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A Gloom of Their Own

Programs at a handful of hospitals treat the special problems of women who are alcoholics and addicts.

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Sally, 28 years old: I grew up in the inner city. We were real poor because my father was an alcoholic, OK, and he was a gambler and he didn't work. My father was very strict. Very. I couldn't even think for myself. I couldn't do anything. Most of the time I sat in a chair all day. I was very angry with my mother for staying with him. I hated her then. Then she got a divorce and we moved to a nicer part of town. I was 13. All of a sudden, I felt free. So I started drinking.

When I was 14 or 15, I started taking barbiturates, and I was using a lot of acid, too. I didn't realize how much I was taking. I almost died about six times. A couple times were suicides. When I was 17 I figured I better stop the drugs, but I couldn't stop the alcohol. Actually, I could control myself when I was using drugs, but when I was drinking I blacked out so I didn't know what was going on. I kept waking up in mental wards.

When I was 21, an AA counselor suggested a halfway house. I knew I had to do something, so I went. But I got kicked out. Not because I was drinking. Because I was pregnant. I got pregnant on that last relapse and I didn't know it. I didn't even know I went to bed with anybody. It was a total blackout. I have a lot of years of my life that's like that.

Sally is a former patient in the Women's Chemical Dependence Program at Chicago's Cuneo Memorial Hospital. (All patients' names in this story have been changed.) Established in 1984, the program is different because it's not for men. There are many for-women-only residences, halfway houses for instance, where women with drug dependency problems can go after detoxification. But hospital programs, usually an addicted person's first stop on the long road to recovery, are almost all coed. A nationwide marketing study Cuneo conducted in the fall of '86 came up with just a handful of hospital-based programs for women only, and Cuneo had the only one in Illinois.

There are several justifications for them, however. First of all, there is the potential patient load. The percentage of women in America who say they drink alcohol leveled off in the 1970s, but not before rising from less than 40 percent in the 1930s to 60 percent or more. Experts now estimate that a third to a half of the 10 to 14 million alcoholics in this country are women. "And that's just alcohol," adds Maureen Kelly, director of Cuneo's program. "That doesn't include the women with other drug dependencies."

In Chicago alone, the National Council on Alcoholism estimates, as many as 150,000 women are addicted to alcohol and other drugs.

Alcohol dependence is the most common problem treated at Cuneo. The second biggest problem is cocaine dependence. When the national hot line 1-800-COCAINE began operating in 1983, more than a third of the first hundred thousand callers were women. According to Fair Oaks Hospital in Summit, New Jersey, which operates the hot line, the proportion of women callers has now risen closer to a half.

Dependence on tranquilizers is a close third. According to a 1985 report by the U.S. Department of Health and Human Services, Women's Health: Report of the Public Health Service Task Force on Women's Health Issues, 17 million women between the ages of 18 and 79 are estimated to have used at least one such psychoactive drug in 1979. Many used the drugs infrequently, but it's estimated that about two million women had been taking them daily for a year or more.

A second justification for a female-only program is economic, and turns on the fact that women are more likely than men to be concerned about their health. Barbara Runyen, chief operating officer at Cuneo, says her predecessor, Sister Antonio, established the program primarily to fill a market niche. She thought it would be a strong revenue producer for the hospital, and she was right.

"The program has done very well for us," says Runyen.

There's also an important medical reason. Some experts believe that an all-female program can make it easier for women to kick their addiction.

Maureen Kelly, who holds a master's degree in social work and previously worked in coed programs, is a strong proponent of single-sex treatment.

"In the old days, the theory was a disease is a disease is a disease, and the age or sex of the patient didn't matter," she says. "I think things started changing in the early 70s with the growth of the women's movement. There was an increased interest in women's health in general; new research studies showed differences in addiction in men and women; and I think women became more aggressive about asking for programs they felt they needed."

Even so, more men than women come forward for treatment. Men are more likely to have jobs, and therefore health insurance, and to be free of child-care responsibilities; and men still feel less of a stigma than women feel being addicts. Which is why "traditional coed programs are usually 70 to 80 percent male," says Kelly. "The women are really outnumbered and they don't feel comfortable.

"In addition, men and women come into treatment with completely different attitudes. Women are passive, frightened, ashamed, and depressed. They have very prominent, unresolved issues of grief and loss--their mother died of alcoholism when she was 30, or their husband left them, or they lost custody of their children.

"Some men, on the other hand, are mad as hell at the people telling them they have a problem. They're much more dominant and aggressive. Women are afraid to speak up."

Patients in recovery programs are encouraged to talk about their feelings, about why they drink, about what happens to them when they do. Sometimes these matters are so personal that women don't feel they can discuss them with men in the room.

Sally: I was in treatment programs with men, and it didn't bother me at first. All my friends were men. I was never around women. I knew what to expect out of men, but I was afraid of women. You can con a man about your feelings a lot more than you can con a woman. Because men don't care.

I used to feel I had to compete with women for everything. And I always felt other women were better than me. I felt so inferior. I didn't like me, and I drank to get away from that. I could stay sober when it was for somebody else, when it was for the baby. But not when it was for me. It's so hard to stay sober for somebody you don't like. So after I had the baby and gave it up for adoption, I started drinking again.

I was going to AA meetings, but I wasn't really into it. My compulsion to drink hadn't left me. A lot of the women in the group were afraid of me. I had been raped a lot, and [gone through] a lot of sexual abuse because I was drunk. And I would tell them all these stories, and the women just kind of stay away from you then. I tried to shock them. I did that on purpose, I think. You don't do that in that kind of manner, not the way I was doing it. I didn't know any better though. Actually, I was trying to reach out, but that was the only way I knew how and it scared them.

But the men would easily listen to me because they'd figure "Oh, she's easy now, she's still sick." I'm not saying all the men, but the ones who weren't working a good [recovery] program themselves. They would just want to be around me because they knew I was sick too.

One of the guys I met in the group got me drinking again. We went to this hotel, but he couldn't do anything without alcohol, so then we both started again.

I think a lot of women have a lot of problems with sexual stuff, or abuse, or what have you, and they cannot talk when men are there because men are who they've been abused by.

When Edith Gomberg began researching women and alcoholism in the late 1950s, few studies on the topic existed and most researchers weren't interested in her work. Her colleagues thought she was wasting her time.

"I was working as a psychologist in an alcoholism clinic after I got my PhD from Yale," says Gomberg, now a professor at the University of Michigan. "I decided to do a research study and compare the women and men who came to the clinic." She also wanted to compare the women from the clinic with women from a state prison where she did alcoholism counseling.

"Alcoholics always interested me," she says. "I worked in state hospitals after I got my master's degree, and alcoholics were all over the place.

"I grew up in New York City in a very nice Jewish world. The only time I ever saw people get high was at a wedding. So I was absolutely entranced by these people who didn't know when to stop and who got themselves into such serious problems that they were in state hospitals. You can or cannot make anything out of the fact that three years ago my brother died of the end-product diseases of alcoholism. Larry and I were at different ends of the business. He was the victim and I was the investigator.

"But when I told the staff at the Yale Center of Alcohol Studies that I wanted to do a study on women, they all looked at me and said 'What are you going to do that for? You have all this information about males. What's different about women?'"

Gomberg found some important differences. And that first paper, published in 1957, began painting the picture of life for female alcoholics. She found, for instance, that women start drinking and become alcoholics later in life than men do; that they tend to drink alone more; and that fewer of them had been hospitalized or arrested, which suggested that most were "respectable" women. The paper was published by the Quarterly Journal of Studies on Alcohol at Yale, and nothing happened.

"There was a great silence," says Gomberg. "And for about 15 years, the paper just sat there."

Research on alcoholism continued to focus on men. "Studies in the literature either said 'We did this study on alcoholism and the subjects were a certain number of males admitted to so-and-so institution,' or else, what's even nervier, they didn't even mention the sex of the subjects," says Gomberg. "You're supposed to assume they're males."

But with the women's movement in the 70s, interest in women's problems and gender differences boomed. "All of a sudden it was an 'in' topic. There were a lot of experts, a lot of people working in the field. And that was terrific," says Gomberg. "The only thing that makes me sad is that there's almost a fad quality about this. Women were 'in' as a research topic, and now they're not so 'in.' Now, who gives a damn? I don't even see it in the newspapers anymore. Last year everybody and his brother had a meeting on cocaine. Back then everybody and her sister had a meeting on females.

"Fortunately, there's a small, hardworking, steady group of women who keep the interest going and keep the work going today even without grants from the government."

Why do women become alcoholics? Is it everyday stress? Traumatic events? Heredity? Do women and men become alcoholics for the same reasons? Now research has given us some answers, and the answers reveal definite differences.

First, men and women can both show a genetic predisposition to alcoholism. But studies show that women alcoholics report an alcoholic parent more frequently than the men do. A 1984 study of 407 professionals in Alcoholics Anonymous showed that 29 percent of the men but 41 percent of the women reported having at least one alcoholic parent. A 1980 study showed that alcoholic women are more likely than alcoholic men to have alcoholic fathers, and a 1976 study said they are more likely to have heavy-drinking mothers.

"It's possible there's some biological predisposition for women to be more affected," Maureen Kelly says. But she points out that it's also possible that women are more responsive to the influences of a relationship with an alcoholic parent.

The psychological differences between boys and girls who grow up to be alcoholics are more clear-cut, she says. "Both male and female alcoholics tend to come from families where there's not a lot of love and support. But studies show that girls internalize the situation more and tend to blame themselves. Boys tend to respond by acting out, running away. And girls report more incest and sexual abuse."

A 1975 study described the defense mechanisms of male alcoholics as "turning against others" and those of female alcoholics as "turning against self." "Which is why," Kelly says, "men often come into treatment mad, blaming other people for their troubles, and women come in submissive and depressed."

To understand more about the early-life events that might lead a woman to become an alcoholic, a few years ago Edith Gomberg interviewed 301 alcoholic women and 137 nonalcoholic women. Comparing the two groups, she found that such conceivable factors as poverty, family piety, a working mother, serious illness within the family, and incarceration of a family member made little if any difference.

But some other things did. For example, the alcoholic women were more likely to have grown up with an alcoholic role model and to have suffered more conflict with their parents.

"As children, the alcoholic women felt unloved and were not close to their mothers," says Gomberg. "They were more depressed and had more tantrums, a sign of difficulty with impulse control. The alcoholic women quit school earlier. They marry earlier. They leave home earlier. And although there was no difference when you ask how they got along with boys during adolescence, there is a difference with how they got along with girls. The alcoholic women had difficulty with relationships with girls."

Sally: I had gone to a couple of women's meetings because a few women I met on the [AA] program, thank God for them, I guess saw something in me and said "I think you should come to some women's meetings." They saw that I wasn't very comfortable around women. They said this would help me. So I did and I started to feel a little more comfortable around women, but it was the last women's residence [I lived in] that really turned me around. It wasn't as bad as I thought. I had so much fear and it was not like that. In fact, I found myself able to open up more and I was really surprised. I didn't know it was possible to be that close to anybody.

But then I didn't keep going with my program. I didn't keep in contact with the women there or the sponsor they suggest you have. I just started hating my life again. In the halfway house I was in a safe environment, protected sort of, you know? And then, all of a sudden, after seven months, I'm out there on my own. I was living by myself, and I guess I let fear take over. And depression. Oh, it all came back.

So I started drinking again.

I've been on a program nine years. One time I had almost two years [of abstinence], another time I almost had 11 months, another time I had a little over a year. All along, I've had a real hard time getting down to the feeling level. And that's basically what the program is telling me to do.

The last time I drank before I came in here [Cuneo], I started drinking at noon at home because I was afraid to go into a bar without having anything in my system. I wasn't one of those people who drank by themselves, alone. Which is kind of unusual. Most alcoholics drink alone. So then I went out. I don't remember a lot of it because I blacked out. The next thing I know I'm in Resurrection Hospital tied to a bed again, the story of my life. The doctor said I had so much alcohol in me that if he would've drank that much he would've been comatose. I couldn't see.

The police took me to Resurrection. They found me passed out on Harlem and Lawrence just laying there on the rocks.

Next day I went to a meeting. I was still very shaky. My blood pressure must have been real high. My sponsor is the one that suggested me coming here [Cuneo]. She called me up and said, "Sally, don't you think you'd better get off this merry-go-round and really do something about your problem? Nine years of this! In and out!"

Before that [phone call] I really wanted to die. I was just so full of guilt because [I thought] this isn't working for me. The program's not working for me. The only thing I thought about was dying. So I did call because I was really tired of it. I was scared to death, but I did call. I was scared to come here because I was afraid it wasn't going to really work. I says "Well, I don't know if it's going to do anything for me. I been through too many programs, too many AA meetings." I started to feel a little hopeless.

So I did come in here. To me it was one of the greatest things I ever did. I know now a lot of women have the problem where it's so hard to relate to our own sex. I know because I've heard it [in the meetings]. But I don't have that problem so much anymore. I just felt good about being here because of the fact that I can open up to women much better now. I care about women much more.

Here they talk a lot about the physical differences between men and women and how alcohol affects them. I never knew any of that.

I've talked in groups here about the abuse, but in AA I wasn't doing it to work through the problem. There I was mostly doing it for shock value. As soon as I could really talk about it, right off the bat I felt better about myself.

Being able to talk about how I've been raped a lot, I've been able to let some of that pain go. Talking about it in AA made me feel worse because I felt I pushed people away. They didn't understand. It made me feel even more inferior. Like I wasn't good enough for them to like me.

I can't say that I like myself yet, but I have gotten to the point where I feel I deserve to get well. That I deserve to take care of myself.

Alcoholic women consistently cite some traumatic event as the cause of their drinking problem. "It could be a death, a divorce, a hysterectomy, something not nice happening," says Gomberg. Men aren't so likely to do this.

But Dr. Gomberg is not convinced an unhappy event is the real reason. "Some researchers think that when women start drinking, bad things happen because of the drinking, so women drink more," she says.

"The problem also may be that they don't respond to stress well. Stress, as experienced by alcoholic women, is in most cases not terribly different from the stresses that everybody else experiences. But how they respond to stress, their capacity to stand up and take a buffeting, is different. I think of life sometimes as for survivors. Like a daruma doll, you knock it over and it rights itself. Some people are not very good at righting themselves."

Kelly and Gomberg think women may feel more defensive or ashamed about their drinking than men. "They seem to feel they need a rationalization more," Kelly says. "So they try to say 'Well, it was my divorce that did it to me.'"

Historically, she says, a drunken woman has always been less accepted socially than a drunken man. "In a milder form, that stigma has persisted. That may be because a woman is supposed to be available to attend to the needs of others, to be a nurturer, a caretaker. But when she's drunk or high, she's pretty self-involved and unavailable. And that takes her out of her role. She's unable to do what she's supposed to do."

Research has shown that women follow men into addiction far more often than men follow women. "We hear this all the time," Kelly says. "Over and over women say they started using it in a relationship with a 'significant other,' usually a man, who is a substance abuser. I think women follow men into drug abuse rather than the other way around because it's more acceptable for men to drink or use drugs.

"I also think that relationships are very important to a woman's sense of self, and if the cost of being in a relationship is that you drink along with someone in order to be with him, then you do that.

"Once, in a meeting, someone asked me 'Are you saying men cause women to become alcoholic?' I said no. These women are choosing, are attracted to, heavy drinkers or drug users, and chose to join them. It somehow fills a need of theirs."

Studies also show that a woman is more likely to stay with an alcoholic husband than a man is to stay with an alcoholic wife. Gomberg's 1957 study showed that only 9 percent of the alcoholic men had alcoholic wives; on the other hand, 35 percent of the alcoholic middle-class women had alcoholic husbands and 56 percent of the alcoholic women from lower-income groups were married to alcoholics.

"Most of our women come in and talk about how they started to drink because of a man," Kelly says, "but by the time we see them, they're often alone. They've been left."

What about work? Has women's migration into the work force led to more, or to less, addiction?

"It's a myth that housewives are more likely to be problem drinkers than working women," says Gomberg. "That came out of the early, naive days of the feminist revolution, when people said that if a woman gets a job and actualizes herself, she's less likely to be a heavy drinker. The fact of the matter is there is more problem drinking in the workplace than there is among women who stay at home."

But a 1984 study of women in Baltimore concluded that "women moving . . . into traditional male executive positions don't develop the heavier drinking patterns of male colleagues," Gomberg added.

"I think women who make it big are not necessarily the ones who get into drugs and alcohol, because they'd lose everything they worked so hard to get. Whereas corporations cover for drinking males, a female executive just better not get herself into difficulty because she's going to lose what she's got. You've got to be above reproach.

"Instead of worrying about the female CEOs, and there may be 1 percent of them who are female, we ought to be worried about the women who work in low-status jobs."

Heavier drinking among women is associated generally with nontraditional life-styles--with being single, divorced, or separated; with not having children; with working outside the home, and in a nontraditional job; with being the head of a household. A 1977 study classified women as "out-of-role" if they were nontraditional in at least three of these areas. A slightly higher percentage of in-role women were social drinkers (50 to 48 percent), but out-of-role women were far more often problem drinkers (27 to 11 percent).

In the 1970s, one of the explanations for female alcoholism was "sex role conflict"--the difficulty in spanning the difference between traditional female roles and women's emerging roles in society. "I'm not sure I buy the phrase 'sex role conflict' or 'dual role conflict,'" says Gomberg. "How about dual role exhaustion? How about plain being tired of juggling two roles?"

Women use different drugs than men and obtain them differently. National surveys consistently show that men use more illegal drugs, and women prefer theirs prescribed. Almost two-thirds of all tranquilizer prescriptions are written for women, according to the Public Health Service task force report.

"I think women use prescribed drugs more because it's more culturally acceptable for a woman to go to a physician with some vague complaints of nervousness, anxiety, or depression," Maureen Kelly says. "And I think physicians are more likely to dismiss a woman's complaints as being neurotic or nervous disorders, pacify her, and get her out of their office with a prescription for Valium.

"I think men are less willing to come forward and say 'I'm unhappy,' but when they do I think their complaints are taken more seriously. The doctors think there might be some real medical cause, or they're more likely to say 'You're too stressed, take a vacation.' They are not as quick to pacify men."

The Public Health Service report looks at the same situation a little differently: "Women are more likely than men to escalate their prescribed dosage and to pressure physicians to increase or extend their psychoactive drug prescriptions."

Laura, 62 years old: I was an alcoholic and I have 30 years of taking prescribed tranquilizers. I was addicted to both. When I first started, I was taking the usual amount, three a day, and I did that for many years. But I would say the last two years I was up to, oh, probably about ten a day. Plus the alcohol. The last six months that was like a fifth a day.

I took pills to get to sleep at night, and toward the end, alcohol too. Toward the end even the pills didn't help. I still wasn't sleeping. Then in the morning I took pills to wake up. Then I'd get anxious and took pills to calm me down. Then a drink. Then depression in the afternoon. Just pill-pill- alcohol days. Half the things [I did] I don't remember doing, half the places I went to I still don't remember.

About 15 years ago I went to a day program. But when I left I didn't follow through with support. After I finished the program I did well for about six months. But I was never completely off the tranquilizers for more than two weeks in the past 30 years.

I knew I needed help. About a month before I entered Cuneo I tried to get in as an outpatient. At that time they didn't have an outpatient program. They wanted me to stay, and I didn't. I went home. A month later I arrived here by ambulance. I was drunk and out of it. I had fallen out of bed and gashed my head. I was bleeding. My husband didn't know what was really going on. So I went to the emergency room and then came up here [to the chemical dependency program unit] and that's when I started the program.

Originally the tranquilizers were prescribed for me for anxiety. I told the doctor "I'm depressed, I can't cope." So he told me to take these tranquilizers, three a day, and that was the start of it all.

At that time my son was about seven years old. I was going through an unhappy marriage and problems that I just couldn't cope with. But his prescribing those tranquilizers was the worst thing that ever happened to me.

I was very unfortunate, when I look back. The doctor I went to didn't get down to the nitty-gritty as to what the problems were. He just treated symptoms.

He should've prescribed what I'm doing now. Therapy. Counseling. Handling problems without prescribed pills.

Despite Edith Gomberg's pioneering work, it wasn't until the 1970s that most researchers awoke to the significant differences in the way men and women handle alcohol.

"It's been known for a long time that prolonged, heavy drinking is a cause of many gastrointestinal, neuromuscular, and cardiovascular system diseases," wrote Sheila Blume, medical director of the alcoholism and compulsive gambling programs of a New York hospital, in a 1986 article in the Journal of the American Medical Association, "but in the last ten years evidence has been accumulating that women may be especially vulnerable to some of these effects."

The Public Health Service report agrees: "Evidence that chronic alcohol abuse exacts a higher price from women than men at comparable levels of heavy use is increasingly compelling."

That higher price includes more frequent and longer periods of disability and more extensive liver damage at lower levels of alcohol intake.

Dr. Blume reported that one study of men and women suffering from alcohol-related diseases found the women had been problem drinkers a considerably shorter time--an average of 14.2 years to the men's 20.2 years. "The average duration of hazardous drinking before the first recorded occurrence of disease was shorter for fatty liver, hypertension, obesity, anemia, malnutrition, and gastrointestinal hemorrhage," she noted.

Blume tells an interviewer that physicians really don't know why this is, "but it likely has to do with the internal milieu of hormones that's different for men and women. Of course, women have less body water so they react more strongly than men do to the same amount of alcohol, but that doesn't explain all the differences by far."

The Public Health Service report suggests that the combination of estrogen and alcohol may be especially damaging to the liver. It observes that the higher incidence of liver damage in women may be caused by a gender-related immune response in women that makes the liver more vulnerable to injury.

And it points out one more interesting research finding--alcohol affects women differently at different points in their menstrual cycle. When they drink during ovulation or just before menstruating, women develop higher blood-alcohol levels for given amounts of alcohol. "In practical terms, then," wrote Blume, "a woman will be less likely than a man to predict accurately the effect of a given amount of alcohol consumed."

More so than nonalcoholic women, alcoholic women suffer from gynecological and obstetric problems, including early menopause, infertility, spontaneous abortions, and complications of labor and delivery. And the alcoholics report higher rates of being sexually abused.

For whatever causes, death comes sooner to alcoholic women than to either alcoholic men or nonalcoholic women. In addition to cirrhosis of the liver, frequent causes of death are suicide, violence, alcohol-related accidents, and a variety of circulatory disorders and malignancies.

One study involved 103 American women who were treated for alcoholism in 1967 and '68. Eleven years later, almost a third of them were dead. Their natural life spans had been decreased by an average of 15 years. The women who successfully gave up drinking were the ones most likely to remain alive.

Patty, 35 years old: I started drinking and drugging when I was 18. But I really can't say I started because that's what all my friends did. I wanted to drink and drug because I found it an escape from life. I never wanted to deal with reality.

Alcoholism is a disease. I was born with it. The first time I ever drank I was probably about nine years old. I can remember sitting on the kitchen floor and drinking out of this bottle. I didn't like the taste; I just loved how I felt after I drank.

I was pretty heavy into drugs. I did barbiturates, amphetamines, mescaline, LSD, angel dust, tic, marijuana, opium. I had tried cocaine once. I think I was so high on other stuff that I never got off on it, so I didn't like it.

And, sure, I was drinking along with this. I had to get the pills down with something.

I became real sick when I was about 22. I finally told the doctor that I did do a lot of drugs and I drank a lot, and he told me that I would have to stop if I wanted to live. So I just stopped doing everything for about a year. When I went back to see him I got a clean bill of health and immediately went out and started drinking again.

Today's experts generally agree that important differences exist between men and women in the causes, patterns, and physiological effects of addiction. The Public Health Service report says these differences "must all be taken into account if effective prevention and treatment are to occur."

Is that a mandate for separate programs?

"I don't think there's a piece of evidence that says women recover better in an all-women's program," says Blume. "I've run both women's and men's programs for alcoholism, and I prefer mixed groups--if the therapist knows what he or she is doing. In an all-men's group, the men will say something like 'Women are only after money,' and it's hard for the therapist to point out reality. In a mixed group, the patients themselves take on that role. Coed programs may not be better for a halfway house, but for an outpatient or a limited inpatient [hospital] setting, I prefer mixed based on my experience."

Maureen Kelly disagrees. And there is at least one study that supports her. In 1985, Carol Falkowski, a Minnesota researcher, looked at 289 women admitted to all-female chemical-dependency programs and 623 women admitted to coed programs in the Minnesota state hospital system.

Falkowski did not find that a woman who'd completed an all-female program was more likely to stay off alcohol and drugs than a woman who'd completed a coed program--although Falkowski believes that if she'd tracked more women after treatment some differences here might have shown up. But she did find that a woman who quit her program--whatever it was--before it was over was more likely to become addicted again than a woman who stuck her program out. And she found: "Generally, women attending a gender-segregated program are significantly more likely to complete treatment than women in coed programs."

The Betty Ford Center in California opened a 20-bed all-female unit in 1983. A spokesperson explained, "We think there's a difference between men and women."

Laura: When I did decide to come into a hospital program, I specifically wanted all women. I thought I'd be more comfortable with an all-women program. I thought I'd speak more freely.

[But] I didn't want to stay here. I didn't want to come here. I wanted to go home every day. The bottom line is I did stay, and a week extra, at the suggestion of the staff, because I had such a difficult detox.

They kept me very busy. It was like going to school, six days a week. A typical day included lectures on alcoholism. We learned an awful lot about it. And about ourselves. In the afternoon we had group therapy. We had assignments to do, which our caseworker gave us. They were discussed in group. Once we had to write a letter on what alcoholism did to us, how it affected our lives.

And then in group, which was very beneficial, we got a lot of feedback. And what also was beneficial was our one-on-one with our counselor, her suggestions and recommendations. Then also we had our AA meetings, four times a week. And before we left they helped you plan what you'd do when you left here. Coming here was terrific, but you needed a program when you left here, too.

The staff recommended extended treatment for me. They didn't think I was well enough or capable enough of going home and doing it alone. So I went to Grateful House in Oak Park for eight weeks, as an outpatient, from nine to three.

I have taken no tranquilizers, no alcohol, no nothing for a year. I'm so proud. Thirty years of pills and ten years of alcohol. It's rough; it's been rough this last year, but you just have to hang in there and use your support group and your AA.

I just enjoy the little-bitty things now. Everyday life. My son's the same; my husband's the same; my dog's the same. You just appreciate them more now. My mind is clear.

Asked to imagine an ideal treatment setting for women, Edith Gomberg cites the following as essential:

Child-care service. "About ten years ago there was a study of women in a state hospital," Gomberg says. "It said women tended to discontinue in the program more than men. And the authors said they felt this was because of domestic responsibilities. No matter how much liberation we have, the primary caretaker of children is still the female, and that fact has to be built into the program in some way."

Job training. "An awful lot of women come to treatment centers undertrained for any kind of job. They usually enter adult life undereducated and underprepared. They have to learn to be in the job market. As a part of evaluation and appraisal, a program could ask 'What's your economic situation? What's your means of support? What are your skills?' And one of the things you might do when planning for the sobriety period is train the woman. You got them sober, but they have to continue now. Also, if you are working at a job in which you have some interest, that's a therapeutic thing in itself. You should try to increase the rewards of sobriety."

Health education. "Women are very responsive to educational material and they're very health-conscious. Some education on general health status, nutrition, and on alcohol's effects on the body, on the female physiological function, on pregnancy, etc, should be included, but not in a way that's preachy or scary."

Single-sex group sessions. "This may be the most important part of treatment," says Gomberg. "Women need their own group for many reasons. First, studies have shown that alcoholic teenage girls tend to have difficulty relating to other teenage girls but not to teenage boys. A fair number said they were not comfortable with girls. They grow up and alcoholic women have trouble with relationships with other women. I would hope that an all-female group would help these alcoholic women in dealing with other women.

"Also, an all-female group would eliminate the problem of heterosexual game playing. In a mixed group you're going to have flirtations, romances, women used, all sorts of games that just compound their problems. You can't stop these games from happening, but you can at least minimize them. And again, in a coed group women are usually a small minority and they don't speak up.

"Single-sex groups are also beneficial for the men," says Gomberg. "I worked in a VA hospital and there wasn't a woman in sight. The men in those groups used to denounce their wives and commiserate with each other. If that had come out in a mixed group the women would have been put on the defensive, and if it hadn't come out the men would have become more resentful because they didn't feel free to say it. So it just seems to me to make sense to have a place where you are free to talk about things in a way that you're not so free to do when the sexes are mixed."

"There are very pure schools of thought about how to treat addiction," says Maureen Kelly. "Some say addiction is a disease and requires medical treatment. Some say it's a psychological/psychiatric disorder and requires psychotherapy. And then there are all kinds of methods in between.

"We appreciate the medical model so we offer a medical detox. We explain the physiological effects, particular to women, of alcohol and other drugs. And we talk about the genetic predisposition to addiction. We also talk about psychological issues important to women--depression, low self-esteem. And we try to consider the social/cultural factors in women's lives. So we make vocational referrals for underemployed women. And we try to get their family involved and get them hooked up with self-help as a way of providing additional support."

"The group at Cuneo is very well trained and open to new ideas," Gomberg says. "It's very exciting. Most all-female units are halfway houses, where women are sent posthospitalization. We're at the beginning of something here, and we have to accept the fact that we're going to be doing a certain amount of trial and error. But the women can tell you how to change and improve the program. By listening to the patients, we'll know what to add."

Patty: My drinking was pretty much a daily thing. I was a surgical nurse for 15 years, and when I came home from work, I would always go to the refrigerator and open up a can of beer.

The few relationships I had, from 24 through 30, were ruined because of my drinking. But I didn't see any of that then. I don't know what happened when I turned 30. But that was when I started to hit my bottom. I really started to drink very heavy for the next three years, and when I was 32 I started doing barbiturates again.

Somehow I made it to work but I felt like a robot. Like there wasn't really a person inside this body. By this time I had no self-esteem, no self-worth. I would look in the mirror and there wouldn't even be a face there.

I was to a point where I didn't want to live but I didn't want to die. But I didn't know how to live. I tried to commit suicide again.

I had been seeing a therapist for about a year and a half for couples counseling. We seemed to be working our relationship out a little bit better, but we had some individual problems and [the therapist] wanted to have individual therapy sessions with us. I'm a lesbian.

My roommate, who is now my ex-lover, had confronted my therapist to do an intervention on me. For six months I had been going to therapy loaded. Usually with a couple of downers in me as well.

I walked in one night and [the therapist] said she could no longer treat me because my problem was with pills and alcohol and she really didn't deal with that. She said I needed to go into a rehabilitation center.

She told me about Cuneo, that they had a women's program, and she thought I should give it a try.

Women have different issues to address. The progression of the disease is more rapid in females. Women are under different stresses than men in the working area, in the home life. There are some things that I needed to deal with and needed help with that I could not sit in a room full of men and discuss. Such as being the survivor of incest.

It happened when I was 11 until I was 15. I would not feel comfortable, in a 28-day program, trying to relive that part of my life with men in the group. And being able to share these feelings is necessary for recovery. I will drink over resentment that I have, that could easily cause me to relapse, and I have to talk about those things.

I think women understand other women and their problems. Women are more compassionate with women. They can understand what it is they're feeling. I never thought people had the same feelings I had. I thought I was the only one going around with all these crazy things in my head. I used to say "Patty, you're nuts. Nobody feels like this. You're crazy."

I felt lonely. I had so much anger. I felt intimidated by other women. I had to get that out when I was in therapy. I was scared to be in a room full of women. It was real frightening for me to have to open up and be vulnerable. I couldn't have done it if there had been men in the room.

The thought of going to a coed program crossed my mind when I had to make this decision. I live right by Martha Washington Hospital and I thought, well, I could go there. I'd be closer to home. But I thought maybe just an all-women's program would be better. For me.

The group therapies were probably the best because I learned a lot. I learned so much there, but I really learned how to listen and how to start sharing. It was very easy for me to learn how to do that with a group of women. I can share with the guys too, at the AA meetings now, but in the beginning it was real difficult.

There's so much more intimate sharing that goes on in women's meetings. Like "Gee, I feel like shit today. I've got PMS." A lot of people don't feel comfortable saying that with men around. And people in the group can say "Yeah, I know how it is; you'll get through it." It's just little things like that.

Edith Gomberg isn't expecting a flood of female-only treatment centers, and she isn't stumping for them. Ever the realist, she sets the goal a little lower.

"We can't wait for women to get their own programs," she says. "If that's the only way we're going to treat women, they're going to be in trouble because you're not going to have enough people willing [to start them up]. They don't have the money.

"So what we do ask, is if you have a program where you admit women, is that you be sensitive to their special needs. And one is a female-only group. You can have all the coed group activities you want, but if you have a 50-bed unit and 8 of those beds are occupied by women, try to set up something where the women meet by themselves. It's really lovely if you can have separate women's units, but I'm not optimistic about there being enough of them to meet the need."

The interviews with Laura, Patty, and Sally were conducted last spring--when Laura had been out of the hospital a year with no relapses, Patty had been out two years with one relapse six months after she left, and Sally had been out just a week. A few days ago all three were doing fine.

Art accompanying story in printed newspaper (not available in this archive): illustration/Tony Griff; photo/Mike Tappin.

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