More severely mentally ill men than women are identified as having alcohol or substance problems (referred to here as dual diagnoses), although substantial proportions of dually diagnosed clients are women. Further, little is known about dual diagnoses among women, although the gender specific effects of either disability alone strongly suggest that gender does affect need, access and utilization of services for clients with both disabilities. The proposed research concerns the characteristics and service networks of dually diagnosed women. In year 1 of an ongoing study of service networks for dually diagnosed clients, data about the presence of dual diagnoses will be collected from record reviews, clinician interviews and direct client interviews on 750 clients in a stratified sample of 26 inpatient, emergency room and outpatient settings. Detailed descriptions of the service networks available to dually diagnosed individuals in each of those settings will be developed. The ongoing study is being conducted in the NIMH funded Center for the Study of Issues in Public Mental Health. The proposed study will add a gender focus to year 1 of this ongoing study by collecting an additional hour of direct interview data from 300 women and men. The enhanced data include a Life Chart interview and validated scales to measure correlates and consequences of women's substance use and the impact of dual diagnoses on access and barriers and utilization of services for mental health and substance use problems across treatment settings. Analyses will focus on the development of more precise rates of dual diagnoses among women, and the differential effect of gender on types of substances used, circumstances and consequences of use and service need, access and utilization. Network variables, such as geographic region (urban, suburban and rural) and availability of integrated treatment (for multiple disorders) from the ongoing study will be used in the analyses as well. Results from this preliminary work will serve as groundwork to develop an expanded program of research to identify gender specific service needs and to develop gender-sensitive service system initiatives.
