The reported prevalence of drug abuse problems in women has increased considerably in the last decade and is now the second most common psychiatric disorder in women of child-bearing age. Despite this increase in reported problems, women are still dramatically underrepresented in treatment; substance abusing males are approximately twice as likely to seek treatment as substance abusing females. Further, data suggest that less than 3% of substance abusing women are actually seeking treatment. These findings are of particular concern given the increasing rates of HIV infection in IV drug using women and their children. Several recent surveys have identified practical treatment barriers for women, particularly the lack of specialized women's treatment facilities. The proposed randomized, clinical trial will evaluate the effectiveness of the Comprehensive Women's Center (CWC), which has been designed to address several common treatment barriers. First, the comprehensive program utilizes a day treatment model of service delivery, which has been shown effective with other substance abuse treatment populations. Second, services will be specialized to address the problems that particularly impact drug dependent women; these problems include anxiety and depression, family/marital discord, low self-esteem, sexual abuse and poor social adjustment. Third, the comprehensive program will offer enhanced, on-site medical services specific to the health care needs of women and their children. Since drug dependent women have been shown to have an increased incidence of a variety of gynecologic and obstetric problems, it is critical to maximize accessibility to medical services while also enhancing continuity of care. These comprehensive clinic services will be compared with standard care for IV drug dependent women of childbearing age in a controlled, randomized clinical trial (N=350). Additional important research features include: the availability of methadone maintenance for eligible research subjects; subject screening in the JHH Gyn/OB clinics as well as through traditional referral sources; and enrollment of both heroin and cocaine dependent women. A comprehensive assessment will be conducted on subjects in both the comprehensive and standard care conditions at the time of intake, with follow-up interviews conducted at 3, 6, 9 and 12 months post-enrollment. Standardized clinical instruments will be used to assess substance use, psychosocial status, psychiatric comorbidity, personality, and HIV-risk behaviors. Health assessments for all subjects will include menstrual and STD histories, and family planning behaviors. In addition, for pregnant subjects, a variety of routine treatment compliance, obstetric and pediatric outcome measures will be assessed. If this """"""""package"""""""" of comprehensive services significantly improves treatment and health outcomes, dissection of this treatment package and matching on the basis of client characteristics found to predict treatment outcome will be important for determining the most cost-effective program for the delivery of services to IV drug dependent women.
| Svikis, D S; McCaul, M E; Haug, N A et al. (1996) Detecting alcohol problems in drug-dependent women of childbearing age. Am J Drug Alcohol Abuse 22:563-75 |
