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2000 Jordan Institute
for Families

Vol. 4, No. 4
September 1999

Women Who Abuse Substances May Benefit from a Different Approach to Treatment

Pretend for a moment that you are working with a family headed by a 22-year-old single mother who abuses alcohol. Through your work with her, you find out she herself was sexually abused as a child, and started using alcohol at the age of 15. Her current level of use prevents her from keeping a job and being able to afford transportation and child care, so if she continues to use alcohol you will have to place her children out of the home.

She genuinely wants to overcome her addiction, but has not had success doing it on her own. Given the situation and the fact that she cannot afford private treatment, what referral might you make to her?

Many social workers would probably connect her to the local chapter of Alcoholics Anonymous (AA). The group is free and has a long history of success with individuals working to overcome their addiction to alcohol.

But AA may not be the best solution for everyone, especially women. Research suggests that because women are socialized differently then men, a different approach to treatment is more effective. Programs that work successfully with substance-abusing women recognize that women are more likely to define themselves through relationships with others than men. For that reason, successful treatment focuses on developing healthy connections with others (Byington, 1997).

Relational Theory

This type of approach, known as relational theory, is based on the assumption that women value relationships differently than men. Because women thrive when they are well-connected to others (more so than men) they are more vulnerable to substance abuse problems when they are without significant relationships or in unhealthy relationships (Byington, 1997). Byington argues that in such situations, women develop "relationships" with a substance or substances: "Addiction develops when a relationship with a drug, including alcohol, food, gambling, or another considered to be at least as important as relationships with other people" (p. 36).

Relational theory holds that because substance abuse in women may be closely linked to relationship problems, treatment of women needs to have a great deal of focus on building healthy relationships if it is to succeed. Healthy women have positive relationships with themselves that include self-care and self-empathy, relationships with other people, spirituality, and some sort of job identification (Byington, 1997).

Addicted women may also tend to have unhealthy relationships with themselves, which include shame-filled and negative self-images. "Relationships with drugs are initially seductive and less stressful than interpersonal relationships, which may be troubled. Unfortunately, as the drug relationship becomes addictive, the initial pleasant connections become more difficult to attain and more effort goes into regaining them" (p. 37).

Relationships Key to Recovery

Although a woman's need for relationships can be at the basis of her addiction, it is also a tremendous strength she can use in her recovery. In particular, focusing on important relationships (such as children) can be a strong motivation for recovery. Also, women-only support groups can provide a way for women to form healthy relationships with others. Byington states that, "since many women have been sexually or physically abused by men, women-only groups can provide a safe haven to explore their experiences away from potential abusers" (p. 42).

In their work Gender-Specific Substance Abuse Treatment (1997), Finkelstein, Kennedy, Thomas, and Kerns also suggest that to help women recover from abuse substance programs should:

  • Provide a setting in which women can role-play and/or practice healthy relationship skills;

  • Help them visualize life without the drug;

  • Encourage women to examine their relationships with themselves; provide them with information about feminism as a basis of identifying women's strengths;

  • Help women to cultivate their spirituality;

  • Avoid a confrontational approach;

  • Offer a safe, nurturing and supportive environment;

  • Address women's relationship issues, especially love relationships with partners, mothers, and children; and

  • Arrange treatment hours that can accomodate working women and mothers of school age children, hours that coincide with local transportation service (p. 21).

To help end a woman's relationship with a drug, Byington suggests encouraging women to give the drug a name and talk to it so that they can separate themselves from the substance; writing a eulogy to say goodbye to the drug may even prove helpful, since recovering from addiction is very similar to the greiving process (p. 41).

Practice Implications

As child welfare workers, you will not be conducting the direct treatment of substance-abusing women, but you will be referring them for treatment. Relational theory suggests that the first and best place to refer women are women-only support groups and those treatment facilities that focus on helping people develop healthy connections with others.

To enhance your practice in this area and improve outcomes for families, you should learn all you can about making referrals (see "More Information: Resources on Substance and Alcohol Abuse") and educate yourself about the substance abuse treatment programs in your community and across the state. In North Carolina there are several programs that specifically target women:

  • Alcoholics Anonymous has women-only chapters,

  • Women for Sobriety is a national women-only group (215/536-8026),

  • The Mary Frances Center (Tarboro) serves women inmates (252/641-1111),

  • At least eight North Carolina communities also have programs that serve pregnant and postpartum women and their families: Step-By-Step (Raleigh); Horizons (Chapel Hill); CASCADE (Charlotte): Day by Day (Johnston Co.); Eastern Region Women and Infant's Project (Greenville); Family Wellness and Recovery Services (Chapel Hill); Mary Benson House (Asheville); and Kelly House (Wilmington).

In addition, consider contacting private nonprofit women's support agencies, such as the Women's Center in Orange County, which often offer support groups and other resources for women. For a list of privately-operated substance abuse treatment facilities, see the Substance Abuse Treatment Referral Site (maintained by N.C. State University) at <>.

Substance abuse is a complex issue for women. Even though each case will need special attention, we can accomplish more by understanding the "big picture" issues women face. Knowing the best services for women with substance abuse problems is a good foundation for best practice.


Byington, D. B. (1997). Applying relational theory to addiction treatment. In S.L.A. Straussner and E. Zelvin (eds.), Gender and Addictions. Northvale, NJ: Jason Aronson, Inc.

Finkelstein, N., Kennedy, C., Thomas, K., & Kerns, M. (1997). Gender-specific substance abuse treatment. For the National Women's Resource Center for the Prevention and Treatment of Alcohol, Tobacco, and Other Drug Abuse. Alexandria: The Center for Substance Abuse Prevention (p. 21).

Lex, B. (1991). Some gender differences in alcohol and polysubstance users. Health Psychology, 10:2, 121-132.

Special thanks to Cynthia Wallis-Hill, Mentor Project Manager, Behavioral Health Care Resource Program, Jordan Institute, UNC-CH School of Social Work for her help on this article.

1999 Jordan Institute for Families