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Part B: 20 Questions and Answers Regarding Methadone Maintenance Treatment Research
Question 9: Is methadone maintenance treatment effective for women?
Answer: Yes. Since the earliest methadone maintenance treatment programs in the United States, women have been treated successfully with methadone through all phases of their lives, including pregnancy. There is consensus that the major outcomes of the effectiveness of methadone maintenance treatment, especially cessation of illicit drug use and lifestyle stabilization, apply to both men and women. However, gender-specific issues, which are often related to the social status of women, are important to treatment effectiveness for female injection drug users.
Compared with men, women are more likely to
- Have total responsibility for child care
- Have lower socioeconomic status
- Encounter greater barriers to treatment entry, retention in treatment, and economic independence
- Have different psychological, counseling, and vocational training needs
- Have difficulty with transportation to treatment.
Research Highlights
- In the past, little emphasis was placed on gender-specific biopsychosocial problems in drug treatment. One reason was the predominance of drug-addicted men, estimated in the United States to be three males to every female. Although mild forms of psychoactive substance use show converging usage rates and patterns for males and females, opioid addiction and other forms of chemical dependency continue to show a male predominance (Kandel, 1992).
- Drug Abuse Reporting Program (DARP) studies showed that 19 to 28 percent of admissions to drug treatment programs from 1969 to 1973 were women. In 12 years of followup of 84 females and 91 males in methadone maintenance, there were no differences between men and women in overall reduction of opioid use. Women required more government financial assistance and had lower rates of employment than men. Compared with men, women were more likely to enter treatment for health reasons (Simpson, 1990; Marsh and Simpson, 1986).
- A study of 567 methadone-maintained patients in California found overall shorter duration of time from first entry to first discharge from treatment for women compared with men (Anglin, Hser, and Booth, 1987). Factors related to poor retention of women in treatment were likely to be a lack of child care and inadequate social and psychological support from domestic partners and other family members (Rosenbaum, 1981; Murphy and Irwin, 1992).
- A study of white, Latina, and African American women in methadone maintenance found that, in general, Latinas were more likely to report familial influences and to display evidence of low self-esteem and self-efficacy, inconsistent condom use, and high-risk injection behavior. White women reported the highest levels of regular condom use at followup; however, they were the least likely to report safer injection practices. African American women expressed the highest levels of self-esteem, yet they reported more alcohol use at intake and crack cocaine use both before and after treatment entry. African American women showed the greatest gains in adopting safer injection practices and were the least likely to report multiple sex partners after treatment entry (Grella, Annon, and Anglin, 1995).
- Drug-using women are likely to experience clinical depression, anxiety disorders, and low self-esteem to a much greater degree than their male counterparts. Women entering treatment have experienced unique gender-specific life events. In particular, female drug users often have been abused physically, sexually, and emotionally. Experiences of sexual violence, especially during childhood, have profound, lifelong psychological effects and often underlie addiction, complicating successful recovery. Methadone maintenance treatment of women requires awareness of these issues and appropriate counseling. Confrontational styles of therapy and counseling are not effective for most women in treatment (Mondanaro, 1987; Marsh and Miller, 1985; Beschner, Reed, and Mondanaro, 1981; Hartel, 1989/1990).
Potential Treatment Issues for Women– Figure 23 delineates key treatment issues derived from the discussion above.
Figure 23 illustrates the potential treatment issues for women.
In research conducted in New York, NY, among 452 methadone-recruited injection drug users early in the HIV epidemic, having an injection drug user as a sex partner was associated with HIV infection status independent of or in addition to injection risk behavior. In this same study, women reported a higher level of sexual risk behavior than men: 57 percent of women compared with 45 percent of men reported one or more injection drug users as sex partners since 1978. In addition, women were more likely than men to have engaged in sex work: 23 percent of women compared with 5 percent of men (Schoenbaum, Hartel, Selwyn, et al., 1989).
References
Anglin D, Hser Y, Booth M. Sex differences in addict careers. American Journal of Drug and Alcohol Abuse 1987;13(3):253-80.
Beschner G, Reed B, Mondanaro J. Treatment Services for Drug Dependent Women. Rockville, MD: National Institute on Drug Abuse, 1981.
Grella CE, Annon JJ, Anglin MD. Ethnic differences in HIV risk behaviors, self-perceptions, and treatment outcomes among women in methadone maintenance treatment. Journal of Psychoactive Drugs 1995;27(4):421-33.
Hartel D. Cocaine use, inadequate methadone does increase risk of AIDS for IV drug users in treatment. NIDA Notes 1989/1990;5(1).
Kandel D. Epidemiological trends and implications for understanding the nature of addiction. In: O’Brien D, Jaffe J (eds.). Addictive States. New York: Raven Press, 1992.
Marsh J, Miller N. Female clients in substance abuse treatment. International Journal of the Addictions 1985;20:995-1019.
Marsh K, Simpson D. Sex differences in opioid addiction careers. American Journal of Drug and Alcohol Abuse 1986;12:309-29.
Mondanaro J. Strategies for AIDS prevention: motivating health behavior in drug dependent women. Journal of Psychoactive Drugs 1987;19:143-49.
Murphy S, Irwin J. Living with the dirty secret: problems of disclosure for methadone maintenance clients. Journal of Psychoactive Drugs 1992;24:257-64.
Rosenbaum M. Sex roles among deviants; the women addict. International Journal of the Addictions 1981;16,859-77.
Simpson DD. Longitudinal outcome patterns. In: Simpson DD, Sells SB (eds.). Opioid Addiction and Treatment: A 12-Year Followup. Malabar, FL: Krieger Publishing, 1990.
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