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SAMHSA’s Award-Winning Newsletter
November/December 2008, Volume 16, Number 6 

Why Gender Matters: Two Workshops

Creating Trauma-Informed Services

“What does it mean to design gender-responsive services for women and girls?” asked Stephanie S. Covington, Ph.D., a workshop presenter at the recent Women, Addiction, and Recovery conference, and a member of SAMHSA’s Advisory Committee on Women’s Services.

Photo of Dr. Lisa Najavits (left) listening to a question from a workshop attendee.

“It means creating an environment—through site selection, staff selection, program development, content, and materials—that reflects an understanding of the lives of women and girls and addresses both their strengths and their challenges. In other words, you look through the lens of their lives, you see what is reflected back to you, and then you begin to develop your services in response to these issues,” Dr. Covington said.

Her workshop, “Women, Substance Abuse, and Trauma: An Integrated Treatment Approach,” explored the relationship between trauma, mental health concerns, and substance abuse, and how these three issues are interconnected in the lives of women.

Dr. Covington described the concept of safe space or sanctuary, which creates the gender-responsive environment that “ideally we want our treatment programs to look and feel like.”

She suggested that each person think about the environment of their treatment setting. This includes the response of the receptionist, the appearance of the waiting room and the treatment areas, as well as the interactions and “energy” between staff members.

In other words, have we created places where women feel safe emotionally and physically?

In the past, according to Dr. Covington, “trauma” was defined as a specific event—an event you experience, an event you witness, or even an event you hear about happening to someone you love. “Now it is not only an event, but also a particular response.”

A woman’s response to trauma may be different from a man’s response, Dr. Covington emphasized. “When people hear trauma, they think ‘Ah, we have to begin working with post-traumatic stress disorder (PTSD).’ However, for many women their response to trauma is depression. Men’s most common response to trauma is PTSD.”

The workshop’s co-facilitator, Carol Ackley, LADC, offered specific examples from her work at the River Ridge Treatment Center in Minnesota, where she is the director. “Women can begin to recover when they feel safe,” Ms. Ackley said. “When the environment reflects that feeling of safety, our work can begin.” She also shared her experiences using Dr. Covington’s three trauma-informed curricula: Helping Women Recover, Beyond Trauma, and Voices (for girls).

Why does this integrated treatment approach work better than traditional treatment methods? “We need to consider everything a woman has experienced in order to help her begin her recovery process from addiction,” Dr. Covington said. “Trauma-informed care is based on the idea that our services need to be adapted so women can benefit from the care we are providing. To ignore trauma in women’s substance abuse treatment is no longer an option.”

For example, many addicted women have been considered “treatment failures” because they relapsed. Now they can be better understood as trauma survivors who returned to alcohol or other drugs in order to medicate the pain of trauma.

According to Dr. Covington, increased understanding of trauma offers new treatment possibilities for women and girls.

A Woman’s Path to Recovery

Lisa Najavits, Ph.D., emphasized the need for gender-based treatment in her workshop, “A Woman’s Path to Recovery.” She is a professor of psychiatry at Boston University’s School of Medicine.

“Women are not ‘small men’,” she said. “Women need services tailored to their needs.”

Dr. Najavits explained to workshop participants that initially addiction treatment was primarily for men. “Men have been the majority of substance abusers throughout history. The addiction field was developed on men, and men have double the substance abuse rate women do. Now women are catching up. There is less stigma than in earlier eras associated with females who use substances,” she added.

“People have been talking about the need for gender-based treatment for a while,” Dr. Najavits said.

The session’s goal was to deepen understanding of how gender affects both the addiction process and recovery. Supportive tools to aid recovery were introduced from Dr. Najavits’s 2002 book, A Woman's Addiction Workbook, including exercises, a self-test, and sample materials. She also reviewed a pilot study on the model.

Dr. Najavits cited several reasons why women may have obstacles in obtaining treatment. They include shortage of services, childcare and transportation challenges, and other issues.

“Women tend to abuse substances in quiet ways,” she said. “They don’t draw as much attention to themselves as men, who more often get into bar fights and drink in groups in public. Also, women may use substances for different reasons than men. Women more often report using substances to lose weight, to engage in sex, and to adapt to their partner's level of use, for example.”

Women have higher rates of comorbid psychiatric disorders, according to Dr. Najavits. She cited the need for more focus on co-occurring disorders, and engaged the audience in a discussion of how trauma, for example, remains an area of particular need for women with addictions.

“We are asking women ‘where did you learn how to hide what your feelings are?’” said Dr. Najavits.

Recommended reading for participants included A Woman's Addiction Workbook (2002, New Harbinger Press) and Women Under the Influence (2006 from the National Center on Addiction and Substance Abuse at Columbia University and Johns Hopkins University Press).

  Women, Addiction, & Recovery  
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Conference Coverage & Related Stories

  Returning Veterans  
image of a woman in the military

Women in the Military: Overcoming Challenges

From mental health issues to sexual harassment—what’s being done to help.

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Veterans & Major Depressive Episode: New Data

Last year, more than 300,000 veterans experienced MDEs.

  Suicide Prevention  
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New Media Increase Options

Virtual suicide prevention efforts are helping.

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Lifeline Answers One Millionth Call

Milestone for SAMHSA’s National Suicide Prevention Lifeline.

  Training Manuals  
TIP 45 image


This Treatment Improvement Protocol training manual offers basics on successful detox.

TIP 43 image

Medication-Assisted Treatment

This Treatment Improvement Protocol training manual discusses treatment for opioid addiction.

  Data on Youth  
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Inhalant Use & Depression

Some adolescents are three times as likely to start using inhalants—find out why.

Mental Health Settings: New Data

Do young people get mental health services at school more often than at specialty treatment centers?

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Out-of-Home Treatment

Effective treatment options for young people.

  Also in This Issue  
logo for SAMHSA's Science and Service Awards

2008 Science & Service Award Winners

For best practices, 29 organizations honored.

Grant Updates

Awards announced.

Staff in the News logo

Advisory Councils

Five new members for SAMHSA’s Advisory Councils.

Treatment Line Gets National Attention

Oprah promotes SAMHSA’s substance abuse treatment line as a resource.

The Voice Awards logo

Voice Award Nominations

You have until March 2009 to cast your vote.

Primary Care Settings

Mental health may improve with treatment location.

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