Gender differences in alcohol treatment

I just read a great article published on The Partnership at Drugfree.org web site called “Gender Differences Emerge in Alcohol Use Disorder Treatment” (Celia Vimont, July 19, 2011). The Partnership at Drugfree.org is a US non-profit organization working to address substance use issues for families.

Vimont interviews several leading researchers about how women’s needs are often different than men’s when looking at treatment for alcohol misuse.

I was particularly interested in the work of Denise Hien who is making links between substance use and trauma. Hien and colleagues published a paper in 2010 called “Do Treatment Improvements in PTSD Severity Affect
Substance Use Outcomes? A Secondary Analysis From a Randomized Clinical Trial in NIDA’s Clinical Trials Network” (Am J Psychiatry 2010; 167:95-101, doi: 10.1176/appi.ajp.2009.090912610).

Clinically, women who have both symptoms of trauma/post-traumatic stress disorder and substance use issues are usually treated for substance use first because of the assumption that treating the trauma first will make the substance use worse. But what if a past experience of trauma underlies the substance use? Should you still treat the substance use first? Hien and colleagues explored these issues by asking:

  1. Should PTSD symptoms be targeted to improve substance use outcomes?
  2. Should substance use symptoms be targeted to improve PTSD outcomes?
  3. Or should both sets of symptoms be addressed for clinically meaningful treatment benefits?

The researchers explored these questions in a group of women participating in a community-based substance abuse treatment program. Half the women participated in a Seeking Safety-style trauma-oriented program while the other half received a more general, issue-oriented program.

They found that treating trauma symptoms first in women who suffer from both substance abuse and trauma/PTSD led to a reduction in substance abuse. There was little evidence that treating substance abuse first improved trauma symptoms. They argue that the most effective treatment models are those that address trauma before substance use or simultaneously.