Why Women Aren’t Diagnosed Sooner with Substance Use Disorder

Earlier this year, I wrote about fears women have that keep them from seeking treatment for alcohol and substance use disorder. Not long after that, our whole world was upended by the coronavirus. However, during this global pandemic, a strange silver living is starting to emerge. Many women are talking openly about anxiety, stress and anger, and they are asking how society can better help women achieve wellness when every day can feel like an obstacle course.

In my experience, women can be exceptionally skilled at hiding their use of substances. In treatment, we see so many women who keep a million balls in the air between work, home and caregiving – all while numbed out from chardonnay and multiple benzodiazepines. The pressure cooker of trying to keep everything in check – now with the added fear and uncertainty about COVID – is taking a toll.

This current environment means that loved ones and colleagues may easily miss or minimize the warning signs until the substance use disorder has progressed. Women are so good at remaining presentable and high functioning in the midst of their substance use that the potential for a problem may not even occur to those around her, including healthcare providers, who may not ask important questions to discern whether substance use is problematic.

Co-occurring disorders complicate diagnosis and treatment
If a woman asks for help, and she is suffering from both anxiety and substance use disorder, she is often funneled towards the mental health sector. Unfortunately, providers may make assumptions that a woman who is “put-together” couldn’t be suffering from a substance use disorder. The reality is outward appearance is not necessarily an indicator of what is really going on inside.

Not surprisingly, treating a mental health disorder without looking at a potential underlying substance use issue is highly problematic. It’s not uncommon for mental health and substance use symptoms to mimic each other. Anxiety, depression, hallucinations, paranoia, and a host of other mental health symptoms can all be a potential side effect caused simply by substance use. And, if anti-anxiety medications are prescribed, the substance use disorder may get worse.

When you add additional issues to the mix – like trauma or eating disorders – it really muddies the water of getting women access to the appropriate care. Many times women are treated like a “hot potato,” where the eating disorder program says the patient has to get the substance use under control first, while the substance use program insists they can't take a patient with an eating disorder. Meanwhile, the root cause of both problems is trauma. That is why it’s so crucial for women to find help at a program that can provide individualized care and an approach to wellness that is specific to their unique needs.

Invalidating treatment experiences make women feel vulnerable
If a woman has reached out for help, and the result is an invalidating experience in a therapeutic or support group environment, that will make her less likely to continue seeking help and get an accurate diagnosis. Trying again in another setting can feel like a huge risk for a vulnerable patient. It is importance that women feel emotionally and physically safe coming into treatment.

We treat women who had a harmful experience in a prior facility and coming into another center felt like a huge risk for them. We listen, validate their experience and communicate with them every step of them way to help build trust.

We want them to feel empowered to get the right diagnosis, because then they can get the appropriate treatment and have a strong chance for recovery. Part of this process is helping them understand the tremendous impact that trauma can have on a person’s decision-making process. It literally changes the brain, coloring the way they see the world.

Creating a safe treatment environment involves encouraging women to advocate for themselves – to speak up when they feel uncomfortable, to ask for what they need, to seek support from other women in the community. We also spend a lot of time focusing on what happens once a woman leaves treatment because that continuum of care is critical to a successful recovery.

In fact, we find that connection really helps to break down the barriers to recovery for many women. In a recent CNN article, a Caron alum discussed the importance of the relationships with other women she met in treatment. Support groups also play a significant role. Programs like She Recovers, SMART Recovery, Recovery Dharma, Women for Women, or Celebrate Recovery can be good alternatives.

Financial barriers keep women from treatment
Many people are reeling from job losses, furloughs or pay cuts during this time. If a woman has not worked or has no financial resources of her own, she may feel hopeless. Women may rely on family to pay for treatment, which can be difficult if the rest of the family is not on board. But it’s important to know there’s often financial assistance available at many not-for-profit treatment centers and more quality centers take insurance these days, which helps offset the cost.

Childcare can be another substantial barrier. But families need to understand that it is much better for everyone if they support mom’s recovery – even when that means she needs a higher level of care and must leave home for residential treatment. A short time away can boost long-term wellness for all involved. We need to think in terms of how a short-term investment in care can have lifechanging results in the long-term. The cost of not taking any action is dire.

Early intervention is key
Just as with any chronic illness, an accurate diagnosis earlier allows for treatment and recovery to begin. It is still possible to recover successfully if the disease progresses, but there may be more significant health and life consequences by that time. Unfortunately, as I mentioned, women are very good at hiding substance use, so the early warning signs are often missed.

Greater awareness will certainly help improve earlier access to care. If health professionals, religious counselors, employers, and loved ones make themselves aware – there will be more opportunities to support and encourage meaningful interventions. Gynecologists can also play a tremendous role, as women see their gynecologist more frequently than their regular doctor. This is why Caron has invested so heavily in educating healthcare professionals on addiction medicine.

Many women get access to care because they have a support system. Family, friends, colleagues or even a good therapist can make a difference in helping a woman who is struggling get the right help from the start. We've come a long way, but we must continue to remove the stigma of substance use disorder and raise awareness that individualized treatment for women works. We deserve to live healthy and fulfilling lives in an authentic way.