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Treatment Outcomes for Women with Substance Use Disorders: a Critical Review of the Literature (2010–2016)

  • Women and Addictions (CM Mazure and Y Zakiniaeiz, Section Editors)
  • Published:
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Abstract

Purpose of Review

This review critically examines recent literature (2010–2016) on substance use outcomes in women-only treatment studies and gender differences in treatment outcomes in mixed-gender studies. We then focus on outcomes in three areas salient to women with substance use disorders (SUDs): treatment of comorbid post-traumatic stress disorder (PTSD), pregnancy and parenting interventions, and treatment for women in the criminal justice system.

Recent Findings

Favorable results were found for behavioral treatments for women including couples therapy and gender-responsive group therapy. When gender differences were observed in mixed-gender behavioral treatment, outcomes were more favorable in women than in men. However, when gender differences were observed in pharmacotherapy trial results, outcomes were worse for women. With regard to the three subgroups that we reviewed, most recent research on co-occurring PTSD and SUD has been secondary analysis studies which suggest that factors such as group attendance and co-occurring psychiatric disorders influence substance use outcomes. In contrast to the other two subgroups examined, behavioral treatments for pregnant women did not show superior outcomes when compared to control groups. However, buprenorphine was found to be safe and effective for use with pregnant women with an opioid use disorder. Finally, studies of treatment outcomes for women in the criminal justice system found preliminary evidence of efficacy for several behavioral treatments.

Summary

Consistent with findings of previous reviews, gender alone did not necessarily predict treatment response; rather, interaction of gender and other factors affected outcomes. Evidence showing worse outcomes for women in pharmacotherapy trials, with the exception of buprenorphine with pregnant women, further reinforces the need for research to evaluate differential treatment outcomes for men and women.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Tuchman E. Women and addiction: the importance of gender issues in substance abuse research. J Addict Dis. 2010;29(2):127–38.

    Article  PubMed  Google Scholar 

  2. Greenfield SF, et al. Gender research in the National Institute on Drug Abuse National Treatment Clinical Trials Network: a summary of findings. The American Journal of Drug and Alcohol Abuse. 2011;37(5):301–12.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Greenfield SF, et al. Substance abuse treatment entry, retention, and outcome in women: a review of the literature. Drug Alcohol Depend. 2007;86(1):1–21.

    Article  PubMed  Google Scholar 

  4. Torchalla I, et al. Smoking cessation programs targeted to women: a systematic review. Women Health. 2012;52(1):32–54.

    Article  PubMed  Google Scholar 

  5. Smith PH, et al. Sex/gender differences in smoking cessation: a review. Prev Med. 2016;92:135–40.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Moher D, et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6(7):21.

    Article  Google Scholar 

  7. Al-Otaiba Z, et al. Age-based differences in treatment outcome among alcohol-dependent women. Psychol Addict Behav. 2012;26(3):423–31.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Farris SG, et al. Do co-morbid anxiety disorders predict drinking outcomes in women with alcohol use disorders? Alcohol Alcohol. 2012;47(2):143–8.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Greenfield SF, et al. Group therapy for women with substance use disorders: results from the Women’s Recovery Group study. Drug Alcohol Depend. 2014;142:245–53.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Kuerbis AN, Neighbors CJ, Morgenstern J. Depression’s moderation of the effectiveness of intensive case management with substance-dependent women on temporary assistance for needy families: outpatient substance use disorder treatment utilization and outcomes. Journal of Studies on Alcohol and Drugs. 2011;72(2):297–307.

    Article  PubMed  PubMed Central  Google Scholar 

  11. McCrady BS, et al. Women with alcohol dependence: a randomized trial of couple versus individual plus couple therapy. Psychol Addict Behav. 2016;30(3):287–99.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Price CJ, et al. Mindful awareness in body-oriented therapy as an adjunct to women's substance use disorder treatment: a pilot feasibility study. J Subst Abus Treat. 2012;43(1):94–107.

    Article  Google Scholar 

  13. • Schumm JA, et al. A randomized clinical trial of behavioral couples therapy versus individually based treatment for women with alcohol dependence. J Consult Clin Psychol. 2014;82(6):993–1004. Women who received behavioral couples therapy had higher alcohol abstinence rates and fewer substance-related problems than women who received individual therapy

    Article  PubMed  PubMed Central  Google Scholar 

  14. Worden BL, Epstein EE, McCrady BS. Pretreatment assessment-related reductions in drinking among women with alcohol use disorders. Subst Use Misuse. 2015;50(2):215–25.

    Article  PubMed  Google Scholar 

  15. Burch AE, Rash CJ, Petry NM. Sex effects in cocaine-using methadone patients randomized to contingency management interventions. Exp Clin Psychopharmacol. 2015;23(4):284–90.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Campbell AN, et al. Gender-based outcomes and acceptability of a computer-assisted psychosocial intervention for substance use disorders. J Subst Abus Treat. 2015;53:9–15.

    Article  Google Scholar 

  17. Lynch KG, et al. Moderators of response to telephone continuing care for alcoholism. Am J Health Behav. 2010;34(6):788–800.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Montgomery L, et al. Motivational enhancement therapy for African American substance users: a randomized clinical trial. Cult Divers Ethn Minor Psychol. 2011;17(4):357–65.

    Article  Google Scholar 

  19. Rash CJ, Petry NM. Contingency management treatments are equally efficacious for both sexes in intensive outpatient settings. Exp Clin Psychopharmacol. 2015;23(5):369–76.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Cropsey KL, et al. Results of a pilot randomized controlled trial of buprenorphine for opioid dependent women in the criminal justice system. Drug Alcohol Depend. 2011;119(3):172–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Adamson SJ, et al. A randomized trial of combined citalopram and naltrexone for nonabstinent outpatients with co-occurring alcohol dependence and major depression. J Clin Psychopharmacol. 2015;35(2):143–9.

    Article  CAS  PubMed  Google Scholar 

  22. •• DeVito EE, et al. Gender differences in clinical outcomes for cocaine dependence: randomized clinical trials of behavioral therapy and disulfiram. Drug Alcohol Depend. 2014;145:156–67. Data from five RCTs that examined various combinations of disulfiram or placebo and/or behavioral treatments showed that women had worse outcomes on cocaine use compared to men. This finding was driven by women receiving less benefit from disulfiram in men. There were no gender differences in behavioral treatment outcomes.

    Article  PubMed  Google Scholar 

  23. Greenfield SF, et al. Gender differences in alcohol treatment: an analysis of outcome from the COMBINE study. Alcohol Clin Exp Res. 2010;34(10):1803–12.

    Article  PubMed  PubMed Central  Google Scholar 

  24. McHugh RK, et al. Gender differences in a clinical trial for prescription opioid dependence. J Subst Abus Treat. 2013;45(1):38–43.

    Article  Google Scholar 

  25. McRae-Clark AL, et al. Buspirone treatment of cannabis dependence: a randomized, placebo-controlled trial. Drug Alcohol Depend. 2015;156:29–37.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Sherman BJ, Baker NL, McRae-Clark AL. Gender differences in cannabis use disorder treatment: change readiness and taking steps predict worse cannabis outcomes for women. Addict Behav. 2016;60:197–202.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Winhusen TM, et al. Multisite, randomized, double-blind, placebo-controlled pilot clinical trial to evaluate the efficacy of buspirone as a relapse-prevention treatment for cocaine dependence. The Journal of Clinical Psychiatry. 2014;75(7):757–64.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Cohen LR, et al. Survey of eating disorder symptoms among women in treatment for substance abuse. Am J Addict. 2010;19(3):245–51.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Hien DA, et al. Do treatment improvements in PTSD severity affect substance use outcomes? A secondary analysis from a randomized clinical trial in NIDA’s clinical trials network. Am J Psychiatry. 2010;167(1):95–101.

    Article  PubMed  Google Scholar 

  30. Hien DA, et al. Attendance and substance use outcomes for the seeking safety program: sometimes less is more. J Consult Clin Psychol. 2012;80(1):29–42.

    Article  PubMed  Google Scholar 

  31. López-Castro T, et al. Pathways to change: use trajectories following trauma-informed treatment of women with co-occurring post-traumatic stress disorder and substance use disorders. Drug Alcohol Rev. 2015;34(3):242–51.

    Article  PubMed  Google Scholar 

  32. • Morgan-Lopez AA, et al. Indirect effects of 12-session seeking safety on substance use outcomes: overall and attendance class-specific effects. Am J Addict. 2014;23(3):218–25. This study is a secondary analysis of the Women and Trauma Study, and reports on the direct and indirect effects of Seeking Safety (SS) on substance use outcomes among a sample of women with co-occuring SUD and PTSD. In the in-treatment phase, women in the SS condition showed significant reductions in PTSD severity and frequency, which mediated the impact of Seeking Safety on alcohol and cocaine use outcomes.

    Article  PubMed  Google Scholar 

  33. Morgan-Lopez AA, et al. Synergy between seeking safety and twelve-step affiliation on substance use outcomes for women. J Subst Abus Treat. 2013;45(2):179–89.

    Article  Google Scholar 

  34. Ruglass LM, et al. Racial/ethnic match and treatment outcomes for women with PTSD and substance use disorders receiving community-based treatment. Community Ment Health J. 2014;50(7):811–22.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Ruglass LM, et al. Helping alliance, retention, and treatment outcomes: a secondary analysis from the NIDA Clinical Trials Network Women and Trauma Study. Subst Use Misuse. 2012;47(6):695–707.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Denton WH, et al. Family discord is associated with increased substance use for pregnant substance users. Subst Use Misuse. 2014;49(3):326–32.

    Article  PubMed  Google Scholar 

  37. Holbrook AM, et al. Induction of pregnant women onto opioid-agonist maintenance medication: an analysis of withdrawal symptoms and study retention. Drug Alcohol Depend. 2013;132(1–2):329–34.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  38. Hutchinson ML, et al. The efficacy of escalating and fixed contingency management reinforcement on illicit drug use in opioid-dependent pregnant women. Addict Disord Their Treat. 2012;11(3):150–3.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Jones HE, et al. Neonatal abstinence syndrome after methadone or buprenorphine exposure. N Engl J Med. 2010;363(24):2320–31.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  40. Jones HE, O'Grady KE, Tuten M. Reinforcement-based treatment improves the maternal treatment and neonatal outcomes of pregnant patients enrolled in comprehensive care treatment. Am J Addict. 2011;20(3):196–204.

    Article  PubMed  PubMed Central  Google Scholar 

  41. • Ondersma SJ, et al. Computer-delivered screening and brief intervention (e-SBI) for postpartum drug use: a randomized trial. J Subst Abus Treat. 2014;46(1):52–9. Postpartum women who received a brief e-SBI had higher abstinence rates in the short term (3 months) compared to women in a timed-control groups.

    Article  Google Scholar 

  42. Ondersma SJ, Winhusen T, Lewis DF. External pressure, motivation, and treatment outcome among pregnant substance-using women. Drug Alcohol Depend. 2010;107(2–3):149–53.

    Article  PubMed  Google Scholar 

  43. Slesnick N, Zhang J. Family systems therapy for substance-using mothers and their 8- to 16-year-old children. Psychol Addict Behav. 2016;30(6):619–29.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Slesnick N, Erdem G. Efficacy of ecologically-based treatment with substance-abusing homeless mothers: substance use and housing outcomes. J Subst Abus Treat. 2013;45(5):416–25.

    Article  Google Scholar 

  45. Tuten M, et al. Lessons learned from a randomized trial of fixed and escalating contingency management schedules in opioid-dependent pregnant women. Am J Drug Alcohol Abuse. 2012;38(4):286–92.

    Article  PubMed  Google Scholar 

  46. Yonkers KA, et al. Motivational enhancement therapy coupled with cognitive behavioral therapy versus brief advice: a randomized trial for treatment of hazardous substance use in pregnancy and after delivery. Gen Hosp Psychiatry. 2012;34(5):439–49.

    Article  PubMed  PubMed Central  Google Scholar 

  47. • Lanza PV, et al. Acceptance and commitment therapy versus cognitive behavioral therapy in the treatment of substance use disorder with incarcerated women. J Clin Psychiatry. 2014;70(7):644–57. Incarcerated women who were randomized to the acceptance and commitment therapy (ACT) group showed greater reductions in drug use when compared to women in the cognitive-behavioral therapy (CBT) condition. This would suggest that there may be alternative and effective treatment modalities that can be used when addressing substance use in incarcerated samples.

    Google Scholar 

  48. Messina N, et al. A randomized experimental study of gender-responsive substance abuse treatment for women in prison. J Subst Abus Treat. 2010;38(2):97–107.

    Article  Google Scholar 

  49. Messina N, Calhoun S, Warda U. Gender-responsive drug court treatment: a randomized controlled trial. Crim Justice Behav. 2012;39(12):1539–58.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Sacks JY, McKendrick K, Hamilton Z. A randomized clinical trial of a therapeutic community treatment for female inmates: outcomes at 6 and 12 months after prison release. J Addict Dis. 2012;31(3):258–69.

    Article  PubMed  Google Scholar 

  51. Witkiewitz K, et al. Randomized trial comparing mindfulness-based relapse prevention with relapse prevention for women offenders at a residential addiction treatment center. Subst Use Misuse. 2014;49(5):536–46.

    Article  PubMed  Google Scholar 

  52. Johnson JE, et al. Gender and treatment response in substance use treatment-mandated parolees. J Subst Abus Treat. 2011;40(3):313–21.

    Article  Google Scholar 

  53. Walitzer KS, Dearing RL. Gender differences in alcohol and substance use relapse. Clin Psychol Rev. 2006;26(2):128–48.

    Article  PubMed  Google Scholar 

  54. McCrady BS, et al. A randomized trial of individual and couple behavioral alcohol treatment for women. J Consult Clin Psychol. 2009;77(2):243–56.

    Article  PubMed  PubMed Central  Google Scholar 

  55. Fals-Stewart W, Birchler GR, Kelley ML. Learning sobriety together: a randomized clinical trial examining behavioral couples therapy with alcoholic female patients. J Consult Clin Psychol. 2006;74(3):579–91.

    Article  PubMed  Google Scholar 

  56. Weiss RD, et al. Group therapy for substance use disorders: what do we know? Harvard Review of Psychiatry. 2004;12(6):339–50.

    Article  PubMed  Google Scholar 

  57. Greenfield SF, et al. The Women’s Recovery Group study: a stage I trial of women-focused group therapy for substance use disorders versus mixed-gender group drug counseling. Drug Alcohol Depend. 2007;90(1):39–47.

    Article  PubMed  PubMed Central  Google Scholar 

  58. Sugarman DE, et al. Measuring affiliation in group therapy for substance use disorders in the Women’s Recovery Group study: does it matter whether the group is all-women or mixed-gender? Am J Addict. 2016;25(7):573–80.

    Article  PubMed  PubMed Central  Google Scholar 

  59. Morgenstern J, et al. Effectiveness of intensive case management for substance-dependent women receiving temporary assistance for needy families. Am J Public Health. 2006;96(11):2016–23.

    Article  PubMed  PubMed Central  Google Scholar 

  60. Morgenstern J, et al. Improving 24-month abstinence and employment outcomes for substance-dependent women receiving temporary assistance for needy families with intensive case management. Am J Public Health. 2009;99(2):328–33.

    Article  PubMed  PubMed Central  Google Scholar 

  61. Weiss RD, Rao V. The prescription opioid addiction treatment study: what have we learned. Drug Alcohol Depend. 2017;173(Suppl 1):S48–54.

    Article  PubMed  Google Scholar 

  62. Najavits L, Weiss R, Shaw S. The link between substance abuse and posttraumatic stress disorder in women: a research review. Am J Addict. 1997;6:273–83.

    CAS  PubMed  Google Scholar 

  63. Hien DA, et al. Multisite randomized trial of behavioral interventions for women with co-occurring PTSD and substance use disorders. J Consult Clin Psychol. 2009;77(4):607–19.

    Article  PubMed  PubMed Central  Google Scholar 

  64. Najavits L. Seeking safety: a treatment manual for PTSD and substance abuse. New York: Guilford; 2002.

    Google Scholar 

  65. Winhusen T, et al. Motivational enhancement therapy to improve treatment utilization and outcome in pregnant substance users. J Subst Abus Treat. 2008;35(2):161–73.

    Article  Google Scholar 

  66. Jones HE, et al. Reinforcement-based therapy: 12-month evaluation of an outpatient drug-free treatment for heroin abusers. Drug Alcohol Depend. 2005;79(2):119–28.

    Article  PubMed  Google Scholar 

  67. Office of Applied Studies. Results from the 2007 national survey on drug use and health: national findings. Rockville: Office of Applied Studies; 2008.

    Google Scholar 

  68. Johnson RE, et al. A comparison of levomethadyl acetate, buprenorphine, and methadone for opioid dependence. N Engl J Med. 2000;343(18):1290–7.

    Article  CAS  PubMed  Google Scholar 

  69. Glaze LE, James DJ. Washington, DC: Mental health problems of prison and jail inmates, in Bureau of Justice Statistics Special Report. U.S. Department of Justice; 2006.

  70. Lynch S, et al. Women’s pathways to jail: examining mental health, trauma, and substance use. Washington, DC: Bureau of Justice Assistance; 2013.

  71. McCrady BS, et al. What do women want? Alcohol treatment choices, treatment entry and retention. Psychol Addict Behav. 2011;25(3):521–9.

    Article  PubMed  PubMed Central  Google Scholar 

  72. Ziedonis DM. Integrated treatment of co-occurring mental illness and addiction: clinical intervention, program, and system perspectives. CNS Spectr. 2004;9(12):892–904.

  73. Kypri K, et al. Assessment may conceal therapeutic benefit: findings from a randomized controlled trial for hazardous drinking. Addiction. 2007;102(1):62–70.

    Article  PubMed  Google Scholar 

  74. O'Farrell TJ, et al. A randomized clinical trial of behavioral couples therapy versus individually-based treatment for drug-abusing women. J Consult Clin Psychol. 2017;85(4):309–22.

    Article  PubMed  Google Scholar 

  75. Greenfield SF. Treating women with substance use disorders: the Women's Recovery Group manual. New York: Guilford Press; 2016.

    Google Scholar 

  76. Poland ML, et al. Punishing pregnant drug users: enhancing the flight from care. Drug Alcohol Depend. U.S. Department of Health and Human Services. 1993;31(3):199–203.

  77. National Institutes of Health. Moving into the future with new dimensions and strategies: a vision for 2020 for women's health research. Strategic plan—executive summary (NIH Publication No. 10–7606), N.I.o.H. Office of Research on Women's Health, U.S. Department of Health and Human Services, Editor. Bethesda; 2010.

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Funding Information

Dr. Greenfield previously received support from National Institute on Drug Abuse grant K24DA019855 (ended 5/31/16) and National Institute on Drug Abuse grant R01DA15434 (ended 6/30/13) for the Women’s Recovery Group study which is described in this manuscript. Neither grant award is applicable to this submission. Support for this manuscript was provided by the Women’s Mental Health Initiative Fund, McLean Hospital (SFG, DES, and MER), and the Sarles Young Investigator Award for Research on Women and Addiction, McLean Hospital (DES), and NIDA Grant U10 DA015831 (SFG).

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Correspondence to Dawn E. Sugarman.

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Dawn E. Sugarman, Meghan E. Reilly, and Shelly F. Greenfield declare they have no conflict of interest.

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All reported studies/experiments with human or animal subjects performed by the authors have been previously published and complied with all applicable ethical standards (including the Helsinki declaration and its amendments, institutional/national research committee standards, and international/national/institutional guidelines).

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This article is part of the Topical Collection on Women and Addictions

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Sugarman, D.E., Reilly, M.E. & Greenfield, S.F. Treatment Outcomes for Women with Substance Use Disorders: a Critical Review of the Literature (2010–2016). Curr Addict Rep 4, 482–502 (2017). https://doi.org/10.1007/s40429-017-0172-9

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