Overview of substance abuse/addiction prevention principles including risk and protective factors. NBCC, NAADAC, CAADAC, and California Board of Behavioral Sciences approved Mental Health continuing education and addictions counselor training series. Narrated versions and CEUs available at http://www.allceus.com
"Treatment Concepts and Techniques in Sexual Therapy" by Clinical Sexologist Dr. Martha Tara Lee of Eros Coaching for "Symposium - Sex and the Spine: All You Ever Wanted to Know about Sex and the Spine but Were Afraid to Ask" by NSpine as part of SpineWeek, at Marina Bay Sands Expo & Convention Centre on Mon 16 May 2016.
Dr Martha Tara Lee is Founder and Clinical Sexologist of Eros Coaching since 2009. She is a certified sexologist with ACS (American College of Sexologists), as well as a certified sexuality educator with AASECT (American Association of Sexuality Educators, Counselors, and Therapists). Martha holds a Doctorate in Human Sexuality as well as Certificates in Sex Therapy, Practical Counselling and Life Coaching. She was recognised as one of ‘Top 50 Inspiring Women under 40′ by Her World Singapore in July 2010 and ‘Top 100 Inspiring Women by CozyCot Singapore in March 2011. Website: http://www.eroscoaching.com.
Mental health is not just about overt behaviours---exposed socially, but there are more volatile intimate emotions that could devastate any human relations forever-though not overtly observed as abnormal--!
We will discuss about such emotions which are banned in social discussions and stigmatized.
"Sexual disorders and dysfunctions" could be present in any socioeconomic classes--not age, education, gender, culture specific.
Understanding these critical emotions on time and accepting it would save human relationships--avoiding suffering, inferiority complex, gender harassment and abuse.
Educate yourself and save relationships!!!
Mental health subject is originally stigmatized, moreover talking to someone about sexual disorders is as critical as finding a pearl into a deep ocean.........
This course provides training and CEUs for addicitons counselors and LPCs working in Addictions, Mental Health and Co-Occurring Disorders will help counselors, social workers, marriage and family therapists, alcohol and drug counselors and addictions professionals get continuing education and certification training to aid them in providing services guided by best practices. AllCEUs is approved by the california Association of Alcohol and Drug Abuse Counselors (CAADAC), NAADAC, the Association for Addictions Professionals, the Alcohol and Drug Abuse Counseling Board of Georgia (ADACB-GA), the National Board for Certified Counselors (NBCC) and most states.
For sharing purposes. All on the focus on what are the common Sexual Disorders seen on the DSM-IV-TR, last 2011. Fully editable. Pictures seen in the presentation are from artists of DeviantArt and Google Search, Credits goes to them as well.
Be informed, and bedazzle the audience!
Writing the winning thesis or dissertation, a step by step guide. Slides have been prepared from the book of the same name authored by Randy L. Joyner, William A. Rouse and Allan A. Glatthorn.
Overview of substance abuse/addiction prevention principles including risk and protective factors. NBCC, NAADAC, CAADAC, and California Board of Behavioral Sciences approved Mental Health continuing education and addictions counselor training series. Narrated versions and CEUs available at http://www.allceus.com
"Treatment Concepts and Techniques in Sexual Therapy" by Clinical Sexologist Dr. Martha Tara Lee of Eros Coaching for "Symposium - Sex and the Spine: All You Ever Wanted to Know about Sex and the Spine but Were Afraid to Ask" by NSpine as part of SpineWeek, at Marina Bay Sands Expo & Convention Centre on Mon 16 May 2016.
Dr Martha Tara Lee is Founder and Clinical Sexologist of Eros Coaching since 2009. She is a certified sexologist with ACS (American College of Sexologists), as well as a certified sexuality educator with AASECT (American Association of Sexuality Educators, Counselors, and Therapists). Martha holds a Doctorate in Human Sexuality as well as Certificates in Sex Therapy, Practical Counselling and Life Coaching. She was recognised as one of ‘Top 50 Inspiring Women under 40′ by Her World Singapore in July 2010 and ‘Top 100 Inspiring Women by CozyCot Singapore in March 2011. Website: http://www.eroscoaching.com.
Mental health is not just about overt behaviours---exposed socially, but there are more volatile intimate emotions that could devastate any human relations forever-though not overtly observed as abnormal--!
We will discuss about such emotions which are banned in social discussions and stigmatized.
"Sexual disorders and dysfunctions" could be present in any socioeconomic classes--not age, education, gender, culture specific.
Understanding these critical emotions on time and accepting it would save human relationships--avoiding suffering, inferiority complex, gender harassment and abuse.
Educate yourself and save relationships!!!
Mental health subject is originally stigmatized, moreover talking to someone about sexual disorders is as critical as finding a pearl into a deep ocean.........
This course provides training and CEUs for addicitons counselors and LPCs working in Addictions, Mental Health and Co-Occurring Disorders will help counselors, social workers, marriage and family therapists, alcohol and drug counselors and addictions professionals get continuing education and certification training to aid them in providing services guided by best practices. AllCEUs is approved by the california Association of Alcohol and Drug Abuse Counselors (CAADAC), NAADAC, the Association for Addictions Professionals, the Alcohol and Drug Abuse Counseling Board of Georgia (ADACB-GA), the National Board for Certified Counselors (NBCC) and most states.
For sharing purposes. All on the focus on what are the common Sexual Disorders seen on the DSM-IV-TR, last 2011. Fully editable. Pictures seen in the presentation are from artists of DeviantArt and Google Search, Credits goes to them as well.
Be informed, and bedazzle the audience!
Writing the winning thesis or dissertation, a step by step guide. Slides have been prepared from the book of the same name authored by Randy L. Joyner, William A. Rouse and Allan A. Glatthorn.
As presented at The Royal by:
- Dr. Melanie Willows, Clinical Director, SUCD Program, The Royal
- Dr. Kim Corace, Director, Program Development and Research, SUCD Program, The Royal
Opioid addiction is a large and growing problem affecting our community, especially our young people, women and their families. This session addressed:
· The current state of prescription opioid problems
· Opioid use, abuse, and addiction as it relates to women and parenting
· Risk factors for opioid use about women, with a focus on mental health problems
· Treatment options to help women who struggle with opioid problems
· Reducing the stigma and myths regarding women with opioid use problems
Poster for the 2018 Society for Teachers of Family Medicine Annual Meeting: A...Christina Czuhajewski
Presented at the 2018 STFM Annual Meeting, entiteld: Adolescent Views on Prescription and Nonprescription Opioid Use: Findings from the MyVoice Longitudinal Mixed Methods Study
This presentation covers the nature and features of drug dependence. It also gives coverage to different psychological or biological models of drug addiction.
A look at how mental health treatment and research have evolved over the last 10 years and about future possibilities for more effective, personalized treatment approaches.
with Dr. Zul Merali, President and CEO, The Royal's Institute of Mental Health Research
Mental illness is common and disabling but the evidence is that fewer than half of people seek any treatment and few receive any help from specialized mental health professionals. In Canada, there are long waiting lists to see psychological therapists face to face despite the importance of non-drug therapies. One way to address this problem is to use computerized e-therapies which deliver structured mental health treatment via a computer. Dr. Simon Hatcher, Psychiatrist at The Royal's Community Mental Health Program and Vice Chair of Research for the Department of Psychiatry at the University of Ottawa, lead a discussion about the role of technology in mental health treatment. Highlights include: the effectiveness of online mental health treatments and opportunities for innovation and policy change in field of mental health.
Not Criminally Responsible. You may have heard this term used in the news or in movies but what does it really mean? At our most recent Conversations at The Royal lecture, we answered this and many other questions about what it means to be a forensic client.
The evening was presented by Dr. Diane Hoffman-Lacombe, Dr. Anik Gosselin, and Raphaela Fleisher, from the Integrated Forensic program at The Royal.
Are you drinking TOO much?
Alcohol is the most commonly used potentially addictive substance in our society. Alcohol is responsible for over half of the $267 million dollars of substance related hospital costs in Canada. Problematic alcohol use significantly impacts individuals, families, and our community, but many struggle to know if they have a problem and where to go for help.
Learn more: http://www.theroyal.ca/mental-health-centre/news-and-events/newsroom/13411/alcohol-how-much-is-too-much/
While terrorism continues to make headlines around the world, some researchers have suggested that terrorists are mentally ill and have used labels such as psychopathic or sociopathic, narcissistic, paranoid and schizophrenic. Others have argued that there is no evidence to indicate that they are mentally ill, disordered, psychopathic or otherwise psychologically abnormal.
The Royal's Dr. AG Ahmed, Dr. Wadgy Loza and Dr. Pius Adesanmi discuss research findings and reflect on the new meanings and manifestations of terrorism and extremism in Canada and around the world.
Our Conversations lecture 'Hope, Humanity and Empowerment: Strengths-focused Cognitive Behavioural Therapy for Psychosis (& Schizophrenia)' was presented by staff members of the Integrated Forensic, Recovery and Schizophrenia programs at The Royal.
Psychosis can be associated with a variety of mental health problems, including schizophrenia, severe depression, bipolar disorder, anxiety, and post-traumatic stress disorders. While traditional treatments for psychosis have emphasized medication-based strategies, research now suggests that individuals affected by psychosis can greatly benefit from talk therapies such as cognitive behavioural therapy for psychosis (CBTP).
Learn more: www.theroyal.ca
The recent attack in downtown Ottawa has deeply affected our city. We have a powerful desire to stay strong as individuals and as a community yet we are all human so it is natural to feel fear, anxiety and loss after this type of event. Recognizing this, The Royal held a special info session on coping with trauma.
Presenters:
Dr. Jakov Shlik, Clinical Director, Operational Stress Injury Clinic and Anxiety program, The Royal
Michelle Antwi, Operational Stress Injury Clinic, The Royal
Katie Bendell, Operational Stress Injury Clinic, The Royal
This session included information on the collaborative work being done between The Royal’s Sexual Behaviours Clinic (SBC) and Ottawa Police Service’s High Risk Offender Unit (HROU). Dr. Paul Fedoroff was the moderator and began the presentations with an overview of innovative work being done within the SBC and the common goals of the Clinic and the HROU. Staff Sargent Dana Reynolds and Det. Mark Horton discussed the role of their team in the community based management of high risk sexual offenders. More specifically they discussed the role of the Unit and common legal designations utilized for high risk sexual offenders. Lisa Murphy, M.C.A. provided an overview of sex offender registries (SORs) and public notification and made comparisons between the approaches used in Canada and the United States. A discussion period followed the panel presentations.
As presented by Dr. Mathieu Dufour, Psychiatrist at The Royal, at a special Men's Mental Health Awareness event hosted by The Men's D.E.N. (Depression Education Network).
Dr. Andrew Wiens, Head, Division of Geriatric Psychiatry at The Royal, talks about behaviour issues in dementia at our monthly lecture series, Conversations.
As presented at our Conversations at The Royal on March 20, 2014 by speakers Karen James, Cynthia DuBaie, and Richard Cottingham.
More at www.theroyal.ca
“Love Sense” (written by Dr. Sue Johnson): the revolutionary new science of romantic relationships offers the reader a ground breaking guide to the new science of love and loving that has emerged in the last 15 years. The science allows us not just to “fall” in love but to make sense of and shape our most precious relationships.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
WOMEN IN MIND: Young women and substance abuse: Understanding vulnerabilities and building on strengths
1. Young women and substance
use: Understanding
vulnerabilities and building on
strengths
Kim Corace, Ph.D., C. Psych,
Clinical Psychologist; Director, Research and Program Development
Melanie Willows, B.Sc. M.D. C.C.F.P. C.A.S.A.M. C.C.S.A.M.
Clinical Director
Substance Use and Concurrent Disorders Program
Royal Ottawa Health Care Group
November 15, 2013
2. Learning objectives:
1. Identify current patterns of substance use among
young women
2. Review risk factors for substance use problems
among young women
3. Discuss promising interventions to address
substance use problems in young women
3. What is addiction?
• Primary, chronic disease of brain reward, motivation,
memory and related circuitry
• Characterized by inability to consistently abstain,
impairment in behavioural control, craving,
diminished recognition of significant problems with
one’s behaviours and interpersonal relationships,
and a dysfunctional emotional response
ASAM, 2011
4. What is addiction?
• Like other chronic diseases, addiction often involves
cycles of relapse and remission
• Addiction is progressive and can result in disability or
premature death
ASAM, 2011
5. What is addiction?
• Addiction is a developmental disease
that starts in adolescence and
childhood1
1NESARC
, 2003
6. Table 1. Past Year Drug Use (%) for the Total Sample,
and by Sex and Grade, 2011 OSDUHS (CAMH)
Total
Male
Female
G7
G8
G9
G10
G11
G12
Alcohol
54.9
54.6
55.1
17.4
26.4
50.5
59.6
75.5
78.4
Cannabis
22.0
23.0
21.0
2.4
5.9
11.9
23.5
36.8
36.4
Binge
Drinking
22.3
22.7
21.8
1.1
4.1
13.7
24.4
35.3
39.7
Opioid Pain
Relievers
(NM)
14.0
12.9
15.2
8.5
10.9
13.0
14.9
18.0
16.0
Cigarettes
8.7
9.3
8.2
2.8
3.7
10.3
14.5
14.4
7. Opioids: A growing problem
• Canada is the world’s second largest per capita
consumer of opioids. Ontario tops the list in Canada
• Opioid misuse, abuse and dependence is a major
public health issue in Ontario and the Ottawa region
• Prescription opioids has become the predominant
form of illicit opioid use (rather than heroin)
• Increase in number of individuals seeking treatment
for opioid dependence in the last 10 years
• Opioids are a commonly abused substance by youth
and young adults
8. A Generation Exposed....
• Although experimentation with alcohol and other
drugs is a natural part of adolescence, experimentation
involving opioids is high risk as addiction occurs much
more rapidly than with other drugs
» National Institute of Drug Addiction (NIDA)
9. What is an opioid?
• Opioids are depressants-- they slow down certain brain
functions, act on the mu receptor
• Opioids are also referred to as narcotics
• Opioids can be effective painkillers
• Some opioids are prescription medications (i.e.
oxycontin, fentanyl) and others are not (i.e. heroin)
11. Commonly abused prescription opioids
• Oxycodone (Oxycontin, OxyNEO)
–
–
–
–
Oxycontin formerly most popular opioid
Replaced by OxyNEO designed to be more difficult to alter
Generic Oxycodone now available but not covered by ODB
Generally chewed, snorted or injected
12. Commonly abused prescription opioids
• Dilaudid, Hydromorph Contin
– Usually chewed, snorted or injected
• Fentanyl “patch”
– Fentanyl is extracted from patches that are designed to be longacting medication
– Fentanyl said to be 80 to 100 times stronger than morphine
– Sucked in mouth (strips), smoked, or injected
– Cost varies: 25mcg patch (approx $60 - $100)
13. Risks of Opioid Misuse
• Overdose (high risk new users, unknown dose,
combined with alcohol and/or benzodiazepines, after
a period of stopping opioids)
• Death
• Accidents
• Addiction
• Infectious diseases from intravenous use and sharing
drug paraphernalia (Hepatitis C, HIV)
14. Why Prescription Opioids? Why now?
•
•
•
•
•
•
Think it’s safe because it’s a prescription
More socially acceptable than heroin
Purity
Potent opioid (euphoria effects)
Easy access
Possible to alter how you use it: chew, suck, snort,
smoke, inject
• Inadequate monitoring
15. Women and Substance Use
• Substance abuse is more prevalent among men, but
women are as likely as men to develop substance use
disorders after initiation
• The gender gap is narrowing1
– In the past, men had higher rates of substance abuse
then women
– In the last 10 years, young women are more likely to
mirror male patterns of drug use then older women
– Shrinking gender gap is especially notable for young
1Grant et al., 2006 as cited in SAMHSA, 2009
women
18. Video: Women of Substance
PLAY
Women of Substance (2013). South Shore District Health
Authority
19. Opioid Misuse: A growing epidemic among
women
• Rates of nonmedical prescription drug use is higher
among women then men, particularly for opioids
• Nearly 48,000 women died of prescription opioid
overdoses between 1999 to 2010 (5 fold increase)
• Female deaths from prescription opioid overdoses have
increased more than 400% since 1999, compared to
265% among males
• Prescription opioids are involved in 1 in 10 suicides
* CDC, 2013
among women
21. For every woman who dies of prescription opioid overdose,
30 go to the ER for misuse/abuse
Source: CDC Vitalsigns, July 2013, as per Drug Abuse Warning Network, 2010
22. * Source where pain relievers were obtained for
most recent nonmedical use among past year
users aged 12 and older: 2011-2012 (NSDUH)
23. Why are women disproportionately affected?
• Women are more like to have chronic pain
• Women are more likely to be prescribed prescription
painkillers
• Women are more likely to be given higher doses
• Women are more likely to use prescription opioids for a
longer time period than men
• Women may become dependent on prescription opioids
more quickly then men
Source: CDC, 2013
24. Risk Factors for Substance Use Problems
Environment/
Sociocultural
Context
Vulnerable
Host
Repeated
substance use
ADDICTION
25. Risk Factors: Relationships
• Women are more likely to be introduced to and initiate
drug use through their boyfriends, partners, spouses, and
relatives
• Even though women are less likely to inject drugs,
women accelerate to injecting at a faster rate than men.
• Women’s IVDU is influenced by their sexual partner’s
injection risk behaviour
• Compared to men, women are more likely to be involved
with a sexual partner who also injects drugs
26. Risk Factors: Relationships
• Women are also more likely than men to be introduced
to IVDU their sexual partners1
– 51% of female heroin users first injected by their male partner
– 90% of men injected by a friend
• Compared to men IVDU, women report being more
influenced by social pressure and by sexual partner
encouragement
• Women are more likely to inject with and borrow needles
and equipment from their partners
1Powis et
al., 1996
27. Risk Factors: Relationships
• Women may see sharing drug equipment and using drugs
as emotional intimacy, means of connection, or
maintaining the relationships
• Men are often responsible for obtaining, purchasing, and
injecting the drug for women.
• There is a power imbalance in these relationships
28. Risk Factors: Telescoping
• Telescoping describes an accelerated progression from
substance use initiation to the onset of dependence and
first treatment1
• Consistently observed, with studies reporting an
accelerated progression among women for opioids.
• Women progress faster even when using similar or lesser
amounts of substances
• When women enter treatment, they have a more severe
presentation than men, despite using less and for shorter
1Hernandez-Avila et al., 2004
period of time
29. Risk Factors: Sex differences
• Sex differences in the stress and reward systems which
increase women’s susceptibility to drug abuse and
relapse
• Women have a greater biological vulnerability to the
adverse consequences of substance use
• Women who use substances have poorer health than
men as a result of substances
30. Risk Factors: Menstrual Cycle
•
•
•
•
Substances disrupt menstrual cycle phases
Menstrual cycle phases affects substance use
Substances can affect fertility
Opioid use can cause amenorrhea and risk of unplanned
pregnancy
31. Risk Factors: Trauma
• The prevalence of PTSD is 1.4 to 5 times higher among
those with concurrent SUD1
• Initiation of substance use and development of substance
use disorders among women is related to traumatic
events:
– Childhood trauma: physical or sexual abuse
– Interpersonal violence: sexual assault, abusive
relationships
– Domestic violence
1Greenfield,
2010
33. Risk Factors: Trauma
• Rates of physical or sexual abuse are extremely high
among women with SUD, ranging from 55 to 99%
• Female crime victims with PTSD are 17 times more likely
to have a SUD than the general population1
• Severity of SUD related to the number of violent assaults
women experience
• Among women seeking treatment for substance use, up
to 70% report sexual abuse prior to the age of 112
1US
National Violence Against Women Survey; Tjaden & Thoennes, 2000; 2Finnegan, 2013
34. Risk Factors: Trauma
• Survey of women from substance use treatment centers
in Ontario, 85.7% of these women were victimized1
–
–
–
–
56.1% reported current physical abuse
45.4% reported current sexual abuse
56.1% reported childhood physical abuse
56.3% reported childhood sexual abuse
• Vancouver treatment facility survey of women2:
– 65% physically assaulted; 38% sexually assaulted as adults
– 47% childhood physical abuse; 53% childhood sexual abuse
1 Cormier,
2000; 2 Poole, 2000
35. Risk Factors: Trauma
• Women who have been abused are more likely to suffer
other adverse outcomes, including depression, anxiety,
personality disorders, eating disorders, suicidal behavior,
and low self-esteem
36. Risk Factors: The cycle of trauma
• Violence is both a risk factor and a consequence of
substance abuse
• Substance use increases women’s vulnerability to retraumatization and re-victimization
37. Risk Factors: Concurrent Disorders
• Compared to men, women have….
– Higher prevalence of concurrent mental health problems
• About 2/3 of women with substance use problems have a
co-occurring mental health problem
– Higher prevalence of multiple comorbidities
– Higher likelihood of using substances to manage negative affect
– Higher likelihood of trauma history and PTSD
• Less access to treatment with a concurrent disorder
• Bidirectional influence: Mental illness both a risk factor
or a consequence of substance use
38. Risk Factors: Anxiety and Mood Disorders
• Lifetime prevalence of mood and anxiety disorders are
higher among women then men, regardless of a SUD
• 12-month prevalence rates in women with SUD1:
– Mood disorder: 29.7%
– Anxiety disorders: 26.2%
• Anxiety and depression positively associated with
substance use, abuse and dependence
1Goldstein,
2009 as cited in Greenfield, 2010
39. Risk Factors: Eating Disorders
• 90% of the cases of anorexia nervosa and bulimia
nervosa are found in women
• High correlation between eating disorders and substance
abuse
• Up to 55% of women with bulimia have a substance use
problem
• 15-40% of women with substance use problems have
eating disorders syndromes, in particular purging
40. Risk Factors: Eating Disorders
• Co-morbidity with other mental health disorders,
personality disorders (borderline personality disorder),
and trauma
• Among women with eating disorders, rates of SUD are
greater for those with a history of sexual and physical
abuse
42. Risk Factors: Socioeconomic Status (SES)
• Gender is a risk factor for low SES
• Women with SUD are more likely to have:
– Lower incomes
– Less education
– Less likely to be employed
• Among women, lower SES is related to:
–
–
–
–
Higher substance-use related illness, including HIV/hepatitis C
Higher substance-use related mortality
Difficulties with healthcare service access and uptake
Lack of appropriate nutrition
43. Video: What is it like to be a female addicted to
heroin?
PLAY
Published on July 2012
44. Issues women face: Sex work involvement
• Survival sex work is very common among women who
use drugs
• Women who use injection drugs are more likely to be
involved with sex work then men
• These women present with greater vulnerabilities:
unstable housing/homelessness, higher rates of
incarceration, less education, younger, concurrent mental
illness, trauma
• High prevalence of HIV and STIs
Marchand, 2012
45. Issues women face: HIV and Hepatitis C
• Growing number of women are becoming infected with
HIV1
• 57% of HIV infections among women are attributable to
use of injection drugs or sexual relations with a person
who injects drugs2
• 24% of reported cases of HIV in Canada were among
youth in 20093:
– 22% males
– 30% females
1CATIE,
2012; 2CDC, 2002; 3PHAC, 2010
46. Issues women face: HIV and Hepatitis C
• Although rates of hepatitis C are higher in males then
females, young females are at particularly high risk1,2
– Males in the 40 to 59 year age group had the highest rates of
reported hepatitis C diagnoses at 78.2 per 100,000
– Females in the 25 to 29 years age group had the highest rates of
reported hepatitis C diagnoses at 34.4 per 100,000.
1CATIE,
2013; 2PHAC, 2012
48. Substance Use Treatment for Women
• Women are under-represented in treatment settings
• Women are less likely to enter treatment then men
• Women tend to seek care in mental health/primary care
settings rather then specialized treatment programs
• Once initiated, women are as likely as men to stay in
treatment
• Gender does not appear to predict retention or outcome
in substance abuse treatment
SAMHSA, 2009; Greenfield, 2010; Green, 2006
49. Women Face Barriers to Treatment on Many
Levels
•
•
•
•
•
Intrapersonal
Interpersonal
Sociocultural
Structural
Systemic
50. Barriers to Treatment
• According to Health Canada (2001), some of the key
issues in accessing substance use treatment that have a
particular impact on women are:
–
–
–
–
–
–
–
fear of losing children
lack of affordable child care
lack of family support
social stigma
lack of women-centred services
cost of treatment
lack of flexible services
51. Barriers to Treatment
• Opposition for entering treatment from family & friends
– Partner substance abuse
• Gender and cultural insensitivity
• Lower rates for identification and referral for women by
care providers
• Threat of legal sanction – child custody
• Lack of transportation
• Caretaker role for dependent family
• Economic barriers to entering and staying in treatment
*Beckman 1986, Miller, 1993, SAMHSA, 2009
52. Barriers to Treatment: Stigma
• Societal stigma toward women who abuse substances is
greater than that toward men
• Stigma is a barrier to admission of a problem, asking for
help, and seeking and initiating treatment
• Stigma, guilt and shame towards drug use and low selfesteem make women feel un-deserving of help
• Gender role expectations result in further stigmatization
• Compounded stigma
53. Barriers to treatment: Caregiver role
• Women are socialized to be other-focused and assume
caregiver roles
54. Overcoming treatment barriers
Understanding how gender-based differences
affect treatment engagement, internalized
stigma and treatment outcome will allow for a
more responsive, sensitive, and effective
approach to treatment
55. Interrelated elements in a
comprehensive
treatment model
Source: Updated
CSAT, 1994 model
in SAMHSA, 2009
56. Core principles for gender-responsive
treatment1
• Acknowledge the importance and role of women’s SES
issues and difference
• Recognize the role and significance of relationships in
women’s lives
• Address women’s unique physical and mental health
concerns
• Attend to the relevance and influence of the variety of
women’s caregiver roles
• Adopt a trauma-informed perspective
1SAMHSA,
2009
57. Core principles for gender-responsive
treatment1
• Recognize that assigned gender roles and expectations
affect societal views of women who use substances
• Use a strength-based approach to treatment
• Incorporate an integrated and multidisciplinary approach
to treatment
• Maintain a gender responsive treatment environment
across settings
1SAMHSA,
2009
58. Factors that encourage treatment retention:
• A collaborative therapeutic alliance
• Onsite childcare and children services
• Integrated, comprehensive, multimodal treatment
– Behavioural, pharmacological, psychological, multimodal
systems of care that address complex issues (ie., social services)
• Support and participation of significant others
• Address pregnancy and parenting skills
• Demographics: Being older; High school education
Back, 2011; SAMHSA, 2009
59. Pharmacological Interventions for Opioid
Dependence
• Methadone: long-acting (>24 hours) synthetic opioid
agonist
• Buprenorphine/Naloxone (Suboxone): long acting
synthetic partial opioid agonist, naloxone component
present to prevent IV abuse
60. Maintenance or Detoxification
• Methadone and Buprenorphine/Naloxone (Suboxone) is
approved for use in opioid substitution therapy for
maintenance
• Buprenorphine/Naloxone (Suboxone) can also be used
for detoxification/tapering
61. Buprenorphine/Naloxone
• May be safer in overdose than methadone1
• May be easier to taper off this medication than
methadone1
• May be better for youth, young adults and for early
intervention2
• High risk of precipitated withdrawal discourages ongoing
opioid use
1Methadone
Maintenance Treatment Program Standards and Clinical Guidelines, 4th edition
February 2011 CPSO
2Buprenorphine/Naloxone for Opioid Dependence: Clinical Practice Guideline CAMH 2011
62. Treatment of Opioid Dependence in Pregnancy
• Methadone maintenance shown to reduce complications
of pregnancy, childbirth and infant development
• Methadone and Buprenorphine/Naloxone considered
Category C medication (medication should only be used
in pregnancy if the potential benefit justifies the
potential fetal risk)
63. Neonatal Abstinence Syndrome (NAS)
• Babies are born with passive dependence on opioids
used by their mother
• After umbilical cord is cut, passive supply of opioids is cut
off
• Baby potentially develops withdrawal symptoms from
opioids
64. Prevalence of NAS
• In Ontario, has increased from 1.3 cases per 1000 births
in 2004 to 4.3 cases per 1000 births in 20101
• Occurs in untreated opioid addiction and also as a
potential side effect for treatment of opioid dependence
with methadone (60% chance of developing NAS)2
1Dow
et al., 2010; 2Finnegan & Kandall, 2005
65. Neonatal Abstinence Syndrome (NAS)
• Serious medical condition that affects the central
nervous, autonomic nervous, gastrointestinal and
respiratory systems
• Characterized by signs of:
– neurologic excitability (irritability, hyperactivity, sleep
disturbance)
– gastrointestinal dysfunction (vomiting, diarrhea, uncoordinated
sucking and swallowing)
– autonomic signs (fever, sweating, nasal stuffiness)
66. Neonatal Abstinence Syndrome (NAS)
• May cause death due to excess fluid loss, high
temperatures, seizures, respiratory instability, aspiration
of fluid into the lungs or the cessation of breathing if not
treated
BUT….NAS is TREATABLE
68. Treating NAS
• Supportive environment: ideally baby and mom
together
• Improved outcomes with rooming in1 and
breastfeeding2
1Abrahams
et al., 2007; 2Abdel-Latif et al., 2006
69. Women’s Resilience
• Women and men appear equally likely to complete
treatment for substance use
• Men and women have similar treatment outcomes
• Women are less likely then men to relapse while in
treatment
• Women show better long-term recovery outcomes then
men
Green, 2006
70. A call to action
• Women have been largely ignored in addictions research
• Much-needed research on gender differences in
treatment response and gender-specific treatments
• Increase efforts to reduce the stigma and discrimination
faced by women who use substances
• Adopt a multidisciplinary, holistic, comprehensive
approach to treatment, prevention, health promotion
• Coordinated and integrated systems of care and services
with gender and cultural competence
SAMHSA, 2009; Finnegan, 2013
72. References
• American Society of Addiction Medicine www.asam.org
• Back, S et al (2011). Comparative profiles of men and women with opioid
dependence: Results from a national multisite effectiveness trial. Am J Drug
Alcohol Abuse, 37(5), 313-323.
• Buprenorphine/Naloxone for Opioid Dependence: Clinical Practice Guideline
(2011). Centre for Addiction and Mental Health (CAMH).
• Canadian AIDS Treatment Information Exchange (CATIE; 2013). Fact sheet: The
epidemiology of hepatitis C in Canada. http://www.catie.ca/factsheets/epidemiology/epidemiology-hepatitis-c-canada
• Canadian AIDS Treatment Information Exchange (CATIE; 2012). Gender matters
in HIV prevention. Prevention in Focus, Spring 2012.
• Canadian AIDS Treatment Information Exchange (CATIE; 2012). Fast Facts: Youth.
Prevention in Focus, Summer 2012.
73. References
• Carter et al (2009). Neurobiological Research on Addiction: A Review of the
Scientific, Public Health and Social Policy Implications for Australia Final Report
January 30, 2009.
• CDC (July, 2013). Prescription painkiller overdoses: A growing epidemic,
especially among women. CDC Vitalsigns: www.cdc.gov/vitalsigns
• Cormier, RA (2000). Predicting treatment outcome in chemically dependent
women: A test of Marlatt and Gordon’s relapse model [Unpublished doctoral
dissertation]. Windsor, ON: University of Windsor.
• Finnegan, L (2013). Substance abuse in Canada: Licit and illicit drug use during
pregnancy: Maternal, neonatal, and early childhood consequences. Ottawa, ON.
Canadian Centre on Substance Abuse 2013.
• Green, C (2006). Gender and use of substance abuse treatment services. NIH
National Institute on Alcohol Abuse and Alcoholism.
74. References
• Greenfield, SF, Back, SE, Lawson, K, & Brady, K (2010). Substance abuse in
women. Psychiatr Clin North Am, 33(2), 339-355.
• Hernandez-Avila, CA, Rounsaville, BJ, & Kranzler, HR (2004). Opioid-, cannabisand alcohol-dependent women show more rapid progression to substance
abuse treatment. Drug and Alcohol Dependence, 74(3), 265–272.
• Lowinson & Ruiz’s Substance Abuse: A Comprehensive Textbook Fifth Edition
Chapter 57 Adolescent Substance Abuse R. Milin and S. Walker. Editors Pedro
Ruiz &Eric Strain. Lippincott Williams & Wilkins, Philadelphia, PA, 2011
• Marchand, K et al (2012). Sex work involvement among women with long-term
opioid injection drug dependence who enter opioid agonist treatment. Harm
Reduction Journal, 9:8.
• Methadone Maintenance Treatment Program Standards and Clinical Guidelines,
4th edition February 2011 CPSO
• National Institute on Drug Abuse (NIDA)
75. References
• National Survey on Drug Use and Health (NSDUH) 2012.
• National Epidemiologic Survey on Alcohol and Related Conditions (NESARC)
2003.
• Nicholson D & Saewyc E (2011). Childhood sexual abuse, substance use and
substance use-related sexual behaviour in a rural school population. Poster
presented at the Issues of Substance national conference. Vancouver, Canada.
• Paglia-Boak, A, Mann, RE, Adlaf, EM (2011). Drug use among Ontario students,
1977-2011: OSDUHS highlights. (CAMH Research Document Series No. 32).
Toronto, ON: Centre for Addiction and Mental Health.
• Poole, N (2000). Evaluation report of the Sheway Project for high-risk pregnant
and parenting women. Vancouver: British Columbia Centre of Excellence for
Women’s Health.
• Powis B, et al. (1996). The differences between male and female drug users:
Community samples of heroin and cocaine users compared. Subst Use Misuse,
31(5), 529–43.
76. References
• Principles of Addiction Medicine 4th ed. (2009). American Society of Addiction
Medicine.
• Public Health Agency of Canada (PHAC; 2010). HIV and AIDS in Canada.
Surveillance Report to December 31, 2009. Surveillance and Risk Assessment
Division. Centre for Communicable Diseases and Infection Control. PHAC.
• Public Health Agency of Canada (PHAC; 2012). Reported cases and rates of
hepatitis C by age group and sex, 2005 to 2010. Community Acquired Infections
Division, PHAC.
• Substance Abuse: A Comprehensive Textbook 4th Ed. Lewinson et al. 2005
• Substance Abuse and Mental Health Services Administration (SAMHSA) (2009).
Center for Substance Abuse Treatment. Substance abuse treatment: Addressing
the specific needs of women. Treatment Improvement Protocol (TIP) Series 51.
Rockville, MD: SAMHSA Administration.
77. References
• Tjaden, P, & Thoennes, N (2000). Extent, nature, and consequences of intimate
partner violence: Findings from the National Violence Against Women Survey
[Publication No. NCJ 181867]. Washington, DC: Department of Justice.
Videos:
• Women of Substance (2013). Exec Producer: South Shore District Health
Authority. http://www.youtube.com/watch?v=xQZNP3p4k2g
• What is it like to be a female addicted to heroin? (2012).
http://www.youtube.com/watch?v=RtXJ-iY5TFk
Editor's Notes
Potent opioid (euphoria effects)High dosePurityMore socially acceptable than heroinPossible to circumvent delivery system: chew, snort, injectEasy accessInadequate monitoring
http://www.youtube.com/watch?v=xQZNP3p4k2g
Source Where Pain Relievers Were Obtained for Most Recent Nonmedical Use among Past Year Users Aged 12 or Older: 2011-2012 (NSDUH)
2. People of Introduction and Relationship Status: Women are more likely to be introducedto and initiate alcohol and drug use through significant relationships including boyfriends,spouses, partners, and relatives. According to the National Center on Addiction and SubstanceAbuse and Columbia University (CASA) research report, females are often introduced tosubstances in a more private setting (2003). In addition, marital status plays an important roleas a protective factor in the development of substance use disorders.3. Drug Injection and Relationships: Even though women are less likely to inject drugs thanmen, research suggests that women accelerate to injecting at a faster rate than men (Bryantand Treloar 2007). When women inject drugs for the first time, they are more likely than menwho are first-time injectors to be introduced to this form of administration by a sexual partner(Frajzyngier et al. 2007). Women are more likely to be involved with a sexual partner who alsoinjects. While various personality and interpersonal factors influence needle sharing amongwomen (Brook et al. 2000), women are more likely to inject with and borrow needles andequipment from their partner, spouse, or boyfriend. Among women who use with their sexualpartners, Bryant and Treloar (2007) highlight a division of labor where men are responsible forobtaining, purchasing, and injecting the drug for them. Thus, needle sharing and drug usingwith a sexual partner may engender a sense of emotional intimacy among women or refl ectinequity of power in the relationship. Other “people of introduction” besides sexual partnersare groups that are predominantly female. While women may initiate drug injection throughrelational means, it is important to recognize that some women are as likely to initiate druginjection on their own.
2. People of Introduction and Relationship Status: Women are more likely to be introducedto and initiate alcohol and drug use through significant relationships including boyfriends,spouses, partners, and relatives. According to the National Center on Addiction and SubstanceAbuse and Columbia University (CASA) research report, females are often introduced tosubstances in a more private setting (2003). In addition, marital status plays an important roleas a protective factor in the development of substance use disorders.3. Drug Injection and Relationships: Even though women are less likely to inject drugs thanmen, research suggests that women accelerate to injecting at a faster rate than men (Bryantand Treloar 2007). When women inject drugs for the first time, they are more likely than menwho are first-time injectors to be introduced to this form of administration by a sexual partner(Frajzyngier et al. 2007). Women are more likely to be involved with a sexual partner who alsoinjects. While various personality and interpersonal factors influence needle sharing amongwomen (Brook et al. 2000), women are more likely to inject with and borrow needles andequipment from their partner, spouse, or boyfriend. Among women who use with their sexualpartners, Bryant and Treloar (2007) highlight a division of labor where men are responsible forobtaining, purchasing, and injecting the drug for them. Thus, needle sharing and drug usingwith a sexual partner may engender a sense of emotional intimacy among women or refl ectinequity of power in the relationship. Other “people of introduction” besides sexual partnersare groups that are predominantly female. While women may initiate drug injection throughrelational means, it is important to recognize that some women are as likely to initiate druginjection on their own.
2. People of Introduction and Relationship Status: Women are more likely to be introducedto and initiate alcohol and drug use through significant relationships including boyfriends,spouses, partners, and relatives. According to the National Center on Addiction and SubstanceAbuse and Columbia University (CASA) research report, females are often introduced tosubstances in a more private setting (2003). In addition, marital status plays an important roleas a protective factor in the development of substance use disorders.
progress faster than men from initial use to alcohol anddrug-related consequences even when using a similar or lesser amount of substances
Sex Differences in Stress Reactivity and Relapse to Substance AbuseSex differences in neuroendocrine adaptations to stress and reward systems may mediate women’s susceptibility to drug abuse and relapse.18 Several studies have examined sex differences in stress response (eg, subjective, autonomic) and relapse.18,19 Among substance-dependent subjects, attenuated neuroendocrine stress response in women (ie, blunted adrenocorticotropic hormone and cortisol) has been shown following exposure to stress and drug cues.20 This hypothalamic-pituitary-adrenocortical (HPA) dysregulation in women may be one key to enhanced vulnerability to relapse in response to negative affect, as it may be associated with greater emotional intensity at lower levels of HPA arousal.21
Menstrual Cycle (Check Greenfield paper)Substances disrupt menstrual cycle phases menstrual cycle phases affect substances Fertility Substances can effect fertility Cocaine & Opioids secondary amenorrhea & risk of unplanned pregnancies Prenatal care may be delayed as woman does not know she’s conceived (Shimi Kang)
75% of women in treatment for alcohol dependence report childhood sexual abuse Severity of SUD directly related to # of violent assaults a women has experienced* Substance use may vulnerability of women to re-traumatization and re-victimization*Jacobsen 2001; Chandler & McCaul 2003 , UN 2004 (Shimi Kang)
Women use substances as a means of coping (self-medication) or to increase social desirability (low self-esteem)
Childhood trauma sexual abuse physical abuseAdolescence/Young Adulthood rape abusive relationships75% of women in treatment for alcohol dependence report childhood sexual abuse Severity of SUD directly related to # of violent assaults a women has experienced* Substance use may vulnerability of women to re-traumatization and re-victimization*Jacobsen 2001; Chandler & McCaul 2003 , UN 2004 (Shimi Kang)
Childhood trauma sexual abuse physical abuseAdolescence/Young Adulthood rape abusive relationships75% of women in treatment for alcohol dependence report childhood sexual abuse Severity of SUD directly related to # of violent assaults a women has experienced* Substance use may vulnerability of women to re-traumatization and re-victimization*Jacobsen 2001; Chandler & McCaul 2003 , UN 2004 (Shimi Kang)
Childhood trauma sexual abuse physical abuseAdolescence/Young Adulthood rape abusive relationships75% of women in treatment for alcohol dependence report childhood sexual abuse Severity of SUD directly related to # of violent assaults a women has experienced* Substance use may vulnerability of women to re-traumatization and re-victimization*Jacobsen 2001; Chandler & McCaul 2003 , UN 2004 (Shimi Kang)
Greater rates of concurrent Axis I & SUD1 More likely to have suffered from trauma1 Anxiety more of a factor for women2 Women with dual diagnosis have less access to treatment3 1 UN 2004, 2ICPE, 3Baker 2001
Estimates of rates of occurrence in womenCo-morbidity with substance use disorders?increased rate of opioid use disorders ?medicating anxiety and depression
Discriminatory acts range from mundane slights to devastating violent actsWomen may experience varied levels of discrimination that affect their substance use and their recoverySubstance use may become a way of coping with the additional stresses of discriminationWhen women experience more than one type of discrimination the effect can be compoundedDiscrimination can result in fewer educational and employment opportunities, lower SES, fewer housing choices and poorer health outcomeLess access to health care and difficulty in getting to treatmentLeads to negative health consequences and psychological distress
http://www.youtube.com/watch?v=RtXJ-iY5TFk
If I have hepatitis C and get pregnant, can I pass it on to my baby?The risk of HCV transmission to the baby is low compared to other viruses such as hepatitis B or HIV. Approximately 5 out of 100 mothers who have HCV might pass it to their babies before or at the time of birth.If a mother has both hepatitis C and HIV, the risk of the baby getting hepatitis C is much higher than when the mother is infected with hepatitis C alone. Anywhere from 22 to 36 out of 100 babies born to hepatitis C and HIV positive mothers will become infected with hepatitis C.Can I do anything to reduce the risk of passing it to my baby?Unfortunately, there is currently no effective way to prevent or reduce the risk of hepatitis C transmission to the baby.The mode of delivery (caesarian or vaginal) does not seem to affect the rate of transmission but firm evidence is lacking.However, for mothers infected with both hepatitis C and HIV, there are medications that can significantly reduce the risk of passing HIV to the baby.
Parental warmth: Agrawal et al., 2005: Tip Manual p. 20Marriage appears to be protective whereas separated never married or divorced are at great risk for addictionParental warmth: High parental warmth = less likely to initiate use, abuse substances, and become dependent on substancesPartner support: Key motivator that brings women to treatment; more likely to accept helpReligious and spiritual practices: Associated with reduced risk for substance use, relapse preventionHealthy coping skills
Women who present to opioid treatment have a broader range of collateral symptomatology such as greater psychiatric comorbidity, medical problems, employment and family/social impairmentWomen seeking treatment have more severe problems, are younger, have lower education levels, and lower incomes then men seeking treatment
Barriers to treatment are: Intrapersonal, interpersonal, sociocultural, structural, and systemicIntrapersonal: Individual factors including health problems, psychological issues, cognitive functioning, readiness/motivationInterpersonal: Relational issues including significant relationships, family dynamics, support systemsSociocultural: Stigma, bias, racism, inequity in health services, attitudes of health care providers towards womenStructural: Program characteristics, design, restrictionsSystemic: Larger systems including country, province, local agencies that generate polices and laws, health insurance and drug coverage, economy
Assuming that a woman is resistant to treatment because she is other-focused in the program is a form of gender biasUse their ability to be other-focused as a tool for motivation for recovery
Another off label use…taper off for individuals physically dependent but not addicted
Few studies on women so inconclusive evidence on treatment outcomes, but current research suggests that:Women and men are equally likely to complete treatmentTreatment outcomes as good as men’sWomen less likely to relapse then men in treatment. When they relapse it’s due to substance abusing romantic partners, or personal problems before relapseBetter long-term recovery outcomes then men