Counseling Addicted Women: A Practical Guide


Monique Cohen

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    We dedicate this book to you, the addiction counselor, along with your staff and your women's programs. We want to inform, inspire, and help you to train your staff to provide the best possible counseling to your female clients.

    Our book is based on more than 25 years of the collective experience and firsthand knowledge of our counselors at the CASPAR Outpatient Clinic in Cambridge, Massachusetts. The focus of every chapter, every staff activity, and every client worksheet is compassion—seeing ourselves in the eyes of the women we treat so that we can counsel them effectively and truly meet their specific needs. Whether you are male or female, this book will give you important insight into how to make sure that your women clients get the best treatment.

    We have designed a book specifically for women because biologically, culturally, and socially, their modern experience is different from that of men. Women have suffered from alcoholism and drug abuse for centuries—just as long as men have—although formal treatment assistance for women has been recognized as important in the United States only during the past few decades. It has only been since the 1990s that women's health has received adequate attention in the national research agenda.1 Until recently, research on women's alcoholism in particular has relied far too much on general societal beliefs about women rather than on scientific findings.2

    The nature and underlying reasons for women's alcohol and drug abuse differ from men's behavior in many ways. It is finally being understood that research on men will not simply translate into effective solutions for women as well. For example, research has shown that due to different socialization patterns, women lack the assertiveness skills of men and need supportive networks to help them remain drug free.3

    Staff Training Activities are provided at the end of each chapter to help you and your staff put ideas into action. We encourage you to explore both facts and feelings about women and chemical dependency. These activities offer you, the counselor, the opportunity to compare your personal experiences and perceptions of alcohol to society's perceptions of female alcoholics. Throughout the book, we compare the stereotypes of chemically dependent women to their actual diversity and learn how stereotypes can influence our counseling behavior.

    Client Training Activities, also at the end of most chapters, allow you to work through similar issues with your clients. Through these training activities, we encourage you to put yourselves in the place of an alcoholic woman and compare her attitudes, feelings, and fears to yours.

    You also will find brief summaries of the latest studies and findings about women and alcohol and drug addiction placed throughout each chapter, putting a current perspective on each issue. In addition, we provide a list of national organizations and Web resources to help you find more information on the issues discussed in each chapter.

    The book is divided into three parts. Part I examines the social and cultural nature of drinking and drug abuse in our society and how women, in particular, react and respond to that culture. Chapters 1 and 2 explore the societal image and stereotypes of a woman who drinks or uses drugs. How women are socialized in American society has a major impact on how they become chemically dependent and on how quickly they recover.

    We consider the relationship expectations of women (e.g., mother, daughter, spouse/partner, lover, caretaker, employee). Each role brings up pressures and issues that can affect a female client's recovery. Chapter 3 introduces the most recent trends in drug and alcohol abuse, summarizing the most important health risks and consequences of abuse for women. We provide a chart of the most commonly abused drugs along with detailed information about the problems women have with each drug.

    Part II contains specific information about how to deal with other common issues that come up in conjunction with helping a female client to recover from chemical addiction. Some of the variables that complicate her recovery might include relapses as she approaches each stage of recovery, protecting her fetus if she is pregnant, treating major health problems such as HIV and AIDS, and coordinating additional services if she is dually diagnosed. Chapters 4 to 8 focus on each major issue: treatment strategies, designing effective programs, pregnancy, HIV and AIDS, and dual diagnosis.

    Part III deals with the many issues that can arise in working with women across different populations. Chapters 9 to 15 focus on learning how young women, women of color, lesbian and bisexual women, disabled women, homeless women, elderly women, and women in the workplace all have specific issues and considerations that we must acknowledge and incorporate into the counseling experience. Racism, homophobia, and stigmas about disability traditionally have limited the number of available agencies sensitized to the issue. These chapters provide you and your staff with an overview of the types of issues your clients might face and tips on organizing your programs so that you can reach all of your clients effectively.

    Our key theme for this book is that a woman who suffers from alcoholism or drug abuse is first and foremost a woman. Wellness for women includes the development of a broad context of relational ties that include family, friends, counselors, and spiritual affiliations. This goes hand in hand with her comfort with her feelings, her inner life, and her sense of self. An ongoing recognition of women's socialization and relationship needs is essential for a full recovery from alcoholism and other drug abuse and to foster a healthy restoration of life.

    We wish you the best of luck and hope that the tools provided in this book make it easier for you and your staff to design caring, effective programs for helping women to recover from substance abuse.

    1. S. J.Blumenthal, “Women and Substance Abuse: A New National Focus,” in C.Wetherington and A. B.Roman, eds., Drug Addiction Research and the Health of Women, NIH Publication No. 98–4290 (Rockville, MD: National Institute on Drug Abuse, 1998), 13–32.
    2. S. B.Blume, “Women and Alcohol: Issues in Social Policy,” in R. W.Wilsnack and S. C.Wilsnack, eds., Gender and Alcohol: Individual and Social Perspectives (New Brunswick, NJ: Rutgers Center of Alcohol Studies, 1997), 462–89.
    3. S.Colletti, “Service Providers and Treatment Access Issues,” in C.Wetherington and A. B.Roman, eds., Drug Addiction Research and the Health of Women, NIH Publication No. 98–4290 (Rockville, MD: National Institute on Drug Abuse, 1998), 337–44.


    This book is an updated version of Getting Sober, Getting Well: A Treatment Guide for Caregivers Who Work With Women, a practical and popular resource for training counselors in the care and treatment of substance-abusing women. When the previous edition of this book was written during the 1970s and early 1980s, very little substance abuse research involved females. The authors of the early book brought together what research was available at the time as well as a wealth of information from their direct experience with female clients at CASPAR Inc. (Cambridge and Somerville Program for Alcoholism and Drug Abuse Rehabilitation) in Cambridge, Massachusetts. Their book has been widely used by providers across the country as an educational and skill-building tool to increase counselors' understanding of the issues that women substance abusers face as they struggle to recover from the disease of addiction. The book served as a guide for us at the CASPAR Outpatient Clinic as we undertook the process of producing an updated tool that will help counselors to increase their understanding of the disease of addiction and offer them a practical approach to implementing theory into practice.

    We express our sincere gratitude to the original authors—Norma Finkelstein, Sally Duncan, Janet Smeltz, and Laura Derman—who continue to do pioneering work in the field of women's substance abuse treatment. Without their commitment to their clients and to the field of social work, this edition would not have been possible.

    In addition, we offer our thanks to the many students who worked on this project including Linda Rosen, Angela Brenner, Melissa Godwin, and Judith Bauman. We also thank Hope Steele and Renée Piernot for their brilliant research and developmental editing work. Finally, without the support of Jim Nageotte at Sage Publications, it would not have been possible to bring this book to the attention of the public.

  • About the Author

    Monique Cohen, LICSW, MHP, currently serves as Program Director of the CASPAR Outpatient Clinic, located in Cambridge, MA. The clinic provides comprehensive substance abuse treatment to individuals and families struggling with either one or multiple addictions. Given her interests in both clinical work in the field of addiction as well as public policy and training, Cohen decided to write this manual to share her experience with other providers working with primarily women clients. In addition, Cohen provides training through her affiliation with CASPAR, Inc., to local community agencies, students, universities, and hospitals in various issues related to addiction, women's treatment, and dual diagnosis. She has served on various local task forces in Massachusetts in an attempt to influence local and state substance abuse policy-related decisions.

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