Changing the Conversation on Women and Addiction
One hundred and ten years ago today, arguably the most effective public health care reformer of the twentieth century was born. Marty Mann’s courage to bring alcoholism out of the shadows and into the mainstream of American life helped incite a social revelation.
Never heard of her?
Throughout the 1940s and 1950s, Marty Mann conducted a national grassroots campaign to reduce the stigma surrounding alcoholism. By shifting public opinion, her efforts, including the founding of what is today the National Council on Alcoholism and Drug Dependence (NCADD), vastly enhanced the possibilities for intervention and treatment. Although far from anonymous, Marty was beloved throughout Alcoholics Anonymous as the first woman to get sober with AA’s twelve steps.
Our understanding of addiction has improved substantially since Mann passed away in 1980. Physicians and counselors are meeting higher standards for patient care. Pharmacologists have discovered medications to improve treatment outcomes. Neuroscientists have explained how substance use impacts the brain and how people become addicted. But sadly, the stigma associated with addiction is still alive and well, especially for women.
Worldwide, women have always had lower addiction rates than men. But as women’s access to opportunity grows along with a nation’s affluence, this gender gap closes. In fact, women in the US have already forged ahead of men in their use of certain substances (sedatives and tranquilizers).
Marty Mann knew what it was like to struggle with the double stigma of being a female alcoholic, but she would be disappointed to know that we’re still stuck in the past when it comes to understanding the distinct experiences of addicted women and expanding treatment options accordingly.
It is far too common for primary care physicians to fail to detect risky substance use and addiction in patients, regardless of gender, but studies show that doctors are much less likely to even consider (let alone diagnose) these sorts of problems in women and girls—which may be one reason why women are prescribed painkillers more often and for longer periods of time. And the stakes are high: According to a recent study by the Center for Disease Control and Prevention, between 1999 and 2010, the number of women overdosing on prescription opioid pain relievers rose 415 percent (compared to 265 percent for men).
Because of differences in body chemistry, women are more vulnerable than men to the effects of drugs and alcohol. In general, women’s use escalates more rapidly into addiction, and we are at greater risk for relapse. Women are also more likely to develop certain complications of addiction, including lung cancer, depression, and post-traumatic stress. Yet a growing body of research suggests that women are not aware of the unique dangers they face because shame, negative stigma, and ignorance hide the gravity and extent of the problem.
Women were mobilizing to advocate for feminist-based solutions to the problem of addiction as early as the late 1960s. By the early 1980s, advocates had organized a sizeable political coalition on the issue. This “women's alcoholism movement” demanded gender parity in access to treatment, argued for the recognition of women’s distinct experiences by establishing women-only programs, and conducted health education campaigns.
After years of lobbying, the women’s alcoholism movement finally achieved some success when their efforts dovetailed with the 1980s public outcry concerning alcohol- and drug-addicted infants. Although much of the furor was punitive towards pregnant women, growing concerns over maternal substance abuse provided a strong political rationale for improving women's access to treatment. The result: treatment units offering specialized services for women essentially doubled, and the federal response to female substance abuse shifted from redistributing existing funds to allocating entirely new ones. Advocates largely welcomed these improvements, although they were tainted:
“Tragically, it is only when a woman's ability to bear healthy children is threatened by the consequences of alcoholism and drug addiction that we, as a society, are willing to take notice,” said auditors for the General Accounting Office. “We take notice not because we care about women, but, because we allege to care about children.”
Today, very few treatment programs have separate women-only units, and even fewer offer services for pregnant or post-partum women. This is a problem, as research indicates that women fare better in programs designed around their needs and experiences than they do in traditional programs, which are typically designed for men.
Because the women-only sector is primarily made up of freestanding, community-based facilities, these programs tend to follow a more “social model,” emphasizing self-help and deemphasizing evidence-based medical services. The vast majority of today’s treatment programs are based in a 12-step recovery (AA) model. These faith-based, abstinence-only fellowships can be a very helpful and affordable resource. That said, these groups were designed to be voluntary supplements to medical care, not medical care themselves. In addition, because powerlessness is the source of women’s oppression in a patriarchy, many feminist thinkers view with serious alarm the first step’s assertion that powerlessness is liberating.
In general, men and women use for different reasons, with women often using to escape feelings of powerlessness and hopelessness. Embracing powerlessness as a first step does nothing to address the very real social, political, and economic inequalities that exist. Thus, in treatment, many women prefer to affirm that they have the power to choose not to use chemicals.
Although they are not nearly as widespread, there are alternatives to 12-step recovery. Women For Sobriety (WFS), for example, was founded in 1976 as a mutual support service tailored to women’s specific needs. Because AA has not proven to be more effective than other support groups, it would behoove treatment providers to match people with support groups suiting their individual preferences.
Advances in science have helped to establish a more comprehensive picture of addiction, yet we’re still treating it as a moral, rather than a brain-based, behavior. Advocates for the wellbeing of women have a critical role to play in shifting public opinion about addicted women. Like domestic violence and reproductive freedom, addiction is an issue revolving around bodily self-determination and medical autonomy. It’s about our collective and deeply personal right to make decisions about our healthcare and our bodies.
Recovering alcoholics and their families have reason to be profoundly grateful to Marty Mann. She was the first to carry the message that the alcoholic can be helped and is worth helping.
Today, we can build on Mann’s work by equipping our healthcare workforce with evidence-based, gender-responsive screening and intervention tools. Treatment providers can offer childcare, vocational counseling, and housing services to support recovering women. As individuals, we can take on a more compassionate, comprehensive view of addiction, one that creates an enlightened climate for conversation, treatment, and recovery.
These are truly the ways to celebrate the legacy of Marty Mann.
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