterans returning from recent wars: Examining gaps in service delivery for unhealthy alcohol use

BackgroundApproximately one in four women veterans accessing the Department of Veterans Affairs (VA) engage in unhealthy alcohol use. There is substantial evidence for gender-sensitive screening (AUDIT-C = 3) and brief intervention (BI) to reduce risks associated with unhealthy alcohol use in women veterans; however, VA policies and incentives remain gender-neutral (AUDIT-C = 5). Women veterans who screen positive at lower-risk-level alcohol use (AUDIT-C = 3 or 4) may screen out and therefore not receive BI. This study aimed to examine gaps in implementation of BI practice for women veterans through identifying rates of BI at different alcohol risk levels (AUDIT-C = 3–4; =5–7; =8–12), and the role of alcohol risk level and other factors in predicting receipt of BI. MethodsFrom administrative data (2010–2016), we drew a sample of women veterans returning from recent wars who accessed outpatient and/or inpatient care. Of 869 women veterans, 284 screened positive for unhealthy alcohol use at or above a gender-sensitive cut-point (AUDIT-C ≥ 3). We used chart review methods to abstract variables from the medical record and then employed logistic regression comparing women veterans who received BI at varying alcohol risk levels to those who did not. ResultsWhile almost 60% of the alcohol positive-risk sample received BI, among the subset of women veterans who screened positive for lower-risk alcohol use (57%; AUDIT-C = 3 or 4) only 34% received BI. Nurses in primary care programs were less likely to deliver BI than other types of clinicians (e.g., physicians, psychologists, social workers) in mental health programs; further, nurses in women's health programs were less likely to deliver BI than other types of clinicians in mixed-gender programs; Those women veterans with more medical problems were no more likely to receive BI than those with fewer medical problems. ConclusionsGiven that women veterans are a rapidly growing veteran population and a VA priority, underuse of BI for women veterans screening positive at a lower-risk level and those with more medical comorbidities requires attention, as do potential gaps in service delivery of BI in primary care and women's health programs. Women veterans health and well-being may be improved by tailoring screening for a younger cohort of women veterans at high-risk for, or with co-occurring disorders and then training providers in best practices for BI implementation.

Utilization of Substance Abuse Treatment: Gender Differences among Participants in an Aftercare Program

This study examined gender differences in the utilization of substance abuse treatment including inpatient, outpatient, and self-help services, using existing data sets from a National Institute on Drug Abuse study that enrolled 78 females and 141 males in a mixed-gender aftercare program in Massachusetts for a 2-year follow-up period. This study found that women came to the study in greater need of treatment than men. Women utilized significantly more outpatient treatment services than men. The characteristic of female per se led to more utilization of outpatient services, whereas the baseline characteristics of employed status and alcohol use led to less utilization of outpatient services.

Explaining long-term outcomes among drug dependent mothers treated in women-only versus mixed-gender programs

Specialized substance abuse treatment for parenting women is thought to improve outcomes, but long-term impacts and how they occur are poorly understood. Utilizing a sample of 789 California mothers followed for 10 years after admission to women-only (WO) or mixed-gender (MG) drug treatment, we examine the relationship between WO treatment and outcomes and whether it is mediated by post-treatment exposures to criminal justice and health services systems. At follow-up, 48% of mothers had a successful outcome (i.e., no use of illicit drugs, not involved with the criminal justice system, alive). Controlling for patient characteristics, WO (vs. MG) treatment increased the odds of successful outcome by 44%. In the structural equation model WO treatment was associated with fewer post-treatment arrests, which was associated with better outcomes. Women-only substance abuse treatment has long-term benefits for drug-dependent mothers, a relationship that may be partially explained by post-treatment exposure to the criminal justice system. Findings underscore additional leverage points for relapse prevention and recovery-supportive efforts for drug-dependent mothers.

Dating Violence and Sexual Assault Prevention With African American Middle Schoolers: Does Group Gender Composition Impact Dating Violence Attitudes?

A dating violence and sexual assault prevention program was presented to 396, predominately African American, middle schoolers in two inner city schools in the United States. In one school the program was offered with a same-gender group composition; in the other school, the same program was offered with mixed-gender group composition. A quasi-experimental design was used to assess how gender composition in programming influenced youths’ attitudes about dating violence. Study findings suggest that boys benefit most from participation in a same-gender program and girls benefit most from a mixed-gender program. Implications for prevention programming are discussed.

Hispanic parenting women in women-only versus mixed-gender drug treatment: A 10-year prospective study

The present study examined Hispanic substance-using parenting women treated in women-only (WO; n=126) versus mixed-gender (MG; n=853) programs and associated outcomes assessed 10years after admission. Relative to other races/ethnicities of women admitted to the set of 40 California treatment programs in 2000–2002, Hispanic women were underrepresented in WO programs. Compared to those in MG programs, Hispanic women in WO programs demonstrated more severe treatment needs, indicated by their greater severity in drug and alcohol use, health and mental health problems, and criminal justice involvement at admission. They also had fewer economic resources (15% WO vs. 23% MG were employed, p<.05; 48% vs. 37% on public assistance, p<.05). Data based on administrative records covering 3years pre-admission and 8years post-admission showed that Hispanic women treated in WO programs had higher mental health service utilization over 8years post-treatment admission, though no differences were found in trajectories of arrests and incarceration. In sum, long-term outcomes (in terms of criminal justice involvement) among Hispanic women in WO treatment were comparable to those in the MG treatment, despite greater service needs at admission. WO programs were able to engage more Hispanic women in use of mental health services. Future research should focus on factors limiting Hispanic women's participation in WO programs, which could suggest ways for improvement so as to benefit all Hispanic women in need of these special services.

Gender Differences in Treatment Outcomes Among Participants in a Mixed-Gender Substance Abuse Aftercare Program

This study examined gender and gender-related predictors in multiple outcomes of substance abuse aftercare treatment among 78 females and 141 males enrolled in a mixed-gender aftercare program in Massachusetts from 1994 to 1996. Female participants entered the program with higher needs than their male counterparts, showing a worse condition in almost all baseline characteristics, of which many are statistically significant. The generalized estimating equations (GEE) model revealed significant gender differences in the two treatment outcomes of employment income and illegal activity days. Also, many significant gender-related predictors and interaction variables were found.

Long-term outcomes among drug-dependent mothers treated in women-only versus mixed-gender programs

This study examined the long-term outcomes of women who were pregnant or parenting at admission to women-only (WO; n = 500) versus mixed-gender (MG; a matched sample of 500) substance abuse treatment programs. Administrative records on arrests, incarcerations, mental health services utilization, and drug treatment participation were collected, covering 3 years preadmission and 8 years postadmission. Women treated in WO programs had lower levels of arrest, mental health services utilization rates, and drug treatment participation during the first year after drug treatment. No differences were found between the two groups in the long-term trajectories except that the WO program participants had lower incarceration rates during the third year after treatment. The study findings suggest a positive short-term impact of WO versus MG programs with regard to arrest and mental health services utilization. Limited long-term gain is shown in the reductions in posttreatment incarceration. The study findings suggest the added value of specialized WO programs and begin to address the gap in knowledge regarding long-term outcomes for substance-abusing women.

Middle School Youth: Satisfaction With and Responses to a Dating Violence and Sexual Assault Prevention Program

This study examined how group composition influences students' level of satisfaction with a dating violence and sexual assault prevention program. A 10- to 12-session program was presented to 396 urban African American middle school students in mixed- and same-gender groups. Both males and females were significantly more satisfied with the mixed-gender program than the same-gender program; females in both programs were significantly more satisfied than the males in both programs. Students especially liked the class activities, discussion, and teacher involvement in the program. The study findings support the importance of taking group composition and gender into consideration, as well as, students' reactions and recommendations when developing prevention programs for young adolescents.

Alcohol & Drug Abuse: What Is "Women-Focused" Treatment for Substance Use Disorders?

Alcohol & Drug Abuse: What Is "Women-Focused" Treatment for Substance Use Disorders?

Treatment for Women Diagnosed with Co-Occurring Disorders

Journal of Addictions Nursing: Volume 19 - Issue 2 - p 43-44 doi: 10.1080/10884600802173457

Women-only and mixed-gender drug abuse treatment programs: Service needs, utilization and outcomes

Objectives This prospective longitudinal study examined service needs, utilization and outcomes for 189 women in women-only (WO) programs and 871 women in mixed-gender (MG) programs. Methods The Addiction Severity Index was administered at both intake and the 9-month follow-up interview to assess clients’ problem severity and outcomes, and the Treatment Service Review was given at the 3-month interview to measure service utilization. Treatment completion and arrests were based on official records. Results Compared to women in MG programs, women in WO programs were more likely to be White, less educated, physically abused in the past 30 days and in residential treatment (as opposed to outpatient treatment). Women in WO programs also had greater problem severity in a number of domains including alcohol, drug, family, medical and psychiatric. They utilized more treatment services and had better drug and legal outcomes at follow-up compared to women in MG programs. Program type was not predictive of treatment retention/completion or outcomes in other domains (i.e., alcohol, employment, family, medical and psychiatric). Conclusions The greater problem severity of women treated in WO programs and their better drug and legal outcomes suggest that these specialized services are filling an important gap in addiction services.

Substance misuse: what place for women‐only treatment programs?

The question of whether programs targeted at women are more beneficial than mixed gender programs is a key clinical and policy issue. Twenty years ago, Vannicelli pointed out that this question had not been examined using rigorous methods (Vannicelli 1984). Since then, several well designed observational studies have been conducted, but there has been only one trial, a 1989 Swedish study comparing a long-term women's residential program with mixed gender programs (Dahlgren & Willander 1989). The paper by Kaskutas and colleagues in this issue (Kaskutas et al. 2004) thus adds to a small but important body of research on the effectiveness of different treatment settings/modalities in treating women with alcohol and drug problems. It broadens the settings studied to outpatient programs, the most commonly found treatment setting in the USA, and to social model programs. Using an empirical design, Dr Kaskutas contrasts a day treatment community-based women's program with three mixed gender day treatment programs (two community-based and one hospital-based program). The community-based programs adhered to a social model program philosophy which differed from the hospital-based clinical or medical philosophy, especially in terms of staffing. How does this study add to what we know about women's programs? On the whole, findings point to more similarities than differences in outcomes between the women's and mixed gender programs. However, the multivariate analysis found higher rates of alcohol and drug abstinence in the hospital mixed gender program when all three follow-ups were included. Unfortunately, other findings are weakened by the multiple outcomes examined requiring corrections for multiple comparisons (alcohol, drug, and total abstinence; at the end of treatment, 6 months and 12 months; and comparing the women's program to each of the three mixed gender programs). Program sizes range from 22 to 42, and statistical power is limited. The differences in some baseline characteristics and outcomes may be clinically meaningful, although they are not statistically significant. For instance, type of dependence at treatment entry differed greatly: 42% of those in the women's program were both alcohol and drug dependent vs. only 17% of those in the hospital-based program. There were also large differences in abstinence rates at follow-ups that were not statistically significant due to correcting for multiple comparisons. The authors also found that the social model women's program produced outcomes similar to the mixed gender social model programs, one of which was twice as costly as the women's program. This is the key comparison, since it controls for program setting and type of staff. Given these results, a study that would compare women's programs to mixed gender programs within other treatment models, such as medical model programs is called for. Policy makers should also be cautioned to remember the potential importance of women's programs in promoting treatment access. Institute of Medicine studies (Institute of Medicine 1990; Edmunds et al. 1997) have argued that these programs may attract women to treatment who would otherwise not go. If outcomes are similar, this is a critical argument in favor of women's programs. This study suggests directions for further study. It challenges research on women's programs to move from observational to empirical designs and demonstrates that it is possible. It recommends studying different modalities, settings, and program philosophies. Because of the importance of program environment, studies also should compare residential with outpatient programs. The need for larger sample sizes is critical. These findings should spur the field to address the roadblocks discussed in the paper. Since observational studies have found better outcomes for women's than mixed gender programs, the issues of self-selection and choice should also be considered in future empirical research designs. The findings underscore the need to develop methods to study group process, as well as program environment. The questions raised are also relevant to the larger area of cultural competency. This study should generate a great deal of controversy and trigger renewed attention to even more rigorous studies of women's programs.

Women's programs versus mixed‐gender day treatment: results from a randomized study

To compare outcomes and costs of out-patient women's treatment to mixed-gender programs. Randomized clinical trial. Northern California (USA). Day treatment: one community-based women's program, two mixed-gender community-based programs and one mixed-gender hospital-based program. Substance-dependent women recruited from the community (n = 122). Women were interviewed at baseline, at the end of treatment (94% response rate) and at 6 and 12 months post-treatment (100% response rates). Measures included alcohol and drug use, and psychiatric and social problems. Program costs were estimated using the Drug Abuse Treatment Cost Analysis Program. No significant differences between the women's program and any of the mixed-gender programs were found for psychiatric problem severity, problems with family and friends or rates of drug use at any of the follow-up points. Rates of alcohol abstinence and total abstinence were similar between the women's program and both of the mixed-gender community programs, but were higher at the mixed-gender hospital program. Only one of these results was replicated in the multivariate analysis, with the odds of total abstinence significantly lower for those randomized to the women's program than the mixed-gender hospital program. However, the average cost of a treatment episode was significantly higher at the hospital program than at the women's program (1212 US dollars versus 543 US dollars). These findings suggest that female substance abusers may be treated as effectively in mixed-gender programs as in women's programs.

"A 28-day program ain't helping the crack smoker"--perceptions of effective drug abuse prevention interventions by north central Florida African Americans who use cocaine.

Cocaine is a major problem in the rural South, but knowledge is limited regarding the impact on African American populations. This study of 18-39-year-old black drug users assessed perceptions of contributing factors to drug use and possible interventions. The study design was qualitative-descriptive, utilizing 4 focus groups with 5 rural women and 14 small-city residents. Some respondents perceived that drug use initiation and continuation were due to themes of (1) loss, (2) peer pressure, (3) personal problems and dealing with pain, (4) desire for fun or to "feel good," and (5) drugs and drug-related messages within their environments. Common themes of effective strategies to stop drug use were (1) the necessity of wanting to quit, (2) the importance of help or support from family and friends, and (3) the need for resources, such as a job, car, and housing. Some respondents agreed on 3 human resources: (1) family, (2) ex-users, and (3) churches. Strategies to increase attendance at drug prevention programs included (1) making the program fun/enjoyable, (2) having mixed gender programs, (3) providing food/money, and (4) having the programs in their community. Recurrent themes were the lack of drug prevention intervention programs available to respondents and the failure of traditional programs of the majority culture to adequately meet their needs. Effective drug prevention programs for southern African Americans who use cocaine must be community based, personalized, and culturally relevant.

The Impact of an Outpatient Program for Women with Substance Use-Related Disorders on Retention

Meeting the needs of women manifesting substance-use disorders is a goal in developing treatment programs for this population. As retention in treatment is positively related to treatment outcome, the length of stay in outpatient treatment of alcohol- and other drug-dependent women in Brazil was compared between two programs. Data were analyzed from 181 women entering a Mixed-Gender Program from 1986 to 1996 and from 80 women entering a Women-Only Program from 1997 to 1998. A greater 3-month retention rate was observed in the Women-Only as opposed to the Mixed-Gender Program. Moreover, the impact was more significant among the alcohol-dependent women. This finding suggests that the heterogeneity of women with substance-use disorders has to be taken into account when developing appropriate treatment strategies.

Women in residential drug treatment: differences by program type and pregnancy.

This study compared the characteristics of 4,117 women treated in publicly funded residential drug treatment programs in Los Angeles County between 1987 and 1994 by pregnancy status and program gender composition, that is, women-only and mixed-gender programs. A logistic regression analysis determined the predictors of program completion. Women in women-only programs were more likely than women in mixed-gender programs to be pregnant, homeless, or on probation; to use methamphetamines; to use alcohol; and have prior drug treatment. Pregnant women were younger, more likely to be homeless, had fewer years of drug use, were more often referred by other service providers, and were less likely to have injected drugs or have prior drug treatment than non-pregnant women. Although women in women-only programs had more problems, they spent more time in treatment and were more than twice as likely to complete treatment as compared with women in mixed-gender programs.

Treatment of substance abusers: single or mixed gender programs?

Single-gender groups are advocated for women because substance abuse treatment programs tend to be male dominated both in numbers and in style. Although there is a paucity of empirical work that directly addresses this assumption, a body of literature that indirectly supports it is reviewed. Male and female substance abusers report different histories and courses for their disorders and display different needs and characteristics in treatment settings. Men and women may benefit from different treatment approaches with less structure required for women, particularly problem drinkers. Moreover, specific characteristics such as victimization, sexual orientation, sex-role conflict and degree of antisocial traits may be important mediating factors in whether single-gender groups are optimal. Social psychological research illustrates the effect of gender composition of groups for men and women. In general, mixed groups are associated with more variation in interpersonal style for men but are restrictive for women who show more variation in style in single-gender groups. These findings are suggestive of testable hypotheses concerning the effects of single and mixed gender programming. Such investigations have the potential of enhancing treatment efficacy.

Treatment of substance abusers: single or mixed gender programs?

Single-gender groups are advocated for women because substance abuse treatment programs tend to be male dominated both in numbers and in style. Although there is a paucity of empirical work that directly addresses this assumption, a body of literature that indirectly supports it is reviewed. Male and female substance abusers report different histories and courses for their disorders and display different needs and characteristics in treatment settings. Men and women may benefit from different treatment approaches with less structure required for women, particularly problem drinkers. Moreover, specific characteristics such as victimization, sexual orientation, sex-role conflict and degree of antisocial traits may be important mediating factors in whether single-gender groups are optimal. Social psychological research illustrates the effect of gender composition of groups for men and women. In general, mixed groups are associated with more variation in interpersonal style for men but are restrictive for women who show more variation in style in single-gender groups. These findings are suggestive of testable hypotheses concerning the effects of single and mixed gender programming. Such investigations have the potential of enhancing treatment efficacy.

A Model for Women's Alcohol/Drug Treatment

An all-women's treatment program for alcohol and drug abuse is presented as a viable alternative to treating women in traditional mixed-gender programs. Women's unique experiences, problems, and special needs can best be addressed in women-sensitive treatment settings. All women's programs provide an opportunity for women to gain a separate sense of self, empowerment, and ability to make important changes which are so necessary in their quest for recovery.