women's experience in holistic chemical dependency treatment: an exploratory qualitative study
TRANSCRIPT
This article was downloaded by: [University of Hong Kong Libraries]On: 16 November 2014, At: 12:55Publisher: RoutledgeInforma Ltd Registered in England and Wales Registered Number: 1072954 Registeredoffice: Mortimer House, 37-41 Mortimer Street, London W1T 3JH, UK
Journal of Social Work Practice in theAddictionsPublication details, including instructions for authors andsubscription information:http://www.tandfonline.com/loi/wswp20
Women's Experience in Holistic ChemicalDependency Treatment: An ExploratoryQualitative StudyJeremy M. Linton PhD a , Mary Flaim EdD b , Constance Deuschle EdDc & Yvonne Larrier PhD da Assistant Professor, Department Head of Counseling and HumanServices , Indiana University South Bend , South Bend, Indiana, USAb Visiting Lecturer, Counseling and Human Services , IndianaUniversity South Bend , South Bend, Indiana, USAc Adjunct Faculty Member, Counseling and Human Services , IndianaUniversity South Bend , South Bend, Indiana, USAd Assistant Professor, Counseling and Human Services , IndianaUniversity South Bend , South Bend, Indiana, USAPublished online: 03 Sep 2009.
To cite this article: Jeremy M. Linton PhD , Mary Flaim EdD , Constance Deuschle EdD &Yvonne Larrier PhD (2009) Women's Experience in Holistic Chemical Dependency Treatment: AnExploratory Qualitative Study, Journal of Social Work Practice in the Addictions, 9:3, 282-298, DOI:10.1080/15332560903110583
To link to this article: http://dx.doi.org/10.1080/15332560903110583
PLEASE SCROLL DOWN FOR ARTICLE
Taylor & Francis makes every effort to ensure the accuracy of all the information (the“Content”) contained in the publications on our platform. However, Taylor & Francis,our agents, and our licensors make no representations or warranties whatsoever as tothe accuracy, completeness, or suitability for any purpose of the Content. Any opinionsand views expressed in this publication are the opinions and views of the authors,and are not the views of or endorsed by Taylor & Francis. The accuracy of the Contentshould not be relied upon and should be independently verified with primary sourcesof information. Taylor and Francis shall not be liable for any losses, actions, claims,proceedings, demands, costs, expenses, damages, and other liabilities whatsoever orhowsoever caused arising directly or indirectly in connection with, in relation to or arisingout of the use of the Content.
This article may be used for research, teaching, and private study purposes. Anysubstantial or systematic reproduction, redistribution, reselling, loan, sub-licensing,systematic supply, or distribution in any form to anyone is expressly forbidden. Terms &Conditions of access and use can be found at http://www.tandfonline.com/page/terms-and-conditions
Dow
nloa
ded
by [
Uni
vers
ity o
f H
ong
Kon
g L
ibra
ries
] at
12:
55 1
6 N
ovem
ber
2014
282
Journal of Social Work Practice in the Addictions, 9:282–298, 2009Copyright © Taylor & Francis Group, LLC ISSN: 1533-256X print/1533-2578 onlineDOI: 10.1080/15332560903110583
WSWP1533-256X1533-2578Journal of Social Work Practice in the Addictions, Vol. 9, No. 3, Jul 2009: pp. 0–0Journal of Social Work Practice in the Addictions
Women’s Experience in Holistic Chemical Dependency Treatment: An Exploratory
Qualitative Study
Women and Holistic Chemical Dependency TreatmentJ. M. Linton et al.
JEREMY M. LINTON, PHDAssistant Professor, Department Head of Counseling and Human Services, Indiana University
South Bend, South Bend, Indiana, USA
MARY FLAIM, EDDVisiting Lecturer, Counseling and Human Services, Indiana University South Bend,
South Bend, Indiana, USA
CONSTANCE DEUSCHLE, EDDAdjunct Faculty Member, Counseling and Human Services, Indiana University South Bend,
South Bend, Indiana, USA
YVONNE LARRIER, PHDAssistant Professor, Counseling and Human Services, Indiana University South Bend,
South Bend, Indiana, USA
Research suggests that gender-specific treatment for women with chemi-cal dependency issues might be more effective than dual-gender pro-grams. Several authors have posited that this might be due to the fact thatwomen in treatment have differing sets of presenting problems thanmen. The purpose of this exploratory qualitative study was to investigatewomen’s experiences in a single-gender, holistically focused chemicaldependency treatment program. Results based on focus group interviewswith 23 women suggest that the variables of empowerment, holistic ser-vices, children in treatment, domestic violence services, cohesion, andstaff characteristics have distinct effects on women’s experiences inchemical dependency treatment. Questions for further study are offered.
KEYWORDS aftercare, chemical dependency, groups, holistic,treatment, women
Received November 1, 2007; accepted April 29, 2008.Address correspondence to Jeremy M. Linton, Counseling and Human Services, Indiana
University South Bend, School of Education, Greenlawn Hall, 1700 Mishawaka Ave., P.O.Box 7111, South Bend, IN 46634–7111, USA. E-mail: [email protected]
Dow
nloa
ded
by [
Uni
vers
ity o
f H
ong
Kon
g L
ibra
ries
] at
12:
55 1
6 N
ovem
ber
2014
Women and Holistic Chemical Dependency Treatment 283
A mounting body of research suggests that the provision of gender-specificchemical dependency treatment (CDT) for women may improve treatmentretention and outcomes (Claus et al., 2007; Haller, Miles, & Dawson, 2002;Najavits, Rosier, Nolan, & Freeman, 2007; Sinha & Rounsaville, 2002; Sun,2007; Wilde et al., 2004). For example, Najavits and colleagues (2007) foundsignificant improvements on several alcohol and drug use measures for womenwho took part in a women-only treatment program. Similarly, Claus andcolleagues (2007) found that when compared to women in dual-genderedprograms, women in gender-specific programs stayed in treatment longerand were more likely to take part in aftercare services. This exploratorystudy was designed to examine women’s experiences in a women-specific,holistic-focused CDT program.
One critique of CDT in the literature is the perception that current the-ories and practices are based mainly on research conducted on male clients(Baletka & Shearer, 2001). If this assertion is true, it follows that many CDTprograms might be structured to specifically meet the needs of men, eventhough services are offered to both men and women (Baletka & Shearer,2001; Bride, 2001; Burman, 1992; Gerolamo, 2004; Hodgins, El-Guebaly, &Addington, 1997; Neale, 2004; Schober & Annis, 1996). Gerolamo (2004) statedthat “evidence suggests that women are different than men and have differentsubstance abuse treatment needs” (p. 185). Some researchers have reportedthat one main difference between men and women in CDT is that womenin treatment tend to report a greater number of life problems (Baletka &Shearer, 2001; Fendrich, Hubbell, & Lurigio, 2006; Najavits et al., 2007; Pelissier,Camp, Gaes, Saylor, & Rhodes, 2003).
Several factors have been identified as being important to women’sCDT. These include (a) a focus on relational aspects of substance abuse anddependency (Hodgson & John, 2004); (b) recognition of the importance ofinterpersonal group communication (Claus et al., 2007); (c) assessment oftrauma and victimization history (Gerolamo, 2004); (d) recognition of childcare, employment, and transportation issues (Haller et al., 2002; Pelissieret al., 2003; Schober & Annis, 1996); (e) a focus on parenting issues (Clark,2001; Claus et al., 2007); (f) assessment of a cooccurring disorder such asposttraumatic stress disorder and depression (Gerolamo, 2004; Haller et al.,2002; Sinha & Rounsaville, 2002); and (g) a focus on women-specific healthissues (Karroll & Memmott, 2001; Walter et al., 2003). Based on these researchfindings, Bride (2001) suggested that to be effective, gender-specific treatmentproviders must do more than simply provide traditional CDT in a single-gender environment; they must also address this multitude of women-specificfactors.
Four of the most salient aspects of women-specific CDT programs are(a) a focus on empowerment, (b) attention to issues of domestic violence,(c) allowing children to be present in the treatment environment, and (d) theapplication of holistic treatment principles. Each of these areas of treatment
Dow
nloa
ded
by [
Uni
vers
ity o
f H
ong
Kon
g L
ibra
ries
] at
12:
55 1
6 N
ovem
ber
2014
284 J. M. Linton et al.
can address many of the presenting problems unique to women in CDT. Areview of the literature on these factors is offered next.
EMPOWERMENT
Several authors have commented on the need for women-specific CDT treat-ment to focus on issues of empowerment (Baletka & Shearer, 2001; Carlson,2006; Cook, Epperson, & Gariti, 2005; El-Guebaly, 1995; Hodgins et al., 1997;Kasl, 1994; Sun, 2007). Many of these authors have posited that womenpresent to CDT with a low sense of self-worth (El-Guebaly, 1995; Sun, 2007);a history of dependence on men (Sun, 2007); and a history of verbal, sexual,and physical victimization (Cook et al., 2005; Hodgins et al., 1997). This hasled Carlson (2006) to state, “recovery by itself will not heal the effects of vic-timization and exposure to trauma; such histories must be addressed specifi-cally in the context of treatment for chemical dependency” (p. 105). Substanceabuse and dependency treatment that is focused on empowering women toaddress their past traumas, become more self-sufficient, and enhance feelingsof self-esteem and self-worth might address Carlson’s dictum.
Pursuant to a focus on empowerment, some have suggested that treat-ment providers in women-specific CDT settings should alter their counsel-ing interventions (Carlson, 2006; Markoff, Reed, Fallot, Elliott, & Bjelajac,2005). These authors suggest that confrontational approaches traditionallyemployed in CDT might be counterproductive in women-specific treatmentsettings and detract from an empowerment focus. As Carlson (2006) stated,“[T]the confrontational approach traditionally used to break through denialis increasingly thought to be ineffective with women, who experience it ashostile, further eroding their already fragile self-esteem; supportive approachesare seen to be more effective” (p. 103). Markoff et al. (2005) further prof-fered that heavy confrontation in treatment might have iatrogenic effects inthat it could elicit feelings associated with previous trauma. Therefore, atreatment model focused on empowerment, and not heavy confrontation,might “help women heal from the sense of helplessness engendered byabuse” (p. 527).
DOMESTIC VIOLENCE
Chartas and Culbreth (2001) reported that women who have been victims ofdomestic violence (DV) are far more likely to suffer from chemical depen-dency than their nonabused counterparts. Despite this, these authors pointedout that programs that address both substance abuse and DV are a rarity. Inrecent years, there have been calls for programs that link CDT with DV ser-vices. For this to be effective, further research is needed in this area.
Dow
nloa
ded
by [
Uni
vers
ity o
f H
ong
Kon
g L
ibra
ries
] at
12:
55 1
6 N
ovem
ber
2014
Women and Holistic Chemical Dependency Treatment 285
CHILDREN IN TREATMENT
A third specialized service that might be of benefit in women-specific CDTis the ability to be accompanied by their children in residential treatment.Although there is some concern expressed in the literature that this mightdivert the mother’s attention from her recovery (Ashley, Marsden, & Brady,2003; Claus et al., 2007; Green, 2006), research has also suggested that the pres-ence of children improves women’s treatment retention rates and “necessitatesan emphasis on family context which provides for . . . an enhanced qualityof [the] family/domestic environment” (Claus et al., 2007, p. 28). Furtherinvestigation is needed to explore this issue.
HOLISTIC TREATMENT SERVICES
A mounting body of research has developed concerning the use of holisticinterventions in CDT settings (Apostolides, 1996; Dorsman, 1996; Galanter,2006; Lake, 2007), with some studies being specific to women (McDonough &Russell, 1994; O’Brien & Young, 2006; Sterk, Elifson, & Theall, 2000; Sullivan,1994). This includes research on acupuncture (Bullock et al., 2002; Courbasson,de Sorkin, Dullerud, & Van Wyk, 2007; Jordan, 2006), music and drumming(Cevasco, Kennedy, & Generally, 2005; Howard, 1997; Winkelman, 2003),and massage (Reader, Young, & Connor, 2005). In general, each of theseservices has been proven effective for reducing cravings to use alcoholand drugs, and reducing symptoms of anxiety and depression. Holisticapproaches have also been correlated to longer time spent in recovery with-out relapse.
Although research in the area of holistic interventions in CDT is increasing,the majority of the studies already cited are quantitative in nature. Quantitativedata provide scientific evidence for the effectiveness of these interventions,but offer little insight into clients’ perspectives about why and how theseinterventions work.
The purpose of this study was to explore women’s qualitative experi-ences in a gender-specific CDT program focusing on issues of empowerment,domestic violence, the presence of children in treatment, and the applica-tion of holistic treatment interventions.
METHOD
Because research is still emerging, this study sought to investigate women’sexperiences in a CDT from an exploratory stance with the overall goal ofdeveloping hypotheses for further study and establishing preliminary theory.As Hill (1990) stated, exploratory, discovery-oriented research investigates
Dow
nloa
ded
by [
Uni
vers
ity o
f H
ong
Kon
g L
ibra
ries
] at
12:
55 1
6 N
ovem
ber
2014
286 J. M. Linton et al.
phenomena from a nontheoretical stance; these studies set out to createtheory rather than test it. The objectives of the study were to (a) assesswomen’s perceptions of holistic CDT services, (b) describe their experi-ences in a gender-specific CDT program, and (c) develop research ques-tions and hypotheses for future study.
Participants
FOCUS GROUPS
The participants in the study consisted of 23 women enrolled in an aftercaretreatment program at a women-only CDT agency. All of the women in thestudy were in an aftercare treatment program at the same agency and hadsuccessfully completed either residential or outpatient treatment at the timeof their participation. Enrollment in the aftercare program was voluntary.Because of the sensitive nature of the data being gathered, the researchersand CDT agency were concerned about participant anonymity. Therefore,participant demographic data were not collected.
THE RESEARCHERS
The first author was a Caucasian male with expertise in substance abusecounseling. He designed the study and conducted the qualitative analysis.He was not involved in data collection. When examining the biases that hebrought to the study, he believed that gender-specific substance abuse treat-ment for women was a valuable and underused service.
The second and third authors were Caucasian women with experiencein substance abuse treatment settings. They collected all the data. They alsobelieved that gender-specific substance abuse counseling was a valuableservice for women. The fourth author was a Black female. She did not haveformal training in substance abuse counseling but had encountered sub-stance abuse issues in school, community, residential, and hospital settings.This author assisted with the final phases of data analysis and editing. Shebrought a degree of objectivity to the study regarding gender-specific sub-stance abuse counseling.
THE AGENCY
The agency where data were collected was a women’s-only treatment pro-gram offering residential, outpatient, and aftercare services. Women in theresidential program were allowed to keep their children with them up toage 18. The agency also provided a DV shelter and treatment program forbattered women, which was separate from the CDT program. These DVtreatment services were available to women in the CDT program.
Dow
nloa
ded
by [
Uni
vers
ity o
f H
ong
Kon
g L
ibra
ries
] at
12:
55 1
6 N
ovem
ber
2014
Women and Holistic Chemical Dependency Treatment 287
In addition to group and individual treatment, the agency also offeredholistic treatment services, and clients were required to take part in two ofthe following holistic services per week: acupuncture, yoga, music therapy,drumming, meditation, art, massage, or journaling. Some of these services,along with other options, were offered during the weekend, giving the cli-ents the option to engage in treatment programming 7 days a week.
The agency’s treatment philosophy was based on Kasl’s (1994) 16-stepmodel. Kasl created the 16-step model to provide women with an alterna-tive to 12-step based models. The focus of the 16-step model is on empow-erment for women with substance abuse issues and is based on the beliefthat “true healing occurs through empowerment and love, not fear” (Kasl,1995, p. 9). Kasl asserts that traditional 12-step approaches are based onfear of relapse, a concept that does not fit well with women’s needs in CDT.The following are the 16 steps:
1. We affirm we have the power to take charge of our lives and stopbeing dependent on substances or other people for our self-esteem andsecurity.
2. We come to believe that God/Goddess/Universe/Great Spirit/HigherPower awakens the healing wisdom within us when we open ourselvesto the power.
3. We make a decision to become our authentic selves and trust in thehealing power of the truth.
4. We examine our beliefs, addictions, and dependent behavior in thecontext of living in a hierarchical, patriarchal culture.
5. We share with another person and the Universe all those things insideof us for which we feel shame and guilt.
6. We affirm and enjoy our intelligence, strengths, and creativity, remem-bering not to hide these qualities from ourselves and others.
7. We become willing to let go of shame, guilt, and any behavior that keepsus from loving ourselves and others.
8. We make a list of people we have harmed and people who have harmedus, and take steps to clear out negative energy by making amends andsharing our grievances in a respectful way.
9. We express love and gratitude to others and increasingly appreciate thewonder of life and the blessings we do have.
10. We learn to trust our reality and daily affirm that we see what we see,we know what we know, and we feel what we feel.
11. We promptly admit to mistakes and make amends when appropriate,but we do not say we are sorry for things we have not done and we do notcover up, analyze, or take responsibility for the shortcomings of others.
12. We seek out situations, jobs, and people who affirm our intelligence,perceptions, and self-worth and avoid situations or people who are hurt-ful, harmful, or demeaning to us.
Dow
nloa
ded
by [
Uni
vers
ity o
f H
ong
Kon
g L
ibra
ries
] at
12:
55 1
6 N
ovem
ber
2014
288 J. M. Linton et al.
13. We take steps to heal our physical bodies, organize our lives, reducestress, and have fun.
14. We seek to find our inward calling, and develop the will and wisdom tofollow it.
15. We accept the ups and downs of life as natural events that can be usedas lessons for our growth.
16. We grow in awareness that we are sacred beings, interrelated with allliving things, and we contribute to restoring peace and balance on theplanet.
PARTICIPANT RECRUITMENT
Participants were recruited from aftercare treatment groups at the agencyselected for the study. Prior approval was obtained from the agency and theclients in the groups were aware that researchers would be visiting. Clientswere invited to participate and informed that their participation was entirelyvoluntary; all 23 women enrolled in the aftercare treatment agreed to partic-ipate. Human Subjects Institutional Review Board approval was obtained atthe university with which the authors were affiliated.
We elected to gather data only from participants enrolled in aftercareprogramming for two reasons. First, these participants had successfullycompleted either the residential or outpatient treatment and could thereforereflect on their experiences throughout the entire program. Second, theresearchers were interested in understanding the perceptions of only thoseparticipants who had been successful in completing treatment because itwas thought that this would allow for an analysis of what aspects of theprogram contributed to the individual’s success.
Data Collection
Data were collected through three focus group interviews. According toMarshall and Rossman (1999), “this method assumes that individual’s atti-tudes and beliefs do not form in a vacuum: People often need to listen toothers’ opinions and understandings to form their own” (p. 114). Marshalland Rossman also stated that during focus group data collection the facilitatorworks diligently to create a comfortable and supportive environment wherethe expression of differing opinions is valued.
Because data were being gathered from a women-specific CDT program,it was thought that the focus groups would be most successful if facilitatedby women. Therefore, the second and third authors, both experiencedgroup facilitators, conducted the focus groups using a semistructured inter-view format. In this method of data collection, questions are typically askedof participants systematically with the group facilitator having the freedom
Dow
nloa
ded
by [
Uni
vers
ity o
f H
ong
Kon
g L
ibra
ries
] at
12:
55 1
6 N
ovem
ber
2014
Women and Holistic Chemical Dependency Treatment 289
to follow up on participants’ comments for clarification or expansion. Allthree focus group meetings were audiotaped and transcribed.
The semistructured interview protocol used in the study was createdcollaboratively by the researchers and several staff members and administratorsat the agency. The questions were designed to elicit information regardingparticipants’ perceptions of the treatment setting, the services offered, client–staff interactions, and other pertinent information about the program. Theinterview questions were as follows:
1. What is your perception of the treatment program here?2. If you have been in another treatment program(s) or facility besides this
agency, discuss the differences between the programs that you havenoticed.
3. Do the holistic services offered here assist your recovery from alcoholand drug abuse? If yes, how? If not, why not?
4. Is weekend programming important to your recovery? If yes, how? If no,why not?
5. Would you take part in the holistic services again? Why or why not?6. What are the benefits of having your children with you in treatment?
Does this pose any problems?7. What is the value of offering substance abuse services in conjunction
with domestic violence treatment services?8. Discuss your relationship with the staff at the treatment center. How have
they affected your treatment here?
Data Analysis
Data analysis began with transcription of the focus group audiotapes.Analysis continued with multiple reviews of each interview transcript.During these reviews, memos were created regarding the identified phe-nomena and several themes began to emerge. Following these reviews, theresearchers engaged in open coding where data were classified into sepa-rate domains and subcategories within each domain. Each of these domainsand subcategories was then reviewed, and data were added or deleted asappropriate.
RESULTS
Six domains were identified during the analysis of participants’ comments.These domains were (a) empowerment, (b) benefits of holistic services, (c)problems with having children in treatment, (d) difficulties with integratingDV services with CDT, (e) importance of cohesion, and (f) effect of staff.Within these domains, several categories were also identified. These domains
Dow
nloa
ded
by [
Uni
vers
ity o
f H
ong
Kon
g L
ibra
ries
] at
12:
55 1
6 N
ovem
ber
2014
290 J. M. Linton et al.
are described in detail next, together with illustrative sample responses inquotations.
Empowerment
Within the domain of empowerment, five categories were observed. Thesewere (a) general comments about empowerment, (b) Kasl’s 16 steps, (c)safety and comfort, (d) accountability, and (e) structure. Each is outlined next.
In the category of general comments, focus group participants dis-cussed their experiences in gender-specific treatment as related to feelingsof empowerment. These comments focused on “learning about who I am,”being able to show their “true self” in treatment, and learning about empower-ment rather than oppression. As one participant remarked, “The programfocused on empowering rather than powerlessness; this makes it great!”
The second category pertained to the effects of Kasl’s 16-step model.Participants discussed how the use of the 16-step model specifically helpedthem to feel empowered in treatment. This was best summed up by twocomments: One person remarked, “The 16 steps are empowering. It catersto women who have to wear so many hats.” Another offered, “I appreciatethe 16-step idea that I have the power to get through this.”
In the third category of this domain, participants discussed how feel-ings of safety and comfort in women-specific CDT related to empowerment.Safety and comfort appeared to be a central component to openness inCDT. One participant’s comment that “this is the only place that I have beenthat I have felt safe [to work on my issues]” best illustrated this category.
The next empowerment category addressed accountability, how beingheld accountable in treatment led to feelings of empowerment. One partici-pant stated that “being held accountable” helped her to feel safe to showher true self in the program.
Finally, participants discussed how the structure in the treatment pro-gram related to personal empowerment. In two different focus groups, par-ticipants discussed how the structure of the program helped them to workon things in treatment that they never had before. A direct quote from oneparticipant relating to this category was, “I needed the structure of this program;I believe this place saved my life.”
Benefits of Holistic Services
The second domain identified in the data analysis pertained to the benefitsof holistic services. Five categories were observed in this domain: (a) generalcomments about holistic services, (b) spirituality, (c) availability of services,(d) whole-life focus, and (e) comments on specific services.
In the category of general comments, focus group conversations cen-tered on the overall benefits of holistic services. One participant called
Dow
nloa
ded
by [
Uni
vers
ity o
f H
ong
Kon
g L
ibra
ries
] at
12:
55 1
6 N
ovem
ber
2014
Women and Holistic Chemical Dependency Treatment 291
holistic services “the icing on the cake.” Others stated that the holistic ser-vices provided a relaxing atmosphere to the program and helped them to“unwind.” Another participant noted that the holistic services helped her to“learn so much about” herself.
In the second category of this domain, the benefits of a spiritual focuswere discussed. Comments about how holistic services were “spiritualitycentered, not religiously centered,” and how the program “allowed us tohave any religion I want” were made as they related to the effectiveness ofholistic services. One participant stated that the spirituality component oftreatment helped to “grab [her] interest.”
In the availability of services category, focus group participants dis-cussed two aspects. First, they remarked how the holistic services madetreatment “a 7-day program which is different from other programs [I havebeen in].” Second, participants discussed how holistic services would havebeen more beneficial if they were more available. This was particularly truefor those participants who had been in outpatient rather than inpatient treat-ment. One participant remarked, “Residential has more access to holisticservices like massage. As a nonresident I could not get a routine massage.”Another echoed this comment by stating, “Evening appointments would bebetter for nonresidents.”
The fourth category summarized focus group discussions regardinghow holistic services led to a “whole-life focus” in treatment. Here, partici-pants remarked how the holistic services “helped me keep my balance.”More poignantly, one participant’s comment best summed up this category:“This is a program; other treatment programs helped me to stop drinkingbut the program here helped me to change my whole life more than just tostop drinking.”
Finally, participants described the benefits of specific holistic services.Acupuncture, for example, was described as “awesome” and “helped to relievestress” (although one person stated that she was not a “needles person”). Arttherapy, meditation, and massage were also described as “awesome” and“excellent in helping me to relieve stress and anxiety.” Finally, regardingmusic therapy, one focus group participant’s observation best illustrated dis-cussions about all holistic services. She stated, “Music therapy is not justabout listening to music during a social hour; it’s about playing music to getin touch with the dark side, the depressive side of me. The music showedhow I broke out of the dark side and other people noticed the difference.”Not all comments were positive, though. One participant remarked that the“drumming got on my nerves.”
Problems with Having Children in Treatment
The third domain in the study pertained to the effects of having children inresidential treatment. This was consistently noted in all three focus groups
Dow
nloa
ded
by [
Uni
vers
ity o
f H
ong
Kon
g L
ibra
ries
] at
12:
55 1
6 N
ovem
ber
2014
292 J. M. Linton et al.
as a negative aspect of the program. Comments such as “When you are busyfocusing on the kids and their acting out it’s hard to focus on yourself,” and“Children make things more difficult to cope with; it’s difficult to focus onwhat you are doing” best summarized this domain. Another participantnoted that “People with children have roommates and this makes it difficultif you don’t have children; it’s hard to focus.”
Difficulties With Integrating Domestic Violence Services with CDT
The fourth domain in the study focused on the negative aspects of hav-ing DV services in gender-specific CDT. It should be noted that DV andCDT services at the agency were offered in separate programs but clientswith both sets of issues could take part in either component of treat-ment. Participants discussed how the presence of “different expectationsfor DV and substance abuse clients” within each program distractedthem from focusing on their own treatment. They also noted that the DVtreatment system was “abused by DV clients,” and that “some DV just cometo the shelter to take a break” from their daily routines and not necessarilyfor treatment. Having separate “wings” of the building for DV and CDTwas suggested.
Some focus group discussions also centered on how different present-ing personality traits of DV and CDT clients distracted from treatment. Oneparticipant’s comment summed this up:
Having been on both sides myself I really see it as a conflict. I alwaysfelt that the DV and [chemical dependency] people, I don’t think that itis good that they are here together because coming from a DV situationyou have self-esteem issues and if you have someone coming downfrom drugs they are in no mood to put up with traumatized DV clients,especially as a roommate.
Similarly, another participant remarked, “The anger and frustration of[substance abuse] clients does not mix with the fear of the domestic vio-lence people.”
Importance of Cohesiveness
In the fifth domain, focus group participants discussed cohesiveness amongclients in this women-specific CDT center. Generally, participants identifiedcohesiveness with other clients as being an important part of their treat-ment. One participant described a situation in which several residentialtreatment clients “rallied around” a woman who was depressed, suicidal,and wanted to leave the residential program. She stated, “A bunch of us justclimbed into bed with her and wouldn’t let her leave.”
Dow
nloa
ded
by [
Uni
vers
ity o
f H
ong
Kon
g L
ibra
ries
] at
12:
55 1
6 N
ovem
ber
2014
Women and Holistic Chemical Dependency Treatment 293
At the same time, differences in cohesiveness among residential andnonresidential clients, who sometimes were included in the same treatmentgroups, emerged. Participants stated, “I’m closer with the people that I wasin residential with during aftercare,” “You bond together with those on the[residential unit] more,” and “There is more cohesiveness among the resi-dential people.” Furthermore, some comments suggested a conflictual andcompetitive relationship between residential and nonresidential clients. Com-ments such as “Nonresidential clients don’t have an understanding aboutwhat goes on here,” and “Nonresidents don’t seem to stick with it” wereillustrative here.
Effect of Staff
In the final domain, participants discussed the effects of program staff memberson treatment. Two categories were identified within this domain: positiveand negative reactions to program staff members. Each category is summa-rized next.
Comments in the positive reactions category focused on the degree ofcaring demonstrated by staff members and the relationships establishedbetween staff and clients. Participants remarked: “We have a very lovingstaff here”; “We are well supervised and you can tell that they care”; “She’snot only a counselor, she’s a best friend”; “My case manager is a nice, beautifulperson”; and “the staff is always happy to hear from me.” Focus group par-ticipants also discussed proactive actions taken by staff to ensure treatmentsuccess. One participant stated, “The staff notice when I have issues andtake [immediate] steps to get me help; they don’t wait for me to ask.” Thecomments in this category can best be summed up by this quote: “This isnot an 8-to-5 job for the staff. They could just go home at the end of the daybut they don’t. They care even though they have so many clients. They knowme and my family. They called me by the same nickname that my familydid.” All of these views were noted as beneficial to treatment effectiveness.
In the negative reactions category, participants commented on staffmembers’ qualifications, skills, and perceived unfair treatment. In terms ofqualifications, participants’ comments can be summed up by the remarks “Itseems that a lot of the staff has lots of textbook education but not a lick ofstreet sense,” and “Those staff members who have not lived it don’t know.”Focus group conversations also centered on poor counseling skills demon-strated by some staff members. One participant stated, “Some of them don’tknow anything about group dynamics so I just shut up and put my time induring those groups.” Finally, participants discussed the negative effects ofperceived unfair treatment by certain staff members. This was best illus-trated by the comment, “Some [staff] get on a power trip and talk down toyou.” Each of the items in this category was noted as having a negative effecton the treatment environment.
Dow
nloa
ded
by [
Uni
vers
ity o
f H
ong
Kon
g L
ibra
ries
] at
12:
55 1
6 N
ovem
ber
2014
294 J. M. Linton et al.
DISCUSSION
One important finding to emerge in the study pertained to feelings ofempowerment, which appeared to be a central component of treatmentsuccess as described by participants in the study. Feelings of empowermentwere described as leading to a sense of safety and comfort, self-discovery,and personal growth. Although causal relationships cannot be established inthe data, the use of Kasl’s (1994) 16 steps as the basis for treatment, alongwith program structure and accountability, seemed to set the tone forempowerment in the program. Although little research has been conductedon the 16 steps, Kasl created the model as a way to address problems sheperceived with 12-step philosophies as they relate to the treatment ofwomen. Specifically, Kasl states that empowerment, not fear of relapse,leads to successful outcomes for women dealing with chemical dependencyissues. Results of this exploratory study suggest that this assertion mighthold merit. If these findings are confirmed through further study, CDT pro-viders might find it effective to change their treatment approaches withfemale clients, specifically as they relate to a 12-step versus 16-step programorientation.
A second finding of interest pertained to the use of holistic services.Participants in the study were required to take part in two holistic servicesper week. These services were available, but not required, during aftercaretreatment. Overwhelmingly, participants identified the use of holistic ser-vices as being very beneficial to their treatment success. As described byparticipants, holistic services “set the tone” for treatment, encouraged a“whole-life focus,” helped with relaxation, and created a spiritual, not reli-gious, treatment environment. If holistic services are to be effective theymust be easily accessible and available on a regular basis. Several focusgroup participants noted a lack of availability of these services in theirCDT program, which was described as a negative aspect of the treatmentenvironment.
Because the results of this study suggest a possible benefit of holisticservices in women- specific CDT treatment, further research in this area iswarranted. Specifically, further investigation should focus on the mecha-nisms of holistic services that lead to positive treatment experiences andoutcomes. In addition, future research should focus on personality–treatmentservice matching. Although participants in this study all identified holisticservices as positive, it should be noted that all were successful treatmentcompleters. Therefore, the experience of holistic services in the treatment ofthose clients not completing the CDT program is unknown.
A third important finding to emerge in the study related to participants’negative views of two of the services provided in their treatment program.These were the ability to have children in residential treatment and the pro-vision of DV services. Given that several authors have suggested that the
Dow
nloa
ded
by [
Uni
vers
ity o
f H
ong
Kon
g L
ibra
ries
] at
12:
55 1
6 N
ovem
ber
2014
Women and Holistic Chemical Dependency Treatment 295
provision of these services could have positive benefits for women in CDT(Ashley et al., 2003; Chartas & Culbreth, 2001), this finding was surprising.Participants in this study identified both the presence of children in thetreatment environment and the mixing of chemical dependency and DV ser-vices as distracting to their focus in treatment. It should be noted, however,that it is unknown as to whether these participants had their own childrenin treatment or a history of domestic violence. Therefore, their perspectiveson these topics might contain bias. Nevertheless, it is suggested that furtherresearch investigate the effects of including children as well as DV servicesin women-specific CDT. If future research suggests positive outcomes fromincluding children or DV services, the manner in which each should bemixed into women-specific CDT programs should be of particular interest.
Finally, participants commented on the effects of staff dedication totheir treatment success. Several participants described situations in whichtreatment staff went “above and beyond” the scope of their duties to assisttreatment clients. In addition, participants made comments on personal charac-teristics of staff. For example, staff members were described as “nice, beautiful”people, and “best friends.” Each of these factors was noted as vital to treat-ment success. Although preliminary in nature, this finding suggests that, forwomen, client–therapist relationship might be one of the most importantcharacteristics of the treatment environment. This finding might also supportconcerns in the literature about using strongly confrontational approacheswith women (Carlson, 2006; Markoff et al., 2005). Further research, therefore,should be conducted in this area. Specifically, the elements of effective client–therapist relationships in women-specific CDT should be investigated.
Study Limitations
Although several findings of interest emerged, this study is not without lim-itations. Due to the research methods employed in this study, results shouldbe considered preliminary in nature and study limitations must be notedwhen interpreting data. First, participants in the study were all volunteers.Although qualitative research does not stress the use of random samplingprocedures to obtain large samples representative of the entire population,the use of volunteers might have created bias. Second, participants’ reportsof their experiences in one women-specific CDT could have been biased bycharacteristics of the treatment program in which they were enrolled andmight not be representative of women’s experiences in other women-specificCDT programs. Third, results could be limited by a lack of diversity in thesample. Information on racial and ethnic backgrounds was not collected forreasons of confidentiality and it is unknown what impact these variableshad on the findings. Finally, all the participants in the study were enrolledin aftercare, and had therefore successfully completed outpatient or residentialtreatment. Because the objective of this study was to obtain the perspectives
Dow
nloa
ded
by [
Uni
vers
ity o
f H
ong
Kon
g L
ibra
ries
] at
12:
55 1
6 N
ovem
ber
2014
296 J. M. Linton et al.
of this population, extension of these results to unsuccessful treatment com-pleters or those currently enrolled in treatment should be made with caution.
CONCLUSION
This exploratory study sought to investigate the experiences of women ingender-specific, holistic CDT. The literature has noted the need for furtherexamination of this topic and the use of women-specific CDT programs isincreasing. The lack of research in this area, however, could limit the effec-tiveness of these programs as they relate to treatment outcomes (Baletka &Shearer, 2001; Fendrich et al., 2006; Najavits, et al., 2007; Pelissier et al.,2003). Some interesting discoveries were made in this study, but muchresearch is still needed. Therefore, future research should continue to buildon the discoveries of this and other studies to investigate the use of women-specific CDT approaches.
REFERENCES
Apostolides, M. (1996). How to quit the holistic way. Psychology Today, 29(5), 34–45.Ashley, O., Marsden, M., & Brady, T. (2003). Effectiveness of substance abuse treat-
ment programming for women: A review. American Journal of Drug and AlcoholAbuse, 29, 19–53.
Baletka, D., & Shearer, R. (2001). Counseling female offenders who abuse sub-stances. TCA Journal, 29, 140–148.
Bride, B. (2001). Single-gender treatment of substance abuse: Effects on treatmentretention and completion. Social Work Research, 25, 223–232.
Bullock, M., Kiresuk, T., Sherman, R., Lenz, S., Culliton, P., Boucher, T., et al.(2002). A large randomized placebo controlled study of auricular acupuncturefor alcohol dependence. Journal of Substance Abuse Treatment, 22, 71–77.
Burman, S. (1992). A model for women’s alcohol/drug treatment. Alcoholism Treat-ment Quarterly, 9(2), 87–99.
Carlson, B. (2006). Best practices in the treatment of substance abusing women inthe child welfare system. Journal of Social Work Practice in Addictions, 6(3),97–115.
Cevasco, A., Kennedy, R., & Generally, N. (2005). Comparison of movement-to-music, rhythm activities, and competitive games on depression, stress, anxiety,and anger in females in substance abuse rehabilitation. Journal of Music Therapy,42(1), 64–80.
Chartas, N., & Culbreth, J. (2001). Counselor treatment of coexisting domestic violenceand substance abuse: A qualitative study. Journal of Addictions and OffenderCounseling, 22, 2–11.
Clark, H. (2001). Residential substance abuse treatment for pregnant and postpartumwomen and their children: Treatment and policy implications. Child WelfareJournal, 82, 179–198.
Dow
nloa
ded
by [
Uni
vers
ity o
f H
ong
Kon
g L
ibra
ries
] at
12:
55 1
6 N
ovem
ber
2014
Women and Holistic Chemical Dependency Treatment 297
Claus, R., Orwin, R., Kissin, W., Krupski, A., Campbell, K., & Stark, K. (2007). Doesgender specific substance abuse treatment promote continuity of care? Journalof Substance Abuse Treatment, 32, 27–39.
Cook, L., Epperson, L., & Gariti, P. (2005). Determining the need for gender-specificchemical dependence treatment: Assessment of treatment variables. The AmericanJournal of Addictions, 14, 328–338.
Courbasson, C., de Sorkin, A., Dullerud, B., & Van Wyk, L. (2007). Acupuncturetreatment for women with concurrent substance abuse and anxiety/depression:An effective alternative therapy. Family Community Health, 30, 112–120.
Dorsman, J. (1996). Improving alcoholism treatment: An overview. BehavioralHealth Management, 16(1), 26–30.
El-Guebaly, N. (1995). Alcohol and polysubstance abuse among women. CanadianJournal of Psychiatry, 40, 73–79.
Fendrich, M., Hubbell, A., & Lurigio, A. (2006). Provider’s perceptions of gender-specific drug treatment. Journal of Drug Issues, 22, 667–686.
Galanter, M. (2006). Spirituality and addiction: A research and clinical perspective.The American Journal of Addictions, 15, 286–292.
Gerolamo, A. (2004). State of the science: Women and nonpharmacologicaltreatment of substance abuse. American Journal of Psychiatric Nursing, 10,181–189.
Green, C. (2006). Gender and use of substance abuse treatment services. AlcoholResearch and Health, 29(1), 55–62.
Haller, D., Miles, D., & Dawson, K. (2002). Psychopathology influences treatmentretention among drug-dependent women. Journal of Substance Abuse Treat-ment, 23, 431–436.
Hill, C. (1990). Exploratory in-session process research in individual psychotherapy:A review. Journal of Consulting and Clinical Psychology, 58, 288–294.
Hodgins, D., El-Guebaly, N., & Addington, J. (1997). Treatment of substance abusers:Single or mixed gender programs. Addiction, 92(7), 1–10.
Hodgson, R., & John, B. (2004). Gender, gender role, and brief alcohol interven-tions. Addiction, 99, 3–4.
Howard, A. (1997). The effects of music and poetry therapy on the treatment ofwomen and adolescents with chemical addictions. Journal of Poetry Therapy,11, 81–102.
Jordan, J. (2006). Acupuncture treatment for opiate addiction: A systematic review.Journal of Substance Abuse Treatment, 30, 309–314.
Karroll, B., & Memmott, J. (2001). The order of alcohol-related life experiences:Gender differences. Journal of Social Work Practice, 1(2), 45–60.
Kasl, C. (1994). Many roads, one journey: Moving beyond the 12 steps. New York:HarperCollins.
Kasl, C. (1995). Yes, you can! A guide to empowerment groups. Lolo, MT: Author.Lake, J. (2007). Nonconventional and integrative treatments of alcohol and sub-
stance abuse. Psychiatric Times, 24(2), 10–11.Markoff, L., Reed, B., Fallot, R., Elliott, D., & Bjelajac, P. (2005). Implementing trauma-
informed alcohol and other drug and mental health services for women: Lessonslearned from a multisite demonstration project. American Journal of Orthopsy-chiatry, 75, 525–539.
Dow
nloa
ded
by [
Uni
vers
ity o
f H
ong
Kon
g L
ibra
ries
] at
12:
55 1
6 N
ovem
ber
2014
298 J. M. Linton et al.
Marshall, C., & Rossman, G. (1999). Designing qualitative research (3rd ed.). ThousandOaks, CA: Sage.
McDonough, R., & Russell, L. (1994). Alcoholism in women: A holistic, comprehen-sive care model. Journal of Mental Health Counseling, 16, 456–475.
Najavits, L., Rosier, M., Nolan, A., & Freeman, M. (2007). A new gender-basedmodel for women’s recovery from substance abuse: Results of a pilot outcomestudy. The American Journal of Drug and Alcohol Abuse, 33, 5–11.
Neale, J. (2004). Gender and illicit drug use. British Journal of Social Work, 34,851–870.
O’Brien, P., & Young, D. (2006). Challenges for formerly incarcerated women: Aholistic approach to assessment. Families in Society, 87, 359–366.
Pelissier, B., Camp, S., Gaes, G., Saylor, W., & Rhodes, W. (2003). Gender differences inoutcomes from prison-based residential treatment. Journal of Substance AbuseTreatment, 24, 149–160.
Reader, M., Young, R., & Connor, J. (2005). Massage therapy improves managementof alcohol withdrawal syndrome. The Journal of Alternative and Complimen-tary Medicine, 11, 311–313.
Schober, R., & Annis, H. (1996). Barriers to help-seeking for change in drinking: Agender focused review of the literature. Addictive Behavior, 21(1), 81–92.
Sinha, R., & Rounsaville, B. (2002). Sex differences in depressed substance abusers.Journal of Clinical Psychiatry, 63, 616–627.
Sterk, C., Elifson, K., & Theall, K. (2000). Women and drug treatment experiences:A generational comparison of mothers and daughters. Journal of Drug Issues,30, 839–861.
Sullivan, W. (1994). Case management and community-based treatment of womenand substance abuse problems. Journal of Case Management, 3, 158–161.
Sun, A. (2007). Relapse among substance-abusing women: Components and pro-cesses. Substance Use and Misuse, 41, 1–21.
Walter, H., Gutierrez, K., Ramskogler, K., Hertling, I., Dvorak, A., & Lesch, O.(2003). Gender-specific differences in alcoholism: Implications for treatment.Archives of Women’s Mental Health, 6, 253–258.
Wilde, J., Soyez, V., Broekaert, E., Rosseel, Y., Kaplan, C., & Larsson, J. (2004).Problem severity profiles of substance abusing women in European therapeuticcommunities: Influence of psychiatric problems. Journal of Substance AbuseTreatment, 26, 243–251.
Winkelman, M. (2003). Complementary therapy for addiction: “Drumming out drugs.”American Journal of Public Health, 93, 547–651.
Dow
nloa
ded
by [
Uni
vers
ity o
f H
ong
Kon
g L
ibra
ries
] at
12:
55 1
6 N
ovem
ber
2014