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Research Snapshot: Integrated, gender-responsive programs show promise for women with co-occurring substance use and mental health concerns

What you need to know

Research has traditionally excluded women from most studies on substance use disorder. As a result, women have limited treatment programs designed specifically for them. However, women are more likely to seek and stay in treatment when they participate in women-only services. Women with substance use disorder are more likely to have experienced rape and other types of physical or emotional abuse and to have mental health challenges. Researchers conducted a systematic review of studies that evaluated programs that provided concurrent treatment for substance use disorder and mental health concerns specifically for women.

They found that by integrating women’s specific needs, including trauma and mental health supports, several of these programs significantly improved both substance use disorder and mental health symptoms. The women who attended these programs also had particularly high client satisfaction and were more likely to stay in treatment.

However, almost all the studies excluded women with a history of or current mental illness, except depression and PTSD. They also excluded women with significant memory, learning, or attention difficulties. Some studies excluded women who were homeless, mandated to receive treatment, or in prison, and those who had difficulty communicating in English or were receiving treatment for opioid use disorder.

What is this research about?

There has historically been a gap in the understanding of women’s experience of substance use disorder and recovery. In particular, researchers have omitted women from most studies. However, studies are now starting to focus on factors related to sex and gender that influence the effects of substance use and treatment outcomes.

Women with substance use disorder are also more likely to have experienced domestic violence, rape, incest and childhood physical, sexual and emotional abuse. They are also more likely to seek and stay in treatment when women-only services are available, yet few treatment programs are available specifically for women. In addition, many treatment programs for substance use disorder have not been evaluated in women or excluded women with psychiatric disorders. This demonstrates a need for gender-responsive treatment and integrated treatment.

Gender-responsive treatment is an approach specifically designed to address women's needs and that reflects an understanding of the realities of their lives. Integrated treatment refers to programs that deliver both substance use and mental health treatment concurrently by the same individual or team.

What did the researchers do?

The researchers searched several databases, looking for studies of integrated and gender-responsive treatments for both substance use and mental health/trauma. They looked for studies that included randomization and a control group, secondary analyses of data gathered by treatment programs themselves, and open-label studies (where both the researchers and participants knew what treatment was being given).

What did the researchers find?

They found 24 studies with 3,396 women and 10 distinct integrated, gender-responsive programs for women with substance use disorder. They identified the following programs:

Their analysis suggests that by integrating women’s specific needs, including trauma and mental health supports, these programs significantly improved both substance use disorder and mental health symptoms. Specifically, Seeking Safety, Helping Women Recover, and Modified Trauma Recovery and Empowerment Model resulted in better substance use and mental health outcomes, including trauma, than comparison treatments.

The women who attended integrated, gender-responsive SUD programs had particularly high client satisfaction and were more likely to stay in treatment.

Almost all the studies excluded women with a history of or current mental illness, except depression and PTSD. They also excluded women with significant memory, learning or attention difficulties. Some studies excluded women who were homeless, were mandated for treatment, were in prison, had difficulty communicating in English and were receiving treatment for opioid use disorder.

Limitations of the research

This research has several limitations. Several of the studies had moderate-to-high risk of researcher bias, such as those that used an open-label design. There was also significant variability in terms of study methods, such as how they assessed addiction and mental illness. Some studies lacked a control group and randomization.

The researchers noted that, since most studies excluded women with serious mental illness, it is not possible to say whether these programs would be effective in this population.

How can you use this research?

This research may be of use to policymakers and program planners intending to implement gender-responsive treatment for women with substance use disorder. There is a need for more research on gender-responsive programs for women with psychosis comorbidities and those in inpatient psychiatric and forensic psychiatric settings.

About the researchers

Samantha Johnstone1, Gil Angela Dela Cruz1, Natalie Kalb1, Smita Vir Tyagi2, Marc N. Potenza3,4,5,6, Tony P. George1, and David J. Castle1

  1. Addictions Division and Centre for Complex Interventions (CCI), Centre for Addiction and Mental Health (CAMH) and Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
  2. Departments of Psychiatry and Neuroscience and the Child Study Center, Yale University School of Medicine, New Haven, CT, USA
  3. Forensic Consultation and Assessment Team, CAMH, Toronto, Ontario, Canada
  4. Child Study Centre, Connecticut Mental Health Center, New Haven, CT, USA
  5. eWomen's Health Research, Yale University, New Haven, CT, USA
  6. Wu Tsai Institute, Yale University, New Haven, CT, USA

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