1. California Association of Drinker Driver Treatment Programs
2007 Fall Forum
Women and DUI Part II
Deborah Werner
Children and Family Futures, Inc.
4940 Irvine Boulevard, Suite 202 * Irvine, CA 92620
714/505.3525 * dwerner@cffutures.org
www.cffutures.org/calwcf
This Presentation is Made Possible Through a Contract
with the State of California Department of Alcohol and Drug Programs
Part 1I: Gender Responsive Services

2. Gender Differences at Treatment
Reasons cited for not getting treatment by
women classified as needing but not receiving
treatment and who felt a need for treatment
included:
• 33% felt not ready to stop using
• 27% felt could handle the problem on their own
• 22% were concerned with stigma (compared to 10%
of men)
• 17% could not afford treatment
ld t ff d t t t
• 9 % did not have time (compared with 2% of men)
• 8% did not know where to go, 7% indicated the
program type unavailable, 4% no openings and 4%
transportation.
Source: Online analysis of the NSDUH 2003 Public Use file
Male-Based Approach
• Knowledge of factors that contribute to DWI and
high-risk driving almost exclusively from studies of
males.
• Factors: demographic characteristics; excessive
alcohol use; personality traits; acute states of
emotional distress; and driving-related attitudes.
• DUI Services based on a cognitive-behavioral model
that integrates the influence of these factors on
driving risk
risk.
(Donovan et al., 1983).

3. Treatment for Women
GENDER DIFFERENCES SERVICE RESPONSES
80s/90s Gender Specific:
• Bi l i l
Biological • S
Separate f iliti
t facilities
• Psycho-social • Separate groups/services
• Parenting/Family • Childcare
• Motivators & Barriers 2000s Gender Responsive:
• Treatment Needs • Trauma Informed
• Recovery Support Needs
y pp • Strengths Based
g
• Relational Theory
Adapted from Christine Grella, Ph.D., What’s so Special About Specialized Treatment for Women presented
at National Conference on Women, Addictions and Recovery, July 2006.
CSAT Model of Comprehensive Services
for Women & Children
CSAT Women, Youth and Families Task Force (2004). Unpublished draft.

4. Comprehensive Model includes:
Components
• Clinical treatment services for women
• Clinical support services for women
• Community support services for women
• Clinical treatment services for children
• Clinical support services for children
• Community support services for children
Cultural Competence, Gender Competence and
Developmentally Appropriate
Characteristics of Gender Responsive
Services
• Relational
• Strength-based, motivational
• Comprehensive
• Trauma informed
• Address the different pathways to use,
consequences of use, motivations, treatment
issues and relapse prevention needs unique to
women
• Provided in an environment where women feel
comfortable and safe

5. Culturally Relevant Treatment
• Honors traditions and values
• Acknowledges cultural pain and racism
• Builds appropriate efficacy and support
• Staff, management and Board reflective
• Respects individuals
• Differentiates drug culture from culture itself
• Helps people learn cultural traditions
• Relational
i
Clinical Treatment Services
FOR WOMEN FOR CHILDREN
• Outreach and Engagement • Intake
• Screening • Screening
• Pharmocotherapy
a ocot e apy • Medical Care a Services
e ca Ca e and Se v ces
• Drug monitoring • Therapeutic Child Care
• Treatment planning • Development Services
• Mental health Services • Mental Health and Trauma
• Detoxification Services
• Medical Care and Services • Assessment
• Assessment • Residential Care in Residential
• Substance Abuse Counseling and Settings
Education • Case Management
• Trauma Informed and Trauma- • Substance Abuse Education &
Specific Services Prevention
• Crisis Intervention • Care Planning
• Case Management
• Continuing Care

6. Clinical Support Services
FOR WOMEN FOR CHILDREN
• Life skills • Primary health care services
• Advocacy • Onsite or healthy child care
• Primary health care services • Recovery community
• Family programs support services
• Parenting and child • Advocacy
development education • Educational services
• Housing support • Recreational services
• Education remediation and • Prevention services
support • Mental health and
• Employment readiness remediation services
services
• Linkages with legal system
and child welfare systems
• Recovery community
support services
• Life skills
Community Support Services
• Transportation
• Child care
• H
Housing services
i i
• Family strengthening
• Recovery community support services
• Employer support services
• TANF linkages
• Vocational and academic education services
V i l d d i d i i
• Faith based organization support
• Recovery management

7. Strategies for Working with Women
Characteristics of Gender Responsive
Services
• Relational
• Strength-based, motivational
• Comprehensive
• Trauma informed
• Address the different pathways to use,
consequences of use, motivations, treatment
issues and relapse prevention needs unique to
women
• Provided in an environment where women feel
comfortable and safe

8. Selected Strategies
• Welcoming/Relational
• Strength-Based
• Trauma
• Relationships
• Motivational
Welcoming
• Welcoming environment
• Trusting relationship
• Building self efficacy
• Strength-based
• Perceived utility
• Ancillary services
• Empathetic counseling style
• Motivational interviewing
• Knowing consequences and alternatives

9. Relational
• Role Models
• People who Care
• People to Talk with
• Safe Environment
• Not a Tool for the Group Process
• Female Staff and Peers
Strength-Based Focus
• What does she have - rather than what she
does not have
d th
• What can she do - rather than what she
cannot do
• What has she been successful at rather than
how she has failed

10. Trauma
Major and/or repeated trauma becomes the core
event in the life of the woman that defines:
• Sense of self
• Sense of efficacy
• World view
• Coping skills
• Relationships with others
• Ability to regulate emotions
• How one approaches services
• How one approaches the culture of the courts
Trauma
A meta-analysis of 126 studies on co-occurrence
between childhood abuse and substance abuse
found an average of 45% of adult women in
f d f f d lt i
treatment experienced childhood sexual
abuse and 39% childhood physical abuse. For
adolescent girls prevalence was 61% for sexual
abuse and 46% for physical abuse. (Simpson
and Miller, 2002)

11. 3 Selves
• The Real Self – contains the true self – the highest
potentialities for self realization and the actual self – those
elements of personality such as strengths and weaknesses,
p y g ,
assets and liabilities
• The Despised Self– all of the unacceptable character defects
which make one “unlovable” and despicable are stored.
Contains shame, hurt, anger, inadequacy and fear.
• The False Self – delusion based on how people believe they
should be, think, behave and feel. Can be grandiose or self-
effacing, Based on others.
from Sandel, James “From Self to Self: Making Recovery Real” The Counselor, Nov/Dec 1990
Women benefit from nurturing strategies
for actualizing the Real Self.
Addressing Trauma
• Avoid retraumatizing women
• Non-confrontational soft approach
• Traumatized women over-respond to neutral cues
and under-respond to danger
• Create safe environments
• Be aware of possible triggers and avoid triggering
trauma response.
p
• Develop referrals and linkages to support clients to
identify triggers, self-soothe, ground and remain in
services.

12. Trauma Programs
• Clark, C., Fearday, F. (eds) (2003) Triad Women’s Project: Group
facilitators manual. Tampa, FL: Louis de la Parte Florida Mental
p
Health Institute, University of South Florida. (contact Colleen
Clark at cclark@fmhi.usf.edu)
• Covington , S. S. (2003) Beyond Trauma: A Healing Journey for
Women. Center City, MN: Hazelton Press. (Contact Stephanie
Covington at sscird@aol.com)
• Ford, J.D., Mahoney, K., Russo, E., Kasimer, N., & MacDonald, M.
(2003). Trauma Adaptive Recovery Group Education and Therapy
(TARGET): Revised Composite 9-Session Leader and Participant
Guide. Farmington, CT: University of Connecticut Health
Center. (Contact Julian Ford at ford@psychiatry.uchc.org )
Trauma Programs continued
• Harris, M. (1998). Trauma, Recovery and Empowerment: A
Clinician’s Guide for Working with Women in Groups. New York,
NY: Free Press. (Contact Rebecca Wolfon Berley at
rwolfson@ccdc1.org)
• Miller, D., & Guidry, L. ( 2001). Addictions and Trauma Recovery:
Healing the Mind, Body, and Spirit. New York: W.W. Norton.
(Contact Dusty Miller at dustymi@valinet.com)
• Najavits, L. (2001). Seeking Safety: Cognitive-Behavioral Therapy
fo
for PTSD a d Substance Abuse. New York: Guilford. (Go to
S and Substa ce buse. ew o : Gu o d.
www.seekingsafety.org)
• Saakvitne, K. W., Gamble, S.J., Pearlman, L.A., Lev, B.T. (2000).
Risking Connection: A Training Curriculum for Working with
Survivors of Childhood Abuse. Maryland: Sidran. (Go to
www.sidran.org)

13. Supportive Relationships
• Women, compared to men, are:
• More likely to report that their spouse/partners
i i /
encouraged initial and current drug use and less likely to
pressure them to enter treatment
• Less likely to report help/support from family or friends
• More likely to report that family or friends used drugs in
the past year (Grella & Joshi, 1999)
• Outcomes all improve when a partner/family
participates in treatment BUT
• More than three-fourths of women participating
in the RWC/PPW reported that their families
were involved in alcohol- or drug-related
activities
• Almost half (42.9%) of women in the RWC/PW
programs reported having fewer than two friends
who did not use drugs (Conners et al., 2004).
h t d

14. Relationships
• Counselor:Client relationship
• Peer support (what is a healthy friendship?)
• Family (as defined by client)
• Self-esteem building interactions
• Reduced powerless … more assertiveness
• Communication skills
• Knowing children are safe
• Filling the “empty hole inside”
Relapse and Recovery
• Recovery - act of regaining or returning
toward a normal or healthy state
• Relapse - slip or fall back into a former worse
state (as of illness) after a change for the
better.
• Must first admit have problem
• Relapse does not occur until after action
• Moving from Acute to Chronic Perspective of
Treatment

15. Current Drinking Pattern of Individuals Meeting Criteria
for Alcohol Dependence in the Past Year
percent of percent of
females males
No past month alcohol use 0.9% 1.9%
Past month use but not binge use 3.5% 4.3%
Binge use but not heavy use 17.5%
17 5% 19.2%
19 2%
Heavy use 44.9% 44.6%
Office of Applied Studies (August 2, 2007). Gender Differences in Alcohol Use and Alcohol
Dependence or Abuse: 2004 and 2005. Rockville, MD: Substance Abuse and Mental Health
Services Administration. Available at http://www.oas.samhsa.gov
Considerations in Relapse
• Women have more barriers to sustained
participation than men.
• W
Women are judged more harshly for alcohol/drug
j d d h hl f l h l/d
problems than men.
• Women take on the alcohol/drug patterns of their
partners, where men do not.
• Women with alcohol/drug problems have more
emotional problems than men.
p
• Women are more likely to experience negative
feelings prior to relapse. Men are more likely to
experience positive experiences and use as a reward.

16. Motivational Interviewing &
Engagement Strategies
Motivational Interviewing
• Express empathy through reflective listening.
• Develop discrepancy between client s goals or
client’s
values and their current behavior.
• Avoid argument and direct confrontation
• Adjust to client resistance rather than opposing it
directly.
• S
Support self-efficacy and optimism.
t lf ffi d ti i
(source: SAMHSA TIP 35: Enhancing Motivation for Change in Substance Abuse Treatment)

17. FRAMES approach
• Feedback: regarding risk is given to individual.
• Responsibility: for change is placed with individual.
• Advice: about changing is clearly given in a non-judgmental
manner.
• Menu: of self-directed change options and treatment
alternatives.
• Empathetic Counseling: showing warmth, respect, and
understanding. (uses reflective listening).
• Self-Efficacy: optimistic empowerment is
engendered to encourage change.
(source: SAMHSA TIP 35: Enhancing Motivation for Change in Substance Abuse Treatment)
Listening
• Empathy. Put yourself in someone else's shoes.
Empathy is not the same as sympathy.
• Non-judgmental behavior
• Repeat what you hear (paraphrase)
• Nod, Make statements like "Uh huh"
• Speak clearly, slowly and simply
• Be direct, do not use jokes
• Avoid arguments about what the participant is
g p p
experiencing, seeing, feeling
• Understand how the situation affects the participant.
What affects one person, may not affect another.
• Help participant understand the available options

18. Body Language
• Be aware of your facial expressions
• Be aware of tone, volume, cadence (i.e. "Is there
something bothering you?" is a statement that could be
you?
said with caring and concern or with an "attitude.”)
• Be aware of your posture and stance
• Do not fold arms or clench fists. This represents an
authoritative position which might threaten the client.
• Do not conceal your hands. An individual who is paranoid
may b li
believe that you h
h have a weapon.
• Personal Space
• Avoid the challenge position which is eye-to-eye, toe-to-
toe.
• Maintain 2-3 feet between you and participant for safety.
Enhancing Motivation
• Distress levels
• Critical life events
• Cognitive evaluation or appraisal
• Recognizing negative consequences
• Positive and negative external incentives
• Cli i i ’ t k is to elicit and enhance
Clinician’s task i t li it d h
motivation
(source: SAMHSA TIP 35: Enhancing Motivation for Change in Substance Abuse
Treatment)

19. Motivators
• Contingency’s
Contingency s
• Contracts
• Carrots and Sticks
• Build on Strengths
• Building Self-Efficacy
Self Efficacy
• Do-able Goals and Objectives
• Celebrating Successes
Comprehensive Development
• Knowledge
• Skills
Skill
• Attitude
• Efficacy and Sense of Worth
• New Habits Emerge with Time
do for … do with … cheer on

20. Program Analysis
• Staffing
• Education – female examples and experiences
• Education – uses emotional examples, non-
shaming
• Counseling – addressing powerlessness
• Check-ins – resources and case management,
screening for mental health, violence
g
• Safe Environment