Gender Differences in Psychosocial Functioning Across Substance Abuse Treatment (Report‪)‬

Female substance abusers entering treatment differ from their male counterparts in several domains of functioning including psychological and social functioning, drug abuse histories, family dysfunction, and physical and sexual abuse histories (e.g., O'Connor et al. 1994). Typically, women entering treatment are younger than men, have less extensive criminal pasts, are less likely to be employed, have more financial and medical problems, and report greater depression, anxiety, and other psychological distress (e.g., Chatham et al. 1999). Gender differences are present in dropout from treatment as well. Among women, factors such as childcare, motivation, problem severity, social support, and lack of spousal support are among key predictors of premature dropout from treatment (e.g., Simpson & Joe 1993), and economic and family concerns can also serve as barriers to entering treatment (Green 2006). Moreover, specialized programs that provide some kind of childcare, gender-specific interventions, and curricula including information on health, HIV/AIDS prevention, and communication training have been found to improve retention and other during- and post-treatment outcomes in females (e.g., Hughes et al. 1995; Schliebner 1994; Dahlgren & Willander 1989), while more traditional approaches that do not take into account women's special needs may not be as effective (although see Kaskutas et al. 2005). However, research suggests that, in general, once economic, family, and other barriers to treatment entry are addressed, women are as likely as men to engage in and successfully complete treatment (Green 2006) and may even have better long-term recovery outcomes compared to men (Green 2006) particularly with regard to abstinence from alcohol (Dawson et al. 2005). It nonetheless remains clear that much remains to be learned about the relationship between gender and substance abuse treatment. One treatment modality that has received increased attention and empirical support is the corrections-based therapeutic community (TC), which is associated with lowered rearrest and reconviction rates (e.g., Wexler et al. 1992). However, as indicated by Hiller, Knight, and Simpson (2006), much more research is required to illuminate the treatment process and its relationship to client change. In other words, researchers are being called to identify key factors or events that must occur in the course of treatment that lead to desired outcomes such as decreased drug use or reconviction rates. Simpson's treatment process model provides guidance in this endeavor, indicating that psychosocial changes that occur during treatment are vital for successful outcomes after treatment has concluded (Simpson 2004, 2001; Simpson & Joe 2004). The treatment process model also indicates that different characteristics of clients (e.g., gender) entering treatment will influence how treatment unfolds.