Texas COSIG ProjectTexas COSIG Project

Gender Differences in Gender Differences in Substance Use Severity and Substance Use Severity and

Psychopathology in Clients with Psychopathology in Clients with Co-Occurring DisordersCo-Occurring Disorders

55thth Annual COSIG Grantee Meeting Annual COSIG Grantee MeetingMay 2008May 2008

Texas COSIG Project Texas COSIG Project Key ComponentsKey Components

Substance abuse treatment counselor Substance abuse treatment counselor training on COD and the use of diagnostic training on COD and the use of diagnostic and assessment instruments to improve and assessment instruments to improve identification of comorbidity and monitor identification of comorbidity and monitor client progressclient progress

A voucher system that provides recovery A voucher system that provides recovery and social support services to enhance the and social support services to enhance the treatment process ($1800 per client)treatment process ($1800 per client)

Voucher Service CategoriesVoucher Service Categories

Child CareChild Care

Housing SupportHousing Support

TransportationTransportation

Food AssistanceFood Assistance

Education SupportEducation Support

Employment AssistanceEmployment Assistance

ClothingClothing

Medical CareMedical Care

PrescriptionsPrescriptions

Peer MentoringPeer Mentoring

Gender DifferencesGender Differences

Prior to this study, research related to gender Prior to this study, research related to gender differences in clients with COD was limited to differences in clients with COD was limited to severely mentally ill populationsseverely mentally ill populations

Studies indicated that women were more likely Studies indicated that women were more likely to have children, had a greater history of to have children, had a greater history of victimization and associated traumatic stress, victimization and associated traumatic stress, more medical problems, and may be more more medical problems, and may be more willing or able to identify relationship and willing or able to identify relationship and psychiatric problems, whereas men tend to have psychiatric problems, whereas men tend to have higher levels of legal involvementhigher levels of legal involvement

Gender DifferencesGender Differences

The current study examines gender differences The current study examines gender differences in a sample of clients with COD entering in a sample of clients with COD entering addiction treatment that includes both severe addiction treatment that includes both severe and non-severe psychiatric disordersand non-severe psychiatric disorders

The purpose of the study is to determine if The purpose of the study is to determine if gender characteristics in this sample, containing gender characteristics in this sample, containing a wider array of psychiatric disorders, are similar a wider array of psychiatric disorders, are similar to those found in previous studies of SMI to those found in previous studies of SMI populationspopulations

Study SampleStudy Sample

The sample consisted of 213 clients entering The sample consisted of 213 clients entering addiction treatment who subsequently qualified addiction treatment who subsequently qualified for the Texas COSIG programfor the Texas COSIG program

The sample was recruited between March 2005 The sample was recruited between March 2005 and January 2006 from six state-funded and January 2006 from six state-funded addiction treatment programs participating in the addiction treatment programs participating in the COSIG projectCOSIG project

The total sample was 60% males, 53% Hispanic, The total sample was 60% males, 53% Hispanic, 41% White, and 7% Black41% White, and 7% Black

Data and AnalysesData and Analyses

Males (n = 127) and females (n = 86) were compared on Males (n = 127) and females (n = 86) were compared on demographic variables, MINI psychiatric diagnoses, demographic variables, MINI psychiatric diagnoses, substance use characteristics, psychiatric severity, substance use characteristics, psychiatric severity, voucher service utilization, and treatment characteristicsvoucher service utilization, and treatment characteristics

Psychiatric severity measures include the Brief Symptom Psychiatric severity measures include the Brief Symptom Inventory (client report) and the Brief Derogatis Inventory (client report) and the Brief Derogatis Psychiatric Rating Scale (clinician rating)Psychiatric Rating Scale (clinician rating)

Demographic, substance use, voucher service, and Demographic, substance use, voucher service, and treatment data were obtained from BHIPS, the Texas treatment data were obtained from BHIPS, the Texas administrative data systemadministrative data system

Client DemographicsClient Demographics

Women were more likely to have children (38% Women were more likely to have children (38% vs. 24%), be living in a group or institutional vs. 24%), be living in a group or institutional setting (28% vs. 6%), and had higher levels of setting (28% vs. 6%), and had higher levels of legal involvement (33% vs. 18%)legal involvement (33% vs. 18%)

Men were older (40.6 vs. 33.5 years) and had Men were older (40.6 vs. 33.5 years) and had higher homelessness rates (24% vs. 12%)higher homelessness rates (24% vs. 12%)

The groups did not differ in race/ethnicity, The groups did not differ in race/ethnicity, education, age, marital status, employment, or education, age, marital status, employment, or past year substance-related arrestspast year substance-related arrests

MINI Diagnostic ImpressionsMINI Diagnostic Impressions

0%

10%

20%

30%

40%

50%

60%

DEPRESSION BIPOLAR DYSTHYMIA HYPOMANIA PANIC OCD PTSD GEN ANXIETY PSYCHOTIC

FEMALES MALES

*

*

Psychiatric Symptom SeverityPsychiatric Symptom Severity

On the Brief Symptom Inventory, men On the Brief Symptom Inventory, men reported greater severity on the phobic reported greater severity on the phobic anxiety, paranoia, and psychoticism scalesanxiety, paranoia, and psychoticism scales

Clinicians rated men as having more Clinicians rated men as having more severe symptoms on the paranoid ideation severe symptoms on the paranoid ideation and psychoticism scales of the Brief and psychoticism scales of the Brief Derogatis Psychiatric Rating ScaleDerogatis Psychiatric Rating Scale

ASI Problems DaysASI Problems Days

0

5

10

15

20

25

30

MEDICAL EMPLOYMENT FAMILY SOCIAL PSYCHOLOGICAL DRUG/ALCOHOL

FEMALE MALE

*

* ** *

*

Primary Substance of Abuse*Primary Substance of Abuse*

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

ALCOHOL COCAINE CRACK OPIATES MARIJUANA OTHER

FEMALES MALES

Substance Use PatternsSubstance Use Patterns

Women reported higher levels of daily Women reported higher levels of daily substance use during the past 6 months substance use during the past 6 months (74% vs. 52%)(74% vs. 52%)

A greater percentage of women reported A greater percentage of women reported polysubstance use (51% vs. 37%)polysubstance use (51% vs. 37%)

Men reported greater years of substance Men reported greater years of substance use (21 vs. 12); however, no group use (21 vs. 12); however, no group differences were found in age of first usedifferences were found in age of first use

Substance Abuse Treatment HistorySubstance Abuse Treatment History

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

PRIOR DETOX PRIOR NON-DETOX AA PAST 30 DAYS

FEMALES MALES

*

Discharge CharacteristicsDischarge Characteristics

Men were more likely to receive detox Men were more likely to receive detox services relative to women (47% vs. 28%)services relative to women (47% vs. 28%)

Men received more types of voucher Men received more types of voucher recovery support services (3.2 vs. 2.4)recovery support services (3.2 vs. 2.4)

No gender differences were found in No gender differences were found in length of stay, treatment completion, or length of stay, treatment completion, or abstinence rates at termination from abstinence rates at termination from treatmenttreatment

Voucher Service UtilizationVoucher Service Utilization

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

HOUSING

FOOD ASSISTANCE

TRANSPORTATION

MEDICAL CARE

PRESCRIPTIONS

PEER MENTORING

FEMALE MALE

*

*

*

*

*

*

ConclusionsConclusions

Consistent with previous findings in the SMI Consistent with previous findings in the SMI population, the current study revealed that population, the current study revealed that women were more likely to have children, had women were more likely to have children, had higher rates of posttraumatic stress disorder, higher rates of posttraumatic stress disorder, displayed higher medical problems, and displayed higher medical problems, and reported more psychosocial problems relative to reported more psychosocial problems relative to menmen

Contrary to past results, women in this sample Contrary to past results, women in this sample were more likely to be legally involved compared were more likely to be legally involved compared to men and reported comparable substance to men and reported comparable substance related arrests during the past yearrelated arrests during the past year

ConclusionsConclusions

Also contrary to past results, men in this sample Also contrary to past results, men in this sample displayed greater severity on psychiatric displayed greater severity on psychiatric measures and received a wider array of ancillary measures and received a wider array of ancillary services, yet reported less social and services, yet reported less social and psychological problem days at admission to psychological problem days at admission to treatmenttreatment

Conversely, females presented relatively greater Conversely, females presented relatively greater substance use severity but reported higher substance use severity but reported higher levels of psychosocial distress and less levels of psychosocial distress and less problems related to substance useproblems related to substance use

ConclusionsConclusions

These findings suggest that a differential pattern of These findings suggest that a differential pattern of awareness may exist regarding the effects of psychiatric awareness may exist regarding the effects of psychiatric and substance use severity on life functioning, with and substance use severity on life functioning, with males more readily admitting to problems related to males more readily admitting to problems related to substance use and females more open to acknowledging substance use and females more open to acknowledging the effects of social and psychiatric problemsthe effects of social and psychiatric problems

The possible presence of differential gender effects on The possible presence of differential gender effects on client reporting has significant clinical implications for the client reporting has significant clinical implications for the assessment process and highlights the importance of assessment process and highlights the importance of using a variety of measures and informant sources to using a variety of measures and informant sources to corroborate the client’s problem presentation corroborate the client’s problem presentation

ConclusionsConclusions

Further, gender differences in problem Further, gender differences in problem awareness may also indicate the need for awareness may also indicate the need for treatment programming and interventions treatment programming and interventions tailored toward increasing recognition of tailored toward increasing recognition of the broader and interactive effects of the broader and interactive effects of substance use and psychiatric problems substance use and psychiatric problems on social functioningon social functioning

Article ReferenceArticle Reference

Mangrum L. F., Spence R. T., & Steinley-Bumgarner, M. Mangrum L. F., Spence R. T., & Steinley-Bumgarner, M. D. (2006). Gender differences in substance abuse D. (2006). Gender differences in substance abuse treatment clients with co-occurring psychiatric and treatment clients with co-occurring psychiatric and substance use disorders. substance use disorders. Brief Treatment and Crisis Brief Treatment and Crisis Intervention, 6Intervention, 6(3), 255-267.(3), 255-267.